Breathing-Related Sleep Disorders

The term sleep disordered breathing (SDB) includes several sleep related breathing abnormalities including  snoring, Obstructive Sleep Apnea (OSA), Central Sleep Apnea, Mixed Sleep Apnea, and Clenching and Grinding (Bruxism).

What is Snoring?

Snoring is the partial obstruction of the upper airways causing noise and vibration produced by the oropharyngeal muscles during sleep.  Basically it is a large volume of air trying to pass through a narrowed space.  Simple snoring is vibration through the soft palate (mouth snoring).  THIS IS EASIEST TO ADDRESS.  You can stop snoring once you breathe through your nose.  

High upper airway resistance (HUAR) is turbulent airflow in the nasopharynx and oropharynx causing inspiratory flow limitation (snoring through the nose).  This is more common.  The nose needs to be decongested and breathing levels need to be reduced to a normal level.

Snoring can contribute to sleep apneas as the constant vibration of the muscles of the mouth, and throat become larger, and may cause changes in width, size and thickness. Central apnea

What is Sleep Apnea?

Sleep Apnea

Airway blockage. Image courtesy Wikimedia Commons.

The next progression after loud snoring is sleep apnea. In fact one half half of those who snore loudly have sleep apnea.  Sleep apnea affects more than 18 million Americans, according to the National Sleep Foundation. Most people are completely unaware that they have sleep apnea and are undiagnosed or untreated.  Left untreated, apnea can lead to high blood pressure, memory problems, impotence, cardiovascular disease, and drowsy driving!

Three Types of Sleep Apnea

  • Obstructive

    This is the most common of the three.  Holding the breath from collapse of the upper airway during sleep.  During sleep throat muscles relax allowing the tongue and fatty tissues of the throat to fall back into the airways and block airflow. Once a breath is taken the brain returns to sleep, and the process begins all over again.

    During an apnea event air is restricted and there is reduced blood flow to the brain.  This reduced flow tells the brain to partially awaken and to breathe.  This is usually followed by a loud gasping, choking or snorting sound as the chest heaves the diaphragm moves down and the airways close.  More than 5 times an hour is significant.  Holding the breath for one minute can drop 02 levels down to 50%.

  • Central

    Airway is not blocked, but the brain fails to signal the muscles to breathe.  Brain sends signals to the body to stop breathing.  It affects about 5 % of people.

  • Mixed

    A combination of both obstructive and sleep apnea.

Severity of Sleep Apnea

  • Mild OSA: 5-14 episodes of interruptions in breathing in an hour.
  • Moderate OSA: 15-30 episodes of interruptions in breathing in an hour
  • Severe OSA: 30 or more interruptions in breathing in an hour

Signs of Children with OSA

  • Snoring
  • Frequently waking up
  • Sweating
  • Mouth Breathing
  • Restless sleeping or leg movement
  • Teeth grinding
  • Bed wetting over the age of 5
  • Pauses in breathing, gasping or choking during sleep
  • Nightmares, night terrors or sleepwalking
  • Hyperactivity or behavioral issues
  • Not growing as quickly as they should be for their age or failure to thrive

Symptoms of Adult Sleep Apnea

  • Excessive daytime sleepiness, (falling asleep while eating talking or driving)
  • Waking up tired
  • Morning Headaches
  • Loud snoring
  • Holding breath during the night
  • Loud snorts and gasps upon the resumption of breathing
  • Problems with memory and concentration
  • Heartburn
  • Bathroom at night-heavy breathing (mouth is open): we believe that the body is unable to produce its natural antidiuretic due to hyperventilation.
  • Sweating during sleep
  • Blood O2 desaturation
  • Apnea prevents you from going into deep sleep. Never reach stage 4.
  • Can cause elevated blood pressure during the day

What is Normal Breathing?

Normal breathing is LIGHT, QUIET, and EFFORTLESS! The fine hairs in the nostrils should barely move. Normal Breathing is 4-6 liters of air per minute during rest!

Asthmatics have a rate of 13-15 liters of air per minute during rest.

Sleep Apnea sufferers have a rate of at least 15 liters of air per minute during rest.

**If breathing volume is brought towards normal, negative pressure is reduced and apneas reduce. The Buteyko breathing Method is one way to achieve this.

Recent research has shown that Myofunctional Therapy decreases apnea-hypopnea index by approximately 50% in adults and 62% in children. Lowest oxygen saturations, snoring, and sleepiness outcomes improve in adults. Myofunctional therapy could serve as an adjunct to other obstructive sleep apnea treatments.

The most comprehensive exercises are described by Guimaraes et al.7 and involve the soft palate, tongue, and facial muscles and address stomatognathic functions. For soft palate exercises, patients pronounce oral vowel sounds either continuously (isometric exercises) or intermittently (isotonic exercises).7 Tongue exercises include moving the tongue along the superior and lateral surfaces of the teeth, positioning the tongue tip against the anterior aspect of the hard palate, pressing the entire tongue against the hard and soft palate, and forcing the tongue onto the floor of the mouth.7 Facial exercises address the lip (i.e., contraction and relaxation of the orbicularis oris), buccinators (i.e., suction movements and application of intraoral finger pressure against the buccinator muscles), and jaw muscles (i.e., lateral jaw movements).7 In addition, stomatognathic functions are addressed by instructing patients to inhale nasally and exhale orally without and then with balloon inflation, and performing specific swallowing and chewing exercises (i.e., swallowing with the teeth clenched together, tongue positioned in the palate and without contraction of perioral muscles; alternating chewing sides).7

— Myofunctional Therapy to Treat Obstructive Sleep Apnea: A Systematic Review and Meta-analysis (http://www.ncbi.nlm.nih.gov/pubmed/25348130, http://www.journalsleep.org/ViewAbstract.aspx?pid=29995)

Sleep Disordered Breathing

Myofunctional Therapy works with the Soft Palate muscles

Other References