External nasal dilators are more effective for most people than internal ones. They gently lift the lateral nasal wall from the outside, directly targeting nasal valve collapse, the most common cause of nighttime nasal obstruction. Internal dilators insert into the nostrils and can work, but they often cause irritation, fall out during sleep, and are simply uncomfortable to wear for hours at a time. For everyday use, external nasal strips are the practical choice that most people can actually stick with.
What Is a Nasal Dilator and Why Does It Matter?
A nasal dilator is any device that helps keep the nasal airway open. The basic idea is simple: if your nose is blocked, you either push open the passage from inside or pull it open from outside. Both approaches target the same area, the nasal valve, which is the narrowest point of the nasal airway and responsible for about 50 percent of total airway resistance in the body.
When the nasal valve collapses or narrows, whether from a deviated septum, mucosal swelling, or structural weakness in the lateral cartilage, airflow drops sharply. You either breathe through your mouth, snore, or wake up feeling like you have not slept at all.
I know this well. I played rugby for over ten years. After various collisions my nose was probably broken more than once, and eventually an ENT specialist referred me to a Consultant Otolaryngologist at a private hospital in Dublin. He assessed my breathing and recommended septorhinoplasty (procedure code 5975). I held off on the surgery so I could keep playing. That decision pushed me to find something that would actually work in the meantime, and that is when I started seriously testing both internal and external dilators.
Internal Nasal Dilators: How They Work
Internal nasal dilators are small devices, usually made from silicone or plastic, that you insert into each nostril. They work by pushing outward against the inner nasal walls, propping the airway open from the inside. Some look like tiny cones or rings. Others are shaped to sit across the septum and apply gentle lateral pressure.
The mechanics are sound in theory. You are physically preventing the nasal passage from narrowing. For some people, particularly those with significant nasal valve weakness, internal dilators do provide meaningful airflow improvement.
The problems are practical:
- They are uncomfortable, especially when worn for seven or eight hours of sleep
- They can irritate the nasal mucosa with prolonged use
- They shift or fall out during sleep
- Cleaning and hygiene become an issue with repeated use
- Many people find them distracting enough to disrupt sleep entirely
I tried a couple of internal dilators over the years. One night was enough each time. The sensation of something sitting inside your nose is simply not something most people can sleep through comfortably.
External Nasal Dilators: How They Work
External nasal dilators, with nasal strips being the most common form, work differently. Instead of pushing from inside, they use a spring action to gently lift the outer nasal wall from outside the nose. A flexible band sits across the bridge and pulls the lateral cartilage outward, widening the nasal valve from the outside.
This approach works well for nasal valve collapse because it directly counteracts the collapse mechanism. The lateral nasal wall is the weak point. It can fold inward during strong inhalation, especially in people with a deviated septum or weakened cartilage from prior trauma. An external strip holds that wall in place.
Compared to internal devices, external nasal strips have real advantages for regular use:
- You do not feel them once they are on
- They stay in place all night
- No irritation to the nasal lining
- Easy to apply, no fitting or adjustment required
- Disposable so there are no hygiene concerns
The Ventriq Sleep Nasal Strips are the ones I use every night. I built them specifically because I needed something strong enough to actually hold my nasal wall open after years of rugby damage. I sleep better, I do not snore, and I wake up actually rested. You can read more about which nasal strips work best for sleep if you are comparing options.
The Science: Which One Opens the Airway More?
Several studies have measured the airflow improvement from both types of dilator. Peak nasal inspiratory flow (PNIF) is the standard measure. It tells you how much air you can pull through your nose in a single breath.
External nasal strips have been shown in multiple studies to increase PNIF by between 25 and 30 percent in people with nasal obstruction. Some studies show improvements closer to 40 percent in individuals with significant nasal valve weakness, including those with a deviated septum.
Internal dilators can show similar or sometimes higher peak flow increases in controlled settings, but compliance in real world use is much lower. A device that works in theory but that you stop using after one night is not an effective solution.
