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On this episode, Kim Shea was joined by Karese Laguerre, myofunctional therapist and author of Accomplished: How to Sleep Better, Eliminate Burnout, and Execute Goals. They talk about what myofunctional therapy is and how it can be used to improve your sleep, increase your quality of life, reduce anxiety, manage ADHD, and accomplish your goals.
Dentistry & Motherhood: Karese’s Myofunctional Therapy Journey
Kim: Can you tell us your background?
Karese: By trade, I am a registered dental hygienist. That's really what got me into everything that I do now. I had four children that went through very common things that affect all children. My employer at that time was a pediatric dentist who happened to be very in tune with a lot of things as far as the airway. She kind of brought me up to speed with the fact that a lot of what I was going through and experiencing with my children was all linked to how they were breathing, how they were using everything that's in their mouth, and how they were engaging in their facial muscles.
Kim: It really makes sense even before we get into it, how you breathe would, of course, affect how you do everything. It's something you just take for granted that if you're breathing, you're doing it right. Everything should be fine, but you ran into some really interesting situations with your own kids, right?
Karese: Oh yes. I think that's a common thing. Honestly, a lot of us as parents, when somebody asks, “How’s everything?” and “How are the kids?” we often say, “Everything's good.” Or you tell them whatever good thing that's coming up, like, “Johnny has a basketball game tomorrow.” But, in reality, I was going through a lot of things that a lot of people go through, but do not admit.
My son, who’s my oldest child, actually had a lot of issues with impulse control, behavioral issues, and ADHD. Then the next oldest one, my daughter, struggled with sleep issues for 10 years. She had every sleep issue under the sun—night terrors, sleepwalking, snoring, and grinding. Bedwetting. You name it. My two youngest had issues with breastfeeding and then they had frequent sore throats and ear infections. It felt like we were always on a constant thread of antibiotics. Amoxicillin was like running over my fridge.
Surprisingly, as varied as those things are and how my children manifested all of them, you don't really talk about that stuff ever. When you do bring it up, maybe to the pediatrician, it's like, “Oh, they’ll grow out of it.” But it's not something that you really want your kids to be going through for these extended periods of time.
I was very happy and blessed that I came across this. Now, it's my passion to share this with others so that they can also overcome a lot of these things and help their children thrive.
Kim: So, you were working for this dentist and you felt like your children needed to go see her.
Karese: Yes, they absolutely did, because we'd seen the pediatrician and we got nowhere. Once we finally made that appointment with the dentist and got to see her, she was able to look inside and see what was going on. I mean, the breadth of what she could see just in their face alone to determine what was going on with them without me actually verbalizing much of it–that was amazing.
Kim: In your book, you had some illustrations showing the difference in a face when the person is breathing better than one who's not. So were you able to see any of that in your kids, or is that something you were able to catch early on? Were there outward things, or was it just like what you're talking about with the constant stream of antibiotics and the sleep issues and the behavioral issues?
Karese: Well, it's a combination of the two, but yes, you do get a lot of physical changes too. What you can see in the face of someone who is not breathing correctly and who's not using their oral-facial musculature correctly, is more long growth or more narrow growth. So, they'll have narrow dental arches. More likely, those arches will be crowded. You'll see more of a gummy smile. When you see a seven-year-old with chubby cheeks and you just want to pinch them, those cheeks are actually flaccid. These cheeks are not working. These are signs that we need to have intervention at some point.
Our teeth are so prone to any sort of pressure. I know a lot of people can relate to the fact that you feel like your teeth shift or move over time. It's because they're not flush on the bone. They don't just sit in the bone. They do have space.
Once you relieve pressures and you start working out those cheeks, on the tongue, and on what's going on, now you're seeing a change in the way the teeth are able to sit within the mouth. You get a lot of amazing and brilliant changes in the face and overall health.
Kim: If you were to institute these changes with myofunctional therapy, what would they be like? You’re saying things can change?
