Frequently Asked Questions About Septoplasty

April 16, 2015 by  

A septoplasty procedure to correct a deviated nasal septum is the most common surgical procedure that I perform. Its’ main purpose is to help people breathe better. Good nasal breathing is also important for CPAP and dental device effectiveness. 
 
I recently made up a frequently asked questions (FAQ) information sheet for my patients. I thought it was a good idea to post the most common questions for this blog post. Please note that this information is for my patients. Other surgeons may have different routines.
 
Frequently Asked Questions About Septoplasty
 
Septoplasty is a generic description for any type of surgery to reshape the nasal septum to improve breathing. It’s also often performed along with rhinoplasty since the septum supports the nasal structures. 
 
What’s a nasal septum?
 
The septum is describes the midline thin wall that separates your right and left nasal cavities. It’s mostly made of cartilage in the front and a thin plate of bone in the back, covered by a mucous membrane covering on both sides. It starts from the tip of your nose all the way back to the back of your nose, just above your soft palate.
 
Why is my septum deviated?
 
Although trauma can cause a septum to become deviated (crooked), most people with deviated septums have never suffered any trauma. During development, the upper jaw is very narrow and high, but during development during the early childhood years, your jaws widen and the roof of your mouth should drop. If the roof of your mouth (floor of your nose) doesn’t drop enough, as your nasal septum grows, it can bulge to one side or the other. Sometimes it gets wider. It’s important to remember that most people with deviated septums will also have swelling of the turbinates (see below) and flimsy nostrils, in addition to a more narrow nasal sidewalls.
 
When is surgery needed for a deviated septum?
 
Surgery is usually recommended when medical therapy doesn’t help your stuffy nose. Oftentimes, over-the-counter and prescription allergy medications are prescribed. Everyone has a slightly deviated septum. Just because it’s deviated is not a reason to undergo surgery. The only reason to consider surgery is if you’re having problems breathing though your nose, despite medical treatments.
 
Do you use packing?
 
Many surgeons use packs or splints after nasal surgery. I try to avoid nasal packs or splints, since having a stuffy nose can aggravate sleep apnea, as well as being much more uncomfortable when it has to be removed.
 
How much pain will I have?
 
Most patients either take only Aacetominophen (Tylenol) or nothing at all. However, in the small chance that you do have pain, a prescription for narcotics will be given to you after the operation. On average, if you do have pain, it will last 3-5 days.
 
Can I blow my nose after surgery?
 
Yes, very gently, after irrigating with nasal saline. Ignore what the hospital tells you.
 
Will my face be swollen or black and blue? 
 
No, not from simple septoplasty and turbinoplasty. Usually, only if the nasal bones are broken for rhinoplasty or after nasal trauma will you have black and blue eyes.
 
Will the operation change the shape or appearance of my nose or face?
 
Not with septoplasty and/or turbinoplasty alone. Procedure for nostril stiffening or external cosmetic procedures may change the nose, so this possibility must be discussed with your surgeon.
 
When can I go back to work?
 
Most people can go back to work about 3 to 5 days after the procedure.
 
When can I exercise?
 
No earlier than 1 week afterwords. You can walk around and do normal activities. After a few days of healing, you can do light exercises, but no strenuous activities. Build up gradually to normal exercise activity by one week.
 
Can I take a shower?
 
Yes, as soon as you get home.
 
What can I eat after the operation? 
 
Right away. In the recovery room you’ll be given liquids and soft foods. As long as you’re able to, there are no restrictions on what kind of food you can eat at home.
 
Will I have bleeding?
 
A little oozing from the nose is expected. This is why you have a small mustache dressing under your nose, which you can change as needed. This is not meant to block you nose. It can be removed after a few days if the oozing goes away.
 
What kind of anesthesia will I have?
 
Most people will undergo general anesthesia, with a tube in the throat during the procedure.
 
How long does the procedure take?
 
About 1 to 1.5 hours.  Add another 30 minutes for getting to sleep and waking up after the procedure. We try to be one time, but surgery can be unpredictable, and there is always a chance that there may be delays. Plan on taking the entire day off.
 
Will I go home afterwards or stay overnight?
 
You should be able to go home. 
 
Is it covered by insurance?
 
Usually it is covered, but it will be checked with your insurance company.
 
Do I need someone to come with me for the procedure?
 
Please make sure that someone is available to help you get home after surgery. You an come in by yourself. You will not be allowed to drive just a few hours after anesthesia.
 
When will I need follow-up after the operation?
 
Most patients will be given an appointment about 3 to 5 days after the procedure. 
 
When will I begin to breathe better?
 
You will be able to breathe much better just after the procedure, but it will get clogged over the next few days due to mucous and blood. During your follow-up visit, your nose will be cleaned out, and you should be able to breathe much better afterwards.
 
What medications will be given after the procedure?
 
You can take Tylenol for routine pain. You will also be given a prescription for a stronger medication, like a narcotic.
 
Which medications should NOT be taken before the operation?
 
No Aspirin, Ibuprofen or blood thinning medications. If you are on blood thinning medications, please let your doctor know.
 
Please pick up a few bottles of nasal saline and squirt it up both your nostrils every 3-4 hours during the day. This should be continued for 7 days after the procedure.
 
Will septoplasty cure my snoring or sleep apnea?
 
In general, no. The main reason to undergo a septoplasty is to improve your nasal breathing. In theory, you should be able to better tolerate and benefit from CPAP or dental devices.
 
Can I use CPAP after the operation?
 
