When there is not enough moisture in the air, it can dry out the lining of the nostrils. This leaves the lining cracked and prone to bleeding.
Also, nosebleeds occur most frequently in children, who often pick or rub their noses while sleeping.
This article will explore:
- why noses are vulnerable to bleeding
- the main causes of epistaxis
- how to stop nosebleeds at home
- how to prevent nosebleeds at night
It will also describe when to seek medical care.
What causes nosebleeds?
Dry air is the most common cause of a nosebleed at night.
The inside of the nose is covered with mucosa, a moist, delicate tissue with a large number of blood vessels that are close to the surface. Even minor injuries to this tissue can make these vessels bleed, sometimes a lot.
This is called an anterior nosebleed. It is the most common type and not usually serious.
Anterior nosebleeds start in the front of the nose, where the mucosa is most accessible, and the blood flows out of the nostrils.
The blood usually comes from the nasal septum, which is the thin wall between the two sides of the nose.
Posterior nosebleeds are rarer, and they tend to be more serious. They start at the back of the nasal passage, near the throat.
In the case of a posterior nosebleed, the blood usually comes from an artery higher and deeper in the nose, and it may flow down back of the throat or out through the nostrils.
Children do not usually experience posterior nosebleeds. A person is more likely to experience one if they have a condition such as high blood pressure or a bleeding disorder.
Causes of nosebleeds at night
The most common causes and risk factors for nosebleeds at night are:
1. A dry climate or home environment
Dry air can crack the delicate skin inside the nose, causing it to bleed.
Nosebleeds are more likely to occur as the seasons change and before the nasal tissues have acclimated to a rise or fall in humidity.
Running a heater during colder months can dry out the air inside the home.
2. Colds and allergies
The common cold can cause a nosebleed, as a result of nasal irritation.
The common cold and other upper respiratory tract infections can lead to an increase in mucus, as well as frequent nose-blowing and sneezing. Allergic reactions can have the same effects.
These can irritate the inside of the nose, and increase the risk of bleeding, especially if symptoms are worse at night.
Also, nasal congestion can cause blood vessels to widen, making them more vulnerable to injury.
3. Chemical exposure
A person may encounter airborne chemicals in pollution or at work.
These chemicals can irritate or damage the inside of the nose, making it prone to bleeding. Cigarette smoke can have the same effect.
4. Heavy alcohol use
Drinking heavily can contribute to the risk of nocturnal nosebleeds in two ways.
First, alcohol interferes with the activity of the blood's platelets, which are the cells that cause blood to clot.
Second, alcohol can enlarge the superficial blood vessels in the nasal cavity, making them more prone to injury and bleeding.
Some medications interfere with the blood's ability to clot. These include:
- prescription blood thinners, or anticoagulants
- nonsteroidal anti-inflammatory drugs, such as aspirin and ibuprofen
A person taking any of these types of medications may have a higher risk of nosebleeds.
Nosebleeds are also a side effect of some nasal sprays, such as those that contain steroids to treat allergies.
When using a nasal spray, carefully follow the instructions to minimize the risk of nosebleeds and other side effects.
Some homeopathic medications and dietary supplements contain chemicals that prolong bleeding. The following ingredients can have this effect:
- danshen, or red sage
- dong quai, or female ginseng
- other types of ginseng
- ginkgo biloba
- vitamin E
How to treat a nosebleed at home
Take the following steps to stop most nosebleeds:
- Older children and adults should blow their noses to remove any clots that may have formed in their nostrils. This step, which may temporarily increase the bleeding, is not necessary for young children.
- Sit, bending slightly at the waist. Refrain from lying down or tilting the head back, which can lead to swallowing blood and choking or vomiting.
- Grip the soft parts of the nostrils at the base of the nose, applying pressure to both sides. Note that gripping the bony bridge will not stop the bleeding.
- Children should squeeze their nostrils shut for 5 continuous minutes. Adults should do the same for 10 minutes. Remember to breathe through the mouth.
- Applying a cold compress or ice pack to the bridge of the nose may help to slow the bleeding by constricting the blood vessels.
- If the bleeding does not stop, repeat the previous steps. Apply pressure for at least 30 minutes.
When to see a doctor
Persistent nosebleeds require medical attention.
People can treat most nosebleeds quickly and easily at home.
However, doctors recommend seeking urgent medical attention if the blood loss is extensive, or if the person:
- is having difficulty breathing
- is pale, fatigued, or disorientated
- is bleeding from other areas or has multiple bruises
- has recently undergone nasal surgery
- has a nasal tumor
- has other serious symptoms, such as chest pain
- has frequent nosebleeds
- has foul-smelling discharge
- has taken the steps listed in the previous section and the bleeding has not stopped
A person taking any of the following medications should take extra steps to prevent nosebleeds:
- a daily aspirin
If a person taking any of these medications cannot stop a nosebleed, they should see a doctor.
How to prevent a nosebleed
To prevent a nosebleed:
- refrain from picking the nose
- blow the nose gently
- refrain from smoking
- use a humidifier during the winter, if the indoor air is dry
- apply dabs of nasal gel or petroleum jelly inside the nostrils before bedtime
- use protective equipment at work to avoid inhaling chemicals and other irritants
Nosebleeds are common, especially in children. Usually, a person can easily treat them at home.
The tissues inside the nostrils are delicate and easy to damage. Picking the nose or dry air is usually responsible for this damage.
Dry air from a heater, for example, can crack the blood vessels and lead to nosebleeds during the night.