OSA due to tongue rolling back?

This must be a silly question as the answer seems a little obvious. Sleep on your stomach and gravity will stop your tongue rolling back, unless you have an over active tongue ...

You would think so. However, many OSA patients still have just as many sleep apnea events when they sleep on their side or on their stomach. The tongue is ONLY part of the picture. I'm sure Snoredog will try to convince you otherwise

I sleep on my stomach and still have OSA - would probably be worse on my back and sides are not comfortable.

split_city wrote:You would think so. However, many OSA patients still have just as many sleep apnea events when they sleep on their side or on their stomach. The tongue is ONLY part of the picture. I'm sure Snoredog will try to convince you otherwise

I think I would have used "a few", "small number", "a rare few" instead of "many".

Because when you consult with "many" of those PSG reports that actually DO positional comparisons, OSA is nearly always worse in the supine position.

and for the OTHER part of that picture, its the back of the throat. Add to that you will most likely be inhaling when that tongue falls back into that hole at the back of the throat.

It all makes perfect sense to me, all you have to do is see where the tongue is attached (in normal patients) to understand what happens. Now I guess if you hunt high and low and far back enough you may find a x-ray of a mutant patient with a severly receding chin where their tongue is attached to the floor of the chin to make your point, but for the rest of us our tongue is attached to the back side of the front of the chin. Just like the cartoon shows:



Gravity, low pressure from inhaling is what slams it shut, cpap pushes it up and out of the way, a TRD (Tongue Retaining Device), MAD (Mandibular Advancement Devices) all the do the same thing they either push the tongue out of the way, or pull the tongue forward by moving the mandible forward or by some other means.

if it wasn't the tongue so much involved with OSA, why is that company spending so much money on that study taking place right now on the tongue tether. It will physically prevent the tongue from falling into the back of the throat, but we will have to wait until the study is completed for the results.

I guess the others falling outside the tongue being involved would be those with central apena or CSDB.

Snoredog, that tongue-wire procedure thing has been around for awhile. Early studies showed the success rate to hover around 50% (about where the up3 surgery is. These numbers are only ballpark as best I can recall). I'm sure you can google the cases I read, if this is an area of interest for you.

Anonymous wrote:Snoredog, that tongue-wire procedure thing has been around for awhile. Early studies showed the success rate to hover around 50% (about where the up3 surgery is. These numbers are only ballpark as best I can recall). I'm sure you can google the cases I read, if this is an area of interest for you.

Don't think so, only one taking place is currently under way in Chicago area, there may be a parallel study taking place in Europe, info on both can be found below:

http://www.aspiremedical.com/pr/pr_052207.html

http://www.aspiremedical.com/tech_us.html

This is the tongue tether, it uses like a fish hook implanted in your tongue and the other end of the tether is attached to the chin, they can adjust the length of that tether to prevent the tongue from falling into the back of the throat and blocking off the airway (shoots split_city's theory all to hell doesn't it ).

As far as I know, this procedure is brand new, I applied to be one of the first test dummies for it and during the interview I found out i'd have to travel to chicago about every 2 weeks to participate in it, so I passed.

Now I could be wrong here & I am NOT a doctor by any means but-

My understanding is that OSA is caused by airway collapse, not the tongue blocking it.

There is thread on here about using the DIY mouthguard to keep the tongue in the back of the throat (for mouth breathers). My sleep tech also told me that the supine position is worse for OSA but my sleep study documented that I had fewer OA's when supine.

I believe the reason is because when I was required to sleep supine, I pulled out my nifty, difty rubber bands & rolled up a hotel towel to place behind my neck (to keep my airway straight). It is something I had been doing since my whiplash injury some yrs. ago.

My theory is that the reason many people have higher OA's when supine is because for some reason they like to pile up pillows (high) up under their head (NOT under the shoulders), thereby cranking their neck at an obtuse angle which increases the collapse, not because of the tongue or gravity. The same people usu. refuse to sleep w/o a pillow. I say give it a try. I have seen memory foam about the size of my rolled up towel.

