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Sleep Disorders

Is mouth exhaling normal during sleep?

07/02/2007

Question:

My husband breathes in through his nose and then exhales/puffs through his mouth when he sleeps. Is this a form of sleep apnea and should we be concerned about it?

Answer:

It’s hard to know for certain whether or not this could represent a breathing disorder in sleep without obtaining additional information and performing an examination of your husband. Most individuals breathe in and out through their noses when at rest. Occasionally, with nasal congestion from a cold or anatomic problem (such as a deviated septum), oral breathing becomes more prominent. However, how this figures into the likelihood of developing or having sleep apnea has not been well studied.

Obstructive sleep apnea is defined as repetitive episodes of airway narrowing or collapse during sleep. During sleep, the muscles supporting the upper airway in the back of the throat tend to relax. When individuals who have a narrowed airway to start with fall asleep, this muscle relaxation may be enough to cause significant narrowing or collapse of the tissue in the back of the throat. A narrowed airway is most commonly the result of being overweight as fatty tissue tends to deposit in the tissues of the airway. Other causes of a narrowed airway may include large tonsils (a very common cause of sleep apnea in children), a large tongue, and abnormal jaw anatomy or nasal anatomy.

When the airway collapses in obstructive sleep apnea, the brain and body protect themselves by making the individual briefly awaken (most people who do this are not aware of this happening) and opening their airway to allow for normal breathing. Unfortunately, as they fall back asleep, the process of airway closure tends to repeat over and over. These recurrent awakenings fragment or break up sleep, resulting in poor sleep, a lack of feeling refreshed after sleep and daytime sleepiness. Other symptoms of obstructive sleep apnea may include morning headaches and restless sleep. Loud snoring often accompanies the sleep disordered breathing. If your husband is experiencing these symptoms, it is best to have a full sleep evaluation. Not only does the poor sleep affect quality of life, but obstructive sleep apnea has now been linked to numerous other problems if it goes unrecognized and untreated for a prolonged time period. Most concerning of these conditions are high blood pressure and cardiovascular disease (for example, stroke and heart disease). Obstructive sleep apnea is treatable by a number of methods and the type of treatment best suited for each individual depends on a number of factors.

It would probably be a good idea to have your husband discuss this with his primary doctor. Referral to a Sleep Specialist in your area may be useful, and additional testing may be needed to determine if there really is a problem that needs to be addressed.

It would probably be a good idea to have your husband discuss this with his primary doctor. Referral to a Sleep Specialist in your area may be useful, and additional testing may be needed to determine if there really is a problem that needs to be addressed.

To learn more about sleep apnea or other sleep disorders, please visit the American Academy of Sleep Medicine's website at www.aasmnet.org. In addition to information, the website contains a list of Sleep Centers across the country so that you may locate one near you. The website www.sleepeducation.com also contains plenty of consumer friendly information about sleep and sleep apnea. Good luck and here's to better sleep!

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Response by:

Dennis   Auckley, MD Dennis Auckley, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University