If you're too sleepy, you might not be able to pick up on subtle cues of happiness and sadness from the faces of those around you, says a new study. Chronic lack of sleep has been linked to high blood pressure, diabetes, aging skin, elevated cholesterol levels, weight gain and more. Now researchers have done a study that seems to suggest missing shuteye has another less serious side effect: the inability to tell when someone else is happy or sad by looking at his or her face.
In the small study – which was led by William Killgore, a University of Arizona professor of psychiatry, psychology and medical imaging – 54 participants were shown 180 photos that were created by morphing commonly confused facial expressions, such as disgust and anger. The participants were asked to identify the emotions they believed each image represented. Then the study volunteers were deprived of sleep for a full night and asked to repeat the test.
The researchers found that, while everyone could still identify obvious facial expressions like a big smile or frown after a sleepless night, they had trouble identifying the more subtle expressions of happiness and sadness, such as an image that might show 70 percent sadness and 30 percent disgust.
A sample of the way expressions were computer blended for the study. (Credit: University of Arizona)
Interestingly, when it came to other emotions like anger, fear, surprise and disgust, there was no change in correct comprehension regardless of sleep levels. The researchers posit this may be because happiness and sadness don't pose an immediate threat to our wellbeing when expressed by someone else, so when we're fatigued, we instinctively know it's OK to drop the processing of those emotions on the faces of others.
"If someone is going to hurt you, even when you're sleep deprived you should still be able to pick up on that," Killgore said. "Reading whether somebody is sad or not is really not that important in that acute danger situation, so if anything is going to start to degrade with lack of sleep it might be the ability to recognize those social emotions."
Killgore also says that in a chronically overtired world, missing the facial cues of others could have a fairly significant societal impact.
"As a society, we don't get the full seven to eight hours of sleep that people probably need to be getting," he said. "The average American is getting a little less than six hours of sleep on average, and it could affect how you're reading people in everyday interactions.
"You may be responding inappropriately to somebody that you just don't read correctly, especially those social emotions that make us human. Or you may not be as empathic. Your spouse or significant other may need something from you and you're less able to read that. It's possible that this could lead to problems in your relationships or problems at work. To me, that is one of the biggest problems — how this affects our relationships."
The study has been published in the journal Neurobiology of Sleep and Circadian Rhythms.
Source: University of Arizona
Updated March 25 2017
How are snoring and sleep apnea related?
A child with sleep apnea almost always snores. They may struggle to breathe and have restless sleep. There are often breathing pauses which may end with a gasping or choking noise. As the child struggles to breathe, they may wake up briefly. In young children the chest may be sucked in at this time. This may lead to the child sleeping in strange positions. They may sweat a lot when they sleep. In some cases they will wet the bed. In the morning they may wake up with a dry mouth, a headache or confusion.
What is sleep apnea?
Sleep apnoea is where the child stops breathing for a short time when they sleep. It tends to happen repeatedly during the night. Each time lasts from 10 seconds to a minute or so. Usually such apneas occur due to the airway being blocked. In children, the cause is usually big tonsils and adenoids. This is called Obstructive Sleep Apnea. A less common form of apnea is called Central Sleep Apnea. Central Sleep Apnea results from a problem with the way that the brain controls breathing.
What are the symptoms of sleep apnea during the day?
Because of the events during sleep, the child with sleep apnea may have a number of problems during the day. Infants may feed poorly, fail to gain weight and be delayed developmentally. Older children may have problems with their behaviour, e.g. being hyperactive, aggressive, having trouble learning and/or not being able to focus well. Being sleepy during the day may lead to personality changes, not doing well at school and problems with how they get on with others. A child with sleep apnea may lag behind in many areas of development. They may get frustrated and depressed. In the long term, if sleep apnea is not treated it may cause heart problems and high blood pressure.
How does this affect the child’s family?
Sleep apnea in a child may be very worrying for the family. Possible behavioural problems, combined with potential problems at school, can be stressful for the whole family.
What is the cause of sleep apnea?
In a child, the most common cause of snoring and sleep apnea is larger than normal tonsils and adenoids. Obesity can play a part as well. Other risk factors are the shape of the skull and the size of the tongue e.g. a child with Down syndrome has a larger tongue that may block the airway. In children with a small or receding jaw, sleep apnoea is more common. Children who have had surgery on a cleft palate may also be at a higher risk for sleep apnea.
How is sleep apnea diagnosed?
A doctor might suspect this if they see large tonsils and adenoids and certain symptoms are reported. This could include the child snoring, feeling sleepy and possibly having episodes of breathing obstruction. However the best way to be really sure about the problem and its severity is with a sleep study. The study is conducted in a special area of the hospital. The child has some fine wires attached to the skin, which are connected to a computer, which measures sleep, breathing and oxygen levels. Studies may be done at night in older children or in the daytime in babies. None of the measurements are uncomfortable or painful and children usually manage to sleep. Parents generally stay with the child.
How is sleep apnea treated?
If a child’s sleep apnea is thought to be due to the size of their tonsils or adenoids, the first thing that is normally done is to take them out. In many cases this will cure the sleep apnea. If the reason is an abnormality of the facial bones, surgery may sometimes be done to fix this. If surgery is not an option, then the best treatment is CPAP – Continuous Positive Airway Pressure. This involves a small a pump that provides air under gentle pressure through a mask worn over the nose. It only needs to be used at night and the treatment starts working straight away. With the right support, most children do well with CPAP. If the sleep apnea is due to the child’s weight, losing weight may help or even cure the apnea.
Can it be treated with drugs?
To date there is no effective drug for treating sleep apnea although a number have been tried. Other remedies have been marketed, but none has been shown to be effective.
What about sleep habits?
