Originally Posted at: https://www.goinmeditations.com/post/how-to-get-sleep-during-these-uncertain-covid-times
Are you noticing its more difficult to fall asleep since this time of COVID 19 hit?
Do you have difficulty falling back asleep if you wake up during the night?
Stress, Anxiety & SleeP
As many of you know, stress and poor sleep go hand-in-hand. The research is clear on this bidirectional relationship and Dr Matthew Walker outlines it clearly in his important book Why We Sleep "The two most common triggers of chronic insomnia are psychological: 1) emotional concerns, or worry, and 2) emotional distress, or anxiety."
The two most common triggers of chronic insomnia are psychological:
1) emotional concerns, or worry, and
2) emotional distress, or anxiety.
So it makes sense why more of us are having difficulty getting quality sleep at night. These times are bringing a heightened sense of anxiety, stress and uncertainty, which are contributing to poor sleep.
In addition to the anxiety and stress that is present during these times, there is also a range of things that are coming from this time of COVID 19 that further disrupt sleep.
Getting to Sleep
So what can we do about it?
While sleep issues are multifaceted and often require a thorough assessment through a sleep clinic (I can't recommend The Breathe Institute highly enough for this), here are some things that you can incorporate into your routine this evening that will help counterbalance the added stress from the COVID pandemic.
Create a routine and schedule for sleep and wake.
Also, give yourself a “wind-down” window before bedtime. Just like it takes time too cool down after 30 minutes of vigorous cardio exercise, give yourself a chance to wind down before bed. Lower the lights, turn down the music, don’t look at screens, and put your to-do list away.
...particularly in the afternoon. Caffeine has a half-life of 5-7 hours for most people, meaning that it takes that long for half of the caffeine to work its way through the system. Implement a caffeine curfew for yourself, so you have had your last cup of java by 11am or 12pm, giving yourself a chance to metabolize as much of the caffeine before bedtime as possible. For more on caffeine, watch a video I posted recently on IGTV.
Use guided meditation for sleep...
...to help combat “bedtime thoughts” and allow your body to reach a relaxed state. In times of increased stress and uncertainty, two things that can disrupt sleep happen. One, when you close your eyes at bedtime, suddenly “bedtime thoughts” and worries have a longer list of things to think about.
Second, the body is in a stressed state - the "fight or flight” sympathetic nervous system state, where the primary goal is to keep us safe and alive by being attentive (alert) to our surroundings. To fall asleep, the body ideally is in a relaxed state, and be able to relax its “guard”. Guided meditation for sleep helps by giving your attention something to focus on, other than the worry list, such as the breath or sensation.
Guided meditation for sleep helps by giving your attention something to focus on, other than the worry list, such as the breath or sensation.
Moreover, meditation can help shift the body from the stress state to a calm state, thereby creating the conditions in which your body can ease into sleep.
There are many options for guided meditations for sleep...
Go In - Calm Down & Sleep
Aura & Insight Timer
Spotify and YouTube.
May you sleep well.
Cassandra Carlopio is the founder of Go In Meditations, a mindfulness and sleep expert, collaborative provider at The Breathe Institute, and thousands of people fall asleep to her meditations each night.
She also offers individual and corporate sessions, using mindfulness and meditation to improve performance.
Go In meditations- guided meditation app with a range of meditations for sleep and calm, as well as breathing exercises and more exploratory meditations
Spotify for guided meditations for sleep
Youtube for a range of guided meditations for sleep and calm and presence.
Insight Timer & Aura - meditation and mindfulness apps
Our autonomic nervous system can alert every cell in our bodies in times of stress, however ‘sounding the alarm’ can sometimes result in shortness of breath or anxiety and such symptoms. The autonomic nervous system receives information about the body and its external environment, and then responds by stimulating body processes through its two main divisions: the sympathetic and parasympathetic nerve pathways.
Balance between the sympathetic and parasympathetic states is vital to overall health and well-being. An imbalance or dominance of one state over the other can divert vital resources away from their most efficient and optimal utilizations.
Imbalance or disruption to a healthy lifestyle, diet and even negative thinking can trigger the sympathetic stress response and prime the body for action through an intimate association with the adrenal glands. This known as the sympathoadrenal system. Within the brain, reception of a stress signal leads increased activity of the sympathoadrenal system. This is done through a complex internal signal cascade that releases a number of neurotransmitters.
A neurotransmitter called acetylcholine causes excitation of the nerves that signal to our skeletal muscles, along with the muscles surrounding certain bodily systems such as the cardiovascular system and respiratory system. This is what can cause increases in strength and speed during times of stress, as well as accelerating our heart rate and breathing.
The sympathetic nervous system response is protective on the scale of seconds to minutes to hours, but chronic levels of increased sympathetic stress on the scale of hours to days may actually interfere with the body’s allocation of energy, resources, and immune reserves to sustain an efficient host defense in the long term.
But it does not stop there; stress disrupts deep sleep by heightening our awareness to external stimuli, which in term suppresses the release of growth hormone and immune modulators. Growth hormone is released during deep stage-3 sleep, and it has been shown that any source of sleep disruption can impair the release of growth hormone, which is important not only for growth and healing, but also for immunoregulation and adaptive immunity.
