sleep apnea & deviated septum

[irab]

Last year I was diagnosed with osa, 31 ahi and 81% saturation. I tried to use a cpap for a few months but could not get used to it. In desparation I ordered a dental device. Using it I felt I was sleeping better but still tired in the daytime. When I returned to the ENT he examined me and asked if I had considered surgery because I had a deviated septum. (I am 61 and no doctor had ever told me that!). Now that I have done another sleep test which was better than the first though not significantly, the doctor suggested that I have the deviated septum corrected because he thinks it would help me. He also told me that I have a large tounge.
I would appreciate hearing people's experiences on the issue.
Thanks

[Diablode]

Success for surgery on treating sleep apnea is low, around 50%. Personally, I couldn't spend that kind of money with those results. And even with success there is still a good chance cpap would be needed anyway to completely treat it.

First thing I would do is give cpap another try. Were you given an auto machine or regular? And at what pressure? What exactly made cpap unbearable for you? There are various comfort settings and features that may make it more usable for you that you weren't using or even aware of.

Do you have problems breathing through your nose? If so nasal steroid spray may be a short term option to see if surgery would in fact be a good idea.

If you do want to get surgery, get a second opinion, particularly someone who will be honest about the likelihood of success for treating apnea. Too many doctors are eager to start carving up people's airways to make money.

[SleepTechTN]

If the OP is asking about having a deviated septum corrected, I've had that surgery and it's the best thing I've ever done for myself. Septoplasty, though, won't correct OSA, it'll only broaden your choices for mask selection. After septoplasty you'll be able to choose from nasal and nasal pillow style masks in addition to full face.
Uvulopalatopharyngoplasty, or UPPP, is the "sleep apnea surgery" and has a fairly low success rate. (To me, anything lower than 85% isn't worth having.) I've seen countless post-op patients come for studies become quite angry when they discover that their apnea wasn't corrected.

To recap: Septoplasty to correct a deviated septum is good, but won't correct your apnea. It will open your nose and allow more mask choices. UPPP probably won't help your OSA with that thick tongue.

I am not a doctor and this is not medical advice. I am only recounting my personal experiences. Consult your doctor for the final word on your health care.

K.

[tiredmama]

I had a septoplasty and turbinate reduction earlier this year and I'm glad I had the surgery, but nighttime breathing was only a very minor consideration. Are there any other reasons you would have the surgery? It's a pretty drastic move to *maybe* reduce or eliminate the need for CPAP.

[LSAT]

I agree wth SleepTech...I had the surgery 2 years ago and it made no difference in my OSA...Pressure remained exactly the same.

[tiredmama]

My septoplasty made a dramatic difference in my nasal and sinus congestion and related headaches and sinus infections because of the poor drainage. It also seems that being able to use my nose to filter the air, as it was intended to do, rather than breathe through my mouth day and night, is helping my overall health.

We tried just about everything we could for my sinus problems, over the course of many years, before deciding on surgery. I wouldn't go to it first. Another consideration for me is that I have a lot of life to live with this nose (I hope!) and I figured I might as well fix it. You hopefully have a lot of life left to live too, but I'm a few decades younger than you.

I did not have my titration study until after my surgery, but my understanding is that sometimes reduces the pressure needed. I have a relatively low pressure and the tech at the sleep lab said she suspected it would have been higher before, but I can't be sure.

Perhaps the best thing would be to look at why you couldn't get used to CPAP and see what could be improved to make the experience better for you?

[Captain_Midnight]

I'm going to suggest the possibility that the surgery might make it easier to adjust to xpap, and that would be a very positive result.

BTW, according to my sleep doc I have had (undiagnosed until age 57) OSA all of my life; and (due to a playground accident at the ripe old age of 9) needed sub-mucous resection surgery at the age of 22. Thus in my case, the surgery didn't cure the osa, but I'm certain that it made the adjustment to the nasal mask ( nearly 40 years later) much easier.

