Link Between TMJ Pain and Sleep Apnea

September 30, 2023
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What is the Link Between TMJ Pain and Sleep Apnea?

TMJ pain that impacts your ability to sleep well may lead to poor sleep quality. So, what exactly is the “link”? How does TMJ affect OSA?

Sleep apnea can also lead to poor sleep quality, which can affect TMJ pain and other chronic pain conditions.

If you are experiencing pain in your jaw muscles or jaw joints, an Orofacial Pain Specialist can perform an exam. They will obtain the necessary tests to determine if you have a temporomandibular joint (TMJ) disorder. A clicking or popping sound when opening and closing your mouth is one of several symptoms suggestive of TMJ. Or, perhaps, you have tight, sore facial muscles.

It is also common that people who sleep poorly are more likely to have a pain condition such as TMJ. Furthermore, if you experience daytime sleepiness, difficulty concentrating, loud snoring, or abrupt awakening while sleeping, you could have obstructive sleep apnea (OSA).

How is TMJ Pain Associated to Poor Sleep?

Ways that sleep might link to your TMJ

Improper bite alignment: If a person has an overbite, underbite, or crossbite, their jaw may not rest in its proper, natural position. This may escalate TMJ pain and contribute to an airway obstruction, leading to sleep apnea. Conversely, sleep apnea can lead to TMJ problems.

Injury to the jaw: People suffering from a recent injury, such as a motor vehicle accident, may experience poor sleep. Disrupted sleep patterns can lead to nighttime teeth clenching and grinding (bruxism). This constant motion by the TMJ throughout the night can add more stress and tension to your jaw joint. In turn, this increases the likelihood of TMJ pain problems. Sports-related injury to the jaw can generate TMJ-related sleep issues.

Sports-related injury to the jaw can generate TMJ-related sleep issues.

TMJ-triggered teeth grinding: As you sleep, your body will do whatever it can to clear an airway obstruction that interferes with your breathing. TMJ issues can develop when the body attempts to maintain an open airway by grinding their teeth. When people grind their teeth during sleep this is called bruxism. Bruxism can lead to symptoms of TMJ including jaw and facial pain, jaw joint noises or difficulty with mouth movements.

Bruxism can be caused by TMD; if that is your situation, you will benefit from a Bruxism Parafunction Risk Assessment.

Consistently getting a good night’s sleep is a basic requirement for people to function and live well. Humans need both quality and a sufficient quantity of sleep. When either lack, sufficient pain control mechanisms may be necessary.

Times of extreme, sustained stress: Your quality of sleep and stress levels due to extreme psychological conditions may be associated with TMJ. In fact, a TMJ dysfunction may trigger psychological distress.

Stress and anxiety are your body’s way of reacting to intense psychological situations. Examples of times of increased emotional stress may include stress during the pandemic, job loss, divorce, work or school related stress or the loss of a loved one. When persistent, these emotional stresses can be detrimental to your health. Common symptoms of stress can be the inability to sleep, headaches, teeth grinding (or bruxism), and muscle pain.

Can Treating TMJ fix sleep apnea?

Commonly, an effective way to treat sleep apnea and TMJ together is through oral appliance therapy. An oral appliance works by preventing the tongue from blocking the airway, moving the lower jaw forward, or both. Once proper jaw placement is obtained, you can train your TMJ muscles while also clearing the obstruction that causes your snoring or getting a poor night’s sleep.

OSA is a sleep breathing disorder characterized by repeated agitation of night time breathing disruption due to upper airway collapse, and is considered as a recognized risk factor for TMD.

Can Treating TMJ help with Sleep Apnea?

Oral appliance therapy is a common treatment for TMD. When someone has mild to moderate obstructive sleep apnea, or more severe sleep apnea and either cannot tolerate CPAP or their sleep physician determines that they are not a candidate for CPAP, oral appliance therapy may be an appropriate treatment option. Some people suffering from both TMJ and sleep apnea have these conditions threated together through oral appliance therapy.

An oral appliance works by gently moving the jaw forward thus preventing the tongue from blocking the airway. Often, once the proper jaw placement is obtained, this can relieve pressure on the TMJ or jaw muscles while also clearing the obstruction that causes your snoring or poor night’s sleep.

What Studies Link Sleep Apnea and TMJ?

There are multiple helpful studies that have evaluated the correlation between obstructive sleep apnea (OSA) and TMJ.

Previous studies have shown the association between sleep disorders and TMD, while only few of them discussed the association between sleep apnea and TMD. A study reported in the Journal of Dental Research “Sleep Apnea Symptoms and Risk of Temporomandibular Disorder” reported data from the OPPERA (Orofacial Pain: Prospective Evaluation and Risk Assessment). [1]

This study recruited subjects from 2006 to 2008 and followed them through 2012. They showed that signs and symptoms of obstructive sleep apnea were associated with a higher risk of having TMD.

