This is not a post about which medical device to use to treat sleep apnea or snoring, but rather a self empowering post for anyone to use to tone your airway muscles and thus improve airway patency during sleep. Even if you have diagnosed sleep apnea and are using a CPAP or an oral appliance to treat it, you should still be doing exercises to tone your airway.

Modern lifestyle… with increased allergies and mouth breathing, poor oral habits of developing children (pacifiers, thumbs, bottle feeding), a softer diet of cooked and/or processed foods… has resulted in poor health outcomes. Weaker jaws, weaker airways, poor sleep quality.

Sleep-disordered breathing (SDB) is the most prominent risk factor for poor sleep, ranging from severe sleep apnea with multiple episodes of cessation of breathing during sleep… to snoring… to simply an open mouth causing airflow restriction and fragmentation of sleep. Wherever you land on the SDB spectrum, the consequences of poor quality sleep can have ill effects on overall health.

The sleep disordered breathing observed in the majority of people has a similar sequence:

Depending on age and a number of other factors, this will lead to any combination of fragmented poor quality sleep, Upper Airway Resistance Syndrome, snoring, and/or apnea.

How to Improve Your Airway to Improve Your Sleep:

FIRST AND FOREMOST, you must be able to consistently breathe through your nose!! If you struggle with nasal breathing, there can be many causes. Consultation with an ENT can be very beneficial to address an underlying problem. Regardless, here are some helpful aids.

Some simple things to try in your journey are Mute or Intake nasal dilators, natural (non-steroidal) decongestants like Xlear or CofixRx, and breathing exercises such as Buteyko and Box Breathing. Buteyko Breathing exercises can be very effective in the transition from chronic mouth breathing to nasal breathing. You can try self guided work on the Buteyko International Youtube channel. For more tailored work with this, you can find a certified Buteyko Breathing Instructor. Here in the metro, I love to have patients work with Allison Peet, certified Buteyko instructor at From Within Wellness.

To keep the airway open and primed for a good night of breathing and a good night of sleep, we must:

• Keep the mouth closed.
• Keep the tongue toned to rest properly up in the palate
• Keep the soft palate toned to prevent collapse back into the airway
• Keep the superior constrictor muscles toned to resist inward collapse

Proper airway tone and stability requires the strength of 3 main muscle groups.

The mouth must stay closed throughout sleep. When the lower jaw falls open, the base of the tongue can fall back and cause some serious airflow restriction in an airway with small dimensions. Strengthening the elevator muscles of the mandible (the lower jaw) to keep the mouth closed is very important, as is neuromuscular education for a subconscious closed mouth posture.

The strength of these muscles improves by simply using them more. We humans were built for gnawing down all of the food that we caught and foraged. As we’ve modernized to become less hunter gatherer and more cooked and packaged, we barely have to chew our food anymore. This disuse leads to smaller and weaker jaws. To strengthen the elevator muscles, we must eat more hard to chew items: carrots, celery, beef jerky, tough steak, etc. Alternatively, get a mastic chewing gum that is more of a workout than a leisurely chew. There are also a number of silicone chewing exercisers available, the Myomunchee (see associated blog post for sizing and use info) and Jawzercise Pop n Go being two of my current favorites.

Neuromuscular education for a subconscious closed mouth posture comes with improved tone. Additional help can be found with mouth taping. Just a vertical strip of 1” paper tape by 3M will do the trick. Alternatively, you can opt for a commercial version designed for mouth taping, such as Myotape or ViO2 tape. You can do it during the day while focused on other things: reading, watching tv, working on the computer. You can do it during light exercise or workouts. You can do it at night while sleeping- this is such an important time to be nasal breathing with a closed mouth. Remember, the first step of all of this work is making sure that you can breathe well through your nose so that you can tolerate this. Rest assured that none of these tapes will ever suffocate you when sleeping- they are adhesive enough to resist your mouth falling open, but they will not prevent your mouth from opening if it needs to during sleep.

The tongue must stay UP in the palate and the soft palate must be toned. The posterior tongue is the #1 most prominent obstructor of sleeping airways. With proper tone and training to rest UP on the roof of the mouth, it will stay suctioned there and out of the airway so long as the mouth stays closed. If it falls down and back off of the palate, the airway volume behind it shrinks, meaning airflow resistance and sleep disordered breathing. If the palatoglossus muscle tone is weak, the flimsy soft palate will easily be sucked into the airway, causing more airflow resistance and snoring.

To strengthen the base of the tongue and the palatoglossus, I love to recommend the REMplensish Myonozzle straw. Proper use will take some practice. However, once you get it down, consistent daily use of this will dramatically improve posterior tongue and soft palate strength. I drink a glass of water first thing every morning, so this was an easy add for me. Now, I just take a bit more time drinking my morning water through my REMplenish straw. No biggie for my daily routine, Big biggie for my airway tone.

Another idea for isolated strengthening of the posterior tongue is “tongue chewing” gum, a term coined by Dr. Mike Mew. The concept is to use your tongue to flatten a wad of gum across as much of your palate as possible, over and over. A simple search will provide multiple YouTube videos of self proclaimed “Mewers” tongue chewing gum.

For isolated strengthening of the palatoglossus in the soft palate, I want you to pay attention the next time you yawn. The palatoglossus muscle activates during a yawn and flexes the soft palate. Once you’ve mindfully realized this action, you will then be able to initiate a flex of that palatoglossus on demand, lifting that soft palate in what I call a “closed mouth yawn”.

The superior constrictor muscles of the lateral airway must be toned. Poor tone of the walls of the airway results in easy collapse of these tissues into the airway if there is airflow resistance from the tongue falling back. Strengthening these lateral wall muscles of the airway will prevent their collapse during periods of more resistant airflow.

The best way to strengthen the superior constrictor muscles is by activating the muscle chain from the lips (orbicularis oris) to the cheeks (buccinators) to the sides of the airway (superior constrictors). You can do this by simply pursing your lips forward and exhale against resistance. If you’ve ever had the pleasure of blowing up a lot of balloons for a birthday party, you’ve had the “cramp” that goes through your cheeks to the side of your neck. That’s this band of muscle.

You can use items to easily find at home or in a nearby store- a balloon to blow up over and over, a small diameter straw to exhale through.

You could also get more serious about it and use a Relaxator breath trainer by Conscious Breathing, with variable levels of resistance. An added benefit of the Relaxator is its ability to improve your CO2 tolerance for better nasal breathing and for better athletic endurance.

For any of these activities, you will always inhale through your nose with a prolonged and controlled exhale through your mouth against resistance. Additionally, be sure to hold the item only with your lips, not with your teeth.

There you have it. An efficient and effective exercise program for the 3 main muscle groups to strengthen your airway for better breathing and better sleep. Now, all you have to do is make your routine to work them into your daily grind.

Strong airways make for better endurance, better sleep, better health, better mood, better humans.

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