Mouth breathing at night is not only uncomfortable but can also worsen sleep apnea. If a deviated septum blocks your nasal passages and forces you to breathe through your mouth during sleep, septoplasty may restore the airflow you need. At Dr. Jordan Weiner‘s Scottsdale, Arizona practice, we perform septoplasty to straighten the nasal septum, making nasal breathing easier and improving both sleep quality and CPAP tolerance.
Septoplasty is a surgical procedure that straightens a deviated nasal septum. The septum is the wall of bone and cartilage running down the middle of your nose, dividing your nasal passages into left and right sides. When this wall is crooked or bent, it can block one or both sides of your nose, making breathing through your nose difficult.
The deviation can occur in the upper septum, lower septum, or multiple areas, and the obstruction it creates varies from person to person. Some people have a slight bend that barely affects breathing. Others have a significant deviation that nearly or completely blocks airflow on one side.
Unlike decongestant sprays or antihistamines that provide temporary relief, septoplasty creates a permanent structural change. Once your septum is straightened, the improvement lasts. You can breathe naturally through your nose without taking medications or undergoing maintenance treatments.
For people with sleep apnea, septoplasty usually results in a dramatic improvement in nasal breathing. When your nose is blocked, you’re forced to breathe through your mouth at night. Mouth breathing makes sleep apnea worse and often makes CPAP therapy more challenging and less well-tolerated. Often, this is due to the need to use a face mask with the CPAP. Face masks are often poorly tolerated and require higher pressures than nasal masks or nasal pillows.1-3 This prevents your body from getting the restorative sleep it needs for health and peak cognitive performance. Straightening your septum restores nasal breathing, which in some cases improves sleep apnea severity directly4 but also makes other sleep apnea treatments work more effectively.
Septoplasty corrects the deviated portions of the septum to restore adequate airflow. The goal is to create an open nasal passage for comfortable nasal breathing during sleep.
Restoring nasal breathing with septoplasty reduces airway stress at night. This often results in measurable improvements in sleep apnea severity, sleep quality, and, for CPAP users, greater tolerance and effectiveness. Nasal breathing likely also improves success with hypoglossal nerve stimulators like Inspire and Genio by helping the tongue stay in its normal location in the front of the mouth rather than slipping backwards due to an open mouth.
Septoplasty may be right for you if:
Not all deviated septums require surgery. In fact, most don’t since they produce no difficulty breathing through the nose. Deviations that do not affect breathing do not need correction. However, if nasal obstruction limits nasal breathing, especially at night, and contributes to sleep apnea or CPAP intolerance, septoplasty can be transformative.
Meet the Expert
Dr. Jordan Weiner is highly trained in nasal and sinus surgery as part of his ENT background. He has performed thousands of nasal airway procedures, including thousands of septoplasties. As a specialist in sleep apnea surgery, he has a deep understanding of how nasal blockage impacts sleep quality.
He frequently combines septoplasty with procedures such as turbinate reduction, pharyngoplasty, or other sleep apnea surgeries to address all sources of airway blockage. His approach is to identify the causes of obstruction and recommend the most effective combination of treatments to improve nasal breathing and sleep quality.
Your consultation begins with a thorough discussion of your symptoms, breathing history, sleep quality, and previous treatments. Dr. Weiner will examine your nasal passages to precisely identify the location and extent of the deviation. He may also use a nasal endoscope to visualize deeper portions of the nasal passages to rule out other possible causes of nasal blockage such as nasal polyps or an enlarged adenoid.
If you have a recent sleep study, Dr. Weiner will review it. He will discuss the potential impact of allergies you may have on your nasal breathing. He may also ask how the obstruction affects you, such as whether symptoms worsen when lying down, if you wake up gasping for air, and if nasal blockage is also present during the day. This information helps determine whether septoplasty alone is appropriate or if additional procedures are needed.
Once septoplasty is recommended, Dr. Weiner’s staff will coordinate insurance approval and schedule your procedure. You will receive clear pre-operative instructions regarding medication adjustments, fasting requirements, and transportation arrangements for after surgery. Your prescriptions for postoperative medications will be sent to your pharmacy in advance so that these can be picked before the day of surgery.
Septoplasty is performed under general anesthesia in an outpatient surgical center.
The operation is performed through a small incision inside the nose. No scar will be visible on the outside of the nose. Through that incision, Dr. Weiner repositions the septal cartilage and bone, placing them back in the middle. Limited trimming of cartilage and bone is used as needed as well. While many surgeons simply resect large portions of the septal cartilage and bone to eliminate the deviations, this removes much of the structure of the septum. This is not desirable as it weakens the support for the nose and increases the risk of getting a hole (perforation) of the septum. He has found that repositioning rather than resection is the better approach. This why the term “septoplasty” which literally means correction and modification of the septum, rather than the older “submucous resection” better describes the surgery he performs.
