TMJ 'dysfunction' - Health implications

The ramifications of sleep apnoea
Breathing difficulties can vary from person to person, with some experiencing significant limitations and others being less affected. This disparity is frequently linked to the degree of asymmetry in the Cranio-dental and skeletal structures. Some individuals may only experience snoring, while others may experience various degrees of distressful sleep apnoea.

While there is plenty of literature available regarding sleep apnoea and its secondary effects, such as a narrow airway or the tongue falling back during sleep, breathing is primarily controlled by a combination of reflex neurological and voluntary mechanisms. Having witnessed the effects of sleep apnoea in numerous patients throughout my years of practice, I am mindful of the long-standing practice among dentists to prescribe oral devices for its mitigation. During examinations, I typically guide my patients to inhale deeply into their chest while upright. What I have often noticed is that many of them struggle to breathe deeply and instead resort to utilizing their neck and shoulder muscles to elevate their shoulders to breathe properly.

For those who suffer from sleep apnoea and have tried the exercise in front of a mirror, the reality of the situation is clear. While lifting one's shoulders to aid in breathing may be an easy feat when standing upright, it is rendered impossible when lying down. As a result, sleeping becomes an arduous task and proper breathing becomes an insurmountable challenge.

In the case of an apnoeic patient, attempting to breathe deeply while unable to get assistance from the neck and shoulder muscles can become an arduous task that leads to exhaustion. The energy required to breathe soon becomes overwhelming, and the patient tries to get some rest by voluntarily stopping breathing.

When breathing is halted, blood oxygen levels begin to drop while carbon dioxide levels increase. The gas sensors located in the neck region then begin to fire rapidly to overcome the voluntary inhibition. The innate neurological signal to breathe increases and ultimately overcomes the voluntary inhibition, resulting in a deep gasp of air and the well-known gasping sound.

Sleep apnoea, disrupts their sleep pattern, resulting in reduced sleep quality and poor health outcomes. People with sleep apnoea often do not spend much time in REM (rapid eye movement) sleep, the most restorative sleep stage.

In the REM stage, the brain becomes more active, dreams occur, and the body carries out vital restorative functions. Among these are the production of thousands of nutrients or chemical compounds, crucial for our physical and mental health. These include hormones and proteins which regulate our moods, improve memory, strengthen the immune system, repair tissues, stimulate growth, and balance energy levels.

However, without sufficient deep REM sleep, people with sleep apnoea may suffer a lack of these essential nutrients. This lack can result in several negative effects, including increased anxiety and depression, impaired cognitive functions like memory and concentration, decreased energy, weakened immune system, slow wound healing, increased risk of chronic conditions such as heart disease, diabetes, and obesity.

This highlights the need for the effective management and treatment of sleep apnoea to ensure that those affected by it can access the vital health benefits of deep REM sleep. Treatment options include lifestyle changes, use of certain devices, and in some severe cases, surgery. The most commonly recommended treatment is positive airway pressure devices, which deliver air pressure through a mask to keep the airway open during sleep.
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, As life progresses, sleep apnoea becomes an increasingly debilitating fight between rest and oxygenation. Parents may find it distressing to watch their child struggle with apnoeic episodes and struggle to function during the day. In adults, partners who are at their wits' end may eventually opt to sleep in separate rooms. In severe cases, patients may start snoring and gasping while watching TV in the evening, making it a nightmare scenario for the entire family.

The chronic effects of this overexertion, combined with inhibited lung inflation and possible smoking habits, may have serious consequences. The heart must work harder to push blood into the lungs, which have difficulty inflating fully. Patients frequently breathe from their chest rather than their bellies, resulting in palpitations and other complications, such as right-sided heart enlargement, tachycardia, heart arrhythmias, atrial fibrillation, and congestive heart failure. It also triggers nightmares.

The repercussions of these cardiac and pulmonary issues are far-reaching, affecting areas of the body that are distant from the heart and lungs. When blood isn't fully saturated with oxygen, compensatory mechanisms must kick in, typically beginning with the sympathetic nervous system, which causes a redistribution of blood, so the vital organs are better replenished at the expense of the extremities, which may become cold and sometimes blue. Maurice Reynaud first characterized this phenomenon in 1888 as "episodic digital asphyxia due to arterial insufficiency", and it is now referred to as Reynaud's Syndrome. While various medical theories have been proposed, many of the mysteries surrounding the syndrome are now obsolete.

One secondary consequence of a deficient dental structure is the impact it can have on the Atlas vertebrae and its repercussions for the rest of the skeleton and visceral systems in the body, as explained in the TMJ and hip asymmetry article.

