Understanding TMJ Disorder

TMJ disorder affects the joints and muscles that control jaw movement. This can lead to symptoms like pain, difficulty chewing and even locking of the jaw. Despite these clear indicators, TMJ disorder often goes undiagnosed. In a study by Johansson et al. (2002), it was found that 6.7% of males and 12.4% of females experience TMJ-related pain. Additionally, data from the National Health Interview Survey in 1993 revealed that 3.5% of males and 6.9% of females reported experiencing pain in the jaw joint or in front of the ear on multiple occasions over six months. These statistics highlight a gender disparity in TMJ disorder prevalence that underscores the need for better understanding and treatment options.

The Role of Medical Training in TMJ Awareness

The limited awareness of TMJ disorder can be traced back to the training of healthcare providers. Very few dentists and medical professionals receive adequate education on TMJ disorders, which contributes to the lack of comprehensive care available for sufferers. This lack of training means the condition is often misdiagnosed or not recognized at all. As a result, many patients do not receive the specialized care they need, leading to ongoing pain and discomfort. Increasing TMJ-specific training in medical and dental programs could significantly improve diagnosis and treatment outcomes for patients. Many physicians tell their patients that it is not something they can see and refer them to other healthcare providers like an ENT, PT or Osteopath doctor.

Common Misdiagnoses and Overlapping Symptoms

TMJ disorder is frequently mistaken for other conditions due to its overlapping symptoms, such as headaches, ear pain and neck tension. For instance, the Osteoarthritis Initiative (2007) discovered that 3.8% of males and 10.9% of females aged 45-79 with a history of knee pain also reported jaw joint or ear pain in the past 30 days. This finding suggests that TMJ pain can easily be confused with other joint disorders, leading to inappropriate or delayed treatment. Educating healthcare providers to recognize these overlapping symptoms can help differentiate TMJ disorder from other conditions and prevent unnecessary treatments.

These overlapping symptoms often result in TMJ disorder being misdiagnosed as more common conditions like migraines, ear infections or even dental issues unrelated to the temporomandibular joint. Headaches caused by TMJ disorder can mimic migraines, making it difficult for both patients and doctors to identify the root cause without specialized knowledge. Ear pain, a common TMJ symptom, is often misattributed to ear infections, particularly in the absence of visible signs of ear problems. Neck tension and pain can lead to a misdiagnosis of cervical spine issues, diverting attention away from the actual problem in the jaw.

Tinnitus — hissing, buzzing and/or ringing in the ears — is often a TMJ problem. This is why an MRI is so critical in determining what the problem is. If the articular disc has slipped forward of the jaw bone (the condyle), this can readily push the condyle back and into the region of the ear. This is where so much ear pain and tinnitus can come from. The problem is that it requires an early enough diagnosis before nerves are damaged badly enough that they cannot be repaired. The TM joint is heavily innervated, meaning if the discs are slipped, they could readily damage the nerves surrounding the joints.

Healthcare providers’ limited training in TMJ disorders compounds these misdiagnoses. Very few dentists and doctors (not all) have the expertise needed to identify TMJ disorder accurately, leading to a cycle of incorrect diagnoses and ineffective treatments. Patients may undergo multiple consultations and treatments for symptoms that never fully resolve because the underlying TMJ disorder remains unaddressed. I have personally heard many stories of patients going on antibiotics for months on end to treat ear problems, or having tubes placed, when the real problem was simply a slipped disc.

Improving the education of healthcare professionals about TMJ disorder is crucial for better diagnosis and management. When doctors and dentists can more accurately identify TMJ disorder, they can provide appropriate treatment plans tailored to alleviate the specific symptoms associated with the condition or refer to a specialist. Addressing this educational gap can significantly reduce the incidence of misdiagnoses and ensure that patients receive the care they need for lasting relief. It is our mission within our practice to do so.

The Impact of Public Awareness Campaigns

Public awareness campaigns are essential for bringing TMJ disorder into the public eye. Increasing awareness can help individuals recognize symptoms early and seek the appropriate care they need. Currently, TMJ disorder has not been prominently featured in widespread public health campaigns, leaving many people unaware of its existence and impact.

Raising awareness can lead to several positive outcomes. Firstly, it can prompt individuals to seek medical advice sooner, potentially leading to earlier diagnosis and treatment. Early intervention can prevent the condition from worsening and improve the quality of life for those affected. Secondly, heightened public awareness can create a demand for more specialized care, encouraging healthcare providers to develop expertise in TMJ disorders. This, in turn, can lead to more comprehensive and effective treatment options.

Public campaigns can also help dispel myths and misconceptions about TMJ disorder. Many people might dismiss their symptoms as insignificant or believe that jaw pain is a normal part of life. Educating the public about the seriousness of TMJ disorder can help people understand that their symptoms are valid and treatable. By providing clear information about the symptoms, causes and available treatments, public health campaigns can empower individuals to take control of their health.

Additionally, increased awareness can foster a sense of community among those who suffer from TMJ disorder. People may feel isolated or misunderstood because their symptoms are not widely recognized. Public awareness initiatives can connect individuals with support groups and resources, offering a network of understanding and shared experiences.

