Sleep apnea is a common disorder that affects a little over 5% of adults in Australia and a growing number of children. While it is known for causing disrupted sleep, loud snoring and plenty of daytime fatigue, sleep apnea's impact extends beyond this. It can significantly affect speech, language development and overall communication. Speech pathologists work alongside sleep specialists, respiratory therapists and ENT professionals to help patients and improve their quality of life. We look at the link between sleep apnea and communication challenges, showing how airway disorders impact speech and how timely interventions can support both children and adults in Australia.

Sleep apnea is a chronic sleep disorder that can cause someone to stop and start breathing in their sleep as the airway becomes partially or completely blocked. It can lead to individuals waking multiple times each night. There are three main types of sleep apnea:

1. Obstructive Sleep Apnea (OSA): The most common form, caused by physical blockage of the upper airway, often due to relaxed soft tissues in the throat or enlarged tonsils.
2. Central Sleep Apnea: This is when breathing repeatedly stops and starts in sleep as the brain fails to send proper signals to the muscles that control breathing.
3. Complex Sleep Apnea Syndrome: This is a form of sleep apnea that can develop as a person is being treated for obstructive sleep apnea. They continue to have pauses in their breathing, even though their airways are open.

While there are several health issues that result from this condition, from cardiovascular risks to metabolic issues, one of the lesser-known impacts of this disorder involves communication and speech.

When we want to speak, we inhale and then start speaking on the exhale. Doing so causes a flow of air that moves up the windpipe and through the voicebox and keeps them vibrating until you run out of breath. This movement works in collaboration with our tongue, lips and palate to produce speech. Sleep apnea can disrupt these patterns, causing pauses, gasping, or irregular breathing during speaking. Obstructions, such as enlarged tonsils or chronic mouth breathing, can lead to nasal or muffled voice quality, while restricted airflow can interfere with the ability to produce certain sounds, particularly those requiring strong airflow (e.g., s, f, sh sounds). This can cause:

• Articulation Disorders: When airflow is restricted, it can be difficult to form clear sounds, leading to slurred or unclear speech. Children may struggle with pronouncing certain sounds.
• Voice Disorders: Chronic mouth breathing and snoring that comes with sleep apnea can lead to vocal strain, hoarseness and a reduced vocal range.
• Delayed Speech and Language Development: In children, chronic sleep disruption from sleep apnea can affect brain development, leading to delayed speech milestones and challenges with reading and communication skills.

This connection between the airway and speech shows the need for early assessment and intervention by speech pathologists. These professionals can help identify airway issues contributing to communication challenges and provide targeted therapies to improve speech.

The first step is the assessment process. Speech pathologists assess articulation, fluency, voice quality and language comprehension to determine the extent of the impact of sleep apnea. They analyse breathing patterns during speech, checking for irregular airflow, mouth breathing, or nasal speech that may result from airway obstruction. Speech pathologists work closely with sleep specialists and ENT doctors to understand the patient’s sleep study results, the severity of airway obstruction, and any medical treatments being used, such as Continuous Positive Airway Pressure (CPAP) therapy.

Based on the assessment results, speech pathologists implement individualised treatment plans that could involve breathing exercises, voice therapy or language development support. Beyond these traditional therapy techniques, speech pathologists are also exploring innovative methods to address communication challenges related to sleep apnea:

• Myofunctional Therapy: Trains the muscles in your face and mouth to work better through a series of exercises.
• Orofacial Myology Therapy: Helps to reposition the tongue and improve nasal breathing for those with OSA.
• Virtual Therapy Sessions: Many speech pathologists now offer telehealth services, allowing patients to continue their treatment from home.

The link between sleep apnea and communication issues is often overlooked yet can have a huge impact. Through a combination of traditional techniques, such as breathing exercises and articulation therapy, and innovative approaches, including myofunctional therapy and virtual sessions, speech pathologists in Australia are helping children and adults alike achieve clearer speech, greater confidence and a better quality of life.