Although sleep apnea usually requires a treatment such as already outlined, it is also very important that the child has good sleep habits. A regular time to go to bed and to wake up should be set. Before bed, the child should be away from anything that stimulates them (e.g. games, TV). The bedroom should be quiet and dark. In the afternoon and evening you should avoid giving caffeine drinks (including cola and hot chocolate) to your child.
If you are worried about snoring or sleep apnea in your child, you should speak with your GP. A referral will be needed to see a sleep physician.
Where can I get further information?
http://www.rch.org.au/kidsinfo/factsheets.cfm?doc_id=8678
http://www.aafp.org/afp/2004/0301/p1147.html
Updated 22 March 2017
Sleep is as essential for good health as oxygen, food and water. Yet we still don’t know exactly what it is or how it works. Most scientists agree that sleep is important for restoring physical and mental health. It refreshes the mind and repairs the body. Lack of sleep, or sleep deprivation, can cause fatigue, poor concentration and memory, mood disturbances, impaired judgment and reaction time, and poor physical coordination.
The body’s internal clock regulates when and how we sleep depending on the amount of light around us. When the sun sets, your brain releases hormones to make you sleepy. In the morning, exposure to daylight suppresses these hormones and releases brain chemicals to keep you awake.
Getting enough sleep:
Before electricity, people used to sleep between sunset and sunrise. The typical person’s sleep averaged a generous ten hours – the same amount enjoyed by other primates such as chimpanzees and baboons. Today, sleep deprivation is common in developed nations, with the average adult sleeping for only six or seven hours each night.
Most of us feel fatigued at least some of the time. It is thought that fatigue causes about one road accident in six. Studies show that common distractions from sleep are the internet and texting. Parenthood, shift work, travel across time zones, illness, poor sleeping habits and some medications are other common sleep-stealers. New parents lose, on average, between 450 and 700 hours of sleep during their child’s first 12 months of life.
Sleep stages:
Sleep isn’t a static state of consciousness. The brain moves through distinct stages of sleep, over and over, every night. The two broad categories of sleep include:
Rapid eye movement (REM) sleep:
Rapid eye movement sleep occurs regularly during sleep, about once every 90 to 120 minutes. It makes up about one-quarter of your night’s sleep. The brain in REM sleep shows significant electrical activity. The sleeper’s eyes tend to dart about under closed lids, hence the name.
Most dreams are thought to occur during REM sleep. Sleep researchers have established that at least some eye movements correspond with dream content, which suggests that we watch our dreams like we watch movies on a screen. REM sleep makes up a larger proportion of the total sleep period in babies (especially premature babies), which suggests that dreams help to mature a developing brain.
Non-rapid eye movement (NREM) sleep
Non-rapid eye movement sleep is what you experience for the remaining three-quarters of your sleep time. The amount and type of NREM sleep vary with age and the degree of sleep deprivation.
The four broad stages of NREM sleep include:
Sleep disorders:
Common conditions that can affect a person’s sleep include:
Things to remember:
Updated 21 March 2017
Not getting enough sleep is a “ticking time bomb” says Dr Sara Gottfried. Researchers from Oxford, Cambridge, Harvard, Manchester and Surrey universities have found people are sleeping almost two hours a night less than they did in the 1960s, and our health is deteriorating as a result.
“We are a supremely arrogant species; we feel we can abandon four billion years of evolution and ignore the fact that we have evolved under a light-dark cycle,” says Oxford University’s Professor Russell Foster, who worked on the study. “What we do as a species, perhaps uniquely, is override the clock. And long-term acting against the clock can lead to health problems.”
These include an increased risk of cancer, heart disease, type-2 diabetes and obesity.
“Under-sleeping is the next sugar scare — it’s a health time bomb, says Dr Gottfried, who adds that just about every aspect of modern living is stealing our sleep. Our lives are more hectic than ever, more people live in cities where they’re less attuned to light- dark cycles, we binge-watch television shows, tablets emit sleep-disrupting blue light all evening, and it’s become normal for our bosses to email us at 9pm. What it means to be available has changed and our sleep is suffering.
Screens aren’t the only culprits — eco-friendly fluorescent light bulbs and LED lights emit more blue light than old-school light bulbs.”
There are some simple tips to make sure you get the right pillow Dr Gottfried says, artificial light has a hugely disruptive effect on our body clocks. Linked to our circadian rhythm, which regulates cell regeneration, brain activity, hormone production and the regulation of glucose and insulin levels, our bodies naturally adjust to daylight and darkness. To stay healthy, we should be sleeping like our ancestors by going to bed at sunset and waking at sunrise — a pattern all but dispensed with in the modern world.
If we deprived ourselves entirely of sleep, we wouldn’t live much longer than if we deprived ourselves of water, and five times quicker than if we stopped eating,” says sleep consultant Dr Neil Stanley. “In over one million years of evolution, our sleep needs remain the same. So how much shut-eye do we actually require? “The eight-hour thing is a myth,” says Dr Stanley. “Sleep needs are like height — different for everybody and down to genetics. Just like there are tall and short people, there are people who need fours hours a night and others who need 11. You cannot train yourself to need less sleep and if you go without your required hours, you’ll do yourself harm. The way to tell if you are getting enough is simple. “If you feel awake and alert during the day, yes,” he says. “If you feel sleepy in the day, no. And there’s a difference between feeling tired and feeling sleepy; the latter means literally wanting to sleep during the day.
