Deviated septum and sleep apnea: is there a link?

A deviated septum rarely causes sleep apnea by itself, but it can make things worse. Sleep apnea happens when the airway narrows or closes over and over during sleep, and straightening the septum rarely fixes that on its own. A blocked nose still matters, though. It's linked to snoring and poorer sleep, and fixing it can make CPAP far more comfortable. Here's what the research says about the two together.

Can a deviated septum cause sleep apnea?

A deviated septum is rarely the main cause of sleep apnea, though it can contribute. In a 2008 randomized trial, 49 people with sleep apnea and a symptomatic bent septum had either septoplasty or a sham operation. Only 4 of the 27 who had real surgery saw their sleep apnea respond, and the authors concluded that nasal surgery rarely treats sleep apnea effectively.

The septum is the thin wall of cartilage and bone between your nostrils. ENT UK explains that it can be bent to one side, either after an injury or because it simply grew that way, and that this can narrow the inside of the nose and make it feel blocked. It also says many people with a twisted septum have no blocked-nose symptoms at all.

Sleep apnea is a different problem. The NHS describes it as breathing that stops and starts during sleep, with gasping, snorting or choking noises, loud snoring and heavy tiredness during the day. Our guide to deviated septum symptoms covers what a bent septum feels like day to day.

How does a blocked nose affect breathing at night?

A blocked nose makes breathing harder work and is linked to more snoring and worse sleep. A 1997 analysis from the Wisconsin Sleep Cohort, which used questionnaires from 4,927 people and overnight lab tests in 911, found that people with nighttime nasal symptoms at least five nights a month were significantly more likely to snore most nights, feel very sleepy in the day, or wake unrefreshed.

The same study found that people with nasal congestion from allergies were 1.8 times more likely to have moderate to severe sleep-disordered breathing. Habitual snorers also had lower nasal airflow than non-snorers. But the researchers didn't find a straight-line link where less airflow meant worse sleep apnea, which fits the idea that the nose is one factor among several.

The 2008 trial adds a clue about who might benefit. The few people whose sleep apnea responded to septoplasty were the ones who had breathed through their nose least before surgery and gained the most nasal breathing afterward. If you breathe through your mouth at night, our guide to sleep apnea and mouth breathing explains how the two connect.

Sleep apnea vs deviated septum: how do you tell them apart?

You tell them apart mostly by what happens at night and how you feel during the day. A deviated septum mainly causes a blocked nose, often on one side. Sleep apnea causes pauses in breathing, gasping and daytime exhaustion. You can have both, and only a sleep study can confirm sleep apnea.

The deviated septum details come from ENT UK and MedlinePlus, and the sleep apnea details from the NHS. If you're not sure whether your stuffy nose is structural, our guide to deviated septum vs. allergies can help you sort it out before an appointment.

Does septoplasty improve sleep apnea?

Septoplasty usually doesn't lower the number of breathing pauses much, but it can help people feel better. A 2015 meta-analysis of 10 studies and 320 patients found that nasal surgery alone improved daytime sleepiness scores and the respiratory disturbance index. It found no significant improvement in the apnea-hypopnea index, the main measure of sleep apnea severity.

A 2022 systematic review of 21 studies came to a similar view. Most studies reported no significant drop in AHI after nasal surgery alone, and the small average drop wasn't clinically meaningful. The reviewers advised against nasal surgery as a first-line treatment for sleep apnea, while noting that daytime sleepiness fell significantly in 18 of the studies. They suggested it may suit people with sleep apnea who also have nasal blockage symptoms or trouble with CPAP.

That doesn't make septoplasty pointless. MedlinePlus lists its main purposes as fixing a bent septum that blocks the nose and easing snoring caused by a nasal blockage. For many people, breathing freely through the nose again is worth it on its own. Our guide to nose surgery for breathing covers the procedures, recovery and risks.

Can fixing a deviated septum make CPAP easier?

