how does this problem lead people to think that your stupid?
my whole family does this and i think it is genetic problem.
I learned to breath this way when i was really young.(not sure how young, I just know its the way I have always breathed). My parents say it was probably because as a baby my nose was always stuffed up...So i just learned it this way.
Just another thing I learned diffrent from others. Also, When i write, I always start my Letters/numbers from the bottom of the letter/number to the top, Instead of top to bottom as most people do. Im not sure Why i learned it this way but now both of the above are pure habit.
My stepson does this all the time, and although I know for certain he is not stupid, it does make him look like he is! He is 12. Maybe he does have problems breathing thru his nose. I don’t know. I’ll have to ask him. I love my stepson very much, and although I find this “habit” annoying, I mostly feel that it would be in his best interest for his future, if he can find a way to “fix” it. I personally tend to think (because of other habits) it’s just laziness on his part.
sarah, I’m sure in you and your family’s case it’s not true, but this problem can sometimes lead people to think one is stupid because the “slack-jawed” , staring-off-into-space look on one’s face can be associated with people who are “not all there”, to put it nicely. I just don’t want my stepson to be thought of in that way, especially when it’s not true. If it’s because his nose is stuffy, then maybe he just needs to blow his nose more often! ;)
@Mark
The nose is built specifically to stop you from breathing in all the bad little floaties in the air. Thats what mucous and nose hair is for.
Breathing through your mouth isnt especially healthy.
Also- You lose more moisture by breathing out through your mouth.
And besides- its just an ugly habbit.
At least in America- its considered kind of obscene. People just dont like to see it.
..and people in America are especially fond of mucous and nose hair? :)
Breathing through the nose is fine - if you are able. Often I’d be gasping for air if all I had was my nose…
To Mark,
It is of extreme importance to breathe through your nose. If you can only get enough air by reathing through your mouth, it means that your body is not functioning properly. The nose was the only intended means of inhaling air and acts as a filter for your lungs. When you breathe through your mouth, particles, dust, germs and pollen enter directly into your body.
Many experts in fact beleive that mouth breathing is the casue of many allergies, such as hay fever and asthma. It is not the other way around, but sometimes we just feel it is.
Mouth breathing can easily be stopped, but simply forcing yourself to breathe through your nose. It may be difficult and uncomfortable at first, but eventually it will ecome second nature and you will find your health improving.
Mouth breathing is yet another way in which humans have forgotten how to function properly.
according to gordon’s comments, my whole family should be in the hospital...but the thing is, is that we all have the immune systems that health canada loves...we hardly ever get sick.
so i don’t know where your ideas come from.
and as far as a “breathing filter"… ive never had a problem with lung infection, or anything like that and i always breath through my mouth.
and the last thing is that i don’t think it makes anyone look stupid.
I’m not an expert on the health aspects of it, But I agree with Mark on the fact that you get alot more air through your mouth (and when you are used to that, You almost feel like you are slowly suffocateing when breathing through your nose).
As for the ‘slack-jawed’ look...I dont think people can even tell my mouth is open when i breath through my mouth...I looked in the mirror and it looks closed, but its not, Its just barely open.(yes, it seems odd i’d get more breath this way then through my nose).
Also, about the noise factor of Mouth-breathing, It seems louder to me to breath through my nose then mouth...When i breath through my mouth, I dont hear anything...But through my nose I hear it. Which probably means nothing, Its probably like that whole ‘not being able to smell your own oder real well’ thing.
Frustrating for those of us who do have a legitimate medical reason for mouth breathing. I was born with a cleft palate, and although surgical techniques have advanced since I was a child, my repair surgeries left me without the ability to breathe through my nose. Let me put it this way: I cannot be intubated nasally (if I were ever in an emergency), because the nasal passages are far, far too small.
Consequently, I breathe through my mouth; I cannot get sufficient air through my nose. I can get a small amount of air through my nose and do try to do so. However, I mostly breathe through my mouth.
And for those of us who are “guilty” of mouth breathing, those of us who are aware of it and cannot change it DO often try our best to avoid that “slack-jawed” look. You’ll often find my mouth barely open.
I am a mouth breather. I’ve had respiratory problems since I was an infant; I’ve been picked on because I am a mouth breather, even though my medical problems could not be helped. Making fun of mouth breathers is an excepted form of discrimination.
To those who make fun of us because we look stupid:
I am in the top of my class and next year I will be starting pre-med to become a neurosurgeon.
A 1997 study (located here at http://tinyurl.com/28zmyl ) found that nasal symptoms cause mouth breathing and that mouth breathing causes nasal symptoms. Because one symptom causes another, a vicious cycle can develop. For example, some congestion leads to mild mouth breathing that can worsen the congestion that causes more severe mouth breathing.
An Atlanta dentist posts some of the dental problems that can be created by persistent mouth-breathing here:
http://www.atlantadentist .com/open_mouth_breathing .html
The lungs are a primary source of our energy level. They extract oxygen from the air we breathe primarily on the exhale. Because the nostrils are smaller then the mouth, air exhaled through the nose creates back pressure when one exhales. It slows the air escape so the lungs have more time to extract oxygen from them. When there is proper oxygen-carbon dioxide exchange, the blood will maintain a balanced pH. If carbon dioxide is lost too quickly, as in mouth breathing, oxygen absorption is decreased.
Excessive mouth breathing is problematic because air is not filtered and warmed as much when inhaled through the mouth, as it bypasses the nasal canal and paranasal sinuses, and dries out the mouth. Mouth breathing is often associated with congestion, obstruction, or other abnormalities of the upper respiratory tract. Co-morbidities include asthma, obesity, snoring, and halitosis (excessive bad breath).
Breathing through the mouth with the nose obstructed usually imposes too little resistance and can lead to micro-areas of poor ventilation in the lungs (atelactasis). Many years of breathing against excessive resistance as with nasal obstruction, may cause micro areas of poor ventilation (emphysema). Barelli (Behavioral and Pshchological Approaches to Breathing Disorders.p.50 )
Certainly, deviated septum, small nostrils, and other medical conditions may make it impractical for some people, but that bottom line is that the human body was designed to breathe through the nose. If you’re breathing through your mouth, you’re depriving yourself of oxygen, aggravating any allergies you have, and making yourself prone to other potentially serious health problems.
Also: the slack-jawed look is associated with the mentally disabled. Hence, the pejorative sense of the term. “Mouth-breather” = stupid.
Boy, did this whole thing blow up out of proportion! The simple comment that started this was that it didn’t make sense to equate breathing through the mouth with stupidity (and the dumbfounded look of people with their mouth wide open - a look mouth-breathers actually rarely have).
Of course, the body was designed to breathe through the nose. Otherwise, why would we have a nose in the first place?
Mouth breathing is the last resort of those with nasal problems. Obviously such people are going to use their mouth; they’re not going to suffocate just to keep some people from thinking they look stupid.
Do we really need to drag this out any more?!? The bottom line is that people who are breathing through their mouth are not stupid, just “nasally challenged”. :)
I just started checking this out today. I have always been a mouth
breather. I do always have a dry mouth. I also had asthma as a child. I wish I could breathe through my nose-I have tried and tried and it doesn’t work. Going to the dentist has always been a challenge. I don’t think I have a deviated septum or anything like that. It sure is annoying to me and no one has ever complained about it. I am just getting worried.
What a wonderful discussion—we don’t have enough pejoratives to sling around, so let’s create one that stimatizes people with nasal conditions!
