Mouth Taping--Consequences?

GoodGuy wrote:I'm having trouble "keeping my mouth shut" also. My question is for those using tape, what kind and size of tape do you use and what if any special procedures do you follow.

The link birdshell gave to rooster's step-by-step procedure (Link to 'Just One Man's Very Successful Mouth Taping Procedure') is very good.

Here's more than a person could ever want to read about various methods of dealing with mouth air leaks if you don't want to use a Full Face mask, and if a chin strap doesn't work:

Links to: Mouth leaks - Air Leaks - Tape - DIY Guard

That goes to this:
viewtopic.php?t=8011

Thanks, RG. You always have the lists--I think we should call you "List Gal" sometimes!!
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The athletic tape will work, but for some it may cause allergy issues. I believe it is a zinc oxide tape.

I've taped my fair share of ankles, arches, fingers, etc. in my volleyball coaching days. The athletic tape is NOT as sticky as the paper medical tape; I can certainly see where it would be easier to remove.

When taping with athletic tape for athletic purposes, a pre-wrap is often used, or a spray containing tincture of benzoin is used before taping to help the adhesion. The pre-wrap works well for girls with sensitive skin; the spray is good for those who sweat the tape loose.
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BTW, anyone hear about the dog who ingested gorilla glue? It frothed up and hardened in its stomach in a clump, and had to be surgically removed. The last I heard, the dog was recuperating well.

I spread Blistex on my lips - the kind you get in a small round box, and use 3M Micropore Hypoalergenic surgical tape.

I'm allergic to normal medical tape.

O.

Rather than debating the scientific proof that taping is safe or not-how about sharing the safest way to do it.
Admonitions against mouth taping by health professionals is based in their education and occasionally in experience. Indeed most of the things health professionals tell us to do or not do is based in their education and experience. We then choose whether to follow that advice or not. I have seen a person with a wired jaw vomit and aspirate but that was post anesthesia. I have never seen a patient on CPAP vomit and aspirate-but that doesn't mean I believe it is safe to tape. If I was caring for a person on CPAP that chose to tape-I would work with that person to assure they knew the risks, had tried other methods, then work with the person to make the taping as safe as possible as I realize for many it is the difference is effective treatment. I might have them sign a release-I would definitely chart very carefully.

Tape above and below the mouth then the last piece placed to close the mouth-so you only have to get that strip off to open your mouth.
Fold over a corner of the tape so it can be easily gripped to pull off.
Don't tape after a large meal, drinking alcohol (you know what it takes to make you sick), if you feel nauseated to begin with

Unfortunately most chinstraps are poorly designed and hence rarely work. I do believe it is possible to integrate the chin strap and headgear into a unit that would work for more people and be relatively comfortable (at least as comfortable as taping).

GoodGuy wrote:I'm having trouble "keeping my mouth shut" also. My question is for those using tape, what kind and size of tape do you use and what if any special procedures do you follow.

There have been many threads here on this subject and I'm sure that if you do a search on mouth taping you'll find several different approaches.

I personally use 3M Micropore paper tape in the 2" width. It's sold under various brands, and I've bought it at Walgreens and at various places on the internet.

I cut off about a six inch strip, turn one end over to form a small flap for easier removal, tuck my lips under a bit, and press it into place. Take your time removing it in the morning or you could find yourself removing small patches of skin. Trust me on this.

OCO

Krousseau, before answering your last posting on this thread, I have something to say:

I very much respect your opinions, and wish to take every statement seriously. Your experience and wisdom are very valuable to me, and I would hope to everyone on the forum.

Thank you very much for your time and explanations. For the first time, I can see more of the medical perspective.

While I am not a medical professional, I do come from a family with many medical professionals. In addition, I have been a doctoral student--I understand research design and have had 5 statistics classes (it takes at least 6 classes to really understand.... ) I understand the basics of the statistical testing done on research.

This is said only because it helps to understand my perspective on the mouth-taping question. This is why I would like to see hard research of the phenomenon.

krousseau wrote:Rather than debating the scientific proof that taping is safe or not-how about sharing the safest way to do it.
Admonitions against mouth taping by health professionals is based in their education and occasionally in experience. Indeed most of the things health professionals tell us to do or not do is based in their education and experience.

This seems to beg the question of a scientific evaluation of the safest way to tape. What are the safest ways to tape, really? Do we know? There are some commercial products for some kind of taping.

As I said, anecdotal evidence (which is basically the same as experience) is valuable. Personally I believe in experience strongly.

krousseau wrote:We then choose whether to follow that advice or not. I have seen a person with a wired jaw vomit and aspirate but that was post anesthesia. I have never seen a patient on CPAP vomit and aspirate-but that doesn't mean I believe it is safe to tape. If I was caring for a person on CPAP that chose to tape-I would work with that person to assure they knew the risks, had tried other methods, then work with the person to make the taping as safe as possible as I realize for many it is the difference is effective treatment. I might have them sign a release-I would definitely chart very carefully.

