This article was written by Dr. Naheed Ali, PhD. Dr. Ali earned an MD degree in 2008 and later completed Harvard Medical School's lifestyle medicine training in 2012, before obtaining a PhD in holistic health elsewhere in 2013. He’s also certified in clinical research by National Institutes of Health (NIH).
Experiencing a nosebleed can be a relatively common but unsettling experience, and they often strike at the most inconvenient times, such as during the night. Understanding why they happen and how to handle them effectively can help alleviate the anxiety they cause.
Nosebleeds occur when the delicate blood vessels in your nostrils get damaged and start to bleed. Our nose, which is lined with a complex network of minuscule blood vessels, can be prone to bleeding due to dry air or even nose picking. There are two main types of nosebleeds: anterior (coming from the front of the nose and is the most common) and posterior (originating deeper within the nose and often more serious). 
Why do nighttime nosebleeds happen?
Nosebleeds seem to have a particular penchant for disturbing our peaceful nights. But why exactly is that? Several factors, both environmental and health-related, play a role in the occurrence of nighttime nosebleeds. 
- Blood flow redistribution: When lying down, the blood flow redistributes, leading to increased blood volume in the head and nasal area. This can put extra pressure on the blood vessels and contribute to nosebleeds.
- Sleeping environment: Low humidity, dusty rooms, or exposure to irritants like cigarette smoke or allergens can irritate the nasal lining and trigger nosebleeds during sleep.
- Dry air in bedrooms: Indoor heating and dry air during colder months can lead to dry nasal passages, making the delicate blood vessels more prone to irritation and bleeding.
- Nose picking and blowing: Nighttime can be a time of relaxation and subconscious habits like nose picking or blowing, which can accidentally maim the nasal lining.
- Nasal congestion: Allergies, colds, or sinus infections can cause nasal congestion, giving rise to increased pressure within the nasal passages and potential blood vessel rupture.
Medical conditions also play a role in increasing the likelihood of nighttime nosebleeds.
- High blood pressure: High blood pressure, especially if not properly controlled, can strain the body's small blood vessels, including those in the nose, potentially leading to nosebleeds. 
- Clotting disorders: Issues with blood clotting can make it difficult for a minor bleed to stop on its own, leading to more prolonged and frequent nosebleeds. 
- Nasal tumors: Though rare, nasal tumors can cause nosebleeds, which may seem more frequent at night due to the body's relaxed state and horizontal position. 
- Certain medications: Some medications, like blood thinners, can increase the risk of nosebleeds. If you've noticed an uptick in nosebleeds since starting a new medication, it might be worth discussing with your doctor. 
Handling nighttime nosebleeds
It can be very upsetting to deal with nosebleeds, especially when they happen at a time when you should be at rest. Managing them properly is crucial to ensuring a swift stoppage of the bleeding and preventing further complications.  
- Stay calm: It's important to stay calm during a nosebleed. Stress can cause blood pressure to rise, which may exacerbate the bleeding.
- Lean forward slightly: Contrary to the old advice of tilting your head back, it's actually better to lean forward slightly. This prevents the blood from flowing back into the throat.
- Apply pressure: Using your thumb and index finger, apply gentle pressure to the soft part of your nostrils. This pressure helps the blood to clot and the nosebleed to stop.
- Use a nasal tampon: The use of a nasal tampon can help effectively manage nosebleeds as they are designed to absorb blood and promote clotting, speeding up the healing process.
What are nosebleed plugs or nasal tampons?
Nasal tampons, also known as nosebleed plugs or nasal packs, are small, absorbent pieces of material used to control and stop nosebleeds. They come in different types such as expandable sponges or foams. Some may also be coated with substances that promote clotting or reduce inflammation. 
Nasal tampons are the new standard of care for nighttime nosebleeds for a couple of reasons:
- Extended contact: Because nasal tampons can be left in place for many hours, they provide continuous pressure to the bleeding vessels, which can assist in clot formation and stop the nosebleed.
- Less messy: Traditional methods like pinching the nose and leaning forward can be messy, especially if the bleeding is prolonged. A nasal tampon absorbs the blood, reducing mess and making the experience less unpleasant.
- Ease of fit: Unlike tissue or cotton, the shape and soft texture of nasal tampons are designed to fit comfortably in the nasal cavity, providing greater comfort during use. Additionally, they are convenient to insert and remove.
- Ease of use: Once a nasal tampon is correctly inserted, it does not require ongoing effort or attention, which can be very helpful at night. One can continue to sleep without having to stay awake to manage the nosebleed.
Nasal tampons can potentially cause irritation and infection if not kept clean or used appropriately, as well as harm to nasal tissues in rare cases. While these can help with nosebleeds, they should not be used in place of consultation with a healthcare expert. Regular nosebleeds may indicate an underlying health problem that needs to be treated.