The ramifications of insufficient sleep are quickly felt: studies show that just one night without proper rest quadruples your risk of catching a cold. It suppresses immunity. “You’ll have less motivation, less empathy, slower reaction times, poor concentration and increased appetite,” says Dr Stanley. Researchers from Pennsylvania State University found that less than six hours sleep a night causes levels of the hormone ghrelin, which signals hunger to rise and levels of leptin, the sense of fullness hormone, to drop. When you’re tired, you’ll feel hungry, but never full. Long term, regularly shaving an hour or more off your required sleep increases the risk of certain cancers, diabetes, Alzheimer’s, obesity, cognitive decline, depression and heart disease.” A study from Harvard Medical School found that people who sleep less than five hours a night for five consecutive years have a 300 per cent greater risk of hardened arteries. “There is not one single good thing about poor sleep,” says Dr Stanley. Yet we live in a society that at best disregards it and, at worst, views getting by on very little as a badge of honour.”
Dr Gottfried says that while you may think you can get by on little sleep, the truth is only 3 per cent of the population has the short-sleep gene (known as DEC2). “I would stay up for 36 hours at a time during my medical training, surviving on coffee,” she says. “But coffee — like anything else that delays sleep — is a high-interest loan and eventually your body will call that loan in.
The brain is the organ most affected by poor sleep, says Dr Gottfried. In the past 10 years, neuroscience has shown a lack of sleep can both change and age your brain. Good sleep, however, “shampoos” your brain and “washes away” ageing toxins.
During sleep, the space between brain cells expands 60 per cent more than when you’re awake,” she says. “This allows the brain to flush out built-up toxins with cerebral spinal fluid, the clear liquid surrounding the brain and spinal cord. It’s called the glymphatic system and this system works better when you’re sleeping on your side, rather than back or tummy.
Then there’s ageing. According to research from the Harvard School of Public Health, sleeping five or less hours a night equates to ageing an extra four to five years. “There’s a reason it’s called beauty sleep,” says Dr Gottfried. From personal experience, it’s pretty dramatic how different my face looks when I’m tired. I look more pale and puffy”.
So can a Sunday morning lie-in repay the sleep debt of a tumultuous week? “Yes, but it requires a mindset change,” says Dr Gottfried. In the past, I’ve racked up gigantic sleep debts and have gained weight, become stressed, and felt stiff and older than my years. Now I view sleep as a non-negotiable, and even though I have two children, a husband and a job, I no longer ‘steal’ from my sleep in order to fit everything in. Little and often are key to repaying sleep debt rather than trying to catch up in one large chunk. Naps also help and a 20-minute daytime nap is the equivalent of an hour at night,” she says.
Another tip is batch cooking: “Every working person will know that cooking a fresh meal in the evening — and washing up afterwards — cuts into sleep. So now I soften my expectations and grab something quick, or I batch cook and eat heated leftovers. This small thing gives me an hour more sleep every night of the week.”
Dr Guy Meadows, clinical director of the Sleep School says: “A small sleep debt is easily repaid with an early night, but if you’ve raised children, travelled a lot for work, or suffered with insomnia, you’ll have a bigger sleep debt. Worse still, you may have become a bad sleeper, which makes the debt bigger. I tell the bad sleepers in my sleep clinic to stop chasing sleep as this drives it further away. If you ask a great sleeper how they get to sleep, they’ll say ‘nothing’. If you ask a bad sleeper how they do it, they’ll give you a long list that includes warm baths and lavender pillow mist. My theory is that often the ways we try to chase or control our sleep is part of the problem. Try to be almost thoughtless about it. Sleep is the most naturally powerful performance enhancer known to humankind. It’s time we started treating it as such.”
Updated 21 March 2017
Working Out Is No Excuse To Be A Mouth Breather
With winter approaching, I decided to get a membership at a local gym. During the first few days of working out at the gym I was blown away at the percentage of people who were mouth breathing while working out. It was 100%. Everyone in the entire place—whether they were gently prancing on the elliptical machine or squatting 500lbs—was breathing with the mouth open. Now, the majority of the people at this gym seem to be very physically fit. They seem like the type of people who do their research and put health first. Maybe this explains why I expected to see a decent percentage of people breathing nasally. I guess I just assumed that with all the health information available these days that a small group of these “fit” people would have this important understanding. I am now a few weeks into my membership at the gym and I am no longer shocked to see all of the mouth breathers plugging away. I guess I have grown accustomed to it. But, seeing this display of dysfunctional breathing and knowing the importance of nasal breathing (100% of the time) I have been motivated to write this post. The message I want to get across is: Don’t be a mouthbreather! Even when you’re working out.
The Mouth VS The Nose
The other day I was on a trusted health website where a man was discussing how to breathe while running. In essence, he said “while running you will want to breathe through your mouth because it is bigger than your nostrils and that way you can get more oxygen into your body.” I was shocked! I wanted to ask him what his physiological justification was. Amazingly, I have heard this same argument in various forms from other trusted sites. While, yes, it is true that you get more air into your body by mouth breathing than by nasal breathing, it does not mean that it is the recommended mode of breathing while working out; nor does it mean that this extra oxygen is reaching the muscles, organs, and cells. Breathing during workouts is not just about getting more oxygen into the body. In fact, your main drive to breathe (at rest or) while working out has nothing to do with oxygen. Your primary drive to breathe is actually your body’s need to rid itself of the increasing supply of carbon dioxide. As you increase your activity level, more oxygen is metabolized, and the main by-product of aerobic metabolism is carbon dioxide. The more you workout, the more the carbon dioxide that is produced. As readers of this blog know well, carbon dioxide is necessary in the delivery of oxygen to the muscles and cells.
Your Nose Knows Best
When done correctly, nasal breathing can completely overhaul your workout. You will get more benefit for the effort, you will increase blood flow and lower the burden on the heart, you will increase oxygen transfer to the muscles and cells, you will increase nitric oxide levels in the blood, and you will produce less lactic acid—and you can get all of these benefits while still receiving more than enough oxygen through the nose. This is how you were meant to breathe while working out.
