How to Maximize Airway Health for the Best Undisturbed Sleep We often don’t think about airway health and what could be the cause. If your airway is insufficient and easily collapses at night this leads to disrupted sleep, reduced ability to breathe, snoring and often obstructive sleep apnea (OSA). These are all referred to as symptoms within the sleep related breathing disorder (SBD) spectrum. Discover how the simple acts of breathing, sleeping, tongue posture and swallow pattern converge to create a foundation for optimal breathing, sleep and overall improved health and wellness.
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AIRWAY HEALTH EPIDEMIC We are facing an airway health epidemic with over 1-billion people suffering from sleep related breathing disorders (SBD) such as obstructive sleep apnea and snoring. Most cases of obstructive sleep apnea are undiagnosed. In the US alone, it's estimated that 80% are undiagnosed.
There are several factors that contribute to why this is the case. ⦁ Lack of Awareness: Many individuals are unaware of symptoms related to SBD or may underestimate their severity. ⦁ Symptom Misattribution: Some symptoms, such as daytime fatigue or snoring, are often attributed to other causes, leading individuals to overlook the possibility of a sleep or breathing disorder. ⦁ Limited Access to Sleep Testing: Access to sleep studies for diagnosis may be limited in some areas due to access or not offered in some healthcare systems or financially unattainable by others. ⦁ Stigma and Perception: There may be a stigma associated with SBD or a perception that symptoms are not serious, leading individuals to delay seeking treatment. ⦁ Asymptomatic Cases: In some instances, individuals with SDB may not exhibit obvious symptoms, making it challenging to identify without a formal sleep study. ⦁ CPAP Avoidance: The stigma associated with SBD or not wanted to be placed on a continuous positive airway pressure (CPAP) machine, may lead to denial or avoidance of seeking diagnosis and treatment.
When someone is diagnosed with OSA there is a 20-50% refusal to wear a continuous positive air pressure machine (CPAP), the gold standard for treatment. For those who do use CPAP, there is only a 50-60% success and/or compliance rate. Unfortunately, the sad truth is that most people who suffer sleep related breathing disorders are not being diagnosed or treated. We must do better for ourselves, our loved ones, and society in general by spreading awareness, screening, and considering all tools and therapies to support treatment.
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HOW DID WE GET HERE?
Modern soft, processed food diets have led to underused facial and tongue muscles resulting in smaller jaws and a smaller, weaker, and ultimately less efficient airway. Early humans had prominent, robust jaws adapted for chewing tough, fibrous plants and raw meats. Chewing this coarse diet required substantial jaw muscles and a strong tongue resulting in the development of a larger and stronger jaw. Bone growth follows muscle; if the muscle is not developed properly it stands to reason that the bone will not grow properly as a result. The advent of farming/agriculture introduced softer, more processed foods that were easier to consume. Over the next few generations, the need for powerful chewing diminished, leading to this reduction in jaw size and ultimately smaller-sized airways. Our ancestors had wide strong airways (think garden hose) while airways today tend to be much narrower and weaker (think beverage straw) due to the underdevelopment of the jaw and weak tongue muscles. With a smaller airway, any amount of increased tissue size through weight gain, inflammation, allergies, or a decrease in muscle tone due to aging, is enough to stress or collapse our airway while we are sleeping. At best this causes us to toss and turn or wake up and, at worst, we stop breathing or have apneic events throughout the night interrupting sleep and wreaking havoc on our health and the ability to get restorative sleep. 3
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Airway collapse affects our ability to breathe and sleep having a profound impact on physical and mental health. Commonly occurring symptoms in adults are often overlooked and unrecognized as contributors to SBD
⦁ Snoring ⦁ Audible breathing while sleeping ⦁ Witnessed pauses in breathing ⦁ Frequent nighttime urination ⦁ Mouth breathing ⦁ Dry mouth or sore throat ⦁ Morning headaches / Brain Fog ⦁ Excessive daytime sleepiness/tiredness
⦁ Chronic fatigue ⦁ Irritability and mood changes ⦁ Impaired cognitive function ⦁ Difficulty concentrating ⦁ Depression / Anxiety ⦁ Excess weight gain ⦁ Decreased libido ⦁ High Blood Pressure ⦁ TMJ issues ⦁ Teeth grinding
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COMORBIDITIES OF SLEEP DISTURBED BREATHING While most often associated with sleep, issues such as snoring, sleep apnea, and poor airway health can contribute to a multitude of many chronic health conditions, see below. Comorbidities of SDB can contribute to or exacerbate other health conditions due to the complex physiological and systemic effects of disrupted sleep and altered respiratory patterns, the severity of which can vary among individuals.
