Tongue Scalloping: A Simple Marker for Sleep Apnea?

January 21, 2010

Besides the typical descriptions of physical features for someone at risk for obstructive sleep apnea (such as male, overweight, obnoxious snoring, and a big neck), one physical finding that's rarely mentioned is tongue scalloping (click here for picture). This is when you have impressions or ridges on the sides of your tongue where it sits against your molars. One past study showed that having tongue scalloping can positively predict the presence of apneas or hypopneas and oxygen desaturation in 89% of cases. Overall, having scalloping is about 70 sensitive in picking up obstructive sleep apnea. 

The traditional explanation is that the tongue is too big, but for sleep apnea patients, the jaw is too small for the normal sized tongue. If you add additional inflammation due to chronic reflux from the stomach with each obstruction, the swelling of the tongue will only aggravate the dental impressions on the tongue. Along with the small jaws and scalloping, you'll also have a high-arched hard palate, and the tongue sits very high in the mouth, preventing you from seeing the back of the throat more fully.

 

This condition is also described in hypothyroid patients, but as I've stated before sleep apnea can cause hypothyroidism.

 

Take a look at your tongue in the mirror right now. Do you have scalloping? Do any of your family members or friends have it? Please enter your responses below in the comments box.

14 Responses to “Tongue Scalloping: A Simple Marker for Sleep Apnea?”

  1. Aganathan Maistry on January 25th, 2010 6:12 am

    Anyong hasayo Dr Park,
    This is such an amazing discovery for me. I've had a deviated septum for a long time, maybe 15 years or more. I haven't done anything about it though. I'm just too scared of surgery. Recently I have been having more trouble sleeping at night. If my left nostril is clear then I have to sleep on my left side.  I often feel something move inside my nose where one nostril clears and then the other blocks. I have to position my hands under my cheek and pull it a little so that I can breathe through a nostril. Some nights are better than others.
    Last year, I was beginning to feel very tired, cold and lazy. I went for a blood test and the doctor diagnosed hypothyroidism. He said that I probably had it for a long time but I just didn't know about it. My tongue is also scalloped like you mentioned. I am shocked to learn that my hypothyroidism can actually be caused because I don't sleep well at night due to a deviated septum. So, I guess I should really take this seriously and go to an ENT doctor and sort this out.
    Much thanks,
    A.Maistry
    South Korea

  2. Steven Park on January 25th, 2010 8:28 am

    Taking care of your nasal congestion is a good start, but don't expect it to cure all your problems. Your deviated septum, tongue scalloping, hypothyroidism, and fatigue are all related to your entire jaw anatomy, from the tip of your nose to your voice box. It also sounds like you have nasal valve collapse. Breathe Right strips or Nozovents may help. In many cases, the septoplasty and turbinoplasty may help, but sometimes, your nostrils will still cave in with inspiration. Your alternating nasal breathing is due to the nasal cycle, where the turbinates swell and shrink, alternating from side to side. Ask your ENT about that state of your nostrils, in addition to your nasal septum and turbinates. Good luck. 

  3. James R. Skinner on February 18th, 2010 5:58 pm

    I have had this tongue scalloping problem for years.  It was one of the earliest signs that I had a problem.  I had even noticed that it seemed to be worse on nights where I felt I hadn't slept well.  I brought it up to doctors but they thought I was crazy to connect my sleep and tongue.  Only years later would I learn that there was indeed a connection. 
    Here is what mine tongue looks like daily http://james.istop.com/apnea/reports/Tongue.png

  4. Tom Walker on April 20th, 2010 9:07 pm

    Can you give me an article that supports your claim regarding scalloped tongue?  I am a dentist and I know that the 70% is correct but I can't find the evidence. 
    Sincerely,  Tom Walker, DMD

  5. Steven Park on April 21st, 2010 5:33 am

    Tom, there's a link to one study in the body of the post.

  6. Diana on June 29th, 2010 11:02 am

    I woke up today with  a scalloping tongue, I thought it looked a bit strange so I googled it. I came upon this website and am a bit frightened. Can you have it one day and not the other?

  7. Steven Park on June 29th, 2010 6:48 pm

    Diana,

    Tongue scalloping can occur overnight, since sudden inflammation of the tongue (such as from allergies, colds, or acid reflux)  can cause it to swell. Long-term scalloping can signify obstructive sleep apnea.

  8. jack040 on December 13th, 2010 8:32 pm

    lately i am getting white scars which can grow to 5mm long and my vessel along the lateral border of the tongue is a little swollen. i get some minor bleeding from some small spots after eating acidic fruits like oranges .

    Could these symptoms be related to tongue scalloping ?

