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[CPAP] Face and Jaw Pain???
#1
Face and Jaw Pain???
I have been using my CPAP machine since August 2021.  I did not find it too difficult to get use to the machine.  I did feel extra tired for about 3 months when starting the machine but kept at it and did get over the initial hump and felt like it has made a difference with my fatigue.  However, about 2 months ago I started to have a lot of jaw and face pain.  I came across this research - https://pubmed.ncbi.nlm.nih.gov/20616213/ - about how the pressure from a CPAP machine can "change the craniofacial form by reducing maxillary and mandibular prominence and/or by altering the relationship between the dental arches."  On various sites around the web I have found that some people have dismissed this as an impossibility and others have claimed that their CPAP therapy did change the alignment of their teeth and jaw. Am wondering if I am having such issues?  It is weird in that when I wake up in the morning I don't seem to have any pain but as the day goes on the pain comes on gradually.  Today my lower jaw hurts below my lower front teeth, my tongue hurts, my check muscles and I am starting to get a headache.  I did go to my dentist who is checking with my insurance company to see if they will cover the cost of a splint to wear at night.  And I am suppose to start physical therapy for TMJ in about a week if my insurance will cover it.  The mask I have been using is a ResMed Airfit N30i.  I am wondering if my maximum air pressure is set too high at 15. I was having none of these issues before starting CPAP therapy.  Any feedback would be appreciated.  THANK YOU!

                                
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#2
RE: Face and Jaw Pain???
Where is the head pain? temporalis?

Do you feel that you clinch your teeth while sleeping?

I think it's possible to get some jaw issues due to the straps. For example, the full-face masks has the lowest placed straps that causes the bottom part of the mask to tug on the chin, and lower jaw. This may cause certain issues. Which is why I went with nasal masks.

Is it possible to try a few days without using CPAP? If you are required to be in compliance, you can just put it on for 4 hours you are free during the day and try not wearing it while asleep, and see if it improves your jaw symptoms.

I had issues after several months of usage, and I'm not sure what I can attribute it on. I had tried a different night guard at the time, and that might have messed me up, but it's also possible that it was the straps from using full-face mask over a period of time.

This is quite difficult to pint-point. Stress can be a possibility as well. Maybe a new stressor that's causing it recently. If you chew gum, I recommend never to chew gum again. I would also suggest filming yourself asleep and see any signs of clinching of teeth.
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#3
RE: Face and Jaw Pain???
(05-31-2022, 10:01 AM)CorruptAlligator Wrote: Where is the head pain? temporalis?

Do you feel that you clinch your teeth while sleeping?

I think it's possible to get some jaw issues due to the straps.  For example, the full-face masks has the lowest placed straps that causes the bottom part of the mask to tug on the chin, and lower jaw.  This may cause certain issues.  Which is why I went with nasal masks.  

Is it possible to try a few days without using CPAP?  If you are required to be in compliance, you can just put it on for 4 hours you are free during the day and try not wearing it while asleep, and see if it improves your jaw symptoms.  

I had issues after several months of usage, and I'm not sure what I can attribute it on.  I had tried a different night guard at the time, and that might have messed me up, but it's also possible that it was the straps from using full-face mask over a period of time.  

This is quite difficult to pint-point. Stress can be a possibility as well.  Maybe a new stressor that's causing it recently. If you chew gum, I recommend never to chew gum again. I would also suggest filming yourself asleep and see any signs of clinching of teeth.
I am uploading a facial muscle diagram that I have put blue boxes around the areas of pain.  When I wake up I do not feel my teeth clenching but the pain seems to indicate that I may be doing so.   The pain waxes and wanes in areas.  As I stated I don't seem to have the pain when I wake up.  It comes on slowly in the morning and sometimes gets worse over the day.  I was wearing the Philips DreamWear Full Face Mask when the issue started.  I did go awhile without using the CPAP and the pain did improve some.  Now I switched to the ResMed Airfit N30i, but the last 2-3 days have been worse than when I wasn't using the CPAP.  I did turn my maximum pressure down from 15 to 12 last night and things seem to be a little better today but it is early.  All of this seem to come on when I started using Guanfacine for my Hyperandrenergic POTS.  It caused terrible dry mouth and then the pain slowly came on.  I backed off of the med some and the dry mouth got better (still have a little bit at night) but I am still having this pain.  See my POTS doctor on Friday so going to discuss with her.  I have also noticed from the watch I wear at night that tracks various bodily functions that my heart rate is dipping rather low at night - average seems to be about 54.