The graph below shows the effects of Jaw asymmetry on sleep and a conglomeration of symptoms conventionally treated as isolated incidents by isolated medical specialists.[/color]

In other cases, some groups of symptoms are grouped together and treated by specialists like "Specialist in ME/CFS" in hospital units always claiming that the "cause is unknown" system of treatment.

This is a graph of 82 patients who had symptoms of JAW AND SLEEP PROBLEMS. It shows that these patients suffer from multiple other symptoms too, as per the list on the graph. Please press F5 if the graph does not load.

Jaw asymmetry affecting sleep
Last week, I had an interesting interaction with a patient. I was treating his wife when she casually mentioned that her husband had backache problems. Out of interest, I said I would have a look at him.

He did not complain of jaw pain, which looked perfect with no restorations or periodontal issues. He had well-built jaws with a Class I bite with no sign of tooth grinding, although he had been under considerable stress most of his life, suffering from the back pain and a very restless sleep problem.

Also, recently, he had to undergo "Cardioversion" (Artificially shocking the heart back into sinus rhythm) as he had developed a severe cardiac arrhythmia which had gone unnoticed for some months.

The patient was seen on the 9th of March 2019. What does one do when one sees nothing wrong and hears nothing about any jaw issues, and yet the patient has problems which I have always assigned to a jaw problem?

This is a list of the patients' presenting symptoms:

However, life is full of surprises. I embarked on examining the functionality of his jaws. His jaw movements and excursions were within normal limits. No clicking of the jaws was present. His lateral Pterygoid muscles were slightly painful on palpation, so were the Occipital muscles and SCM muscles. On closer examination, I discovered that his jaw was just 2 to 3 mm out of synch. This was affecting his breathing capacity and his hip was out of level by about four Centimetres. It was decided to bring about symmetry with an appropriate dental appliance. This, the patient consented to wholeheartedly, as he had been suffering most of his life. An appropriate appliance was constructed and fitted, and he was prescribed some swallowing exercises.

This is his response about 4 days later, telling us about the dramatic reduction in his symptoms, which had been present for some 30 years!

S. B. Wed 3/13/2019 21:10
Hi Dr Amir,

My back has been good, thanks. It is much better, with only the odd twinge in my left hip. I managed the drive home, a 200-mile journey, on Sunday with no pain at all, which for me is remarkable as normally driving can be a struggle. I have also been sleeping much better and even when I do wake during the night, I have been much more comfortable than normal.
Many thanks again
Stuart

This is the latest response: I did complete your questionnaire update, but as all my current symptoms have all but disappeared over the last month, there were no results to update.

Here is a graphical representation of his recovery. Graph of sleep problem patients' recovery

Lesson learned:
One does not have to have classical TMJD to suffer from the effects of jaw asymmetry. In fact, "Jaw asymmetry" is the overriding factor. TMD or TMJD is one of the extreme facets of this asymmetry and may or may not be present. This is true across all age groups, especially children.

Likewise, sleep apnoea is also one symptom of a huge plethora of sleep disorders, as exemplified by the patient inputs below. Here are some examples of patients who do not fit into the sleep apnoea spectrum, and who form most patients with associated sleep disorders:

Best sleep and pleasant dreams
".......... One amazing improvement to mention is that my 20-year habit of clenching and grinding my teeth at night stopped after Dr Amir fitted my custom appliance, the next morning I woke without a headache and had the best sleep ever. I started getting a very deep sleep with pleasant dreams that I could remember. I started waking up much refreshed, while before I was fatigued in the mornings.

After twenty years of questions, Dr Amir diagnosed my problem in a matter of minutes and this is no exaggeration, and the proof of his treatment is that my overall health is feeling so much better. Dr Amir’s staff are friendly and knowledgeable, and his work is life-changing."
13th March 2019.
Paul writes further:
My 1st-night sleep after wearing Dr Amir’s appliance and following the exercises he recommended. I experienced the best sleep, no teeth grinding, no interrupted sleep, no jaw and tongue falling backward and no neck and jaw spasms, I felt relaxed upon waking after having slept for 6hrs uninterrupted. This was a total relief and felt wonderful. Sleeping before this was literally a nightmare, and would wake feeling more tired and fatigued than before sleeping, and would only sleep in fits and starts.
I also started to experience more detailed dreams which I cannot explain. This has continued throughout treatment.
Paul Swan - Ambulance driver-Scotland

