Relationship Between Tongue Tie & Sleep Apnea Written By: Dr. Ankita Shah, October 2021

Tongue tie is more than just a metaphor for stumbling over your words. It is an oral condition that can cause issues right from infancy like difficult breastfeeding, impact your child’s airway(breathing and sleep) and affect speech, posture and dental health. In adults, it could lead to Orofacial pain and TMJ dysfunction, snoring, headaches, pain in the shoulder, neck and back.

Overall, these peculiarities in the oral tissues can affect the growth and function of the airway and jaws. The medical term for these restricted oral tissues is “frenum restrictions” - commonly known as tongue ties and lip-ties.

If left untreated, they can contribute to the narrow and backwardly positioned jaws which can interfere with breathing and sleep, posture, jaw pain, dental problems, tongue thrusting, and sleep-disordered breathing in children as well as adults.

In the below article, we’ll look at the relationship between sleep apnea and tongue tie along with its likely treatment options.

Discover the possible connection between tongue-tie and sleep apnea, and take action to improve your health and quality of life. Find expert solutions and take the first step towards better sleep and better health today!

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1. What is Tongue Tie?

A tongue tie is a condition wherein a string of tissue restricts the tongue's range of motion. This tissue is known as the frenulum. The frenulum connects the floor of the mouth to the underside of the tongue. This can suppress movements that are vital for breathing, breastfeeding, sucking, eating, drinking, chewing, swallowing, digestion, speech, jaw growth, and postures.

1.1 Symptoms of Tongue Tie

Symptoms of Tongue Tie in Infants

Some of the symptoms of tongue tie that infants,breastfeeding mothers, young children/toddlers and adults face are:

Prolonged latching and long feeding hours

Being unsettled after feeding

Short sleep duration

Poor/shallow latch or chewing on nipples

Reflux symptoms, Colic symptoms/Gassiness

Falling asleep during feeds or pulling the body away from the breast while feeding

Symptoms in Breastfeeding Mother

Problems faced by the mothers during breastfeeding are:

Reduced milk supply

Bleeding nipples

Creased nipples

Blanched nipples

Painful latching

Incomplete breast drainage after feeding

Mastitis/Infected nipples

Nipple Thrush

Anxious/Depressed (state of mind)

Symptoms of Tongue Tie in Toddlers and Children

History of difficulty in breastfeeding

Gagging while brushing teeth

The children could become sluggish eaters, picky eaters, or slow eaters.

Clenching or grinding of teeth at night

Delayed speech or speech difficulties

Forward neck and shoulder posture

Frequent cold, cough and allergies

Tonsils and Adenoids

Digestive problems – refluxes, colic

Distrubed sleep like tossing and turning in bed

Difficulty in brushing upper front teeth

Gags easily

Restlessness & lack of attention with daytime sleepiness/hyperactivity are a few other issues

Symptoms of Tongue tie in Adults

Mouth Breathing and Sleep Apnea, Noisy breathing or Snoring

Clenching and grinding their teeth

Headaches, shoulder, neck and back pain

Orofacial pain and TMJ dysfunction

Eating slowly or gulping big chunks of food

Difficulty swallowing or tongue thrusting

Incorrect facial and jaw development

Tingling in calves & feet and Pronated feet

Deep palate, crooked teeth, speech problems

Tightness in the chest or Acid Reflux

2. What is Obstructive Sleep Apnea?

Obstructive Sleep Apnea (OSA) is a well-known sleep-related breathing disorder. The characteristics of OSA are repetitive episodes of partial or complete obstruction of the upper airways. This leads to shortened or absent breathing during sleep. These episodes are termed apnea with near-complete or complete discontinuance of breathing or hypopneas when the reduction in breathing is partial. A high frequency of apneas or hypopneas during sleep may interfere with the quality of sleep, having several negative consequences on one's health and quality of life.

Fatigue and anxiety even after 8-9 hrs of sleep

Daytime sleepiness and low energy levels

Difficulty waking up in the morning

Low-quality performance in school, on the job, or in sports

Increased clumsiness and poor concentration

Risk of fatal accidents and injuries

Falling asleep during work or class

Inability to retain information and irritability & moodiness

Headaches and tiredness even after waking up

Loss of libido

For instance, long term consequences of chronic sleep deprivation may lead to a host of health problems including high blood pressure, obesity, diabetes, cardiovascular disease, and even early mortality.

