Both products promise the same thing: a wider nose and easier breathing at night. One sticks to the outside of your nose, the other sits inside your nostrils. They cost about the same and they compete for the same shelf space.
The research on them is more interesting than either set of packaging suggests. On raw airflow, the two are not equal. On snoring and sleep apnoea, the honest answer is one most brands avoid printing.
Here is what each device is, what has actually been measured, and how to work out which one suits your nose.
The Two Types Explained
A 2016 systematic review in JAMA Facial Plastic Surgery catalogued 33 over the counter mechanical nasal dilators and sorted them into four classes. That classification is still the clearest way to understand what you are choosing between.
External nasal dilator strips are adhesive bands worn across the bridge of the nose. Flexible springs inside try to straighten, and in doing so they pull the soft outer walls of the nose outward, widening the nasal valve from the skin side.
Nasal clips sit inside the nostrils and push outward from within, usually a small sprung device that rests just inside the opening.
Nasal stents or cones are tubes inserted a little further into each nostril, holding the passage open along its length.
Septal stimulators claim to work by pressing on the septum. The review found no studies supporting them.
The evidence base was not evenly distributed. That review found five studies supporting external nasal dilator strips, four supporting nasal clips, one supporting nasal stents, and none for septal stimulators. External strips and nasal clips both relieved obstruction at the internal nasal valve, which is the narrowest part of the nasal airway and the usual site of collapse.
What the Evidence Shows on Airflow
When researchers measure air moving through the nose rather than asking people how they feel, internal devices tend to come out ahead.
In direct comparison testing, peak nasal inspiratory flow with no device sat around 66 litres per minute. With an external strip it rose to roughly 102. With an internal dilator it reached about 139, which is more than double the unaided figure.
That is a real difference and it makes mechanical sense. An internal device works at the narrowest point from inside the channel, while a strip has to transmit its force through skin and cartilage from the outside. The strip is working at a mechanical disadvantage.
So if the only question were airflow on a test bench, internal dilators would win. The reason that is not the end of the discussion is that most people are not buying a test bench result. They are buying a night's sleep.
What the Evidence Shows on Snoring and Sleep Apnoea
This is where both devices meet the same limit, and it is worth being straight about it.
A 2016 systematic review and meta-analysis in Pulmonary Medicine pooled 14 studies on internal and external nasal dilators as a treatment for obstructive sleep apnoea. Across 147 patients, the apnoea hypopnoea index moved from 28.7 to 27.4 events per hour, a change that was not statistically significant. There was no significant improvement in the lowest oxygen saturation or in the snoring index either.
A sub-analysis did find a small edge for internal devices: a reduction of about 4.9 apnoea events per hour with internal dilators, against a negligible change with external strips.
A larger 2026 systematic review and meta-analysis in Cureus reached the same conclusion from a wider base. Across 17 studies and 496 participants, it found no significant differences between nasal dilator users and controls in the apnoea hypopnoea index, apnoea index, hypopnoea index, snoring index, total sleep time, sleep architecture, oxygen saturation, or nasal airway resistance.
The authors' conclusion is the sentence to remember: nasal dilators cannot be recommended as monotherapy for sleep disordered breathing, but may be helpful as adjunctive therapy in specific populations with mild symptoms or nasal congestion.
That is the correct frame for both products. They are nasal breathing aids that can help mild, congestion driven snoring. Neither is a treatment for sleep apnoea, and any brand telling you otherwise is ahead of the evidence. We set out the same point about strips specifically in do nasal strips help with sleep apnoea.
Comfort Is the Deciding Factor for Most People
A device delivers nothing once it is on the bedside table at 2 a.m. That is why the airflow ranking and the real world ranking are not the same.
Internal dilators ask you to tolerate something inside your nostrils for seven or eight hours. Some people forget it is there within a week. Others never adjust, and report pressure, dryness, or a persistent awareness of the device. They can also be dislodged by rubbing your face into a pillow, and they need cleaning daily.
External strips ask you to tolerate adhesive on the bridge of your nose. The failure mode is different: they can peel off if the skin is oily, and sensitive skin can get red or sore with nightly use. But nothing is inside your nose, which for a lot of people is the entire argument.
There is also the visibility question. A strip is obvious across the nose. An internal dilator is nearly invisible. People differ enormously in how much they care about that, and it is a legitimate reason to choose one over the other.
Two practical points. Anyone who has had nasal surgery, has a very narrow nostril, or gets frequent nosebleeds should be cautious with internal devices and speak to a pharmacist or GP first. And anyone whose skin reacts to plasters should expect the same reaction to a strip.
Which Should You Try First?
The evidence supports a simple decision rule based on why your nose is narrow.