For people with a structurally compromised nasal airway, like a deviated septum that narrows the valve directly, the best nasal strips for a deviated septum deliver reliable improvement night after night because they are simply easy to use consistently.
Which Is Better for Sport?
For athletic use, whether running, cycling, rugby, or gym training, external nasal dilators are the clear winner. Internal dilators are impractical during intense exercise. They can shift with vigorous breathing, they create pressure discomfort when breathing hard, and they are simply not designed for high intensity use.
External sport nasal strips are specifically designed for exercise. A stronger adhesive and wider lifting band mean they stay in place even when you are sweating. The Ventriq Sport Nasal Strips are what I use during training and matches. Nasal breathing during exercise is significantly more efficient than mouth breathing. You maintain better CO2 balance, oxygen uptake is more controlled, and your breathing rate tends to stay lower. You can read more about the benefits of nasal strips for sport if you train seriously.
When Internal Dilators Might Be Worth Trying
I want to be fair. Internal dilators are not useless. There are specific situations where they are worth considering:
- If you have dry or sensitive skin and cannot use adhesive strips
- Short term use during the day for focused nasal breathing work
- If a clinician recommends them as part of postsurgical nasal rehabilitation
Some internal dilators are also designed for athletic use. They clip to the septum rather than inserting fully into the nostril, which is less invasive. These can work for some athletes, though in my experience external strips remain more practical across the board.
My Personal Recommendation
If you are choosing between internal and external nasal dilators for sleep, go external. Specifically, go with a good quality nasal strip that is strong enough to actually lift your nasal wall and has adhesive that stays on all night. That is the version that most people can use consistently, and consistency is what produces results.
I spent years testing options before I found something that worked reliably for my deviated septum. External strips were the answer. Surgery is still potentially on the table for me somewhere down the line, but right now I sleep well, I breathe well during training, and I do not wake my wife up snoring. That is what I was looking for.
If snoring is your main issue, have a look at whether nasal strips stop snoring and which strips work best for snoring for more detail. If sleep quality is the bigger concern, read about sleeping better tonight with nasal strips. And if you want to understand how a deviated septum affects breathing at night, this post on sleeping better with a deviated septum covers it in full.
Frequently Asked Questions
Are internal or external nasal dilators better?
For most people, external nasal dilators such as nasal strips are more effective in practice. They are comfortable enough to wear all night, stay in place, and directly address nasal valve collapse without causing irritation. Internal dilators can show similar airflow improvements in clinical settings but have much lower real world compliance due to discomfort.
Can nasal dilators fix a deviated septum?
No. A deviated septum is a structural issue that can only be corrected surgically, through septoplasty or septorhinoplasty. Nasal dilators work around the problem by opening the nasal valve wider, which reduces the impact of the obstruction. They are a drug free management tool, not a cure. Read more about nasal strips for a deviated septum.
Do internal nasal dilators fall out during sleep?
Yes, this is a common complaint. Internal dilators that insert into the nostril can shift or fall out during sleep, especially if you move around a lot. External nasal strips stay in place more reliably due to the adhesive bond on the skin outside the nose.
Are nasal dilators safe to use every night?
External nasal strips are safe for nightly use. They are drug free, not invasive, and do not affect nasal function or structure over time. Internal dilators used every night can cause minor irritation to the nasal mucosa in some people, though they are generally considered safe at recommended use levels.
Can I use a nasal strip and an internal dilator together?
Technically yes, but there is no real evidence that combining them delivers better results than using a quality external strip alone. For most people with nasal valve issues, a strong external strip that properly lifts the lateral wall is sufficient.
Do nasal dilators help with snoring?
Yes, when snoring is caused by nasal obstruction that forces mouth breathing. If your airway can be kept clear nasally with assistance, nasal strips can significantly reduce or eliminate snoring. If snoring has another cause such as palatal vibration or sleep apnea, nasal dilators will have limited effect on their own.
