Myofunctional therapy and obstructive sleep apnoea
Sparkle Dental | 11/09/2016
Orofacial myofunctional therapy is a non-invasive option for the treatment of sleep disordered breathing.
Last year, a study of the best available research investigating this therapy supported it as an effective adjunct in the management of obstructive sleep apnoea in children and adults.
What is myofunctional therapy?
Myofunctional therapy is the neuromuscular re-patterning of the oral and facial muscles.
The therapy involves facial and tongue exercises and behaviour modification techniques to promote proper tongue position, improved breathing, chewing and swallowing.
There are a wide range of applications for this therapy including dealing with orthodontic relapse, speech problems, thumbsucking, tongue ties, headaches and TMD problems, low muscle tone and more.
Integrated care between orthodontists and myofunctional therapists to optimise facial growth has been well established in some parts of the world for over 40 years.
Only more recently has it been considered for opening up the airway, and as a treatment approach in obstructive sleep apnoea.
How does myofunctional therapy work to improve the airway?
These exercises improve the tone of the oral and throat muscles. This helps to make the airway less collapsible.
In this sense, myofunctional therapy is like a personal training or gym workout for some of our most critical muscles – those that are involved in with keeping the airway open.
This video illustrates a set of exercises that was used in a study by Guimaraes from 2009.
What is the evidence for myofunctional therapy in obstructive sleep apnoea?
There is a lot of new evidence for myofunctional therapy emerging. Over 30 universities in Brazil are doing PhD level research in this area. In the US there are a handful of universities involved in research.
Some of the most compelling research is coming from Stanford Sleep Centre, the leading sleep institute.
Many of the studies involve relatively small samples of patients. A meta-analysis is a study that compiles all the best quality studies and combines the results to increase the power of any findings.
Last year, a meta-analysis published in SLEEP journal
concluded that current evidence demonstrates that myofunctional therapy
Decreases the Apnoea-Hypopnoea Index (AHI – a measure of obstructive sleep apnoea) by 50% in adults and 62% in children.
Reduces the severity of oxygen desaturation, snoring and sleepiness in adults.
Could serve as an adjunct to other obstructive sleep apnoea treatments.
Why could myofunctional therapy have greater potential in children?
One of the outcomes of myofunctional therapy is to establish continuous nasal breathing. When the mouth is open, there is a lack of tongue-to palate contact necessary for the “suction-cup” effect that holds the tongue in place and prevents it from falling into the throat during sleep.
In children, establishing this good resting tongue posture is critical for good facial growth and airway development.
Research from Stanford Sleep Centre
has demonstrated that even when a child with obstructive sleep apnoea has their airway opened through removal of their adenoids and tonsils, and palatal expansion, that they will not automatically become nose breathers. If mouth breathing persists, they will develop a recurrence of obstructive sleep apnoea due to the secondary impacts on their facial and airway development.
Whilst more research is required, this therapy is a non-invasive option which helps restore nasal breathing. The nose is specially designed to filter, warm, and humidify the air before it enters the lungs, and the benefits of nasal breathing for good health should not be underestimated.
Stanford Sleep Centre has adopted myofunctional therapy as a standard of care in the management of children with obstructive sleep apnoea. Many other centres around the world following are also adopting change based on new evidence.
Myofunctional therapy at Sparkle Dental
Dr Shereen Lim is qualified in dental sleep medicine, and twice certified in the assessment and management of orofacial myofunctional disorders. Within Perth, she is the most qualified to assess an individual's potential benefit of this therapy, and she will liase with your Sleep or Ear Nose and Throat specialist and collaborate with them to ensure personalised and optimal care.
To find out more on whether you or your child would be a suitable candidate for Orofacial Myofunctional Therapy as an adjunct in the management of Obstructive Sleep Apnoea, please contact us
to organise an consultation wtih Dr Lim.
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