7 Common Procedures That Can Worsen Sleep Apnea

October 25, 2010

Millions of surgical operations are performed every year to improve your health, beauty, and even your smile, but there’s a hidden danger in some of the most common procedures that can aggravate if not actually cause obstructive sleep apnea. Sleep apnea happens when your jaws are too narrow, which constricts the internal soft tissue layer that lines your upper breathing passageways, from your nose to your throat. More than a few times a week, I see patients that underwent procedures in the past that clearly was detrimental to the quality of their sleep. Here are 7 common and uncommon procedures that can affect the way you breathe and sleep.

1. Rhinoplasty

One of the most common procedures that’s performed today is your routine nose job, or rhinoplasty. In most cases a hump is taken down, or the tip is made more narrow. In the process, certain support structures are weakened, with flimsy nostrils resulting many years later. In the 1950, the Goldman tip was one of the more popular styles, where the tip of the nose was made very narrow and lifted up slightly. With any procedure that narrows the tip, a portion of the lower lateral cartilages have to be either removed or weakened. This cartilage is one of the main support structures that keeps your nostril from collapsing inwards.

Initially after the procedure, patients can breathe well, but years or decades later, with constant inspiration and vacuum forces from routine breathing, the nostrils slowly cave inwards, worsening nasal congestion.

We know that nasal congestion can aggravate or cause obstructive sleep apnea. This is why nasal packing after any surgery is a miserable experience, and why you’ll toss and turn whenever you have a cold (from a stuffy nose). If your jaws are already narrowed, you’re more likely to have a nasal hump and narrowed nasal cavity, so worsening nasal congestion can only aggravate breathing problems downstream. Underdevelopment of the midface pulls the upper lip and the lower cartilaginous nose down, creating the classic nasal hump.

Even with contemporary rhinoplasty techniques, it’s important to prevent this from happening using proper technique and by minimizing removal of excessive cartilage.

2. Orthodontics / Headgear

I’m sure you’ve seen children wear headgear in past years, with a brace around the head and wires pushing or pulling teeth. Children with overjets (overbite) were managed by pushing the upper teeth back, thus creating the illusion of a proper bite. The fact is that in these children, the lower jaw is underformed, and the best thing to do is to pull the lower jaw or teeth forward to match the upper teeth.

Additionally, some orthodontists still extract teeth to make room for the remaining teeth. Your smile may be nice, but in the process, your jaw just became smaller. Any amount of narrowing of your jaws creates less room for your tongue, and with muscle relaxation in deep sleep, you’ll stop breathing much more often. It’s bad enough that modern human’s jaws are shrinking more and more (due to a radical change in our diets and with bottle-feeding), but when you start to extract multiple teeth, you’re definitely going to have problems breathing. The back molars also act to support the soft tissues of your throat. So removing your molars can destabilize the soft palate, aggravating more soft tissue collapse, especially later in life.

3. Jaw Surgery

Once in a while, I’ll see patients that underwent lower jaw surgery to push back a prominent lower jaw. In this situation, the upper jaw should  have be pulled forward. Since the base of your tongue attaches to you back of your mandible, any backward movement of your jaw can push your tongue back, aggravating breathing problems while you sleep.

4. Thyroglossal Duct Cyst

The thyroid gland starts at the back of your tongue and migrates down your neck in front of your voice box, and then divides into your right and left thyroid lobes with a small connection between the two over the top of the windpipe. Sometimes, a remnant of that tract from your tongue to the voice box can remain, with cysts or tracts or even thyroid tissue along this pathway. When a cyst develops, you’ll have a midline ball or swelling that won’t go away. The treatment for this condition, called thyroglossal duct cyst, it surgical removal.

The procedure is classically called the Sistrunk procedure, named after the surgeon that originally described it. The critical part of this procedure involves removed the midline 1/3 of the hyoid bone, which is a c-shaped bone that sits on top of your voice box. Unfortunately, you’re also weakening and destabilizing the attachments to the tongue and voice box. Upon questioning the handful of patients that have undergone this procedure in past years (some by me and some by other surgeons), most have said that their sleep quality worsened. If you’re ever going to undergo this procedure, it’s important to reattached or reconstruct the tissues that help to support your tongue and voice box.

