Mouth Breathing and Sleeping: Everything you need to know for kids and adults
Mouth breathing is an epidemic. We often don’t consider how pervasive the problem is because it is the default way most of us breathe. What I want to focus on here is the causes of mouth breathing, what it is doing to sleep and how you can fix it for yourself and your kids.
Essentially, you can tell a lot about a person by how they breathe. The main reason people are mouth breathers is because of nasal obstruction. It resembles the features of a cold.
Think of what that feels like when you are congested. It makes it difficult to breathe and eat, as you rely mostly on breathing through your mouth to compensate for the blocked nasal pathway.
The main causes of mouth breathing in adults is a deviated septum. For children, it is enlarged tonsils and adenoids and the most criminally unknown, tongue ties or ankyloglossia also known as a short frenulum.
Mouth breathing is a problem because it leads to sleep apnea. Obstructive sleep apnea (OSA) is when the muscles of your upper airway in your nasal cavity or soft palate relax and eventually collapse, blocking your airway. When the soft palate is relaxed, air passes through it causing a vibration known as snoring.[i]
A blocked airway prevents oxygen from entering the system. The body doesn’t fully rest, because it is constantly reacting to being suffocated. Your body cannot enter a deep sleep cycle because it cannot breathe.
The prolonged effects of OSA can result in progressive brain damage.[ii] The litany of ailments from OSA include poor memory, emotional problems, decreased cognitive functioning and increased cardiovascular disturbances.
Deviated septum: Characteristics and Causes
It is estimated that 80% of people suffer from blockage related to a deviated septum.[iii] Not all blockage is significant, but the more obstructed the greater the difficulty in breathing, and therefore, sleeping.
A deviated septum occurs when the thin layer of bone and cartilage that separates the nasal canals becomes off center or imbalanced. When the bone and cartilage are bent or deviated, one side becomes blocked, while the other side may be clear.
Nasal imbalance is the fluctuating blockage between one nostril and another. This is something that most experience without knowing, however, with a deviated septum you can feel a chronic obstruction in one nostril.
Some people are born with a deviated septum. But it is mainly caused by trauma to the nose from sports or accidents. You could deviate your septum by bumping into a wall or accidentally getting hit in the nose. It doesn’t take much force to permanently restructure your face. It happens quickly and the subtle change compounds over time.
The structural change of a deviated septum can also be the result of chronic sinusitis or allergies. The constant blockage and pressure change the shape of the nose, which permanently impacts breathing.
Remediation involves treating the infection and the allergies, but if the structure changes, then it is important to consider a septoplasty. This surgery realigns the septum to increase airflow and return it to a symmetrical state. Obviously, there are risks to any surgery; however, I can speak from personal experience about how transforming this procedure is to someone’s life.
It is important to note here that there will be no significant improvements in your breathing if you have a deviated septum, even if you manage your allergies. Inversely, your breathing will not improve if you fix your deviated septum but continue to have allergies.
Both these problems must be fixed in order to improve breathing.
This is a complex problem because it requires assessing and remediating multiple variables. This is where you need the help of an otolaryngologist or ENT (ear nose and throat doctor) particularly one with a focus in sleep surgery.
ENTS can help you assess your nasal pathway by instrumentally evaluating how deviated your septum is. They can also evaluate your allergies and help you find methods of treatment.
My wife had 95% blockage on her right side, which meant that she was only breathing through one nostril. The ENT couldn’t even put the scope through her nose. She lived this way for over 20 years. Her first night after the septoplasty, she felt remarkably different. She describes it as one of the most drastic changes she has ever felt in her life. She had finally felt rested, despite having two kids under 2.
Bandaide Solutions for deviated septums:
You can use breathe right strips to open up your nose while you sleep. I use them when I have a cold. I would recommend spending the extra 5% on actual breathe right strips and avoid the store brand because the adhesive is often abrasive. These can be effective in the short term, but after one night of clear breathing you will be convinced that changing how you breathe will change your life. I have tried many brands but the original is still the best. You can support this post by purchasing in the link below.
