BBEA Annual Conference 2018
The Nasal Capsule: Function, Assessment, and Role in Sleep Disordered Breathing
Dr Soroush Zaghi, MD – Keynote Speaker
The Breathe Institute
Los Angels, CA
Establishment of exclusive nasal breathing is now appreciated as the single most important objective in securing adequate craniofacial and airway development in children. Indeed, chronic mouth breathing in actively growing children is associated with palatal growth restriction, alterations of craniofacial development, altered head posture, and increased risk for obstructive-sleep apnea later in life. Nasal breathing in adulthood also has many advantages: nasal ventilation filters, warms, and humidifies the air; protects against exercise-induced bronchospasm; reduces snoring, improves daytime energy, and self-reported sleep quality, decreases vocal effort and laryngeal dryness; and facilitates anxiety reduction and deep meditation techniques. This presentation will provide a comprehensive overview of the nasal capsule with an emphasis on structural and functional impediments to proper nasal breathing and impact on sleep-disordered breathing.
- Reviewtheroleofthenasalcapsuleforolfactoryfunction,taste,immunity,humidificationofair,and breathing, and understand the pathologies that may arise in patients that present with loss of olfactory function (hyposmia or anosmia), diminished taste sensation, sinus disorders, nasal bleeding, and nasal obstruction.
- Learntoevaluatenasalobstructionfromastructural(nasal polyps, deviated septum, turbinate hypertrophy) and functional perspective (nasal valve collapse, low tongue posture).
- Appreciatetheimpactofrestrictedtonguemobilityonnasalobstruction, mouthbreathing, snoring, upper airway resistance syndrome, and obstructive sleep-apnea.
- Understandtherisksandpotentialbenefitsofmedical, surgical, and functional treatment approachesfor patients presenting for treatment of dysfunctional nasal breathing with an emphasis on the importance of a collaborative team-approach.
Dr. Soroush Zaghi graduated from Harvard Medical School, completed a residency in ENT (Otolaryngology- Head and Neck Surgery) at UCLA, and Sleep Surgery Fellowship at Stanford University. The focus of his sub-specialty training is on the comprehensive treatment of nasal obstruction, snoring, and obstructive sleep apnea. He is very active in clinical research relating to sleep disordered breathing with over 70+ peer-reviewed research publications in the fields of neuroscience, head and neck surgery, and sleep-disordered breathing.
Dr. Zaghi is particularly interested in studying the impact of tethered-oral tissues (such as tongue-tie) and oral myofascial dysfunction on maxillofacial development, upper airway resistance syndrome, and obstructive sleep apnea. He is an invited lecturer, author, and journal reviewer for topics relating to the diagnosis and management of sleep-disordered breathing and tongue-tie disorders.
You Can’t Connect The Dots Looking Forward
“You can’t connect the dots looking forward. You can only connect them looking backwards. So you have to trust that the dots will somehow connect in your future.”
This is quoted from Steve Jobs. In this opening address of the conference, I will talk first about the history of Buteyko. There are many stories out there about Buteyko and the Man himself. Some are outrageous; some are unbelievable; some have never been told. How many are true? What does Vladimir Buteyko, Dr Konstantin’s son have to say about that period now? Besides the milestones and setbacks in the early days in the USSR and what happened after 1990 when Buteyko came to the West, I will also look at the evolution of Buteyko as a technique. In speaking to many of the pioneers in Australia, New Zealand, North America and Europe, I will provide an overview of the range of experiences, ideas and developments that the dedicated individuals have brought to the growth and propagation of Buteyko.
- Will understand more of the history of Buteyko
- Will learn how the evolution of Buteyko Breathing Technique has evolved over the past 30 years
- Will have an opportunity to voice your thoughts on where Buteyko is going next
Chris Bauman graduated from the University of Waterloo in Ontario in 1980 and the School for International Learning in 1996 with a Masters in Teaching. After nearly dying from status asthmaticus in 1997, she went to London, England to learn Buteyko from Alexander Stalmatski in 1999. She was the first Buteyko Breathing Educator in Canada in 2000, having trained with Jennifer and Russel Stark. She was a clinician for the first Canadian medical study on Buteyko in 2004 in Calgary, Alberta with Jennifer Stark and Sally Gething. It was led by Dr Robert Cowie. She became a trainer in 2007 with Buteyko Institute of Breathing and Health. She is a founding member and past president of the Buteyko Breathing Educators Association. She worked in Japan, Australia, New Zealand and the US and has been teaching, presenting and training in Canada for the past 18 years.
