AIRWAY and Sleep HEALTH

One of the first things that is assessed during an Orofacial Myofunctional Assessment is the airway and the ability to nasal breathe.

We were never created to breathe through our mouth, and whilst mouth breathing is common it is by no means normal.

Breathing through your mouth is like eating through your nose… we weren’t designed to do either!

So before we start any therapy, you must have a patent (open and usable) airway which is assessed at your initial appointment.

THE IMPORTANCE OF NASAL BREATHING AND NITRIC OXIDE

When we nasal breathe, our paranasal sinuses release a gas known as Nitric Oxide which has numerous benefits for the whole body that you don’t get with mouth breathing.

Benefits of Nitric Oxide:

→ Vasodilation (opening up of blood vessels) - This decreases the blood pressure and improves the flow of blood to the organs and decreases the risk of stroke and cardiovascular disease

→ Bronchodilator (opening up of the bronchi and bronchioles of the lungs) - To aid in oxygen delivery throughout the body

→ Anti-inflammatory - Part of the bodies immune system, acting as an important first line defence against infection

Nasal breathing is also responsible for:

  • Filtering the air, trapping tiny particles and pathogens to prevent them from reaching the lungs

  • Humidifying the air, adding moisture to keep your airways from drying out

  • Warming the air to body temperature before it enters the lungs

negative EFFECTS OF MOUTH BREATHING

→ Narrow jaws and dental crowding. Correct oral resting posture is lips sealed, and the tongue lightly suctioned to the roof of the mouth. When we mouth breathe, our tongue is positioned in the floor of our mouth rather than up in the palate and our jaws are more open than they should be (back teeth should only be approximately 2mm apart at rest). When the tongue is not resting up in the palate we typically see a high palate and narrow jaws. This often causes dental crowding and crooked teeth due to the lack of jaw growth. It also makes a person more likely to have airway issues as directly above the palate is the nasal cavity. If space is limited in the palate, then it’s also likely to be limited in the nasal airway. Narrow jaws and dental crowding is discussed in more detail, under Dental & Orthodontic Issues.

→ The development of a long face, and “gummy smile” where a large portion of the upper gum is visible when smiling.

→ Sleep Disordered Breathing/Obstructive Sleep Apnoea. When mouth breathing occurs the tongue rests in the floor of the mouth. During sleep the muscles relax, and the tongue can fall back into the airway space. This causes a resistance to airflow and is associated with snoring, sleep disordered breathing and Obstructive Sleep Apnoea.

→ Neck and shoulder pain. Mouth breathing distorts the skeletal system and we often see a forward head posture in those who mouth breathe and the development of chronic neck and shoulder pain into adulthood.

→ Dry mouth. When the lips are sealed, saliva is able to lubricate the mouth and teeth and provides protection to the teeth and gums. Mouth breathing changes the microbiome of the mouth and contributes to mouth dryness, thus increasing the risk of dental decay and periodontal disease.

→ Gingival inflammation/increased risk of periodontal disease.

→ Bad breath (halitosis)

Mouth breathing may be due to allergies, a deviated septum, nasal polyps,  or enlarged turbinates, and in children it is often due to enlarged tonsils and/or adenoids. 

Orofacial Myofunctional Therapy is a vital part of the process of relearning nasal breathing and correct oral rest posture.

When we breathe normally during sleep, the muscles of throat and mouth support the airway allowing the smooth passage of air to the lungs. During sleep, the muscles of our body relax which can cause a narrowing/obstruction of the airway. When the airway is narrowed or in some cases partially blocked the air is unable to flow freely, causing the tissues of the airway to vibrate, resulting in snoring.

The most common cause of snoring in children is enlarged tonsils and/or adenoids. Approximately 30% of children snore, 10-15% of children snore most nights, and a 2-4% of children have obstructive sleep apnoea.

snoring

SNORING INDICATES THAT SOMETHING IS INTERFERING WITH BREATHING

⥤ DO NOT IGNORE THE SNORE ⥢

obstructive sleep apnoea

Obstructive sleep apnoea occurs due to an obstruction in the airway preventing the flow of air to the lungs. When this occurs, the sympathetic nervous system is activated (fight or flight), and the body sends a signal to the brain to wake up.

This is a serious sleep disorder which can place you at higher risk of a number of health problems if not treated.

  • Hypertension (high blood pressure)

  • Cardiovascular disease

  • Endocrine disorders

  • Obesity

  • Diabetes

  • Alzheimers

  • Dementia

  • Clinical depression

  • Chronic tiredness

  • Fatigue related conditions

  • Inability to think clearly

  • Difficulty with memory

  • Impaired ability to complete tasks

SIGNS AND SYMPTOMS OF SLEEP APNOEA

  • Snoring

  • Episodes in which you stop breathing during sleep

  • Gasping for air during sleep

  • Headaches on awakening

  • Dry mouth on awakening

  • Difficulty staying asleep (insomnia)

  • Excessive daytime sleepiness (hypersomnia)

  • Lack of concentration and focus during the day

  • Irritability

Having Sleep Apnoea puts you at a higher risk of a number of health problems including:

Approximately 30% of the adult population suffer from sleep disordered breathing, with the most common sleep disorder being Obstructive Sleep Apnoea (OSA).

It is estimated that 15-20% of adults are affected by OSA.

Signs and symptoms of

paediatric Sleep disordered breathing

The follow is a list of conditions and behaviours related to Paediatric Sleep Disordered Breathing. These are NOT normal and shouldn’t be ignored.

