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Advanced symptoms of dysfunction

Sleep Disordered Breathing (Including Obstructive Sleep Apnea and Snoring)

Sleep disordered breathing describes a group of disorders characterized by breathing difficulties during sleep. It includes Obstructive Sleep Apnea (OSA), Upper Airway Resistance Syndrome (UARS), and snoring. Obstructive Sleep Apnea is the most serious form of sleep disordered breathing. It occurs when there is complete obstruction of the airway caused by relaxation of the muscles that support the soft tissues in the throat, such as the tongue, soft palate, and uvula. The resulting airway obstruction can cause pauses in breathing, a drop in oxygen saturation, and sleep disruptions. Risk factors include sex, age, weight, neck size, alcohol use, and smoking.

Snoring and mouth breathing can be early warning signs of sleep disordered breathing. Mouth breathing causes the jaw to open and move down and back and partially obstruct the airway. Since the tongue is attached to the lower jaw, the back of the tongue also falls into the airway and causes an obstruction. Sleep related grinding and clenching is often seen as part of the body's response to try to protect itself from the effects of sleep disordered breathing.

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The signs and symptoms of Sleep Disordered Breathing include:

  • Abrupt awakenings with shortness of breath, coughing, gasping or choking

  • Pauses in breathing while asleep 

  • Difficulty staying asleep and restlessness while asleep

  • Frequent need to use the bathroom at night (or bedwetting in children)

  • Audible breathing or snoring

  • Headache or jaw pain upon waking

  • Waking with a dry mouth or sore throat

  • Mouth breathing

  • Excessive daytime fatigue

  • Memory, attention or concentration problems - "brain fog"

  • Teeth grinding at night

  • Weight gain or difficulty losing weight

  • Irritable, mood swings, anxiety or depression

  • Acid reflux/GERD

  • Hyperactivity, ADD/ADHD (common in children)

  • Slowed growth (in children)

The long term effects of undiagnosed or untreated Obstructive Sleep Apnea include:

  • Alzheimer's disease 

  • Depression

  • Stroke

  • Heart disease

  • High blood pressure

  • Diabetes

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Identifying and correcting myofunctional disorders in children prior to completion of jaw and facial growth is key to preventing sleep disordered breathing. Achieving the four goals of myofunctional therapy can improve sleep disordered breathing as many of the exercises centre on improving the tone of the soft palate, throat, and back of the tongue.

Recent studies have shown that myofunctional therapy decreases the apnea-hypopnea index (AHI) by approximately 50% in adults and 62% in children, improves daytime sleepiness, and improves snoring.

Temporomandibular Disorders (TMD)
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A low resting tongue posture affects the stability and support for the jaw. Incorrect tongue posture leads to improper muscle function and muscle compensation due to the tongue not functioning properly, causing orofacial pain and strain on the temporomandibular joint (TMJ). Forward head posture is a common symptom of mouth breathing and a narrow airway as it helps to open the airway by shifting the head forward. As the head comes forward, the neck muscles strain and fatigue, which contributes to more pain and discomfort in the head, neck, back, and/or shoulders. Chronic grinding and clenching causes strain on the muscles and pulls the TMJ out of place. While TMD is multifactorial, it is often of muscular origin and therefore, can be improved with myofunctional therapy.

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Myofunctional therapy is not speech therapy. It focuses on the muscles and tongue placement needed for speech sounds. Articulation errors can be caused by low tongue posture, tongue ties, and lip incompetence.

Ear Infections and Ear Concerns
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Proper swallowing creates negative pressure to draw fluid out of the ear. When poor swallowing mechanics are present, the Eustachian tubes cannot drain effectively. Ear infections are often connected to tongue tie, mouth breathing, and tongue thrust. Ear concerns such as ringing, vertigo, feeling of fullness, and trouble clearing/popping of the ears are often interconnected with myofunctional symptoms. 

Laryngopharyngeal Reflux (Silent Reflux)
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Obstructive sleep apnea and acid reflux are closely related. The obstruction causes a vacuum effect in the throat, which suctions up stomach acid into the throat and causes inflammation. Mucous membranes of the throat and the tonsils become swollen and irritated. The tongue can also become irritated and swollen, which causes it to push against the sides of the teeth.

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Myofunctional therapy can be done before, during or after orthodontic treatment, but ideally it is done before or during treatment. It helps to eliminate any dysfunctional habits that may interfere with orthodontic treatment or cause relapse. If the tongue is in the incorrect position, it is working against orthodontic treatment and applying pressure in the incorrect spot. The tongue helps to retain any expansion that was gained, while the lips act as natural braces and balance out the pressure of the tongue to keep the teeth straight. 

If you have noticed any of these symptoms in yourself or your child and you would like more information on how Orofacial Myofunctional Therapy could benefit you, please do not hesitate to contact us. 

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