Episode 260: Reshaping Health Through Nasal Breathing with Dr. Shehab Faragallah

Hi and welcome to episode 260 of the Untethered podcast. Today we have Dr. Faragala joining us. Dr. Faragal is a dentist with over 20 years experience on the Gold coast of Australia. He has been working at Gold Coast Holistic dental care since 2017 and has a special interest in Oral Myology. He's a co founder of myospots Australia. Quick Disclaimer all information, content and material of this podcast are the opinions of the speakers and is for the informational purpose only and not intended to serve as a substitute for the consultation, diagnosis and or medical treatment of a qualified healthcare provider. Welcome to the Untethered Podcast. I am your host, Hallie Balkan. I'm a certified myofunctional therapist, feeding specialist, podcaster, business owner and mentor. This podcast is all about getting your questions answered and collaborating with colleagues to bring you the most up to date information in the orofacial myofunctional therapy, airway, tethered oral tissue and pediatric feeding therapy space. If you're new here, I challenge you to keep an open mind and join my mission to spread this message far and wide. If you've been around since June 2019, thanks for being a loyal listener. As we jump into today's episode, remember to listen with correct oral rest posture, tongue up, lips closed, teeth apart, breathe through your nose. Let's get started. Shehab, welcome back to the podcast today. I'm excited to have you here.

Thanks Hayley. I miss speaking to you. The last time we spoke about was really cool. It was one of the first podcasts I did with anyone. So awesome. Love to be back.

That's awesome. And I know that you've since come out with some fun things that we're going to talk about today with MYO Spot. But before we jump into all of that and I know you know a lot of professionals listening know these things, but for those who maybe don't know or who are new to Mayo, I would love to jump into, you know, what correct oral rest, posture looks like and ultimately the connection between where our tongue is supposed to rest and nasal breathing.

Yeah, that's a really good question. I did have a patient in the other day and I did a full assessment on him to try and work out exactly what was going on with him because Mum brings them in, they're about five years old and and they, their teeth were really short on the front because they developed a really bad bruxism habit. So she was like what is going on with my son? Only a year ago they were fine and after the assessment, I realized that their tongue was thrusting between her teeth. So it was kind of like every time he would swallow, it would go in between the teeth and back in. And it was a very difficult thing to try and get their tongue back. And I had to explain to the. To mom that looks the correct oral tongue posture is to be up against the roof of your mouth, behind your teeth, and not between the teeth. And it needs to rest up there all the time. Not only that, it shouldn't thrust between the teeth during a swallow. So if you're swallowing and every time you swallow your tongue moves between your teeth, then what can happen is that you have to compensate with other muscles in order to make sure that, you know, for instance, the saliva might pull down in your lips, and in order to stop that, you start activating all these other muscles around your face. And that then pulls your maxilla and mandible back backwards, and sometimes it drops as well. So correct oral tongue posture is not just keeping your tongue up against the roof of your mouth, but it's also swallowing correctly. Because we do that, it could be over a thousand times a day. And if you're doing that incorrectly, you then that can cause disturbances in the way your face looks and the way you function as well. So up against the incisor papillae, which should be where the tip of your tongue goes, and the middle of your tongue should be up against the roof of your mouth as well at all times. When you see it, it looks really nice because you can often see that you're sagging. You know, I've got a little bit of facial hair, but you can often see a bit of sagging underneath the, you know, underneath the chin when the tongue drops down a bit. And if you look very carefully with somebody with their lips together, you'll see that there's a bit of, like, sagging skin. And you can, almost, especially in children, you can, you can know that, well, the tongue is not sitting in the correct position. So that's a quick summary on how the tongue should be. And I know you know that as well.

Yeah, no, but I think that's so helpful for our listeners to hear because that's such a good visual indicator when the tongue is. Is laying on the floor of the mouth. Like I'll have sometimes therapists say to me, well, how can you tell with their mouth closed that their tongue has moved from the floor to the top? And exactly what you said you see, like that droopiness or that bulge or that, like just the Tongue, you can see it really sitting on the floor of the mouth. And then as soon as that tongue goes up to the, you know, the roof, we see kind of this elevation of the skin underneath and you don't see that same like bump, if you will. Right. And so it's, it's a really good indicator.

Yeah. And also, Hayley, like what? One other thing that tends to happen is that when you've got correct tongue posture, your head posture tends to correct as well. Because what happens is that when the tongue drops down and forward, you often, often connected to mouth breathing as well. And so what happens is that you rotate down and forward and when the tongue goes up against the roof of the mouth, that it brings the lips together in most cases. And when that happens, you start nasal breathing. When that happens, your head adjusts on top of your neck and you end up with better posture as well. So I feel like tongue posture is one of the most important things to have for correct general posture. Because if you don't have that right, then your neck posture goes out. If that happens, then your back posture goes out and it can have a follow on effect all the way down. So a lot of people, you know, in the posture industry focusing very heavily on, on getting their hips correct, rolling their shoulders back and you know, pulling everything backwards. But if you start, yeah, if you start with the tongue, then you often find that that is a massive advantage in keeping your, your head and body posture correct as well. I mean, it's multi, it's multifactorial, but that's a really important part to get done properly. And you often find, and even with myself, if I start slouching, the back of my tongue starts to drop and it's related to me slouching and the moment I get the back of my tongue, it's almost like, you know, the whole thing straightens out. And I often with, especially because I deal with a lot of children, often we talk about how they eat and in between swallowing and in between, you know, putting the food in your mouth or whatever, I get them to sit up straight because when you sit up nice and straight, then your tongue will be up against roofy mouth. And then when they're swallowing, they're reinforcing that posture with a tongue pushing up against the roof of your mouth. So it's always reinforcing, it's always happening. And that's, that's really important. It's not just, I guess it's not just facial development, but it's general well being and health. Because posture Means that your blood flows is optimum, and, you know, things are healing and cleaning the way they should be for the human body. So it's really complex, but it's a simple thing to do.

