Tongue tie, medically known as ankyloglossia, is a condition that restricts the tongue’s range of motion due to an unusually short, thick, or tight lingual frenulum—the membrane connecting the underside of the tongue to the floor of the mouth. Recent studies have explored the potential link between tongue tie and sleep apnea, a serious sleep disorder characterized by repeated interruptions in breathing during sleep.
This limitation can lead to various complications, including difficulties with speech articulation, oral hygiene, posture, jaw position, breathing, and sleep.
What is a Tongue Tie?
First, let’s explore how a tongue tie occurs. A tongue tie, also known as ankyloglossia, forms during the early stages of fetal development, typically between the 4th and 8th weeks of pregnancy.
The tongue starts as a completely attached structure to the floor of the mouth during early fetal development.
As the fetus develops, the tongue naturally separates from the floor of the mouth, leaving a small, flexible connection called the lingual frenulum.
If this separation process is not complete, the result is a short or tight frenulum, creating a tongue tie.
This congenital condition varies in severity; in some cases, the tongue may appear heart-shaped or have a notch at the tip when extended. The tip of the tongue may be anchored, or the tie may be further back, a posterior tie anchoring the mid-back of the tongue.
The limited mobility of the tongue can interfere with essential functions such as sucking, swallowing, speaking, and breathing.
If the tongue tie was not addressed in infancy or childhood symptoms for adulthood can impact several areas of wellness.
Symptoms of Tongue Tie – Tongue Tie and Sleep Apnea
Infants: Difficulty latching during breastfeeding, prolonged feeding times, poor weight gain, and irritability during feeding. Difficulty transitioning to table foods with textures, picky eating, and restless sleep.
Children: Challenges with speech development, particularly in pronouncing certain sounds like K G L S, and R. Often leading to many years of speech therapy. Picky eating and ADD or ADHD diagnosis commonly co-occur with tongue-tied children.
Adults: when tongue ties persist into adulthood untreated the adult may feel self-conscious about their speech. Articulation may have improved but feelings of sluggishness or strain overcome longer sequences of speech productions.
Chewing and swallowing may be difficult with certain foods such as steak and lettuce. Avoidance of certain foods and digestive issues can occur.
Many adults with tongue ties complain of jaw pain due to the jaw compensating for poor oral muscle movements. This compensation gradually over time weakens the joint. Jaw difficulties can lead to neck and back compensation.
Years of the tongue sitting low in the mouth can lead to the tongue blocking the airway while sleeping. Restless sleep and daytime drowsiness are serious risks of tongue-tied adults.
What is Sleep Apnea? Tongue Tie and Sleep Apnea
Sleep apnea is a sleep disorder characterized by repeated pauses in breathing during sleep.
These pauses, known as apneas, can last from a few seconds to minutes and may occur multiple times per hour. The most common type is obstructive sleep apnea (OSA), where the airway becomes partially or completely blocked during sleep.
According to the Mayo Clinic Sleep apnea is defined as a potentially serious sleep disorder in which breathing repeatedly stops and starts. If you snore loudly and feel tired even after a full night’s sleep, you might have sleep apnea.
The main types of sleep apnea are
Obstructive sleep apnea (OSA), which is the more common form that occurs when throat muscles relax and block the flow of air into the lungs
Central sleep apnea (CSA), occurs when the brain doesn’t send proper signals to the muscles that control breathing
Treatment-emergent central sleep apnea, also known as complex sleep apnea, happens when someone has OSA — diagnosed with a sleep study — that converts to CSA when receiving therapy for OSA
If you think you might have sleep apnea, see your healthcare provider. Treatment can ease your symptoms and might help prevent heart problems and other complications.
Symptoms
The symptoms of obstructive and central sleep apneas overlap, sometimes making it difficult to determine which type you have. The most common symptoms of obstructive and central sleep apneas include:
Loud snoring.
Episodes in which you stop breathing during sleep — which would be reported by another person.
Gasping for air during sleep.
Awakening with a dry mouth.
Morning headache.
Difficulty staying asleep, known as insomnia.
Excessive daytime sleepiness, known as hypersomnia.
Difficulty paying attention while awake.
Irritability.
When to see a doctor
Loud snoring can indicate a potentially serious problem, but not everyone who has sleep apnea snores. Talk to your healthcare provider if you have symptoms of sleep apnea. Ask your provider about any sleep problem that leaves you fatigued, sleepy and irritable.
Can Tongue Tie Cause Sleep Apnea?
The relationship between tongue tie and sleep apnea has been a subject of medical interest. Some studies suggest that an untreated shortened lingual frenulum at birth is associated with obstructive sleep apnea.
Restricted tongue movement can lead to improper tongue positioning, which may contribute to airway obstruction during sleep.
However, it’s important to note that not all medical professionals agree on this connection. Some experts assert that tongue tie does not cause sleep apnea or snoring.
Though research is scarce we wanted to share a few articles for your review.
Research
In their study Does Frenotomy Modify Upper Airway Collapse in OSA Adult Patients? The authors felt there was a connection.
The debate continues as more research is conducted to understand the potential link between tongue tie and sleep-disordered breathing.
