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The Fascial Imbalance That Pulls The Tongue Into The Airway

People who suffer from obstructive sleep apnea often struggle with their tongue collapsing into their airways during sleep. Sleeping on one’s back increases the risk of the tongue and jaw collapsing into the airway. 

Much of this blamed on gravity. Gravity is not the sole factor for the tongue falling into the airway. This article will describe another reason that I have discovered that can pull the tongue into the airway during sleep. This factor is not dependent on gravity. 

An overlooked component of swallowing is the balance of tension above and below the tongue. During normal swallowing, the front of the tongue pushes up against the palate so the back of the tongue can rise. This lifts the hyoid bone (a free-floating horseshoe-shaped bone under the jaw), which in turn pulls up the rib cage and organs within it. 

This creates increased fascial tension on the trachea, rib cage, and organs, as well as the infrahyoid muscles. As soon as the tongue relaxes, all the structures are drawn back down to their resting state. It is not gravity that is responsible for this. If it was gravity, we would be unable to swallow while laying down or even suspended upside down. This is more of a process called “biotensegrity.” 

Understanding The Anatomy That Produces This Balance Of Tension

I’m about to get nerdy. If you don’t understand it, I’ll do my best to summarize it at the end of this section. The fascia that is continuous with the tongue is anchored to the cranial base from above. It is part of a very strong layer of fascia called “visceral fascia.” It attaches onto the hyoid bone and continues into the neck as “pretracheal fascia.” 

It continues and flares into the rib cage lining the inner wall of the rib cage as well as enveloping the lungs, heart, and blood vessels. Finally, this fascia anchors into the diaphragm and continues into the abdomen to envelop the organs in your abdomen ending at the pelvic floor. 

Every single time you swallow, the hyoid bone rises. When that happens, it pulls and stretches the pretracheal fascia and investing fascial layers of the neck upward. Because it is more strongly anchored from below, the moment you relax the tissues will go back to their baseline. 

To put it another way, the fascia that is continuous with the tongue is attached to the undersurface of the cranial base above and anchors into the rib cage below. There is a balance of tension between the attachment above and anchoring below. The anchoring into the rib cage is much stronger than from above.

So when we swallow, the back of the tongue rises and lifts the hyoid bone upward increasing the tension on the fascia below. The more the increased tension below, the more difficult it will be to keep the back of the tongue up. When things go wrong, they can shift the balance of tension. Let’s talk about that next. 

When Things Go Wrong

The most common factor that I have found that can throw off this balance of tension is a tongue tie. Tongue ties take the “slack” out of the tension in the fascia. By doing that, it can pull the base of the skull and head downward producing a forward head posture. This can also be a reason for a tongue thrust or reverse swallow because the tongue cannot rise easily. 

The other dangerous piece of this is that tightening the tension in the fascia increases the tensional pull from below. During the day, people may be able to compensate for the tension with their muscles. It is at night during sleep that it becomes a problem. 

When a person’s body relaxes during sleep, the fascial tension will go towards its natural “balance” point. Unfortunately, if the tensional pull from below has increased, it will pull the tongue into the throat and the jaw backward. The result is an obstructed airway. 

How Do I Know If I Have A Fascial Imbalance?

In another article, I have described a test for a tongue tie, but what it’s doing is testing out this fascial imbalance. It works by trying to take the “slack” out of this layer of fascia. You can do this test by arching your back and tilting your head as far as you can while seated or standing. Then keeping your mouth closed, try to swallow. 

If you have a fascial imbalance, you will be unable to swallow. The fascial tension from below will not allow the back of your tongue to rise upward. On the other hand, if you have plenty of slack, then swallowing will be effortless. That is where you want to be. 

What Can I Do About It? 

So you are realizing that maybe you have this problem. What can you do about it? You may need a release of your tethered oral tissues such as tongue and lip ties. Before doing that, I would suggest having an evaluation from a qualified myofunctional therapist. If you do need a release, then you want to work with them before and after the release to help improve your outcome. 

In addition, proper bodywork is important. You want to go to a bodyworker who understands and can work on the tongue, head, and body-wide fascial connections. Most bodyworkers are not trained nor do they understand all of this or treat many of these specific structures. 

This is something that I have been pioneering along with Dr. Curtis at Osteopathic Integrative Medicine in Lakewood, Colorado. I am also putting together a course for professionals titled, “The Continuous Tongue.” If you want to learn about the fascial layers more in-depth, then you’ll definitely want to check it out. 


In this article, I have described a novel way of understanding that explains why the tongue and jaw collapse into the airway no matter what position they’re sleeping in. We briefly went into the fascial layer above and below the tongue and when the balance of tension is increased from below, it will pull the tongue into the throat when we sleep. 

Simultaneously, we explained how this could account for tongue thrusting and forward head posture. Finally, we described how to test if you have a fascial imbalance and what to do about it. This information came from observation, palpation of patients, and a lot of studying. It is consistent with what I see and ties many problems together. 

Don’t hesitate to leave comments or questions below.

Daniel Lopez, D.O.

Author Daniel Lopez, D.O.

Daniel Lopez, D.O. grew up with a lot of pain trying many things that did not help. Realizing that if he could not help himself, he would be unable to help others effectively, he dedicated himself to finding real answers. Since that time, Dr. Lopez has found a unique but powerful style where he has patients from around the country and the world that travel to see him for headaches, TMJ issues, eye issues, neck pain, back pain, and more. Daniel Lopez, D.O. is an osteopathic physician with Osteopathic Integrative Medicine. Prior to that he had a private practice in NYC for 6 years. He is the author of the Amazon best seller "Unwinding the Body and Decoding the Messages of Pain: An In-Depth Look into the World of Osteopathic Physicians and How They 'Magically' Use Their Hands for Healing." He lives in Aurora, CO with his wife and daughters.

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