Yes, but the pressure needs may be off. If it’s too uncomfortable, then hold off until after the first post-op visit.
 
Can I use my oral appliance? 
 
Yes. However, you may have some problems if you nose is stuffy.
 
What can I do if my nose is stuffy after the procedure?
 
Use lots of nasal saline, using a spray or squirt bottle, aerosol can, or a Neti-Pot container. 
 
You can also make your own isotonic saline solution (0.9%). Boil (or microwave) 1/2 teaspoon of sea salt or Kosher salt (not iodized) and 1 cup of water for a few minutes. Cool to room temperature and store in a clean jar. For larger quantities, use the same proportions. If it’s too irritating, you can also add 1/4 teaspoon of baking soda. Use at room temperature or preferably, close to body temperature. You can use an old Nedi-Pot container, a large syringe, or even a turkey basting syringe. Make sure it’s cleaned between each use.
 
What do I do if there’s excessive bleeding?
 
Call your surgeon or go to the nearly emergency room.
 
Why does my throat hurt?
 
The tube that was temporarily placed can cause throat soreness for 1-2 days. 
 
What time do I show up for the surgery?
 
The hospital will tell you what time to come. You’ll get a phone call the day before, since the OR schedule can change up to the last day. Usually, you’ll have to come in about 2 hours before your scheduled time. 
 
When should I stop eating before surgery? 
 
Nothing to eat (except water) after midnight.
 
Do I need to use ice on my face?
 
No, not for routine septoplasty. For any external procedures, your surgeon will let you know.
 
Do I need to sleep upright after the operation?
 
You can sleep in whatever position is most comfortable for you.
 
Why am I still stuffy, even though it’s been 6 months after the operation?
 
A very small percentage of patients will have persistent or recurrent nasal congestion months or years later. An office exam is needed to see what’s causing the blockage. The two most common reasons for recurrent nasal congestion are enlarged turbinates or flimsy nostrils.
 
When should I call the doctor?
 
For heavy bleeding or severe anesthesia side effects (severe nausea, vomiting, etc.)
 
What additional procedures are commonly done with septoplasty?
 
Oftentimes, the nasal turbinates (wing-like structures with bone on the inside), need to be shrunk, trimmed, or cauterized. Sometimes, flimsy nostrils need to be stiffened.
 
Is septoplasty the same thing as rhinoplasty? 
 
Rhinoplasty describes surgery of the external nose, either for structural deformities or for cosmetic reasons. Septoplasty is a completely different procedure. Oftentimes, it’s done together. 
 
What are the different types of septoplasty operations?
 
Surgeons have various preferences for technique when it comes to the septoplasty procedure. In general, a cut is made inside the nose on the septum, thought the mucous membrane, and the cartilage is freed up on both sides. The crooked parts of cartilage or bone is then removed using appropriate instruments. Some surgeons weaken the cartilage and place it back. The incision is closed using stitches, which dissolves in a few weeks. Other surgeons will use plastic sheets with or without cloth, paper or an tampon-like packing to keep the mucous membranes pressed together on both sides of the nose, to prevent blood from building up. Packs and splints, if placed, are usually removed in the office a few days after. 
 
My preference is to avoid packs or splints altogether. 
 
Do you use a laser?
 
Not usually. Rarely, I will use a laser for specific reasons, such as for cutting through scar tissue. Surgeons now rarely use lasers for septoplasty. 
 
Do I need to have stitches taken out?
 
No, since the stitches dissolve within a few weeks.
 
Why do my front teeth hurt?
 
During the procedure, the nerves that go to the front teeth can be bruised from electrocautery or chiseling. This usually goes away after a few days. Rarely it can take weeks.
 
Do you use cameras (an endoscope) for septoplasties?
 
Not usually. I have done it both ways and find that the traditional way is much faster, and you can use both eyes to see in 3-D, where the endoscope can give you only a 2 dimensional view. Sometimes I will use the camera for teaching purposes or for special situations.
 
Do I need blood tests or medical clearance from my doctor for the surgical procedure?
 
If you are healthy, then no. But each patient has to be addressed on a case by case basis. You will be notified if you need any tests or medical clearance at the time of scheduling. If a medical clearance is needed, you must be seen within 30 days of the date of the procedure.
 
What is your success rate?
 
In my experience, about 90% of patients are happy with the results. About 5% say it helped somewhat and 5% need further surgery, which usually takes care of the problem.
 
 
 

The Sleep Apnea–Autism Connection

April 8, 2015 by  

Guest blog by Deborah Wardly, MD

I have written guest blogs (Part 1 and Part 2) in the past about the link between obstructive sleep apnea (OSA) and intracranial hypertension (IH).  We know that apneas can raise intracranial pressure, and that intracranial hypertension can be caused by OSA. I suspect that some of the symptoms of OSA can be explained by increases in intracranial pressure. My most recent paper discusses the idea that it may be the anatomy of the recessed jaw that (outside of respiratory factors which increase intracranial pressure) predisposes these two conditions to go hand in hand. More than likely it is the recessed jaw anatomy that also allows for temporomandibular joint dysfunction to also be present when OSA and intracranial hypertension exist in the same individual.

We have seen increasing rates of most of the chronic illnesses associated with OSA over the last 20 years, to the extent that I have wondered if the human jaw is shrinking more rapidly or has reached a critical point in its shrinkage. Along with adult human chronic disease, we have seen increases in childhood illness, not the least notable of which is autism spectrum disorder.

