Posts by: Momentum

Doctors Specializing in TMJ

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The temporomandibular joint in your jaw is responsible for allowing you to move your jaw comfortably. It is a huge asset with chewing and yawning, but occasionally, disorders develop. These can come about from trauma, medications or repetitive stress. When looking for the best TMJ doctor to treat it, here are some actions to take.

1. Ask for Testimonials

During the initial consultation with the TMJ doctor, you can always ask for him or her to share patient testimonials. Before meeting with a doctor, you can also look up reviews on sites, such as Yelp.

2. Find Out Success Rate

It may be impossible for a doctor to provide percentages, but the professional should be able to provide anecdotes of patients who found relief. The doctor can also determine what factors promote a more successful treatment. It is important for a doctor to be upfront and honest with you about how much relief you can expect to receive.

3. Get Recommendations for Self-Care

TMJ doctors often prescribe mouth guards or recommend surgery in extreme cases. However, a doctor should also be willing to share with you information related to exercises you can do on your own. The professional may also suggest changing your diet or using hot compresses to relieve muscle tension.

4. Receive Explanation of Treatments

In the event you require jaw surgery to alleviate TMJ disorder, your doctor should be able to describe this surgery in fine detail. Most professionals reserve this treatment for the last resort, so most people with TMJ disorders do not have to worry too much. However, if you do need it, then it is important to understand what you will need to do in terms of aftercare and preparation.

5. Diagnose TMJ Disorders Effectively

Over the phone or through email, you should ask the doctor how he or she actually diagnoses people with TMJ disorder. There are many afflictions that can affect your jaw, and you want to be certain you have a TMJ disorder and not something else before beginning treatment. Most doctors will look at your overall health history in addition to using MRIs and other types of imaging technology.

6. Look Into Percentage of TMJ-Related Services the Office Provides

There are many dental offices that offer treatments for jaw disorders. However, some merely practice it on the side while others are more dedicated to it. It is important to find a professional you trust who has studied temporomandibular joints extensively.

7. Find Doctor’s Credentials

Most people do not want to pry, but it is important to know where your TMJ doctor went to school and received training. In addition to the school itself, you also want to ask what specific TMJ courses the professional took.

8. Delve Into Doctor’s Experience

As you ask about a doctor’s background and references, it is also important to see how long a practice has been in business. A young medical professional may be perfectly capable to help you, but there is not much to go off of. You should really play it safe and go with a doctor who has operated in your area for several years now. That way there is tangible evidence the individual has made a difference.

9. Ask About Specific Procedures

Although you go to a medical office to receive professional opinions, it is important to remain well-informed yourself. You should know what goes into treating TMJ disorders, and some of the most common methods used include:

• Magnetic resonance imaging
• Ultrasonography
• TENS therapy
• TMJ orthotics

This is also a good time to ask how many treatment phases you will likely require. It is advantageous to get an idea of how long you will need to pay visits to this office.

10. Ask About Cost

Finally, you should always figure out how much you will need to pay. It is common for insurance agencies to deny coverage for TMJ treatments. However, there are some companies that are changing their tune. In the event your insurance agency will not cover it, ask the doctor about payment plans.

You can have a productive consultation with your TMJ doctor by going in well-informed. Your doctor will be able to better help you if you know something about your disorder and the various treatments involved.

Could My Teenager Have TMD?

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All children and teenagers have accidents, sports injuries, and countless falls throughout their youth. Most of the time, there is nothing to worry about. However, if your adolescent child says that they are experiencing pain, or they hear noises in their jaw, then they should be evaluated by a TMJ specialist (dentist who is skilled in TMJ orthopedics) right away.  It is possible that they may have sustained an injury to their TMJs (temporomandibular joints). TMD in teenagers is more prevalent than previously thought.

tmd in teenagers


could my teenager have tmd?


Acute macrotrauma is either an impact injury or hyperextension injury, like falling and hitting your chin on the ground.  TMJ disc displacement is usually the result of a ligament injury, and ligament injuries in the human body are a result of acute macrotrauma.  If a TMJ disc is displaced during adolescence, facial asymmetry could be a result. This is best documented through magnetic resonance imaging (MRI).  Facial asymmetry usually means that the TMJ dysfunction has reached an advanced level, as it has stopped the condylar growth within the joint, affecting the facial skeleton.

Teenagers who have injured their TMJs may have a midline discrepancy of their upper (maxillary) and lower (mandibular) teeth. This dental discrepancy happens naturally, because the teeth continue to occlude even after there have been changes – good or bad – to the TMJs.  Subsequently, this change in dental occlusion causes a midline discrepancy; TMD in teenagers eventually leads to facial asymmetry.

Teeth in mouth

The best time to treat TMJ disc displacement is early in the process, which is why great emphasis is placed on taking your child to a specialist, should they become injured.  With the right treatment methods, further progression of TMD  in teenagers and associated symptoms/dysfunctions can be eliminated.

