How to Prevent Mouth Breathing and Dry Mouth When Using CPAP Therapy

Opening the nose, using a chinstrap, and adjusting device settings may help

Chinstraps are one treatment that can help mouth breathing and dry mouth with CPAP therapy for sleep apnea
Chinstraps are one treatment that can help mouth breathing and dry mouth with CPAP therapy for sleep apnea. Credit: Brandon Peters, MD

If you struggle with mouth breathing or dry mouth while using continuous positive airway pressure (CPAP) therapy for sleep apnea, keep in mind that there are several things you can do that will help. Discover how to avoid mouth breathing by opening the nose, using a chinstrap, and adjusting device settings.

What Causes Mouth Breathing on CPAP and Why Does It Matter?

First, you may be wondering: Why is mouth breathing with the use of a CPAP machine bad?

The CPAP delivers a constant flow of air that is meant to keep your upper airway open so you can breathe easy. However, if your mouth falls open while the air is being delivered through your nose via a mask, it will escape. This can cause an uncomfortable sensation. It can also dry your mouth or throat out. This may also lead to problems with your gums or teeth. Most importantly, it may reduce or eliminate the effectiveness of your treatment.

Mouth breathing may occur for a few reasons, but it most commonly occurs due to a blockage within the nose. If you can't breathe through your nose, you will start to open your mouth at night, especially when you are asleep. Some people may have an anatomical problem, like a deviated septum. If you have allergies or nasal congestion, such as can be worsened with a cold, this will likewise be a problem. Tissues called nasal turbinates can swell within the nose and block off the delivery of air.

If you know that you are a mouth breather during the day, there is a high chance that you are also a mouth breather at night.

How to Fix Nasal Obstruction and Open the Nose

It is important that you be able to take breaths through your nose without a sense of the air meeting resistance. If you have allergies, you may need to speak to your doctor about treating them with oral medications or nasal steroids.

You may also find it helpful to rinse your nose with saline from a neti pot, which delivers warm water into your nose and sinuses.

If you have a deviated septum, this may need to be corrected with surgery. Turbinates may also be reduced with a surgical procedure that may open the nose. These surgeries are typically done by an ear, nose, and throat (ENT) specialist.

Use a Chinstrap to Keep the Mouth Closed

If it is a simple matter of your mouth falling open, this can be corrected with a chinstrap. A chinstrap is usually a piece of fabric, often fitted with Velcro, that can be secured around your lower jaw and the top of your head. It will keep your mouth closed and often corrects mouth breathing on CPAP.

It may not be a cure-all, as some people may still have problems that persist despite the use of a chinstrap, either snoring or having their lips buzz as the air continues to escape. Chinstraps may not be comfortable and, unfortunately, many people stop using them.

What If Mouth Breathing Occurs Due to a CPAP Equipment Problem?

The next likely culprit may be your CPAP mask or machine. If the mask is not fitting properly, it may leak or cause other problems. If the air is escaping, moisture may be lost with it.

 It is important to follow basic fitting guidelines, which take into account your unique facial features and find a mask that suits you well. If air is leaking from your mouth, this presumes you are using a mask that delivers the air into your nose.

One possible solution is to try a full-face mask that covers both your nose and mouth (or even one that delivers the air directly into your mouth). This will allow mouth breathing to occur with CPAP. It is important that the mask not leak. In addition, the mask must not cause the lower jaw to shift and block the airway. This is more likely to occur if the mask fits poorly and is overly tightened.

Regardless of the mask type that you choose, it is highly recommended that your machine is fitted with a heated humidifier and heated tubing. The humidified air will keep the nose, mouth, and throat moist and this will make things more comfortable and tolerable. If possible, turn up the settings to deliver more moisture. Make sure to avoid water condensation in the tubing by not turning the settings up too high.

In addition, the pressure of the device may need to be adjusted by your doctor. Sometimes a high pressure may cause the mouth to come open. In addition, sleep apnea should be resolved to ensure persisting events are not leading to mouth breathing. If you are uncertain as to the effectiveness of your therapy, or if settings need to be changed, it may be time to make a visit to your sleep medicine doctor.

Further Troubleshooting of Mouth Leaks and Alternative Treatments

If your problems persist, you may need to seek out other interventions. It may be necessary to have a repeat sleep study to ensure that you have a proper amount of pressure delivered. In some cases, it may be helpful to switch to bilevel therapy. If you have old equipment, you should have this checked. As the equipment ages, the pressure that is delivered may wane through leaks or other problems.

Some people have even tried taping their lips, which is discouraged if you are at risk of vomiting due to the likelihood of aspiration. Drinking a little water or using Biotene rinse at night may also be helpful. Finally, exploring other interventions and alternative therapies including weight loss, oral appliances, position therapy, or even surgery for sleep apnea may be necessary as a last resort.

You should continue to be diligent about finding a solution. Compliance to a CPAP can be tough, and there are many potential tolerance problems, but avoiding the serious consequences of sleep apnea makes the hard work worth it. If you struggling, meet with your sleep medicine specialist to get the help that you need.