THE ROLE OF NASAL BREATHING IN SLEEP OPTIMIZATION: A CLINICAL ANALYSIS OF THE EFFICACY AND RISKS OF THE MOUTH TAPING METHOD
Abstract
Background. Nasal breathing is obligatory for maintaining airway patency, humidifying and delivering Nitric Oxide (NO). In contrast, mouth breathing increases airway resistance and leads to significant nocturnal dehydration and sleep fragmentation. Nocturnal Mouth Taping (NMT) has gained popularity as a tool to enforce the nasal route.
Aim. To explore the physiological advantages of nasal respiration, and to study the clinical effect and safety for mouth taping approach.
Materials and Methods. A narrative review of 20 peer-reviewed sources (2003–2025) was conducted using databases such as PubMed, Scopus, and Google Scholar, focusing on respiratory physiology and clinical outcomes of nocturnal mouth taping.
Results. In mild OSA (Obstructive Sleep Apnea) patients NMT reduces significantly Apnea/Hypopnea Index (from 8.3 to 4.7 events/h) and snoring (by47%). However, it is ineffective for moderate-to-severe OSA, where "mouth puffing" indicates persistent airway collapse despite mechanical lip closure.
Conclusions. The existing evidence is inadequate for clinical use of NMT. The practice is explicitly discouraged for the general population, especially those with moderate-to-severe OSA or nasal obstructions, due to life-threatening risks of asphyxiation and aspiration. NMT cannot replace medical treatment and potentially dangerous delay of appropriate surgery may occur for underlying anatomical pathologies.
References
Ahn Y. M. (2010). Treatment of obstructive sleep apnea in children. Korean journal of pediatrics, 53(10), 872–879. https://doi.org/10.3345/kjp.2010.53.10.872
Alghamdi, F. S., Albogami, D., Alsurayhi, A. S., Alshibely, A. Y., Alkaabi, T. H., Alqurashi, L. M., Alahdal, A. A., Saber, A. A., & Almansouri, O. S. (2022). Nasal Septal Deviation: A Comprehensive Narrative Review. Cureus, 14(11), e31317. https://doi.org/10.7759/cureus.31317
Bandara, S. M. R., Samita, S., Kiridana, A. M., & Herath, H. M. M. T. B. (2021). Elevated nitric oxide and carbon monoxide concentration in nasal-paranasal sinus air as a diagnostic tool of migraine: a case - control study. BMC neurology, 21(1), 407. https://doi.org/10.1186/s12883-021-02434-y
Fangmeyer, S. K., Badger, C. D., & Thakkar, P. G. (2025). Nocturnal mouth-taping and social media: A scoping review of the evidence. American journal of otolaryngology, 46(1), 104545. https://doi.org/10.1016/j.amjoto.2024.104545
Fitzpatrick, M. F., McLean, H., Urton, A. M., Tan, A., O'Donnell, D., & Driver, H. S. (2003). Effect of nasal or oral breathing route on upper airway resistance during sleep. The European respiratory journal, 22(5), 827–832. https://doi.org/10.1183/09031936.03.00047903
Georgalas C. (2011). The role of the nose in snoring and obstructive sleep apnoea: an update. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, 268(9), 1365–1373. https://doi.org/10.1007/s00405-010-1469-7
Jau, J. Y., Kuo, T. B. J., Li, L. P. H., Chen, T. Y., Lai, C. T., Huang, P. H., & Yang, C. C. H. (2023). Mouth puffing phenomena of patients with obstructive sleep apnea when mouth-taped: device's efficacy confirmed with physical video observation. Sleep & breathing = Schlaf & Atmung, 27(1), 153–164. https://doi.org/10.1007/s11325-022-02588-0
Jau, J. Y., Kuo, T. B. J., Li, L. P. H., Chen, T. Y., Hsu, Y. S., Lai, C. T., Yue, W. C., Huang, P. H., & Yang, C. C. H. (2023). Mouth Puffing Phenomenon and Upper Airway Features May Be Used to Predict the Severity of Obstructive Sleep Apnea. Nature and science of sleep, 15, 165–174. https://doi.org/10.2147/NSS.S384387
Kawasumi, T., Takeno, S., Ishikawa, C., Takahara, D., Taruya, T., Takemoto, K., Hamamoto, T., Ishino, T., & Ueda, T. (2021). The Functional Diversity of Nitric Oxide Synthase Isoforms in Human Nose and Paranasal Sinuses: Contrasting Pathophysiological Aspects in Nasal Allergy and Chronic Rhinosinusitis. International journal of molecular sciences, 22(14), 7561. https://doi.org/10.3390/ijms22147561
Keating, M. K., Phillips, J. C., & Phillips, J. (2023). Chronic Rhinosinusitis. American family physician, 108(4), 370–377.