Yeah, there was an OT once who taught me what we see on the hips, we see on the lips. And so that's always kind of stuck with me because I'm like. It's like what you're talking about, that postural and that support from the core. And even just our pelvic tilt is so directly connected to where our tongue is resting. And I do this thing when I do this free training three times per year, and I do this thing where I have the therapists doing the training. I'm like, take a tiny sip of water or use your own saliva and. And like, you know, slouch back in your. In your seat and try and swallow that water. Right? Then I have them put themselves into, like, an anterior tilt and do the same thing. And then I have them go into, like, a, you know, more neutral position and do the same thing. And everyone's like, oh, my gosh, when you're sitting up straight, it's so much easier to swallow than when you're in a posterior or an anti, you know, anterior pelvic tilt. And I'm like, yeah, and look at all these kids that we're working with and how they're sitting. And so, you know, that's definitely the most more ptot job of, like, supporting their posture, posture until they can do it themselves. But so much of it ties to what's going on in the oral cavity in the mouth and the lips and the tongue. And so I love that you're making that connection here, because I don't often hear, you know, dental professionals talk about that. And I think it's so important to recognize, especially when, you know, you also touched on the swallow pattern. And, you know, it's not just, where is our tongue at rest? Where's our tongue when we're talking? Where is our tongue when we're chewing? Where is our tongue when we're prepping that bolus to swallow? Where's the tongue when we actually do the swallow? It's all so important and so interconnected. So I love that you highlighted that.

So true. One. The, like. One thing that I do want to mention to listeners is that our body is so adaptable, and it's not necessarily. It's not necessarily a good thing in a lot of the times, because you could swallow upside down if you. You could be doing a handstand and you could actually swallow. And what will happen is that the body will have an amazing peristalsis kind of motion where the, the liquid will go against gravity and end up in your stomach. And I'm not saying do that by any means, but your body's capable of doing that. Right? But that doesn't mean that's the correct thing to do. Just because we're capable of doing it doesn't mean it's the correct thing to do. Just because we're, we can swallow slouching, that doesn't mean that's good for us either. And so like you mentioned once, that once your posture is in the right position, well, all those tubes on the inside of us, they start straightening out and it makes things easier. So going against what we should be doing, I believe habitually, can be detrimental for our health. And there are things out there that we may not understand. Well, not from my, from my point of view anyway, but things like fascia, how that you start developing adhesions in the wrong. Because what happens when you start swallowing incorrectly and your posture is in the wrong place? Then the body starts compensating for being in that. You know, it needs to hold itself up and you start developing fascial adhesions, and that can cause you problems later on. And do you know what I mean? Like, the blood flow is not in the right place, and who knows what toxins start to build up in those areas because the capillaries aren't functioning. So it's a very, very dynamic system. And just fixing up something like your tongue is a massive advantage to health, which you think it's. It doesn't sound like a big, big deal, but it's a massive advantage for general health. And it's easy to do. And once you develop the habit, then that's it. You've pretty much developed the habit and you can just maintain it. But it's, it's going through that difficult part of developing the habit of elevated tongue posture all the time. Once you develop it, you're okay. And I've seen tons of patients that have started off and it was hard for them, and once they get through the therapy and, and they've done it, then they maintain it, and that's great. And they'll be talking, and then in between talking, their lips are together and the tongue's up the roof of the mouth, and that's great.

That's beautiful. It's a beautiful thing. So what about. Right, so now we've kind of talked about nasal breathing when Awake. What about when we're sleeping? Because that's a different habit, I think, for some people to develop. For some people, it's easy. For some people, not so much.