Tonsils and Adenoids – Mainly in kids
ENTs are the authority in treating swollen tonsils and adenoids in children. Sleep apnea is a major concern with nasal obstruction. If your child has swollen tonsils or adenoids, you will notice:
-Dark circles around the eyes
-Gasping for air after swallowing (drowning reflex)
-Hyponasal vocal quality (sounding like they have a cold)
I’ve written about the profound effects of what happens when tonsils are removed. I noticed when my son got his tonsils out, he slept through the night. He no longer snored. He slept deeper. The black rings in his eyes had significantly decreased. He had more energy. He was more alive.
The recovery took about two weeks. The first week was not pleasant… for anyone. But it was a short-term setback for a long-term solution.
Since I was familiar with the effects of swollen tonsils, there was little debate when the ENT said it was “definitely plausible to take them out”. We were lucky to have an ENT that was able to explain the problem simply, but with great detail. He recommended a sleep test for my son, but we considered this to be completely unnecessary. I was already sold on the efficacy of removing the tonsils. The sleep study would have been a waste of time and an extra expense, especially with knowing how huge his tonsils were.
The major concern, which bears repeating, is sleep apnea caused by the nasal obstruction from swollen tonsils/adenoids. Deep sleep is what enables cognitive development. If your child can’t breathe when they sleep, it will impact their entire life.
Another issue that nasal obstruction creates is a blockage in the eustachian tubes. This is the canal that connects your ears to your nose. When this is clogged, it can create a conductive hearing loss. This means that fluid is built up and it prevents sounds from being fully processed, like listening underwater. Perceiving high frequency sounds like /s/ are impacted most by hearing loss. This can have a pervasive effect on speech and language development and therefore literacy development and academic achievements. For more information on hearing loss, visit the ASHA page here.
Tongue Tie – Short Frenulum - Ankyloglossia
This is an esoteric problem that few fully understand. A well educated Speech-Language Pathologist is an expert on how a short frenulum affects oral-facial structure, articulation, and breathing. A tongue tie is a short, thick lingual frenulum which is the membrane that attaches the tongue to the base of the mouth. Ankyloglossia is a congenital abnormality that occurs in 4-5% of the population.[iv]
Although there are varying levels of severity, there is a significant impact on speech, breathing, chewing, swallowing and the ability to breastfeed. The more severe, the easier it is to detect because of its impact on breastfeeding. But the subtle occurrences are deceiving because they go unnoticed. This is often the case with children who are seen because of articulation errors and not stimulable to produce sounds that require raising or curling the tongue tip, such as for /l/ and /r/ sounds.
Here is where we distinguish the efficacy of treating a tongue tie for children as it relates to sleep apnea and orofacial development as opposed to adults[v]. Since the jaw is fully developed by age 13 -15, fixing a tongue tie on an adult will not have the same impact on improving structure as it does a child.
To Sum it up:
If you are an obligatory mouth breather, your sleep is being disrupted. The band-aid fixes would be using breathe right strips and sleeping on your side, but it is highly recommended that you see an ENT with a focus on sleep surgery to assess what is really the cause of your problems.
You can lose weight, go on an elimination diet and that would help improve your breathing, however, if you have structural abnormalities an ENT can guide you on where to go from there.
I am not a doctor; I just have personal and professional experience with nasal obstruction. I recommend to pretty much everyone I know that you need to have an ENT in your life. If your breathing sucks, so will your sleep. ENTs can help you see why your breathing is so bad and help you figure out what to do to fix it… so you can sleep better and therefore have a better life.
If you found this article useful follow me on twitter @thinktalkideas and join my mailing list. I send out posts every Thursday at 10 am EST. I write about a range of topics including self-awareness, antifragility, and communication. I also include some fun and interesting short stories along the way. I am currently working on a book about breathing, chewing and sleeping so sign up and stay up to date on my adventures.