Clinical Director; Las Vegas Institute for Advanced Dental Studies
(LVI), DDS, FAGD, DICOI, LVI Fellow
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 (TMJ)?
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 (TMJ)? 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.
Experts estimate that more than 44 million Americans have one of the several variants of TMJ disorder, or TMD, with women more prone to the condition than men. Pain when chewing is a common symptom, as are other warning signs including limited movement of the jaw or a locking sensation, ringing in the ears, jaw clicking and grating or popping of the jaw joint. These symptoms are often a result of muscle tension and misalignment in the jaw. Although minor symptoms may be relieved with a little rest, hot and cold packs, a soft diet, TMJ massage and/or jaw exercises, persistent symptoms can lead to chronic problems that disrupt your sleep and can become more difficult to treat.
We have all seen the images of tools used to manage sleep apnea that require sufferers to sleep with a CPAP mask, making them look like a super villain or scuba diver. However, obstructive sleep apnea is a potentially serious condition. Sufferers experience obstructed airflow and stop breathing repeatedly during sleep, sometimes for a minute or even longer. This may happen from five times an hour to more than 100 in severe cases. The body is damaged by only 5 of these episodes an hour, and as we learn more, it appears that even minor episodes can cause chronic damage.When breathing stops, the brain reacts to the situation by producing a rush of adrenalin which in turn quickens the heartbeat. Muscles in the chest then work to resume airflow and the person gasps for a breath and falls back asleep. This scenario is then repeated multiple times during the same night while the person never realizes what is occurring. That's because they never really "wake up" but only experience a short pause in sleep. This pause destroys the normal sleep cycle cascade which is critically important to health and brain function.
More and more studies are showing a connection between TMD and sleep disturbances. In many sleep apnea cases, a misaligned jaw joint or TMJD, is actually to blame. This is because the tongue's position is impacted by the alignment of the upper and lower teeth. When the teeth are misaligned, the tongue can block the airway as you sleep. This problem with the jaw alignment or malocclusion can cause a person to wake up frequently throughout the night.Untreated sleep apnea causes snoring and can lead to much more serious health issues such as high blood pressure and heart disease. In addition, people with sleep apnea do not get the rest they need because, as a preventative reaction, their brains keep them from falling into a deep sleep mode.BruxismAnother symptom of TMD is bruxism, commonly called teeth grinding. A misalignment of the jaw can cause you to unconsciously grind or clench your teeth together.Bruxism causes significant damage to your teeth and is something that is easily corrected with proper physiologic care. You would be surprised at how forcefully we can clench our teeth. As we are waking, the pressure when clamping the teeth together can reach about 200 pounds per square inch. However, when we are asleep, that force can reach more than 700 pounds per square inch!Because of this force, people with severe bruxism can break their dental fillings and/or cause the outer layers of their tooth enamel to wear away, exposing the highly sensitive dentin. Additionally, this extreme jaw muscle tension can result in complications that include other TMJ disorder symptoms like lockjaw and tension headaches.Night Headaches
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.The same obstructive breathing that causes sleep apnea also can cause nighttime or hypertensive headaches. To put it simply, lack of oxygen can trigger a painful headache.Many people turn to over-the-counter pain medication for headaches rather than exploring the root cause of the pain. Common signs that a headache is related to a TMJ disorder include:● A clicking or popping sound emanating from the jaw● A bite that feels off or does not close properly● Complaints of snoring at night from your spouse or family● Forward head posture
Researchers from the University at Buffalo School of Dental Medicine found that headaches related to TMJ dysfunction are frequently misdiagnosed as tension headaches. In a study of 583 patients with frequent headaches, 82 percent of female cases and 17 percent of male cases had symptoms associated with TMD.
Finding ReliefIf you think TMD could be causing your sleep problems, here are some tips you can try at home:
● Gently stretch your neck throughout the day● Improve your posture● Avoid chewing gum● Gently massage your jaw muscles● Commit to a soft diet● Try to use other home remedies to lessen the severity of a TMD flare up● Learn to combat stress with exercise or meditation. (Stress can exacerbate pain.)● Move the jaw gently from side to side 10 times and then allow it to rest for a minute. Do this for 5 sets a few times a day. This will help to stretch the muscles of mastication.Although the exercises above may help, if the system is not physiologically correct, the best advice is to get it corrected. The headaches can start as a nuisance but can eventually become incapacitating.In my experience as a educator for TMJ dentists and clinical director at LVI Global, up to 85% of TMJ disorder symptoms can be resolved without prescription drugs or surgery. Instead, we return the jaw muscles to their natural place of physiologic rest which allows the system to function correctly. Treatment through neuromuscular dentistry strives to reduce or resolve symptoms by focusing on fixing the muscles that support the bite. The result is a dramatic lessening of muscle pain and in many cases, a better night's sleep.
Want to Learn More?
If you believe you are suffering from Sleep Apnea or TMJ and would like more information about the disorder, contact Beth Snyder DMD at (215) 346-7462 and receive a professional diagnosis.