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| A lot of the tongue is still not visible | |||||||||
The Tongue - the real McCoy
Conventional thinking in sleep medicine states that the throat collapses during sleep, thus causing obstructive sleep apnea. But there is no agreement concerning exactly which part of the throat collapses. Let’s examine the following anatomical parts to arrive at a working hypothesis to better treat sleep apnea:
1. The Soft Palate:
The soft
palate is like a curtain that drapes over the back of the mouth (just behind the teeth) which closes the nose when you are
swallowing. Its function is to prevent food from getting up the back of the throat to the back of the nose. It is not very
muscular which makes it flexible and vibrate (resulting in ‘snoring.’)
The soft palate falls towards the back surface of the throat during sleep. Sometimes, this
prevents air from the nose getting into the lungs. But a person can still breathe through the mouth if the nose is closed
up (like when you have a stuffed nose.)
So the soft palate cannot be the cause of collapse of the airway leading to apnea.
2. The Throat muscles:
These are muscle groups that line the inside of the throat and are attached to the skeletal structures. They keep the airway open. Only in the presence of neurological disease (such as post-polio syndrome, multiple sclerosis, muscular dystrophy and Parkinson's disease) or neurological (nerve) damage or immunological disease (such as asthma) will the muscles not function normally.
These are muscle groups that line the inside of the throat and are attached to the skeletal structures. They keep the airway open. Only in the presence of neurological disease (such as post-polio syndrome, multiple sclerosis, muscular dystrophy and Parkinson's disease) or neurological (nerve) damage or immunological disease (such as asthma) will the muscles not function normally.
So for a person who has sleep apnea but who does not have the conditions mentioned above, it is not conceivable that the throat muscles would cause airway collapse.
3. The Tongue:
If you look at a dissection of the head and neck region, you will find that the tongue is the biggest muscle in the throat. About one-third of the tongue resides in the mouth; the rest is found part way into the throat.
When you lie back, or when you are relaxed, or when you are distracted, you will find your tongue unconsciously slipping back into the throat. This will, in time, cause complete or partial closure of the airway. The tongue acts like a cork – closing up the neck of the bottle (your lungs). When the tongue ‘corks’ up the airway, no amount of air forced through the throat will get through to the lungs.
That is why CPAP treatment that does not take the tongue into consideration would not work. Besides problems with the interface (masks, tubes, machines), CPAP has to overcome an anatomical barrier – the tongue. That is why, in our office, our oral appliances do not only move the jaw forwards to open the airway, we also move the tongue away from the throat.
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| Just Surviving! | |||||||||
4. Daytime effects caused by blockage of the tongue:
a. Clearing of throat: when the tongue sinks into the throat for short or long periods of time in the day, fluids will tend to accumulate. This causes a person to clear his throat often. But this person would think that he is clearing his throat because of the accumulation of fluid. It is the other way around: the fluids accumulate because the tongue has plugged up the airway.
b. Shallow breathing: because the tongue partially closes the airway, a person cannot breath deep unless he makes a conscious effort to.
c. Choking: in some people, the tongue chokes off the airway thereby causing the body to go into ‘survival mode.’ This means, the body secretes a large amount of adrenaline. This flood of adrenaline (very much like a child who has been given too much sugar) causes a person to be labeled ‘hyper’ by people who are not used to their level of physical activity. But in fact, these individuals are 'just surviving!’
Sing praise to the LORD, you His godly ones, And give thanks to His holy name.
For His anger is but for a moment, His favor is for a lifetime;
Weeping may last for the night, But a shout of joy comes in the morning. (Ps 30:4,5)
Dr. Alfred W Choi, D.D.S., M.B.A., M.A.
9303 Seminole Blvd Suite D
Seminole FL 33772
Tel 727-394-1631 or 727-391-LIFE (5433)
Copyright Alfred W Choi
9303 Seminole Blvd Suite D
Seminole FL 33772
Tel 727-394-1631 or 727-391-LIFE (5433)
Copyright Alfred W Choi