for all people who are still tired despite using CPAP, poll

[DreamStalker]

I too am sorry to see the tone of this discussion go downhill but am pleased to see others have lifted it up again

Re breathing -

One other factor I don't think has been mentioned yet is that the lungs use force to suck air in. That creates a vacuum that is satisfied by airflow in. UARS is a good example of how types of flow obstructions can prevent a good airflow in and can stress the heart & lungs as well as add the usual SDB complications.

It seems logical that the sucking of the lungs may draw the tongue down for some people. Add the cpap pressure coming in through the mouth (for mouth breathers) and one would imagine both forces would tend to contribute to the tongue 'plugging' the throat. I was wondering if the original poster was thinking of that ?

Just a few thoughts re the dynamics

DSM

Doug, you too are confusing pressure with flow. Pressure has no effect on tongue unless you are missing your lower jaw and the only thing standing between your mouth and the outside ambient air is your tongue.

In UARS, as I understand it (admittedly not all that well), the restricted air flow is due to a reduction in the esophageal diameter.

When the tongue plugs the airway, it is more likely because gravity pulls it into the throat opening while supine and not a vacuum which with UARS would be very restricted anyway.

[aka fuzzy96]

i remember what my physics professor quipped "gravity sucks"

i am eagerly watching this thread it may become comical

[williamco]

aren't we blessed to have such highly educated person to enlighten every body about his/her confusion and pull us out of the dark ages we have been in for the last few years.

I can't imagine our lives "sleep apnea patients" without such brilliant and genius

guys, did you believe that pressure is the force on square inch, before today I thought pressure was that force coming out of earth and going to the sky!

thanks to the lord who sent us those people who are just lighting candles for all of us, to pull us out of darkness

[dsm]

<snip>
Doug, you too are confusing pressure with flow. Pressure has no effect on tongue unless you are missing your lower jaw and the only thing standing between your mouth and the outside ambient air is your tongue.
<snip>

DS
Which part of what I posted is confusion ? (can't quite figure out where )

<snip>
In UARS, as I understand it (admittedly not all that well), the restricted air flow is due to a reduction in the esophageal diameter.

I think there are multiple reasons for UARS - I understood that nasal restriction can also be a cause.

When the tongue plugs the airway, it is more likely because gravity pulls it into the throat opening while supine and not a vacuum which with UARS would be very restricted anyway.

Again, I always considered the 'choking & gasping' that is a characteristic of OSA, *can* be caused by the tongue plugging and the person trying to breathe in. Whilst gravity has its role, the suction *has* to contribute, surely ?

Cheers

DSM

[akcpapguy]

I will attempt to clear a few things up for those that are still interested.

I worked for the National Institute of Health for a couple of years as a sleep tech/researcher. One particular assignment I went on was to observe a study done on the physical affects of CPAP on the body during sleep. The study was done over 4 months and hundreds of OSA subjects, not all of them under went a sleep study but many did, I believe around 70%. We would hookup the test subjects and throughout the night the Radiologist would turn on the xray machine (They used the same types of xray machine that is used in cardiac cath procedures so the image was real time and moving.) and observe as we would titrate the pressure on the CPAP. In 90% of the subjects the tongue was the cause of obstruction, and in 100% of those subjects we visualized the CPAP pressure lift the tongue and move it forward. In every case after the obstruction was relieved by titrating the pressure up, the pressure would then be reduced and we would see the tongue once again slide back on the lower palette and obstruct the airway. As I said we actually visualized this on the monitor of the xray machine in real time as the subject was sleeping. So there is NO QUESTION in my mind that CPAP does infact provide enough pressure to move the tongue forward and prevent it from obstructing the airway. Would I say that it does this 100% of the time with 100% of patients, ofcourse not that would be a foolishly ignorant statement.

I hope that puts to bed the theory that CPAP doesn't move the tongue.



AKCPAPGUY

[DreamStalker]

<snip>
Doug, you too are confusing pressure with flow. Pressure has no effect on tongue unless you are missing your lower jaw and the only thing standing between your mouth and the outside ambient air is your tongue.
<snip>

DS
Which part of what I posted is confusion ? (can't quite figure out where )

This statement ...

Add the cpap pressure coming in through the mouth (for mouth breathers) and one would imagine both forces would tend to contribute to the tongue 'plugging' the throat.

CPAP pressure does not push the tongue into the throat. There may be air flow resistance against the tongue caused by inhaling ... but not CPAP pressure. That is what I meant that you are confusing pressure with air flow. Irregardless, there is insufficient airflow from inhaling to move the tongue into the throat. Just try it ... as hard as you may you cannot suck your tongue into your throat because the airflow resistance (ie. resistance as force) is way too small to move the tongue. You would need air flow rates on the scale of a wind tunnel ... air flows you cannot achieve even on your bike.

<snip>
In UARS, as I understand it (admittedly not all that well), the restricted air flow is due to a reduction in the esophageal diameter.

I think there are multiple reasons for UARS - I understood that nasal restriction can also be a cause.

As I said my understanding of UARS is limited. I just thought it was differentiated from other breathing restrictions by the fact that it was attributed to the esophagus. Otherwise, how is it different from a hyponea?

