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Sarah Hornsby, RDH- Mouth Breathing, Sleep Apnea & Oral Microbiome

by Mike Mutzel


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About Sarah Hornsby, RDH

Sarah graduated from Eastern Washington University with a bachelor’s degree in Dental Hygiene, is a registered Dental Hygienist and Myofunctional Therapist

Connect with Sarah

Books Discussed in this Podcast

The Toxic Tooth: How a root canal could be making you sick

The 8-Hour Sleep Paradox: How We Are Sleeping Our Way to Fatigue, Disease and Unhappiness

Interview Show Notes

02:34 Myofunctional Therapy: It is an oral facial muscle based exercise treatment. One of the most important things Sarah teaches is lip seal. This ensures that our lips rest together and we breathe through our noses. If there is a physical reason why someone cannot breathe through their nose, Sarah works them through it. She also teaches tongue position and swallowing.

03:27 Open Mouth/Low Tongue: An open mouth resting position causes a low resting tongue, which creates a cascade of effects upon our health and eventually effects sleep.  When you cannot breathe through your nose easily, you breathe through your mouth. Even barely parted lips cause the tongue to drop low. A low tongue effects the development of our maxilla, our jaws and our facial structures. This has an impact upon the airway.

04:46 Issues with an Open Mouth: Our noses are meant to moisten, warm and clean air. Nitric oxide helps with the microbiome within our noses. Mouth breathing lowers nitric oxide levels. When we breathe through our mouths, we bypass these benefits. Chronic mouth breathing is a cause of sleep apnea. If you are mouth breathing during the day, you will be mouth breathing during the night. That leads to snoring. Snoring leads to upper airway resistance syndrome. It is a precursor to sleep apnea.

07:17 Small Airways and Sleep Dysfunction: Most of Sarah’s patients are women in their 30s, 40s, and 50s. Airway dysfunction is not necessarily related to weight or gender. The common denominator is a small airway. This could be from improper jaw development or mouth breathing for years. Less oxygen is getting to your brain and organs.  Sleep dysfunction is linked to diabetes, heart disease, obesity and most other diseases.

09:12 Contributors to Small Airways: A small airway can come from enlarged tonsils and adenoids. In young children allergies can enlarge tonsils and adenoids, effecting the development of their face. We can use allergy testing or surgery to remove the enlarged tonsils and adenoids can be the remedy for toddlers. Mouth breathing for a child moves their heads forward. Their shoulders roll forward. They don’t breathe as fully as they should. Their jaws develop differently. As they grow, it changes their jaw, skull, neck, shoulders, and even their chest.

12:08 Enlarged Adenoids and Tonsils in Children:  For older children there is a chance to reduce tonsil size naturally. Young kids may need surgical removal of adenoids and tonsils, especially if they are not growing optimally because of reduced oxygen intake. Breathing techniques may help. Sometimes tonsils respond to acupuncture and aroma therapy. Breathing through the nose reduces tonsil size. This is challenging with young children.

14:47 Oral Microbiome: Mouth breathing also affect the bacteria that can lead to tooth decay and gum disease. This then leads to the gut microbiome. Dysfunctional species of bacteria in our nasal passages and mouth go travel to the gut, which effects

15:44 Jaw Tooth Anthropology: Dr. Kevin Boyd, a dentist, has teamed up with anthropologists. There are enormous differences in today’s jaws and skulls and those from those just 4 or 500 years old. The older skulls showed that people had all of their teeth, had their wisdom teeth and had broad jaws. They had fully developed mandibles and maxillae. They had room for all of their teeth. They had straight teeth. Something in our modern diet and our modern lifestyle is leading to dental changes, breathing changes and airway changes.

17:23 Causes of Myofunctional Problems: We are all born with a tongue thrust swallowing pattern that we use to breastfeed. Sometimes we do not grow out of that pattern. Tonsil and sinus issues, or being frequently sick with nasal congestion can contribute to a myofunctional problem. The dental development and development of the muscles in the tongue position are impacted in children who suck their thumb into age 5, 6 or 7.

19:13 Tongue Tie: The frenum is an attachment of tissue under your tongue. For some of us, it is too short. You should be able to use the tip of your tongue to reach the back side of all of your molars. If you cannot, you cannot get the food out of your teeth, putting you at a higher risk for tooth decay. Tongue ties are often detected in infants when they have difficulty breastfeeding. Dr. Bobby Ghaheri in Portland is a specialist in tongue tie, tie lip and breastfeeding medicine. He has an adult tongue tie support group and also a baby tongue tie support group on FaceBook. Many people who are tongue tied have speech issues. This could be a lisp, or L and R sounds. Sarah sees lots of adults in their 40s and 50s who are severely tongue tied and it had never been detected. Most people who are tongue tied have a great deal of jaw pain and airway issues.