She studied and meditated with Pema Chodron from 1985 – 1990 and has been a meditation instructor and retreat co-ordinator since 1991. She lives off-grid in the mountains of the Okaganan with her husband, 20 Icelandic horses, 2 dogs, many chickens, deer, bear and cougar and other, human friends.
Linking The Dots Together
Loree Christianson, RDH, Orofacial Myofunctional Therapist, RBBE, MBP
317-1529 Sixth Avenue West
Vancouver BC V6J 1R1
Loree Christianson graduated from the School of Dental Hygiene, Faculty of Dentistry at the University of Manitoba as a registered dental hygienist, initially practiced in periodontal and then general dentistry. In 2011, Loree began training in Orofacial Myofunctional Therapy, Buteyko Breathing Technique in 2013, Rubenstein Method in 2014 and Elena Dyakova's therapeutic massage, in 2016. Loree works with children and adults using these modalities. She is also assisting dental providers providing a collaborative functional approach frenectomy and frenuloplasty. Loree is particularly interested in Airway and Breathing Disorders, Tethered Oral Tissues like Tongue-tie, the Microbiome, and Diet and how these all are impacting the Growth of the Orofacial Complex.
Osteopathy and Breathing: What is the Connection?
Vanity Osteopathy, Unit 302 - 805 w Broadway
In this presentation, I will take the audience through how Osteopathic evolved – the early understanding and treatment of the diaphragm and breathing and its relationship to hypertension, kidney functionality and the lymphatics; the defacilitation of the ANS and its importance to meditation, anxiety, immune functionality and the ectoderm; and how the neuroendocrine system can reorient itself through diaphragmatic neutral-idling through an Osteopathic treatment.
The history of Osteopathy and the founding father, AT Still, and the treatment of the diaphragm to help hypertension, kidneys and lymphatics. I will show an example of how this is true in women - short waisted women - visceroptosis of kidney - diaphragm sags down and in the space that diminishes and compromises renal functionality. Treatment of the diaphragm can help with peripheral oedema, hypertension and influences blood pressure and renal output.
We will also look at the embryological development of thoracic respiration and its relationship to the in-dwelling therapeutic forces which heal and sustain health; how this relates to children and the forces of growth and development and adults when discussing the bodies capacity to heal.
I will lead you through the defacilitation of autonomic nervous system and importance of breathing and how this to relates to meditation and the body’s capacity to heal. The history of this finding and the work of Dr Hoover and his finding of bringing diaphragm into a neutral - idling (relation to meditation and origin of term). This is when breathing is functioning easily - when the diaphragm is able to work without any resistance. There is a systemic point of rest whereby the whole system will purr - like an engine that comes to rest and idle quietly, gently and effortlessly. Just like Buteyko.
- Understand what Osteopathy is and its history
- Realize the importance of the treatment of diaphragm on the kidneys, hypertension and lymphatics and how it interfaces with Buteyko breathing
- Learn about ebryological development of breathing prior to the mechanics of breathing
- See how an embryo can grow without lungs, diaphragm or ribs
- Understand defacilitation of the ANS and what happens to breathing
- Experience how we breathe with meditation
- Recognize diaphragmic idling and and its importance in Osteopathic treatment
“The Dentistry ‘Dot’”
Dan Kinkela, DDS
This talk will discuss why Buteyko Breathing needs to be incorporated into the practice of Dentistry.
Some background will first be provided into what we look for in our daily practice. Then clinical examples will be shown to illustrate these principles and how Buteyko can have a direct impact on treatment outcomes. Samples of treatment methods in growth modification will show how Buteyko principles can be interwoven into conventional therapies to greatly improve outcomes. The presentation hopes to provide enough background to encourage BBEA members to begin a conversation to work more closely with their allied dental professionals for the betterment of our patient’s health.
Dentistry is concerned with all aspects of oral health. A critical area of focus in this regard is facial growth and development. Soft tissue forces play a significant role in hard tissue development of the mid-face. ‘Oral-Posture’ is a term that summarizes the totality of all soft tissue positioning surrounding the oral cavity. Our oral posture is, in turn, largely governed by breathing and airway. Soft tissue adaptation to poor breathing will lead to inadequate airway development which will encourage further poor breathing habits and a downward cycle in oral and overall health.
There are facial characteristics that are shared by all airway-compromised persons. They will tend to look like each other regardless of their genetic background. Dark circles will be present under the eyes due to venous pooling. ‘Adenoid Facies’ is a medical term to summarize the mid-face changes seen in these patients. A flat cheekbone area, under-developed nares, cupid bow lip, incompetent lips, high narrow palate, clockwise growth pattern, tongue-thrust swallow, cross-bite, open bite, convex profile, dental crowding and many other features as a direct result of poor oral posture and breathing. Other co-morbidities seen as a consequence of improper breathing are difficulty in swallowing, chronic ear aches, recurrent throat infections, OSA, enuresis, fatigue, poor concentration in school, and tinnitus.
