Obstructive sleep apnea (OSA) is a prevalent sleep disorder that affects millions of people worldwide. Characterized by repeated interruptions in breathing during sleep, OSA can lead to a variety of health complications, including cardiovascular issues, fatigue, cognitive decline, and a diminished quality of life. While Continuous Positive Airway Pressure (CPAP) therapy remains the gold standard for treating OSA it is too often intolerable to use.  I am not against the use of CPAP, it can be a great treatment for many people, but unfortunately half the people that try CPAP cannot sleep with it for a variety of reasons.  If you can’t sleep with CPAP, you are not the “world’s biggest looser” – you are a member of a big club!  In addition, we understand there are thousands of people (maybe more) that will not even get tested for OSA because CPAP is the only treatment know and they do not want to try it.  In terms of the ability to open the airway during sleep, the next best treatment for OSA is Oral Appliance Therapy (OAT) – and it’s another non-surgical approach that is far more tolerable than CPAP. For most patients OAT treats their OSA as well as CPAP, but for others it reduces their OSA but leaves some residual OSA and/or symptoms untreated.  To optimize treatment with OAT other modalities can be added based on patient preference, problems and medical necessity to optimize treatment. Today’s blog will discuss adding Mouth Taping to OAT – we will talk about other adjunctive modalities, like nasal patency, lateral sleep aides, etc in another blog.

Oral Appliance Therapy (OAT)

What is Oral Appliance Therapy?

Oral Appliance Therapy involves wearing a custom-fitted device in the mouth during sleep. These devices are designed to keep the airway open by repositioning the jaw and tongue forward during sleep. OAT is more effective for people with mild to moderate OSA but can also be used for those with severe OSA if they cannot tolerate CPAP or refuse to try one.  For others, it’s a great alternative treatment for travel, or when they are in places that make their CPAP difficult to use. Sometimes the more tools in the toolbox the better!

How Does OAT Work?

The primary mechanism behind OAT is the advancement of the lower jaw (mandible) and the stabilization of the tongue in a more forward position. By moving the jaw and tongue forward, oral appliances prevent the soft tissues in the throat from collapsing and blocking the airway during sleep. This leads to a more unobstructed breathing pathway, reducing apneas (total closures) and hypopneas (partial closures).

Benefits of OAT:

  • Comfort and Convenience: Oral appliances are small, portable, and easy to wear, making them more comfortable than bulky CPAP machines.
  • Improved Compliance: Studies show higher long-term adherence rates with OAT compared to CPAP, largely due to its non-invasive nature and increased comfort
  • Non-Invasive: Unlike surgery, OAT does not involve any permanent alterations to the airway structure, making it a low-risk option.
  • Custom-Fit: These appliances are tailored to fit each patient, ensuring a snug and effective treatment.
Woman with tape on her mouth.

Mouth Taping for OSA

What is Mouth Taping?

Mouth taping is a technique where a piece of hypoallergenic tape is placed over the mouth to encourage nasal breathing during sleep. If you Google mouth taping you will find hundreds of specifically designed tapes. The theory behind mouth taping is simple: by keeping the mouth closed, individuals are forced to breathe through their nose, which can help reduce airway collapse.  In addition, it can also help prevent that dry mouth feeling during the night (because breathing through your mouth creates that dry mouth).

Mouth Taping alone rarely treats OSA

However, mouth taping can be a useful adjunctive therapy to use with your oral appliance or with CPAP.  Please only use mouth taping under the guidance of your healthcare practitioner.

How Does Mouth Taping Help?

Mouth taping helps mitigate sleep apnea symptoms by promoting nasal breathing. Breathing through the nose has multiple benefits for OSA sufferers:

  • Nasal breathing activates the diaphragm, which leads to deeper, more stable breaths.
  • The nose filters and humidifies air, making breathing smoother and less prone to obstruction.
  • Mouth breathing can lead to snoring and throat relaxation, which may exacerbate OSA symptoms.
  • By keeping your mouth closed and breathing through your nose your airway will stay slightly more “inflated” during sleep – thus helping to reduce airway collapse which is the “apnea”.

It is important to note that mouth taping should be done cautiously and under professional guidance.  Mouth taping needs to be done using a relatively weak adhesive that so that it is easily removed and it always has to be done so that you can still breathe through you mouth if your nose gets clogged during sleep.

Benefits of Mouth Taping:

  • Non-Invasive: No equipment or devices are needed other than a small piece of tape.
  • Inexpensive: Mouth taping is a low-cost option compared to other treatments.
  • Improves Sleep Quality: Promoting nasal breathing can lead to fewer sleep interruptions and better overall sleep quality.

Downsides:

  • Not a Standalone Solution for OSA: Studies show mouth taping alone is unlikely to treat sleep apnea effectively, even mild OSA.
  • Risk of Nasal Obstruction: Those with nasal congestion or structural issues, like a deviated septum, may struggle with mouth taping.
  • Discomfort: Some users may find the sensation of having their mouth taped shut uncomfortable or claustrophobic.

Combining OAT and Mouth Taping: A Holistic Approach

As we discussed above, for some patients, although the use of oral appliance therapy improves their OSA, residual OSA or symptoms persist.  This dual approach can potentially improve the effectiveness of treatment by addressing multiple factors that contribute to OSA.

A study performed in our office in conjunction with the Brigham and Women’s’ Hospital/Harvard Medical School showed that the use of both together can improve the efficacy of treatment for some patient (https://www.atsjournals.org/doi/10.1513/AnnalsATS.202109-1050OC). You will not know until you try!          

Before combining treatments, however, it is crucial to consult with a healthcare provider or sleep specialist. They can help determine the best course of action based on the severity of the apnea and individual needs.

Conclusion

Oral Appliance Therapy and mouth taping represent two alternative treatment options for people struggling with OSA, especially for those who cannot tolerate CPAP. While OAT is backed by robust clinical evidence and is widely recognized as an effective treatment for OSA, mouth taping is still relatively new in the OSA treatment space but shows promise as an adjunct therapy. Both options have their benefits and potential downsides, and individual results will vary. Consulting with a healthcare provider is essential to determine the most appropriate treatment based on the severity of your condition.

If you or a loved one suffer from sleep apnea, consider exploring these alternatives as part of a comprehensive treatment plan that can improve your sleep quality and overall health.

Disclaimer: Always consult with a licensed healthcare provider before making any changes to your sleep apnea treatment plan.