Sleep Quality Decline in Patients With Painful TMD
People suffering from ongoing chronic pain conditions, including temporomandibular disorders, often experience poor sleep quality.
The Minnesota Head & Neck Pain Clinics believe in patient education on the complex relationship between sleep, pain, and TMD. This article will explain why a sleep evaluation is an important part of our comprehensive treatment for TMD. We’ll discuss how undiagnosed and untreated Obstructive Sleep Apnea (OSA) can be a contributing factor for sustained jaw pain in your jaw muscles. It can also be a contributing factor in a person’s ability to get a good night’s sleep.
Table of Contents
- Are Obstructive Sleep Apnea and TMD Related?
- Why is Chronic Pain Associated with Sleep Problems?
- Sleep Disturbances and TMJ Pain Sensitivity
- Difficulty Sleeping Impacts 88% of Chronic Pain Patients
- How does TMD link to poorer sleep?
- How Sleep Issues may Contribute To TMD’s Development
- Sleep Quality and Temporomandibular Joint Osteoarthritis
- Take Action if Experiencing a Sleep Quality Decline
Are Obstructive Sleep Apnea and TMD Related?
The National Institute of Health’s (NIH) Sleep Apnea Symptoms and Risk of Temporomandibular Disorder article stresses that “An emergent body of evidence suggests that OSA is associated with chronic pain disorders including temporomandibular disorder (TMD)” . It states the following:
“High likelihood of OSA was associated with greater incidence of first-onset TMD. In the case-control study, high likelihood of OSA was associated with higher odds of chronic TMD. Both studies supported a significant association of OSA symptoms and TMD, with prospective cohort evidence finding that OSA symptoms preceded first-onset TMD.”
This topic raises several questions. We’ll start with some answers and provide a basic understanding of this complex relationship.
Why is Chronic Pain Associated with Sleep Problems?
Repeatedly, we find that patients with chronic pain experience poorer sleep than healthy individuals. Sleep latency, sleep efficiency, trouble breathing during sleep, and awakenings after sleep onset can all contribute to worsening pain levels. A sustained lack of quality sleep is known to trigger higher pain levels in TMD patients.
A basic human need for good health is sufficient sleep. Both how long you sleep and the quality of your sleep matter. Sleep is vital for physical health, the body’s capacity to heal, emotional well-being, cognitive functioning, good work performance, a higher quality of life, and pain control. Treatment for chronic pain should always include an assessment of the person’s sleep patterns.
Can TMD cause sleep apnea?
A person experiencing continual motion by the TMJ throughout the night may ultimately have TMD issues. Grinding of the teeth, stresses, and tension on the jaw joint increase with untreated sleep apnea. TMD is also seen in people with chronic fatigue syndrome. Sleep apnea dysfunction can contribute to continued motion of the jaw, which intern can negatively impact your overall well-being.
“TMDs” refers to the disorders, and “TMJ” refers only to the temporomandibular joint itself.
In 2016, Science Direct released a report on Sleep Quality in Temporomandibular Disorder Cases. It was reprinted by NIH with a significant statement: “The prevalence of poor sleep quality was 60.3% in temporomandibular disorder (TMD) patients.” It assesses sleep quality (SQ) and suggests the following for people suffering from dysfunctional TMD pain.
“SQ is impaired in TMD patients with pain-related diagnoses, and even more in those with dysfunctional pain. This relationship between sleep and pain suggests that SQ should be assessed in TMD pain patients, especially in those with significant Axis II involvement.” – Author Ksenija Rener-Sitar
Will treating sleep apnea help with TMJ?
Since sleep apnea and TMJ, as well as a TMD disorder have a close medical relationship, treating sleep apnea can often help improve TMD symptoms. When a person’s airway collapses, it causes an automatic response in the body to protrude the lower jaw forward. The constant back-and-forth muscle motion can cause tension and stress on your jaw joints.
Treating sleep apnea with a suitable oral appliance will stop pauses in breathing while also reducing TMJ strain. It’s a simple, non-invasive way to improve your body’s quality of sleep, and in turn, your ability to heal. Additionally, by improving how long you sleep, you can typically reduce jaw pain, gain consistent sleep time, and find more energy for stress-relieving exercises.
People suffering from TMJ Disorders typically face issues like increased daytime sleepiness, exhaustion levels, headaches, and psychological stresses. Control studies that reduced total sleep and disrupted slow-wave and rapid-eye-movement stages of sleep found that it evoked musculoskeletal pain. Sleep deprivation and restriction are also associated with an increase in muscle inflammatory signals, decreased pain thresholds, and increased pain sensitivity.
Do chronic TMD patients struggle with sleeping well?