Dental therapies to treat these findings include a combination of hard and soft tissue modalities to both correct the structural component of airway and the soft tissue habits that will support the growth changes that are achieved. A variety of appliances may be employed to develop the dental arches, provide growth modification, encourage correct oral rest posture, and improve jaw and TM Joint function. Myo-functional therapy is used to strengthen the oral musculature in order to train correct rest oral posture and swallowing patterns. Ultimately, all of these changes are driven by the underlying breathing pattern and Buteyko breathing can play a very important role in creating stability and longevity in the growth modification achieved. This is the straight line connection to the ‘Dentistry Dot’ from Buteyko breathing to the dental office and beyond.
- Will have an overview of the challenges facing dentists today with their patients
- Will understand the interface between dentistry and Buteyko
- Will learn the ways that cutting edge dental practices work together with OMT and Buteyko
Graduated from the Univ. Of Washington School of Dentistry 1979
Passed NDEB of Canada 1979, Member, IAO, AAFO, AACP, GPo. In private solo practice in Smithers, BC since 1998.
Actively providing early interceptive orthodontic care. Staff is trained in OMT and Buteyko Breath Retraining.
Dentistry and Breathing - The Unknown Crucial Role of Dentistry in Breathing
Edmund Liem, DDS, Vancouver TMJ & Sleep Therapy Centre
Burnaby, BC V5H 4M4
The discipline of Dentistry was born out the necessity of pain control. The next role was functional repair (e.g. functional issues like chewing) followed by cosmetic enhancement. This profession has been very innovative and creative in fixing broken things. However, little thought has been given to the reason why things are breaking. In the last 30 years, the profession has slowly started to understand the connection to the whole body and its systems, and just recently awareness is growing about how dentistry can play a crucial role in total health. At the same time, we are coming to realize that some forms of dentistry can negatively affect total body health.
- Will understand the evolution of dentistry over the centuries
- Will see how present dental practices are changing and their role in breathing.
Dr. Liem graduated in January 1979 from the University of Nijmegen in the Netherlands and was in general practice until 1994 when he moved to Canada. Since then he pursued his interest in Orthodontics, TMD and Sleep Disordered Breathing. To learn and stay up to date he has spent more than 2000 hours of continuing education on the topics of Orthodontics, Craniofacial Pain and Sleep Disordered Breathing. [D.A.B.C.P. (Diplomate American Board of Craniofacial Pain); D.A.B.C.D.S.M. (Diplomate American Board of Craniofacial Dental Sleep Medicine); D.I.B.O. (Diplomate International Board of Orthodontics); D.A.A.P.M. (Diplomate American Academy of Pain Management); D.C.A.P.M. (Diplomate Canadian Academy of Pain Management); F.I.A.O. (Fellow International Association of Orthodontics); F.A.A.C.P. (Fellow American Academy of Craniofacial Pain); F.I.C.C.M.O. (Fellow International College of Cranio Mandibular Orthopedics); C.A.A.F.O. (Certified American Association for Functional Orthodontics); Master Instructor International Association of Orthodontics]
Since 2001 Dr. Liem has lectured in Canada and the USA on the topics of Digital Photography, Electro Diagnostics, Orthodontics, TMD and Sleep Disordered Breathing (Snoring and Sleep Apnea).
In 2011 Dr. Edmund Liem founded with Dr. Arshad Pirani and Dr. Roger Cheung the Vancouver TMJ & Sleep Therapy Centre, a practice limited to the non-surgical therapies for TMD, Craniofacial Pain and Sleep Disordered Breathing. This practice is one of the centres that belong to the TMJ & Sleep Therapy Centre International, founded by Dr. Steven Olmos. At this time there are 41 centres located in the world; 8 of them are in Canada.
Currently he practices in an office in Burnaby, BC. He treats only pediatric and adult Craniofacial and Sleep Disorders. He is the immediate past president of the Canadian Chapter of the AACP (American Academy of Craniofacial Pain). His professional passion at the moment is the dissemination of knowledge about the important and underrated role that dentistry plays in pediatric and adult sleep disorders.
The Gut Microbiome & Beyond
Ria Raschig, RHN, CBT
Long gone are the days when we didn't have to pay much mind to what we ate. The world has changed, we're more vulnerable than ever before. The soil in which food grows in, the foods we choose to eat, whether animal or plant, GMO’s, antibiotics, chemicals that are everywhere…...media, marketing, our air quality….we are well beyond the gut, it’s about more than “we are what we eat” anymore.
