Q: What’s a deviated septum?

A: The nasal septum is the midline partition that divides your nose into your right and left nasal cavities. You have other septums in your body as well, including your heart and your frontal nasal sinuses. The front part of the nasal septum is made of cartilage, but parts of the rear are made of thin bone. It starts just behind your fleshy nostrils in the middle, continues to the roof of your nose and ends just above your hard palate, in the rear of your nose. No one has a perfectly straight septum. However, if it’s slightly deviated to the right or the left, any degree of nasal inflammation in the other parts of the nose can narrow your breathing passageways, leading to a stuffy nose.

 

 

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50 thoughts on “Q: What’s a deviated septum?

  1. Dear Dr. Park,

    I know you are NOT an EP Doctor but I have been diagnosed with mild OSA finally after 3 sleep studies, the latter of the 3 was at Cooper University just this past December. My doctor was Doctor Johnathan Kass. I was referred to him by my cousin Dr. Annette Reboli, as the former studies seem to yield an accurate diagnosis, essentially since I couldn’t sleep. Anyway, the e-mail included below is to ask you whether OSA and RLS/w PLMD could contribute to my arrhythmias as stated below?? I was told by Dr. Kass, that OSA and “lack of” restorative sleep (chronic insomnia), which I have had since the onset of my so-called very bothersome and benign arrhythmias in 1992, could contribute to their onset, whether it be the PVC’s OR IST/PSVT?? I truly appreciate your opinjnionand advice. Oh, and I do now use CPAP it’s just been hard to get used to. I still get interpolated PVC’s while in REM, as shown on the EKG portion of the readout strip/report. Thank you. Any advice based on the information I gave you would be appreciated, if you have anything to add, as a Sleep Specialists.

    I just happen to do a search on interpolated PVC’s and a link lead me to your forum. Anyway, although I have a teo-fold problem which began with PSVT/IST in 1992 “followed a few years later by a “2nd curse” PVC’s which were ONLY single-form uni-focal PVC’s in roughly 2000 my 1st episode of both Multiform/complex PVC’s started. I have been getting interpolated PVC’s pretty regular “when they start up” since about 2001. Now getting these pretty frequent “runs” if you will, of Interpolated PVC’s, I am able to tolerate and endure single form and the occasionally garden variety PVC’s alike, as they are “now” nothing compared to the feeling of ongoing runs and clusters I get. I would like to post this at the forum, as I haven’t posted recently since I am coincidentally going through with the EP study after being on the fence with abaltion for these arrhythmias for almost 16+ years now. I just can’t deal with these interpolated PVC’s and the “occasional breakthrough of SVT as well, ANYMORE. I have already seen a Dr. Frances Marchlinski at the University of Penn. who is supposedly one of the best at PVC ablation. According to my EKG’s, he has a good idea where they me be coming from. The drawback, is I may have a focus on the left and right side of my heart. I was told by another EP doctor that you can have only a single focus causing these types of PVC’s. I guess he was wrong? My understanding of Multi-Form PVC’s is more than likely the result of Multi Foci (lesions) present. Where remains to be determined by the EP study itself, although as I stated he has a good idea of where they are emanating from. I just hope that the “majority” of these PVC’s can be successfully ablated and that the SVT, if sampled or induced during the study, can be as well. Killing to birds with one stone, in my case, would be ideal. He primary goal is to go after the PVC’s “first”. Then if he can find a bypass tract that is rarely ( only less common because of the BB) still causing my PSVT while he’s up there and can ablate that too, it will be the greatest gift and most ideal outcome one can expect. I go in April..Quite “scared” I will admit as a 53 year male, as it will be my 1st invasive procedure and ALL I dwell on, and I shouldn’t so much, are the possible WORST complications such, as MI, Stroke, Artery Perforation, Valve Damage. After those, worrying about coming out with a worse life threatening arrhythmias that were termed “benign” but truly bothersome arrhythmia’s that are affecting the quality of my life. Only thing I can say is that if the ablation is successful for even on of these arrhythmias, I will only wish that I would have done this sooner and maybe I could have avoided the 16 years I suffered from this problem. Conclusively, do you think I am expecting too much from this procedure or is it possible to get the “ideal” outcome? Just to point out Dr Marchlinksi, told me if he were to rid me of 95% of my problem, especially the PVC’s, would I be happy with that.. I said of course! Are my expectations too high or is it possible to kill two birds with one stone during what I hope to be a “single” ablation.

