Orofacial Myofunctional Therapy and Sleep Apnea

July 13, 2022

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Did you know that 29.4 million US adults have an obstructive sleep disorder, with more men than women suffering from this disorder? Obstructive sleep apnea (OSA), a type of sleep-breathing disorder (SBD), can have multiple contributing factors. OSA is an intermittent-breathing sleep disorder, which causes the person to stop and then start breathing on and off during their sleep.1

One of the most recognizable symptoms of OSA is snoring.10 While there are a few causes of the disorder, sleep apnea can be directly related to an orofacial myofunctional disorder (OMD), which means the tongue, lip, or jaw is misaligned, causing issues with swallowing, speech, or night breathing.

A doctor can diagnose this disorder, while a dentist can help screen and provide treatment. Upon diagnosis, a highly effective treatment is orofacial myofunctional therapy (OMT). OMT uses training exercises to help the patient reposition the tongue and increase nasal breathing, giving them a more complete night’s sleep with less disruption and snoring.

Sleep apnea is disruptive and can and should be treated. With the option of OMT, a patient’s quality of life can be greatly improved. Let’s dive into everything you need to know about orofacial myofunctional therapy, such as what it is, its connection to OSA, the steps to diagnosis, and who would be an excellent candidate for treatment.

What is orofacial myofunctional therapy?

Simply put, orofacial myofunctional therapy is therapy that includes exercises for the face, tongue, and mouth. The aim is to increase muscle tone, endurance, and coordinated movements of pharyngeal and peripharyngeal muscles. Because increased muscle tone (especially with the tongue) can decrease snoring and open up breathing passages, it can be an effective treatment for sleep apnea.

One orofacial myofunctional disorder, tongue-tie, can be a contributing factor to sleep apnea. OMT engages in exercises that help with disorders such as tongue-tie. These exercises may include the following:

  • Lip puffing exercises
  • Balloon blowing
  • Lip movement with different sounds
  • Tongue exercises

Therapies and treatments will vary depending upon the physician or dentist’s approach. Treatment is most effective when performed and practiced consistently. As with any muscle development, regular exercise is required to maintain the facial, tongue, and mouth muscles.

Can OSA be caused by OMDs (orofacial myofunctional disorders)?

Anything that causes the tongue to rest in such a way that obstructs the airways can lead to an orofacial myofunctional disorder. The American Speech-Language-Hearing Association (ASHA) points out that no single cause of OMDs has been identified. Rather, there are several factors that can contribute to OMDs. Some of the factors listed include the following:

  • Nasal Obstruction. Due to allergies, the structure of the nasal passages, and enlarged tonsils, the nasal passage can become obstructed. This can cause an OMD in both children and adults.
  • Anatomical Variations. Macroglossia, a high, narrow palate, or enlarged tonsils can also contribute to an OMD.
  • Chewing or Sucking Habits. Habits that were formed and continued after age three or when all primary teeth are present can contribute to an OMD.
  • Other Factors. Maxillary incisors that prematurely exfoliate, or orofacial anomalies, are other contributing factors to OMD.

Obstructive sleep apnea also has several contributing factors.10 A study on nocturnal arrhythmias in older men showed that both obesity and aging are highly contributing factors for men 50 and older. As people age, the position of the tongue while sleeping may change. This can lead to an OMD.

The ASHA points out that OMDs can also be found in children, adolescents, and adults. However, while OMDs can be found in all demographics of the population, symptoms may differ between age groups. For example, sleep apnea in children may exhibit as inattention, hyperactivity, and malnutrition, so thorough screening and interviewing are necessary to determine the possible origins of an OMD.

Who can diagnose an OMD?

Screening, diagnosing, and treating an OMD requires an interdisciplinary team. There are a variety of screening and assessment tools, which health care providers can use to determine whether a patient has an OMD. When screening for an OMD, providers should consider the following signs and symptoms:

  • Chronic headaches
  • Teeth moving after an orthodontic treatment
  • Neck pain
  • Tempromandibular joint (TMJ) pain
  • A lisp with “s” sounds
  • Mouth breathing
  • Teeth grinding
  • Tongue-tie

A dental professional will check for tongue thrust (the tongue is pressed against or spreads between the teeth). A dentist may refer a patient to an orthodontist due to an overbite. A dentist will also check for malocclusion or misalignment of the teeth. A dentist or orthodontist may check to see if the teeth have been moved even after an orthodontic treatment. All of these check-ups can indicate the possibility of an OMD.

In addition to a dentist, a doctor can check for difficulties with eating or breathing changes (such as increased mouth breathing). The doctor can also point out a tongue thrust and will ask questions about sleep patterns, especially in children. Developmental delays can also be contributing factors for an OMD, and a pediatrician will watch carefully for these.

Who performs OMT?

