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[Diagnosis] Tongue falls back - why?
#1
Tongue falls back - why?
Other than being severe, my sleep apnea is pretty run of the mill - my tongue falls back against the pharynx when asleep, blocking the flow of air. I have been aware of this for a long time, but today I am interested in figuring out why this happens. When I was younger it never happened, so the cause is apparently age-related. 

My sole theory so far is that the nerves controlling the genioglossus and/or styloglossus muscles fail to do their job when I am asleep. If that is correct, why? A form of neuropathy? Strange that it happens only when asleep, else I'd be choking all day long.

I searched the net and all I can find is 'the tongue falls back against the throat,' without a word as to why. I am in search of clues. Smile
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#2
RE: Tongue falls back - why?
I should have added that part of the problem is that we stand upright. Other animals never have sleep apnea, and it's because our pharynx moves down. Not only does standing upright make our front paws available for producing and carrying things, it also makes language possible. No human language has fewer than three vowels, but animals can produce only one vowel, not to mention our vast array of consonants. So I'm happy that I can stand upright, but why did it have to give me sleep apnea?
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#3
RE: Tongue falls back - why?
Apnea is due to thickness and tone.  As we age, we acquire....ummmm...............uuhhhhhh........mass....yeah, mass.  It happens that the industry begins to suspect 'mass' in the neck as a likely precursor to sleep apnea as one ages.  To be specific, a circumference mid-neck greater than 16.5" is highly predictive of the onset or the existence of sleep apnea.  And, as you have suspected, we lose tone in our muscles as we fall asleep.  It's why some of us find ourselves startling awake with air blasting out of our just-slackened jaws.  We have to wear chin straps, use a soft foam cervical collar, or in my case, ...well, see my signature below.

Sleep apnea is almost universally much worse when we sleep supine, on our backs.  Wouldn't you know it...we 'swallow' our tongues, or it sags back, or our necks' muscles relax and our head rolls forward toward our chests, pinching off our trachea or forcing neck mass higher up toward the pharynx, and epiglottis. 

If you do sleep supine a lot, you will likely have to seek a remedy, either becoming adept in another position or using an accessory.
Serial Tapist
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#4
RE: Tongue falls back - why?
Good explanation. You helped me!

Thanks
DaveL
Compliant for 35+ Canadian years

I'm just a cpap user like you. I don't give medical advice. I hope to learn from you, and share my experiences with you. 
Seek the advice of a physician before seeking treatment for medical conditions including sleep apnea. Sleep-well

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#5
RE: Tongue falls back - why?
(08-31-2020, 06:10 PM)mesenteria Wrote: Apnea is due to thickness and tone.  As we age, we acquire....ummmm...............uuhhhhhh........mass....yeah, mass.  It happens that the industry begins to suspect 'mass' in the neck as a likely precursor to sleep apnea as one ages.  To be specific, a circumference mid-neck greater than 16.5" is highly predictive of the onset or the existence of sleep apnea.  And, as you have suspected, we lose tone in our muscles as we fall asleep.  It's why some of us find ourselves startling awake with air blasting out of our just-slackened jaws.  We have to wear chin straps, use a soft foam cervical collar, or in my case, ...well, see my signature below.

Sleep apnea is almost universally much worse when we sleep supine, on our backs.  Wouldn't you know it...we 'swallow' our tongues, or it sags back, or our necks' muscles relax and our head rolls forward toward our chests, pinching off our trachea or forcing neck mass higher up toward the pharynx, and epiglottis. 

If you do sleep supine a lot, you will likely have to seek a remedy, either becoming adept in another position or using an accessory.

Very interesting, but it doesn't explain my sleep apnea. When I was 18 my neck was 15.5 inches, and at age 76 it's still 15.5 inches. And my weight is only a few pounds more than then. Yet I have severe sleep apnea, and I need a chin strap to keep my mouth shut while I sleep. And, while there are those who have suggested that I can't keep my mouth shut even while awake, I never have difficulty breathing once I wake up.

What you say about supine sleeping is true; during my sleep study I had 63 events on my back and only 41 on my sides, although I never slept on my stomach. Gravity definitely makes things worse, but it's not the basic cause of the problem. Something makes these muscles relax as soon as we're asleep.

There has to be another reason why my tongue and jaw muscles stop working when I fall asleep.
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#6
RE: Tongue falls back - why?
If you use a chin strap that pulls back, rather than upward, that is the cause of your obstruction.
Sleeprider
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#7
RE: Tongue falls back - why?
(08-31-2020, 11:44 PM)JJJ Wrote: Very interesting, but it doesn't explain my sleep apnea. ..

...Gravity definitely makes things worse, but it's not the basic cause of the problem. Something makes these muscles relax as soon as we're asleep.

There has to be another reason why my tongue and jaw muscles stop working when I fall asleep.

It must have to do with muscle loss, connective tissue degradation, and general loss of tone.  As you say, the nerves don't seem to have been impeded, or they're not diseased apparently, and you have no apparent neuropathy.  Your neck girth has not changed appreciably over time.  But, it's still an aged neck.  So, it MUST be gravity (what else is there?).  If tone is lost, and we both agree that it must be in order to account for the occlusion inside the pharynx, then something must cause the shifting of tissue and the tongue, and that can only be gravity.
Serial Tapist
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#8
RE: Tongue falls back - why?
mesenteria wrote:
Quote:It must have to do with muscle loss, connective tissue degradation, and general loss of tone.  As you say, the nerves don't seem to have been impeded, or they're not diseased apparently, and you have no apparent neuropathy.  Your neck girth has not changed appreciably over time.  But, it's still an aged neck.  So, it MUST be gravity (what else is there?).  If tone is lost, and we both agree that it must be in order to account for the occlusion inside the pharynx, then something must cause the shifting of tissue and the tongue, and that can only be gravity.

Can you define what you mean by 'tone'?
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