  2. You’re right in that I’m not a cardiologist, nor am I an electrophysiologist, but one thing for sure is that any degree of untreated sleep apnea can aggravate heart rhythm problems due to the extra stress state that’s created during the apneas. One shocking statistic that I recently read was the fact that 60% of people with pacemakers had undiagnosed obstructive sleep apnea!

    Are you doing everything possible to make sure you’re getting maximum benefit from your CPAP? Even low levels of apneas and hypopneas that don’t even meet the criteria for sleep apnea can in theory aggravate your heart problems. It sounds like you may be having some difficulties. In the meantime, I would follow your doctor’s recommendations.

  3. Background:
    I am a 46 year old woman
    Diagnosed with UARS (164 incidents).
    Placed on a CPAP machine for which I had poor tolerance and compliance.

    Sought eval by an ENT to get a better understanding of what was going on.
    ENT reported that I was a difficult patient to treat due to many smaller problems (enlarged turbinate, narrow, flimsy nares, large tongue in back, overweight/”thick”, tonsils prominent when scoped from above) adding up to a larger one; the surgery he described sounded awful, and he ended by saying there would be no guarantee that it would help.

    I am a known tongue thruster (all 3 of my kids are thrusters have gone through tongue thrust therapy related to their orthodontia); I trace my sleep issues back to age 12, and at age 12 was when they put the spurs/cage on the back of my lower braces, which effectively kept me from thrusting but did not train proper placement (my tongue now “floats” positionally).

    After seeing the ENT, I then really focused on the CPAP (the nurse practitioner was doing back flips with my compliance), but after a month, I felt no different. The nurse practitioner looked at my study results again and noted that my naps average of 11 minutes was skewed by only the last nap which was 18 minutes (others all less than 10). She suspects idiopathic hypersomnolence in addition to the UARS. I started 100 mg of Provigil last week, and by day two, I found that I feel human again.

    QUESTION: I read somewhere online that patients with UARS often do not tolerate CPAP (I think it was a comment from you?). Is there an understanding as to why there is limited tolerance and why one might not feel better using it despite compliance?

    Sincerely,

    Sara

  4. It’s not surprising that you can’t tolerate CPAP. Even Dr. Guilleminault, the sleep medicine pioneer at Stanford who first described UARS (and treated with CPAP) now admits that UARS patients can’t tolerate CPAP. It’s thought to be due UARS patients’ hypersensitive nervous systems. Because of the low-grade stress response, your nervous system is overly active, so having a mask on your face wakes you up more than it helps.

    My feeling is that idiopathic hypersomnolence is due to your UARS.

    Unfortunately, there’s only so much you can do without changing your anatomy. Everything else that we do conservatively helps to some degree, but never “cures” it. Many of these options include ways to lower inflammation in your nose and throat (controlling acid reflux or nasal allergies, for example), or slightly modify your anatomy (nasal strips, sleep position, etc.). Another option for you would be a mandibular advancement device, which pulls your lower jaw forward. But again, you may not like having something in your mouth.

    As described by your ENT, you have multiple areas in your upper airway that can potentially narrow or collapse, and one can aggravate the other, either upstream or downstream.

    One of the big revelations I had years ago is what happens when you deal with the anatomy definitively in someone with UARS. I describe this story in my book, Sleep, Interrupted. Surgery is not for everyone, but probably worth looking into for a few select, motivated people.

