Snoring & Modern Anatomy Issues

"The air that enters your lungs affects every moment of your life"

Over 18 million Americans suffer from sleep apnea and most of them don't even know it. Snoring can be seen as an unfortunate by-product of human evolution.

The goal of Breath Science is always to broaden your scope of knowledge about breathing and how it relates to our patient's overall health. So that we can share this vital information with our patients. After all, If we do not discuss this with our patients, who will?

The National Sleep Foundation estimates that 18 million Americans have sleep apnea. The condition causes repeated breathing interruptions throughout the night; the pauses can last from a few seconds to minutes and may occur 30 or more times per hour. These pauses happen because the muscles in the back of the throat are flaccid, the tongue is too large, or the jaw is too small, causing airway obstructions.

Considerations for Dentistry: The first sign of sleep apnea is often bruxism.

We know that improper breathing leads to anything from behavioral challenges, anxiety, and depression to cognitive issues. These include sleep apnea, ADHD, failing lungs, mental fatigue, infections, colds, congestion, respiratory issues, and so much more!!

Inhaling from the nose has the opposite effect.

It forces air against the tissues at the back of the throat making the airways wider and breathing easier. After a while, these tissues and muscles become toned to stay in the open and wide position.

When seasonal allergies hit incidences of sleep apnea and other breathing difficulties shoot up. The nose gets stuffed up, we start mouth breathing, and the airways collapse. Sleeping exacerbates these issues. When we lay down at night, gravity pulls the soft tissue and tongue downward, closing off the airway even more, after a while our airways get conditioned to this position- snoring and sleep apnea become the new normal.

We also know that conscious & restorative breathing can lead to reduced blood pressure, boost athletic performance, balance the nervous system, straighten scoliotic spines, blunt autoimmune disease, heal emphysema, raise body temperature, and improve endurance. Just to name a few.

“How could all of a sudden we develop crooked teeth and narrow jaws and impacted nasal airways?"

We often think of evolution as something that happened in the distant past, the truth is that our bodies are still evolving —And our faces are still changing too, leading to dramatic changes in our teeth, noses, and jaws.

We are stuck with our smaller modern faces, but there are steps we can take to address the conditions that come with them.

Sleep medicine doctor Stephen Sheldon is discovering recovered techniques — that encourage the jaw to grow wider and move forward in order to align the teeth and enlarge the airway and often enlist myofunctional therapy to create healthy tongue and mouth habits. Traditionally, orthodontists are most concerned with straightening teeth, rather than moving the mandible forward as a primary goal.

The human throat has too many functions to do any of them perfectly and instead does everything adequately.

This small section of our body needs to be able to breathe, swallow, and generate speech, switching between the three processes seamlessly – all whilst supporting our head with a heavy human brain.

There are bound to be conflicts of interest. Snoring is that conflict making itself known.

Problem #1 – Speech

To breathe at optimal efficiency (and not snore) our airway would need to be a long, straight, rigid tube structure. To vocalize beyond the grunts of our pre-human ancestors, some different facial characteristics are necessary.

Our tongue works by shaping the sounds generated lower down the throat in the larynx. To do so, it has to sit further back in the mouth compared to other mammals. It, therefore, rests precariously close to the back of our upper airway and risks causing obstruction if it relaxes too much.

Problem #2 – Upright posture

Our neck is optimally positioned to support the skull and the heavy brain within. Hence, humans’ throats are more centrally located underneath the skull. This is contrary to other mammals, where the throat sits further forward in a nice spacious neck.

Overall, there is less space to fit more material. These conditions are perfect for partial airway obstruction – the underlying culprit for snoring.

Problem #3 – Creature comforts

The prime example of this is weight. In the developed world, humans now have ready access to food – sometimes too much of it. Excess weight around the neck and chest is one of the biggest causes of snoring.

Other uniquely human vices such as smoking and alcohol consumption set up snoring perfectly.

Modern humans are not an end-point; we are merely a snapshot in an evolutionary story with much history and an interesting future (which may or may not include snoring).

Obstructive sleep apnea affects approximately 20% of US adults, of whom about 90% are un-diagnosed.

When discussing this with our patients, the conversation can simply start by discussing bruxism.

At night while sleeping, “When you tense your jaw and grind your teeth, it sends a message to your brain to wake up so you can take a breath."

Grinding is just one oral health sign of sleep apnea. A small jaw, tongue with scalloped edges, or redness in the throat (caused by snoring a lot, which is another symptom of sleep apnea) are also signed.

Gasping for breath causes people to wake up repeatedly, which diminishes sleep quality and causes fatigue. Sleep apnea is linked to a higher risk of high blood pressure, heart disease, diabetes, and obesity.

If you're concerned that your patient may be suffering from severe sleep apnea, the best option is to recommend a sleep study.

An airway questionnaire and an in-office examination is a great way to identify patients with airway dysfunction. During the examination, there should be an evaluation of facial form and symmetry, an exam of the nose, the tonsils and adenoids, the tongue, the teeth, and the soft and hard palates. A home sleep study using a cardiopulmonary coupling device should be completed for a patient suspected to have airway dysfunction based on the questionnaire and examination. A follow-up with a formal sleep study in a lab with a sleep MD may need to be performed to achieve a complete and accurate diagnosis for a patient suspected to have apnea.