Moreover, raising public awareness can influence policymakers and funding bodies to allocate more resources toward TMJ research and treatment. Increased funding can lead to breakthroughs in understanding the disorder and developing new, more effective treatments. By spotlighting the issue, public campaigns can drive systemic changes that benefit everyone affected by TMJ disorder.

Public awareness is a great beginning. This is a big reason we reach out to our referring providers to provide educational classes on how to screen. In addition, with our practice, we educate the patient as well. We show on models how the disc behaves and how it is affecting the patient and causing their symptoms. In addition, Dr. Brown participates as a guest speaker at seminars for healthcare providers to share cases and show how the symptoms relate to the rest of the body. The goal is always to educate and share screening techniques. This translates to how we help these patients with their craniofacial pain.

The Importance of Specialized Care

Managing TMJ disorder effectively requires specialized care from professionals who understand the condition’s complexities. TMJ disorders often involve a variety of symptoms that can be influenced by hormonal factors, especially in women. Research has shown that women who use either supplemental estrogen or oral contraceptives are more likely to seek treatment for TMJ disorders. This suggests that hormonal changes could exacerbate TMJ symptoms, making it even more crucial for healthcare providers to consider these factors when diagnosing and treating the disorder.

Additionally, TMJ disorders can be interconnected with other conditions such as fibromyalgia, rheumatoid arthritis and sleep apnea. A specialized approach can help identify these connections and tailor treatment plans accordingly. This is why a multidisciplinary approach often proves beneficial, involving dentists, orthodontists, rheumatologists and other specialists to provide comprehensive care.

In-depth knowledge of TMJ anatomy, pathophysiology and the latest treatment options is crucial for creating effective treatment plans. This includes understanding the role of physical therapy, occlusal appliances and surgical interventions when necessary. Specialized care can also focus on pain management techniques tailored specifically for TMJ-related pain, which may differ from standard pain management approaches.

By seeking care from professionals trained in TMJ disorders, patients are more likely to receive accurate diagnoses and effective treatment plans. This specialized care can lead to significant improvements in quality of life, reducing symptoms such as chronic pain, headaches and jaw dysfunction. Given the complexity and the broad impact of TMJ disorders, specialized care is not just beneficial but essential for those affected.

The actual treatment for people with TMD usually involves wearing some small appliances in the mouth that allow room for the discs to go back into place if they can. If they are unable to return to their proper position, it may be possible to manage them or do surgery to finally fix the problem. In almost all cases, surgery can be avoided and the patient can live a very normal lifestyle with displaced discs. This is why it is important to meet with a TMJ doctor who understands all the various issues.

The Future of TMJ Research and Treatment

The future of TMJ research and treatment is filled with potential advancements that could revolutionize care for those affected by this disorder. Ongoing research aims to uncover the underlying causes of TMJ disorders, which could lead to the development of more targeted and effective treatments. One promising area of research involves genetic studies, which may help identify individuals at higher risk and facilitate early intervention.

Advances in imaging technology, such as MRI and 3D CT scans, are improving our ability to diagnose TMJ disorders accurately. These tools allow for a more detailed understanding of the joint’s structure and any abnormalities present, leading to more precise treatment plans. Additionally, innovations in minimally invasive surgical techniques offer new options for patients who require surgical intervention, potentially reducing recovery times and improving outcomes.

Interdisciplinary collaboration is becoming increasingly important in TMJ research. By bringing together experts from fields such as dentistry, rheumatology, neurology and physical therapy, researchers can develop a more comprehensive understanding of TMJ disorders and create holistic treatment approaches. This collaborative effort can also lead to the discovery of connections between TMJ disorders and other conditions, such as sleep apnea and chronic pain syndromes, allowing for more integrated and effective care.

Telemedicine is also emerging as a valuable tool in the management of TMJ disorders. Virtual consultations can make specialized care more accessible, especially for patients in remote areas or those with mobility issues. This technology enables continuous monitoring and follow-up, ensuring that treatment plans are adjusted as needed to achieve the best outcomes.

The role of patient education and self-management is gaining recognition in the treatment of TMJ disorders. By providing patients with the knowledge and tools to manage their condition, healthcare providers can empower them to take an active role in their care. This approach can include techniques such as stress management, dietary modifications and exercises to improve jaw function.

As awareness of TMJ disorders increases, so too will the availability of funding for research and treatment development. This financial support is crucial for driving innovations that can ultimately improve the quality of life for those affected by TMJ disorders. With continued effort and investment, the future holds promise for more effective, accessible and comprehensive care options.

We Are Here To Help!

At Sleep & TMJ Therapy, Dr. Jeffrey Brown and the team are here to help you get the care you need for TMJ disorder symptoms in Falls Church, Virginia. Call 703-821-1103 to learn more or schedule a consultation.

The post The Mystery of TMJ Disorder Explained! first appeared on Sleep & TMJ Therapy.

Unmasking the Culprit: What Is Sleep Apnea?

