Should Mouth Taping Be Used with Oral Appliances?

A study adds some legitimacy to the viral “sleep hack” of mouth taping—in conjunction with oral appliances—for improved obstructive sleep apnea therapy.

By Chaunie Brusie, RN, BSN

If you’re active on social media, you may have noticed that the practice of mouth taping has been touted as a “sleep hack.” Proponents claim the practice can help foster nasal breathing during sleep, reduce snoring, and decrease the incidence and severity of sleep apnea.

And while sleep medicine experts may not be so quick to jump on the latest viral sleep hack bandwagon (safety is a concern, as well as efficacy), a new study published in Annals of the American Thoracic Society adds some legitimacy to mouth taping—specifically in conjunction with oral appliances—for improved sleep apnea therapy.

Mouth Taping: More Than a Viral Hack?

Lead study author Gonzalo Labarca, MD, a postdoctoral fellow at Brigham and Women’s Hospital, explains that the practice of mouth taping is exactly what it sounds like: using tape, typically silicone-based, to keep the mouth closed during sleep. It can be applied in either a vertical position in the middle of the lips to adhere to the skin both above and below or in a horizontal position where closed lips meet.

He notes that when the mouth falls open during sleep, it narrows the respiratory airways, which reduces the level of ventilation received through the nose. So the concept is that by reinforcing the mouth to stay closed, forced nasal breathing and improved ventilation will result. Proponents of the practice also say that mouth taping can help decrease snoring and lead to a better night of rest. But, according to Labarca, there’s no proof that mouth taping has any real benefits for people without obstructive sleep apnea. “The clinical implication of mouth breathing is not well understood,” he says.

Labarca also points out that the change in the ventilation is a potential problem because some patients with obstructive sleep apnea breathe through their mouths. To help clear up some of the confusion over mouth taping—and knowing that mouth breathing does increase upper airway collapsibility, which decreases the efficacy of obstructive sleep apnea treatments—Labarca and his team proposed the study to test how a combination of mouth taping, described In the study as an adhesive mouthpiece (AMT), along with a mandibular advancement device (MAD) style of oral appliance, could impact therapy efficacy.

The study confirmed Labarca and his team’s hypothesis: the combination of mouth taping and oral appliance use showed an 81% response (defined by a decrease in the apnea-hypopnea index (AHI) <10) and a median AHI of 5.6, compared to 49 % of responders and a median AHI of 10.5 with the oral appliance alone. “An explanation for our findings should be that mouth breathing can contribute to the respiratory event (apnea or hypopnea), reducing the airflow and making it more unstable during respiration,” he says.

The study included participants with moderate to severe sleep apnea; Many past studies have allowed only those with mild to moderate disease. The results of a subgroup analysis were also promising, Labarca notes: In those with moderate to severe sleep apnea, the combination of an oral appliance and mouth tape reported a 63% positive response to therapy and a median AHI of 8.0, compared to 27% of positive response and median AHI of 18.1 in the oral appliance only group.

Despite the study’s success, there are still considerations before a recommendation for mouth taping should be made. For example, if the patient breathes exclusively by mouth, their sleep apnea symptoms and oxygen saturation could worsen. “The response is not the same for everyone,” Labarca cautions.

Additionally, the only true benefit was in the combination of mouth taping with an oral appliance. “Although we identified different responders to mouth tape, oral appliance, or the combination, in additional analysis, we found that an increase in the arousal index was associated with worse responders,” he adds.

Which Oral Appliances Work in Combination with Mouth Taping?

While the benefits of the study clearly demonstrated the use of mouth taping with an oral appliance, the team did not stipulate a specific type of oral appliance in the study design; the only requirement was that the patient must have previously used an oral appliance. “This decision was made to increase the applicability of our results to both patients and dentists,” Labarca says.

Mark T. Murphy, DDS, DABDSM, lead faculty for clinical education at ProSomnus Sleep Technologies and a private part-time dental sleep practitioner in Rochester Hills, Mich, says mouth taping may be most beneficial in older style devices that have engagement mechanisms at 70 degrees. “The newer precision devices have a 90-degree post, which prevents the mandible from falling backward upon opening when relaxed,” he says. ‘[It’s] Likely another reason these older style devices seem to require a larger dose or advancement to be therapeutic.”

While the designs may differ, Labarca says he doesn’t believe the study’s findings imply that oral appliance designs should be altered in any way. “This is an additional therapy to the existing oral appliance, not restricted to a specific design or company,” he says.

“Additionally, the benefits of this combination are limited to a subgroup of patients where mouth breathing contributes significantly. Therefore, the focus should include a proactive search of patients with sleep apnea and mouth breathing.”

One potential roadblock to mouth taping could be oral appliance devices that feature a titration/adjustment mechanism, says Nicholas Michalak, CEO of SomniFix, marketers of the mouth tape used in this study. When that mechanism is present, and the adjustment arms protrude from the front of the appliance, it is impossible to achieve full lip closure.