  5. Thank you for your quick response. I am now on a mission to figure this out, as my sleep issues have made me miserable for 35 years. NO ONE would listen to me. I was really frustrated when the sleep doctor told me that I had UARS and put me on CPAP without understanding anything about my upper airway.

    I have been researching on the web, and I was finding that any time I noted something that I related to or made sense to me, it was authored by you. I have ordered your book, but I was being impatient when I sent you my question.

    As far as oral appliances go, I have had quite a few with orthodontia, as well as a bite splint, and I tolerated those just fine. Dr. Jonathan Parker (Minneapolis) does oral appliances for sleep disorders, so I could go see him. I am a PT have some concerns regarding TMJ issues with thrusting the jaw forward; however, the sleep issues are bigger.

    QUESTION: How effective are oral appliances for UARS?

    -Sara

  6. Sara,

    It sounds like mandibular advancement devices may be a good option for you, in light of the fact that you’ve used oral appliances before. I’ve had some good experiences with them, but not everyone can tolerate it. Everyone’s different. Coincidentally, I have lined up for one of my upcoming expert interview series Dr. David Lawler, a dentist who has a passion for helping people with obstructive sleep apnea and UARS. It’s tentatively scheduled for 4/2—stay tuned for details on how you can participate in the teleconference. In the meantime, you can check out his website at http://www.centerforsoundsleep.com.

  7. Dear Dr. Park,

    I am reading your book, and I am finding it quite helpful in educating myself. Yesterday, I was evaluated by a dentist who specializes in oral appliances for sleep diagnoses. So I have been processing your info along with what the dentist provided, and I am coming up with a theory about my situation I would like to run by you.

    I have a diagnosis of UARS, and I have not felt better on the CPAP. I have a history of tongue thrusting which was “corrected” at age 12 during orthodontic treatment. The specialized dentist reported that basically, my airway is too crowded (primarily due to the tongue with a soft palate and uvula that are moderately long), and I am narrow across the front of my lower jaw (my bottom teeth are clearly tipped forward when looking at the mold, so it appears my tongue is looking for a place to exist).

    The CPAP with nasal pillows has trained me to rest my tongue in the “proper” position and to breath through my nose, but it dictates that I sleep on my back (never a personal choice of mine, of course). So… if I am too crowded in the airway (primarily due to the back of my tongue), placement of my tongue in this position while lying on my back, could possibly be making the airway issues even more challenging ????

    I saw the photos in your book of the airway in supine compared to the airway with jaw advancement. Suddenly it only makes sense why the CPAP might not be working and makes a strong case for the MAD for me.

    I realize that there are likely other factors involved and that you cannot know without seeing me, but does this thought process make some sense?

    -Sara

  8. Sara,

    You’re on the right tract. Your “tongue thrust” condition is a common situation where due to upper and lower jaw side to side narrowing, the front insiders are pushed outwards. Your airway is too crowded, not because of all the soft tissue structures, but due to the lack of space within your jaw space.

    I’m not sure exactly what kind of orthodontic treatment you received, but most orthodontists only straighten the teeth sometimes using extractions, rather than enlarging the jaw space to better align the teeth.

    The “elongated” soft palate and uvula that’s frequently described is actually an illusion: due to the high sitting position of the tongue, the soft palate seems abnormally long. This is also why it’s hard to see the back of your throat even when pressing with a tongue depressor, and more often than not, you may gag during thing maneuver.

    CPAP is adjusted with the optimal pressure while on your back. But it’s set for frank apneas, not short obstructions and arousals. So when you sleep on your back, things may get worse, in addition to having the CPAP mask bother you even more. So by opening up your airway using these devices, it’ll take care of your breathing problems. Hope that answers your questions.