21:44 Tongue Thrust: Sarah screens her patients for two things. The low resting tongue is the overarching thing. You can have a low resting tongue from a tongue tie or a tongue thrust. A tongue thrust is when your mouth is open and your tongue learns to lay down on the bottom of your mouth. Your tongue should be filling your entire mouth.

23:02 Things We Can Do: Begin to build an awareness around your mouth. Think about what your lips are doing. Are they resting together or are they parted?  Where does the tip of your tongue rest? Is it on the roof of your mouth, behind your upper front teeth, between your teeth or below your bottom teeth? Is the bulk of your tongue high, touching the roof of your mouth, somewhere in the middle or low?  Are you breathing through your nose?

26:07 Functional Appliance: Sarah works with a number of orthodontists on patients with orthodontic relapse, where teeth have shifted over time after orthodontic intervention due to a chronically open mouth. Sarah only works with and refers to orthodontists who use functional appliances. Orthotropics focuses on facial development and growth, rather than just on straightening teeth. The tongue has a huge impact upon tooth position.

29:40 Breastfeeding: Since difficulty breastfeeding is an indicator of a tongue tie and so few women are breastfeeding their infants, this means that tongue ties are not discovered until much later, after damage has been done.

30:14 Hereditary Aspects: A tongue tie is hereditary. The mutation of the MTHFR gene is also responsible for spina bifida, cleft pallet, and other issues.  Tongue tie is a minor birth defect. There is no standard measurement for tongue tie, so there are no true statistics.

32:41 Minor Corrective Surgery for Tongue Tie: If you can open your mouth wide, elevate your tongue to the roof of your mouth, and touch your back molars with your tongue, you are functional enough to probably not require surgery. It is a simple and quick surgery, a snip or laser under the tongue.

33:30 Clearing a Stuffy Nose: Buteyko breathing techniques help with sleep apnea and asthma. Sarah uses it with her patients. See Sarah’s YouTube video. Your number one priority is to breathe through your nose.

36:22 Oral Exercises and Sleep Apnea: Oral exercises can help with sleep apnea. They firm and tone throat and tongue. Apnea hypopnea index is a measurement tells us how many disturbances or how many fully stopped breaths you have per hour. C-PAP, continuous positive airway pressure, is designed to force air into you. Daily exercises for the tongue and throat can positively change your numbers. The bi-PAP and V-PAP deliver the air more gently. If you are grinding your teeth and/or you are snoring, you have sleep disordered breathing.

45:07 Swallowing and Chewing:  The low postured tongue will push forward during each swallow in a tongue thrust. In kids this shows as messy eating. Adults with a tongue thrust may hold their breath while they chew to compensate. Your tongue should go up and back when you swallow.

46:47 Sarah’s Favorite Nutrient: Sarah loves the smell of lavender and that it is relaxing and helps you sleep better.

47:53 Sarah’s Morning Routine: Sarah drinks some coffee and then spends about an hour mediating and journaling.

51:07 Sarah’s Elevator Pitch: Start noticing your nasal breathing.


  2. Thank you Mike and Sarah, for all this information, since I was a child I used to breathe through my mouth, later on the doctor advised me to put a tape on my mouth, as a result I bitted myself so many times that I decided to stop tapping my mouth, At the same time I had problems because when I slept with my mouth closed I used to grinding my teeth to the point that I broke one tooth while sleeping. I am on my 40’s now and I had notice a big change in my sleep, I suffer from insomnia but when I do sleep I notice my tongue goes flat and back covering the airway on my throat, this had caused me to wake up in the middle of the night coughing with my tongue and mouth dry that I can barely move and I need to drink some water. I notice also that while sleeping sometimes I am not breathing or stop breathing for a while, I am not exactly sure how long but some times just woke up extremely scared and coughing again, trying to breath. When we sleep, do we need less oxygen in our bodies than when we are sleeping? should I go to an specialist for a check up?
    Thank you for all this videos, I am learning step by step how to take good care of myself and I can understand better many things that are happening in my body.

    • Hi there Carmen,

      Sounds like a sleep study and visit to dental-sleep specialist would help. Have you tried mouth taping at night?

      Thanks for tuning and and hope it helped some,


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