Try an external strip first if your nose collapses inward when you breathe in hard, if pulling your cheeks outward with two fingers noticeably improves your breathing, if you dislike anything inserted into your nose, or if you want the option that is easiest to abandon after a week's trial.
Try an internal dilator first if the finger test does nothing, if a strip has already been tried properly and did not help, if the narrowing feels further inside the nose, or if you need something invisible.
Try both if your response to the first one is partial. Individual anatomy varies enough that the published averages tell you very little about your own nose, and both are cheap enough to test.
What should not decide it is the headline airflow figure. A 110 percent improvement measured in a clinic is worth nothing if the device is out of your nose by midnight, and a smaller improvement worn all night is worth a great deal.
Getting the Best From Either One
Most disappointing results come down to use rather than the device.
Clear the nose first. A saline rinse or spray before bed removes mucus and allergens, so the device is widening a clear passage rather than a congested one. Neither type reduces swelling inside the nose, which is the single most common reason people conclude the device does not work.
Get the size right. Internal dilators come in sizes and the wrong one either falls out or hurts. Strips are the same: one that overhangs the sides of the nose loses tension and lifts poorly. Massner strips come in medium for narrower noses and large for wider ones.
Place a strip properly. It belongs just above the flare of the nostrils, over the soft part of the nose, not high on the bony bridge where it lifts nothing. Clean and dry skin first, since face oil and moisturiser are the usual reason a strip is on the pillow by morning. Our guide on making nasal strips stick all night covers this in detail.
Give it seven nights. Sleep quality varies for many reasons, so a single night tells you almost nothing. Judge it on whether mornings feel different across a week, whether your mouth is less dry, and whether your partner reports less noise.
Clean reusable devices daily. Internal dilators sit in a warm, moist place and go back in your nose the following night.
When Neither Is the Answer
Both devices address the nose. A lot of snoring does not come from the nose at all, and no amount of nasal widening will change vibration originating at the soft palate or the base of the tongue.
See a GP rather than buying another device if the same nostril is blocked every night regardless of season, if you have facial pain, repeated sinus infections, or a lost sense of smell, or if breathing changed after an injury to your nose. Those point to something structural or inflammatory that needs treating directly, as we covered in do nasal strips work for a deviated septum.
Seek advice sooner if anyone has seen you stop breathing, gasp, or choke during sleep, or if you are exhausted during the day despite a full night in bed. That combination suggests obstructive sleep apnoea, and both meta-analyses above agree that neither device treats it.
Frequently Asked Questions (FAQs)
Are internal nasal dilators better than nasal strips?
On measured airflow, generally yes. Comparison testing found peak nasal inspiratory flow of around 139 litres per minute with an internal dilator against 102 with an external strip, from a baseline near 66. On comfort and whether people keep wearing them, the ranking often reverses, which matters more over a full night.
Do nasal dilators cure sleep apnoea?
No. A 2026 review of 17 studies and 496 participants found no significant difference in the apnoea hypopnoea index, oxygen saturation, or snoring index between dilator users and controls. Its authors concluded that dilators cannot be recommended as monotherapy for sleep disordered breathing.
Can I use an internal dilator and a nasal strip together?
There is no interaction that makes it unsafe, but there is little point. Both widen the same narrow region, so the second device adds little once the first has opened it. Trying them separately for a week each tells you more than combining them.
Do internal nasal dilators hurt?
They should not. Discomfort usually means the size is wrong or it is inserted too far. If a correctly sized device still causes pain, pressure, or nosebleeds, stop using it and speak to a pharmacist or GP, particularly if you have had nasal surgery.
Which is better for a blocked nose from a cold or allergies?
Neither is ideal on its own, because both widen the nose mechanically rather than reducing the swelling inside it. Treat the congestion with saline, and with a steroid spray or antihistamine where allergy is involved, then use the device for the narrowing that remains.
How long do nasal dilators and strips last?
Strips are single use and are discarded each morning. Internal dilators are typically reusable for weeks to months depending on the material and how well they are cleaned, and should be replaced when they lose springiness, discolour, or stop fitting snugly.
Sources
- Alotaibi S et al., Clinical Effectiveness of Nasal Dilators in Sleep-Disordered Breathing: A Systematic Review and Meta-Analysis, Cureus, 2026
- Camacho M et al., Nasal Dilators (Breathe Right Strips and NoZovent) for Snoring and OSA: A Systematic Review and Meta-Analysis, Pulmonary Medicine, 2016
- Kiyohara N et al., A Comparison of Over-the-Counter Mechanical Nasal Dilators: A Systematic Review, JAMA Facial Plastic Surgery, 2016
This article is general information, not medical advice. If a blocked nose or snoring is affecting your sleep, speak to a pharmacist, your GP, or an ENT specialist.