I understand the importance of the release. I had to sign one about driving at my CPAP sleep tests. And, I know I tried other methods first--two chin straps and self-improvised things.

krousseau wrote:Tape above and below the mouth then the last piece placed to close the mouth-so you only have to get that strip off to open your mouth.

This was exactly like my first attempt, and I've tried it again. I awake tired and with the tape separated! Obviously, this is not doing the job. I now make vertical strips stuck together, and they can be quickly ripped off due to using milk of magnesia smeared and dried on the skin before applying the tape.

krousseau wrote:Fold over a corner of the tape so it can be easily gripped to pull off.

Good advice, and I hope we all do so. I know that I do.

krousseau wrote:Don't tape after a large meal, drinking alcohol (you know what it takes to make you sick), if you feel nauseated to begin with

Again, good advice. I would hope that we would follow this. I do feel a bit more secure with taping because I am unable to vomit (due to a Nissen fundiplication for GERD.)

krousseau wrote:Unfortunately most chinstraps are poorly designed and hence rarely work. I do believe it is possible to integrate the chin strap and headgear into a unit that would work for more people and be relatively comfortable (at least as comfortable as taping).

I agree, but the whole 'lab-ratting' thing has not brought up a better method of keeping my big mouth closed! Maybe my fingers should be tied so I can't type so much!!

Once again, thank you Kay! This is helpful when added to Melissa's(NyNurse) experience.

I would still like to see research, because it appears that aspiration has primarily occurred while anesthetized or otherwise similarly impaired. So, has this ever happened to a person NOT impaired? I just want to know.

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CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP

You know, Birdshell, I've bee wondering about why we're not hearing any research results... and that started me thinking of the study population:

1. No known breathing problems while awake
2. Breathing obstruction caused by sleep only - if any problems shoud be considered

And the study conditions:
Anyone doing a study on mouth taping during sleep would have to observe the sleepers at night, with nurses and resucitation equipment handy - at least till results show it isn't dangerous. Can you imagine the price of such research? (Not to mention legal wavers, ect.).

So, chances are, a controlled study that is relevant to healthy, concious people, whose breathing is disturbed only by sleep, will never be done.

However, we do have an equivalent of an observational study in our group. Between us, we taper have amassed many thousands of nights without serious mishaps Tens of thousands - probably more - night after night after night.

Anecdote: I use a flap on each side of the tape- and have discovered that when I have an upset stomach, I wind up with both tape and mask off my face, having removed them semiconciously.

I've decided not to worry at this point (I'm 53) about "what if I have a stroke or heart attack while on cpap with my mouth taped" - but it's an important considration for some people.

O.

I have vomited and aspirated. Before the CPAP, I had severe acid reflux. Often I would wake up with the feeling of acid in my throat. I would have to go the bathroom and cough hard until I coughed all the acid out of my lungs and sometimes there was a lot.

This is what sent me to the gastroenterologist who then spotted the symptoms and sent me to a sleep apnea specialist.

Since using CPAP I occasionally get some acid reflux, but not like what I had. This is usually just some irritation in my throat and I can feel nothing in my lungs.

I now use an Ultra-Mirage Full Face mask. The clips come off easily if I need to remove it quickly. If I can't find the clips, I can just pull the whole thing off my head quickly.

Use your own judgement, but people with sleep apnea often have acid reflux. (Contrary to what many people think, acid reflux is not just heartburn. It means that acid is coming up into your throat. It may also be getting into your mouth, sinus or lungs.)

If you feel irritation in your throat, you probably have acid reflux. If you have acid reflux, you are in significant danger of aspirating.

Sleep apnea causes you to wake or move to a lower level of sleep and engage the stronger muscles of your lungs to breathe. This can put pressure on other organs such as the stomach and the bladder causing acid reflux or the urge to urinate.

Kind of goofy sounding but I have also used Poligrip as an alternative to taping.

Pluses -- it seems gentler than taping. The seal seems to be more complete but weaker than tape The seal is easily broken if you need to cough, etc. then it tends to reseal just by closing your lips. Depending on the air pressure you are using --- it can work quite well.

Negatives -- Not as strong a seal as tape. Can be slightly messy (Use the Clear Poligrip -- not the "Original".) And finally, it takes a couple of minutes to peel it off in the AM which is why I cycle through taping/Poligrip/chin strap/nothing. Currently I am using the chinstrap.

birdshell wrote:Precisely why I want to know:

How can our medical professionals recommend AGAINST mouth taping IF they have no good studies showing that is is counter-indicated?

Because they base their recommendations on what they learned in books or in the hospital.

birdshell wrote:This could be done as a survey of sleep doctors polling their mouth-taping patients.?

I wonder how many of them know. ( I'm going to run a poll on that one).

birdshell wrote:Studies can be formulated based on records kept by sleep specialists, had anyone wished to do so.
It could also be done by combing medical records for any such reported consequences.

And, the large number of anecdotal results among all of us here would indicate that mouth taping is safe.

So, why is it that so many medical professionals have problems with mouth taping?

Because they never asked.

O.