Sleeping normally
"To be well enough to go out for dinner and enjoy myself around food was just wonderful. Ten years have passed since that time, and the girl who thought her life was over at 16 is now married with two beautiful children, happy and healthy, and able to do all the things I wanted to do in life. I can eat, sleep normally, exercise, work, look after my family, and live a normal life. I wouldn’t hesitate to recommend Dr Amir to anybody. If you’ve tried everything and nothing worked, Dr Amir will fix you."
Emma Hursit - London, February 2019

Sleeping deeply
"I began to get a lot of pressure and throbbing at the base of my brain, and by the time I found Dr Amir my breathing was restricted. I had to drag myself slowly across Putney Bridge from the tube station to reach him. Dr Amir spent some months correcting my dental arches. The first improvement I noticed was in the duration and depth of sleep. My breathing improved, although I seem to have some shrinkage of my diaphragm muscles. My energy levels improved."
Lucie Webb London

Recovery from excessive sleep
"I was initially seeking braces purely for cosmetic reasons. Dr Amir was convinced my sleep disorder was also related, and he seems to have been right! During my worst bout, I was sometimes sleeping as long as 16 hours, this hasn't happened in years now."
Jonathan Trotter, London

Much improved sleep
"I had been wearing appliances for 14 months, when suddenly I felt my teeth fall into a good bite for the first time ever. I nearly cried! My neck pain was relieved very soon after. My sleep is much improved, and I hope I can keep my teeth for much longer now that they are not constantly grinding each other down. Dr Amir and his small team have been wonderful. Dr Amir listens is highly skilled and really seems to care about his work. I am truly grateful to have found him."
Maria, Manchester

Recovery from chronic fatigue sleep
"By the end of two years of treatment, Jasmine’s fatigue is no longer there; she sleeps normal hours and has resumed her education, bringing about indescribable happiness to both of us. I do not want to even imagine what our life would have been like if we had not found the extraordinary doctor Amir, who made the impossible possible for Jasmine. He saved Jasmine from the bungling of conventional medicine and dentistry."
Y. Baird, London

The best night’s sleep
"Dr Amir always said it would be a long journey and the outcome not certain, but I was happy to go with it as the first removable brace he fitted resulted in the best night’s sleep I had had in ages."
Sarah Phillips London

Comment: At any given time, some 25% of people suffer from some sleep disorder. Dr Mercola says the following about the importance of sleep and how Sleep Is Critical for Brain Detoxification:

" - Sleep is deeply interconnected with your health in a myriad of ways. For example, previous research has found that sleep deprivation has the same effect on your immune system as physical stress or illness
- Recent research shows that your brain has a unique waste management system, similar to the lymphatic system in your body. This system, dubbed the glymphatic system, is activated during sleep
- By pumping cerebral spinal fluid through your brain’s tissues, the glymphatic system flushes the waste from your brain back into your body’s circulatory system and into your liver, where it’s ultimately eliminated.
- During sleep, your brain cells also shrink by about 60 per cent, which allows for more efficient waste removal
- Amyloid-beta, for example—proteins that form the notorious plaque found in the brains of Alzheimer’s patients—is removed in significantly greater quantities during sleep"

It is imperative that we learn everything to put right whatever is the cause of sleep disturbances for the proper health of our patients.

On a parallel subject, Professor Russell Foster For the Daily Mail published the following article on 28 January 2020:
"The only prescription you need to sleep like a baby: Feast on breakfast, exercise early and cover your bedside clock "
It is well worth reading and shows additional reasons for a good sleep, for all the insomniacs and those suffering from sleep apnoea.

Posted by M. Amir B.D.S., M.Sc. (U. Of London), L.D.S., R.C.S. (England)
© 2024 Dr M. Amir. All rights reserved.

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CONDITIONS OF USE AND IMPORTANT INFORMATION: This article is for educational purposes only. The improvement or benefits identified in this article or on this site are based on individual experiences which are dependent upon the patient’s unique health condition, medical history, and other individualised factors, and should not be considered representative of all treatment outcomes. You must do your own due diligence by consulting your physician before embarking on what may be suggested here. This information is meant to supplement, not replace advice from your doctor or healthcare provider, and is not meant to cover all possible uses, precautions, interactions or adverse effects. This information may not fit your specific health circumstances. Never delay or disregard seeking professional medical advice from your doctor or other qualified health care provider because of something you have read on this forum. You should always speak with your doctor or health care professional before you start, stop, or change any prescribed part of your health care plan or treatment and to determine what course of therapy is right for you.