Airway Development in Kids

Obstructive sleep apnea is a condition typically associated with adults. But pediatric sleep apnea – snoring in children – happens much more frequently than many people realize. As it turns out, there are some very good reasons why. In some ways, young children can be more predisposed to snoring than adults.

  • A child’s airway is generally a small diameter and shorter than an adult’s airway, particularly in the glottis (the portion of the larynx that contains the vocal cords).
  • The epiglottis (the flap of cartilage that keeps food from entering the airway) is relatively long and floppy for small children.
  • The tongue in the oropharynx (the portion of the throat at the very back of the mouth, behind the oral cavity) is relatively larger in kids than in adults.

Put it all together – the relatively larger tongue, the naturally smaller airway, the greater likelihood for the epiglottis to get in the way – and children can be naturally predisposed to chronic snoring. It’s a major reason that parents of newborns are strongly advised to lay their babies on their sides when putting them down to sleep as a preventative measure against crib death.

What’s more, children can come up against upper respiratory illnesses more frequently than adults. As pretty much any parent can readily attest, runny noses, nasal infections and head colds can be more or less nonstop for toddlers and preschoolers. And kids are especially susceptible to croup, which is characterized by swelling of the airway.

With all that in mind, it shouldn’t be surprising that it’s not uncommon for children to become accustomed to breathing through their mouth when they’re little. We’ve covered the issue of mouth breathing – breathing through the mouth instead of the nose while asleep – in other blog posts. The upshot is that it contributes heavily to obstructive sleep apnea, or chronic snoring.

But for kids who are still undergoing a lot of growth and development, mouth breathing can present some serious consequences. In nasal breathing, the tongue rests along the roof of the mouth, and the regular pressure against the teeth can help the form outward properly. Mouth breathing forces the tongue to rest on the lower jaw instead of against the roof of the mouth, which can cause both the upper and lower jaw to poorly form at the same time.

This can have severe long-term consequences for children. They can end up with crooked teeth, misalignment of the joints in the jaw resulting in TMJ disorder, and airway development problems causing obstructive sleep apnea.

So if your child is dealing with this, how can you address it so they get back on the path to healthy development, along with getting back to a good night’s sleep?

  • Address their upper respiratory issues early if possible. Yes, it’s easier said than done, but if you can help your little one avoid the upper respiratory issues that can lead to mouth breathing, you can typically prevent him or her from developing the habit of mouth breathing in the first place.
  • Oral appliances for children have become a proven solution to help children with jaw development issues. By using the right kind of oral appliance, the inside of the oral cavity is reshaped to create more space. And for small children, it’s generally much easier to treat with early intervention. Even in cases in which an oral appliance is needed to improve jaw alignment, children often need to wear the appliance for a much shorter time than adults to achieve the same effects.

Early intervention for children who are still growing and developing can be critical to helping them avoid more serious complications down the road.

Reddit aficionados may know something of r/AmITheA**hole, a subreddit where users can go and get feedback as whether they were in the wrong in a particular disagreement or argument. Last week, a redditor asked if she was off base for telling her husband not to wake her up…because of her snoring.

She made it clear that she dislikes being woken up, even if she’s snoring. She went so far as to disclose that she has informed him, repeatedly over the years, that she does not want him to wake her up because she won’t be able to get back to sleep. And then there was this showstopper:

I do not want to sleep separately all the time just because of it, but he is welcome to go sleep on the couch if he wakes up because of my snoring (probably AH-ish on my part).

Sleeping on the couch for thee, but not for me? Wow. Just wow.

As you might imagine, redditors had a field day with this post. Here are a few of the sparklier gems from the comment thread:

So you waking him up by snoring is ok though? I think YTA



So it’s an issue and you snap when he wakes you up because you snore but it’s 100% ok to wake him up because…you…snore?

How is that fair OP? You know you snore but your husband has to be punished more?


Oh, the entitlement here. Synopsis: I can snore and do nothing about it, even thou it’s a huge sign that something is wrong with my breathing, but it’s not okay for my husband to wake me up to reset my issue, even though I can wake wake him up endlessly. YTA, duh.


If he is waking you up because you are snoring then you are missing the fact that you woke him up first with your snoring. So, to turn your argument on its head he has every right to wake you up because he can’t sleep with you snoring.

You need to talk to your doctor about you snoring. You could have sleep apnea or some other underlying condition that could be treated (maybe your adenoids need to come out). Also apologize to your husband for waking him up because you snore.