  9. Dear Dr. Park,
    I am quite confused about my condition. I am late 30’s, 6’3″ and 220 pounds, in good shape and was diagnosed with mild OSA 1.5 years ago. I was previously very energetic and had become more & more sleepy during the day. My AHI was found to be between 5 and 6.5 on two studies. I have been using CPAP with mixed results. I can function ok, but still not feeling 100%. I went to a sleep lab for a comprehensive test. With CPAP, they could eliminate all obstruction related apnea & hypopneas. However, I still had a few central apneas and a high degree of RERA’s, which caused alot of arousals. Also, I had reasonable amounts of REM sleep, but no N3 sleep at all. The RERA’s were present in supine and lateral positions (even slightly higher in lateral). They suspect I may have a mild case of complex apnea, and also stated that I have “cyclical RERA’s”. The RERA’s do not disappear until pretty high pressure (14 or higher). Also, I had a septum surgery & turbinate reduction in November. It did not cure the problem. I also noticed I am frequently congested in my nasal pasages, with it being particularly bad when I wake up (maybe thats why the surgery did not help that much???). They are considering doing a servo activated machine study, which I hope to do in the next few months. I am also looking into treating the rhinitis. I am really motivated to fix the problem, but am quite confused. Here is what I can surmise:
    (1) Obstructive AHI responds with CPAP treatment pressure of 7-9.
    (2) Central apneas occur at all pressure levels, but seem to increase at higher pressure levels. Still, centrals are generally less than 1 per hour.
    (3) RERA’s show weak response to pressure, and even increase at some higher pressure levels. RERA is present in back & side positions. I am sensitive to the RERA’s, with high degree of arousals.

    Any thoughts on my condition & how to treat it?
    Thank You!
    -Bruce

  10. I saw your post on the NYT blog regarding jaw size, tooth crowding, and UARS. I’ve been poking around your website, and you are clearly one of those “SuperDocs” who has a dedicated mission in life. I have to give you contact info for another kindred soul, Dr. Paul Miller, DDS. (He has offices in Astoria, Queens and out on the Island in Melville). 631-271-0390 or 718-278-1505

    He is an orthodontist who has dedicated his life to identifying and treating children with UARS/OSA syndromes: onset insomnia, nocturnal enuresis, +/- night-time snoring, prolonged sleep, difficulty arousing, hyperactivity, poor attention, behavioral / learning problems (all often misdiagnosed and mistreated). Like you, he has come up with this paradigm himself over the years. He specializes in the use of Rapid Palate Expansion (RPE) in children for increasing mandibular size, relief of tooth crowding, repositioning of tongue, AND of course increasing posterior nasal aperture size, all of which anatomically relieve airway narrowing and dynamic collapse. His treatments have been life-altering and saving for hundreds of kids. I have met many of them, and his work is truly amazing. He frequently works with Dr. Avram Gold, a sleep specialist at Stonybrook who has also studied the functional somatic syndromes and their relationship to disordered sleep secondary to airway obstruction.

    I am an anesthesiologist & pain management specialist here in NY, I have many patients with chronic pain, disordered sleep, and depression, at my urging many get involved in the kinds of therapies you discuss .

    I met Dr. Miller for one of his custom, hand-made nocturnal mandibular advancement devices after CPAP failed for my own case of UARS, and am finding great success with it for now. LIke you seem to be, he is a personal and technical wizard and I think you should contact him at some point. He has taken some of your ideas even further, and his practice would benefit from your input as well. Call him for his email and for a chat. You won’t regret it! Contact me anytime if you wish to chat. Thanks.