Gather ’round, health enthusiasts and nocturnal adventurers, for a tale most troubling yet all too common. Our villain tonight is not one of folklore, but a foe that lurks in the shadows of our bedrooms: sleep apnea. This dastardly disruptor of dreams is no mere snorer’s complaint but a bona fide breathing brouhaha that turns rest into a restless endeavor.

In the realm of slumber, sleep apnea is the thief that steals your breath away—literally. Imagine, if you will, your body taking a pause on breathing, not just once, but perhaps hundreds of times throughout the night. These pauses are not dramatic pauses for effect but rather, perilous periods where oxygen and your body part ways, leaving you gasping and grappling for air.  This happens because the muscles in the back of the throat relax and cause the airway to narrow or close as you are breathing. The brain kicks in and briefly rouses you causing you to wake up, snort, choke or make gasping sounds. These reactions are so quick you may not remember. The effects create the inability to reach a restful state causing you to be tired during the day.

There are three known accomplices in this nighttime heist: obstructive, central and complex sleep apnea syndromes. The most notorious of the trio, obstructive sleep apnea, plays its hand when the muscles at the back of your throat decide to take an ill-timed siesta, collapsing and blocking the very airways they’re supposed to protect. Central sleep apnea, the more insidious cousin, sees the brain forgetting its lines, failing to signal the muscles to breathe. Then, in a twist of fate, complex sleep apnea syndrome enters, blending the characteristics of its kin, proving that sometimes, the whole is indeed more menacing than the sum of its parts.

So, there you have it, a peek behind the curtain at the antagonist of our nighttime narratives. Sleep apnea, in all its guises, waits in the wings, ready to turn your sleep into an unintended adventure.

The Ripple Effect: How Sleep Apnea Affects Your Health

Ladies and gentlemen, fasten your seatbelts and prepare for a journey into the shadowy impacts of sleep apnea on your health. This insidious condition does more than just pilfer your Z’s; it embarks on a nefarious quest to undermine your well-being, one breath at a time. Think of it as the health equivalent of a computer virus, silently corrupting your system while you’re none the wiser.

Imagine, if you will, your body as a bustling city. Sleep apnea is the unexpected traffic jam causing chaos on the roads, leading to a domino effect of problems citywide: high blood pressure, heart disease and stroke.  These are the pileups on the freeway, slowing down emergency services and causing widespread distress. Diabetes? Consider the power outage at the traffic lights, throwing crossroads into disarray. Depression sneaks in like the creeping fog, clouding judgment and dampening spirits.

Sleep apnea directly correlates with higher risks of cardiovascular disease. The National Health Institute found high blood pressure, diabetes, heart disease, heart attack and stroke can occur if not addressed. In addition, this increases the risk of heart rhythm problems known as arrhythmias. Arrhythmias can lower your blood pressure. Your poor little heart just can’t pump enough oxygenated blood to the brain and becomes overworked.  This is why you are tired.

But wait, there’s more. The Mayo Clinic found risk factors that increase this development to be: excessive weight, older age, having a narrow airway, hypertension, chronic nasal congestion, smoking, diabetes, family history and asthma.  This condition doesn’t stop at the metaphorical city limits. It extends its reach to the jaw, stirring up trouble in the form of temporomandibular joint (TMJ) disorders. Sleep apnea often causes the body to naturally push the jaw forward. This motion of the jaw moving back and forth causes stress and tension within the masseters. This in turn increases TMJ problems. Another aspect let’s not forget is inflammation, the silent alarm that signals something is amiss in the body. Together, they form a formidable gang, wreaking havoc and leaving a trail of health woes in their wake.

In the grand scheme of things, sleep apnea is not just a nighttime nuisance but a health hazard with far-reaching consequences. The key to thwarting this villain lies in recognizing its presence and taking action. Because in the battle for your health, knowledge and intervention are your greatest allies.

Knight in Shining Armor: Treatments That Can Help

Fear not weary sleepers, for our tale of nocturnal nuisance, need not end in despair. The kingdom of sleep science offers a veritable armory of solutions to combat the villainous sleep apnea, each weapon more innovative than the last. Leading the cavalry charge against this nightly adversary is my team and I. We start with a CBCT X-ray and an at-home sleep test. I always recommend this to my patients. The first tool is an X-ray. This diagnostic tool allows us to measure the airflow and see the skull highlighting the neck and jaw area. The sleep test (insurance may require an in-lab) gives us the AHI (Apnea Hypopnea Index). If severe (AHI ≥ 30 per hour) the knight in shining armor is the CPAP machine delivering a constant airstream to keep the pathways of breath open. For those with minimal (AHI < 5 per hour), mild (AHI  ≥ 5, but < 15  per hour), or moderate (AHI ≥ 15, but < 30) the knight is an oral sleep appliance. This appliance pushes the jaw forward opening the airway. This is a great option for those who prefer their armor a bit less conspicuous. Think of it as a dental retainer with a PhD in airflow management.

Lastly, let’s not forget the foot soldiers in our battle for uninterrupted slumber: lifestyle changes. Though they may not carry the immediate clout of their mechanical and surgical counterparts, their contributions to the war effort are invaluable, often preventing the enemy from gaining ground in the first place. Posture is a major player in breathing — be aware of keeping your neck and head straight at all times and you will breathe better. It’s that simple. Weight loss could also be a benefit.

