Posts by: Momentum

How Pain can Exacerbate Existing TMD Pain

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When we think about the different types of pain that exist, many things can come to mind. Let’s break it down scientifically for a moment.

Pain, more specifically musculoskeletal pain, is classified into 3 categories:

 

 

 

 

 

 

Neuropathic pain arises from damage to the nervous system and affects 7–10% of the general population. This type of pain feels like a burning or electrical pain, even a stabbing pain. Many patients report feeling like they are being shocked when these bolts of pain occur.

Another related pain is Sciatica, which many TMD patients suffer from. This is lower back pain caused by the sciatic nerve. Nerves do not typically heal well, so unfortunately patients that suffer from neuropathic pain will suffer from chronic pain throughout their lifetime.

Neuropathic pain in the orofacial region includes trigeminal neuralgia, glossopharyngeal neuralgia and Atypical Odontalgia. AO is usually localized in a tooth that has been misdiagnosed, which often leads a patient to have many unnecessary dental treatments in attempt to relieve pain.  Two other comorbidities of AO are depression and anxiety, often intensified by pain.

 

 

 

 

 

Studies estimate that the incidence of chronic orofacial neuropathic pain is 5-10 per 100,000 people.

Orofacial pain is characterized as pain manifested in the face or oral cavity, including such disorders as TMD.  As studies have shown, TMD has significant impact on physical and psychosocial factors. Its prevalence has been reported as three to five times more frequent in women.

It can be hypothesized that extracranial trigeminal nociceptive inputs arising from the craniofacial structures as a result of a TMD may influence the activation of the trigeminovascular system, since these nociceptive inputs convey in TNC where intracranial inputs do.

The trigeminal nerve (Cranial Nerve V) is a mixed-function, major cranial nerve (sensory, motor, and autonomic functions). This nerve is termed “trigeminal” due to its three main branches: the ophthalmic nerve (V1), the maxillary nerve (V2), and the mandibular nerve (V3). Sensitive axons of the trigeminal nerve innervate the majority of cranial and facial tissues, except the posterior area of the cranium, the mandibular angle, part of the external auditory canal and pavilion, and part of the pharynx.

Trigeminal Neuralgia is described as a severe, electric-like unilateral pain. It is localized most often in trigeminal nerves V2 and V3, intraorally and extraorally. Patients usually have a trigger spot, when stimulated, causes a great amount of pain (lasting seconds or minutes). TN will vanish for a while and then return months later sometimes, making it difficult for the patient to identify the problem, or even know what type of doctor to turn to for treatment.

Glossopharyngeal neuralgia is a less common condition associated with pain supplied by the glossopharyngeal nerve. Locations of pain include the tongue, throat, tonsils, larynx and ears. Triggers for this include swallowing, chewing, talking, coughing and head movements (basic functions of daily life). These episodes are also short-lasting, but can occur multiple times throughout the day, and can also go into remission for periods of time.

 

 

 

 

 

 

Nociceptive pain is the type of pain that we are all most familiar with. It arises from trouble in the tissues, reported to the brain by the nervous system. Examples include nausea, burns, stubbing your toe, getting stung by a bee, etc. In other words, it is recognizable and familiar.  It is a necessary protective sensation to the human body.

Inflammatory/Other pain arises from a dysfunction like fibromyalgia, rather than damage. Historically, pain like this is seen as a “functional” pain disorder, when the patient is not incapacitated and still able to go about the functions of everyday life.

Fibromyalgia typically intensifies TMJ symptoms, and alternatively, when one or both temporomandibular joints are dislocated, fibromyalgia pain in the neck and upper back is amplified.

TMD and fibromyalgia produce similar painful symptoms:

  • Headaches
  • Jaw Pain
  • Facial Pain
  • Eye Pain
  • Ear Pain
  • Neck Pain

It is well known that headaches and TMD are highly prevalent conditions in the general population. Evidence suggests that a clinical comorbidity migraines/headaches and TMD exists. Existing TMD may, therefore, influence and/or exacerbate a headache disorder, and a headache disorder may exacerbate a TMD condition.

