Airway health and breathing

Your mouth is not your optimal channel for breathing – that job belongs to the nose. It’s important to establish nasal breathing as soon as possible at any stage of life.

Your nose cleans filters and humidifies air before it comes into your lungs, the mouth does not. Nasal breathing has important sensory and neurological functions and it’s the foundation of all proper breathing patterns.

Mouth breathing, on the other hand, contributes to many functional and structural problems and a cascade of health issues [1], such as the following:

Oral health

  • Mouth breathing leads to mouth dryness and alters the microbiome of the mouth, leading to tooth and gum disease.

Children's health

  • Children who mouth breathe are more likely to have glue ear and require grommets, snore at night, develop behavioural and learning difficulties, have problems with speech. They are more likely to have issues with sleep and feeding (2).
  • Mouth breathing changes the growth patterns of the face and jaws and impacts on overall posture .

Snoring and sleep apnea

  • Mouth breathing increases the turbulence of the air passing over the soft palate. It also makes the soft palate and upper airway more collapsible contributing to snoring and sleep apnea. Nasal breathing reduces snoring and sleep apnea and helps to keep the airway more toned and open.

Facial growth, posture and muscles

  • Along with mouth breathing there comes a change in the posture of the tongue, head, neck and upper body. Mouth breathing also leads to abnormalities of muscle function related to swallowing, chewing and speaking.
  • These postural and muscular changes impact on the growth and development of the face, teeth and jaws.

Facial and dental development

  • Closed-mouth nasal breathing with the tongue in the roof of the mouth creates the ideal conditions for optimal growth patterns of the teeth, jaws and face. Mouth breathing interferes with these growth patterns and leads to narrow and small upper and lower jaws, long face, crooked teeth and small airways.

Brain function and stress response

  • Nasal breathing helps to activate brain circuits associated with emotion, memory and learning (3). During nasal breathing, electrical activity in various parts of the brain starts to synchronise with respiratory rhythms. Mouth breathing on the other hand does create any changes in brain activation.
  • Researchers found that people’s ability to perform mental talks and remember is better when they are nasal breathing.
Mouth-breathing_closed-mouth

What causes mouth breathing?

The complex cascade of issues that lead to mouth breathing can begin in infancy and early childhood.

Mouth breathing in babies might be a consequence of tongue tie, reflux, upper respiratory infections or other respiratory issues. Enlarged tonsils and adenoids and allergic rhinitis are other common reason for mouth breathing.

Structural issues such as deviated septum, narrow nasal passages and small jaw size can also contribute to mouth breathing.

To some extent mouth breathing is a self-reinforcing and learned behaviour that is associated with other dysfunctional breathing and poor function of the muscles of the mouth and face.

How to fix mouth breathing?

The Integrative Breathing Therapy approach to fixing mouth breathing involves improving the size and health of the airway, as well as by optimising nasal function, breathing, posture and muscle function.

1. Improve the size and health of the airway

This might involved the following:

  • see an Ear, Nose and Throat specialist to assess adenoids and tonsils
  • see see an allergist or nutritionist to identify and treat allergies
  • see a dentist to correct the jaw and airway size
  • improving diet and digestive function to improve immune health and correct gut issues such as dysbiosis, reflux and dysmotility.

2. Optimise nose function

The nose has many functions and these can decline when there has been nasal “disuse”. An integrative approach to improving nasal function includes improving the function of nasal muscles, its role in making sounds and in connecting with the limbic system.

3. Optimise breathing

Most people who mouth breathe also have other types of dysfunctional breathing, including poor breathing patterns and hypo or hyperventilation. These also need to be retrained with individualised breathing therapy.

4. Optimise posture and muscle function

Long term mouth breathing leads to postural and muscular changes. The head is often carried forward of the body and the neck muscles become tense and unbalanced. Muscles of the lips, tongue and throat can become weak and dysfunctional. These can be corrected with exercises and manual therapy.

Sometimes mouth breathing can be corrected with the help of simple breathing techniques (practiced regularly with determination and persistence!

The Buteyko Breathing Method

The Buteyko Breathing Method includes breathing techniques for clearing the nose and teaching people to breathe nasally.

These techniques are suitable for adults and even young children.

Here is a step by step approach based on the Buteyko method:

1. Just breathe through your nose

The first rule is to breathe through your nose as often as you can. Make an effort not to open your mouth unless it’s to eat or talk. After persisting with this for a few days it gets easier and easier to breath through your nose and mouth breathing can actually start to seem strange.

2. Repeated short breath holds (the Buteyko Control Pause)

The second technique is to do about 3-5 short breath holds in succession. Each short breath hold makes the nose clear a little more if you make sure that you keep your mouth closed between breath holds. The instruction is:

“Breath in through your nose and then out through your nose holding your breath until you feel the first urge to breathe. When you feel the urge to breathe,  take a breath but make sure its through your nose, keeping your mouth closed. Then keep breathing through your nose until you feel ready to do it again (about 1 minute or so)”

Repeat 3-5 times.

3. Single long breath hold (the Buteyko Maximum Pause)

If the nose is still not clearing or if there is not enough time to do multiple short breath holds you can do a single long breath hold where the breath is held as long as possible. The instruction is:

“Breath in through your nose and then out through your nose then hold your breath as long as you can. As the urge to breathe gets stronger distract yourself by moving your body (forward and backward) or by nodding your head (up and down) and when you finally do take a breath make sure it is through your nose”.

Now just keep your mouth closed and keep breathing through your nose.

4. Walking breath hold (the Buteyko Steps)

This technique like the single long breath hold requires that you hold your breath (after gentle exhalation) as long as you can. The difference is that instead of sitting you will be walking. With children you can count the number of steps. This seems to motivate them to go as long as they can.

Again, you must take your recovery breaths through your nose, not your mouth.

Mouth breathers also need to make sure that they do not have other forms of dysfunctional breathing. A breathing assessment will help to determine if this is the case.

Even when mouth breathing is corrected postural and oral muscle functional issues can remain and need to be addressed with orofacial myology.

It may also be necessary to see a dentist or ear, nose and throat physician to correct structural issues and optimise the airway size.

References

  • Trabalon M, Schaal B. It takes a mouth to eat and a nose to breathe: abnormal oral respiration affects neonates’ oral competence and systemic adaptation. International journal of pediatrics. 2012;2012:207605.
  • Lee SY, Guilleminault C, Chiu HY, Sullivan SS. Mouth breathing, “nasal disuse,” and pediatric sleep-disordered breathing. Sleep Breath. 2015.
  • Zelano C, Jiang H, Zhou G, Arora N, Schuele S, Rosenow J, et al. Nasal Respiration Entrains Human Limbic Oscillations and Modulates Cognitive Function. The Journal of neuroscience : the official journal of the Society for Neuroscience. 2016;36(49):12448-67.

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