“Try taping your mouth at night.”
It’s not the kind of advice you’d expect to hear at a dental checkup. But it’s something Dr. Mark Burhenne suggests every day in his practice.
Author of “The 8-Hour Sleep Paradox,” Burhenne has recommended mouth taping for a dozen years. It’s a cheap, easy way to find out if his patients are struggling with sleep or breathing and then to guide them toward solutions for sleep apnea, either in his office or through referrals.
Mouth taping, which can be done with medical tape or branded products, ebbs and flows as a social media challenge. Recently it’s gotten the attention of mainstream media and doctors, who are flat-out saying, “Don’t do it.” Burhenne says this binary thinking does a real disservice to people who want to explore health deficiencies.
“(Doctors) are afraid this is misinformation that it will kill someone and it will mislead them into thinking all they have to do is tape when they have sleep apnea,” he said. “Does it reverse sleep apnea? No. This is not going to treat sleep apnea.”
Obstructive sleep apnea is a chronic sleep-related breathing disorder in which the upper airway collapses and blocks the nasal passageway, causing a wake cycle as breathing unconsciously switches to the mouth. It’s more common as you age and with thickening of fatty tissue in the neck and tongue. Hormones, various diseases, anatomical abnormalities, obesity, and lifestyle habits such as drinking and smoking also are risk factors.
When Burhenne suggests taping to patients, he asks them to text him the next morning about whether it improved their sleep. He said it can shorten the diagnostic process, which sometimes involves different specialists and lengthy tests.
“The patient who can’t keep it on, we know in one or two nights they have a problem,” he said.
Patrick McKeown, international breathing coach and creator of Oxygen Advantage, has been mouth taping since 1998, but he also acknowledged it doesn’t stand alone as a treatment for breathing dysfunction because it doesn’t address the root cause.
Most of his clients breathe by mouth as a result of anxiety or asthma, which are sometimes exacerbated in part by mouth breathing. McKeown helps them establish nasal breathing during the day by working on congestion and habits, improving tolerances for carbon dioxide, and training them to recruit the diaphragm to support the breath.
“It’s unfortunate medical doctors haven’t embraced the importance of nose breathing and breathing exercises to help people with asthma,” he said. “There’s a role for medication. It’s also very good to give people simple tools to help their condition.”
The debate lends itself to controversy because very little research on mouth taping has been done, though anecdotally many doing it rave about improved energy, athletic performance, mental clarity, and recall. Certainly, not everyone will find that slapping a piece of tape over their lips will solve all of their breathing-related health problems. Instead, the reason those doing it experience success is really just because nasal breathing is functional breathing.
“We aren’t just taping everybody willy-nilly,” McKeown said. “The benefits of keeping the mouth closed during sleep far outweigh what would happen if the mouth is open.”
Table of Contents
Who Should Mouth Tape?
Not everybody needs to use tape, and nobody should try to correct sleep apnea by exclusively taping. A key indicator that it could help you, McKeown said, is if you wake up with a dry mouth in the morning.
Dysfunctional breathing impacts nearly 10 percent of the population, but it affects 30 percent of asthmatics and 75 percent of those with anxiety, according to a 2021 article in the Journal of Clinical Medicine. In adults 50 and older, 43 percent of men and 27 percent of women have sleep-disordered breathing because upper airway muscles get weak as we age. Mouth breathing, McKeown said, makes obstructive sleep apnea worse.
And just because you use a continuous airway positive pressure (CPAP) machine, doesn’t mean you’re exempt from mouth breathing. Twenty years of data suggest that only 34 percent of patients are adhering to proper use of the device, according to a 2016 article in the Journal of Otolaryngology – Head & Neck Surgery. This review of studies on CPAP pointed out that the many techniques for improving compliance have had no effect, suggesting CPAP can no longer be considered the gold standard of sleep apnea treatment.
Breath training is beneficial, McKeown said, and it should always be considered prior to long-term use of mouth tape.
Step one is to make sure congestion isn’t the main problem or that mouth breathing hasn’t become habitual. This applies to adults and children.
“The main thing about mouth taping is to make sure you can breathe functionally through the nose first of all,” he said. “The more you breathe through your nose, the better it works.”
If your nose is too congested, McKeown said:
- Take a normal breath in and out through your nose.
- Pinch your nose to hold your breath, and move your body or gently nod your head up and down.
- Hold your breath for as long as you can—until you feel a strong air hunger.
- Release your nose and inhale as calmly as possible.
- Rest for 30–60 seconds and then repeat six times.
“You establish you can breathe through the nose during wakefulness,” McKeown said. “When they’re feeling comfortable breathing in and out of their nose after a week of practice, we’ll have them tape their mouth when they sleep.”
Another person who may struggle with mouth tape is someone who has a low tolerance to carbon dioxide. They might experience distress over the sensation of air hunger if they don’t first build up their chemosensitivity, or tolerance for carbon dioxide.
Burhenne said he was taught in dental school that carbon dioxide is toxic, something he’s been challenged to see completely differently. Those who mouth breathe take in more oxygen but tend to have lower blood oxygen levels, affecting air exchange balance that takes place in the lungs and leading to low energy, brain fog, and trouble with memory. The balance, or exchange of gases, is the goal.
“We wouldn’t be alive if it wasn’t for carbon dioxide,” Burhenne said. “If you breathe through your mouth, you’re going to breathe in too much oxygen.”
