Dr. Ben: On today's episode of the Modern Vital Podcast, we're going to talk a little bit about environmental factors that can play a role in sleep apnea, and on today's episode we have a special guest in Corinne Jarvis, founder of BreatheWorks and a speech-language pathologist or SLP, specializing in sleep apnea and all things related to sleep, particularly with regard to sleep disorder, breathing issues in children. Corinne is also an orofacial myologist, looking at orofacial myofunctional disorders, or OMD, conditions involving the lips, the jaw, the tongue, position at rest and looking at swallowing in speech. Corinne, a Vermont native, brings extensive expertise to her own practice since opening her first in New York in 2006, specializing in orofacial myofunctional disorders and sensory motor feeding therapy. She has received fellowship training in autism, parent training and treatment. Corinne's career has expanded to include educating and mentoring graduate clinicians, while utilizing additional modalities such as craniocacral and manual therapy to address structural and physiological disorders. Welcome to the show, Corinne.
Corinne: Thank you so much. I'm really happy to be here.
Dr. Ben: It's so great to have you, so I'd love to hear a little bit about what led you down this path, why did you become an SLP and what led you to sleep apnea.
Corinne: Yeah, it's kind of an interesting path. It's a newer path for speech pathologists. Actually, I think that we've been addressing a lot of dysfunction that relates to speech or sleep apnea for a long time, but now more and more speech pathologists are seeking out how can we be a piece of the puzzle in treating sleep apnea and airway dysfunction.
I have always been interested in the musculoskeletal approach. Kind of more like a physical therapist might take, since the very beginning of my career. And so I really was all about how we can change muscle function to improve overall function of speech, of cognition, of how our body feels, how we digest, how we chew and swallow our food. So it's always been the foundation, And about I'd say 10 years ago I was finally at a time where I could take the official training to become an orofacial myologist and specialist. And it really brought a new lens of a community of who we work very closely with. So it really becomes more of a team interdisciplinary approach. So I just, I've always traveled my career in this way and have just landed my dream career right now.
Dr. Ben: So can you tell us a little more? What does orofacial myology entail? What is it looking at particularly?
Corinne: Yeah. So form follows function. I always like to tell our patients that the form of our structures, the muscul, you know the scale, our skeleton, the length of our bones, it's all. It's all following what our muscle patterns are doing. So if we have a restriction or a tightness on one side, our bones, through development, might now form the same as if they didn't have that asymmetry. So what our tongue, our lips, our jaw muscles are doing, our muscles of respiration and overall muscles of body posture, what they're doing repetitively is going to affect the shape and maturation of the bones.
So you know, we work pediatrics, infants through geriatrics, and have a different lens for each age. But orofacial myology is sort of oral mechanism, myos for muscle and then with regard to function. So orofacial myology is really the study of the oral muscle function. So we use our oral musculature in clearing our teeth after we eat a sandwich, we use it to speak, we use it to chew, swallow and then we have our overall resting posture And all of those determine the structure, how it comes out.
Dr. Ben: Right, So what are some environmental factors that you see like main ones that could impact or mediate this in early stages of life.
Corinne: Yeah, great question. I mean there's so many. I think that allergens, inflammation, are huge ones. You know, we are all living right now in our population that we treat is in the Pacific Northwest, so we are treating very high allergens. We have a lot of molds here and any inflammation that can cause congestion or just general inflammation in the nasal, pharynx and the pharyngeal structures can alter how we develop or the compensations that we might start doing because we have more blockage or inflammation in certain areas. So I'd like to think it's all about flow, right, it's all about the flow of our bodies. It's about how we process things, it's how we about move things through our bodies. And if you have a congestion, whether it's from allergies, whether it's from food allergies or environmental, from this mold toxicity, I mean, it has a huge impact on how we breathe, which can lead to things that are imbalanced, like sleep apnea or sleep disorder, breathing and lots of other, you know, swallowing issues and speech.
