How does mouth breathing impact sleep apnea?

[balor123]

When I had my sleep study done, I couldn't breath through my nose at all. My titration was done while breathing through my mouth then. I'm told from a clinical exam that I have a nice airway. An ENT looked in my throat and said he wouldn't believe that I have sleep apnea absent the sleep study. Other times others have noted that I have a long soft palate, narrow arch, large tongue for my mouth, and high palate however they're all pretty minor. Anyway, mostly I have hypopneas, not apneas, and it makes me wonder, once I get treatment so that I can reliably breath through my nose, how will that impact my sleep study results? Will they be the same or is it possible that my results could significantly improve? It seems to be that if there was space between my tongue and uvula before, then opening up a passage that goes behind the uvula should really improve things, assuming that's the primary location of obstruction of course. Is my thinking correct?

[ChicagoGranny]

once I get treatment so that I can reliably breath through my nose

What treatment are you pursuing? Why do you have problems breathing through your nose?

[balor123]

I took a course of Levaquin and am using Flonase right now. It's definitely helped with average congestion but not those acute bouts. I've gone from nose breathing 25% of the time to 75% of the time. However, most of the time I still feel a good amount of resistance and I suspect that I'm getting nocturnal reflux again as a result. I have a nasal spray but I don't think it does much - I'm going to try a rinse or Neti pot next I think. I'm also going to ask about Astelin. Any other things I should try before looking for surgery?

I'm scheduled for a CT scan in ~1 week. Debating whether I should do it to see if there's an anatomical problem or if I should demand more medication in the mean time. If he pushes for surgery, then I'm planning on asking for balloon sinuplasty before turbinate reduction. I'm located in Austin, TX btw - I don't know if you can recommend any particularly good surgeons for this problem nearby.

I visited an allergist as well. My blood tests were boring but I had a lot of strong reactions on the skin test, particularly dust mites and grasses. I'm taking Allegra 180mg for that right now but have noticed absolutely no difference from it.

[ChicagoGranny]

Any other things I should try before looking for surgery?

A good ENT will have you try some things. My husband had nasal surgery (reduction of nasal turbinates size and correction of deviated septum). The surgeon first tested him for allergies to see if that was the cause of enlarged turbinates and it wasn't. Then he put him on a strict 6-week course of cortisone spray to see if the turbinates were inflamed. The cortisone did not work so they did surgery. My husband is very happy about the results of the surgery.

[Julie]

It impacts treatment because if your mouth is wide open (or even just your lips... chin straps are not always effective that way) the air being sent in by Cpap that's meant to open your airway gets lost to the room instead. A FF mask allows you to breathe with your mouth open, but therapy air is not lost.

[BlackSpinner]

It is like having holes in your water canteen, some of it may get where you are going but most will be lost along the way.

[LSAT]

If you mouth breathe you can use a FF mask...life goes on.

[Janknitz]

Many people have sinus congestion from food sensitivities they don't realize they had. The most common culprits are dairy and wheat. Notice I didn't say food ALLERGIES. You may test negative for food allergies and still have a response. The ONLY way to tell is to eliminate these from your diet ENTIRELY for a period of time (2 weeks minimum, 30 days is better) and then see how you do on re-introduction.

Personally, I'd try such an elimination diet long before I'd consent to go under the knife and have my anatomy rearranged. If the underlying issue turns out to be a food sensitivity, you could go through all of that pain and expense and STILL have the problem.

Any ENT you talk to is going to deny that a food sensitivity could be the issue. Our doctors who take the Hippocratic Oath have forgotten another important thing that Hippocrates said--"Let food be thy medicine."

[balor123]

Many people have sinus congestion from food sensitivities they don't realize they had

I follow a strict gluten free diet. I eliminated dairy for a few months. I don't really get mucus, my turbinates just swell up for no obvious reason. It often changes over just a few minutes and seems to come and go as it pleases. I hadn't aimed for reintroduction over a 30 day period though. What foods do you keep when you're eliminating? I follow a Paleo diet but I get the impression just about everything can be a source of problems.

If you mouth breathe you can use a FF mask...life goes on.

It causes dental problems. Gum inflammation, cavities, and bite changes to name a few. Some people say mouth breathers hyperventilate and don't get enough NO, among other benefits noses provide for the lungs.

It impacts treatment because if your mouth is wide open (or even just your lips... chin straps are not always effective that way) the air being sent in by Cpap that's meant to open your airway gets lost to the room instead. A FF mask allows you to breathe with your mouth open, but therapy air is not lost.

