Myofunctional Therapy
What Is Myofunctional Therapy?
"Myo" means muscle, and "functional" refers to how something works.
Myofunctional therapy describes how the muscles of the face, mouth, and tongue work together in harmony. It is a painless, exercise-based treatment that retrains these muscles when they malfunction, often due to habits or structural issues.
Why Is This Important?
Everyday behaviors such as mouth breathing, thumb sucking, or extended pacifier use can weaken the tongue and facial muscles. Over time, this can lead to:
Difficulty with breastfeeding
Improper jaw development
Swallowing or speech issues
Crooked teeth and bite problems
TMJ dysfunction
Digestive problems
Behavioral issues
Poor oral hygiene
Orthodontic relapse after braces
How Does Myofunctional Therapy Work?
The therapy strengthens the facial and tongue muscles and teaches you to maintain proper oral posture, most importantly, keeping the tongue resting against the roof of the mouth. You will also relearn how to swallow properly, pressing the tongue firmly against the hard palate.
When the facial muscles function correctly, other muscles follow suit. With consistent daily practice over several months, these small exercises can transform how you eat, speak, breathe, and sleep. In many cases, it can also improve facial aesthetics, restore self-confidence, reduce snoring, and alleviate sleep apnea symptoms by helping maintain an open airway.
Common Questions
What is the link between feeding and speech?
Weak facial and tongue muscles can cause speech delays, lisps, or trouble articulating. Poor muscle posture affects the ability to form normal sounds.
Why is breastfeeding important?
Breastfeeding naturally strengthens the tongue and muscles and encourages healthy facial growth and development.
Why do some babies struggle to breastfeed?
Tongue-ties or weak lips that can't form a tight seal around the nipple can interfere with sucking.
How do thumb sucking and pacifiers cause problems?
Anything that blocks the tongue from resting on the palate—thumbs, pacifiers, straws—can affect facial development, tooth alignment, and speech patterns.
Why do some kids prefer soft foods?
Weak chewing muscles can make eating tough foods uncomfortable. Gradually introducing firmer foods helps build muscle strength and supports healthy facial development.
Is it bad to chew on one side?
Yes. It creates muscle imbalance, affects jaw alignment, and puts uneven pressure on the temporomandibular joint (TMJ), potentially leading to pain or dysfunction.
How does myofunctional therapy help with braces?
Proper tongue posture supports long-term stability of teeth alignment, helping prevent them from shifting after braces are removed.
What causes a misaligned bite?
Mouth breathing, incorrect swallowing, and harmful oral habits can all interfere with natural jaw and dental development.
What causes TMJ problems?
TMJ dysfunction may result from one-sided chewing, mouth breathing, clenching, grinding, poor posture, or stress. Symptoms include jaw pain, clicking, stiffness, earaches, and headaches. Strengthening facial muscles and correcting oral posture can help.
Can weak muscles affect appearance?
Yes. Weak or poorly coordinated facial muscles can create a dull, tired look. Overcompensation with grimacing or puckering may lead to premature wrinkles or an imbalanced chin appearance.
Can it help with snoring or sleep apnea?
Absolutely. The airway is made of muscle, not bone. Weak oral muscles and poor posture can lead to airway collapse. Strengthening these muscles through therapy can reduce snoring and improve sleep apnea symptoms.
How do you spot a mouth breather?
Signs include open mouth posture, dry or cracked lips, long facial structure, sagging cheeks, dark under-eye circles, and forward head posture.
We obtain objective measurements from oral muscle strength testing. From these measurements, we determine if muscle strength and endurance are normal or abnormal. If the strength and endurance are normal, we can eliminate weakness as a cause of the swallowing, speech, or breathing problem. If the strength and endurance are weak, we can begin strengthening exercises. If the strength and endurance are not increasing over time, we can asses if you are performing the exercises enough or forcefully enough. If the strength and endurance does increase, even a little bit, it can be rewarding for you to see objective evidence of improvement.
Our strength training protocols apply exercise science principles:
60% effort week 1, 80% effort weeks 2-8
3 sets of 10 reps
3-5 days/week
6-8 weeks
We customize our exercise protocols by determining the target value, the number of times to illuminate the green light, and, for each repetition, how long to illuminate the top light before releasing pressure on the bulb. The customization is also based on whether the exercises are rehabilitative or preventative and your individual goals.
A strength training protocol example is listed below:
Bulb position - Anterior tongue
Pmax - 18 kPa
Effort Level - 60%
Target Value = (Pmax)(0.6) = 11 kPa
Frequency = 3 sets of 10 repetitions
We re-evaluate weekly, if possible, to ascertain your progress and adjust the protocol as needed.
How do we use Myofunctional therapy?
We can utilize myofunctional therapy to monitor, prophylactically treat, and rehabilitate the oral musculature in various conditions:
Monitoring
Monitor disease progression
ALS
Parkinson's Disease
Monitor therapy effects on oral motor strength and endurance
Didgeridoo for Obstructive Sleep Apnea
Speech therapy
Prophylactic Treatment
Promoting proper facial development in children
Preventing sarcopenic dysphagia in the elderly
Strengthening before an intervention that causes oral muscle atrophy
Head and neck surgery
Radiation Therapy
Rehabilitation
Strengthening after an event
Stroke
Traumatic Brain Injury
Strengthening as a primary or adjunctive treatment
Sleep-disordered Breathing
Speech
Maintaining oral motor strength during a degenerative disease process
ALS
Parkinson’s Disease
Plasticity Principles
We have practiced myofunctional therapy for over twenty years. Our myofunctional therapy success, in part, is derived from addressing the ten principles of plasticity.