The National Institute of Health (NIH) released study results in its August 19, 2023 “” report. It concludes that “Moderate to severe OSA will aggravate orofacial pain and tooth wear, affect TMJ volume and superficial area, even change the location of condyles. Appropriate OSA therapies may be effective ways to alleviate these adverse effects in long-term.”

Another January 2023 study carried out in dental students associated the increased prevalence of temporomandibular disorders with increased stress, anxiety, depression, and altered sleep levels due to stress. It adds to healthcare professionals understanding of dental sleep medicine.

“Comorbidities are of great interest in the field of orofacial pain. Headaches, TMD, and sleep are strongly associated. Poor sleep quality increases the risk of TMD, and people who develop TMD have impaired sleep quality [31,32]. Sleep is also related to headaches, and headaches are related to TMD” – How Confinement and Back to Normal Affected the Well-Being and Thus Sleep, Headaches and Temporomandibular Disorders – Department of Stomatology, Prosthodontics & Orofacial Pain

Previous experimental NIH studies have established that pain and sleep disruption occur in both reciprocal, bidirectional relations. [2]

Medical researchers have found that nearly half of people with TMJ also have trouble sleeping. Historically, OSA and temporomandibular joint pain were typically diagnosed and treated separately. Today, healthcare professionals no longer view them in silos, meaning you get better coordinated care. [3]

TMJ-related sleep issues include the following symptoms:

  1. Excessive daytime sleepiness.
  2. Awakenings during the night and problems returning to sleep.
  3. Insufficient regularity and duration of sleep.
  4. Potential snoring issues.
  5. If your teeth are worn down from grinding them.
  6. If you wake in the morning with jaw muscle soreness.

TMD is also commonly linked to chronic fatigue syndrome, which can further provoke sleep apnea. Think of how your airway is connected to the position of your jaw. Logically, then, this helps you see that sleep apnea and TMD are linked. Read how sleep declines in patients with TMD.

What are orofacial sleep disorders?

Common sleep disorders which an Orofacial Pain specialist may treat include obstructive sleep apnea and snoring. They may also see people with neurosensory and chemosensory disorders (e.g. taste, paresthesia, or numbness). The specialty of orofacial pain also encompasses occlusal dysesthesia, oromandibular dystonia’s, dyskinesias’, neck pain caused by poor posture, and bruxism. Here is more context as explained by Dr. James Fricton, an Orofacial Pain specialist and clinical research scientist.

“Orofacial Pain is the discipline of dentistry that includes the assessment, diagnosis, and treatment of patients with orofacial pain disorders, including temporomandibular disorders, masticatory muscle and joint disorders, oromotor and jaw behavior disorders, neuropathic and neurovascular pain disorders, orofacial sleep disorders, and chronic orofacial, head and neck pain, as well as the pursuit of knowledge of the underlying pathophysiology and mechanisms of these disorders. – James Fricton, DDS, MS [4]

 

“The face and associated cranial, oral and dental structures are among the most complicated areas of the body, contributing to an array of common orofacial disorders that include temporomandibular disorders (TMD), orofacial pain disorders and orofacial sleep disorders. We need a broad, inclusive approach to diagnosis and management of TMD that reflects both conceptual models of human systems in understanding chronic illnesses as well as systematic reviews of treatment for successful management.” – James Fricton, DDS, MS

CONCLUSION: Gain Aligned TMJ and Sleep Apnea Treatment

TMJ and sleep disturbance commonly occur together. It may be possible to align your TMJ and Sleep Apnea Treatment.

Your overall health can be impacted by either TMJ or OSA; however, if you have both, it can greatly impact your daily lifestyle. Using a combination of treatments, the MN Head & Neck Pain Clinics can align the jaw to clear obstructions and strengthen jaw muscles to boost your long-term comfort.

Call our office at (763) 577-2484, or Request Your Consultation Online

Resources:

[1] A E Sanders, et al., “Sleep apnea symptoms and risk of temporomandibular disorder: OPPERA cohort”, May 2013, https://pubmed.ncbi.nlm.nih.gov/23690360/

[2] A.E. Sanders, et al., “Sleep Apnea Symptoms and Risk of Temporomandibular Disorder”, July 2013, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3706181/

[3] Ju-Hui Wu, et al., “The Association between Temporomandibular Disorder and Sleep Apnea—A Nationwide Population-Based Cohort Study”, August 2020, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7504469/

[4] James Fricton DDS, MS & Jeffrey A. Crandall DDS, “Orofacial pain as a new dental specialty” https://www.tandfonline.com/doi/full/10.1080/08869634.2020.1716140, Feb 2020

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