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Your tongue might be making you sleepy!

Wednesday, April 20, 2022 - Facts about sleep

Did you know that your tongue can reveal a lot about your sleeping habits?

In essence, the size of your tongue may hold the answers to whether or not you could be suffering from sleep apnea, a condition that prevents you from getting a good night’s sleep.

Obstructive sleep apnea (OSA) is a common sleep disorder. It occurs when your tongue and the muscles of your throat relax, blocking your airway, preventing you from breathing while you sleep. It can cause pauses in breathing (apneas), which may last up to 30 seconds, and unconsciously wake you up in the middle of the night to gasp for air. Frequent pauses in your breathing can impact sleep quality, causing excessive daytime sleepiness and other long-term impacts to your health.

Factors which may contribute to an increased risk of sleep apnea include:

  • Age - more prevalent among adults >50.
  • Gender - more common among men than women.
  • Weight - BMI>30, obesity has strong links to OSA.
  • Genetics - narrow airways can be hereditary.
  • Smoking and alcohol - increase the risk of snoring or airway obstruction.

Can a large tongue be a sign of sleep apnea?

There are several indicators to help determine if you have sleep apnea—one of them is your tongue!

A study published at the University of Pennsylvania Medical Center presented that patients with sleep apnea have larger tongues. Patients showed increased fat deposits at the base of their tongue. Increased abdominal fat is also associated with a bigger tongue, supporting the strong link between obesity and sleep apnea

In order to diagnose obstructive sleep apnea your doctor may evaluate the size of your tongue and the anatomy of your oral cavity. The examination helps them determine your Mallampati score. It was originally examined by the tongue protruding maximally, but the modified Mallampati score can be determined with the tongue in resting position as shown below.

The Mallampati score was first used in 1985 to determine whether individuals were at risk for difficult intubation. 

The Mallampati classification describes tongue size relative to oropharyngeal size (part of the throat at the back of the mouth behind the oral cavity). The classification ranges from Class 1 to 4:

*image from ClinicalAdvisor.com
  • Class I: The soft palate, tonsils, and uvula of the patient are all visible.
  • Class II: Visible hard and soft palates, tonsils, and uvula.
  • Class III: The hard and soft palates are visible, but the uvula is hidden.
  • Class IV: Only the hard palate may be seen.
A Class III or IV result indicates that the patient's airway is more likely to be closed by tissue while sleeping, resulting in obstructive sleep apnea.

In addition, scalloping or swelling of the tongue with dental impressions indicate a tongue that is relatively too large that can contribute to development of obstructive apnea.

Weight loss for the tongue

Obesity has been strongly associated with sleep apnea. It is estimated that 60 to 90% of adults with obstructive sleep apnea are overweight. Evidence also suggests that having sleep apnea can cause weight gain. Weight gain around the neck and on the tongue can reduce airflow. Studies have shown that weight loss significantly reduces sleep apnea-related symptoms.

A recent study was published at the University of Pennsylvania Medical Center by Dr. Schwab’s team examined the effect of weight loss on tongue fat, and severity of sleep apnea. 

The study participants underwent lifestyle changes (increased physical activity, restricting calories and behavioral changes) or bariatric surgery to promote weight loss.

The study showed that losing weight significantly reduced tongue fat and lowered apnea–hypopnea index (AHI). The AHI score indicates the number of apnea episodes (pauses in breathing) per hour of sleep. Your sleep apnea can be categorized as ‘mild to severe’ based on your AHI score. Your positive airway pressure (PAP) treatment will be tailored to your needs, based on your sleep apnea severity, to help you breathe better at night. 

Importance of sleep apnea therapy

Over time, fragmented sleep can impair mental health, steal the vibrance and opportunities that come with a good night’s sleep. Facing the day with vitality and energy is not only desirable, it’s a necessity for a happy and productive life. Too many adults report that they feel tired and lethargic when starting their day.

