Sleep Apnea TMJ Symptoms
How is a TMJ disorder connected to sleep apnea? This is a question which is being asked more and more often as the correlation becomes more well known. You may wonder how TMJ is connected to your breathing passageways. How does an incorrect placement of your jaw joint impact your airways and lead to night-time problems, including sleep apnea? For understanding this connection, let us first understand what sleep apnea is.
Sleep apnea is a sleep disorder characterized by pauses in breathing or instances of shallow or infrequent breathing during sleep. Each pause in breathing, called an apnea, can last for several seconds to several minutes, and may occur, by definition, at least five times in an hour.
Common symptoms of sleep apnea:
- Loud snoring
- Episodes of breathing cessation
- Abrupt awakenings accompanied by shortness of breath or feelings of choking
- Awakening with a dry mouth or sore throat
- Morning headache
- Difficulty staying asleep (insomnia)
- Excessive daytime sleepiness (hypersomnia)
- Trouble concentrating
- Increase in heart rate and/or blood pressure
- Unexplained weight gain
- Frequent heartburn
Causes of obstructive sleep apnea
Obstructive sleep apnea occurs when the muscles in the back of your throat relax. These muscles support the soft palate, the triangular piece of tissue hanging from the soft palate (uvula), the tonsils, the side walls of the throat and the tongue. It’s normal for the muscles and soft tissues in the throat to relax and collapse to some degree while sleeping. For most people this doesn’t cause breathing problems, but in people with OSA (obstructive sleep apnea) the airway is too narrow or has become narrow due to a number of factors such as:
- being overweight or obese
- having a large neck
- taking medications that have a sedative effect, such as sleeping tablets
- having an unusual structure in the neck, such as a narrow airway, large tonsils, adenoids or tongue, or a small lower jaw
- smoking or drinking alcohol, particularly before going to sleep
In OSA, when the muscles relax, your airway narrows or closes as you breathe in, and you can’t get breath in adequately. This may lower the level of oxygen in your blood. Your brain senses this inability to breathe and briefly rouses you from sleep so that you can reopen your airway. This awakening is usually so brief that you don’t remember it. Your partner, family or roommates may notice that you make a snorting, choking or gasping sound when sleeping. This pattern can repeat itself 5 to 30 times or more each hour, all night long. These disruptions impair your ability to reach the desired deep, restful phases of sleep, and you’ll probably feel sleepy during your waking hours.
The Relationship of TMJ disorder and Sleep Apnea
Firstly, let us consider how TMD can cause sleep apnea?
- TMD leads to imbalance in bite or severe overbite. If the lower jaw needs to go backwards in order to get the teeth to come together to bite, chew, speak clearly, etc., then the tongue has to go back towards the throat. If the upper teeth cover the lower teeth, the tongue is forced back in your mouth. This restricts your breathing airways and compounds the sleep apnea
- Also, TMD, leads to damaged and loosened joints. So in sleep, the jaw falls further back, worsening the airway.
Secondly, why does TMD result from sleep apnea?
- The treatment for sleep apnea involves the use of oral appliances. Oral appliances are non-invasive, non-surgical, simple, well tolerated and efficient. Oral appliances advance the mandible forward and change the volume of the upper airway. The acceptable range of mandibular advancement for each patient must be carefully determined using advanced measurement equipment only available from TMJ dentists trained in its operation.
- People with sleep issues tend to clench and grind at night, trying unconsciously to find the best possible positioning to keep their airway open so they can breathe. The constant pressure on the muscles may inflame the Temporomandibular joint leading to TMD or exacerbate preexisting TMD. Use of the oral appliance may relax the jaw muscles by aligning them correctly while also positively impacting the sleep apnea symptoms.
TMD symptoms can both overlap and mimic those of sleep apnea. Thus it is imperative that the treating dentist has an appreciation of proper physiologic function of both hard and soft tissues e.g. jaw and muscles and their relation with sleep apnea. A trained neuromuscular dentist and his team can help you find the answers to all the questions about this very complicated connection between two seemingly unrelated problems. Many times, for both sufferers of TMJ disorder and sleep apnea, one of the treatments is what resembles an athletic mouthguard. The device appears similar to a night guard and will be worn while you sleep. It repositions the jaw, easing jaw joint tension and preventing soft tissue from obstructing airflow.
