The Mouth Taping Controversy For Better Sleep

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Does It Work And Is It Safe?

My wife Kathy keeps making fun of me for using tape to fix all of life’s problems. For example, I take black electrical tape with me while traveling to cover up all electronic LED lights at night to sleep better. I have to admit that I’ve used duct tape on a number of occasions for temporary home repairs. More recently, I have been taping my lips closed at night for better sleep. I have to admit that overall, I do seem to be sleeping better.

Mouth taping has been promoted by dentists, myofunctional therapists and various holistic health practitioners for a number of years. During a cursory search for its origins, I could not see anything mentioned before the past 5 or 6 years, except for lip taping in children with a cleft lip.

Several societies and prominent physicians have cautioned against it. This myofunctional therapy website recommends avoiding lip taping. Dr. Kasey Li, a world-renown ENT and maxillofacial surgeon advises against it in this Forbes article. My specialties (ENT and sleep medicine) are generally against it. Up until recently, I was against it too, until I heard countless patients telling me that they sleep better with mouth taping.

My Personal Journey

About 3 months ago, I decided to take the plunge and try mouth taping for myself. I tried different types of tape and different ways of placing the tape. The most commonly recommended type of tape is the 1 inch 3M micropore paper tape, but I had no problems using other types of tape. It’s a personal preference. The other issue that I played with was tape placement. Most experts recommend a single horizontal position across your lips. There are several commercially available mouth tape options to keep your mouth closed. I’ve even seen some photos of people using nasal dilator devices (Breathe Right strips®) or a Band-Aid.® Remember to use lip balm if your lips get dry. 

One way of tape placement ended up working best for me: vertically from the upper lip (base of the nose) to under my chin. What I found was that if you stop just under your lower lip in front of your chin, your mouth can still open significantly. I see this happening all the time in the operating room during drug-induced sleep endoscopy. With the mouth closed, the space behind the tongue is relatively open (Photo 1), but if your mouth opens about 1/2 inch distance between your teeth, the tongue moves back severely with almost total obstruction (Photo 2). Try it yourself. While keeping …

Can CPAP Make You Gain Weight?

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Scanning through my daily schedule of patients, I noticed Mr. Johnson was on the schedule. I have been following him for over 10 years since diagnosing and prescribing CPAP for his severe obstructive sleep apnea. I last saw him 3 years ago. He was faithful in using his CPAP 100% of the time, and his adherence numbers were perfect, with an average AHI of 1, minimal leaks, and being used 8-9 hours every night. As I entered the exam room and greeted him, I was shocked to see how much weight he had gained (30 pounds) over the past few years.

One of the basic tenants of sleep medicine is that poor sleep leads to weight gain. It naturally follows that sleeping better with CPAP will lead to weight loss. It’s not uncommon to see patients losing weight after sleeping better with CPAP, dental appliances or even after surgery. However, I had seen a few studies over the years showing that a small proportion of people using CPAP may gain some weight, but what I discovered over the past few weeks studying basal metabolic rates and weight loss in relation to CPAP was surprising.

It turns out that overall, CPAP use has been found to increase weight significantly, in proportion to how long you use CPAP. The more hours you use CPAP every night and the more number of years, the higher the amount of cumulative weight gain.

  • Researchers from Harvard and Stanford Universities found that patients randomized to receive CPAP for 6 months gained 0.77 pounds, whereas people on sham CPAP lost 1.5 pounds. Of note, people who more highly compliant (using more than 4 hours/night, at least 4/7 days/week) had higher degrees of weight gain.
  • In another study, overall BMI did not increase in CPAP compliant patients after one year, but women and non-obese subjects did gain significant weight.
  • A Finnish study in 2016 found that CPAP compliant, more obese patients had higher levels of weight gain after 5 years.
  • Lastly, a meta-analysis of randomized only studies analyzed over 3181 patients from 25 studies, finding significant weight increase in compliant CPAP users.

A number of explanations are given as to why CPAP can promote weight gain. The one most reasonable proposal that I saw is that when you have obstructive sleep apnea, your basal metabolic rate (BMR) in higher.  Due to the extra energy demands of having sleep apnea, you burn up more calories. It’s been shown that using CPAP reduces your BMR.  Since dietary intake and