Migraines are commonly thought of as just a headache that causes pain behind the eye, neck, and cranium; however, migraine headaches can also present in the lower part of the face, particularly in the teeth.

 

 

 

 

 

 

 

In terms of the clinical presentation of TMD, one of the most frequent symptoms is pain. A relationship between the orofacial pain specialist and the neurologist must be established, as management should be focused on addressing both the headache and the TMD condition, since they considerably increase the prevalence of each other.

 

 

 

 

 

 

 

A physical evaluation of the TMJs includes a full head and neck examination for any signs of dysfunction or pain symptomatology. The physician should be looking for any joint sounds upon opening/closing, decreased ROM, and deviations in the opening/closing of the mouth to start. Imaging such as a closed MRI of the TMJ’s, tomograms and/or CT scan may be needed.

Conservative treatments for TMD include intraoral appliances, medication, physiotherapy, cognitive behavioral approaches, and potential surgical interventions.

 

 

 

 

 

Emotional factors play an important role in the treatment plan as well. Research has shown that high levels of fear of pain are associated with low levels of physical activity, often leading to a multitude of health issues (other than pain itself).

If you have any questions or would like more information on chronic pain and TMD, please visit our website or call us at 586.573.0438.

References

Chantaracherd P, John MT, Hodges JS, Schiffman EL. Temporomandibular joint disorders’ impact on pain, function, and disability. J Dent Res. 2015;94(3 Suppl):79S–86S.doi:10.1177/0022034514565793

Epker J, Gatchel RJ. Coping profile differences in the biopsychosocial functioning of patients with temporomandibular disorder. Psychosom Med. 2000;62(1):69–75.

Ghurye S, McMillan R. Pain-related temporomandibular disorder: current perspectives and evidence-based management. Dent Update. 2015;42(6):533–536. 539–542, 545–546.

Gil-Martínez A, Paris-Alemany A, López-de-Uralde-Villanueva I, La Touche R. Management of pain in patients with temporomandibular disorder (TMD): challenges and solutions. J Pain Res. 2018;11:571–587. Published 2018 Mar 16. doi:10.2147/JPR.S127950

Graff-Radford SB. Myofascial pain: diagnosis and management. Curr Pain Headache Rep. 2004;8(6):463–467.

Ohrbach R, Gale EN. Pressure pain thresholds, clinical assessment, and differential diagnosis: reliability and validity in patients with myogenic pain. Pain. 1989;39(2):157–169.

Okeson JP. Bell’s Orofacial Pains. The Clinical Management of Orofacial Pain. 6th ed. Carol Stream, IL: Quintessence Publishing Co, Inc; 2005.

Oono Y, Wang K, Baad-Hansen L, et al. Conditioned pain modulation in temporomandibular disorders (TMD) pain patients. Exp Brain Res. 2014;232(10):3111–3119.

Oral K, Bal Küçük B, Ebeoğlu B, Dinçer S. Etiology of temporomandibular disorder pain. Agri. 2009;21(3):89–94.

Romero-Reyes M, Uyanik JM. Orofacial pain management: current perspectives. J Pain Res. 2014;7:99–115. Published 2014 Feb 21. doi:10.2147/JPR.S37593

Sessle BJ. Neural mechanisms and pathways in craniofacial pain. Can J Neurol Sci. 1999;26(Suppl 3): S7–S11.

Sessle BJ. Peripheral and central mechanisms of orofacial pain and their clinical correlates. Minerva Anestesiol. 2005;71(4):117–136.

Sweeney L, Moss-Morris R, Czuber-Dochan W, Murrells T, Norton C. Developing a better biopsychosocial understanding of pain in inflammatory bowel disease: a cross-sectional studyEur J Gastroenterol Hepatol. 2020;32(3):335-344.

Are You Experiencing Eye Twitching/Spasms?

