How is the TMJ connected to sleep?

20 years ago, when I started my TMJ practice, I was observing 40% of my patients coming back with pain. No matter how many neuromuscular orthotics and adjustments were done, the pain would just not go.

Almost all of them, however, had a very common symptom – morning headaches and tightened facial muscles on awakening from sleep.
I began understanding the role of sleep and importance of airway patency during sleep.

Sleep disordered breathing and Craniofacial pain go hand in hand. It’s not just a quality of sleep connection but also a chemical, hormonal and even physical problems like sleep bruxism.

During sleep, all our muscles relax; including the strongest muscle in the head and neck region – the tongue. When the tongue relaxes in a supine sleeping position, the air pipe that tuns behind the tongue gets occluded. This would lead to a lack of oxygen entering the body emanating in an oxygen desaturation event; wherein the oxygen level in the body goes below 97%. If those desaturations last for more than 20 seconds, it becomes an apnea/hypopnea event. These events also affect the heart adversely as it needs to pump harder to absorb the minimally available oxygen.

In the long term, the heart muscles get tired and one day just stops! There are papers that cite that nearly 80% of all the deaths during sleep could have been avoided as they weren’t diagnosed with the silent killer – Obstructive Sleep Apnea.

Holding the lower jaw and tongue forward using sleep appliances or improving tongue muscle tonicity with specific exercises or enabling increase in size of the airway itself are all procedures that we help our patients with. It’s the quality of sleep that matters; not the quantity. Atleast 25% of your total sleep should be deep/REM sleep. If not, then it carries over to the next day, and the next, and the next…. till daytime fatigue hits you.

I always suggest buying a smartwatch that can record a hypnogram if your sleep; especially if it’s a snorer (both loud and soft).