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Scalloped tongue - what are the causes?

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jmr106 +0 points · over 4 years ago Original Poster

I've had scalloped tongue on and off since I was probably 10-12 years old. It wasn't the odd shape that bothered me, it was the canker sores that would form around the edges of the tongue from where it apparently pressed into the teeth while I slept. Another source that I found online said that breathing issues within the nose can create suction in the throat and cause a scalloped tongue because you subconsciously press the tongue down to open the airway in the throat. My dentists never remarked anything about it and only one of them mentioned that I have geographic tongue.

At 35, they finally figured out that my turbinates were swollen and that I had a deviated septum with spurring in various spots. I had the surgery on 7/16, the septum was straightened and the turbinates had coblation (shrinking of the inner tissue). I can breathe properly through my nose, but it is still healing and kind of raw for maybe another week or two. The stitches also kind of hurt, as well. For about a week after surgery, I used a 12" wedge pillow on my bed. I had splints in my nose for 7 days, as well. Before that surgery, I was normally using a flatter pillow about 3-4 inches high.

After using the wedge pillow after surgery and breathing through my mouth only, my scalloped tongue went away for that entire time period. I used to wake myself up making odd noises and that stopped, too. I went into surgery with a scalloped tongue that morning and the next day it was gone after I slept on the wedge pillow (which is too tall and uncomfortable). When I stopped using my wedge pillow and went back to my regular flat pillow for 2-3 days, the scalloped tongue is back. I also get the "burn marks" of sorts that they call geographic tongue, on top of my tongue. They move around depending on the day and relocate, but they don't hurt. The scalloped edges of the tongue, however, can turn into canker sores.

Months before the surgery, I had a sleep study done previously. I had a 4.7 hypopnea index, just 0.3 below the 5.0 required for official sleep apnea diagnosis. The ENT doctor said that my turbinates were swollen and that I had the deviated septum; doing surgery should help stop that. I only slept 2.75 hours during the study (their pillow was too high and uncomfortable and their bedding was like sandpaper texture), but during that time they noted 13 hypopneas and 50 breathing events.

Sometimes I find that a "loud noise" (unsure if nasal or throat - or neither) makes me jerk awake like something scared me. After surgery, I also feel like the front of my throat is "pinched" or in an awkward/tight position when I use my old pillow. I have had a dull pain like a cramp in the tendon of the left back of my neck and also running up into the edge of the left back of my head since after surgery. I told my ENT doc and they didn't note anything remarkable about that. Is it time for a new pillow or something? I tried a higher one before and felt so uncomfortable that I couldn't sleep. I should clarify that the pinched/awkward position of my throat is only while sleeping, but the cramped pain in my neck and back of head is at various times throughout the day.

While sleeping, it feels like I'm not high enough on my pillow, so my head pitches back and chin sort of pitches down and inwards. The other day I woke up with quite a violent muscle spasm in my neck that caused my whole head to draw up and move to one side/shake and that is what woke me up. Other times I wake up with the loud noise. Yet if I got a higher pillow to satisfy the "not high enough" feeling, it likely won't be comfortable (as before). So now I'm freaking out as to whether this is just phlegm running down the back of my throat and making my throat stick together (from the still open surgery spots in my nose) or if I'm still having some sort of mild sleep apnea issues with my throat closing. I had read that problems breathing in the nose can create a vacuum in the throat and make it close or pull the tongue to the back of the throat because of the vacuum, so I had been hoping that this was the case.

I also still feel flat out exhausted from my surgery. Not sure if that's just from the procedure and healing or if I'm still having OSA issues with my nose or throat. Even after the septum surgery and turbinate reduction, I hear "pops" in my nose sometimes when I lay on my back. I had planned to take two weeks off from work to heal, but I'm going back on 7/26.

Got any advice?

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Sierra +0 points · over 4 years ago Sleep Patron

It sounds like you have a lot going on. I have had none of the issues you describe, but here are some of the things I have tried with the pillow issue. Prior to using CPAP I have used an orthopedic shaped memory foam pillow. It seems to minimize getting kinks in the neck, as it provides higher neck support than head support, kind of like your wedge pillow. However with a CPAP mask on, I find it is too resistant to pressure and dislodges the mask easily causing mask leaks. For that reason I have switched to a down alternative pillow, which form fits to your head neck, but does not have the same push back resistance on the mask. Costco has them for about $18 a pair.

Some people suffer from positional apnea, or restrictions caused by your head position when sleeping. I do not, but those who do report that wearing a cervical collar during sleep helps by keeping the neck more aligned.