Koutsourelakis, I., Vagiakis, E., Roussos, C., & Zakynthinos, S. (2006). Obstructive sleep apnoea and oral breathing in patients free of nasal obstruction. The European respiratory journal, 28(6), 1222–1228. https://doi.org/10.1183/09031936.00058406
Laidlaw, T. M., Mullol, J., Woessner, K. M., Amin, N., & Mannent, L. P. (2021). Chronic Rhinosinusitis with Nasal Polyps and Asthma. The journal of allergy and clinical immunology. In practice, 9(3), 1133–1141. https://doi.org/10.1016/j.jaip.2020.09.063
Lee, Y. C., Lu, C. T., Cheng, W. N., & Li, H. Y. (2022). The Impact of Mouth-Taping in Mouth-Breathers with Mild Obstructive Sleep Apnea: A Preliminary Study. Healthcare (Basel, Switzerland), 10(9), 1755. https://doi.org/10.3390/healthcare10091755
Lepley, T. J., Frusciante, R. P., Malik, J., Farag, A., Otto, B. A., & Zhao, K. (2023). Otolaryngologists' radiological assessment of nasal septum deviation symptomatology. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, 280(1), 235–240. https://doi.org/10.1007/s00405-022-07528-y
McKeown, P., O'Connor-Reina, C., & Plaza, G. (2021). Breathing Re-Education and Phenotypes of Sleep Apnea: A Review. Journal of clinical medicine, 10(3), 471. https://doi.org/10.3390/jcm10030471
Rhee, J., Iansavitchene, A., Mannala, S., Graham, M. E., & Rotenberg, B. (2025). Breaking social media fads and uncovering the safety and efficacy of mouth taping in patients with mouth breathing, sleep disordered breathing, or obstructive sleep apnea: A systematic review. PloS one, 20(5), e0323643. https://doi.org/10.1371/journal.pone.0323643
Spector, B. M., Shusterman, D. J., & Zhao, K. (2023). Nasal nitric oxide flux from the paranasal sinuses. Current opinion in allergy and clinical immunology, 23(1), 22–28. https://doi.org/10.1097/ACI.0000000000000871
Yi-Fong Su, V., Chou, K. T., Tseng, C. H., Kuo, C. Y., Su, K. C., Perng, D. W., Chen, Y. M., & Chang, S. C. (2023). Mouth opening/breathing is common in sleep apnea and linked to more nocturnal water loss. Biomedical journal, 46(3), 100536. https://doi.org/10.1016/j.bj.2022.05.001
Varghese, L., Rebekah, G., N, P., Oliver, A., & Kurien, R. (2022). Oxygen desaturation index as alternative parameter in screening patients with severe obstructive sleep apnea. Sleep science (Sao Paulo, Brazil), 15(Spec 1), 224–228. https://doi.org/10.5935/1984-0063.20200119
Zaliene, L., Mockute, A., & Levickiene, L. (2025). Breathing Interventions Improve Autonomic Function, Respiratory Efficiency and Stress in Dysfunctional Breathing: A Randomised Controlled Trial. Advances in Respiratory Medicine, 93(6), 56. https://doi.org/10.3390/arm93060056
Views:
15
Downloads:
102
Copyright (c) 2026 Klaudia Brzoza, Filip Matusiak
This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.
