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Its possible that your sleep apnea is actually responsible for your TMJ symptoms. I see this a lot in my practice. The sleep apnea or choking events causes your cortisol to spike. This leads to a lot of hormonal events. One of them is rapid breathing instead of diaphramatic or belly breathing. When you breath rapidly you breath with your chest instead of your belly. This chest breathing causes you to lift your shoulders while breathing. In order to do this you must tighten your neck muscles and in turn the muscles involved in TMJ symptoms. By treating your sleep apnea you may actually be treating the true cause of your TMJ. It happens a lot in my practice. Once the sleep apnea is controlled years of TMJ symptoms begin to fade away. But keep in mind often the damage to the muscles is already done and they must be treated as well for complete relief. When your muscles stay contracted they eventually develop trigger points. These are little knots in the muscle fibers. They can be very tender and refer pain to other muscles. So the muscle hurting may not be the source of the problem. Once the knots develop they have to be manually rubbed out by massage therapy, acupressure, or acupuncture. Once the knot is released the muscle must be stretched to release any lactic acid buildup in the muscle. This why you need to drink lots of water after a deep tissue massage. So the long term answer to your TMJ problem may be a series of deep tissue massage including the pterygoid muscles located inside the mouth towards the top and back. Once these knots are removed and the sleep apnea is controlled your cortisol levels will drop and you should sleep like a baby.
Dr Tony Soileau
You are correct that most doctors, myself included, had limited or no education on sleep apnea in school. And yes most are very busy and treating sleep apnea problems takes time to understand what the patient is going through. There is also the problem that different fields don't talk to each other. If you look at the data the hormonal and neuraltransmitter response to a sleep apnea event, a panic attack, and a choking event are all identical. Yet the dots have not been connected across specialty fields. So the patient with depression, or anxiety, or diabetes, or TMJ dysfunction, or obesity is never offered a sleep study to see if apnea is the true cause of the problem. So it may be up to the patient to find a doc to talk to that sees the big picture.
The above reply is correct. Most women under 40 that appear healthy are not seen in medical community as possibly having sleep apnea. Same is true for younger males but not as much as women. This is one of my blog post on LinkedIn about depression, anxiety, and sleep apnea. https://www.linkedin.com/pulse/i-have-great-life-so-why-do-cry-get-depressed-angry-much-soileau?trk=prof-post I see it every week in my practice where young women come in with fatigue, insomnia, depression or anxiety. Choking on their tongue at night causing their fight or flight response to surge cortisol into their body all night has never been discussed with them. Prescriptions for anxiety (lower cortisol) and for depression (raise cortisol) are written in these cases without considering a sleep study or a cortisol test to determine the true problem.
You would help a tremendous amount of people if you covered this topic. Very few doctors connect these dots.
Dr Tony
In my practice 99% of my patients its the tongue being the major part of the problem. A sleep study does not show the location of the blockage. If you have any snoring its pretty much a given your tongue is the cause especially if you can breath well through both nostrils of your nose. For moderate AHI a dental appliance should always be considered often the first choice. Opinions will vary as to CPAP or dental appliance as first choice for moderate and severe AHI numbers.
Your treating doctor should spent a little more time explaining to you what sleep apnea is and options for treating it. The problem, at least here in Lafayette, is that the sleep docs are so busy and have never explained sleep apnea or HST/PSG study results they dont feel a need to. I guess that explains why this forum exists.
Hey John good to hear from you buddy!
Fair question and I understand you may not know a lot about dental appliances.
How does the dental appliance work. Try to keep this simple so if I am over simplifying it I apologize. The issue with apnea (choking) is the throat is blocked by the tongue and sometimes the nose is blocked usually by thickening of the turbinates. A CPAP works by forcing air past the blocked points. A dental appliance works by bringing the lower jaw forward thereby keeping the tongue from blocking the throat. If the only blockage is the throat/tongue then a dental appliance will work well even with severe apnea levels of AHI50+. I practice in south Louisiana where all my patients have sinus problems. So most of my patients also see my medical director Dr Philip Noel who is an ENT and sleep specialist. He did a turbinate reduction on me. Took ten minutes. Insurance pays in Louisiana without preauth. No swelling, pain , or complications. Amazing how much better I breathe now.