What are the treatment options for someone diagnosed with an OMD and sleep apnea? Recent studies have shown orofacial myofunctional therapy to be an effective treatment for both of these issues.2,4 This treatment was shown to significantly reduce sleep apnea’s severity and symptoms for patients with moderate OSA.

So, who can perform OMT? Dentists, hygienists, doctors, and speech therapists trained in OMT can offer the therapy to their patients.

The Vivos Institute welcomes providers from around the world to learn more about obstructive sleep apnea (OSA). For a dentist looking to learn more about OMT, several state-of-the-art training sessions are scheduled throughout the year. These events include instruction and learning from industry experts on obstructive sleep apnea’s impact, as well as how to grow a dental practice and change lives with this life-improving therapy.

Who can receive OMT?

Studies have shown orofacial myofunctional therapy to be effective in adults for severe snoring or OSA, as well as for the treatment of children for residual apnea. The use of the basic OMT exercises, when done daily, can significantly decrease the sleep apnea index by 50 percent in adults and 62 percent in children alone. Being a dentist or doctor who can perform OMT is a noninvasive treatment option for treating OMDs and sleep apnea. This therapy has proven to be quite successful and is a good option for those looking to decrease their snoring and sleep issues.

Recognizing OMDs early and providing OMT can improve quality of life, giving patients better sleep, increased oxygen, healthier habits, and more. For in-depth training on these OMT treatments, visit The Vivos Institute.

References
1. American Academy of Sleep Medicine. (2016). Hidden Health Crisis Costing America Billions Underdiagnosing and Undertreating Obstructive Sleep Apnea Draining Healthcare System. Retrieved from https://aasm.org/advocacy/initiatives/economic-impact-obstructive-sleep-apnea/
2. Bandyopadhyay, A., Kaneshiro, K., & Camacho, M. (2020). Effect of myofunctional therapy on children with obstructive sleep apnea: a meta-analysis. Sleep medicine, 75, 210–217. doi:10.1016/j.sleep.2020.08.003
3. Camacho, M., Certal, V., Abdullatif, J., Zaghi, S., Ruoff, C. M., Capasso, R., & Kushida, C. A.(2015). Myofunctional Therapy to Treat Obstructive Sleep Apnea: A Systematic Review and Meta-analysis. Sleep, 38(5), 669–675. doi:10.5665/sleep.4652
4. de Felício, C. M., da Silva Dias, F. V., & Trawitzki, L. (2018). Obstructive sleep apnea: focus on myofunctional therapy. Nature and science of sleep, 10, 271–286. doi:10.2147/NSS.S141132
5. Guilleminault, C., Huang, Y. S., Monteyrol, P. J., Sato, R., Quo, S., & Lin, C. H. (2013). Critical role of myofascial reeducation in pediatric sleep-disordered breathing. Sleep medicine, 14(6), 518–525. doi:10.1016/j.sleep.2013.01.013
6. Guimarães, K. C., Drager, L. F., Genta, P. R., Marcondes, B. F., & Lorenzi-Filho, G. (2009). Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome. American journal of respiratory and critical care medicine, 179(10), 962–966. doi:10.1164/rccm.200806-981OC
7. Koka, V., De Vito, A., Roisman, G., Petitjean, M., Filograna Pignatelli, G. R., Padovani, D., & Randerath, W. (2021). Orofacial Myofunctional Therapy in Obstructive Sleep Apnea Syndrome: A Pathophysiological Perspective. Medicina (Kaunas, Lithuania), 57(4), 323. doi:10.3390/medicina57040323
8. Mehra, R., Stone, K. L., Varosy, P. D., Hoffman, A. R., Marcus, G. M., Blackwell, T., Ibrahim, O. A., Salem, R., & Redline, S. (2009). Nocturnal Arrhythmias across a spectrum of obstructive and central sleep-disordered breathing in older men: outcomes of sleep disorders in older men (MrOS sleep) study. Archives of internal medicine, 169(12), 1147–1155. doi:10.1001/archinternmed.2009.138
9. Mohammed, D., Park, V., Bogaardt, H., & Docking, K. (2021). The impact of childhood obstructive sleep apnea on speech and oral language development: a systematic review. Sleep Medicine, 81, 144–153. doi:10.1016/j.sleep.2021.02.015
10. Strohl, K. P. (n.d.). Obstructive Sleep Apnea. Retrieved June 2, 2022, from Merck Manuals Professional Edition website: https://www.merckmanuals.com/professional/pulmonary-disorders/sleep-apnea/obstructive-sleep-apnea
11. Villa, M. P., Evangelisti, M., Martella, S., Barreto, M., & Del Pozzo, M. (2017). Can myofunctional therapy increase tongue tone and reduce symptoms in children with sleep-disordered breathing? Sleep And Breathing, 21(4), 1025–1032. doi:10.1007/s11325-017-1489-2