OT: Reporting from the TMJ wars

[robysue]

Folks who have been following my saga about my long and drawn out adaption to xPAP therapy know that I've been dealing with four distinct, but interrelated, conditions that aggravate my (lack of) sleep on a pretty regular basis: The infamous CPAP-induced insomnia monster (who is slowly being tied up for good I hope), chronic migraines and a variety of other headaches, seasonal allergies, and TMJ problems.

Today I started a new adventure in therapy: The TMJ specialist I was referred to back in July has not only designed a special TMJ orthotic device, but has also devised two to three months of therapy designed to help my long abused TM joints actually start healing from the damage that's accrued through the years by my over tight muscles and ligaments that have also caused the clenching and grinding.

The tests done earlier this summer showed that my TMJs both dislocate every time I close my mouth when my molars are touching, but they slip back into place with very loud audible (and sometimes quite painful) pops when I start to open my mouth OR when I shift my jaw forward slightly so that my lower incisors are hitting the backside of the top incisors pretty close to the cutting edge of the tooth. And throughout all the years I've been gnawing through night guards, apparently the cause of my gnawing was my jaw trying (in vain) to get my lower teeth to settle into a place that was more stable for the TMJs: The standard guards allow (possibly encourage) my jaw to pull back to where my molars are touching and my bottom incisors are not touching the back of my top ones at all. And through the years, this position for my jaw unfortunately encouraged the muscles and ligaments attached to the TMJ to spasm and shorten and tighten through the years and resulted in my TMJs starting to dislocate every time I closed my mouth.

The new guard has a place for my lower teeth to fit into and an acrylic tab that fits against the back of my lower incisors. This allows the new guard to keep the jaw ever so slightly forward in a more natural position and stable position for my TMJs. Even with that tab for the back of the lower incisors, the new guard is not much bigger than my old one. So talking is not overly difficult, except for a lisp when trying to pronounce s's. Which is good, because: For the first 2 1/2 weeks I have to wear the guard 24-7 taking it out only to brush my teeth and the guard. And I'm on a "no chew" diet. Not quite a liquid diet, but no chewing or biting into anything with my front teeth---so as to allow my TMJs to start healing and to help stretch those over tight muscles and ligaments out. After that, there will be a couple of weeks of not wearing the guard after finishing eating and a "soft diet". Then more time with wearing the thing half days (and continuing to wear it at night). And then some physical therapy and exercises designed to strengthen those muscles to help keep the joint stable. At the end of two or three months, I should be down to wearing the guard only at night or---in the best of outcomes---not at all.

As to how all this relates back to BiPAP and OSA: Well the tech who fit the new device said that there's a good chance that with the new orthotic pulling the jaw a bit more forward that it will help keep my airway just a bit more open at night. That should help the BiPAP do a better job of keeping the airway open AND that should allow the BiPAP to stay at the lower pressures that my stomach can tolerate. And with a bit of luck, it may help end the intermittent snoring that still occurs a couple of nights a week, which will also keep those BiPAP pressures down where my tummy can tolerate them! And that can only help my ability to get decent, restful sleep at night.

And on other tangent: It's a good thing this TMJ guy has a staff that can figure out how to properly code things. My insurance company, which pays only 50% of my xPAP and xPAP supplies, pays 100% of the cost of the TMJ orthotic. Which is good because this little baby is almost as expensive as my BiPAP at just over $1500. Of course the real question is why would they chose to fully cover the TMJ orthotic and not the xPAP equipment. Treating the TMJ problem will improve the quality of my life by reducing pain, but most likely will NOT prevent any truly nasty stuff like heart disease, strokes, HBP, type II diabetes, etc. But we all know a major reason for treating the OSA is to try to prevent or mitigate all those nasty comoridities. So why would an insurance company pay 100% for the TMJ orthotic to treat facial pain, but only 50% of the machine and supplies to treat OSA?

[msradar65]

Glad to hear you will be getting some relief. I hope it works well.

[ems]

My insurance company, which pays only 50% of my xPAP and xPAP supplies, pays 100% of the cost of the TMJ orthotic. Which is good because this little baby is almost as expensive as my BiPAP at just over $1500. Of course the real question is why would they chose to fully cover the TMJ orthotic and not the xPAP equipment. Treating the TMJ problem will improve the quality of my life by reducing pain, but most likely will NOT prevent any truly nasty stuff like heart disease, strokes, HBP, type II diabetes, etc. But we all know a major reason for treating the OSA is to try to prevent or mitigate all those nasty comoridities. So why would an insurance company pay 100% for the TMJ orthotic to treat facial pain, but only 50% of the machine and supplies to treat OSA?

Hmmmmmmm?? Interesting.

Hope this works well for you.

