Taking It On The Chin

Many sleep apnea patients loathe chinstraps, and yet chinstraps may be the essential supplement to PAP therapy to make things work at the most beneficial level. Many patients who refuse to try a chinstrap are those who feel they have made enough progress in breathing comfortably through their noses while using a pressurized airflow device. However, because they may not attend to or even appreciate “abnormal” actions of the mouth and the jaw while sleeping, they do not comprehend how their results could be improved irrespective of their insistence on using only an over-the-nose or nasal pillow mask. It should also not go without saying that while these types of masks are more likely to need the supplement of the chinstrap, remarkably, a great proportion of patients using full face masks (FFM) also need to take advantage of something to keep them from mouth breathing, which is the more obvious dilemma that must be addressed with a chinstrap. Shortly, we’ll also mention the problem with jaw laxity that may also require a chinstrap.

Chinstraps are often a crucial piece to your PAP puzzle, but it is also true this addition to your headgear can be quite awkward to apply, uncomfortable to boot, and in a not inconsequential number of sleep apnea patients, the chinstrap can be downright painful. Think about patients prone to headaches, neck soreness, TMJ dysfunction, or bruxism (teeth clenching) and how the added pressure from the chinstrap on the top or back of the head and underneath the jaw could generate more tension. This tension adds to existing problems of head, neck or jaw/dental pain, and such patients rebel very quickly when they have to “take it on the chin.” Moreover, finding the right amount of tension for a chinstrap is very difficult for a person with any of these sensitivities. “Too tight” and “too loose” are incredibly common refrains among those who struggle to make the chinstrap work. Then, there’s the matter of which goes on first the chinstrap after the mask or the mask after the chinstrap. Either way can work, but here’s the critical point: if you only try it one way, for example, put the chinstrap on first and then the mask and you give up because it hurts, you just might discover that putting on the mask first and the chinstrap second solves the whole problem and relieves all the discomfort and pain. So, taking the time to get the exact fit can make a difference in the usability of a chinstrap, despite the large hassle factor in trying to get it just right.

But, what if the patient can never tolerate the chinstrap?

Here’s where the jaw laxity issue comes into play. Most people think chinstraps are solely for preventing mouth breathing. While the idea is an accurate one, it does not explain the full value of the chinstrap. First and foremost, chinstraps are effective in many patients not just in preventing mouth breathing, but also they prevent jaw laxity.

Jaw laxity is a subtle finding, but one you can test on yourself right now. Look in the mirror and let your jaw drop but do not let your lips part. In other words, you are not conducting an experiment in mouth breathing, you are testing what happens to your airway when your jaw is lax but you are not mouth breathing.   Now, breathe through your nose and go back and forth between two jaw positions: 1) when held in the normal position (i.e. normal bite, teeth touching); and, 2) when your jaws go lax. When your jaw drops, you should quickly feel less air going through the nose to the back of the throat, and even more so you will immediately feel a sense of obstruction in the back of the throat. This acute sensation is the real reason to learn to take it on the chin, that is, using the chinstrap can make a huge difference in how well you breathe whether or not you use PAP. In fact, there are many older customs in different civilizations where chinstraps were hand-made to treat the problem of loud snoring and obstructed breathing.

If you cannot wear a chinstrap, it remains imperative to find another means to prevent the jaw from dropping regardless of whether or not you are mouth breathing. And, the surprisingly simple solution to fix this problem is tape, usually of a gentle type, which can be purchased at nearly all drugstores or other pharmacy outlets. 

The tape is usually about 1 inch thick, although wider versions may also work. Depending upon the size of your face or head, the first strip of tape is anywhere from 8 to 12 inches long. You hold both ends of the tape as you direct the middle part upwards underneath your jaw, let’s say anywhere from one to two inches back from the chin. Once the tape is centered in this spot, you gently lift up the two ends of the tape, pulling the jaw into a more snug positon, after which you press the tape against the sides of your face. In effect, you have created a poor man’s chinstrap, but more importantly you have done so without requiring any additional headgear attached over the top of the head, back of the head, or the back of the neck. Thus, in terms of hassle factor, this approach is very doable and likely to trigger less discomfort. If you want a tighter fit, using a second length of tape, the same size or shorter can be positioned closer to the chin and its two ends are also pulled up and placed along the face.

The most generally used final positions for the ends of the tape that are pressed against your face are somewhere between your eyes and the most anterior portion of your ears. But, the tape does not necessarily need to be situated as high as the level of your eyes. It can still work to apply the proper snugness to the jaw at a lower level, for example, no higher than the tops of your cheeks. 

While the do-it-yourself (DIY) chinstrap may not prove to be a long-term solution, many people who use this approach will gain confidence when they immediately experience improvement in the overall breathing sensation and eventually a higher quality of sleep. To sum up, then, even though many PAP patients must use a chinstrap, the gentle tape version may be a better way to start for some individuals who find the regular chinstraps too confining. If you learn to sleep better with the tape version, you will probably figure out a way at some point to use a regular chinstrap.

Two final points. First, similar to our discussions on nasal strips, you cannot remove nasal strips or gentle paper tape chinstraps in random fashion. Be sure to unseal the tape slowly and carefully or use soap and water to do so; these steps are important to prevent skin abrasions. Second, searching the internet you can find ready-made chinstraps-by-tape (“chin-ups”) based on the principles described above and which serve the same purpose; but, they are usually larger and may have stronger adhesive. They are also a very important resource to consider if you cannot use traditional chinstraps and it’s too complicated to try the DIY version with gentle paper tape.

The most well-known company for chin-ups can be found here.


Barry Krakow MD

Author

Dr Krakow’s 27 years of sleep research have focused on the complex relationship between physiological and psychological sleep disorders. Dr Krakow currently operates private sleep medical center, Maimonides Sleep Arts & Sciences, Ltd., and serves as Classic SleepCare’s paid Medical Director.



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