Armed with these interventions, sleep apnea’s days of unchecked tyranny are numbered. Choose your weapons wisely, consult with the wise wizards (also known as sleep specialists), and prepare to reclaim the night.

Breathing Easier: Tips for Improving Nighttime Breathing

Ah, the quest for serene slumbers and untroubled breathing! For those embarking on this noble journey, fear not, for there are strategies aplenty to enhance your nocturnal respiration. First and foremost, let’s talk about your sleeping posture. Much like choosing the right dance partner, selecting the side-lying position over the back or stomach can lead to a more harmonious relationship with your airway. Imagine your body as a flute; when positioned correctly, the music (or in this case, air) flows freely.

Next, consider the siren’s call of the evening libation. While tempting, alcohol and sedatives are akin to inviting a bull into the china shop of your throat muscles; they relax them just a tad too much, leading to an increased chance of obstruction. Opt instead for a soothing herbal tea, which plays more nicely with your body’s internal orchestra.

And in the realm of the corporeal kingdom, maintaining a fortress at a healthy weight acts as a formidable defense against the siege of sleep apnea. Excess weight can add pressure on the throat, narrowing the airway’s halls, and inviting trouble to your nightly repose. Did you know that your tongue can harbor fat? Well, it can, and if it does this will actually block your airway.

Transform your bedroom into a haven for slumber with a few lifestyle tweaks that could rival any fairy tale. If you’ve ever envied Sleeping Beauty for her effortless dozing, worry not. Your castle awaits, no wicked fairy required. First, banish the blue light brigade. Yes, your kingdom of screens – smartphones, tablets, laptops – emits a glow that could keep even the sleepiest heads wide awake. Swap out scrolling for a book (the kind with actual pages) and watch your eyelids grow heavy with the promise of dreams.

Next, create a bedtime ritual more sacred than the royal coronation. A warm bath, some gentle yoga or a few minutes of meditation can signal to your body that it’s time to wind down. Think of it as lowering the drawbridge and preparing the castle for nightfall.

Temperature plays a court jester in your quest for quality sleep, too. Keep your sleeping quarters cool, akin to a crisp, autumn evening in the enchanted forest. Your body’s internal thermostat will thank you, offering deeper sleep as tribute.

Lastly, for the realm’s finest slumber, consistency is key. Keep to a sleep schedule as diligently as a knight adheres to his quest. Hitting the hay and rising with the sun at the same times daily sets your internal clock to ‘serene’, paving the way for restorative rest.

By implementing these strategies, not only do you stand a better chance at defeating the nefarious sleep apnea, but you also set the stage for a night where dreams can indeed come true, free of unwanted interruptions.

The Dream Team: When to Seek Professional Help

Should the specter of sleep apnea start haunting your slumbers, it’s time to call in the big guns: your healthcare dream team. We are seasoned professionals, equipped with their arsenal of sleep studies and diagnostic tools, and stand ready to dive deep into the mysteries of your nocturnal disturbances. A sleep study, whether it’s an epic adventure in a high-tech lab or a solo quest at home, is the key to unlocking the secrets of your sleep patterns. It’s like having your own personal detective agency, investigating the who, what, when and why of your interrupted breathing. With this report, our team can tailor a battle strategy uniquely suited to vanquish your sleep apnea, transforming restless nights into peaceful slumber. Remember, in the saga of sleep, you’re the hero, and it’s perfectly okay to call for reinforcements. After all, even superheroes work best with a little help from their friends.

Dr. Jeffrey Brown, and the rest of our team at Sleep & TMJ Therapy are here to help you get a good night’s sleep with sleep apnea treatments in Falls Church, Virginia. Please call our office at 703-821-1103 to learn more!

The post Sleep Apnea: The Unsung Villain in Your Nighttime Story first appeared on Sleep & TMJ Therapy.

The testing that is done for sleep apnea is through a test called a Polysomnogram. This entails hooking you up to a bunch of wires that will analyze sleep quality and snoring as well. It also measures how much desaturation of oxygen occurs and how often. The problem with the Polysomnogram (PSG) is this; let’s say you slow or stop breathing perhaps five times each hour of the night, yet that slowing, or cessation, lasts for several minutes, not just 20 or 30 seconds. Your apnea index will be the same, regardless of whether you stop breathing for 10 seconds or 10 minutes! In other words, you need to look at how long the breathing ceased or slowed to understand how serious the problem is.

When a person performs the PSG, a number called the Apnea Hypopnea Index (AHI), is generated. If that number is 0-5, it is considered mild apnea, and no treatment is indicated. If that number is 5-15, the apnea is moderate, and a CPAP is usually prescribed as the gold standard of treatment. If the apnea index is above 15, then the apnea is considered severe and most definitely the CPAP is required. In many cases, people who have a hard time wearing the CPAP can benefit greatly by wearing a dental appliance that opens and brings the jaw forward. Studies indicate that 93% of the people prefer this over the CPAP. It is easier to wear and much more portable. Carrying that bulky CPAP machine is hard to do when you travel.