Moreover, chronic stress may predispose one to mouth breathing (an attempt to keep up with increased respiratory demands) and negatively impact the body’s innate nasal immunity defense mechanism against infectious microbes.
The human immune system has two arms: Innate immunity, and adaptive immunity. Innate immunity is the body’s first line of defense and includes mechanisms that activate immediately or within hours of detecting an unwelcome microbe or antigen in the body.
The adaptive immune response is a secondary response, and is more complex. The microbiological invader first must be processed and recognized. Once the enemy has been recognized, the adaptive immune system creates an army of immune cells specifically designed to attack that antigen specifically.
Coronavirus enters the body and infects alveolar epithelial cells of the upper respiratory tract. Once the virus has penetrated the cell it invades the cells’ biology machinery to replicate new viral particles. In that process, the virus constantly evolves to evade the adaptive immune response, until either the virus or the immune system dominates the fight. The viral particles are potent inducers of inflammatory cytokines
The best way to prevent the infection is to limit direct transmission through taking social distancing measures, committing to vigilant and thorough hand-washing, and to avoid touching the mucosal surfaces of the face (eyes, nose, and mouth) as much as possible.
If the virus does somehow find its way into the body, the primary line of defense will be the innate immune response of the sinonasal tract. The innate immunity of the nose is our first line of defense against pathogens, but our immune-system will never get the chance to say “shields up” and fight for us, if those pathogens are invited directly into our lungs through the oral breathing route.
Chronic mouth breathing bypasses the well armed nasal defenses, and as a result our inflammatory and immune pathways must attempt to fight the virus and infection in a much more delicate territory (our lungs). Mouth breathing also drops the temperature in the sinonasal cavity, which further impairs nasal mucociliary function, and can cause the stagnation of mucous, which further impairs nasal breathing and nasal immunity.
So, besides washing our hands what can we do as we temporarily physically distance ourselves from others...
(4) Relax and meditate.
If you are experiencing a challenge with any one of those four goals, get in touch with us at The Breathe Institute so we can help. We have case managers available for remote telemedicine evaluations to review your case and direct you to the proper resources, as well as Zoom online medical evaluations.
Our team of doctors and healthcare professionals is available to provide you with individualized medical advice. We look forward to the deep breath of relief we will all experience when we pass though the other side of this interesting time, but for now: keep calm, wash your hands, and Breathe on!
Your Friends at The Breathe Institute
Dr. Soroush Zaghi, Chad Knutsen, Leyli Norouz-Knutsen
“Tongue up, lips closed, healthy breathing through the nose.”
Dr. Kevin Coppelson (MD, DDS), an Oral and Maxillofacial surgeon, has joined the team at The Breathe Institute to treat a myriad of oral, jaw, and airway related issues. He will also be focusing with TBI on researching ways to improve surgical outcomes by incorporating myofunctional therapy, craniosacral and body work among other multidisciplinary collaborations.
Dr. Coppelson is a fellowship trained Oral & Maxillofacial Surgeon from Los Angeles, California. He pursued his undergraduate studies at the University of California, Los Angeles. He went on to graduate from the University of Southern California with a D.D.S. and received his M.D. from the University of Maryland.
At TBI, Dr. Coppelson will be working closely with ENT/Sleep Surgeon Dr. Soroush Zaghi, and Myofunctional Therapist Sanda Valcu-Pinkerton to advance the standards of care and overall patient experiences in relation to orthognathic jaw surgery and less invasive modalities.
Studies* have found the surgical success and cure rates of Maxillomandibular Advancement (MMA Surgery) were 86.0 ± 30.9% and 43.2 ± 11.7% respectively. Exploring innovative and less invasive ways to reduce this discrepancy is one area of interest for Dr. Coppelson, as well as potentially reducing the extent of advancement required to achieve optimal results through collaboration with providers from other disciplines such as Myofunctional Therapy and Body Work.
“There are many modalities being used worldwide to address sleep disordered breathing, apnea, and other airway conditions. Although the success rates of some of these procedures is high across the field, the actual cure rate is shockingly low so and I could not be more excited to now be a part of such an amazing team at TBI to improve the outcomes and innovate new, safe and effective solutions for our patients." said Dr. Kevin Coppelson.
We look forward to many years working with Dr. Coppeson to continue to make The Breathe Institute the place Where Goodness Meets Wellness!
Learn more about Dr. Coppelson at:
* Giarda M, Brucoli M, Arcuri F, Benech R, Braghiroli A, Benech A. Efficacy and safety of maxillomandibular advancement in treatment of obstructive sleep apnoea syndrome. Acta Otorhinolaryngol Ital. 2013;33(1):43–46.
Written By: Kathy Soto
One of the first things most of us notice about a person is their smile. Smiling has been linked to an improved mood for only the person smiling, but others around them as well. Still many people may feel shy or embarrassed when smiling, which could be due to having crooked or misaligned teeth. Many patients end up seeking the help of an orthodontist (a dental professional who specializes in early detection and correction of malpositioned teeth and jaws). If done right, orthodontics can improve a person's quality of life, bolster self esteem and just feel better in general by smiling more often. Straight teeth are also easier to keep clean, which helps them look their best, and you feel your best. The effects of misaligned teeth reach far beyond the mouth however, and can even contribute to malformations of the jaw and mandibular arch, resulting in airway and sleep issues for example. On the other hand, improperly applied, orthodontics can lead to similar restrictions as well, by limiting the body’s natural growth or driving the development of poor oral habits. A patient may go on to suffer from airway issues for years without knowing that the suffering was caused by the orthodontic work they had years ago, with symptoms not rearing their heads for many years in some cases. Let’s examine the benefits of a straighter smile, the causes of malalignment and possible consequences of extracting teeth to make room for that beautiful straight smile.