Might I suggest two more pejoratives for inclusion in this dictionary:
nose-breather—A vain and shallow person; snob, diva, vainster (cf. the authors of the preceding citations)
non-breather—an expired mouth-breather whose demise was due to asphyxiation in the course of aspiring to nose-breather status; corpse, carcass, stiff
There are muscles which act to hold the nose open when breathing nasally, in order to switch from a mouth breather to a nasal breather you must exercise and tone these deep facial muscles in order to get to a point where you can effortlessly breathe through the nose…
The face, the breathing mechanism, the jaws, the tongue, these things are all important areas of the human body that need exercise just like the rest of the body.
For anyone interested in mouth-breathing vs nasal breathing, you should look into Tongue posture adn positioning.
In a healthy adult ideal tongue posture is one in which the tongue rests against the upper hard palate of the mouth, in mouth breathers the tongue always rests on the floor of the mouth.
Take care,
Little B.
Hi
I had developed asthma five years ago, and was on medications for it. I felt very scared at not being able to breathe well, and eventually I searched the web to find a natural healing method. I discovered a technique called Buteyko, which you can read about on the web. The basic thing I learned, which resulted in my getting well from the asthma, being off all medications, and being healthier than I had been in several years, with only about three or four mild colds in the past 4 years, was that I had been overbreathing, including breathing through my mouth. By learning to slow my breathing I got well!
Buteyko was a Russian doctor who discovered that many many illnesses, including asthma, were associated with faster and more breathing than healthier people had. He asked himself whether the fast breathing could be the cause rather than the result of the illnesses, and tested his theory by teaching people to slow down their breathing. In fact, his theory is that asthma is actually the body’s response to the situation of having too much oxygen. It is closing the breathing tubes in order to regain the proper balance of CO2 in the blood. Why? It turns out that when the body has enough CO2, the blood cells can release oxygen to the cells. (This is called the Bohr effect. It’s a necessary part of the regulation of O2. Too much oxygen in the cells would destroy them. ) When people breathe more than they need (and we don’t need a whole lot when we’re just sitting in a car or at a computer) their oxygen levels increase to the point that oxygen is not released to the cells, hence the feeling, despite rapid breathing, that one is not getting air. As the cells use up O2, there is more CO2 in the blood, and eventually at the correct level of CO2 in the blood, the hemoglobin releases more O2. I am now healthier than I had been in the past 5 years or so before I got sick. I know this is a long letter, but there are so many people writing in here who have respiratory issues, I really want to tell you about this! If you google Buteyko or just mouth breathing + asthma, you will find the Buteyko method and also plenty of other teachers who understand this link between overbreathing and asthma, snoring, allergies etc. Western Medicine hasn’t figured this out yet, but they will. The Western Docs scratch their heads because there are so many varied “triggers” for asthma, and they don’t understand the connection. However, every asthma trigger I’ve ever heard of: exercise, fearful emotions, certain foods (sugar and simple carbs), allergins, inner city living (where life is dangerous, putting people into the stress response nervous system, the sympathetic), all have this in common: they speed up the breath. When I was so sick, I took the Buteyko course. Although I don’t do exactly the thing I was taught in the Buteyko training, (which is a kind of bio feedback system of counting the pulse, slowing the breathing and counting the pulse again) I do meditate twice a day for about a half hour with the idea of relaxing and allowing my breath to slow down and my out breath to be come as slow and long as possible. I also tape my mouth closed at night (I know it sounds weird, but I soon saw that doing this cleared up the congestion in my nose (more CO2, and the nasal passages open) Through this method I have cured my asthma and am living a much happier life. The proper balance of CO2 does lots of nice things. It relaxes muscles, improves digestion and elmination functions, gets more 02 to the cells, and results in (or is associate with) a generally peaceful state of mind. So not only am I healthier, I am much happier too. Please check out Buteyko, and if you want to know why I got well in a slightly different way than what they recommend, send me an e-mail and I’ll explain more. But the point of all this is that in my very direct experience, breathing through the mouth is the cause rather than the result of nasal congestion. I offer those of you who have nasal congestion to try this test the Buteyko folks use. Breathe out naturally then plug your nose with your thumb and finger. Hold your breath and keep your mouth and nose closed, and nod your head vigorously; this will use up Oxygen. If you do this long enough you will feel the nasal passages begin to open, sometimes the congestion will all go away. If you are overbreathing your nose will probably close up again in a little while, but if you simply keep your mouth closed (except when eating or talking of course!)you may find that you immediately will have considerably less congestion. I have several friends, who have improved their health immensely and rarely get colds any more, just through taping their mouths at night, being careful to keep their mouths closed, and keeping their mouths closed during excercise (a great way to balance the CO2 O2 levels...just slow your running down to the speed you can manage with mouth closed. Withing a few days you’ll have more energy and will regain your speed and surpass your earlier ability. The best runners in the world, in Uganda, run with their mouths closed!)
If anyone actually read through all of that, thank you, and I hope it’s helpful. Feel free to write to me with any questions! Kathleen
I’d been hearing this term for maybe five years, and it never made any sense to me, but a quick Googling found me this page and now I totally get it. Whew. I didn’t read all the comments above, but maybe I can explain it pithily.
This has nothing to do with mouth-breathing per se being equal to “stupid”. It’s that someone who does it often has (at least in my own US culture) the appearance of being slow-witted. A caricatured “country bumpkin” or “dolt” saying “duh” will usually have that “slack-jawed” look, and by inference is a mouth-breather.
I used to take offense at this term, but I don’t think I will any more, now that I understand it.
hey folks anyone who is a mouthbreather PLEASE READ THIS http://www.westonaprice.o rg/healthissues/facial-de velopment.html
I used to think mouthbreathing was just a bad habit socially but it actually affects many aspects of ones health and vanity
to Jane Burgess:
u r a doctor or sth?
My daughter is a mouth breather, not sure how it started but she used to get an infected ear every month from the age of 1 or so.
She also had a hearing difficulty relating to glue ear, a couple of operations using grommits cured that however she still has high pressure in the left ear. I know she can breath through her nose as I often ask her to and I can hear the noise of the air gushing through the nose but she will then stop say after 50 breadths and revert to mouth breadthing.
It’s a great effort for her to breadth through the nose and her nose seem to be constantly running/blocked. I know she’s not getting enough energy into her blood as she gets easily tired and at times every thing is a massive effort. She does no sport or other exercise and when she joins in any sport she gets tired very easily. Mouth breadhing is definately impeading her and I think she may be in a vicious cycle of gettting alergies when breathing through her mouth resulting in runny nose which seems blocked at the same time making it hard to breadth through the nose. When I took her to the doctors 2 years ago I was told “oh she’s a mouth breather and that’s OK” but I know it’s not, I wish I had done more research and then I could have discussed it in more detail but I just took her word. I am taking my daughter, now 14, to the doctor again tomorrow and hope to get a more understanding response rather than being “buffed off”.
In the mean time thank you for making me aware of the Buteyko method which I will discuss with my daughter.
If anybody is aware of any other successful remedies please let me know. Many Thanks
Vipin,
Seeing as your daughter has been a long time mouth breather, you have to be careful with methods like buteyko which simply tell you to “close your mouth and breathe through the nose"… You have to understand that your daughters facial muscles are weak and adapted to mouthbreathing, trying to have her forcefully hold her lips closed all day can result in further muscular damage, weakness, and eventually pain.
YOU MUST BE VERY CAREFUL!
I myself used to be a mouthbreather, and have successfully been making a gradual change to nasal breathing using a facial exercise program which strengthens all the facial/throat/and tongue muscles to support nasal breathing in a natural and effortless way.
I encourage you to visit www.voicegym.co.uk and read through the information on that site very carefully and thoroughly. Feel free to contact the author of the program, she is more than willing to answer questions.