  9. Adriane on July 24th, 2011 7:08 pm

    I just found this on a sudden impulse to look into my “weird tongue” situation. I have always had this .. for as long as I can remember! I never stuck my tongue out in public because it was “weird”.

    Turns out, I do have hypothyroid. I guess I should look into sleep apnea as well. I do have sinus issues – feel like my nose is never “clear”.

    Great article find!!

  10. Kelley on January 29th, 2012 9:21 pm

    I too have the scalloping along the sides of my tongue. I have awakened myself some nights with a gasping for a breath, so I’m sure I have sleep apnea even though I’ve not been tested. I have had a problem with my blood pressure spiking and have been to the E.R. twice only to have them tell my I have hypertension. I knew that going in but something is causing it to spike and give me weird feelings. After reading these comments, I’m beginning to wonder if part of my problem isn’t hypothyroidism also. I experience the same sleep problems as A. Maistry in that only one nostril is clear at a time when I am on either side lying down.

  11. Randi S. Wagiu on February 28th, 2012 10:36 am

    Hi, I recently had a tooth extracted, it was a frontal side tooth, and for two weeks i’ve had tounge scalloping. And last night i woke up gasping for breath. i’ m really scared and don’t know what i should do? Is this serious? I have anxiety disorder. and i’m taking clonazeapam. It’s making it worse.

    Thanks’
    RSW

  12. Dr. Thomas Armstrong on July 19th, 2012 7:55 pm

    Kudos to Dr. Park for such a timely article. He is correct, scalloped tongue is a significant predictor of Obstructive Sleep Apnea. To the readers and commenters with this sign, a proper diagnosis is the first step.

    The “Gold Standard” for diagnosis is a laboratory sleep study. Many physicians may treat the symptoms you are having without establishing a cause. A sleep study is a diagnostic study to determine if one has a sleep breathing problem and how severe it is. Many physicians are unfamiliar with Obstructive Sleep Apnea (often abbreviated as OSA) and the myriad of sometimes obvious but often subtle signs and symptoms.

    Many times, patients have to be insistent to get a referral for a sleep study. Note: many physicians may use an overnight oximetry test (a pulse oximeter on your finger) as an OSA test and call it a “sleep study.” The medical literature is very clear – pulse oximetry is NOT a sleep study. In addition, home sleep studies are often done as an alternative to a lab study. They are absolutely nowhere near as comprehensive as a lab study. Home studies are recommended for monitoring patient treatment, but not for detailed diagnosis.

    The good news is that there are effective treatments for OSA is it is diagnosed. At the present, physicians are often aware of only CPAP, using a mask that covers the face to allow high pressure air to be forced down the throat to keep the airway open and prevent collapse. Studies have shown that over 50% of people told they have to use CPAP quickly give up on it. Unfortunately, most physicians are not familiar with Oral Appliance Therapy.

    In 2006, the American Academy of Sleep Medicine (AASM), the national professional organization of sleep medicine physician specialists, endorsed Oral Appliances as an effective alternative to CPAP for many patients. Recent medical research has shown that in patients diagnosed with mild to moderate OSA, Oral Appliances and CPAP can provide comparable results. Even patients with severe OSA who cannot tolerate CPAP are candidates for an Oral Appliance.

    It is very important to understand that effective Oral Appliances are FDA approved. The AASM recommends that properly trained dentists provide this particular treatment so that necessary follow up is done.

    Over the counter or television “snore devices” are NOT FDA approved for sleep apnea, and may actually cause the person’s airway to collapse. There is no monitoring at all, or follow up care, with these homemade items. The advertisements for these often use the term “FDA cleared”, which is misleading and meaningless. If there is no dentist actually seeing you in person for your appliance treatment, it is not a tested and proven medical device. Made-up success stories from fake users are not proof.

    Sleep apnea is a serious medical problems, and the specific FDA approved appliances are considered medical devices. The primary organization of dentists who are treating sleep apnea patients is the American Academy of Dental Sleep Medicine (AADSM) and there is a member locator on the website when you put in your zip code (aadsm.org).

    To sum up, if you have the slightest concern that you may have sleep apnea, get a diagnostic sleep study. If your physician insists that the only treatment is CPAP, you may have to educate him/her about Oral Appliances. If you are put on CPAP and cannot tolerate all the problems with it, locate a dentist in your area who has extensive training and experience and can work with you using an FDA-approved Oral Appliance.

  13. Sen Lee on September 7th, 2012 10:51 am

    yes on the scalloped tounge. Had it all my life. No health problems.

  14. hollie on February 20th, 2013 6:06 pm

    The edge of my tongue is often sore, i have never really taken any notice of it until i recently have got my tongue pierced and the swelling has increased allowing me to see the scalloping. Is scalloping dangerous to me?

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