[cflame1]

Robysue,
At least you don't have to wear it 24X7 for a year like I did with my first TMJ splint.

[saltyk9]

Good luck.

I wear a lower TMJ orthotic that brings my jaw further forward as well. I have been wearing it 24/7 for the last 7 months, taking it out only to brush it and my teeth.
I have been relieved of 'almost' all of my pain from it, but still suffer from sleeping issues which includes massive clenching during my sleep. This occurs both with and without CPAP. I also have a stuffed up ear constantly. I can pop it, but it plugs right back up within 1 second. Hasn't been unclogged for more than 1 second for the past 6 years. This is my current battle..

[robysue]

Of course it's early.

But so far so good. A bit of teeth sensitivity, which is to be expected according to the tech and which makes sense to me as a long veteran of braces in my long ago youth. The jaw itself is enjoying having the new orthotic in the mouth. Absolutely no jaw pain. The muscles are tired, but not sore. And the popping seems to have all but disappeared. Talking is getting better, but I'm still lisping the S's. The "no-chew" diet is difficult. We had crustless quiche for supper last night---not a favorite of mine, but it was OK for the diet. I really missed the crust. And it seems as though so many of the "soft chewless foods" are either sweet (pudding, flavored yogurts, ice cream, milk shakes) or really bland (cream of wheat for breakfast this morning). So I'm developing a real craving for something salty and crunchy. Hubby is making homemade mashed potatoes for supper. (He makes superb mashed potatoes---far better than mine.) I'll likely salt them much heavier than normal.

Sleep last night was the best *by far* this week. Both in terms of insomnia and apnea:

On the insomnia side: Got to bed at 2:20 and slept till 7:30 with only ONE wake---Woo-hoo! So that's about 5:10 hours of time in bed with about 4:50-5:00 hours of actual sleep time and only one wake. A very good night insomnia wise.

On the apnea side: An AHI of 0.6 comprised of 2 CAs and 1 OA (if I recall correctly)

And at 7:30 I was WILLING to get up even though I'd not gotten to bed until 2:20. And I felt pretty decent and awake until the campus senate meeting started. I'm a campus senator. It was a boring meeting. One of the administrators droned on and on about the enrollment numbers. Important to the college, but very, very boring and sleep inducing. I am afraid I may have fallen asleep briefly a couple of times. Not good.

Snoring was down from the last two nights so the aerophagia was also not a problem this morning. Still not as low as I'd like that snoring to be, but I'll take what I can get.

[Muse-Inc]

Sounds promising! I wore a custom-fitted bite plate 24x7 'cept for eating and brushing teeth and it for gosh, seems like 2 yrs or so. It moved my jaw forward about 1/8 of an inch if I remember correctly. My dentist was one of the very first in Atlanta to study this new TMJ condition -- that's how long ago it was! Turns out he took the training along with one of the docs in the back clinic I frequented for pain following a back fracture. Took 3-4 hrs with TENS on my jaw muscles to get them relaxed enough for him to fit the device. After getting mine, within a few days my chronic headaches lessened and that weekend I could swim overhand (crawl) which I hadn't been able to do for yrs -- I was thrilled. Mine back then was adjusted every several months to create more jaw movement. My jaw had been dislocated to remove 4 impacted, infected wisdom teeth (Rooster's narrow jaw cause of apnea strikes again ). Dentist said I'd likely have to wear that the rest of my life maybe just to sleep in if my jaw changes remained stable. I was lucky, within 6 months after we determined that my jaw changes were stable, I was able to stop wearing it altogether and my jaw position has remained stable for um, 30 yrs or so. I wish you the same good results RobySue!

[Brent22]

The new guard has a place for my lower teeth to fit into and an acrylic tab that fits against the back of my lower incisors. This allows the new guard to keep the jaw ever so slightly forward in a more natural position and stable position for my TMJs. Even with that tab for the back of the lower incisors, the new guard is not much bigger than my old one. So talking is not overly difficult, except for a lisp when trying to pronounce s's. Which is good, because: For the first 2 1/2 weeks I have to wear the guard 24-7 taking it out only to brush my teeth and the guard. And I'm on a "no chew" diet. Not quite a liquid diet, but no chewing or biting into anything with my front teeth---so as to allow my TMJs to start healing and to help stretch those over tight muscles and ligaments out. After that, there will be a couple of weeks of not wearing the guard after finishing eating and a "soft diet". Then more time with wearing the thing half days (and continuing to wear it at night). And then some physical therapy and exercises designed to strengthen those muscles to help keep the joint stable. At the end of two or three months, I should be down to wearing the guard only at night or---in the best of outcomes---not at all.

Yes i agree with u i have seen so many people having physical therapy for strengthen their muscles and it is quite helpful for their joints and bones.......