The key to nose breathing is a tongue which rests on the roof of the mouth, mouth breathers have weak and dysfunctional tongues which rest in the floor of the mouth. You can’t simply tell a mouth-breather to “close your lips”, although this can be an effective strategy in the short term, it will only cause dysfunction/pain in the long run.
again, i encourage you to check into www.voicegym.co.uk
Best of luck in the future
Vipin,
Again… I want to stress, that telling a long-term chronic mouth breather to “close your mouth and breathe through your nose” can be like telling a hunch-back to simply stand up straight.
Your daughters facial muscles are weak and dysfunctional, that is why when you tell her to breathe through her nose she automatically reverts back to mouthbreathing within 50 breaths.
Having her use brute force to hold her lips closed all day can weaken the muscles further and make her even more of a mouth breather than before. You must strenghten the face, lips, and tongue in favour of mouthbreathing, and re-program the use of the muscles so that everything happens naturally and effortlessly, this is what Voicegym is for, again I highly encourage you to check into it, www.voicegym.co.uk
all the best
Kathe Chandler,
I am interested in this voicegym program, how long did it take for your daughter to see the improvements? How long did it take for the snoring and mouth breathing to go away once she started the exercise program? 6 months? a year?
please let me know!
LB.
Kathe,
Voicegym sounds very promising and I hope it suitable for us. Tell me what is the one exercise that has made the greatest improvement to you and your daughter.
Many Thanks
Vipin
KATHE,
How long do you do voicegym each day? 30 minutes? an hour? 2 hours? Are you supposed to do it everyday of the week or everyother day???
WoW, all good information and helpful comments.
I’m a mouth breather, although I try at times to breathe through my nose during the day when I become aware of it. At night though when I go to sleep and lose awareness I always breathe through my mouth. And I would like to learn to breathe through my nose all the time because I feel like breathing through my mouth is giving me dry skin. I have eczema which isn’t that bad but its a chronic thing that won’t really go away. When we breathe through our noses the air we breathe in is filter a little and its also moistened by our little nose hairs, so when the air enters our lungs it isn’t as dry. Chinese medicine makes a direct correlation between lung vitality and skin vitality, and thats how I made the connection. It makes so much sense. That would explain why those who breathe through there mouths are prone to asthma which I don’t have but my brother whose dry skin is much much more serious does have asthma quite seriously. And he is always breathing through his mouth. Unfortunately it is very very difficult to breath through your nose if there is nasal congestion chronically, and that maybe can be changed through diet but sometimes not, maybe sometimes through some medication which I want to avoid at all costs. I think as mouth breathers we are used to getting a certain amount of oxygen when we breath in, and then when you suddenly switch to nose breathing it can feel like your not getting enough air, thus why when I fall asleep I switch to mouth breathing, anyways I wanted any suggestions on how to train myself to nose breathe more (there are some in the posts above), I know its going to be difficult and a long path since this is such an ingrained habit but I know its drying out my body and my body is already dry to begin with so I’m trying to do all that I can. I just wanted to post to make the connection between dry skin conditions and mouth breathing.
Very good… eat well… breath well…and get plenty of fresh air.
We all agree that mouth breathing is best, but thankfully we have our mouths as a backup. Aside from speaking and breathing, our mouths are primarily for EATING; and the practice of doing so quietly—WITH OUR MOUTHS CLOSED—seems to be THE FORGOTTEN EXERCISE.
Additionally, chewing whole foods THOROUGHLY and COMPLETELY stimulates our nasal and throat passages, promotes digestion, and positively impacts our overall oral and respiratory health.
Thank-you,
RDH
From Kathleen:
If anyone actually read through all of that, thank you, and I hope it’s helpful. Feel free to write to me with any questions!
From Randall:
I did, and thank-you! Kathleen
How do I write directly to you or anyone else who has written on this mouth breathing topic?
I am a mouth breather with sleep apnea, but I am getting better with the help of nasal surgery to relieve the obstruction (probably stemming from hereditary snoring, a childhood accident, and man made and concentrated things in our air), CPAP therapy, and a chinstrap and 3M First Aid tape to help be keep my mouth closed while sleeping.
I am still working on trying to keep my tongue in the upper position --which seems to be the key to improved nasal breathing --especially at night.
I have tried Hawaii’s Dr.Sue’s dental appliance but it cut into the back of my tongue and otherwise irritated it. But I think he is on to something with a pacifier that can exercise ones sucking and swallowing muscles while nose-breathing.
Respiratory Therapist should be picking be picking up his work as well as that of Buteyko and others to provide strait forward therapy.
Thank-you
Randall,
I suggest that you read some of the information contained on Dr Brian Palmers website, www.brianpalmerdds.com
Sucking is no way to train your tongue and swallowing muscles, these are completely different and infact sucking has been known to create abnormal tongue action and breathing airways in children who use pacifiers as opposed to breastfeeding (when babies breastfeed they do not suck, they squeeze the nipple between the tongue and the roof of the mouth).
Sucking pulls the facial structure inward and creates smaller airways and abnormal muscular function.
Proper breastfeeding (which is not sucking) creates an outward and upward growth of the facial and oral structures and increases airway size and promotes proper muscular function.
I strongly advise you to read that advice before using any sucking device to “strengthen” your tongue and airways.
sincerely,
LB
Yes,
Dr.Sue is an orthodontist and he is working on a divice to avoid the problems you mention.
Do you have thoughts on :How best to strengthen our nasel breathing such that it becomes natural while sleeping and that Proper Tongue Positioning keeps one from snoring and gasping for breath.
Do you and/or Dr. Palmers agree that the tongue positioning is key?
I will ckeck to see.
Thanks L Brittle
RDH
Thank-you.
This is the most thorough web site I have ever seen. There is clearly such kind of problems accruing.
There is an orthodontist named Dr. Sue in Hawaii that is working on devices to help this non-breast feeding problem. And for those that are older something to try and train the tongue to be in proper position to promote nasal breathing.
My tongue seems large but aside from reduction surgery (so that my tongue might better fit up top to stop mouth breathing)this Nose Breath device seems to bea plausable option.
Any thoughts?
Randall Dean Holycross
PS
I had braces as an adult.
I use CPAP and headgear and tape on my mouth to try and stop mouth breathing.
Dr. Sue’s device cut into the skin under my tongue so I could not wear it.
My nasal passages are generally clear after having my septum and turbinates cleared.
LB
You wrote:
For anyone interested in mouth-breathing vs nasal breathing, you should look into Tongue posture and positioning.
There are muscles which act to hold the nose open when breathing nasally, in order to switch from a mouth breather to a nasal breather you must
The face, the breathing mechanism, the jaws, the tongue, these things are all important areas of the human body that need exercise just like the rest of the body.
[For anyone interested in mouth-breathing vs nasal breathing, you should look into Tongue posture adn positioning.]
In a healthy adult ideal tongue posture is one in which the tongue rests against the upper hard palate of the mouth, in mouth breathers the tongue always rests on the floor of the mouth.
YES,
Please tell us what you have found. What can be done to “exercise and tone these deep facial muscles in order to get to a point where you can effortlessly breathe through the nose…”
RDH
Hi Randall
I’m happy to hear that you read through my lengthy post! You asked whether you can write directly to people here....I don’t know the answer to that. But I’ll put my e-mail in the text here, and I’m sure if that’s not ok the moderator will tell me. My e-mail is merpig@juno.com and I’d be happy to hear from you directly.