   
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#4
RE: Face and Jaw Pain???
I'm quite sensitive to what's around my head. If I wear a cervical collar, I can't have the pointy parts pushing against my jaws on the sides. I think it cause my mouth to clinch.

Also, I cannot have straps positioned certain areas around my jaws, which causes my jaw to work in some ways. It's odd.

It is likely the new meds maybe causing teeth clinching. I would look into this first. Because teeth clinching is really really bad in the long term. Your jaws are very important. If it is the meds, you have to weigh what is really important. you need healthy jaws.

Other things to consider are trying out different types of nasal masks and see if any one relieves your symptoms. Something like N20, Wisp, Dreamwisp, N30, P10, etc.. N30 and P10 are worth a try due to very minimal straps. You'd likely have to adjust the pressure that's most comfortable to you (and gives good numbers) when you change masks.

It's probably a good idea to avoid full-face masks. Perhaps try out a cervical collar to see if it helps with your flow limitations?
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#5
RE: Face and Jaw Pain???
It does sound like you are having referred TMJ pain.  A lot of people with POTS have loose joints (hypermobility), OSA and TMJ pain too.  If you are hypermobile, you would be more sensitive to the straps and masks shifting your jaw, causing more or less obstruction, and potentially TMJ pain.

I have this problem myself, and, without a night splint I am an obligate mouth breather.  So, knowing I could not breathe well though my nose, I started with a full-face mask, which, to be fair, works well.  But I also got a mandibular advancement device (MAD) as I already knew I had a dislocating jaw and I both hoped I would not need the APAP (no such luck) and thought maybe it would stabilize my mandible like a night splint (it does).

Having paid big bucks for the MAD, I wanted to use it.  But it pokes into the cheeks with a full-face mask.  So, I tried a nasal mask, and lo and behold, with both the MAD (jaw positioning/keeps my mouth closed) and nasal mask (pressure) I can breathe great through my nose, and it is more comfortable than the full-face mask. But, with just a nasal mask and no MAD my O2 sat plummets, and I am back to mouth breathing with a full-face mask.

So, I wonder if you are having similar issues.  BTW, insurance is often more likely to pay if the splint is billed as a MAD.  (See my previous posts re the MAD, though one was sabotaged by the spellchecker, so substitute MAD for MAP in that one) Good luck!   Smile
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#6
RE: Face and Jaw Pain???
(06-01-2022, 12:08 AM)RainbowFish Wrote: It does sound like you are having referred TMJ pain.  A lot of people with POTS have loose joints (hypermobility), OSA and TMJ pain too.  If you are hypermobile, you would be more sensitive to the straps and masks shifting your jaw, causing more or less obstruction, and potentially TMJ pain.

I have this problem myself, and, without a night splint I am an obligate mouth breather.  So, knowing I could not breathe well though my nose, I started with a full-face mask, which, to be fair, works well.  But I also got a mandibular advancement device (MAD) as I already knew I had a dislocating jaw and I both hoped I would not need the APAP (no such luck) and thought maybe it would stabilize my mandible like a night splint (it does).

Having paid big bucks for the MAD, I wanted to use it.  But it pokes into the cheeks with a full-face mask.  So, I tried a nasal mask, and lo and behold, with both the MAD (jaw positioning/keeps my mouth closed) and nasal mask (pressure) I can breathe great through my nose, and it is more comfortable than the full-face mask. But, with just a nasal mask and no MAD my O2 sat plummets, and I am back to mouth breathing with a full-face mask.

So, I wonder if you are having similar issues.  BTW, insurance is often more likely to pay if the splint is billed as a MAD.  (See my previous posts re the MAD, though one was sabotaged by the spellchecker, so substitute MAD for MAP in that one) Good luck!   Smile
Thank you for the feedback. I am somewhat hypermobile. Certain areas of my body show some hypermobility but others not at all. I was never able to do the splits or any extreme bending. I have wondered about my jaw because when I was younger I was able to stick my fist into my mouth and I have a rather small mouth.  Does your jaw hurt when you first wake up?  This is one of the things that I find strange is that if I am clenching or grinding my teeth at night I would think everything would hurt when I first wake up.  Instead it comes on slowly over the morning so that by the afternoon I am usually in a lot of pain.  I do not find myself clenching my jaw during the day.
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#7
RE: Face and Jaw Pain???
Weirdly, I am not real hypermobile myself, but I have always had a popping jaw which started to get stuck open in my 20’s, so that is when I first got a night splint.  It worked great and stablized the jaw until the splint broke, and the subsequent one was a different type and I found it useless. I basically ignored the TMJ dislocating as it got looser because it stopped getting stuck open.  In hindsight not the best move.  Oh-jeez  I never have any jaw pain - maybe I would have been more compliant wearing a splint if I did - but in my family joints slowly get looser over the decades and by the time my mom was in her 90’s she could painlessly disarticulate all her fingers (Ick!).

