Medically reviewed by
Dacelin St Martin, MD
Triple board-certified in Sleep Medicine,
Internal Medicine, and Pediatrics.
What Causes Bad Morning Breath? | What Is Obstructive Sleep Apnea? |
Does OSA Cause Bad Morning Breath? | How To Get Rid Of Bad Morning Breath?
Overview
What Makes Morning Breath So Bad? A Sleep Disorder Might Be Responsible
Waking up in the morning with bad breath can be very annoying, especially if you sleep next to a partner.
Morning breath, or halitosis, is the unpleasant mouth smell caused by odor-producing bacteria. When we sleep, our mouth produces less saliva, and these bacteria proliferate. That’s why it’s normal to have slightly bad breath in the morning.
However, you’re more likely to have morning breath if you smoke, practice poor oral hygiene, snore, or breathe through your mouth while sleeping.
More recently, scientists discovered a link between halitosis and obstructive sleep apnea (OSA), a sleeping disorder.
Continue reading to learn more about bad morning breath and whether OSA may be causing you to wake up with bad breath in the morning.
What Causes Bad Morning Breath?
Halitosis is a term that describes an unpleasant mouth odor or bad breath in the morning.[1] Everyone experiences morning breath to some degree, even people who practice good dental hygiene. Several things can be responsible for morning breath, including
1) Dry Mouth
Your mouth contains bacteria that break down food residues and dead cells on your tongue and inside your mouth. These bacteria produce gas that causes your breath to smell bad in the morning.[2]
When you’re awake, the constant movement of saliva cleanses the inside of your mouth and removes the odor-producing bacteria.
During sleep, your saliva production decreases, and your mouth becomes dry, allowing these bacteria to grow and release a foul smell.[3]
That is the most common cause of why your breath smells in the morning, even when you brush your teeth at night.
2) Poor Oral Hygiene
Poor dental hygiene is another common cause of bad breath while sleeping. If you don’t brush your teeth and floss well, food particles can remain stuck between your teeth, tongue, or gums.
The bacteria in your mouth break down the leftover food, releasing bad-smelling gas. Hence, the more food stays stuck inside your mouth, the worse your breath will smell in the morning.
Moreover, halitosis could signify periodontitis, a serious gum infection. Leftover food can form a sticky layer containing bacteria (plaque) on your teeth. If you don’t brush your teeth properly and remove this layer, plaque can form pockets between your teeth and gums, causing infections. Periodontal disease can cause strong and persistent bad breath after waking up.[4]
3) Certain Foods
Eating strong-smelling food in the evening, such as garlic, onion, and spices, can be why you wake up with bad breath the following day.
4) Smoking
Smoking and other tobacco products produce an unpleasant odor in the mouth. Additionally, people who smoke are more likely to have gum diseases, another cause of halitosis.[4]
5) Certain Medications
Certain medications, such as antidepressants, antipsychotics, and muscle relaxants, can contribute to dry mouth and waking up with morning breath.[5]
6) GERD
Gastroesophageal reflux disease (GERD), or acid reflux, is a possible cause of halitosis.[6] People with GERD may experience bad breath in the morning because of the backflow of acid from the stomach into the esophagus while sleeping at night.
7) OSA
More recently, scientists have noticed a link between obstructive sleep apnea (OSA), a sleep disorder, and bad breath in the morning.[7]
What Is OSA?
OSA is a common sleep disorder. People with sleep apnea experience pauses in breathing while sleeping, which causes them to wake up several times during the night gasping for air or choking.[8]
OSA occurs because the muscles in the throat relax intermittently during sleep, blocking the airway. The most noticeable sign of obstructive sleep apnea is loud snoring. Other signs and symptoms may include:
● Observed pauses in breath during sleep
● Waking up from sleep suddenly, choking or gasping for air
● Excessive daytime sleepiness
● Waking up frequently with a dry mouth or sore throat
● Trouble concentrating during the day
● Morning headaches
● Mood changes, such as irritability or depression
Anyone can have this sleep disorder. However, some factors increase the risk of developing obstructive sleep apnea, such as:
● Obesity or being overweight
● Older age
● Pregnancy
● Smoking
● Chronic nasal congestion
● Alcohol use
Does OSA Cause Bad Morning Breath?
Can bad sleep cause bad breath? The short answer is yes.