At the conclusion of the procedure, the nasal passages are thoroughly washed out. Finally, flexible “splints” are placed in both nasal passages and a temporary suture is placed to hold them in place. The splints are needed to prevent any movement of the septum after it has been straightened. No packing is placed in the nose so that some breathing through the nose is possible even with the splints in place.
Most patients go home the same day of surgery.
Recovery from septoplasty is generally well-tolerated. To reduce swelling and discomfort, it is helpful to sleep with your head elevated. Exercise and heavy lifting should be avoided for 2 weeks after surgery.
First Week: Pain levels vary considerably from patient to patient but are generally mild to moderate. The pain is usually greatest in the first 2 days, easing up after that. Some mild nasal bleeding can occur in the first day or two as well. Because there is no internal “packing” placed, Dr. Weiner has his patients begin flushing their nose with saline solution starting the evening after surgery or the following morning. This is extremely helpful as it removes any dried blood and mucus making breathing easier and reducing pressure. This is performed several times a day. Many patients can return to desk work during this week if they feel up to it. The splints are removed at the end of the first week.
Weeks Two to Four: Once the splints have been removed, nasal breathing is usually excellent immediately. Residual congestion generally resolves. Most patients can resume normal activities and exercise at this time.
Full Healing: Complete healing takes several weeks to a few months. Internal swelling fully resolves and your nasal passages settle into their new, straightened configuration.
Dr. Weiner will see you for follow-up appointments to monitor your healing and discuss any concerns.
Success rates vary considerably based on the procedure and individual’s anatomy.
Septoplasty significantly improves nasal breathing for most patients. Published studies reveal success rates of about 75% in improving nasal airflow obstruction.5 However, Dr. Weiner’s success rate is greater than 95%.
For people with sleep apnea, the benefits are more than easier breathing. Studies show that correcting nasal obstruction can reduce sleep apnea severity. However, the direct impact of septoplasty on sleep apnea severity is generally modest. In Dr. Weiner’s experience, a 3-4 point reduction in AHI is common. This is in line with published studies looking at this issue.4 However, in some cases, there is no improvement or in others, it can be significantly greater. This is difficult to predict.
However, septoplasty almost always improves CPAP tolerance for those who continue using it. This is the result of the ability in most cases to switch from a face mask to a nasal mask or nasal pillows. Nasal CPAP is often effective at lower pressure (2-3 points)1 and this lower pressure is simply more comfortable and less suffocating. Additionally, even at lower pressure, nasal CPAP is on average slightly more effective than face mask CPAP in terms of reduction of sleep apnea. Studies report residual AHI of 4.9-11.3 events/hour with oronasal (face) masks versus 2.2-6.7 events/hour with nasal masks.2,3 Also, with lower pressures and a much smaller area to maintain a seal, the straps don’t have to be as tight.
Correction of nasal obstruction also enhances the effectiveness of other treatments like oral appliances or surgical procedures.
Success means you can breathe comfortably through your nose, have fewer breathing pauses during sleep, and wake up feeling refreshed.
Septoplasty is generally safe, but like any surgery, there are short term side effects and risks. Dr. Weiner will discuss these during your consultation so you know what to expect.
Common temporary side effects include:
Possible complications include:
Most perforations result in no symptoms and don’t require further interventions.
In Dr. Weiner’s extensive experience, complications occur in fewer than 1% of patients.
Talk with Dr. Weiner about any concerns regarding side effects or complications before surgery.
Septoplasty is typically covered by insurance when it’s medically necessary for nasal obstruction that hasn’t responded to appropriate medical treatment. Most insurance companies require:
Dr. Weiner’s staff will work with your insurance company to obtain prior-authorization and explain your expected out-of-pocket costs based on your deductible and coinsurance. If you’re interested in self-pay options, we can discuss fees and payment arrangements at your consultation.
A deviated septum is often one piece of the airway obstruction puzzle. Many people also have enlarged turbinates, a narrowed throat, tongue obstruction, or other anatomical factors that contribute to sleep apnea.
Dr. Weiner frequently combines septoplasty with turbinate reduction or pharyngoplasty procedures or hypoglossal nerve stimulation to address all sources of obstruction. For some patients with very mild sleep apnea, septal straightening alone is enough to improve sleep apnea. For most, septoplasty is an essential first step that, combined with other procedures, creates a comprehensive solution.
