I will try to be concise with my story. My girlfriend has been increasingly snoring in the past few months to the point I had to start sleeping in a spare room. We don’t live together and only see each other during the weekend, still it was enough for me to make her to go see a doctor. The doctor asked for a sleep study which pointed that she has only mild apnea.
Here I want to make an observation: she is a mouthbreather since she was a kid. As there wasn’t enough “room” for the air to go through, she started breathing through her mouth during the her sleep and that continues to this day. Sometimes even when she is awake she is breathing through her mouth, not really because she can’t breath through her nose, but because she kinda got used to it.
Anyway, going back to the doctor, as she has only mild apnea he recommended an oral device to move her jaw forward, so the air could go through more easily. She has been using it for about 2-3 weeks and we haven’t seen that much of difference so far, despite decreasing her snoring a little bit. Although the device keeps her mouth partially shut, she still breathes through her mouth. We have been monitoring her snoring daily using an app called SnoreLab.
I know there is a long way through and the doctor will make a lot of adjustments in the following weeks and months, but my question is: doesn’t the fact that she is a mouthbreather impacts the efficacy of the device? I mean, as she is a mouthbreather, even if the device opens up “room” for the air, wouldn’t she continue breathing through her mouth, as she is use to, thus continuing to snore? Or will she simply started breathing through her nose once the air has “room” to go through? Sometimes I feel we should be focusing more on making her sleep with her mouth shut than in bringing her jaw forward.
I don’t wanna say the dentist is wrong cause he is specialized in sleeping issues, but I have been reading a lot of things in the internet lately and sometimes I feel that finding a solution is almost a matter of trial and error. I’m almost sure that her snoring comes almost entirely from the fact that she can’t keep her mouth closed. I’m almost going for some crazy experiences like mouth taping her to see what happens, but I also don’t want to dicredit the dentist with some ridiculous measures. I mean, the doctor has so much knowledge and I’m going to use such a rudimentary and stupid technique, it doesn’t feel right.
So, has anyone experienced anything like this? Does the oral device really works for mouthbreathers? Am I being just too impatient? Should we be looking for something else? I know it’s a long story, but I would really appreciate if anyone could help!
Thanks in advance!
I know where you are coming from. I am also a mouth breather and use a TAP 3 oral appliance. I have been wearing it for over 6 months now and still open my mouth some while sleeping. Perhaps an adjustable chin strap would help. I have the ruby red adjustable chin strap that I used to wear with my CPAP. If adjusted not too tight it is relatively comfortable. Maybe it would help her get used to keeping her mouth closed while sleeping.
Make sure you wait until the titration is complete before determining if the oral appliance therapy is a bust. A chin strap is a great idea. I am a fan of combination therapy. She could wear the appliance and use a cpap to augment. I do this and recommend it highly. My cpap with oral appliance is very comfortable because pressures are low. Without oral appliance, cpap is uncomfortable. I think many of the reasons people dismiss cpap is because of mask leaks-lower pressures will eliminate those. Good luck:)
Thank you for your responses!
We asked the dentist about using a chin strap, but he said he wouldn't recommended it because the jaw is supposed to be loose during the sleep. Cpap was not even considered due to her apnea being mild.
I must say there has been only 3 weeks she started using the application, so I might be going way to fast. It just seems odd to me that the fact that she is a mouthbreather doesn't really caught his attention, so she might start breathing through her mouth once the jaw moves forward, I don't know.
I will keep this topic updated as we get more news, in case anyone experience something similar!
I am a dentist working in dental sleep medicine. The vast majority of oral appliances are designed to allow both nasal breathers and mouth breathers to use them successfully. In my 12 plus years of experience, I have found no reason to believe that mouth breathing decreases the efficacy of an oral appliance. The only negative of mouth breathing that I find is that it can result in dry mouth, which, in a few cases, can be unbearable. However, if the patient mouth breathes BECAUSE there is limited or no nasal patency, that is material to the efficacy of oral appliances. One way to find out is to use Breathe Right strips for a few days to see if that improves the efficacy of the appliance. As a practical matter, I always refer a mouth breather with limited nasal patency to an ENT for evaluation before placing an oral appliance. A.B. Luisi, D.M.D.
I have been using a SomnoDent appliance for the last couple of months. I really thought it was working, until the last week, when I've noticed more sleep interruptions. Then, around 5' o'clock this morning I was sleeping on my stomach and had, for the first time since I started wearing the device, a bad apnea episode, complete with suffocation dream. If the device is opening up the airway by moving the jaw forward, why would this happen? Of course I understand my chin is going down into my chest in this sleep position, but shouldn't the concept of the way the oral device works prevent this from happening? I go back to my dentist in a few days, but I was interested in your opinion. Also, I have been adjusting the device forward, and then I have to adjust it back because of the discomfort of the jaw alignment and the fact that my mouth wouldn't close at all, causing sleep issues.
You said that you thought it was working. The first thing that I would ask is whether or not the efficacy of the device was ever objectively confirmed by either a home sleep test or an in-lab sleep test with the oral appliance in place. It is mandatory that the efficacy be confirmed this way because there is a placebo effect wherein patients can think the OA is working well when it actually is not. Assuming that it was tested, you would then have to ask yourself what changed during the last week. Typically, there has been a change in nasal patency, i.e., a head cold, a sinus attack, allergic rhinitis, or similar. This can put a drag on the OA and make it less effective. If so, a trip to an ENT doctor may be in order to clear it up. One drawback of the Somnodent, is that it does not hold the mouth closed as some other appliances, like the Tap3, do. When the mouth falls open, the mandibular protrusion created by the Somnodent can not overcome the apneas caused by mouth opening in all instances. I would theorize that when you slept on your stomach, your mouth may have been forced wide open for an extended period of time, thus allowing apneas. You may also have over-adjusted the appliance forward past your optimal "sweet spot", thus allowing more apneas. Arthur B. Luisi, Jr., D.M.D.