The "gut microbiome" is made up of trillions of microorganisms, bacteria, yeasts, fungi, parasites, candida, viruses all unique to you as your own fingerprint. To date, science has currently calculated we have fifteen times more microbes in our body for every human cell. They work for you not only digesting and absorbing the nutrients of your food but many other important processes that extend beyond your gut including your metabolism, body weight, oral health and immune regulation, as well as your hormone health, brain functions, mood & more. It's an OCEAN, we are more than just taking " probiotics" (which are controversial). It is about the impact on our tight junctions, mitochondrial health, intern our overall health!
Let's learn how and WHY we absolutely need to keep our own ecosystem healthy...
1. Understand what the "Gut Microbiome" is, and how its much, much, more than we ever knew,..... and how fascinating we are!
2. Realize the importance of our gut and how along with other modalities, taught in these seminars, is the start of better health.
3. Learn a few simple tips on nutrition & supplements to recommend to your clients for gut & overall health.
Ria Raschig RHN, CBT is a Certified Holistic Nutritionist, Bowen Therapist, Educator and avid Gardener and Healer for our Planet. Over 25 years of experience in health and nutrition, she is a passionate "old soul" who's journey is a gift of " traditional knowledge" for an everchanging world.
Yoga and Breath: How Buteyko has influenced my teaching
Jennifer Snowdon, BCM, E-RYT200
58 Rose Avenue
Have you ever been to a yoga class felt out of breath during the practice? Have yoga teachers directed you to breathe in a way that made you feel uncomfortable with the practice? What kind of breathing is happening in a yoga class? In this workshop, you will experience and explore how movement can follow breath while practicing yoga. Let your breath be your guide as you explore movement and your body.
- Have awareness of how yoga and Buteyko breathing can be integrated
- Learn how to let your body guide you in healthy breathing as you do yoga
- Learn how to talk with your clients about yoga and healthy breathing
Jennifer is a yoga teacher in Toronto, Canada. It was the connection between movement and breath that first drew her into yoga. After practicing for many years, she became a teacher and then began to explore the world of functional movement. Applying functional movement principles to yoga, she then explored functional breath and the breathing we do in a yoga class. She studied Buteyko, became an Educator, and has been teaching workshops and in yoga teacher training programs.
The relaxation power of the breath – rebalancing the autonomic nervous system
Hung Cheng Tseng, MD
Taichung, Taiwan 403
The autonomic nervous system in our body can be categorized into sympathetic nervous system, which activates our fight or flight response, and the parasympathetic nervous system, which helps us to relax. The best way to correct the autonomic nervous system imbalance is through breathing; it’s not only very efficient but you can do it anywhere and anytime you want. The key to relaxed breathing is slow, steady and rhythmic. We’ll introduce to you why and how to do this breathing re-training in a very simple way. I’ll discuss how combining the Buteyko Breathing and Chinese meditation counting-number breathing can be very efficient in helping people reach a relaxed and mindful state. I’ll also discuss the difference between Buteyko Breathing and traditional deep breathing.
We’ll evaluate the anatomy and physiology of breathing volume, breathing muscles, and gas exchange; and then further discuss the difference between Buteyko Breathing and deep breathing. We’ll also discuss the 4 stages of breathing: inhalation, pause, exhalation, pause; and analyze their difference among various breathing methods.
Due to the high stress environment in this modern society that we now live in, the sympathetic nervous system activates more frequently than it should for many people. By consciously increasing the duration of exhalation, we can increase the activation of parasympathetic nervous system, and use it to re-balance our autonomous nervous system to correct dysautonomia.
One reason why people have insomnia is that their brain wanders through random thoughts, and the breath counting method in traditional Chinese meditation can help people to easily focus and rest their mind.
We have put together a simple mindfulness breathing exercise, combining the essence of Buteyko, traditional meditation, and modern neuroscience.
(1) According to the meditation and modern neuroscience, focusing on the current moment with regular and rhythmic breathing is the best way to relax your mind. The breath counting method can help us do this easily.
(2) According to the modern neuroscience, the best balance of autonomic nervous system is when the breathing rate is 5-6 times per minute.
(3) According to the relationship of breathing and autonomic nervous system, increasing the duration of exhalation (parasympathetic nervous system) may help to correct the over-excitement of sympathetic nervous system.
(4) Buteyko reduced breathing technique: nasal breathing, diaphragmatic breathing, stop breathing after exhalation may further enhance the relaxation from gentle breathing.