3. Relation Between Tongue Tie and Sleep Apnea

There are several ways a tongue tie can contribute to sleep apnea (OSA). The tongue comprises 8 muscles, all of which are vital for the function of swallowing and maintaining a posture of the neck and shoulders. It also plays a role in breathing and keeping the back of the tongue resting high up on the palate that helps keep the airway wide open.

In rare cases, the tongue rests low because of a tongue tie, low muscle tone, mouth breathing, or inadequate space in the mouth. This can lead the back part of the tongue to fall behind and narrow the airway causing airway function disorder. Airway function disorder includes noisy breathing, snoring, mouth breathing, UARS, sleep apnea and oral muscle dysfunction in children and adults.

Habitual mouth breathing: Mouth Breathing means simply breathing through the mouth. Mouth breathers are those that keep their lips open more than 90% of the time throughout the day or while sleeping. It is one of the most common and early signs of sleep-disordered breathing, which may slowly progress to noisy breathing, snoring and eventually sleep apnea.

Lower resting position for the tongue: Tongue ties can prevent the tongue from resting in the roof of the mouth, which also interferes with the growth of the palate. It can cause an abnormally arched or high palate, leaving little room for the nasal passageways above it, which adds to breathing difficulties, including OSA.

Comprehensive Treatment Approach for Tongue Tie and Sleep Apnea

Sleep disorders can worsen with age. As such, taking action at an early age is important. The traditional approach to treat sleep apnea was CPAP (Continuous Positive Airway Pressure). However, today, several methods can be used alongside CPAP to treat OSA, including Breath Retraining, Oral Myofunctional Therapy, Airway Orthodontics, Correction of Tongue Function & Mobility and Dental Sleep Appliances.

Oral Myofunctional Therapy

Oral Myofunctional Therapy involves strengthening the tongue and orofacial muscles. As a tongue exercise program, it is used to correct the irregular function of the tongue and facial muscles. In this therapy, individuals learn how to tone and use their muscles to achieve vital functions like nasal breathing and swallowing. By training the muscles in the face to act in their best biological way, muscle memory can help with teeth and jaw alignment as they grow and develop.

Myofunctional therapy is utilised as a vital adjunct before and after tongue-tie surgery (Functional Frenuloplasty) to achieve complete success. Before surgery, the therapy conditions the muscles, re-educating the tongue to implement its functions, thereby preparing the tongue to undergo the release procedure. Like physical therapy aids in training bodies after an injury to get back to their optimal shape. Likewise, Oral Myofunctional Therapy is a tongue exercise for sleep apnea that helps train the soft tissues of the tongue, face, neck, mouth, and throat to function at the best of their ability.

Functional Frenuloplasty

A functional frenuloplasty is an effective method for the release of tongue tie and lip tie. It includes surgical removal of the fascial tissue along with the blunt dissection of the fascia to improve the tongue's range of motion.

Breath Retraining

The main goal of breath retraining is to adjust every aspect of the breathing pattern, including the heart rate, rhythm, volume, mechanics and use of the nose for all situations like when the body is awake, during exercise, at rest, during eating, and speech. Breath retraining helps achieve physiologically normal nasal breathing throughout the day and night. It is used as an adjunct to treat tongue ties, sleep disorders & airway orthodontics for children and adults. In our practice, we use the Buteyko Method of breath retraining.

Further reading: Let’s re-evaluate our breathing

Airways Orthodontics

In general, sleep and breathing disorders are caused by the backward position of jaws and incorrect tongue resting posture. Airway Orthodontics recognises this fact and focuses on bringing the jaw growth forward and making it wider, so it expands the airways which help correct the tongue and spine posture, leading to healthy sleep and breathing patterns.

Dental Sleep Appliances

Depending on the diagnosis, an airway focused dentist will recommend a suitable dental sleep appliance to treat sleep apnea, snoring, and OSA. This will help alleviate the symptoms of OSA and reduce the unhealthy effects of sleep apnea & snoring.

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Final Note

Being well-informed about how tongue-tie causes sleep apnea, this can help you make the right choices. You can read through our blog on myths and facts about obstructive sleep apnea to learn more. Also, if you have any queries related to tongue tie and sleep apnea, connect with us. Our team would be happy to assist you.

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