Outside of those specific designs, however, most oral appliance therapies are compatible with mouth tape. “Fortunately, most oral appliances do not have this feature, so I would expect similar for a broad spectrum of oral appliances,” he says.

Clinical Applications

Obstructive sleep apnea can be a costly sleep disorder, both from the potential downstream medical complications that can occur, as well as the diagnosis and therapy. Additionally, adherence therapy continues to be a problem.

In fact, Michalak notes that when his father, a physician, invented the first iteration of SomniFix Strips, he was trying to prevent both the unconscious opening of the mouth during sleep (exacerbating sleep issues that he witnessed in his patients), as well as the nonadherence that can occur with sleep apnea therapeutic devices.

“He aimed to create a simple solution that would neutralize a sleeper’s jaw movements during sleep to keep airflow exclusively through the nose,” Michalak says.

If something as simple as a single piece of tape could make a difference, then Anthony T. Dioguardi, DMD, DABDSM, who practices general dentistry and dental sleep medicine at Downtown New Haven Dental in Connecticut and who wasn’t involved in the study, is in full support.

“This is an extremely well-done study that suggests AMT to be an effective adjunct to appliance therapy. Based on these results, I certainly would consider presenting AMT as an adjunct, along with other options such as positional therapy, in cases where MAD therapy alone is less than fully effective,” says Dioguardi, who is also a Sleep Review editorial advisory board member. “Our patients are best served when we use all the scientifically validated tools available to manage their condition. Hopefully, these encouraging results will be confirmed by future studies, ideally, with a larger sample size.”

Kenneth A. Mogell, DMD, DABDSM, is also a supporter of mouth taping in certain patient populations and has even tried to use mouth tape himself. “I’m unable to because I have so much facial hair,” he says. “But I do have a few patients who use it that wear by it.”

In general, nasal breathing and lip closure with oral appliance therapy are always encouraging, says Mogell, who is the founder of Florida Dental Sleep Disorders and a Sleep Review editorial advisory board member and was not involved in the study. There are other interventions, such as orthodontic elastics and nasal dilators, that can also help those results for those who prefer them achieve or can’t tolerate mouth taping, he says. Some patients, for instance, report feeling claustrophobic with a limited ability to open their mouths.

However, like Dioguardi, Mogell sees the premise as an encouraging one for further research. “The results of this study look very, very, very promising,” he says. “If you can get people to keep their mouths closed while wearing an oral appliance, we have a much greater degree of success in managing sleep apnea.”

And Michalak believes that tape solutions such as SomniFix Strips can help solve some of the dental complications other accessories can cause, like bruxism and even temporomandibular disorders. “SomniFix Strips use a skin-friendly, easy-release adhesive that allows for minor jaw movement, the same a sleeper would have in a normal closed-mouth position,” he says.

While he has no larger clinical studies planned for oral appliance therapy and mouth taping in particular, Labarca notes that after the promising results of this study, he and his team are now examining if mouth taping can also improve CPAP usage and benefit.

They are currently testing the hypothesis by enrolling patients with sleep apnea and CPAP adherence below 5 hours per night, then evaluating the change in CPAP adherence after one month of mouth tape usage. Any physicians or patients interested in being part of this research can contact David Melton at djmelton[at]bwh.harvard.edu.

Future research in the field, he says, should focus on a few key areas, including the determination of the prevalence of mouth respiration in sleep apnea patients, the identification of how much mouth breathing contributes to respiration (for example, determining the percent of total ventilation due to mouth versus nasal breathing), and the identification of the subgroup of sleep apnea patients who could most benefit from mouth tape.

“We believe that the prevalence of mouth breathing among sleep apnea patients is high,” Labarca says. “However, research in this field is limited, and more studies, including epidemiological and physiological studies, are strongly required to determine the contribution of mouth respiration to sleep apnea.”

SomniFix is ​​also exploring research that may just reveal mouth taping benefits for broader populations in promoting nasal breathing during sleep, according to Michalak. Currently, SomniFix Strips are classified as a Class I device by the United States Food and Drug Administration (FDA) and are indicated for snoring. As a combination therapy, SomniFix plans to pursue Class II clearance for use with oral appliances.

For now, Labarca cautions that seeing a specialist should always be the first step before turning into mouth tape. “Mouth breathing and mouth taping are unexplored research areas with clinical implications for sleep apnea,” he says. “Mouth breathing and snoring can be the ‘tip of the iceberg,’ with hidden clinical important diseases, including sleep-disordered breathing.”

Chaunie Brusie, RN, BSN, is a content creator specializing in health, medical, parenting, finance, and travel.

Reference

Labarca G, Sands SA, Cohn V, et al. Mouth closing to improve the efficacy of mandibular advancement devices in sleep apnea. Ann Am Thorac Soc. 2022 Jul;19(7):1185-92.

Photo: A person uses SomniFix Strips to keep their mouth closed during sleep. The study by Labarca et al was supported by a grant from SomniFix.

Leave a Comment