Myofunctional Therapy for Snoring & Sleep Health

ByRohan Smith
Myofunctional Therapy and Sleep Health: A Functional Perspective on Face Yoga for Snoring

Author: Rohan Smith | Functional Medicine Practitioner | Adelaide, SA

Quick Answer

Myofunctional therapy, a set of targeted oropharyngeal exercises sometimes called “face yoga,” may reduce snoring and decrease obstructive sleep apnoea (OSA) severity by approximately 50% according to a meta-analysis by Camacho et al. published in Sleep (2015). These exercises strengthen the genioglossus and other upper-airway dilator muscles, helping to maintain airway patency during sleep. A functional medicine approach may also consider nutrient status, magnesium levels, and chronic inflammation alongside the exercises. Lower serum vitamin D, for example, has been linked with more severe OSA (1,2,3,11).

At a Glance

  • Myofunctional therapy targets the genioglossus, palatoglossus, and pharyngeal dilator muscles to reduce upper-airway collapse during sleep (1,2).
  • A 2015 meta-analysis by Camacho et al. found myofunctional therapy may reduce the Apnoea-Hypopnoea Index (AHI) by approximately 50% in adults with OSA (2).
  • Guimaraes et al. (2009) demonstrated that oropharyngeal exercises performed for approximately 30 minutes daily over 3 months were associated with a significant reduction in snoring frequency (1).
  • Low vitamin D has been linked with more severe OSA, and suboptimal magnesium status may be common (3,10). Both can be worth checking as part of a wider assessment.
  • Systemic inflammatory markers run higher in people with OSA than in controls, although whether inflammation or gut dysbiosis drives upper-airway oedema is not well established (14).
  • Myofunctional therapy is considered adjunctive and should not replace CPAP or other prescribed treatments for moderate-to-severe OSA without specialist oversight (2,15).

In the clinical pursuit of restorative sleep, attention is often placed on the brain or lungs. However, the strength and coordination of the oropharyngeal muscles, including the genioglossus, palatoglossus, and tensor veli palatini, also play a critical role. “Face yoga” — clinically referred to as myofunctional therapy or oropharyngeal exercise therapy — is a series of targeted exercises designed to improve tone and neuromuscular control of the tongue, mouth, and neck. For individuals experiencing snoring or mild obstructive sleep apnoea (OSA), improving upper airway stability may be a meaningful step toward better sleep quality and systemic recovery.

Myofunctional Therapy as Airway Support

A 2009 randomised controlled trial by Guimaraes et al. published in the American Journal of Respiratory and Critical Care Medicine demonstrated that oropharyngeal exercises may significantly reduce snoring frequency and intensity in adults with moderate OSA (1). Snoring commonly occurs when airflow becomes partially obstructed, leading to vibration of the soft tissues in the pharynx and soft palate. Reduced tone of the tongue and pharyngeal muscles (hypotonia) can allow these structures to relax excessively during sleep, narrowing the airway (4,6).

Myofunctional therapy focuses on retraining neuromuscular patterns of the tongue, soft palate, and surrounding structures. Rather than serving an aesthetic purpose, these exercises aim to improve muscle tone and endurance, which may help maintain a more stable and open airway throughout the night (5,8). A 2018 review by de Felicio et al. in Nature and Science of Sleep reported benefits for OSA severity and snoring in adults, while noting that randomised, high-quality studies are still rare (15).

Mechanisms of Improvement: Strengthening the Respiratory Gateway

Three primary neuromuscular mechanisms have been identified in the literature supporting how myofunctional therapy may reduce snoring and mild OSA severity.

Mechanism Target Structures Clinical Relevance Supporting Evidence
Tongue posture retraining Genioglossus, intrinsic tongue muscles Aims to encourage resting tongue posture against the hard palate and limit backward movement into the oropharynx. Randomised trials of exercises have reported less snoring, and an uncontrolled series of a tongue-repositioning manoeuvre with a nightly oral shield reported benefit in primary snorers with a normal BMI. These results are for snoring, not tongue position itself Ieto et al. (2015), Engelke et al. (2010) (1,9,13)
Reduced oropharyngeal collapse Palatoglossus, palatopharyngeus, superior pharyngeal constrictor Aims to strengthen muscles that resist airway narrowing during inhalation. A small pilot trial in severe OSA linked stronger tongue and lip muscles with a lower AHI Camacho et al. (2015), O’Connor-Reina et al. (2020) (2,12)
Nasal breathing promotion Orbicularis oris, buccinator (lip seal muscles) Aims to promote lip seal and nasal breathing. Small trials have reported less mouth breathing and lip hypotonia in children, and stronger tongue and soft palate muscles in men with OSA Villa et al. (2017), Diaferia et al. (2017) (7,8)

The Functional Medicine Perspective: Why Muscle Tone May Falter

At Elemental Health and Nutrition, assessment extends beyond exercises alone, reflecting the functional medicine principle that structural symptoms often have underlying biochemical contributors. When response to myofunctional therapy is limited, additional physiological contributors may be explored.

