Mask moving jaw back

[anomaly32]

I have been using my BiPAP since July. I'm having great results as far as AHI goes — usually under 1.0. And while it's not my favorite thing to sleep with, I haven't had too much trouble using the machine. But I've recently realized that the mask is pulling my upper jaw back.

I suspect that one of the main reasons I have OSA in the first place is because of the orthodontic treatment I received as a kid, which pulled everything back and closed off my airway. I had TMD as a kid as well, and it was corrected through the orthodontic treatment, but in the last few weeks, I have been having problems with it again. My bite has been misaligned for years, but now when I try to bite together, my lower teeth are running into the back of my upper teeth because my upper jaw has moved back so far.

I'm pretty discouraged, because I tried a lot of alternative treatments before finally giving in to BiPAP. It's nice to feel less zombie-ish with the apnea treated, but it seems like it's just going to make things worse in the long run by compressing my face even more and causing bite problems. Has anyone else experienced anything like this?

[Geer1]

Your upper jaw is fixed, I doubt it is moving. Your lower jaw and teeth may be moving in relation to upper jaw though and that is common in people with bruxism which may be the reason for your TMD and what you are noticing.

I used to have good teeth and everyone thought I had braces to get that way. Now my lower teeth are all crowded, being pushed into weird angles, slight wear in some spots etc all from my sleep bruxism I believe.

[SarcasticDave94]

How tight do you have your mask straps adjusted? Too tight ain't right when dealing with masks. Take a long hard look at how your mask fits. Is it the correct sized cushion? the correct shape? adjusted correctly?

[CorruptAlligator]

Try sleeping on your side if you don't already do that. Also, I recommend not using full-face masks with the bottom straps. If you can, go nasal, pillows, or non-full-face cradle masks.

[readingteacher]

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 a year 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. Have you tried anything but a full face mask? I would suggest that you do.

Interestingly, since my sleep apnea has been successfully treated, I am not clenching and grinding my teeth at night as much!

Your upper jaw cannot move back, because it is an integral part of your skull. The changes you are feeling in your bite are most likely from change in position of your lower jaw. In addition to trying a different type of mask, you may want to consult your dentist about getting and using a custom-made nightguard to wear on your teeth at night if you don't already use one. I wear a custom dental appliance 24/7, so of course I wear it when sleeping. It does not interfere with my CPAP use at all.

[DaveL]

If you have issues with you lower jaw being pulled back, and mouthbreath please take a look at reviews for the Knightsbridge Dual Band cap.

I bought 2 of them. One, and a spare. Initially it solved my mouth breathing issues. I had zero leakage at first. However, since then I've had issues with the way I put it on. I haven't resolved those.

I don't find it hot to wear. I think my hair loss is due to other nasal masks and their headgear.

I hope this helps.

[readingteacher]

I would be cautious about using a chin strap with TMD. A look at the Knightsbridge website claims that their strap uses "gentle vertical force" rather than wrapping around the chin and pushing the jaw directly into the jaw joint. However, any sustained "force" on the jaw can cause problems for people with TMD.

Mouth tape does not apply any force to the jaw.

[anomaly32]

I heard from my airway orthodontist today. He's about as knowledgeable as they come with airway issues and the options available. He said that within 1.5-2 years of CPAP mask usage, it can push the upper jaw 6mm back. It's called Smashed Face Syndrome. I don't have 6mm to spare. My lower jaw isn't going anywhere, it's the upper jaw, because if it were the lower jaw, I would be getting an overbite instead of an underbite. I use the F30i, and I have had no problems with it until this issue. I do have to keep tightening the straps to keep a good seal, otherwise I'd have to replace the cushion about every 2 weeks, and that's pricey when you're self-pay. I saw the Bleep Dreamport, which uses adhesive instead of a headgear, but it's even more pricey for the adhesive. 

[Geer1]

I would question the prevalence of this, lots of people use CPAP and I don't see a bunch of deformed facial structures walking around because of it.

I honestly don't think this is worth worrying about or we would hear a lot more about it. And that is coming from someone with bruxism/TMJ issues that uses a CPAP machine even though he probably doesn't have to.

Edit: I just reread a couple things and believe you think this has already happened (this was the reasoning orthodontist gave you)? Unless you have xrays/cts showing the change I would have a hard time believing it. I would think shifting forward of the lower jaw would be a much more likely reason for the new misalignment but that is juts my opinion.

Especially since you use a FFM which actually puts more pressure on lower jaw and up on cheek bones etc rather the maxilla.

[anomaly32]

How could putting pressure on the lower jaw move it forward? The F30i goes right under the nose, so most of the pressure is on the maxilla. And yes, this is already happening to me. I haven't had problems with TMD since I was a teenager, ever, until now. And it's getting hard to bite together because my teeth are running together, which wasn't an issue before. Interestingly, I haven't been using my BiPAP the last 2 nights and am just using my cervical collar by itself, and my bite feels a bit better today. The apnea is not perfect without the machine (according to my pulse ox that records all night), but it's definitely not even close to where it was without the collar.

I wonder if a true full face mask would be better, that goes all the way on the forehead. I think I would hate feeling the air on my eyes though.