By: Katrina Basso, Myofunctional Therapy Provider, Communicative Disorders Assistant on May 8th, 2018
Integrative Healthcare: The Myofunctional Therapist’s Collaboration with Sleep
This is part four in a six-part series on the evolution of the sleep technologist. AAST has engaged professionals from across allied healthcare to address, from their perspective, the value of collaborating closer with sleep technologists and/or incorporating the discipline into their area of health.
Orofacial myology is the study and understanding of the normal and abnormal patterns surrounding the development of the muscles of the face and mouth, and in turn, how they affect speech, swallowing, dentition and sleep, among other areas.
A myofunctional therapy provider is concerned with the importance of a term coined Oral Rest Posture (ORP). This refers to the proper resting place of the tongue in one’s oral cavity. At rest, the tongue should rest against the upper alveolar ridge, just behind the front teeth. The tongue should rest against the palate, with the sides of the tongue contained by the teeth. This position provides the proper foundation for the growth and development of the entire craniofacial mechanism and guides a persons tooth eruption, craniofacial and airway development.
Not only are myofunctional therapists assessing ORP, they are also concerned with the consequences of improper oral rest posture. Unknowingly, a person who habitually breathes through their mouth alters their tooth eruption, muscle and craniofacial development. This results in compensatory bodily strategies where natural development would typically prevail, and in turn may lead to oral myofunctional disorders (OMDs). OMDs can include, but are not limited to tongue thrust and deviated swallow, malocclusions, high narrow arches and periodontal disease, TMD and TMJ issues, pelvic misalignment as well as allergies and chronic illness. Preventative and early intervention is therefore of utmost importance.
There are two main factors that can lead to OMDs. First, a myofunctional therapist will assess the patient for functional issues that have prevented them from having proper ORP. That is, do they have a tongue-tie that is preventing the tongue from resting on the upper palate, or a lip tie promoting a lip incompetency? From here, a patient would be referred to a specialist to correct underlying issues before beginning a therapy program. If there were no functional issue, a myofunctional therapist would take a detailed history report to learn more about the individual’s oral habits. For example, was the child a thumb sucker, use pacifiers, sippy cups or bottles? Sleep habitually on their stomach or with a blanket covering their head? All of these oral habits promote open mouth breathing, and a low forward tongue, which may lead to OMDs.
Without proper development and function of the tongue, there is also improper development of nasal passages, the airway, as well as muscle and bone development. If the width of the upper airway is decreased due to abnormal development from tongue placement, there is an increased chance of collapsibility of the airway. This is where the collaboration between a myofunctional therapist and a sleep clinician takes place. If an individual’s tongue is unable to move and rest properly, it may block the airway during sleep, especially if the patient is sleeping on their back. It is important to treat the underlying functional tongue problem in order to restore nasal breathing.
To stress the collaboration between the aforementioned allied healthcare professionals, I would like to discuss an article by Huang, Quo, Berkowski & Guilleminault (2015) from the International Journal of Pediatric Research. Here, a retrospective study of 27 pre-pubertal children referred for suspicion of obstructive sleep apnea (OSA) were found to have short lingual frenums (tongue tie), as well as enlarged adenotonsils.
Children with short frenums developed improper tongue function with secondary impact on craniofacial growth and sleep disordered breathing (SDB). The results found that when an adenotonsillectomy was performed with and without a frenectomy, the children’s apnea-hypopnia index (AHI) was not normalized. A frenectomy on children two years and older without enlarged adenoids/tonsils also did not lead to AHI normalization. The study concluded that recognizing and treating short frenums at birth would improve orofacial growth, and prevent SDB. Otherwise, the study concluded, restoring nasal breathing through myofunctional therapy later in life is necessary.
Tongue mobility and function plays a very important role in many areas of development. Screening and assessing our patients for whole body health is of utmost importance to prevent issues such as OSA in both children and adults. Recognizing and treating sleep and breathing issues from infancy can help prevent issues with growth and development later in life and provide our patients with the foundation they need to thrive.