Yeah, I guess, like, it'd be good just to touch on the importance of nasal breathing really quickly before we talk about why we should do it day and night. But nasal breathing is so essential. I mean, our nose is designed for breathing, and our mouth is designed for talking and eating. And when you look at the nose and the structure, it's got these things, these turbulence on the inside that actually create kind of like a little. It's almost like a mist of air on the inside of your nose. And the reason it does that, it slows down the air coming inside. It warms it, humidifies, it purifies it. It cleanses it all out. It enriches it with nitric oxide. And when that air goes in, one of the key things it does is that it slows it down as well. So you don't have a really large amount of air coming in in one go. And the important thing about that is that when the airflow is slower, then what happens is that you need to work your diaphragm to bring the air in all the way down. And it's kind of like a big suction, and it comes in nice and slow rather than like in. In one second with. With mouth breathing. And. And when a number of things happen and. And I could talk about this for a long time, but we'll just get really quick and. And sort of give you sort of like the pearls of. What I think happens. Number one, is that you change your blood oxygen and carbon dioxide ratio. That's really important because when you got more carbon dioxide and get used to it, then that. That opens up blood vessels, especially in your lungs, and it allows more absorption of oxygen. The other thing is it allows the oxygen to be released easier from your. And that's really, really important as well. And the third thing, which I think is really important is that in addition to the nitric oxide, which. Which obviously is antibacterial and antifungal and all those kind of things, but what happens is that when it goes into those deeper lungs, you're actually activating the parasympathetic nerves in the deeper part of your lungs. And that's a really important thing to do, because people who are breathing all the time through the mouth, that they don't activate those areas of their lungs. And if you don't do that, then they're always in this Flight of flight sort of system. But the moment they go into those deeper parts of their lungs by nasal breathing, then they all of a sudden relax. And, you know, you should be into that parasympathetic nervous state. I would say, like 70 to 80% of the day you don't want to be. And most people are operating at 80 in a sympathetic nervous state. And a lot of it is related to breathing. The moment you get that breathing right, your mind calms down, you become more efficient, you're less likely to make mistakes in whatever you're doing, you're less likely to become angry, you sleep better. And all those things are really important. So nasal breathing, if you're doing that during the day, you want that to follow on during the night when you're asleep. So you don't want to do all this nasal breathing. And then all of a sudden daytime you start mouth breathing and you lose all that effort that you did during the day. And so what happens is that the nasal, nasal breathing during the night, I would say it's as important, if not more important, than the daytime because you're resting, you're recovering. So you want that kind of quality air. And a quality air depends on using your purification system. And that purification system is your nose. So if you're not using that, you're not like it's the air modulator and purifier. That's. I mean, people go spend all this money on getting air purifiers and things like that, where you've got it right there. And if you could just use that, then the quality of your air would be any kind of artificial kind of machinery. And so the idea is to be able to breathe 24 hours a day. Let's. Let's say. Let's say 22 hours, because we do a little bit of breathing through them. It's very difficult to breathe, to talk, you know, the way I'm talking. And in between, breathe through your nose. And I know a lot of the Buteyko experts, they'll be looking at me frowning, saying, look, between every, every, every word, they close their mouth and through the night. It's a hard thing to do, but it is. I would be saying, aside from that, you need to be breathing through your nose for the remaining hours. So.

Yeah, yeah, no, I completely agree. And, you know, again, you touched on so many important points. One of the ones that we talk about a lot too, is that living in fight or flight or rest and digest and, you know, the sympathetic parasympathetic nervous system and it's so interesting, too, because when I've had these conversations with other people who don't realize they live their life in, you know, fight or flight, it's just. It also, they say, well, this just feels like another thing I have to do. And they just don't have the capacity to, you know, sometimes to even approach it. So that's where obviously MYO comes in and other modalities. And I know you have a lip tape that I would love to transition to and talk about. And people have heard my, you know, stances on lip taping in the past, and I'm not, I'm not anti lip tape, but I have seen this, like, trend online where it's like tape for the rest of your life. And I know you'll talk about all this, but, you know, I would love for you to share with us, like, your lip tape pros and cons, you know, your whole take on. On the lip taping conversation.

Yeah, thank you for asking me that question. Look, with regards to lift tape, lip tape in general, there are so many types out there, and it's very difficult to. And I'm not saying that one is bad and one is good, but from my point of view, and, you know, we've spoken about my spots before and things like that, we. I try very, very hard to make sure that everything that we do make is an adjunct to assisting people to learn how to have correct tongue posture, to nasal breathe, and to nasal breathe during sleep as well. And that's. That's a. That's a primary goal. So one of the things that you see a lot out there is a complete seal of the mouth. And I think James Nestor speaks about it in his book as well, Breath, where he just uses a little bit of tape in between his lips and the corners of the lips are left open. And I think he uses it every night. Now, I'm not. And I think we spoke about this before, before that we began the podcast that I'm not a big fan of taping every night for the rest of your life, but I do believe that there's a place for training, for learning how to breathe through your nose. And if you can do it without tape, that's fine, but I believe that tape helps. And so what we've done with the lip tape at my spots, we've made a small tape that doesn't extend from corner to corner. Yeah, you've got it there. Yeah, that's it. Like that. Yeah. And one of the things about it is that if you and I Do have one here, and I want to show you something about it is if you do wear either the way you had it or. Or if you wear it horizontally, you'll find that. And I'll just show you, Hayley. So you'll see that the tape stretches. Do you see that? So the idea is that it will stretch that way so that when you put it on your lips, if you need to open your mouth and breathe through your mouth, you still can. And you'll find that you can breathe through the corners of your lips. And the reason is that you don't want to forcefully close people's mouth. And if you forcefully close people's mouth, then you. You can end up stressing a patient out, especially if they've got sleep apnea. And what can happen is that they can struggle and that. Yeah, you can. So you can still breathe through the corners like that. And if. But if you have it vertically as well. So if you did it like this and you went sort of like vertically, sorry, horizontally like that, you can feel it will stretch. Yeah, you can still get through the corners.

You can also breathe through the tape itself. It doesn't completely. Like if your lips slightly, teeny bit. It's not completely stopping air.

