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Training Yourself to stop Mouth Breathing?
I guess there's nothing wrong with someone attempting to self-train to no longer be a mouth breather, if that seems to him/her to be a desirable goal (Ren of Planet Earth makes a good point questioning the desirability of this goal.)
I used a nasal mask for five years, adding a chin strap during the last part of that period in an attempt to "train" myself to no avail. Why I waited so long before switching mask type is a good question; just dumb. Come to think of it, the variety of masks available for my first sleep study were all nasal masks. That's probably why I started out with one; I had not even seen a FFM.
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Gee, I feel sorry for you folks having all these problems. I have a full face mask and never had a problem. Maybe I'm just lucky or simple. Bigwink

I don't use the humidifier either and never have dry lips or mouth, mind you all the windows are open so maybe there's enough moisture in the air.

I always hear about people not adjusting well to the CPAP routine and wonder why. I found it easy to deal with. Maybe a good provider who is willing to work with you to find the right equipment. Dont-know
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I had enough trouble with a nasal mask leaking, let alone a full face mask. I would have to get up in the middle of the night to wash my face and wipe down the mask seal. I turn over a lot in my sleep and I like to sleep on my side and my stomach. The mask kept hitting the pillow. I hated it. I am so glad there are nasal pillows.

The OP asked about mouth-breathing, which is something that can be solved only with a full face mask. Mouth-leaking is different. This occurs when the pressurized CPAP air tries to make its way out of the airway, into the mouth, and then out through the lips. Chin restraints (chin straps) help us keep our mouth from opening too far when our jaw muscles relax. I've found that I can go without one for weeks and have no problem, then I'll start mouth-leaking like crazy and have to go back on the chin strap. Sometimes I could tell I was mouth-leaking because I'd wake up with air hissing out of my mouth. But sometimes I would have to have to look at the leak data to figure it out. I don't mouth-leak when I wear the chin strap, so that's why I now wear it whenever I'm sleeping. It's as natural to me now as wearing a seat belt when I'm in a car.

When I started CPAP therapy the pressurized air would leak into my mouth and puff up my cheeks. To stop this from happening I followed the advice I'd heard and I practiced holding the tip of my tongue tucked up against the roof of my mouth, just behind my front teeth. This works. Sometimes I find myself doing it out of habit in the middle of the day.
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I'm still not convinced that all the folks who say they can only breathe through their mouth are giving themselves enough of a chance with a nasal mask.

The issue many times with newly-diagnosed (untreated) sleep apnea patients is that they have mistakenly convinced themselves that they are "mouth-breathers" during sleep. Why? Because they've had untreated OSA for a long time - and they naturally have learned to breathe out of their mouth since it generally offers greater relief from untreated obstructive apneas than trying to breathe out of the nose only. It is easier to snore with your mouth shut, and opening the mouth does reduce snoring sometimes. So, an untreated apnea patient naturally becomes a mouth-breather - it's a naturally-learned behavior.

So, because "they've been breathing out of their mouth for several years" (due to the untreated OSA), they become convinced that they are "permanent mouth breathers", (even after a CPAP prescription is given). So they are given a full face mask right from the start, instead of attempting to re-learn how to breathe properly from the nose.

Many times in emails, I hear from newbie patients who are unhappy or unsuccessful using CPAP for whatever reason. Then they tell me they're using a FFM. When I ask "Why are you using a full face mask?" the vast majority of folks answer by saying, "Because I told the doctor or clinician or RT that I'm a mouth-breather so they gave me a full face mask". Most of them never even tried to use a nasal mask or nasal pillows system.

I realize that there are true mouth-breathers out there that have major issues with nasal passages, but that's not who I'm talking about. I'm talking about folks who have no serious nasal passage issues, but mistakenly think they're a "mouth-breather" simply because the untreated OSA gave them a tendency towards mouth-breathing before being diagnosed.

