Have you ever experienced pain or clicking in your jaw? These symptoms are prevalent in a dental health disorder referred to as temporomandibular joint disorder (TMD). On the flip side, if you are also experiencing sleepiness during daytime hours, difficulty concentrating during the day, partner experiencing loud snoring, mood changes, or abrupt awakenings during the night, you could have sleep apnea. Studies have shown that sleep apnea can be linked to your TMJ disorder.
What Is Sleep Apnea?
Sleep apnea is a common but potentially severe medical condition in which breathing stops and starts up again for periods of up to 10-20 seconds at a time while you sleep (this can occur hundreds of times throughout the night). Even though sleep apnea is treatable, sleep often goes undiagnosed. Sleep Apnea affects more than 20 million people in the U.S. alone, and less than 10% ever get diagnosed. If left untreated, sleep apnea can possibly take 8-10 years off a person’s life.
Obstructive sleep apnea (OSA) is the most common type of sleep apnea. It occurs when the soft tissue in the back of your throat relaxes during sleep, causing a blockage of the airway (along with loud snoring). In turn, this blocks the airflow into the lungs. Obstructive sleep apnea – defined as five or more episodes of apnea (temporary absence of breathing) or hypopnea (diminished depth and rate of breathing) per hour of sleep (called apnea-hypopnea index or AHI) in individuals who have excessive daytime sleepiness. Patients with 15 or more apnea episodes or hypopnea per hour of sleep will receive the diagnosis of moderate sleep apnea.
Untreated sleep apnea prevents you from getting a good night’s sleep. The pausing of breathing literally shocks your body out of its natural sleep rhythms. As a result, you tend to spend more time in light sleep, and less time in the deep, restorative sleep you need to be full of energy, mentally sharp, and productive the following day. It can be difficult to diagnose sleep apnea without help since most symptoms only occur when sleeping. So it’s advisable to ask a bed partner or record yourself while sleeping. Not everyone who snores has sleep apnea and vice versa.
What are the types of sleep apnea? There are three types of sleep apnea.
Obstructive sleep apnea (OSA): Obstructive sleep apnea occurs when the airways behind the throat are physically blocked. This obstruction causes a temporary decline in breathing.
Central Sleep Apnea (CSA): Central Sleep Apnea is caused by a problem with the brain system that controls the muscles involved in breathing, resulting in slow and shallow breathing.
Mixed sleep apnea: When a person has Obstructive sleep apnea and Central sleep apnea simultaneously, it is called mixed sleep apnea or complex sleep apnea. Due to the different underlying causes, there are essential differences in the symptoms, causes, and treatments of CSA and OSA.
How common is sleep apnea?
Obstructive sleep apnea is estimated to affect between 2% and 9% of adults in the United States, but many cases are suspected to remain undiagnosed. This is consistent with studies that found significantly higher OSA rates. It is difficult to determine the exact incidence because individual research studies use different criteria to diagnose the condition. But a consistent finding is that OSA affects men more than women. It can occur in people of all ages, but it is more common in the elderly. Central sleep apnea has been shown to affect approximately 0.9% of adults five years and older. It is found much more often in men than in women.
As this data shows, Obstructive sleep apnea is much more common than Central sleep apnea. For this reason, when people talk about “sleep apnea,” they usually refer to obstructive sleep apnea.
What are the symptoms of sleep apnea?
All three types of sleep apnea share certain common symptoms.
-Intermittent breathing makes it difficult for a person to breathe or stops for one minute at a time.
-Excessive daytime sleepiness
-Limited attention or difficulty to think clearly
Many of these symptoms are the result from low oxygen levels due to lack of sleep and respiratory interruptions.
Some additional symptoms are associated with obstructive sleep apnea.
-Snoring, especially large snoring, with snoring, choking, or snoring that may cause a person to wake up for a short time.
-Morning sore throat and thirst
-Need to wake up frequently and urinate (nocturia)
Chronic snoring is the most common symptom of Obstructive sleep apnea, but not all people who snore suffer from sleep apnea. Snoring is not a common symptom in people with Central sleep apnea.
In general, people with sleep apnea are unaware of night breathing problems. Because of this, they often find problems only through their bedmates, family, or roommates. Excessive daytime sleepiness is the most likely symptom of sleep apnea living alone.
