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.

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

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.

https://www.nobelprize.org/prizes/medicine/1998/press-release/

Mouth breathing Research articles

Mouth breathing, “nasal disuse,” and pediatric sleep-disordered breathing
https://aomtinfo.org/wp-content/uploads/2016/06/Mouth-breathing-_nasal-discuse_-and-pedo-SDB-4.2015-Guilleminault-Lee-Sleep-Breath.pdf

The mouth breathing syndrome: prevalence, causes, consequences and treatment
https://aomtinfo.org/wp-content/uploads/2016/06/Mouthbreathing-Martins-2014.pdf

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?
https://aomtinfo.org/wp-content/uploads/2017/04/Souki-Mouthbreathing-in-Children-IJOP_2009.pdf

Breathing mode influence in craniofacial developmen https://aomtinfo.org/wp-content/uploads/2017/04/Breathing-Mode-Influence-on-Craniofacial-Developent-2005-Campos.pdf

Pediatric and Adult Sleep Medicine – Key Takeaways with Dr. Soroush Zaghi