Can a Deviated Septum Cause Sleep Apnea?

Sleep apnea is a sleep disorder affecting millions of people worldwide. It is characterized by repeated pauses in breathing during sleep, which can lead to poor-quality rest and other complicated health issues. Many people with sleep apnea are also living with a deviated septum and, with a lifetime of breathing difficulties, it's only natural to wonder if your septal deviation is the root cause of your sleep apnea.

In short, a deviated septum can not directly cause sleep apnea, but it can exacerbate your condition, making it even more difficult to breathe properly while you sleep.

In this article, we’ll discuss deviated septums, their role in sleep apnea, and how to treat sleep apnea with a septal deviation.

The septum is the part of the nose that separates the two nostrils and is made of mainly cartilage and some bone. It is diagnosed as deviated when it sits off-center between the nostrils or leans to one side.

This deviation can cause a blockage of airflow into the nose, making it difficult to breathe through your nose while sleeping. A minor deviation may cause no symptoms, but more drastic cases can cause headaches or repeated sinus infections. In any case, a deviated septum can increase breathing difficulties and impact sleep apnea treatment.

A deviated septum does not directly cause sleep apnea. However, it often worsens existing cases and may increase your risk for sleep apnea. This is because people with deviated septums are more likely to breathe through their mouth, which has been linked to sleep apnea.

The reason experts say that a deviated septum does not directly cause sleep apnea is because it does not cause airway obstruction. Associate Medical Director of the Weill Cornell Center for Sleep Medicine and author of Let’s Talk About Sleep, Dr. Daniel Barone, says that Obstructive Sleep Apnea (OSA) is caused by the closure of the airway, but that closure typically occurs near the tongue.

“Nasal congestion, whether it be from a deviated septum or allergies, etc., can make OSA worse, or more difficult to treat with CPAP, but should not cause OSA,” says Dr. Barone. “Snoring and OSA are on a spectrum, and here’s how you can think of it: the airway passages are narrow in snoring. As air moves through the tightened airway, it causes vibration of the tissue, which is what snoring is. This narrowing can happen anywhere along the airway, either nasally or down near the tongue. But actual blockage—that usually occurs by the tongue. So the short answer is: you can definitely have septum deviation as a cause of snoring, but not usually OSA.”

A deviated septum can make it more difficult to get sufficient oxygen while breathing through your nose. This can lead to increased episodes of sleep apnea and an overall decrease in sleep quality.

Additionally, the deviated septum can increase the inflammation and irritation in your nasal passages, making them more narrow and prone to collapse and worsening sleep apnea symptoms.

Lastly, a deviated septum worsens sleep apnea by making it more challenging to treat. Nasal and nasal pillow masks are not a reliable treatment method for those with deviated septums and will force the majority of your therapy air to be delivered orally, increasing your chances of gas and burping caused by CPAP.

While some people are born with a congenital deviation, deviated septums can also result from an injury. Sometimes this injury even happens during birth which is difficult to diagnose in babies.

We know that about 80% of people have some degree of deviation in their septum. If a deviated septum caused sleep apnea, many more of us would be chronically sleepy.

Deviation can occur during growth periods, but it’s just as likely to result from injury. Any blow to the nose, whether in a fistfight, a car accident, face planting, or walking into a door can cause enough injury to impart a deviation.

For more debilitating cases, surgical intervention (a septoplasty) is an option that can relieve many symptoms. It involves a small incision and the straightening of the septum.

It is still possible to treat your Obstructive Sleep Apnea with a deviated septum, though you may find that not all mask types are effective. Typically, nasal and nasal pillow masks will struggle to properly treat your airway blockage due to the deviation.

While in some cases, the continuous pressure can partially clear the deviation, even to the extent that daytime breathing improves, but this is not always the case. Dr. Barone notes that medication is sometimes needed to reduce nasal congestion and, sometimes, even surgery.

“I have seen many patients tell me that the pressurized air of CPAP basically “blows open” the nasal passages, which even helps their daytime breathing,” says Dr. Barone. “Unfortunately, this is not always the case, and sometimes nasal congestion, whether it be from septal deviation or otherwise, can make it more difficult to use CPAP. In that case, medication to reduce nasal congestion (such as nasal steroids like Mometasone AKA Nasonex), nasal saline spray, or even surgery (see below) might be needed.”

If surgery is not an option, you may find it easier to treat your OSA with a full-face CPAP mask which delivers therapy air to both the nose and mouth. You’ll also want to be sure to use heated humidification, as most of the air will bypass the natural humidification of your nasal passages.

A deviated septum may worsen existing sleep apnea symptoms and may even increase your chances of developing sleep apnea, but a deviated septum won’t inherently cause sleep apnea.

A deviated septum does not cause sleep apnea, though it can worsen existing sleep apnea. Correcting the deviation can help make CPAP treatment more tolerable and accessible, but it won't cure or prevent sleep apnea.

To the question of whether fixing a deviated septum will cure sleep apnea, Dr. Barone says, “Typically not. However, treating a septal deviation or any form of nasal congestion, such as turbinate reduction, would help nasal breathing. This likely would reduce snoring; as for OSA, these kinds of procedures would make it easier to tolerate CPAP or other forms of treatment for OSA (such as an oral device).”

While you can use a CPAP machine with a deviated septum, a CPAP will not repair the deviation. Treating sleep apnea with CPAP is more challenging with a deviated septum because it limits mask options, but a full face CPAP mask can still be used even with a septal deviation.

A deviated septum does not prevent airflow through the nasal passages but it does restrict it. You may experience whistling or other noises while breathing through your nose, but a deviated septum will not fully prevent you from breathing either during the day or at night by itself.

A deviated septum occurs in enough people to render it commonplace. 80% of people have this condition, but less than 30% of the general population is living with sleep apnea. The second number would be much closer to 80% if a causal link existed, and the reason these numbers aren’t closer together is because a deviated septum does not cause sleep apnea.

Deviated septums can worsen existing sleep apnea and limit treatment options via CPAP therapy, but the primary obstruction of OSA occurs in the throat and not the nose. Surgically correcting a septal deviation won’t cure sleep apnea, but it can make it more manageable and open treatment options that were not previously available.