One thing that has helped friends of mine, and myself, with sinus, snoring and sleep apnea issues is taping their mouths closed at night. I’ve been doing this for 5 years since doing the Buteyko program, and I sleep much better than before the taping. I know it can sound sort of weird, especially if you have sleep apnea, but a friend of mine with sleep apnea feels that taping hasn’t cured her of snoring,or even completely stopped the apnea, but it has improved a lot, and she is sleeping much better than she did before taping.
I hadn’t heard about this voice gym program, but I’m going to check it out now. Sounds very
interesting. Thank you everyone for all the info. Kathleen
Hello Kathleen thanks for writing back.
My ENT suggested Duct Tape but 3m works much better and my experience is like your friends.
I have been taping it closed for a year or two and my mouth and throat feels fresher when I wake.
Proper tongue positioning and whatever exercises that may help with that is of interest to me.
The breathing methods are very interesting as well.
What Buteyko materials do you suggest? Do they mention tongue positioning?
I recall doing Aikido meditative breathing many years ago (during a very healthy time of my life) and the goal was to inhale and then slowly exhale.
I would like to know more about your meditative practice.
LB’s mention of the site www.brianpalmerdds.com is worth looking at. There is a tongue resectioning/reduction proceedure that looks gross but effective.
Basically, it says that lack of breast feeding leads to poor mouth and throat cavity development.
With a narrow and deep upper mouth cavity the tongue can not fit up into the space to seal off the airway between the nose and mouth—and so breathing is more “naturally” through the mouth than the nose.
Dr. Sue : www.nosebreathe.com has the device for holding the tongue in place but it did’nt fit me.
Do you think the voice gym program could actually shrink ones tongue?
It seems unlikely,
RD Holycross
More information:
The next area to consider is the palate area, at the level of your tonsils. In young children enlarged tonsils are the most common reason for obstructive sleep apnea, and this is easily treated with tonsillectomy (most of the time). However, as one gets older, the tonsils shrink, and the soft tissues of the throat and palate begin to stretch inwards with every apnea. Some young adults are lucky (or unlucky) enough to have persistently enlarged tonsils and in general do much is a better after tonsillectomy (with or without a palatal operation). If you have small or no tonsils your chances on a palatal operation curing you of obstructive sleep apnea is about 40% only. There are a number of ways of predicting whether or not an adult will respond to palatal surgery for sleep apnea. In general, if you have small tonsils and you can’t see at least some of your uvula (the thing that hangs down the middle of your throat) when you open your mouth, then a palatal operation alone is successful in 40%. What this means is that your tongue may also be involved.
When you have tongue involvement, this means that either your tongue falls back from a normal position sitting up to almost completely collapsed when on your back. In most people with this condition, one is breathing through a small slit about 1/8 to 1/4 of an inch wide between the back of the tongue and the back of the throat. When awake, the muscular “reflexes” keep the airway open, but during sleep (especially deep sleep), this reflex does not work, and the tongue falls back completely, leading to an apnea. Another variation might be that the tongue falls back only partially, causing a more forceful vacuum upstream, narrowing the palatal area, when can then collapse totally, or when air squeaks through a very small palatal opening, one starts to snore. This is why certain dental devices that pull the jaw forward, pulls the tongue forward, alleviating snoring.
As you can see from the above descriptions, if you place a pump on the “nasal” end of the long thin tube, and blow a gentle amount of air, the tube does not collapse. This is the basic principle behind a CPAP machine (continuous positive airway pressure). A soft padded mask is placed over your nose and a pre-measured amount of air pressure is delivered from a small bedside machine. CPAP is the first-line treatment for obstructive sleep apnea, and it works, but only if you use it. Due to obvious practical or logistical issues, many people are not able to use it consistently. Studies have shown compliance rates between 40-60%. In addition, intensive support and follow-through by the sleep medicine technicians and durable medical equipment was found to significantly increase the odds that you will do well and like your machine. Technology has advanced enough so that they are small enough to travel with, and there are hundreds of different masks, straps, and other gadgets that are available to suits one’s needs.
I strongly encourage anyone with obstructive sleep apnea to at least try CPAP first, even if you have only mild sleep apnea. Despite your hesitation about CPAP and it’s implications, once it’s tried, about 1/3 of my patients love it instantly, another third hate it, and the remainder have to get used to it and after a period of follow-up and adjustment, they can use it effectively.
Only after absolutely refusing CPAP, or if you tried it and hate it, can other options be discussed.
Before rejecting CPAP altogether, if your nose is stuffy and the pressure seems too uncomfortable, then treating your nasal congestion may allow you to use CPAP more effectively. Allergies or sinusitis may be treated with medications. A deviated nasal septum can be easily repaired. Not only can you breathe better through your nose in general, but you can use CPAP much is a more effectively.
As mentioned previously, a dental device can be made (by a dentist that specializes in this) to pull your jaw forward. This is effective in patients with mostly tongue involvement, and not appropriate for people with palatal level narrowing. The device is worn nightly, and incrementally advanced slowly to prevent jaw pain and bite changes. These devices have been shown to help significantly in appropriately selected people with mild to moderate sleep apnea.
Lastly, there are surgical options, but only if you’ve rejected or failed the other options.
Uvulopalatopharyngoplasty (or UPPP) was first described in the early 1980’s (about the same time as CPAP). Initially, they had good success rates, but over time, the success rates dropped to about 40%.
A side note about success: One of the biggest frustrations is that people use different definitions of success. The most commonly used definition in our field is a greater than 50% drop in the AHI, and that final number has to be less than 20. Unfortunately, many studies vary significantly from this definition, and others use very unorthodox ways of defining success.
Over the years, researchers have discovered that in cases where a UPPP fails, the tongue is the main culprit. Once the tongue collapse is addressed as well, the “success” rate increases to ~75%. Many subsequent studies report success rates in the 70-80% range.
There are many ways of addressing tongue collapse. At Stanford, they perform (in addition to the UPPP) a mandibular osteotomy with genioglossus advancement (MOGA), and hyoid myotomy with suspension (HMS). MOGA involves advancing the portion of your tongue that attaches to the midline lower jaw, and HMS involves pulling the hyoid bone, which is a c-shaped bone on top of your voicebox that attaches to your tongue and voicebox. Of the 25% that fail this operation, a portion went on to more definitive surgery, called a maxillo-mandibular advancement. This is a complex and long procedure that literally pulls the middle of your face and jaw bones forward. As expected, this procedure is well more than 90% effective.
An alternative to the MOGA is a procedure where a suture is attached to the midline lower jawbone, and looped around the back of the tongue, thus suspending the tongue from falling back. Results are similar to the MOGA, but much less invasive.
One last word about palatal treatments for obstructive sleep apnea: There are various modifications of the UPPP procedure, which all have their roles for selected patients. A recent alternative to the UPPP for mild obstructive sleep apnea is an implant procedure called the Pillar procedure. Three thin polyester rods are implanted into the soft palate which causes a tightening of the soft palate as it heals over weeks to months. It was originally developed for snoring, but recently received FDA approval for mild obstructive sleep apnea. For treatment options on snoring, please refer to the snoring section on this website.
If you have any questions about sleep apnea or any of the treatment options, please contact Dr. Steven Park, MD
Yeah, it’s me again. Wow, this topic has taken off!
In case anyone is considering it, I’ll just say that I got my nasal septum realigned surgically, and now I breathe a bit better. At least it seems that, when analyzed over the long haul, I seem to be stuffy less often.
I still snore, though. Above, I read the following: “For treatment options on snoring, please refer to the snoring section on this website”. My question is, “What Web site?!?” I checked www.nosebreathe.com and www.brianpalmerdds.com but couldn’t find it.
