“Doc, I’m still snoring.” “My mouth is so dry I’m not able to use my device.” These are common signs your patient is A) not happy with therapy and B) not breathing solely through their nose.
I am a nose geek, fascinated by the layers of physiologic support provided by what most people think about only in the negative. A cold, allergies, sinus infection, or perceived poor esthetics bring the nose to mind, but breathing through this remarkable organ supports every cell of the body in ways open-mouth breathing can never do.
The Nose is the First Line of Body Defense
We know about the conditioning nose breathing provides – warms, humidifies, cleans the air to protect delicate lung tissue. In the age of COVID we learned that viruses are trapped there as the first line of body defense. Maybe you’ve heard of nitric oxide, a multifunctional molecule generated from nasal mucosa. NO supports the vital surfactant that keeps lung alveoli from collapse, among dozens or hundreds of other body functions. NO is not supplied by any oral tissue.
Nasal Breathing with an Oral Appliance
We provide oral devices to keep the back of the throat open during sleep. Collapse of oropharyngeal walls interrupts respiration and that means trouble. Oral devices can make it hard to keep the lips closed. If we solve one problem yet create another by not promoting nasal breathing, we are not being good enough doctors.
Our patients must breathe through their noses while they use the mandibular advancement devices. Sounds simple, but some folks have been mouth breathing so long they have ingrained habits. Others have not solved allergy problems in their sleeping environments. Many patients with poorly formed maxillae have structural narrowing of their nasal cavity that restricts airflow.
Clinicians, How Can You Help?
First, make sure they understand the importance of nasal breathing and recognize how much better it feels to breathe through an open nose. Provide saline rinse samples, prescribe nasal steroids (yes, you can) and, above all, set expectations. Make it part of your breathing and airway support therapy to ensure good nasal use. Have them breathe for two minutes without ever opening their lips. If you want a bit more vigorous test, have them walk in your office hallway for those two minutes. If they feel air hunger during this test, help them clear their nose. Saline spray with xylitol is a helpful, benign, agent.
Have you heard of lip tape? While some consider it controversial, keeping the lips together during sleep has a long history. Weston Price, a dentist who studied breathing in aboriginal populations, noticed mothers pinching the mouths of babies closed to promote proper nose breathing. Papers in early 20th century scientific publications mention mouth closure as a strategy. Lip taping can be done with simple medical grade paper tape or specialized products designed for that purpose like MyoTape.
Mouth Shield to Promote Nasal Breathing
What about dental device design? Does the one you have in mind for your patient easily allow the lips to seal? Most people will close their lips, if they can, and if their nose is clear. If you deliver a device and they cannot close their lips over the front, you must help them by providing lip tape or an equivalent, along with instructions. This takes more time and makes the solution more complex – two barriers to the optimum outcome.
The TAP Sleep Care system addresses this more simply. Every TAP device has a thin, soft, flexible silicone Mouth Shield that slips under the lips to seal the mouth against unwanted airflow. The patient’s lips do not need to strain to close or be pulled together with tape. A side benefit is extra saliva from early appliance use is kept in the mouth.
Help your patients achieve their best respiratory support by making sure they only breathe through their nose. When they breathe better at night, the benefits extend to the daytime, too. Some people may have been given a treatment plan involving resective nasal surgery – by helping them breathe better, you can often give them hope for a non-invasive option. While sometimes that is necessary, it’s not as often as most doctors recommend. Nasal disuse distorts tissue in the nose. Breathing more through your nose creates better breathing through your nose.