Yeah, it is a breathable type of tape. So the reason we do that is to make sure under stress you can still breathe. Now, if I was to tape all the way across and I've got sleep apnea and I have some apnea episodes that can be quite traumatic. Now, I haven't heard of anything serious happening, but I do believe it can still cause quite a bit of. You know, some people hold their breaths when they're asleep for a minute or more. And you imagine you're taping him and now that they're going to get up, they'll wake up physically because they're not. They're not able to breathe. So I don't believe that's a good thing. So tape becomes like an adjunct. You need to learn how to breathe through the nose during the daytime before you. Before you consider. In my opinion, anyway, before you consider taping when you're asleep, you've got to make sure that your tongue is elevated, lips are together, and the majority of the hours during the day, you're breathing through your nose. If you're unable to do that, I do not recommend lip taping at all. And that's the first thing that I think I want to get to your listeners because the daytime training needs to follow on to the sleep, not the other way around. Because if you don't, you don't have. You got no consciousness, you don't know what's going on. And that includes correct tongue posture. Because if you don't have the correct tongue posture, there's a couple of things that's going to do. If somebody has sleep disturbances, often the tongue goes down the back of the throat. Now two things can happen. If they're mouth breathing, the tongue can go down the back of the throat and cause turbulence, and that's what we call snoring. And that can then move on to like, more serious sleep disturbances. But there's also the other subtle form where they're nasal breathing, but their tongue is sitting low and, and it still drops down the back of their throat and causes disturbances in their nasal breathing as well. So the tongue elevation, in my opinion, is really important to get correct because it addresses the nasal breathing and it also makes sure that you've got the patent retropharyngeal airway. So if you get those two things right, then go ahead and tape. And when you start taping when you're asleep, if you use something like the, my, the my spot slip tape, and if you don't use that, you can get some micropore tape and just tear a little bit off that so it just fits on your lips right in the middle. Whatever way that works for you, then that is, I recommend you start doing that until it becomes habitual and then wean off it. Wean off it to the point where you can start saying, well, okay, I know that I'm nasal breathing through. Not because the tape is there in the morning. That's a really good sign. And then you can start weaning off it instead of wearing it every night. You can do it every second night and see how you feel on every second night. A lot of this comes down to feel. I mean, there's a lot of apps you can, you can do like, you can wear those, those rings that monitor your sleep and all that kind of stuff, but you just see how you feel and then you can, then you can cut back pretty much completely off it and from time to time audit yourself, see how it feels when you wear the tape when you go to bed. Has it improved your sleep or has it not? If it's pretty much the same, then you know that you're doing the right thing. So I do believe, and I agree with you, like, not all tape is, you know, is, is good. And, and taping every night for the rest of your life may not be the best thing to do because you're now dependent on it, and you haven't developed good orofacial musculature. One thing to add, and I know it's still, like, connected to the tape, but if, if your mouth opens, then one of the things that happens is that you can develop weaker lip muscles, and you need to develop the strength of those muscles. And sometimes seeing a therapist is good to assist in that. But if you're able to get your lips to close together, what, in effect, what's happening is that the strength of your lips coming together carries on throughout your sleep. And that's, that's why some people, they have no issues because their orofacial musculatures working really well. They don't have to worry about lip tape because they've got that lip seal all the time. And some people struggle to even get the lips together. And in that case, they need to see a therapist to work at, work that out, or they need to do something online to work out how to get their lips together. So it carries on 24 7. Once the lips get strong and a tongue posture is really good, then you could pretty much say, okay, let's wean off that lip tape eventually. And so I hope that makes sense.

Yeah, no, I love that. Now, is there a specific age that you recommend people start taping or avoid lip taping?

Do you know what? Like, when it comes to the my spots lip tape, we've said not to use in young children, and that's a deliberate thing because the age is, I think every case is unique. Do you know what I mean? Like, so, yeah. And like, for example, like, if you, if one, if you had a, a young child in your family, I'd be saying for you, you can tape at, like, as young as three or four years old. And why I'd say that to you is because I know that you're an expert and I know that you're a therapist, and I know that you'll be watching him for the first few hours to see how things go. And I know that you're going to be training him before they actually get to tape. So I'll be, I'll be comfortable saying, like, Hayley, you're an expert, and under your guidance, something like this tape will be, will be fine at a young age. But then if somebody doesn't have that expertise and the child hasn't gone through the training, then at a young age, that might be, not be suitable. And so I would be saying it's, it's really dependent on the individual circumstances. Typically, at My practice, I will get them using it between ages of, say, like, 7 or 8 years old, so long as they have developed habitual nasal breathing throughout the day and good tongue posture. And I won't make him use it every day to begin with. It'll be every second or third day and see how they feel. And one of the things about the tape, I've got, like, a little dotted line in green, so you could actually cut it shorter so it doesn't. I don't want to. I don't want to completely seal the lips. Do you know what I mean? So if. If that's completely sealed, then I feel like that's too much for a child as well. And I don't want them panicking because it can be quite. It can be quite distressing to complete. If, If a child knows that they can breathe through their mouth if they have to, then I think it's so much more reassuring to them psychologically. And when you go to bed, you go, oh, look, if I really need a breath through my mouth, then I can. So I know I haven't given you a straight answer to that question, but it really.

I think it's. It makes sense. It's. It's very individualized. It depends on certain factors. And I think that's a great. It's a good answer because there's just, again, this, like, trend that I see online and even in news reports where it's just like, tape across the lifespan and it's fine to do in kids. And I'm thinking, like, what are we doing? How do we know these kids can breathe? Number one, like, just going to an ENT does not necessarily mean that they're cleared to lip tape, because some ents will say, oh, your kid's fine. Did they scan them? Did they scope them? Did they check the adenoids that they. I mean, how do we know they can actually breathe through their nose? Just. My own daughter had massive tonsils at age 4, actually. Sorry, that was 24 months. She was age 2. Massive tonsils, her adenoids, when we did do a scan two years later, which who knows what they were at 24 months, but at four, four years, she had a huge blockage. And I was told by an ent, well, she's fine because her. She's sitting here with her mouth closed right now. Well, yeah, she's sitting with her mouth closed because I'm her mother and she knows she's supposed to do that. So she's in front of a medical professional trying to keep her lips together and that's not normally her posture, you know, so not to say that's every child, but I just think these, like, functional evaluations with, you know, someone like yourself, with a myofunctional therapist, dentist who's airway centric, ortho airway centric, somebody who really is looking at certain factors and can help determine if a child. Child is ready. You know, I think that's key. And then to your point, if a child can do this during the day, that also tells us they can nasal breathe. And it's, you know, probably safe to try this at night if they're ready and also if they can breathe through their mouth if they have to. And that's the biggest thing for me that started, like, to really give me pause was recommending lip taping with all these different products. And I would put them on my lips and I'm like, I'm going into fight or flight right now. And I'm a nasal breathe. Like, I can nasal breathe. So we're going to put this on a kid and just. No. So this. That's why I put, when I put this on the first time, and I've done it before today, but when I put it on the first time and I could breathe through the tape and I also felt like my lips were not sealed together. It was just more guiding my lips to where they were supposed to be, but also gave me that flexibility to do what my body needed to do. I was like, okay, I can, I can see this working, you know, and I think it could be a really good therapeutic tool in sessions with like a myotherapist. Right. Like, we could put it on a child, even in a session while we're sitting there with them. Maybe we're playing a game where they're not having to talk, but we're practicing just keeping those lifts together for 15 minutes. And we're kind of doing this back and forth thing where they're getting used to having something like this. And we can also then identify are we ready for the next step or not. So, yeah, that's my, my, my two cents.

