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You need to find a way to treat your apnea. You need to find a doctor to quarterback all your symptoms. You should never just take antidressants. Very dangerous and very addictive. Find a doctor willing to take the time to go through all your symptoms and treat the root cause and then any symptoms that don't subside. Best way to approach your problems.
Dr Tony
NiceSilverBison1316 I would suggest wait and let your dentists make the adjustments after you discuss your jaw soreness. Dental appliances work by bringing the jaw forward and holding it in a position where your tongue does not fall back into your throat. And the key to success is to get the muscles of the head and neck to allow the appliance to take you to that position. Its not that for out usually. Most of my patients are brought forward to about there you would bite though a sandwich. The appliance is not causing the sore and cramped muscles. The sleep apnea is. But in order to treat the sleep apnea you need the muscles to relax. I would do the following.
Consult with your dentist about appliance design and advancement. Possibly consider a different appliance. Not all CPAP mask work for each patient. Not all dental appliances work for each patient.
Have a new sleep study after 3-4 months of wearing the appliance to see if it have your AHI number where you want them. If not continue advancement and get a another study.
Consider therapy for your muscles. Massage, chiropractor, physical therapy, etc. Sleep apnea causes several additional health problems. Heart issues, blood pressure issues, diabetes, weight gain, etc. All these additional issues are treated. Muscles spasms and TMJ dysfunction are also a very common problem with sleep apnea. But the medical community does not treat TMJ so it is often ignored in sleep apnea patients.
Hope this helps. Feel free to reach out to me if I can answer any more of your questions.
BeLovely, To answer your primary question I think an oral appliance is your next best step. You have tried a CPAP and its not working for you next step is oral appliance because if you have sleep apnea you need to do something to get air into your lungs.
Your what we call a combination case in my office meaning you have several issues all related to the apnea and a domino effect is happening. Combination cases can be frustrating for patients because they don't realize sometimes several issues have to all be treated before you sleep amazing each night. Getting air into your body is step one but may not be the only step. If you are waking up after 1 hour of sleep that is probably due to a pain response or cortisol. Your sleep study may give that answer. We tend to grind our teeth mostly in stage 2 of sleep. If your getting to stage 2 and then grinding hard enough to cause muscle spasms or pain that spikes cortisol and wakes you up. You also said you can sleep for 12 hours and still not feel rested. It may be that your making cortisol in very low levels or in spikes just enough to fragment your sleep. It sounds like your looking in the right place with melatonin pathway but you may need a full cell spectrum analysis to find where the break down is. It could be a problem with seratonin, B6, magnesium, GABA, and insulin. And 15 other hormones and neural precursors. So you may need and probably will need 2-3 doctors of different specialties working together to put your entire hormonal and circadian rhythm system back to its normal balance. This may take a few months to get just right. Don't get frustrated and be ready to try different treatments until everything is restored.
Thats a very good question and will take a lot to answer. So sorry for the long response. I am listing some of my videos that may help answer your questions as well if you would rather listen than read. They are only a couple of minutes long.
When you have sleep apnea its NOT the lack of air that causes the problem. If you hold your breath for ten seconds thats the same as an apnea event. You could hold your breath over and over all day and not have a health problem. And snorkeling where you hold your breath for prolong amounts of time under the water is actually healthy activity. So why does sleep apnea cause health problems and in this response cause TMJ dysfunction. Its not the lack of air. Its how the body responds to the lack of air. When your snorkeling your brian knows at any time you can go to the surface and take a breath. So the brain is calm. When you have a sleep apnea event the brain does not know when your going to breath again. So it panics! Big time. Remember the last time you choked on a piece of food? Think about how your body responded. Same thing. Your heart started racing. Your breathing rate rapidly increased or the attempt to breath rate increased. So you started to breath with your chest instead of your belly. To chest breath you must lift your shoulders. To continually lift your shoulders you must stiffen your neck. And to stiffen your neck you must clench your teeth. All this happens simultaneously. So each apnea event has the potential to cause TMJ dysfunction event. Decrease the apnea and you decrease the TMJ problems. But if you have already been clenching for so long and so hard your muscles may have shortening to the point where they stay tight all the time. You may not have headaches but you may have a lot of wear on your teeth. TMJ dysfunction has a lot of varied symptoms all related to over working the muscles of the head and neck. When you sleep appliance attempts to bring your jaw forward the muscles may not be used to lengthening this far. So they say OUCH! The sleep appliance did not cause the problem. It just making you aware of it. Ever have a sunburn and not know it until someone ot something toughed your skin? Burn was always there. You just didn't know it. My advice is to start slowly with the appliance advancement. It may mean you don't get great sleep for a few weeks. But your sleep will get better each night. And expect some setbacks. If you had a rough day your muscles may be tighter than usual. So they may not like your appliance. If so just have your dentist back it up a millimeter or two and start again. There is a position your jaw can be in where your tongue is not in your throat. This is true for everyone. Give your muscles the care they need to let your jaw get there comfortably. And you may need help from other than your dentist along the way. Massage therapy, chiropractic care, physical therapy, acupuncture, etc. All depends on how knotted up your muscles are.