Interestingly, it has been noted that there are differences in the faces of the autistic children when compared to non-autistic children, and between low and high functioning autistic children. Scientists investigating this phenomenon do not appear to be aware of how facial structure reflects underlying airway patency, or what this might mean regarding an airway etiology of autism. Autistic children are described to have very prominent sleep problems. These problems are well known to pediatric sleep specialists to reflect underlying sleep disordered breathing (SDB). For example, 53% of autistic children have difficulty falling asleep, and 34% have frequent awakenings. These are signs indicating that autistic children have insomnia. Dr. Barry Krakow has eloquently demonstrated that chronic complex insomnia in adults is strongly associated with sleep disordered breathing, and it doesn’t seem likely that the cause in children is very much different.

There are a great many correlations between what is found in autistic children and what is seen in OSA, and there are also many findings in autistic children that could be explained if autistic children have mild intracranial hypertension from birth. For example, leptin, IL-6, and TNFα are elevated in OSA, and in autism. Accelerated head growth in the first year of life and favorable response to substances which decrease brain edema, as are seen in autism, might be explained by intracranial hypertension.   Intracranial pressure in autistic children has never been investigated. I have collected the data available prior to 2013 and presented it in my recently published paper: “Autism, sleep disordered breathing, and intracranial hypertension: the circumstantial evidence.”  If each correlation between autism and OSA, and between autism and intracranial hypertension is thought of as a “puzzle piece” in constructing the answer to the etiology of autism, then I have constructed over 90 pieces of the autism puzzle with the hypothesis presented in my paper. The ASD/OSA hypothesis is four-fold, and requires that: 1) the mother has SDB during her pregnancy, 2) the infant is born with SDB, 3) both mother and infant have variations of the methylation pathway which are then triggered by the SDB, and 4) the infant is prone to intracranial hypertension.  

The idea is that the combination of SDB with the tendency for intracranial pressure to increase, leads to a pattern of increased intracranial pressure early on in development which contributes to autism, compounding the effect from repeated low oxygen levels in the mother’s womb due to maternal SDB.  It is unlikely to present the same as the typical childhood case of intracranial hypertension, because it will vary depending on waxing and waning SDB symptoms. OSA can sometimes cause optic nerve (essentially brain) swelling in the presence of normal intracranial pressures while awake, therefore this process can be very subtle. This hypothesis takes into account most of the findings seen in autism, including the multiple various gene mutations seen between individuals. 

I propose that it is not so much these mutations which cause autism, but it is the underlying methylation problems as triggered by OSA/SDB that leads to random mutations of genes, producing the wide variations seen. The ASD/OSA hypothesis may also account for the association of pesticides with autism development, in multiple ways. Some pesticides have been shown to affect the growth and development of the maxilla and mandible, and it has even been noted that the risk of autism from maternal organochlorine exposure during pregnancy is greatest during the 8 weeks immediately after neural tube closure—this is the embryological period when the face is forming. Surely pesticides can be directly neurotoxic, however if they are found to influence brain swelling then this may add to the brain edema that has already been determined to occur from OSA.

It has also been demonstrated that autistic brains are swollen. If children with autism tend to have recessed jaws that predispose them to not only compression of the airway with OSA, but also compression of their jugular veins preventing easy egress of cerebrospinal fluid (CSF), then this brain swelling becomes more clinically significant and may raise intracranial pressure.

Since the acceptance of my paper for publication, several articles were published which support my hypothesis. In 2013, Shen et al. at the MIND Institute published a study which demonstrated increased extra-axial fluid in infants who later developed autism. They concluded that this suggests an imbalance between CSF production and CSF drainage in these infants. Increased extra-axial fluid has also been seen in children with intracranial hypertension. In intracranial hypertension, the increased pressure is present in this extra-axial space surrounding the brain, pushing in on the brain, as opposed to in hydrocephalus where the increased pressure is present in the ventricles, pushing out on the brain. In December of 2012, Lemonnier et al. published a study demonstrating that bumetanide can be helpful in children with autism, improving autism rating scores and social functioning. Bumetanide is a loop diuretic which has also been used in children with intracranial hypertension, to reduce intracranial pressure. Diuretics are a mainstay of treatment in intracranial hypertension.  

There is another piece of data which is more anecdotal at present. It has been reported that people with intracranial hypertension can have photophobia, and phonophobia: increased sensitivity to light and sound.  (Dr. Park has also noted in his first book that he sees these characteristics in his SDB patients.)  It does not seem to be generally acknowledged however, that most people with intracranial hypertension are significantly sensory defensive. I know this from knowing a great many of them.  Almost 180 of them have compiled their symptoms on this spreadsheet.

If one believes this data, then 79% of patients with intracranial hypertension have auditory hypersensitivity, 33% of patients with intracranial hypertension have olfactory hypersensitivities, and 50% of patients with intracranial hypertension have sensitivity to proximity. These are very similar to the prevalence of these different types of sensory disorders among autistic children.  

I believe that all of these correlations demand further investigation. It has never been determined that children with autism have normal intracranial pressures, and it has never been determined that the majority of autistic children do not have sleep disordered breathing. Miano et al. in 2010 stated that it is not possible to conclude how significant OSA might be in causing the insomnia in autism, because most autistic children do not get sleep studies. Add to this the difficulties encountered in diagnosing mild sleep disordered breathing at your average sleep lab, and it is likely to take a century before we figure out the answers to these questions. Given that it has been predicted that in ten years 50% of all children born will develop autism, we don’t have too much time.  