Karese: Yes, things can change. It's easier to change the younger you are—as with everything in life. A lot of those growth plates do close off, around the age of 12 or 13, but you can get changes in adults too. It's just more of a collaborative effort. It would be the myofunctional therapist, along with a dental provider doing a dental appliance or an orthodontist doing some braces. Then, you get these nice changes in the face and in the teeth.
Accomplishment vs. Achievement
Kim: In your book, the title of it is Accomplished and you talk about what the difference between accomplishment and achievement is. Can you touch on that so we can see where we're going with all this?
Karese: Yes, absolutely. I love the title. Accomplished, it in and of itself, is an accomplishment, right? When you think about the task of writing a book, reaching that accomplishment, you have little micro-achievements you have to make along the way. You've got to finish your chapters, do your research, and develop your outline. You have to finish reviewing and editing. There are so many little achievements you have to make before you can get to exactly what you're trying to accomplish. Your accomplishment is your overall collection of those achievements.
Kim: I'm glad you differentiated these two because I think most people, including me probably, tend to think of them as being interchangeable, but they're really different. Why did you come up with that specifically for the title for this book?
Karese: I've worked with hundreds of clients in various places—in America and internationally. I find that one of the biggest things that teenagers and adults find that they are able to achieve is more focus—more presence—in their day. I think that is really through everything that we accomplish. When you get their sleep to a better position, then we're able to get them to be their most productive self.
I think Accomplished is the culmination of a lot of my personal findings in my work and with my clients. What exactly it is that we're able to achieve is at the end of it. After we've really made these little steps, we’re accomplished people. We’re able to get things done and reach those goals.
Kim: We keep talking about myofunctional therapy. Can you define that for us?
Karese: Absolutely. The easiest way that I can explain myofunctional therapy is that it is like personal training, but it only works for the muscles below the eyes and above the shoulders.
What we do essentially is we're like personal trainers helping you to work, to strengthen, and to coordinate all of those oral, facial, and some of the oral pharyngeal muscles. That way, we can facilitate better breathing, chewing, swallowing, and sleeping.
Kim: Is this something one gets certified in?
Karese: Yes, it is something that one can be certified in and you definitely need advanced training. It is not something for everybody to do, though. Speech language pathologists, registered dental, hygienists, and dentists (because we have that background in oral health, oral embryology, and oral development and function) have that training from university and so forth. That's why we are eligible to take that advanced training and certifications.
Kim: Is this standard for most dentist's office or was your dentist unusual in focusing on this?
Karese: I don't know how I feel about the word “unusual,” but she was definitely unique. I would say about 1% of the dentists that are practicing now do actively practice and look for airway. However, the American Dental Association has now jumped on board and as of late 2019, I believe, they did change their recommendation to say that they want all dentists to start screening for this oral-facial function and so forth. We're definitely coming along.
Kim: That's great to hear. I remember going to get braces when I was a teenager and either the orthodontist or some specialists saying I didn't swallow right and that my tongue was hitting the back of my teeth instead of being up on the roof of my mouth. I remember thinking, “Well, this is stupid. That's the way my tongue works.” I wished I had known about this. Like when the tongue isn't quite doing what it's supposed to be doing, I guess sleep apnea comes in here. I mean there are a lot of factors that would play into someone needing to have myofunctional therapy, right?
Karese: Absolutely. There are a lot of factors, for sure. The tongue is a major, major component. When it comes to the tongue, people have often had this misconception that it is the strongest muscle in the body, but the tongue is actually not one muscle. It's actually innervated by eight muscles that work in pairs. There are 16 muscles that work in this tongue. So, when you think about the pressure of these 16 muscles as they're pushing against your teeth or pushing through your teeth to help you swallow, that's actually creating a negative pressure in your mouth that is going to impact the way those teeth are shifting.