Dr. Ben: So then do you occasionally see that where somebody you know, a child, comes to you with a dysfunction and then you identify a mold toxicity or an allergy and then you clear that and then the dysfunction goes away?
Corinne: Yeah, absolutely So, I mean, I just treated an eight-year-old today and the tongue posture was completely forward, you know, and I was thinking why is that tongue wanting to sit forward in this child's mouth, right? So I took a look. I, you know, took a deep dive down the throat and I looked to see the tonsils are, you know, of maybe a level two out of four. So they're not completely blocking the airway, but there's definitely inflammation, you know.
And then we start to probe around. You know, tell me a little about where you're at in your life. Have you moved? Do you have any changes? Do you have a pets in the house? And you start to hear patterns of you know, oh, we've actually had a pet or a high allergen, or, yeah, we found out that we have a food intolerance and it's causing a lot of wreaking havoc in the body. When we start to remove those things or treat for molds, when those issues are a piece of the puzzle, we can then start working on the muscle function to strengthen it, to get back towards optimal function. Because once you can remove those allergens, the environmental factors, then it's the secret recipe to then strengthen the habits that are unwinding, the habits that might have been occurring and then strengthen the structures to get towards optimal function.
Dr. Ben: Wow, that's really inspiring. So do you sometimes see that a child had it maybe for five or six years or longer and then you help remove the thing and then it takes maybe many months to kind of get back to an optimal level. Like how do you get back to optimal?
Corinne: Absolutely. I mean we see so many patients that have been in speech therapy for years, I mean years, and you know there are oral habits that maybe just the articulation is off or maybe the swallow function is off and they just can't seem to correct it right. They can't be told where to put their tongue or how to do things or exercise without that other layer, and then we start to kind of peel back what's underneath and let's look at the case history and look for patterns and then bring somebody in like you, Dr. Reebs, to really identify those, that foundation piece for inflammation, and that's when we can then treat and discharge within a couple of months. I mean, it's a completely different story, wow.
Dr. Ben: Well, I was reading UpToDate recently and I think up to like 925 million individuals worldwide are estimated to have some form of like OSA or obstructive sleep apnea. And that's not even really looking at children. I don't think, because it's usually adults that are over 30 years old. But how often are children, you know, evincing or displaying symptoms of sleep apnea and it is being underdiagnosed and not even seen? Or maybe it's being misdiagnosed as asthma or chronic allergies or something else, or maybe completely missed?
Corinne: Oh my gosh, so many. I mean, if you think about it, people are really used to seeing their kids sleep with their mouth open. They're not. That's not ringing any red bells or warning for most of the parents, until we start to kind of pull some signs and symptoms and say, hey, you're having signs and symptoms with digestion, oh, you're having signs and symptoms focusing and paying attention in class, or you know, you have chronic throat infections or you know something.
We start to talk about the signs and symptoms And they realize, hey, this person, this child, this adult, may have been mouth breathing and letting so many more allergens through directly into their, you know, pharyngeal system and they're not and they're bypassing that whole beautiful filtration system that we have.
I think it's feeling like the norm now to be able, oh yeah, this person snores. This person snores. And that's acceptable and the norm. But it's such a warning sign. And if you start to take those people that are just even mouth-breathing at night, not even snoring or mouth closed and snoring through their nose or you know, looking for those and asking them about signs, are you having signs and symptoms with allergies? Are you having signs and symptoms with digestion? Maybe like feeling like it's hard to swallow things and focus and attention and, honestly, overall mental health. We start to pull those pieces together and say what's going on in that airway and that you know oropharyngeal system. And I mean, we're seeing so much of the population from, you know, pediatrics all the way up to geriatrics.
Dr. Ben: That's so frustrating, right, absolutely. So how often are we seeing sleep apnea, that really hasn't been looked at at all from an oral, facial, myological perspective.