It has been demonstrated that the degree of symptoms in SDB is inversely proportional to the AHI, therefore I believe that we need to start taking mild SDB very seriously and figure out how to diagnose it outside of the most elite university sleep centers. Given the amount of circumstantial evidence arguing for the ASD/OSA hypothesis, I think that autism researchers must rise to the challenge and rule it out formally before it is dismissed.

If you have a child with autism, does your child show the subtle signs of sleep disordered breathing? Can you hear his breathing when he sleeps? Does he snore sometimes? Does he wake frequently? Does he sleep with his mouth open and head extended? Is he a restless sleeper? Does he fall asleep during the day? Does he have a small lower jaw (“pixie” face)? 

If you are an adult with autism, do you get headaches? Do you hear whooshing sounds in your ears? Do you have visual complaints (symptoms of intracranial hypertension)?

If you are a mother of a child with autism, do you have OSA or symptoms of sleep disordered breathing?  Did you have signs of worsening SDB during your pregnancy?

Announcing the New Book Cover for Sleep, Interrupted

April 6, 2015 by  

New Sleep Interrupted CoverWell over 300 of you voted for the new cover for my book, Sleep, Interrupted. The clear winner by far was choice #4, with 35% of the vote. The three other options were split evenly around 20 to 21%. Personally, I had a preference for #4 as well. We should be uploading this new cover within a few weeks. Thanks for helping me make this important decision.

Stay tuned for your chance to help me choose the cover for my forthcoming book, The Sleep Apnea Solution: Dr. Park’s Complete Guide to Getting the Sleep You Need and the Life You Want.

Attention All Mouth Breathers – 5 Important Reasons Why You Must Breathe Through Your Nose

March 30, 2015 by  

If you’re a chronic mouth breather because of a stuffy nose, you’re not alone. As the weather chills and allergies and colds abound, and nasal congestion becomes a common trend, mouth breathing inevitably follows-especially when you’re sleeping. I’m sure you’ve seen many passengers asleep on the subways and trains, head and pitched back, mouth wide open, and snoring louder than a diesel engine. Mouth breathing can surely ruin your social image, but that’s nothing compared to the havoc it can wreak on your health.

 

5 Potent Benefits of Breathing through Your nose

One of the most important reasons to breathe through your nose is because of a gas called nitric oxide that’s made by your nose and sinus mucous membranes. This gas is produced in small amounts, but when inhaled into the lungs, it significantly enhances your lung’s capacity to absorb oxygen, increasing oxygen absorption in your lungs by 10-25%. Nitric oxide also can kill bacteria, viruses and other germs. This is why you often hear fitness and yoga instructors emphasize inhaling and exhaling through your nose during workouts.

Also, if you can’t breathe well through your nose, your sense of smell will suffer and therefore your sense of taste, since your smell and taste buds are connected. This can lead to disturbances in your appetite and satiation levels, wreaking havoc on those struggling with weight issues.

Your nose also has vital nervous system connections to your lungs and heart. Not breathing well through your nose can alter your heart rate and blood pressure, as well as increase your stress responses.

Your nose makes about 2 pints of mucous every day. If your nose isn’t working properly and mucous isn’t cleared, the stagnant mucous can lead to infections such as sinusitis or ear infections, not to mention bad breath.

Lastly, not breathing well through your nose can aggravate snoring or obstructive sleep apnea. Nasal congestion alone doesn’t cause obstructive sleep apnea, but it can definitely aggravate it. If your palate and tongue structures are predisposed to falling back easily due to sleeping on your back and muscle relaxation in deep sleep, then having a stuffy nose can aggravate further collapse downstream. Untreated obstructive sleep apnea can lead to chronic fatigue, depression, anxiety, weight gain, high blood pressure, heart disease, heart attack and stroke.

Knowing all these benefits of breathing through your nose, however, doesn’t help much if you don’t know why you’re not able to do so.  To stop mouth breathing, the first thing you must do is to figure out what’s blocking up your nose.

What Can Stop Up Your Nose

Nasal congestion is something everyone experiences now and again. Yet, if you’re trying to prevent this from happening it’s important to explore the various reasons behind why and when this occurs.

Here are five of the most common reasons for a stuffy nose:

“I Have a Deviated Septum

By definition everyone has a slightly crooked (deviated) nasal septum. There are various reasons for having a deviated septum, including trauma, but the most common reason is no reason at all. It’s just the way your nose developed. What’s more important than how deviated your septum is is what’s happening in front of an around your septum.

Wings in Your Nose 

Turbinates are wing-like structures that attach to the sidewalls of the nasal cavity, opposite the midline nasal septum. They normally smooth, warm, humidify, and filter the air that you breathe, but they also become enlarged and produce mucous when inflamed. Turbinates also swell and shrink alternating from side to side, which is a normal neurologic process called the nasal cycle.

Is It An Infection or Allergies?

If you have allergies, a cold or any kind of infection, then your turbinates will swell up, clogging your nose with lots of mucous production. Contrary to popular belief, the color of the mucous has no relation to bacterial vs. viral infections.

Flimsy Nostrils 

Once you have inflammation and swelling inside your nose, for some people, depending on the configuration of your nose, your nostrils can literally cave in as you inhale. Different noses have differently shaped nostrils with various nostril thicknesses. The more narrow your nose, the more likely your nostrils can cave in. People who undergo cosmetic rhinoplasty are more at risk years later, since narrowing the nose can weaken the support structures of the nose.

A Nervous Nose? 

