Mouth breathing and how it affects your sleep

Why the mouth falls open at night

If the nose is blocked, the body takes the easiest route and the mouth opens. Allergy, a cold that drags on, a deviated septum and, in children, enlarged adenoids all make it harder for air to pass through the nose. In some people the nose is clear but the habit has settled in: through the nose by day, through the mouth once asleep. Lying on your back also lets the lower jaw slide backwards, and the lips part on their own.

Waking up with a dry mouth

Saliva flow is already at its lowest overnight. Once the mouth stays open, the air moving across it dries away what little is left. The tongue and palate feel like paper and the lips stick together. The smell you notice on waking starts here: bacteria spend the night in a dry mouth with no saliva to rinse them away.

• A dry, rough feeling on the tongue and palate
• Breath that is strongest before you brush
• Waking in the small hours for a glass of water
• Cracked lips and a scratchy throat

What teeth lose when saliva runs low

Saliva does more than keep things wet. It dilutes acid after meals, carries minerals back into enamel and constantly sweeps away the bacterial film. When that protection is missing for hours at a stretch, decay starts sooner along the gum line of the front teeth and around bridges and braces, where cleaning is awkward anyway. Gums in the dry area redden more readily and bleed when brushed.

Waking with a dry mouth usually says less about the mouth than about the nose, and that is where the way out tends to be.

Why the nose blocks up

Pollen, house dust, a cold that will not clear and cigarette smoke all swell the lining inside the nose. In children, adenoids and tonsils narrow the space air has to pass through. In adults, a deviated septum or enlarged turbinates do the same. An ear, nose and throat specialist is the one who sorts these out, and allergy is handled separately. Once the nose clears, the mouth often closes at night of its own accord.

What changes in children

When a child breathes through the mouth for years, the tongue rests low instead of sitting up against the palate. Without that support the palate grows narrow and high, the upper jaw runs short of room and the teeth come through crowded. The lower jaw can sit further back and the lips meet only with effort. The front teeth stay dry and the gum margin looks permanently red. Picked up early, both the nose and the bite can be dealt with while growth is still under way.

• Sleeping with the mouth open and a damp pillow
• Snoring, restless turning, sweating in bed
• Hard mornings, daytime vagueness and irritability
• A permanently red gum margin on the front teeth and dry lips

Snoring is not the same as sleep apnoea

In snoring, air rattles the soft tissues of a narrowed airway. In sleep apnoea, breathing stops altogether for short spells, the person surfaces without knowing it, and the pattern repeats many times through the night. From the outside the two sound alike, but the consequences are not the same. Only a doctor can tell them apart and decide whether a sleep study is needed. Where an appliance worn in the mouth comes into play, a dentist and a sleep physician plan it together.

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