The Trouble with Mouth Breathing and Treatment Options

Wondering why mouth breathing matters, how it affects you and how to stop mouth breathing? If you are a mouth breather, you probably have all of these questions and more. Read on to learn why being a mouth breather can have a surprising impact on your health.

Nose Breathing vs. Mouth Breathing

You might not realize how big of a difference the way you breathe can make on your well-being, but believe it not, there are so many ways that breathing can be more (or less) efficient. From your breathing technique to your body position when you breathe to whether you breathe through your nose or mouth, all of these factors make a difference^[1] in whether or not you get the oxygen you need. When it comes to nose breathing vs. mouth breathing, the difference is surprisingly significant. 

Your nose serves an essential purpose when it comes to breathing: it protects and serves the respiratory system by filtering, warming and humidifying the air you breathe.^[2] In addition to acting as the respiratory system’s first line of defense, nasal respiration – or breathing through the nose – also plays a critical role in protecting your health. First, it is essential to the production of nitric oxide, a gas naturally produced by the body. The nitric oxide created during nasal respiration increases oxygen exchange efficiency, blood oxygen and arterial oxygen tension, and also improves oxygen absorption by the lungs.^[3] Furthermore, breathing through the nose activates the calming part of your nervous system, rather than keeping you in a stress state.^[4] This results in lower blood pressure, better immune defenses and improved neurotransmission.^[3,4] 

Overall, with nasal breathing, your body is better able to maintain balance in regards to the chemical conditions inside the body. In addition, the nitrous oxide produced through nasal breathing relaxes vascular smooth muscle and allows blood vessels to dilate, which increases oxygenation and reduces snoring, mucus production and fatigue.^[3] But what happens when nasal passages go awry, forcing a person to breathe through their mouth? Is mouth breathing at all beneficial or can it be hazardous to our health?

What Causes Mouth Breathing?

The underlying cause of most cases of mouth breathing is an obstructed (completely blocked or partially blocked) nasal airway. In other words, there’s something preventing the smooth passage of air into the nose. If your nose is blocked, the body automatically resorts to the only other source that can provide oxygen – your mouth. There are many causes of a blocked nose. These include: ^[2]

• nasal congestion caused by allergies, a cold, or a sinus infection
• enlarged adenoids
• enlarged tonsils
• deviated septum
• nasal polyps, or benign growths of tissue in the lining of your nose
• enlarged turbinates
• the shape of the nose

Although allergic rhinitis is considered one of the leading causes of respiratory obstruction; it is of utmost importance to note that upon the first onset of nasal congestion, a feeling of air deprivation occurs, causing the individual to switch to mouth breathing.^[5]

The Impact of Mouth Breathing: Are You in the Dark?

If you are a mouth breather, you probably want to know, “What is the problem with mouth breathing?” Most people, including many healthcare professionals, are unaware of the negative health effects brought on by mouth breathing.

Habitual mouth breathing, conversely involves an individual breathing in and out through the mouth for sustained periods of time, and at regular intervals during rest or sleep.   It is well documented that mouth breathing adults are more likely to experience sleep disordered breathing, fatigue, decreased productivity and poorer quality of life than those who nasal-breathe.  In children, the harmful effects of mouth breathing are far greater, since it is during these formative years that breathing mode helps to shape the orofacial structures and airways.^[5]     In children, mouth breathing can cause crooked teeth, facial deformities, or poor growth. ^[3]

In an interview conducted by registered dental hygienist, Trisha O’Hehir, Dr. Steven Sue, DDS, MS, explains the following:^[6]

“Because the breathing mechanism is situated in the nose and not in the mouth, the brain of a mouth breather thinks carbon dioxide is being lost too quickly from the nose and stimulates the goblet cells to produce mucous to slow the breathing. Thus the viscous circle of mouth breathing triggers mucous formation, blocking nasal passages and nose breathing, leading to more mouth breathing.”

This means that once you get in the habit of mouth breathing, your body could become confused into continued mouth breathing. At this point, intervention of some kind may be required.

Mouth Breathing and Supplemental Oxygen

Supplemental oxygen therapy is generally prescribed to people whose partial pressure of oxygen (PaO2) as measured by arterial blood gases (ABGs) is less than or equal to 55 mg Hg and a documented oxygen saturation level of 88 percent or less while awake (or that drops to this level during sleep for at least five minutes). Many people receive in-home oxygen through an oxygen delivery device known as a nasal cannula. The nasal cannula can comfortably deliver oxygen to a person at one to six liters per minute (LPM), in concentrations ranging from 24 to 40 percent, depending upon how many LPM are being delivered. In comparison, room air contains about 21 percent oxygen, which is generally not enough for people with lung disease.

