Is Using Nasal Spray For A Stuffy Nose As Bad As Everyone Says It Is?

Photographed by Megan Madden.
Recently, I was bored while checking out at Walgreens, so I posted an Instagram story of a bottle of generic nasal decongestant spray with hearts around it. Next thing I knew, my DMs were popping off with people who were warning me about the effects of nose spray addiction.
"That stuff is so bad," they said.
"Noooooooo," they said.
"You know you can get addicted?" they said.
Concern trolls are the worst, but this fervent reaction to an otherwise innocuous Instagram story made me wonder if nasal decongestant spray really is the devil? But to answer that question, I needed to know how exactly nose spray works.
When you have a stuffy nose, what's really happening is your nasal membrane is swollen due to increased blood flow, according to the American Academy of Otolaryngology. Decongestant sprays work as a "vasoconstrictor," meaning they reduce blood flow to your nasal membranes. That's why one spritz of nose spray in your nostrils can take you from stuffed and mouth-breathing to completely clear in seconds. Ahhhh.
So, nose spray definitely works well at first (most sprays last for 12 hours), but the issue is that some people use it too frequently, and experience a rebound effect. Over time, your nasal membrane gets too used to having its blood vessels constricted, making the medication less effective. Often you end up feeling worse and more congested, which is a bummer. When people talk about getting "addicted" to nose spray, this is what they're talking about. (To be clear: Even though people use this term colloquially to describe nasal spray withdrawal, it is not the same thing as true substance addiction. Addiction is defined as a primary, chronic disease of brain reward, motivation, memory, and related circuitry.)
For this reason, most nasal decongestants include clear warnings that you're only supposed to use the medication for three days. But obviously many people (myself included) just ignore that, because nothing feels as good as being able to breathe, you know? Given this, I wanted to ask an expert what the verdict really is on nose spray, so I turned to Christopher Chang, MD, an otolaryngologist in Warrenton, VA.
"It's totally safe and fine to use a nasal decongestant spray as it does work VERY well and quickly to alleviate nasal congestion/obstruction due to illness and/or allergies," Dr. Chang says via email. Take that, haters. But he typically recommends that people only use nose spray for three days. "If an individual uses such sprays for more than three days, that's when the nose may start to risk becoming 'addicted' to it," he says.
You can tell when you're dependent upon nose spray because you'll feel like you have to use it several times a day, Dr. Chang says. "One may initially start off using it once a day, but than over time, you now need to use it two times a day, then three times a day," he says. And if you continue to "need" to use the nose spray daily even after your cold or allergies have subsided, then it's usually a sign that you've used it too much, he says. Ultimately, if you become dependent upon nasal spray to breathe, then it'll take longer to resolve the underlying issue. In some cases, people may need to use other medication to treat it, or have surgery to correct the problem.
Bottom line? Nose spray is good, until it's not. Too much of a good thing is possible, so you just have to be responsible.

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