Specialist article palate
Training the soft palateHow the soft palate gets back to work
The soft palate is muscle that works with every breath, every swallow and every word, and also ventilates your middle ear in the process. Here you will learn what a “slack soft palate” means, what gargling, singing, the didgeridoo and surgery can do, and how to integrate the palate back into everyday life through breathing, swallowing and head balance.
Does this sound familiar?
Your uvula hangs low, and things get loud at night?
What applies to you?
Tap whatever applies to you.
If two or more points apply, it is worth looking at the whole pattern. In our view, a soft palate that seems slack is usually the result of it being too little involved in its tasks in everyday life. That can be trained.
Cause or consequence?Exercises comparedThe key points at a glance
- The soft palate, also called the velum, is a flap made up of five muscles. It switches between nose and mouth, seals off the nasal cavity when you swallow, shapes speech and opens the Eustachian tube.
- In our view, a “slack soft palate” is usually the result of impaired function: mouth breathing, a low-lying tongue, an unclean swallowing pattern. Muscles that are not used lose tension.
- Gargling, singing or the didgeridoo put muscles to work but do not change the pattern in everyday life. FaceFormer training re-integrates the palate through negative pressure, swallowing, the tongue reference position and nasal breathing.
Video
Soft palate surgery or training? How it all fits together
Das Video lädt erst nach dem Klick. Dann werden Daten an YouTube (Google) übertragen.
Fundamentals
What the soft palate is
Anyone searching for “soft palate training” means the movable rear part of the palate. It is not an appendage but muscle with several tasks.
Run the tip of your tongue backwards along the roof of your mouth. At the front you feel bone, the hard palate. It is also the floor of the nose. Where the bone ends, it becomes soft. This is where the soft palate begins. It hangs freely backwards into the throat and ends in the middle in the uvula.
The soft palate separates two routes that cross in the throat: the airway from the nose and the food passage from the mouth. The hard palate separates these spaces in area. The soft palate separates them in time, depending on whether you are breathing, swallowing or speaking.
Like a sail on a mast
A sail hangs slack as long as there is no pull on it, and sets as soon as the lines are working. For the soft palate, the lines are muscles. Whether it seems taut or slack therefore depends less on the fabric than on whether the lines are being used.
Structure
Five muscles, one seal
The soft palate consists of a plate of tendinous tissue and five muscles. Each one pulls from a different direction.
The elevator
It pulls the soft palate backwards and upwards against the back wall of the throat. It is the actual sealing muscle towards the nose.
The tensor
It tightens the soft palate into a firm surface and, when you swallow, pulls open the Eustachian tube, the passage to the middle ear.
The uvular muscle
A narrow strand in the middle. It shortens and thickens the soft palate and makes the seal tight.
The palatoglossus muscle
It runs from the soft palate into the back of the tongue. It lowers the soft palate, raises the back of the tongue and couples the two.
The palatopharyngeus muscle
It runs from the soft palate into the side wall of the throat, lowers the soft palate and narrows the throat from the side.
A review from Illinois State University describes the seal between mouth and nose as a muscular valve. It extends from the end of the hard palate to the back wall of the throat and includes the side walls of the throat. Besides the soft palate muscles, muscles of the throat wall also take part1. The seal is therefore formed as a ring from several directions, not by a single muscle.
The soft palate is not a flap of tissue in the throat. It is a valve made of muscles.And muscles keep the tension that their everyday tasks demand of them.
Breathing and swallowing
What the soft palate does in breathing and swallowing
The soft palate constantly switches between two positions. Which one it takes depends on what you are doing at the moment.
Calm breathing through the nose
- The soft palate hangs down and rests on the back of the tongue
- The way to the nose is open, the way to the mouth is closed
- The lips are closed, the tongue rests against the palate
Swallowing
- The soft palate rises and settles against the back wall of the throat
- The nasal cavity is sealed, nothing rises into the nose
- The Eustachian tube opens briefly
The soft palate switches between the two positions with every swallow, many hundreds to a thousand times a day.
Which muscles guide the soft palate depends on the airway. A research group in Denver measured muscle activity in eight healthy men using fine electrodes placed directly in the tissue. The palatoglossus muscle was more active during nasal breathing than during mouth breathing. For the elevator it was the other way round2. The authors conclude that the interplay of both muscles helps determine whether breathing is through the nose or the mouth.
This fits a simple picture. During nasal breathing, the soft palate keeps contact with the back of the tongue and closes off the mouth at the back. During mouth breathing, it is lifted so that the nose is closed. In our view, anyone who has breathed through the mouth for years runs the second pattern as their default setting. The contact between soft palate and tongue is lost in the process.