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There are many different kinds of muscle spasms that exist, ranging in intensity from mild twitches to severe pain.  The spastic muscle may feel harder than normal to the touch, and/or appear visibly distorted.  It may also show visible signs of twitching.  I treat TMD patients with eye twitching caused by the orbicularis muscles becoming spasmodic.

You may be wondering what causes eyelid/eyebrow twitching in the first place.  It can stem from a number of different things including the following:

  • Stress
  • Caffeine
  • Eyestrain
  • Medication
  • Fatigue
  • Magnesium deficiency

It could also be the result of an underlying condition like Tourette’s syndrome, MS, Parkinson’s, Bells Palsy, TMJ disorder or a sleep disorder.  Sometimes this twitching/spasm can last only a few minutes (or even just seconds), however sometimes it persists for several hours.  While these involuntary movements are typically painless, they are still an annoyance and can cause headaches, nausea and pain in/around the eye.

Blepharospasm, also known as BEB (benign essential Blepharospasm) is a condition where the eyelids close forcefully or spasm involuntarily.  It is a type of dystonia or condition characterized by unusual movements.  Dystonia is a neurological disorder causing involuntary muscle spasms and twisting/distortions of the limbs.  Sometimes, people with BEB experience muscle spasms that will spread beyond the eyelids to other facial muscles. This condition is twice as common in women as in men.

Sometimes, Botox injections can help reduce twitching, but a person may need additional treatments, as the effects of Botox wear off.  There is also a surgical procedure called a Myectomy where doctors remove muscles and nerves in the eyelids.  This would be a last resort.

In certain cases, an underlying TMJ disorder is the culprit of the twitching.  In that case, I would treat the patient with an intraoral appliance, physical therapy, trigger point injections or pharmaceuticals, just as I treat other TMJ patients.

Medications that can cause twitching/spasms include stimulants and antipsychotic medications used to treat OCD, ADHD, and other mood disorders such as Bipolar disorder.  And although it sounds like it doesn’t make sense, anti-seizure medications can also cause tics and tremors.  Diuretics may also lead to twitching and spasms, and can prompt magnesium deficiency.

It is not well known, but magnesium plays an important role in muscle and nerve function.  People who are deficient in magnesium and also experience other effects such as tremors, appetite loss, nausea, fatigue and weakness.  NIH recommends almonds, cashews, spinach, avocado, beans and soymilk as good sources of magnesium.

If you suspect that your medication is causing twitching, please talk to your doctor.  You may need a different type of medication, or a lower dosage, to avoid these effects.

Another cause mentioned above is eyestrain.  The majority of us are sitting in front of a computer every single day or reading text messages.  Our eye muscles become overworked and tired, so we should avoid sitting in front of our screens for hours at a time without a break.  Remember to get up and walk around periodically, and take breaks.  Additionally, make sure that you see your eye doctor regularly, as you may just need a new pair of prescription glasses or contacts.

When a person is tired, their eyes are more likely to twitch.  Getting between 7 and 9 hours of sleep per night may help reduce eye twitching.  If you feel like you are getting 7-9 hours of sleep, but you’re still tired, you may have an underlying sleep disorder.

Stress can also affect the body and cause twitching/spasms.  Exercise, yoga, breathing exercises, meditation, and other relaxation techniques have been known to lessen stress and reduce eyelid or eyebrow twitching.

White Sands says taking recreational drugs or abusing prescribed stimulant type drugs can cause eyelid twitching, just as too much caffeine can cause this.  Excess consumption of alcohol and cigarettes can also have the same effects.  Reducing or avoiding the consumption of these items will alleviate the spasms/twitching.

If you are experiencing twitching that lasts for more than a few weeks, eyelid drooping, swelling, redness, discharge or pain in the eye, please consult your doctor.  For more information on treatments for eye twitching as it relates to TMD and OSA, please visit our website at www.michiganheadandneck.com.

What Happens if TMJ Goes Untreated?

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What Happens if TMJ Goes Untreated?

