How does the nasal cycle work? How does chronic nasal spray use just make things worse?
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Over the counter Nasal decongestant sprays are only for temporary relief of symptoms and are not used to treat the main issue. These sprays contain chemicals that shrink congested blood vessels. That’s how they open up your clogged passages. Because they’re applied directly to the nose, they give you quick relief.
After a few days, though, the blood vessels don’t respond to the medication anymore. You spray away, but your problem just gets worse. This cycle can continue for months, years, and even decades. Just suppressing your symptoms and allowing the swelling/infection/virus or whatever you have, continue to infect you.
It’s similar to how taking Tylenol for the pain of a Urinary tract infection, will not cure the infection but maybe stop the discomfort. But if you continue to take Tylenol to suppress the pain and never go to the doctor, that’s how things get worse.
Specifically talking about sprays containing oxymetazoline and phenylephrine, these two drugs are known to cause rebound congestion after stopping prolonged use so your congestion does actually get worse than it would have been without use. The mechanism of the rebound congestion are currently unknown with a few theories some may use to explain.
One of the theories is because the drugs are vasoconstrictive (they cause blood vessels to constrict) the can lead to ischemia (lack of blood) to the area, when blood flow returns it can cause edema (leaking of fluid outside of blood vessels).
Another theory is that of tachyphylaxis which is the down regulation of receptors in the body to certain medications when repeatedly exposed to that medication.
Source: Am pharmacist for some reason I vividly remember my classes pertaining to this specific problem.
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