  11. Edit of above post: RPE is for increasing MAXILLARY size, sorry for the important typo.

    PJW MD

  12. dr. park, i have a question. how long does it take for the symptoms of uars to improve once you have improved your sleep breathing with a dental device?. is it a night and day difference or does it take days, weeks, etc. ? i am 37 and have had this for most of my life. sleepsurfer

  13. Dr. Wagner,

    Thanks for posting. I was just thinking that I needed more New York area orthodontists to collaborate with that can treat the kind of problems that you talk about. Then you came along. As you can see from my site, my mission is to spread this important message to as may people as possible. UARS has been talked about and debated on for years, but it’s poorly understood and not applied in any practical manner on a large scale. Most physicians, unfortunately, are very resistant to the idea that a sleep-breathing problem may be the root cause of various medical ailments. Instead of focusing on one particular modality, I stress looking at the entire picture and offer guidance for the lay public.

    I would encourage you to take a look ay my book, Sleep, Interrupted, which looks at the big picture when it comes to sleep-related breathing disorders.

    Thanks again for the referral, and I will definitely contact Dr. Miller.

  14. Sleepsurfer,

    It depends. You’ve had your sleep-breathing problem for years, and it won’t go away overnight. Sometimes, it can take weeks to months to see any significant improvement (assuming that it’s adjusted properly with good follow-up). Most people with UARS do well with mandibular advancement devices, but there are some people where the device itself causes arousals (similar to CPAP). My general philosophy is to address the big picture (sleep hygiene, diet, exercise, stress reduction, etc.), in addition to one major treatment option. Lastly, if your nose is stuffy at all, this should be addressed definitively.

  15. Bruce,

    Your experiences with CPAP are typical for someone with upper airway resistance syndrome. Essentially, your nervous system is so hypersensitive, any physical device either on your face (CPAP) or inside your mouth (dental devices) can sometimes wake you up more than it helps. You nasal congestion is probably aggravated by a neurologic imbalance in your nose due to the multiple arousals. Either way, you still need to definitively address your nasal congestion.

    It also sounds like your central apneas happen only when you apply CPAP. By definition, complex sleep apnea only applies to mixed central and obstructive apneas that are seen during a diagnostic study only, not seen during CPAP titration.

  16. thank you again dr. park

    since i have been using the dental appliance, i have been dreaming like crazy…all night. last night i fell asleep at 1130 and woke up at 945am dreaming….i woke up 2 or three times in the night during vivid dreams. i have been using the neti pot and flonase to improve my nasal passages as per your advice. no caffiene at night anymore…maybe a beer but not after 700pm or so. i am in good physical condition 5’7″ 160…surfing all my life….less and less however lately….i’m feeling a little better but i feel there is a long way to go….is there such thing as a long term sleep debt?

  17. Sleepsurfer,

    What this means is that you’re reaching REM sleep, when you dream. But this is also the stage when your muscles are most relaxed. Dreams will be vivid by definition if you wake up while you’re dreaming. Your dental device is probably not fully able to keep your tongue from falling back during this sleep stage.

    What type of dental device are you using? Is it adjustable?

  18. Dear Dr. Park,
    Thanks for your feedback about CPAP. I have read much of your material about UARS and the potentially negative side effects of CPAP. However, I believe I have a mix of UARS and mild OSA. Why? Because with CPAP at a pressure of 8, I feel much better than no CPAP. However, we know at CPAP pressure of 8, I have alot of RERA’s, so I am not getting optimal therapy. Its like I am fixing one big problem (OSA), and then aggravating or not helping a smaller but significant problem in the RERAs. It seems many of your comments are addressing the “pure” UARS crowd, whereas I am a mixed case of OSA + UARS. BTW, I tolerate the mask and CPAP relatively well, I don’t mind it.

    There have been reports that BiPap can work for such situations. You set the EPAP to the level that clears Apneas/Hypopneas (in my case EPAP would be 8). Then, set IPAP higher until it clears the RERA’s. What is your opinion about this type of therapy?

    Thank You!
    -Bruce

  19. it is the full breath, which i have adjusted weekly by my dentist….my normal bite is about 2 0r 3 mm under bite….after two adjustments, i am at about 1.5 to 2 mm overbite…..i have noticed a little positive change at this point so i want to hold it here a bit before advancing further…..to allow my jaw to adapt…..also i have begun to get quite used to the appliance in my mouth….much worse at first….also there is a tongue suppressor that the dentist slowly elongates…..