“So, why did you decide to get braces at the age of 28?” I casually asked one of my new dental hygiene patients during an initial dental cleaning visit. At this point in my career I had been a dental hygienist for 10 years and I could see that he had a significant amount of gumline recession (likely due to orthodontic extractions of the first bi cuspids). He simply stated that he “wanted to do something nice for himself”, to improve his health and have a better smile. Jacob had been a mouth breather for as long as he could remember. He had suffered from allergies since he was a young child, which made it difficult to breathe through his nose which was always stuffy (even with the use of over the counter medications). His mouth breathing was not addressed as a child, leaving Jacob with a high narrow arch, lips that could not close fully at rest, and crowding of his anterior teeth. Living in Los Angeles, Jacob wanted to have that straight smile that he saw many people have and he decided to explore braces. He wanted to look better and perhaps more importantly, feel more attractive.
In Jacob’s case, like many who grow up with allergies or chronically stuffy noses, he always found it difficult to breathe through his nose and as a child, developed the compensatory habit of mouth breathing. His allergies were not addressed, leaving Jacob’s upper arch to develop in a high, narrow V shape, rather than a healthy U shaped arch (more like that of a horseshoe).
When the tongue rests at the palate or top of mouth it acts as a natural retainer for the maxilla development, and the body develops with straighter teeth as a result. Jacob, due to having his mouth open for breathing, developed with his tongue resting low on the floor of the mouth. Imagine pulling the scaffolding out from under a dome while it’s still being built. This certainly did not help much in the development of a healthy airway or upper arch. This also led to dental crowding, for which he sought out 3 orthodontic opinions as an adult. Two of the orthodontists suggested 4 first bicuspids be removed prior to orthodontics to make room for the other teeth to straighten due to the narrow maxillary upper arch. One orthodontist who was primarily trained outside of the US suggested Mandibular advancement jaw surgery - he was addressing the functional airway issue and was concerned about the actual physical airway space, suggesting he could widen the maxilla with orthodontics, but that Jacob would need jaw surgery. The thought of that surgery seemed extreme to him at the time so he decided to simply remove 4 teeth to avoid surgery and get straight teeth. Although he expressed to me that in the back of his own mind it didn't make sense to him to remove 4 perfectly healthy teeth to straighten his smile, but he ignored his gut feeling, and that seemed to be the standard practice so he decided to trust the US trained orthodontist and go that route.
Ultimately, Jacob had his 4 healthy bicuspids extracted, and additional 4 healthy wisdom teeth extracted at the request of his orthodontist who had apparently explained that he couldn’t keep those teeth clean, and down the line they would need to come out anyways. During the treatment, things seemed to be going good. He could see that his teeth were becoming straight, just like he’d always wanted.
Fast forward 18 months or so into his orthodontic treatment, and around the time elastics were being used to close the bite, Jacob started having trouble sleeping. He would wake up gasping for air. He had no idea that one had anything to do with the other. Due to his mouth breathing habit he was unconsciously gasping for air during the night, but the elastics were preventing him from opening his mouth enough to get a breath, which was of course reducing the air he was intaking. Shortly after orthodontics being removed, Jacob started developing symptoms of obstructive sleep apnea.
Unknown to him, when the dentist, at the request of the orthodontist, took out those healthy 8 teeth they inadvertently made his airway smaller. The tongue remained the same size, and using ortho elastics to push the lower jaw back further impinged on his airway. When I met Jacob he mentioned talking to many doctors and medical specialists explaining his symptoms of increased tiredness, unusual dependency on coffee and sugary substances, and weight gain even though he was an avid gym goer (2 hrs daily average 6 days a week). Thinking back on my training in orofacial myofunctional therapy, I suggested that he be evaluated by a specialist in the area of sleep medicine and airway health.
He had a consultation with Dr. Soroush Zaghi at the Breathe Institute, who was sympathetic and understood what was going on with his health condition. He suggested a sleep study which revealed moderate to severe obstructive sleep apnea. This condition can lead to high blood pressure, sleep deprivation, heart attacks and stroke among others. This diagnosis made sense to Jacob because he was already diagnosed with high blood pressure and had woken up many evenings choking on his tongue with rapid heat rate. He was then referred to Dr. William Hang, a functional orthodontist based out of Agoura Hills, CA. A cone beam CT scan was used to evaluate his airway and the decision was made that Jacob indeed had his lower jaw pushed into his airway and there was no room for his tongue to rest properly in mouth due to lack of space. With a new plan of action, crafted for him by a multidisciplinary team, Jacob underwent a year of ortho in preparation to see Dr. Reza Movahed for MMA surgery (a procedure in which both jaws are moved forward to create a more open airway), used a CPAP machine and underwent myofunctional therapy training to teach him benefits of nasal breathing, toning the tongue and keeping it up resting at the palate.
