Friday 18 July 2014

The mouth breathers dilemma: Sleep apnea and stasis

From a evolutionary standpoint, kids today are being born with narrower dental palates, a common slim, long, pushed back face (malocclusion), crocked and crowded teeth. All of which is representing and coinciding with the migration away from the consumption of real food, breast feeding, open aired living and movement towards overexposure to various ranges of radiation, pesticides/commercial food sprays and increased perceived lifestyle stressors, of which can all be linked to the sad transitioning from nasal to open mouth breathing.

To appreciate healthy/'normal' breathing mechanics; Man relies on breathing in and out through the nose, utilising the diaphragm (belly expands), external intercostals, lavator costae, QL, serratus anterior/posterior etc.. and you cannot noticeably see it and you cannot hear it i.e. healthy breathing is calm, quiet and effortless.
Now most hyper-stimulated-western-folk's breathing is noisy, irregular, through the mouth and very noticeable, with rapid vertical rising of the chest and often accompanied with a congested nasal passage, leading to hyperventilation and respiratory alkalosis i.e. a reduction in CO2+excitability of the CNS.
Open mouth breathing forces the tongue
to drop from the roof of the mouth and jaw
back, thus narrowing the airway

Since nasal breathing seems to be the preferred route during sleep, nasal obstruction frequently leads to nocturnal mouth breathing, snoring and ultimately obstructive sleep apnea (OSA). When the individual begins to dysfunctionally transition towards mouth breathing, their ability to retain sufficient carbon dioxide (C02) is reduced. Now C02 isn't just a useless waste product of metabolic-respiration, it plays a vital role in the dilation of blood vessels and transportation of oxygen via the haemoglobin, your blood cells may be carrying sufficient oxygen but without the CO2 it will struggle to be released. Not only that, CO2 enhances sleep quality during REM stages, rids the system of ammonia and urea and down regulates histamine- mucosa production (thats why asthmatics often have to clear their trachea, due to low CO2).

Not only is the CO2 deficiency a risk factor associated with sleep apnea, at the same time as the mouth being open the lower jaw begin to drop posteriorly. In other words, as the individual is lying supine on their back, with the mouth beginning to open the mandible (lower jaw/chin region) will move backwards and down closing the airway, leading to the poor oxygen supply and CO2 retention. This lack of air forces the central nervous system to perceive a stressful situation, initiating the adrenal cortex to become stimulated, promoting  adrenaline, histamine and various glucocortisiods to send signals towards the neurotransmitters in the hypothalamus/brain stem to wake you up! Leading to the evident lack of sleep and constant waking around 2-4am…. 
    
Allergenic symptoms, daytime mouth breathing, restless sleep and hyperactivity are significantly common independent risk factors for habitual snoring….

Males with a 17inch+ neck and
women with a 16inch+ neck, have
increased risk of sleep apnea.

60-80% of snorers are very likely to test positive and experience symptomology of disruptive sleep patterns. 

Men and women with chronic nasal obstruction such as night time rhinitis (blocked nose, runny nose, excess mucosa, allergies), are significantly more likely to be habitual snorers and experience frequent episodes of apnea, indicative of severe sleep disordered breathing. 

Open mouth breathing during sleep is a risk factor for OSA and its associated with increased disease severity and upper airway collapsibility. The more elongated and narrow the upper airway is, the increased likely hood of aggravating its delicate structure (have a look around, most faces are heading 'down', not out and wide in order to accommodate the teeth and open airway).

Just something to consider:
ADHD is misdiagnosed all too often. Those with ADHD not only exhibit muscle excitability, but may be intuitively trying to build blood CO2 levels by hard physical exertion. Working muscles produce CO2. Perhaps 25% of children diagnosed with ADHD may actually have obstructive sleep apnea; their learning difficulties and behavior problems can be the consequence of chronic disrupted sleep as well as poor brain oxygenation???? Also children with sleep disturbances are often well below their peers in terms of height and weight.  


I don't think it will be long before we begin to see the spread and development of 'Sleep apnea' as the leading chronic health condition throughout the industrialised societies. 

Be Wise, close your mouth.

Beatle.      

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