Speech and ears
Speech and pressure equalisation: two further tasks
The same valve shapes the sound of your voice and ventilates your middle ear.
Pinch your nose and slowly say “Mama”, then “Papa”. What do you notice?
without a speech disorder, in a study from Illinois, used only the lower range of the force that the elevator reached during forceful blowing when speaking4
spoke, blew and swallowed in a study from Osaka. When swallowing, all five used different parts of the elevator than when speaking and blowing3
The seal during swallowing is innate, whereas the seal during speaking is learned, the authors from Osaka emphasise. For training, this means: an exercise that challenges the soft palate through sounds or blowing does not automatically train the seal during swallowing.
From the nasopharynx, the Eustachian tube leads to the middle ear. This passage equalises the air pressure behind the eardrum and is normally closed. When you swallow or yawn, the tensor of the soft palate briefly pulls it open. Every swallow is therefore also a small pressure equalisation.
in Pittsburgh received a paralysis of the tensor on one side. Afterwards, the opening pressure and compliance of the Eustachian tube changed markedly5
of 20 people with middle ear infection in Rome showed reduced activity of the tensor on the affected side when swallowing6
Both are small studies, one of them in animals. They show, however, that this muscle helps determine the mechanics of the Eustachian tube. You can read more under Ear pressure and pressure equalisation and Middle ear infection in children.
The causal chain
“Slack soft palate”: cause or consequence?
Medical reports often state that the soft palate is slack or the uvula too long. That describes what can be seen. It does not say why it is so.
In our view, a slack soft palate is usually not the cause but the consequence. Muscles that are not integrated into their function are not used and lose tension. If the tongue lies low, the mouth is open and the swallowing pattern does not run cleanly, the soft palate lacks precisely the work that keeps it in shape.
The pattern deviates
The mouth is open, the tongue lies low, the head moves forwards. This often starts early, for example with a dummy or bottle.
The body compensates
The soft palate is lifted to close off the nose and loses contact with the back of the tongue. The nervous system stores this compensation as the preferred pattern.
The tissue follows
Whatever is not integrated into its task is not used and loses tension. The soft palate and uvula appear long and slack.
The complaints arrive
During sleep the soft palate vibrates and it gets loud. Swallowing, voice and ear ventilation can also be affected. When and how strongly depends on extent, duration and age.
Head balance also plays a part. The hyoid bone, larynx and throat hang in a network of muscles that starts from the base of the skull and the lower jaw. If the head moves forwards, the directions of pull in this network change, and with them the starting position from which the soft palate works.
That is why a slack soft palate rarely occurs on its own; it is often accompanied by mouth breathing and a low-lying tongue. You can read where the tongue belongs under Tongue resting posture and tongue reference position.
A sail does not become taut because you pull on it. It becomes taut because it is used.What matters, therefore, is to integrate the soft palate back into breathing, swallowing and head balance.
Snoring
The soft palate and snoring
During sleep, the baseline tension of the muscles drops. The soft palate becomes softer, the throat narrower, and every inhalation pulls on the soft walls.
When the throat becomes narrow, the air has to pass through faster. The soft tissue starts to flutter, and you hear this fluttering as snoring. In studies, the soft palate is regularly involved, but rarely on its own.
When the mouth is open, the lower jaw and tongue sink backwards. In our view, the soft palate then loses its support on the back of the tongue and vibrates more freely. That is why it often gets louder with the mouth open.
of 52 people with snoring or sleep apnoea showed vibration of the soft palate in a sleep endoscopy in Beijing, examined during drug-induced sleep7
also showed vibration of the side wall of the throat. In many, other sites vibrated as well, especially in pronounced sleep apnoea7
A research group in Chicago showed in eight people with sleep apnoea that the airway stays open through interplay. Each breathing pause began when the elevator, the palatoglossus muscle and the large tongue muscle were all at their least active at the same time. It only ended when all three reached their maximum together8. It is not one muscle that decides, but the pattern. You can read how we view snoring overall under Snoring and sleep apnoea.
If you use a CPAP machine or a splint because of sleep apnoea, do not stop using either on your own initiative. The training can be started alongside. Whether anything can change later is shown by a follow-up measurement in the sleep laboratory, decided together with your sleep medicine specialist. We do not recommend taping the mouth shut at night; you can read why under Mouth taping.
Assessing the exercises
Soft palate exercises: what gargling, singing and the didgeridoo can do
There are many soft palate exercises online. The well-known ones have a grain of truth: they put muscles in the throat to work.
