Obstructive Sleep Apnea:

Using Orofacial Myofunctional Therapy as a Part of a FxMed (Functional Medicine) Approach to Treatment

By Dr. Jeremy Montrose. 

Thank you to Kara Fitzgerald, ND. for allowing me to share this comprehensive article with you. 

As an Osteopath addressing Obstructive Sleep Apnea, using hands on techniques and home exercises to support maintenance and development of the airway, and enhance diaphragm and mouth breathing, I have a deep appreciation for the impact both Osteopathy (Osteopathic Manipulative Treatment) and Orofacial Myofunctional Therapy can have on the trajectory of the lives of the people we are fortunate to see. The kids we see may be bed wetting, waking up moody and lethargic, have unrestorative sleep, irritability, poor learning, memory, concentration and constant fatigue. They are often mouth breathers, persistent thumb suckers or have had a history of thumb sucking. These are the kids that tend to suffer more recurrently with tonisilits and ear infections, colds and congestion. Occasionally there is crowding of the teeth due to the high arched palate - all related to the dysfunctional breathing pattern, often with mouth breathing as a feature. We also treat adults for Sleep Apnea, applying the same Osteopathic principals to restore mechanics and therefore optimise function. Orofacial Myofunctional Therapy closely fits the principals and application we use in Osteopathy, therefore both are key interventions that can support optimal development of these structures, habits and symptoms. Dr Jess Harvey (Registered Osteopath).

Obstructive Sleep Apnea is a condition affecting up to 22 million Americans and close to 1 billion people worldwide.

This condition can have serious impacts on overall health and has been shown to be a contributing factor to:

  • heart disease
  • diabetes
  • stroke
  • cognitive decline
  • weight gain
  • daytime fatigue
  • anxiety
  • depression
  • chronic pain
  • teeth grinding
  • and chronic headaches

There are a variety of treatment options available to manage Obstructive Sleep Apnea including Positive Airway Pressure devices (the most common being CPAP), dental mandibular advancement appliances, and various surgeries, but there are also functional treatment approaches that can target the underlying causes of the disease.

What we know is that Obstructive Sleep Apnea occurs when a person’s upper airway, directly behind the mouth, collapses during sleep restricting or blocking airflow to the body.  This can happen due to a structural problem if the size of the airway is too small, a functional problem if the tissues surrounding the airway are loose, or both.

All of the treatment options for Obstructive Sleep Apnea have the same goal, which is to prevent this collapse from happening in order to maintain steady airflow to the body during sleep. While Positive Airway Pressure devices and dental mandibular advancement appliances are beneficial to many people there is an additional component that is often not addressed, and that is the functional ability of a person to increase the size and reduce the collapsibility of their own airway.

What research has shown is that in addition to reducing snoring, jaw and facial pain, Orofacial Myofunctional Therapy can reduce Obstructive Sleep Apnea by up to 50% in adults and 62% in children.  Orofacial Myofunctional Therapy is the neuromuscular and functional re-education, strengthening, and toning of the muscles of the mouth, throat, and face.  Most people in our modern society have some form of Orofacial Myofunctional Dysfunction which can start as early as infancy or develop later in life.

Where does Orofacial Myofunctional dysfunction come from?

Believe it or not the first factor that can lead to the development of dysfunction can be diagnosed immediately after birth.  

Tongue and lip ties are restrictive tissues attached to the tongue and lips that can limit the amount of movement possible.  These restrictive tissues were meant to dissolve before the infant was born but sometimes the tissues remain to a degree that can prohibit proper function.

Historically these tissues were cut at birth by the midwife, but in modern society this is not always done.  If the lip and tongue remain functionally restricted then this can lead to difficulties with feeding that can include pain for the mother, inefficient feeding for the child, increased swallowing of air, failure to thrive, or complete inability for the child to breastfeed. Additionally, it creates a different swallow pattern where the child will use facial muscles to aid in swallowing to compensate for the lack of tongue mobility.  A tied tongue also tends to sit low against the lower jaw rather than up against the upper jaw and roof of the mouth as it should.

As a child’s facial bones are growing and developing this altered tongue resting position and swallow pattern, where the muscles of the lips and cheeks contract to push in on the facial and jaw bones rather than the tongue resting on the roof of the mouth and pushing up and out during swallowing, will change the forces on the facial bones and has been shown to lead to a narrower, longer face with a smaller mouth and increased dental tooth crowding later in life.  If the bones of the jaws do not grow fully due to this change in function, the space inside the mouth is smaller leaving less room for the tongue, and since the tongue grows independently from the facial bones it may look like the tongue is too big for the mouth but in most cases it is the mouth, that due to dysfunction, did not grow large enough to accommodate the tongue.  Now there is a structural problem, and if the tongue does not fit in the mouth as it should, it will be forced backward into the airway directly behind the mouth and can cause a restriction which can increase air turbulence and lead to snoring or sleep apnea. It is amazing how such a small piece of tissue can have such a huge impact.

The other dysfunction that can be addressed early in life is mouth breathing.  When a growing child breathes through their mouth their tongue is forced down which leads to all the same problems as a tongue tie including long, narrow faces and dental crowding.  Additionally, when mouth breathing, the inhaled air bypasses the nose which is built to warm, filter, and humidify air before it reaches the sensitive tissues of the throat and lungs. When cold, dry, and dirty air bypasses the nose and goes directly through the mouth to the throat and lungs there is increased risk of inflammation of the adenoids and tonsils, increased nasal congestion, and increased risk of irritating the tissues of the lungs and contributing to asthma.

Read more of this article here: https://www.drkarafitzgerald.com/2020/10/08/obstructive-sleep-apnea-using-orofacial-myofunctional-therapy-as-a-part-of-a-fxmed-approach-to-treatment/


Written by Dr. Jess Harvey B.Sc. (Anat, Phys), B.Ap.Sci (Comp. Med.), Ma Osteo., Registered Osteopath and Director of Head 2 Toe Health.

We provide Osteopathy, Acupuncture, Massage, Life Coaching and Counselling in Springwood (Brisbane) and Oxenford (Gold Coast). We aim to get you as well as possible, as fast as possible, permanently. We believe in a thorough approach to restoring and maintaining health and address many aspects of our lifestyles that can contribute to pain, stiffness, dis-ease and disease. For any further information, please contact us on info@head2toehealth.com.au or 07) 3208 8308.

This information is intended as a general guide only and is not specific for any particular condition or situation. This information is for educational purposes only. Please seek specific advice for your individual circumstances.