Sleep Breathing Disorders

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Some helpful and related resources:

how to help promote proper craniofacial development

This is not medical advice.

What is a Sleep Breathing Disorder?

A sleep breathing disorder is when someone has trouble breathing properly while they sleep (many throughout the day, as well). For kids, this can show up as snoring, restless sleep, mouth breathing, or even pauses in breathing during the night. Because their bodies are still growing, these interruptions can affect everything from brain development and behavior to growth and overall health.

When a child’s airway is too small or blocked, often due to underdeveloped jaws, enlarged tonsils/adenoids, or chronic allergies, it can make it harder for them to get enough oxygen while they sleep. Instead of the deep, restorative sleep their body needs, they wake up tired, cranky, and may struggle with focus, energy, or even mood during the day.

Sleep Breathing Disorder (possible) Symptoms

• ADD/ADHD

• Bed Wetting

• Delayed Speech

• Overweight/Obesity

• Learning Difficulties

• Vertigo/Clumsiness

• Restless Legs

• Aggression/Defiance 

• Teeth Grinding

• Snoring

• Mouth Breathing

• Daytime Sleepiness

• Nightmares/Night Terrors

• Allergies/Asthma 

• Anxiety

• Frequent Illness

• Stunted Growth

• Crooked Teeth

• Swollen Tonsils/Adenoids

• Forward Head Posture

• Recessed/Stunted Chin

• Dark Circles Under the Eyes

OSA vs UARS - the provider you see matters!

Obstructive Sleep Apnea (OSA) and Upper Airway Resistance Syndrome (UARS) are both sleep-related breathing issues, but they show up in different ways. OSA happens when the airway becomes blocked during sleep, causing pauses in breathing or very shallow breaths. This often leads to loud snoring, noticeable breathing pauses, drops in oxygen levels, and daytime sleepiness. It’s also linked to higher risks for things like high blood pressure, heart problems, and stroke.

UARS, on the other hand, is a bit different. Instead of full pauses in breathing, the airway becomes more narrow and resistant, making it harder to breathe smoothly. This doesn’t usually cause oxygen drops, but it does cause frequent sleep disruptions. People with UARS may not snore as loudly and may not seem “sleepy” during the day, but they often feel exhausted, unrefreshed, or struggle with insomnia-like symptoms.

If left untreated UARS will, most times, turn into sleep apnea. This is important to keep in mind, because if you undergo a sleep apnea test and it comes back negative, UARS could still be at large. If a provider is not properly trained in airway disorders (most aren't), then this often goes overlooked.

The Importance of Nasal Breathing

Our nose is designed to prepare the air for the lungs. The nose warms, filters, accelerates, humidifies, and cleans the air, which leads to efficient oxygen exchange in the lungs. The mouth does none of this, and actually reduces oxygen absorption (1.4).

Nasal breathing also produces Nitric Oxide (1.1), an anti-inflammatory molecule that aids in immune function. Where as mouth breathing decreases immunity and causes inflammation throughout the body (1.2, 1.3).

Think about hyperventilation…what happens when you hyperventilate? You rapidly breathe through your mouth and do not receive the proper exchange of oxygen, which results in a negative effect all over. When you are mouth breathing (day or night) the body is sent into a constant fight or flight mode, which puts your adrenal glands on max 24/7. 

Sleep Disorders and ADHD

It is estimated 50-70% of children with ADHD have some form of sleep disturbance (AAP, National Resource Center on ADHD). Oral dysfunction, underdeveloped jaws, and a compromised airway prevents the proper sleep needed for glymphatic drainage and nitric oxide production.

The AAPD recognizes that children with untreated obstructive sleep apnea may be inappropriately diagnosed with ADHD. When children can’t breathe, they can’t sleep (properly). This puts them in a constant state of sleep deprivation. The brain stimulates the body in order to keep it awake - hence the ADHD symptoms.

Even The National Resource Center on ADHD acknowledges that ADHD may be associated with a state of increased sleepiness rather than hyperactivity, and that the hyperactivity could be a coping mechanism to counteract the daytime sleepiness. 

So what causes sleep breathing disorders?

There are a myriad of reasons a compromised airway/sleep breathing disorder may form, and many go hand-in-hand:

• high narrow palate caused by

  • thumb sucking

  • soft food diet

  • prolonged bottle use

  • prolonged paci use

  • prolonged sippy cup use

• weak tongue

• enlarged tonsils/adenoids

• low tongue posture

• oral ties - read about infant ties ; read about child/adult ties

• to name a few

Mouth Breathing: Primate Study

Two fascinating studies by Dr. Egil Harvold, published in the American Journal of Orthodontics and Dentofacial Orthopedics, observed young monkeys with plugged noses forcing them to adapt by mouth breathing.

This study found that ALL the monkeys who mouth breathed developed crooked teeth and poor jaws & facial development. Specifically, mouth breathing led to “a lowering of the chin, a steeper mandibular plane angle, and an increase in the gonial angle.” Their faces become long and narrow, with the jaw prominent and the chin recessed. 

Weston A. Price Foundation

Mouth Breathing: Interventions

Treatment will vary depending on age and severity. If caught early during childhood, the treatment is often much more simple. Early correction for optimal child development will typically involve a TEAM approach of an airway centered & trained dentist, an ENT specialist, speech/myo therapist, body worker, and possibly orthodontist. 

Browse a list of providers by state here.

CLICK HERE TO READ MORE!!!