 

Have you ever had your jaw lock up on you? Does your face often hurt when you wake up? Do you hear clicking when you are eating, do you have eye or ear problems? All of these symptoms are possible signs of a temporomandibular joint disorder or TMJ. If you fail to seek  TMJ treatment, then it can lead to complications and difficulties later in life.

 

Common Symptoms of TMJ

While clicking and facial pain are both common symptoms of TMJ, several other potential issues may develop as well, including dizziness, hearing loss, ear congestion, buzzing or ringing in the ears, sensitivity to sounds, headaches, ear pain, difficulty chewing, as well as many other conditions such as eye pain, blurred vision, pain in or around the eyes & excessive tears. Though men can also have this condition, it is more often found in girls and women. Approximately 80% females and 20% males worldwide.

 

Diagnosis of TMJ

Before a treatment plan can be created, your dentist will need to identify whether TMJ is the underlying cause of your pain and discomfort. They will likely examine your range of motion by having you open and close your mouth, watching the movement of your jaw and neck. Also, they will listen to the clicking and popping noises as well as press on different areas to identify trigger points or nerves that are entrapped by tight muscles. However, to get a clear image of the causes of your discomfort, the dentist will probably want to perform a Radiograph X-Ray, which is an imaging machine used to provide a view of the temporomandibular joint and it’s relation to the skull. Once they have all of this information, the dentist can diagnose your condition and offer a personal treatment plan.

 

Consequences of Non-Treatment

Seeking treatment for TMJ pain is necessary as avoidance may lead to further deterioration and the worsening of symptoms over time. The disorder is unpleasant and can encroach on the quality of life, affecting your mood, eating habits and sleep as well as nutritional health. Also, while there are several typical health concerns of TMJ—joint damage and inflammation, wearing down of teeth, increasing muscle contractions, and pain or TM Joint damage—you may develop an airway sleep disorder.  As TMJ muscles tighten, it pushes back your lower jaw, causing a restricted airway when you sleep. Airway sleep disorders lead to a lack of oxygen while you sleep which harms all the bodies cells that require oxygen as well as lack of exhaling acidic air that remains in and damages cells, which in turn may lead to chronic headaches, neck pain and brain fog, particularly in the morning. While all of this may sound frightening, both conditions are treatable.

 

Common TMJ Treatments

Struggling with continued TMJ pain is unnecessary. There are multiple individualized treatments and therapies that can help return you to a happy, healthy and restful life.

Physical therapy and other medical treatments
Physical therapy is one of the main treatments for TMJ. Therapy will include exercise, massage, TENS, laser electrical stimulation, trigger point & entrapped nerve injections and functional manual therapy. Posture correction, hot and cold therapy may also be used.

Medication
As TMJ can be painful and cause a lack of sleep, your dentist may prescribe medication. Most often, you will be prescribed muscle relaxants, NSAIDS or neuropathic medicines.

Chiropractic treatment
TMJ can often affect posture or partially be caused by it, which may lead to the need for chiropractic therapy for correction. Some treatments may include applied kinesiology, cranial therapy and even spinal correction.

Oral appliances
Oral appliances are used to realign the jaw, reduce clicking and to relieve pressure on the nerves and the TM joint. There are other appliances that may be used as well to reduce facial pain and limit the grinding of teeth.

Sleep appliances
As stated, TMJ is one of the many reasons that lead to airway sleep disorders due to the setting back of the lower jaw. Each appliance is individually prescribed based on the personal anatomy and needs of a patient.  Sleep appliances help to correct this restrictive behavior, allowing for more oxygen intake during the night and proper exhalation of toxic air.

Trigger point injections
Trigger point injections, often a local anesthetic, help to reset the nerve endings, relaxing muscles and reducing pain. While these injections are not permanent solutions, they do reduce pain as they allow blood flow to the very tight areas to assist healing. 

Are you in need of a TMJ doctor? If you think you are, then contact the Michigan Head & Neck Institute at (586) 588-9444 and schedule an appointment.