What does the dental appliance not do. It cannot fix your nose. And even with a CPAP you need to breath in through your nose. Not your mouth. The nose filters, warms, and humidifies the air. This makes the oxygen transfer into the lung tissue easier.
The dental appliance will help TMJ issues but only after the muscles are relaxed. Trigger pints and lactic acid must be manually rubbed out.
If you view the dental appliance as one part of restoring your body back to its normal breathing and sleeping cycle and rhythm its an amazing option that works very well for what its only designed to do, keep the tongue out of your throat so you don't choke on it. The other parts need to be addressed separately. And the same is true for a CPAP or throat surgery.
Did this get us started on how a dental appliance works?
Very sorry to hear that you had to wake up in the middle of the night to relax your jaw muscles. And the dental assistant not knowing what "silent apnea" means should be a concern.
Lets start with the jaw issue. The way all dental appliances work is to bring your jaw forward so you cannot choke on your tongue at night. Apnea is choking as you all know. The problems caused by apnea is NOT the lack of air. Hold your breath for ten seconds over and over all day today. No bad consequences. Tha'ts because your brain knows you can breath again at any point. During a sleep choking (apnea) event the brain does not know when you will breath again. I promise I am getting to the jaw problem. Just keep reading. Because the brain does not know when you will breath again the fight or flight response kicks in. Cortisol surges through the body. And now the bad stuff starts to happen. One of the bad things is your breathing rate will greatly increase. Cortisol indirectly does this. So you will begin to "chest breathe" and not "belly breathe" To breathe with your chest you must lift your shoulders. Its how the body is designed. As you lift your shoulders you will brace your teeth together. This prolonged and repetitive clenching (and grinding) is known as TMJ dysfunction. The jaw muscles begin to stay tight and develop trigger points and lactic acid buildup. Its actually more complex but lets keep it simple. If the muscles are very tight and have been this way for a while you will become accustomed to biting this way even if it is not healthy. The dental appliance is now trying to bring your jaw forward where your jaw may be able to comfortably go while in the dental office. But at night the muscle tighten up and fight the appliance. That's what happening to you. In my practice we have a full time massage therapist specifically trained to relax the muscles of the head and neck using massage, acupressure, and yoga stretches. By getting the muscles free of trigger points, lactic acid, prostaglandins, and reprogramming the muscle memory (engrams) the muscles relax and lengthen. She sees each patient before I take my bite record for the appliance and at adjustment appointments Your options then become to reset the bite on your device, back up the device and advance slower, or see a massage therapist, physical therapist, or chiropractor to heal your muscles and rest your skeletal alignment. You probably need this even if the appliance was working perfectly. Sleep choking (apnea) cause a lot of TMJ problems. 95% of my patients with sleep apnea have TMJ issues to some extent. They just have not made the connection between the two. Your muscles will at some point adapt to the appliance. They just may need some help along the way.
As the the silent apnea situation the sleep dentist you are seeing will or should suggest a new home study at the 1-3 month mark of treatment to verify that the appliance is working. If I am using the Micro2 appliance I test at 1 month. Narval, Moses, Somnodent, or Respire Appliance I test at the 3 month mark.
Please let me know if this post helps or how I can communicate better. I am new here so I could use some feedback.
To introduce myself I am Dr Tony Soileau. I am the dental/clinical director for Louisiana Sleep Solutions and Dedicated sleep. You can see more about my practice at tonysoileau.com I have been treating sleep apnea for 18 years with dental appliances. I still treat patients four days a week in my private practice in Lafayette Louisiana. I just joined this sight so I am still learning the rules and how things work. I have read several posts and really like the questions and advice given to help solve the problem. If any of you have a dental appliance that you have questions about or you are considering getting one I am happy to give you the best advice I can share.