The split across many healthcare specialties working to address airway health has led to a fragmentation of knowledge and treatment methodologies. Fortunately, this is starting to change. Airway focused professionals are working together to identify signs of SDB and the causes of a person’s airway collapse and how to address these factors to achieve the best individual results.
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WHAT FACTORS CAN AFFECT AIRWAY COLLAPSE AND THE BODY’S ABILITY TO AROUSE OR AWAKEN? Take a moment to picture the back of your throat, known as the upper airway. While we sleep, the muscles in our mouth and throat relax, making them more prone to falling back and obstructing the air passage due to the influence of gravity and the negative pressure created during breathing, similar to a vacuum. Different individuals may have specific areas of the airway that are susceptible to collapse, such as the tongue, soft palate, epiglottis, and throat. For instance, when lying on the back, some people may experience increased snoring and sleep apnea because the tongue falls back into the airway under the influence of gravity. When our airway is smaller it makes it harder to breathe resulting in little or no airflow. The body works harder to breathe and the airway dilator muscles in the tongue and upper throat work harder to open the airway. When the airway is blocked an arousal happens sending the brain an alarm to wake up the body to breathe. There are 4 factors affecting the collapsibility of the airway, including anatomical structures, muscle responsiveness, arousal threshold and loop gain. Anatomical Structures The development and size of the anatomical features of the skull, jaw size and muscles of the airway allow for collapse. The development of adequate bone structure and space is a key element. By age six, 60% of a child’s orofacial development is complete and increases to 90% by age twelve. These structures develop based on the pressure exerted by the tongue and jaw while chewing foods and at rest, counteracting pressure from our cheeks and lips. A weak tongue will not support optimal growth and development, leading to a narrow upper jaw and crowded teeth. Maintaining proper tongue posture, nasal breathing, correct swallowing technique, and overall muscle strength are keys to early intervention and supporting proper development. The tongue is crucial in the formation of the upper jaw and floor of the nasal cavity. A weak tongue often lacks the strength to stay in the proper position, lightly suctioned to the roof of the mouth while at rest. When the tongue rests against the roof of the mouth, it exerts a gentle force that helps in proper growth and alignment of the upper jaw. This contributes to a wider dental arch, enough space for teeth and the development of a sufficient airway. If tongue strength and position is not addressed, it can lead to the underdevelopment of the airway and impact one’s ability to breathe both day and night.
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In a somewhat common condition, tongue-tie (ankyloglossia), the tongue’s range of motion is limited. Depending upon its severity can be extremely difficult, or even impossible, to lift or elevate the tongue, preventing the tongue from being held in its ideal position lightly suctioned to the roof of the mouth at rest. There are procedures that can be performed to correct and release these tied oral tissues. Other Soft Tissues within airway space can also impact breathing including fascia and muscles of the throat and tongue and soft palate. When weight is gained these tissues can increase in size further reducing the overall space for breathing. Further, inflammation of these soft tissues due to allergies or enlargement of the tonsils and adenoids can take up additional room in the airway. Specialized exercises called myofunctional therapy focus on the soft tissues to the mouth and throat to strengthen and tone muscles having a positive impact on overall airway health. Muscle Responsiveness How well muscles of the mouth and throat work react to keep the airway open. Our mouth and throat muscles relax while we sleep making it easier for the airway to collapse. Poor coordination of airway muscles can lead to vibration (snoring) and other disordered breathing during sleep. Upper airway exercises or myofunctional therapy can also help improve muscle coordination, tone, and responsiveness. Arousal Threshold Arousal Threshold refers to the moment when the body signals to wake up due to insufficient oxygen levels. The sensitivity of this response varies among individuals, influencing the likelihood of being roused to resume breathing. Breath training has the potential to enhance this capacity, reducing the frequency of arousals and promoting a more restful sleep experience. Loop Gain Pertains to alterations in the breathing process and disruptions that can result in unstable breathing, encompassing both insufficient breathing (hypoventilation) and excessive breathing (hyperventilation). Adopting healthy breathing habits and engaging in breath coaching, such as Buteyko breathing, can enhance carbon dioxide tolerance, decrease arousals, and improve the ability to manage overbreathing.