When you were in the dentist’s office and he was telling you about this, I think his main approach would have been to put in an appliance that would prevent your tongue from coming forward. That appliance wouldn't have trained your tongue to do the right thing. It just would have stopped it from doing the wrong thing for now. What we do as myofunctional therapists is we help to facilitate a more natural response where we're trying to rehabilitate the tongue into a proper position when you're swallowing, when you're speaking, and when you're at rest. That way, you're able to get those negative pressures and turn them into positive pressures.
Kim: Do you mind explaining what training would look like?
Karese: When we're thinking about all those muscles, they help the tongue do lots of various things, such as elevate, protrude, lateralize, or retract. A lot of various muscles go into a lot of these actions.
What I'm trying to do is focus on where exactly my patients need help. For example, let's say that they have a problem with the tongue elevating and connecting with the roof of the mouth. Then, what we're going to do is we're going to try to engage as much as we can with the roof of the mouth.
We would take something such as peanut butter and rub it on the roof of the mouth and we're going to have that tongue tip go up and try to get the roof of the mouth with the peanut butter. We call that a “peanut butter rub” to try to get that engagement.
We want to make sure that the tongue is isolated when it's doing that, so we'd probably use a mouth cropper or something else to disengage the jaw and the lips and the cheeks. Now the tongue has to go at it independently, which is going to activate a lot of those muscles, as well.
Kim: So, you're actually working with muscles to try to get the tongue to be a certain way by building up muscles that are relaxed or not in good shape. Is that right?
Karese: Exactly. That's why I compare it to personal training. It's very focused.
Breathing For Your Best Self
Kim: You talk about Maslow's Hierarchy of Needs. Would you describe that as the pyramid of what people need in order to succeed and accomplish their goals and purpose in life?
Karese: Yes. At the very base of that, we have all of our physiological needs because, honestly, we can only go weeks without food and days without water, but you're not going to get beyond a few minutes without air. We have to be able to breathe. We have to be able to sustain ourselves. Before you can get to self-fulfillment, which is the top of that pyramid, you're going to have to deal with any sort of physical barriers that might hinder your productivity.
Kim: Self-care is a topic that's really big right now, especially with what we've all been going through. It seems like this is one of the most basic self-care things you could be doing is figuring out if you're getting enough oxygen and if you're breathing properly. It sounds like you could change your life.
Karese: Absolutely. It causes changes in almost every aspect. If you think about what you could really accomplish, if you presented your best self every day, this is going to be the start of an absolutely great thing.
Kim: In your book, you talk about a one-minute breath test to see if you need therapy. Do you want to talk about that?
Karese: We can actually do it right now because it's super simple and easy to do. You just have to sit up nice and straight in a chair. You'll have your feet flat on the floor. I want you to take a deep breath in through your nose and then breathe back out through your nose. As you bring it back in again, through your nose, I want you to tell me where your tongue is.
Kim: It's floating in the middle. It's kind of just floating in the air.
Karese: That's all right. That is improper, but it's okay. So, if you were to now take your tongue and lift it up to connect it with the roof of your mouth and take that deep breath in through your nose, you might feel like you're getting more air in.
Why might that be? Our tongue is a very long thing. It goes all the way down to C4. If you know anything about your anatomy, it's far down there. If you get your tongue up and out of that airway and it's flush with the palette (that's the roof of the mouth), you're able to move that tongue out of your airway and get more air.
Kim: I can tell the difference. That's fascinating. You could tell right away I need therapy. What percentage of the population would you say could benefit from having some therapy like this?
Karese: I would say on average, maybe 10-15%. I don't want to overestimate, but a good chunk of the population could definitely use it.
Kim: Do you work virtually? What would I do next?
Karese: I do work virtually. The first step is for you to come on my website. Because there's plenty of information on the website and it connects to my blog site, you’re either able to learn more, or you can just skip all that and just schedule a free consultation. The free consultation is essentially a 20-30 minute meeting with me where we go over everything that you've been experiencing. We might go back into some of your medical history and try to figure out what connections may be in existence there.