While sleep bruxism (SB) is relatively common in patients with TMJ, it’s difficult to document a clear medical causation relationship. Multiple contributing factors may affect a person’s sleep. A pain clinic specializing in both sleep apnea and TMD can assess your overall health condition and help with diagnosis. During sleep bruxism, jaw and neck muscle activation is significantly coherent.
Study results published by NIH on March 14, 2022 state that “Chronic temporomandibular disorder patients had markedly impaired sleep quality than healthy controls. Poorer sleep in patients with a chronic temporomandibular disorder was associated with a variety of clinical factors, including a higher likelihood of excessive daytime sleepiness, older age, female gender, higher Epworth sleepiness scale scores, and the presence of headache attributed to temporomandibular disorder.”
The Poorer sleep quality in patients with chronic temporomandibular disorders compared to healthy controls article talks further about how pain is the most frequently reported symptom of TMDs. It frequently triggers neck pain, headache, disturbances in mandibular movement, and functional jaw muscle impairment.
Factors such as stress, work-life trauma, household occurrences, sedentary lifestyle, obesity, anxiety, possible pathologies present, muscle pain, and even the light you receive when you sleep – may hinder sleep quality.
So, how does low-quality or little sleep increase a person’s pain sensitivity?
Sleep Disturbances and TMJ Pain Sensitivity
Ultimately, pain stemming from a temporomandibular disorder can affect and determine sleep quality. The complex interaction between sleep and pain can vary. A comprehensive TMD and sleep treatment approach is necessary because good sleep is required for improved jaw muscle pain levels. The amount of total sleep loss can be a major contributor to increased pain responses, and the dynamics of the sleep loss may target components of pain processing.
“Sleep disturbances affect pain pathways at several anatomical levels. Insufficient sleep causes a shift in the immune system toward a proinflammatory profile. While the increase of these proinflammatory factors (notably prostaglandins and cytokines) at the periphery is not sufficient to trigger evoked pain hypersensitivity, these agents might promote migraine as well as the risk of developing abnormal pain after injury (and inflammation).” – John Hopkins School of Medicine 
The average person sleeps for a quarter to a third of their lifetime. Our human activity decreases during sleep, leaving energy to go instead toward healing and pain control. People’s productive activities occur while awake but crucial health benefits occur during sleep. Immune function regulation, memory consolidation, growth, recovery of body tissue, and relaxation happen while we sleep. Sleep deterioration, pain, and life stresses are interlinked and inseparable. 
Often patients report to us that they sleep poorly with muscle–joint mixed TMD pain. A poor night’s sleep also heightens daytime awareness of pain.
Difficulty Sleeping Impacts 88% of Chronic Pain Patients
Internationally, pain specialists recognize that reciprocal, bidirectional interactions exist between chronic pain and sleep disorders. Yeon-Hee Lee, author of Poorer sleep quality in Patients with Chronic Temporomandibular Disorders, states that “In clinical settings, sleep problems have been found to impact 88% of patients with chronic pain”.
Chronic temporomandibular disorder patients often experience impaired sleep quality, the March 14, 2022, study reports. When compared to healthy controls, poorer sleep in chronic temporomandibular disorder patients links to multiple clinical factors.
How does TMD link to poorer sleep?
NIH and the BMC Musculoskeletal Disorders report finds the following associations between TMD and sleeping problems:
- A higher likelihood of excessive daytime sleepiness.
- More commonly found in persons of older age.
- It impacts more of the female gender than males.
- Patients having higher Epworth sleepiness scale scores.
- A higher number of headaches attributed to temporomandibular disorder.
- Higher levels of pain-related depression and isolation keeping a person awake at night.
- Issues are found more often in cigarette smoking cases.
Signals indicate that sleep quality differs in patients with painful TMD depending on the origin of TMD pain. Causes may be myalgia, arthralgia, and muscle–joint mixed TMD pain. Typically, sleep may be worse when there are multiple origins of pain or multiple compromised health indicators. Likewise, symptom associations between poor sleep and TMD increase if diagnosis at early onset is delayed.
How Sleep Issues may Contribute To TMD’s Development
Conversely, findings suggest that TMD contributes to a decline in quality sleep.
Our bodies are complex, and one health issue can easily trigger another. To gain some background, Temporomandibular Disorder (TMD) is an umbrella term related to heterogeneous pain and temporomandibular joint (TMJ) dysfunction.