The web address as given www.voicegym.uk.co does not get a hit.
Such exercises should be part of good physical therapy breathing disdorders and be publically available. I have no doubt that it helps. The whole marketing thing, however, seems a little cheesy.
Randall,
Please notice that if you take a good look at the site www.voicegym.co.uk you can see that Angela Caine is not just a typical internet marketer.
She actually runs A Voice and Body Center in which she has children, singers, performers, and speakers come to her center and get training on how to work the voice and the body for optimum performance.
She has been running this center for nearly 30 years, long before the internet.
Not only that but she is a member of cranio group and works very closely with dentists and orthodontists to make sure that children who are currently undergoing orthodontic work maintain proper tongue strength and posture.
I encourage you to throughly read through the site and most specifically ready through the research section of her site,
documents like “How voice training can assist in orthodontic treatment” and “beyond chewing” etc…
Again, Angela Caine is not just another health guru attempting to sell a few exercises for mouth breathing on the internet.
She is a professional that works with real clients on a daily basis face to face and specialises in re-establishing and maintaining healthy, proper tongue positioning and strength.
I believe that voicegym only became available as a “package” that could be sold on the internet a few years ago. Up until that point if you wanted to benefit from Angelas work you had to goto England and books personal appointments with her at her center. The fact that she took the time to put together everything into a package that could be purchased by clients any where in the world is a huge bonus for those of us that are not in england. She did nto have to do this and I imagine that most of her clients are still local and work directly with her face to face at her center.
If you do anything, even if you don’t want to purchse the entire voice gym system right away, I highly suggest you purchase the book “Voice Gym Book - Get to know your Voice” by Angela Caine (available on amazon or www.voicegym.co.uk). It contains a WEALTH of information regarding how the jaws, tongue, breathing system, mouth, etc… all work together. This is information that is not easily obtained elsewhere. I can tell you this from someone who was a mouthbreather and attempting to fix the problem and the typical “Just shut your lips” was not cutting it (which is explained clearly in the book I just mentioned).
Do yourself a favour and seriously read through the site, see that Angela and her program are very sincere, and at least be open to the possibility that the program may be able to help you.
If anything you can AT LEAST read through the Research section on her website, which is JAM PACKED with free information, spend a couple of hours reading through and digesting the information contained there and you will see that she knows what she is talking about.
PS: In addition to helping my breathing, Voicegym has also helped my TMJ inredibly
If you wish to contact me personally to ask questions about the program please don’t hesitate:
tylerw@telus.net
Vancouver, CANADA.
Randall,
You said that “Such exercises should be part of good physical therapy breathing disorders and be publically available”
You are right, they should be, but unfortunately as I’m sure you know the medical community can only agree on one thing, that they can’t agree on anything.
Much of what Angela Caine writes about in her book and in her research papers on her website are ideas that are just plain and simple NOT known and understood by the medical community at large, even those that specialise in breathing and such things. Much of what Angela has discovered and bases her program on are very detailed and interlocking concepts. Unfortunately in the world we live in everyone wants quick fixes, and the medical community is obliged to gear most of its treatment in this regard. Unfortunatley voicegym is not a magic pill that you take, it is a tool that helps to inform and instruct you on how to keep this specific area of your body in top functional shape for breathing, speaking, singing, chewing, balancing, etc… The main factor in all of these is healthy tongue positioning, another thing she will teach you.
Again, Angela for the most part works with real clients face to face at her voice and body center in the UK, many of whom are recommended to her by the medical community (dentists, orthodontists, physiotherapists, osteopaths, etc.) We should feel lucky that she put the time into making her program available to people who are not in the UK. AND yes it’s unfortunate that it seems only ONE person in one very tiny corner of the earth seems to have a serious grasp on just how this important area of the body really works.
For instance, did you know that your tongue muscles ultimately insert in your shoulder blades??? I be that is something that you would never find anywhere. But angela understands these concepts. She knows that the tongue inserts via the hyoid and larynx into the shoulders, and that in order to work the tongue properly this must be taken into account.
Do you know what the most important muscle is for Airway patency and tongue positioning? I will give you a hint, it is attached to your temporal bones on either side. You will learn all this, how these muscles work together to allow you to chew, breathe, eat, speak, balance, etc… and how to target these muscles with functional exercises which are fun and engaging and not boring like running on a treadmill all day.
Sincerely,
Tyler.
Vancouver CANADA
I am sure that Angela and her program are very sincere, and I am open to the possibility that the program is helpful, especially from a developmental perspective.
I just wonder why Respatory Therapist and OSA doctors are not documenting and distributing her work.
Randall,
You said “I just wonder why Resparatory Therapists and OSA doctors are not documenting and distributing her work.”
For the same reason that if you went to one of these doctors for help with your mouth breathing they will simply tell you to “Close your lips and breathe through your nose”
It’s ignorance of functional anatomy and just how complex and interrelated the body is all the way from the tongue to the pelvis and down to the toes. Again, read through some of the research section on the voice gym site, and it is explained by Angela in some of those pdf’s why you cannot just close your lips and hope to defeat mouth breathing, it is more complicated than this. You might think Ok I’ve also been told to simply hold the tip of my tongue behind my front teeth, well it’s not as easy as that either, I can tell you from personal experience that this can be dangerous.
Plus, treating OSA by strengthening and conditioning your entire breathing system (tongue, jaws, mouth, throat, etc.) takes hard work on the part of the patient. The problem is not cured over night, and as I said, people want over night cures (ie sleep apnea machines, surgeries, etc...) and don’t want to put the time and effort into undrerstanding and building themselves a healthy body. And of course the medical community has to supply where there is a demand, and the demand is for bandaids for modern health problems, not long term rehabilitation and preventative solutions.
Did you read Dr Brian Palmer’s website about how important breastfeeding is for the development of a babies airway, face, tongue, teeth, swallowing, etc… and how pacifiers, sippy cups, bottles actually create an inward growth of these structures making for crowded crooked teeth, narrow faces, smaller airways, sleep apnea, and breathing problems later in life?? You would think that this information would be on every doctors desk and that there would be a HUGE push in western culture to make sure that all kids are breast feed and get a head start in life. But alas you never see this information anywhere, it is underplayed, misunderstood, and ignored because we are a culture of convenience, mother is too busy to breast feed baby, or worried about what it will do to her breasts, or worried about what it will look like in public. I tell you mother should be worried about the development of her babies skull and breathing passages.
Look, if you want to understand your breathing, your body, and how your tongue and jaws play a central role in your overall health then I encourage you to at least read angelas book and research papers (free) and if the information seems important and relevant to you than i encourage you to think about purchasing the entire voice gym package and giving yourself a tool to keep your breathing, mouth, throat, voice, tongue, jaw, face, shoulders, etc all healthy and strong into old age while most people are becoming weaker, breathing worse, snoring, losing their teeth, mouth breathing, faces narrowing and of course, ultimately breathing problems lead to heart failure.
I can tell you that I have spent hours a daily basis for more than i care to admit (and no, not just a couple of weeks or months) looking through information online concerning this subject. I can tell you honestly that two of the best recources I have found with reliable, expert advice on this subject are the websites of Brian Palmer (http://www.brianpalmerdd s.com/) and Angela Caine (www.voicegym.co.uk).
Take a month or two, go slowly through the information on both of these sites, comprehend and digest it, and you will be equipped with the information you need to understand this very complex area and make decisions about whith professionals can help you with your problem.
Once you have a firm understanding of this subject you will be illuminated to the fact that many doctors who are treating TMJ, Sleep apnea, Mouth breathing, Swallowing disorders, speech impediments, Poor posture, etc… are extremely misinformed and miseducated concerning this area.