Some people’s noses are extra sensitive, especially to weather changes, like temperature, humidity, and pressure changes. Certain chemicals, scents and odors can set off a reaction as well. Many people mistakenly think this reaction is an allergy, but it’s really your nasal nervous system over-reacting to the weather or to odors. One of the most common reasons is from poor quality sleep, which causes a low-grade stress response, which can heighten your senses.

It’s All Under Your Nose

A chronically stuffy nose doesn’t happen by itself. Usually it’s part of a bigger picture, where the entire upper and lower jaws are more narrow and constricted, in addition to more narrow nasal cavities. I’ve described this process in my book, Sleep Interrupted, where due to modern human’s eating soft, mushy, processed foods, our jaws are much more narrow than normal, with dental crowding. Bottle-feeding, which is another modern, Western phenomenon, is also thought to aggravate this problem.

If you have a stuffy nose, it can also aggravate soft palate and tongue collapse when in deep sleep, due to muscle relaxation. With more obstruction, more stomach juices are suctioned up into the throat and nose, causing more swelling and more nasal congestion. All this from smaller and more narrow jaws. 
 

Help Me Choose A New Book Cover for Sleep, Interrupted

March 25, 2015 by  

For the longest time, I haven’t been too happy with the cover for my first book, Sleep, Interrupted. Please help me to choose a new cover from the following 4 candidates below. Scroll to the bottom to see all the covers and to submit your choice. I will announce the winner shortly. I truly appreciate your help with this important decision.
 

Create your free online surveys with SurveyMonkey , the world’s leading questionnaire tool.

7 Tips to Breathe Better Through Your Nose

March 25, 2015 by  

bigstockphoto_face_close_up_-_nose_and_mouth_352732Most people take breathing through their nose for granted. But for many chronic mouth breathers, breathing through the nose is a struggle, if not impossible. Not only is their quality of life diminished, but they’ll also have a variety of other health-related conditions such as dry mouth, snoring, fatigue, and poor sleep. In my last article I addressed 5 reasons why it’s important to breathe through your nose. In this article, I’ll talk about 7 ways that you can breathe better through your nose naturally. 

Nasal Anatomy 101

Before I discuss the various ways to breathe better, a short anatomy course in in order. The nasal septum is a thin piece of cartilage and bone that splits your nasal cavity right down the middle. No one has a perfectly straight septum; everyone’s septum is slightly curved. Sometimes, nasal trauma can shift or move the septum away from its’ midline position. The nasal turbinates are wing-like structures that line the sidewalls of your nose. It’s covered with a mucous membrane, and normally it helps to smooth, warm and humidify air. The turbinates and sinuses also produce about 2 pints of mucous every day. The turbinates swell and shrink, alternating from side to side every few hours. This is called the nasal cycle. 

The front side walls make up your nostrils, which are soft cartilages covered on the inside and outside with skin. The back of your nose is one big cavity (called the nasopharynx), and the passageway turns down 90 degrees into the back of your throat. The nasopharynx is also where your ears connect via the Eustachian tubes. 

If any part of the anatomy that I described becomes obstructed partially or completely, you’ll feel stuffy in your nose. Usually it’s not one thing, but usually due to a combination of different reasons. For example, if you have a mildly deviated septum, suffering from mild allergies will swell up your nasal turbinates, narrowing you nasal passageways. This may not be enough to clog up your nose, but if you have flimsy nostrils or had rhinoplasty in the past that weakened the nostrils, then breathing in with a stuffy nose may trigger your nostrils to collapse. 

1. Do you have flimsy nostrils?

Starting from the tip of your nose, the first thing you must do is to find out if you have flimsy nostrils. If you have a very narrow nose, or if your nostril openings are very narrow and slit-like, then you may be prone to having flimsy nostrils. Try this experiment: Take both index fingers and press them just besides your nostrils on your cheek. While firmly pressing on your cheeks, lift the cheek skin upwards and sideways, pointing towards the outer corners of your eyes. Take a deep breath in. Can you breathe much better through your nose? Let go and try it again. If this maneuver works for you, you may benefit from using nasal dilator strips at night (one brand is called Breathe-Rite). Sometimes, the adhesives on these devices are not strong enough, or end up irritating the skin. Another way of treating this condition are various internal dilators (such as Nozovent, Breathewitheez, Nasal cones) that you can find over the counter or over the internet. 

2. Try Nasal Saline Irrigation

Second, try using nasal saline sprays. You can use the simple spray bottles that put out a fine mist, to more sophisticated methods such as aerosol cans or even using a Water-pik machine (there’s a nasal adaptor that you can buy for this). Another popular variation is something called a Nedi-pot, which uses gravity to pour salt water into your nose and sinuses. You can either use prepared saline packages, or mix your own recipe (one cup of lukewarm water and 1/2 teaspoon of sea salt or Kosher salt with a pinch of baking soda). Whatever method you use, you’ll have to do it frequently to get maximum results. Besides cleansing out mucous, pollutants and allergens, saline also acts as a mild decongestant. 

3. Avoid Eating Before Bedtime

Third, try not to eat anything within three hours of going to bed. If you still have food or juices lingering in your stomach when you go to bed, it can leak up passively into your throat and not only prevent a good night’s sleep, but these same juices can also leak up into your nose, causing swelling and inflammation. In addition, many people will also stop breathing once in a while, which creates a vacuum effect in the throat which actively suctions up your stomach juices into your throat and nose. 

4. Don’t Drink Close to Bedtime

Fourth, try to avoid drinking alcohol close to bedtime. Not only does alcohol irritate the stomach, it also relaxes your throat muscles as you sleep, which aggravates the process described in the previous paragraph. 