Another interesting aspect of sleep apnea is that it often correlates with TMJ  disorder. When the jaw joint discs are slipped off, i.e. displaced, this creates chronic inflammation that can tighten up the throat and make the apnea worse. It is my belief that if you are going to go through all the trouble of the PSG and sleep analysis, you really should look at any underlying issues with the TM joints. As it turns out, most people with TMD (TMJ Disorder) also have underlying distortions to their cranial bones (the bones in the skull) and this can cause the neck to turn or twist. The twisting of the neck can then impede the airway. These are all the things we need to look at.

Just to add more to the mix, a critical aspect of sleep involves knowing what your Vitamin D₃ levels are. This is important because D₃ is actually not a vitamin, it is a hormone, and it controls aspects of your sleep. A simple blood test will reveal your D₃ levels. In most people, the D₃ is well below the bare bones minimum of  30 ng/ml. This is not healthy, and you simply will not sleep. Your D₃ needs to be around 60-80 ng/ml yet most doctors are not really aware of this.

As you can see, dealing with sleep apnea means we need to look at more than just what the PSG tells us. You need to talk to the doctor, then look at the numbers. The more information you gain, the more likely you can get improvements in sleep and overall health!

Getting Help

Dr. Jeffery Brown can help you with your sleep apnea symptoms.  Please call our team in Falls Church, Virginia to schedule your consultation. Please call 703-821-1103 today!

The post Breathing in the Night: Understanding Sleep Apnea and Its Fundamentals first appeared on Sleep & TMJ Therapy.

AHI- Apnea-Hypopnea Index

The Apnea-Hypopnea Index (AHI) is a diagnostic tool used to assess the severity of sleep apnea, a sleep disorder characterized by pauses in breathing or periods of shallow breathing during sleep. The AHI measures the number of apnea (complete pauses in breathing) and hypopnea (partial reductions in breathing) episodes that occur per hour of sleep. It is calculated based on data collected during a sleep study, known as polysomnography.

Here’s how the AHI is categorized in terms of sleep apnea severity:

-0-5 is considered none to mild.
-5-15 is moderate.
-15+ is considered severe apnea.
-UAR: Upper Airway Resistance – blockage in the upper airway.
-MSLT- Multiple Sleep Latency Test – naps to see sleep efficiency.
-OSA: This is obstructive sleep apnea.
-PSG: Polysomnograph – the sleep apnea test.
-Multiple leads are placed over various muscles to see how they react while asleep.

Visible and Audio Symptoms for Adults and Children

If a spouse or parent sees or hears a person snoring, gasping or waking up a lot, then the HST, Home Sleep Test, is indicated to determine if apnea is present. Look for big circles under the eyes. Subjective symptoms include the following:

-Tiredness during the day and daytime drowsiness.
-Overwhelming urge to take naps.
-Difficulty falling or staying asleep.
-Unusual breathing patterns and movement patterns while falling or during sleep.

Epworth Sleepiness Scale Questionnaire

The Epworth Sleepiness Scale (ESS) is a questionnaire used to assess daytime sleepiness. It provides a measure of a person’s general level of daytime sleepiness or their average sleep propensity in daily life. The scale was introduced by Dr. Murray Johns in 1991 as a simple, self-administered questionnaire.

The ESS consists of eight questions, each asking the respondent to rate, on a scale from 0 to 3, their likelihood of dozing off or falling asleep in different common situations that vary in terms of their somnolence-inducing potential. The situations include passive activities such as sitting and reading, watching TV, sitting inactive in a public place, being a passenger in a car for an hour without a break, lying down to rest in the afternoon, sitting and talking to someone, sitting quietly after a lunch without alcohol, and being in a car while stopped for a few minutes in traffic.

-0-7 is unlikely abnormally sleepy.
-8-9 is the average daytime sleepiness.
-10-15 is excessively sleepy, depending on the situation.
-16-24 is continual, excessive sleepiness.

The Breathing Triangle?

The “Breathing Triangle” refers to three key areas of the face that are essential for optimal breathing: the two nostrils and the mouth. This concept is often discussed in the context of health and wellness, specifically in relation to sleep and breathing disorders such as obstructive sleep apnea (OSA). This involves both nostrils and the throat and the two points make up the inverted triangle. If the top of the triangle is blocked (the nostrils) then the breathing is compromised.

(MSLT) Multiple Sleep Latency Test

The Multiple Sleep Latency Test (MSLT) is a diagnostic tool used in sleep medicine to measure the speed at which a person falls asleep in quiet daytime situations. It is often used to diagnose narcolepsy and other disorders associated with excessive daytime sleepiness.

Your Sleep Visit

We take your vitals, note neck measurements, etc. At the initial visit, the vitals are the same as TMD: BP, Oxygenation, Pulse, Neck measurement, BMI, and pH. At each visit, the ROM (range of motion) is measured, discuss your symptoms, mostly subjective on how you feel you are sleeping with the appliance. If your spouse is present, we will ask if snoring still occurs.