You would probably tell me about that time that you went to the orthodontist and they told you about your tongue doing the wrong thing. At that point, we determine whether or not myofunctional therapy would really be a help to you. If it is a help to you, then we schedule an evaluation, we get you on my schedule, and we work on getting to the root of your problems. If it's not a myofunctional problem, it might be more of an ENT problem or a pulmonology problem. I have an expansive network of people that I can refer you to.
Tongue-Ties & Myofunctional Therapy
Kim: Can you talk about tongue-ties? I mentioned to you before the podcast that my stepdaughter had brought it up to me with her son. I didn't know anything about it and then you touch on it in your book. What can you tell us about that?
Karese: So, we've talked about how the tongue is really, really important. There are times where a child is born with a tongue tie and can't nurse, or can't use their tongue as effectively in speech, in breathing, and in eating. A tongue-tie is where the tongue is going to be attached through a small string of connective tissue that is either short or just restricting the tongue’s full range of motion. The tongue might not be able to elevate all the way. It might not be able to protrude out all the way, or lateralize. You won't be able to get good use of that tongue.
This affects a lot of babies. We're hearing about it now as this big trend with babies, because lactation and being able to breastfeed is a big deal nowadays. With the babies, they really need those tongues. So, between the tongues and the cheeks, they're going to be getting a lot of compression on the nipple in order to get the milk out and they can't do that if they cannot elevate the tongue or cup it around the nipple.
When we don't resolve it, then we wind up trying to do the one-minute breath test and the tongue can't elevate to the roof of the mouth. Then, we're having issues with moving the tongue out of the airway, which causes negative pressure within the mouth. That leads to issues with how the teeth develop. We get those picky eaters. We get the gaggers. You're going to have a lot of issues as far as your oral-facial function.
Kim: What needs to be done about this?
Karese: It is a simple surgery, but still surgery, nonetheless. It typically does involve some level of myofunctional therapy. With babies, it's typically afterward to just help with the wound management because, after the surgery, you have to do stretching to keep those tissues and those fibers from reconnecting. The therapy is there to help with pre-habs, as well as the healing and the function post-release.
The Link Between Poor Sleep & ADHD
Kim: In your book, you talk about personal and physical barriers. If you don't have your breathing in order, that would be a physical barrier to achieve some of your goals.
Karese: Exactly. I think people don't really think about these physical barriers very often. I think when people think about sleep and productivity and so forth, you get a lot of superficial goals. Like, “stop using your phone an hour before bed” or “don't eat before bed.” These things aren't going to help you with anything that might be physically impeding you from being able to get good sleep.
If you physically aren't capable of achieving any sort of good sleep, good breathing, and good habits, then you're going to be stuck in a bad way for a while.
Kim: Sleep is important. You talk about sleep apnea in your book and you talk about ADHD. Is there a correlation between the two?
Karese: A huge correlation. I am so happy you asked about that. There's actually a 70% overlap between the manifestations of ADHD and the manifestations of poor sleep, especially in children. That 70% overlap is huge, because when you think about what ADHD actually is, it's not something that you could take a blood test for. It's not something that you can officially be diagnosed with. It's something that's based upon the symptoms that you exhibit. There’s a broad spectrum of providers who would say, “Yes, you do have ADHD based upon the symptoms that you're showing me.” But when many of those symptoms overlap with something that you can get a definitive test for, like a sleep study, then that's when we have to look at a possible overlap that many people don't even consider.
When kids get poor sleep, it's not like when adults get poor sleep. If you or I got a bad night of sleep, we'd probably be tired the next day. If a kid gets a bad night of sleep, the kid’s wired the next day. They're up and their body can't slow down. It's still going, going, going. I think we don't process it the same way. If we've ever seen a child, just kind of running around and talking, talking, talking, you think, “Oh man. They're going to sleep really well. They need a nap.”
Something that we have to start considering is that ADHD could very possibly be a misdiagnosis because, in and of itself, it's only based on symptoms.