One condition that you may have heard before is something called “Cheerleader’s Syndrome”, which affects teenage girls who participate in sports activities.  This syndrome is known in the medical world as Idiopathic Condylar Resorption (ICR).  Very rarely is this condition seen in teenage boys.  According to studies, the frequency of females to males is 9:1.  Microtrauma and Macrotrauma to the jaws can either initiate a symptomatic response, or it can exacerbate an already present underlying condition.  ICR is a progressive disease affecting the TMJs, and can result in malocclusion and facial disfigurement as well.

Before and after photos

Unfortunately, ICR is not well understood, but can be treated by the right clinician.  Patients who suffer from ICR are usually in their pubertal growth phase and have specific occlusal relationships.  They may even be candidates for orthognathic surgery or extensive orthodontics prior to the onset of the disease.

While no specific one cause has been identified, the female predisposition may stem from the levels of estrogen in the body.  Estrogen has been known to interfere with bone metabolism and cartilage within the joints.  Tissues surrounding the TMJs can be affected, then causing symptoms such as headaches, clicking/popping noises, jaw pain, facial pain and crepitus.

Treatment of TMD in teenagers is approached the same way as treatment of adults.  First, the initial screening is done, followed by the Head & Neck Exam, and Range of Motion (ROM) measurements.  A formal workup including necessary x-rays, impressions and MRI is performed, followed by a consultation to review the treatment options.  Achieving a stable joint position is done with a mandibular repositioning appliance that is worn in the mouth, much like a retainer.  Dr. Klein prefers conservative methods before surgery would even be considered.

This is one example of a mandibular repositioning device that could be worn:

Teeth mold

As seen in the illustration below, the orthotic device will move the lower jaw forward, taking pressure off the jaw joint:

Jaw illustration

Skull illustration

By wearing the appliance, it creates changes in your jaw joint/s to decrease and/or eliminate the existing pathology.  It does this by moving your lower jaw downward and forward to decompress the tissues within the jaw joint/s.

Aside from an intraoral appliance, physical therapy can be used, including the TENS unit, physical massage and/or heat applications.  Pain-relieving injections are also an option for more severe cases.  And of course, patient education is very important to Dr. Klein and his staff.  They are available to answer any questions you may have and can be reached at (586) 573-0438.


Schellhas KP, Piper MA, Omlie MR. Facial Skeleton Remodeling due to Temporomandibular Joint Degeneration: An Imaging Study of 100 Patients. Cranio. 1992;10(3):248–259.

Ahn SJ, Lee SP, Nahm DS. Relationship Between Temporomandibular Joint Internal Derangement and Facial Asymmetry in Women. Am J Orthod Dentofacial Orthop. 2005;128(5):583–591.

Schellhas KP, Pollei SR, Wilkes CH. Pediatric Internal Derangements of the Temporomandibular Joint: Effect on Facial Development. Am J Orthod Dentofacial Orthop. 1993;104(1):51–59.

Simmons HC 3rd, Gibbs SJ. Initial TMJ Disk Recapture with Anterior Repositioning Appliances and Relation to Dental History. Cranio. 1997;15(4):281–295.

Simmons HC 3rd, Gibbs SJ. Recapture of Temporomandibular Joint Disks Using Anterior Repositioning Appliances: an MRI study. Cranio. 1995;13(4):227–237.

Wolford LM. Idiopathic Condylar Resorption of the Temporomandibular Joint in Teenage Girls (cheerleaders syndrome). Proceedings (Baylor University Medical Center). 2001;14(3):246-252.

Wolford LM, Cardenas L. Idiopathic Condylar Resorption: Diagnosis, Treatment Protocol, and Outcomes. Am J Orthod Dentofacial Orthop. 1999 Dec;116(6):667-77.

Simmons HC 3rd. Your 13-year-old daughter fell at school – She reports a clicking jaw – What Should Happen Next?.  Cranio. 2017, 35:3, 133-134.

Obstructive Sleep Apnea Hypopnea Syndrome

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While most of my discussions involve Obstructive Sleep Apnea (OSA) in adults, today I will be talking about OSA in children.  Childhood OSA is a common, often undiagnosed, disorder that 1 in 4 children suffer from. While the severity may differ, literature suggests that only 1% – 4% of children are diagnosed with OSA.

For the first 6 months of life, an infant is an obligate nose breather as a result of contact between the epiglottis and soft palate at birth.  Contact between the epiglottis and the soft palate at birth provides a channel from the nose to the lungs.

External nares –> nasal cavities –> nasal pharynx –> larynx –> trachea –> lungs

Food passes on either side of the interlocked larynx into the esophagus without interfering with the airway.  Then at approximately 18 months old, the laryngeal complex migrates from its original subcranial position to lie opposite the 5th cervical vertebra, eliminating the interdigitation between the soft palate and epiglottis and developing an oropharynx. The oropharynx is the part of the throat just behind the mouth. It includes the back of the tongue, the soft palate, the tonsils, and the side and back wall of the throat.

obstructive sleep apnea hypopnea syndrome

The peak age for OSA in children is between 2-8 years old.  The tonsils are very large compared to the airway size at this age. In a newborn, the cranium is 8 to 9 times larger than the facial portion.  This relationship is changed by differential growth to the extent that the adult face is about 50% of the size of the cranium. Airway obstruction can affect facial growth.  By age 4, the craniofacial bones are at 60% of their adult size. By the age of 12 the cranium is 90% of the adult size.