Nobody wants to spend their entire adult life *not* getting a good nights sleep because their partner snores so much, and then being told they’re an a**hole when they try to address it. Have you considered that your husband is trying to cause you some discomfort in order to incentivize you to solve the problem? You say it’s been years that this has been an issue so to me that sounds like he’s tried to address it the “mature” way, and you just aren’t doing anything about it so at this point, what else is he supposed to do?

Fortunately, several other redditors chimed in with the suggestion that the woman who posted (“original poster,” or OP in Reddit slang) is suffering from sleep apnea and could probably benefit from a sleep study. Hopefully she seeks treatment soon so that she – and her husband – can get back to a good night’s sleep.

Source: AITA for snapping at my husband for waking me up at night because of my snoring? (Reddit)

There have been several articles floating around recently regarding mouth taping before going to sleep. Several of them have expressed alarm about the practice, which is understandable. But what might surprise you is that, as a leading sleep clinic, we actually endorse mouth taping as a short-term remedy for those suffering from obstructive sleep apnea.

Mouth taping is exactly what it sounds like: you tape your mouth shut before going to sleep. (We recommend a small strip of tape vertically from upper lip to lower lip. The idea is that it forces you to breathe through your nose during the night, thereby bypassing the mouth completely. It’s obviously a first step, and a very short-term step, to addressing sleep issues. It’s not something you can realistically do long-term, it’s not really an option for those suffering from allergies or nasal congestion, and most of all, it does nothing to address the underlying issues if you’re suffering from obstructive sleep apnea. But it does offer some very real up-front benefits:

  • It’s a simple test to see if you have sleep apnea. If you live alone and are uncertain as to whether you’re suffering from chronic snoring, try mouth taping for a night or two and see how you feel in the morning. If you feel more rested, then you may have a strong case of sleep apnea.
  • It’s cheap, and readily available. A decent CPAP machine will probably cost $1,000. The NightLase is well within reach for most people, even without insurance. But pretty much every remedy from the medical community is going to be more expensive than a $5 roll of tape and a couple of minutes in front of a mirror.
  • It’s an exceptionally fast remedy. Every meaningful treatment for sleep apnea can’t be implemented overnight. If you want to get a CPAP machine, you still have to get a doctor’s prescription. Even the laser treatment for snoring that we offer – which really does produce immediate results for the overwhelming majority of patients – still takes time to implement. (After all, you do have to come to the clinic!) But if it’s 10pm, and you’re desperate to get to sleep right now, mouth taping may be the only real option at your disposal.

Obviously, it needs to be done carefully. Use the wrong tape, and you could cause some serious skin irritation. (It’s one reason that some people can’t use CPAP machines.) And as stated above, it isn’t any kind of long-term solution. But in a pinch, it will do the job if you need a good night’s sleep ASAP.


It has long been known that getting good sleep is invaluable to your overall health. Poor sleep has been connected to a range of other health problems, such as glaucoma. However, disrupted sleep has now been directly connected to heart disease.

The American Heart Association has added sleep to a list of factors considered essential to heart health. Previously it was accepted that poor sleep influences behaviors that can impact cardiovascular fitness, particularly around diet and exercise. (If you aren’t sleeping well you’ll start craving junk food, and it’s harder to go do some cardio if you haven’t been sleeping through the night.)

But this latest change on the part of the AHA goes beyond, and says sleep is a factor that has a direct impact on cardiovascular health for a few reasons:

  • Interrupted sleep patterns leave you at greater risk of developing hypertension, Type 2 diabetes and obesity which can all contribute to heart disease.
  • Deep sleep allows the body to go into a sort of “rest and recharge” state where circadian rhythms can be reset, and helps maintain healthy hormone and metabolism levels. In addition, the nervous system can dial down and rest, which can help keep blood pressure lower during the day.
  • Deep sleep also appears to be highly correlated with lower arterial blockage, which is directly connected to heart disease. “In a study of nearly 4,000 middle-aged men and women, researchers found more atherosclerosis, a condition characterized by a buildup of fatty plaques in the arteries, in people who slept fewer than six hours a night than in those who got seven to eight hours. The scientists found increased amounts of plaque and in more locations in the participants whose sleep was most fragmented compared with other study participants.”

Bottom line: there are lots of very good reasons to get back to having a good night’s sleep. You can just add this to the list.


It’s long been known that getting deep, restful sleep is critical to overall wellness; we’re previously mentioned it here and here. Now another study surfaces demonstrating how uninterrupted sleep is connected to a longer overall lifespan.