Kim: That's so interesting. And you had a child with ADHD, right?
Karese: Yes. My only son.
Kim: So, did this help, once you had the therapy?
Karese: This helped significantly. I write about it in my book, but we struggled for such a long time because I ignored it, and then it got to the point where we went to get the diagnosis. We saw the neurologist, but I didn’t want to medicate him. And then you get to the point where you're like, “Okay, fine. We'll medicate him, so he doesn't fail out of fifth grade.”
But none of that really was helping 100%. It didn't get to the root of the issues. We were just managing things. Once that wonderful pediatric dentist came into my world, and I really got on this train with the myofunctional therapy, and we got him engaging in his breathing and myofunctional therapy exercises—it was like day and night. It was like meeting him for the first time, because he’s a totally different person. He’s somebody who is well rested and able to engage and have an actual conversation with you. It was absolutely amazing to be able to engage with him.
Kim: That's really neat. It's actually got me thinking. I have a son who's got ADHD, and I ignored it too when he was younger because I didn't want to medicate him. I just figured, “Well, it’s elementary school. It's not a big deal.” When he hit junior high, he said, “I am not able to compete in class the way the other kids are. I know I need some help.” So, we did get him on something that he can take from time to time whenever he needs it. He's almost 20 now, but he sleeps a lot. He can sleep for hours and hours and hours. I'm wondering if somebody like your child is sleeping all the time, is it possible that they're not getting a good enough night's sleep? Is there any correlation there?
Karese: It is quite probable that they might be trying to play catch up and trying to get back some of that sleep that they've been missing out on. The body does need it, so if you're not going through your sleep cycles appropriately, then you might be extending your period of sleep in an attempt to catch up.
Sleep: Quality Over Quantity
Kim: What you do see with people who have to use a C-PAP machine to help them breathe at night? Is that something that you do or are you able to work around that?
Karese: It's not a 100% guarantee, but I have had clients who have gotten off of their C-PAP entirely and who have had clean sleep studies after doing the myofunctional therapy program. What was diagnosed as mild or moderate obstructive sleep apnea then turns into no signs of sleep apnea. There are those wonderful cases where we could get off of it. Then, there are the cases where we just lessen the need for it. So, instead of having moderate sleep apnea, by the time you're done, it's a mild case, and then you just need to use your C-PAP as a precautionary thing.
Kim: My dentist has offered a couple of times to conduct a sleep apnea study. I'm wondering if people can do that too. Is that something somebody should try if your dentist offers it to you?
Karese: Absolutely, especially because many of them offer it at a drastically cheaper rate than what it would cost if you went to a sleep physician. A sleep study is thousands of dollars. I mean, for one of my kids, it was like $28,000 for that sleep study. So, if the dentist is going to offer you something to help you screen, I guarantee you it's a better deal than going to the sleep center.
Kim: You talk about hours of sleep that people need. I find this very interesting because you talk about the quality of sleep. As a person who has kind of trained herself to get about five hours of sleep a night and does well on it, you hear other people who are like “You're going to die if you don't have eight hours of sleep.” You talk about that in your book. Can you explain that?
Karese: The quality of your sleep will always trump quantity. You had your example of your child that is sleeping for a longer duration, but probably isn't functioning so well. Sleeping for a long period of time does not mean that you're getting good quality sleep.
What you want to get out of your sleep is restoration. If you're not waking up naturally, around the same time generally, and feeling like your best self, then you're not getting good sleep.
If you hit snooze on your alarm clock all the time, because you don't feel like you've gotten enough sleep and you just need more, it’s definitely a problem. Just because you've been in the bed for eight hours, it doesn't mean that you've gotten good quality sleep. When you're waking up and you’re feeling the physical manifestations of good sleep, that's good sleep.
If five hours are working for you so you're waking up, you're your best self, and you're able to be productive and accomplished every single day, then that's the right amount of time for you. It's a very common misconception that we all need 7-8 hours. It varies for every individual.
