I've sewn a 3×3" square of material (I chose an old wool shirt for it's moisture, odor and anti-bacterial properties) and put a synthetic insulation layer inside. I place this over my nose/mouth at night and pull my balaclava up over it/my face on really cold winter nights. This gives most of the benefit of breathing in your bag without filling it with moisture. I know Ryan uses a synthetic hood from his cocoon series **backwards** to breath through for the same purpose. It really makes a difference in warmth.
I generally use down quilts (with vapor barrier in the winter) in all four seasons. If they're wide enough and attached to your pad properly I find them the lightest and most versatile system for the warmth. (Mike Martin taught me to cut slits in my pad and feed the straps through the pad if you really need draft control). I definately add the weight of a down balaclava in the winter but in other seasons the hat I use around camp keeps me warm enough.
Side sleeping is a bit harder with a quilt, but if it's wide enough and attached properly I've had no issues. In all but winter they can be used without a bivy and in winter I carry the bivy for moisture management anyhow.
The same 20oz sleeping bag can take me from a 75F night (draped over my legs and belly) to 0F (with insulated clothing that I'd bring anyhow for cooking outside, a down balaclava–4oz bringing my sleep specific items up to 24oz) and everywhere in between.
There's a narrower difference between a quilt and bag in the winter–the easier draft control and hood are there for you and you're very likely to need them. You can control your insulation/temperature with your extra clothing and, if you have continous baffles, by where you shake the down.
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