If you’ve ever had a patient whose snoring was bad enough to send their partner to the spare room, you’re not alone—and neither are they. That rattling, rumbling noise we call snoring is more than just an annoying habit. In many cases, it’s a sign that there’s dysfunction in the way the upper airway is operating during sleep. Obstructive sleep apnea (OSA) affects millions globally, with an estimated prevalence of 9-38% in adults. It’s linked to severe health risks, including hypertension, heart disease, and stroke.
While it may not typically be a reason people seek chiropractic care, it has been reported in numerous case studies, including one new case report and a discussion paper published in the recent edition of the Asia Pacific Chiropractic Journal. As ASRF turns its eyes toward quality of life and functional health outcomes in chiropractic care, this is exciting to see, as it opens the door to meaningful, measurable care for OSA sufferers.
While the case report followed the case of a 64-year-old corporate consultant who presented for chiropractic care with primary presentations related to long COVID, OSA was one condition that manifested in the aftermath, leading to his use of a CPAP machine. In this case, subluxation-based care was complemented with oropharyngeal exercises which allowed him to augment his CPAP usage over time, in line with improvements with his sleep quality.
The case study was authored by Masarsky and Todres-Masarsky – not the same author as the discussion paper (Scott Cuthbert). Still, the papers dovetail together nicely as Cuthbert shone a light on what is going on biomechanically when a chiropractic patient with OSA enters care, and what exercises can be done to complement. While the best thing to do is absolutely to go read this at the reference below (as it comes complete with clinical nots and pictures), for those of us who aren’t (yet) chiropractors, lets take a look at the paper:
Snoring: Not Just a Nuisance
Snoring happens when airflow through the mouth and nose is partially blocked during sleep. The tissues of the soft palate, throat, and tongue can relax and vibrate, producing that unmistakable sound. While this might seem like a minor issue, it can point to deeper problems like Obstructive Sleep Apnea—where the airway collapses completely, interrupting breathing.
Chiropractors often see patients for issues that seem unrelated to sleep, only to uncover broader patterns of dysfunction that include snoring, jaw tension, neck pain, or even digestive issues. One of the keys here? The stomatognathic system—the interconnected web of the jaw, neck, cranial nerves, and upper airway muscles.
Chiropractic would be classified as a conservative management strategy- that is one without drugs, surgery or machine intervention – with the aim of correcting dysfunction that leads to sleep apnea. We are not suggesting this replaces CPAP or other strategies, but that this can assist in strengthening muscles and correcting dysfunction with the aim of decreasing necessity for such interventions over time and with relevant oversight.
So how does Cuthbert recommend we go about it?
He starts with simple functional neurology. Snoring is often made worse by weak or dysfunctional muscles in the mouth, tongue, and throat. Strengthening these muscles can help keep the airway open during sleep.
Here are four effective exercises you can suggest to your patients:
– Say “Ahh”. This simple vocalisation activates the muscles of the soft palate and throat.
– Tongue Slide. Push the tongue against the roof of the mouth, then slide it back as far as possible.
– Gargling Water. Do this with every sip of a large glass of water. Gargling activates theVagus nerve and strengthens the back of the throat.
– Sing Loudly. Especially in the car or shower! Singing strengthens the pharyngeal muscles and improves tone (Muscle tone that is).
He then moves to Applied Kinesiology and the Hyoid Muscle, providing a simple guide as to how chiropractors may adopt this approach.
Applied Kinesiology (AK) provides a method for assessing and treating the muscles surrounding the airway. The hyoid bone plays a pivotal role in supporting the tongue and maintaining an open airway. Dysfunction in the muscles attached to the hyoid (like the digastric, omohyoid, and geniohyoid) can contribute to snoring and OSA.
AK practitioners can assess these muscles through manual testing and challenges to the hyoid bone in various directions (anterior, posterior, superior, inferior and lateral as discussed in the paper in greater detail). If a previously strong indicator muscle weakens when the hyoid is stressed, that suggests involvement. Treatment involves improving neuromuscular spindle cell function—essentially ‘waking up’ these muscles so they can do their job better.
Trigger points, especially in the omohyoid, can be worked on manually—either with stretching, ischemic compression, or percussion. Working out tender points at the root of the tongue and floor of the mouth (glove on, of course) can also significantly improve function.
What About the TMJ?
Temporomandibular joint (TMJ) dysfunction is a frequently overlooked contributor to snoring and sleep apnea. A misaligned or dysfunctional TMJ can distort cranial function, affect airway muscles, and interfere with the cranial nerves involved in swallowing and breathing.
Interestingly, TMJ dysfunction can sometimes be driven by a pelvic imbalance, part of a larger structural pattern. That’s why thorough chiropractic analysis—spanning cranial, cervical, and pelvic regions—is essential. Yes, subluxation-based care is important even here, though some chiropractors adjust the TMJ inside the mouth, too.
Many snorers benefit from TMJ correction alone. However, there an argument has been put forward that chiropractors collaborating with dentists can lead to exceptional outcomes with conditions such as trigeminal neuralgia or even posture. This appears to be one more area in which a collaboration could be positive. Understanding dental terminology and anatomy helps create those bridges—after all, we’re often treating different expressions of the same problem.
The Bigger Picture: Posture, Trauma, and Lifestyle.
Patients with a history of whiplash, poor posture, or repetitive strain to the neck muscles may be more prone to airway issues. Muscles like the sternocleidomastoid (SCM) and scalenesprotect the neck during trauma—but they’re also deeply involved in breathing and postural control.
If they’re tight, weak, or out of sync, they can affect the hyoid and tongue base position—further reducing airway patency during sleep.
And then there’s lifestyle. Weight gain (especially around the neck), poor muscle tone, and sleeping on the back all increase the likelihood of snoring. While chiropractors can’t promise overnight weight loss, we can educate patients on how even a small increase in neck circumference can lead to big breathing problems.
We often say that subluxation is a result of trauma, toxins or stress. It seems OSA can also be a junction in which trauma and environmental stressors combine to create the perfect conditions for dysfunction.
The papers essentially presents a call to clinical curiosity – to bring together chiropractic, exercises and environmental considerations in order to create the right conditions for healing, not just at the adjusting table but also beyond it.
If your patient snores—or if their partner’s nudging them to the couch every night—it might be time for a check in with you chiropractor. Look beyond the surface. Assess oral muscle tone, jaw function, hyoid mobility, and cranial-cervical dynamics.
In the end, snoring is often a symptom, not a diagnosis. By understanding the complex interplay between the jaw, neck, airway and nervous system, chiropractors are uniquely placed to offer long-term, non-invasive support to people living with noisy nights.
And when we get it right? We’re not just improving sleep—we’re improving relationships, brain health, and quality of life.