Whatever you do, try to keep your neck straight.

I have for yrs. before being diagnosed, trying to sleep with my airway straight. It is supposed to help reduce snoring too. When using pillows, the whole idea is supposed to be to keep the airway (neck) in a straight alignment. Most folks simply do not do that.

Ask someone to check your alignment the next time you assume the position.

That's my 2 cents on it.
GumbyCT
ps. I read in another thread where Snoredog (was it?) has much more experience sleeping than I do. I can only hope I live that long .

If you sleep face down without PAP treatment and you have severe OSA, I can tell you from experience that you are most likely going to slobber/drool all over the place. Before being diagnosed with OSA, I would always end up sleeping on my stomach even if I started out sleeping in any other position. My body would automatically move into that position so that gravity could pull my tongue out of the way and help to keep me alive I suppose.

Since going on the hose, I have noticed that I now sleep in all different positions and I do not drool or slobber all over the pillow. In fact, I manage to keep my mouth closed and use a nasal interface leak free without any tape, glue, chinstrap, or any other contraption.

I really don’t know the stats for how many are affected by tongue causing the obstruction but for me … I think the tongue definitely plays a major roll in my OSA as does my thick neck and slight under-bite. It's a complex condition.

[quote="DreamStalker"]If you sleep face down without PAP treatment and you have severe OSA, I can tell you from experience that you are most likely going to slobber/drool all over the place. Before being diagnosed with OSA, I would always end up sleeping on my stomach even if I started out sleeping in any other position. My body would automatically move into that position so that gravity could pull my tongue out of the way and help to keep me alive I suppose.

Since going on the hose, I have noticed that I now sleep in all different positions and I do not drool or slobber all over the pillow. In fact, I manage to keep my mouth closed and use a nasal interface leak free without any tape, glue, chinstrap, or any other contraption.

I really don’t know the stats for how many are affected by tongue causing the obstruction but for me … I think the tongue definitely plays a major roll in my OSA as does my thick neck and slight under-bite. It's a complex condition.

Nah! Too late. I already spent a bunch of coin on my PAP equipment.

Besides ... I don't shop Costco or Wally Wolrd cuz all that stuff is made in China --- all those leaded products eat the brains of their consumers so that science can easily catch up to them.

[quote="Snoredog"][quote="DreamStalker"]If you sleep face down without PAP treatment and you have severe OSA, I can tell you from experience that you are most likely going to slobber/drool all over the place. Before being diagnosed with OSA, I would always end up sleeping on my stomach even if I started out sleeping in any other position. My body would automatically move into that position so that gravity could pull my tongue out of the way and help to keep me alive I suppose.

Since going on the hose, I have noticed that I now sleep in all different positions and I do not drool or slobber all over the pillow. In fact, I manage to keep my mouth closed and use a nasal interface leak free without any tape, glue, chinstrap, or any other contraption.

I really don’t know the stats for how many are affected by tongue causing the obstruction but for me … I think the tongue definitely plays a major roll in my OSA as does my thick neck and slight under-bite. It's a complex condition.

A fascinating discussion...Seriously, could everyone be right?

My sister may be one of the many: She was told by her ENT that her apnea is caused by a large tongue, small jaw, and narrow airway. The tongue is the major obstruction.

I may be one of the few: I was told by my ENT that my apnea is caused by a long palate and uvula reaching the back of the throat, redundant soft palate, and narrow airway. (Tonsils and adenoids were not a factor, as they were removed in early childhood.)

Here is what my first sleep study reported...

Respiratory Summary by Body Position

............Dur (hr).. Obstructive......Central..........Hypopnea.........All
..........................Total Index.....Total Index....Total Index.......Total Index
Supine......1.4.........0....(0.0)........0....(0.0).......36...(26.0).......36...(26.0)
Prone.......1.8.........9....(4.9)........4....(2.2).......75...(40.7).......88....(47.8)
Left..........0.5.........1....(2.1)........1....(2.1).......25...(52.2).......27....(56.3)
Right........2.2.........0....(0.0)........8....(3.6).......69...(31.3).......77....(34.9)

Snoredog wrote:

split_city wrote:You would think so. However, many OSA patients still have just as many sleep apnea events when they sleep on their side or on their stomach. The tongue is ONLY part of the picture. I'm sure Snoredog will try to convince you otherwise

I think I would have used "a few", "small number", "a rare few" instead of "many".

