orofacial myofunctional therapy, are a widely
used and very effective way to treat sleep disorders. Mandibular advancement devices (MAD)
are especially helpful in patients with mild to
moderate range disorders such as UARS. Dental
appliances are also good for treatment in conjunction with a CPAP (continuous positive air
Many patients are “CPAP intolerant,” which
means they cannot stand wearing the CPAP.
Even the American Sleep Apnea Association
confirms, “the actual usage of CPAP is only approximately 50 percent of the time.” Luckily, the
masks of CPAPs have changed and evolved into
smaller and more comfortable devices.
In recent news, former U.S. Supreme Court Justice Antonin Scalia died in his sleep, but his CPAP
was on the bedside table unplugged and unused.
Worst-case scenario, surgery is always an
option; some options include nasal surgery, UPPP
(uvulopalatopharyngoplasty), and tongue advancement, to name a few. I have had patients
go through surgical options with mixed results.
I haven’t had one patient, though, who has experienced great results from any surgery. Patients
suffer loss of time and function for these surger-ies, and many times patients are not satisfied
with the results. Plus, there’s no turning back.
There are no soft palate donors for those who
want the procedure reversed.
The last form of treatment to mention is
orofacial myofunctional therapy. In 2015, a meta
analysis of CPAP compared to myofunctional
therapy concluded: “Current literature demon-
strates 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
We think that is a huge percentage, and this
is all from oral and facial muscle retraining. Pretty
MY OFUNCTIONAL THERAPY
Myofunctional therapy is a series of exercises that
not only strengthen, but repattern oropharyngeal
muscles and their use. The exercise sequence is
sometimes called rehabituation. OMT teaches people how to break old habits and create new ones.
Habits that will last a lifetime require adjustments,
so the therapy may take a while.
Dr. Leslie Gonzalez Rothi, a professor of neurol-
oxygen saturation levels drop every time they stop
breathing, which in turn makes the heart work harder
trying to get oxygen to the cells.
Two other major indexes are the apnea/hypopnea
index (AHI) and the respiratory disturbance index
(RDI). AHI measures the apneic events in an episode
of fully occluded breathing that lasts 10 seconds or
more, and a hypopnea event is an episode of partial
occlusion. The respiratory disturbances measured
are called RERAs (respiratory effort related arousals),
which is a short arousal that follows partial occlusion
of the airway. In a 2012 article in SLEEP, Krakow
studied over 500 awakenings and found 90% were
preceded by sleep breathing events. The patients
didn’t know they had a sleep breathing event before
they woke up. They thought they had a nightmare,
had to go to the bathroom, or had some kind of pain.
When patients present with high RDI results, it’s
labeled as an upper airway resistance syndrome.
Researchers have reported lately that, although these
patients don’t qualify as having obstructive sleep
apnea, there was a reason the RDIs were coming
back so high. They found that the patient was receiving enough oxygen, but struggling to do so.
This is a chance to treat early on, before the patient
falls into the category of obstructive sleep apnea. A
majority of patients fall into this category, especially
women in the 30-55 age range. Christian Guillemi-nault wrote a study titled “Upper Airway Resistance
Syndrome (UARS): A Common Cause of CFS and
Fibromyalgia.” Those with OMT training can help
people with UARS to find out early what is best for
the patient. Once obstructive sleep apnea is diagnosed, the job becomes a little more difficult.
TREATING SLEEP DISORDERS
Now that we know a little bit about the different
types of sleep disorders and which are appropriate
for OMT referrals, let’s look into how they are
It is always a good idea to have two referrals
for your patients: a sleep doctor and airway focused dentist. In most states, dentists are not
allowed to interpret sleep studies, so a sleep
physician is good to have on your team. The sleep
doctor is important in order to get the sleep
readings, and it is always a good idea to get a full
PSG (polysomnogram) for patients you suspect
as having obstructive sleep apnea. Also, referrals
to an airway focused dentist can lead to oral sleep
appliances, as well as a closer look into why patients are struggling with sleep apnea in the first
Sleep appliances alone, or in conjunction with
RECOGNIZING SLEEP APNEA
From an anatomical perspective, the oropharynx is
the part of the body that includes the mouth and
throat. In simple terms, the oropharynx is a tube
lined by muscular tissues. These muscles help us to
eat, talk, and breathe. They also help to keep the
airway open, especially during sleep.
When the muscles of the oropharynx are weak,
they disrupt the flow of air, and that is when snoring
happens. If the tube collapses, the airway becomes
blocked, such as what happens during sleep apnea.
Moreover, a weak and floppy tongue may fall back
into the throat and create an obstruction.
An orofacial myofunctional therapist can help
manage those muscles. Sleep apnea is categorized
into two different types: obstructive sleep apnea
(OSA) and central sleep apnea (CSA). Central
sleep apnea is caused when the brain fails to
signal the muscles to breathe. It’s pretty serious,
and orofacial myofunctional therapy is limited
in effectively treating it.
On the other hand, obstructive sleep apnea is far
more common. It’s caused by a blockage in the throat
(which is usually the soft tissue, namely the soft
palate) while sleeping. Orofacial myofunctional therapy can help this kind of sleep apnea by working with
the muscles of the oropharyngeal complex, although
the therapy is considered adjunctive.
One more category should be added to this discussion. This category is often missed, because it
doesn’t “qualify” as a type of sleep apnea. Yet, an
uncounted number of people are affected by it. Upper
airway resistance syndrome (UARS) is a type of sleep
disorder that is characterized by resistance of the
airway while sleeping. It’s similar to OSA in the sense
that there’s abnormal airway blockage or resistance,
but it doesn’t get to the point where the airway is
UARS is underdiagnosed because it doesn’t show
up as a problem on a classical sleep study while examining the apnea/hypopnea index (AHI). UARS
may be caused by allergies or structural conditions
such as small maxillae.
HOME SLEEP STUDIES
Let’s walk through a home sleep study. Many important things are recorded during a sleep study—for
example, eye movement, heart rhythms, breathing
patterns, and brain activity. The most important
recording is the oxygen desaturation index (ODI).
Oxygen saturation is the percentage of oxygen that
is in our blood. So we pay attention to how much the
ODI drops when someone is sleeping.