Best CPAP Mask for Mouth Breathers: Options, Dry Mouth and Fit

For most people who breathe through the mouth during sleep, a full face (oronasal) mask is the usual first option, because it seals over the nose and mouth and keeps the pressure in when the mouth opens. Two alternatives also work for many people: a hybrid mask, which covers the mouth and seals under the nose, and a nasal mask or nasal pillows with a chin strap when the nose is clear and the jaw simply drops open. There is no single best brand. The best CPAP mask for a mouth breather is the one that stays sealed all night, and the choice should be made with the sleep physician or respiratory therapist.

Why mouth breathing causes leaks and dry mouth on CPAP

CPAP keeps the airway open with a steady stream of pressurized air. With a nasal mask or nasal pillows, that air goes in through the nose. If the mouth opens, part of it escapes through the lips instead of holding the airway open. This mouth leak has three effects:

• Dry mouth and throat: air rushing out over the tongue dries the mouth, often worst by morning.
• Less effective therapy: pressure that escapes is not supporting the airway, and the leak noise can wake you or your partner.
• Less use: discomfort makes people take the mask off. In a study of 51 new CPAP users published in Chest, 71% of nose breathers but only 30% of mouth breathers were using CPAP more than 4 hours a day after one year.

The same study found that mouth breathing fell from 84% to 22% of sleep time after three months of CPAP, so some people shift toward nose breathing once therapy settles in. That is a good reason to review the mask with your clinician after the first weeks instead of giving up.

Signs that you may be breathing through your mouth on CPAP include waking up with a dry mouth or sore throat, a partner hearing air escape from your lips, and high leak readings in your device's therapy data.

CPAP mask options for mouth breathers

Full face masks

A full face mask is a common option because it does not depend on keeping the mouth closed. The American Academy of Sleep Medicine (AASM) notes that this type may help if you have air leaks with a nasal mask, and it is also used when the nose is often congested.

It is not automatically better, though. A 2018 meta-analysis in Chest found that oronasal masks were associated with slightly higher CPAP pressures, more residual breathing events and about 48 fewer minutes of use per night than nasal masks. Good fit and follow up make the difference.

The iRiFiT F300 full face mask is one example of this type: an adaptive "V" rebound silicone cushion covers the nose and mouth, soft fabric headgear holds it in place, an anti-asphyxia valve is built in, and S, M and L cushions come in every unit.

Hybrid masks

Hybrid masks cover the mouth and seal at or under the nose, usually without a forehead support. They suit mouth breathers who feel confined by a traditional full face mask, wear glasses in bed or get sores on the bridge of the nose.

Nasal mask with a chin strap

A chin strap is a fabric band that supports the jaw so the mouth stays closed. Studies suggest it can help when it is combined with CPAP:

• In a randomized crossover trial of three interfaces, adherence was similar with a nasal mask, a nasal mask plus chin strap and a full face mask. Residual breathing events were higher with the full face mask, and most patients preferred the nasal mask.
• A small sleep study found that a chin strap reduced mouth leak from about 43% to 24% of sleep time, although snoring increased in some patients.
• A retrospective study of 124 veterans linked chin strap use to better CPAP adherence and lower leak.

A chin strap is not a treatment on its own: a 2014 study found that it did not improve sleep apnea without CPAP. It is also a poor choice if your nose is blocked. The iRiFiT N300 nasal mask, which seals around the whole nose, is an option for this setup when the clinician agrees. Some people ask about taping the mouth closed; do not try it without your clinician's approval, especially if your nose is often blocked.

Humidification and other ways to ease dry mouth

• Use the heated humidifier: the AASM recommends a humidifier for a dry mouth, throat or nose. The iBreeze CPAP/APAP, for example, has an integrated heated humidifier with 8 levels and automatic detection of room temperature and humidity.
• Fix the leak first: no humidifier can keep up with air escaping through the mouth all night, so a better seal often matters more than extra moisture.
• Ask about heated tubing: it helps keep moisture in the air instead of letting it condense in the hose.
• Treat nasal congestion: the AASM notes that a saline nasal spray can ease mild congestion; ask your doctor before using anything stronger.

Adjust humidity and other device settings with your provider, and never change the prescribed pressure on your own.

When to see your clinician about nasal obstruction

Many people breathe through the mouth because the nose is partly blocked. Talk to your sleep physician, and ask whether an ear, nose and throat (ENT) evaluation makes sense, if:

• your nose is blocked most nights, or you have chronic allergies, sinus problems, a deviated septum or nasal polyps;
• dry mouth, sore throat or nosebleeds continue after you fix the fit and use the humidifier;
• your device still reports high leak or residual events with a new mask;
• you still feel sleepy during the day or wake up gasping.

Treating the nose can make a nasal interface possible again. Changing the mask type does not change your prescription, but your clinician may review your therapy data after a mask change.

Fitting tips for mouth breathers

1. Fit lying down in your usual sleep position, with the device running at the prescribed pressure.
2. Check the seal with your mouth slightly open, as it will be during sleep. A full face cushion should not lift off around the lower lip when the jaw drops.
3. Tighten gently: overtightening folds the cushion and pushes leaks toward the eyes. If you have to pull the straps hard, try another size.
4. Reseat the cushion after lying down: pull the mask slightly away from your face and let it settle back so the cushion inflates evenly.
5. Side sleepers can look for a low profile mask and use a CPAP pillow. See our guide to the best CPAP mask for side sleepers.
6. Replace worn cushions on time. Our guide to the types of CPAP masks includes a replacement schedule.

Mask supply for clinics and homecare providers

When mouth leak shows up, programs that stock both a nasal and a full face option can switch the patient in the same visit. SysMed USA supplies the iRiFiT N300 nasal mask and the iRiFiT F300 full face mask to hospitals, sleep clinics, homecare providers and distributors across Latin America; both use a standard 22 mm connection. Browse our nasal and full face CPAP masks or request a wholesale quote.