Jacob has since had his MMA surgery and is already experiencing the benefits of a wider maxilla and larger airway. His nostrils are a normal shape whereas before they were very narrow due to not being used for many years. He no longer suffers from sleep apnea, and states that his tongue naturally rests at the upper palate and now he breathes through his nose. He also reports that he now dreams again, and is not dependent on coffee or sugary sweets to keep his energy levels up. He, like many others wishes he knew about this sooner in life, because if he had simply learned to breathe through his nose and keep the tongue up to the palate as a child, he could have developed optimally and probably avoided years of health struggles that he experienced as an adult.
I am grateful that there are indeed many dental and health professionals acting as detectives, asking the right questions to optimize their patients paths to better health. Even something as simple as asking “why” when deciding on ortho as an adult, opened a conversation on this patient as a whole.
A minor surgical intervention can be a life changing experience. “There’s nothing I can say enough, do enough, or give back enough that explains my gratitude to her,” was Dalan Motz’ heartfelt response to Dr. Amy Luedemann-Lazar. The experience a father and mother shared when their son, Mason, who was finally able to speak clearly and articulate his words without difficulty for the first time in his life, after a tongue-tie release surgery, should serve as a testament to that fact.
Mason Motz is a 6 year old boy who until recently lacked the ability to fully enunciate words despite years of speech therapy. The Motz family emphasized that the combination of Mason’s sleep disordered breathing and inability to chew and swallow food without choking was the source of numerous behavioral problems in his life. Mason was diagnosed with Sotos syndrome, a genetic disorder identified by a long, narrow face, overgrowth in childhood, and learning disabilities. Seeking remediation from numerous clinicians, including pediatricians, geneticists, neurologists, and speech pathologists, proved personally frustrating and ineffective in alleviating these symptoms.
Enter Dr. Amy Luedemann-Lazar, a dentist specializing in tongue-tie release who recognizes the virtues of holistic treatment and interdisciplinary treatment modalities. While performing routine dental work, she observed Mason’s tongue-tie. After consulting with his parents, she performed a simple, non-invasive surgical release that permanently changed the course of the entire Motz family. The results were astonishing! Upon returning home, Mason began to speak in full sentences. He is presently not afflicted by obstructive sleep apnea and snoring. Chewing and swallowing food no longer present a daily choking hazard for him. In short, his quality of life has drastically improved.
Points worth considering…
Detecting the presence of tongue-tie should be a priority for our child(ren)! Dr. Luedemann-Lazar advocates, as do I and virtually all the myofunctional therapists I know, for mandatory tongue-tie screening as part of a comprehensive health treatment assessment.
Tongue-tie, medically termed ankyloglossia, which is defined as a short or thickened frenulum restricting the tongue’s range of motion has multiple sequela which even experienced medical professionals may dismiss or overlook. Tongue-tie affects the natural resting posture of the tongue inside the mouth, inhibiting one’s ability to speak, eat, practice nasal breathing, and/or sleep soundly. An aberrant oral resting position can develop multiple pathologies, anatomical, physiological, and behavioral: including malocclusion, mouthbreathing, and altered facial development (such as “long face syndrome”).
Collaborative interdisciplinary treatment modalities are beneficial in diagnosis, assessment, and remediation. Mason’s case teaches us that the more clinical professionals we incorporate in our treatment plans, the higher the odds of achieving optimal health. Mason’s team included pediatricians, geneticists, neurologists, speech therapists, and a caring, attentive dentist who was able to properly diagnose and release his tongue-tie.
Successfully treating orofacial myofunctional disorders (OMDs) through the combination of surgery and myofunctional therapy greatly enhances the patient’s quality of life. Clinical research has demonstrated the effectiveness of myofunctional therapy, both alone and as an adjunct treatment modality to surgical intervention. Repatterning dysfunctional orofacial behaviors (ie. tongue thrust, mouth breathing, etc.) and eliminating harmful habits (ie. finger sucking, nail biting, etc.) are examples of integral behavior modification techniques applied by myofunctional therapists.
In this month’s professional profile, I would like to bring attention to an individual who embodies these traits. Kristie Gatto is not only a successful SLP (speech language pathologist), but she is also a lifelong student, a business owner, and an accomplished author. Ms. Gatto’s career delineates a deliberate and methodical approach to improving oneself. To better understand the nature of the pathological elements that the orofacial myologist must address, Ms. Gatto devoted thousands of hours to reading research materials which identified exactly how dysfunction develops throughout the orofacial region from a physiological and anatomical perspective. She is driven to know, explain, and illustrate the relationships that disparate units of the orofacial complex can have when they are underdeveloped and/or when deleterious behavior negatively impacts anatomical function
The pursuit of continuous education and professional excellence are important pillars, but the foundational stone of orofacial myology is the desire to be prolific in addressing clinical issues that patients bring one’s way. Ultimately, the orofacial myologist’s purpose is to incapacitate the patient’s pain and discomfort by teaching them how to overcome potentially debilitating behaviors/habits which frequently inhibit the execution of vital functions! Maladaptive orofacial behaviors (including non-nutritive sucking, mouth breathing, tongue thrusting, etc.) can significantly alter the musculature, structure, and function of the orofacial complex. A myofunctional therapist must be aware of exactly how to address a patient’s unique condition as there is no universal treatment solution.