We developed a very simple and relaxing breathing method, suitable for everyone. You can potentially reach the utmost relaxed breathing – turtle breathing by this breathing training. Through this breathing exercise, we can quickly reduce stress in various environment, and it’s also very helpful for jetlag adjustment and insomnia.
- Understand the relationship between autonomous nervous system and breathing; the physiology and anatomy of breathing
- See the four stages of breathing: inhalation, pause, exhalation, pause
- Hear why meditation breath counting helps us to relax
- Explain the stress relief breathing method; combining Buteyko and meditation breath counting
- Recognize difference between Buteyko and deep breathing
Education: National Yang-Ming Medical University
Attending physician at Department of Otolaryngology-Head & Neck Surgery, Veterans General Hospital-Taichung, Taiwan
Owner of Shyhung ENT Clinic, Taichung, Taiwan, specializing in the management of rhino-sinusitis and otitis media with effusion by pulsatile nasal irrigation and xylitol nasal spray. (Partnered with ENT Dr. Murray Grossan in USA to make and promote pulsatile nasal irrigator)
Owner of Sancare Health. Inventor and manufacturer of Sanvic pulsatile nasal irrigator, Sanvic ear irrigator, Sanvic xylitol nasal irrigation and spray, Sanvic mouth tape, Sanvic ear dryer
Co-Founder of AirwayFit program, Stop snoring course, Buteyko breathing course for airway diseases, Breathing relaxation course for autonomic imbalance.
Foreword writer of the Chinese translation (in Taiwan) of The Oxygen Advantage by Patrick McKeown
An Innovative program to stop snoring
Howard Tseng, P.Eng
Vancouver, BC, V6P 3W1
The key cause of snoring is rapid inspiratory airflow. Snoring is the sound produced by the rapid vibration of the soft tissue of the oropharynx due to the rapid inspiratory airflow. Mouth breathing will move the tongue base backward and weaken the related muscle power, will narrow the oropharyngeal airway. Both the rapid airflow and narrow passage will induce snoring and obstructive sleep apnea.
We developed an innovative stop snoring program to help reverse snoring. Most learners can successfully alleviate or stop snoring the same night after taking the course. A 10 minutes orofacial exercises and mouth tape before sleep are what they have to do to stop snoring.
Currently most physicians think snoring or obstructive sleep apnea (OSA) are due to structural abnormality, that’s why the three major management methods (surgical removal of the oropharyngeal soft tissues, dental mouth piece, and CPAP) are not satisfactory. However, from the viewpoint of basic medicine, snoring and OSA are functional abnormality instead of structural abnormality. So we developed an innovative stop snoring program to restore the normal breathing habit.
There are 4 steps to stop snoring: Step 1 – close your mouth and breath via the nose. Step 2 – reinforce your oropharyngeal muscles strength. Step 3 – use nasal irrigation to remove any obstacle for nasal breathing. Step 4 – breathe gently and slowly. Our clients can learn and practice step 1 & 2 in within the 2.5 hours program, and most of them report successful relief the same night after the course.
We develop an innovative oropharyngeal exercise to help the students to put their tongue back to the normal resting position in a very short period of training time, and an easy way to strengthen the lip muscle power.
The key point of snoring and OSA is rapid inspiratory breathing airflow. Mouth breathing may move the tongue base backward toward oropharyngeal lumen, and may weaken the tongue muscle power too, both will cause the oropharyngeal lumen narrowing when lying down to sleep. When brain stimuli to oropharyngeal muscle contraction disappears during sleep, people will start to breathe rapidly. Bernoulli effect then cause the oropharyngeal lumen to be narrower, the vicious cycle eventually leads to OSA.
We will also discuss the breathing physiology of the following:
- Why sleep on the side is better for snorers?
- Why snoring sound is from oropharynx instead of from nose or trachea?
- Why elder person snores more often than younger person? Male snores more often than female?
- Why snoring always happens during sleep, but not during daytime?
- Why nasal obstruction surgery may not alleviate snoring?
- Why the incidence of stroke is higher in snoring and OSA sufferers?
- Understand the key cause of snoring and OSA (obstructive sleep apnea) from the point of breathing physiology.
- Learn the orofacial exercises to put the tongue back to normal position within 30 minutes.
- Learn how to close the mouth by lips exercise and mouth tape, and a tip to remove mouth tape smoothly.
Howard Tseng, P.Eng
Education: University of Toronto, Mechanical and Biomedical Engineer
- BBEA trained by Carol Baglia, Hadas Golan, Patrick McKeown, Susan Neves since 2011.
- Partner of Sancare Health
- Co-Founder of AirwayFit program