  20. Note: I know my AHI without CPAP is 6.5, and with CPAP, its about 0.2. So, I know subjectively and objectively that CPAP helps against my OSA. Also, I ordered your book, and hope to learn alot more when it arrives.

  21. Regarding your response to Sleepsurfer about how long it can take to note improvement using a MAD…

    If the device appropriately improves the airway, why might it take weeks to months to note significant improvement? What criteria is used to determine that the MAD is not successful?

  22. Sara,

    There are two ways of measuring success: one is subjective (do you feel any better after proper adjustments?), and objective (what is the final AHI with the device in place on a sleep study?). Timeframe responses to CPAP or dental devices, and even surgery, varies from person to person. With all three options, I’ve had certain patients that responded immediately, whereas some took weeks to months. There are various reasons for this including built-up sleep debt, getting used to a new device, or scarring from surgery that can takes months. However, sometimes the patient can feel subjectively much better, but objectively on a sleep study is not much improved. This is why it’s important to get a sleep study after dental devices or surgery. But overall, with the exception of these outliers, your subjective improvement correlates with improvement in the numbers on a sleep study.

  23. Sara,

    Regarding criteria for MADs not being successful, there are many: The patient can’t tolerate the device despite many adjustments and fittings due to pain, drooling, or bite changes. In most cases, a competent and experienced dentist should be able to deal with these issues. Also, a post-MAD sleep study can show that the AHI did not drop significantly (ideally down to the low single digits).

    In general, patients with mild to moderate sleep apnea seem to benefit the most, but ultimately it depends on the patient’s anatomy and the skill and experience of the dentist administering the device.

    Once in a while I see patients that don’t respond to dental devices at all, and when I look with my fiberoptic camera, I see that the tongue base is involved, but when the patient thrusts the lower jaw forward, the tongue doesn’t move forward at all—instead it moves backwards!

  24. Looking for clarification…

    I have a diagnosis of UARS (AHI = 1). Despite adequate compliance with CPAP (provider is very happy) and a 10% decrease in weight, I don’t feel better. The only thing that makes me feel better is 100 mg of Provigil (it makes me feel human and I am no longer “dopey” in the evening); however, I realize that it is just a band aid and does not resolve the sleep problem. I am waiting for a MAD to be fabricated (self-referred to “sleep DDS”).

    I saw my sleep specialist this morning. Again, she is happy with my CPAP compliance (by the way, I still HATE my CPAP). The specialist noted that I am triggering pressures of 5, 6, 7, 8 throughout my sleep. She firmly believes that this should take care of the arousals; however, no additional sleep studies have been completed since the initial one, so there is no proof that the arousals have been resolved…The provider strongly believes that since I am not feeling better on CPAP, it is likely that a second condition co-exists (i.e., idiopathic hypersommia, which is not meaningful if the arousals are still occurring).

    As a result of reading your book, this is confusing me. I have the understanding that due to the hypersensitive neurological nature of UARS, I could be experiencing arousals BEFORE the CPAP responds (or even as a result of the CPAP response)? If it was really doing the job for me, shouldn’t I feel better using the CPAP?

    Side note: I feel like I am beating this concept into the ground a bit. A big part of my frustration stems from the fact that following my sleep study and diagnosis of UARS, I was issued a CPAP with little education as to the diagnosis and absolutely no assessment of my upper airway. As a scientist, this makes NO sense to me at all, and it resulted in a very poor attitude toward the CPAP (I hardly used it at all for the first 6 months). I convinced the sleep doctor to send me to an ENT who provided a great deal of information about my anatomy and led to the sleep DDS route.