But no, no, that's really valuable. And what you said makes a hundred percent. And one of the things I do do is exactly what you said is to try and get them to wear it for a short period of time during the day.

Yeah.

To see how they feel. Right? To see how they feel. Are they able to do this? Are they stressed when they do it? Because it, it is like, do you know me? Like, it is. It can be quite Daunting having your lips shut for you. So if they can do that. One thing that you did mention about the ENT is that, okay, the child, your child was nasal breathing at the ent. And the assumption is if they're nasal breathing during the daytime for that period of time, then they'll be doing it when they're, when they're asleep. Things happen when you lay down, when you lay down and you start resting. Some children, you know, during the nighttime, they start getting more congested for whatever reason that is. And the, and that congestion then gets exacerbated as soon as they go to bed. And so it's really important, like you said, to make sure that the child's monitored not just during the daytime, but during sleep. And sometimes it's good to actually take a video footage throughout the night, different periods of time to see what's happening when they go to sleep. And you're right, there are some children that they, they get me because they come in and they lift it together and they're breathing through the nose and I'm like, well, but you don't look like your nasal breathers. Something, something's not right. And you eventually see them breathing through the mouth, you know, periodically, and sometimes only have to open their mouth a tiny bit and that's all they need. So the mouth opens up a tiny bit. But what they're doing, they're actually breathing through their mouth and it's so subtle, you can hardly tell. So just, just having a look at them and saying, okay, they're, they're nasal breathing right now, right this second is not, in my opinion, a very good sign that that is what they're doing for the rest of the day. 24, 7. So that's a really important point as well. So. Yeah, I appreciate that.

Yeah, yeah, no, I think it's. And it can be tricky to figure out. And a lot of therapists will even say, well, the parent said X. And I'm like, I love our parents, but they're not trained in this. Usually we can't, you know, put it all on them and expect them to know 100% of the information that we need to obtain. And so we do the same thing, like you said, is we'll ask them to Send us like 3 to 5 minute video clips of their child during sleep so that we can, like, with their face, you know, in the camera and with their chest and their belly sometimes to see like what's happening. And. But usually their face is enough and, you know, we'll very quickly See what they. What's actually happening during sleep with one of those videos.

One thing that's really difficult to hide, Hayley, is the. Whether or not they're upper chest breathers or, like, belly breathers. And a lot of the times, if they're. If they're nasal breathing in front of you, they still can't hide it. Like, their chest seems to be doing this, you know, even with their nasal breathing. And it, like, because that transition takes time. If you start nasal breathing, it's not always through the diaphragm, especially if you're doing a lot of mouth breathing. So one thing that I tend to do, I always ask permission to put my hand on their belly, just have a feel and see what's going on. And you'll see, like, a little bit of, like, in the tension in the neck and things very subtly move up and down. If that's happening, then you know that, okay, it's. They're probably mouth breathing throughout the day as well. And that's something that I feel is very important to sort of, like, look at. To touch the belly, you know, And I think if we do that, we can always get a gauge of what's going on. The other thing is just ask them, ask the patient, ask the child, you know, do you find that you like to breathe through the mouth sometimes? Do you like to breathe through? And kids are, well, it depends who's sitting in the room, right? Like, so if the. If mum's been watching, like, all these YouTube videos and they're like, you've got a nasal breathe, so they're scared of mum. And. But if. If most kids are quite honest, and I'll tell you, oh, sometimes I breathe through myself, and I'll tell you straight out. And so, yeah, I guess one of the biggest takeaways is make sure that you get them breathing through their nose during the daytime. Most 95% of the daytime, if you can get that done, then at that point in time, we can stand, then look at mouth taping. But before then, I think it's a bad idea. And I also think it's a very bad idea completely sealing their lips. And that's one of the things. And I agree with you, because I read your article. I agree with you, 100. I. I don't think that you should be completely sealing, and I don't think we should be taping all the time. It should be. In the vast majority of cases, it should be something that assists them to develop the habit, and then they can wean off. And if they do that. Then I think you've succeeded in your therapy. And you know what? Like, sometimes people develop. Ha. I had this young lady, and I say young lady, years ago, she was a patient with incredible facial development. And she disappeared from clinic for a good couple of years because she got a modeling job in Sweden or someplace in Europe. And I saw her years later. And when I saw her, I noticed that she had some collapsing of a maxilla. Not much, but enough for me to notice. And I also noticed that she was starting to get a little bit dark under the eyes and. And I had to start probing it. I had to start asking her what happened. And she eventually opened up and she said to me, look, when I went there, I got into a lot of drugs. And if you, as, you know, if you get into, like, recreational drugs, it can change your breathing pattern. So she started mouth breathing when she's asleep. And that was enough for me to notice a difference in her face. And so that even at any age, you can develop, you can be a nasal breather and you can actually go into mouth breathing and you can have a mouth breathing and go back into nature breathing. And it happens all the time. And you can see, like, if you look at some of, like, you know, Hollywood actors and things like that, you can tell. You can tell that, you know, I'm pretty sure, like, I don't want to put any names out there, but I'm pretty sure Joe Rogan used to be a nasal breather when he was 24, 7. Nasal breather. And I'm pretty sure now he does mouth breathing when he's asleep. And. And he can. And. And it's not just an age thing. You can tell by the way that, like, the face sort of changes. So. But I could probably rattle off a whole bunch of names out there and do you know what I mean? And I can tell if. If there's still nasal breathing, do you know what I mean? Even if they're aging. So you can.