Gargling
The base of the tongue rises and the soft palate works against the airflow. It is practised with the head tilted back, i.e. precisely not in the head balance of everyday life. We are not aware of any study on gargling for snoring.
“ng” sounds and vowels
With “ng” as in “gong”, the soft palate rests against the back of the tongue; with the following “a”, it rises. Exercises like these come from speech therapy.
Singing
In a pilot study from Exeter, 20 snorers practised singing for 20 minutes a day for three months. Snoring decreased on average; there was no comparison group12.
Didgeridoo
When playing, you breathe out against resistance. In Zurich, 25 people with moderate sleep apnoea practised for around 25 minutes on just under six days a week for four months11.
fewer breathing pauses and shallow breaths than the waiting-list group were recorded in the didgeridoo players after four months. Daytime sleepiness decreased11
was the fall in the number of breathing pauses and shallow breaths in 16 people in São Paulo after three months of exercises for the tongue, soft palate and throat wall. Nothing changed in the sham group9
was the fall in the number of loud snores in 19 snorers after three months of mouth and throat exercises10
In 2020, a Cochrane review, a particularly rigorous form of study analysis, pooled nine randomised trials with 347 participants. Compared with sham exercises, such exercises probably reduced daytime sleepiness, observed over two to four months. The certainty of the evidence ranged from moderate to very low13. None of these studies examined the FaceFormer.
Isolated soft palate exercise
- Trains individual muscles for the duration of the exercise
- Works with sounds, blowing or the head tilted back
- Swallowing, tongue reference position and nasal breathing are not specifically included
- In everyday life, the old pattern remains
FaceFormer training
- Practises lip closure, tongue, nasal breathing, swallowing and head balance in one sequence
- The soft palate works in its innate task, the seal during swallowing
- Mouth closed, tongue against the palate, soft palate against the back of the tongue: the position that should apply in everyday life
- The aim is a pattern that runs without thinking
Both approaches put muscles to work. They differ in whether this work carries over into everyday life.
In our view, isolated muscle training therefore falls short. The didgeridoo, singing or sounds can tone muscles, but the causes remain as long as mouth breathing, a low tongue and a disturbed swallowing pattern dominate everyday life. And because swallowing uses different parts of the elevator than speaking and blowing, the rule is: if you want to change the swallowing seal, you have to practise swallowing.
Putting treatments into context
Soft palate surgery: tightening, shortening, laser
When snoring or breathing pauses originate from the soft palate, surgery is often suggested. There are several procedures.
Uvulopalatopharyngoplasty (UPPP)
Parts of the soft palate and uvula are removed and the palatal arches tightened, often together with the palatine tonsils.
Laser-assisted uvulopalatoplasty (LAUP)
The uvula and the edge of the soft palate are shortened with a laser. The resulting scar is intended to stiffen the soft palate.
Radiofrequency
Tissue in the soft palate is heated via a probe. It scars, shrinks and becomes firmer.
How well surgery works depends heavily on patient selection. In a randomised trial at the Karolinska Institute in Stockholm, 65 selected people with moderate to severe sleep apnoea were operated on either immediately or six months later. After UPPP, the apnoea-hypopnoea index, the number of breathing pauses and shallow breaths per hour of sleep, fell by an average of 60 per cent, compared with 11 per cent in the waiting-list group. No serious complications occurred16.
with random allocation were found by a Swedish review in 2009 on the benefit of such operations. For laser and radiofrequency they demonstrated no benefit for daytime sleepiness, breathing pauses, quality of life or snoring15
had persistent side effects after UPPP or uvulopalatoplasty in the observational studies analysed, especially swallowing difficulties, a lump-in-the-throat feeling and a changed voice15
At the University of Ulm in 1989, the volume of snoring fell by 20 to 30 decibels after UPPP in snorers, but only slightly in people with sleep apnoea. The author concluded that the procedure does not help if the narrow point is not at the level of the soft palate14.
Surgery changes the shape. It does not change the pattern that lets the throat give way at night.The tissue in the soft palate has tasks in swallowing, speaking and pressure equalisation. What has been removed can no longer be trained.
In our view, the function belongs before the decision for a procedure. Tissue that has been shortened or removed cannot be brought back, whereas the training can be started before any procedure and continued afterwards. An operation can make sense in selected cases. Whether surgery is nevertheless performed in the end is something you decide with your ENT practice. An overview is given in FaceFormer and other treatments.
Training
Training the soft palate with the FaceFormer
For us, targeted “soft palate training” means integrating the soft palate back into the tasks it is built for. This happens through negative pressure, the swallowing sequence, the tongue reference position and nasal breathing.
