Close-up of a person with tongue tie

The Connection between Tongue-Tie and Sleep Apnea Explained

May 5, 2022

Many people wonder if there is a connection between tongue-tie and sleep apnea. So, let’s address two questions right up front: First, can sleep apnea and tongue-tie be connected? Second, which type of breathing is a good indicator that you have neither health issue?

The answers, would you believe, are yes and nose. (See what we did there?)

Considering the connection occurs in the muscles of the mouth, maybe we should delve into the tissue further as research indicates that the main connection between tongue-tie and sleep apnea occurs mostly in children due to the way tongue-tie affects the shape of their palate over time.

What Is Tongue-Tie?

Present at birth, tongue-tie (ankyloglossia) is a condition that restricts the tongue’s range of motion. With tongue-tie, the tongue is tethered to the floor of the mouth by a band of tissue called the lingual frenulum. According to the Mayo Clinic, babies with tongue-tie may experience trouble breastfeeding. Other telltale signs of a child with tongue-tie include difficulty sticking out their tongue as well as additional problems with eating, speaking, and swallowing.

Further symptoms of tongue-tie include the following:

  • Problems sticking the tongue out past the lower teeth
  • A tongue that is notched when stuck out
  • Difficulty moving the tongue from side to side
  • Difficulty lifting the tongue to the upper teeth

According to John Hopkins Medicine, tongue-tie is classified into four distinct levels. They are as follows:

  • Type I: The frenulum is thin and elastic and anchors the tip of the tongue to the ridge behind the lower teeth.
  • Type II: The frenulum is fine and elastic, and the tongue is anchored 2–4 millimeters from the tip to the floor of the mouth close to the ridge behind the lower teeth.
  • Type III: The frenulum is thick and stiffened and anchors the tongue from the middle of the underside to the floor of the mouth.
  • Type IV: The frenulum is posterior or not visible; when touching the area with the fingertips, the examiner can feel tight fibers anchoring the tongue, with or without a thickened, shiny surface on the floor of the mouth.

Other tongue-tie facts: Tongue-tie is more common in boys. In some cases, tongue-tie may not cause problems. Some cases of tongue-tie may require a simple surgical procedure for correction.

What Are the Most Common Symptoms of OSA?

Obstructive sleep apnea is a serious breathing disorder that affects an estimated 22 million Americans. It occurs during sleep when the soft tissue at the back of a person’s throat relaxes and blocks their upper airway. This can happen myriad times during the night, depriving the sufferer of oxygen and often forcing them to awake gasping for air.

Symptoms of OSA include the following:

  • Loud snoring
  • Episodes of stopped breathing
  • Waking up gasping for air
  • Morning headache
  • Awakening with a dry mouth
  • Difficulty staying asleep
  • Excessive daytime drowsiness
  • Difficulty focusing or paying attention
  • Irritability

Sleep apnea complications can be extremely serious. Health issues associated with OSA include daytime fatigue, high blood pressure, heart problems, type 2 diabetes, liver problems, metabolic syndrome, additional complications with surgery and medications, and sleep-deprived partners.

The main risk factors for sleep apnea include obesity, neck circumference, a narrow airway, being male, being older, family history, nasal congestion, other medical conditions, and the use of alcohol, sedatives, or tranquilizers.

How Does Tongue-Tie Affect Sleep Apnea?

There doesn’t necessarily appear to be a direct cause-and-effect correlation between tongue-tie and sleep apnea, but there is a distinct trail of connection between the two.

When tongue-tie goes untreated, especially in children, the tongue tends to sit lower in their mouth instead of making contact with the roof of the mouth when swallowing. This often results in a high, narrow palate that reduces the spaces necessary for nose breathing. Because of this, those children tend to rely mostly on breathing through their mouths.

Mouth breathing, in turn, has been found to contribute to OSA later in life. So the common connection between many cases of tongue-tie and sleep apnea is mouth breathing.

Snoring is the top sign of mouth breathing at night, and it’s a key symptom of OSA. According to WebMD, other common symptoms of mouth breathing include the following:

  • Bad breath
  • Dry mouth
  • Hoarseness
  • Brain fog
  • Waking up tired and irritable

If you find yourself with these symptoms, you should schedule a visit with your physician to see if there is a connection between tongue-tie, mouth breathing, or sleep apnea in your case.

Orofacial Myofunctional Therapy and Sleep Apnea

Orofacial myofunctional therapy is a treatment that helps offset some of the issues of tongue-tie and also targets risk factors of sleep apnea. The therapy is a series of exercises aimed at strengthening the facial muscles primarily used to swallow and chew. The exercises also make the tongue stronger.

Orofacial myofunctional therapy exercises are meant to improve muscle strength in the oropharynx—the part of the body that includes the mouth and throat. Those muscles are all intrinsic in talking, eating, and breathing and are what keeps the upper airway open when we sleep. If those muscles are weak, they allow the airway to collapse and become blocked. Additionally, a weak tongue may flop back in the throat and create an obstruction. The exercises also help reinforce the tongue’s proper position.

Myofunctional therapy exercises may be used by children six years and older as well as by adults. The main exercises can be done at home. For a complete list of exercises, visit VeryWell.com.

The sooner children are diagnosed with tongue-tie, the sooner strategies—from surgery to orofacial myofunctional therapy—can be employed to correct or offset the symptoms. Taking those steps will help diminish the propensity of mouth breathing and the likelihood of developing obstructive sleep apnea later in life.