Thank you for your query.
The nasal turbinates congest and de-congest alternately. This happens every two to seven hours in normal individuals, causing alternate nasal congestion and blockage. This is known as the Nasal Cycle. This may also happen when you sleep on your side. However, it may also happen with autonomic nervous system imbalance and most importantly in case of DNS (Deviated Nasal Septum), even if it is mild.
On the concave side of the DNS, the turbinates hypertrophy asymmetrically. The middle turbinate may also develop into a concha bullosa (large air cell). Also the color of the mucosa gives a clue to the diagnosis. For example, pale mucosa indicates long standing allergy, reddish purple indicates acute allergy, reddish red indicates vasomotor or intrinsic rhinitis as compared to normal moist pink healthy mucosa.
The 4 mm space that you mention is not too wide. Usually, when the roomier nasal cavity is open and the narrower nasal activity is blocked, there is no feeling of nasal congestion. The opposite happens when the better side is blocked. Then both the nostrils feel blocked and the feeling of nasal congestion is experienced.
I usually recommend a trial with an antiallergic, antileukotriene and steam inhalation for 15 days. If there is good relief, medication is continued and tapered off over a few months. Do you have any other symptoms such as sneezing, headaches or rhinorrhea (nasal discharge)? If there is no or poor response, I get a special CT Scan of the Paranasal Sinuses (PNS) done pre- and post- decongestion with Otrivin nasal drops. Turbonate reduction by Radio-Frequency Ablation or with Co-ablation is the latest surgical treatment for hypertrophied turbinates with excellent results.
Hope that this information helps and hope that you will get better soon.
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Dr. Sumit Bhatti