Nosebleeds while sleeping

Synonyms

Epistaxis in sleep

introduction

Epistaxis is a common phenomenon and is usually sudden and completely unexpected. In children and young adults in particular, heavy nosebleeds can occur even when they are physically calm, for example while sleeping. The causes of nosebleeds during sleep are largely unknown. In most cases, however, it is a stressful but nonetheless harmless phenomenon. In general, it can be assumed that there are simply people who tend to get nosebleeds quickly and frequently. In these people, the smallest vessels within the nasal mucosa appear to be more sensitive to stimuli.
In addition, bleeding can occur in the area of ​​the sinus lining. Even a slight increase in pressure in the area of ​​the nose, for example when sneezing or blowing the nose, can lead to nosebleeds in the affected person.

Other people, on the other hand, do not develop any bleeding in the area of ​​the nose, even after intense physical exertion or even after violence. Although nosebleeds, even if they occur during sleep, are complete in most cases harmless a specialist (ear, nose and throat specialist) should be consulted as soon as possible. Changes requiring treatment, such as anatomical Malformations the nasal septum (Nasal septum), High blood pressure (hypertension) or Blood clotting disorders should be urgently ruled out if there is frequent nosebleeds.
In addition, those affected must observe which colour has blood flowing from the nose. A nosebleed is usually a so-called venous bleeding. In these cases, the source of the bleeding is a small vein in the lining of the nose or sinuses. The bleeding then appears sooner dark red. With an arterial lesion, however, the bleeding works bright red.
In addition, the flow properties of the nosebleed can provide information on whether it is a venous or arterial bleeding. If the venous vessels are impaired, the blood oozes out slowly from the nose. Arterial lesions, on the other hand, are characterized by a fast, splashing Blood flow out. While venous nosebleeds are usually harmless even during sleep, they must Always see a specialist in arterial bleeding to be clarified.

causes

There can be a variety of causes for nosebleeds to develop during sleep. In general, a distinction is made between so-called local and global Causes. While various Diseases of the internal organsthat lead to nosebleeds in sleep require urgent medical attention, most are local The causes are usually perfect harmless. Especially in the cold seasons there may be increased nosebleeds during the day or while sleeping.
By Upper respiratory tract infections it happens frequently to Swelling in the area of ​​the nasal mucosa. This swelling increases the size of the mucous membranes irritated. This can result in nosebleeds during sleep. In addition, it can be observed that too Allergy sufferers suffer more from nosebleeds during sleep. In these cases, too, the causes of the bleeding are in the area of ​​the swollen nasal mucous membranes. Decongestant nasal sprays, which are often used for the symptomatic treatment of flu-like infections, can damage the nasal mucosa and thus lead to nosebleeds during sleep.
One of the most common causes of nosebleeds during sleep is pronounced Malformation the nasal septum (Nasal septum). Especially protruding bone edges can damage the sensitive lining of the nose and cause bleeding.

You can also small holes in the area of ​​the nasal septum (so-called Septal perforation) Provoke nosebleeds while sleeping. Such perforations can be found especially in people who chronic mucosal damage suffer or certain Chemicals are exposed. Also the consumption of Drugs how cocaine can cause nosebleeds during sleep due to damage to the nasal mucosa. Also Nasal polyps or Ulcers the nasal mucous membrane are a common cause of severe nosebleeds during sleep.
In addition to these local causes, internal diseases can also lead to nosebleeds. In this context, play mainly Blood clotting disorders and high blood pressure a crucial role. In addition, the nosebleed during sleep can be a possible side effect different medicines.

diagnosis

Above all, frequent nosebleeds during sleep should be dealt with urgently Specialist to be clarified. Although nosebleeds are usually perfect harmless serious causes must be ruled out. Diagnosing nosebleeds during sleep involves several steps. First there is a detailed doctor-patient discussion, in which details about nosebleeds are discussed. Also possible Pre-existing illness (for example, high blood pressure or restrictions on the Blood clotting) and existing allergies play a crucial role in this conversation.
In addition, it should be clarified whether the patient concerned is taking anticoagulant medication such as Aspirin® or Marcumar®. Various diagnostic measures can then help to find out what causes the nosebleed during sleep. The ear, nose and throat doctor usually examines the affected patient with the help of a special one Nasal mirror (so-called nasoscopy or Rhinoscopy). In most cases, mirroring the anterior nasal sectionsto be able to determine the source of the bleeding with certainty.
When examining the anterior sections of the nose, the attending physician uses a so-called Nasal speculum. With the help of this forceps-like, round converging instrument and a suitable light source, the mucous membrane of the nose can be optimally examined. If the nosebleed is particularly strong, bright red Noticeable blood loss, mostly must further investigations be performed. Imaging procedures, such as taking an x-ray, can help to better assess the anatomical conditions in the area of ​​the nose.

In addition, computed tomography (CT) or magnetic resonance imaging (MRT) can be useful in individual cases. If it is assumed that the nosebleed during sleep is caused by an injury to a larger vessel, the blood vessels are shown using Angiography often unavoidable. In addition, various blood values, for example the coagulation values, should be determined if there is frequent nosebleeds during sleep.

therapy

The treatment of nosebleeds while sleeping is primarily based on the person underlying cause. Is the nosebleed related to sleep high blood pressure, it should be lowered urgently. In most cases, severely elevated blood pressure can only be lowered with potent drugs. Regardless of the actual cause, you can simple immediate measures help stop nosebleeds effectively. Affected individuals should turn their heads immediately after the bleeding starts Bend forward. That way it can blood from the nose flow and not into the windpipe reach. In addition, bending the head forward can prevent blood from spilling into the stomach and there one Nausea triggers.