There are many benefits of long-term oxygen therapy; but are people who use oxygen and breathe through their mouths able to derive the full benefit of oxygen therapy? Or, does mouth breathing result in low levels of oxygen in the blood, cells, and tissues?

Research involving this topic is contradictory as demonstrated by the following examples: ^[7]

The first measured oxygen saturation in 323 subjects who were mouth breathers. Of these, 34.6% had normal (95% or greater) oxygen saturation levels, 22.6% had an oxygen saturation of 95% and 42.8% were considered hypoxic, having an oxygen saturation of less than 95%. The study concluded that, while mouth breathing doesn’t always lead to hypoxia, it can contribute to it. ^[8]

In the second study involving 10 healthy subjects, researchers analyzed gas samples taken from the tip of a nasal cannula positioned in the nasopharynx, an area in the back of the throat. The study concluded that subjects who breathed through their mouths while using supplemental oxygen had a significantly higher FIO2 (fraction of inspired oxygen) than those who didn’t. However, an editorial published in Respiratory Care disputed the validity of this study, stating that the results were likely to be inaccurate. Under normal circumstances, when a patient breathes supplemental oxygen through a nasal cannula, they breathe a combination of oxygen mixed with room air. During mouth breathing, oxygen delivered through a nasal cannula doesn’t mix with room air; it is pushed through the nose and into the nasopharynx where it remains highly concentrated. Gas samples taken from an oxygen-enriched area may yield a higher concentration of oxygen, but they are unlikely to represent a patient’s true oxygen concentration because the gas is undiluted by room air.^[9]

What can you do about Mouth Breathing?

If you are a mouth breather and want to know how to stop mouth breathing, it is important to try to discover the cause. Once you know the cause, you can treat it, which will help resolve the symptom of mouth breathing. If you cannot find the cause on your own, seek help from a specialist.  Once accurately diagnosed, you can address treatment options which may include the following:

Clear Your Nasal Passages  – Some people have no choice but to breathe through their mouths because their nasal passages are blocked. A stuffy nose may be caused by allergies, illness, prior trauma, or even weather changes. Over-the-counter antihistamines are available to keep allergy symptoms at bay and open up clogged nasal passages. Saline nasal spray is a natural alternative to medication and helps lubricate the nasal passages, often relieving congestion. If over-the-counter antihistamines and/or saline nasal sprays don’t work for you, talk to your ​healthcare provider about using a prescription nasal spray such as Flonase. ^[7]  Adhesive strips applied to the bridge of the nose can also help breathing. A stiff adhesive strip called a nasal dilator applied across the nostrils helps decrease airflow resistance and helps you breathe more easily through your nose. ^[3]

Practice nose breathing vs. mouth breathing – If you are a mouth breather, it has likely become a habit, so practicing your nasal breathing technique can actually be a surprisingly effective way to change your breathing. Try to pay attention to the way you breathe throughout the day. Then, once you have noticed a pattern in the times that you typically breathe through your mouth, work on intentionally changing the way you breathe at those times. ^[10]

Stress Reduction – When people are stressed, their breathing is more rushed. You are more likely to use your mouth to take deep breaths during stressful situations. You may need to see a doctor or change your environment but reducing stress will help improve the way you breathe. ^[10]

Change your Pillows – If you struggle with mouth breathing when you are sleeping, try changing the height of your head.  Prop your head up with or use a thicker pillow. ^[10]

Exercise – By exercising regularly with a regimen of a daily walk or run, you will increase your need for deep breaths; and your nose will naturally take the breathing away from your mouth. ^[10]

Make an Appointment With Your Dentist – Dentists are sometimes more knowledgeable than doctors when it comes to understanding mouth breathing. If your dentist determines that a facial or dental abnormality is the root of your mouth breathing, they may fit you with a functional device to help correct the problem. ^[7] 

Switch to a Simple Face Mask – The easiest solution to mouth breathing, if medically appropriate, is to switch to a simple face mask. Generally, this is not very practical for many people and must first be approved by your oxygen-prescribing healthcare provider. One alternative is to consider using the nasal cannula during the day and switching to a simple face mask at night, so at least you’ll be getting the full benefit of oxygen therapy during the hours in which you are asleep. Talk to your healthcare provider for more information about alternatives to the nasal cannula. ^[7] 

Transtracheal Oxygen Therapy – Transtracheal oxygen therapy (TTOT) is a method of administering supplemental oxygen directly into the trachea (windpipe). As an alternative to the nasal cannula, it delivers up to six liters of oxygen per minute through a small, plastic tube called a catheter. TTOT is generally reserved for people who have low blood oxygen levels that don’t respond well to traditional methods of oxygen delivery. ^[7]  

Nasal Surgery – If your nasal passages are blocked because of a deviated septum, consider talking to an Ear, Nose, and Throat (ENT) specialist about the surgery that may help correct the problem and allow you to breathe better. Remember, people with COPD should be especially cautious when undergoing surgery, because of the potential post-operative complications associated with anesthesia. ^[7] 

If you identify as a mouth breather, talk to your health care provider today to get properly diagnosed so you can determine the cause of your mouth breathing and determine which type of mouth breathing treatment is best for you.