Use it or Lose it: Muscles either strengthen or atrophy
Use it to improve it: Training strengthens muscles
Intensity: We set targets as a percentage of maximum effort and progressively increase difficulty
Repetition: Exercise science dictates our protocol frequencies
Specificity: We identify weak muscles to increase strength or endurance (or both)
Interference: Maladaptive behaviors can interfere with learning good habits.
Time: We initiate treatment early before maladaptive behaviors set in
Age: Our training-induced changes affect all ages but more readily the young
Transference: Changing muscle function as a result of targeted training can help learn other similar skills
Salience: Biofeedback is motivational
Frequently Asked Questions
How effective is myofunctional therapy for obstructive sleep apnea?
“Current literature demonstrates that myofunctional therapy decreases apnea-hypopnea index by approximately 50% in adults and 62% in children. Lowest oxygen saturations, snoring, and sleepiness outcomes improve in adults. Myofunctional therapy could serve as an adjunct to other obstructive sleep apnea treatments.’
Camacho M, Certal V, Abdullatif J, Zaghi S, Ruoff CM, Capasso R, Kushida CA. Myofunctional therapy to treat obstructive sleep apnea: a systematic review and meta-analysis. SLEEP2015;38(5):669–675.
What is the protocol for achieving optimal tongue strength?
The goal tongue strength is 60 kPa.
Sleep and Brain will set the starting kPa when the IOPI Trainer is dispensed.
The tongue pressure target should be increased by 1 kPa approximately every one to three days until 60 kPa tongue strength is achieved.
The target tongue pressure setting should not be increased quickly as you may “cheat” and utilize your lower jaw achieve the target tongue pressure.
The lower jaw must remain quietly stable with all effort exerted by the tongue during the exercises.
Hold the tongue bulb tube using one hand.
Place a finger on the other hand between the upper and lower teeth and ensure that no pressure is exerted on the finger when doing the exercises to assist in immobilizing the lower jaw.
What is the protocol for achieving optimal tongue endurance?
The goal tongue endurance is 30 kPa.
Tongue endurance can be optimized after tongue strength is optimized to 60 kPa.
The tongue pressure should be sufficient to achieve the green light and disallowing the light to drop three light levels.
The tongue pressure should be maintained at this level for at least 15 seconds and preferably 30 seconds.
How often do you use the IOPI trainer?
The ideal number of tongue press repetitions is three sets of 10 in the morning, three sets of 10 in the afternoon, and three sets of 10 in the evening per exercise physiology.
Given the regimen above may not be conducive to lifestyle, Sleep and Brain recommends completing at least 100 repetitions for day at your convenience.
The exercises should be performed at least 5 days per week for approximately three months.
The IOPI Trainer should be returned after 60 kPa tongue strength and 30 kPa tongue endurance is achieved.
Do you need to use the IOPI Trainer indefinitely?
In the process of tongue strength and endurance optimization, it is the expectation that you will learn proper oral posture.
Lips closed, teeth together, and tongue firmly on the roof of your mouth at rest.
Swallowing with lips closed, teeth together, and tongue pressing and pushing food from a front to back motion on the mouth roof
Where should you place the tongue bulb in your mouth?
Please see page 16 of your IOPI Trainer user manual for bulb placement visuals.
How do you enter the program mode to adjust the target value?
Turn the device off
Press and hold the target button
With the target button held down, turn on device until PROG is displayed on the bottom left corner of the screen
Let go of the buttons
To adjust the target value, press the up or down arrow until the screen shows the desired pressure value
Exit the program mode by pressing the power button to turn the unit off
The steps above are described on page 14 of the IOPI Trainer user manual.
The steps above are demonstrated in the following IOPI Medical video.
How do you clear the error “ERR” message?
Enter the program mode as described above
Hold down the reset button while a countdown from 3 is displayed on the screen, followed by “- - -” and “000.”
Exit the program mode by pressing the power button to turn the unit off
The steps above are described on page 14 of the IOPI Trainer user manual.
The steps above are demonstrated in the following IOPI Medical video.
If the “ERR” message is flashing, the Target and Power buttons must be held through the startup of the device for 10 seconds.
What are the use contraindications for Iowa Oral Performance Instrument?
Age under three
Risk of seizure
Pain disorders involving the jaw muscle or temporomandibular jointCan the tongue bulb be re-used?
One person can use and re-use the tongue bulb if cleaned between uses. It is best if you replace the tongue bulb monthly.
How do you clean the tongue bulb?
Clean the tongue bulb by rubbing all surfaces with a mild dishwashing soap and water.
Rinse thoroughly, shake off any extra water, and let air dry.
Do not place in dishwasher or in boiling water.
What if the tongue bulb is too slippery to perform the exercises?
If you can't stabilize the tongue bulb, you may not be able to stabilize a bolus of food. Focus on stabilization first.
Can the tongue bulb be re-used?
An individual can re-use the tongue bulb if they clean it between uses.
When does the tongue bulb need to be replaced
Replace the tongue bulb if it stays flattened or dimpled after compression.
It would be best to replace the tongue bulb monthly.
