Could a Sleeping-Disorder be the Cause of Weight Gain?

May 16, 2014

Excess weight is a well-established predictor of sleep-disordered breathing (SDB), which true across the world: US, Australia, Europe, and Asia

Dr. Liao, with patient’s permission, shares the experiences of other patients to assist those with similar symptoms. Below is a recent patient’s story: K.O., his patient, came to Dr. Liao and his team for her cleaning after a year’s absence. This is their ChairSide chat:
Weight gain patient dr felix liao
DFL: “How are your teeth doing?”

KO: “No big problems. All is under control.”

DFL: “Nice to hear, Next, how’s your health? Any problem you wish you did not have to live with day after day?”

KO: “I am 40 pounds overweight, and I feel like I am missing a battery. I am motivated to do everything, but can only do one thing! I wake up refreshed maybe once a week, and my son says “I snore” when we went on a trip together. I eat very little and still gain weight — “It’s not my diet. I wish I could go for a walk with my husband but I am so exhausted all the time, I just can’t.”
KO weight gain patient of dr felix liao
KO’s baseline history includes:

  • Bleeding gums
  • Food traps in ULQ
  • Teeth Grinding – “Big Time”
  • Poor digestion
  • Sleeps poorly
  • Wakes up tired
  • Low thyroid properly supplemented
  • History of amalgam revision 8 years ago with sauna and Vitamin C, which “helped make me felt better but still not feeling well.”
  • History of Lyme Disease – now gone
  • Teeth crowded again despite braces in high school

DFL: K.O. is clearly trying but frustrated with her outcome. Medically, she is well-managed for her thyroid and Lyme disease. Oral-Systemically, Dr. Liao can see the airway as her number one issue, and stress as number two.

Oral-Systemic Links (OSA)

”… caniofacial abnormalities play significant roles in the pathogenesis of OSA in Malay patients,” concludes a 2011 study published in European Journal of Orthodontics (1). It is found in the following OSA patients:

  • Larger neck and Body Mass Index (BMI, an indicator of obesity if > 25 kg/m2)
  • Thicker tongue and longer soft palate
  • Narrower airway spaces

I find the same to be true in American patients in my office just about every day.

“Excess weight is a well-established predictor of sleep-disordered breathing (SDB), which true across the world: US, Australia, Europe, and Asia (2). Among its findings:

Mouth Airway

Color Scale of Severity:
White – Blue: adequate airway
Green – Yellow: hazardous airway
Orange – Red: dangerous airway
Black: dire straits

  • As Body Mass Index (BMI) and neck size goes up, so does the prevalence of Sleep Disordered Breathing (SDB, defined as AHI > 5 from sleep test)
  • 41% of adults with mild SBD have excess weight (BMI > 25)
  • 58% of adults with moderate-severe SBD (AHI > 15) have excess weight (2)

There is a greater risk for Sleep-related Breathing Disorders coming from living and sleeping with excess weight. Later, a 2008 study confirms:

  • Obesity is probably the most important risk factor for the development of OSA
  • 60–90% of adults with OSA are overweight
  • Relative risk of OSA in obesity (BMI >29 kg/m2) is ≥10 times
  • “Thus, it appears that obesity and OSA form a vicious cycle where each results in worsening of the other.” (3)

Obesity sleeping disorder chart
Weight gain is simple and complex at the same time. How and when does it start? Once you have K.O’s issues, how can you reverse the vicious cycle?

Holistic Mouth Recommendations

  • Epworth Sleepiness Scale to assess Excessive Daytime Sleepiness (EDS)
  • CBCT Imaging to evaluate cranial-facial abnormalities
  • Clinical photos of her oral-facial-postural status
  • Cranial-Facial Analysis
  • Sleep Test as needed
  • Refer to own physician for thyroid evaluation
  • Consultation on treatment options
  • Begin exercise once oxygen debt is paid down sufficiently

Clinical Findings

Tongue Position Test for OSA.004 copy6 Ft Tiger dr felix liao

  • Tongue posture is a clinical indicator of OSA risk (4)
  • Tooth prints on sides of tongue is 70% specific for one of the criteria for OSA and correlates with poorer sleep efficiency. (5)
  • Tongue swelling may indicate thyroid disorder (6, 7)
  • Tongue Tie contributes to the relapse of her orthodontic (braces) treatment.

My Points: These are based on my clinical experience from listening to patient feedback after carrying out Whole Health recommendations. My Points do not constitute proof that I am right, nor am I offering medical advice with them. They are offered for consideration by you, your dentists and doctors, and for future studies to prove them right or wrong.

    tongue positioning

    Upper Jaw is too narrow by 5 mm in the front and 3 mm in the molars.
    Lower jaw of is too narrow by 1 mm in the front and too wide by 3 mm in the molars.