The Importance of Identifying OSA in Children

OSA or sleep disordered breathing can affect the craniofacial structure, thus it is important to detect OSA in children earlier rather than later.

osa in children

Diagnostic records include a PSG study, in which the AHI (apnea hypopnea index) recorded must be greater than 1/hour (AASM guidelines).  If more than 10 episodes occur per night, then this level of OSA is considered severe in a child.  The point is that all children should be screened for snoring and OSA, including not only the PSG, but also a thorough History & Exam.

The American Academy of Pediatrics (AAP) Clinical Practice Guidelines state that all children should be screened for snoring and recommended PSG as the gold standard for diagnosis of OSA because patient history and physical examination are poor discriminators of primary snoring and OSAS.

There are multiple treatments for OSA in children, including palatal expansion with an orthodontic appliance, tonsillectomy, adenoidectomy, correction of a deviated septum, etc. This article will focus on tonsillectomies is children.

Tonsillectomy is one of the most common surgeries performed in the United States.  While it was popular during the 1950’s – 1960’s for sore throats, today these procedures are more focused on alleviating symptoms and dysfunctions associated with OSA.  Enlarged tonsils block the airway, causing impaired sleep.

Normal vs Swollen tonsils illustration

During these periods of sleep, it may appear that the child is trying to breathe because the chest is moving, but no air is actually being exchanged through the lungs.  This results in an interrupted sleep cycle, with routine awakenings.

enlarged tonsil illustration

Tonsillectomy remains a top treatment choice for children because of the success rate – much higher than adults.  By removing the tonsils at an early age, the chance of developing OSA as an adult is greatly reduced.

 In 2006, there were 530,000 tonsillectomies performed in children younger than 15 years old.

Children who have the surgery achieve better quality of life overall, less anxiety and depression, less chance of developing ADHD, fewer mood swings, less chance for negative behavior, and improved overall cognitive function. The procedure should be performed as early as possible/detected to prevent complications (metabolic, cardiovascular, neurologic, endocrine).  It has been documented, however, that children under 3 years old have had more postoperative complications than those older than 3, but again it depends on the severity of the case.

Typically, a tonsillectomy is an outpatient procedure, performed by an ENT (ear, nose and throat specialist).  Depending on the case, it is possible that the tonsillectomy will not eliminate the OSA.  Sometimes there are comorbidities that are present, including obesity, neuromuscular diseases, severe bleeding or craniofacial abnormalities.  If so, then CPAP therapy may be recommended for the more moderate to severe cases of OSA.

The CPAP remains the gold standard for treatment of OSA, however compliance for children can be an issue.  The CPAP can cause different side effects, which sometimes become unbearable to children.  These include nasal congestion, dryness, skin irritation, rash, sores, excess mucus (rhinorrhea) and in some cases, facial hypoplasia (facial distortions).   In order to make the CPAP more appealing to children, several companies have started making “kid-friendly” designs like the pictures below:

CPAP for kids


CPAP for kids

For more information on OSA in children and/or questions regarding tonsillectomies, please contact our office at (586) 573-0438.


Sheldon SH, Ferber R, Kryger MH. Principles and practice of Pediatric sleep medicine. 1st ed. Philadelphia: Elsevier Saunders Co; 2005. pp. 197–267.

Ahn, YM. Treatment of obstructive sleep apnea in children. Korean Journal of Pediatrics. 2010;53(10).

Clinical practice guideline: diagnosis and management of childhood obstructive sleep apnea syndrome.Section on Pediatric Pulmonology, Subcommittee on Obstructive Sleep Apnea Syndrome. American Academy of Pediatrics. Pediatrics. 2002 Apr; 109(4):704-12.

Brigance JS, Mitamoto C, Schilt P, Houston D, Wiebke JL, Govan D. Surgical management of obstructive sleep apnea in infants and young children. Otolaryngol Head Neck Surg. 2009;140:912–916.

Barsh, LI. The Origin of Pharyngeal Obstruction During Sleep: Sleep and Breathing, 1999, 3:17-2.

Kids’ Tonsillectomies Make More Sense For Sleep Apnea Than Strep Throat

Published on January 19, 2017;


Strenuous Exercise Can Affect Your Teeth

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While this is something that you may not think about, there are several reasons that strenuous exercise and teeth do not go together well.  Especially when it comes to activities like weightlifting, athletes need to take precautions so that no permanent damage occurs. There is a definite relationship between strenuous exercise and teeth; especially the health of your teeth.