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MORE RESOURCES:

Pediatric Sleep & Breathing Case Studies: The Breathe Institute with Dr. Soroush Zaghi

PODCASTS

• Dr. Leonard Sax | The Over Diagnosis of ADD Children & How Parents Can Advocate

• A Mother's Journey: When an ADHD Misdiagnosis is Actually a Sleep Breathing Disorder

• The Co-Morbidities of Mouth Breathing: ADD/ADHD | Dr. Ben Miraglia

• The Co-Morbidities of Mouth Breathing: Asthma | Dr. Ben Miraglia

• The Co-Morbidities of Mouth Breathing: Bed Wetting | Dr. Miraglia

• Epigenetic Jaw Orthopedics for Airway & Facial Development | Dr Felix Liao

TONGUE TIE RESOURCES & RESEARCH:

• Tongue Ties For Infants - READ BEFORE RELEASING

• Tongue Ties for Kids/Adults - READ BEFORE RELEASING

• Lingual Frenuloplasty (tongue tie) with Myofunctional Therapy

• Tethered Oral Ties: The Assessment and Diagnosis of the Tongue and Upper Lip Ties in Breastfeeding

• Muscle tension dysphonia in singers and professional speakers with ankyloglossia: Impact of treatment with lingual frenuloplasty and orofacial myofunctional therapy

  • Eleven out of twelve patients (91.6%) reported clinical improvement in the use of their voice after functional frenuloplasty

• Assessment of posterior tongue mobility using lingual-palatal suction: Progress towards a functional definition of ankyloglossia

• Ankyloglossia as a risk factor for maxillary hypoplasia and soft palate elongation: A functional – morphological study

• Tongue surgeries for pediatric obstructive sleep apnea: a systematic review and meta-analysis

• Tongue–lip adhesion and tongue repositioning for obstructive sleep apnoea in Pierre Robin sequence: A systematic review and meta-analysis

  • Results: Tongue–lip adhesion and tongue repositioning can improve apnea/hypopnoea index and oxygenation parameters in children with Pierre Robin sequence and obstructive sleep apnea.

• Speech Outcomes of Frenectomy for Tongue-Tie Release: A Systematic Review and Meta-Analysis

  • Overall, frenectomy for tongue-tie was associated with an improvement in speech articulation

• Frenectomy for the Correction of Ankyloglossia: A Review of Clinical Effectiveness and Guidelines

TONGUE TIE BOOKS

• Tongue Tied by Dr. Richard Baxter

MORE RESOURCES

• Long-term implications of untreated tongue ties by Dr. Soroush Zaghi

• Tongue Tie Compensations

Sources

1.1 Lundberg JO, Settergren G, Gelinder S, Lundberg JM, Alving K, Weitzberg E. Inhalation of nasally derived nitric oxide modulates pulmonary function in humans. Acta Physiol Scand. 1996 Dec;158(4):343-7. doi: 10.1046/j.1365-201X.1996.557321000.x. PMID: 8971255.

1.2 Edwards DA, Chung KF. Mouth breathing, dry air, and low water permeation promote inflammation, and activate neural pathways, by osmotic stresses acting on airway lining mucus. QRB Discov. 2023 Feb 14;4:e3. doi: 10.1017/qrd.2023.1. PMID: 37529032; PMCID: PMC10392678.

1.3https://scholarhub.ui.ac.id/cgi/viewcontent.cgi?article=1005&context=jdi#:~:text=In%20conclusion%2C%20the%20results%20of,when%20compared%20to%20nasal%20breathers.

1.4 Mouth Breathing: Understanding the Pathophysiology of an oral habit and its consequences Ramirez-Yanez German O., DDS, MDSc, MSc, PhD

2.1 Lörinczi F, Vanderka M, Lörincziová D, Kushkestani M. Nose vs. mouth breathing- acute effect of different breathing regimens on muscular endurance. BMC Sports Sci Med Rehabil. 2024 Feb 9;16(1):42. doi: 10.1186/s13102-024-00840-6. PMID: 38336799; PMCID: PMC10858538.

2.2 Neiva PD, Kirkwood RN, Mendes PL, Zabjek K, Becker HG, Mathur S. Postural disorders in mouth breathing children: a systematic review. Braz J Phys Ther. 2018 Jan-Feb;22(1):7-19. doi: 10.1016/j.bjpt.2017.06.011. Epub 2017 Jul 5. PMID: 28709588; PMCID: PMC5816083.

3 Oeverland B, Akre H, Skatvedt O. Oral breathing in patients with sleep-related breathing disorders. Acta Otolaryngol. 2002 Sep;122(6):651-4. doi: 10.1080/000164802320396349. PMID: 12403129.

4 Caruso S, Nota A, Darvizeh A, Severino M, Gatto R, Tecco S. Poor oral habits and malocclusions after usage of orthodontic pacifiers: an observational study on 3-5 years old children. BMC Pediatr. 2019 Aug 22;19(1):294. doi: 10.1186/s12887-019-1668-3. PMID: 31438904; PMCID: PMC6706895.

5 Page DC. Breastfeeding is early functional jaw orthopedics (an introduction). Funct Orthod. 2001 Fall;18(3):24-7. PMID: 11799699.

6 Wagner Y, Heinrich-Weltzien R. Occlusal characteristics in 3-year-old children--results of a birth cohort study. BMC Oral Health. 2015 Aug 7;15:94. doi: 10.1186/s12903-015-0080-0. PMID: 26251128; PMCID: PMC4528377.