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How Does the Brain Process Fear?

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We’ve all heard the saying “Fight or Flight” before.  When something triggers fear in us, the body’s reaction begins in the brain and spreads through the body to prepare the best defense (flight) reaction.  Anytime we are faced with the sign of an invader/attacker, an emotional response is triggered within us.  This activates the areas involved in motor functions.  Stress hormones are released throughout the nervous system and your heart starts racing.  You react by wanting to escape the threat.

A person (male or female) with chronic pain will have chemical changes.  The fear of the unknown related to signs and symptoms that are not understood by the person becomes a deeper fear with consequences that generally are followed by increased muscle tension and exacerbation of the same consequences.  Muscle tension can exacerbate underlying conditions related to TMJ dysfunction.  One example of this would be teeth clenching, leading to jaw pain and headaches.


Depending on the level of “scariness”, the brain will react appropriately.  In more threatening circumstances, the brain response is critical for survival. 

This article focuses on probing the brain circuits that underlie fear, utilizing neuroscience tools to map their connections to determine how specific components relate to fear.  Reactions can be controlled, anxiety levels can be lowered, and the way people react to fear in general can be changed.  Perhaps someone who has an overactive imagination can experience reduced mental and physical stress levels, thus improving their overall health and well-being.

Many of the studies begin with the amygdala (the fear-processing hub).  Researchers are now broadening their understanding of its role, finding that the amygdala communicates with the part of the brain that controls movement.  As they trace its connections to other parts of the brain, they are uncovering additional complexity.

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What is Fragmented Sleep?

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Have you found that you fall asleep quickly at night, but then wake up multiple times?  Typically these waking periods are short, but many times it’s a struggle to get back to a restful deep sleep.   If this sounds familiar, you may be experiencing fragmented sleep (frequent awakenings during the normal sleep-wake cycle).  People that suffer from fragmented sleep often report waking up tired and never feeling fully refreshed in the morning.

We all know the impacts that occur from sleep deprivation by now.  It impacts more than just how tired you feel, but there is a huge influence on your overall physical and emotional health.

Am I Getting Enough Sleep?

According to the CDC, approximately 1/3 of adults do not get the recommended 7-8 hours of sleep per night.  Many people don’t get enough sleep or sleep poorly because of their jobs, packed schedules, long shifts at night or they have to rush to get their kids ready in the morning before work.  Also included in this grouping are the 50-70 million people who already suffer from insomnia, OSA or other sleep disorders.

what is fragmented sleep

Fragmented sleep can be short-term, stemming from an obvious cause such as being a new parent and waking to care for an infant, or experiencing trouble sleeping due to illness.  Then there are more subtle awakenings, which can be caused by sleep disorders such as PLMD (periodic limb movement disorder), RLS (restless leg syndrome), OSA or snoring.  Although 80% of patients who have RLS have PLMD, RLS commonly presents with insomnia rather than sleep fragmentation.  Medications that can cause sleep fragmentation include SSRIs.  There are also lifestyle triggers that cause poor sleep, such as caffeine and alcohol consumption, excessive ingestion of chocolate which contains theophylline, caffeine & nicotine which constrict the peripheral blood vessels causing muscle pain and sleep disturbance, exercise too close to bedtime, and having an irregular sleep schedule. 

Can Fragmented Sleep Lead to Health Problems?

Fragmented sleep has been linked to a higher risk of chronic health issues.  Common symptoms of fragmented sleep include:

  • Morning Headaches
  • Daytime Sleepiness
  • Memory Lapse
  • Difficulty Concentrating

Long-term issues associated with fragmented sleep can include:

  • High Blood Pressure
  • Cardiovascular Problems
  • Diabetes

Sleep performs a range of vital functions, including restoring damaged tissuesboosting learning and memory, and flushing toxins from the brain.  Inadequate amounts of sleep can have serious long-term health consequences, increasing the risk of obesity, diabetes and cardiovascular disease.

why am I tired every day

Getting insufficient sleep repeatedly (less than six hours a night for adults) can trigger the release of various proteins that cause inflammation in the blood and in the body, leading to sleep problems.  In 2014, adults in the United States who reported sleeping less than 7 hours a night were also more likely to report having health problems, compared to those getting the recommended amount of sleep.