When a person picks up a heavy weight, they end up clenching down on their teeth, which is the natural response of the body.  If this cycle is repeated over and over, tooth enamel can become worn down. This action is similar to a TMD symptom that I have discussed in the past, which is nighttime bruxism.

strenuous exercise and teeth

Many weightlifters use their chest as a brace and/or stopping point when they lift. Air gets trapped in their lungs when they pause and their throat is partially closed when they exhale. Simultaneously, they clench their jaws hard when doing this, which forces the top of the lower jaw up and back, causing the disc within the joint to be pushed forward. At first, it may be barely noticeable as it is only slight pain and or clicking noise.  After a while though, this will turn into irreversible damage done to the disc.

Over time, this clenching and grinding will alter your occlusion, eventually spiraling into a TMJ disorder.  Alternatively, there may have been an underlying disorder present, and then daytime clenching and nighttime bruxism will exacerbate the condition.  This restorative dentist in Kennesaw explores the common symptoms that may follow include headaches, facial pain, ear pain, tinnitus, eye pain, neck pain, shoulder pain, dizziness/vertigo, and photophobia among other things.

Because so many athletes suffer from this, it is common that they will wear a protective mouthguard during their workouts.  This protects their teeth and enamel if they are clenching down.  If they DO have an underlying TMJ disorder already, this mouthguard will NOT “cure” their nighttime bruxism.  That would be a different strenuous exercise and teeth issue and will need to be addressed separately.

Bruxism vs Healthy Teeth

In addition to wearing a mouthguard, some tips to prevent clenching during weightlifting are as follows:

  • Do your lifting in front of a mirror so that you can pay attention to see if you are clenching or not – you will be able to see tension in your face
  • Massage your masseter muscles in between sets and try to relax your face/mouth
  • Try to avoid caffeine prior to your workout, as this leads to additional clenching

US Power lifter Robert Herbst had a back molar explode due to the pressure he was exerting during his lifts.  He was clenching his teeth together as he was picking up several hundred pounds of weight.  He ended up needing a bone graft and an implant, after the emergency dentist Unionville removed tooth fragments from his mouth. This is one of the more well known cases portraying the relationship between strenuous exercise and teeth.

Man weightlifting



Scuba divers are another group of athletes that experience TMD.  Because they are continuously biting down on the breathing apparatus, learn this here now and learn how this can put stress on the jaw and cause muscle spasms and headaches when they dive.

Many think that the water pressure is the culprit, but really an underlying TMJ disorder is present.

Scuba diver illustration

Something else we don’t think about is the reduction in saliva that is caused by exercise.  Saliva protects the teeth and gums, and a lack of it can lead to tooth decay eventually.  Most athletes breathe through their mouth, which can dry up the saliva.  Try to practice nose breathing during exercise.

According to this link, it is also helpful if you brush your teeth prior to your workout, and avoid a lot of the sugary sports energy drinks that are out there.  Consuming these types of beverages while working out leaves sugary residue in the mouth, leading to cavities and tooth decay.  If you are going to drink these during your workout, it is recommended that you rinse your mouth out with water so that the sugar doesn’t just sit in your mouth the whole time.  Another option is to chew sugar-free gum during your workout, which can aid in saliva production.

Still, the best option for a workout drink is plain old regular water or coconut water.  These will keep you hydrated without the sugar and problems to follow.

Water bottle


Coconut and glass of coconut water


For more information on daytime clenching, nighttime bruxism, the relationship between strenuous exercise and teeth, or anything else mentioned above, please give our office a call at (586) 573-0438.


Frese, C, Frese, F, Kuhlmann, S, Saure, D, Reljic, D, Staehle, HJ, and Wolff, D. Effect of Endurance Training on Dental Erosion, Caries, and Saliva. 2015 Scand J Med Sci Sports, 25: e319–e326. doi:10.1111/sms.12266

Bryant S, McLaughlin K, Morgaine K, Drummond B. Elite Alhletes and Oral Health.  Int J Sports Med. 2011 Sep; 32(9):720-4. Epub 2011 May 17.

Yokoyama Y. Involuntary Teeth Clenching During Physical Exercise. J. Jpn. Prosthodont Soc. 1998;42:90–101. doi: 10.2186/jjps.42.90.

Nukaga, H, Takeda, T, Nakajima, K, Narimatsu, K, Ozawa, T, Ishigami, K, Funato, K. (2016). Masseter Muscle Activity in Track and Field Athletes: A Pilot Study. The Open Dentistry Journal, 10, 474–485.

Hellmann, D, Giannakopoulos, NN, Blaser, R, Eberhard, L, Rues, S, Schindler, HJ. (2011). Long-term Training Effects on Masticatory Muscles. Journal of Oral Rehabilitation, 38: 912–920. doi:10.1111/j.1365-2842.2011.02227

Murphy, Patricia. “Could the Gym be Ruining Your Teeth”.  Life Health Newsletter, 25 July, 2017.

Eaves, Ali. “5 Surprising Ways You’re Seriously Hurting Your Teeth”. Prevention Magazine, 16 October, 2014.

How to Choose The Right Sleep Apnea Specialist

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If you’re asking yourself, “do I have sleep apnea?” you may already be concerned about your sleep habits. Sleep apnea is a condition in which you have a pause, (or many pauses) in your breathing while you sleep. These pauses can last a few seconds to a minute or longer. Unfortunately, there is no way to diagnose sleep apnea when you are awake. Blood work or lab tests will not provide information to your sleep apnea specialist.