Contributing Factor Relevant Biomarkers / Tests Mechanism of Influence
Nutrient status Serum 25-hydroxyvitamin D (25(OH)D), red blood cell magnesium, HTMA (Hair Tissue Mineral Analysis) Vitamin D and magnesium are involved in neuromuscular signalling and muscle contraction. Lower vitamin D has been linked with more severe OSA, and suboptimal magnesium status may be common (3,10). Rosanoff et al. (2012) reported that subclinical magnesium deficiency may be widespread and underrecognised.
Inflammation and gut health High-sensitivity C-reactive protein (hs-CRP), faecal calprotectin, intestinal permeability markers Chronic low-grade inflammation, sometimes associated with gut microbiome imbalances and intestinal dysbiosis, is one possible contributor to upper-airway tissue oedema, although this link is not well established. Nadeem et al. (2013) found that systemic inflammatory markers were higher in people with OSA than in controls (14).
Metabolic efficiency Organic acids (succinic, fumaric, malic acid), CoQ10 status, Organic Acids Test (OAT) Adequate mitochondrial energy production via the Krebs cycle and oxidative phosphorylation supports muscle endurance, including muscles that help maintain airway patency during sleep.

When to Consider a Clinical Assessment

Facial and airway exercises are most effective when integrated into a broader clinical picture that addresses both structural and biochemical contributors to sleep-disordered breathing. A comprehensive assessment may be appropriate if you experience:

  • Excessive daytime sleepiness or symptoms consistent with chronic fatigue, which may indicate nocturnal hypoxia.
  • Waking gasping for air or with a persistently dry mouth, which may suggest oral breathing and reduced airway tone.
  • Persistent snoring that significantly affects a partner’s sleep quality and daily functioning.
  • Unexplained morning headaches, which may be associated with impaired nocturnal oxygenation and elevated carbon dioxide levels.

Next Steps

  1. Assess airway function: If snoring or unrefreshing sleep is affecting your quality of life, consider a personalised assessment to clarify contributing factors beyond airway exercises alone. This may include screening for OSA severity using the Epworth Sleepiness Scale (ESS) and the STOP-BANG questionnaire.
  2. Integrate nutritional and metabolic support: Airway-focused strategies combined with targeted nutritional and metabolic support, including assessment of vitamin D, magnesium, and mitochondrial function markers, can address sleep-related concerns within a functional medicine framework.

Frequently Asked Questions

How long before I notice a reduction in snoring?
Trials such as the Guimaraes et al. (2009) study in the American Journal of Respiratory and Critical Care Medicine, report measurable improvements after approximately three months of consistent daily practice, although the daily time varies between programs. A small trial in children with residual OSA after tonsil and adenoid surgery measured AHI rather than snoring and reported improvement after two months (1,5).

Is face yoga a replacement for CPAP?
No. In cases of moderate to severe obstructive sleep apnoea, myofunctional therapy is generally considered an adjunctive approach and should not replace prescribed medical treatments such as continuous positive airway pressure (CPAP) without specialist oversight (2,15).

Does it help with double chins or only breathing?
While the therapeutic focus is airway stability and breathing function, improved tone of the platysma and submental muscles may occur as a secondary, non-therapeutic effect. The primary clinical goal remains reducing the Apnoea-Hypopnoea Index (AHI) and snoring frequency (11).

Key Insights

  • Reduced upper-airway muscle activity during sleep is a recognised contributor to airway collapse in OSA and may also play a part in snoring (4,6)
  • Myofunctional therapy is an evidence-supported approach that may improve airway stability in snoring and mild OSA, as confirmed by the Camacho et al. (2015) meta-analysis (1,2)
  • Physiological factors such as mineral balance (vitamin D, magnesium), systemic inflammation (hs-CRP), and metabolic efficiency (Krebs cycle intermediates) may be worth assessing alongside exercises, although direct evidence in airway muscles is limited (3,10)
  • An integrated functional medicine approach considers both airway exercises and underlying contributors to tissue function, including gut health and mitochondrial capacity

