Using CPAP When You Mouth Breathe

It is fairly common for people with obstructive sleep apnea to breathe through their mouths. Since continuous positive airway pressure (CPAP) is the most recommended, and effective, treatment for this condition, it is natural to question: Can I use CPAP if I mouth breathe and avoid a dry mouth? Learn whether this is possible and discover what accommodations might allow you to use CPAP without difficulty.

Why CPAP Users So Often Mouth Breathe

Our airway works best when we consistently breathe through our nose. This decreases evaporation that can contribute to dry mouth. It also strengthens the muscles of the upper airway, including those that line the throat. If you have difficulty breathing through your nose, the default option is to breathe through your mouth. Many people with sleep apnea have an obstruction within the nose that leads to increased mouth breathing. What are the effects of this? 

Over time, persistent mouth breathing may cause changes in our airway’s anatomy. The muscles of the jaw relax to allow the mouth to be open. Over time, this can cause the face to become elongated, especially among children who are not fully developed. The tissues lining the nasal passage may also become swollen with the vibration of snoring. In some cases, this may cause the nasal passage to collapse and further close. As a result, it becomes even more difficult to breathe through the nose and more mouth breathing occurs. This can worsen sleep apnea as well as snoring.

In general, mouth breathing is less stable. The soft tissues, especially the palate, are more prone to collapse. When the mouth opens, the jaw becomes free to move and it may shift the tongue back into the throat, especially when sleeping on the back. Although mouth breathing is a common characteristic among those with sleep apnea, many will find that sufficient airflow delivered via CPAP can open the nose up. This may require some accommodations.

When It’s the Nose That Leads to a Dry Mouth

If you breathe through your mouth because you cannot breathe through your nose, it is important to target therapies to open up the nasal passage. Nasal obstruction may be relieved by treating allergies or with surgery to treat a deviated septum.

Allergy treatment can be initiated by your primary care doctor, sleep specialist, or by an allergist. It may be helpful to use saline sprays or even sinus rinses delivered through a Neti pot. This will clear away allergens that may cause irritation and swelling of the lining of the nose called the nasal mucosa.

Oral medications may be used to treat allergic rhinitis. Some are available over-the-counter, such as Allegra (fexofenadine), Claritin (loratadine), and Zyrtec (cetirizine), and others require a prescription such as Singulair (montelukast).

Nasal steroid sprays can also be helpful. They work as an intranasal glucocorticoid, coating the lining of the nose and decreasing the allergic reaction. These steroid sprays can reduce the swelling of the tissues in the nose called turbinates. Some are now available over the counter without a prescription, including Nasacort and Flonase. There are also multiple other prescription options including:

• Nasonex
• Astelin
• Rhinocort

Some people find benefit from using a Breathe Right nasal strip to increase the caliber of the nose. This may open up the passage and allow you to breathe a little easier.

It can also be helpful to consider surgery if your anatomy is contributing to the obstruction. A deviated nasal septum may be corrected with septoplasty and enlarged nasal turbinates can be reduced in size with radiofrequency ablation.

Alternatives to Avoid Mouth Breathing on CPAP

If you are trying to use CPAP, you should ensure that you use your heated humidifier at an optimal setting. Adjust it to maximize the amount of moisture delivered to your nose. Water that is left in the tank in the morning does you no good; instead, get as much as you can delivered through your mask overnight. It can also be helpful to use heated tubing to avoid condensation within the tubing.

If your mouth falls open with a nasal mask, you may experience extreme dry mouth. You may awake in the morning with your tongue as dry as the Sahara desert. If this happens consistently, consider using a chinstrap to support your jaw and keep your mouth closed. In addition, you may consider switching to a full-face mask that covers both your nose and mouth. This will prevent air from escaping from your mouth as it will all be on the same circuit.

Occasional dryness may be tolerated. Simply drinking a little water or using rinses like Biotene to improve oral dryness may be used. However, if you experience consistent dry mouth in the morning upon awakening, you should speak with your equipment provider or sleep specialist about the options available to you.

You should not need to drink water in the night or wake with a parched mouth in the morning. If it is a frequent problem, this dryness could lead to damage to your teeth or gums. Therefore, it is important to find a solution that prevents mouth breathing on CPAP, which may require looking to treatments to open up your nose.

The good news is that many people who were mouth breathers previously are able to adapt and with CPAP can breathe better through their nose both day and night.