So, I am not sure I am the person to comment on pain. But I do wonder if somehow the jaw is shifting slowly throughout the night and resetting slowly during the day.  It could the change that irritates it.  It may be that a splint would help give a more consistent position when it relaxes.  Just guessing though.

A word of caution if you consider any splint! Not all craniofacial providers are created equal. Beware providers with a financial stake in the MAD or for whom MADs/splints are a sideline. The semi custom mail order ones (like SnoreRx - and other brands) are not as comfortable, but are 10x cheaper, and could at least give you an idea of if one helps or hurts. A full face mask with a regular night splint (I like the ResMed F30i myself with a regular non-MAD night splint) could also be a good option, as you need no MAD to mess with your bite, or strap or tape for the mandible/mouth with that setup.  Sorry for the novel!  Coffee
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#8
RE: Face and Jaw Pain???
So just a follow up, I turned the maximum pressure down on my CPAP machine from 15 to 12 and then to 11. My numbers are actually better than they have been for awhile. The pain has slowly subsided over the last 4-5 days. I am still considering get the splint from my dentist if it is affordable so my teeth don't shift anymore.
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#9
RE: Face and Jaw Pain???
How has the pain been after this little while on reduced APAP max..? Did the splint help, too (if you went ahead with it)?
I’ve had X-rays over time which have showed facial bone changes due to high tension on the mask (I have high IPAP 90th which requires a strong grip to be effective in limiting leak), and over the years, I’ve moved from a ffm to nasal (pillows) combined with a splint and homemade chin/mouth/cheek strap to prevent mouth leak, and this combo seems to give the least amount of bony change over time. Each annual splint is becoming less different - this is how I can tell Smile
I do still have significant bone pain in my face and forehead every day, which arrives within a couple of hours after use, and usually lasts all day. I’ve never really worried about it to be honest - I’ve always put it down to the high IPAP 90th combined with high tension on my face and head from the gear.
It does create a lot of work for the dentist though - I crush splints quickly.
I don’t have POTS however I have autonomic damage (brain) which results in some similar (and some different) symptoms.
Just wondering how you’re going now Smile

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#10
RE: Face and Jaw Pain???
(06-20-2022, 06:07 PM)Peach25 Wrote: How has the pain been after this little while on reduced APAP max..? Did the splint help, too (if you went ahead with it)?
I’ve had X-rays over time which have showed facial bone changes due to high tension on the mask (I have high IPAP 90th which requires a strong grip to be effective in limiting leak), and over the years, I’ve moved from a ffm to nasal (pillows) combined with a splint and homemade chin/mouth/cheek strap to prevent mouth leak, and this combo seems to give the least amount of bony change over time. Each annual splint is becoming less different - this is how I can tell Smile
I do still have significant bone pain in my face and forehead every day, which arrives within a couple of hours after use, and usually lasts all day. I’ve never really worried about it to be honest - I’ve always put it down to the high IPAP 90th combined with high tension on my face and head from the gear.
It does create a lot of work for the dentist though - I crush splints quickly.
I don’t have POTS however I have autonomic damage (brain) which results in some similar (and some different) symptoms.
Just wondering how you’re going now Smile

Thanks for your reply.  Since turning down the max. pressure on my CPAP from 15 to 11 the pain has completely gone away.  I didn't end up getting the splint - 1. Because of costs and insurance will not cover and 2. The discomfort went away.  Although even before CPAP therapy my bottom teeth had started to shift so thinking of trying to get some sort of mouth guard to wear at night that might help to stop continued shifting.  Dentist is suppose to get back to me.  I also switched to a different sleep doctor who is now going to see if I can get a full sleep assessment. The other doctor I had refused to try and help me get my insurance to cover this and would only allow me the home study.  The new doctor said the full sleep study would help to assess more accurately what the pressure needs to be on my machine.
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