Implications For Osa And Tmd Patient Screening And Treatment
Clearly, with a large-scale study documenting a statistically relevant coexistence of OSA and TMD, the approach to screening and optimally treating both conditions needs to reflect this association. When a patient presents with one or the other, best practices should include screening for the both. If one is initially present but not the other after assessment and diagnosis, such as OSA without TMD, periodic screening checks for TMD should be conducted.
The Connection Between Sleep Apnea And Tmj
April 24, 2018 by Dr. Tanenbaum
Medical research continues to assess how poor sleep quality and sleep disorders in general influence pain thresholds and the experience of muscle and joint pain. One common area of study pertains to obstructive sleep apnea and the larger field of sleep-related breathing disorders conditions that can lead to fragmented sleep.
Therefore, if you have TMJ pain, its really important to tell your doctor if you have a sleep-related breathing disorder , and heres why.
Is Tmj And Sleep Apnea Correlated
TMJ and obstructive sleep apnea are conditions that might develop together and reinforce one another. One wellness center found that 52% of people with sleep apnea suffer from TMJ, and 75% of people with TMJ suffer from snoring, sleep apnea and other sleep disorders.
Once you experience symptoms of sleep disordered breathing, it can lead to further TMJ damage. Breathing through your mouth causes you to clench your jaw leading to damage in the joints.
Those who struggle with TMJ first usually restrict the airway because the jaw is shifting backward. The physical misalignment of your jaw blocks the airway causing interruptions in breathing.
Although TMJ can go away on its own, dealing with the pain can be incredibly difficult. There are pain-relieving medications and exercises you can do to help improve TMJ. However, the best solution to help with sleep while suffering TMJ is using mouth guards and oral splints.
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How Does Tmd Relate To Sleep Apnea
Obstructive sleep apnea describes a condition in which you experience very shallow breathing or stop breathing altogether when you sleep. It can happen hundreds of times a night, preventing you from getting a solid nights sleep. Sleep apnea can make you experience excessive daytime drowsiness and increase your risk of developing chronic disease, including heart disease.
Research shows that TMD and sleep apnea often correlate and occur together. TMD often leads to an imbalance in your bite, making the tongue displace during sleep potentially causing the apneas. The looser joints associated with TMD can also cause your jaw to fall farther back, potentially compromising your airway during sleep.
Sleep apnea also raises your risk of TMD. If an oral appliance used to treat sleep apnea isnt fit quite right, it can irritate your jaw and lead to TMD. People with sleep apnea may also tense their jaws and grind their teeth at night in an attempt to create the right space in the airway. This can inflame TMJ or exacerbate an existing problem.
The Role Of Pain A Double
If youve ever been in chronic pain you know that getting a good nights sleep can be quite a challenge. Moreover, studies reveal that insufficient sleep can actually lower your threshold of pain, meaning you feel pain more intensely than if you were well-rested. The reason is this: when you dont sleep well your body cant produce a normal level of endorphins . On top of that, poor sleep can cause your nerve pathways to malfunction which causes a more intense experience of pain.
So, it can go both ways.
When breathing difficulties disrupt your sleep, you become more at risk of developing bruxism. And if your overworked jaw muscles become painful, the pain can cause fragmented sleep. Its a symbiotic relationship.
Hopefully, you can now see the connection between sleep apnea and TMJ. Please consider getting evaluated for sleep apnea if youre suffering from TMJ pain. A careful evaluation process, which may include an overnight sleep study will determine the best type of treatment.
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Symptoms Of Tmd Include:
- Pain in the jaw area
- Pain, ringing, or stuffiness in the ears
- Frequent headaches or neck aches
- Swelling on the sides of the face
- Muscle spasms in the jaw area
- A change in the alignment of top and bottom teeth
- Locked jaw or limited opening of the mouth
Should you notice any of these symptoms, let your doctor know. Your dentist can help indicate the presence of TMD and create an effective treatment just for you.
There are a few simple steps you can take at home or work to prevent TMD from becoming more severe, or to prevent it from occurring:
- Relax your face remember the rule: “Lips together, teeth apart”
- Avoid grinding your teeth
- Avoid constant gum chewing
- Don’t cradle the phone receiver between your head and shoulder either use a headset or hold the receiver in your hand
- Chew food evenly on both sides of your mouth
- Do not sit with your chin rested on your hand
- Practice good posture keep your head up, back straight, and shoulders squared
Are you drowsy during the day with no explanation? Do you snore loudly or wake up breathless in the middle of the night? If you’re experiencing any of these symptoms, you may be one of more than 12 million Americans who are affected by sleep apnea.
Does Nasal Congestion Cause Sleep Apnea
Congestion is the main cause of both chronic sinusitis and sleep apnea. There are multiple conditions that contribute to sinusitis and snoring, such as allergies, humidity, obstruction in the sinus , enlarged turbinates/deviated septum, and even obesity.
While there are lots of similarities between the two, the connection is still unclear. According to a scientific report in 2016 that studied 971 sleep apnea patients and 4855 patients who did not suffer from sleep apnea, only 7% of sleep apnea patients were diagnosed with sinusitis. Only 2% without sleep apnea had sinusitis.