When working out, let your nose dictate your pace. In other words, cut back on your routine to the point where nasal breathing is comfortable. While working out, each breath should be deep into the diaphragm and not rushed. Over the next several weeks, your body will adapt and allow you to build back up to your regular routine…except this time you will be comfortably breathing through the nose. If you find that you are struggling to breath with your nose and are tempted to open your mouth, it simply means that you are working out at a level that is more intense than what your body desires. Let you nose be your guide. Build up gradually. For the best success in making the transition to nasal breathing while working out, it is vital to learn to breathe properly at rest.
John Poulton.
Last updated March 21 2017
Everyone is born with the intrinsic knowledge to breathe, but not everyone knows how to breathe properly. Some children struggle to breathe through the nose, and instead breathe through the mouth. Open-mouth breathing lets in too much dry, unfiltered air that irritates the airways. Some open-mouth breathers also use the chest muscles, instead of the diaphragm, to breathe. Poor breathers may complain of sore throats, fatigue and muscle aches, in addition to feeling out of breath. Poor breathing can affect anyone, but it's especially hard on children with asthma. Through a daily exercise, a child learns to retrain his body to breathe from the diaphragm and through the nose.
Step 1
Instruct the child to place her hands atop her head.
Step 2
Tell the child to close his mouth and breathe in through the nose, as if he was taking a light whiff of something that smells good.
Step 3
Instruct the child to relax and breathe out through the nose, pausing at the end as she exhales.
Step 4
Ask the child to breathe in again through the nose and out through the nose until he develops a rhythm. If he breathes in softer or harder than he breathes out, correct him; demonstrate how you breathe through the nose.
Step 5
Have the child bring her arms down to her side. Instruct her to continue breathing this way, letting the air come from the diaphragm, not the chest muscles. If she has problems, ask the child to place her hands atop her head and try getting into a breathing rhythm again.
Ivy Morris
Last updated March 21 2017
Sleep And Happiness
If you are a worrier you are at greater risk of having insomnia.
How do I stop feeling anxious about my sleep?
It is important to understand that waking up at night is normal. Everyone does it to a greater or lesser extent. Some people remember waking up and may worry about it. Others do not remember waking up. Worrying about sleep usually makes the sleep worse. Do not think “I won’t be able to function tomorrow unless I get back to sleep”. Instead try: “I’ve been able to function on less sleep before and I will get by OK again tomorrow”. Relaxation exercises before going to bed may help. If sleep anxiety continues, a doctor should be consulted. A referral to a specialist sleep psychologist may also be needed.
You do not need to have general anxiety for an overactive mind to get in the way of a good night's sleep. It is true that some people do not sleep well due to stress in their lives. But others have mostly stress free lives, except that they worry about their sleep. By itself, this can disrupt the quality of sleep. You must aim to lower overall levels of worry or ‘stress’. Being fit and having a healthy diet also play a part in how well you sleep.
Can alcohol help with sleep? Should I give up caffeine altogether?
Caffeine and alcohol can be bad for sleep. It is important to have both of them in moderation. This will result in better sleep quality. However they should be avoided for at least 4 hours before going to bed. Using alcohol to relax and de-stress before going to bed will not help your sleep. It may help to get you off to sleep, but will interrupt your sleep during the night. Too much caffeine will make you too alert to sleep well.
Can medication help make me worry less about sleep?
Medicines (e.g. hypnotics or anti-anxiety drugs) will not always work. Their effectiveness decreases with time and they can be habit forming which makes it difficult to stop taking them. The best way to lower anxiety about sleep is to try to alter how you think about sleep. They will help you to learn new ways of dealing with being awake or with being nervous about the night falling. There are many methods to learn new ways to think about your sleep, or lack of it. These include Cognitive Behavioral Therapy (CBT) and Mindfulness. These have been proven to be effective.
What can be done about a mind that doesn’t seem to shut down?
I’m not worrying, just thinking a lot, often about mundane things.
There are many things you can try if your mind seems overactive e.g. CBT for insomnia and Mindfulness. If you learn to notice when your mind is racing, you can use methods to relax and aim not to feel too alert or worried. These can work across the whole day. Most importantly, don’t do the thinking or worrying in bed. Many people find that setting aside a ‘worry time’ during the day is helpful. Choose a time during the day when you are usually free and do your worrying, thinking and planning at that time. Bed is for sleep, so if you are not asleep or likely to fall asleep, it’s not where you should be. Aim to gently let go of the thoughts and not let them distract you. This is just like people living next to railway lines learn to not notice the train noise after a while. It takes time and practice but can be done.
Can some people suffer from anxiety but sleep well?
Yes. If you suffer from anxiety it does not mean you won’t sleep well. Very anxious people can still sleep well and not feel too tired or sleepy. But if the person with anxiety starts to sleep poorly, this will make them feel tired. They can then start to worry about lost sleep. This can set up a vicious cycle resulting in chronic sleep problems.
I am having problems with my sleep. What should I do?
Talk to your GP, there are also specialist sleep centres that can help. There are psychologists who are trained to help people sleep better. They can explain to you about the mental factors involved. In the meantime:
Do not try too hard to sleep
Let sleep come to you when the timing is right
Keep a regular daily routine when possible, with consistent times for eating, sleeping and doing other things
Make sure you can learn or get taught some methods to relax
Realise that part of the reason why you don't sleep well might be that you worry about sleep too much
Don’t blame every little thing that goes wrong on your poor sleep
Do not lie in bed awake for a long time. Give yourself about 20 minutes, then get up and go and sit in a quiet, dark room somewhere, not doing anything, until you feel sleepy again
Know that sleeping tablets are not as helpful as you might think
Also know that there is a chance that you might actually be getting more sleep than you think you are
Make sure you don't have too much alcohol and caffeine
http://www.cci.health.wa.gov.au
Harvey, A.
Updated March 21 2017
By P. McKeown & M. Macaluso.
