Can a deviated septum cause snoring or sleep apnea?

Short answer: A deviated septum can contribute to snoring and may worsen obstructive sleep apnoea by narrowing the nasal airway and encouraging mouth breathing. However, snoring usually also involves the palate, tonsils and tongue base. Correcting nasal blockage may reduce snoring and make CPAP easier to use, but septoplasty alone does not reliably resolve sleep apnoea.

Key takeaways

• Nasal blockage encourages mouth breathing, which makes throat tissues more likely to vibrate.
• A deviated septum may worsen sleep apnoea but is rarely its only cause.
• Improving nasal airflow may make CPAP more comfortable for people with sleep apnoea.
• A full airway assessment, sometimes with an ENT evaluation, guides treatment.

How does a deviated septum affect snoring and sleep apnoea?

A deviated septum affects snoring mainly by pushing you to breathe through your mouth during sleep.

The septum is the wall between the nostrils. When it is significantly bent, the nasal airway narrows. At night, normal swelling of the nasal lining adds to this, and many people switch to mouth breathing. With the mouth open, the jaw and tongue tend to fall back, and the soft palate and throat tissues vibrate more easily. That vibration is snoring.

Obstructive sleep apnoea (sleep apnea) is different from simple snoring. The airway repeatedly narrows or closes during sleep, oxygen levels may dip and sleep is broken. Nasal blockage can make the throat more collapsible, so a deviated septum may worsen apnoea, but the main blockage is usually in the throat.

How can you tell simple snoring from sleep apnoea?

Simple snoring is noise without breathing pauses; sleep apnoea involves pauses, gasping and daytime effects.

• Simple snoring: steady noise, no witnessed pauses, you wake reasonably refreshed.
• Possible sleep apnoea: loud snoring with pauses in breathing, gasping or choking, frequent night-time urination, morning headaches, and daytime sleepiness.
• Nasal contribution likely: snoring worse when the nose is blocked, a dry mouth on waking, one-sided blockage.

Risk factors for sleep apnoea include excess weight, a larger neck size, enlarged tonsils, a small or set-back jaw, alcohol before bed and certain medicines.

What can you do at home to reduce snoring?

Several practical steps may reduce snoring, especially when the nose plays a part.

• Rinse with saline before bed and treat any allergy.
• Sleep on your side rather than on your back.
• Raise the head end of the bed slightly.
• Avoid alcohol and sedatives for a few hours before sleep; they relax throat muscles.
• Work towards a healthy weight if advised; even modest weight loss may help some people.
• Keep regular sleep hours, even during deadline weeks.
• Avoid nightly decongestant drops. If you have used one for more than a week, speak to an ENT about a safe way to stop.

How are breathing, sleep and energy connected here?

This is where breathing, sleep and energy are most tightly linked.

Every snore reflects turbulent airflow, and every apnoea pause can briefly disturb sleep, often without you knowing. Over weeks, the result can be non-restorative sleep, low energy, irritability and reduced concentration.

Untreated sleep apnoea is also associated with high blood pressure and other health risks. Improving nasal breathing is one part of a whole-airway plan that may help many people sleep more deeply and feel steadier during the day.

How does nose breathing support energy and BMR?

Your basal metabolic rate (BMR) is the energy your body burns at rest to keep the heart beating, the brain working and cells repairing. Your cells make that energy using oxygen, so how well you breathe matters.

Nose breathing helps in two ways:

• Warm, moist, filtered air. The nose warms, humidifies and filters each breath before it reaches the lungs. Conditioned air is gentler on the airway lining, which matters in Bangalore's air-conditioned offices and traffic dust. Mouth breathing skips this step and can leave the throat and airways dry.
• Nitric oxide from the sinuses. The paranasal sinuses continuously make nitric oxide (NO), a natural gas. When you breathe in through your nose, small amounts of this NO travel to the lungs, where studies suggest it may help widen tiny blood vessels and improve oxygen uptake. Mouth breathing largely bypasses it.

Nose breathing does not "boost" your BMR. That is set mainly by muscle mass, age, body size and hormones such as thyroid. But comfortable nasal breathing by day, and undisturbed breathing at night, support efficient oxygen supply and deeper sleep, which your body needs to use energy well and recover.

A simple check: sit quietly and breathe through your nose with your mouth closed for two minutes. If that feels difficult, or one side is always blocked, it is worth having your nose examined.

When should you see an ENT?

See an ENT if you snore regularly, especially if it disturbs others or you wake unrefreshed.

• Loud, nightly snoring
• Snoring with a blocked nose or dry mouth
• Morning headaches or daytime sleepiness
• A child who snores most nights, breathes through the mouth or has restless sleep

Seek prompt medical care if someone has noticed pauses in your breathing, gasping or choking during sleep, or if you feel sleepy while driving.

Seek urgent care for any breathing difficulty while awake, chest pain or severe breathlessness.

How an ENT evaluates and treats it

An ENT assesses the whole airway, from the nose to the throat, because snoring rarely has a single cause.

The examination includes a nasal endoscopy to check the septum, turbinates and sinuses, plus an assessment of the palate, tonsils, tongue base and jaw. An ENT evaluation checks where the airway narrows and guides treatment.

Treatment depends on findings. For simple snoring with nasal blockage, sprays, allergy care or septoplasty and turbinate reduction may help. For sleep apnoea, CPAP, a machine that keeps the airway open with gentle air pressure, is a common option; better nasal breathing may make it more comfortable. Oral appliances, weight management and throat procedures may also be discussed. The right option depends on the cause.

Frequently asked questions

Does nose breathing give me more energy? It does not add energy by itself, but it delivers warm, humidified air and sinus nitric oxide to the lungs, which may help oxygen uptake. Together with better sleep, that supports the energy your body uses at rest (BMR) and during activity.

Will septoplasty stop my snoring? It may reduce snoring when the nose is a major contributor, but results vary. Snoring from the palate or throat may continue.

Can septoplasty treat sleep apnoea? Septoplasty alone does not reliably resolve sleep apnoea. It may make CPAP more comfortable and is usually part of a wider plan.

Do I need an ENT evaluation if I snore? Not always. It is usually advised if there are breathing pauses, gasping, daytime sleepiness or other risk factors.

References

• Lundberg JO, Farkas-Szallasi T, Weitzberg E, et al. High nitric oxide production in human paranasal sinuses. Nature Medicine. 1995;1(4):370-373.
• Lundberg JO, Settergren G, Gelinder S, et al. Inhalation of nasally derived nitric oxide modulates pulmonary function in humans. Acta Physiologica Scandinavica. 1996;158(4):343-347.
• Keck T, Leiacker R, Heinrich A, Kühnemann S, Rettinger G. Humidity and temperature profile in the nasal cavity. Rhinology. 2000;38(4):167-171.

About the author

Dr. Prashanth R Reddy is an ENT surgeon at ENTHealth360, Bangalore (MS ENT; MBA, IIM Bangalore; Seoul Rhinoplasty Fellowship), seeing patients at Sakra World Hospital, Marathahalli and in Koramangala. His practice focuses on how breathing affects sleep, energy and everyday performance.

Related reading: Why does my sinus keep coming back every few months? · How do I know if I have sinus problems?

For educational purposes only. Not a substitute for medical advice. Please consult a qualified ENT specialist.