The Oxygen Advantage®: Addressing dysfunctional breathing patterns for sleep disordered breathing
By Patrick McKeown MA
According to Dr. Christopher Winter who is medical director of the Martha Jefferson Hospital sleep medicine center in Charlottesville, Virginia, “There are athletes everywhere who have sleep apnea.” “Not only does the apnea affect their athletic performance, but it is extremely hard on their cardiovascular systems as well.”
In a study published in The New England Journal of Medicine, the prevalence of sleep-disordered breathing among professional football players (NFL) is 14 percent overall and 34 percent within the high-risk group. (Offensive and defensive linemen) 1
Breathing through the nose during sleep in a quiet and gentle manner reduces snoring and obstructive sleep apnea. Snoring occurs due to a large volume of air passing through a narrowed space which causes turbulence in the soft palate, nose or back of the throat. There are two factors here; the first is that the individual is breathing too noisily during sleep. The second is that their nose may be congested causing narrowing of the upper airways.
Simply by unblocking the nose, switching to nasal breathing and calming breathing towards normal, snoring and sleep apnea greatly reduces. This is not a coincidence given the number of studies highlighting the relationship between nasal obstruction, mouth breathing and snoring/sleep apnea. (scroll down for further reading)
Upper airway resistance is much higher while breathing orally than nasally during sleep, with obstructive apneas (holding of breath) and hypopneas (resistance to breathing) profoundly more frequent when breathing through the mouth. (apnoea-hypopnoea index 43+/-6) than nasally (1.5+/-0.5).2
The good news is that sleep experts are increasingly becoming concerned of the impact of open mouth breathing during sleep. Among these is Stanford University based, Dr Christian Guilleminault who is a leading figure in the field of sleep medicine. According to Dr Guilleminault, “the case against mouth breathing is growing, and given its negative consequences, we feel that restoration of the nasal breathing route as early as possible is critical”.3
Effect of nasal or oral breathing route on upper airway resistance during sleep
Upper airway resistance during sleep and the propensity to obstructive sleep apnea are significantly lower while breathing nasally rather than orally.
Eur Respir J. 2003 Nov; 22(5):827-32
Mouth breathing during sleep
Influences of the breathing route on upper airway dynamics properties in normal awake subjects with constant mouth opening. When compared with nasal breathing, mouth breathing decreases the stability of the lower airway independent of mouth opening.
This effect of mouth opening and moving from nasal breathing to mouth breathing may add to the effects of sleep on upper airway muscle tonic activity worsening upper airway stability and favor the occurrence of upper airway obstruction during sleep. Clinical Science (2006) 111, 349–355
The impacts of open-mouth breathing on upper airway space in obstructive sleep apnea: 3-D MDCT analysis.
Results suggest that the more elongated and narrow upper airway during open mouth breathing may aggravate the collapsibility of the upper airway and, thus, negatively affect OSA severity.
Eur Arch Otorhinolaryngol. 2011 Apr; 268(4):533-9
Effect of Nasal or Oral Breathing Route on Upper Resistance during Sleep.
Upper airway resistance during sleep and the propensity to obstructive sleep apnea are significantly lower while breathing nasally rather than orally. This mechanical advantage may explain the preponderance of nasal breathing during sleep in normal subjects.
Eur J Pediatric. 2013 Apr172 (4)
Airway collapsibility in normal sleeping subjects
We conclude that mouth opening increases UA collapsibility during sleep and that mouth opening may contribute to the occurrence of sleep related breathing abnormalities.
Am J Respir Crit Care Med. 1996 Jan; 153(1):255-9.
The Nose and Sleep-Disordered Breathing
Although increased nasal resistance does not always correlate with symptoms of congestion, nasal congestion typically results in a switch to oronasal breathing that compromises the airway. Moreover, oral breathing in children may lead to the development of facial structural abnormalities associated with SDB. We postulate that the switch to oronasal breathing that occurs with chronic nasal conditions is a final common pathway for SDB.
Chest. 2003 Dec; 124(6):2309-23.
- Increased Prevalence of Sleep-Disordered Breathing among Professional Football Players. N Engl J Med 2003; 348:367-368
- Fitzpatrick MF1, McLean H, Urton AM, Tan A, O’Donnell D, Driver HS. Effect of nasal or oral breathing route on upper airway resistance during sleep. Eur Respir J. 2003 Nov;22(5):827-32.
- Vorona R et. Al. Treatment of Severe Obstructive Sleep Apnea Syndrome with a Chinstrap. J Clin Sleep Med. Dec 15, 2007; 3(7): 729–730.
- Seo-Young Lee* , Christian Guilleminault, Hsiao-Yean Chiu,**, Shannon S. Sullivan. Mouth breathing, “nasal dis-use” and pediatric sleep-disordered-breathing. Sleep and Breathing (2015) Stanford University Sleep Medicine Division, Stanford Outpatient Medical Center, Redwood City CA