When the tongue plugs the airway, it is more likely because gravity pulls it into the throat opening while supine and not a vacuum which with UARS would be very restricted anyway.

Again, I always considered the 'choking & gasping' that is a characteristic of OSA, *can* be caused by the tongue plugging and the person trying to breathe in. Whilst gravity has its role, the suction *has* to contribute, surely ?

Cheers

DSM

I think that by the time one begins to gasp and choke, the tongue has already plugged the throat opening. Any suction occurs after the airway has been already been closed off.

[DreamStalker]

I will attempt to clear a few things up for those that are still interested.

I worked for the National Institute of Health for a couple of years as a sleep tech/researcher. One particular assignment I went on was to observe a study done on the physical affects of CPAP on the body during sleep. The study was done over 4 months and hundreds of OSA subjects, not all of them under went a sleep study but many did, I believe around 70%. We would hookup the test subjects and throughout the night the Radiologist would turn on the xray machine (They used the same types of xray machine that is used in cardiac cath procedures so the image was real time and moving.) and observe as we would titrate the pressure on the CPAP. In 90% of the subjects the tongue was the cause of obstruction, and in 100% of those subjects we visualized the CPAP pressure lift the tongue and move it forward. In every case after the obstruction was relieved by titrating the pressure up, the pressure would then be reduced and we would see the tongue once again slide back on the lower palette and obstruct the airway. As I said we actually visualized this on the monitor of the xray machine in real time as the subject was sleeping. So there is NO QUESTION in my mind that CPAP does infact provide enough pressure to move the tongue forward and prevent it from obstructing the airway. Would I say that it does this 100% of the time with 100% of patients, ofcourse not that would be a foolishly ignorant statement.

I hope that puts to bed the theory that CPAP doesn't move the tongue.



AKCPAPGUY

Was there also movement of the mandible? To which the tongue is attached.

I think what more likely may have happened is that the tongue was flattened out against the bottom of the jaw but obviously I was not there.

[DreamStalker]

i remember what my physics professor quipped "gravity sucks"

i am eagerly watching this thread it may become comical

Funny, that's what mountain climbers say too.

[williamco]

thanks akcpapguy- one post that worth all the fight

[frh]

I think I stop breathing because I'm a nose-breather and my nose is stopped up.

Hope1952, I am the least qualified person here to try to give advice, but my sinuses have been congested for years. I have pretty bad nasal allergies on top of a deviated septum and very small nasal airways. (On friday I have an appointment for an MRI of my sinuses.)

A steroid allergy shot several times a year kept the sneezing at bay, but never helped with my sinuses. My sleep study was done on a very rare un-congested night with a Swift FX mask. That congestion came back full force when I started on CPAP. Nasal irrigation and saline spray didn't help at all, so my GP started me on 2 puffs of Nasonex a day. It took about 2 weeks to start working.

I keep the humidity on my Resmed S9 (with climate line hose) turned up as high as possible because it eases irritation in my damaged esophagus (from many years of GERD) and also helps keep my sinuses open.

If you haven't tried Nasonex, you might ask your doc for a prescription for it or Flonase. (I'm pretty sure they work the same.)

[-SWS]

CPAP creates static pressure that stents or inflates the airway as Dreamstalker had mentioned. That static pressure difference relative to ambient pressure creates a little more diaphragmatic work of breathing (WOB) during exhalation and a little less during inhalation.

...Either that or our machines "shoot down" apneas with teensy air pellets. <scratching my head> ...It's one or the other and now I forgot which.

[sleepsurfer]

wow, thank god that some useful information was actually attained after reading through all of this silly bickering! thank you akacpapguy!!!

[DreamStalker]

aren't we blessed .... blaaa blaaaa blaaaa

Look.

Quit PMing with your personal problems!

I'm not your shrink!

I won't respond to your PMs. I'll post them here and maybe someone else can help you. Take your meds, go to sleep, and quit bugging me!!!!

[williamco]

what personal problems you are talking about and what PMs.
go ahead and post them here

[DreamStalker]

what personal problems you are talking about and what PMs.
go ahead and post them here

If anyone can help this idiot ... good luck!

it is quiet obvious you have inferiority complex regarding education. educated people really don't care to flex their muscles, but undereducated do.

it is also obvious you are sick person to antagonize many people on the forum
it is also obvious you have no life to spend that time in that hobby attacking people with 5400 posts. who posts 5400 times unless they have no life.

apparently you even have no life, no wife, no family, so you spending your time on line, sure who would stand you with this psychosis. stupid moron sick person

get a life idiot and know that these forums are not for your psychotic episodes

apparently you are even jobless, spending that much time on line.

do you think an educated person will spend that much time on line, or he will have a professional job.
apparently, no standard and poor 500 company (if you know what that means) had discovered your high talents and offered you a job with your high education in physics and knowlege, spend your life on line moron

didn't he prove that you are an IDIOT, and that you don't know what the hell you are talking about

a qualified person not a moron like you are

so shut your mouth up stupid moron and get the hell out of that thread