There's that one, like, black and white image of, like, the kid when he was 7 that a lot of the dentists will show in their presentations that by the time he was a teenager, his whole profile totally changed. And it was because the family got like, a gerbil or something at age 8. And so he went from having this, like, beautifully developed face to having basically the mouth breather profile. And I think that's always stuck in my head because it can happen at any age, like you're saying, and you'll start to see, like, I'll see people's facial profiles change. I mean, it's happened to me. And you know, you kind of go like, wait, what's going on? Like they have dark, you know, circles under their eyes. And it's not because they're not, not getting enough sleep. It's because the quality of their sleep probably is not great. Right. Why is it not great? What else is going on? So it's a really fascinating conversation.

I had this, a random guy call me up the other day. He got my number from. I don't know who. I don't really know who he is. I've never seen him. But he, he called me up in a panic and he said, look, I'm about to get a, some surgery done. And the things that is, that he's going to get done is that his reduction in his uvular turbulent reduction. He's getting his, his septum, the deviated septum fixed. He's getting his tongue reduced in size. And I'm like, why are you getting. Because I've got severe sleep apnea and I heard that you can do something. And I said, well, I can't do anything over the phone without seeing you how. But he's been on a wait list to get this operation for so long. And I feel like, you know, sleep is such an important thing to get right. And the options for treatment are not very much. Like here in Australia we've got, you know, CPAP is considered the gold standard. If you got like in the US too.

Yeah, right. Unfortunately.

And then shortly out, like followed close second is, is the mandible advancement splint brings you your jaw forward and then there's a range of products out there, things that sort of pull your tongue forward and things like that. And I feel like all these treatments are not treating the root cause of any of this. Right. And, and the problem, the problem we face as practitioners is that the root cause is a difficult thing to treat, but it's not impossible. But it's difficult and it requires therapy. It requires compliance from the patient and motivation. And if you don't have those things, it's not going to work. You and I are probably quite lucky because the patients we attract are motivated. They probably come to us and say, look, we want to get this sorted. But the vast majority of like, patients out there, like, I need a fix, I need to sleep better tomorrow, I need to. Well, it's probably taking you a good 10, 15 or 20 years to get to where you are. You don't expect to be able to get to Reverse that kind of damage in, in just one night. And so this is where the therapy comes in, where, like, correcting tongue posture, correcting, you know, swallow patterns, understanding nasal breathing, understanding lip seal, getting all those things right. But once it's good, you get massive improvements. And everybody improves now, and I know now I'm going to go on record saying this, but everybody improves to what extent varies and it depends because how young do you start treating him? That's a big factor. The other thing is obviously compliance and motivation. Another thing is like, how, how much of the craniofacial dystrophy are they suffering from? That is how underdeveloped is their face and to what extent? Because sometimes that, you know, a lot of people say, oh, my tongue is too big for my mouth. But it's not that it's. Your mouth is too small for your tongue because it's yet like. And I had this conversation with, with the fellow that called me up the other day, and I explained to him, look, is, is your hand too big or too small for you? And he's not, it's perfect for my. It's how it should be. Well, that's what your tongue is. Your tongue is never too big for you. I mean, there are rare conditions out there that can, Generally speaking, your tongue is the right size for your body. One thing that does happen is that when you nasal breathe, your tongue gets swollen because you're, because it's not in the correct number one. It's just flopping down. So there's no muscular strength in there that once you start to get the muscular strength of habitual tongue elevation, it gets a little bit smaller. Now, if anybody, like, if you just start going to the gym and you've never worked your arms before and all of a sudden start working out your arms after quite a few months, you find that it starts to get initially a little bit smaller toned. And that's because you're developing that strength before it gets bigger. The tongue is kind of like that. It's not one of those muscles like a skeletal muscle that gets bigger and bigger and bigger. When you actually get it elevated in the correct position, you start losing fat from around the tongue and it starts getting less inflamed and it starts to fit a lot better. Now, it may not fit completely and perfectly inside your mouth because of the, you know, the amount of craniofacial dystrophy, but it will fit better. And you can still train it to fit. Even in a narrow maxilla, you can still train it to get up there. And I guess that's one of the things that I'd love for your viewers to take away, even if your face is a little bit broken. And I don't want people walking around thinking they've got a broken face. That's not what I mean. But if it's not perfectly developed, because I get patients that, you know, they're like, I don't have the perfect jawline, and, you know, they look amazing, by the way. And I would say to most patients that in. In 2024 in the West, I would say 80% of people have some kind of cranial facial dystrophy to some extent. Some are a lot worse than others. But if you can f. Compared our skulls to, say, a couple of thousand years ago, we all got smaller faces to some extent. And so. But when you do see a face that's well developed, you admire it because it's rare. So don't be thinking that, you know, we've got perfect faces. We don't, but we can. We can help perfect our faces by doing the correct thing. And that is, you know, the good tongue posture, the lips heal, the nasal breathing, the good swallow. If you do that. And I sound like a broken record, but I really want. I want your.