The FaceFormer sits in the oral vestibule, behind the lips and in front of the teeth. The tip of the tongue rests at the reference point behind the upper front teeth, you breathe through the nose, and the head is balanced upright. In the basic exercise you press the lip wedge together, bite down briefly and swallow once. The video shows the pull exercise, in which you also pull.
With each of these swallows, the soft palate works in its innate task and under everyday conditions: mouth sealed, tongue against the palate, nose open, head in balance. In this way it is not strengthened in isolation but put back to use. The aim is for this pattern to run over time between the exercises and during sleep as well.
A pattern does not change through insight, but through precise, frequent repetition. That is why you train for a few minutes three times a day.
The free FaceFormer app guides you through the basic exercises. You will find all the modules, including the pull exercise and the head balance rotation, on the exercise pages.
- From day 1
Basic exercise
A few minutes three times a day with the FaceFormer ZERO; you increase the repetitions week by week.
- From around week 3
Pull exercise and night
The pull exercise is added. At night you wear the FaceFormer ZERO as soon as you have mastered the basic exercise.
- After a few weeks
Switching to the ONE
During the day you train with the FaceFormer ONE, the same size as the ZERO, just made of a firmer material.
- Over months
The pattern runs by itself
The exercise manual allows six to twelve months until the new sequences run without thinking.
On FaceFormer training itself, for snoring there is so far a pilot observation without a comparison group, presented as a poster in 2004. You can find out what studies exist and what is still missing under Studies and science.
Everyday life
Integrating the soft palate into everyday life
Lips closed, nose open
Except when speaking and eating, the lips rest loosely together. That way the soft palate rests against the back of the tongue and the air takes the route through the nose.
Tongue to the reference point
The tip of the tongue rests behind the upper front teeth without pressing. The back of the tongue follows when you swallow.
Swallow consciously
Every now and then, swallow consciously with closed lips and brief tooth contact. This is the movement in which the soft palate seals off the nasal cavity.
Pressure in the ears
When flying or in a lift, many people find it helpful to place the tip of the tongue and swallow consciously a few times. In doing so, the tensor of the soft palate pulls open the Eustachian tube.
Head in balance
Adjust your screen and seat so that your head is balanced over your body.
Sing if you like, as a supplement
If you enjoy singing, carry on. It just does not replace training the basic functions.
Increase gradually
If your tongue or throat tire at first, reduce the repetitions and build up more slowly. Sticking with it counts more than strength.
Questions
Frequently asked
Can the soft palate be trained?
Yes. The soft palate is made of muscles, and muscles adapt their tension to what is demanded of them. In our view, what matters is less the isolated strength exercise than integration into breathing, swallowing and head balance. That is exactly what FaceFormer training practises.
What exercises are there for the soft palate?
Common ones are gargling, “ng” sounds alternating with vowels, singing and the didgeridoo. They put muscles in the throat to work, and there are small studies on singing and the didgeridoo. In our view they fall short as long as mouth breathing, a low tongue and a disturbed swallowing pattern dominate everyday life.
What does a slack soft palate mean?
The soft palate and uvula appear soft and long and vibrate slightly during sleep. In our view, this is usually the result of the palate being used too little in everyday life, for example with mouth breathing or a low-lying tongue.
Does soft palate training help with snoring?
Studies on mouth and throat exercises show that snoring can be influenced by training, though with programmes other than FaceFormer training and over short periods. The training targets the basic functions. In our view, an improvement in snoring is a frequent consequence, not a promise.
When does soft palate surgery make sense?
In selected people with sleep apnoea whose narrowing lies at the soft palate, uvulopalatopharyngoplasty can markedly reduce the pauses in breathing. For laser and radiofrequency, robust evidence of benefit is lacking. Persistent side effects are not rare. In our view, training the function belongs before this decision, because what has been removed can no longer be trained. Whether surgery is performed is something you decide with your ENT practice.
What does the soft palate have to do with the ears?
The tensor muscle of the soft palate briefly pulls open the Eustachian tube with every swallow and every yawn, thereby equalising the pressure in the middle ear. In our view, an unclean swallowing pattern can therefore also affect ventilation of the ears.
How long does it take to train the soft palate?
A pattern changes through repetition. The exercise manual reckons on six to twelve months until the new sequences run without thinking, followed by maintenance training. How quickly you notice changes varies from person to person.
Can I train while using a CPAP machine?
Yes, the training can be started alongside positive airway pressure therapy. Do not stop using the device on your own initiative. Whether it can be reduced later is shown by a follow-up measurement in the sleep laboratory, and you decide this together with your sleep medicine specialist.