When sleep apnea goes untreated, it can have dire consequences. For starters, this chronic condition makes you sleepy throughout the day. You could fall asleep while driving. It also affects your sleep partner. But it also increases the risk of:

• High blood pressure
• Heart attack or heart failure
• Stroke
• Diabetes

Types of Sleep Apnea

The most common type of sleep apnea is obstructive sleep apnea. This is when your airway is blocked, causing you to stop breathing at night. The most typical symptom is loud snoring, but you might also gasp for air in your sleep. Both adults and children can suffer from obstructive sleep apnea.

Another type of sleep apnea is central sleep apnea. This occurs when your brain doesn’t send the right signals to the muscles that control your breathing. Central sleep apnea can affect children and adults, but it’s most common in those with certain medical conditions. Typically, snoring is not a symptom, but you may experience the same types of sleepiness and shortness of breath as you would with obstructive sleep apnea.

When to See a Sleep Apnea Specialist

Sleep apnea is a chronic condition that often isn’t treated until it gets serious. You may not even notice the symptoms until your sleep is severely disrupted. You should consult with your sleep apnea specialist when you first experience sleep problems. The sooner you start treatment for sleep apnea, the less it disrupts your life. Definitely see your sleep apnea specialist if you observe the following symptoms:

• Loud snoring that disturbs your sleep or that of others in your home
• Waking up choking or gasping for air
• Excessive daytime drowsiness, even though you sleep at night
• Difficulty staying awake
• Pauses in your breathing during sleep

Sleep problems that lead to chronic fatigue are not always due to sleep apnea, which is why you should have a sleep apnea specialist diagnosis your problem before you begin treatment.

Why Choose a Sleep Apnea Specialist?

You may go to your family physician when you think you have sleep apnea for initial diagnosis. It could be something else causing your sleep problems. Your primary doctor will evaluate the symptoms and make a referral to a sleep apnea specialist for further testing.

Physicians who specialize in treating sleep apnea typically have one to two years of additional training in sleep medicine after completing medical school and their residency. A doctor may specialize in neurology, otolaryngology, family medicine or internal medicine in addition to taking a fellowship in sleep medicine.

Look for a board certified sleep specialist, who has to complete a fellowship in sleep medicine and pass a national examination to prove their expertise. These doctors have to re-certify every 10 years to show that they are keeping up with current medical information and education.

When you have a board certified sleep specialist, you can be assured that your doctor is up-to-date with the most recent sleep apnea treatment options and technology concerning sleep apnea. You may also want to look for a sleep center that is accredited by the American Academy of Sleep Medicine, but you may have to travel to a larger community that has this resource.

Selecting the Sleep Apnea Specialist

In some communities, you may not have many different options for finding a sleep apnea healthcare provider. Your insurance may limit coverage to certain locations or specialists. Even so, you should still take the time to read about the clinic and the doctor to check credentials and reviews. Make sure the clinic where you are being treated has the resources to provide testing and treatment.

If you have multiple options, do the research and find out which sleep apnea specialist fits your needs. Check their credentials and resources. Ask friends and family if they have recommendations. You may want to check with your primary care physician, too.

With research and information, you should be able to find a sleep apnea specialist that meets your needs.

Ideal Nap Time Length

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Most people enjoy a good nap when they’re tired. Some of us even work it in to our schedules on a daily basis so that we can be more productive. The question remains, what is the ideal nap time length?

ideal nap time length

There are 3 different types of naps – planned, habitual and emergency naps.

Planned – taking a preventative nap before you actually become tired, for example if you know you will be up past your normal bedtime.

Emergency – when you become extremely tired and cannot function, as many drivers do when they must pull off the road and nap before continuing to drive.

Habitual – taking a planned nap at the same time every day, for those of us who take a quick power nap after lunch every day at the same time.

what is the ideal nap length?

If you’ve ever wondered what the ideal nap time length is, take a minute to read over the following pointers and suggestions.

10-20 Minutes

Otherwise known as the “power nap”, this ideal nap time length is for gaining an energy boost and becoming more alert. Because of the quick length of time, you will not enter into a cycle of REM sleep, making it much easier to wake back up afterwards and get back to your day. Many people like to take a power nap after lunch, before they start on their workload for the afternoon. Otherwise, you might end up consuming more coffee than you really need, creating difficulty when trying to go to bed later that night.

Sign that reads Powernap Area

30 Minutes

If you opt for something a little longer than the traditional power nap, you may end up feeling groggy, almost defeating the purpose of the nap in the first place. This feeling usually lasts for about 30 minutes after waking, before the restorative benefits really come into play.

60 Minutes
For those of us lucky enough to have an hour to nap, you can enter into the deepest type of sleep here – the slow-wave sleep. While you may experience some grogginess when you initially wake up, taking an hour nap has proven to be beneficial in terms of memory improvement.