5. Control Your Allergies

Fifth, if you have any known allergies, especially if it’s something in your bedroom, try to either remove it or or lessen your exposure to it. For example, many people are allergic to dust or molds, and if you have carpeting, or an area rug, it can harbor these allergens. Frequently washing your bed sheets in very hot water also helps. Investing in a quality HEPA filter should help even more. If you have any pets, consider keeping them out of your bedroom. If conservative measure to control allergies is not good enough, consider seeing an allergist for a more formal evaluation. 

6. Get Out And Exercise

Sixth, get regular exercise, especially outdoors. Not only are you exercising your heart and your muscles, you’re also exercising the nervous system in your nose. Vigorous physical activity activates your sympathetic nervous system, which constricts the blood vessels that supply your nasal turbinates. This allows you to breathe better through your nose, with all the added benefits described in my previous article. 

7. Take A Deep Breath And Relax

Lastly, slow down and relax. Modern society has removed all the natural built-in breaks throughout the day. Along with all the information overload and constant stimulation, going nonstop all day only adds to the increased stress levels that everyone experiences. In between major activities, take a minute or so to stop what you’re doing and stretch, get up and move around, and do some deep-breathing exercises. Stress can tense up the muscles, causing you to breathe shallower, which causes physiologic changes that can ultimately aggravate nasal congestion. 

 

These simple 7 steps won’t help everyone, but If you can go down the list and apply all the steps, many if not most of you should feel some improvement in your ability to breathe through your nose. If you’ve tried all these steps and still can’t breathe through your nose, then seek medial help. An otolaryngologist (an ear, nose and throat doctor) is the best doctor to take care of this condition. 

If you are a chronic mouth breather, in addition to what I described above, your jaw is probably more narrow than normal, with some degree of dental crowding. Chronic mouth breathers also tend not to sleep well at night due to various degrees of breathing difficulty. I talk about this new phenomenon my my book, Sleep, Interrupted.

I discuss in more detail how you can breathe better in my free report: How to Unstuff Your Stuffy Nose. Click here to access your free report.

 

 

 

5 Reasons Why Your Nose is Stuffy

March 20, 2015 by  

A repost of an article on why your nose is stuffy this allergy season.

Although many people assume that big nosed people naturally breathe better, there’s nothing further from the truth.  The shape and size of your nose is mostly cosmetic. How well you breathe actually depends on what your internal breathing passageways look like. And for many sleep apnea sufferers, a stuffy nose can make or break their treatment therapy.

Yet, opening up the nose through medical therapy or even surgery has been found to “cure” sleep apnea in only 10% of people. Patients will definitely feel and breathe better, but it’s unlikely that their sleep apnea is addressed definitively. However, I have seen many of the people in the “10%” group derive significant benefits from clearing up their nasal congestion. Besides breathing better for the first time in years, opening up the nose can allow the person to tolerate and benefit from other treatment options for OSA besides CPAP.

Why Is My Nose Stuffy?

Problem #1:  Deviated Nasal Septum

One of the more common reasons for a stuffy nose is due to a deviated nasal septum. A “septum” is a term that describes a structure that acts as a wall or separator between two cavities. Your heart has one too. No one has a perfectly flat or straight septum.

All septums, by definition, have slight irregularities or curvatures. A major reason for a crooked septum, unbeknownst to many people, even other doctors, is because your jaw never developed fully. Most people with sleep apnea have narrow upper jaws, which pushes up the roof of your mouth into your nasal cavity, which causes your septum to buckle.

If medical options don’t help you to breathe better through your nose, then you may be a candidate for a septoplasty. To get a much more detailed explanation about this procedure see the accompanying article, Myth and Truths About Septoplasty.

Problem #2. Flimsy Nostrils

In some people, the space between the nasal septum and the soft part of both nostrils is either too narrow to begin with, or they collapse partially or completely during inspiration. In many cases, this can be seen years after reduction rhinoplasty, where the nose was made smaller or narrowed for cosmetic reasons. Occasionally, people can have naturally thin and floppy nostrils.

Another common reason for flimsy nostrils is due to a narrow upper jaw. The width of your nose follows the width of your jaw. If the angle between the midline septum and the nostril sidewall is more narrow than normal, then it’s more likely to collapse with any degree of internal nasal congestion. It’s not surprising that people with sleep-breathing disorders will typically have narrower jaws, and thus more susceptible to nostril collapse. Certain ethnicities are also more prone to this phenomenon than others.

One way that you can easily tell if you have this problem is to perform the Cottle maneuver: Place both index fingers on your face just beside your nostrils. While pressing firmly against your face and simultaneously pulling the skin next to the nostril apart towards the outer corners of your eyes, breathe in quickly. Then let go and breathe in again. If there is a major improvement in your quality of breathing while performing this maneuver, then you have what’s called nasal valve collapse.

The simplest way of correcting nasal valve collapse is by using nasal dilator strips, or Breathe-Rite® strips. If you do the Cottle maneuver and there is no significant difference in your breathing, don’t waste money buying these strips. If you perceive an improvement in your breathing, you can continue using the strips at night while you sleep. For some people, these “strips” are not strong enough to hold up the nostrils, or may cause irritation to the skin.

There are also many other “internal” options available over the counter, including metal springs or plastic cones that are placed inside the nostrils. People tolerate these particular devices differently, so the only way to know if you’ll like them is to try them. Three examples are Breathe With EEZ, Nozovent, and Sinus Cones.

