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So your mouth opens and you snore when you fall  asleep…

If during the night, when you fall asleep your mouth opens and you start snoring, then it’s easy (but perhaps mistaken) to think a chin strap to stop it doing so, would be a simple solution.

So, if you’re wondering:

Do chin straps work? Are they safe and effective?

Then read this independent sleep-industry expert (no affiliate links!) review. 

I’m a sleep-industry insider (learn more about me: Adrian Zacher) with a quarter of century of sleep medicine experience.

Adrian Zacher MBA

Author, Dental Sleep Medicine Instructor and Sleep Apnoea Evangelist, Snorer.com

Snoring and mouth-opening: The case for a chin strap

As you breathe IN (inhale) the soft tissue in your throat and sometimes nose, together with your uvula (the dangly bit hanging from the roof of your mouth) may vibrate as the air passes.

This makes the snoring noise

If your mouth is closed while you sleep (sounds positive for the chin strap – for a moment) then assuming you can… your breathing has to occur through your nose, which is what your nose is designed for.

Sounds good in principle…

And if you Google “chin straps for snoring” you will see there are plenty to choose from. With lovely colours, different length straps and sizes etc. etc.

But almost all cup your chin and have straps that go around the back of your head.

So its a reasonable question to ask:

Do chin straps make snoring better or worse?

 

Do chin straps make snoring better or worse?

When your airway gets narrower the air you breathe must travel faster. As the air speeds up, it makes floppy tissue in your airway vibrate and this makes the snoring noise.

If you sleep on your back, the problem is not that your mouth falls open, its because as your mouth opens your jaw moves backwards, which allows your tongue to reduce the size of the airway in your throat.

A chin strap exaggerates this backwards movement of your jaw, making your airway smaller and your snoring worse.

The diagram below (used with permission from Elsevier Press1) and taken from our FREE How to Choose a Mouthpiece Guide illustrates the negative consequence of backward jaw movement.

Three airway examples: normal, with apnea, restored.

On the far left the airway is normal and open.

Breathing occurs freely and quietly.

The middle picture shows how the jaw and tongue have moved backwards and no breathing is possible.

This is technically known as ‘mandibular retrusion’ and it is not safe. It is dangerous.

The third diagram on the right illustrates how a ‘Mouthpiece’ protrudes the jaw and helps the individual sleep and breathe at the same time.

More about them later in this post.

How does jaw position relate to snoring?

This brief video will will show you how jaw position relates to snoring:


Video length = 26 seconds

chin straps and airway volume

The X-ray images on the left have red highlighted areas, that indicate the size of the airway behind the tongue.

The right-hand one illustrates how airway volume increases with protrusion.

What does the clinical research say about chin straps?

Since I first published this post (2017) I have seen some vendors of chin straps misquote a case study2 (which means ONE patient) to make out that clinical research proves chin straps are a valid option for snoring and obstructive sleep apnoea (OSA).

Which is not the case at all. 

The key things to know about chin straps are:

  1. Clinical research has proved chin straps are not effective for snoring
  2. If you use Positive Airway Pressure therapy for sleep apnoea / apnea then a chin strap may help avoid mouth leak

Since the case study (2007) found one patient experienced an improvement with a chin strap, Bhat, et al,3 (2014) established chin straps had no place in treating sleep-disordered breathing and snoring. Indeed the original case study authors also published a paper4 (2014) trying to clear things up:

We learned that entrepreneurs were advertising high priced (to our mind) chin straps for treatment of snoring and OSAS, and that information from our case report was used to bolster claims of chin strap effectiveness.

They continued:

The lead author spent considerable time answering emails and phone calls to state unequivocally that we at Eastern Virginia Medical School Sleep Medicine did not support the use of the chin strap for the treatment of OSAS, and that more investigation was warranted.

Here’s the pertinent extract:

We thus applaud Bhat et al. for their work in investigating the potential utility of the chin strap for treatment of snoring and OSAS.

They demonstrated that the chin strap appears to be an ineffective treatment for a typical apnea population.

Which means that chin straps for snoring are not safe nor effective, and they also delay diagnosis and effective treatment.

For the sake of a balanced argument, in the next paragraph I will explain how some patients using Positive Airway Pressure (PAP) therapy for obstructive sleep apnoea (OSA) may find certain chin straps have a role.

A chinstrap alone is not an effective treatment for OSA. It does not improve sleep disordered breathing, even in mild OSA, nor does it improve the AHI in REM sleep or supine sleep. It is also ineffective in improving snoring.

Bhat, S, et al, 2014. Journal of Clinical Sleep Medicine

The Efficacy of a Chinstrap in Treating Sleep Disordered Breathing and Snoring (2014)

I use Positive Airway Pressure (PAP):  Will a chin strap help with mouth leak?

A chin strap may help if you use a nasal mask and air is escaping from your mouth5.

However, the real solution if you use PAP and have mouth leak, is a full face mask.

Grab our freeHow to Choose Positive Airway Pressure (PAP) Guide‘ ↗ to learn more.

I would add, that if you’re fixed on buying a chin strap, then find one that is designed to just close the mouth and NOT pull your lower jaw backwards

The big PAP companies sell these: look for Philips Respironics. (No I’m not on commission and no, I do not have, or want, an affiliate link! Thank you).

Don't buy a chinstrap if you want to stop snoring!

If snoring is a problem…

You can’t ‘fix’ something if you don’t know what is wrong.

So, see your Doctor/Primary Care Physician (and/or a sleep-trained dentist if you’re in the UK) and have a review of your medical history before you decide to ‘treat’ yourself to anything.