90 Minutes
This long of a nap is considered a full cycle of sleep, including the light and deep sleep, and REM sleep. It is very likely that you will start dreaming in this length of sleep cycle. Waking up after this is usually much easier than during the 30 or 60 minute naps. Studies have shown that these longer naps lead to heightened creativity and improved emotional and procedural memory.

A study at NASA on sleepy military pilots and astronauts found that a 40-minute nap improved performance by 34% and alertness 100%.

In addition to enhancing performance, increasing alertness and reducing accidents, there are psychological benefits as well. A nap can be treated as almost a mini-vacation for your mind. It provides a time of relaxation and rejuvenation and can ultimately decrease the daily stressors in your life.

If you feel that you may be suffering from a more serious sleep disorder, and your daily naps jut aren’t cutting it, please contact our office at (586) 573-0438 or feel free to visit our website to read more about sleep disorders.

Medical & Psychological Disorders Named After Popular Literary Characters

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Medical practitioners and psychologists use the term “syndrome” to refer to a set or pattern of symptoms that usually occur together and are indicative of a particular disorder, disease, or social condition.  Most syndromes are named after the physicians who first discovered or detected the association of the symptoms. There are exceptions, however.  Many names of syndromes originate from psychological analysis of fictional characters. The following examples are medical and psychological disorders named after literary characters:


  1. Pickwickian Syndrome

Named after an excessively fat boy named Joe Pickwick, a character in Charles Dickens’ very first novel, this syndrome is medically known as Obesity Hypoventilation Syndrome.  This medical condition involves the combination of excessive obesity and Obstructive Sleep Apnea (OSA), a life-threatening disorder characterized by repetitive breathing interruptions during sleep.  It has even been known to lead to heart failure.  The most effective treatment is weight loss, in combination with CPAP therapy.  This syndrome is often utilized in my lectures, showing that literature recognized OSA long before Sir William Osler did.

psychological analysis of fictional characters


 2. Othello’s Syndrome

Named after the Shakespearean character that murdered his wife out of intense distrust (also called delusional jealousy), describes a person’s stubborn belief that their mate is being unfaithful.  As a result, incessant groundless accusations of infidelity are made, taking considerable pains to test their mate’s trustworthiness – even to the extent of displaying stalking and violent behavior.  The average onset age of Othello’s Syndrome is 68 years old, with a 60/40-male/female ratio. Othello’s Syndrome is commonly associated with a neurological disorder rather than a psychiatric disorder.

Scene from 1995 film Othello



3. Lady Windermere Syndrome

Named after the vivacious but meticulous, difficult woman (the main character from an Oscar Wilde play), this mycobacterial lung disease exhibits symptoms such as persistent cough, shortness of breath and lethargy. Patients with this disorder voluntarily suppress their cough out of politeness, and it is typically treated with strong antibiotics and anti-tuberculosis drugs. This habit results in lung infection and inflammation, as it allows secretions to collect in the airways.

Oscar Wilde's Lady Windermere


4. Peter Pan Syndrome

Named after the well-loved J.M. Barrie character that simply refuses to grow up, people with this syndrome display immaturity, shun responsibility and oppose accepted norms.  More often than not, they focus on fantasy rather than reality and usually need to be mothered well into adulthood. These individuals feel isolated and alone, and have a hard time building relationships with others.

Peter Pan


5. Mowgli Syndrome

Named after the main character in “The Jungle Book” by Rudyard Kipling, this syndrome describes children with weak mental and/or physical traits, especially those who have suffered tremendous emotional stress due to parental neglect and abuse. It is also used to refer to children who grew up without the influence of human contact (such as those said to be raised by wild animals). Isolation from human contact at a very young age results in little or no experience of human care, social behavior, eating habits, hygiene and human language.



6. Cinderella Syndrome

Named after Charles Perrault’s fairy tale character made popular by Disney, this syndrome is characterized by false accusations made by adopted children or stepchildren regarding abuse and neglect by their adoptive mothers or stepmothers. This syndrome can manifest from actual physical abuse that occurred in a child’s previous home, the early loss of a mother/mother figure, or emotional abuse received in another home. This syndrome should be recognized as a cry for help, although all reports of child abuse should be handled accordingly.


Cinderella’s cruel stepmother Lady Tremaine and stepsisters Anastasia and Drizella


7. Rapunzel Syndrome

Named after the Brothers Grimm fairy tale princess with amazingly long-flowing hair, this disorder is called trichobezoar. This rare condition is characterized by intestinal obstruction caused by hair ingestion, and occurs mostly in female patients with an underlying psychiatric illness. Trichobezoar is associated with trichotillomania – a psychological condition manifested by an uncontrollable urge to pull out head and body hair. Treatment options include endoscopic removal, laparoscopic removal, or via laparotomy.



8. Huckleberry Finn Syndrome

Named after a very popular adventurous boy-character created by the great American writer Mark Twain, this condition refers to the habitual neglect of responsibilities by kids of superior intelligence because of parental disapproval and feelings of rejection. These responsibilities avoided as a child turn into frequent job changes and absenteeism as an adult.  This can also stem from the inability of normal/bright children born to mentally impaired parents to adjust socially and psychologically.  This syndrome is thought to be a possible defense mechanism for low self-esteem and depression.