Corinne: Yeah, yeah, so good question. I mean the traditional you know routine for people to get you know if somebody is really going to…they're not honestly screened very often by their primary care providers to see if that might be a contributing factor. But if they are going to the primary care providers and saying this is something that is having an effect on my life, that's typically the people that start to get tracked into. Then they go for a sleep study, maybe to an ear, nose and throat doctor to make sure that they have clear nasal patency and airway patency. And then, if they qualify for sleep apnea, they're usually given two choices, one being a CPAP, and with that decision it's a wonderful resource for acute issues, but they're never given a way to unwind needing that as a tool for the rest of their life. And it has a lot of trial and error that goes with it to get it to be a useful tool. And the other one being a mandibular advancement device where it's kind of like a retainer that they wear to advance the mandible to give themselves more airway, so that you don't have those apnea episodes.
But again, those are a great tool for acute issues. But over time they elongate the tendons, that can't go back, that you can't unwind some of the effects that that has on your overall musculature over time. So the therapy is just now starting to get more attention. We have very solid research that shows that we can improve sleep apnea with muscle function therapy and with a musculoskeletal approach. But just now sleep centers are starting to recognize, primary care physicians are starting to recognize, it's slow going.
Dr. Ben: I'm really intrigued by the title of your company, BreatheWorks. And I know that you and I had gotten together when we had lunch. And you were talking all about the connection between the diaphragm and sleep apnea and how you'll assess the diaphragm. You'll assess breathing patterns. It's so profound. Can you tell us a little bit more about what you do?
Corinne: Yeah, so the tongue base. This is kind of where we have our specialty on our team. But that tongue base has a direct central fascia line right to the diaphragm. And so if this is tight or misused or habitually weak, so is that diaphragm. And we have three layers of valves in our body. We have our tongue. We need a valve for swallowing. And we have our diaphragm, that we valve throughout our body. Then we have our pelvic floor. And they're very interconnected through the fascial web and how they move.
So oftentimes when the tongue is low, resting and not lightly suctioned to the roof of their mouths, like optimally we would like them to be, that diaphragm is weaker or tighter or doesn't have as much mobility as what we would like. So we tend to see more upper clavicular breathers. So they're breathing. Let me take a deep breath. It's all up here. And it's not into the diaphragm…you know that kind of three-dimensional diaphragmatic breathing that calms the nervous system. So you know you can actually affect your nervous system with your breath, so you can up-regulate your nervous system and down-regulate your nervous system. And with that upper clavicular shallow breathing you can up-regulate your nervous system.
So if you're doing that all the time, people tend to be in more fight-or-flight mindset versus rest and digest and focused and calm. So it has, you know, it has a big effect. That tongue-relational piece to the diaphragm is really important. So we, day one, we're giving exercises not only for the mouth and the oropharyngeal system but for the diaphragm and you know overall body posture, because that's another piece of the puzzle with you know environmental allergies or you know inflammation, is that we tend to bring our head forward, to open the airway, creating more of a forward head posture. And then it affects the whole chain of events of how our, how our muscles and the function of our body wants to kind of sit and posture.
Dr. Ben: And Corinne, you had said that you know it seems like it's almost the norm now that there's some kind of breathing disorder, some kind of sleep disorder or apneic issue. I know that a lot of holistic practitioners are seeing sicker and sicker people, you know, than the decade ago or so. I'm curious, what degree do you think our environmental exposure is playing in this, you know, in airway inflammation, you know, just with all the millions and millions of pesticides and persistent organic pollutants and electromagnetic fields, things that we're exposed to, that we weren't exposed to nearly as much as even 10 or 20 years ago. You know kids are holding hand-helds as they, as they fall asleep. I'm curious, like without falling off of the deep end, just what role do you think that's playing in this?
Corinne: I think it's a fundamental role. I think it is the absolute tipping point of pushing everything into the norm. It’s that piece that it's everywhere. I mean, it's really really hard to create a non-toxic environment. You know, it's a lot of work. I think iit sets the foundation for our bodies to be able to tolerate less, right. We have a lot of compensations that are beautiful in our body, but they can't, just they can't be done, you know, overused for the long term. So I think that environmental air quality, what we're able to tolerate with our bodies, plays the fundamental role in this, being kind of you know, we're seeing it everywhere. And by reducing those we can then easily access the muscle systems and retrain things. But it takes 10 times longer to even make a bump in overall body function when you're still struggling off of a weak foundation from this kind of topic.