In addition, heavy nosebleeds can be relieved by letting the person down cooling a cold compress or a damp towel on the neck lays. Because the source of bleeding in a nosebleed that begins during sleep is roughly 80% of the cases in the area of ​​the anterior Nasal septum can also be found Squeeze the ala of the nose help stop the bleeding. Normally, the nosebleed should already follow under these first aid measures few minutes to stop.

If the nosebleed cannot be stopped despite these first aid measures, a doctor and appropriate treatment initiated. In the case of heavy bleeding, special Tamponades in the Nostrils be introduced. Through the pressurethat these nasal packings apply to the source of the bleeding usually manage to stop the nosebleed. In addition, the treating doctor can try to find the source of the bleeding. As soon as the responsible vessel found, it can by various means desolate become.
For people who frequently take strong If you suffer from nosebleeds in your sleep, the responsible vessel should be embolized. Embolization means that the doctor treating the affected vessel with the help of a special Lasers permanently locked. After this treatment measure, there should be no more bleeding in the area of ​​the sclerosed vessel.

Complications

Nosebleeds are perfect in most cases harmless. However, especially in the case of severe nosebleeds that occur during sleep, the blood may not flow out optimally via the nostrils, but rather reaches the trachea or esophagus from the nasopharynx. If large amounts of blood seep through the esophagus into the stomach, vomiting usually occurs promptly. No further consequences are to be expected in these cases. However, nosebleeds, which occur during sleep and in which blood drains through the windpipe, can provoke the development of inflammatory processes in the area of ​​the lungs. For this reason, after the nosebleed, it should be observed whether the person affected develops a cough, fever and / or other symptoms that suggest pneumonia. With normal nosebleeds during sleep, the blood loss is usually like this lowthat it can be easily balanced by the organism. Profuse, insatiable nosebleed caused by an arterial injury, on the other hand, can lead to high blood loss and must therefore urgently medical to be clarified.

forecast

Also, nosebleeds that occur during sleep will roughly 80% of cases caused by injuries to the smallest vessels in the area of ​​the anterior sections of the nasal septum (so-called Locus Kiesselbachi) caused. The reason for this is the fact that this area particularly well supplied with blood and the supplying vessels are very close to the Mucosal surface lie. Nosebleeds that occur during sleep and the cause of which can be found in the Kiesselbachi locus are usually not dangerous and does not require any special treatment.
In rarer cases, however, nosebleeds during sleep are caused by injuries to arterial vessels around the back of the nose. In case of arterial nosebleeds during sleep, this usually occurs bright red Blood from the nose. In contrast to venous nosebleeds, blood flows out of the nose in large quantities. The loss of blood in these cases can even be dangerous. In addition, with arterial nosebleeds during sleep, there is a risk that blood from the nasopharynx will reach the lungs via the windpipe. As a result, it can become too Difficulty breathing, Inflammation of the lungs or even for Apnea come.

Nosebleed while sleeping in the child

Also nosebleeds in sleep, that in one child occurs is usually no reason to worry. Especially in the cold Months can Upper respiratory tract infections cause severe nosebleeds in the child. Reason are Injuries the sensitive Nasal mucosamainly by local Swelling and Inflammatory reactions be evoked. It can also be decongestant Nasal spraysas they are often used in children to treat a Otitis media used, dry out the nasal mucous membranes and thus lead to nosebleeds during sleep. In such cases there is usually no need for treatment.
However, if the child experiences nosebleeds particularly frequently during sleep, they should urgently promptly Pediatrician to be visited. Only in this way you can serious Diseases that provoke nosebleeds during sleep can be excluded. In children, for example, the bleeding can be congenital Malformations of the Nasal septum caused.

Nosebleeds while sleeping during pregnancy

Pregnancy triggers a variety of change processes in the expectant mother. Especially the conversion of the Hormonal balance and the adaptation of the cardiovascular system can be felt by various ailments. In this context, nosebleeds, which can occur both during the day and during sleep, also play a crucial role. In the course of pregnancy, various hormones cause an increase in the Mucosal blood flow. Even this increase in blood flow during pregnancy can lead to nosebleeds during sleep.
In addition, it can occur in the course of pregnancy too local water retention come in the area of ​​the nasal mucous membranes or the sinus membranes. This phenomenon can mainly occur during the cold Months are favored by infections of the upper respiratory tract. In general, it should be assumed that fine veins in the nose area are essential during pregnancy more sensitive and for this reason tear more quickly.

Nosebleeds, which occur both during the day and during sleep, are therefore typical Pregnancy complaints and in most cases can be considered absolute harmless be considered. Women who are pregnant during pregnancy increased Suffering from nosebleeds can often reduce the risk of bleeding simple measures effectively lower. Especially firm snort should be avoided. In addition, it must dry out the nasal mucosa during pregnancy urgently avoided become. Especially in the cold winter months, it is advisable to regularly use the nasal mucosa vaseline or more special Eye and nose ointment to moisten. In addition, women should always use a sufficient dose during pregnancy Hydration respect, think highly of. This is another way of preventing nosebleeds from developing during sleep.
However, women who are particularly prone to nosebleeds during sleep during pregnancy should take one to be on the safe side Specialist seek out. The nosebleed can in some cases be an indication of one increased Blood pressure be. This phenomenon can also be directly related to pregnancy and may need urgent treatment.