Breathing is one of the most vital functions of the human body. Every breath we take can have a positive or negative impact on our bodies depending on how it is performed; and it has been well established that normal breathing should be achieved through the nose. However, it may be detoured to the oral cavity in the presence of an airway obstruction.
During normal breathing, the abdomen gently expands and contracts with each inhalation and exhalation. There is no effort involved, the breath is silent, regular, and most importantly, through the nose. Abnormal breathing or mouth breathing on the other hand; is often faster than normal, audible, punctuated by sighs, and involves visible movements of the upper chest. This type of breathing is normally only seen when a person is under stress, but for those who habitually breathe through their mouths, the negative side effects of stress and over-breathing become chronic. Habitual mouth breathing has serious implications on an individual’s lifelong health, including the development of the facial structures. This article explores the benefits of nasal breathing over mouth breathing, and provides a self-help exercise to help decongest the nose.
Nasal breathing and the Importance of Nitric Oxide
Nasal breathing has been well documented to providing various benefits. The nose is equipped with a complex filtering mechanism which purifies the air we breathe before it enters the lungs. Breathing through the nose during expiration helps maintain lung volumes and so may indirectly determine arterial oxygenation.
One of the most important reasons for nasal breathing, is due to the production of nitric oxide (NO). NO exists in the human breath, but little is known about its site of origin or enzyme source. Most NO in normal human breath derives locally from the nose where it can reach high levels during breath-holding. This incredible molecule, is said to be produced in mammalian cells by specific enzymes and is believed to play a vital role in many biological events including regulation of blood flow, platelet function, immunity, and neurotransmission. Although this gas is produced in minute amounts, when it is inhaled through the nose into the lungs, it will follow the airstream to the lower airways and the lungs where it aides in increasing arterial oxygen tension; hence enhancing the lungs capacity to absorb oxygen. Nitric Oxide also plays an important role in reducing high blood pressure, maintaining homeostasis, immune defense and neurotransmission.
Effects of Mouth Breathing
Habitual mouth breathing, conversely involves an individual breathing in and out through the mouth for sustained periods of time, and at regular intervals during rest or sleep.
It is well documented that mouth breathing adults are more likely to experience sleep disordered breathing, fatigue, decreased productivity and poorer quality of life than those who nasal-breathe. In children, the harmful effects of mouth breathing are far greater, since it is during these formative years that breathing mode helps to shape the orofacial structures and airways.
Children whose mouth breathing is left untreated for extended periods of time, can set the stage for lifelong respiratory problems and including, a less attractive face to name a few. As a result, malocclusions such as a skeletal Class II or Class III, along with a long lower face height (characterized as “long face syndrome”), and high palatal vaults may also be noted. These resultant craniofacial alterations associated with mouth breathing can significantly aggravate or increase the risk of snoring and obstructive sleep apnea in both children and adults.
A study conducted by Fitzpatrick et al, demonstrated the critical role of the soft palate in determining oral or nasal airflow. The study showed that during mouth breathing, the soft palate will tend to move posteriorly against the posterior pharyngeal wall, thus closing the nasopharyngeal airway. Whereas, during nasal breathing, the soft palate moves inferiorly and anteriorly until it lays against the dorsum of the tongue, thus closing the oropharyngeal airway.
The opening of the mouth during sleep in normal subjects and in patients with obstructive sleep apnea was also documented in this study. Mouth opening, even in the absence of oral airflow, has been shown to increase the propensity to upper airway collapse. The two most likely explanations for the latter finding are that jaw opening is associated with a posterior movement of the angle of the jaw and compromise of the oropharyngeal airway diameter, and that posterior and inferior movement of the mandible may shorten the upper airway dilator muscles located between the mandible and hyoid and compromise their contractile force by producing unfavorable length-tension relationships in these muscles. Therefore, it is of utmost importance to address mouth breathing accordingly.
Unfortunately, it has been noted that there is a lack of awareness regarding the negative impact of airway obstruction via mouth breathing on normal facial growth and physiologic health; and as a result, may be confused for (ADD) and hyperactivity. 14 According to the National Sleep Foundation, attention deficit hyperactivity disorder (ADHD) is linked to a variety of sleep problems. Children and adults behave differently as a result of sleepiness. Adults usually become sluggish when tired while children tend to overcompensate and speed up. For this reason, sleep deprivation is sometimes confused with ADHD in children. Children may also be moody, emotionally explosive, and/or aggressive as a result of sleepiness. In a study involving 2,463 children aged 6-15, children with sleep problems were more likely to be inattentive, hyperactive, impulsive, and display oppositional behaviours.
Another study published in the International Journal of Pediatrics investigating the long-term changes to facial structure caused by chronic mouth breathing noted that this seemingly ‘benign’ habit “has in fact immediate and/or latent cascading effects on multiple physiological and behavioral functions.” Therefore, with this in mind, mouth breathing can have a tremendous impact on the mental and physical health of children; as it can be associated with the restriction of the lower airways, poor quality of sleep, reduced cognitive functioning and a lower quality of life.
Prevalence, Causes and Physical Manifestations of Mouth Breathing
Brazilian researchers investigating the prevalence of mouth breathing in children ages three to nine found that a 55% random selection of 370 subjects were mouth-breathers. 2 Reported causes of mouth breathing included: allergic rhinitis (81.4%), enlarged adenoids (79.2%), enlarged tonsils (12.6%), and obstructive deviation of the nasal septum (1.0%). The main clinical manifestations of mouth-breathers were: sleeping with the mouth open (86%), snoring (79%), itchy nose (77%), drooling on the pillow (62%), nocturnal sleep problems or agitated sleep (62%), nasal obstruction (49%), and irritability during the day (43%). 3 Although allergic rhinitis is considered one of the leading causes of respiratory obstruction; it is of utmost importance to note that upon the first onset of nasal congestion, a feeling of air deprivation occurs, causing the individual to switch to mouth breathing.