Just an update. She went to the dentist today and he reinforced that he doesn't recommend using any chin straps or strips to keep her mouth shut. He said when her jaw moves forward she will start breathing naturally through her nose again. I'm not so sure about this, but since he said, let's believe him.
On the other hand he also asked about the possibility of removing the adenoid which in his opinion is blocking the passage of air and that's the reason why she has breathed through her mouth all her life. Has anyone removed it? I have seen much worse cases of snoring/apnea, but I don't really see people opting for surgical solutions. And I must say I'm not a fan of this idea either.
Anyway, I don't want to sound pessimistic but I feel the dentist is already thinking about other ways to solve the problem. I would say he will eventually suggest the CPAP in case we say no to the surgery. Let's wait and see.
In adults, surgeries have a very low success rate for both snoring and, even more so, OSA. They are also painful with a high risk of post-operative infection and, in the rare cases they have any positive effect, they can revert over time. This is all based on the literature. Approach with great caution.
CPAP should still work just fine for snoring, even without any apnoea, of your decide to go that route.
I am a dentist working in dental sleep medicine. Fundamentally, I agree with your over-all assessment of surgical options. However, I would make one exception. Some minor ENT procedures to improve nasal patency have greatly improved the performance of oral sleep apnea appliances. Most notably, the turbinate reduction. This is relatively painless, not debilitating, and not too expensive and really does significantly improve nasal patency. In some select cases, a septoplasty, although more serious surgery, can also make a significant difference. A.B. Luisi, D.M.D.
So I'm back here to tell how the story has been goingfor the past two months. After all this time and a few more adjustments in the oral device she did improve her snoring. She doesn't really snore anymore, but we can definitelly hear her breathing during the night. It's a reasonably loud noise of the air going through the respiratory tract, like she is pulling the air harder. It's much better than the noise of her snoring though.
However the dentist is confident that the adenoid is causing this and he is tending to suggest her to remove it. The thing is this surgery is not that simple from what I've read and it's commom to have some severe side effects, so I'm not really sure it's worth as it seems to be ok now. Not perfect, but much better than before.
I also don't think CPAP would be worth to correct such thing and has not even been considered so far. So what you guys think? Go all the way to the surgery as the dentist is sugestting or just leave like this as it seems to be ok?
CPAP means positive air pressure to keep the airway open. If the mouth is shut, it does facilitate my breathing without any snoring BUT if the patient doesn't have sleep apnea, seems like much to do for no reason. Suggest you have your doc prescribe and in clinic sleep study and if no sleep apnea, perhaps all is good and certainly no CPAP or other PAP machine is indicated.
Well, the obvious question now is,"How does she feel?" Is she sleeping soundly at night? Does she wake up feeling refreshed? Any morning "brain fog"? How is her energy during the day? If all the answers are good and she isn't snoring and she had mild sleep apnea to begin with, you can pretty much deduce that she is home free enough in the current state. Arthur B. Luisi, Jr, D.M.D.
Airway surgery, including tonsils or adenoids, has not been found terrible successful in adults. Adenoids are almost always vestigial (not really there) and tonsils tend not to be floppy as they are in children and do not block the airway. Since a dentist cannot see the adenoids (They are tucked way up behind the soft palate), an evaluation by an ENT is the next step. Remember that snoring is controlled with an oral appliance 80% of the time, but sleep apnea only 50% of the time. As Dr. Luisi said, follow-up testing by a sleep physician is required for every oral appliance. Keeping the mouth closed at night is the ideal, but research has shown that this makes a big difference only in severe sleep apnea. The majority of patients only open a small amount each night and that is related to the level of sleep (it is natural to have your mouth open wider during dream sleep). Chronic nasal congestion and a steep jaw angle make correction of sleep apnea with an oral appliance more difficult. B. Gail Demko, DMD Assoc. Editor: Journal of Dental Sleep Medicine
I think that both patients and sleep dentists tend to underestimate the importance of chronic nasal congestion in reducing the efficacy of oral appliances. I always try to get patients to go the ENTs to optimize their nasal patency prior to oral appliance therapy. After that, they need to understand that they have to use their medications and other things RELIGIOUSLY to keep that air flowing through the nose. and at the first sign of increased nasal trouble, back to the ENT should they go. Arthur B. Luisi, Jr., D.M.D.
If you have nasal obstruction due to narrow nostrils:
I've had nasal obstruction all my life mostly because of narrow/partly collapsed nostrils, esp. the right.
If you have this, nasal dilators can be LIFE-CHANGING. No exaggeration.
I had a difficult nose job to open them more when I was about 40. The surgeon took a piece of cartilage out of my ear and used that to prop the nostril open (he said he liked a challenge; expected to spend an hour on it; he took 4). I'd say about 75% improvement. VERY pleased.
Still, I always use a nasal dilator, and always have spares. There are many kinds. I don't use the Breathe-Right adhesive strips on the outside, but they're worth a try. There are many kinds, shop online, they're inexpensive, some don't work for me. Some are almost invisible when you wear them. Basically a plastic spring that spreads the nostrils. Low-tech, elegant devices.
I think I was a mouth-breather all through my childhood, youth, early adulthood. I tried to invent these things myself: I took sections of Bic pen barrels and wide drinking straws and tried to prop my nostrils open with them. I believe my life would have been different if I'd had these back then.