3D Facial Photography

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Technology has come a long way in recent years.  Imaging especially has had great advancements and has impacted the efficiency with which physicians are able to diagnose and treat Obstructive Sleep Apnea.  Utilizing 3D facial photography, the study in this article predicted OSA patients with 89% accuracy.  These diagnoses were determined using a technique that identifies landmarks on the face and neck.  Increased neck width and retrognathia are common indicators that were taken into consideration when predetermining the landmarks.  Additionally, the length and width of the jaw and face, and distance between the eyes were also contributing factors.   As we know, these structural features allude to an obstructed airway.

More testing must be done to fully attain accurate data with this tool, but if used in conjunction with other devices (ex: digital health tracker or another phone app), this could be a widely used, user-friendly, and cost-effective device for the future of healthcare.

This rings true of the time that we’re in right now with the Covid-19 pandemic.  Physicians have been operating via Telemed, and virtual visits and zoom meetings are being used daily.  Obstructive Sleep Apnea continues to be a huge health problem, so simple and accurate screening tools to mitigate the risk effectively is certainly welcome.

Please click here to read the full article.

Is the Quarantine Causing Depression, or Are You Suffering from Sleep Apnea?

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Since the Quarantine started, many people are feeling the effects of isolation, both physically and mentally.

While it has been proven that people with Obstructive Sleep Apnea have higher rates of depression, little is known about rates of OSA in patients with a major depressive disorder.  When someone is depressed, having suicidal thoughts, or their depression treatment just isn’t working, physicians may want to consider a sleep study.  (Maybe use at-home sleep test for right now because of COVID?)

Many symptoms of depression and OSA overlap, causing an under-diagnosis of both issues.  OSA patients can present with major depressive symptoms, but it is highly recommended that the physician should determine the underlying cause of depression, rather than just diagnosing the patient as depressed.  Both Depression and OSA are rapidly growing problems.   Patients with OSA present with sleep problems, anxiety, and depressive symptoms.  Depressive patients can also present with the same symptoms.

 

 

 

 

 

 

 

 

 

Typically, a patient who is diagnosed with depression will start on a series of different medications to see which one is the best fit for their body chemistry.  If the patient does not improve after antidepressant therapy, they should be screened for OSA to rule it out.

One option to rule it out would be presenting patients with a questionnaire as a starting point, similar to the screenings that I do with my TMD and OSA patients in my office.

Examples of questions may include any of the following:

  • Have you lost interest in activities that you normally enjoy?
  • Do you feel hopeless?
  • Are you constantly tired/fatigued?
  • Do you have trouble sleeping? Staying asleep and falling asleep?
  • Are you having trouble focusing or concentrating?
  • Do small tasks seem unmanageable?
  • Is your appetite affected? Are you eating more or less?
  • Do you feel nervous or anxious?
  • Have you thought about hurting yourself?

 

 

 

 

 

 

 

 

 

 

 

 

Depression and OSA have major associated comorbidities, and therefore patients should be tested for both.  We cannot ignore other possibilities such as Endocrine malfunctions, Hypothyroidism, Coronary artery disease or cancer, or even reactions to medications, but for the sake of this article, we want to make sure to integrate treatment for OSA if the treatment for depression is not showing signs of improvement.

Once the quarantine started, people all over the world have experienced something that they probably thought they never would.  Being in quarantine is not an easy situation to handle.  Our bodies and minds are used to social interaction, and with that being removed for our daily lives, many people are finding that they cannot function as they normally would.

 

 

 

 

 

 

 

Exercise, healthy eating habits, and sufficient sleep are the 3 most important things that people can maintain during the quarantine.  This may be easier said than done, as many of us rely on establishments like gyms for exercise.  Some of us don’t cook, and suddenly we had to fend for ourselves.  It’s not always easy to make changes to your daily routine (especially the older we get) so this has certainly been a challenging time for all of us.

