Aim The detrimental effects of nasal obstruction are well-documented, yet its impact on sleep remains unclear. Whether patient-perceived nasal congestion or actual airway resistance contributes more significantly to sleep disturbances is still debated. This study aims to define the relationship of patient reported sleep disturbances and nasal obstruction to physical nasal airway resistance (NAR). Methods Patients presenting to a tertiary rhinology clinic for any complaint were included. All patients completed a SinoNasal Outcome Test–22 (SNOT-22). Active anterior rhinomanometry was performed on all patients in a controlled condition prior to any decongestion to give a total NAR (Pa/cm3/s at a reference pressure of 150 Pa). The SNOT-22 nasal obstruction score, sleep subdomain combined score, and individual sleep components were correlated to NAR. Results 682 patients were assessed (44.6 ± 17.4 years, 48.6% female). NAR was statistically correlated with SNOT-22 nasal obstruction score (rs 0.14, P < 0.01) and total SNOT-22 score (rs 0.11, P < 0.01). Among individual sleep components, only difficulty falling asleep demonstrated a statistically significant correlation with NAR (rs 0.11, P < 0.01). There was no statistically significance relationship between NAR and fatigue, nor between NAR and overall sleep subdomain scores. Conclusion While nasal obstruction may contribute to sleep disturbances – particularly difficulty falling asleep – our findings suggests that other factors beyond nasal obstruction likely play a more prominent role. Patients complaining of nasal obstruction and sleep disturbance should be carefully assessed for other factors that may be negatively impacting sleep.