At the 3-12 Month Markers From Delivery

At three months we run a new HST (home sleep test) and titer the appliance forward by 0.5mm and Dr. Jeffrey Brown will adjust the strap. The HST will be performed again six months after the last visit until no more apnea or snoring is reflected. The 12-month check after the last visit will be more of a review, then once each year thereafter with a new sleep test every 2-3 years.

As you can see, Dr. Brown and our team take your sleep health seriously. If you would like to read more, check out our Sleep Apnea Therapy page. If you would like to schedule an appointment, please call 703-821-1103 to speak with a friendly member of our team!

The post What You Should Know About Your Sleep Numbers first appeared on Sleep & TMJ Therapy.

There are so many issues involved with SDB that it would take pages to explain, so in this short blog, we will review some of the major players in the equation.

The symptoms of SDB include morning headaches, night terrors, teeth grinding, polyuria (lots of bathroom visits at night), mood changes (irritability during the day), cognitive difficulties, restless sleep, gasping/snorting while asleep, and periods of outright cessation of breathing. As you can see, SDB is a very serious matter and needs to be addressed.

Let’s start with how to measure SDB. To get somewhat of a handle on the problem, a fairly simple test called the PSG (Polysomnogram) can be done. The PSG produces a number that allows an assessment of how serious sleep apnea might be. It’s sort of similar to getting a blood pressure number. For sleep apnea, if the number goes above 5-15, the apnea is considered to be moderate. Anything over 15 is generally considered severe apnea and needs to be addressed right away. A CPAP is usually the first course of treatment, and if a patient cannot handle wearing the CPAP, a dental sleep appliance usually works quite well.

As part of a good sleep analysis, the Vitamin D3 level should be analyzed carefully. The reason for this is that D3 is not really a vitamin, it is actually a hormone that regulates your sleep. If the D3 number is around 30 ng/ml or below, you are running really low and should address the problem. The proper number for good healing and good sleep is around 60-80 ng/ml. If you maintain a very low D3 level over time, eventually your body stops the ability to process D3 and you will have lots of problems with sleep later in life.

Snoring is another SDB issue that is very common in our society. Snoring is created by a harsh sound that occurs when the tissue is vibrating as you breath. This can turn into a chronic problem causing a vibration of the carotid artery, and this can cause damage to the artery to the point where your body sends plaque to fill in the damaged areas. If a plaque loosens and goes to your heart, then a cardiovascular event, even death, can occur. Snoring can be caused by a condition having fat deposition in the throat and tongue, nasal congestion, deviated septum, or even enlarged tonsils and adenoids. These factors can lead to snoring and prevent a good night’s sleep.

Another important aspect of good sleep is a very much ignored thing called sleep hygiene. That’s right; how clean, how good is your sleep pattern? What this means is that if you can program your body into going to bed at a regular time each night, your body will get used to that pattern and sleep more effectively and efficiently. Good sleep can be prevented by other factors such as:

-Sleep Disturbance: This is mostly caused by stress, insomnia and even excessive screen time.

-Poor Diet: Food is obviously a very important part of fuel for our body. With a poor diet, nutritional deficiencies become present, like the vitamins and minerals your body needs.

-Dehydration: This affects the function of your body’s organs and blood volume. The effect makes you feel tired.

-Psychological: This could be stress from work or a traumatic event causing a considerable degree of uneasiness leading to your mental health and exhaustion.

As you can see, when sleep is poor, you will be tired. It’s as simple as that.

If you are experiencing any of these symptoms, Dr. Jeffrey Brown and our team are here to help. We offer sleep apnea therapy in Falls Church, VA. Please give us a call if you would like to learn more, or to schedule a consultation. Just call our office at 703-821-1103. Better sleep awaits you!

The post Why am I Always Tired? first appeared on Sleep & TMJ Therapy.

One of the best things, just for starters, is to consume enough water to keep your cells functioning as best as possible. The rule of thumb is that whatever your body weight is, cut that in half and that is how many ounces of water you need daily just to survive. For example: a 140-pound person needs at least 70 ounces of water per day. The water from your refrigerator filter is usually the best unless you can afford the fancy glass bottles at exorbitant rates.

Another factor in good sleep is getting enough Vitamin D3. You see, D3 is not a vitamin. It is actually a hormone that regulates your sleep. Vitamin D receptors, together with the activating enzymes (hydroxylase) control the activation and degradation (waste) being expressed during the sleep cycle. This is also an important item to help produce melatonin. This hormone is involved with the circadian rhythm, an important aspect of the sleep cycle. If your D is too low, you simply cannot sleep. The D level is determined by drawing blood and then the lab analysis is done. The results will tell you what level you have. Generally, 30 ng/ml is the bare bones minimum. Most people are either below or pretty close to that. If you are low then the recommendation is to take 5000 IUs of D-3 with K2 per day and then re-assess in three months.

Vitamin D3 and K2 are taken together for best absorption in the body. Vitamin K2 is generally not produced in sufficient amounts within our bodies. Achieving a healthy level of vitamin K2 will support our heart, blood circulation and bones. While vitamin D is well understood, the importance of K2 is not so known.