If you are feeling like you may have depression, take a moment to think about when it started.  In addition, if any of the below symptoms apply to you, a sleep study may be what you need instead of antidepressants.

warning signs of sleep apnea

 

 

 

 

 

 

 

 

Should your sleep study show signs of OSA, there are several different treatment options.  The first thing that the doctor will usually tell you is to lose weight, but that may not always apply.  Some patients may already have a low BMI.   While CPAP therapy has long been considered the “gold standard”, many patients benefit from treatment with an intraoral appliance which is customized and fitted to each individual patient, and then adjusted on a periodic basis throughout the duration of the treatment plan.

For more information on OSA, or if you think you are a candidate for a sleep study, please view our website for more information www.michiganheadandneck.com.

References

  1. McCall WV, Benca RM, Rumble ME, Case DP, Rosenquist PB, Krystal AD. Prevalence of obstructive sleep apnea in suicidal patients with major depressive disorder.Journal of Psychiatric Research, 2019; 116: 147. doi:10.1016/j.jpsychires.2019.06.015
  1. Medical College of Georgia at Augusta University. (2019, July 23). Obstructive sleep apnea may be one reason depression treatment doesn’t work. ScienceDaily. Retrieved May 21, 2020 from www.sciencedaily.com/releases/2019/07/190723104041.htm 
  1. Jehan S, Auguste E, Pandi-Perumal SR, et al. Depression, Obstructive Sleep Apnea and Psychosocial Health. Sleep Med Disord. 2017;1(3):00012.
  1. McCall WV, Harding D, O’Donovan C. Correlates of depressive symptoms in patients with obstructive sleep apnea. J Clin Sleep Med. 2006;2(4):424‐426.
  1. Harris M, Glozier N, Ratnavadivel R, Grunstein RR. Obstructive sleep apnea and depression. Sleep Med Rev. 2009;13(6):437‐444. doi:10.1016/j.smrv.2009.04.001
  1. Stubbs B, Vancampfort D, Veronese N, et al. The prevalence and predictors of obstructive sleep apnea in major depressive disorder, bipolar disorder and schizophrenia: A systematic review and meta-analysis. J Affect Disord. 2016;197:259‐267. doi:10.1016/j.jad.2016.02.060
  1. Epstein LJ, Kristo D, Strollo PJ Jr, et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5(3):263‐276.

Has Your OSA Been Misdiagnosed as Depression?

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SleepAches

 

 

 

 

 

Have you or someone you know been battling depression for years without any results? If this sounds familiar, then you may have a sleep disorder. Because many of the side effects are the same, countless people go undiagnosed for long periods of time. Sometimes people find that they never had depression, to begin with, they were just sleep-deprived and not able to function normally.

 

 

 

 

 

 

 

 

If you are consistently only getting 4-5 hours of sleep per night, there is no way that you can perform and function (and feel) like a “normal” person.  It takes a toll on us.  We have slower reaction times, we are constantly fatigued, we have no energy, we can’t make decisions that others may find easy, etc.  This all adds up and can make us feel depressed like we are not “normal”, and that something is wrong with us.

Many people turn to a psychiatrist and undergo a series of treatments and different medications, all with failed results.  It is important that physicians are doing thorough examinations and making the appropriate referrals so that we don’t miss any signs and symptoms.

 

 

 

 

 

 

 

 

Let’s take a look at the similarity in the symptoms of OSA vs. Depression:

OSA Symptoms:

• Fatigue
• Snoring
• Frequent Illness
• Memory Loss
• Weight Gain
• Irritability
• Headaches
• Difficulty Breathing
• Daytime Sleepiness
• Voice Hoarseness
• Depression

Symptoms of Depression:

• Fatigue
• Trouble Concentrating
• Hopelessness
• Restlessness
• Daytime Sleepiness
• Aches and Pains
• Suicidal Thoughts
• Overeating or Appetite Loss
• Digestive Problems
• Feelings of Guilt
• Insomnia

What we fail to realize oftentimes is that OSA may be the one reason depression treatment doesn’t work. We as physicians need to be evaluating these patients and testing them for sleep disorders. Now maybe these patients don’t seem like the “typical” OSA candidate, but just because they aren’t overweight and snore doesn’t mean they aren’t suffering from a sleep disorder. If they complain of daytime sleepiness for an extended period of time, send them for a sleep study.