 To find out if your nasal valve collapse is from weak or flimsy cartilages or is aggravated by internal nasal congestion, you can spray nasal saline (which is a mild decongestant) into your nose. If your nostrils doesn’t collapse as much, then you need to address your internal nasal congestion first. A stronger over-the-counter medication that you can use is oxymetazoline, which is a topical spray decongestant. There are many brand name and generic versions that are sold that contain this ingredient. It’s very important that you don’t use this medication for more than two to three days—otherwise, you may get addicted to it.

If you want a permanent solution to this problem without having to use dilator strips or internal devices, the only option is surgery. The traditional way of dealing with this issue is to perform a kind of reconstructive rhinoplasty surgery, usually by taking small portions of your nasal septal cartilage or ear cartilage and placing in underneath the weakened portions of your nostril walls. A newer, simpler way of addressing this problem is by attaching a permanent suture just underneath the eye socket and tunneling the suture under the skin and looping it around the weakened area to suspend the nostril to prevent collapse.

Problem #3: Wings in Your Nose

Another common source of nasal congestion is from swelling of your nasal turbinates, which are the wing-like structures on the side-walls of the nasal cavity opposite the septum. Turbinates are comprised of bone on the inside and mucous membrane on the out- side. The area just underneath the mucous membrane is filled with blood vessels which can swell significantly. As the turbinates swell due to allergies, colds, or weather changes, the air passageways narrow further, especially if you have a mildly deviated nasal septum, and particularly if you have nasal valve collapse.

One of the most common misunderstandings that I see by both doctors and patients alike is that they think that swollen turbinates are polyps. The nasal turbinates can swell so much that you can sometimes see the reddish-pink, fleshy grape-like mass through your nostrils. Once decongested, they shrink dramatically and the air passageways open up again.

If conservative treatment including prescription allergy medications don’t work, various surgical options are available from very conservative 5 minute in-office procedures to more aggressive procedures that are performed in the operating room. These procedures are usually performed alongside a septoplasty to improve nasal breathing.

Problem #4: Sinusitis

If you suffer from sinusitis, this can cause nasal congestion and inflammation combined with post-nasal drip, sinus pressure, and pain. Put simply, pure misery. Sinus infections typically follow either a routine cold or allergy attack; they cause both swelling and blockage of the sinus passageways, leading to negative pressure initially and, if allowed to progress, can turn into a full-blown sinus infection, with yellow-green discharge, fever and severe facial pain. Your teeth can also hurt since the roots of the upper molars jut up into the floor of the maxillary sinuses. Similarly, dental pain can sometimes feel like sinus pain.

Fortunately, most cases of sinus congestion will eventually go away. The body has a remarkable ability to take care of these issues without any intervention. Sometimes bacterial infections occur, and with proper conservative treatment using saline and decongestants, the infection gradually resolves. Rarely, you may need an antibiotic to control stubborn bacterial infections.

Problem #5: Poor Sleep

As you can see from the above discussion, there are a number of various reasons for having a stuffy nose. But the most common reason for nasal congestion that I see routinely is due to inefficient breathing and poor sleep. This is why sleep apnea sufferers, more often than not, suffer relentlessly from nasal congestion. 

Without a doubt, structural reasons like allergies or nasal polyps can definitely block your nose and these issues must be dealt with appropriately. But in general, it’s the inflammation that’s created by a combination of your hypersensitive nasal nervous system and possible stomach acid regurgitation into the nose from multiple obstructions and arousals, that causes nasal congestion. Without addressing this underlying source of inflammation, correcting a deviated nasal septum or treating for nasal allergies will only provide a temporary solution.

 

Allergy Solutions for Sleep Apnea Sufferers

March 18, 2015 by  

Reposting a classic article that’s very relevant this month.

Spring is in the air, and so are the tree pollens. Millions of people suffer this time of the year from sneezing, scratchy, itchy eyes, nose and throats, nasal congestion and chronic cough. It’s also a given that if you have allergies, you won’t sleep as well, along with everything from asthma, cough, and sinusitis to diarrhea. So how do allergies cause sleep problems, and in general, and how does it specifically cause or aggravate obstructive sleep apnea?

When Allergies Lead to Something Worse

There are already tomes of articles, books and websites offering tips for allergy sufferers including traditional options like nasal saline irrigation, homeopathic remedies, and using a HEPA filter to prescription medications and allergy shots. But again, how can having a runny nose cause you not to sleep well at night? I’ve combed through numerous medical and internet resources and to date, I haven’t found one good explanation.

However, looking at it from a sleep-breathing standpoint, it makes total sense: any degree of nasal congestion, whether from allergies, colds, or even weather changes, causes a slight vacuum effect downstream in the throat which can aggravate tongue collapse, especially in certain susceptible people. Who then, are susceptible to tongue collapse? Almost every modern human!

It’s All In Your Jaws

To be more specific, the smaller your jaws, the more likely you’ll sleep poorly when you have allergies. Even if you’re completely normal, having a stuffy nose can suddenly cause your tongue to fall back and block your breathing. Plugging your nose has been shown to cause obstructions and arousals during sleep. This is why you’ll toss and turn when you have an allergy or a simple cold.

Many people with allergies and small mouths will also have grooves or indentations along the side of their tongues. This is called tongue scalloping. Since the tongue and other soft tissues grow to their genetically predetermined size, and due to crowding from having smaller jaws, the teeth leave their imprints along the side of the tongue. If you have additional inflammation from gastric reflux that’s a given with sleep-breathing problems, then this scalloping problem gets worse. Not too surprisingly, tongue scalloping is predictive of having apneas, hypopneas, or oxygen drops in almost 90% of people.

