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[Treatment] I have TMJ Syndrome and mask straps can aggravate it.
#1
I have TMJ Syndrome and mask straps can aggravate it.
Hi Ya'll, I have TMJ Syndrome and Myofascial pain related to that. I am new to CPAP and all this. But not the pain, that usually happens at night. I am using a Dreamwear Full Face Mask..full face because I mostly breathe thru my nose but also my mouth. I have gotten the Medium mask to fit well, but the straps pull on my jaw and put pressure on my face at times, which can trigger the pain and tension. 
So, a few things, I am wondering about trying a nasal mask or I'd like to find a full mask that doesn't have straps that will put pressure on my face and jaw. My dentist was talking about Botox injections and I have had steroid injections before that helped. She is also looking for me for a specialist here in Apnea and TMJ.  I guess my questions are, How have you( that also have these issues) dealt with this? What masks work best for you...and does it affect your pressure settings? Do any of you see a specialist about this? I have just learned too, that TMJ and Apneas are connected. I had no idea! But it makes sense. 
I live in Zapopan Mexico. It's in Jalisco, in west central Mexico. We are part of the Guadalajara Metroplex. Thank you in advance for your help!
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#2
RE: I have TMJ Syndrome and mask straps can aggravate it.
You have a lot going on there.

I start with your mask requirements. In order to, successfully, use a nasal or nasal pillow mask, you have to get your mouth breathing under control. This is something you will have to work on during your awake hours.

Your anatomically correct mouth position is tongue placed against the roof of your mouth, just behind the ridge. Lips together, touching lightly, teeth apart slightly.

The tongue position is vital. If correctly in position, you should be able to open your mouth and no air will escape (nasal mask necessary to perform this test).

From there look at nasal and nasal pillows masks online and choose one that suits your needs. Contact a local DME for a fitting to see if this meets your needs.

I also have TMJ but have worn an appliance for 30 years or more. Since I started XPAP, I wear two. I rarely have pain. A long time ago, I had acupuncture. It relaxed my jaw for quite a while.
Sleep-well
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#3
RE: I have TMJ Syndrome and mask straps can aggravate it.
I don't have TMJ, but I did have problems with mask straps and leaks.

My solution to both those problems is the Bleep strapless nasal mask, which technically isn't really a mask, which I've used for around 2 years. I also tape my mouth, which eliminated mouth leaks.

It took a few days to adjust to the Bleep mask, but once I did, its worked great for me.
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#4
RE: I have TMJ Syndrome and mask straps can aggravate it.
Ok, thanks Ya'll.  
I am finding that I like the full face mask but still want to try others. I think that I need to adjust the pressure too because it feels like I'm swallowing a wind tunnel with the pressure that high(13-16)...and the leaks that happen if I don't have the mask really tight.  I do have my tongue and jaw the way you described Cpapian. Massage and Acupuncture have helped me too. I feel like I'm on a steep learning curve..about my Apnea, my TMJ, and using a CPAP. Not a bad thing but a little intimidating at times. Thanks for your responses.
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#5
RE: I have TMJ Syndrome and mask straps can aggravate it.
Hi KstanLD,

I also suffer from TMJ and sleep apnea.  I believe that wearing the full face CPAP mask with straps actually aggravated my TMJ considerably to the point my jaw locked one day and I ended up with a displaced disk and severe pain for many, many months.

I'll share a bit with you about what I've done to achieve some relief and improvement in my specific case.

The first thing I did that helped was, I got a small oral appliance called a "Kois Deprogrammer" from my dentist, which reset my jaw position and seemed like it re-opened the space between my jaw joints again.  This eliminated a LOT of my pain.  It might not be applicable to your situation, though, so check with your dentist.  I wore it full time for a few weeks, and right now I dont need to wear it at all (although I still have a lot of clicking and popping in my jaw).

