The nasal septum is the thin wall of cartilage and bone that divides the inside of the nose into two separate passages. While it should ideally sit in the center, estimates suggest that as many as 80 percent of people have some degree of misalignment. When this displacement is significant, it becomes a deviated septum, a structural issue that severely restricts airflow. This obstruction often leads to breathing difficulties, confirming that a deviated septum can profoundly affect the quality and duration of sleep.
How a Deviated Septum Impairs Breathing
A crooked septum physically narrows one or both nasal passages, creating a bottleneck for incoming air. This structural narrowing increases airflow resistance, requiring greater effort to pull air through the nose. The mechanical distortion can also contribute to nasal valve collapse, where internal nasal structures are pulled inward during inhalation.
This chronic restriction means the body cannot achieve sufficient airflow through the nose, especially during deep sleep when muscle tone relaxes. Consequently, the individual shifts to mouth breathing to compensate for the reduced nasal capacity. Mouth breathing bypasses the nose’s natural functions of filtering, warming, and humidifying the air, placing strain on the throat and lower airway. The increased effort and resulting turbulent airflow are the primary mechanisms leading to sleep problems.
Resulting Sleep Disturbances and Symptoms
Obstructed nasal breathing caused by a deviated septum is frequently associated with chronic, loud snoring. Snoring occurs when compensating airflow through the mouth causes the soft tissues in the throat to vibrate. This turbulent breathing pattern often disrupts the sleep cycle, preventing individuals from reaching restorative sleep phases.
A deviated septum can also exacerbate the severity of Obstructive Sleep Apnea (OSA). While the deviation is not the sole cause of OSA, the nasal obstruction forces greater negative pressure in the upper airway. This increases the likelihood of the throat collapsing. For individuals predisposed to the condition, this structural issue can worsen the frequency of breathing pauses throughout the night.
Waking up with a dry mouth or throat is a common symptom, resulting directly from forced mouth breathing during sleep. The fragmented sleep and constant fight for air lead to significant daytime consequences. Many people report persistent morning headaches, increased irritability, and pervasive daytime fatigue. Some individuals even develop a preference for sleeping on a specific side, attempting to optimize airflow through the less obstructed nostril.
Identifying the Cause: Diagnosis
A physician, often an Ear, Nose, and Throat (ENT) specialist, begins diagnosis by taking a thorough history of the patient’s symptoms, focusing on the duration and severity of the nasal blockage. The physical examination typically involves visually inspecting the inside of the nose using a bright light and a nasal speculum. This initial step allows the doctor to determine the extent and location of the septal displacement.
In some cases, a small, flexible tube with a camera, called a nasal endoscope, may be used to examine the nasal passages further back. To assess the underlying bone structure and identify other contributing factors, such as chronic sinusitis, a computed tomography (CT) scan may be ordered. If symptoms suggest a sleep-related breathing disorder, particularly OSA, the physician will likely recommend a polysomnography, or sleep study, to objectively measure breathing patterns and sleep quality overnight.
Management and Treatment Pathways
Initial management for milder deviations often focuses on non-surgical symptom relief. Over-the-counter options like nasal strips can physically widen the nasal passages externally for temporary relief. Medications such as decongestants or nasal steroid sprays can reduce swelling in the mucous membranes, helping to open the airway when the deviation is minor. However, these approaches only manage symptoms and do not correct the underlying structural problem.
For patients with significant functional impairment due to the deviation, the definitive solution is a surgical procedure called septoplasty. During a septoplasty, the surgeon works through a small incision inside the nose to straighten the cartilage and bone, repositioning the septum back to the center of the nasal cavity. This procedure is designed to improve nasal airflow without changing the outward appearance of the nose.
Often, septoplasty is combined with other procedures, such as a turbinate reduction, if enlarged nasal tissues contribute to the obstruction. By structurally improving the airway, septoplasty can drastically reduce nighttime mouth breathing and snoring. It can also make treatment for co-existing conditions, like using a CPAP machine for OSA, more comfortable and effective.