How to determine OSA's exact cause (or causes)?

[Unkikonki]

What kind of study would I need to do if I wanted to pinpoint the exact cause (or causes) behind my sleep apnea? Is it my tongue falling back, my soft palate, a combination of factors? It seems to me that determining this should be a priority, yet most sleep physicians don't seem to care about it at all. All they do is follow their little playbook and prescribe either CPAP or MAD (or even UPPP) and hope for the best.

[srlevine1]

Due to the differences in human physiology and the number of variables involved, it is not often possible to develop a definitive cause for sleep apnea, especially mixed and complex apneas. Therefore, most doctors will treat the symptoms and use the AHI guideline or the nighttime oxygen levels to pronounce the solution as good.

The issue I found is that dentists will apply dental device solutions, including oral surgery, whereas other physicians will consider solutions within their specialty. Most agree that xPAP is a viable solution, and few do follow-up studies.

Such is life. We do the best we can. The purpose of this forum is to share generalized suggestions and advice, limited by the lack of specific individual medical history and tests.

As for physicians, I started with an ENT (otolaryngologist, often called an ear, nose, and throat doctor) to examine the interconnected systems in my head and neck, consulted my cardiologist (echocardiogram for pulmonary hypertension, ejection fraction for potential ASV restriction), pulmonologist for COPD, and a sleep specialist. 

Best of luck. -- Steve

[Unkikonki]

Thank you, Steve. I understand it is not that straight forward, but if I wanted to paint as clear of a picture as possible of what might be triggering my OSA, would I have to start with an ENT then? And maybe combine their approach with that of a dentist?

Were you able to understand what triggers your OSA after seeing all those specialists?

[Phaleronic]

Obstructive Sleep Apnea is primarily caused by the relaxing of the muscles in your throat that support your airway/soft pallet:

'OSA occurs when the airway becomes blocked, which ultimately affects your ability to breathe correctly as you sleep. This obstruction occurs due to a combination of two processes that affect the muscles of the throat.

First, when you go to sleep at night, your muscles are designed to relax so that they can recover and repair after the events of each day. While this process is normally a good thing, sometimes they can relax too much. This can be a problem if the airway is already naturally narrow for one reason or another.

These effects are enhanced even further if those muscles become overworked or tired by the end of the day. In the case of obstructive sleep apnea, it’s the muscles in the neck and throat that become fatigued. Oftentimes this is due to underlying issues that have either weakened those muscles or caused them to experience additional strain throughout the day, such as aging or being surrounded up fatty tissue.'

[HalfAsleep]

I’ve discovered that you can get apnea episodes if your throat becomes too dry. The uvula gets stuck. This can be a hazard if you mouth-breathe.

[srlevine1]

I see that you have a ResMed AirCurve 10 ASV, which is not routinely prescribed and is limited by ejection fraction/congestive heart failure considerations which implies a past echocardiogram.

Personally, I would not limit my quest to obstructive sleep apnea alone but would consider the entire spectrum of apneas including mixed and complex.

And I would start with an ENT to look at your throat. I would also suggest you post a few Oscar screenshots, as some forum members might spot something suggestive of a good follow-up.

In my case, it was adipose (fatty) tissue in the neck region.

Steve