5. Hysterectomy

Total hysterectomy with or without removal of the ovaries is a common procedure for many women. We know that especially when the ovaries are removed, this creates a state of surgical menopause. I’ve described in past articles that as progesterone naturally drops in normal menopause, sleep quality can diminish, mainly due to the effects of progesterone on tongue and upper airway muscle tone. As the tongue muscle tone slowly drops, obstructions and arousals become more frequent, and you won’t sleep well.

This is also one of the main reasons why hormone replacement therapy (HRT) helps many women sleep better. However, with the recent finding that HRT can increase rates of cancer, it’s not generally recommended anymore. If you’re thinking about undergoing a hysterectomy, be prepared not to sleep as well.

6. Breast Implants

If you’re a woman and like to sleep on your stomach, then getting breast implants can definitely worsen your sleep quality. For a few weeks after this procedure, most surgeons will ask you to sleep on your back. The problem is that when on your back, your tongue will fall back more often, leading to more frequent breathing obstructions and arousals. Until you’re able to go back to stomach sleeping, be prepared to lose a lot of sleep. Unfortunately, some women are never able to sleep on their stomachs again, being forced to sleep on their sides or back.

7. Any Type of Surgery

No matter what type of surgical procedure you undergo, if you’re forced to sleep on your back, then your sleep apnea will be worse. If you never had sleep apnea or sleep-breathing problems, then being on your back may bring on your first experience, especially if you’re a natural side or stomach sleeper.


As you can see, millions of people undergo these procedures every year. Sometimes, the effect on sleep occurs immediately, whereas in others, it can take months or years to surface. If you’re planning any of the above procedures, or if you’ve undergone any in the past, think about how it can potentially affect your quality of sleep. It’s something you should definitely sleep on.

12 Responses to “7 Common Procedures That Can Worsen Sleep Apnea”

  1. Roseanne Levy on November 20th, 2010 8:00 pm

    So, should my son not have his wisdom teeth puled? They are blocking his molars from coming out.
    Thanks.

  2. Steven Park on November 21st, 2010 6:56 pm

    Roseanne,

    That’s a question that one of the specialized dentists (OSB, ALF, DNA) can possibly answer. Without looking at his particular situation, it’s difficult to give to an accurate answer. In theory, if you can expand the jaws and make more for the molars, then it’s possible to preserve your wisdom teeth. In real life, that’s a difficult outcome to predict.

  3. Georgw on November 21st, 2010 9:18 pm

    I had septoplasty surgery because I had labored breathing and while laying down I could not breath the “side down” of my nose. I was dx’d with OSA a few years after this……would this or should this septoplasty have helped my OSA?

    Also I have a diviated septum and even though it was “corrected” I’m told it’s deviated ….how does this happen?

  4. Caroline on November 22nd, 2010 7:15 am

    Hi, this is the first time I have seen that a narrow jaw has been mentioned. My dentist has often commented about my narrow jaw but nothing was said by my doctor when sleep apnea was diagnosed. All that he said was that I should lose some weight (which I agree with) but my neck size is normal and even when I was a normal weight about 10 years ago I still snored loudly then, and probably think I had sleep apnea even then. I have suffered an early menopause too and take HRT but the impact of that was not discussed either. I feel that I was just dismissed because I am slightly overweight. Any suggestions?
    Thank you

  5. Steven Park on December 6th, 2010 8:52 pm

    Caroline,

    Most doctors still believe that you have to be overweight to have obstructive sleep apnea. While it’s true that being overweight can aggravate things, sleep apnea is ultimately an anatomic jaw underdevelopment problem. You can be young, thin, female and not snore, and have significant sleep apnea. Poor sleep quality from sleep apnea can diminish reproductive hormones as well.

  6. Steven Park on December 6th, 2010 8:55 pm

    George,

    Nasal surgery alone typically doesn’t cure sleep apnea (although it can happen occasionally). Your septum was probably not fully corrected. What actually more important is the size and shape of your nasal turbinates, as well how flimsy your nostrils are. Did you ever try using Breathe Rite strips? You just need to address all three of these areas and you should be able to breathe better through your nose. This will also help you with your other treatment options for obstructive sleep apnea.

  7. Paul R Jacobson on February 28th, 2011 12:34 pm

    I am 55 I have been diagnosed with

    ADD (age 42),
    Acid Reflux (age 46),
    OSA (age 48),

    When I was a teenager I had braces and they pulled 4 teeth. A few years later my wisdom teeth became impacted and they were all removed. Periodically I notice that my jaw “pops” when I clench my teeth. This comes and goes.

