You don’t need to go to the gym to tone your tongue muscles. They have an essential role in the acquisition of restorative sleep, especially in the presence of sleep apnea. Physiotherapist Thierry Gooseland, an expert in this field, explains why it is imperative to exercise several times a week at home. However, prior specialist assessment is required to assess future management.
What is the main goal of lingual physiotherapy?
“Of course, tongue muscle training (or rather myofunctional therapy) is one aspect of OSAS management. However, even if the tongue represents one of the main bucco-pharyngeal elements, it is not the only representative. It is really necessary to also take care of the ventilation problem. Some patients present with normal tongue functionality but difficulty breathing. Remember, it should be nasal, not oral. The mobility of the soft palate should also be assessed. With all these elements in hand, the oro-maxillo-facial reductor then decides what is the best therapeutic approach to adopt, whether or not accompanying the appliance or orthosis as the case may be. mandibular advancement recalls Thierry Gooseland
First, a warning is in order. People too often engage in exercises that are not tailored to their problems and do not exactly respond to them. As our expert reminds us in the introduction, the exercises are applied on a case-by-case basis. ” For this reason, the preliminary assessment stage is essential. There’s no question of getting yourself into the moves seen in the tutorials found on social media. Only a physiotherapist experienced in the problem of OSAS can then indicate precisely the procedure to be followed to achieve good nasal breathing and correct positioning of the ‘sucking’ tongue on the palate. Then it’s a matter of locating the structures we’ll need to work on. On the other hand, this first-line evaluation allows to assess whether the rehabilitation will lead to a real improvement of the patient. Then it is a matter of performing the exercises that must be done daily in the morning and evening at home.
Toning and acquiring automaticitywith
For the patient, ideally, daily exercises last 3-4 minutes in the morning and evening. A monthly progress assessment by the re-educator is then scheduled. In this way, the movements are gradually adapted according to the clinical evolution. Then one can achieve sufficient muscle tone and change the behavior of the tissues“.
” Along with this, the patient must acquire certain automatisms during the day. It monitors the position of the tongue glued to the palate and maintains the contact of both lips to encourage nasal breathing. If these two criteria are not acquired, physiotherapy does not have the expected effect. It is therefore necessary, somehow, to re-accustom the person to having only nasal breathing. This warms the air, humidifies it, traps nasal nitric oxide. For good steering, three axes are complemented by action On:
–The side of the ENT and pharyngeal muscle
– The ventilation side with an explanation of the mobility of the diaphragm, etc..
– Nasal hygiene and reinventing the idea of airflow through the nose, not through the mouth”.
Are the exercises the same for adults or children?
This rehabilitation applies to both adults and children (from 3 1/2-4 years) with some differences. In fact, in adulthood, facial growth is complete. Thierry Gooseland explains that in the Nouvelle-Aquitaine region, screening in schools appeared with the Isidore program
As for children, in the case of hypertrophy of the tonsils, tonsillectomy in the context of OSAS is now an indication for ENT surgery. However, as T. Gouzland points out, ” postoperatively, some improve, some do not, with a return to mouth breathing when there is no longer any obstruction. And here maxillofacial physiotherapy acquires its full meaning in cooperation with ENT specialists. As for the Anglo-Saxon fashion of frenotomy or frenectomy, it must be moderate“. With this in mind, the Academy of Medicine issued a warning in July 2022.
Is it necessary to undergo specific training to exercise this specialty?
This is what our expert explains
” As part of the initial training course as a physiotherapist, the subject is of course covered. However, it is better to follow training that is truly adapted to OSAS. Thus, for several years, a university diploma issued in Bordeaux and recognized by the Council of the Order has been offered. There is also the possibility of following private training.
In the context of sleep apnea syndrome, we have created Cardiosleep, a specific training course (Somnoreab) for pediatric and adult therapy and rehabilitation. During this course, a large number of health professionals with CPD validation (physician, speech therapist, physiotherapist, dentists, etc.) are involved to better understand the management of this pathology. In fact, according to their practice, they can practice this specific discipline or at least know the good indications. At the same time, it allows for a second time the creation of interdisciplinary connections, the emulation of knowledge and a professional network interesting for all ».
Illustration by DCSstudio for Freepik
1- Somnorehab https://www.cardiosleep.fr/cible/formation-therapeutes-myo-fonctionnels/
2-URPS Isidort program https://www.isidort.fr