Another study conducted by Pereira et al, demonstrated that orofacial changes were noted in mouth breathers such as: half-open lip and lower tongue position, lip, tongue and cheek hypo-tonicity, and tongue interposition between the arches during deglutition and phonation.
Effect of Low Tongue Position
A mouth breather carries the tongue in a low downward position, creating an airspace which allows the person to breathe more freely; and as a result it can lead to abnormal tongue activity. This abnormal tongue activity, can exert an excessive force upon the dentition during swallowing, contributing to malocclusions in children; and leading to periodontal disease and atypical myofascial pain in adulthood. This displacing force and misdirection of the tongue, can additionally contribute to microscopic changes in the attachment apparatus; leading to increased tooth mobility and advancing periodontal disease.
Furthermore, this low tongue resting posture can contribute to various morphological changes to the orofacial structures; and consequently, Orofacial Myofunctional Disorders (OMDs) may develop as well. “OMDs are disorders pertaining to the face and mouth and may affect, directly and indirectly, chewing, swallowing, speech, occlusion, temporomandibular joint movement, oral hygiene, stability of orthodontic treatment, facial esthetics, and facial skeletal growth.” The most common forms of OMDs include: oral breathing or lack of habitual nasal breathing; habitual open mouth posture, and lack of lip seal with patent nasal passages; reduced upper lip movement with or without a restricted labial frenum; restricted lingual frenum, from borderline to ankyloglossia; anterior or lateral tongue thrust at rest (static posture); low and forward tongue position at rest, usually accompanied by an increased verticle dimension; inefficient chewing (related or not) to temporomandibular joint (TMJ) disorders or malocclusion; atypical swallowing, with or without a tongue thrust (dynamic posture); oral habits; and forward position of the head at rest, during chewing and during swallowing to name a few.
The resting posture of the tongue plays a pivotal role since its effects are far more constant than atypical swallowing. Mouth breathing encourages incorrect positioning of the tongue (on the floor of the mouth), while nasal breathing naturally places the tongue in its proper resting position (on the roof of the mouth), and most important of all aides in achieving a lip seal.
A study conducted by Schmidt et al, indicated that correct tongue resting position (on the roof of the mouth) resulted in a significant activity in the temporalis and suprahyoid muscles as well as a significant reduction in heart rate variability when compared with a low tongue resting position (on the floor of the mouth). 27 In other words, a proper tongue resting posture is essential for achieving orofacial balance.
Postural Problems
In addition to abnormal swallowing patterns and facial characteristics, postural problems may also be present in those who habitually breathe through their mouth. Mouth breathers tend to assume a characteristic posture, carrying their heads forward in order to compensate for the restriction to their airways and make breathing possible.
A study conducted by Okuro et al, demonstrated how the respiratory biomechanics and exercise capacity were negatively affected by mouth breathing; and that the presence of moderate forward head posture acted as a compensatory mechanism in order to improve respiratory muscle function. 24 This forward head posture often leads to muscle fatigue, neck pain, tension in the temporomandibular joint area, spinal disc compression, early arthritis, tension headaches, and dental occlusal problems.
Multidisciplinary approach.
In order to achieve proper oronasal balance, a patient must be examined as a whole in a multidisciplinary approach. “It is of fundamental importance to obtain information from the parents/guardians during the medical interview. Therefore, questions about the child’s sleep patterns, if he/she sleeps with the mouth opened, if there is noisy breathing, if the child lacks concentration at school, if the child feels sleepy during the day, if the pillow is wet in the morning; these questions should all be recorded, because they represent important elements in the diagnosis of oral breathing.” 38 Although there is no discernible test to identify mouth breathing, simply observing an individual’s resting breathing habits for at least three minutes can form part of a diagnosis for both children and adults.
It is important to note that an accurate diagnosis of mouth breathing cannot be done with data alone. Therefore, it is recommended to also carry out the Glatzel metal plate test and the time through which the child keeps water in her/his mouth with the lips sealed and without swallowing it, since the results may differ and complete each other.
A team of qualified professionals such as Pediatricians, Ear Nose and Throat Doctors, Orthodontists, Dentists, Dental Hygienists, Myofunctional Therapists, Buteyko Breathing Specialists, and Speech Pathologists to name a few; can help arrest the cascading effects associated with mouth breathing.
Management of Nasal Congestion.
Proper management and early detection of nasal congestion is key to arresting mouth breathing in an individual. As previously stated, mouth breathing can be a result of various origins associated with respiratory obstruction; such as allergic rhinitis.
Therefore, with rhinitis being one of the leading causes of nasal obstruction, some of the most common treatments used for treating rhinitis include: trigger avoidance, decongestants, corticosteroids or allergy shots. While these offer some therapeutic benefits; for some, they may be effective only for as long as treatment continues. Meanwhile, the individual becomes accustomed to breathing through their mouth and will likely continue this habit even after their nasal airways have cleared, causing a vicious cycle of recurrent congestion. While it may seem counterintuitive nasal breathing is essential for decongesting the nose, along with breathing exercises designed to open the airways, such as the Buteyko Breathing Method.
