Member contribution: Robert M. Mason, DMD, Ph.D.
Following some recent inquiries, Dr. Bob Mason, our unofficial "medical expert" tackles a common but serious problem in therapy. Lips taping.
FACTS, ASSUMPTIONS AND RESPONSES REGARDING LIP TAPING:
Fact: the metabolic processes of the body change during sleep as compared to being awake.
Fact: the breathing process changes during sleep as compared to being awake.
Fact: moisture or dryness in the air can influence the way a person breathes either while awake or asleep. As well, allergies, medications, normal mucous flow and nasal debris accumulations can also influence the body in a different manner while asleep as compared to being awake.
Fact: many individuals who breathe adequately during the day need help to maintain a healthy exchange of oxygen during sleep, such as a CPAP.
There are many false assumptions that are associated with a decision to tape the lips together at night:
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Assumption: All individuals are left with an ability to take in a sufficient amount of oxygen through the nose as may be needed during sleep with the lips taped together.
Responses: does a MFT know the relationship between the body's increased need for oxygen during sleep and the degree of mouth opening that may be required to fulfill changing oxygen needs during sleep
Is the assumption that there is sufficient area around the tape provided as sleep needs change during the night a reasonable presumption? If so, based on what? Is there no impact on breathing when the range of mouth opening is restricted during the sleep process with lips taped together?
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Assumption: During sleep, the configuration of the nasal airway does not change as metabolism slows down; that is, there are no changes in size of the mucous membranes of the nose, nor does nasal resistance change during sleep. Said another way, the nasal chamber remains patent during sleep.
Responses: for most individuals, upon awakening, there is a need to clean the nasal cavity of debris that accumulates during the night. This may and will vary night-by-night, as related to a host of environmental and bodily influences and needs.The posture of lying recumbent changes the natural flow of drainage in and out of the nasal cavity during sleep, and the buildup of nasal debris differs from the self-cleansing processes while awake. As a result, there is often a need for increased oral breathing during sleep as the resistance to airflow through the nasal cavity changes during sleep.
Can a MFT presume arbitrarily that whatever increased oxygen needs that may exist can be met if the range of mouth opening is restricted by taping?
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Assumption: Since taping the lips shut at night provides a sufficient flow of oxygen in and out of the mouth so that there is no chance that any cardiac or other episode could occur or develop later with a patient that could possibly be linked to this intervention in the sleep process
Responses: There is going to be, somewhere down the line, an instance where a patient experiences a cardiac incident or developmental problem that can, in part, be related to sleep. If taping of the lips is revealed during a physician's questioning of the individual's recent history, what defense would a MFT have if linked to the problem that has been identified.
Should a minimum requirement for lip taping (during day or especially night) include approval and clearance by the family physician? The answer is a resounding YES.