CARE: A Four-Step Plan For Better Sleep
Kim: Can you talk about CARE? You have that acronym in your book.
Karese: Yes. My CARE process and plan is a really good way to help you develop your best sleep cycles and manage everything.
“C” is for “consistency.” You want to make sure that you are consistent every night with the time that you're going to put yourself down and get some rest, but also that you have consistent wind down habits before you get rest.
“A” is for “airway management.” We have to breathe. That's our most important function. If we're not oxygenating properly, our brain is not going to be able to restore. The only time it restores is when we're sleeping and only if we reach REM sleep. So, we've got to get our airway management right. My simplest and easiest trick is to start a nasal hygiene routine.
If you are having difficulties beyond that, I would say you want to see a myofunctional therapist or you want to see an ENT, or you want to get something started to really manage your airway outside of that. But, a nasal hygiene routine is great. You want to get some saline rinse or a good nasal decongestant aromatherapy, and make sure that you are actually using it. Cleanse out the nose, breathe in the decongestant, and be able to really feel it. You should feel it because the ear, nose, and throat are all one nice track (the upper respiratory tract), so you should feel that decongestant in your upper airway.
Then “R” is “relax.” You finished your routine. Now, you want to relax and wind down. You got to wind your body down because the first sleep stage is when your body starts to shut itself down. You want to get yourself prepped for that.
This is a great time to pamper yourself and show a little self-love. If you have a little massager or massaging chair, you may want to sit in that for a little bit, just to wind yourself down and then gently take yourself into the bed. You've got to relax to get yourself into that sleep cycle.
Our final letter is “E” for “efficiency.” We want to make the most of waking up in the morning and using that energy to get ourselves started. Get up out of the bed, get yourself moving, and expose yourself to some sunlight. Preferably, if you're waking up really early, you might catch the sunrise. It's got a beautiful hue of red light that emits infrared light therapy. If you're able to expose yourself to red light in the morning, you'll be a better person for it every single day. Your skin will thank you.
Start your day off really, really well. Imagine what your goals are for the day, write them down, have an accountability partner, let that accountability partner know what exactly those goals are, and keep yourself accountable.
We want to be “consistent” with our bedtime routine; do “airway management”; “relax” our way into our sleep cycles; and be “efficient” with the first breath we take in the morning.
Karese’s Most Memorable Success Story
Kim: What are some of your success stories that you could share with us?
Karese: I have one that I will never forget. I still keep in contact with her. This wonderful woman was in such a bad place when I met her. She had a lot of personal issues. She had just lost a job and lost a spouse, and she was just struggling with life and with sleep. This was almost her last resort. She just needed to get herself together in some way. Through our working together, developing her own CARE plan, and getting her oral-facial function to a much better place so she could have restorative sleep, we were able to get her off her C-PAP and relieve a lot of that anxiety and some of the depression.
There is such a connection between anxiety, depression, and the way you breathe. A lot of psychologists will prescribe breathing exercises for anxiety or depression. We were able to help her a lot with that. I don't want people to think that I'm a psychologist or anything. I didn't work with her in that way, but through breathing, she was able to relieve a lot of that anxiety and some of the depression. She found another job, which was a much better position. She was more herself and much more alive. She was able to pull herself up and reach a really good point of self-realization, which would be that top of Maslow's hierarchy there. We really had to address a lot of her physiological needs before we could even get to some of the other stuff.
Check out Karese Laguerre’s website and schedule an appointment here.
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About Us: Co-hosts Lisa Thorp, John Biethan, Lisa Victoria, and Kim Shea discover and share new alternative health tools and resources from alternative healthcare practitioners and experts. Want to know more about Alternative Health Tools? Visit our website.
Did you like what you heard? This show is produced by Imagine Podcasting DBA of Heard Not Seen Media, Inc. For more, visit Imagine Podcasting.