What is it?
You have probably heard of some of the Sleep breathing disorders (SBD’S), such as Snoring & Sleep apnea. Like most conditions and diseases there are varying degrees of severity. It is important to note that not everyone who snores has sleep apnea! However, the most obvious sign of obstructive sleep apnea (OSA) is snoring.
Apnea– airflow is completely blocked and there is a STOP in breathing for at least 10 seconds.
Hypopnea- decrease in airflow by 50% for at least 10 seconds, or 30% decrease in airflow in conjunction with awakening or serious drop in blood oxygen saturation level.
It’s not just annoying to your roommates or bed partner. It can be a sign of something more detrimental to your health. Snoring in general is sound created by vibration of the tissues of the oropharynx (throat) when restricted air flow passes through. Basically, air flowing over and through loose tissues. Snoring that is mild occurs from vibrations of the soft palate of back of the mouth, this occurs during mouth breathing. According to the American Sleep Association mild snoring rarely has negative affects but if it gets worse over time it can lead to other health issues. Scientific evidence suggests that years of snoring can lead to lesions to form in the throat.
Symptoms of UARS
– simple snoring worsens
-cold hands & feet, low blood pressure, orthostatic hypotension
-daytime sleepiness and fatigue set in.
-If left untreated chronic sleep disturbances(insomnia), difficulty falling or staying asleep and weight gain occur. Over time as the obstruction becomes worse, noticeable by louder snoring, UARS will eventually progress to OSA.
Causes of UARS:
Loose relaxed fatty tissues of the throat collapses in combination with narrowed airways. The tongue falling back into the throat during sleep can contribute to the obstruction making it harder to breath. Small facial structure & dental crowding also contribute to airway issues. People with UARS may have heavy labored breathing rather than loud snoring as they struggle to bring in more air. Deep sleep is interrupted as the brain wakes the body to compensate for the extra effort needed to breath. It may not be a complete wakefulness but just enough to disturb the necessary restorative sleep cycle. If this occurs over hours, days, weeks months and years imagine the issues that arise.
Is UARS the same as OSA?
No, there are similarities, but the main differences are in OSA you STOP breathing for periods of 10 seconds or more (apneas) and have decreases in flow (hypopneas). In UARS you do have apneas but for less than 10 seconds as well as hypopneas multiple times per hour. Neither are good short or long term. People with OSA are generally overweight or obese as opposed to those with UARS who tend to be average weight or petite. UARS affects any gender and ethnicity and OSA is more common in Caucasian men.
Treatment for UARS:
If you suspect that UARS has progressed such as daytime sleepiness & increase in snoring, then you should seek help. Treatment for UARS include:
-Lifestyle changes such as diet, exercise and limit alcohol intake
-good sleep hygiene
-dental and oral appliances to open airway
-CPAP is usually a last resort for UARS according to the American Sleep Association.
There are different types of apneas such as Central, Mixed and Obstructive Sleep Apnea. Obstructive Sleep Apnea (OSA) is the most common form of sleep apnea. OSA is noted as frequent pauses in breathing while asleep, this sounds much nicer than what it actually is. I compare apneas to “choking events” because the inhalation is forcefully stopped by a blockage. The blockage occurs due to the muscles in the throat relaxing and blocking the airway. During an apneic event the brain panics due to lowered blood oxygen levels. The brain wakes the body to restart breathing. These small rousals are so brief and minor than most people do not remember or even notice. If this occurs all through the night the sleep cycle is interrupted over and over again. it’s no wonder some of us are so tired! In fact, according to the American Sleep Association 25 million U.S adults have obstructive sleep apnea! The varying degrees of OSA are mild, moderate and severe.
Is apnea the same for children and adults?
No adults and children have different symptoms.
Symptoms of OSA in Adults
- Excessive sleepiness during the day making it difficult to focus or concentrate.
- Dry mouth, sore throat in the morning
- Chest pain upon waking up
- Morning headaches
- Mood instability, depression, anxiety, excessive irritability
- Waking in the middle of the night gasping/shortness of breath
- Insomnia, problems staying asleep
- Hypertension/high blood pressure
Children with OSA may have the following symptoms
- Inattentiveness in class/home/ADD
- “Zoning out”, “daydreaming”
- Failure to thrive
- Reduced or delayed growth can occur because the effort it takes to breath is burning a lot of calories.