The 5-year long study suggests the correlation was not significant. Therefore, those diagnosed with sleep apnea do not necessarily develop sinusitis, and vice versa. However, there is a small increase in risk of developing sinusitis among sleep apnea patients.
Since nasal congestion symptoms make it difficult to breathe normally while sleeping, people suffering from chronic sinusitis who do not properly treat their nasal problems are prone to develop sleep apnea. Fortunately, sleep apnea caused by sinusitis can be treated effectively if the sinusitis is treated first.
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The Connection Between Sleep Apnea And Tmj Disorders
Roughly 43% of TMJ patients have problems sleeping with sleep apnea being especially common. When the airway becomes blocked, the body automatically moves the lower jaw forward in an attempt to reopen it. Since sleep apnea episodes can occur several times throughout the night, the TMJ is constantly being moved, resulting in a lot of stress and tension. This can cause you to wake up feeling exhausted and with consistent jaw pain.
Additionally, TMJ disorder can be a side effect of factors that contribute to sleep apnea. For example, TMJ issues may be linked to chronic fatigue syndrome, a disease characterized by sleep abnormalities, pain, and other symptoms made worse by exertion. It can also be caused by jaw misalignment, which blocks the airway while you sleep. These issues make sleep apnea worse, so itâs important to find the root cause of both your TMJ issues and sleep apnea so they can be treated effectively.
If You’re In Need Of Guidance Get In Touch With Us
If you know or suspect you have obstructive sleep apnea and/or TMD, find out how Dr. Katherine S. Phillips can help you find relief. Her practice is dedicated to treating TMDand sleep disorders, including obstructive sleep apnea. With a Master of Science in Orofacial Pain and as a board-certified sleep dentist, she will develop a treatment plan that best fits your individual needs.
Medical Reviewer:About The Author
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So What Can You Do About These Conditions
Luckily, theres a solution that can treat TMJ disorders atthe same time as sleep apnea: oral appliance therapy. An oral appliance is wornat night to position the jaw into a comfortable resting place. By moving thejaw and tongue forward, itll prevent your breathing from becoming obstructed.It also serves as effective temporomandibular joint treatment by taking thestrain off of your jaw. Overall, youll notice that the quality of your lifewill start to substantially improve over time.
Of course, your dentist needs to diagnose your conditionsbefore deciding what the best course of treatment is. If youve been dreamingof a better nights sleep and a life free of constant pain, schedule aconsultation today!
Is Tmj Disorder Costing You A Good Night’s Sleep
If you are one of the estimated 40 million+ Americans who suffer each year from chronic sleep disorders or one of the additional 20 million who experience occasional sleeping problems, you know first hand how the problem can affect your quality of life. A sleep disorder can interfere with your work, your ability to drive and your participation in social activities.
Did you know that many patients who suffer from sleep disorders are also dealing with a problem directly related to disorders in their temporomandibular joint ? The TMJ is the joint that attaches your lower jaw, or mandible, to the temporal bone of your head. More precisely, it is where the lower jaw fits into the skull and is supported by the muscles in your face. It is the joint that allows you to chew, swallow and yawn. However, when it isn’t functioning properly it can be the root of a lot of problems.
A disorder in this important joint can cause pain and discomfort in other parts of the body and these TMJ disorder symptoms — including sleep apnea, teeth grinding and tension headaches or migraines — can impact your ability to get a good night’s sleep.
When the bite and the lower jaw are misaligned, muscles are strained which can result in head pain that can mimic a migraine. This pain can be around the forehead, on the back of the head or radiating down the neck.
Finding Relief If you think TMD could be causing your sleep problems, here are some tips you can try at home:
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Treating Sleep Apnea And Tmj
Your dentist has the solution you need to treat both conditions using an oral appliance. The custom-fit device is worn at night to reposition the lower jaw to keep the airway open. This will stop pauses in breathing while taking strain off your TMJ. Its a simple, effective way to improve your general health and quality of life.
Besides treating sleep apnea, you can take several steps at home to reduce jaw pain, like practicing stress-relieving exercises. Home massages and stretching exercises can improve the joints mobility to bite, chew, and yawn without discomfort.
Dont lose sleep at night from TMJ or a narrowed airway. Your dentist can stop your pain and help you get the rest you need to feel your best.
About Dr. Henry Hsue
After earning his dental degree, Dr. Hsue has completed extensive continuing education to master the art and science of dentistry. He specializes in many advanced treatments, including TMJ therapy and sleep apnea therapy. He can create the oral appliances you need. Contact our office today to schedule your consultation.
Sleep Apnea: Treatment Options
Because the positioning of the jaw and/or tongue can create the conditions that result in apneic episodes, oral appliance therapy can be highly effective in eliminating sleep apnea. The oral appliance holds the jaw or tongue forward to keep the soft tissues away from the airway opening.
Some congenital issues, such as a narrow airway or a deviated septum, may also need to be addressed in order for the patient to get complete relief from sleep apnea symptoms. In such cases, we will refer you to a specialist, such as an ENT, who can treat these concerns.
