Jaw/throat clenching negating CPAP therapy

[jeff123816]

So I have been on CPAP for two and a half years, and in that time, I have been struggling to find any benefit to CPAP therapy. My sleep study concluded that I have a sleep index of 40 arousals per hour. No centrals, and, in fact no real apneas- all hypopnias. For the last couple of years I have been back and fourth to sleep doctors, trying to determine why I am not feeling any better on CPAP. I would also wake up in the morning with horrible back pain from the bottom of my spine,all the way up to my head. Went to back doctors who could find nothing structurally wrong with my back. Session after session of physical therapy without results.

Finally, this year, I began reading about TMD and noted that I had a lot of soreness in the classic TMJ areas of my head. My jagged teeth indicated grinding. Went to a neuromuscular dentist who fit me with a $5000 splint (insurance wouldn't pay, but I was desperate at that point).I began feeling some relief immediately and I began paying attention to my jaw habits a little more. After maybe two weeks of feeling really good and rested every day, I slowly began returning to my fitful, painful sleep, even while wearing the splint. While I no longer have pain in the classic TMJ areas of my jaw and head, the horrible pain in my neck and back has returned. This time, however, I have been a little more aware of my jaw when I fall asleep or wake up and recently, I have just become conscious of, what I believe, to be the root of my problem: When I fall asleep, I have caught myself beginning to clench my teeth and pressing my tongue up to the roof of my mouth, with a pressure that I can hardly believe I'm capable of producing. This, in effect, while causing what is similar to a gagging sensation, opens up my throat for air to pass through. I have no doubt that I developed this habit unconsciously throughout many years of untreated sleep apnea. When I lay down, I have an insatiable urge to clench my teeth and push my tongue up as hard as I can, even when conscious. Although, with the CPAP, I have no problem breathing at night without doing this, I cannot stop myself from contracting these muscles in my throat and neck while I'm unconscious. Last night I counted almost 48 times that I woke up, fully conscious and in a great deal of pain. This is in addition to the fitful, restless sleep that I get when unconscious. The weird thing about all of this is that, in any given week, I will generally have 4 nights of horrible, painful, restless sleep, and on average, 3 nights of absolutely perfect sleep. Sometimes it's more and sometimes less. I don't know what it is that sets me off. I don't believe it's stress because there doesn't seem to be any correlation... I may sleep great after a particularly stressful day of work and then I will have a horrible night following a day of relaxation. It doesn't make sense.

My sleep doctor titrated me at a pressure of 9.0 cm and I currently use autopap at a range of 8.0-12.0. He has had my pressure all over the map, including setting it up as high as I could stand, in an attempt to stop this reflex of my throat. Nothing has worked. At this point, he has said that my problem is beyond his expertise and that I need to see a pain specialist, who, in turn, has recommended more physical therapy. I feel like this is the wrong path to take, because I have tried physical therapy many times, without any improvement.

I went back to my neruomuscular dentist and she recommends that I try a sleep apnea oral appliance to use in conjunction with CPAP (another $2000 that the insurance refuses to cover) but admits that this is just a guess on her part. She doesn't know if it will truly be of any help. I don't know what the next move should be. I haven't found a doctor that really knows what do to in a case like mine. I was wondering if anyone else had a problem similar to this... any suggestions?

[robysue]

jeff123816,

I use a BiPAP (since Sept 2010) and am currently undergoing treatment for my own TMJD problems under the care of a dentist who specializes in treating TMJD and other causes of facial pain; he is actually considered "in network" for my regular health insurance.

My own TMJD therapy involves a $1600 splint (which I was fortunate enough to have insurance pay for) and a pretty intense plan of getting my TMJ's the "rest" they need to heal as well as retraining my muscle memory on how/where my lower jaw should close.

For the first 2 1/2 weeks I wore the splint 24/7 with the only time it was taken out was to brush my teeth and to clean the spint. And I was put on a "no chew" diet. I had my 2 1/2 week follow-up today. The verdict was mixed: I'm not making enough progress fast enough to start weaning me off the 24/7 wear period (yet) because I haven't been using moist heat enough each day. But I have made enough progress to advance to a "soft chew" diet. And I have a follow-up in another 3 weeks. But I'll still be on a soft chew diet for a while: If there's enough progress towards healing the joint and relieving the pain by that appointment, I'll be able to take it out for about 2 hours after every meal or some such thing for another 2 1/2 to 3 week period. Then (if things go as planned) there will be a period of wearing the device half days, and then another period of wearing it half days every other day. And slowly I'll be allowed to start chewing more dense and harder foods. And at the end of the weaning period---i.e. when I'm only wearing the splint at night, there is likely going to be some physical therapy prescribed for me to do (jaw exercises, no doubt) to help make sure that I don't re-injure the TMJs by falling back into the clenching/grinding habits that caused the problems in the first place. The whole thing could take as long as six or seven months before I'm just wearing the guard at night.

I bring all this up because you say:

Finally, this year, I began reading about TMD and noted that I had a lot of soreness in the classic TMJ areas of my head. My jagged teeth indicated grinding. Went to a neuromuscular dentist who fit me with a $5000 splint (insurance wouldn't pay, but I was desperate at that point).I began feeling some relief immediately and I began paying attention to my jaw habits a little more. After maybe two weeks of feeling really good and rested every day, I slowly began returning to my fitful, painful sleep, even while wearing the splint.

I'm wondering: Did the neuromuscular dentist just fit you with that $5000 splint and then just tell you to "wear the splint when you are sleeping"? Or did/does she have a well thought out plan for using the splint to help heal the TMJ in the first place? If there was a whole plan, what did it consist of? And how far into the plan are you?