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Nasal Breathing is Essential Humans are obligatory nasal breathers and are not intended to breathe through their mouth. The tongue’s resting position is crucial for proper function, growth, development, and nasal breathing. Breathing through the nose, as opposed to the mouth, serves several important functions that contribute to optimal wellbeing.
Here are some reasons why nasal breathing is considered critical: Activation of Diaphragmatic Breathing & Optimal Oxygenation: Nasal breathing encourages diaphragmatic breathing, where the diaphragm, the primary muscle involved in breathing, is engaged. This type of breathing promotes efficient oxygen exchange and helps activate the lower part of the lungs, enhancing respiratory function. Maintaining Airway Resistance: Nasal breathing creates mild airway resistance. This resistance helps maintain optimal pressure in the airways, supporting the balance of oxygen and carbon dioxide levels in the blood. Filtration of Air: Nasal breathing helps filter out airborne particles, allergens, dust, and pollutants, preventing them from entering the respiratory system and causing irritation or inflammation. Humidification and Warming of Air: Nasal breathing helps warm and adds moisture to the air before it reaches the lungs which is crucial for maintaining the health of the respiratory tissues. Dry, cold air can irritate the airways and may contribute to conditions such as nasal congestion and discomfort. Nitric Oxide Production: The nasal sinuses produce nitric oxide (NO), a molecule with various physiological functions. NO has vasodilatory effects, helping to expand blood vessels and improve blood flow. It also has antimicrobial properties, contributing to the body's defense against infections. Reduction of Mouth Breathing-Related Issues: Chronic mouth breathing, especially during sleep, can contribute to dry mouth and increase the risk for dental cavities, and SDB issues including snoring and obstructive sleep apnea. Nasal breathing helps prevent these problems and supports more restful sleep. Promotion of Relaxation and Calmness: Nasal breathing is associated with the activation of the parasympathetic nervous system, often referred to as the "rest and digest" system. This can help promote a sense of relaxation and calmness. 8
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REMplenish Myo-Nozzle: the simple solution to help improve airway health REMplenish targets the root cause of weak tongue muscles and low tongue posture by providing guided exercise repetitions with targeted resistance to easily strengthen the airway by simply drinking water. These actions reinforce proper tongue posture helping to stabilize the airway and support essential nasal breathing. Myofunctional therapists and speech language pathologists have reported a reduction in therapy times when incorporating REMplenish. “What makes my program unique is that I use REMplenish with ALL my clients, young kids and adults.” Kimi Nishimoto In a 2020 REMplenish usability study, 93% of snorers showed improvement. Currently, Mayo Clinic is researching the potential application of REMplenish in the treatment of obstructive sleep apnea (OSA).
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SLEEP DISORDERED BREATHING ISSUES OFTEN BEGIN IN CHILDHOOD
A majority of children with sleep disordered breathing remain undiagnosed. The most common reason lies in the fact that children frequently present signs and symptoms that are less widely recognized. If left unaddressed, these issues in children will continue and develop into more substantial problems as we age. When children are unable to breathe well at night, their quantity and quality of sleep suffers. If your child exhibits any of the following symptoms, they could be suffering from sleep disordered breathing: • Snoring • Mouth Breathing • Odd Sleeping Positions • Bed Wetting • Restless Sleep • Teeth Grinding • Behavioral & Learning Issues •Cognitive Developmental Delays • Dark Under Eye Circles • Hyperactivity • ADHD like behavior • Enlarged Tonsils or Adenoids • Over Tired • Anxiety • Speech Problems • Digestive Issues • Teeth Crowding
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How REMplenish Jr Can Help? Early intervention is critical in the growth years. Correct oral function and correct tongue posture play crucial roles in the development and overall wellbeing of children. By the age of 6, a child’s orofacial development is 60% complete – that number is 90% by age 12. Because of this, early intervention is critical in ensuring development happens properly. Having good tongue posture, nasal breathing, correct swallowing technique, and muscle strength will have a greater (positive) effect the younger you are.
