What Happens to Your Body When You Wear a Mask?!

For months, I had been meaning to investigate the physiological changes that long-term mask wearing may have on our bodies. For the record, I wholeheartedly encourage the importance of mask-wearing; I don’t want this to be misconstrued. There are some mindful modifications I think we need to recognize in order to be healthier about it and take care of our bodies. Masks are not going away.

I have worn a mask for my profession for the last 10+ years; it’s part of the job when working in healthcare and inside people’s mouths. Of course, the Covid-19 pandemic has been a game-changer. I used to wear a single surgical mask, and now I wear an N-95 respirator AND a surgical mask over it to protect it throughout the day.

My first day back in the office under these new PPE conditions in mid-June 2020 was unbearable. I truly almost had a panic attack in the first seconds I put on my two masks. My heart was racing and I could feel the palpitations by the end of most days, especially the hot ones. My glasses would fog, I could feel the beads of sweat dripping from the humid intra-mask environment. I hate to admit this, but there have been times I would get so dizzy and I thought I may pass out while in the middle of working. There were also moments I was on the verge of despair, especially in the beginning weeks. I worked hard at keeping my cool, keeping it together, and then I would crash by the end of the day. My nose I think is possibly permanently indented where the top of my mask sits. My body is definitely taking toll from these new work conditions, unfortunately.

Back in June I was famished. I was deflated. Is this how it’s going to be from now on?!

I discussed along with my colleagues about how beyond exhausted we felt. I talked to friends in other countries who had started working before I had.

“You will get used to it” they said. Somehow, I have.

I have also noticed that my breathing patterns have changed while wearing a mask (this is generally-speaking). As an airway-minded orthodontist, I also know THIS MATTERS. I tend to mouth-breathe a lot more often. I also think my actual oxygen intake was depreciating during long spans of mask-wearing, such as while working. I had hypothesized that long-term mask wearing induces physiological changes mimicking an apneic or hypopneic episode.

Finally, months later, I’ve done my literature review, and have reaffirmed many of my experiences and theories.

A study just came out in October 2020 discussing the perceptions of face mask wearing by healthcare professionals. 90% perceived it reduces aerosol/droplet transmission. 67% believe it reduced the habit of touching one’s face. 64% believed it protected from air pollution and dust. 58% replied that it offered a sense of protection against infection, comprising the most commonly reported benefits. On the other hand, the most common side effects included: 62% reported fogging of spectacles/hindered vision, 56% expressed discomfort and pain from the elastic bands, 55% reported suffocation and difficulties in breathing, especially when climbing stairs, and 49% reported excessive sweating inside the masked areas.

According to Johnson (2018), there are numerous physiological and psychological consequences of wearing a respirator (such as an N-95). A few of these outcomes comprise challenges with breathing/respiration, thermal equilibrium, vision, communication, feelings of well-being, ability to eat or sneeze.

There are increases in respiratory rate, tidal volume (i.e. the amount of air breathed in each breath), as well as increases in heart rate. These are consequences to increased carbon dioxide (CO2) in the blood. Ganong (1997) indicated that the increased breathing resistance makes it difficult to take in sufficient oxygen. This consequently stimulates the sympathetic nervous system and increases heart rate. (Just like an apneic episode!)

There is increased risk of hyperthermia, especially when wearing masks and PPE since there is no easy means to release heat (we’re sealing it in!).

Long-term (such as >1 hour) continued respirator wear can lead to dehydration and electrolyte depletion. The authors recommend frequent eating and drinking. However, we are in an unfortunate conundrum since it is difficult to remove masks frequently when on the job. Furthermore, they cited feelings of fatigue, anxiety and discontent are common. Elevated CO2 levels can actually trigger panic disorders.

Li et al. compared surgical masks with N-95 respirators in 2005. They concluded that subjects felt drier, cooler, more able to breathe and more comfortable than when compared to wearing respirators.

Interestingly, there have been studies to see if wearing a mask has similar effects to athletic training at altitude. There are “elevation training masks” to mimic these effects! Porcari and colleagues in 2016 aimed to see if wearing a mask improved endurance performance markers. What is happening here? Altitude training-induced hypoxic conditions stimulates the kidneys to produce erythropoietin (EPO), which increases red blood cell production (Paula and Niebauer, 2012). This increases one’s oxygen-carrying capacity in the blood and would lead to improved endurance performance. Maybe we’ll all come out of this on the other side as endurance athletes 😉

Finally, let’s quickly review mouth-breathing. One study came out in 2019 that demonstrated a statistically significant association between halitosis and mouth breathing. They also saw mouth breathing more commonly in males, compared to females. The oral cavity becomes dry due to the evaporation of saliva when the mouth remains open (Motta et al., 2011). Saliva balances pH and is anti-microbial, and thus mouth-breathing also increases the levels of acidity in the mouth. These changes may increase risks of decay or gum disease. As I mentioned in my last article, mouth breathing also increases tissue inflammation due to the increased velocity of airflow (while air, breathed in nasally, is warmed and humidified and the velocity is lessened).

Mouth-breathing in growing populations (i.e. kids) can also really negatively affect craniofacial growth patterns. I’ve reviewed this in several articles over the past few years – please reach out to me if you have trouble finding them specifically. Basically we need to nip this in the bud!

Roberge and colleagues reviewed facemask wearing and thermoregulation in 2012. They encouraged promoting nasal breathing when wearing protective facemasks (PFMs). Nasal breathing results in less heat or humidity retained in the “microclimate of PFMs” and assists in cooling the body overall (Harber et al., 1997).

How may we address this mouth-breathing tendency while wearing a mask? First step is mindfulness: being aware of the behavior. This is purely anecdotal, but I have started my own mindfulness practice to encourage nasal breathing. I will rest my tongue on the roof of my mouth and make sure my lips are sealed. This is similar to an effect of using mouth-tape, which is one form of treatment for mouth-breathing that I’ve mentioned in the past! Then breathe through the nose, slowly and mindfully, and can consider this even as a meditative practice.

To conclude, here are a few take-aways:

1. Wearing a mask is important during a pandemic and/or in healthcare setting!

2. Minimizing long (1+ hour) timespans of mask wear is important, if possible, to maintain physiological homeostasis: physical and mental wellbeing

3. Try mindfulness exercises to support nasal breathing patterns, since there is a tendency to mouth breathe while wearing a mask

If you want any of these references, please reach out to me! Here’s to staying healthy and in good spirits during these trying times.