Deviated Septum

[snoozemaster]

I have a deviated septum and enlarged turbinates. Lately I’ve been recording myself at sleep and noticed that I’m nose breathing during sleep, but when I’m having apnea episodes I’m NOT opening my mouth to breathe, only turning my head from one side to another. I’ve already had tongue base surgery that didn’t help.

I know that it’s less common, but could my nose be THE reason for my moderate sleep apnea? My CPAP doesn’t seem to help much too, with multiple flow limitations showing up. 

I’m 29, healthy otherwise, good BMI. I’m seeing my specialist next week but wanted to hear your opinions first.

[HalfAsleep]

I recently had a septoplasty and turbinate reduction. Here's my take.

There are many reasons for apnea and flow limitations that have nothing to do with the nose, but can be positional, un-therapeutic settings, non-OSA, etc. You'd have to post Oscars to get input on that. Personally, I'd be gasping on the pressure settings for your unit, but everyone is different in that regard.

My nose surgery may or may not have made an impact on CPAP therapy. It didn't change my numbers or experience, really. BUT what is far more important, IME, it's helped me general life, because I actually get to experience the universe with healthy breathing. I get to sniff fresh air like humans are meant to.

So, I recommend you think about the surgery in terms of life improvement rather than CPAP improvement.

[snoozemaster]

Thanks for the reply Halfasleep. Can you tell me what were your expectations going into the surgery? Was CPAP not helpful?

I’m sure that breathing better overall is worth it, but I personally wouldn’t go through another surgery just for that. I need to find something that will help my OSA or otherwise make me more CPAP compliant, and septoplasty is the only current option.

I’m adding my latest OSCAR as an example. My sleep study showed no central apneas so all the ones I’m having here are therapy related.

[Jay51]

Snoozemaster, have you tried a soft cervical collar yet?  It might help decrease all of the hypopneas that you are having.  They tend to cluster at times.  Also, you are hitting your max pressure of 12.  You can try raising this max pressure also and see if it helps.  

Great points by HalfAsleep on the surgery.  I had a septoplasty and turbinate reduction also.  My quality of life has improved also.  Better day breathing and less congestion and the same at night.  I read where this is not enough incentive for you to have the surgery though.  Totally your call and choice on this.  

There can be some resistance in the nasal passages during sleep either by obstruction (or partial obstruction) or inflammation.  After this surgery, I could tolerate my ventilator better.  I can breathe only through my nose now at night (before my left nostril would completely clog at night at times).  I would guess somewhere around a 10% to 25% improvement with my therapy.  The 1st few days after surgery were rough.  But it has gotten better.  HalfAsleep is right in that there can be other reasons for flow limitations, etc. that have nothing to do with the nasal area or turbinates.  Have you tried different types of masks?  Which type seems to work best for you personally?  

I would encourage you to do a lot of independent research.  Sort through all of the bias and commercialism of the surgery and look at results that you believe are honest.  I found lots of information on the internet and also here at ApneaBoard using the "search" button at the top of the page to search related threads (on septoplasty or turbinate reduction also).  

I hope you make the correct decision about this surgery and your expectations and needs (whatever that decision will be).

[Sleepster]

I’m sure that breathing better overall is worth it, but I personally wouldn’t go through another surgery just for that. I need to find something that will help my OSA or otherwise make me more CPAP compliant, and septoplasty is the only current option.

FWIW long before I was diagnosed with OSA and started CPAP therapy, I had sinus surgery. It was definitely worth it because for the first time it seemed I could breathe normally.

[Deborah K.]

You also have very high flow limits. On ResMed machines, they have EPR which gives pressure relief on exhale and lowers or stops flow limits. I think there is something on your machine that does the same thing. If so, set it to the highest setting, as your flow limits are hindering good therapy.

[BoxcarPete]

I recently had the surgery and recorded a clean (0.0 AHI) PSG, down from 5.6 overall and 25ish in REM. HOWEVER, I also had an adenoidectomy as part of my procedure, which probably was a big source of the benefit for sleep. Before my follow-up sleep study I put up some nice CPAP charts with improved overall ventilation and fewer arousals overall, so it definitely helped both blockage and resistance. As the others have stated, daytime nasal breathing is somewhat improved overall as well.