Because when you consult with "many" of those PSG reports that actually DO positional comparisons, OSA is nearly always worse in the supine position.

Are you sure? What % of patients do you think have posture dependent OSA? I would disagree with your "rare," "small number," "a rare few" given the results from these studies:

http://www.ncbi.nlm.nih.gov/sites/entre ... d_RVDocSum

"In 55.8% of our patients, OSAS was position dependent."

http://www.ncbi.nlm.nih.gov/sites/entre ... d_RVDocSum

"Positional sleep apnea was seen in 49 of 99 patients (49.5%) with mild sleep apnea (AHI, 5 to 15/h), 14 of 72 patients (19.4%) with moderate sleep apnea (AHI, 15 to 30/h), and 5 of 77 patients (6.5%) with severe sleep apnea (AHI > 30/h)"

Interesting, sleep apnea became less postural dependent when AHI increases.

http://www.ncbi.nlm.nih.gov/sites/entre ... d_RVDocSum

"In the lateral position, most subjects in the snorer group showed decreased snoring both in time (p = 0.0004) and intensity (p = 0.0003), but subjects in the apneic group showed variable changes"

"OSA patients who often fail to decrease snoring even in the lateral position."

Snoredog wrote:and for the OTHER part of that picture, its the back of the throat. Add to that you will most likely be inhaling when that tongue falls back into that hole at the back of the throat.

Yes, this would likely explain what happens when supine. What about patients sleeping in the lateral position or prone?

Snoredog wrote:It all makes perfect sense to me,

So explain the results I just presented to you.

Snoredog wrote:all you have to do is see where the tongue is attached (in normal patients) to understand what happens. Now I guess if you hunt high and low and far back enough you may find a x-ray of a mutant patient with a severly receding chin where their tongue is attached to the floor of the chin to make your point, but for the rest of us our tongue is attached to the back side of the front of the chin. Just like the cartoon shows:

I don't like these cartoon pictures. They always tend to oversimplify things. Anyways, I have already shown you a MRI image of an obstruction that didn't involved the tongue.

Snoredog wrote:Gravity, low pressure from inhaling is what slams it shut, cpap pushes it up and out of the way, a TRD (Tongue Retaining Device), MAD (Mandibular Advancement Devices) all the do the same thing they either push the tongue out of the way, or pull the tongue forward by moving the mandible forward or by some other means.

Unfortunately, there are many non-responders out there when using these devices. You think they would work given "they pull the tongue forward, preventing the tongue flopping back." The results pretty much shoot your theory down.

Snoredog wrote:if it wasn't the tongue so much involved with OSA, why is that company spending so much money on that study taking place right now on the tongue tether. It will physically prevent the tongue from falling into the back of the throat, but we will have to wait until the study is completed for the results.

So? There are thousands of researches spending a millions of dollars on their work, but it doesn't necessarily mean what they believe is right.

Snoredog wrote:I guess the others falling outside the tongue being involved would be those with central apena or CSDB.

So around 50% of patients given the results I presented? Ok..

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CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP, AHI

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CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP, AHI

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CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP, AHI

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CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP, AHI

Split_City:
Hey I'm not arguing the positional dependency, I say it DOES play a role in severity of OSA.

While I didn't look at your referenced studies, I'd be willing to bet they show the same and I would guess those studies would also show a patient sleeping non-supine found normal for OSA and moderate to severe when placed in supine position, that wouldn't surprise me.

zorrro13 wrote:This must be a silly question as the answer seems a little obvious. Sleep on your stomach and gravity will stop your tongue rolling back, unless you have an over active tongue ...

Doesn't help my OSA (maybe I'm one of those mutants Snoredog mentions.)



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