Sleep hygiene is a sort of new term that is in vogue these days. What this basically involves is your body’s ability to sleep efficiently. This involves your behavioral practices and environmental influences to obtain a healthy habit of falling asleep. Some sleep problems are caused by bad habits but to start the change a person needs to go to bed around the same time each day and wake up around the same time the next morning. If the bad habits have been reinforced over many years, then a better night’s sleep may take longer to be affected. Proper hygiene also means not drinking caffeine in the late afternoon and not consuming too much alcohol in the evening hours. A rule I tell my patients is to follow the 10,3,2,1 Rule:

-10 Hours Before Bed: No More Caffeine

-3 Hours Before Bed: No More Food or Alcohol

-2 Hours before Bed: No More Work

-1 Hour Before Bed: No More Screen Time (phones, TVs, Computers, etc)

As one leader of a campaign for sleep and mental well-being asserted, supported by the Mental Health Foundation, the author created the 5 principles of good sleep health: Value, Prioritize, Personalize, Trust and Protect one’s sleep.

In cases where the sleep apnea index (the AHI) is sky-high, the gold standard for treatment is the CPAP (Continuous Positive Airway Pressure). This is a device that forces the air down your throat and into the lungs to make sure you are breathing. It is quite effective in lowering the apnea index but can cause stomach bloating and even dry mouth or eyes. For most people, if they commit to wearing it, they can greatly benefit. For other folks, the CPAP is quite difficult to wear and since it really inhibits your movements at night, it can be a real bother.

A new device that just came on the market is the hypoglossal nerve stimulator. It basically involves a surgical procedure to embed a small shock wire into the hypoglossal muscle in your tongue and if and when the tongue falls back at night and closes your airway, it shocks the tongue into popping out of your mouth and thus opens the airway. Shocking, to say the least.

A much better approach to treating apnea is the Panthera device. It is made by a dentist and is an anti-snoring and opening airway device by bringing your chin forward (just like in doing CPR) to widen the breathing passage allowing for more air. This in turn reduces the potential of snoring. This appliance is customized to your mouth and is also adjustable. It is very effective and easy to wear. For most people, it does the job as well as a CPAP and, in some cases, even better.

There are many other ways to deal with apnea, and most of these are surgical, but the above ideas are simple and generally quite easy to implement for most people. If you would like to learn more about Sleep apnea and your oral health, please give our Sleep & TMJ Therapy team a call at 703-821-1103. Our dedicated dentist in Falls Church, Virginia, Dr. Jeffrey Brown, has been successfully helping patients with sleep apnea get a great night’s sleep!

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If you snore or wake up gasping in the middle of the night, you really should consider having at least a HST-Home Sleep Test- done to see if you are in the range of sleep apnea. In most cases, you would do the home test to get the basic indicators to see if there is more of a problem than meets the eye. The test will reveal a number called the AHI-Apnea Hypopnea Index. If that number is between 0 and 5, there is a very low risk of apnea. If the number is over 15, then it is usually labeled as moderate to severe apnea. AHI refers to how many times you either stopped or slowed breathing each hour of the night.

The problem with sleep apnea is that your brain does not get enough oxidation to function properly. Often this can manifest as a morning headache. Other manifestations of apnea include cardiovascular disease, high blood pressure, stroke, diabetes and even some cancers. When the brain and body do not receive proper oxygen supply, systems in the body begin to shut down. This is when disease processes can set in and now you have to deal with daily meds for diabetes or high blood pressure. Many times, some of these meds prevent the good, deep sleep that we need for better health. Painkillers are notorious for allowing us to fall asleep, yet they prevent the deeper, restorative sleep that is critical to good health.

So, what are some of the warning signs that you might have sleep apnea? One clear sign of potential OSA (Obstructive Sleep Apnea) is waking up with a headache regularly. This oftentimes means that your brain is not getting enough oxygen and it lets you know by making your head hurt when you first wake up. This is serious stuff – deal with it. Other indicators include restless legs and even gasping for air in the middle of the night. Your brain jolts you into waking up so that you can breathe and get some oxygen into the body. Other signs include waking with a dry mouth or even a sore throat.

A really strong sign of OSA is excessive daytime sleepiness. Again, your body is warning you of a potential problem and you really need to listen. Another symptom is trouble focusing during the day. As you can see, OSA is a serious problem and it’s wise to deal with it. Get the proper help you need from someone who understands sleep apnea. Please call our team in Falls Church, Virginia to schedule a visit with Dr. Brown. Call 703-821-1103 today!

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Sleep apnea is a condition with multiple symptoms and even more treatment options. When a person sleeps at night, they should stay asleep all night with minimal movement and there should be no snoring. Unfortunately, many people these days snore and have little control over this. Snoring can be a symptom of obesity or might be present in even the slimmest people – there is no true rhyme or reason here. The best way to diagnose the problem is to do a sleep study – a polysomnogram. This requires wearing all sorts of wires across the head and neck for a two-night study in most cases. Then a board-certified sleep MD reads the results. Without getting too technical, the measurement achieved is called the AHI – Apnea Hypopnea Index. If the AHI is quite high, then the usual first measure is to wear a CPAP – continuous positive airway pressure – to force the air into the lungs. For some people, it really works well,  yet for others, it just cannot be tolerated.

