How Mouth Breathing Can Lead to LPR Symptoms

By Stu Leo︱Published July 2, 2017

Simple heartburn is usually easy fairly to treat with drugs and diet, but laryngopharyngeal reflux(LPR) is more complex and debilitating.

Chronic hoarseness, vocal fatigue, coughing, trouble swallowing, throat clearing, and nighttime regurgitation are just a few symptoms that LPR patients deal with that can have a serious impact on quality of life. (1)

More troubling is that several studies have shown that PPIs, the most popular anti-reflux medication on the market, seem to be ineffective against LPR.

One multi-center study tested the effectiveness of PPI drugs by treating 145 suspected LPR patients with 70 mg of omeprazole twice a day for 16 weeks. 

They then gave them a placebo to compare the difference. They found none.

The patients showed no difference between the placebo and PPI drug. (2) Up to 50% of GERD patients do not respond to PPIs and require pH monitoring. (3)

LPR and Mouth Breathing

Why is there such a high failure rate treating patients with LPR? The root cause of LPR and GERD remains somewhat of an enigma, but one possible explanation is habitual mouth breathing.

We all mouth breath when we engage in day to day tasks like conversation and exercise, but exclusive, prolonged breathing through the mouth can irritate the throat by causing saliva in the vocal tract to dry out very quickly.

This can cause common LPR symptoms like hoarseness, mouth sores, trouble swallowing, and sore throat. (4)

These symptoms can be exacerbated if you mouth breathe constantly during sleep when salivary flow is significantly reduced. (4)

It’s not really clear why the body decreases saliva during sleep when we are most vulnerable to acid reflux, but circadian rhythm is thought to play a role. (5)

Studies have found that saliva flow is lowest during the morning and peaks in the afternoon. (4)

Take a moment to observe your breathing.

Are you breathing through your mouth or nose? We don’t really give breathing much attention because it’s such an automatic reflex but if you find yourself frequently breathing through your mouth during the day, mouth breathing may very well be the culprit behind your LPR symptoms.

Born to Breathe through the Nose

Breathing through your nose is the healthy way to breath and has several benefits over mouth breathing. In fact, all healthy mammal infants naturally breath through the nose.

First, the nose acts as a natural filter to keep harmful particles out. (6) Large airborne objects like insects are stopped by our nostril hairs.

Finer particles like pollen and dust are caught by a sticky mucus that lines the inside of our nose. Our noses can also filter out pollutants in gas and prevent them from reaching our lungs.

Another important task the nose does is humidify and warm the air we breathe. Over 80% of the air we take in is warmed by a complex process of conduction, convention, and radiation before it reaches our lungs. The temperature of the nose is maintained at 31-37 degrees Celsius to keep the throat moist. (7) (8)

Causes of Mouth Breathing

Habitual mouth breathing is almost always because of nasal constriction. (9) (10)

If you frequently suffer from a stuffy nose and experience LPR symptoms, opening your nasal passageways can help.

So here are seven tips to stop mouth breathing and breathe better.

1. Raise the head of your bed

Multiple doctors today recommend raising the head of your bed about 5-6 inches if you experience acid reflux symptoms at night. The theory is to stop reflux with gravity, but did you know that raising your bed can also help you breathe better?

The reason is that lying down makes it harder for your nose to warm and humidify air, as it decreases nasal air volume. Scientists are not exactly sure why this happens but one theory is that lying down creates a negative back pressure in the nose which decreases blood flow and makes it harder to breath. (11)

Raising the head of your bed so your upper body is elevated can help you breath easier. You can use bed risers to achieve this, or if you want to save a few bucks, just use bricks.

If you’re super thrifty still, you can use phone books(I’ve used all of the above).

Adjusting my bed at an angle of 15-20 degrees works for me, but a higher angle may help you to breathe easier.

Pragma Bed Frames

If you are concerned with looks or just want to play around with more angles, I like Pragma adjustable bed frames.

I love these bed frames because they’re easy to use, convenient, and cost less than half the price of automatic adjustable beds.

Pragma bed frames are made from powder-coated steel and can be manually adjusted from about 23 degrees to 90 degrees so you are completely upright. They’re super easy to set up and come in twin, full, queen, king, and California king sizes.

Pragma frames come with a 3-year warranty too.

My favorite part about Pragma bed frames is that unlike pillow wedges, you can elevate the foot of your bed so you won’t slide down your bed at night.

The only beef I have with these frames is that a handle and a spring broke on me. Can’t say I was really surprised. I was experimenting with different frame positions basically every day to see what effect it would have on my GERD symptoms.

Seems like I might be the only one with this problem because none of the reviews on Amazon mention this issue.

Fortunately, Pragma’s customer service is awesome. I gave them a call and they shipped me extra handles and a new set of springs free of charge immediately.

5 stars for that!

One caveat: Pragma frames work best with a 6-8 inch memory foam mattress. Thicker mattresses may be harder to manipulate. If you have a heavy mattress, an electronic bed frame may work better for you.