What Causes Sleep Apnea?
Obstructive sleep apnea occurs when a person’s airways are blocked during sleep.
Several factors have been discovered that increase the risk of obstruction and OSA.
-Anatomical features. The size of a person’s neck, chin, tongue, tonsils, and other tissues near the back of the throat can directly affect airflow.
-Obesity – is one of the leading causes of OSA and can be an underlying risk factor in up to 60% of cases. Obesity contributes to the anatomical narrowing of the airways, and studies show that even a 10% weight gain can represent a six-fold increase in the risk of OSA.
-Use of sedatives along with alcohol. Sedatives and medications relax the tissues of the throat and help block the airway.
-Family history. People who have one or more relatives of OSA are more likely to develop OSA.
-Use Of Cigarettes. Smokers, especially heavy smokers, have been found to develop OSA at a higher rate than nonsmokers.
-Sleeping Position. Those who sleep on their back have a higher incidence of sleep apnea. This sleeping position causes tissue to collapse into the airways,
-Nasal congestion. People whose ability to breathe through the nose is reduced because of congestion are more likely to experience OSA.
-Hormonal disorders. Hormonal conditions such as hypothyroidism (hypothyroidism) and acromegaly (excessive growth hormone) cause inflammation of tissues near the airways and contribute to the risk of obesity.
In CSA, the effects on breathing are different from OSA. Instead of the obstruction that causes respiratory decline, the problem arises in the way the brain communicates with the muscles involved in breathing. In particular, the brainstem does not observe the proper levels of carbon dioxide in the body, and breathing is slower and shallower than it should be.
CSA is usually associated with the underlying medical condition. For example, a stroke, a brain infection, or, rarely, a brain tumor can damage the brain stem. Painkillers such as opioids can also interfere with this normal breathing process.
Heart failure is considered a risk factor for CSA. CSA can also occur if a person’s oxygen levels change quickly at high altitudes.
What are the effects of sleep apnea?
If left untreated, sleep apnea can cause many health problems, including high blood pressure, stroke, arrhythmias, cardiomyopathy (enlarged heart muscle tissue), heart failure, diabetes, obesity, and heart attacks.
Sleep apnea can cause arrhythmias and heart failure. This is because sleep apnea tends to increase blood pressure. Sleep apnea actually occurs in about 50% of people with heart failure or atrial fibrillation.
This is because sleep apnea can cause the following:
-Repeated episodes of oxygen depletion (doctors call it hypoxia).
-Changes in carbon dioxide levels.
-Direct effects on the heart due to changes in chest pressure.
-Elevated levels of inflammatory markers.
Patients are advised not to delay seeking advice from a doctor due to the high incidence of sleep apnea due to cardiac rhythmic disorders and heart failure.
What are the health risks of sleep apnea?
Sleep apnea can lead to sleep deprivation due to constant interruptions at night and generally an overall light sleep. Sleep deprivation is associated with a wide range of health effects that affect a person physically, mentally, and emotionally, and as a result, it is unsurprising that sleep apnea is associated with a variety of health problems.
Untreated sleep apnea affects the body’s oxygen balance and poses a risk to various types of cardiovascular problems, including high blood pressure, heart attacks, heart disease, and stroke.
What happens if I stop breathing?
When you stop breathing, your heart rate also tends to drop, and your body takes longer to deprive you of oxygen. Then your involuntary reflex awakens you at the end of the period when you are not breathing. When this happens, your heart rate tends to increase, and your blood pressure tends to rise.
These are the changes that occur abruptly when you stop breathing. However, when you experience regular apneas, your body begins to experience chronic consequences. The data show that the risk increases, especially if you stop breathing about 30 times or more per hour. However, if it is less frequent, there is probably a risk.
For example, blood pressure tends to rise, and increased workload thickens the walls of the heart and changes the structure of the heart. As more fibrous cells grow between muscle cells, they tend to become stiffer and less flexible. All of these increase the risk of atrial or ventricular arrhythmias. It also tends to reduce the function of the heart, reducing the efficiency of pumping blood.
What are TMJ and TMD?