I don't understand. I can use nasal pillows and have my mouth wide open while awake with no air leakage through my mouth. Of course, I can let air escape that way but it's not a function of whether the lips are apart so much. However, it's hard to keep up with higher pressures on the machine I've noticed. Air escaping through the mouth is quite disruptive so I'm pretty sure I maintain it most of the night, except when my nose becomes blocked and then I just struggle to breath. Even with air escaping into my mouth, I haven't found that my lips are all that strong at keeping it in.

A good ENT will have you try some things. My husband had nasal surgery (reduction of nasal turbinates size and correction of deviated septum). The surgeon first tested him for allergies to see if that was the cause of enlarged turbinates and it wasn't. Then he put him on a strict 6-week course of cortisone spray to see if the turbinates were inflamed.

That's where I am right now. Testing shows I have bad allergies but treatment for allergies hasn't helped. Also, other than turbinates swelling up, I don't have many symptoms of allergies. My blood tests weren't even interesting I just got a lot of excitement from the skin tests.

[49er]

balor123,

As an FYI, I am seeing ENT #2 next week for a 2nd opinion regarding having a turbinate reduction and a deviated septum corrected so I can better tolerate pap therapy which so far, I have been unable to do in spite of trying everything I can think of to make things work. While it is my understanding in reviewing medical citations that having nasal issues can definitely make sleep apnea worse, it is not the prime cause of it. In my situation, I have a narrow jaw and a tongue too big for my mouth.

Your concerns about mouth breathing are definitely legitimate. And furthermore, I have read anecdotal cases of people having dental problems after wearing full face masks. Of course, that doesn't prove anything but as one who developed alot of dental problems thanks to psych meds long term, that would definitely be a concern to me.

Anyway, if you want to PM me to talk further, please do as obviously, having surgery is not an easy decision. Good luck with everything.

49er

[Julie]

Don't compare awake experiences with sleeping ones while on the machine... they're very different. How you breathe while awake is not the same as you do when sleeping and the machine senses the difference and responds to that (though of course it doesn't actually 'know' you're awake or asleep, but rhythms of inhaling and exhaling are different, as are amounts of 02 you take in and use.

[ChicagoGranny]

I don't understand. I can use nasal pillows and have my mouth wide open while awake with no air leakage through my mouth. Of course, I can let air escape that way but it's not a function of whether the lips are apart so much. However, it's hard to keep up with higher pressures on the machine I've noticed. Air escaping through the mouth is quite disruptive so I'm pretty sure I maintain it most of the night, except when my nose becomes blocked and then I just struggle to breath. Even with air escaping into my mouth, I haven't found that my lips are all that strong at keeping it in.

If I understand it correctly, you were originally prescribed a FFM. Your doctors would only do this if you were observed mouthbreathing and losing the therapeutic pressure during a sleep study.

Do you want your therapy to work? Use a FFM.

[Denial Dave]

+1

If you mouth breathe you can use a FF mask...life goes on.

[balor123]

If I understand it correctly, you were originally prescribed a FFM. Your doctors would only do this if you were observed mouthbreathing and losing the therapeutic pressure during a sleep study.

It hasn't been my experience that doctors do all that much. The sleep technician observed that I was struggling to breath with the nose mask and replaced it with a FFM to see if that would work better. I had trouble with it at first but my home healthcare company had the best nurse. I tried probably another dozen masks. In the end, I went back to the original FFM! It wasn't until 2 years later that I tried nasal pillows. No one ever mentioned the problems that mouth breathing causes.

Do you want your therapy to work? Use a FFM.

I didn't think much of it until I started having jaw pain. Research shows that jaw pain comes from chronic low levels of muscle tension. The FFM does that, since the only way to maintain a good seal is to have it tight against the jaw. Unfortunately, switching the nasal pillows didn't help because then I started clenching from the airway collapsing instead.

She also points out that the pressure from the mask isn't great for the joints, nor is keeping my mouth open all night to breath through it. I already have a messed up bite (3-4mm anterior open bite, class 3 maloclussion) with a lot of tooth damage. My gums swell up often from the dryness and I'm more prone to cavities.

I'm using the FFM again now but I know it's only a temporary measure. I'm thinking of switching to a hybrid mask, where I can still use nasal pillows but if air escapes during the night through my mouth I shouldn't lose therapy. I've always struggled with leakage and as I recall that mask was no different. Sleeping on my back helps with leakage but I need to sleep on my left side to minimize reflux. I've found that the pressure from the mask is greater on my face when on my back too.

[Julie]

"The FFM does that, since the only way to maintain a good seal is to have it tight against the jaw."

That is absolutely untrue! She has no idea what's she's talking about. Try the Hybrid or other masks, but get them fitted properly by someone who knows what they're doing, or follow online video help which you can probably access from Cpap.com (or ask them to link you to some).