The next thing I did was switch to a nasal only mask, and use mouth tape so I dont get mouth leaks.  The tape i'm using is Leukoplast Cover-roll Stretch tape.  Its weird and takes some getting used to, but its the only way I can still do CPAP without aggravating my TMJ further.  The straps from my full face mask were pushing my lower jaw back every night, and it was clearly making things worse.  I saw an oral surgeon who agreed that I needed to find an alternative to the full face mask.  So far, it does seem to be helping.  I am also experimenting with a chin strap , which "lifts" my jaw shut upwards instead of pushes it backward into my face like the full face masks I tried were doing.  Occasionally the tape will come loose at night and I'm finding the chin strap is helping eliminate this from happening.  Its a bizarre looking setup, certainly, but getting a restful sleep is more important to me after many years of problems.

However, at least in my case (this might just be me) I'm finding my CPAP treatment is less effective with the nasal mask.  My AHI's are lower and OSCAR graphs look better, but my fatigue and brain fog do feel a bit worse.  I think I'm still struggling to get the machine settings dialed in, maybe, or there could be something specific to my anatomy that is causing problems with the nasal mask+tape.  Many many people report using this successfully, so I may be a bit of an outlier.

Hope some of this helps... I personally believe using a nasal mask and mouth tape and/or chin strap to be worth testing out in your situation.

Feel free to check out any of my previous threads or send me any questions you may have, happy to help further if i can.
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#6
RE: I have TMJ Syndrome and mask straps can aggravate it.
I second the suggestion for a nasal pillow or nasal mask and mouth tape!

I have severe and permanent TMD caused by a faulty jaw joint implant which I had in 1982. (It was recalled by the FDA.) When I was diagnosed with sleep apnea three years ago, my dentist and my physical therapist were both adamant that I could not use a full face mask because it could put pressure on my lower jaw. I use a nasal pillow, with mouth tape to combat mouth leaks. It works very well for me!

Once I got used to the CPAP and got the settings adjusted properly for me, my dentist told me that I had less tooth grinding. (He can see the marks from grinding on the dental appliance that I wear.) I attribute that to getting better quality of sleep without struggling to breathe.
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#7
RE: I have TMJ Syndrome and mask straps can aggravate it.
Thank you for you detailed reply! I will ask my Dr. & dentist about the Kois Deprogrammer. I have never heard of it but have tried wearing dental guards & they make things worse. I think it’s partly because I bite up and down, rather than grind, when the muscle spasms happen. I tried the LG mask last night; still waiting for the nasal pillow. LG Mask felt better on my face but still pushes my jaw back & tilts my face/chin down.  I feel like I’m wearing a gag in some awful novel! Also turned off the humidity & that felt better too. It’s the rainy season here now, so more humid. I’ll see how that feels the next few nights. Hoping for better sleep soon.
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#8
RE: I have TMJ Syndrome and mask straps can aggravate it.
Yes I had also tried a more simplistic dental night guard a couple years ago, and it definitely made my TMJ worse.  I found myself clenching and biting down on the guard subconsciously and it was causing a lot of muscle pain in the jaw.  You need a guard that is made from a hard enough material that it won't soften when you bite, and then your brain doesn't want to subconsciously chew on it.  The other "benefit" of the temporary Kois deprogrammer is it has a pronounced ridge in the front of it, so you literally can't bite down on it comfortably.  It worked quite well to train my jaw to stop clenching and biting.  I found some relief from the TMJ pain after the first night with it.  Of course, there are many causes of TMJ pain so it may not apply to your situation, but hopefully you can find some relief sooner than later.

I personally do not have much experience with nasal pillows, as they are a bit different than a nasal mask.  The pillow masks sit kind of in front of your nose and inside the nostrils a little bit, while the nasal masks sit around the whole nose similar to how the full face mask fits around the nose/mouth.  I wouldn't mind trying the nasal pillows to see if it would work a little better for me in terms of sleep quality and treating my fatigue/brain fog, but it seems i have some sort of skin reaction to the silicone in the masks because I keep getting red marks when I wear silicone masks.  For this reason I'm now using a foam ResMed AirTouch N20 nasal cushion.

Hope you find something that works!
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