It's so true. Yeah.

Yeah.

I mean, it's so true. Like, if I think about it, right, I had expansion as, you know, in your typical age when I was 11, 12, then I had a permanent retainer put in. Then when I had the permanent retainer taken out when I was 30, because they told me it would fall out by the time I was 17, which didn't happen. Upper and lower. I finally got 30, was like, can you take this out? It's really hard to clean behind my teeth. And every time I come in here, you guys are telling me how much build up there is. Just take the thing out. And then all of a sudden, within weeks, my teeth. Teeth start to shift, right. Because my tongue was not in the right place. So I'm like, I was the myo patient. I went into expansion as an adult. I then retracted myself accidentally with Invisalign using the last couple weeks of my trays, which apparently I shouldn't have done, but didn't know at the time and all. And then I had nasal surgery two years ago, almost two years ago, where I did have a deviated septum that was blocking my left nasal passage from breathing. So something needed to be done. So I had the turbinates reduced and I had the, you know, septoplasty and my nasal swell bodies reduced as well. Now having just done all of those structural things was not enough. I still needed body work. I still needed myofunctional therapy. I still needed to address the muscles and the fascia throughout my body. And what was really interesting to me that I've shared before is when I was in the appliance that I was in because it was a removable one, I was able to turn like the key on it and put it back in. Only when I saw the physical therapist who was trained, he called himself a, he's trained in pri, but he called himself or he said what he did was like more modern counter strain technique. But it was fascinating because I would bring the appliance and I couldn't crank it and put it back in my mouth until he actually worked on my body. And so it really started to show me what I had learned, but experienced it firsthand. This like marriage between form, function, you know, muscle and bone and the fascia and everything working together. And I think there's a lot of people who go just one direction, right. And so I think that myofunctional therapy, like you're saying, I've seen tremendous results. Even without addressing heart tissue, without addressing bone, I've seen tremendous results. I don't typically see it the other way around. Sometimes, you know, you go, you have a surgical procedure, you address the bone, whether it's a septum or whatever. In the beginning I think it tends to be like, oh wow, like now that I've healed, after the first couple weeks I can breathe. And then because we haven't addressed where the tongue is and how we're breathing, everything starts to collapse again. And within a couple of years these people are going back for follow up septoplasties, going like, oh, it failed or oh, the septoplasty, you know, like I, or like I've got empty nose syndrome or I've got all these different things going on that they've now found terminology for because again, I don't think the function was ever properly addressed. And so that's one of my biggest things is like if you're going to go through with a surgical procedure, we got to address the function or like what's the point?

Yeah, that's so interesting you say that. And I love how you saw somebody who does counter strain as well because you know, that's a really specific modality for. And there's not many people, I don't know anybody in Queensland that does it really well. The closest person that does it is in Melbourne and they're really good at it. And Melbourne is 2000km flight south. So it's a great modality. And just to touch on that is what you mentioned is really important. So every, every patient that comes to see me say, for example, they're getting like a tongue tie release. They have to get some kind of like bodywork because if they don't, then that fascia that's been tight there for so long is connected to the entire body through like a number of like anatomy trains and things like that. And so if you don't get that, if you don't get that addressed, then you're not going to get the results that you need. And fascia is, is connected to the whole body. So if you release an area, there are other areas that are still connected and you need to be able to release that. And that then connects again to the maxillary expansion. So if you're, if you're doing maxillary expansion manipulated and maxillary expansion, you need to be able to make sure that the rest of the body is moving because if it's not, you're forcing something and it's, and there's a blockage somewhere, you need to be able to work out where that is. And that's not my expertise. And that's why you have to work with others to do that. And that's really, really like a really important part.

Yeah.

And another, another point that you mentioned is about the innos and throat specialists. There's a ton of literature out there that says that, you know, maximizing your results for route of breathing, especially following things like adeno tonsillectomy, where, you know, for children at that they should be doing RMI functional therapy before and after. Now this is a massive problem because it's not, it's not addressed and it's not a hard thing to do. So if you're an ent, listening to this is, it's not a hard thing to do to connect to a therapist and say, look, go get this done before you do your operation, before and after. And I even think it's a little bit lazy not to do it because when I say lazy like an ENT is supposed to be, you know, we've got some great ents here, by the way. So I'm not saying all of them, but we've got, so that they're the top of their field when it comes to surgical intervention for airway. So maximize, maximize the results. Get them to learn to train how to breathe through their nose before and after now, if you do that, then the, the relapse to, you know, breathing that way is almost nil. Do you know what I mean? Like, you are able to get the route of breathing done properly, especially if you're doing it at a young age. So, yeah, that's, that's. I really appreciate what you're saying, and I think that there are a lot of great practitioners, so I'm not speaking about all of them like, but the ones that have a kind of say in, in breathing, I believe they should be doing that because that's so important.

Yeah, no, and I feel like there's a growing body of professionals who are getting the whole, you know, team approach thing now and who really also, like, you're saying they really are optimizing the results of their procedure by collaborating with somebody who's going to work on the functional behavior, you know, aspect of breathing and what's, what's happening with the orofacial structures. And so, you know, I think that we really all support ourselves, but also best support the patients. Right. And that, you know, that's kind of what I'm hearing you say too. So I love that. So, yeah. All that said, is there anybody else that you typically, like, refer to on your team for any of the patients that you work with?