Another issue that CPAP users of nasal masks have issues with is the mouth coming open during sleep. It is often called mouth breathing, but with CPAP pressure on your nose, it is nearly impossible to breathe through your mouth. However, if you do open your mouth and your tongue does not block the airway, you can get a major flow of air out of your mouth which is being supplied from the CPAP. That can cause a dry mouth and irritation. In your case without a CPAP you may be actually breathing through your mouth and causing issues with your tongue. Just guessing. I deal with the air leakage through my mouth by using paper medical tape on my mouth to force all air flow through the nose, and not the mouth.

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jmr106 +0 points · over 4 years ago Original Poster

In your case without a CPAP you may be actually breathing through your mouth and causing issues with your tongue. Just guessing. I deal with the air leakage through my mouth by using paper medical tape on my mouth to force all air flow through the nose, and not the mouth.

It could be, but I stopped having issues with my tongue right after I had the surgery done. I had splints in my nose for 7 days, so I literally could not breathe out of my nose. A very few rare occasions gave me like 5% breathing out of one side of my nose and then it would clog back up again. Yet when I was breathing completely out of my mouth, there were no more marks on my tongue. It did look a little funny and sickly for some reason the whole time that I was mouth breathing for the week, but I never saw any marks on it. When I started breathing through my nose after the splints came out, the marks on my tongue returned along with the pain in my neck and odd random jerks awake.

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SleepDent +0 points · over 4 years ago Sleep Commentator

I am a dentist working in dental sleep medicine. The scalloped tongue could possibly not be related to the sleep apnea at all. A scalloped tongue is a classic symptom of nocturnal (and daytime) tooth clenching and bruxing. However, the clenching and bruxing are a common co-morbidity of OSA, so there might be a relationship in that respect. Arthur B. Luisi, Jr.,D.M.D.

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snuzyQ +0 points · over 4 years ago Sleep Commentator

Your medical doctor is your best resource here. Right now you're really involved with just recovering from your surgery. It's tough sledding. Be patient. Find a pillow that suits you and let your worries about whether you have apnea go for now. After you are more recovered, tell your doctor that you are still worried that you may have sleep apnea and ask him/her if you may have another sleep test. Your surgery may have rearranged some things, so this should be taken as a reasonable request. A comparison before and after surgery is a good thing to have in your hand. If you actually have sleep apnea, your second sleep test will show it and you can follow up from there. Be good to yourself and help yourself to get better. Best wishes to you.

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jmr106 +0 points · over 4 years ago Original Poster

I'm not sure if my sleeping habits changed after the surgery or what. I do get headaches and I'm 2 weeks post-op for the Septoplasty and turbinate reduction. They are only in the back left of my head. The ENT doc wasn't sure.

I have noticed that I don't keep my head straight on my pillow. I lay on the lower back side of my head instead of the middle back side. This seems to make me push my chin down towards my chest and sort of crunches my throat in somehow. I suspect this may make me have trouble breathing in my throat due to the angle and/or may be helping my tongue slide back and block my airway while sleeping. When I remove my pillow and lay completely flat, I seem to breathe a little better through my throat because my head isn't at the odd angle, but flat is uncomfortable. My pillow is a bit old - probably 6-8 months old, and rather flat. When I'm laying on it, it is probably 2-3 inches tall at most. I have considered a stiffer memory foam pillow (Noffa - I bought one for my mother a long time ago). I suspect my pillow because after the surgery I slept on the 12" gradual wedge pillow and saw that the teeth marks were gone (possible tongue thrusting or just me pushing my tongue down into the lower teeth to open the airway). Breathing through my mouth only stopped it for some reason. So I'm starting to think my pillow needs to be stiffer and a little taller to support my head properly. I still feel really out of it and a danger for stuff like driving.

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Sierra +0 points · over 4 years ago Sleep Patron

Some sleep with a soft cervical collar to keep their neck aligned. Futuro is one brand available here at places like Walmart.

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snuzyQ +0 points · over 4 years ago Sleep Commentator

It's great that the mouth breathing is gone. Instead of pushing your tongue down into your lower teeth, try resting it at the roof of your mouth with the tip of your tongue resting against the backside of your upper front teeth. This will support your newfound closed mouth when you sleep.

If you're still really feeling out of it and like you might pose a danger to yourself or other motorists, then take a short retirement from driving, by all means. You should feel much better soon.

Pillows are very individual. I don't think we recommend any particular pillow here on the apnea forum. It's pretty much up to us to find out what works best. And hang in there. Recovering from a surgery such as what you had takes a lot of energy and patience. Just that might be the cause of your fatigue. I'm hoping for the best for you.

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