9. Dorian Gray Syndrome

Named after the character from Oscar Wilde’s novel about a handsome young man who desires his picture would grow old instead of himself, this condition describes people who are overly critical of their own physical appearance despite the lack of any defects. They have great difficulty coping with the aging process, and thus try to cling to their youth by depending heavily on cosmetic products and procedures. Psychological maturation is often lacking in people with this disorder.



10. Alice in Wonderland Syndrome

Named after the curious wandering character from Lewis Carroll’s most famous work, this neurological disorder is a condition wherein a person suffers from visual image distortions, perceiving parts of their body or any other objects as having been altered in size. Though most closely linked with migraine, it is also a sign of epilepsy, mononucleosis and hallucinogenic drug consumption.

Alice in Wonderland

Peripheral Nerve Field Stimulation

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We have all had headaches before, but what about migraines? Chronic migraine (CM) is characterized by having more than 15 migraine episodes per month, lasting for a minimum of 3 months in a row. CM is 3 times more prevalent in women than men, and typically more severe. Women report greater disability, longer duration, greater frequency, and increased recovery time.

peripheral nerve field stimulation

This disabling condition can be partially managed with conservative treatments, but when those conservative treatments fail, another option is Occipital Nerve Stimulation (ONS). ONS is an innovative treatment for headache disorders, as it reduces muscle tension. Originally, ONS was used in the treatment of occipital neuralgia (chronic pain in the upper neck, back of the head and behind the eyes, corresponding to the locations of the lesser and greater occipital nerves), visit this original site to learn more about alignments and how it affects your body. ONS can also be used to treat facial pain, cluster headaches, and Cephalgia related to TMD. It is still considered somewhat experimental for the treatment of CM, but there are more and more studies being performed with good results.

The pain of occipital neuralgia usually arises from trauma to or entrapment of the occipital nerve, but the pain may also arise from the spine.

At Michigan Head & Neck Institute, Dr. Klein uses masticatory cervical muscle therapy and injections to reduce pressure on the entrapped greater occipital nerve, which then significantly reduces  jaw clenching due to Cervicogenic Cephalgia (headache/pain). Cervicogenic headache is often a sequela of head or neck injury, but may also occur in the absence of trauma. Symptoms are similar to tension-type headache or migraine, diagnosing these can be challenging.

Occipital nerve diagram

Predominantly in women, migraine (with aura, specifically) has been identified as a risk factor for vascular disorders. Additionally, some comorbidities of migraine include asthma, depression, anxiety and other chronic pain conditions.

“Migraine is not just a headache. Migraine is a common, complex neurovascular disorder that likely involves neuronal hyperexcitability with a cascade effect of cellular depolarization called cortical spreading depression and associated vascular changes. Several previous studies have demonstrated an increased risk of ischemic stroke with migraine.” -Tricia C Elliott MD, FAAFP

Dr. Robert Weiner and Dr. Kenneth Reed first introduced ONS for the treatment of headache in 1999, performed with equipment that is normally used for Spinal Cord Stimulation (SCS). Dr. Weiner is internationally recognized for pioneering surgical procedures in the treatment of various chronic pain syndromes, and specializes in treating chronic pain syndrome, headaches and trigeminal neuralgia. Dr. Reed specializes in Peripheral Nerve Stimulation and is board certified in pain management treatment, anesthesiology and internal medicine.

The ONS procedure involves inserting electrodes and leads (secured to connective tissue with anchors) into the epidural space and powering them (externally) via an implantable pulse generator (IPG) linked to a remote. The IPG can be located at the buttock, thoracic region, or lower abdomen. Patients control the ONS (turn on/off) and adjust the stimulation with a handheld remote control.

occipital nerve stimulation

This procedure is typically performed in two stages. The first stage, carried out under local anesthesia with sedation, is used to test the stimulation and determine optimal placement of electrodes. The second part, which involves insertion of the rest of the ONS system, is carried out under general anesthesia.

Patients who would be excluded from this kind of therapy meet the following criteria:

• Confirmed pregnancy, or the desire to get pregnant soon
• Significant psychological problems
• Pervious surgeries in the occipital region
• Recent or current drug/alcohol abuse
• Frequent need for MRI
• Received nerve block injections in the last 3 months
• Participation in other clinical trials

Recent studies:

For patients with chronic migraine (CM), peripheral nerve stimulation of the occipital nerves reduces the number of headache days, according to a study published online October 25, 2016 in Pain Practice. HealthDay News article (10/28/16)

Nagy A. Mekhail, M.D., Ph.D., from the Cleveland Clinic, and colleagues implanted 20 patients at a single center with a neurostimulation system, and overall, the researchers observed a reduction in the number of headache days per month. All patients had reductions in Migraine Disability Assessment and Zung Pain and Distress scores. “Our results support the 12-month efficacy of 20 CM patients receiving peripheral nerve stimulation of the occipital nerves in this single-center trial,” the authors write. (7/8/16)


Lambru G, Matharu MS. Occipital nerve stimulation in primary headache syndromes. Therapeutic Advances in Neurological Disorders. 2012;5(1): 57-67.