Another article to consider is Myofunctional assessment for obstructive sleep apnea and the association with patterns of upper airway collapse: a preliminary study
Then for one more Relationship of ankyloglossia and obstructive sleep apnea: systematic review and meta-analysis
Here the authors concluded “ This systematic review and meta-analysis provide evidence supporting the association between ankyloglossia and obstructive sleep apnea in children. Nevertheless, it is crucial to consider additional factors such as tongue mobility and the presence of a high-arched palate in further evaluations.”
Imagine, if the finding is that apnea is present in childhood how significant that impact would be on a person who reached adulthood with a tongue tie intact.
Solutions for Tongue Tie and Sleep Apnea
If a tongue tie is suspected to contribute to sleep apnea, several treatment options may be considered. These interventions aim to improve tongue mobility, enhance airway function, and alleviate sleep apnea symptoms.
Myofunctional Exercises-Tongue Tie and Sleep Apnea
Myofunctional therapy involves exercises designed to strengthen the tongue and orofacial muscles, promoting proper tongue posture and function.
This non-invasive approach can help reduce obstructive sleep apnea symptoms by retraining the tongue and muscles to maintain an open airway during sleep.
The main focus would be to teach the tongue to rest on the palate rather than low in the floor of the mouth.
The high resting placement will pressurize the oral cavity and help the sinuses stay open for easy breathing. The tongue is less likely to fall into the airway, blocking it, if it remains sucked into the palate.
An easy exercise to teach tongue placement is tongue clicks or pops. Sucking the tongue up into the mouth to seal it tightly then forcefully popping it down and out. This can teach sensory awareness of the palate and tongue connection, build strength, and encourage an upward placement.
Myofascial Releases
Myofascial is a technique under the umbrella of myofunctional exercises. This technique allows the fascia within the muscles to be manipulated with ease. Reducing tension and restrictions on movement.
Consistent practice of these exercises can lead to improved muscle strength and function, potentially reducing sleep apnea severity.
Mouth Taping
Mouth taping is a practice aimed at promoting nasal breathing during sleep by gently taping the mouth closed.
This method encourages the tongue to rest against the palate, which can help maintain an open airway. However, mouth taping should be approached with caution and under professional guidance, especially for individuals with nasal obstructions or other underlying conditions.
It’s essential to consult with a healthcare provider before attempting mouth taping to ensure it’s appropriate and safe for your specific situation.
Surgical Release
A surgical procedure known as a frenectomy or frenotomy can be performed to release the tongue tie, allowing for greater tongue mobility.
In adults with obstructive sleep apnea and ankyloglossia, frenotomy has been shown to reduce tongue collapse by allowing the tongue to assume a higher physiological position in the oral cavity.
Post-surgical therapy, including speech therapy and oropharyngeal exercises, is often recommended to enhance outcomes and prevent complications such as glossoptosis (downward displacement of the tongue).
Pre-surgery myofunctional therapy that includes myofascial releases for the tongue and jaw often allows for better visualization of the frenulum. This provides for a more complete surgical release of the frenulum.
Surgical release alone will not be enough to improve tongue posture to influence sleep apnea scores. Pre and post-surgery myofunctional therapy is the best practice to ensure favorable outcomes.
Preferred Providers -Tongue Tie and Sleep Apnea
Every field of practice has specialists. This is especially true for the area of tethered oral tissues. Finding a provider that has knowledge of tethered oral tissues, and the possible impact they can have on oral and overall health is imperative,
Too many adults have been led away from these treatments under the guise of it being a fad.
The website Tongue Tie Life offers you a state-by-state list of providers who are familiar with tongue ties and the treatments involved.
Please read reviews and vet the providers you find, not every provider will be right for you, so please feel free to get second and third opinions. Providers you like may have their own team of professionals to refer you to helping to streamline the process for you.
Orthodontic Intervention- Tongue Tie and Sleep Apnea
Orthodontic treatments can address structural issues contributing to sleep apnea. Interventions may include Palate Wideners: Devices that expand the upper jaw to create more space for the tongue and improve airway dimensions.
After years of low resting posture, the palate may be too narrow to fit the tongue. Creating space through palate wideners can improve sleep and breathing outcomes.
Braces: Aligning the teeth and jaws can enhance oral function and potentially reduce airway obstruction.
These treatments are often part of a comprehensive approach, possibly combined with myofunctional therapy, and surgical release to address the underlying causes of sleep-disordered breathing.
Conclusion Tongue Tie and Sleep Apnea
The potential connection between tongue tie and sleep apnea underscores the importance of a comprehensive evaluation by healthcare professionals. Seek out those knowledgeable in ties.
While some studies suggest a correlation, others dispute the connection between tongue ties and sleep apnea.
For those who have suffered with little results, it might be time to consider tongue tie as a possible contributing factor to sleep apnea.
If you’re interested in what the process entails to embark on the journey of tongue tie release grab your FREE GUIDE here. We will deliver it directly to your inbox!
Check out our other blog articles on tongue ties and tethered oral tissues HERE.
Listening to your body and traveling along a path to healing can be fraught with ups and downs. We at Lynn’s Tied Together Hub want to help make that journey a little less scary. Let us know any questions you might have or provide us a suggestion on a topic you need more information about!