During your consultation, Dr. Weiner will evaluate your complete airway anatomy. His goal is to identify everything restricting your breathing and sleep, then recommend the most effective combination of treatments.
If you’re struggling with nasal obstruction, mouth breathing, or sleep problems made worse by a deviated septum, septoplasty could restore the clear breathing you deserve. Schedule a consultation with Dr. Weiner to see if straightening your septum can help you breathe easier and sleep better.
Clear nasal passages are possible. Solutions exist.
You may have a deviated septum if you consistently struggle to breathe through one or both sides of your nose, especially when lying down or sleeping. Some people notice the obstruction more during sleep or when they have a cold, while others experience it throughout the day. Dr. Weiner can determine if you have a deviated septum during an office examination, which may include a nasal endoscope to visualize deeper parts of the nasal passages.
Septoplasty improves sleep apnea when nasal obstruction contributes to your condition. A blocked nose forces you to breathe through your mouth at night, which worsens sleep apnea. Restoring nasal breathing often reduces the number of apneas during sleep. In Dr. Weiner’s experience, a 3 to 4 point reduction in AHI is common, though results vary. If your sleep apnea is caused mainly by throat collapse rather than nasal obstruction, septoplasty alone may not fully resolve your condition. This is why a complete evaluation of your airway anatomy is essential before recommending any procedure.
For most patients who continue using CPAP, septoplasty significantly improves tolerance. Clearing the nasal passages usually allows you to switch from a face mask to a nasal mask or nasal pillows. Nasal CPAP works at lower pressures, typically 2 to 3 points lower, which is more comfortable and less restrictive. Studies show that nasal CPAP is slightly more effective than face mask CPAP at reducing sleep apnea, with residual AHI consistently lower. Smaller masks also do not require straps to be as tight, which makes a meaningful difference each night.
Septoplasty is not a replacement for other sleep apnea treatments in most cases. It works best as part of a combination approach. For patients whose sleep apnea is mainly due to nasal obstruction, septoplasty can be highly effective on its own. For others, it is an essential first step that makes other treatments like CPAP, oral appliances, pharyngoplasty, Inspire, or Genio work more effectively. Dr. Weiner will explain how septoplasty fits into your treatment plan during your consultation.
Pain levels vary but are generally mild to moderate. Nasal pressure and congestion are more bothersome than pain for most patients. Discomfort is greatest in the first two days and eases after that. Because no packing is placed in the nose, patients begin saline rinses the evening after surgery or the next morning, which helps clear dried blood and mucus and makes breathing easier. The internal splints are removed at the end of the first week, after which nasal breathing typically improves immediately.
Temporary changes in smell or taste are common during the first few weeks of recovery due to swelling and nasal drainage. These changes resolve as healing progresses. Permanent changes in smell are rare. Many patients find their sense of smell improves after septoplasty because air flows through the nasal passages more efficiently once the deviation is corrected.
Most patients experience notable improvement in airflow through both sides of their nose. The goal is not perfect symmetry but comfortable nasal breathing. Some patients may have slight residual asymmetry, which rarely affects breathing function. Dr. Weiner will discuss realistic expectations based on your anatomy during your consultation.
You’ll notice improvement in breathing within the first one to two weeks as swelling decreases and the splints are removed. Most patients experience marked improvement within 4 to 6 weeks. Complete healing takes several weeks to a few months as all internal swelling fully resolves and the nasal passages settle into their new configuration.
Yes. Dr. Jordan Weiner often combines septoplasty with turbinate reduction, pharyngoplasty, or other sleep apnea surgeries to address all sources of airway obstruction. Correcting nasal obstruction also improves the effectiveness of hypoglossal nerve stimulators like Inspire and Genio by helping the tongue stay in its normal position rather than falling back due to mouth breathing. He will discuss the most effective combination and sequencing for your anatomy during your consultation.
Not all deviated septums need surgery. Deviations that don’t affect breathing don’t require correction. If septoplasty isn’t appropriate for your anatomy or your sleep apnea, Dr. Weiner will explain why and recommend alternatives. Options may include turbinate reduction, pharyngoplasty, Inspire therapy, Nyxoah Genio, or other procedures tailored to your obstruction pattern. Your consultation will cover all possibilities.
Dr. Jordan Weiner of Scottsdale, AZ, is an ENT and sleep apnea surgeon with deep experience in nasal airway procedures. He has performed thousands of septoplasties and achieves a success rate greater than 95% — well above the published literature average of approximately 75%. His focus on sleep apnea surgery means he evaluates nasal obstruction in the context of your overall airway rather than in isolation. He will identify everything restricting your breathing and sleep, then recommend the most effective combination of treatments.
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