With an ever growing spotlight on orofacial myofunctional disorders (OMDs) and their impact on overall well being, the orofacial myologist must be committed to continuous education. Research demonstrates that focusing on an isolated behavior, such as tongue thrust, is not nearly as effective a treatment plan as addressing the multiple interrelated factors which arise from and/or precipitate the behavior. Additionally, there are concepts, such as compensation, dissociation, impact of motor reflexes, and congenital neurological conditions that have slowly, but steadily received increasing attention from research in an attempt to illustrate a comprehensive view of the cause and effects behind (OMDs). A successful myofunctional therapist is aware of these advances. Awareness is not circumscribed to the orofacial myologist by any means!
In this day and age, parents are increasingly coming into offices with questions, having done some preliminary investigative work. Iit is incumbent upon the myofunctional therapist to stride over some of the comfortable boundaries he/she may have in respect to being researchers and lifelong students. One of Ms. Gatto’s contributions to the field of orofacial myology is The Orofacial Complex The Evolution of dysfunction. This insightful tool effectively illustrates the various muscles, structures, and co-relational functions of the orofacial complex. With over 170 pages, The Orofacial Complex outlines everything from terminology to the interconnections between the facial/cranial nerves and the specific muscles of each orofacial structure. Detailed pictures of muscles and bones add color and stunning visual cues, in addition to functional significance assessments, and real life implications of abnormalities. This manual is comprehensive in tying together the phenomenon of various organs/muscles and how dysfunction within each potentially leads to OMDs.
After obtaining her certification in Orofacial Myology, administered through the IAOM (International Association of Orofacial Myology), Ms. Gatto dedicated her professional life to improving people’s quality of life. She has been a strong promoter of interdisciplinary relationships ranging between hospital based teams, oral and maxillofacial surgeons, neurologists, otolaryngologists, orthodontists, pediatric dentists, pediatricians, and myofunctional therapists . Orofacial myology encourages a collaborative atmosphere of professionals as a means of addressing not only the noxious habits people have come to practice, but also the anatomical etiologies behind those behaviors. Often times, the habits are merely an individual’s attempt to achieve an acceptable degree of function. Compensation is the result of an individual’s desire to achieve function to the very best of their ability!
The logic behind having a team approach is to ensure that each aspect of pathology is appropriately addressed. Myofunctional therapists for habituation and behavior modification, surgeons for surgical interventions, psychologists for the process of transition and healing, nutritionists for implementation of a balanced and healthy diet, and pharmacists to ameliorate any pain or discomfort after a surgical intervention. The more facets that are covered by the team, the more successful the outcome. The orofacial myologist’s goal is to assist the patients transition into a healed, healthy, and vibrant human being. This is the benchmark of care and what each service provider must strive for.
Often times, it is easy to disregard the significance of a single conversation, never mind the profound impact it can have on an entire profession, a specific medical field, and perhaps even the world. Such an impactful conversation took place in 2009, when two very successful dentists and iconoclastic visionaries, Dr. Gelb and Dr. Hindin, were able to conceive a novel way of looking at dental pathology. They decided to shine light through an entire new prism: Airway Centric®.
The effects of this conversation produced powerful, redounding ripples across the field of dentistry. Ultimately, from the seeds of this conversation sprouted a bountiful harvest including the creation of AirwayCentric® (philosophy, appliances and education), the American Academy of Physiological Medicine and Dentistry (AAPMD), the Foundation for Airway Health, and the book, GASP: Airway Health; The Hidden Path to Wellness, along with the terms “Hidden Airway”, “Connecting the Dots”, White Flag Event” and “Airway for All.”
One of the major tenets established by Dr. Gelb and Dr. Hindin was the imminent need for a paradigm shift in the field of dentistry. Their vision is a recalibration of the focus that medical provider direct: rather than treating the side effects of pathology, one should aim for direct remediation on the pathology itself! In other words, instead of simply fixing the visible symptoms (dental malocclusion, allergy problems, mouth breathing, improper chewing / swallowing, mandibular protrusion, etc.) there must be a recognition that those symptoms are an effect, however significant they may be, of a greater cause; usually an insidious underlying problem. One that traditional medicine often overlooks.
Drs. Gelb and Hindin understood the necessity of directing attention to an open airway, or a patient’s ability to breathe effectively, before anything else. It is only through a patent airway that we can access the essential nutrient for life; oxygen. With myofunctional therapy, much like orthodontics and general dentistry, each provider must realize that, “Without the airway problem ever being discovered by patient or practitioner, interventions produced only symptomatic and temporary relief.”1 When people develop pathology due to a compromised ability to breathe, structural compensation and tissue deformation follow sequentially, as every living organism needs oxygen to live. Breathing is an indispensable function, without equal, as every living creatures need for air supersedes water and food intake; respectively in order of importance. Regardless of the cause of compromised oxygen intake due to: either tongue-tie, habituation of mouth breathing, deformation due to genetic factors, or impaired reflex development, the inability to secure an ample amount of oxygen all the way down to the cellular level destroys, inhibits, and retards our ability to grow and function optimally.