In 2016, a study investigated the relationship between obstructive sleep apnea and oral health. The authors found a strong correlation between OSA with dry mouth and bad breath.[7]
OSA-induced dry mouth and morning breath
OSA causes your upper airway to collapse and block the airflow. Consequently, you might breathe through your mouth while sleeping to increase the airflow, which can dry out your mouth.
A dry mouth is the most common cause of halitosis. Furthermore, in one study on children, researchers found that more than 76 percent of participants who breathed through the mouth while sleeping had unpleasant mouth odor in the morning, and over 50 percent had really bad morning breath.[14]
Therefore, sleep apnea can lead to mouth breathing which causes bad morning breath.
Sleep apnea-induced sleep deprivation and morning breath
People with sleep apnea constantly wake up at night because they can’t breathe well, leading to chronic sleep loss.
A population-based study in Korea investigated the relationship between sleep deprivation and bad breath. The study revealed that adolescents who don’t get enough sleep were twice as likely to develop bad breath than those who sleep well.[9]
The authors explain that lack of sleep increases the risk of bacterial infections, which can cause periodontal disease, a common cause of halitosis.[9]
Thus, sleep apnea can cause sleep deprivation, which, in turn, leads to morning breath.
How To Get Rid Of Bad Morning Breath?
You can often treat bad morning breath at home with good oral hygiene and lifestyle changes.
Below are some of the best tips that can help you wake up without morning breath:
● Practice good oral hygiene: This is the quickest solution for bad morning breath. Brush and floss your teeth well after every meal and before sleep. Don’t eat or drink anything after you brush your teeth before bed. That prevents bacteria from building up and releasing a foul odor in your mouth while you sleep.
Make sure you also brush your tongue. Studies show that toothbrushing and tongue cleaning before bed can effectively treat halitosis.[10]
Moreover, using an antiseptic mouthwash can reduce the bacterial load in the mouth and prevent stinky morning breath.[11]
● Cut Down on Smoking: It’s better to quit smoking altogether. Try to cut back on the number of cigarettes you smoke a day. That can significantly improve how your breath smells, especially in the morning. Nonetheless, until you manage to quit, avoid smoking and other tobacco products at night and before you sleep.
● Clean Orthodontic Gear Daily: If you wear a retainer, clean it well every day. As soon as you wake up, brush your teeth immediately to eliminate any remaining foul breath.
● Chewing Gum: Research shows that chewing gum can stimulate salivary secretion and reduce halitosis.[13] Chew sugar-free gum to freshen your breath smell while avoiding tooth decay.
Make an appointment with your dentist if your breath still smells terrible in the morning after making these changes.
You can get rid of bad morning breath by treating the underlying condition causing it. Medical treatments for morning breath may include the following:
● Periodontitis Treatment: You will need deep dental cleaning if you have gum disease (periodontitis). Usually, a gum specialist (periodontist) removes the pockets full of odor-causing bacteria between your teeth and along your gums. You may require dental surgery if the infection is advanced and has spread deeper.
● GERD Treatment: Your doctor might prescribe an antacid medication before bed to reduce your acid reflux during sleep.
● Sleep Apnea Treatment: Sleep apnea might be the reason behind your halitosis. Consult a sleep specialist if you have halitosis and often snore loudly or wake up at night because of breathing difficulties.
Several lifestyle changes can help treat obstructive sleep apnea, including:[8]
● Losing Weight: People with obesity or overweight have a higher risk for sleep apnea. Weight loss can reduce the severity of OSA and improve sleep.
● Exercising: Scientists found that exercising, even if you don’t lose weight, can help treat obstructive sleep apnea.[12]
● Avoiding Alcohol: Alcohol interferes with your breathing during sleep and can worsen your OSA.
● Quitting Smoking: Smoking weakens your throat, decreases oxygen supply, and increases the severity of obstructive sleep apnea.
● Changing Sleeping Positions: You can prevent your airway from collapsing during sleep by sleeping on your sides or stomach instead of sleeping on your back (supine position).
● Continuous Positive Airway Pressure (CPAP) Therapy: Continuous positive airway pressure (CPAP) devices treat moderate and severe sleep apnea. The CPAP device pumps pressurized air through a mask on your face to keep your throat and airway open. The continuous positive pressure prevents your airway from collapsing.
● Adaptive Servo-Ventilation (ASV): This is a more recent ventilation method, similar to CPAP, used to treat OSA. While sleeping, the ASV machine adjusts the pressure of the air supply according to your breathing. That helps normalize your breathing and prevent pauses in your breath during sleep.
