Nosebleeds, medically known as epistaxis, are common. While alarming, morning nosebleeds are typically not serious and often resolve on their own. They arise when delicate blood vessels within the nasal lining rupture, a frequent event due to the nose’s rich blood supply and its role in filtering inhaled air. Understanding these factors can help.
Common Environmental and Behavioral Contributors
Dry air is a frequent cause of morning nosebleeds. When humidity levels are low, particularly from indoor heating in winter or air conditioning, the nasal membranes can dry out. This dryness makes the delicate tissue inside the nose crusty and cracked, increasing the likelihood of blood vessels breaking. As the nasal lining becomes less elastic due to dehydration, even minor irritation can lead to bleeding.
Beyond environmental factors, certain habits directly impact the nasal lining. Nose picking, even if done unconsciously during sleep, can easily injure the fragile blood vessels in the front part of the nose. Vigorous nose blowing, especially when congested from allergies or a cold, creates pressure that can rupture superficial vessels. Inserting objects into the nose also causes trauma, increasing the risk of bleeding.
Anatomical and Physiological Factors
The nose contains an intricate network of blood vessels close to the surface, making them prone to injury. A specific area in the front part of the nasal septum, known as Kiesselbach’s plexus or Little’s area, is particularly susceptible. This region is a common site for anterior nosebleeds, accounting for about 90% of all cases, because several arteries converge there.
Some individuals naturally possess more fragile or superficial blood vessels in their nasal lining, increasing their predisposition to nosebleeds. This fragility means even minimal trauma or dryness can trigger bleeding. Hereditary conditions, such as hereditary hemorrhagic telangiectasia (HHT), can also lead to abnormally fragile blood vessels that bleed easily.
While high blood pressure is not a direct cause of nosebleeds, it can exacerbate bleeding once started. Uncontrolled hypertension may damage nasal blood vessels over time, making them more susceptible to rupture. Certain clotting disorders can also impair the blood’s ability to form clots, leading to more prolonged or severe bleeding.
Medication-Related Causes
Certain medications increase the risk of nosebleeds by affecting blood clotting. Anticoagulant and antiplatelet medications, commonly known as blood thinners, are a prime example. Drugs like aspirin, warfarin, clopidogrel, rivaroxaban, and heparin prevent blood clots from forming or growing larger, meaning a minor nasal vessel rupture can result in more significant or prolonged bleeding.
Beyond systemic medications, certain nasal sprays can also contribute to nosebleeds. Overuse or improper application of corticosteroid nasal sprays or decongestant sprays can irritate and dry out the delicate nasal lining. This irritation makes nasal tissue more fragile and prone to bleeding, especially if the spray bottle tip causes minor trauma.
When to Seek Medical Advice
While most morning nosebleeds are minor, certain situations warrant medical attention. If nosebleeds become frequent, severe, or are difficult to stop despite applying pressure for 15 to 20 minutes, consult a healthcare professional. Persistent bleeding, especially if heavy enough to fill a cup, requires immediate evaluation.
Other symptoms accompanying nosebleeds can signal a more serious condition. These include easy bruising, excessive bleeding from other body areas, dizziness, weakness, or fever. A nosebleed after a head or nose injury requires medical assessment for fractures or trauma.
If nosebleeds begin or worsen after starting a new medication, particularly blood thinners, discuss this with a doctor. Individuals with known bleeding disorders or those on anticoagulant therapy should seek medical advice for any nosebleed.