People with OSA statistically have higher rates of depression. And patients suffering from depression who receive treatment for OSA have a better chance of recovering from it.

 

 

 

 

 

 

 

Depression treatment often does not work, and if it does, it has a high return rate.  By testing these patients for OSA, we can also possibly eliminate some of the concomitant symptoms and dysfunctions including insomnia, weight gain, suicidal thoughts, brain fog, frequent illness, and difficulty concentrating.

If you are not waking up fully refreshed and full of energy with a good level of concentration, you could be at risk for an undiagnosed sleep disorder.  For more information on sleep disorders or to schedule a consultation with Dr. Klein please call 586-573-0438 or visit us online at www.michiganheadandneck.com.

Sleep Difficulties in Preschoolers Associated with Behavioral Disorders

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SleepAches

The International Journal of Environmental Research and Public Health has presented a study in which preschoolers with behavioral and communication disorders may have higher rates of sleep disorders. A diagnosis of a behavioral disorder or communication disorder was significantly associated with parent-reported sleep problems. Parents who have children with current behavioral disorders are also more likely to report that their child has trouble falling asleep, parents of children with communication disorders are more likely to report their child waking up often at night, and parents of children with developmental coordination disorder were less likely to report either sleep symptom. If you have to fight this condition, the FluxxLab™ combination. CBG with CBD tincture will work amazing for sleeping.

The presence of behavioral disorders in children predicted an increase in parental reports of sleep problems. Oppositional defiant disorder (ODD) is the main diagnosis composing this category. The present results are consistent with studies showing that ODD is associated with significantly higher levels of concurrent sleep problems in older children aged 9 to 16 years. Sleep problems were also associated with behavioral problems in a community sample of preschoolers aged four to five years. As adults, we know that sleep plays a vital role in mental health and stability. Sleep disturbances in school-aged children go hand-in-hand with anxiety, depression, and behavioral problems. Additionally, this ties into academic difficulties, learning disabilities, impaired performance and cognitive dysfunction.

Psychiatric diagnoses obtained from the evaluations are pooled into 4 categories: behavioral, relational, developmental coordination, and communication disorders. In this article, the final sample was comprised of 228 children who later were treated with CBD gummies for sleep. Overall, 39.0% of children were diagnosed with a behavioral disorder, 44.7% with a relational disorder, 76.8% with developmental coordination disorder, and 77.6% with a communication disorder. “A better understanding of the relationship between sleep and psychiatric disorders in this vulnerable population will provide insight into the use of more specific and appropriate interventions,” the investigators wrote.

Please click here to read the full article.

What Doctor Treats Sleep Apnea?

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Individuals who have sleep apnea experience interrupted breathing again and again during the night, which disrupts sleep and can lead to serious physical and mental health complications. If you’re experiencing daytime sleepiness, chronic snoring, mood disturbances, depression or fatigue, sleep apnea could be the cause. While a primary care physician can diagnose sleep apnea, he or she may refer you to another specialist for treatment such as a sleep apnea doctor or a dentist if you prefer to not wear a CPAP.

 

Dental Treatment for Sleep Apnea

Although you might not immediately connect sleep apnea with oral health, many dentists specialize in treating this condition with appliances designed to keep the airway open as you sleep. 

what doctor treats sleep apnea

This device is fitted to the mouth, similar to a retainer or mouthguard, and supports the jaw in a position that facilitates breathing. When searching “sleep apnea doctor near me,” keep in mind that dentists who treat sleep apnea are often certified by the American Academy of Dental Sleep Medicine, the American Academy of Craniofacial Pain, the American Academy of Physiological Medicine & Dentistry and the American Sleep and Breathing Academy.