How much of the time were you wearing the splint during those two weeks of feeling good and rested? Just at night? Or did you have instructions to wear the splint at least part of the time during the day? Did the return of the restless, unrestorative sleep coincide with a change in how long you were wearing the splint during each 24 hour period?

And how long ago did you get the $5000 splint?

All the best in trying to deal with the difficult combination of serious TMJ pain and CPAPing

Robysue

[Elvin]

jeff123816,

I use a BiPAP (since Sept 2010) and am currently undergoing treatment for my own TMJD problems under the care of a dentist who specializes in treating TMJD and other causes of facial pain; he is actually considered "in network" for my regular health insurance.

My own TMJD therapy involves a $1600 splint (which I was fortunate enough to have insurance pay for) and a pretty intense plan of getting my TMJ's the "rest" they need to heal as well as retraining my muscle memory on how/where my lower jaw should close.

For the first 2 1/2 weeks I wore the splint 24/7 with the only time it was taken out was to brush my teeth and to clean the spint. And I was put on a "no chew" diet. I had my 2 1/2 week follow-up today. The verdict was mixed: I'm not making enough progress fast enough to start weaning me off the 24/7 wear period (yet) because I haven't been using moist heat enough each day. But I have made enough progress to advance to a "soft chew" diet. And I have a follow-up in another 3 weeks. But I'll still be on a soft chew diet for a while: If there's enough progress towards healing the joint and relieving the pain by that appointment, I'll be able to take it out for about 2 hours after every meal or some such thing for another 2 1/2 to 3 week period. Then (if things go as planned) there will be a period of wearing the device half days, and then another period of wearing it half days every other day. And slowly I'll be allowed to start chewing more dense and harder foods. And at the end of the weaning period---i.e. when I'm only wearing the splint at night, there is likely going to be some physical therapy prescribed for me to do (jaw exercises, no doubt) to help make sure that I don't re-injure the TMJs by falling back into the clenching/grinding habits that caused the problems in the first place. The whole thing could take as long as six or seven months before I'm just wearing the guard at night.

I bring all this up because you say:

Finally, this year, I began reading about TMD and noted that I had a lot of soreness in the classic TMJ areas of my head. My jagged teeth indicated grinding. Went to a neuromuscular dentist who fit me with a $5000 splint (insurance wouldn't pay, but I was desperate at that point).I began feeling some relief immediately and I began paying attention to my jaw habits a little more. After maybe two weeks of feeling really good and rested every day, I slowly began returning to my fitful, painful sleep, even while wearing the splint.

I'm wondering: Did the neuromuscular dentist just fit you with that $5000 splint and then just tell you to "wear the splint when you are sleeping"? Or did/does she have a well thought out plan for using the splint to help heal the TMJ in the first place? If there was a whole plan, what did it consist of? And how far into the plan are you?

How much of the time were you wearing the splint during those two weeks of feeling good and rested? Just at night? Or did you have instructions to wear the splint at least part of the time during the day? Did the return of the restless, unrestorative sleep coincide with a change in how long you were wearing the splint during each 24 hour period?

And how long ago did you get the $5000 splint?

All the best in trying to deal with the difficult combination of serious TMJ pain and CPAPing

Robysue

o really he took 5000 bucks dont u think u it was very costly how long ago??

[NightMonkey]

jeff123816

You need to take a serious look at this:

http://www.centerforsoundsleep.com/blog ... c-balance/

and

http://drugfreepainhelp.com/

Be sure to watch several of the videos - this will take some time.

■For information on finding a qualified Oral Systemic Balance practitioner, contact Dr. Farrand Robson’s office at 800-977-1945.

I am assuming you had a different brand of appliance. If it was OSB, please let me know because I have only seen positive results with OSB so far.

[jamiswolf]

Hi Jeff,
Sorry you're having such difficulty. I find it odd that it seems to be cyclical and have no ideas on why that would be.

I would certainly think that along with the appliece you received, some drug intervention might be in order...to sort of break the cycle.

I'm thinking either a muscle relaxer or pain medication and perhaps even some sleep medication.

I have a little difficulty with my jaw and was thinking about getting an inexpensive tooth guard like for bruxism or even a sports tooth guard. What happens with me is that my jaw is not comfortable when my teeth are touching. So when I wear a chin strap, I'm constantly fighting it to hold my teeth about 1/4" apart...just enough to get the tip of my tongue through. And then my jaw area muscles get tired and sore.

I know this doesn't directly relate to your issues but I thought I'd mention them. Do you use a chin strap?
Good luck,
Jamis

[saltyk9]

jeff123816

You need to take a serious look at this:

http://www.centerforsoundsleep.com/blog ... c-balance/

and

http://drugfreepainhelp.com/

Be sure to watch several of the videos - this will take some time.

■For information on finding a qualified Oral Systemic Balance practitioner, contact Dr. Farrand Robson’s office at 800-977-1945.

I am assuming you had a different brand of appliance. If it was OSB, please let me know because I have only seen positive results with OSB so far.

Have you used OSB or are currently using OSB???

[cflame1]

You might think that this is crazy... but the thing that got rid of the pain for me and keeps it at bay is a specific type of massage therapy. It's called cranial-sacaral therapy (sp?). It'll quite literally put me out while having it done it's that relaxing. They literally work on your head and your neck. I have one of those massages every couple of weeks, use my machine and my bite guard and I'm good.

Pre-TMJ treatment (which was long before XPAP treatment) I would have extreme headaches to the point that they almost put me on long term disability.

[Brent22]

Yes my dog have the same issue last year i have visited so many people for this problem finally physical therapy helped me but it took so much time about 3 months total waste......

[Brent22]

Yes in this scenario massage therapy really helped us to recover one of my uncle have had the same issue basically they lived in the country yard they took him to the therapist and the therapist helped him so much.........