I'm not a doc, and I'm not recommending surgery. Just saying that it's a possibility that it might help osa xpap therapy. (This might be a good q for your doc.)

Good luck


.

[GumbyCT]

...the doctor suggested that I have the deviated septum corrected because he thinks it would help me. He also told me that I have a large tounge.
I would appreciate hearing people's experiences on the issue.

Correcting a Deviation is the first thing anyone, esp. w/OSA, should do.

Use a thumb or forefinger - Block off one nostril and breath thru the other for 60 seconds - then block the other nostril for 60 seconds. IF you found that breathing exercise difficult YOU should have that fixed.

How could you possibly be successful at cpap IF you can't breath?

I too have a large tongue - I don't know that there is a fix for that. That makes breathing thru the nose even more critical as blocking off one nostril AND then blocking the throat with the tongue does NOT sound like a recipe for success to me.

A Full Face Mask is NOT the answer and breathing thru the mouth is not normal. The reason people breath thru their mouth is because the nose is clogged or simply not functioning.

Folks the nose is not just an ornament. It should be functioning.

[Diablode]

...the doctor suggested that I have the deviated septum corrected because he thinks it would help me. He also told me that I have a large tounge.
I would appreciate hearing people's experiences on the issue.

Correcting a Deviation is the first thing anyone, esp. w/OSA, should do.

Use a thumb or forefinger - Block off one nostril and breath thru the other for 60 seconds - then block the other nostril for 60 seconds. IF you found that breathing exercise difficult YOU should have that fixed.

How could you possibly be successful at cpap IF you can't breath?

I too have a large tongue - I don't know that there is a fix for that. That makes breathing thru the nose even more critical as blocking off one nostril AND then blocking the throat with the tongue does NOT sound like a recipe for success to me.

A Full Face Mask is NOT the answer and breathing thru the mouth is not normal. The reason people breath thru their mouth is because the nose is clogged or simply not functioning.

Folks the nose is not just an ornament. It should be functioning.

Why wouldn't a ffm be the answer? It will allow for treatment of the sleep disordered breathing via CPAP despite less than ideal nasal flow, no?

[GumbyCT]

Why wouldn't a ffm be the answer? It will allow for treatment of the sleep disordered breathing via CPAP despite less than ideal nasal flow, no?

It may keep you alive long enuff to get your real breathing problem fixed but it is a bandaid fix.

Did you not read this?

That makes breathing thru the nose even more critical as blocking off one nostril AND then blocking the throat with the tongue does NOT sound like a recipe for success to me.

Obstructing with the tongue reduces the O2 to the brain.

In this exercise ..

Use a thumb or forefinger - Block off one nostril and breath thru the other for 60 seconds - then block the other nostril for 60 seconds. IF you found that breathing exercise difficult YOU should have that fixed.

IF you had difficulty breathing or were short of breath exactly what do you think will happen when this occurs while you are sleeping? You have a FFM on, your tongue obstructs your airway and you have one working nostril (maybe - maybe both are clogged tonite).

So your thoughts are? Oh not me?

Hey it's your life - you do what you see fit.

[archangle]

I've always wondered about the idea that a deviated septum can cause OSA.

Most of us have occasional stuffed noses from colds, allergies, etc. Won't we open our mouth before we have serious apneas? Obviously, we'll eventually open our mouths or we'd die every time we had a cold or serious allergy attack.

I'm sure a deviated septum makes things a lot worse if you're using a nasal mask.

[sleepycarol]

I had a deviated septum fixed in 1990. If I had it to do over, I would leave well enough alone. It was horrible and recovery was slow. It was suppose to be done on an outpatient. I ended up having to stay 4 days in the hospital.

Funny thing is my 2 year old granddaughter headbutted me in May of 2011. I had a CT scan in June of this year due to headaches. Yep my septum is deviated and when the doctor suggested surgery I politely told her no way am I doing it -- been there done that already -- not again.

[GumbyCT]

I'm sure a deviated septum makes things a lot worse if you're using a nasal mask.