  25. sara,

    im in the same boat as you…….i also was diagnosed with uars ahi 1.9…..rera 19…..with many spontaneous arrousals. what was your rdi or rera count. anyway, the sleep doctor(who i am still greatful for diagnosing uars, they don’t always acknowledge this diagnosis) set me up for a cpap titration study…..which went horribly ……never really fell asleep……so he THEN recommended a dental appliance…..i think the sleep doctors stand to make a bit more cash by prescribing cpap!?!? i have been using my dental appliance for about a month. with the last advancement for about two weeks…..i think it is helping maybe 10% or so but hard to tell…..i am hoping i am one of the ones dr. park describes as taking weeks to months to reap the benefits of this thing. my wife says i no longer snore or move around as much at night so that has to be helping some.

  26. ps

    i think idiopathic hypersomnia is a “i really don’t know what is wrong diagnosis” in most cases….i would never accept that!

  27. Hi Mike,

    I have been following your postings, as what you were saying was sounding very familiar to me, as well. Are you also “Sleepsurfer”?

    RERA’s=167 total RERA’s Index = 28

    In contrast, I sleep like the dead…I don’t budge (when I am not wearing my CPAP), and if I fall asleep before getting myself to bed, there is no waking me up. Per report, no snoring (occasional “purring”).

    I will receive the MAD in about 2 weeks. How are you tolerating it?

    P.S. You are correct on the “idiopathic” part. The translation is “of unknown cause”. Note that the root of the word is the same as in “idiot”.

  28. sara,

    yes i am sleepsurfer…..i also sleep like the dead…in fact, i always have thought sleeping was my greatest skill…..well apparently not! the only times i have trouble sleeping is during stressful times….i just received dr. park’s book today and i was skimming and came across a section were he talked about uars sufferers needing to exercise often in order to feel decent…..are you like this?…..that is definitely me…..however i have gotten to the point were exercise is getting very difficult….i now have to force myself and recovery is long. the mad has taken some getting used to, but i am adapting….which mad are you getting?

  29. Dear Dr. Park,

    As I don’t seem to fit the textbook picture of the UARS patient very well, could you please comment on those patients who do not fit the common features identified by studies?

    Of the fairly extensive lists, I exhibit only blood pressure on the lower end of normal (not low), treatment for anxiety/depression x 2 (correlating to significant periods of stress and poor sleep), and I can’t sleep in supine. In fact, I exhibit some opposite features (e.g., I can fall asleep anytime/anywhere and I fall into a deep enough sleep that no one can wake me). I do have the crowded airway.

    Can you also comment on why some patients with UARS and/or OSA do NOT snore?

    -Sara

    P.S. The teleconference on sleep disorders and Alzheimers was very interesting and informative.

  30. Sara,

    You listed 4 of the most common signs and symptoms for UARS: low BP, not being able to sleep supine, anxiety/depression, and being excessively sleepy. You don’t have to have all the symptoms. If your airway is crowded, then by definition, you have a sleep-breathing problem.

    There are many different scenarios, but here’s one explanation: If you have a normal sized airway in the throat and you gain significant weight. The fat cells impinge on the airway, narrowing it to the point where it partially collapses easier when in deep sleep due to muscle relaxation. At a certain point, the free edge of the soft palate flutters, like a reed on a woodwind instrument.

    Here’s another possibility: your tongue falls back half way from normal due to gravity on your back. As you breath in at the same rate through a partially open airway, the air gets suctioned in faster, creating a relative vacuum effect upstream, which collapses the soft palate tissues, causing it to flutter at a certain point.

    But if you start off with a very small space behind the tongue (due to small jaws) and your tongue falls back the same distance due to gravity and muscle relaxation, then you’ll skip the snoring stage and go straight to obstruction.

  31. dr. park,

    a symptom that i have not heard you speak of in regards to UARS is feeling like you need to take deep breathes or yawning all the time….this is a symptom i have….is that typical?

    thank you, sleepsurfer

    enjoyed the book, read it in 2 days….i will pass it on.