Frequently Asked Questions About Mouth Breathing

Is it bad to be a mouth breather?

Habitual mouth breathing involves an individual breathing in and out through the mouth for sustained periods of time, and at regular intervals during rest or sleep.   It is well documented that mouth breathing adults are more likely to experience sleep disordered breathing, fatigue, decreased productivity and poorer quality of life than those who nasal-breathe.  In children, the harmful effects of mouth breathing are far greater, since it is during these formative years that breathing mode helps to shape the orofacial structures and airways.^[5]     In children, mouth breathing can cause crooked teeth, facial deformities, or poor growth. ^[3]  If you identify as a mouth breather, talk to your health care provider today to get properly diagnosed so you can determine the cause of your mouth breathing and determine which type of mouth breathing treatment is best for you.

How do I stop mouth breathing?

If you are a mouth breather, there are ways to stop and retrain yourself to breathe through your nose instead. Start by practicing nasal breathing whenever you notice you are breathing through your mouth. From there, you should try to treat the cause of your mouth breathing, including nasal congestion. If you are unable to stop mouth breathing on your own, see your doctor to explore the cause of your mouth breathing. Learning to practice nose breathing vs. mouth breathing can significantly improve the way you feel and your long-term health. ^[7,8]

Can mouth breathing cause shortness of breath?

Mouth breathing can worsen symptoms like shortness of breath, and it can also increase the need to breathe faster, which can make you feel breathless. This can create an unfortunate cycle wherein you breathe through your mouth in an attempt to address shortness of breath, which then causes you to feel more short of breath. Learning to breathe through your nose can help you stop this cycle and can help you treat your shortness of breath by slowing your breathing down and allowing your blood to become more oxygenated.^[3]

References

1. Jefferson, Yosh. “Mouth Breathing: Adverse Effects on Facial Growth, Health, Academics, and Behavior.” General Dentistry, U.S. National Library of Medicine, Jan. – Feb. 2010, Mouth breathing: adverse effects on facial growth, health, academics, and behavior – PubMed (nih.gov)
2. “Respiratory System: Functions, Facts, Organs & Anatomy.” Cleveland Clinic, Cleveland Clinic, 24 Jan. 2020, my.clevelandclinic.org/health/articles/21205-respiratory-system.
3. Cafasso, Jacquelyn. “Mouth Breathing: Symptoms, Complications, and Treatments.” Healthline, Healthline Media, 15 July 2019, www.healthline.com/health/mouth-breathing.
4. Berman, Jae. “Perspective | Could Nasal Breathing Improve Athletic Performance?” The Washington Post, WP Company, 30 Jan. 2019, www.washingtonpost.com/lifestyle/wellness/when-it-comes-to-breathing-during-exercise-youre-probably-doing-it- wrong/2019/01/23/b4d3c338-1e59-11e9-8b59-0a28f2191131_story.html.
5. Macaluso, Martha, and Patrick McKeown. “Mouth Breathing: Physical, Mental and Emotional Consequences.” Oral Health , Oral Health Group, 9 Mar. 2017, www.oralhealthgroup.com/features/mouth-breathing-physical-mental-emotional-consequences/.
6. O’Hehir, Trisha E. “An Interview with Steven Sue, DDS, MS, on Mouth Breathing vs. Nose.” Hygienetown.com, Hygienetown, Oct. 2010, www.dentaltown.com/Images/dentaltown/magimages/1010/DTOct10pg112.pdf
7. Can Mouth Breathing Affect Supplemental Oxygen Therapy? (verywellhealth.com)
8. Niaki EA, Chalipa J, Taghipoor E. Evaluation of oxygen saturation by pulse-oximetry in mouth breathing patients. Acta Med Iran. 2010;48(1):9-11.
9. Wettstein, Richard B, et al. “Delivered Oxygen Concentrations Using Low-Flow and High-Flow Nasal Cannulas.” Respiratory Care, U.S. National Library of Medicine, May 2005, Delivered oxygen concentrations using low-flow and high-flow nasal cannulas – PubMed (nih.gov)
10. “Stop Mouth Breathing.” Colorado ENT and Allergy, 11 Mar. 2020, www.coloradoent.com/7-ways-to-stop-mouth-breathing/.