Allergies From Stress?

So then, why do allergies happen in the first place? Again, there are tons of proposed explanations that I don’t have the space for, but here’s a simple concept from Robert Sapolsky’s classic book, Why Zebras Don’t Get Ulcers:

Humans can handle big stresses such as a major catastrophe, a death in the family, or running away from a tiger. In these scenarios, your stress response leads to an intense activation of your immune system (in addition to your nervous system’s fight or flight response). Once the stress is over, your immune system’s activity level drops down to normal, but only after it dips below normal for a short period of time. During this short period, you’re also more susceptible to getting sick.

However, modern societies don’t have very big stresses such as running from a saber tooth tiger. Rather, we have multiple micro-stresses spread throughout the day such as being honked from the rear on the way to work, your boss yelling at you, or your computer crashing. These little stresses push your immune system’s activity higher and higher, with not enough time for it to recover and go back to normal levels. After a certain point, your immune system is on constant overdrive, leading to the typical allergic or autoimmune conditions that are all-too-common today.

When Your Allergy is Not An Allergy

This process also explains why you may also have a chronically runny nose. This is called chronic or nonallergic rhinitis, when the involuntary nervous system in your nose overreacts to irritants, chemical, odors, or weather changes (either pressure, temperature, or humidity changes). Symptoms include runny nose, sneezing, nasal congestion, post-nasal drip and headaches, and is often mistaken for regular allergies. This condition may respond to regular allergy medications, but not as well. Either way, inflammation and swelling can also cause nasal congestion, leading to poor quality sleep.

Overcoming Your Allergies

If you have classic allergies, you must start with the basics: Avoid outdoor activity on high-pollen days, shower before bedtime to get the allergies out of your hair, don’t wear shoes indoors, get a HEPA filter, and take over-the-counter medications as needed. Some people benefit from routine use of HEPA filters as well in their bedrooms. You may have to see your doctor if conservative measures don’t help.

There are various over-the-counter allergy medications. The newer, nonsedating antihistamines block the effects of histamine, which is what causes watery, itchy, runny eyes and nose. The most common brands are Claritin, Allegra, and Zyrtec. They all work differently in different people, so the only thing you can do is to try each one and see which you prefer. Although they are nonsedating in theory, there are reported cases of drowsiness with all three. Benadryl is an older antihistamine that’s very effective for allergies, except that many more people may get drowsy.

If your nose is stuffy, then two options are nasal decongestant sprays (which you can only use for 2-3 days) or decongestant pills. Routine nasal saline irrigation can also help your breathing and sleep.

There are a number of prescription medications, including topical nasal steroid or topical steroid sprays. Leukotriene phosphate inhibitors, such as Singulair, and various others also available. Oral steroids can also be useful in emergency situations. As a last resort, an allergy evaluation with shots are a consideration.

Regardless of which way you treat your allergies, it’s important to follow all my recommendations for better breathing while sleeping, such as avoiding eating or drinking alcohol within 3-4 hours of bedtime, sleeping on your side or stomach. Having a stuffy nose for whatever reason can trigger breathing pauses downstream, ultimately giving you a bad night’s sleep.

 

Ask Dr. Park Your Question About Obstructive Sleep Apnea

March 3, 2015 by  

My monthly Ask Dr. Park Teleseminars in years past were very popular with many of you. It was also a way for me to understand the frustrations and pains for those of you with obstructive sleep apnea. I truly enjoyed the live Q&A format, but due to recent time constraints from my new academic position, I’ve had to transition my telesemianrs to pre-recorded podcasts. My recent 3-part podcast series on Vitamin D and sleep with Dr. Stasha Gominak was extremely well-received, with well over 2000 downloads so far. 

As a way of connecting with you again, I’ve decided to re-launch my Ask Dr. Park series, but in a different format. Submit your one question in the text field below, and I’ll try to answer as many as I can. I will then select a handful of questions to answer on an upcoming Ask Dr. Park podcast. If possible, please state at least your first name, where you live, and a brief question. I’ll try to choose questions that can help as many people as possible. 

Please enter your question for Dr. Park below.

Podcast #5: Interview With Dr. Stasha Gominak on How Low Vitamin D Can Ruin Your Sleep (Part 3)

February 25, 2015 by  

This is part 3 and the final segment of my conversation with Dr. Stasha Gominck, a neurologist with some very insightful information about vitamin d and how it’s vitally related not only to sleep, but to every aspect of your health. As mentioned previously, Vitamin D is actually a hormone that’s needed by every area of your body, including your brain. 
 
In this segment, Gominak is going to tell us
  • How to optimize growth hormone release
  • The link between slow wave sleep and the B vitamins
  • How this b vitamin can help REM behavior disorder 
  • How much Vit D is made in your skin by sunlight
  • Vitamin D’s anti-cancer properties
  • The importance of quality sleep and cancer prevention

Download MP3 audio file

NY Time article on Meditation for a Good Night’s Sleep.

Mindfulness meditation sites: calm.com, headspace.com, and saagara.com

CBT-i sites: cbtreferee, CBT-i coach and cbtforinsomnia

Visit Dr. Gominak at drgominak.com
 
Subscribe in iTunes. I would appreciate it if you can rate my podcast and provide feedback within iTunes.
 
Please leave your feedback or any comments about this episode in the space below.

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The material on this website is for educational and informational purposes only and is not and should not be relied upon or construed as medical, surgical, psychological, or nutritional advice. Please consult your doctor before making any changes to your medical regimen, exercise or diet program.



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