Sleep apnea can be damaging to a patient’s health if left undiagnosed and without therapy. Over time abnormal breathing can cause intermittent hypoxemia (low levels of oxygen in the blood) and hypercapnia (high levels of carbon dioxide in the blood), and undiagnosed sleep fragmentation that can increase the likelihood of chronic diseases like high blood pressure, stroke, and diabetes.

Sleep apnea therapy using Continuous Positive Airway Pressure (CPAP) devices help you breathe well at night, and can make you feel refreshed and energetic when you wake up. It is considered the most effective non-invasive treatment for sleep apnea. Learn more about the benefits of sleep apnea therapy.

Think you might have sleep apnea? Consider sleep apnea testing.

Did you know sleep apnea currently affects over 6.4% of the Canadian adult population? It is estimated that 1 in 4 Canadians is at high risk for obstructive sleep apnea.

Take the first step towards better sleep by considering one of the following: 

  1. Take a STOPBANG questionnaire - a simple 8-question quiz that predicts your risk for sleep apnea based on your symptoms (e.g. snoring, fatigue) and comorbidities (high blood pressure, diabetes, depression, etc.). Take this convenient screening test online here to understand your risk for sleep apnea.
     
  2. Book a Doctor’s Appointment - your doctor will assess your symptoms, comorbidities, and conduct a simple physical exam to determine if you need an in-clinic sleep apnea test or a home sleep apnea test.  The type of sleep apnea test available to you depends on the province you reside in. If you think you suffer from sleep apnea symptoms, book an appointment with your family doctor.
     
  3. Get a Sleep Test - your doctor will prescribe a sleep apnea test, a Polysomnography (PSG) or home sleep apnea test (HSAT), if your symptoms strongly suggest the condition. Testing is the first step toward seeking long-term treatment and a better quality of life. Learn more about sleep apnea diagnosis.

It is important to get tested, if you are showing signs of sleep apnea. Sleep apnea therapy provides long-term benefits for your health. Our experienced clinical therapists help you through your therapy needs. 

Contact us at any of our numerous locations across Canada to learn about our comprehensive sleep management program.

References:

Canada, P. H. A. of. (2010, December 10). Government of Canada. Canada.ca. Retrieved April 21, 2022, from https://www.canada.ca/en/public-health/services/chronic-diseases/sleep-apnea/what-impact-sleep-apnea-on-canadians.html 

Edjoc, R., & Gal, J. (2018, October 24). This is a health fact sheet about sleep apnea among Canadians 18 to 79 years of age. the results are based on data from Cycle 5 (2016-2017) of the Canadian Health Measures Survey. Sleep Apnea in Canada, 2016 and 2017. Retrieved April 21, 2022, from https://www150.statcan.gc.ca/n1/pub/82-625-x/2018001/article/54979-eng.htm 

How weight affects sleep apnea. Sleep Foundation. (2022, April 11). Retrieved April 21, 2022, from https://www.sleepfoundation.org/sleep-apnea/weight-loss-and-sleep-apnea 

Kim, A. M., Keenan, B. T., Jackson, N., Chan, E. L., Staley, B., Poptani, H., Torigian, D. A., Pack, A. I., & Schwab, R. J. (2014, October 1). Tongue fat and its relationship to obstructive sleep apnea. Sleep. Retrieved April 21, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4173920/ 

Understanding the Mallampati score. Sleep Foundation. (2022, April 20). Retrieved April 21, 2022, from https://www.sleepfoundation.org/sleep-apnea/mallampati-score 

Wang, S. H., Keenan, B. T., Wiemken, A., Zang, Y., Staley, B., Sarwer, D. B., Torigian, D. A., Williams, N., Pack, A. I., & Schwab, R. J. (2020, March 15). Effect of weight loss on upper airway anatomy and the apnea-hypopnea index. the importance of tongue fat. American journal of respiratory and critical care medicine. Retrieved April 21, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7068828/

Tags: CPAP therapy tips Sleep apnea Sleep hygiene