Citable Takeaways

  1. Camacho et al. (2015) found that myofunctional therapy may reduce the Apnoea-Hypopnoea Index (AHI) by approximately 50% in adults with obstructive sleep apnoea, based on a systematic review and meta-analysis published in Sleep (2).
  2. Guimaraes et al. (2009) reported that oropharyngeal exercises performed for about 30 minutes daily over 3 months were associated with significant reductions in snoring frequency in a randomised controlled trial published in the American Journal of Respiratory and Critical Care Medicine (1).
  3. Serafin et al. (2024) pooled 24 studies in a systematic review and found that lower serum 25(OH)D tracked with more severe OSA, although the studies carried a high risk of bias, as published in Sleep and Breathing (3).
  4. Nadeem et al. (2013) pooled 51 studies in a meta-analysis and found that systemic inflammatory markers, including C-reactive protein and interleukin-6, were higher in people with OSA than in controls, published in the Journal of Clinical Sleep Medicine (14).
  5. Rosanoff et al. (2012) reported in Nutrition Reviews that subclinical magnesium deficiency may be widespread and associated with impaired neuromuscular function, with potential relevance to airway muscle tone (10).
  6. Ieto et al. (2015) demonstrated in a randomised trial published in Chest that oropharyngeal exercises may reduce objectively measured snoring in adults with primary snoring or mild to moderate OSA (9).

Reclaim Restorative Sleep

If snoring or unrefreshing sleep is affecting your quality of life and conventional approaches have not provided lasting relief, a deeper investigation into airway function, nutrient status, and metabolic health may help. At Elemental Health and Nutrition, we integrate airway-focused strategies with targeted nutritional and metabolic support to address sleep-related concerns within a functional medicine framework.

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References

  1. Guimaraes KC et al. Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 2009 Jan 15;179(2):962-6. https://doi.org/10.1164/rccm.200806-981OC
  2. Camacho M et al. Myofunctional therapy to treat obstructive sleep apnea: a systematic review and meta-analysis. Sleep. 2015 May 1;38(5):669-75. https://doi.org/10.5665/sleep.4652
  3. Serafin M et al. Serum 25(OH)D levels and obstructive sleep apnea syndrome severity in patients without comorbidities: a systematic review and meta-analysis. Sleep Breath. 2024;29(1):53. https://doi.org/10.1007/s11325-024-03167-1
  4. Puhan MA et al. Didgeridoo playing as alternative treatment for obstructive sleep apnoea syndrome: randomised controlled trial. BMJ. 2005;332(7536):266-270. https://doi.org/10.1136/bmj.38705.470590.55
  5. Villa MP et al. Oropharyngeal exercises to reduce symptoms of OSA after AT. Sleep Breath. 2015;19(1):281-9. https://doi.org/10.1007/s11325-014-1011-z
  6. Horner RL et al. Mechanisms of upper airway muscle control in sleep reveal therapeutic targets for obstructive sleep apnea. Am J Respir Cell Mol Biol. 2026;74(7):847-857. https://doi.org/10.1093/ajrcmb/aanag089
  7. Villa MP et al. Can myofunctional therapy increase tongue tone and reduce symptoms in children with sleep-disordered breathing?. Sleep Breath. 2017;21(4):1025-1032. https://doi.org/10.1007/s11325-017-1489-2
  8. Diaféria G et al. Myofunctional therapy improves adherence to continuous positive airway pressure treatment. Sleep Breath. 2017;21(2):387-395. https://doi.org/10.1007/s11325-016-1429-6
  9. Ieto V et al. Effects of Oropharyngeal Exercises on Snoring: A Randomized Trial. Chest. 2015;148(3):683-691. https://doi.org/10.1378/chest.14-2953
  10. Rosanoff A et al. Suboptimal magnesium status in the United States: are the health consequences underestimated? Nutr Rev. 2012 Mar;70(3):153-64. https://doi.org/10.1111/j.1753-4887.2011.00465.x
  11. Kattenstroth JC et al. Six months of dance intervention enhances postural, sensorimotor, and cognitive performance in elderly without affecting cardio-respiratory functions. Front Aging Neurosci. 2013 Feb 26;5:5. https://doi.org/10.3389/fnagi.2013.00005
  12. O’Connor-Reina C et al. Myofunctional Therapy App for Severe Apnea-Hypopnea Sleep Obstructive Syndrome: Pilot Randomized Controlled Trial. JMIR Mhealth Uhealth. 2020;8(11):e23123. https://doi.org/10.2196/23123
  13. Engelke W et al. Functional treatment of snoring based on the tongue-repositioning manoeuvre. Eur J Orthod. 2010;32(5):490-5. https://doi.org/10.1093/ejo/cjp135
  14. Nadeem R et al. Serum inflammatory markers in obstructive sleep apnea: a meta-analysis. J Clin Sleep Med. 2013;9(10):1003-12. https://doi.org/10.5664/jcsm.3070
  15. de Felício CM et al. Obstructive sleep apnea: focus on myofunctional therapy. Nat Sci Sleep. 2018;10:271-286. https://doi.org/10.2147/nss.s141132

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