One reader comments: "I have always thought my problem was muscle related. My sleep doc has no idea why my throat really closes because when I am awake everything looks normal, but within a few seconds of starting to fall asleep my throat starts to collapse from side to side. My sleep doc filmed this and said he would only be guessing as to why this would happen and I was a good example of severe apnea not caused by a small airway, excess fatty tissues or the usual causes of blockage."
MY RESPONSE
In this article, the author argues for muscle injury as a result of overuse from trying to maintain the airway open despite negative pressures. It is clear that in everyone, normal and apneic, upper airway muscle tone decreases dramatically when one falls asleep, even prior to REM, and this seems to be what your doctor is observing, only to a more dramatic extent than usual even for sleep apneics. It is, as you say, as if the muscles "collapsed" as soon as waking muscle tone was lost, which does suggest some incompetence of these muscles. It is usual with sleep apneics that the waking muscle tone is actually higher than normal, and this evidence of excessive activity may represent part of the problem. Presumably CPAP would serve to keep the airway open despite the incompetent musculature, but prolonged muscle damage might not repair itself just as a result of the "rest" afforded by CPAP.
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