Millions of surgical operations are performed every year to improve your health, beauty, and even your smile, but there’s a hidden danger in some of the most common procedures that can aggravate if not actually cause obstructive sleep apnea.

Sleep apnea happens when your jaws are too narrow, which constricts the internal soft tissue layer that lines your upper breathing passageways, from your nose to your throat. More than a few times a week, I see patients that underwent procedures in the past that clearly was detrimental to the quality of their sleep.

Here are 7 common and uncommon procedures that can affect the way you breathe and sleep.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Steven Y. Park is Clinical Assistant Professor of Otolaryngology at the New York Eye & Ear Infirmary, and author of the book, Sleep, Interrupted: A Physician Reveals The #1 Reason Why So Many Of Us Are Sick And Tired.

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