  • Apple-shaped belly is connected to Impaired Mouth through Sleep-related Breathing Disorder, not by diet alone.
  • Retruded (opposite of protruded) spells airway troubles, as mentioned in Impaired Mouth Syndrome discussion.
  • A common oral-facial sign of an Impaired Mouth is Lack of upper lip support in profile. Flat upper lip that drops straight down on side view, usually indicates a retruded upper jaw and teeth, which usually spells airway troubles.
  • Have K.O.’s doctors picked up on her sleep related breathing disorder?
  • ChairSide chats in a dental office are an effective place to screen for SBD and control OSA-Obesity vicious cycle early.


1. Albajanlan OA, et. al, Eur J Orthod (2011) 33 (5): 509-514.)

2. Young T, Peppard PE, Taheri S. Excess weight and sleep- disordered breathing. J. Appl. Physiol. 2005; 99: 1592–9.

3. Pillar G., et al, Diabetes Care February 2008 vol. 31 no. Supplement 2 S303-S309.

4. Barcelo X, et al, Oropharyngeal Examination To Predict Sleep Apnea Severity, Arch Otolaryngol Head Neck Surg. 2011;137(10):990-996.

5. Weiss et al, Archives of Otolaryngology, Head & Neck Surgery 2005:133(6)966-71

6. Shalu C & Manish B, Oral Manifestations of Thyroid Disorders and Its Management. Indian J Endocrinol Metab. Jul 2011; 15(Suppl2): S113–S116.

7. Huber MA, Terezhaimy GT, Risk Stratification and Dental Management of the Patient With Thyroid Dysfunction. Quintessence Int. 2008 Feb;39(2):139-50.

Recent Blogs

Alternatives to CPAP: 6 Ways to Treat Sleep Apnea Without CPAP

May 30, 2023

Imagine sleeping with a device that sends constant pressurized air to keep your airways open as you sleep – that is what a CPAP does for obstructive sleep apnea patients. However, there are options for sleep apnea treatment without CPAP. So, to stay informed on what the CPAP alternatives are, continue reading! What is Continuous […]

2574 Views Read more

Sinus & Tooth Pain: Exploring the Link Between Teeth & Sinuses

May 15, 2023

Did you know an infection in your sinuses can affect your teeth? Our entire body is interconnected, with no exclusion of any body part. Sinuses are located near your mouth, so when it becomes infected, the resulting pressure causes pain in the upper teeth. But how to know if you have sinus tooth pain or […]

4213 Views Read more

Waking Up Gasping for Breath: What is Your Body Trying to Tell You?

Apr 30, 2023

Imagine going to sleep after a long day, looking forward to a deep slumber – but it ends with you waking up gasping for breath. It can be pretty spine-chilling to catch your breath during sleep as if you’re choking. But what could be the reason? When you wake up with a gasp, it could […]

752 Views Read more

What’s the Link Between Sleep Apnea & Genetics?

Mar 15, 2023

Many individuals do not realize that the disorder they are suffering from might run in their family. If you or your loved one has been diagnosed with sleep apnea, there’s a possibility that it was passed down. The belief that there exists a connection between mouth and body is well-founded; sleep apnea is known to […]

85 Views Read more

Wellness While On Vacation

Oct 9, 2019

“I need another vacation to recover from this vacation!” Does that sound familiar? Or how about, “I’m on vacation, so I’m going to indulge, then diet after I get home”? What’s the point of going on vacation: to harm – or to restore – yourself? Is it possible to make wellness fun? I decided to […]

85 Views Read more

ABC Before D: Dr. Felix’s Guide to More Health at Less Cost

Aug 12, 2019

A quiet revolution is starting in medicine and dentistry: Chronic pain, fatigue, and overall health can be improved without drugs. Oral sleep appliances can activate stem cells around natural tooth roots to widen both the jaws and the airway, as I describe in Six-Foot Tiger, Three-Foot Cage and Early Sirens. “What you write in your […]

130 Views Read more

Fix Mouth Breathing with Buteyko Breathing

Dec 29, 2014

Got chapped lips, dry mouth, inflamed gum, bloating, snoring, bad breath, anxiety, and/or sleep apnea? Habitual Mouth Breathing (HMB) may be the culprit, and Buteyko Breathing can help. HMB is an unhealthy habit with many oral-systemic side effects. In children, HMB can lead to undesirable cranio-facial changes, narrowed jaws, crowded teeth, long face, weak chin, […]

139 Views Read more

Habitual Mouth Breathing: Damages and Solutions

Dec 15, 2014

Nose breathing is basic to natural health, while habitual mouth breathing (HMO) can contribute to cavities, bleeding gums, narrow jaws, crowded teeth, less attractive face, snoring, aging faster, and more — see over-breathing next. Are the lips of your child apart when she/he is sitting quietly? Are they dry and chapped? These small signs can […]

227 Views Read more
Skip to content