What is Sleep?

• Sleep is a physiological behavior that is common in all animal species. It forms around one third of a human life.
• It is a state where awareness to environmental stimuli is reduced. Sleep is different from states of coma, hibernation and death by the fact that it can be rapidly reversed.
• By various spheres, Sleep is considered a relatively more active state of certain parts of the brain. It may be even quite right to state, the by-products of the active and conscious brain gets detoxified during sleep.

What happens when we are asleep?

During Sleep, our brain mainly juggles between five stages of Sleep

⦁ N-REM (Non- Rapid Eye Movement) – Stage 1,2,3,4
⦁ REM (Rapid Eye Movement)

**Stages 1 & 2 – Light Sleep
Stages 3, 4 & REM – Deep Sleep

Why do Human Beings need Sleep?

To wake fully refreshed and ready for the day, you need to pass through all 4 stages and REM sleep every night, multiple times, for the recommended hours of sleep.

⦁ REM sleep is supposed to restore mind – thereby keeping the memory and other cognitive functions intact
⦁ Slow wave sleep, or more commonly known as NREM sleep, restores body, thereby keeping the tiredness away.
⦁ During REM sleep, dreaming occurs which is vital for dealing with traumatic events.
⦁ Removal of toxins, release of hormones and other chemical exchanges take place during REM sleep.
⦁ Decreased metabolic rates in sleep help for improved performance of the species. This gains more importance from the perspective of a child, as we know that infants (less than 1 year old) grow at an exponential rate with a proportional time of sleep.

Some theories to explain it all up :

⦁ Restoration/Growth Theory,
⦁ Evolutionary/Adaptive Theory
⦁ Energy Conservation Theory

What happens when we don’t sleep well?

Mood

⦁ Anxiety/Irritability
⦁ Increased temper tantrums
⦁ Short temperedness
⦁ Depression

Cognition

⦁ Poor concentration
⦁ Poor Memory
⦁ Difficulty in learning new task
⦁ Drop in school performance

Health

⦁ High Blood Pressure
⦁ Obesity
⦁ Diabetes
⦁ Temporo-Mandibular Joint Disorders
⦁ Immunosuppression
⦁ Risk of injuries
⦁ Obstructive Sleep Apnea
⦁ Neurological degenerative diseases

Others

⦁ Hyperactivity
⦁ Excessive Daytime Sleepiness
⦁ Frequent sighs/yawning
⦁ Brain fog/groggy
⦁ Morning Headaches
⦁ Bedwetting beyond potty training age
⦁ Frequent arousals in sleep

What is good sleep?

• A good sleep is measured by QUALITY and QUANTITY.
• When measured by quality, sleep has to replenish the person or child to perform to the fullest on the period following the sleep.
• By quantity, though it cannot be specified as a common count of various races, the following is a reasonable guide. However, it has to be remembered, that Asians in particular sleep significantly less time than the rest of the world, physiologically.

Some of the aspects of good sleep could be:

Falling asleep quickly	Sleep latency not more than 15 minutes
Staying asleep through the night	No troublesome Night awakenings
Rising without much trouble each morning	Refreshing Sleep
Not feeling drowsy during the day	Excessive Day Time somnolence

Healthy Sleep Duration

Sleep Routine

• Start your bedtime activities/sleep routine one hour prior to your regular bedtime because your sleep regulating hormone(melatonin) starts to secrete 30-60 mins prior to your regular sleep time.

P.S : Not to perform any mentally, physically and cognitively stimulating activities

What is Sleep Disordered Breathing?

• Sleep Disordered Breathing (SDB) is abnormal breathing during sleep affecting the quality of sleep, preventing proper rest, repair and rejuvenation of the body, muscles and brain leading to tiredness and exhaustion. This might also result in excessive strain on their nervous system and major organs.
• They vary from a spectrum of primary snoring to Obstructive Sleep Apnea.
• SDB has become an epidemic that has gradually taken over the lives of physically healthy children but has a lasting impact on their cognition and mental growth. Recent studies have shown the prevalence of Obstructive Sleep Apnea among school children to be 9.6%.

Tongue-Sleep-Airway Connection

So, THE BACK OF THE FACE IS THE AIRWAY!