Birdshell wrote

I have been a doctoral student--I understand research design and have had 5 statistics classes (it takes at least 6 classes to really understand.... ) I understand the basics of the statistical testing done on research.

We have something in common-spent 4 years in a doctoral program in nursing before deciding I'd rather be fishing. 22 years of disuse have done little for my retention of more than the basics. But some things I remember-so I'm sitting here imagining a research design for this one-presenting it to a dissertation committee and ethics committee-not to mention the informed consent aspect. OK you could say it was survey research and you were only going to survey people who already taped. (No new tapers would be created by this research.) One of the problems would be identifying people who tape-even though a number of people here do. So you could survey all people who go to a several clinics to see how many taped (anonymous response takes care of some informed consent issues). You could ask what people had tried and any problems with taping-specifically with vomiting/aspiration. The most significant problem would be getting a response from those who may have suffered the most severe consequence you mentioned-death.

How can our medical professionals recommend AGAINST mouth taping IF they have no good studies showing that is is counter-indicated?

I do not make something like taping "taboo" because then patients don't tell you about it. Before reading people's experiences here I would not have even known to ask about taping-I would now. Trust me I would never advise taping saying no one ever proved it was not safe. My attitude is show me it is safe and beneficial first-not I'll do it until it is proven to be unsafe. My approach with any patient I worked with would be to look at what they had tried-see if they were making an informed choice and try to make that choice as safe as possible. There are instances in which I'm willing to base my actions in a new situation on similar experiences I've had in the past or on knowledge gained from books. Indeed one of the tests of the usefulness of knowledge is the applicability to other similar situations.

From reading here and from my experience-mouth openings seem (to me) to occur for two basic reasons 1)to breathe, or 2) when a person is deeply relaxed and the lips part, the tongue seal is lost at the oropharynx and the pressure of the air comes out through the mouth. Chinstraps IMO would be unlikely to help mouth breathers because they are actively opening their mouths to breathe. Chinstraps if well designed have the potention of helping the mouth poppings that occur due to relaxation and the CPAP air pressure. One of the problems of most chinstraps is that they pull the chin backwards-thereby making the problem even worse. If the chinstrap is designed with only a strap to the back of the head to help keep it from slipping there is a tendency for some of that force to pull the chin back. The chin strap I use is incorproated into the headgear so that it is stabilized from the front and the back and doesn't pull backward (I wouldn't want it to slip and be a victim of strangulation instead of aspiration ). It also does not touch the front of my chin. It supports the base of my tongue. And it is a very sturdy/firm stretchy material that really gives support. I can't believe I'm the only person here who gets benefit from a chin strap. Would I tape if nothing else worked-YES-because then my perceived benefit would become worth my perceived risk.

Ozji wrote

Because they base their recommendations on what they learned in books or in the hospital.

I 'm not sure how you meant that-as a bad thing or a good thing... I hope I did learn something from my education and experience. How else do we learn besides what we learn through our experience and the experiences of others (through books and sharing knowledge)??? I don't want a sleep doc with no education and experience. Questioning is necessary in developing new ideas-research helps test ideas. Books help disseminate new information and ideas. Putting them into practice is experience.

BTW As regards taping, GERD, acid reflux and aspiration. It can occur whether or not a person taped. That is a different issue than vomiting and having no way to immediately clear the mouth/airway. While some people regurgitate relatively large amounts many people have "silent" aspiration, where a person is not even aware that tiny amounts of stomach contents are entering the lungs. It happens behind taped or untaped lips-with the mouth open or closed. Knowing one has regurgitation of large amounts would be one contraindication to taping IMO.

krousseau wrote: Ozji wrote

Because they base their recommendations on what they learned in books or in the hospital.

I 'm not sure how you meant that-as a bad thing or a good thing... I hope I did learn something from my education and experience. How else do we learn besides what we learn through our experience and the experiences of others (through books and sharing knowledge)??? I don't want a sleep doc with no education and experience. Questioning is necessary in developing new ideas-research helps test ideas. Books help disseminate new information and ideas. Putting them into practice is experience.

That was the way I meant it, Kay. And I wish all medical professionals I met were like you - your professional approach to mouthleaking is all that I would want it to be.

Learning from books is a very good thing. I was trying to comment on the possibility that many of the professionals we meet don't have the experience to tell what the results of taping are - since they themselves don't know about it.

However, if any responsible professional (they do exist) had a cpap patient who was found dead with a taped mouth - wouldn't they have started enquiring? Wouldn't they eventually publish a paper on this bizzare (...) albeit popular and possilbly dangerous behavior so that the knowledge of its danger would be disseminated - to other doctors, and then to patients?

The minute anyone has reference to that paper, I hope they post it - we've been waiting for ever since this thread started.

O.

(Editing some typos, I was in too much of rush...)
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Do you have any suggestions for search topics-on medscape & medline mouth taping+CPAP got nothing about mouth taping. Preventing mouth breathing+CPAP got oral appliances, face masks. Aspiration pneumonia+vomitus+CPAP got nothing relevant to mouth taping.