  32. Hello Dr.Parks,

    I a question I have never had my tonsils and adenoids taken out. I’m 36yrs in a couple of mths ill be 37yrs old. I have been have trouble breathing at night, i always have a sinus injections about every other month if not every. I have a infection now I have had about 4weeks and i going on with my second round of antibiotics and with antibotics shots also. I have to asthma also. I’m always trying to clear my throat like something is in there. I’m also couphing my head off. I always have bad headache. I have shotness of breaths all the time but im not having a asthma atack when it happen. I never to seem to get better. I went to a allergyest and i when through six months worth of allergy shots that was not working so i quit them. He told me quit them if they was not help me so i did. My family doctor suggested i have my tonsils out or tonsils and adenoids both. What do think about. this and whats your opinion? I live in the south if you might was wondering like in Alabama. I think my family doctor might be sending to me a ENT. Tell me what you might request or what is your opinion. Thank you, I think you web site is great and i enjoyed it.

    Thanks Again & Have a wonderful Day,

    Keith

  33. Without examining you it’s hard to say, but if you do have relatively large tonsils (and/or adenoids), and if you have a deviated septum that is blocking your breathing (and not helped with allergy medications), then taking our your tonsils and adenoids with a septoplasty should help you to breathe better. There are other things to consider such as flimsy nostrils and tongue collapse, but a good ENT should be able to detect these things.

    This first step is to help you breathe better through your nose definitively. Then reassess your situation. If you’re not improved, I usually look for any underlying sleep-breathing problem before getting a sinus CT to check for chronic sinusitis.

    Good luck!

  34. Sleepsurfer,

    If you’re not getting deep, refreshing sleep, you’ll naturally yawn. Taking a deep breath just means that your body craves more oxygen and wants to slow down your breathing. Yawning also forces you to take a slow, deep breath. This is not unique to UARS.

  35. I came across your blog on alzheimers and sleep apnea. I have noticed many of the parkinsons,ms, and alzheimer pts have poor oral posture, tmj dysunction,and poor overall posture with the head tilt that is indicative of chronic airway difficulties. Could it be that this leads to arterial compression, decreased blood flow to the brain, edema in the neck, etc. and therfore be the causative factor in these diseases. jmho dls
    BTW – great website

  36. Dr. Swoverland,

    I do agree that many of the conditions you mentioned may all be ultimately related to sleep-breathing problems, but the carotid artery and its’ main branches are very pliable, so head positioning and poor posture is unlikely to cause isolated and scattered brain abnormalities. However, chronic hypoxia from sleep apnea, or increased sympathetic activity from frequent arousals can lead to vasoconstriction, leading to transient or permanent brain tissue damage. Sleep-breathing problems also lead to increased vascular inflammation and increased risk of coagulation and clotting. Having said this, we do know that if you snore, you’ll have a much higher chance of having thickening in your carotid artery, or even having a stroke.

  37. Pingback: Your Nose | BOOKS
  38. Hi Dr. Park,
    I recently found you on YouTube and was really impressed by the straight-forward way in which you explain things. I was diagnosed with sleep apnea about a year ago and have struggled to use it since my nose is clogged in at least one nostril every night. I went to an ENT doctor who told me that I had three anatomical problems: bone spur, enlarged turbinates, and deviated septum in left nostril. I have postponed surgery to decide if I want to only have the first two done and forget the deviated septum; do all three; or do nothing. I worry about the potential downsides (may not work, scar tissue build-up, tearing a hole in the septum, etc.). I had a rhinoplasty about 30 years ago and remember how awful that surgery was to recover from. I assume that a deviated septum is somewhat similar. My doc said that the surgery will not free me from using the cpap – and with all of the issues I am trying to decide if the possible results are worth the pain. It really would be great if it all worked since I can’t remember the last time my nose wasn’t clogged at night. What would you advise?