The Buteyko Method, developed in the 1950s by Russian respiratory physiologist Dr. Konstantin Buteyko, was subject to a study investigating its effectiveness for the treatment of chronic rhinitis in asthma. The study validated evaluations, including the Sinonasal Outcome Test (SNOT); which showed a 71% reduction of rhinitis symptoms at the three month follow up. 1
The Buteyko Breathing Method features a measurement appraisal known as the Control Pause, a breath hold exercise to unblock the nose, and reduced breathing exercises to reset breathing volume towards normal. 19
Nasal Decongestion Exercise. The nose can be unblocked for both allergic and non-allergic rhinitis by performing a breath hold as follows:
In conclusion, it is essential for medical and dental professionals to assess mouth breathing in children and adult patients. If mouth breathing is treated early, its negative effects on facial and dental development, along with the medical and social problems associated with it, can be reduced or averted. 14
As healthcare professionals, we are afforded the perfect opportunity to observe whether patients habitually breathe through their mouths, and to offer practical and effective life-changing recommendations. OH
References
Martha Macaluso, MLT, RDH, BS, is a practicing Registered Dental Hygienist and Myofunctional Therapist. She received her degree in Dental Hygiene from Farmingdale State University and specialized in Myofunctional Therapy through the AOMT.
Martha is faculty at New York University College of Dentistry, where she teaches dental hygiene clinic. In addition to her published work, Martha has presented various continuing educational courses in the field of dentistry and myofunctional therapy.
She is extremely involved in the profession acting as editor to the Long Island Dental Hygiene Association, delegate to the Dental Hygienist Association of the State of New York and delegate to the American Dental Hygiene Association.
Buteyko practitioner and author Patrick McKeown completed his clinical training in the Buteyko Breathing Method at the Buteyko Clinic, Moscow, Russia in 2002 and was accredited by the late Professor Konstantin Buteyko. Patrick has spent the last 15 years working with thousands of children and adults worldwide, who experience breathing pattern disorders, sleep disordered breathing and anxiety. To date, he has written eight books on the subject, and his latest book, The Oxygen Advantage, is an extension of this work, combining specifically formulated exercises, which empower athletes to improve their sports performance.
Updated March 18 2017
Children who experience inadequate or disrupted sleep are more likely to develop depression and anxiety disorders later in life, suggests new research.
"Healthy sleep is critical for children's psychological well-being," said principal investigator of the study Candice Alfano, Associate Psychology Professor at the University of Houston in the US. "Continually experiencing inadequate sleep can eventually lead to depression, anxiety and other types of emotional problems," Alfano noted.
The findings are based on temporary sleep restrictions in 50 pre-adolescent children between the ages of seven to 11. Inadequate sleep impacts children's emotional health not only by creating more negative emotions, but also by altering positive emotional experiences, the results showed.
For example, after just two nights of poor sleep, children derive less pleasure from positive things, are less reactive to them and less likely to recall details about these positive experiences later. When their normal nightly sleep habits are adequate in duration, however, they find these emotional effects are less apparent, the study found.
"Parents, therefore, need to think about sleep as an essential component of overall health in the same way they do nutrition, dental hygiene and physical activity," Alfano said in a University of Houston statement.
"If your child has problems waking up in the morning or is sleepy during the day, then their nighttime sleep is probably inadequate. This can result for several reasons, such as a bedtime that is too late, non-restful sleep during the night or an inconsistent sleep schedule," Alfano pointed out.
Updated March 18 2017
Every person spends one third of his or her life sleeping. Sleep, which is a daily function, is not simply a resting period for all systems of the body going into a passive state. This is the time when the body enters into an active renewal process. Now let's see how the human body renews itself in sleep. Sleep is among the critical necessities of human life. Our body needs sleep as much as it needs water, oxygen and food. A refreshing sleep is of vital importance in order to maintain a balanced life. Sleep is not a state of passive resting. During sleep, activities that occupy one's mind such as stress is cleaned out as if formatting computer memory. Hormone levels are stabilized, the digestive system improved, the immune system rebooted and the skin reconfigured during sleep. Cell division continues intensively in sleep. But if you are struggling to get a good night’s sleep then you could be in trouble.
A new study has found that if you don't get enough sleep, you might start forgetting things. Sleep deprivation can interfere with the process that helps reinforce our memories. The researchers at Johns Hopkins University, US have fortified evidence that a key purpose of sleep is to re-calibrate the brain cells responsible for learning and memory so that we can 'solidify' lessons learned and use them when awaken. They conducted the research on mice to study the correlation between sleep and memory.
The researchers also report they have discovered several important molecules that govern the re-calibration process, as well as evidence that sleep deprivation, sleep disorders and sleeping pills can interfere with the process. "Our findings solidly advance the idea that the mouse and presumably the human brain can only store so much information before it needs to re-calibrate," said Graham Diering from Johns Hopkins University.
"Without sleep and the re-calibration that goes on during sleep, memories are in danger of being lost," said Diering. Diering said that current scientific understanding of learning suggests that information is "contained" in synapses, the connections among neurons through which they communicate. On the "sending side" of a synapse, signaling molecules called neurotransmitters, are released by a brain cell as it "fires"; on the "receiving side," those molecules are captured by receptor proteins, which pass the "message" along. If a cell receives enough input through its synapses, it fires off its own neurotransmitters. More specifically, experiments in animals have shown that the synapses on the receiving neuron can be toggled by adding or removing receptor proteins, thereby strengthening or weakening them and allowing the receiving neuron to receive more or less input from nearby signaling neurons.
When neurons are "maxed out" and constantly firing, they lose their capacity to convey information, stymieing learning and memory. One possible reason that neurons do not usually max out is a process that has been well studied in lab-grown neurons but not in living animals, asleep or awake. Known as homeostatic scaling down, it is a process that uniformly weakens synapses in a neural network by a small percentage, leaving their relative strengths intact and allowing learning and memory formation to continue.
To find out if the process does occur in sleeping mammals, Diering focused on the areas of the mouse brain responsible for learning and memory: the hippocampus and the cortex. He purified proteins from receiving synapses in sleeping and awake mice, looking for the same changes seen in lab-grown cells during scaling down. Results showed a 20% drop in receptor protein levels in sleeping mice, indicating an overall weakening of their synapses, compared to mice that were awake.
This new study has added one more point to the already long list of benefits of sleep in our life. So in order to prevent brain related problems one must take adequate amount of sleep in a day.