By Sanda Valcu-Pinkerton
Myofunctional Therapy is far more than just a regimen of exercises designed to improve the musculature of the tongue, cheeks, jaw, and neck. It is a functionally practical treatment that develops in compliant patients an awareness of what a healthy oral rest posture is supposed to be. For most of the day, we do not engage the 57 muscles of the orofacial region, however we are impacting their ability to function by the way we allow them to rest. A healthy oral rest posture means placing the tongue on the palate, maintaining lip seal, and exclusively utilizing nasal breathing. One of the most effective methods of focusing awareness on their behavior is to teach patients how to identify a correct resting posture for their orofacial muscles.
Breathing is one of the most important functions our body performs, and most of the time the act of breathing is mostly subconscious. One of the key priorities or a myofunctional therapist is ensuring that a patient has nasal patency. One can go without food for months, without water for weeks, but lack of oxygen precipitates death in a few minutes. So what does proper oral resting posture have to do with nasal breathing? When the tongue and lips are in an incorrect rest posture, one’s ability to breathe is impaired. The consequence is people establishing the oral myofunctional disorder of mouth breathing and the resultant litany of dysfunctions. A myofunctional therapist, should educate their patients that a patent airway is achieved through nasal breathing only when the tongue is properly placed on the roof of the mouth.
The tongue is another organ that is more critical to breathing than many people realize. It has eight separate muscles. This small organ manipulates food placement as one chews solids, implements the swallowing of solids and liquids, and, through various movements, and facilitates articulation. In addition, through continuous pressure exerted by placement on the roof of the mouth, the tongue stimulates proper upper jaw growth, much like how a retainer can alter the position of teeth and oral structures, the tongue plays a major role in the development of the human airway and orofacial complex. Proper tongue placement, which begins in infancy, is responsible for the formation of a wide, u-shaped upper jaw. The upper jaw, or mandible, is extremely prominent in facial development and the wider the mandible and palatal arch, the more patent the airway. It is through the formation of a voluminous airway than an individual develops an efficient ability to perform nasal breathing. Who could have thought how much the tongue accomplishes while at rest?
Sometimes people are born with conditions they have little or no control over which prevent them from attaining proper oral rest posture. An example of a congenital, or present at birth, condition which can prevent proper tongue placement, lip seal, and nasal breathing is “Ankyloglossia,” or “Tongue Tie.” For those who have lived with a shortened or thickened tissue membrane, called a frenum, throughout their lives, (i.e. tongue-tie), myofunctional therapy becomes more than an awareness of learning proper oral rest posture. These individuals have learned to compensate by incorporating other muscles of the orofacial region (i.e. cheek, lip, and neck areas) in an attempt to perform the basic functions of breathing, chewing, and swallowing. This learned behavior leads to dysfunction and various disorders, known as compensatory behaviors. Unfortunately, the individual is often unaware of the behavior until he/she suffers harm. The perniciously insidious effect of orofacial myofunctional disorders (OMDs) is that one becomes cognizant of the symptoms before they can identify a cause.
Through the extended use of muscles other than the tongue to perform functions designated specifically for the tongue, the tongue’s muscle tone and mobility diminishes. As a means of correcting this deficiency, compensatory behaviors, executed by a union of muscles whose functions should otherwise be separate from the tongue’s, are developed. This is the body’s attempt to compensate for, or balance out the loss of, proper tongue function. These patients have learned to improperly integrate or associate their cheek, jaw, and neck muscles when chewing and swallowing. Myofunctional Therapy is used to teach individuals how to strengthen the tongue and prepare it for its natural functions by dissociating the tongue’s movements from other muscles.
An especially prevalent compensatory behavior involves a prominent activation of the jaw and neck muscles in swallowing. As a means of coping with the diminished tongue mobility caused by a shortened frenum, a person (usually subconsciously) attempts to correct the defect by using the jaw or neck muscles to swallow. As a person swallows anywhere from 500 – 1000 times day, these muscles, that were never intended to aid in the function of swallowing, gradually begin to grow in size. The excessive and prominent growth of muscles in the face, jaw, and neck region is not only dysfunctional, but is for the most part unattractive. From a functional point of view, the priority is: 1) to bring awareness to the patient of what muscles they are using to perform the functions of chewing and swallowing, and 2) to teach patients how to separate cheek, jaw, and neck muscle use from tongue movements. Jaw dissociation is separating the jaw and neck muscles from the acts of chewing and swallowing.
Ideally, the muscles of the orofacial region should work in concert with each other, not as substitutes for one another. Every muscle and organ we have is specifically designed for a purpose. Inter-muscle relationships must be clearly defined, with each muscle performing its discrete function. Myofunctional Therapy is not simply a regimen of exercises and stretches, but ultimately it is about being able to breathe, chew, and swallow efficiently.
Originally shared at:
Dr. Soroush Zaghi, Medical Director of The Breathe Institute, has been invited to join PLOS ONE’s Academic Editorial Board as an Academic Editor, where he will participate in the review and selection of scientific manuscripts submitted to the journal for publication. Dr. Zaghi was selected for this honor because he was recognized by the journal as an international expert in his field of study and practice.