Tests to Diagnose Sleep Apnea:
- Nocturnal Polysomnography. During this test, you’re hooked up to equipment that monitors your heart, lung and brain activity, breathing patterns, arm and leg movements, and blood oxygen levels while you sleep
- Home sleep tests. These tests usually involve measuring your heart rate, blood oxygen level, airflow and breathing patterns at home. If you have sleep apnea, the test results will show drops in your oxygen level during apneas and subsequent rises with awakenings
- Epworth Sleepiness Scale Questionnaire: This asks how likely you’ll be to doze off in a number of different situations, such as watching TV or sitting in a meeting. The final score will help your doctor determine whether you may have a sleep disorder (Click here for a copy of this tests that you can print.)
If the results are abnormal, your dentist may be able to prescribe a therapy without further testing.
Sleep Apnea Treatment
For milder cases of sleep apnea, your dentist may recommend only lifestyle changes, such as losing weight or quitting smoking, avoiding alcohol, tranquilizers, doing regular exercise, using nasal sprays. If you have nasal allergies, your doctor will recommend treatment for your allergies. Sleeping on a side as opposed to sleeping on the back is also recommended.
If you have moderate to severe sleep apnea, you may benefit from therapeutic interventions. like Positive Airway Pressure whereby a breathing machine pumps a controlled stream of air through a mask worn over the nose, mouth, or both. The additional pressure holds open the relaxed muscles. There are several variants:
- Continuous Positive Airway Pressure (CPAP) is effective for both moderate and severe disease. CPAP machine delivers air pressure through a mask placed over your nose while you sleep. With CPAP, the air pressure is somewhat greater than that of the surrounding air, and is just enough to keep your upper airway passages open, preventing apnea and snoring.
- Variable Positive Airway Pressure (VPAP), also known as bi-level or BiPAP, uses an electronic circuit to monitor the patient’s breathing, and provides two different pressures, a higher one during inhalation and a lower pressure during exhalation
- Nasal EPAP, which is a bandage like device placed over the nostrils that utilizes a person’s own breathing to create positive airway pressure to prevent obstructed breathing.
- Automatic Positive Airway Pressure (APAP), also known as “Auto CPAP”, is the newest form of such treatment. An APAP machine incorporates pressure sensors and a computer which continuously monitors the patient’s breathing performance.
- Oral appliances, these are mouth guards similar to those used in sports to protect the teeth. However when properly fit for a patient within the guidelines of neuromuscular dentistry it will align the jaw and affected tissue to increase positive airflow naturally. It is designed to hold the lower jaw slightly down and forward relative to the natural, relaxed position. This position holds the tongue farther away from the back of the airway, and may be enough to relieve apnea or improve breathing in many cases.
Surgical Treatments for Sleep Apnea
Surgery should only be an option after other treatments, including airway pressure devices, have failed. The goal of surgery for sleep apnea is to enlarge the airway through your nose or throat that may be vibrating and causing you to snore or that may be blocking your upper air passages and causing sleep apnea. Surgical options may include:
- Tissue removal: During this procedure, which is called Uvulopalatopharyngoplasty, your doctor removes tissue from the rear of your mouth and top of your throat. Your tonsils and adenoids usually are removed as well. This type of surgery may be successful in stopping throat structures from vibrating and causing snoring.
- Jaw repositioning: In this procedure, your jaw is moved forward from the remainder of your face bones. This enlarges the space behind the tongue and soft palate, making obstruction less likely. This procedure is known as Maxillomandibular Advancement.
- Implants: Plastic rods are surgically implanted into the soft palate after you’ve received local anesthetic.
- Creating a new air passageway (Tracheostomy): You may need this form of surgery if other treatments have failed and you have severe, life-threatening sleep apnea. In this procedure, your surgeon makes an opening in your neck and inserts a metal or plastic tube through which you breathe
- Other types of surgery may also help reduce snoring and contribute to the treatment of sleep apnea by clearing or enlarging air passages:
- Nasal surgery to remove polyps or straighten a crooked partition between your nostrils (deviated nasal septum)
- Surgery to remove enlarged tonsils or adenoids
- Weight-loss surgery
To find a medical professional who is trained in the assessment of TMD and sleep apnea search our database of neuromuscular TMJ dentists:
More Articles on TMJ Sleep Apnea:
More on TMJ Disorders at Leading Dentists:
Additional Sleep Apnea Resources:
- Wikipedia Obstructive Sleep Apnea Wiki
- American Sleep Apnea Association
- Sleep Apnea: National Heart Lung & Blood Institute