- Nasal or airway obstruction may make it difficult and a lot of work for the child to eat and drink while breathing at the same time. They become tired due to the effort it takes to get the food in them. You may notice it takes a long time for them to finish a meal compared to siblings or other peers.
What causes obstructive sleep apnea?
– Age- flaccid muscles
– Anatomy such as:
– Obesity = an increase in soft tissue around the airway
– Enlarged tonsils/adenoids
– A narrow high arched palate will create less space for the tongue to rest forward which leads to it falling back into the throat during sleep.
– Tongue tie-a restricted tongue creates a low rest posture which prevents the tongue from resting on the roof of the mouth and out of the throat.
– Structural deformities that block the airway.
– Weak muscle tone of the muscles of the oral and pharyngeal(throat) complex.
– Alcohol, substance abuse, neurological disorders and underlying health issues can contribute to weak muscle tone as well
– Genetics – studies have shown a connection between OSA sufferers and a positive family history of OSA.
– Snoring lesions – scientific evidence suggests that years of snoring can lead to lesions to form in the throat. Lesions from snoring vibrations have also been linked to neuron and nerve lesions all around the body.
Diagnosis & treatments for OSA;
The first step is to see your primary care physician (PCP) if you suspect an airway issue. They will refer you to a sleep physician for a sleep study. Depending on your diagnosis there are different options. Your physician can recommend the best course of action for you.
For more information please see your PCP and check out: https://www.sleepassociation.org/sleep-disorders/sleep-apnea/obstructive-sleep-apnea
Treatments for OSA vary depending on the severity of obstruction. Lifestyle changes such as weight loss, exercise, smoking cessation, limiting alcohol and sleep hygiene are great starts to achieving better health and sleep quality. Continuous positive airway pressure (CPAP), Variable positive airway pressure (VPAP), sleep apnea oral appliances and surgery are just a few of the options you can discuss with your physician.
Sleep Apnea that is left untreated can lead to
- Heart disease
- Liver disease
- Memory issues
- Behaviors problems such as ADHD/ADD
- Daytime fatigue-increases risk of accidents
Some benefits of Nasal breathing; Our body functions optimally when everything is in balance. Just as overeating can lead to obesity, over breathing can lead to too hyperventilation, not in the sense that you pass out but in the definition of the over exchange of oxygen and carbon dioxide. During respiration Oxygen is inhaled and Carbon dioxide is exhaled from our body but we need a certain amount of each to keep our body systems in balance.Carbon Dioxide(Co2) plays an important role in internal respiration inside the human body. The Co2 helps to deliver the oxygen in our blood to our muscles. If we are exhaling too much Co2 we will have less Oxygen delivered to the muscles which means they will fatigue faster. Co2 also aides in vasodilation or widening of the pathways of blood flow. When we mouth breath we expel too much Co2 which over time can contribute to vasoconstriction or narrowing of the pathways for blood flow making it harder for blood to reach vital organs such as the heart and brain.
Nitric Oxide is another gas that is essential to our health in the right amounts. Nitric Oxide is produced in the paranasal sinuses of the nose. Nasal Nitric Oxide is toxic to bacteria, fungi, viruses and tumor cells. Nitric oxide plays an important role in cardiovascular health by assisting in dilation of the blood vessels. It helps with relaxation & dilation of the respiratory system. It has been found to be essential to the function of the immune system, nervous system, the treatment of chronic inflammation, erectile dysfunction and cancer.
What causes mouth breathing?
– force of habit (observed behavior or preexisting corrected issue caused habit)
– allergies-nasal polyps,-congestions,-enlarged tonsils/adenoids,
– short upper lip(caused by lip-tie, digit sucking, extended use of a bottle, pacifier or sippy cup).
How can we fix it?
Myofunctional Therapy is like detective work. Sometimes referrals to specialists are warranted to rule out blocked nasal passages or other more serious issues that prevent you from nasal breathing. Once these issues are addressed we can then focus on establishing proper nasal breathing. This is achieved by creating new neuromuscular pattern behaviors to replace the compensations, such as tongue thrust, or low tongue rest posture, that have resulted in mouth breathing.
