Sleep Apnea – Your Tongue and Your Airway (Podcast)

John Maher: Hi. I am John Maher, and I’m here today with Dr. Nammy Patel, founder of Green Dentistry in San Francisco, California, helping patients recognize the vital connection between dental health and whole body health and author of the bestselling books Age with Style: A Guide to a Youthful Smile & Healthy Living and Total Wellness: Understanding the Link between Your Teeth and Your Health. Today, our topic is your tongue and your airway. Welcome, Dr. Nammy.

Dr. Nammy Patel: Thanks for having me here, John.

How Does Tongue Position Affect Sleep Apnea?

Maher: Sure. So Dr. Nammy, how does your tongue position affect sleep apnea?

Dr. Nammy: Sleep apnea actually means that the tongue is obstructing the functional airway. So what usually happens is we’re standing up and our tongue is at the roof of the palate. But when we’re laying down, sometimes the tongue doesn’t have enough space or the tongue is not strong enough. So what happens as we lay down on the side, that hole that we have, the airway, it actually blocks it. So imagine having a windpipe like this and then something goes right over it, so it’ll actually stop you from breathing. When you stop breathing, it sends an alarm bell to your body. It goes, “Ding, ding, ding, ding. She’s not breathing. She’s not breathing,” and then you wake up. So that’s what obstructive sleep apnea actually means. You stop breathing.

There are some patients who have apnea, but that is because they don’t have a chemical signal. So their body doesn’t release a specific chemical that tells them to breathe properly. So there’s two types of sleep apnea. The one we’re going to talk about today is more of the obstruction or the obstructive sleep apnea, which is actually a physiological blockage because of the tongue.

Exercises to Strengthen Your Tongue and Treat Sleep Apnea

Maher: So, is that caused by your tongue being weak and so it’s falling back into your throat? And are there exercises that you can do to strengthen your tongue?

Dr. Nammy: Absolutely. There definitely are. There’s many reasons why the tongue is a problem, and it can stem all the way back to childhood. If people are not breastfed, the tongue doesn’t develop properly, so that’ll lead to obstructive sleep apnea. If people thumb suck, the tongue doesn’t have… it can’t latch at the roof of the palate, so people will get sleep apnea. Same thing with the pacifier use. And then this thing called aging. Just as we get wrinkles on our face, the tongue is also a muscle, so it does lose collagen fibers. So that’s another reason why people get sleep apnea.

So all of those reasons are all related to the tongue. The real problem is really, the tongue doesn’t have enough space and it also can’t latch at the roof of the palate, which is the way we want it to. So there’s a lot of different exercises. Just like what we do when we have weak muscles, we go to the gym. We start exercising. We do the same thing with the tongue. We start going to the gym. We start doing exercises that helps the tongue become stronger over a period of time.

Tongue Exercises

Maher: And what are some of those exercises that you recommend?

Dr. Nammy: The easiest ones are really fun, is sticking your tongue out at everyone. That’s a really fun one. And then, clicking is really great or even…

Maher: What are you doing there?

Dr. Nammy: And clacking. Yeah, just clacking about a hundred times. That works really well to make that tongue become stronger. The tongue, just like this stomach or the abs, it has actually several component of the muscles. You don’t just have one big muscle. You have the front of the tongue, you have the sides of the tongue, and you have the base of the tongue. Then you have muscles of the back of the pharynx. So what we want to do with these exercises is really activate all of those muscles to become stronger because the tongue is going to influence it.

The tongue, as it attaches to the base, is going to start attaching to the muscles into the throat, so we really want to activate all of those muscles properly through various exercises to be able to make sure that the tongue is strong enough or has enough muscle tone to make sure that it stays at the roof of the palate and it stops any obstruction because we don’t want it to fall back.

That’s the biggest problem we have, is that it falls back and it blocks the airway. We want it to be strong so it stays at the roof of the palate so it cannot block the airway.

How to Change the Position of Your Tongue

Maher: So other than doing exercises to make your tongue stronger, are there any other things that you can do to change your tongue’s position in your mouth?

Dr. Nammy: Absolutely. We actually have different lasers that we can utilize. They’re really great because what the lasers actually do is the laser actually activates collagen fibers. Earlier, I mentioned that as we age, our collagen unravels. And we actually stop producing collagen the age of 25. So collagen fibers are really important. And as our telomeres or our DNA unravels, it unravels our collagen fibers as well. So, that’s why our skin gets saggy and things like that.

So, the laser, just like we do in aesthetics, we take a laser to get rid of our wrinkles. We take a laser on the roof of the palate, also on the sides of the palate and the sides of the airway, the top of the tongue and the base of the tongue, and what we can do with that is strengthen that tongue and induce healing. So what we do is we give it a stimulus. That collagen fiber, like I said, stops being produced at the age of 25. The only way it’s going to produce more is through stimulation. Either that’s through tongue training exercises… right, or it’s going to be a laser. A laser actually sends a energy and tells it, “Hey body, produce more collagen. Hey body, produce more collagen.”

And the process in which it does that is called neocollagenesis. So new collagen is formed and new tighter, stronger fibers are formed in order to keep the tongue… It actually shrinks the tongue. It’s done in about three sessions. We do a first one. We wait about 21 days to let that heal. We induce it again, and then we induce it again. As we do that over a period of 21 days, we’re actually able to open up the windpipe and also make that tongue stronger so it is at the roof of the palate.

How Long do Treatments Take to Work?

Maher: How long does it typically take to see results from a treatment like that?

Dr. Nammy: Oh, it’s immediately. We can see windpipes that are about this small open up just like that. It’s immediately. You can actually immediately see the results of the laser therapy right off the bat. People feel the difference. As soon as they go home at night, they’re able to sleep better. They’re more comfortable. It works really great.

Side Effects of Tongue Positioning Treatments

Maher: Are there any potential risks or side effects associated with those treatments?

Dr. Nammy: There is not. There aren’t any concerns that comes with laser therapy. The main reason is because new collagen fibers are being produced, right, and there’s nothing that can be harmful about it. And these laser therapies are really titrated also. We have specific amount that we do. We have a specific way we work with it, and there’s safety protocols that are put into place to make sure it’s very safe and comfortable and easy.

Your Tongue and Your Airway

Maher: Any final thoughts on your tongue and your airway?

Dr. Nammy: Other than it’s… Everyone says it’s all about the base. I always say it’s all about the tongue when it comes to your functional airway and sleep apnea. So it’s all about the tongue. That tongue position is really important, and we want to make sure that it’s in the correct place.

Because whether you’ve had this issue from when you were younger, it’s going to happen to all of us. It’s because we’re aging, and that’s part of the aging process, is to lose that collagen fiber. So when we’re aware of that in our 40s, it really makes a difference because sleep apnea is diagnosed by 60. It actually started at 40, so we want to get to it earlier.

Maher: All right. Well, that’s great information, Dr. Nammy. Thanks again for speaking with me today.

Dr. Nammy: My pleasure.

Maher: And for more information, you can visit the Green Dentistry website at sfgreendentist.com or call 415-433-0119.