Dr. Ben: Yeah, Well, what are a couple of…? I mean, we can wrap up here in a minute, but what are a couple of practical tips you can give people? You know, maybe pearls, that one could take with them without having to go in to see, you know, an expert like yourself? What are a couple things people could do right now who are maybe struggling, you know, when they're like, oh yeah, my partner is snoring, or my child, I walk into the room and they're breathing through their mouth half the time.
Corinne: Yeah, I think, first of all, number one is educating, like understanding where our tongue is supposed to be in our mouth, because our tongue is like our natural palate, will expand and our lips are like our natural braces. So if the tongue is out, we tend to see a higher arched palate. And whenever we gain, you know, vertical space in our mouth, we're taking it away from the nasopharynx, we're taking it away from our nose. So we want to keep our tongue lightly suctioned to the roof of the mouth within our dental margins, day in, day out. That is actually your optimal tongue resting posture, not a strong tension where you're really creating more tension, but just a nice light suction, the tip, the middle and the back to the roof of the mouth. We want lips closed, but we don't want to create extra tensions. That's how our job is to look for compensations that are actually causing more harm than their gaining improvement. So we look for too much tension in your chin muscles, the mobility and what are you engaging to get that posture? And that's kind of where we come into play. If you are having a hard time keeping your tongue lightly suctioned to the roof of the mouth and your lips closed and breathing through your nose and your head over your shoulders, then we want to ask why, right, and a piece of that puzzle could be that overall inflammation throughout the body. But then we want to strengthen and unwind and retrain your brain and your body on how to deal with that. Because nasal breathing is so important. I mean you get 20% more oxygen through your nasal pharynx than you do through your oral pharynx, mouth breathing.
And sleep apnea is now...there's research showing it linking to dementia, to Alzheimer's and so many other cardiac problems. That tends to be how I get kind of the typical snorer population if you start talking about that, because oftentimes they don't really care that they're snoring. People generally care when they have sleep apnea because that's a much higher level of dysfunction. But we start talking about how you get 20% more oxygen to your brain and to your muscles if you're breathing through your nose and that tongue up into your palate, lightly suction. That is your natural exercise. So that's when, when we see the tongue low, resting, it's not getting its exercise by being lightly suction to the roof of the mouth. So if that's difficult, then seeking some therapy, this is under your speech therapy benefits, is for medical insurance. It's covered and something that just you need maybe a couple of sessions to get there or a couple months of sessions, but it's something that is non-invasive and a really easy way to improve overall in dealing with inflammation and filtering with breathing. That's your breath work.
Dr. Ben: I didn't realize that we get 20% more oxygen. I do know studies show that we produce more glutathione when we breathe through our nose, but that's probably the reason, right. I mean we get more oxygen to the mitochondria and the liver makes more of our master antioxidant, indirectly, probably.
Corinne: Yeah, and the nitric dioxide yeah. The nitric oxide plays a big role in how we bind and uptake that oxygen.
Dr. Ben: Well, Corinne, thank you so much. All right. Thank you so much for joining us today. Where can people find you?
Corinne: Yeah, you can schedule with us online. We take most in medical insurances. My website is breathworks.com and that's with an E in the middle, and we have locations in Lake Oswego, Eugene, Northeast Portland and Camas, and we also treat over teletherapy.
Dr. Ben: Well, thank you so much for joining me today.
Corinne: Yeah, I really appreciate you and all the work that you do.
Dr. Ben: That concludes today's episode of The Modern Vital Podcast. We would love to hear from you. We value your feedback. If you have any questions or suggestions, please reach out to me at ben@modernvital.com and leave us a review. If you enjoyed this episode, we look forward to having you join us next week for another exciting episode of The Modern Vital Podcast.
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