Mouth Breathing and Obstructive Sleep Apnea

Posted on October 30, 2017 by Dr. Erin Elliott

The normal “mode of breathing” is through the nose. However, many people breathe through their mouth. The primary reason is because of nasal congestion. This could be due to allergies, chronic sinusitis, inflammation or some kind of physical obstruction (polyps, deviated septum, or trauma). Another explanation could be from a “habit” often stemming from early life. I meet many patients that breathe through their nose fine, but “just don’t” or “never have.”
During childhood, chronic oral breathing can negatively affect growth of the face and oral cavity such as: development a “long” face, narrower upper and lower jaws, high palate and overly crowded teeth. Ultimately, this results in restricted airway and sinuses which can affect breathing as an adult.
Why is nasal breathing so important? For one, your nose is a filter, not your mouth. Your nose filters out germs, dust, particles and allergens. Oral breathers tend to suffer from more upper respiratory infections because of a build-up of mucous in the nose. And viruses and bacteria easily enter through the mouth and can cause lung infection and inflammation of the tonsils. Over breathing is also common which disrupts normal blood-gas balance in your lungs decreasing oxygen to your brain and tissues. Your nose also contains nitric oxide. This is a gas inside your nose that is taken into the lungs. It has a whole host of benefits, including the ability to increase oxygen content up to twenty five percent. Additionally, mouth breathers often have dry mouths. Dry mouth is one of the leading causes of cavities and periodontal disease. Also, because of breathing compensation, oral breathers tend to have a forward head position posture. With the head positioned in this manner, an over curvature of the neck occurs leading to neck, back and facial pain. And lastly, it is a risk factor for snoring, sleep apnea and upper airway resistance syndrome.
Studies have found that oral breathing can induce obstructive sleep apnea (OSA) or make it worse by increasing airway collapse and nasal resistance (1). It’s like a vicious cycle—the more that you oral breath, the more nasal resistance (congestion), thus, more problems with sleep apnea. What’s even more alarming is that oral breathing even reduces the effectiveness of oral appliance therapy (2) and more patients become intolerant of the CPAP machine and not compliant using it (3). Therefore, not only could you have incomplete resolution of OSA with continued oral breathing but conventional sleep apnea treatments may not work as well. Therefore, correction of nasal resistance and oral breathing should be part of sleep apnea treatment (4).
So, if you are a mouth breather here are a few suggestions. It will make a huge difference in not only your sleep but your overall health. Firstly, any chronic nasal congestion must be addressed. You must be able to breathe clearly through your nose. A referral to an allergist or ENT may be warranted for treatment, but natural remedies many be helpful in the absence of pathology. Reduce allergens around the house and in your diet. Dust, dander and dairy are the biggest culprits for nasal congestion. Make sure bedding is thoroughly clean, change pillows regularly and make Fido sleep somewhere other than your bedroom. Breathe-rite strips, nasal cones, saline rinses or chin straps may also be helpful. Regular exercise such as yoga or cardio are a benefit. And lastly, myofunctional therapy, which is like physical therapy for your airway, is an important co-treatment to obstructive sleep apnea. It’s conservative, low cost and hugely beneficial. Studies conclude that myofunctional therapy alone reduces the severity of sleep apnea by as much as 50% (4). Often, those with OSA also have weak or under functioning airway muscles (5). Myofunctional therapy remodels the airway by toning the soft palate and oropharynx and positions the tongue on the palate. Improving the function of upper airway muscles is extremely important to reduce collapsibility. Lastly teaching patients to keep their mouth closed and nasal breathing decreases obstruction and severity of OSA.
There are many ways to stop the cycle of oral breathing. It’s an important step to make, especially for those affected with sleep apnea. If you have more questions about oral breathing, please don’t hesitate to call Spokane Myofunctional Therapy at 509-467-1117.
Sleep Well, Always!

Tamara Anderson is a dental hygienist and myofunctional therapist for Dr Robb Heinrich, DDS, Sleep Better Northwest and Spokane Myofunctional Therapy. She specializes in sleep apnea and mouth breathing in children and adults.

(1) How Does Open Mouth Breathing Influence Upper Airway Anatomy.
Seung Hoon Lee, MD; Ji Ho Choi, MD; Chol Shin, MD; Heung Man Lee, MD; Soon Young Kwon, MD; Sang Hag Lee, MD. The Laryngoscope. 2007 Vol. 117. Issue 6.

(2)Influence of Nasal Resistance on Initial Acceptance of Continuous Positive Airway Pressure in Treatment for Obstructive Sleep Apnea. Sugiura T., Noda A., Nakata S., Yasuda Y., Soga T., Miyata S., Nakai, S., Koike. Y. Respiration. Volume 74, No. 1, 2000.
(3)Effect of Improved Nasal Breathing on Obstructive Sleep Apnea. Friedman, M., Tanyeri, H., Lim J., Landsberg R., Vaidyanathan K., Caldarelli, D. Otolaryngolgy Vol. 122., Issue 1., 2000.
(4)Myofunctional Therapy to Treat Obstructive Sleep Apnea: A Systemic Review and Analysis. Camancho M., Certal V., et al. SLEEP, Volume 38, No. 5., 2015.
(5)Obstructive Sleep Apnea. The Importance of Oropharyngeal Structures. Schellenberg J., Maislin G., Schwab R., DOI: http://dx.doi.org/10.1164/ajccm.162.2.9908123.
August 30, 1999.
Therapy to Treat Obstructive Sleep P, 2015