Secondary to the amount of sleep you’re getting is the amount of restorative sleep, or more commonly called “deep sleep”.  In one of our deepest stages of sleep, slow-wave sleep, there is a drop in the level of hormones that raise blood pressure, such as adrenaline.  As one progresses into a deeper sleep, parasympathetic nervous system tone increases while sympathetic nervous system activity, along with heart rate, blood pressure, and systemic vascular resistance decreases.  As a result, workload on the heart is reduced.  People with sleep disorders experience arousals, or very brief periods of awakening.  When you have fragmented sleep, high levels of these hormones can prevent blood pressure from going down.

how sleep affects your blood pressure

Studies show that poor sleep quality is an independent risk factor for the development of chronic pain conditions, especially those characterized by musculoskeletal pain (particularly back, neck and head/facial pain).  Sleep fragmentation during the period when musculoskeletal sensitization develops will exacerbate the effects of musculoskeletal sensitization.

At Michigan Head & Neck Institute, we treat patients with a variety of sleep disorders, who have symptoms similar to those described above.   Our focus is on restoring patients’ quality of life with an oral appliance for those who cannot use a CPAP, and by pain reduction of the mouth, eye, ear, jaw, face & neck caused by TMD.

Some preventative measures that you can take to deal with conditions such as fragmented sleep include:

  • Establish a stable sleep schedule
  • Limit alcohol and caffeine intake
  • Avoid exercise before bed
  • Avoid blue light-emitting devices before bed
  • Try to read or listen to music rather than watch TV before bed
  • Make sure your bedroom is uncluttered
  • Maintain a cool temperature for maximum sleep quality
  • Make sure your mattress is adequate

If you would like additional information on fragmented sleep or other sleep disorders, please contact our office at 586-573-0438.


Bonnet MH, Arand DL. Clinical effects of sleep fragmentation versus sleep deprivation. Sleep Med Rev. 2003;7(4):297-310.


Kaneshwaran K, Olah M, Tasaki S, et al. Sleep fragmentation, microglial aging, and cognitive impairment in

adults with and without Alzheimer’s dementia. Sci Adv. 2019;5(12):eaax7331. Published 2019 Dec 11. doi:10.1126/sciadv.aax7331

Stepanski E, Lamphere J, Badia P, Zorick F, Roth T. Sleep fragmentation and daytime sleepiness. Sleep. 1984;7(1):18-26.


Sutton BC, Opp MR. Sleep fragmentation exacerbates mechanical hypersensitivity and alters subsequent

sleep-wake behavior in a mouse model of musculoskeletal sensitization. Sleep. 2014;37(3):515-524. Published 2014 Mar 1.


Ting L, Malhotra A. Disorders of sleep: an overview. Prim Care. 2005;32(2):305-v.


Klein, Richard E. The Evolution of Obstructive Sleep Apnea (OSA) Treatment and Monitoring. Journal of the Macomb Dental Society. 11-12. Published 2016 Summer.

Sleep Disorders in Parkinson Patients

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In a perfect world, sleep is a time for rest, renewal, and regeneration.  Unfortunately, for people suffering from Parkinson’s disease, this is not the case.  There are a number of reasons that these patients suffer from sleep loss and sleep disorders, and these factors continue to be researched by physicians for a better understanding.  On average, Parkinson’s patients sleep about 5 hours per night, and wake up twice as many times as adults (in the same age group) without Parkinson’s.  Reasons for sleep disturbances can include insomnia, nightmares, restless leg syndrome, sleep apnea, nocturia and periodic limb movement disorder.  This of course results in daytime sleepiness (76% of Parkinson’s patients), fatigue, and inability to focus, to name a few symptoms. 

The above-mentioned sleep-related signs can have a major impact on quality of life for Parkinson’s patients.  Treatment for these symptoms/disorders should be integrated with their therapeutic regimens such as physical and occupational therapy, speech therapy, and medication regimens.

A recent study by UCLA researchers found an association between Parkinson’s disease and narcolepsy, a disorder caused by the brain’s inability to regulate sleep/wake cycles normally.  There may also be a connection between REM sleep disorder and the subsequent development of Parkinson’s disease.  Sleep disorders may be an early sign of Parkinson’s disease, even before the tremors, memory loss and motor symptoms begin.

Please click here to read the full article.