Yes, I refer to a number of people. So I'll refer to allergy specialists if I feel like there's something that I can't sort of figure out because that's not my domain. And, you know, just to work out, just to get some allergy testing to work out what it is that they might be. That might be causing their intolerances, that might be an underlying cause. I also. Naturopaths, I refer to them as well, because I feel like a good naturopath. Sorry, a good naturopath is very valuable because they can then, you know, they can work out things like nutrition, for example, like what it is that. That that they might need in order to. To fortify their immune system, to assist them in being able to, you know, reduce the, the allergic load or the toxic load, to assist them to breathe. Sometimes I'll send them to speech therapists. There's a lot of value in speech therapy, especially when it comes to, you know, they might be. They might have like, lisping or whatever. So I feel like the tongue is connected to that very closely. So I'll send them to speech therapists as well, obviously, the osteopaths and chiropractors. I do have some craniosacral people that work with me as well and, you know, throat specialists as well. But sometimes I'll, I'll send them to specialists for, you know, those fussy eaters. There's like, you've got a really cool practitioner. Her name's Melanie Potok. I think in the States. She's. We don't have in here in Australia, I haven't, we don't have anybody as professional as her. So sometimes I actually refer straight to her and I'll get like a zoom appointment straight, you know, online. And that's really important, I think, especially for those patients that come in who are extremely fussy eaters. So there's a psychological aspect there. So if I could be teaching them how to chew, how to position their tongue and, you know, that's something I, I didn't mention to you, your listeners and viewers is the, the other thing that's really important is being able to chew correctly. And if they're not chewing correctly, then I think that that's, that's something we want to make sure they, they do properly. And if they're fussy eaters, well, they're not getting that. And so chewing correctly is a massive, a massive aspect. And so seeing somebody who can address those fussy eaters and sometimes it's psychological, it's nothing I can do. And so getting to see a therapist who understands the psychology, who can get them through because then that translates to my treatment because I want them to chew. I want them to chew. And if they've got like a block in their mind on, on eating, well, that needs to be addressed. So that gives you an idea of roughly, like the people that I do refer to and I do probably a day, three or four referrals a day. And that's, I've got like all these templates and stuff. So it really is, it really is like, you know, you can't, you can't. I don't think you can really do justice to good treatment on your own because you've got, everybody's got their own specialty. How much.

It's an onion, right? There's so many multifaceted layers, I think to a lot of the work that we're doing. And to your point, you know, so Mel, Melanie Potok really has a specialty with arfid. And so that's where you get those, like, avoidant, you know, feeders. And I have had some people in Australia take my Feed the peds class where we do focus not on arfid, but we focus on like the sensory, oral, motor aspect of, of Chewing and the sensory system and that kind of stuff. So I'll have to see who's. And I have a. I've got a directory, so I can always send you that. But I'm curious to see who's added themselves to the directory that's in Australia, because not for the ARFID cases, but for kids who are maybe still, you know, restricted food profiles, not chewing properly and that kind of stuff, it can be so beneficial to see one of those SLPs or OTS who specializes in that. And, you know, and if. I don't know, I don't know if they also would dabble in ARFIT or not. I don't personally. It's not my area of expertise like it is Mel's, but I love that you have that as a resource because I know, you know, a consult even with her for somebody who. Who is, you know, having that type of an issue. It's. It's not well recognized and it's. I don't think it's something that many are even aware of outside of just typical chewing and swallowing challenges and food expansion challenges. So. I love that you brought that up.

Yeah, yeah. And it's not just. It's not just not well recognized.

Just.

It's frowned upon by some practitioners as well. And I just think it's ridiculous that. That you've got a child. Okay. I had a child that came in who still has smoothies every day, and that's all they have. Can you imagine?

We get kids like that all the time, unfortunately. Yeah.

What do you do there? What can I do as like. I mean, you can. You can talk to them, you can encourage them. You may issue a Maya Munchie to assist in the chewing. You may do those things, but there's. There's a lot more to it, and you need some help. And. And it's not. It. You know, we shouldn't be too proud to ask for help, and we need it. And that's where referrals come in. It becomes like a team effort. And so, yeah, I do appreciate that you do that kind of stuff and you refer to those people as well, because the more we do that, I think we'll get much better outcomes with our patients. And that's what, that's what matters, right? That's what matters.

Absolutely. Well, this has been absolutely amazing. Thank you so much. Where can they find you? Where can they buy MYO spots if they're like, where do I get this tape you guys are talking about? It sounds amazing.

Yeah. Myospots.com My O S P-O-T S.com but we do have a couple of distributors in the states as well. So if you just jump onto the Myspots website and have a look, you can also get us on on Instagram and you can email me as well. So my email will be on the website as well. So I'm happy to sort of answer any questions in future.

Awesome. Well, we'll link the the website and the Instagram underneath the show notes of the episode and thank you so much for joining me. Our conversations are always so helpful and informative and and really truly I hope that you know, especially for parents that may be listening or even practitioners who are newer to this space, that they would have gotten so much information out of, you know, this conversation with you. So thank you.

Thank you so much, Hayley. Always a pleasure.

Thanks for listening to this podcast. If you found value in this episode and want to hear more of these Myotots, Airway and Feeding related episodes, be sure to leave a review on Apple Podcasts and share this episode on your social media platforms. You can access free resources and all I offer@hally balkan.com or pop over to Holly Balkan on Instagram to get all the latest updates.