| One-Minute Clinician

Sleep Dysfunction and Myofascial Pain

There is a tremendous interplay between sleep and pain and stress and function, adrenal glands, fatigue and healing. We're not as aware of the sleep issues as we need to be. All of our pain patients, with rare exception, have some issue with sleep. When we have pain, pain will wake us up when we turn over. And then the more pain we have, the more worry we have, the more stress we have, the less sleep we have. Sleep apnea will indirectly increase pain because as the patient goes into stage 3 sleep and they really start to relax, their tongue falls to the back of their mouth and obstructs their airway and they wake up in a panic. Now you have a tremendous cortisol release, the adrenal glands have responded, blood pressure goes up, and all the muscles have tightened, especially the ones that are causing pain.

One of the issues has been the shape of the mouth and the way that the mouth grows and where the tongue can hide or not hide. If there is not enough room in the mouth for the tongue, it goes back into the throat more and the airway gets compromised. So, what we can do in dentistry is palate expanders and mouth appliances to widen that upper arch, make more room for the tongue so it tends not to fall to the back of the mouth and compress the airway. We can also use CPAP and positive pressure. Whether that positive pressure is constant or whether it varies does make a difference in compliance and also seems to make a difference in how effective it might be, but these are ways to increase pressure to open the airway from outside rather than from inside. There's also a device you can buy for under $10 that holds your upper teeth and your bottom teeth and doesn't let your jaw come to the back. Many people can find help just with that inexpensive treatment.

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