Depending on who the doctor is,  the next level of treatment is usually a dentist-fabricated device that opens the jaw and brings it more forward – just like if you did CPR on a person. The dental sleep device is a very good way to help open the airway in most mild to moderate apnea cases. Sometimes the device is used along with the CPAP to allow the machine to use less pressure to get the air into the lungs.

There are many other techniques to help sleep apnea cases – they involve surgery to cut away the palatal area – often referred to as UPPP (Uvula Palatal Pharyngeal Plasty) or even balloon plasty to just temporarily open the airway. Another surgery is called MMA -Maxillary Mandibular Advancement. This effectively brings the upper and lower jaws forward permanently. Beware of these surgeries as they might disrupt the TM joints. Other techniques include various medications that serve many different purposes.

Recently, HNS (Hypoglossal Nerve Stimulation) has been developed. This involves putting, for lack of a better word, an electrical ‘shock’ wire into the hypoglossal nerve in the tongue, then running a wire down the inside of the neck to a battery pack under the skin just below the collar bone. As with any surgical procedure to do an implanted device, there are risks associated with the procedure. Once the therapy is turned on, what happens next is when the patient has an apneic event, the sensor detects this and sends a ‘shock’ and in turn the tongue begins jutting forward to open the throat. Some people seem to tolerate this technique fairly well, others not so much. Some patients may experience discomfort from the stimulation, notice tongue abrasion, experience mouth dryness, or experience discomfort from the presence of the device. Overall, this is a relatively simple technique. The question brought up there is some concern that after a year or two the tongue may no longer be responsive to the shock wire.

Overall, there are many treatments for sleep apnea and no one system of therapy is right for every patient.  Based on the AHI, the most non-invasive treatment, a dental sleep appliance,  does still work and is highly recommended.

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Why is sleep important? When the body does not sleep well, it is far more likely that disease processes can begin. As anyone knows, when your body is just tired all the time, it is far more likely you will catch the flu and infections are far more likely to set in. This is the case with cancer as well. When your body is debilitated from lack of sleep it is easier for cancer to set in.  There is now plenty of research to support this. If you simply Google ‘cancer from sleep apnea’ you will find that with moderate to severe sleep apnea, you are two and a half times more likely to develop cancer and three times more likely to die from cancer. This is a serious statement. What this means is that if you are not sleeping well, you are far more likely to contract kidney cancer, melanoma, breast cancer, and uterine cancer. Even though the risk of lung or colorectal cancers is less, it is just not worth the risk when you do not sleep well. TMJ disorder affects not only your joints but impacts the quality of sleep. A confirmation from UVA hospital’s research is that good sleep has been confirmed to be key to good health. With good sleep, the lymphatic system is regulated, and in turn, helps regulates many immune systems.

So, what is the message of this little blog? The message is to pay attention to your body. If the jaw joints are causing pain – headaches, neck or back pain, or even dizziness and tremors – then pay attention and have it looked at by someone who understands the situation. And this has now opened up another proverbial can of worms: Who do I see? TMJ disorder is so poorly understood that there is no consistency in diagnosis or treatment. So please stay tuned as the next blog will delve into the devious world of diagnosis and treatment.

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Did you know that your tongue can hold fat deposits, just like your belly? If you were ever overweight in the past, your tongue would likely have fat deposits in it, and these are kind of hard to lose. The tongue, like any other muscle in the human body, needs to exercise. But like most patients who are referred to a myofunctional therapist, they don’t go, they won’t do it. It costs money and time, and they feel like it’s kind of silly to exercise this area of the body. Well, folks, it does work and does make lots of sense, so get out there and start exercising that tongue!

In so many cases where a patient has sleep apnea, the tongue is quite large and is full of fat tissue. This can readily be seen on an X-ray that shows the tongue and what can be seen is that the tongue is elevated because it is thick due to fat deposition. Like so many areas of the human body, if you exercise the tongue and surrounding tissues, the fat will decrease over time which will effectively open the airway for better breathing. Snoring usually reduces as well as the tongue becomes smaller and tighter. The tissues around the tongue also become more toned with these exercises so if you have sleep apnea, it might reduce as you exercise this area over time. In fact, in many of the dental sleep medicine training programs, it is taught that myofunctional exercises are mandatory to improve a patient’s health.

There are other obvious benefits to exercising your tongue.  Your speech and articulation of words are improved, caused by the weakness in the tongue. If you have Dysphagia (trouble swallowing), your ability to develop a stronger tongue able to move more easily and then swallowing becomes easier. Finally, another plus is the jawline. Tongue exercises include the muscles groups below the chin and toning of the jawline begins.

So once again, dear reader, consider sticking out your tongue and making it work like it has never worked before. Get that tongue at attention! Get that tongue out there into the real world! Make that tongue healthier, happier, and improve your life!

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