Something to think about: Most people in western culture have a tongue position in which their tongue tip rests against or just behind their front teeth. Does this mean that this is ideal tongue posture? No it does not, in our culture it is rare to find someone that has a strong tongue that rests up, wide, and back in the mouth with the tongue tip spread wide and the body of the tongue postured like a cobra (up and back). But then again it is also quite rare to find anybody over the age of 40 that is in exceptional health.
Sincerely,
Tyler.
Yes, to better therapies.
Keep up the good work Tyler and Kathy.
Perhaps, “Tongue Gym: A Guide to Healthy Nose Breathing and Bettre Sleep” would be a better distibution title for the wholistic method.
If we could get Dr. Palmer,DDS and Dr. Park, MD (Clinical Assistant Professor of Otolaryngology - New York Medical College) in on it that would be even better
Dr.Palmer suggest reading Dr.Parks forthcoming book, Breathe Better, Sleep Better: How Sleep Position Affects Your Health And Your Life.
I look forward to continued reading and practice....
Cheers,
And Happy Thanks-Giving
Kathe and Tyler:
Since your practice, are your tongues smaller? In conversing with Angela Caine some time ago I believe she said it should. Do your tongues rest up, wide, and back in the mouth with the tip spread wide (up and back)? The tongue being postured like a cobra sounds good. Does this hold up during deep, unconscious, sleep?
If we could get such success documented in a clinical trial many, many people could be help.
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Randall,
The reason it is called Voicegym, and not tongue gym is because the program is much more than just tongue exercises, tongue exercises are only one part of the whole system which aims to condition and strengthen your entire voice system. The tongue being an integral part of that system. Angela caine specifically works with performers (singers/muscians) who are looking to improve their voice but have hit a plateu of development ususally because of physical barriers (ie, poor dysfunction tongue posture, mouth breathing, etc...)
I really don’t want to go into too much detail, please read through the free information in the research section of her site and educate your self. You can see how the voice is something that is dependant on muscular function, strength, and balance all the way from your skull, through to your pelvis, and down to your toes. Obviously the tongue is a very important part of this equation since a strong healthy tongue ensures an open airway, nasal breathing, and proper articulation of words. But many other important parts play a role in speaking and singing which are important such as the hyoid, larynx, jaw, pelvis, shoulders, etc… All of which are conditioned, strengthened, and balanced using the voicegym program. All of these muscles insert into eachother and need to be worked together.
Concerning Christian Goodmans program, I actually bought this program a few years ago, you can go ahead and purchase it (it’s pretty cheap) and take a look at some of the exercises, some of them are useful but I would not call him an expert by anymeans. All you can do is try things and see how they work for you.
The thing that has produced the best results for me so far (after trying many options like the face former, christan goodmans exercise program, and a few other devices and systems) has been voicegym.
I will not lie to you, results with voicegym do not happen over night, it is not a magic pill, and your problem won’t be solved in a few weeks or even a few months. Although for you it might, different people will probably respond differently to the program depending on what condition your voice and tongue in are to start.
For myself, before starting the program my tongue was resting in a position so low in my mouth that the top of my tongue was below my bottom teeth (actually about even but the top of my tongue was below the top of my bottom teeth).
Now my tongue is well up and away from my bottom teeth and you can actually see the indents in the side of my tongue from resting below the bottom teeth. I’d say that it is about 65% of the way up towards the roof of my mouth at this point. I have been working on the program in a disciplined fashion for approximately 6 months, and expect the tongue to reach its full posture (against the roof of the mouth) in the next 6 months or so.
I imagine that reaching ideal tongue posture may take less time, or even more time for some people depending on how hard they work and what the starting condition of their voice and body is.
Other things must happen for the tongue to reach proper posture, not just strengthening of the tongue. The hyoid must decend to it’s adult position, the shoulders must be worked on, the pelvis, and the brain must be re-programmed to use the tongue in a new way (especially articulating consonants further back in the mouth and not against the front teeth). This is all taken care of through voice gym. Angela has covered all her bases and understands this stuff functionally inside and out. The voice is a complicated mechanism, with the tongue being a very important part, but again everything is connected and inserts throughout the entire body which is why you must work the entire body and the voice/tongue together in order to establish the correct muscular relationships and balance.
Sincerely,
Tyler.
Randall,
You said “Does your tongue get smaller”
To be honest I have not heard anything such as this, you would be better to email Angela directly and ask her. It’s possible that if your tongue is too big for your mouth then you may need to have your palate widened by an orthodontist in order that your tongue may fit into the roof of your mouth, i know that some of angelas clients have had this done, in conjunction with using the voice gym program. Again, Angela helps to treat many kids who are going through orthodontic work, working closely with dentists and physiotherapists to estbalish good function of the voice, tongue, and jaws.
You also said,
“The tongue being postured like a cobra sounds good. Does this hold up during deep, unconscious, sleep?”
When you strengthen the appropriate muscles of the tongue (and not just change the position in which you forcefully hold the tongue) then what you are doing is changing the resting muscle tone of the muscles involved.
This means that yes, even in deep sleep your tongue posture will remain. And the stronger everything gets, the stronger and stronger your resting muscle tone will become, to the point where your muscle tone in deep sleep should be exactly the same as your muscle tone during your awake hours.
The reason is that when your tongue is strong and finally resting up and back in your mouth, it will be doing so with absolutely no effort on your part, it will be resting here because this will be it’s position when the muscles are completely relaxed. You shouldn’t have to think about where your tongue is resting in your mouth, if you are forcing it into certain postures and positions then you are most likely using muscular force to do so, using continuous muscular force to do something like hold your tongue in a certain posture or position will create muscular fatigue and will eventually weaken your tongue muscles.
In the same way that if you walked around trying to make your biceps look big all day by flexing them you would eventually tire out and damage the muscle and then it would get weaker and smaller.
However if you you work your bicep muscle with enough time and discipline then you don’t even need to flex it for it too look big, it is big and strong even when in a state of total relaxation.
When you increase the strength of a muscle you cannot help but to increase the resting muscle tone of the muscle. (The tone of a muscle when it is in a state of total relaxation)
Well stated Tyler!
I had my doubts, but you are a true campion for the cause.
Thank-you
I had to check on the word ‘hyoid’:
I found this online (and medically speaking there appears to be good success with improvement in this area):
OPERATIVE PROCEDURE
Hyoid Suspension / Myotomy
In the event of sever OSA, HSM is performed in conjunction with TS. This method inhances the anterior superior repositioning of the tongue base, enlarges the airway in a lateral dimension, and partially separates the tongue base from the lower airway by an infrahyoid myotomy.
HSM is usually performed in conjunction with and immediately following TS. The anterior neck is prepped and redraped. The anterior mandible, hyoid, and thyroid are then outlined with a skin marker, with the neck slightly extended. Lidocaine with epinephrine 1:100,000 is injected into the planned incision sites. A 1-cm incision is made under the chin in the midline; with blunt dissection, the soft tissues overlying the mandible are cleaned. The screw inserter is loaded with a new spare screw and positioned perpendicular to the mandible, and with firm pressure applied, the screws is inserted into the inferior edge of the mandible. A loop of #1 polypropylene suture has already been attached to the screw by the manufacturer (Fig 1).
A second, horizontal incision measure 5-7 cm is made over the body of the hyoid. Subcutaneous fatty adipose tissue can be dissected and removed. Electrocautery is used to separate the infrahyoid bone. A single bone hook is placed to retract and stabilize the hyoid during the dissection. The sternohyoid and thyrohyoid muscles are detached from the body of the hyoid between the lesser cornuae (fig 2). Careful dissection, avoiding injury to the pre-epiglottic far, and good hemostasis are mandatory.