Saper JR, Dodick DW, Silberstein SD, McCarville S, Sun M. Occipital nerve stimulation for the treatment of intractable chronic migraine headache: ONSTIM feasibility study. Cephalgia. 2011;31(3):271-285.

Paemeleire K, Bartsch T. Occipital nerve stimulation for headache disorders. Neurotherapeutics. 2010; 7(2):213-219.

Jasper JF, Hayek SM. Implanted occipital nerve stimulators. Pain Physician. 2008;11:187-200.
Schwedt TJ. Occipital nerve stimulation for medically intractable headache. Curr Pain Headache Rep. 2008 Jan;(1):62-6.

Marchioretto F, Serra G. Nerve Stimulation for Chronic Migraine: A Randomized Trial. Pain Physician. 2012;15:245-253.

Vetvik, KG et al. Sex differences in the epidemiology, clinical features, and pathophysiology of migraine. The Lancet Neurology. 2016 Nov; 16(1):76-87.

Daily Physical Activity

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For many of us working long days in the office, we tend to forget the importance of exercise and the health benefits of physical activity associated.  We make excuses to avoid going to the gym, and we place exercise at the bottom of the priority list most times.  Even as little as 15-30 minutes per day can make a huge difference in our health and happiness. Think about it, are you getting enough exercise? Exercise is especially important in treating both diagnoses that I specialize in – OSA and TMJ disorders. Aerobic exercise in particular helps to keep blood flowing to all the cells in the body that need it. A good, moderate exercise regiman assists healthy sleep, which reduces pain and increases energy levels.

Exercise is a subset of physical activity that is structured, planned and repetitive, with an objective in line. Physical activity in daily life is categorized as either sports, occupational, conditioning, household, or other activities.  According to the World Health Organization, the definition of physical activity is “any bodily movement produced by skeletal muscles that results in energy expenditure” (1985 – “Global Recommendations on Physical Activity for Health”).


daily physical activity

The different recommendations for physical activity in various age groups are as follows:

Ages 5-17

  • 60 minutes daily of moderate to vigorous activity
  • Focus on aerobic activity

Benefits for children in this age range include a healthy cardiovascular system, improved motor function and neurological awareness, healthy tissues, bones and joints, and weight maintenance.

Additionally, psychological benefits include lessened anxiety and depression, increased self-confidence and social awareness/interaction, and high academic performance.

Children who develop healthy habits early on tend to stay away from tobacco, alcohol and drug use as well; they do not have a tendency to become influenced by the “wrong” group of peers.

physical activity at school

Ages 18-64

  • 150 minutes weekly of moderate activity, or, 75 minutes of vigorous activity
  • Combination of moderate & vigorous activity is optimal
  • Muscle-strengthening activities recommended 2 days/week

The health benefits of physical activity for adults in this age range include lower risk of cardiovascular and coronary disease, less chance of stroke and diabetes, lower blood pressure, higher metabolism, lower risk for cancer, and better weight control.  Chances of bone fractures are lessened as well as neck/back problems and arthritis.  Psychological benefits are also found in adults in this age range, including greater mental stability, lower incidence of anxiety, depression, insomnia and other sleep disorders.

physical activity at work

Ages 65+

  • Moderate physical activity 3 days/week
  • Muscle-strengthening activities recommended 2 days/week

Enhancing balance and preventing falls/injuries is the main benefit for adults in this age range.  Depending on a person’s condition, they can be as active as their body allows.  Improved heart and lung function, lower rates of heart attack and stoke, and enhanced bone health are all direct results of increased physical activity.  Improvement in cognitive function is also noticeable in older adults who are physically active.

benefits of physical activity

A common benefit of physical activity for ALL age groups is an improvement in sleep quality/quantity, and a decreased chance for developing OSA (or another sleep disorder).  It is well established that obesity is linked to OSA, so staying physically fit is one sure way to reduce your chance of an OSA diagnosis.

We need to make sure that we incorporate physical activity into our daily routines and place more value on taking care of ourselves.   If we start imparting physical activity as a symbol of longevity, hopefully we can attain longer life expectancy, less diseases/disorders and greater focus on overall prevention.  Make it something that you enjoy, so it’s less of a task and more of a fun activity.

For tips on how to make physical activity a part of your daily living, please contact the Michigan Head and Neck Institute at (586) 573-0438.


Silva KS, Garcia LM, Rabacow FM, de Rezende LF, de Sa TH. Physical Activity as Part of Daily Living: Moving Beyond Quantitative Recommendations. Prev Med. 2017 Mar; 96:160-162. (Epub 11/10/2016)

(PDF Download Available):

Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical

fitness: definitions and distinctions for health-related research. Public Health Rep.


World Health Organization – Global recommendations on Physical Activity

Centers for Disease Control & Prevention