In addition to restoring nasal breathing, McKeown trains clients with a wide variety of exercises to recruit the diaphragm in the breath, slow respiration, and increase chemosensitivity.
This forms the foundations of Buteyko breathing techniques, but McKeown emphasized that breath work ought to be tailored to the person and their unique anatomy and struggles. The Buteyko method was introduced in Russia in the 1950s by Dr. Konstantin Buteyko, who is credited for identifying dysfunctional mouth and upper chest breathing patterns.
The good news is that how we breathe during the day influences how we breathe when we sleep, meaning practice will reestablish habits. The goal is to breathe through the nose with a technique that is light, slow, and deep. Deep doesn’t mean big and expansive through the chest but describes how far down the breath goes, utilizing the diaphragm, a thin muscle deep in the trunk that partitions the chest and abdomen.
“We all assume we can breathe properly. We’ve never been taught how to breathe. We really need to learn how to,” Burhenne said. “Some doctors will say it doesn’t matter what part of the lungs you breathe from. Mouth breathing doesn’t engage the diaphragm or lower lobes of lungs.”
Here are a few exercises McKeown uses:
- Place one hand on your chest and one just above your navel. Put slight pressure on your body with your hands and then soften your body against the pressure. Snoring causes air turbulence, so imagine breathing in an opposite way, slow and soft.
- Breathe in such a way that you are trying to hide the fact that you are breathing but not by holding your breath. (If you do this right, it should make your saliva more watery, a sign that your nervous system feels more relaxed.)
- Slow your respiratory rate down and as you do, imagine the top of your head becoming very relaxed, then the back of your head, jaw, shoulders, arms, and all the way down the body.
- Practice air hunger, which improves chemosensitivity, by taking in about 30 percent less air. Do this for about four minutes but stop if you feel like you are suffocating.
Another breathing goal is to put the tongue in its proper location, which is up against the palate with the tip of the tongue resting behind the top teeth. A lazy tongue slips and blocks the nasal passage that runs behind the throat.
“You don’t want your throat collapsing at the slightest pressure,” McKeown said. “If your mouth is open, you’re not likely to have your tongue resting at the roof of the mouth.”
How We Became Mouth Breathers
Despite being common in older adults, mouth breathing often has roots in childhood. Chronic mouth breathing influences musculoskeletal development, creating a small palate and increasing the chances of obstructive sleep apnea.
“Children who are mouth breathers, their tongue is not resting on the top of their mouth. As a result, they tend to develop narrow v-shaped maxilla,” McKeown said. “There’s not enough room for their tongue, causing overcrowding of teeth. But the real problem is there is not enough room for the child’s tongue and that encroaches on the airway and causes dysfunction for the rest of their life.”
McKeown is determined to use holistic tools, because it’s unlikely telling someone to stop mouth breathing will correct their behavior.
“Cognitive training isn’t going to change respiratory physiology, and we have to change physiology. And we have to regulate the autonomic nervous system,” he said.
Teaching people of all ages how to properly breathe is essential for self-regulation, and it matters because mouth breathing, anxiety, and sleep all affect one another in ways that are mostly subconscious.
Breathing, however, can be manipulated, trained, and practiced in such a way that it can influence the body subconsciously. This somatic method can impact habits better than cognitive behavioral therapy alone.
While most of us might relate this to something like a panic attack—you can’t talk the body out of having one but you can breathe your way out—it applies to any kind of physical or emotional trauma the body experiences.
“Mouth breathing is trauma. The mouth is simply not for breathing,” McKeown said. “If we breathe hard and fast, we are telling the body things are not good, we aren’t safe. When we have some control over our breathing, we have some control over the mind.”
That’s why it’s important to proceed with caution with mouth tape, so it doesn’t create additional trauma.
There are tapes specifically designed for children that put gentle pressure on the jaw to stay closed without sealing the lips. Mouth tape should always be applied soft enough that it will fall off if your mouth opens.
The Danger of Continued Mouth Breathing
In addition to the disrupting of sleep and contributing to disorders rooted in breathing difficulties, mouth breathing can also dry out the mouth, cause damage to the upper airways, give you bad breath, and cause tooth decay.
Those are the reasons Burhenne will sing the praises of mouth taping and continue to incorporate breathing into his dental practice.
“Imagine breathing through your nose for six hours straight. how calming that would be, how it humidifies the nasal membranes, how it opens up the nasal passages, it humidifies the air, it’s gentler on the lungs, it changes mouth pH, lowers cavities, increases saliva, which remineralizes and fixes teeth,” he said.
“Breathing is important. You need to learn as quickly as possible what your status is.”
For him, mouth taping is like the stress test for sleep. And because nasal breathing coaxes a more relaxed state by dropping respiratory and heart rates, it plays a role in overall health.
“Is it a fix to your whole poor sleeping and apnea and relationship with your spouse? No,” Burhenne said. “But having said that, if you breathe properly, things come easier—less brain fog, less headaches, less joint aches. You feel better. You can sleep better.”
Benefits of Functional Nasal Breathing
- Better sleep breathing
- Reduces chemosensitivity to carbon dioxide
- Normalizes respiratory rate
- Improves muscle tone
- Increases lung volume
- Increases stores of oxygen and carbon dioxide
- Increases heart rate variability
- Improves vagal tone/easier to bounce back after stress
- Puts tongue in correct position
(Source: Journal of Clinical Medicine, 2021)