Mouth breathing may contribute to:
- Abnormal facial growth
- Crooked/crowded teeth
- high blood pressure/heart problems
- asthma, allergies
- headaches, body aches
- bad breath, gum disease, tooth decay
- sleep apnea,snoring,sleep breating disorders
- Not only does it look less attractive and less intelligent, over time it is physically harmful. As mentioned above it distorts the balance gas exchanges that occur in nasal breathing. Nitric oxide is produced in the paranasal sinus during nasal breathing and not during mouth breathing.
- The tongue rests on the floor of the mouth during mouth breathing which interferes with proper facial bone growth. Without the tongue resting on the roof of the mouth, the arch of the top teeth or maxilla will narrow and teeth will become crowded. The lower arch (mandible) and the teeth usually follow suit of the top teeth. Over time, as crowding of the teeth occurs, the tongue will then have even less room to rest in the mouth which decreases one’s ability to breath properly, especially at night as the tongue blocks the back of the throat due to low rest posture. The body then overcompensates by mouth breathing more frequently to bring in more air which then exacerbates the dysfunctional gas exchange. Over years this can contribute to many health issues such as hardening of the arteries, high blood pressure, anxiety, asthma, body aches and pains and more.
- As we inhale air in through our mouth a drying affect occurs in the mouth. The dryness on the surface of the teeth and gums allows the bacteria to stick better to these tissues. The bacteria produce acid as a bi-product. The increased acidity facilitates more growth of bacteria which throws off the Ph balance in the mouth resulting in increased risk and incidence of cavities and gum infection. It is not uncommon in mouth breathing patients to see a higher incidence of gum disease and dental decay. Mouth breathing in conjunction with certain medications that have a drying affect may exacerbate the progression of dental diseases. Let’s get you nasal breathing!
- Mouth breathing/airway problems in children are directly related to Bedwetting, asthma, recurrent ear infections, allergies, snoring, asthma, OSA (obstructive sleep apnea) and ADHD(related to airway)
- During mouth breathing particles in the air can be inhaled which can result in swelling and irritation of the throat. This can aggravate and trigger allergies. The nose is brilliant at filtering out viruses, dust, bacteria and fungi. The hairs in our nose, our mucus and paranasal sinuses are working to keep us healthy!
- If you have a tongue -tie or ankyloglossia it will restrict the ability of your tongue to function optimally. The person with a tongue “tied” in a low rest posture is more likely to have airway dysfunction (especially at night), irregular swallow patterns, difficulty keeping the teeth clean and possibly speech issues.
- Keeping the nasal passages clear, smelling and tasting food effectively,
- regulating sleep patterns, clearing the inner auditory tubes from debris, humidifying the air they inhale( cold air restricts the lungs),
- Cooling the pituitary gland to help regulate body temperature.
60%of facial growth occurs during the first four years of life, & 90%occurs by age twelve, the lower jaw grows until around age 18.
10% of children that snore have OSA (obstructive sleep apnea), about 25% of children snore.
A high percentage of children with ADD/ADHD have been shown to have mouth breathing disorders.
Mouth breathing Research articles
Mouth breathing, “nasal disuse,” and pediatric sleep-disordered breathing
The mouth breathing syndrome: prevalence, causes, consequences and treatment
Intraoral pH and temperature during sleep with and without mouth breathing
The mouth breathing syndrome: prevalence, causes, consequences and treatment https://aomtinfo.org/wp-content/uploads/2016/06/Mouthbreathing-Martins-2014.pdf
Decreased chewing activity during mouth breathing https://aomtinfo.org/wp-content/uploads/2017/04/mb_1.pdf
Oral breathing and speech disorders in children https://www.sciencedirect.com/science/article/pii/S0021755713000958
Three-dimensional assessment of pharyngeal airway in nasal- and mouth-breathing children https://aomtinfo.org/wp-content/uploads/2017/04/Three-dimensional-assesment-of-pharyngeal-airway-in-nasal-and-mouthbreathing-children-Alves-Int-Jour-Ped-Otorhino-2011-1.pd
Prevalence of malocclusion among mouth breathing children: Do expectations meet reality?
Breathing mode influence in craniofacial developmen https://aomtinfo.org/wp-content/uploads/2017/04/Breathing-Mode-Influence-on-Craniofacial-Developent-2005-Campos.pdf