Yes, for some people nasal surgery makes CPAP more comfortable to use. A 2015 meta-analysis in Sleep found that in people with sleep apnea and nasal obstruction, nasal surgery lowered the CPAP pressure they needed from an average of 11.6 to 9.5 cm of water. It also found that 57 of 64 people who weren't using CPAP before surgery accepted or tolerated it afterward.

Use went up too. In the studies that measured it with the machine's own records, average nightly use rose from 3.0 to 5.5 hours in the months after surgery, though that was a small group of 33 people.

The American Academy of Sleep Medicine's 2021 guideline reflects this. It suggests that clinicians discuss referral to a sleep surgeon with adults who have sleep apnea, a BMI under 40 and ongoing trouble using PAP because of pressure-related side effects. Our guide to getting used to CPAP has other ways to make the mask easier to live with.

What is septoplasty like, and what are the risks?

Septoplasty is a fairly short operation done from inside the nose. MedlinePlus says most people have general anesthesia, the surgery takes about 1 to 1.5 hours, and most people go home the same day. The surgeon works through a cut inside the nose, moves or removes the bent cartilage or bone, and holds the lining in place with stitches, splints or packing.

The risks are worth weighing against a modest effect on sleep apnea. MedlinePlus lists the nasal blockage coming back, which could need another operation, along with scarring, a hole in the septum, changes in skin sensation, unevenness in how the nose looks, and loss of smell or taste. ENT UK adds that surgery doesn't always improve symptoms and that it may not be possible to straighten the septum completely. It also advises not flying for 14 days afterward.

If you use CPAP, ask your surgeon how to manage it while your nose heals.

What else in the nose can play a part?

The septum isn't the only thing that can narrow the nose at night. Swelling of the inside walls of the nose can add to a blockage, and allergies are a common reason for it. In the Wisconsin study, the link with moderate to severe sleep-disordered breathing was found in people whose congestion came from allergies, which is easier to treat than a structural problem.

ENT UK notes that steroid sprays or drops can bring down swelling of the inside walls of the nose, which might improve blockage. Our guide to turbinate hypertrophy explains swollen turbinates, and an ENT doctor can tell you which parts of your nose are causing the blockage.

Should you have surgery or try CPAP first?

For most adults, CPAP comes first. The AASM guideline suggests that clinicians recommend PAP as the first treatment for adults with sleep apnea and a major upper airway abnormality, before referral for upper airway surgery. It also recommends discussing referral to a sleep surgeon for adults with a BMI under 40 who can't tolerate or don't accept PAP.

ENT UK points out that a bent septum does no harm by itself, and that steroid sprays or drops can reduce swelling inside the nose, though they need to be used long term. Whether surgery is worth it depends on how much your nose affects your breathing, sleep and exercise. If you have signs of sleep apnea, the NHS advises seeing a GP, and a sleep study will show whether surgery on the nose is likely to be enough.

Can nasal strips or mouth tape help?

Nasal strips and mouth tape don't treat sleep apnea, and neither is a substitute for a sleep study or CPAP. Some people with a narrow nose use nasal strips at night, and our guide to nasal strips for a deviated septum explains what they can and can't do for a bent septum.

Mouth tape only makes sense for people who can breathe easily through their nose and don't have sleep apnea. If your nose is blocked by a deviated septum, leave the tape off. If you've had septoplasty and want to try tape once you've healed, check with your surgeon first; our guide to mouth tape after nose surgery covers the timing.

We don't recommend mouth tape for children. If you snore loudly, stop breathing or gasp at night, or feel exhausted during the day, see a doctor rather than trying to fix it at home. This article is general information, not medical advice.

Read next

• Deviated septum: symptoms, nighttime effects and when to see an ENT
• Nose surgery for breathing: which procedure, recovery, risks and results
• Nasal strips for a deviated septum

* This content is for informational and educational purposes only and is not medical advice. It is not intended to diagnose, treat, cure or prevent any disease or health condition. Talk to a qualified healthcare provider about your health.