TMJ *and* FFM xPAP?

[MoneyGal]

It seems like the TMJ for which I have been treated on and off for the past 20 years has returned. I am having classic (for me) TMJ symptoms: sore, aching jaw and severe headaches (and I know my OSA is not to blame for the headaches; I consistently have no leaks and AHI numbers below 2.)

Does anyone here use both a CPAP with full face mask AND a TMJ mouthguard?

My current dentist has fitted me with a mouthguard in the past. However, I haven't even seen her since my OSA diagnosis. Is there anything she or I need to know about OSA and TMJ mouthguards in order to make this work for me?

Any advice or stories very welcomed.

[judyhorowitz@aol.com]

I just use the bite plate with the cpap. No problems. Of course I do wake up with a dr ymouth because i'm a mouth breather. That is a problem.

[MoneyGal]

Judy -- what kind of mask do you have?

I guess I am going to have to take my mask in and see if I can fit a bite plate and a full-face mask. I mean, I think I can; I just don't want to spend the money on a bite plate if I can't make it work with CPAP treatment. But neither do I want to continue with TMJ pain and headaches. I am hardly functioning today, and I'm pretty sure it's all TMJ-related.

[slapmeawake]

I use a FF mask and also have a dental bite guard. I usually don't have a problem but if I overtighten the mask I can tell my jaw gets sore. Try loosening your mask. Also I use Pad a Cheek pads on the straps and that really cushions the mask against my face. Also at first I was having trouble and I used to use the bite guard one nite on and one nite off. Now I am used to it and wear it every nite and have no problems. Good Luck.

[cflame1]

I use a variety of FF masks (usually just the Hybrid though) and a bite guard without any problems (and I have TMJ)

[KSMike]

I've had comparatively minor TMJ pain for at least 30 years, but it got bad almost immediately after I started CPAP. I couldn't understand why until I began to realize I was thrusting my jaw forward all night in an attempt to keep leaks to a minimum.

I had a full mouth guard made by my dentist which I wore a total of one night. With my Quattro it was just too much "stuff" on/in my face and although one night is meaningless I just didn't feel like it was going to help. So he made me an NTI device which is much more minimalistic - just fits between your front 2 teeth - and that did help. I was able to wear it with the Quattro without much trouble at all. For me, I haven't had any TMJ pain now in several weeks. I think the biggest thing for me was recognizing what was causing it (the thrusting), concentrating on complete relaxation of my face before falling asleep, massaging the TMJ area a few times during the day, letting the warm shower run on it, etc. The NTI device acted as a sort of "band aid" while the relaxation techniques took effect.

[jeff123816]

I wanted to bump this because I am having the same problem as the original poster. I have been on APAP with a pressure of 8.0-12.0 for almost a year now. My AHI is below 2 and leak is almost zero with my Liberty mask properly tightened. The problem is that ANY pressure on my jaw seems to make the muscles in my neck and jaw flair up like crazy. I toss and turn all night and wake up feeling absolutely horrible. This has been going on for such a long time, the fatigue is starting to make me feel like I am losing my mind... I have been doing things like putting orange juice (instead of milk) in my cereal and and sideswiping parked cars on the road. The doctors insist that my numbers are good and that it is all in my mind. But it is almost as if I had not used the CPAP machine at all. If I loosen the straps of the mask any more than I have, it leaks around the mouth like crazy and I get no therapy. I have gone trough every mask available, including regular nasal pillows but my mouth opens at night. The taping of the lips was a disaster. I just can't seem to make anything work. I've been to see a dentist about a oral appliance. I have what is considered "severe" apnea. He says that an oral appliance could get me an AHI of approx 10. That is not very good but I am considering it because I don't know what else to do. I have no problem with the CPAP pressure itself. I've gotten used to the air blowing up my nose but the pain in my jaw and neck is preventing me from getting any sleep. My sleep doctors at Stanford are absolutely useless. They have been prescribing pain killers and sleep aids. They have no idea what to do and can make no suggestions. Does anyone have any experience with this problem?

Thanks,
Jeff

[cflame1]

do you have a bite guard... and are you wearing it with your FFM?

Besides, these masks shouldn't need to be tightened so much that it hurts. I know my hybrid doesn't.

[jeff123816]

I don't use a bite guard. I've tried one from a drug store that is designed to remedy bruxism but I don't think I am clenching my teeth as much as I am, perhaps, pulling my jaw back. I don't know why I do this but it is all night. The mask is not very tight at all. It just that it obviously puts some pressure against my lower jaw. It's not a lot but it's enough to cause my body to react in this way. With any less pressure, the mask leaks severely, around my mouth and chin.

[cflame1]

I use a bite guard from the dentist... it's less expensive than a dental device for sleep apnea.

The bite guard goes on... then the mask goes on.

If your mask has to be that tight to keep from leaking... then it's not the right mask for you. There are masks that don't have to be so tight that it hurts.

[jeff123816]

I really don't know what to do at this point. I have been through EVERY mask that my provider has available. Nasal pillows are the only masks that don't leak. But when I use those, my mouth opens and I get no treatment. The chin strap aggravates my TMJ. The standard full face masks don't work because they say that I have "sensitive" skin and I get a welt at the bridge of my nose. The hybrid/liberty masks leak like crazy, both around my mouh and at my nose. Even the slightest movement makes everything come loose. My provider says that I am difficult to fit because I am skinny (I'm tall but pretty lean) and that most full face masks are made for people with more mass in their faces. They can't suggest anyhing else to me but meanwhile, even though my AHI is below 2, I am waking at least 25 times a night (that I'm conscious of) to correct the leaks that continually develop with the liberty. I don't know what to do. It has been a year on CPAP and I have NEVER had any consistancy. If I am lucky, I may have one good night per month. They say my apnea is severe and caused mostly by the tounge and so a dental device would not be sufficient. Surgery wouldn have less than a 30% success rate for me. No one can give me any suggestions and, at 30 years old, I am already in danger of losing my job due to poor performance, simply from being so tired and unable to concentrate.

Are there any FFM's for skinny people or people with narrow faces? Are there any other ways of keeping one's mouth closed while on nasal pillows, that don't involve putting pressure on the chin and jaw?

[calamityjane403]

Jeff - I have TMJ pain as well as other mouth and facial pain. I have been on CPAP for about 4 1/2 months and have gone through 5 masks trying to find one that will work and not give me so much pain. I have been using the Respironics EasyLife mask for about 2 1/2 weeks now and I love it. You don't have to have the straps tight in order to get a good seal. My sleep doc (who has apnea and uses a cpap himself) recommeded the EasyLife or the Resmed Activa (another nasal mask).

[ozij]

The way the hose is routed often makes a big difference in leaks.

Take a look at this thread:
Rested Gal's LINKS to Hose hangers and methods of managing the air hose viewtopic.php?t=10640

[jeff123816]

I appreciate the suggestions. The Easylife seems to only be a nasal mask, is that right? Part of my problem is that I open my mouth at night, so I don't think it would work for me. Like I said, the nasal pillows (swift mask) worked great and I didn't have any TMJ problems. But because I open my mouth, I don get any therapy.

[calamityjane403]

Yes it is a nasal mask not a ff. I know there are some people on this board who tape their mouths shut. I think they use the blue painters tape.