 

The Role of Sleep Specialists

Appliance therapy is most effective for patients who have obstructive sleep apnea, the most common type of this condition. Central sleep apnea, which is relatively rare and occurs when the brain fails to signal the body to breathe during sleep, might require the care of a board-certified sleep specialist. These doctors have special training and testing to diagnose and treat sleep disorders.

 

Surgical Sleep Apnea Treatment

If your sleep apnea doesn’t respond to more conservative treatments such as a dental appliance or continuous positive airway pressure (CPAP) therapy, you may need to see a surgeon. He or she can determine whether a surgical procedure to widen the airway and remove excess skin could resolve your sleep apnea.

For those who will not wear the CPAP mask, schedule a consultation at the Michigan Head and Neck Institute. We only treat Sleep Apnea with an oral appliance and Temporomandibular Joint Disorder. Call 586-473-6735 to make an appointment with our physician.

Self-Care for TMJ Pain

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TMJ Pain

Pain and symptoms of locking or popping/clicking noises are common at the temporomandibular joint, where your jawbone connects to your skull. TMJ treatments often begin with self-care. This involves conservative means of pain control and lifestyle modifications to avoid the activities that put pressure or strain on the muscles and soft tissues of the TMJ.

 

Pain Management

Over-the-counter pain reducers and anti-inflammatories, such as acetaminophen, naproxen, or ibuprofen, may be effective at controlling TMJ pain on a short-term basis. However, this is not a reasonable long-term solution due to the side effects these medications can have. You should consult a doctor about your TMJ symptoms and only use medications to manage them according to his or her recommendation.

Another effective way to manage pain symptoms is to apply ice or moist heat to the affected area in an alternating fashion up to four times per day. Ice can be applied wrapped in a towel for up to five minutes at a time, while moist heat can be applied for 15 to 20 minutes. Each works to relieve your symptoms in different ways. Ice helps to numb the pain and reduce the inflammation, while heat works to relax tension in the muscles.

You can keep a pain diary to track your symptoms. This can help you identify factors that make the pain worse. Once identified, these factors can then be avoided.

 

Relaxation

The cause of TMJ pain is not always clear because there are multiple factors that may cause or aggravate it. However, researchers believe that it has something to do with the tension of the jaw, face & neck. You can help to relieve this tension by maintaining a relaxed position of your jaw during your waking hours, with your teeth apart and your tongue up and keeping a balance posture. Make a conscious effort to monitor this position during the day and relax your jaw if you find it becoming tense. Breathing exercises and relaxation techniques can help you deal with stress and prevent tension from building up in your muscles.

 

Lifestyle Modifications

To help relieve TMJ pain and prevent it from coming back, there are a number of changes you can make to your day-to-day activities.

1. Sleep Smarter

You should be sure that you get enough sleep and try to improve its quality by avoiding stimulating activities before bed and managing your sleep environment. Sleeping on your stomach can put pressure on your jaw, so try to maintain another position.

2. Improve Your Posture

When you maintain good posture, it puts less pressure on your muscles and joints. Keep your head posture balanced, forward, and relaxed.

3. Monitor Your Oral Habits

There may be a number of habits that you perform without thinking about it that may put pressure on the muscles and joints of your jaw. This includes shrugging your shoulders, biting your lips or cheeks, and clenching or grinding your teeth. Chewing gum or biting on objects such as pencils or fingernails can also create undue pressure. Make an effort to catch yourself at these behaviors and then stop them.

4. Avoid Caffeine

Caffeine occurs naturally in coffee, tea, and chocolate and is added artificially to sodas and energy drinks. It should be avoided as it can increase the tension of the muscles and interfere with your sleep.

5. Chew on Both Sides Equally

Don’t use only one side of your mouth to chew your food. Instead, alternate between sides or chew on both sides at the same time. Otherwise, you could put uneven pressure on the joints and muscles of your jaw.

 

Medical Evaluation

TMJ disorder is not life-threatening, and symptoms may go away on their own. Michigan Head & Neck Institute was founded by a TMJ doctor. Our staff can evaluate your condition and work with you to develop a plan for the management/treatment of your pain. Contact us to schedule an appointment.