TMJ is the name of the joint, the Temperomandibular Joint. In contrast, TMD is the disorder associated with the Temperomandibular Joint.
How Are They Connected?
Medical research studies have shown that approximately 50% of people with TMJ disorder also have trouble sleeping. Those suffering from obstructive sleep apnea (OSA) often experience a collapse in their airway, which then, in turn, causes the body to push the lower jaw forward to open up the airway. This constant motion by the temporomandibular joint throughout the night can cause constant stress and tension on the jaw joint and increase the likelihood of apnea. A vicious cycle repeated night after night. The intimate connection between your jaw joint and collapsing of the airway is irrefutable.
Studies have also shown that TMJ Disorder is also commonly linked to chronic fatigue syndrome. Chronic fatigue will aggravate your sleep apnea, impacting your overall general health.
How To Treat TMJ Disorder And Sleep Apnea
Dentists like Dr. Marielaina Perrone, DDS, trained to recognize the outward signs of sleep apnea. Most patients who suffer from disturbed sleep episodes rarely talk to their physician or dentist about it. Many consider that what they are experiencing is normal. A well-trained, experienced dentist can determine if you are at risk for sleep apnea by completing a thorough oral and visual examination. A scalloped tongue, oversized tongue, wear on teeth from grinding, and a narrow palate are all common signs for those experiencing sleep apnea.
Thankfully, if sleep apnea is ruining your sleep or you are experiencing jaw pain, sleep apnea treatments are available. Occasionally TMJ Disorder will go away on its own. Even if it does not, you should not have to live with the ongoing pain. Your dentist may be able to help you get back on your way to better general health and wellness so that you can feel better and sleep better.
Common dental treatments for TMJ Disorder can include:
- Mouthguards or nightguards.
- Muscle relaxers or anti-inflammatories.
- Injections of corticosteroids to relieve pain.
- Botox injections relax the muscles surrounding the joint.
- Stress counseling to get at the root causes of what might be causing your jaw-clenching.
- Massage and stretching exercises.
- Weight Loss
- Surgery is the most severe TMD cases.
Sleep apnea will not go away on its own. If left untreated, apnea in all its forms can lead to very severe health complications. Untreated sleep apnea can leave you at increased risk of heart attack, stroke, diabetes, and other serious diseases.
Common treatments include:
- Oral appliance therapy, including mouthguards and nightguards. TAP appliance (Thornton Adjustable Positioner). The TAP holds the lower jaw in a forward position so that it does not fall open at night and cause the airway to collapse. It can maintain a clear airway to reduce snoring and improve breathing. We feel this gives the patient the best option for success. The unique design allows patients to fine-tune their treatment at home and work with the dentist to achieve the best possible results. Patients are empowered to manage the degree of lower jaw protrusion over as many nights as it takes to achieve the optimal treatment position. The TAP has a single point of central adjustment, which prevents uneven bilateral adjustment that can create an irregular bite and discomfort. The TAP has over a 95% success rate. It is the key to a snore-free, restful night of sleep. This appliance also treats sleep apnea without the need for surgery, a mask, or medication.
- Use of a continuous positive airway pressure (CPAP) machine.
- Most severe cases will require surgery.
When you share your possible concerns about TMJ and/or sleep apnea with Marielaina Perrone DDS, she will discuss all treatment options with you. This will include oral appliances, a properly aligned bite, and treatment for bruxism and other dental issues that can help you hold your mouth differently. She will also assess at that time if you need dental crowns replaced or fixed. Or possibly have dental fillings that no longer fit your natural bite.
Call Dr. Perrone If You Are Experiencing Sleep Apnea or Trouble With Your TMJ.
You don’t have to struggle with sleep apnea or TMJ Disorder. Both conditions can be diagnosed with a dental visit. Along with a complete and thorough oral assessment. Dr. Perrone can help diagnose the cause of your TMD and prescribe the conservative treatment you need. Give our office a call to request an appointment.
Contact Marielaina Perrone DDS at (702) 458-2929 to schedule a no-cost cosmetic consultation appointment if you are ready for a smile makeover. We cannot wait to help you with your smile makeover to create the smile of your dreams in Summerlin, Henderson, and Las Vegas, NV.