The REMplenish Jr Myo-Nozzle can help as it’s designed especially for children between 3-9 years of age to strengthen their tongue and supporting these key components. Children easily drink water through a REMplenish Jr Myo-Nozzle. They think they are simply drinking water with a fancy spout. In reality, they are getting targeted exercise repetitions to strengthen the muscles of the tongue, mouth and throat. This easy form of oral exercise reinforces proper tongue position which impacts proper speech, helps strengthen the airway, supports nasal breathing and is a critical component to arch growth and development. REMplenish Jr leads to improved breathing, better quality sleep, and healthier and happier kids simply by drinking water.
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Myofunctional Therapy Myofunctional therapy includes specific exercises to target the muscles of the tongue neck and throat and is usually guided by a therapist to achieve the best results. The goal of therapy is to retrain these muscles to promote proper function and positioning. Everyday habits can lead to neuromuscular imbalances that can overuse or underuse some muscles leading them to work harder than others to compensate for one another. Increases in fat tissue and reduced muscle function with age can exacerbate these imbalances. Conditions such as snoring and obstructive sleep apnea can result. Studies have shown myofunctional therapy to be an additional support and option to reduce obstructive sleep apnea and snoring by 50% or greater. Goals of Myofunctional Therapy Breathe through nose during the day and night Rest tongue on roof of mouth Swallow correctly Keep lips together with light pressure REMplenish targets the root cause of weak tongue muscles and low tongue posture by providing guided exercise repetitions with targeted resistance to easily strengthen the airway by simply drinking water. These actions reinforce proper tongue posture helping to stabilize the airway and support essential nasal breathing.
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What can I do today to make a change in my breathing and sleep Improving your breathing, tongue position, nasal hygiene, and sleep can have a positive impact on your overall well-being. Here are 4 tips to help you breathe better and enhance your sleep quality: Practice Nasal Hygiene: Incorporate nasal hygiene into your daily wellness routine. Cleaning your nose daily is just as important as brushing your teeth. Keeping your nasal passages clean, clear and moisturized enhances all the functions of your nose, and removes allergens, and reduces congestion and disrupts breathing or causes inflammation, infections and disease. Consider using a saline nasal spray such as Xlear by Spry or a neti pot to irrigate your nasal passages. Use the REMplenish Myo-Nozzle to Maintain Proper Tongue Posture while staying hydrated: Regular use develops the natural strength to maintain your tongue lightly suctioned against the roof of your mouth, day or night, while not talking or chewing. This posture can contribute to better respiratory and oral health. Drinking enough water throughout the day will help to keep your nasal passages and throat moist. Hydration supports healthy mucous membranes and can reduce snoring.
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Practice Nasal Breathing: Make a conscious effort to always inhale and exhale through your nose while keeping your lips closed. Not only will it help you get optimal oxygenation to your blood and organs, but the nose’s filtration system also plays an important role in your immune system by creating nitric oxide. Try Buteyko Breathing: Learn more about the role to proper breathing in Patrick McKeown’s book The Oxygen Advantage
Try Myofunctional Exercises Keep your tongue suctioned to the roof of your mouth. Say the letter N, this gets the tip of your tongue to the correct spot, then lift the rest of your tongue, and press it to the roof of your mouth and hold. This represents the correct or ideal tongue posture. Strengthening your tongue can facilitate maintaining it in this optimal position. Your tongue and throat muscles can benefit from exercise just like any other muscle group in your body. This can help prevent airway collapsibility at night and can reduce vibration that we know as snoring. See a list of additional myofunctional exercises to try on the following page.