  • Snoring

  • Heavy breathing

  • Mouth breathing

  • Stopping breathing when asleep/gasping for air during sleep

  • Teeth grinding when asleep

  • Sleep talking/sleep walking

  • Night terrors/nightmares

  • Nocturnal enuresis (bed wetting) beyond about 8 years of age and in some cases 5 years of age

  • Waking up tired or daytime tiredness

  • Symptoms suggestive of Attention Deficit Hyperactivity Disorder (ADHD)

  • Emotional sensitivity- anger/moody/teary

  • Educational problems- may require extra help at school

  • Behavioural issues- defiance, inability to sit still, inability to concentrate

  • Sleeping with the head arched back

  • Restless sleep/waking up with a messy bed

  • Hot and sweaty sleeper

  • Difficulty chewing/swallowing (often avoiding chewy foods like steak)/or chewing food and then spitting it out

  • Repeated ear infections

  • Drools on the pillow

  • Wakes up with a headache

  • Coughing at night

  • Frequent blood noses specially when asleep

  • A regular or persistent blocked nose

  • Narrow jaws/high palate

  • Small lower jaw (lower jaw sits back relative to the upper jaw when viewed from the side)

  • Sneezing a lot in the morning

  • Having itchy eyes, nose, ears and/or throat

This list was compiled by Dr David McIntosh of ENT Specialists Australia. If you would like to learn more, please visit the website: ENT Specialists Australia

Once you have read through the list, make a note to pop into your child’s room and sit with them for 5-10 minutes to check on their breathing.

If your child displays any of these conditions/behaviours please call for a complimentary chat. We can discuss your concerns over the phone to establish the best course of action.

Every domain of a child’s development is affected by the quality of their sleep:

♦ PHYSICAL ♦ SOCIAL ♦ EMOTIONAL ♦ MENTAL ♦

When a child’s breathing is disturbed during sleep, the body is put under stress. The heart rate increases, blood pressure increases, oxygen levels drop, the brain is aroused and sleep is disrupted.

Sleep disordered breathing

is a wide spectrum of sleep related conditions ranging from;

Mouth Breathing → Snoring → Resistance to airflow through the upper airway (UARS) → Marked reduction in airflow (Hypopnea) → Cessation of breathing (Apnoea)

the importance of quality sleep

A quality nights sleep is crucial for optimal health

Quality sleep allows for adequate oxygenation of our blood, and nourishment of the cells in our bodies. When our airway is affected, our sleep quality is reduced.

The cumulative long term effects of sleep disorders and sleep deprivation have a profound and widespread effect on human health.

In children this has a direct effect on behaviour, learning, moods, memory consolidation and academic ability.

Children who display signs of Attention Deficit Hyperactivity Disorder (ADHD) display similar behaviours to that of a child with Sleep Disordered Breathing.

It is important for all children to have their sleep assessed prior to a diagnosis of ADHD.

‘A tired child is often a wired child’

Whether an adult or child, it is important that we go through all of the sleep cycles without interruption, as each stage of sleep is vital.

If you have Sleep Disordered Breathing/Sleep Apnoea your brain is continually waking during the night (though you most likely will not be aware that you have been aroused from sleep).

During each of the stages of sleep, there are different brain and body activities occurring each with its own purpose. This includes the removal of toxins via the glymphatic system, the release of hormones, the creation of spatial and procedural memory, and even the processing of emotional or traumatic events.

Poor quality sleep is dangerous to the body and has negative long term consequences

Breathing should be:

- through the nose

- lips sealed

- quiet and peaceful

- tongue suctioned to the palate

The importance of orofacial myofunctional therapy

in the management and treatment of sleep disordered breathing

Orofacial myofunctional therapy exercises improve the strength and tone of the muscles of the oropharynx (the mouth and throat), including the tongue. By strengthening theses muscles the airway is more supported and open, especially during sleep. When the muscles of the oropharynx are weak the muscles can collapse creating an obstruction and blocking the flow of air.

“Current literature demonstrates that myofunctional therapy decreases apnea-hypopnea index by approximately 50% in adults and 62% in children. ”

ADENOIDECTOMY AND TONSILECTOMY IN CHILDREN

The surgical removal of enlarged tonsils and adenoids in children is often undertaken when they are causing airway obstruction. Whilst in many cases the surgery is beneficial, there are a number of children who never revert from mouth breathing to nasal breathing post surgery. This isn’t surprising as these children have often spent years struggling to nasal breathe, and therefore mouth breathing has become a habit.

Remember; the nose is for breathing, and the tongue must be resting in the palate. If the tongue is not resting in the palate then its more likely to relax into the back of the throat and can cause further airway issues.

If your child has had or is going to have a tonsillectomy or adenoidectomy it is important that they then revert to nasal breathing with their tongue resting in the palate.

Orofacial Myofunctional Therapy is similar to post surgery physio, and is an important part of the treatment process. You wouldn’t book in for knee surgery but skip the physiotherapy as it is highly likely you won’t get the functional outcomes from your knee surgery. In the same way, OMT is often necessary to get the full benefit of having tonsils and adenoids out because a successful tonsillectomy/adenoidectomy is about improving airways and sleep which is intricately linked to nasal breathing and the tongue resting in the palate.

Many children who have been mouth breathing for a long time (whether it be from enlarged tonsils/adenoids, or due another type of airway obstruction, e.g. allergies) need to be taught how to rest their tongue in their palate as they have only ever had it resting in the floor of the mouth.

Adenoidectomy and Tonsillectomy surgery needs to go hand in hand in hand with Orofacial Myology to get the best airway outcomes.

The effect of airway obstruction on the Temporomandibular joint (TMJ)

Airway obstruction and mouth breathing can cause Temporomandibular Joint Disorder (TMD). If you suffer from TMD it is important to have your airway health assessed.

The Research…