2. Give the Neti Pot a Shot

If you deal with frequent congestion I would try the Neti Pot. Neti Pots, popularized by Oprah and Dr. Oz helps open up your nasal passages by flushing your sinus cavities with warm saline water and clearing out contaminants and mucus. They are an effective way to treat stuffy noses and sinus infections.

You can usually find a Neti Pot at a specialty store like Bed Bath Beyond or your local pharmacy store. The saline solution you add to the water for your Neti Pot can be found at most drug stores like Rite Aid or CVS as well.

I use this ceramic Neti Pot and it works great. 

If you have a sensitive nose, drug store saline packets may sting a bit. If that’s the case for you, you could try NeilMed Sinus Rinse packets.

The solution in these packets tends to be finer and a bit weaker so they won’t burn your nose. I find that generic saline packets at my local Rite Aid are usually more concentrated and work better for my deviated septum.

A Couple Pointers

Make sure you use distilled water only for your Neti Pot rinses. Never under any circumstances use tap water. Tap water can be contaminated with bacteria and harmful microorganisms. Rinsing your nose with infested water could cause a serious infection or even kill you.

In 2011, 2 people died from Naegleria fowleri, a brain-eating amoeba after using Neti Pots with tap water to flush their sinuses. (12) So don’t use tap water with your Neti Pot!

Also, make sure to use warm to hot-ish water with your Neti Pot. Some Neti Pot guides will tell you to use lukewarm water but I’ve noticed that warmer water does a better job of flushing out my sinuses. I mix one saline packet with 1 ¼ cup of water, pop it in the microwave for 40 seconds, and give it a quick stir.

If it’s too hot, I wait 15 seconds, then wade my finger in the water again until it reaches an acceptable temperature. Experiment with different temperatures to find the one that clears out your sinuses best.

Obviously, don’t burn yourself. The water should be hot-ish—not scalding hot.

3. Try a Nasal Strip

Nasal strips is another product that can help open your nasal passageways for easier breathing. Nasal strips are frequently used by people who snore. They work by lifting the skin on each side of the nose up with adhesive tabs so the nose lets in more air. If you have trouble breathing through your nose when you are laying down, nasal strips can help.

Nasal strips have been pivotal in my reflux healing journey. I wear one every night and sleep much better because of them.

In my opinion, BreatheRight makes the best nasal strips. They’re more pricey than the generic drugstore brands but I’ve noticed they last longer and don’t lift off the next morning. Cheaper strips don’t seem to stay on for the whole night for me.

5. Try Chin-Up Strips to Stop Mouth Breathing

Chin-Up Strips are U shaped adhesive strips you place on your lower cheeks and chin to keep your jaw and mouth closed during sleep. They are in my opinion the best product on the market for nocturnal mouth breathing.

If you frequently experience a sore throat or dry mouth in the morning due to mouth breathing, Chin-Up Strips can help alleviate your symptoms.

I use Chin-Up strips in conjunction with nasal strips as part of my nightly regimen and they have worked wonders for me. I no longer get sore throats or vocal fatigue and my voice has never felt better.

 If you’re not sure whether you’re mouth breathing during sleep, Chin-Up Strips are a great test to see if you are. Before going to sleep with a Chin-Up strip I usually lay in bed for a few minutes to make sure I can breathe through my nose.

Chin-Up strips come in 3 varieties, the regular Horseshoe model, a boomerang model for sensitive skin, and another model for oily skin and short beards(I prefer this model). Chin-Up strips are an FDA-approved snoring device.

6. Check and see if you have a Deviated Septum

A deviated septum is when the dividing wall of the nasal cavity is crooked and “deviates” from the center. Most people have a slightly deviated septum but a severely deviated septum can cause breathing issues.

One simple test you can take to see if you might have a deviated septum is press one nostril closed and breath in from the other. Now do the same with your other nostril.

If it is difficult to breathe through either nostril you may have a deviated septum, in which case you may benefit from a septoplasty, a surgery that straightens the septum and allows you to breath easier.

Keep in mind that difficulty breathing through a nostril is not always an indication of a deviated septum. A healthy person typically experiences a cycle of congestion and decongestion on each side of the nose every 3-7 hours.

So a little nasal resistance in one nostril can be normal. (7) You should see an experienced ENT for a detailed evaluation to see if a septoplasty is right for you.

Summing it up

  • There is a well-established link between mouth breathing and LPR. Prolonged mouth breathing dries out saliva making the throat more susceptible to injury from reflux.
  • Mouth breathing can cause sore throats, mouth sores, cavities, and other extraesophageal symptoms.
  • Opening up your nasal passageways can help you breath easier at night which discourages mouth breathing.
  • Sleep aids like Chin-Up strips and nasal strips prevent the jaw from dropping down and encourages nose breathing.

*This post contains affiliate links. See my disclosure here.