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Myofunctional Exercises Each exercise should be repeated 10 times and ideally the entire set should be done at least 3 times throughout the day. It is helpful to watch yourself in a mirror or selfie setting on your phone. While performing the exercises try to maintain relaxed facial muscles and avoid moving the chin up and down or side to side. Exercise 1: Push the tip of the Tongue up to “Spot” – Say the letter “N” where the tip of the tongue lands is the “Spot”. Place and hold the tip of the tongue against the “Spot” on the roof of the mouth, just behind the top teeth. Hold for 5 seconds. Repeat 10 times. Exercise 2: Tongue Waggle – Stick the tongue all the way out and shift it from side to side trying to reach the corners of the mouth. Try not to touch the lower teeth or shift the chin as the tongue moves from side to side. Waggle to each side 10 times doing a complete set of 20 Exercise 3: Touch Nose - Stick out your tongue and try to touch the tip of your nose and hold for 10 seconds, then relax. Repeat 10 times. Exercise 4: Touch Chin - Stick out your tongue and try to lick the bottom of your chin and hold for 10 seconds, then relax. Repeat 10 times. Exercise 5: Click the Tongue – Suction the tongue to the roof of the mouth and release making a loud clicking sound when the tongue is released. Click the tongue for 15 seconds and then repeat 10 times. Exercise 6: Push the Tongue Against a Spoon -Push the tip of your tongue firmly against a spoon held in front of your lips for 10 seconds. Keep the tongue straight and don't let it point downwards. Repeat 10 times. Exercise 7: Hold a Spoon - Place the handle of a metal spoon between your lips and hold it in place with only your lips for 10 seconds. Do not place the handle between your teeth. Try to keep it parallel to the floor. As your strength improves, you can place other small objects on the spoon for added weight (i.e., sugar cube). Repeat 10 times. Exercise 8: Roll Tongue - Roll your tongue by folding the edges toward the middle lengthwise, so it looks like the end of a taco shell. Stick it out as far as you can while keeping it folded and hold for 10 seconds, then relax. Repeat 10 times. This is an advanced exercise and may be difficult for some.
For more advance support seek care from a trained myofunctional therapist from resources listed on the last page. 15
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Additional Resources If you are looking for more information, there are several great books related to airway health and how we can live our best lives. Check out the list below! “No matter what we eat, how much we exercise, how resilient our genes, how skinny or young or wise we are —none of it will matter unless we're breathing correctly. That's what these researchers discovered. The missing pillar in health is breath. It all starts there.” Learn more about the long-term effect of small jaws and its impact on proper breathing. We invite you check out the book Breath by James Nestor
“There's a silent epidemic sweeping Western civilization, and it is happening right under our noses. Our jaws aren’t developing properly, and our teeth are increasingly crowded and crooked. Our shrinking and sagging jaws are leading to problems from the obviously critical to the seemingly small, from obstructed airways to less attractive faces. Braces and other devices can fix the tooth problems, but not the hidden dangers and serious diseases such as sleep apnea, heart disease, and cancer that can result from poor jaw development. It’s crucial that we address the underlying causes of too-small jaws, including insufficient chewing and mouth breathing.”
“Chances are, you or someone you know is affected by a tongue-tie. Common, yet little understood, tongue-ties can lead to a myriad of problems, including difficulty when nursing, speaking or eating. In the most crucial and formative parts of children’s lives, tongue-ties have a significant effect on their well-being. Many parents and professionals alike want to know what can be done, and how best to treat these patients and families. And now, there are answers.”
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“One of the biggest obstacles to better health and fitness is a rarely identified problem: chronic over-breathing. We often take many more breaths than we need—without realizing it—contributing to poor health and fitness, including a host of disorders, from anxiety and asthma to insomnia and heart problems.”
Need further guidance seek support from an airway focused professional:
Visit our website at www.remasteredsleep.com and save 15% with code DRTALKS15 at checkout. Your journey to better airway health starts at
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