It's those people who I think could benefit from trying to "train themselves" to nose-breathe again. I know there are always exceptions, but the majority of folks who use full face masks have major leak issues eventually, end up with tissue dehydration (dry, sore throat needing additional humidification) or have less than effective CPAP treatment. FFMs are notorious for leaks.

It would seem to me that a FFM should only be recommended as a last resort. But increasingly, I'm seeing a ton of newbies who are started off with a full face mask. The issue is not really "use whatever works", but rather "use whatever works best"... and generally speaking, the average patient who has no nasal issues (sinus problems, allergies, deviated septum, etc) benefits greater from using a nasal mask over a full face mask.

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(01-22-2013, 02:41 PM)TheWerkz Wrote: First off, I don't understand the logic as to why anyone would want to go through all the grief of wearing chin straps and/or tape on their mouth and then having to hold your tongue in a certain position (and to always face West) while you sleep or other extremes when the simple problem of breathing through the mouth is easily remedied with a properly fitted Full Face Mask.

FFM drawbacks

  1. FFMs press on your jaw. This can cause your jaw to move backwards and make your apnea worse. Think of it as an oral appliance, but it works to make your apnea worse, not better.

  2. FFMs have a longer edge to seal. This increases the possibility of leaks.

    It also means the mask has to contact more points on your face, and has more variations in shape to adjust to. Again, a larger chance for leaks.

  3. The larger area means there is more force due to air pressure, and you need more tension on the headgear.

  4. You can't sip water, take pills, eat, or talk with the mask in place.

  5. More claustrophobic, bigger, gets in the way of vision or glasses more.

However, some people need a FFM. If so, that's fine, but I think it should always be a last resort after dismissing the better options. I'm sure we'd all rather not use CPAP at all, but we need it and there are no better options.

I am disgusted that many DMEs and doctors foist FFMs on their patients without trying nasal masks first. I think it's just laziness and desire to not have to put in the effort to deal with chin straps, or change masks for those who can't use nasal masks.

It's like giving everyone XXXL jumpsuits because you don't want to take the time to give them properly fitted pants, belts, and shirts. Unfortunately, lots of people just go along and wear the jumpsuit without ever realizing they could have had a better choice.
Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
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you cannot kiss someone and breathe thru your mouth Too-funny

Mouth Breathing vs. Nose Breathing (for Mouth Breather)
source: normal breathing

If you are a mouth breather, you need to know the following medical facts. Published-western-clinical evidence clearly proved that mouth breathing is one of 2 immediate leading causes of mortality in the severely sick patients with chronic diseases. Early morning hours (from about 4 to 7 am) have the highest death rates due to coronary-artery spasms, anginas, strokes, asthma attacks, seizures and many other exacerbations. The relevant medical research is considered on the web page "Sleep Heavy Breathing Effect".

CO2-related biochemical effects of mouth breathing

CO2 is not a toxic waste gas. Research articles on respiration often mention dead space, a physiological parameter, which is about 150-200 ml in an average adult person. Dead space is inside the nose, throat, and bronchi. This space helps to preserve additional CO2 for the human body to invest elsewhere. During inhalations we take CO2 enriched air from our dead space back into the alveoli of the lungs. When the mouth is used for respiration, the dead space volume decreases, since nasal passages are no longer a part of the breathing route. Consequently, air exchange for mouth breathing is stronger since air goes directly from the outside air to the alveoli. This reduces alveolar CO2 and arterial blood CO2 concentrations. Such an effect does not take place with nose breathing.

When you stop nose breathing and your mouth is open, you suffer from deficiencies in O2 (oxygen), CO2 (carbon dioxide), and NO (nitric oxide) in body cells due to hyperventilation.

Furthermore, the nasal-breathing route provides more resistance for respiratory muscles as compared to oral breathing (the route for mouth breathing is shorter and it has a greater cross sectional area).

