Chinstraps have been used as a method for treating snoring and obstructive sleep apnea. Are you exploring Chinstraps as treatment for snoring or as a method to help stop mouth leak when you use CPAP?

It can be a challenge to find a summary of the available information and we would like to help you.

This Chinstrap, snoring and obstructive sleep apnea information blogpost was written by a sleep medicine physician.

In order to make this more helpful and as part of the research for this information guide, we searched the internet for frequently asked questions.

First, this information blogpost provides general information about Chinstraps as they relate to snoring and obstructive sleep apnea. Then, the second section answers frequently asked questions.

This blogpost provides illustrations that provide examples of how Chinstraps are used for snoring and obstructive sleep apnea.

Snoring in a patient. He has his mouth open. The vibration typically occurs when the soft tissues in the throat vibrate. CamachoMD.com
Snoring in a patient. He has his mouth open. The vibration typically occurs when the soft tissues in the throat vibrate.

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Summary:

How effective are Chinstraps for the treatment of snoring and obstructive sleep apnea?

Research has shown that Chinstraps have not been effective in treating snoring and obstructive sleep apnea as a stand-alone treatment in a generalizable way. Two studies on PubMed/MEDLINE have evaluated the use of Chinstraps alone.

The first is a case report in which a 71 year old man had a dramatic and significant improvement in his obstructive sleep apnea.[1]

The second study evaluated 26 patients who had obstructive sleep apnea and had a Chinstrap for the first two hours of sleep before a CPAP titration.[2]

The authors found that there was no significant difference between no Chinstrap and a Chinstrap during the sleep study with regard to both snoring and obstructive sleep apnea outcomes (apnea-hypopnea index and lowest oxygen saturations).[2]

This does not mean that there is not potentially an ideal candidate, but research hasn’t identified the ideal candidate; so the use of Chinstraps for snoring and obstructive sleep apnea as a stand-alone treatment has not been recommended.

Background:

What do the studies show with regard to use of Chinstraps as the sole treatment for snoring and obstructive sleep apnea?

Chinstraps have been used as a method for keeping helmets on, such as in football or while riding motorcycles.

In medicine, Chinstraps have been used to help place pressure on the face after facial surgery and also has been used to help keep the mouth closed during sleep especially in patients who are using CPAP and leak air from their mouths. 

Over the years, there has been debate as to whether or not Chinstraps are effective treatments for snoring and obstructive sleep apnea.

It is advertised that Chinstraps can treat snoring and there are many Chinstraps being sold commercially for snoring purposes.

A simple google search for “Chinstrap and snoring” demonstrates 389,000 results.

A search for “Chinstrap and sleep apnea” demonstrates 297,000 results.

A search on Amazon for “Chinstrap snoring” demonstrates 100 results.  The price range for a single Chinstrap was between $8.00 and 32.95.

Because Chinstraps are being marketed for snoring and obstructive sleep apnea, the goal of this blogpost is to summarize the literature on Chinstraps. In order to provide the most reliable information, and to investigate further whether or not there is medical literature, we searched PubMED/Medline for research describing the use (successful, neutral or unsuccessful) of Chinstraps for snoring and/or obstructive sleep apnea.

Two manuscripts provided information for Chinstraps as a stand-alone treatment for snoring and obstructive sleep apnea.

Case report:

A case report in a thin, 71 year old man with an normal appearing airway in clinic (Mallampati 1) who presented with an apnea-hypopnea index of 42 events per hour and oxygen saturations that were maintained at 90% or higher and found that snoring and obstructive sleep apnea resolved after the use of a Chinstrap (apnea-hypopnea index of 1 event per hour and oxygen saturations of 96% or higher).[1]

An ENT surgeon performed a flexible airway examination and found that with the Chinstrap, the patient had improvement in the posterior airway space at the base of the tongue and the epiglottis.[1]

The authors recommended that “inexpensive Chinstrap deserves further investigation”, but they did not say that the results would help any and everyone.[1]

Chinstrap on with the mouth closed. CamachoMD.com
Chinstrap on with the mouth closed.

Can the findings from a case report on the use of a Chinstrap on snoring and obstructive sleep apnea be generalized?