Updated March 18 2017
We all know the havoc that is created because of lack of sleep. Most of us have experienced the consequences of late night movies and early morning work schedules. Besides making you drowsy for the entire day, you also struggle to think straight, concentrate and feel energized. Now imagine if you don't get proper sleep for a week or months! It can severely impact your health. World Sleep Day is an initiative that aims to spread awareness about the importance of sleep for our health and well-being and also highlight various preventive measures and management of sleep disorders.
One may assume that at the end of a hard day's work, sleep should come instantly but contrary to the belief, there are many who suffer from sleeping disorders such as sleep apnea or insomnia. In most cases, it is stress that springs up as the culprit. According to an earlier report, one in every five people across the world is sleep deprived.
Leading a hectic life balancing work pressure, family relations, personal life and daily errands are bound to take a toll on a person's health if he or she is not taking enough time to stop and rest. Sleep is crucial for one's good health. It is the time when your body functions get some rest too, to be able to perform more effectively while up and awake. Sleep disorders generally fall into two categories: sleep-breathing problems and sleep-wake disorders. Sleep breathing problems like sleep apnea disrupt breathing while asleep. Sleep-wake disorders like insomnia and restless leg syndrome affect the amount of time spent asleep. If you are wondering how poor sleep could impact your health, here's a list.
Poor Sleep Could Hamper Your Immune System
A study done by the University of Washington in Seattle, found that those deprived of regular sleep are likely to have a weak immune system. The findings showed that chronic short sleep shuts down programs involved in immune response of circulating white blood cells. Seven or more hours of sleep is recommended for optimal health.
Poor Sleep May Make It Hard to Remember Things
According to Johns Hopkins University in the US, if you don't get enough sleep, you might just start forgetting things. Sleep deprivation can interfere with the process that helps reinforce our memories. A key purpose of sleep is to re-calibrate the brain cells responsible for learning and memory so that we can 'solidify' lessons learned and use them when awaken.
Poor Sleep Can Put You at Increased Risk of Stroke
People with sleep disorders like insomnia and sleep apnea are more likely to have a stroke or recovery problems after having one than those who get sound sleep, says a study done by researchers at University Hospital Essen in Germany. Another German-based study stated that short-term sleep loss due to long working hours may adversely affect your heart function.
Poor Sleep Increases Your Appetite for Unhealthy Food
Sleep deprivation may make you munch on more calories the following day, potentially leading to weight gain and obesity, says a study done by King's College London. This study found that partial sleep deprivation resulted in a large net increased energy intake of 385 kcal per day. Another Japan-based study had found that poor sleep leads to increased consumption of unhealthy foods, specifically sucrose and fat.
Poor Sleep May Adversely Affect Kidney Function
Short and poor quality of sleep may worsen kidney function in patients with chronic kidney disease (CKD) stated a study done by researchers from the University of Illinois at Chicago in the US. "Short sleep and fragmented sleep are significant yet unappreciated risk factors for CKD progression," said one of the researchers, Ana Ricardo.
Poor Sleep May Make You Put on Belly Fat
Lack of exercise, nutrition, sleep and high levels of stress are all important factors contributing to increased belly fat. Belly fat is becoming more and more common in adults, as they are adopting sedentary lifestyles. Subcutaneous fat, also known as love handles, and visceral belly fat, which surrounds your organs, shouldn't be ignored. They can cause havoc in the long run.
Poor Sleep Affects Our Mood
Lack of sleep takes a toll on our physical health in the long run, but it affects us psychologically too. It impacts our behaviour and mood. A study done by Johns Hopkins University School of Medicine states that waking up several times throughout the night is more detrimental to your positive moods than getting the same shortened amount of sleep without interruption. "When your sleep is disrupted throughout the night, you do not have the opportunity to progress through the sleep stages to get the amount of slow-wave sleep that is key to the feeling of restoration," said study lead author Patrick Finan.
Poor Sleep May Put You at Risk of Asthma
A study conducted at Norwegian University of Science and Technology stated that people with chronic insomnia had more than three times the risk of developing asthma, suggesting that any changes in the body due to insomnia may accumulate and result in more severe harmful effects on the airways. Along with asthma insomniacs are likely to develop symptoms of depression and anxiety as well in adulthood.
Poor Sleep Can Increase The Risk of Diabetes
According to a study done by the University of Colorado Boulder in the US, when people get too little sleep it leaves them awake at a time when their body clock is telling them they should be asleep. And when they eat something in the morning, it impairs their ability to regulate their blood sugar levels.
Updated March 18 2017
Oral habits, like mouth breathing are impacting 9 out of 10 children with arrested or altered growth, crooked teeth, snoring, bedwetting, ADHD type behaviour and may even affect the profile of their face. Once a child reaches puberty, the skeletal development is all but complete and the window for change closes.
HealthyStart CEO Leslie Stevens says early childhood treatment, avoiding years of damage that could be only marginally corrected later in life is essential. We like to start even in the toddler years and before they reach puberty, to give children every advantage and help them reach their greatest potential.”
The science and research connecting an airway centric, nasal breathing habit to the sleep connection, has moved more MD’s to work with the pediatric and general dentists or orthodontists who screen for Obstructive Sleep Apnea. Providing this all natural approach and well-researched treatment is now becoming the Standard of Care for the children with outward symptoms of Sleep Disordered Breathing.
For parents, it may start in conversation with their pediatrician, discussing concerns with childhood bed-wetting, physical appearances, aggressive behavior, snoring, night terrors, allergies, arrested growth or the tooth decay, inflamed tonsils and adenoids that come with mouth breathing. The crooked, crowded teeth and grinding may seem like a closer dental fit, but as it turns out they are all tied together.
Updated 4th March 2017
