What Happened to Our Airways? A Brief History Lesson …
Around 12,000 years ago, before the development of agriculture, humans’ skulls and faces were much more ape-like, with wide jaws and rounded facial structures. This allowed for large nasal openings through the sinuses, plenty of room for the tongue and a lower jaw that could comfortably rest in a forward position, which created open airways in the throat. The staples of a hunter-gatherer lifestyle up until that point included meat, fruit, nuts, wild grains and vegetables, most of which were uncooked and difficult to chew. The introduction of agriculture changed the human diet to a diet of soft foods, such as cooked beans and grains that didn’t require the same level of chewing strength. Over time, the shape of our faces began to change. The jaws narrowed, and airways became more restricted.
Fast forward to the Industrial Revolution, and one can see other factors contributing to the narrowing of our airways. Take breastfeeding, which plays a crucial role in normal facial development. The sucking and swallowing action creates the musculature and bone formation that are needed for proper airway development. Yet as women left home to work, nursing began to fall out of favor. In addition to this, our soft and nutrient-deficient Western diet contributed to malocclusion (problems with how the upper and lower jaws fit together, also known as the bite), which was observed to be virtually nonexistent in non-industrialized cultures. These new problems, underdeveloped jaws and narrow airways, were not the result of a genetic change, but rather the epigenetic effect (changes in gene expression) that had occurred.
Here’s the bottom line: smaller jaws leave less room for teeth, causing crowding. There is also less room for the tongue, forcing it to move backwards into the throat. During sleep, the tongue tends to fall back even more, where it tends to block the airway. Blockages of the nasal passages and/or throat can affect breathing 24 hours a day. There is extensive documentation of the myriad negative effects of breathing difficulties during sleep, collectively known as sleep-disordered breathing. Disrupted or fragmented sleep has profoundly disturbing effects on the brain, causes systemic inflammation, oxidative stress, and a host of severe health problems. Deep, restorative sleep is critical to our ability to thrive. Indeed, it is critical to our survival.
As a result of this research, the American Dental Association® (ADA) released a policy statement in 2017 addressing the role of dentistry in sleep-related breathing disorders. Dental professionals are encouraged to screen patients for sleep apnea and other breathing disorders, and should work in collaboration with other medical colleagues to provide treatment. Oral appliance therapy is emphasized as an effective way to treat and manage sleep apnea, particularly for patients who cannot tolerate treatment using a CPAP machine.
History (signs & symptoms)
You may not be aware that you are a mouth breather. Mouth breathing is considered a type of dysfunctional breathing because it prevents you from receiving the benefits of regular breathing through the nose. When you breathe through your nose, the air is humidified, warmed and sterilized (an anti-microbial effect due to producing and releasing nitric oxide), and your rate of breathing is controlled to maintain a better ration of carbon-dioxide to oxygen in your bloodstream. If you breathe through your mouth, you allow “dirty air” to pass directly to your lymphoid tissues, and may end up with an inflamed and infected throat.
Most people are not aware that they snore in their sleep. Snoring occurs as a result of the soft tissues of your throat vibrating and is a sign of airway blockage. One in three snorers also suffer from sleep apnea.
- Sleep Apnea
Sleep apnea is a very serious medical condition. It is a breathing disorder that can impact your health and that may contribute to other medical conditions. Sleep apnea is characterized by pauses and interruptions in regular breathing patterns. These interruptions may last for 10 seconds or longer, and can mimic the experience of choking, stimulating the “fight or flight” response in the nervous system. This all leads to a drop in oxygen levels in the body and a release of stress hormones into the bloodstream. Sleep apnea has been linked to increased risk of heart disease, stroke, obesity, and problems with the nervous and immune system, among other issues. It is critical that you seek treatment as soon as possible if believe you may have this condition.
- Poor Sleep Quality
If you sleep poorly or wake up often during the night, it could be a sign that you have sleep apnea. Frequent urination at night is a common side effect. It actually has nothing to do with your need to urinate, but more to do with the fact that you woke up from the fight or flight response produced by a pause in breathing due to sleep apnea.
- Daytime Sleepiness
If you find yourself sleepy and tired during the day, it could be a sign of sleep apnea. Failure to get the right amount of rest at night often results in daytime fatigue and could disrupt your ability to focus as well as your memory and concentration. This could make it particularly dangerous for you to drive or operate machinery.
- Nasal Congestion
If you experience frequent nasal congestion or difficulty breathing through your nose, it could lead to dysfunctional mouth breathing. This congestion could occur due to allergies (to food or the environment), a deviated septum, or acute/chronic sinusitis. You may also experience a “full” feeling in your ears if you are congested.
- Forward Head Posture
Another contributing cause to dysfunctional mouth breathing is forward head posture. If your neck bothers you and you find yourself putting your head into a forward posture, it may be a result of your body trying to breathe. Neck and shoulder tension is often the result of this forward posture.
Tongue restrictions, including tongue-ties, may affect sucking, swallowing or speech. These attachments are also associated with decreased sizes in upper airway support, increasing your risk of sleep apnea as well as creating additional tension in your head and neighboring regions.
- Chronic Cough
Do you have a chronic cough, sore throat, or difficulty swallowing? Chronic cough and similar throat issues are highly correlated with sleep apnea and gastroesophageal reflux disease (GERD), which often occur together. It’s reported that 80% of the 60 million Americans who’ve been diagnosed with GERD report worse symptoms at night, and three out of every four wake up routinely from sleep. Often by breathing in the cold, non-filtered air, a cough continues to be aggravated and lingers.
- Deviated Septum
A deviated septum or nasal deformity can be present from birth, be the result of poor maxillary development or occur due to an injury. This condition makes it difficult to breathe through the nose, and can lead to nasal congestion, chronic sinus infections, nosebleeds, difficulty sleeping, snoring and sleep apnea, chronic headaches, and a post-nasal drip.
Factors which allow our dentist and other medical professionals to diagnose sleep apnea include:
- Neck circumference
- Mallampati scores (assessments of the distance from the tongue base to the roof of the mouth)
- Scalloped tongues
- 40% greater tongue restriction
- Nasal stenosis (whether one nostril or both collapses in during nasal breathing)
- Skeletal profile
“SDB characteristically occurs when the flow of air through the nose or mouth is obstructed during sleep. While this airflow obstruction is typically caused by relaxation and poor muscle tone around the throat and jaws, there are many underlying causes of SDB. The most common of these are chronic mouth breathing, poor diet, obesity and poor development of the jaws. Additionally, orthodontics with extractions can exacerbate breathing issues.
“Traditionally, treatment for SDB, particularly obstructive sleep apnea, has involved the use of a Continuous Positive Air Pressure (CPAP) device. However, the inconvenience caused by the bulky CPAP machine and discomfort caused by the mask often discourages patients from using their machine. As a result, treatment with intraoral appliances is now considered to be the most convenient way to alleviate SDB. However, much research is happening to prove great results from the use of widening the palate and moving the teeth forward, along with myofunctional therapy to strength the soft palate.”
Myosa. (2021). from http://myosa.com/what-is-myosa/understanding-SDB
Concerned about your airway health? Give us a call today at 703-237-7622 for a consultation with Dr. Roca.