• The upper airway is made of a complex of structures including Tongue, Soft Palate and Lateral wall of Pharynx. Hence, the tongue position plays an important role in respiration during day and sleep.
• If the Tongue is pushed backward, it would collapse the normal function of soft tissues around, as well as pushing the soft palate backwards, all of which together cause circumferential narrowing of the upper airway.
• At birth, tongue is habitually placed in the upper jaw unless there is a restriction in the case of a tongue tie, where the tongue is seated on the lower jaw. At infancy, the most ideal way to retain the tongue position is through breastfeeding which sets the foundation for a well-defined facial and jaw growth.
• Poor Breastfeeding, Habits like Bottle feeding, use of pacifiers, Thumb sucking, Nail biting etc during childhood can make the tongue muscles weak. As the tongue becomes weak, it does not provide form or function in development of facial growth thereby doesn’t do its job in developing a healthy airway.
• When the airway is narrow the primary compensation is breathing through the mouth which includes a low quality of sleep. As Mouth Breathing continues in sleep there is increased retention of Carbon Dioxide and reduced absorption of oxygen which in long run causes the brain to focus on breathing rather than a restful sleep.

Role of Tongue in Jaw Growth

Correct Tongue Posture:

• The tongue can also be referred to as the architect of Face, as it has the ability to establish a healthy jaw which in turn provides a wider airway. The effects of altering tongue volume/position on jaw growth will restrict lateral expansion and forward growth resulting in underdeveloped upper jaw which causes backward and downward growth of the mandible. This results in long face and flat cheek appearance.

On other hand, Low Tongue Posture can also cause either

⦁ restriction of the growth of lower jaws leading to short chin
⦁ Forward growth of the lower jaw

In both the cases, there is an absolute possibility of airway obstruction due to poor tongue posture. In patients with Short chin, the lower jaw is pushed backward adding to the obstruction of the airway while asleep.

Mouth Breathing is a symptom which has its own Cause and Effects!

What causes Mouth Breathing?

⦁ DEVELOPMENT
⦁ Poor Breastfeeding
⦁ Narrow Jaws
⦁ Crowded Teeth
⦁ Long Face

⦁ HABITS
⦁ Early Introducing of bottle feeding
⦁ Pacifiers
⦁ Thumb sucking

⦁ PHYSICAL CAUSES
⦁ Tongue Tie
⦁ Deviated Nasal Septum
⦁ Cleft Lip and Cleft Palate
⦁ Sinus Polyps

What are the RED FLAGS of a LOW QUALITY SLEEP ?

• Dry Mouth
• Bruxism (Teeth Grinding)
• Restless Sleep Position
• Flattened Cheeks
• Dark Circles
• Loud Breathing
• Choke or struggle in breathing at night
• Frequent Nightmares/ Night Terrors
• Halitosis (Bad Breath)
• Difficulty in waking up
• Bedwetting beyond potty training age
• Snoring
• Frequent Cold and Cough
• Delayed Speech
• Learning Difficulties
• Reduced Attention Span
• Aggression Defiance
• Underdeveloped Jaw Bone
• Anxiety Attacks
• Easily Distracted
• Hyperactivity
• Difficulty in organizing tasks
• Crooked Teeth
• Frequent Tooth decay

Diagnosis

Sleep Questionnaire
Sleep Study

Treatment

Conventional :

⦁ Can also be referred as supportive care or symptomatic treatment which will be correcting the symptoms, not the underlying cause. This mode of treatment will give a temporary relief as the causes are left untreated.
⦁ List of some conventional treatments:
⦁ Psychotropic drugs, Psychiatric Testing, Sleep aids, Nasal Drops, Behavior modification, Counseling Therapy, Tooth Extractions, Surgery
⦁ CPAP

Holistic :

⦁ Guiding the facial growth
⦁ Re-establishing a good airway
⦁ Breaking the cycle of Mouth Breathing
⦁ Breathing Re-Training
⦁ Orofacial Myofunctional Therapy – Tongue Training and Orofacial Muscle strengthening
⦁ Functional Frenuloplasty
⦁ Airway Orthodontics
⦁ Dietary Modification

Prevention

What Can You Do?

⦁ Learn to Identify the Red Flags. The indicators listed as red flags represent a low quality sleep.
⦁ On observing early signs, get an evaluation done by a qualified practitioner who will help not only to fix the problem, they can as well reverse the damage and restore the child’s ability to breathe freely.

The most simple way to help with Correct Tongue Posture :

⦁ Say N and see where the tip of your Tongue goes. It naturally will rest behind the upper front teeth. Its called “N” Spot.
⦁ Place the tip of your tongue at the “N” Spot without touching the teeth for 10 seconds.
⦁ Now, close your lips keeping your tongue at the same spot and take a slow deep breath through your nose, then exhale slowly while imagining a feather on your upper lip which shouldn’t move while you exhale.
⦁ Practice this for 2 mins at least 3 times daily.

Know Your Sleep Quality

At Oraface, We are proud to have a collaborative team of like-minded professionals to help You and your family have Sleep, Breathe and Smile better!
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