Diagnosis

Especially frequently occurring nosebleeds during sleep should urgently be clarified by a specialist. Although nosebleeds are usually completely harmless, serious causes must be excluded. The diagnosis of nosebleeds during sleep involves several steps.First of all, there is an extensive doctor-patient consultation in which details about nosebleeds are discussed.

Also possible pre-existing conditions (for example high blood pressure or restrictions in blood coagulation) and existing allergies play a decisive role in this discussion. It should also be clarified whether the patient concerned is taking anticoagulant medication such as Aspirin® or Marcumar®. Subsequently, various diagnostic measures can help to find out what causes nosebleeds during sleep.

The ear, nose and throat specialist usually examines the affected patient with the help of a special nasal speculum (so-called nasoscopy or rhinoscopy). In most cases, a mirror image of the front part of the nose is sufficient to determine the source of bleeding. For the examination of the anterior nasal sections, the treating physician uses a so-called nasal speculum.

With the help of this forceps-like instrument, which converges round at the front, and a suitable light source, the mucous membrane of the nose can be optimally examined. If the nosebleed is noticeable as a particularly severe, bright red blood loss, further examinations are usually necessary. Imaging procedures, such as the preparation of an X-ray image, can help to better assess the anatomical conditions in the area of the nose.

In addition, computer tomography (CT) or magnetic resonance imaging (MRI) may be useful in individual cases. If it is assumed that nosebleeds in sleep are caused by injury to a larger vessel, the imaging of blood vessels by angiography is often unavoidable. In addition, various blood values, such as coagulation values, should be determined in the case of frequent nosebleeds during sleep.

Therapy

The treatment of nosebleeds during sleep depends primarily on the underlying cause. If the nosebleed during sleep is associated with high blood pressure, this should be urgently reduced. In most cases a strongly increased blood pressure can only be lowered by potent drugs.

Regardless of the actual cause, simple immediate measures can help to effectively stop nosebleeds. Affected persons should bend their head forward immediately after the start of bleeding. In this way, the blood can flow out of the nose and not enter the windpipe.

Bending the head forward can also prevent blood from entering the stomach and causing nausea. In addition, heavy nosebleeds can be stopped by placing a cold compress or a damp towel in the neck to cool the affected person. Since the source of bleeding in nosebleeds that start during sleep is found in about 80% of cases in the area of the anterior nasal septum, squeezing the nostrils can also help to stop the bleeding.

Normally, under these first aid measures, the nosebleed should stop after a few minutes. If the nosebleed cannot be stopped despite these first aid measures, a doctor must be consulted immediately and appropriate treatment initiated. In case of heavy bleeding, special tamponades can be inserted into the nostrils.

The pressure that these nasal tamponades exert on the source of bleeding usually makes it possible to stop the nosebleed. In addition, the treating doctor can try to locate the source of bleeding. Once the responsible vessel has been found, it can be sclerosed by various means.

In people who frequently suffer from severe nosebleeds during sleep, the responsible vessel should be embolized. Embolization means that the treating physician closes the affected vessel permanently with the help of a special laser. After this treatment there should be no more bleeding in the area of the obliterated vessel.