Ask a Doctor: How Nasal Surgery Improves CPAP Use

Introducing: Ask a Doctor

At UTHSC ENT, we understand that patients need clear, helpful answers to their questions. We also know that a flood of new information can be overwhelming.

That’s why we’ve started Ask a Doctor: an ongoing series of posts that tackle Frequently Asked Questions about common issues. We hope these articles give you a better understanding of your situation and an easy path to treatment.

Today, we’re discussing nasal surgery and CPAP use:
Prepared by: Alec Wright, UTHSC Medical Student
Reviewed by: Dr. M. Boyd Gillespie, MD, MSc, FACS

What is sleep apnea?

Sleep apnea is a disorder in which patients have repeated pauses in their breathing while sleeping. This may result in symptoms such as loud snoring, dry mouth, and/or headaches in the morning. If left untreated, sleep apnea can result in more serious issues such as high blood pressure, heart disease, or stroke.

Sleep apnea is typically diagnosed by a sleep study where a healthcare provider will record the number of times the patient had slowed or paused breathing while asleep.

There are two main types of sleep apnea: obstructive sleep apnea (OSA) and central sleep apnea (CSA). Obstructive sleep apnea is caused by the relaxation of throat muscles and/or enlarged tissues that obstruct the throat. This narrows the airway and prevents the patient from getting sufficient oxygen with each breath. Central sleep apnea, on the other hand, is caused by the brain not sending signals to the chest to take a breath. In either case, the patient has difficulty breathing while asleep.

At UTHSC ENT, our Sleep Surgery Clinic is renowned throughout the region and offers cutting-edge treatment for sleep apnea. If you’d like to learn more, feel free to browse our sleep apnea articles and success stories!

What is a CPAP and how does it work?

CPAP is currently the main treatment for patients diagnosed with obstructive sleep apnea and many forms of central sleep apnea. CPAP stands for Continuous Positive Airway Pressure.

A CPAP machine is a small air compressor that provides moderate air pressure into the patient’s airway in order to keep the airway open, thus allowing better flow of air. While sleeping, the patient will wear a mask over either their nose or both their mouth and nose, which allows the air pressure to be directed into the patient’s airway.

Depending on the severity of the airway obstruction, the doctor may recommend a higher or lower air pressure from the CPAP machine. A higher air pressure is used for patients with more severe obstructive sleep apnea since more air pressure will be needed to keep the airway open.

What types of nasal surgeries can help with CPAP use?

The main nasal surgeries performed in patients with sleep apnea are the septoplasty and turbinate reduction (submucous rection). A septoplasty is a procedure in which the surgeon straightens the septum (the cartilage and bone that separates the nostrils in the nose).

Deviation of the septum can result in an obstructed airway with blocked nose; mouth breathing; dry mouth in the morning; worsening snoring; and post-nasal drainage. A turbinate reduction is a procedure in which the surgeon opens the airway that is obstructed by small bones in the nose. These bones normally serve the purpose of warming the air as we breath it in. At times, the tissues on these bones can become enlarged due to allergies or infection, causing an obstructed airway. It is common for patients to have these two procedures together.

How do these surgeries improve use of a CPAP machine?

Studies have shown that patients who undergo a septoplasty, turbinate reduction, or both procedures together require less air pressure when using a CPAP machine, and many patients actually increased their use of a CPAP machine.

In 7 different studies with a total of 82 patients who underwent nasal surgery, there was an average of nearly a 23% reduction in the amount of air pressure required to keep the patient’s airway open.

These surgeries are both used to clear up obstructions in the patient’s airway, thus less air pressure is required to keep the airway open while the patient is sleeping. Further, 11 different studies with a total of 153 patients who underwent nasal surgery, showed that nearly 90% of patients who were not using CPAP prior to surgery began to use them afterwards.

Due to the surgeries clearing up the airway, the CPAP machine was more beneficial for these patients, prompting them to use the machine more often. In addition, nasal surgery has been shown to improve sleep quality; reduce daytime sleepiness; and allow for deeper, more restful sleep.

What are the potential complications?

As with any surgery, there are potential complications. With a septoplasty, there is a risk of excessive bleeding, temporary numbness in nose and upper mouth area, or a hole in the septum. A turbinate reduction is a minimally invasive procedure with low risks, although there is a chance of excessive bleeding, nasal congestion, or infection.

It is important to discuss the risks and benefits of these surgeries with your doctor before deciding on a particular treatment.

How can our Dream Team help?

UTHSC ENT’s Dream Team provides world class treatment in your hometown, and our Sleep Surgery Clinic is nationally-renowned.

If you’d like an appointment concerning sleep apnea, we’d love to hear from you!

(901) 737-3021