A joint study between Stanford University and the Danish Center for Sleep Medicine administered more than 13,000 polysomnography tests. PSGs gather a range of biometric data while an individual is asleep, including nasal pressure, breathing rate, oxygen levels and heart rate. They can also tell if an individual is in REM sleep. In particular, they looked at the number of times an individual’s sleep was disrupted during the night, which can be used to calculate the individual’s “sleep age,” or the amount of sleep they’re getting relative to their actual age.

Researchers found a clear correlation between the amount of sleep you get and your overall mortality rate. Individuals who have more hours of uninterrupted sleep tend to live longer. Specifically, people whose sleep age is ten years younger than their actual age – i.e. have fewer sleep disturbances – can live up to 8.7 years longer than their peers with similar health profiles.

However, this cuts both ways. People whose sleep age is ten years older than their actual age – i.e. people who have fewer hours of uninterrupted sleep – can reduce their life expectancy by the same number: 8.7 years.

Bottom line: getting sleep issues under control can help you stay alive.

Source: Reducing The Amount Of Disruptions To Your Sleep And Making Sure You Are Well-Rested Each Night Can Lower Your ‘Sleep Age’ – And Extend Your Life Up To 8.7 Years, Study Finds (Daily Mail)

Obstructive sleep apnea is associated with a number of other health problems, including heart disease, high blood pressure and diabetes.  Surprisingly, it’s also correlated with another health issue: glaucoma.  

Glaucoma is a general term referring to a collection of diseases that result in damage to the optic nerve.  It is marked by loss of peripheral vision and later central vision, and can result in blindness if left untreated.  One form of this is normal-tension glaucoma.  Like its more common sibling, open-angle glaucoma, NTG develops painlessly and slowly over time, but has a unique characteristic: it lacks elevated intraocular pressure, the classic sign of glaucoma.  

Sleep apnea leads to hypoxia, or decreased oxygen levels in the bloodstream.  If hypoxic episodes last long enough and occur with sufficient frequency, they can result in optic nerve damage.  In addition, apneic episodes are associated with a decrease in intraoptic pressure.  Add the two together, and you end up with a contributing factor to NTG.  

One of the problems of glaucoma is how long it can take to get diagnosed.  Because the onset of so many forms of glaucoma is so slow, it may go unnoticed until a great deal of irreversible vision loss has occurred.  Regular checkups with an ophthalmologist can determine if you’re experiencing glaucoma.  

In the meantime, if you’re suffering from sleep apnea, do something to address it.  As discussed here, it can lead to all kinds of serious health issues, and can even lead to an early grave.


Tinnitus afflicts millions of Americans each year. It’s generally connected to some sort of underlying condition, such as age-related hearing loss or some sort of ear injury. However, many Americans may be unaware that it can be connected to TMJ disorder, and could potentially be at least partially reversed with the right treatment.

Tinnitus is phantom noise, generally described as some sort of ringing in the ears that the individual encounters even though no external noise is present. Tinnitus sufferers describe the noise in a variety of ways, including hissing, clicking, buzzing and more. It very much lives on a spectrum: it can occur in one or both ears, it can come and go, and it can vary from being a minor annoyance to being so intense that it interferes with the individual’s ability to hear external sound.

Many cases of tinnitus are symptomatic of hearing loss. The inner ear, or cochlea, has tiny hairs that move when sound waves enter the ear. That movement generates electrical signals that are passed through your nerve from your ear to your brain, and the brain interprets those electrical signals as sound. But if those hairs are bent or broken – which can happen with age or if you don’t wear proper hearing protection when being exposed to loud noise – they can pass along random electrical impulses to your brain, which will cause tinnitus.

However, temporomandibular joint disorder can also be the cause. The TMJ is the joint in your jaw on either side of your head directly in front of your ears, where the lower jawbone meets the skull. Because of its placement, it can cause a number of complications with the inner ear.

  • The chewing muscles are near some of the muscles that also insert into the inner ear, so any problems with those chewing muscles can be transmitted up by the inner ear and can manifest as tinnitus.
  • There can be a direct connection between the ligaments that attach the jaw to the skull and one of the hearing bones inside the middle ear. Since bone is an excellent conductor of sound, ligament issues related to the bones can also present as tinnitus.
  • TMD can create a number of nerve-related problems. And the nerves connecting to the TMJ have some level of connection with the nerves related to the auditory system. As a result, TMD-related nerve issues can pass electrical signals over to the inner ear as well, causing tinnitus.

