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TMJ Blog

10. 16. 2018

Recent News, Sleep Apnea, TMJ

Can I Have TMD and OSA at the Same Time?

TMJ sleep apnea appliance

The answer is YES; you can have both TMD (temporomandibular joint disorder) and OSA (obstructive sleep apnea).  Sometimes it can be hard to know which symptoms belong to which disorder, as many are overlapping.  For example, some overlapping symptoms of TMD and OSA are as follows:

  • Headaches (especially upon wakening)
  • Jaw Pain
  • Facial Pain
  • Chronic Fatigue
  • Frequent Illness
  • Irritability
  • Difficulty Concentrating
  • Memory Problems
  • Depression

A study published in the Journal of Clinical Sleep Medicine stated, “PSG (overnight sleep test) recordings showed that nearly 36% of TMD patients meet diagnostic criteria for insomnia, and more than 28% meet criteria for obstructive sleep apnea.” (Dubrovsky, et al)

There are a multitude of reasons why you could be suffering from TMD, OSA or both.  Muscle strain, trauma, or pre-existing bite problems are a few examples of causes.  Now you are probably wondering which one you treat first.  You’ll be happy to know that you can actually treat both at the same time!

Believe it or not, wearing a TMJ sleep apnea appliance can in some cases also reduce the severity of your sleep apnea.  Wearing a mandibular intraoral TMJ sleep apnea appliance moves your mandible (lower jaw) into a forward position, opening up the airway.  In mild Obstructive Sleep Apnea the repositioning of mandible to cranium may be enough to control, but the more severe the OSA, the less successful is an oral appliance for OSA since the mandible cannot be advanced to the point of creating pain or TMD.

If you have the proper amount of air flowing through your system, the chances of you suffering from a sleep breathing disorder are automatically reduced.  Depending on the severity of a person’s OSA, both a CPAP and TMJ sleep apnea appliance may be necessary for maximum benefit/relief.

During sleep, airway obstruction may occur anywhere between the nasopharynx and the larynx – the most common areas being behind the base of the tongue (retroglossal) and behind the soft palate (retropalatal).

 

There have been several studies that indicate advancement of the mandible forward can open up the airway and reduce pharyngeal collapsibility.  Additionally, anterior movement of the tongue decreases the gravitational effect on the soft palate.

The mandible is limited in the amount of advancement necessary for OSA and the centralization of condyles within the glenoid fossae (the back of the jaw as it hinges in the TM joint) may not be sufficient to preventing airway collapse in the back of the throat, even if that is the correct position to control TMD.

                   Jaw moving forward = Tongue moving forward = Opened airway

 In regards to TMD treatment, moving the lower jaw (mandible) forward with the use of an TMJ sleep apnea appliance takes pressure off of the jaw joints.  Space is created in the joint compartment/s for the displaced disc/s to return to their normal anatomical position.

The first goal is to relieve the muscle spasm and pain using the removable TMJ sleep apnea appliance, and hopefully restore the dislocated disc/s within the jaw joint/s to normal anatomical position.  Once the jaw joints are stabilized, your treatment advances into the second phase, which is to correct your bite.

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

The educational model below is invented and patented by Dr. Richard Klein

With Oral Appliance air flows normally                             Without Oral Appliance air cannot flow into                                                                                                              lungs

Most TMD cases can be controlled with an orthotic and/or physical medicine technique.  Treatment with an intraoral TMJ sleep apnea appliance should always be tried first, before any surgical intervention.  Depending on the severity of the case, there is a possibility that the disc/s could go back into place.  A treatment time of anywhere from 1-2 years is recommended, prior to a consultation with a maxillofacial surgeon.

If the tissues of the jaw joint/s are severely damaged to such an extent that they do not respond to appliance therapy, or only partially respond, then surgery may be necessary to obtain the desired result.

For more information on TMD or OSA, please call our office at (586) 573-0438 to schedule a consult as soon as possible.  You can also visit us online at www.michiganheadandneck.com.

References

Hui DS. Craniofacial Profile Assessment in Patients with Obstructive Sleep Apnea. Sleep. 2009;32(1):11-12.

Smith MT, Wickwire EM, Grace EG, Edwards RR, Buenaver LF, Peterson S, Klick B, Haythornthwaite JA. Sleep Disorders and their Association with Laboratory Pain Sensitivity in Temporomandibular Joint Disorder. Sleep. 2009 Jun; 32(6):779-90.

Dubrovsky B, Raphael KG, Lavigne GJ, et al. Polysomnographic Investigation of Sleep and Respiratory Parameters in Women with Temporomandibular Pain Disorders. Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine. 2014;10(2):195-201. doi:10.5664/jcsm.3452

Rener-Sitar K, John MT, Pusalavidyasagar SS, Bandyopadhyay D, Schiffman EL. Sleep Quality in Temporomandibular Disorder Cases. Sleep Medicine. 2016;25:105-112. doi:10.1016/j.sleep.2016.06.031

Epker J, Gatchel R J. Prediction of Treatment-seeking Behavior in Acute TMD Patients: Practical Application in Clinical Settings. J Orofac Pain. 2000 Fall;14(4):303-9.

Schiffman E, Ohrbach R, Truelove E, et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: Recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group. Journal Orofac Pain. 2014;28(1):6-27.

Wieckiewicz M, Boening K, Wiland P, Shiau Y, Paradowska-Stolarz A. Reported Concepts for the treatment modalities and pain management of temporomandibular disorders. J Headache Pain. 2015;16:106. Epub 2015 Dec 7. doi: 10.1186/s10194-015-0586-5

Guarda-Nardini L, Manfredini D, Mion M, Heir G, Marchese-Ragona R. Anatomically Based Outcome Predictors of Treatment for Obstructive Sleep Apnea with Intraoral Splint Devices: A Systematic Review of Cephalometric Studies. J Clin Sleep Med 2015;11(11):1327–1334. doi: 10.5664/jcsm.5198

Olaithe M, Bucks R. Executive Dysfunction in OSA Before and After Treatment: a meta-analysis. Sleep. 2013 Sep 1;36(9):1297-305. doi: 10.5665/sleep.2950

Gauer RL, Semidey MJ. Diagnosis and Treatment of Temporomandibular Disorders. Am Fam Physician. 2015 Mar 15;91(6):378-86.

Stansbury RC, Strollo PJ. Clinical Manifestations of Sleep Apnea. J Thorac Dis. 2015 Sep;7(9):E298-310. doi: 10.3978/j.issn.2072-1439.2015.09.13

Aarab G, Lobbezoo F, Wicks DJ, Hamburger HL, Naeije M. Short-term Effects of a Mandibular Advancement Device on Obstructive Sleep Apnoea: an open-label pilot trial. J Oral Rehabil. 2005 Aug;32(8):564-70.

Chantaracherd P, John MT, Hodges JS, Schiffman EL. Temporomandibular Joint Disorders’ Impact on Pain, Function, and Disability. J Dent Res. 2015 Mar;94(3 Suppl):79S-86S. Epub 2015 Jan 8.  doi: 10.1177/0022034514565793

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The contents of this website, such as text, graphics, images, and other materials are for informational purposes only. While there are many commonalities among multiple TMD and sleep apnea cases, each patient is unique. Information on this website should be used to educate the reader about what they should discuss with their doctor if they are suffering from the listed symptoms. The information is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Seek the advice of your physician or you may call our office with any questions you may have regarding TMD or sleep apnea. If you think you may have a medical emergency, call your doctor or 911 immediately.


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