Because the findings were for a single patient, the use of a Chinstrap for snoring and obstructive sleep apnea cannot be generalized.[1]

The authors subsequently wrote a letter to the editor stating that they did not support the use of a Chinstrap for treatment of obstructive sleep apnea, and that they recommended that additional research be performed on the topic. [3]

In order to make the findings more generalizable, there would need to be multiple patients who demonstrate improvement with a Chinstrap.

Case series study (multiple patients)

The second study evaluating Chinstraps on snoring and obstructive sleep apnea patients was published in 2014. The conclusion was that there was no significant improvement in snoring or obstructive sleep apnea [2].

The study evaluated 26 patients who had obstructive sleep apnea and had a Chinstrap for the first two hours of sleep before a CPAP titration.[2]

The authors found that there was no significant difference between no Chinstrap and a Chinstrap during the sleep study with regard to both snoring and obstructive sleep apnea outcomes (apnea-hypopnea index and lowest oxygen saturations).[2]

Does this mean that a Chinstrap will not help in any circumstances as a stand-alone treatment?

No, it does not mean that. Clearly, the initial case report of a thin, elderly man, with a fairly normal airway when viewed in clinic was able to benefit.[2]

However, research hasn’t identified the ideal candidate; so the use of Chinstraps for snoring and obstructive sleep apnea as a stand-alone treatment has not been recommended in a generalizable way until it is studied further.[2]

Are there certain people who would be good candidates for Chinstrap as a method for treating their snoring?

It is possible that there is a specific sub segment of the population that could benefit from a Chinstrap, however, it has not been researched scientifically yet.

An example of a hypothetical person who could potentially benefit from a Chinstrap is a patient who has:

  • No nasal congestion or obstruction,
  • Has primary snoring only (no obstructive sleep apnea on a sleep study),
  • Snores when their mouth is open,
  • Has had sleep endoscopy that shows that the snoring resolves or improves significantly when the mouth is closed during the evaluation, and
  • Is being closely followed by their sleep medicine specialist or their ENT surgeon and that healthcare provider is instructing them to try a Chinstrap after having evaluated them.
  • If any one of the above elements is missing, then the use of a Chinstrap might not be beneficial.

What are contraindications to wearing Chinstraps?

Regarding primary snoring patients, if the patient has nasal obstruction or congestion, then a Chinstrap would not be a good choice as the patients cannot breathe through their nose or their mouths with the Chinstrap on.

Should you make your own Chinstrap?

Although there is no one preventing you from making your own Chinstrap, there are multiple problems with making your own Chinstrap. Cost, pressure points from making one that is too tight, and making one so tight that you can’t open your mouth during sleep are all potential problems.

Is a snoring Chinstrap dangerous?

If a patient has obstructive sleep apnea and is only using a Chinstrap as a standalone treatment, then they could potentially be causing more harm than good.

If someone who has nasal blockage starts wearing a Chinstrap, then they will have trouble breathing from both their nose and their mouths.

What is the best Chinstrap for snoring?

You can find reviews on Amazon or on the internet if you want to find a Chinstrap. We cannot endorse Chinstraps as a stand-alone treatment, but Chinstraps have been shown to help improve mouth leak in patients who are wearing nasal CPAP and open their mouths when they sleep.

***The following section is more advanced and discussed the use of Chinstraps in combination with CPAP therapy. Please read on if you are interested in the topic.

Have Chinstraps been studied in patients using CPAP?

Chinstrap on with a nasal triangle mask, the patient has a closed mouth. This allows the air to go down into the airway. CamachoMD.com
Chinstrap on with a nasal triangle mask, the patient has a closed mouth. This allows the air from the CPAP to go down into the airway.

Chinstraps have successfully been used in patients who are using CPAP therapy, especially if they sleep with their mouth open and have mouth leak.