More articles from the knowledge section
Where to go next
Sources
- Perry JL (2011). Anatomy and physiology of the velopharyngeal mechanism. Seminars in Speech and Language 32(2):83-92. PMID 21948636. Source
- Tangel DJ, Mezzanotte WS, White DP (1995). Respiratory-related control of palatoglossus and levator palatini muscle activity. Journal of Applied Physiology 78(2):680-688. PMID 7759440. Source
- Nohara K, Kotani Y, Ojima M, Sasao Y, Tachimura T, Sakai T (2007). Power spectra analysis of levator veli palatini muscle electromyogram during velopharyngeal closure for swallowing, speech, and blowing. Dysphagia 22(2):135-139. PMID 17333429. Source
- Kuehn DP, Moon JB (1994). Levator veli palatini muscle activity in relation to intraoral air pressure variation. Journal of Speech and Hearing Research 37(6):1260-1270. PMID 7877285. Source
- Ghadiali SN, Swarts JD, Doyle WJ (2003). Effect of tensor veli palatini muscle paralysis on eustachian tube mechanics. Annals of Otology, Rhinology and Laryngology 112(8):704-711. PMID 12940669. Source
- Picciotti PM, Della Marca G, D’Alatri L, Lucidi D, Rigante M, Scarano E (2017). Tensor veli palatini electromyography for monitoring Eustachian tube rehabilitation in otitis media. Journal of Laryngology and Otology 131(5):411-416. PMID 28294083. Source
- Xu HJ, Jia RF, Yu H, Gao Z, Huang WN, Peng H, Yang Y, Zhang L (2015). Investigation of the Source of Snoring Sound by Drug-Induced Sleep Nasendoscopy. ORL Journal for Oto-Rhino-Laryngology and Its Related Specialties 77(6):359-365. PMID 26460924. Source
- Carlson DM, Onal E, Carley DW, Lopata M, Basner RC (1995). Palatal muscle electromyogram activity in obstructive sleep apnea. American Journal of Respiratory and Critical Care Medicine 152(3):1022-1027. PMID 7663778. Source
- Guimarães KC, Drager LF, Genta PR, Marcondes BF, Lorenzi-Filho G (2009). Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome. American Journal of Respiratory and Critical Care Medicine 179(10):962-966. PMID 19234106. Source
- Ieto V, Kayamori F, Montes MI, Hirata RP, Gregório MG, Alencar AM, Drager LF, Genta PR, Lorenzi-Filho G (2015). Effects of Oropharyngeal Exercises on Snoring: A Randomized Trial. Chest 148(3):683-691. PMID 25950418. Source
- Puhan MA, Suarez A, Lo Cascio C, Zahn A, Heitz M, Braendli O (2006). Didgeridoo playing as alternative treatment for obstructive sleep apnoea syndrome: randomised controlled trial. BMJ 332(7536):266-270. PMID 16377643. Source
- Ojay A, Ernst E (2000). Can singing exercises reduce snoring? A pilot study. Complementary Therapies in Medicine 8(3):151-156. PMID 11068344. Source
- Rueda JR, Mugueta-Aguinaga I, Vilaró J, Rueda-Etxebarria M (2020). Myofunctional therapy (oropharyngeal exercises) for obstructive sleep apnoea. Cochrane Database of Systematic Reviews 11:CD013449. PMID 33141943. Source
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- Franklin KA, Anttila H, Axelsson S, Gislason T, Maasilta P, Myhre KI, Rehnqvist N (2009). Effects and side-effects of surgery for snoring and obstructive sleep apnea: a systematic review. Sleep 32(1):27-36. PMID 19189776. Source
- Browaldh N, Nerfeldt P, Lysdahl M, Bring J, Friberg D (2013). SKUP3 randomised controlled trial: polysomnographic results after uvulopalatopharyngoplasty in selected patients with obstructive sleep apnoea. Thorax 68(9):846-853. PMID 23644225. Source
Get started
Ready for the training?
The free FaceFormer app guides you through the basic exercises, counts along and reminds you of your sessions. If you wish, a practice from the practitioner directory can support you.
FaceFormer ZERO + ONE
Both material hardnesses for getting started, day and night. The set for adults.
FaceFormer ZERO
The softer FaceFormer for getting started, for children and for the night.
FaceFormer ZERO Children’s Set
ZERO with hygiene box, plush bag and success book with stamp.
FaceFormer training aims to restore the physiological setting of the basic functions of breathing, swallowing and head balance, with lip closure and the tongue reference position, thereby creating the conditions under which symptoms can improve. It does not replace a medical assessment. You can find practitioners near you in the practitioner directory.
