Breathing and Sleep: A Holistic Dentist's Perspective

This week in our ‘guide to feeling good’ series, we’re talking to my good friend, holistic Dentist Dr Vijaya Molloy. She is the owner and Principal Dentist of Vitality Dental here on the Central Coast.

Vijaya has trained across many areas of Dentistry including Orthodontics, Implants, Sleep Apnoea, Acupuncture, Cosmetic Dentistry and Nutrition and is passionate about taking a whole-body approach to dental care.

Breathing and Sleep by Dr Vijaya Molloy

The pursuit of wellness is a common theme in many people’s lives.  I think we’d all agree our mental wellbeing is elevated when we have the physical and mental capacity to pursue our lives to the fullest, whatever that personal definition may be.

Within my practice I encounter a number of people that have spent many years battling with chronic exhaustion. In these patients, often their breathing and sleep have not been checked.   In my opinion the two go hand in hand. 

Breathing

One of the routine questions I ask my patients is whether they breathe through their nose or mouth. Sometimes people do not know, or they may breathe through their nose during the day and their mouth at night. 

A clue that you are mouth breathing is waking with a dry mouth or needing to drink through the night.  My personal favourite phrase is ‘the nose is for breathing, the mouth is for eating.’ 

Why the nose is better

Nose breathing is more of an effort than mouth breathing which means we are less likely to over breathe or potentially hyperventilate.  The ability of the red blood cells to effectively release oxygen into the bloodstream relies on the correct concentration of Carbon Dioxide in the blood stream, this is known as the Bohr Effect. 

When we over-breathe, we are less likely to achieve this critical Carbon Dioxide concentration which results in less bioavailable oxygen.  The result is ongoing fatigue both physically and mentally. 

Our Nervous System

We have two nervous systems, the sympathetic and parasympathetic.  These systems are mutually exclusive, which means they cannot work together. 

The role of the sympathetic system was primally responsible for helping us deal with imminent threat such as running away from wild animals and coping with famine and should only be active for short bursts of time.   We experience a ‘fight or flight’ response.  

Our blood vessels dilate, heart rate and breathing increases and we get a surge of adrenalin.  The body cannot continue to produce adrenalin over a long period of time so eventually cortisol (stress hormone) takes over. 

When we are ‘sympathetically activated’, the main focus of our brain is to keep our body alive, we are essentially living in ‘survival mode.’  This means that our digestive ability will be impaired, rational thought and reasoning becomes difficult and weight loss is almost impossible. 

It is also very difficult for women to conceive during periods of extreme stress as the body interprets the increased cortisol as a signal that the conditions are unsafe for procreation.  Mouth breathers live in a perpetual state of sympathetic activation. 

Our parasympathetic system is responsible for unconscious processes such as digesting food, regulating blood sugar and maintaining our sleep quality.  When the sympathetic system is constantly ‘on’, the parasympathetic system doesn’t get a chance to perform and our health suffers. 

Sleep

Chronic Mouth breathing impairs the quality of our sleep.

Children and Sleep

In my clinic I often see children with a diagnosis of ADHD, learning difficulties, or restless, erratic sleep. 

In many cases these behaviour patterns are symptoms of an underlying sleep disorder.  Sleep disorders may range in severity from laboured breathing to actually stopping breathing, this is sleep apnoea.  

Children with a sleep disorder or sleep apnoea will often wet the bed past 4 years old and mostly breathe through their mouths.  They may also experience reflux and regularly complain of stomach aches.  

They might have been a poor sleeper from birth.  Unlike adults who become slow and sluggish when they are overtired, a child will show signs of hyperactivity.  Other symptoms are unprovoked aggression and emotional outbursts.

Untreated sleep disordered breathing will impact every aspect of a child’s life, from their academic performance to personal interactions, physical and emotional development.   

Crowded teeth and a narrow palate are also common problems.  The ideal facial rest position for both children and adults is to have the tongue resting against the roof of the mouth (the hard palate), lips lightly held together and breathing through the nose. 

In a young child the pressure of the tongue helps develop the palate to a shape that neatly accommodates all the teeth and encourages the development of symmetrical facial proportions.  Mouth breathers usually have a narrow palate, crowded teeth and a long face shape. 

Adults

Along with the cognitive and emotional symptoms previously mentioned, an adult that snores regularly has a higher risk of heart disease, stroke and dementia. 

Causes

In children, sleep disordered breathing or sleep apnoea is usually the result of enlarged adenoids, tonsils or food or environmental intolerances. 

Adults don’t usually have adenoids but a deviated nasal septum and enlarged turbinates may be a problem.  Excessive weight can be a problem too. 

Treatment

A common trend circulating the net is taping the mouth to force nasal breathing. (Medical micropore tape, not duct tape!)  I have mixed feelings about this approach. 

If someone has a physical blockage in their nasal passages, I see no benefit in trying to force them to nasal breathe.  The tape can however be useful in retraining someone with a clear nose under the guidance of a trained oral myologist or dentist. 

I notice that some children and adults breathe and sleep better after I have expanded their palate.  This is because the expansion also creates space in the nasal passages and facilitates easier breathing. 

Children and adults with sleep disordered breathing may require surgical treatment with an ENT.  In some people eliminating certain food groups may help. Gluten and Dairy are the most common culprits. 

Sleep studies are useful in both adults and children in establishing the severity of the sleep disorder. Even after surgery sleep apnoea may still be present as there can also be a blockage in the throat. 

In this case a CPAP machine or dental device to position the lower jaw forward can be used at night.  The benefits of a good night’s sleep can be life changing.

Once the nose is clear, breath training may be needed as it’s hard to suddenly switch to nasal breathing after years of using your mouth.  Nasal breathing requires a lot more effort which can make the transition challenging. 

Feel Good Tips

1.  With the fast pace of life today most of us don’t breathe to our full potential.   I recommend finding at least three one minute intervals throughout the day to focus on your breath. 

Inhale deep into your stomach for 5 breathes, hold for 6 counts and exhale for 8.  It is important that the exhalation is longer than the inhalation.  Repeat several times and notice how much more grounded and relaxed you feel.  This little exercise helps us ‘turn on’ the parasympathetic nervous system.

2.  It’s a mantra that is often repeated, but I will say it again; limit your screen time.  Screen time especially in the couple of hours before bed sends neurological messages that affect our sleep quality. 

Summary

Be mindful of your breathing and the quality of your sleep.

If you feel you could use help with either consult a medical professional you can trust. An ENT who is mindful of the effects of mouth breathing is a good place to start.  

To find out more about Dr Molloy’s whole-body approach to dental care, head to

www.vitalitydentaltuggerah.com.au or listen to her podcast, Mind Body Mouth.