Can Mouth Breathers Overcome CPAP Mask Leak?
Mouth breathing can lead to multiple health problems.
It can also creates challenges for people using PAP therapy. How might these folks overcome this treatment obstacle?
We’re built to breathe through the nose
Anatomically speaking, nasal breathing serves us the moment we’re born, as it supports breastfeeding.1
Breathing through the nose filters, heats, and humidifies air before delivering it to the lungs. Our central nervous system (CNS) also relies on nasal breathing during sleep to help communicate respiration needs to the brain.2
Respiration describes gas exchange within the respiratory system. When we inhale, we breathe in oxygen. When we exhale, we release excess carbon dioxide.
For proper function, the body must maintain a balance between oxygen and carbon dioxide. An imbalance alters body chemistry in a way that causes both acute problems (such as asthma attacks) and chronic problems (such as obstructive sleep apnea).
When we can't breathe through the nose
Blocked nasal breathing, for any reason, causes chemistry imbalances in the body that force a stress response. The brain reacts by prompting the body to breathe through the mouth.
This is a useful safety mechanism for temporary breathing issues. It’s when we constantly mouth breathe that this quick fix becomes an abnormal learned response.
Some causes of mouth breathing include:3-5
- Congenital conditions (such as Down syndrome)
- Chronic nasal congestion (such as due to untreated allergies)
- Learned behavior developed over years of inefficient breathing (such as due to untreated deviated septum)
Mouth breathing compromises:4,6-8
- Oral health. Dry mouth, in particular, causes cavities, reduced salivary flow, and periodontal infection
- Orofacial development in children
- Behavior in children, and is linked to ADHD
- Breathing while asleep. Mouth breathing renders the upper airway muscles less efficient, increasing the chance that these tissues in the throat collapse during sleep. This potentially leads to snoring or obstructive sleep apnea
When mouth breathers use CPAP
Oral leaks occur when the pressurized air delivered by PAP leaks through the open mouth. This cancels the therapeutic benefits of the treatment. The following represent three options for mouth breathing prevention.
Note: The American Academy of Sleep Medicine (AASM) only supports the use of FFM or chin supports to prevent mouth breathing while using PAP therapy.9
Full face mask (FFM)
Also called an oronasal mask, this PAP mask covers both the nose and mouth. This allows the mouth to open of its own free will without compromising the effectiveness of the therapy.
For the FFM to work, it must fit correctly to achieve a good seal. Tip: Check your fit while reclined in your favorite sleeping position. While sitting or standing, your profile—and especially the position of your jaw—shifts when compared to your profile while lying down. Check for gaps where it fits around the contours of your cheeks, the bridge of your nose, and your chin.
Facial hair will also affect the quality of your mask seal, so this may factor into choosing the FFM.
A chin strap or other support may be partnered with a nasal pillow (for lower pressures) or a nasal mask (for higher pressures). This gently holds the mouth closed during sleep.
For people who don’t like the FFM, the chin support option remains attractive and popular. And for good reason: more than 15 years of research supports the use of a chin support or chin strap to reduce oral leak while using nasal forms of PAP.10
This “hack” involves the use of medical-grade tape to literally seal the mouth shut at bedtime. In spite of its popularity, mouth taping remains scientifically unproven and potentially unsafe.11-13
The most concerning risk for mouth taping is aspiration — the breathing in of substances unintended for the respiratory tract. Such substances include the products of vomiting or expectoration due to acid reflux, excessive saliva, influenza, or foodborne illness.
A taped mouth won't let you spit without first removing the tape. Sometimes, coughing or spitting occurs during your sleep without warning. This places you at risk for concerns like aspiration pneumonia, lung infection, chronic cough, asthma, or bronchitis.
Other mouth taping risks include:14,15
- Allergic responses to the tape material
- Skin damage caused by adhesives
- Chronically chapped lips
- Aerophagia caused by pressurized air directed into the mouth instead of down the airway. This causes air swallowing, leading to excessive bloating and gassiness. For some, aerophagia is the chief reason they reject PAP therapy
- Inhaling or swallowing tape not anchored properly to the face. To prevent this, try a U-shaped strip of medical tape applied to the corners of the mouth, allowing the lips to open
Have you struggled with mouth breathing? Have you tried any methods to prevent it? Tell us more!
What did you do before your first sleep study? (check all that apply)