[snoozemaster]

Snoozemaster, have you tried a soft cervical collar yet?  It might help decrease all of the hypopneas that you are having.  They tend to cluster at times.  Also, you are hitting your max pressure of 12.  You can try raising this max pressure also and see if it helps.  

Great points by HalfAsleep on the surgery.  I had a septoplasty and turbinate reduction also.  My quality of life has improved also.  Better day breathing and less congestion and the same at night.  I read where this is not enough incentive for you to have the surgery though.  Totally your call and choice on this.  

There can be some resistance in the nasal passages during sleep either by obstruction (or partial obstruction) or inflammation.  After this surgery, I could tolerate my ventilator better.  I can breathe only through my nose now at night (before my left nostril would completely clog at night at times).  I would guess somewhere around a 10% to 25% improvement with my therapy.  The 1st few days after surgery were rough.  But it has gotten better.  HalfAsleep is right in that there can be other reasons for flow limitations, etc. that have nothing to do with the nasal area or turbinates.  Have you tried different types of masks?  Which type seems to work best for you personally?  

I would encourage you to do a lot of independent research.  Sort through all of the bias and commercialism of the surgery and look at results that you believe are honest.  I found lots of information on the internet and also here at ApneaBoard using the "search" button at the top of the page to search related threads (on septoplasty or turbinate reduction also).  

I hope you make the correct decision about this surgery and your expectations and needs (whatever that decision will be).

I did try a soft cervical collar for a few hours (not a whole night) and it didn't seem to help. I emptied half the filling from my pillow and recorded myself sleeping, it seems as though my airway is flat with no particular chin tucking, so I'm inclined to think that is not the problem. I've been experimenting for the last two weeks and actually head the pressure higher at times, but it seems to increase my CA and not do much otherwise.

I've also tried 4 different kind of masks, two FFM, one full nasal and one nasal pillows. The nasal ones are much better leak wise, but none of them seems to improve my AHI enough to be considered better.

I'm doing a lot of research. With CPAP not working and a surgery that didn't help, it's frustrating. Suffocating every night, waking up with a headache, not being able to function as usual. Doing everything I can to fix this.

You also have very high flow limits.  On ResMed machines, they have EPR which gives pressure relief on exhale and lowers or stops flow limits.  I think there is something on your machine that does the same thing.  If so, set it to the highest setting, as your flow limits are hindering good therapy.

Thanks for the suggestion, but unfortunately, the EPR was all the way up on that last image I uploaded. Doesn't seem to help, maybe even does the opposite when I compare it to other nights with lower or no EPR.

I recently had the surgery and recorded a clean (0.0 AHI) PSG, down from 5.6 overall and 25ish in REM. HOWEVER, I also had an adenoidectomy as part of my procedure, which probably was a big source of the benefit for sleep. Before my follow-up sleep study I put up some nice CPAP charts with improved overall ventilation and fewer arousals overall, so it definitely helped both blockage and resistance. As the others have stated, daytime nasal breathing is somewhat improved overall as well.

What exactly did you have? I had adenoidectomy as kid so not sure there's much to do there (or does it grow back?). Are you CPAP free or no AHI with the CPAP? If so, how did your AHI improve without it?

On another note, last night I tested my hypothesis with BreatheRight strips and Otrivin (Xylometazoline Hydrochloride), and my nasal breathing improved, but based on the recording and my overall feeling this morning it seems I was still suffocating as usual.
So back to square one.

[BoxcarPete]

I have had two adenoidectomies: at ages 8 and 33. I know someone who has had three. It's rare, but they do grow back sometimes. My ENT said that with turbinates it's not always the size, but in sleep apnea patients they tend to go further back, which can impinge the nasopharynx. Along with the regrown adenoid tissue, that was apparently the bulk of my problem and I had a 0 event PSG a couple weeks ago so I am apnea-free for the moment. However, I never had a severe AHI to begin with and never had events outside of REM sleep. I had a REM AHI of 25 and nREM AHI of 0 (overall somewhere around 6) in my initial diagnostic PSG, and squeaky clean follow-up.

When were you last evaluated? At the same time as the other surgery?

[Sleepster]

I also had an adenoidectomy as part of my procedure, which probably was a big source of the benefit for sleep.

It may be that you no longer need a CPAP machine. Try lowering the pressure to 4.0 cm (the lowest possible) and see if your AHI is very low. If so, get a sleep study. You may be able to free yourself from CPAP therapy!