Airway Expansion and Sleep Apnea

Sleep Disordered Breathing (SDB) refers to breathing difficulties that occur during sleep, such as heavy mouthbreathing, snoring, and sleep apnea. These conditions may interrupt the sleep cycle and lead to reduced oxygen levels that negatively affect the quality of sleep. Interrupted sleep can then manifest during the day as restlessness, behavioral issues, headaches, brain fog, attention difficulties, and loss of focus. Some children may be so exhausted during the day that they even fall asleep while at school, relaxing at home, or in the car. Unfortunately, symptoms often go unnoticed, where signs like hyperactivity, mouthbreathing, bedwetting, poor academic performance, and a limited attention span may be mistakenly viewed as normal behavior.

Sleep Disordered Breathing is caused by some type of obstruction of the airway during sleep. Obstruction may be caused by enlarged tonsils, swollen adenoids, narrow jaws, a deviated septum, an undersized nasal cavity, a sinus infection, or allergy-induced nasal congestion.

Since the tonsils, adenoids, and irregularities of the nasal cavity are the most common cause of obstruction in children, an evaluation with an ENT doctor is a very important step when looking to determine the cause and possible treatment options. Fortunately, we have many amazing ENTs on Staten Island that we work closely with at 103 Ortho.

To properly diagnose Sleep Disordered Breathing, an ENT or sleep physician will often order a sleep study, which can be done at home or in a sleep study center. In-office sleep studies are generally viewed to be more accurate and detailed, but at-home sleep studies serve as a good first step.

A critical component of healthy breathing lies in the structure of the jaws, especially the upper jaw. The roof of the upper jaw is the palate. The key here is that the palate is the same bone as the floor of the nose. If the upper jaw is narrow, then the palate is narrow, which means the floor of the nose is narrow. If the floor of the nose is narrow, then air flow through the nose is restricted, making the person more prone to breathe through the mouth and thus more prone to snore.

So, orthodontists can play a very important role in helping to improve Sleep Disordered Breathing by expanding the upper jaw. If the upper jaw is expanded, the palate is expanded, so the floor of the nose is expanded, which means the volume of the nasal cavity is increased, and airflow through the nose can improve.

Keeping your mouth closed throughout sleep is aided by positioning your tongue to the roof of the mouth to create a suction. With the tongue properly suctioned, the mouth remains closed with the lips sealed together, preventing mouth breathing and encouraging nasal breathing. However, if the palate is too narrow and high, part of the tongue may be unable to fully reach the roof of the mouth, preventing the necessary suction. This is where an expander can be extremely helpful. An expander not only widens the roof of the mouth but also actually causes the palate to drop down. With the palate lower, the tongue can more easily sit up in the palate, suctioned in a way that keeps the mouth closed throughout sleep.

A myofunctional therapist is also extremely helpful in this situation to help teach proper tongue position and exercises. At 103 Ortho, we work hand-in-hand with many amazing Staten Island myofunctional therapists to provide coordinated multi-disciplinary care. If a patient is unable to create proper tongue suction to the roof of the mouth because the palate is too high and narrow, the myofunctional therapist will refer to our office. We will use an expander to predictably widen and drop the palate, while the myofunctional therapist teaches exercises to create the appropriate tongue suction.

Another factor that is important to note is that some patients have a tongue tie. A tongue tie can prevent proper tongue positioning, as the tongue may be unable to extend and sit up in the palate properly. In this situation, the tethered tongue may hinder the ability of the tongue to suction to the roof of the mouth during sleep, making the patient more prone to having an open mouth posture. In this situation, we also work closely with a myofunctional therapist to evaluate the tongue tie, determine the best treatment, and teach appropriate exercises.

The short answer is yes! Extensive clinical research has actually shown that palatal expansion can help alleviate bedwetting in children. Unfortunately, this does not mean that an expander will fully stop bedwetting in every child, but we have fortunately seen a lot of success in our office in reducing bedwetting with early expansion. Although not 100% successful, we certainly encourage expansion if bedwetting has become problematic to the point that prescription medication is being considered.

Of course! In adults, a palatal expander is utilized in conjunction with small bone anchors to achieve true bone expansion and increase airflow through the nasal cavity. Although adult expansion is not the focus of this website or our office, we encourage you to read online about MARPE and DOME procedures to learn more.