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How Is Tmd Diagnosed
If you come in with symptoms that suggest TMD, the dental team does a thorough exam. They rule out any tooth decay or other conditions that can cause similar symptoms.
They may order an X-ray of the joint to look for bite misalignment. A physical exam reveals any pain or clicking sounds in the joint.
What Should I Do If I Suspect That Someone In My Family Suffers From Sleep Apnea
Contact our practice, and we can refer you to a sleep apnea specialist. The specialist may recommend a sleep study to diagnose the precise extent of the problem, and can prescribe appropriate treatment. Depending on your situation, treatment may involve an oral device that we can custom-create for you.
Does snoring or sleep apnea keep you up at night? The Thornton Adjustable Positioner might be your key to a snore-free, restful night of sleep. It treats sleep-disordered breathing without the need for surgery, a CPAP mask, or medication, and is recommended for use by the American Association of Sleep Medicine .
The TAP appliance is non-invasive and fully adjustable to create the jaw position that best treats your symptoms. The device holds your lower jaw in a forward position so it does not fall open during the night and allow the airway to collapse. The TAP is clinically proven to treat high upper airway resistance syndrome as well as all levels of obstructive sleep apnea, including severe sleep apnea.
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What This Means For Patients And Treatment Providers
There is still much to be studied and learned about the connection between OSA and TMD, but the OPPERA prospective cohort study identified a significant connection that had not been well-documented with a large-scale study. With this knowledge, treatment for both OSA and TMD can be better-coordinated and optimized. As a result, patients may experience fewer symptoms and better treatment outcomes. Dr. Katherine Phillips has over a decade of experience coordinating patient care with Sleep Physicians and helping patients manage both TMJ disorders and obstructive sleep apnea. Torequest a consultation with her, you can do so here.
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Sleep Apnea And Tmj: What Is Tmj
As mentioned, TMJ is short for the temporomandibular joint. The temporomandibular joint and muscle disorder affects between 5% and 12% of people and TMJ disorders are at least twice as prevalent in women as men. The interesting thing about TMJ is that there is no standard definition. It can be diagnosed by asking about simple symptoms and the prevalence of them.
The temporomandibular joint is moved by four different muscles. These are the:
- Lateral pterygoid
These four muscles, all linked to the nerve V3 , work in different groups to be able to move the jaw in different directions. When one of these muscles is affected, it can cause a chain reaction to the other groups that now need to work harder to make up for it. This can cause a host of issues that become TMJ disorders.
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Signs/symptoms Of Obstructive Sleep Apnea
From the Pittsburgh Sleep Quality Index , we extracted responses to 3 questions that asked about loud snoring, trouble staying awake, and witnessed apnea. From the medical history, we extracted hypertension information. Together, these 4 hallmarks of OSA comprise the 4-item OSA screening questionnaire called STOP that was validated against polysomnography . STOP was developed to identify individuals likely to have OSA, so that special precautions could be taken during/after general anesthesia. Affirmative responses to â¥ 2 of these questions indicated high likelihood for OSA. We adopted this scoring convention, and, consistent with the scoring of STOP, we defined â¥ 2 affirmative responses to these signs/symptoms as indicative of high likelihood of OSA. In addition, people with a self-reported history of sleep apnea were classified as having high likelihood for OSA, regardless of their responses to the four approximated STOP questions.
Sleep Apnea And Its Symptoms
Sleep apnea is a common disorder that leads to pauses in breathing during sleep. These pauses can be as short as a few seconds or as long as a full minute, and a person may experience over 30 stops and starts to their breathing in an hour. During a pause in breathing, you will usually move from a deep sleep to light sleep. Many patients often wake with a loud snort or choking sound. It is also common for sufferers of sleep apnea to experience headaches, weight gain, depression, and excessive tiredness and fatigue during the day. The condition can also lead to severe health concerns such as high blood pressure and risk of stroke.
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Links Between Tmj Problems & Sleep Apnea Coming To Light
When a friend learned that what she was eating was leading to skin rashes, she was puzzled by the connection. Yet, researchers are now connecting the dots between just how closely one system in the body influences the others.
A particular connection that is moving front-& -center is the connection between obstructive sleep apnea and TMJ disorder.
But, how could oxygen intake during sleep be affected by problems associated with the jaw joints?
Results from a number of studies are showing a close relationship between the two disorders. In one study, one-third of participants with TMJ Disorder also suffered from obstructive sleep apnea. Through advanced imaging technology, researchers have become better able to hone in on how the connection exists.
In another study, 75 percent of patients who were diagnosed with sleep apnea also reported pain associated with their jaw joints. This has prompted some dentists and physicians to advise their TMD patients to be tested for sleep apnea. For many, an oral appliance that resolves TMD can have dual advantages for sleep apnea sufferers.
Why now? It is felt that the connection hasnt been obvious before because the average patient with each ailment doesnt share much of a similar make-up.
While age is a risk factor for both genders, sleep apnea tends to be experienced by older men, .
Compare this to the average TMD sufferer, who are generally women in the 25 50 age range.
Testing is thorough yet comfortable.