Hope this is information you were looking for.If not just let me know and I will try to explain it better.
The answer to that is probably yes. We have many patients each month come to us for an oral appliance because they are frustrated with the same issues you are having. Some use both CPAP and oral appliance together and some switch to only oral appliance. If you go this route at some point make sure to get sleep study with the oral appliance in after 1-3 month to make sure it working effectively.
The idea of trying an inexpensive one size fits all appliance like Wiredgeorge suggested is not a bad idea. It may work great and save you some money. Please keep in mind the boil and bite appliances are prone to starting TMJ issues for a variety of reasons. But if its working to help you sleep but causing some TMJ dysfunction you can then go to a sleep dentists for a custom appliance knowing it will be worth your time and money. Some custom appliances are better for patients that prefer to sleep with their mouth open. Better to breath in your nose and out your mouth. But that's another discussion for another time. But if you just have to breath through your mouth consider an appliance where the top and bottom pieces are not joined together.
It could be the major cause of your sleeping issues. Or it could be something as simple as enlarged turbinates. Actually just the membrane over the turbinates. Very easy for an ENT to reduce with cold laser.
I would suggest working with your dentist as you begin to advance the appliance forward again. Have you spoken to your dental office about the problems your having? What did they say if you did?
The TAP is a good appliance. Been around for a long time. Its not my favorite design. The job of the appliance is to bring your jaw forward so your tongue does not fall into your throat. This means along with bringing the jaw forward there also needs to be room for your tongue inside your teeth for it to sit. The design of the TAP (not sure if you have the MyTap, TAP I, TAP II, or TAP III) has the advancement mechanism between your front teeth. By design this takes up some of the room for the tongue. I have found you have to bring patients out further than other appliances because of this. But I have to give it to TAP that they constantly work to improve their design. Back to your situation. My advice would be to start from the beginning. Turn the screw so it backs your jaw up to the starting point. Sleep a few night in this position and see how you do. After 2-3 nights if your not sleep well advance it one turn and then sleep 2-3 nights. Then decide if need to advance it again. For some patients the "sweet spot" is a very small window. Don't over shoot it. For some its quite big. Also look at other factors that may be contributing to either a good nights sleep or a bad one. If you are congested you may not breath as well. Yeah I know thats stating the obvious. But it also means don't advance it too much until your better. Try nose spray, vapor rub, or what ever works for you to clear your nose and chest. On a bad night did you sleep on your back? Thats a hard one to answer because your asleep so how would you know. But it is something to consider. Have you consulted your dentist about the issue? He should be available to help. And of course you can ask me as many questions as you like.
Yeah it does sound like it is moved too far out to be effective. Personally I adjust all my appliances instead of having the patient adjust them. Not that a patient can't do it. Its just turning a screw. Its more because sometimes my patients need me to monitor whats going wrong. I would suggest backing it up maybe all the way to the beginning. Not sure how far it is set initially. Then slowly bring it forward. Can I ask which appliance you are using? Will help give better advice how to adjust it.
I appreciate your concerns. Dental Appliances for sleep apnea have been around since the 1970s so they have pretty much passed the experimental stage a long time ago. Your dentist set the bite for the appliance where it keeps your jaw forward and keeps your tongue out of your throat. Unless the appliance is slipping or being adjusted in reverse the symptoms should not keep returning. If they are you must figure out why and adjust the appliance accordingly if it is a choking (sleep apnea) issue that is keeping you tired, go back to wearing a CPAP, or do nothing (strongly advice against this one). Sleep apnea causes a lot of TMJ symptoms especially tight and sore muscles. If your dentist suspects you are clenching and grinding he may have chosen to set the starting position for the appliance less forward than he normally would. This allows him to adjust the appliance forward slowly as the muscles relax and return to normal healthy length. I have an in office massage therapist work on all my patients just for this reason. Helps us get to the forward position of the jaw much faster. It may be that the appliance is working fine but you have other issues affecting your sleep. This would account for the on and off sleep your experiencing, I have patients that do just fine until they go back off shore, go on a trip, stay at the hunting camp for a weekend, etc. The different environment causes their sinuses to become congested and the back of their throat to swell. This can often be picked up as hypopneas on a sleep study. If you do a center PSG look for spontaneous arousals. These can often be pain responses that are fragmenting your sleep but the system does not know how to categorize them. Also you or your dentist may have advanced the appliance too far forward. This can cause tension on the muscles over a time period and cause you to experience non restful sleep. Simple solution is to back it up to the position when you had a a good night. Sorry I don't have specific answers. This is the best I can do with the information you have presented. If you can think of anything else please let me know.
Can I ask you for a little more information so I can give you my best answer? Did you have a follow up study at 1-3 months with the appliance in your mouth to see where your sleep scores fall? And also what symptoms are you still having?