In their study "An assessment of nasal functions in control of breathing" (Tanaka et al, 1988), Japanese researchers discovered that end-tidal-CO2 concentrations were higher during nose breathing than during oral breathing. This research study revealed that a group of healthy volunteers had an average CO2 of about 43.7 mm Hg for nose breathing and only around 40.6 mm Hg for oral breathing. In practice, in terms of body oxygenation or the CP, this corresponds to 45 s and 37 s at sea level. Hence, mouth breathing reduces oxygenation of the whole body.

Each mouth breather needs to know this short summary of immediate negative biochemical effects of mouth breathing related to CO2:
- Reduced CO2 content in alveoli of the lungs (hypocapnia)
- Hypocapnic vasoconstriction (constrictions of blood vessels due to CO2 deficiency)
- Suppressed Bohr effect
- Reduced oxygenation of cells and tissues of all vital organs of the human body
- Anxiety, stress, addictions, sleeping problems and negative emotions
- Slouching and muscular tension
- Biochemical stress due to cold, dry air entering into the lungs
- Biochemical stress due to dirty air (viruses, bacteria, toxic and harmful chemicals) entering into the lungs
- Possible infections due to absence of the autoimmunization effect
- Pathological effects due to suppressed nitric oxide utilization, including vasoconstriction, decreased destruction of parasitic organisms, viruses, and malignant cells (by inactivating their respiratory chain enzymes) in alveoli of the lungs, inflammation in blood vessels, disruption of normal neurotransmission, hormonal effects.

Nose breathing delivers nitric oxide to lungs, blood and cells

Normal nose breathing helps us to use our own nitric oxide that is generated in the sinuses. The main roles of NO and its effects have been discovered quite recently (in the last 20 years). Three scientists even received a Nobel Prize for their discovery that a common drug, nitroglycerin (used by heart patients for almost a century), is transformed into nitric oxide. NO dilates blood vessels of heart patients, reducing their blood pressure and heart rate. Hence, they can survive a heart attack.

This substance or gas is produced in various body tissues, including nasal passages. As a gas, it is routinely measured in exhaled air coming from nasal passages. Therefore, we can't utilize our own nitric oxide, an important hormone, when we start mouth breathing.

Respiratory systemThe confirmed functions of nitric oxide are:

1. Destruction of viruses, parasitic organisms, and malignant cells in the airways and lungs by inactivating their respiratory chain enzymes.

2. Regulation of binding - release of O2 to hemoglobin. This effect is similar to the CO2 function (the Bohr effect).

3. Vasodilation of arteries and arterioles (regulation of blood flow or perfusion of tissues).

4. Inhibitory effects of inflammation in blood vessels.

5. Hormonal effects. NO influences secretion of hormones from several glands (adrenaline, pancreatic enzymes, and gonadotropin-releasing hormone)

6. Neurotransmission. Memory, sleeping, learning, feeling pain, and many other processes are possible only with NO present (for transmission of neuronal signals).

Obviously, during mouth breathing it is not possible to utilize one's own nitric oxide which is produced in the sinuses. The mouth, according to Doctor Buteyko, is created by Nature for eating, drinking, and speaking. At all other times, it should be closed.

Cleaning, humidification and warming of air flow due to nose breathing

Our nasal passages are created to humidify, clean and warm the incoming flow of air due to the layers of protective mucus. This thin layer of mucus can trap about 98-99 percent of bacteria, viruses, dust particles, and other airborne objects.

If you are an endurance athlete and an asthmatic, you must train mostly, or even better, only, with nasal breathing. For really important competitions, you can use the mouth for breathing, but only if you have no current problems with your asthma. Sport training is useful due to its aerobic training effect. This is achievable while breathing only through the nose, as one Australian study confirmed (Morton et al, 1995; see the abstract in the references).

A group of US doctors from the Department of Surgery, University of Chicago even wrote an article with the title "Observations on the ability of the nose to warm and humidify inspired air". The abstract of their study is also provided in the references.

