The internet is full of health and wellness products that are cheap, seem harmless and are vague enough in their marketing that you might be tempted to order them if it puts you over the minimum Amazon needs to offer you free shipping.

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Nasal strips are a perfect example. They promise better breathing, deeper sleep and a cheap easy fix to snoring. At pennies per strip, there is little upfront cost or risk. But even 70 cents per strip adds up with daily use. Over 10 years, these strips will cost you over $2,555, assuming their price doesn’t go up.

There is no shortage of such devices on the market, but they can be grouped into four categories. The most common and most well studied are external nasal dilator strips. These adhesive strips are placed over the bridge of the nose and pull open the lateral nostril to improve airflow and decrease nasal resistance.

Other devices like internal nasal stents, nasal clips and septal stimulators are available but their popularity is limited. These reusable devices are probably cheaper long term, but the upfront cost and the population’s general reluctance to stick anything other than their own finger up their nose mean that external strips are the most widely used. A 2016 review found 33 different products, though only six had any hard data backing their health claims.

When measured objectively, external nasal dilator strips do exactly what they promise. They open the nose and decrease resistance at the narrowest part, the internal nasal valve. The resultant improvement in air flow may indeed make someone feel like they are breathing better. But subjective feelings are one thing. These products should actually prove that they can fix a real problem.

A quick perusal online will identify a myriad of nasal strips promising to help with better sleep. We all know that sleep suffers when you’re sick. Nasal congestion forces you to sleep with your mouth open and makes a rejuvenating night sleep impossible.

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Intuitively, opening up the nasal passages should make breathing and sleeping better. But two randomized placebo-controlled studies in patients with chronic nasal congestion suggest otherwise.

The first study randomized 140 patients and the second study 130 patients to daily use of the Breathe Right nasal strips or placebo strips that were cosmetically similar but provided no effect on nasal dilation. Over two weeks, patients completed questionnaires about their nasal congestion sleep symptoms and fatigue scores. By study’s end, the patients using the nasal strips showed a marked improvement in sleep, fatigue and nasal congestion symptoms. But the placebo group improved by the same amount. There was a strong placebo effect at play.

Reduced snoring is another common claim. External nasal dilators are supposed to open up the airways to help relieve snoring and obstructive sleep apnea. For most individuals, the pathology that leads to snoring and sleep apnea occurs much deeper in the airways. But even setting aside this anatomical implausibility, researchers have tested to see if nasal dilators might possibly help.

In 2003 the American Academy of Sleep Medicine found very limited data and a paucity of evidence to support their use. In 2016, another review found that nasal dilators like Breath Right strips and NoZovent didn’t improve snoring, oxygen saturation at night, or measures of obstructive sleep apnea like the Apnea Hypopnea Index. There was a small benefit of five fewer apnea events per hour with internal nasal dilators, so perhaps there is a small subset of patients with specific anatomic abnormalities that would benefit from these more invasive devices. But the pervasively popular external strips did nothing.

Intuitively, nasal strips should work. You breathe in more air and feel better. But they don’t fix any medical problem when measured objectively or compared against placebo. Sadly, this is very common with health products you buy online. Most of them don’t pass the sniff test.

Christopher Labos is a Montreal physician. He is the host of the podcast The Body of Evidence and the author of Does Coffee Cause Cancer?

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