Grab our completely free (no registration or email required), British Medical Association Patient Information Awards, winning Overview of Snoring and Sleep Apnoea Guide

What about Mouthpieces?

I mentioned ‘protrusion‘ earlier and this is what a ‘mouthpiece’ technically known as a mandibular (jaw) advancement device (MAD) does.

There are two basic groups. They work by holding your jaw more forwards and this opens your airway behind your tongue.

The first group you can buy in shops and on-line, the second group of MAD is custom-made exclusively for you by a dentist with a special interest in sleep apnoea. Be careful not to confuse custom-made with customised (customised means a ‘gumshield’ adapted or customised to you).

But this is not a definitive guide to choosing a dental device (Mandibular Advancement Device – MAD) to stop snoring. This is.

chinstrap or dental device for snoring?

What about Surgery?

Although surgeries are rarely performed, surgical approaches have been largely confined to:

  • Reduction of the soft palate and uvula (dangly bit at the back of the mouth)
  • Removal of nasal polyps (‘lumps’ inside your nasal airway)
  • Septum straightening (correcting a crooked nose)
  • Advancing the upper and lower jaws which advances the soft palate and tongue, opening up the airway, known as an MMA (MMA = Maxilla (upper jaw) Mandible (lower jaw)

If you want to know more about safe and effective ways to stop snoring and treat obstructive sleep apnoea/apnea, then grab our free, evidence-based Information Guide:

Things to discuss when considering surgery for snoring and obstructive sleep apnoea

What about surgery for snoring?

Summary

Chin straps do not stop snoring and may well be dangerous. 

I implore you NOT to waste your money, harm yourself, your loved one or I pray your children.

Chin straps have been clinically proven to be neither safe nor effective.

And they could mask symptoms of obstructive sleep apnoea / apnea (OSA) and/or delay your eventual OSA diagnosis and effective treatment.

OSA if left untreated may:

  • Reduce your life expectancy
  • Increase your risk of stroke
  • Increase your risk of a fatal heart attack
  • Predispose you to type II diabetes, depression, impotence and driving or work place accidents to name but a few!

Thanks for reading. Now share this with your long suffering friends. (If you dare!)

Created by Adrian Zacher. Last updated 12th Nov 2018.

Related posts

Here are some more of high quality posts about snoring and sleep apnoea / apnea, ‘cures’, assessment, diagnosis and treatments.

Dental Appliances for Sleep Apnoea | Snorer.com

Dental appliances for sleep apnoea are an appealing option. But how do you know if they will work without buying one? This post explores how predictor or titration dental appliances for sleep apnoea came to be and the vital role they may play building trust between medical and dental sleep professionals.

read more

Glossary

Airway Volume The volume is the amount of space that a exists in your throat to breathe through.
Information Standard NHS England’s Information Standard. Organisations that join The Information Standard are showing their commitment to producing good quality health and care information.
MAD Mandibular Advancement Device Jaw advancing device, worn at night while asleep to hold forward the lower jaw to stop snoring and prevent obstructive sleep apnoea / apnea.
Mandibular Retrusion Backwards movement of your jaw
MMA Surgery to move both jaws. MMA = Maxilla (upper jaw) Mandible (lower jaw).
OSA Obstructive Sleep Apnoea When an individual is unable to sleep and breathe at the same time. Visually, a repetitive pattern of breathing interruptions (apnoeas) occurring while the individual sleeps, due to a physical obstruction in the airway. Apnoea is spelt Apnea in the US.
Palate Roof of your mouth.
Polyps Refers to nasal polyps in this Guide. These are ‘lumps’ inside your nasal airway.
Protrusion Forwards movement of your jaw.
Septum is the tissue that separates the left and right airways in the nose, dividing the two nostrils.
Sleep-trained Dentist A dentist that has undergone special interest training in sleep. As such they are able to obtain professional indemnity insurance.
Soft-palate Soft tissue behind your palate (roof of your mouth).
Uvula ‘Dangly’ bit at the back of the mouth.

References

1. Sleep-disordered Breathing, Adrian Zacher & Michael McDevitt, Carranza’s Clinical Periodontology – E-Book: Expert Consult: Online, Elsevier Health Sciences, 2017. Accessible here: https://www.elsevier.com/books/carranzas-clinical-periodontology/newman/978-0-323-18824-1 new window [accessed 24th May 2018]

2. Vorona RD, Ware JC, Sinacori JT, Ford ML, Cross JP. Treatment of severe obstructive sleep apnea syndrome with a chin strap. J Clin Sleep Med. 2007;3:729–30.

3. The Efficacy of a Chinstrap in Treating Sleep Disordered Breathing and Snoring, Bhat, S, et al, 2014, Journal of Clinical Sleep Medicine, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4106943/ new window [accessed 24th May 2018]

4. Vorona RD, Ware JC. Use of a chin strap in treating sleep-disordered breathing and snoring. J Clin Sleep Med. 2014;10(12):1361. Published 2014 Dec 15. doi:10.5664/jcsm.4304 Available here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4237533/new window [accessed 4th Nov 2018]

5. Mouth closing device (chinstrap) reduces mouth leak during nasal CPAP. Bachour, Adel et al. 2004, Sleep Medicine, Volume 5, Issue 3, 261 – 267 https://www.sleep-journal.com/article/S1389-9457(03)00252-1/abstract new window [accessed 24th May 2018]

 

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I found this document clear, understandable with no jargon and recommend the advice given to any sufferers.

Sylvia Explanation of subject May 26, 2018