The suture passer is loaded with the polypropylene suture and tunneled subcaneously into the lower (hyoid) incision (Fig 3). The suture passer is then removed. One free end of the polypropylene suture is loaded into a Mayo needle and passed through the suprahyoid muscles, with a full thickness bite of the tissue. The hyoid bone is divided in the midline (hyoid distraction). This can be performed when the hypopharyngeal airway needs to be enhanced laterally, as determined by preoperative fiberoptic endoscopy. Following the division of the hyoid bone, the polypropylene suture is passed around both sides of the divided edges in a figure-8 configuration (Fig 4).
The two ends of the polypropylene suture are then tied together to achieve a superior anterior pull of the hyoid and tongue base. The inferior wound is drained, and both wounds are closed in layers.
All patients were admitted for close observation overnight. Peri- and postoperative care included steroids, intravenous antibiotics, antireflux medications, humidified oxygen, intravenous fluids, nasal trumpet, and pulse oximetry.
FIGURE 1. A Repose system is used to insert a single screw to the bony mentum, via a small stab incision. A loop of #1 polypropylene suture is attached to the screw.
FIGURE 2. A small horizontal incision is made over the body of the hyoid bone. The infrahyoid muscles are detached from the body of the hyoid bone using electrocautery.
FIGURE 3. The loop of polypropylene suture is tuneled through the chin to the lower neck incision using a suture passer.
FIGURE 4. The hyoid is divided in the midline, the loop suture is passed around the hyoid in a figure-of-eight fashion. The loop suture will suspend the tongue base antero-superiorly enhancing the posterior air space. The hyoid distraction will limit or eliminate the hypopharyngeal wall collapse. To see figures click here
RESULTS
Of the 55 patients who underwent HSM, all patients tolerated the procedure well, with no intra- or postoperative complications. Patients remained hospitalized postoperatively for 1-3 days, with an average stay of 1.4 days. No episodes of airway obstruction or bleeding were encountered. The most common postoperative patients complaints included dysphagia, odynophagia, and surgical wound pain. All patients were able to tolerate liquids and a soft diet at the time of discharge. No patients requested or required removal of the suspension sutures.
After 3-12 mo of follow-up postoperatively, over 90% of the patients were subjectively improved, as determined by patient and / or spouse history. Symptomatic improvement included decrewsed snoring, improved quality of sleep, and decreased daytime somnolence. Follow-up PSG studies were performed 3 mo to 1 yr postoperatively in 52 patients. The patients who had undergone HSM showed significant improvement in the mean RDI, from 71.2 (+ / - 18.0) preoperatively to 28.4 (+ / - 16.8) postoperatively. We should note that the percentage of sleep time recorded with an oxygen saturation above 90% was 51.4% preoperatively and 80.1% postoperatively.
Do you have clear hyoid improvement as well?
Your provide very good example of success;I wish Steven Y. Park, M.D. Clinical Assistant Professor of Otolaryngology - Head & Neck Surgery New York Medical College
New York Eye & Ear Infirmary could hear from you as part of background information before finishing his book: Breathe Better, Sleep Better: How Sleep Position Affects Your Health And Your Life.
Perhaps his new book could be:
“Breathe Better, Sleep Better: How Voice Exercises Can Improve Your Health”.
He can be reached at:
sypark@mac.com
www.westside-ent.com
West Side ENT, PLLC
212-315-9058
212-315-9558 fax
He is I very good fellow and I really do feel that you-all have a good deal to contribute to mission of better sleep through better breathing.
It is essential your message that follows gets recognized:
Other things must happen for the tongue to reach proper posture, not just strengthening of the tongue. The hyoid must decend to it’s adult position, the shoulders must be worked on, the pelvis, and the brain must be re-programmed to use the tongue in a new way (especially articulating consonants further back in the mouth and not against the front teeth). This is all taken care of through voice gym. Angela has covered all her bases and understands this stuff functionally inside and out. The voice is a complicated mechanism, with the tongue being a very important part, but again everything is connected and inserts throughout the entire body which is why you must work the entire body and the voice/tongue together in order to establish the correct muscular relationships and balance.
Well stated Tyler!
I had my doubts, but you are a true campion for the cause.
Thank-you
I had to check on the word ‘hyoid’:
I found this online (and medically speaking there appears to be good success with improvement in this area):
OPERATIVE PROCEDURE
Hyoid Suspension / Myotomy
In the event of sever OSA, HSM is performed in conjunction with TS. This method inhances the anterior superior repositioning of the tongue base, enlarges the airway in a lateral dimension, and partially separates the tongue base from the lower airway by an infrahyoid myotomy.
HSM is usually performed in conjunction with and immediately following TS. The anterior neck is prepped and redraped. The anterior mandible, hyoid, and thyroid are then outlined with a skin marker, with the neck slightly extended. Lidocaine with epinephrine 1:100,000 is injected into the planned incision sites. A 1-cm incision is made under the chin in the midline; with blunt dissection, the soft tissues overlying the mandible are cleaned. The screw inserter is loaded with a new spare screw and positioned perpendicular to the mandible, and with firm pressure applied, the screws is inserted into the inferior edge of the mandible. A loop of #1 polypropylene suture has already been attached to the screw by the manufacturer (Fig 1).
A second, horizontal incision measure 5-7 cm is made over the body of the hyoid. Subcutaneous fatty adipose tissue can be dissected and removed. Electrocautery is used to separate the infrahyoid bone. A single bone hook is placed to retract and stabilize the hyoid during the dissection. The sternohyoid and thyrohyoid muscles are detached from the body of the hyoid between the lesser cornuae (fig 2). Careful dissection, avoiding injury to the pre-epiglottic far, and good hemostasis are mandatory.
The suture passer is loaded with the polypropylene suture and tunneled subcaneously into the lower (hyoid) incision (Fig 3). The suture passer is then removed. One free end of the polypropylene suture is loaded into a Mayo needle and passed through the suprahyoid muscles, with a full thickness bite of the tissue. The hyoid bone is divided in the midline (hyoid distraction). This can be performed when the hypopharyngeal airway needs to be enhanced laterally, as determined by preoperative fiberoptic endoscopy. Following the division of the hyoid bone, the polypropylene suture is passed around both sides of the divided edges in a figure-8 configuration (Fig 4).
The two ends of the polypropylene suture are then tied together to achieve a superior anterior pull of the hyoid and tongue base. The inferior wound is drained, and both wounds are closed in layers.
All patients were admitted for close observation overnight. Peri- and postoperative care included steroids, intravenous antibiotics, antireflux medications, humidified oxygen, intravenous fluids, nasal trumpet, and pulse oximetry.
FIGURE 1. A Repose system is used to insert a single screw to the bony mentum, via a small stab incision. A loop of #1 polypropylene suture is attached to the screw.
FIGURE 2. A small horizontal incision is made over the body of the hyoid bone. The infrahyoid muscles are detached from the body of the hyoid bone using electrocautery.
FIGURE 3. The loop of polypropylene suture is tuneled through the chin to the lower neck incision using a suture passer.
FIGURE 4. The hyoid is divided in the midline, the loop suture is passed around the hyoid in a figure-of-eight fashion. The loop suture will suspend the tongue base antero-superiorly enhancing the posterior air space. The hyoid distraction will limit or eliminate the hypopharyngeal wall collapse. To see figures click here
RESULTS
Of the 55 patients who underwent HSM, all patients tolerated the procedure well, with no intra- or postoperative complications. Patients remained hospitalized postoperatively for 1-3 days, with an average stay of 1.4 days. No episodes of airway obstruction or bleeding were encountered. The most common postoperative patients complaints included dysphagia, odynophagia, and surgical wound pain. All patients were able to tolerate liquids and a soft diet at the time of discharge. No patients requested or required removal of the suspension sutures.
