Nasal Breathing / Septoplasty questions

[Ptee8899]

Hi guys, I am new here. I was diagnosed with sleep apnea about 5 months ago. AHI 34 from in home sleep study. Prescribed CPAP.

Been using it on and off, mostly not using it... I can only get a few hours most nights before I take it off then leave it off the rest of the night. Mostly due to difficulty breathing through my nose / switching to mouth breathing. I am using a nasal mask and haven't tried a full face mask yet.

Will a septoplasty help me here? I have a severely deviated septum and enlarged turbinates. I've been seriously considering these surgeries, but I see a lot of mixed reviews on their efficacy long term. Even though it doesn't cure sleep apnea, shouldn't it help me breath through my nose better, which would be a huge benefit?

Also, is there anything that can be done about the nasal congestion? after a bath, I go to bed pretty comfortablly with a clear nose, but I always wake up in the middle of the night sweating and with a blocked nose.

[BoxcarPete]

I had septoplasty, turbinate reduction, and adenoidectomy last month and it has helped. I don't have enough charts post-op to say for sure, but I would say that overall the best ones look better and the worst ones less bad compared to pre-op. Wife reports significantly less snoring even off-PAP so that's nice too, but if you don't have an adenoid problem that might not be a benefit you get much of. I'd definitely recommend the procedure I had, but without the adenoidectomy the recommendation gets a little more lukewarm. My septum was considered moderate though so if you're severe, it's likely worth it.

[Ptee8899]

Thanks. how did you decide on which doctor to go with for your surgeries? my ENT does this, but should I be shopping around to see who is the best in region?

[BoxcarPete]

This is the most routine operation done by every ENT in the country. They are all capable of doing the job, so the risk is pretty low if you want your nose cleaned up and then to be done surgically. If you have any desire to possibly go further, the payback for getting picky gets much higher because the same surgeon will do followup operations and can do things their way from the beginning with that in mind.

I read through over 250 reviews of my doc before deciding to go ahead and liked what I found in the reviews. That's not always infallible because reviews can get pruned or cultivated to some extent but I generally got a good feeling from the guy and my gut told me he was a good choice. I was originally referred to him by the sleep center who did my sleep study and never helped me with anything else because the MD is an allergist and immunologist, so I told them I wanted to go see an ENT sleep specialist based on my own history of tonsillectomy and adenoidectomy improving my sleep in a completely life changing way when I was a kid.

Edit to add: Regardless, before you go for this procedure make sure they are doing the turbinates the new way, not the old way. Don't go with any doc who cuts away the bone, the best way is an orthoscopic submucosal resection and outfracture. They should know the difference and acknowledge it, if they don't then go find another. I don't know how many docs are still doing the old school way, but that procedure is how people run into empty nose issues.

[Luka07]

I have done the other way around . I thought that I just have deviated septum and sinus issues and that this is the reason for sleeping bad, but it wasn't.

I had septoplasty + rfitt of inferior turbinate. Would recommend this surgery to anyone, just be careful about turbinates, I have it done by rffit method.

Second I had Fess( sinus surgery) + adenoid removal surgery.

After all this surgeries I done sleep study and then started to use cpap. ENT surgeon told me that without surgeries my cpap experience would not be so good and that it wouldn't work so well. Probably I would need full face mask in order to work good

[Ptee8899]

Thanks for sharing guys

[BoxcarPete]

Looked up that RFITT method, studies comparing it to the MAIT method my doctor used found no difference between outcomes at 6 months, but slightly better outcomes on average with MAIT after three years. I'd say those are the two methods worth considering, your ENT may have a preference so go with that one. If they sign you up for anything else, go take a walk!

[HalfAsleep]

I went through a phase where I'd rip my mask off and neglect to put it back on in the middle of the night. That was a while ago. Somewhere in that process, I was smacked in the nose by a toddler at work and realized my nose wasn't working. At the same time, it was getting kinda obvious that I couldn't get CPAP figured out (but that's a long story); I don't actually use one at the moment.

However, I only got around to fixing my nasal labyrinth recently (5 weeks ago). I had 3 different surgeries...forget what all they're called. An ENT did it. Was it an EZPZ surgery for the ENT? Yep. Was it an EZPZ surgery for me? NOOOOOOO. I'm still shedding bits and pieces of surgery sponges, the strangest looking nose glop, and I don't know what else. For a while, I had balance issues and lost my sense of smell. It's been miserable. I'm finally back to work after 4 weeks. Would I do it again? YESSSSSS! Why? I have nostrils! I clearly can breathe better, but it sounds like total healing might be a few months.

On the nasal congestion thing.... which I guess I suffered for years! A doc convinced me to do NeilMed rinses (with little salt/baking soda packets) every day. This holds up quite well for at least 12 hours. No problem doing it twice a day if my nose needs a little extra oomph. Before I got to that, I added Simply Saline to my arsenal. Best feel good treatment ever. Goes in nice and cool and relaxing. Now.....Simply Saline makes a night-time version that's a really good de-clog. If I get desperate, I use it during the day, too. It just takes a quick spritz. I could probably do it in the middle of the night and never wake up totally, so I'd fall right back to sleep.

[FWIW Simply Saline comes in a spray can that spritzes. It also doesn't dry out or leak like the plastic squeeze bottles of saline.]

The other item that works for drainage (I had to use it for my surgery) is a wedge pillow. I actually really got to like sleeping with one of these. However, run it by the advisors here, because it might not be the best thing for apnea.

Bottom line: I have no idea whether my nasal labyrinth surgery makes any difference to my apnea (I haven't had a new sleep test yet), but my experience is that it makes a difference to other segments of my life. I can breathe through my nose when I go for a walk! I don't feel like I'm gulping air so much. I can talk and breathe at the same time....

So, I think that's the most important consideration. Will septoplasty make you feel better and keep you healthier? If the answer is yes, I wouldn't worry too much about whether it lowers your AHI. Lowering AHI might just be an extra bonus.