PLOS ONE is an organization dedicated to giving researchers a faster path to publishing in a high-quality peer-reviewed journal. All work that reaches their rigorous technical and ethical standards is published and freely and immediately available to everyone. In a nutshell, providing open access to outstanding research for the furthering of science and medicine.
Peer reviewed studies serve a critical purpose in science and medicine especially. Besides offering valuable information to professionals and researchers in many industries, once published, peer reviewed studies can generally be understood to have been heavily scrutinized by professionals in that field. This lends not only credibility, but confidence to decisions that are supported by such research.
Most studies that pass the peer review process go on to be published in a an industry/field specific journal or magazine so that the knowledge can be shared and spread. One unique organization; PLOS ONE, is the world’s first multidisciplinary Open Access journal. They accept scientifically rigorous research in many fields. PLOS ONE’s broad scope provides a platform to publish primary research, including interdisciplinary and replication studies as well as negative results. The journal’s publication criteria are based on high ethical standards and the rigor of the methodology and conclusions reported.
Dr. Soroush Zaghi has been invited by PLOS ONE to join it’s the Academic Editorial Board. Dr. Zaghi has previously served PLOS ONE as a guest editorial editor. The editorial staff at PLOS ONE poured through the many reviews of the myriad of papers and studies being entered into the journal for peer review and selected Dr. Zaghi to oversee the review process of these manuscripts for publication given his demonstrated commitment to accuracy and clarity.
In his role on the Academic Editorial Board, Dr. Zaghi will be conducting independent assessments of submitted manuscripts to decide whether they fit within the journal’s scope and publication criteria. He will be also be evaluating other reviews already collected and weighing them against his own judgments before rendering a decision, and submitting the final version for publication.
The editorial staff at PLOS ONE poured through the many reviews of the myriad of papers and studies being entered into the journal for peer review and selected Dr. Zaghi to oversee the for his demonstrated commitment to accuracy and clarity.
Specializing in the treatment of sleep and airway disorders, Dr. Zaghi has already published over 60 peer reviewed articles during his career so far, and looks forward to continuing to contribute to education and research as well as in his clinical capacity at The Breathe Institute.
The Breathe Institute offers whole health, for the whole family by integrating dental and medical healthcare under one roof. Our multidisciplinary center for precision diagnosis and comprehensive treatment of nasal obstruction, snoring, obstructive sleep apnea (OSA), and breathing disorders is at the forefront of airway management. The Breathe Institute serves the Greater Los Angeles Area, and also patients from around the globe who are attracted to the world class care offered by it’s field leading professionals.
In Support of Myofunctional Therapy and Functional Frenuloplasty as a promising collaborative therapeutic approach to addressing tongue-tie and Obstructive sleep apnea
Recently, our practice, our Medical Director, and several of our dedicated colleagues have been the target of some rather slanderous blogging by a fellow leader in the field of sleep medicine. His article questioned our approach, and ultimately our integrity. Although we appreciate the opportunity to learn from others perspectives, we are disappointed anytime someone (especially in the medical arena) refuses to exercise their own right to maintain an open mind and possibly learn something new that could have a positive impact on our field in a meaningful way.
In essence, what we do here at The Breathe Institute is simple; We promote and facilitate a healthy roadmap to natural and exclusive nasal breathing. Our whole focus is on helping our patients optimize their health by restoring lip competency, exclusive nasal breathing and improving tongue resting posture to the roof of the mouth. We have learned and seen that some patients with sleep apnea have low resting tongue posture, and in some cases this is associated with restrictions in tongue mobility due to a restricted lingual frenulum. We have also learned that restoring the tongue to its natural biological position at the roof of the mouth helps improve CPAP compliance, helps reduce snoring, and can reduce the severity of obstructive sleep apnea indices as measured by many sleep studies. We stand by our experience thus far of 2+ years specifically dedicated to a functional approach to sleep medicine. We have successfully treated hundreds and hundreds of patients locally as well as many who fly in from all over the world specifically for our unique approach of patients using our functional approach. Based on our experience, including 350 cases specifically of functional frenuloplasty that we have documented to date, we proudly endorse a satisfaction rate of 88% or more in regards to post-treatment health as well as a reported improved quality of life.
We firmly believe that patients deserve to be offered an alternative to aggressive surgeries. If surgery ends up being the best option for a patient, then that would indeed be the recommendation of our practitioners, and Dr. Zaghi is a brilliantly skilled surgeon who practices conventional surgeries as well. But we are of the mind that less invasive, more holistic modalities ought to be considered when appropriate. We are fortunate to have recruited Dr. Zaghi to be our Medical Director because of not only his demonstrated commitment to individualized patient care, but his passion for driving research and growing and sharing the compendium of medical knowledge. Dr. Zaghi is dedicated to presenting patients with an entire roadmap of different surgical and non-surgical treatment options - our patients are offered both conservative and functional approaches and we do see benefits to both of these individualized approaches depending on the patient.