Study by Bacour and colleagues:

One study by Bacour and colleagues evaluated the use of Chinstraps during CPAP in fifteen patients who complained of mouth leak. [4]

They added a Chinstrap use found that the number of obstructions decreased, the leak from the CPAP machine decreased, but snoring increased. [4]

The authors hypothesized that by having the Chinstrap on, the chin was pulled back and the soft tissues of the neck were pulled back and this caused a narrowing in the upper airway and that led to snoring. [4] 

Because snoring should be eliminated with CPAP use, the authors point out that the pressures may need to be increased in patients when a Chinstrap is added.[4]

Willson and colleagues:

Wilson and colleagues evaluated patients using a nasal compared to a full facemask for patients who had chronic respiratory failure.[5]

They found that in 14 out of 16 patients needed to use a Chinstrap in order to minimize leak from their mouths when they wore nasal masks.[5]

Knowles and colleagues

A study of Veteran Affairs patients who had CPAP and obstructive sleep apnea found that the use of a Chinstrap led to higher use (10.4% more compliance) and the patient slept with the mask for an average of 59 minutes longer with the mask.[6]

The study also found that the leak was 19 minutes less when the Chinstrap was used, the sleepiness was improved and the number of blockages of the airway per hour was less by 1.2 events per hour.[6]

One method to help reduce the chance of snoring and apneas after adding a Chinstrap is to set the patients on an automatically titrating PAP machine, so that rather than them having one

Fixed pressure, they would get a range of pressures and the machine could automatically increase to relieve the obstructions.

Rowland and colleagues

A study by Rowland and colleagues compared nasal CPAP, nasal CPAP with Chinstrap, and a full facemask and found that nasal CPAP with or without Chinstrap should be the prescribed as the first choice for CPAP users.[7]

Lee and colleagues

A case report was presented in which a 60 year old woman had significant improvement in the treatment of her obstructive sleep apnea by adjusting the CPAP device pressures and adding a Chinstrap.[8]  

The patient had tried nasal CPAP and a full facemask and still had residual obstructive sleep apnea.[8]

A sleep endoscopy was performed for the patient and she had the most improvement in her airway with nasal CPAP and manual mouth closure, so nasal CPAP with a Chinstrap was recommended and she did well with it.[8]

Government Disclaimer: The views expressed in this website are those of the author(s) and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.

References:

1. Vorona RD, Ware JC, Sinacori JT, Ford ML, 3rd, Cross JP (2007) Treatment of severe obstructive sleep apnea syndrome with a chinstrap. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine 3 (7):729-730

2. Bhat S, Gushway-Henry N, Polos PG, DeBari VA, Riar S, Gupta D, Lysenko L, Patel D, Pi J, Chokroverty S (2014) The efficacy of a chinstrap in treating sleep disordered breathing and snoring. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine 10 (8):887-892. doi:10.5664/jcsm.3962

3. Vorona RD, Ware JC (2014) Use of a chinstrap in treating sleep disordered breathing and snoring. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine 10 (12):1361. doi:10.5664/jcsm.4304

4. Bachour A, Hurmerinta K, Maasilta P (2004) Mouth closing device (chinstrap) reduces mouth leak during nasal CPAP. Sleep medicine 5 (3):261-267. doi:10.1016/j.sleep.2003.11.004

5. Willson GN, Piper AJ, Norman M, Chaseling WG, Milross MA, Collins ER, Grunstein RR (2004) Nasal versus full face mask for noninvasive ventilation in chronic respiratory failure. The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology 23 (4):605-609

6. Knowles SR, O’Brien DT, Zhang S, Devara A, Rowley JA (2014) Effect of addition of Chinstrap on PAP compliance, nightly duration of use, and other factors. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine 10 (4):377-383. doi:10.5664/jcsm.3608

7. Rowland S, Aiyappan V, Hennessy C, Catcheside P, Chai-Coezter CL, McEvoy RD, Antic NA (2018) Comparing the Efficacy, Mask Leak, Patient Adherence, and Patient Preference of Three Different CPAP Interfaces to Treat Moderate-Severe Obstructive Sleep Apnea. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine 14 (1):101-108. doi:10.5664/jcsm.6892

8. Lee CH, Seay EG, Dedhia RC (2019) IMAGES: Drug-Induced Sleep Endoscopy: An Investigative Tool for Mechanisms of PAP Failure. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine 15 (1):171-172. doi:10.5664/jcsm.7604