To be clear, TMD may not be the sole cause of tinnitus. If a person is at risk of tinnitus due to age or pre-existing hearing damage, TMD may simply aggravate the condition. But even in these cases, treatment for TMD may reduce tinnitus, which itself could be a real improvement.

When diagnosed with sleep apnea, turning to a continuous positive airway machine is generally the first route some people take to getting back to a good night’s sleep. However, many people quickly discover that using a CPAP comes with a number of downsides that can range from being minor annoyances all the way to deal breakers as far as using a CPAP is concerned.

1. Wearing a mask overnight may not be feasible.

Using a CPAP means you have to wear a large respiratory mask overnight, and that comes with a number of complications. Many users report skin irritation, particularly around the nose. Getting the mask to fit properly – if there are any air leaks, the CPAP won’t work – can be challenging. Most of all, some people just can’t get used to wearing a mask overnight. Some users end up pulling it off in their sleep, and for a few unfortunate individuals suffering from claustrophobia or some level of PTSD, wearing a mask for eight hours straight is just not an option.

2. Forcing air into your lungs comes with a number of downsides.

By definition, a CPAP blows a continuous stream of air into the wearer’s airway. Many users end up feeling bloated when they wake up, and for some, that’s a bit much to tolerate. Experiencing severe dry mouth or dry, cracked nasal passages is also common, and these can also be issues that interrupt sleep.

3. A CPAP is a machine, which means that it carries a machine’s limitations and annoyances.

  • Noise. While most newer CPAP machines run in near silence, older machines can sometimes generate enough racket that they ironically keep the user from getting to sleep.
  • Dependence on electricity. Every CPAP has at least one non-negotiable requirement: access to a functional electrical outlet. If you ever lose power, you also lose the ability to sleep through the night.
  • Travel can become more complicated. Many CPAP machines are relatively bulky and can eat up a lot of luggage space (and can you imagine the nightmare of an airline damaging or losing your CPAP?). Compact, travel-friendly CPAP machines are available, but they’re not cheap. And as noted earlier, CPAP machines require electricity, which can impact where you choose to go on vacation (overnight campouts may be off the table).
  • Many users quickly learn to hate the reality of regular machine maintenance. The CPAP is by definition a respiratory device, which means that its cleanliness requirements are rather stringent: they have to be cleaned at least once a month to prevent germs and other contaminants from growing inside and infecting the user. In fact, many CPAP machines require such frequent maintenance that some users buy a second machine to make it easier to clean.

Many folks are fine with using a CPAP machine to treat their sleep apnea systems and it is still the best treatment option for the most severe cases of sleep apnea. Given how widespread the CPAP has become, the machine is not going away anytime soon. But as with any treatment, it’s important to be aware of the limitations and side effects and that there are other less intrusive options available.

Sudden infant death syndrome is a nightmare for parents who have experienced it. Also known as crib death, roughly 3,400 babies die from SIDS annually in the U.S. alone – making up 37% of sudden unexpected infant deaths – and researchers have long struggled to understand what drives it and how it might be more effectively prevented.

Since it usually occurs when a baby is sleeping, SIDS is closely connected to pediatric obstructive sleep apnea. In most cases of an apneic episode in both children and adults, when the body becomes sufficiently starved of oxygen, the person will at least partially awake, gasping for breath. But a few babies simply don’t wake up to breathe, and end up suffocating in their sleep.

Now scientists think they have identified a contributing factor. In a recent study, researchers compared blood samples from babies that dies from SIDS and other unknown causes to the blood of 655 babies in a control group. They found that the children who died from SIDS were deficient in an enzyme called butyrylcholinesterase (BChE). This particular enzyme is part of the autonomic system, which controls functions like blood pressure and breathing. Simple version: a shortage of this particular enzyme could make some babies predisposed to SIDS.

While experts welcomed the discovery, they’re also moving with an abundance of caution, saying that this is only one piece of the puzzle. There’s plenty more that can contribute to a baby’s susceptibility to SIDS, such as premature birth and exposure to tobacco smoke. In addition, it’s going to take time to develop a screening test for BChE in infants. But this breakthrough can, at a minimum, reassure parents who have lost children to SIDS that their baby’s death wasn’t their fault.

Researchers Pinpoint Important Biomarker for SIDS (
Study Identifies Potential Biomarker for SIDS, But a Test For It Is a Long Way Off (CNN)