Working alongside Dr. Zaghi, our Myofunctional Therapy Director, Sanda Valcu-Pinkerton has also extensively studied and researched both the scientific work of our colleagues abroad as well as those actively teaching content in the States including, but not limited to; AOMT/Joy Moeller, IAOM, Sandra Coulson, Mary Billings, Linda D'onofrio and Diane Bahr to name a few. After witnessing numerous amazing emotional, dare we say almost spiritual releases from our patients, we have even started delving deeper into research and information from the 1800’s and even further discussing the significance and health benefits of nasal breathing. In many ancient cultures, children were trained to breathe through their nose so not to become mouth breathers. Thousands of years ago, Vedic Yogi’s discussed the benefits of “Kechari Mudra” which is a breathing mudra involving touching the tip of the tongue to the uvula, and other such orofacial and nasal breathing exercises. Some of these practices reach back many thousands of years and are continued to this day.
We agree completely on one thing with the author of the piece that sparked this one: We need the standardization of protocols, scientifically rigorous research, university-based programs and institutional accreditation, so that what we are working diligently to produce alongside AAMS, and many other great organizations, educators and practitioners in the field.
Dr. Zaghi, Sanda and our entire team continue to dedicate ourselves and our time to refining our treatment protocol that incorporates a specific set of myofunctional exercises aimed at achieving lingual palatal suction and floor of mouth/jaw disassociation and awareness which we believe to be key elements of our therapy success.
We fully support the field of myofunctional therapy and wish to thank the thousands of myofunctional therapists from Boston to Brisbane, to Brazil who are pushing this field forward, and as a result seeing legitimate improvements in sleep and breathing issues in their patients (Often this is the first thing to improve after tongue-tie release).
We would love to hear from more of you, so that we can learn from your experiences as well.
It has been said that curiosity killed the cat, but in reality it's often a lack of curiosity that kills (or fails to help) patients. How are new approaches to anything tested if no one ever conducts the research required to fully determine efficacy?
At The Breathe Institute, we whole-heartedly believe that:
We wouldn’t ask anyone to just take our word for it. In that light, we are happy to here share a link to a collection of some of our patient testimonials and we very much look forward to releasing the findings of our ongoing study for you, the good readers of this post to review for yourselves and make up your own minds. Meanwhile we at The Breathe Institute shall continue to work diligently at treating our wonderful patients, and finishing our research publications.
We will continue to do what we can to propel the research forward, building upon the work of Dr. Christian Guilleminault whose research has been cited well over 51,800 times, as well as other leaders from Europe, Brazil and the US who are dedicating so much of their time, energy and ability to the field of myofunctional therapy. We will always strive to be patient-centered in that pursuit, even if it means questioning or venturing outside the warmth of the status quo. We can not refute the wonderful results we are seeing in our practice - especially as we continue to get thank you card after thank you card from patients and families whose lives are being positively impacted and changed for the better.
At one point in history the majority of people were calling Galileo a heretic for having the audacity to suggest that indeed the Earth might be round. Today it seems a small number of others, seem disinclined to consider that perhaps, there could be something they don't know. Perhaps out of genuine concern for patients, or perhaps out of fear that if patients realize there may be an alternative to highly invasive surgery in some cases, they might choose to explore a more conservative treatment approach first. While some practitioners who claim to be innovators are balking at anyone who suggests more tolerable and accessible alternatives to the methods they've been proselytizing for years (entire careers in some cases), we always reserve the right to get smarter.
We now have experience and data from 350+ cases to support specifically our functional approach to treatment of sleep and breathing issues as helpful adjuncts and honestly are honored to be singled out and identified as pioneers and leaders in this approach. Furthermore we are grateful for the continued requests from many outstanding institutions, organizations and practitioners for us to lecture, teach and share our methodologies and protocols worldwide. As awareness is rapidly spreading about the benefits of our functional approaches to frenuloplasty and sleep medicine, we are seeing our own in-house courses in Los Angeles filling up as well. This is surely an indicator that the zeitgeist is on the side of health and progress.
A series of research publications on our experiences will be available soon. For more information, please do not hesitate to reach out to us at anytime. We do hope that our research will plant the seeds of a more positive, curious and collaborative perspective moving forward.
What is needed now is a united front, pushing for awareness and undertaking investigative studies to give us more tools to use in helping all of our patients better!
We want to hear from you:
Child development and craniosacral therapists who understand the importance of establishing nasal breathing, a normal swallowing pattern, and an adequate tongue position in growing children. the interaction between orofacial structural growth and muscle activity starts early in development, and the physiologic functions of suction, mastication, swallowing and nasal breathing in infancy play an important role in developing healthy oral habits and craniofacial development, and in stimulating subsequent growth.
Dentists who understand how low tongue resting posture causes the maxilla not to fully develop from the oral habit of resting the tongue on the floor of the mouth (rather than the palate), as well as causing improper deglutination/swallow habits. Narrow palatal vaults restrict the airway, and left untreated lead to sleep disordered breathing symptoms.
Myofunctional therapists and speech and language pathologists (SLP’s) who understand that a low tongue position can contribute to improper muscle functioning and that Increased labial muscle tone, proper positioning of the tongue on the anterior palate, and labial seal at rest contributed to the development of nasal breathing.
ENT’s and Sleep MD’s who are treating patients in a myriad of ways and understand that myofunctional therapists can be a great ally in identifying and treating patients that may have not otherwise been referred to an ENT due to obstructions present in breathing.
In the words of Thomas Jefferson, “Be bold in the pursuit of knowledge, never fearing to follow truth and reason to whatever results they lead.”