● Oral Appliances: Sleep apnea oral appliances are custom-fit devices that you wear in your mouth before you sleep. They prevent your lower jaw and tongue from sliding backward during sleep, which causes airway obstruction.
● Surgery: Uvulopalatopharyngoplasty (surgery to reshape the roof and back of the mouth) and jaw repositioning surgery can be done to prevent airway collapse and treat obstructive sleep apnea.
Consult with a sleep specialist if you experience pauses in your breath during sleep and wake up with bad breath in the morning.
Treating your sleep apnea can improve your sleep quality and help you get rid of snoring, mouth breathing, and dry mouth during sleep. All these can help you wake up with a fresher breath every morning.
References:
- Tungare S, Zafar N, Paranjpe AG. Halitosis. StatPearls Publishing; 2022. Accessed November 29, 2022. https://www.ncbi.nlm.nih.gov/books/NBK534859/
- Delanghe, G., Ghyselen, J., van Steenberghe, D., & Feenstra, L. (1997). Multidisciplinary breath-odour clinic. Lancet (London, England), 350(9072), 187. https://doi.org/10.1016/S0140-6736(05)62354-9
- Bicak D. A. (2018). A Current Approach to Halitosis and Oral Malodor- A Mini Review. The open dentistry journal, 12, 322–330. https://doi.org/10.2174/1874210601812010322
- Zanetti, F., Zivkovic Semren, T., Battey, J. N. D., Guy, P. A., Ivanov, N. V., van der Plas, A., & Hoeng, J. (2021). A Literature Review and Framework Proposal for Halitosis Assessment in Cigarette Smokers and Alternative Nicotine-Delivery Products Users. Frontiers in oral health, 2, 777442. https://doi.org/10.3389/froh.2021.777442
- Talha B, Swarnkar SA. Xerostomia. StatPearls Publishing; 2022. Accessed November 29, 2022. https://www.ncbi.nlm.nih.gov/books/NBK545287/
- Moshkowitz, M., Horowitz, N., Leshno, M., & Halpern, Z. (2007). Halitosis and gastroesophageal reflux disease: a possible association. Oral diseases, 13(6), 581–585. https://doi.org/10.1111/j.1601-0825.2006.01341.x
- Suzuki, S., Kojima, Y., Takayanagi, A., Yoshino, K., Ishizuka, Y., Satou, R., Takahashi, N., Tazaki, M., Kamijo, H., & Sugihara, N. (2016). Relationship between Obstructive Sleep Apnea and Self-assessed Oral Health Status: An Internet Survey. The Bulletin of Tokyo Dental College, 57(3), 175–181. https://doi.org/10.2209/tdcpublication.2016-1000
- Slowik JM, Sankari A, Collen JF. Obstructive Sleep Apnea. StatPearls Publishing; 2022. Accessed September 2, 2022. https://www.ncbi.nlm.nih.gov/books/NBK459252/
- Do K. Y. (2020). Relationship between Insufficient Sleep and Bad Breath in Korean Adolescent Population. International journal of environmental research and public health, 17(19), 7230. https://doi.org/10.3390/ijerph17197230
- Wilhelm, D., Himmelmann, A., Axmann, E. M., & Wilhelm, K. P. (2012). Clinical efficacy of a new tooth and tongue gel applied with a tongue cleaner in reducing oral halitosis. Quintessence international (Berlin, Germany : 1985), 43(8), 709–718.
- Aylıkcı, B. U., & Colak, H. (2013). Halitosis: From diagnosis to management. Journal of natural science, biology, and medicine, 4(1), 14–23. https://doi.org/10.4103/0976-9668.107255
- Andrade, F. M., & Pedrosa, R. P. (2016). The role of physical exercise in obstructive sleep apnea. Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia, 42(6), 457–464. https://doi.org/10.1590/S1806-37562016000000156
- Rösing, C. K., Gomes, S. C., Bassani, D. G., & Oppermann, R. V. (2009). Effect of chewing gums on the production of volatile sulfur compounds (VSC) in vivo. Acta odontologica latinoamericana : AOL, 22(1), 11–14.
- Motta, L. J., Bachiega, J. C., Guedes, C. C., Laranja, L. T., & Bussadori, S. K. (2011). Association between halitosis and mouth breathing in children. Clinics (Sao Paulo, Brazil), 66(6), 939–942. https://doi.org/10.1590/s1807-59322011000600003
