Pulsating airflow jets delivered via nasal cannula offer a promising, comfortable, non-invasive alternative to continuous positive airway pressure (CPAP) for treating obstructive sleep apnea (OSA). However, the fluid dynamic mechanisms by which pulsatile flow influences upper airway pressure remain poorly understood in anatomically realistic geometries. This study used large eddy simulations (LES) to examine pressure and flow characteristics of pulsating nasal jets within a patient-specific upper airway model. Two airflow conditions were simulated: (1) steady high-flow nasal cannula (HFNC) at 40 L/min and (2) pulsatile flow at 20 Hz with a 30% duty cycle, matched to the same mean flow rate. Each pulse generated a vortex ring that impinged on the nasal walls, creating localized high-pressure regions and asymmetric shear stress. Compared to steady flow, the pulsatile jet increased time-averaged pharyngeal pressure by up to 50%. Spectral analysis revealed that the 20 Hz pressure oscillations were primarily confined to the upper airway, with substantial attenuation through the pharyngeal–laryngeal region and negligible coherent oscillatory content by the trachea. These effects, shaped by jet-wall interactions in complex anatomy, diverge from classical vortex dynamics. Pulsatile nasal flow may offer a precise, geometry-responsive method for upper airway stabilization, suggesting a path toward a more tolerable, mask-free alternative to CPAP for OSA therapy.