    Is this all connected?

  8. Steven Park on February 28th, 2011 8:00 pm

    You may have been predisposed to obstructive sleep apnea, but pulling excessive teeth can make things much worse. Obstructive sleep apnea, reflux, TMJ and ADD all go hand in hand.

  9. Cali on July 28th, 2011 2:55 am

    Hi Dr. Park,

    First off I want to say that I really respect you. You speak volumes of wisdom about the material that you practice. It truly reflects your empathetic approach towards helping to positively change the lives of thousands. And I wish you were in Canada, because I would love to come and see you with my dad (who has severe sleep apnea). If only private health insurance was international I would come in a heartbeat to have my father and I assessed by you.

    I really have a question for you. I believe I have sleep apnea. I am getting a sleep study next month to verify whether I do or not. I have many of the connections that you speak of. I am currently finding it difficult to sleep, especially on my back, and with a mild congestion from a cold/allergies I feel like I can’t take any deep breathes all day long. I feel like I’m suffocating and I don’t even have a visible cold, its very slight with a mild touch of sore throat and light mucus nasal blockage (although not enough to promote a runny nose or sneezing).

    I am celiac, I have pcos, my progesterone is low, I have an overbite (my mom has forever teased me about having beaver teeth), I have a small jaw, my nose is slightly crooked bending to the left, I have insulin resistance, I can’t sleep on my back because I can’t breathe well, I always have to sleep on my right side, I’m tired all day long, I have to sleep minimum 10 hours to function, if I sleep 7-8 I need a nap in the afternoon, and my dad has sleep apnea as does his nephew. Also, the other day I woke up to myself choking/gasping for air as I tried to have a nap. My mother says I snore, but I truly do not know.

    Specifically, I have impacted wisdom teeth on only my lower jaw. I am interested in getting them removed because I am scared of getting infections, pronounced inflammation (as I have had gingivitus), and I am a bit vain about my bottom teeth becoming crooked (to reduce the chance of them matching my nose of course). By getting my teeth removed will I be putting myself at more risk for worse sleep apnea? I feel very conflicted. Also, could the wisdom teeth be pressing backwards into my throat thereby narrowing the passage way even more? I don’t know what to do. Not feeling rested when I wake up in the morning has been a life-long struggle. Does exercising strengthen the chest muscles and allow for better breathing at night in any situation involving sleep apnea? I am just new to the idea of me having sleep apnea. For the past few years I’ve been researching celiac, pcos, and reversing insulin resistance when maybe my pain root problem has been sleep apnea.

    Thanks for any insight Dr. Park.

  10. Steven Park on July 28th, 2011 5:59 am

    Cali,

    Thanks for sharing your story. It seems like getting the sleep study is the right step for you. As for your wisdom teeth, it probably won’t make that much difference with your possible sleep apnea. It’s when you take out other teeth in addition to your wisdom teeth that can make things worse. One option to consider (after starting standard sleep apnea treatment) is to consider one of the jaw-expanding orthodontic options that I talk about (see past Expert Interviews). Good luck, and please keep in touch.

  11. Ben on June 21st, 2013 3:58 am

    To everyone who has a constantly blocked or stuffy nose.. I think if you have a blocked nose you will never be able to have a good nights sleep. having a clear nasal airway is of great importance to health. I think it is stupid to have a sleep a study done when you know you have a blocked nose as this will be the reason that you are tired fatigued depressed……address your blocked nose then worry about everything else, because chances are that is going to clear up everything else. The nose is extremely important to us, you will not meet a person who is thriving and truly happy with a stuffy or blocked nose they don’t exist. We need to breathe through our noses.

  12. Ben on June 21st, 2013 4:08 am

    I’m sick of hearing about sleep apnea it is not the only thing that can ruin sleep. Those with a blocked nose 24/7 never get to feel relaxed. The brain must be doing something and put us in survival mode by triggering the release of some type of hormones, stress hormones or something like that so that we are constantly on edge. I’ve come to realise that many people are depressed/anxious as a symptom of having a long term obstructed sinus but they don’t even see the connection. People really need to wake up and see what is right in front of them.

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