It impacts the masticatory muscle regions and has a multifactorial onset. Abnormal alignment of the jaw may cause sleep disturbances or a lack of deep REM sleep. Proper sleep should be viewed as a cornerstone of good health. When treating TMD the symptoms of clenching and grinding must be resolved to maximize deep/REM sleep. This aids jaw muscle cell physiology and re-energization. The goal is to maximize your body’s ability to heal and to reduce the chronic pain and tiredness that is common to TMD patients. Learn more about how TMJ pain may impact sleep apnea.
TMD triggers come from the accumulation of daily microtraumas in the TMJ area due to parafunctional oral habits, bruxism and clenching are common causes. However, trauma, psychological distress, and sleep issues also contribute to its development. TMD diagnosis based on myalgia and arthralgia of the TMJ describes a complex inflammatory process. The number of painful joints involved is related to poor sleep quality.
On the other hand, chronic myalgia is caused by puzzling pathophysiological mechanisms and is better known as a pain syndrome that interferes with both sleep quantity and quality. Some patients suffering from severe muscle knots gain relief by obtaining trigger point injections.
Without quality sleep its challenging to form or maintain the pathways in your brain that let you learn, heal, concentrate and respond quickly. Recent NIH findings suggest that sleep plays a housekeeping role that removes toxins in your brain that build up while you are awake. Everyone needs sleep. Sleep affects almost every type of tissue and system in the body. 
Let’s take another look at sleep quality and how it may impact your muscles and jaw joints.
Sleep Quality and Temporomandibular Joint Osteoarthritis
The Multidisciplinary Digital Publishing Institute (MDPI) has taken a close look at this.
Four studies assessed the relationship between sleep quality and Temporomandibular Joint Osteoarthritis (TMJ-OA). They conclude that poor sleep quality was common in patients with TMJ-OA. However, one study was indecisive. Although TMJ-OA was presented in patients with poor and good sleep quality, no statistically significant differences between sleep quality and TMJ-OA in patients with temporomandibular Joint disorders (TMJD) could be medically proven.
“Osteoarthritis (OA) is a leading cause of disability, the most common form of chronic disease in the temporomandibular joint (TMJ), and the most severe disease type of temporomandibular disorders (TMD). The etiology of TMD is multifactorial, considering parafunctional habits, sleep bruxism, or sleep disturbance as common factors. Insomnia and apnea are the two most frequent forms of sleep disorders in TMD patients. ” – (MDPI) 
Your overall health depends on the amount and type of sleep you get each night. That is well established. The lack of deep sleep has been linked to many ailments and weakens a person’s ability to heal. If you are suffering from painful TMD, don’t delay an early diagnosis. Our Twin Cities pain clinics offer first-class pain management and personal pain health coaches.
Patients diagnosed with TMJ concerns or TMD who experience discomfort when they sleep may find that some sleep positions exacerbate their breathing problems. For example, sleeping on your side without proper head and neck support can cause you to wake up with headaches and pain. We recommend that patients with TMJ/TMD try sleeping on their back. To fall asleep easily and feel rested when you wake up is a real gift.
Take Action if Experiencing a Sleep Quality Decline
Our sleep apnea treatment will help you establish good sleep habits.
Treating TMD and/or OSA needs to be a multidiscipline approach. Our dedicated staff will help you maximize deep/REM sleep naturally, or with a sleep appliance if needed. The goal is to improve your quality of life, sleep, wellness, and reduce the effects of temporomandibular joint dysfunction. You can read more on our blog about our multidisciplinary approach to patient care. We encourage you to become better educated. The following articles are helpful.
Call us at 763-577-2484 to request an appointment for TMJ & Sleep Treatment.
About the Author
Cory Herman DDS, Doctor of Dental Surgery, treats adults and children with sleep issues, TMJ, and Orofacial pain disorders within the Minnesota Head and Neck Pain Clinic. He is known for his non-surgical orofacial pain management with an emphasis on collaborative, integrative, mind-body rehabilitative care.
Co-authored by Jeannie Hill, a healthcare digital marketing consultant.
 Sleep Apnea Symptoms and Risk of Temporomandibular Disorder, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3706181/, 2013
 Sleep Extension in Sleepy Individuals Reduces Pain Sensitivity: New Evidence Regarding the Complex, Reciprocal Relationship between Sleep and Pain, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3490349/, 2022
 The Science of Sleep: Understanding What Happens When You Sleep, https://www.hopkinsmedicine.org/health/wellness-and-prevention/the-science-of-sleep-understanding-what-happens-when-you-sleep, current
 Brain Basics: Understanding Sleep, https://www.ninds.nih.gov/health-information/public-education/brain-basics/brain-basics-understanding-sleep, 2022
 Association between Sleep Disorders and Sleep Quality in Patients with Temporomandibular Joint Osteoarthritis: A Systematic Review, https://www.mdpi.com/2227-9059/10/9/2143, current