Mouth breathing influences on the autoimmunization effect

This is another advantage of nasal breathing over mouth breathing. The thin layer of mucus moves as a long carpet from sinuses, bronchi and other internal surfaces towards the stomach. Therefore, objects trapped by the mucus are discharged into the stomach, where GI enzymes and hydrochloric acid make bacteria, viruses and fungi either dead or weak. Later, along the digestive conveyor, some of these pathogens (dead or weak) can penetrate from the small intestine into the blood (due to the intestinal permeability effect). Since these pathogens are either dead or weakened, they can not do much harm (cannot cause infections). Moreover, they can provide a lesson for the immune system. This is exactly how natural auto-immunization can work with success. Medical doctors and nurses inject vaccines with dead or weakened bacteria or viruses so as to teach and strengthen our immune response to these pathogens, but not to bed bugs NYC. Therefore, nasal breathing creates conditions for natural autoimmunization.

Practically, when a household member is sick (as with the flu or cold), the still-healthy people could breathe either through their nose, teaching the own immune system how to deal with the pathogenic bacteria or viruses, or through their mouth, as in mouth breathing, allowing these pathogens to gain access, settle and reproduce themselves in various parts of the body, causing the infection.

Effects of mouth breathing
This leads to:
- decreased perfusion (blood supply) of all vital organs
- suppressed Bohr effect
- over-excited state of nerve cells causing increased anxiety, more problems with sleep, etc.
- constrictions of airways, leading to dyspnea, nasal congestion, and frequent infections
- muscular tension
- tissue hypoxia
- generation of free radicals in body cells
- increased inflammation and heart rate
- abnormalities related to regulation of the blood pressure, blood glucose levels, and body weight
- suppressed repair of cells, tissues and organs; and so forth

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(01-23-2013, 03:33 AM)zonk Wrote: you cannot kiss someone and breathe thru your mouth Too-funny

Mouth Breathing vs. Nose Breathing (for Mouth Breather)
source: normal breathing

Zonk, you mention links, but didn't include them.

Of course, for those with nose problems, mouth breathing is superior to non-breathing. It may even be preferable to nose sprays, antihistamines, etc.

I'll also point out that not everyone who needs a FFM mouth breathes that much of the time. You may even mouth breathe less with a FFM because the air outside your lips is not at a lower pressure than inside your mouth. With a nasal mask, the pressure tents to force your lips open or force air past your tongue.
Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
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(01-23-2013, 03:42 AM)archangle Wrote: Zonk, you mention links, but didn't include them.
the link might interfere with the rules
sent you the link via PM

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I use a Quattro FX ffm and it works great. However, even using the H5i humidifier and the Climateline hose, I'll still wake up in the morning with a dry tongue/mouth. So, I'm trying to train myself to keep my tongue on the roof of my mouth. Sometimes it seems to work, others not...so will keep trying.
We're all family here...you can call me B36 if you'd like!Cool
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Here's my thoughts & opinion...

Your nose is there for one primary one reason: to breathe out of. Secondarily, it's there for the sense of smell, and to a lesser degree, helping with the sense of taste.

Your mouth is there for one primary reason: to eat, drink and talk with. Secondarily, it's there as a backup breathing device just in case your nose ain't workin'. It's also useful to blow up party balloons for birthday parties or to whistle with. Whistle

If you have major nasal passage issues, yep, you might have to go the FFM route and breathe through your mouth.

But if you have no major nasal issues, it's generally best to use the body part best suited for breathing (your nose).

Mouth breathing is kind of like using a pair of pliers to pound in a nail: yeah, it can be done if there's no alternative, but it's more difficult and can introduce unintended consequences, including damage to the pliers if used like that over time. Much better to "use the right tool for the job", as the gang on "This Old House" likes to say.

Bigwink Coffee

I also think that Arch is correct in saying that many DMEs and RTs incorrectly give brand new patients a FFM just to make their life easier, not to make the patient's life easier and certainly not to make the treatment more effective.

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