Or when your tongue suddenly blocks your airway with your FFM mask on. Sure you'll wake-up <repeatedly>

[tiredmama]

I've always wondered about the idea that a deviated septum can cause OSA.

Well...in my case, snoring and apneas were reported by others from a very young age. As in, my mom could hear me snoring down the hall when I was a baby, and she'd hear me stop breathing and restart, or watch it happen. (My own kids did the stop breathing thing occasionally and the drs told me it was not abnormal to do that occasionally.) Around 3rd grade, I started getting repeated strep infections. Docs would tell me I had some of the biggest tonsils they'd ever seen when they WEREN'T swollen. When they were swollen, along with my uvula, my throat was barely passable. But they don't routinely take out tonsils anymore. SIX YEARS of tonsil and upper respiratory infections and problems and my huge tonsils and adenoids are finally removed. The adenoids were blocking airflow from my nose and I could breathe better after they were out. Snoring was not quite as horrible.

And then the sinus problems really kicked in. About 10 years of those before I finally demanded to see an ENT. And we started various treatments, including allergy shots and otherwise treating allergies, since the inflammation and irritation from those was a big part of the problem. We also did a sleep study and I did not have enough apneas to qualify for CPAP. Four years in to allergy injections, I got pregnant, and there is extra congestion associated with pregnancy and with the hormonal changes while breastfeeding as well. Sinus pressure and other nose problems are pretty ridiculous, but doc wants to wait until my hormones are back to normal to decide whether surgery would be the best bet. Wean last kid, still getting sinus infections, make appt with ENT, and start discussing surgery. In addition to a severely deviated septum (that looks fine from the outside...all the problems are hidden inside), the turbinates on the open side had gotten super swollen from taking on almost double duty, and that side was almost blocked too. A CT scan showed my SINUSES were fine. All these years of thinking I had awful sinuses, and they were fine...my nose was the problem. In addition to the other problems making it difficult for them to drain, one of those turbinates was blocking part of the entrance to the sinus that most frequently got infected.

I had a second sleep study around the time the ENT and I were starting to seriously talk about surgery, and this time I had a lot of hypopneas and some apneas and qualified for CPAP. I should also mention that I was maybe 25-30 lb. heavier than I had been when I had the first study several years prior. And maybe they are paying more attention to things like apneas now...I don't know. ENT suggested waiting until after surgery to titrate because it would change settings and it was also *possible* that with my mild to moderate case I might no longer need it. Months of waiting to get it done, recovery, and then we finally scheduled a split study. First part confirmed I still needed CPAP, second part put me on the mask. I have not seen the results of the second study to see what my numbers were before I masked up.

My septum is perfectly straight now. I still have sleep apnea. As my ENT said in the surgical consult, there are a lot of things that can contribute to the snoring and the apnea and it's hard to say how much correcting just the septum will affect other things. I don't snore as loudly as before...and I guess it was pretty loud. I'm grateful for that.

I am STILL retraining my brain to remember that I can breathe with my mouth closed. I would feel panicky at first when I realized my mouth was closed. Yes, I could breathe, but it used to be I'd start gasping for breathe if I did that. On a subconscious level, I'm still uncomfortable with not being able to easily open my mouth at night if I have to/want to.


As for Gumby, well, my body isn't perfect and I'm not interested in surgery to conform to the ideal unless the imperfections are causing medical problems. I do not consider using the mouth when breathing to be a medical problem. Sinus infections, headaches, congestion, yes, those can justify surgery. But some people might find nasal sprays, allergy treatment, etc. will open things up enough to alleviate symptoms.

[GumbyCT]

As for Gumby, well, my body isn't perfect and I'm not interested in surgery to conform to the ideal unless the imperfections are causing medical problems. I do not consider using the mouth when breathing to be a medical problem. Sinus infections, headaches, congestion, yes, those can justify surgery. But some people might find nasal sprays, allergy treatment, etc. will open things up enough to alleviate symptoms.

Hey gf - don't shoot the messenger