After 3-12 mo of follow-up postoperatively, over 90% of the patients were subjectively improved, as determined by patient and / or spouse history. Symptomatic improvement included decrewsed snoring, improved quality of sleep, and decreased daytime somnolence. Follow-up PSG studies were performed 3 mo to 1 yr postoperatively in 52 patients. The patients who had undergone HSM showed significant improvement in the mean RDI, from 71.2 (+ / - 18.0) preoperatively to 28.4 (+ / - 16.8) postoperatively. We should note that the percentage of sleep time recorded with an oxygen saturation above 90% was 51.4% preoperatively and 80.1% postoperatively.
Do you have clear hyoid improvement as well?
Your provide very good example of success;I wish Steven Y. Park, M.D. Clinical Assistant Professor of Otolaryngology - Head & Neck Surgery New York Medical College
New York Eye & Ear Infirmary could hear from you as part of background information before finishing his book: Breathe Better, Sleep Better: How Sleep Position Affects Your Health And Your Life.
Perhaps his new book could be:
“Breathe Better, Sleep Better: How Voice Exercises Can Improve Your Health”.
He can be reached at:
sypark@mac.com
www.westside-ent.com
West Side ENT, PLLC
212-315-9058
212-315-9558 fax
He is I very good fellow and I really do feel that you-all have a good deal to contribute to the mission of better sleep through better breathing.
It is essential that your message that follows gets recognized:
Other things must happen for the tongue to reach proper posture, not just strengthening of the tongue. The hyoid must decend to it’s adult position, the shoulders must be worked on, the pelvis, and the brain must be re-programmed to use the tongue in a new way (especially articulating consonants further back in the mouth and not against the front teeth). This is all taken care of through voice gym. Angela has covered all her bases and understands this stuff functionally inside and out. The voice is a complicated mechanism, with the tongue being a very important part, but again everything is connected and inserts throughout the entire body which is why you must work the entire body and the voice/tongue together in order to establish the correct muscular relationships and balance.
Kathe,
I have tried Amazon for a book on voice Gym proceedures but without success.
The web site does have some good information but it is not clear what is available for what price.
Is the training a work in progress?
What did you buy and what do you do.
How is you tongue and hyoid position?
Randall,
I encourage you to read through voicegym.co.uk with more attention and detail, notice the links down the left side,
- About Voice Gym
- About Angela Caine
- Research
etc… etc…
Click the link “VoiceGym Shop” and it has everything listed there with prices. What I bought is the total VoiceGym pack (down at the bottom of the list)
The book she wrote is called “Voicegym book - Get to know your Voice” (which is one of the best books I have read which explains the entire breathing system and how it connects into the rest of the body).
She also wrote another book called “The Devil Within” which is about her personal health struggle that started her on the road (30 years ago or more) to understanding and solving her own problem and creating voicegym to help other people.
Randall, I am going to have to ask you to not ask me any more questions about Voice Gym until you at least read through all of the information which is contained in the “Research” section of the site,
http://www.voicegym.co.uk /publications.htm
This will give you a firmer understanding of some of the concepts, plus the information she has can explain things much better than I can.
You asked,
“Is the training a work in progress?”
Yes, It is, and it will be for life. Just as you should want to make exercise and fitness a part of your life in order to maintain health and bodily strength, you should make exercising your tongue, voice, breathing system and whole body a part of your lifestyle and something that you do for the rest of your life.
EVEN AFTER You have reached a level of success with the program in which your breathing ways are open during sleep, tongue is resting on roof of mouth, hyoid decended to adult position (ie all the results that you eventually want out of the program) you are still going to want to use the system in order to maintain this strength and make sure that you do not lose it as you get older.
Just like how exercise is not something you just do for a few months and then stop, you make it a part of your lifestyle once you make the decision that you want to be healthy and strong. This is a life long decision, not just a year long decision, it is a change of lifestyle.
Voicegym is the same way, it is a tool for life to keep your voice, breathing, tongue, and all the connected parts working in a strong balanced and functional manner. It is not something you just do for a year and then stop once you achieve the results you were looking for.
You asked,
“What did you buy and what do you do. “
I bought the VoiceGym pack, it has everything you need in it. What do you do? You use the exercises and activities that are demonstrated and outlined in the book and on the CD to exercise all the parts of you that we have been discussing thus far.
You asked,
“How is you tongue and hyoid position?”
Regarding my tongue position, I explained that in one of my last few posts please read carefully and you will see.
Regarding my Hyoid position, I believe that it is nearly at adult position. I gather this from corespondance I have had with Angela in which she states that the way i am reacting to certain exercises means that the hyoid has nearly decended to the desired positioning. Angela explains in her book and in her free research papers how the hyoid decends during childhood eventually to an adult position, unfortunately this does not happen fully with everyone. Remember that the tongue is attached to the hyoid (more information that is explained in Angelas free research papers).
Randall, I have to stress that you should really take the time to read through the research section of her website, there is TONES of information there to help you to understand much of what we are talking about here.
Also You can search wikipedia for terms like hyoid, suprahyoid muscles, infrahyoid muscles, larynx, tongue, pharynx, nasopharyx, oropharynx, omohyoid, mylohyoid, styloglossus, etc… Look at pictures and learn all the muscles that are involved in this area and you can learn alot.
Sincerely,
Tyler.
Some of you people are so damn defensive! Work with what god gave you, if you breath through your mouth because you have medical conditions, thats one thing… if you do it because you’re lazy, or don’t know any better - then try and improve yourself. I was born with a cleft pallet, and often times suffer a rather nasty post-nasal drip, and as a kid, i had a hard time breathing properly through my nose… But by being conscious of my breathing (mainly through meditation and the accompanying breathing exercises) i’ve found that I CAN breath through my nose and that it increases my overall energy level.
We have nose hair, not mouth hair (or if you do - might want to buy you’re lover a razor for christmas, and comb the bets) for a reason!
In fact, the only times i catch myself slack-jawed and breathing through my mouth is when I’m totally engrossed in the TV… No wonder, the Idiot Box makes me look like an idiot.
Until 2 years ago, I was a mouthbreather. (I’m middle-aged.) I was dying. I was continually sick of colds and flu in the winter, and felt like I had a beehive up my nose in spring and summer. I learned about Buteyko techniques and they do help. PS: I have the physiological traits related to mouth breathing, but I can breathe through my nose now.
In case you all didn’t notice it, Read the comment about Buteyko again. In Russia,where Buteyko breathing got started and where the asthma rate is now around 2% , the Buteyko techniques are used to help people breathe gently and through their noses. In the US and UK and Ireland, where inhalers are used and for some odd reason our professionals think people are too incompetent to learn new breathing techniques, the rate is around 25%. So, Russia, dirty, few environmental controls, little asthma. US, UK, Ireland, first world countries - loads of asthma. Enough said.
Very Good.
Are you doing anything else, better? Saline rinse? Excercise? Food? Sex?
Do you snore?
Well,
since I was born,
I have NEVER breathed through my nose.
I do not know how to do it.
I have never done it
and I don’t even know how to go about learning.
Doctors think I’m “disabled”
But a private health clinic said that it may not even be possible for me to do it as I have never done so before.
It is physically impossible.
Please help,
Annie , 13 years of age.