TMJ or Tempero Mandibular Joint problems

[Sleepster]

I wear my night guard with my nasal pillows and chin strap. No problem.

TMJ can flare up like that, a sign that you need to wear the night guard more often, or perhaps it should be a part of your every night routine.

Anyway, I haven't had a problem with this combination of gear. Add in an eye mask and ear plugs when traveling and I've got quite the outfit.

[ThatOtherGuy]

I wear my night guard with my nasal pillows and chin strap. No problem.

TMJ can flare up like that, a sign that you need to wear the night guard more often, or perhaps it should be a part of your every night routine.

Anyway, I haven't had a problem with this combination of gear. Add in an eye mask and ear plugs when traveling and I've got quite the outfit.

Yes my wife has already commented on the new sexy look I have.

I've decided to try a different chin strap. I did have a full head double strap version, but it didn't feel right, so trying a ResMed single strap version tonight to see if it alters the TMJ alignment.

[nmbugs]

So my second question to the community is have others found in the initial stages of use that they woke with tension headaches that disappeared soon after getting up and over time did the problem go away?

Any assistance or other ideas would be appreciated.

I had TMJ surgery back in 1993 (mandibular osteotomy) and prior to the surgery I had daily horrible migraines. I started waking up with horrible headaches again almost a year ago. I was having other symptoms too (shortness of breath/chest pains) but every morning I woke up with a killer headache.

First thing the doctors found out was my oxygen was dropping when I would walk around. Then at my sleep study that found out I was desaturating to 69%. So it wasn't my TMJ that was causing my headaches this time around it was my oxygen starved brain screaming at me. I wasted a lot of time/delayed treatment blaming it on my good ole TMJ flaring up again.

Not sure if this is happening with you, but you may want to see what your saturations were during your study. Do you think you are clenching/grinding your teeth trying to keep your mouth closed? I worked in dentistry for many years for both oral surgeons and DDS (both clinical and as manager ). I can see how those oral appliances they use to treat apnea can mess with a person's TMJ but I am not sure how a cpap can, unless again, if the cpap is causing you to grind/clench your mouth to keep it closed. Either way discuss it with your doctor and see what he/she has to say. I would be interested to see what they think.

I hope you start feeling better soon.

[ThatOtherGuy]

So my second question to the community is have others found in the initial stages of use that they woke with tension headaches that disappeared soon after getting up and over time did the problem go away?

Any assistance or other ideas would be appreciated.

I had TMJ surgery back in 1993 (mandibular osteotomy) and prior to the surgery I had daily horrible migraines. I started waking up with horrible headaches again almost a year ago. I was having other symptoms too (shortness of breath/chest pains) but every morning I woke up with a killer headache.

First thing the doctors found out was my oxygen was dropping when I would walk around. Then at my sleep study that found out I was desaturating to 69%. So it wasn't my TMJ that was causing my headaches this time around it was my oxygen starved brain screaming at me. I wasted a lot of time/delayed treatment blaming it on my good ole TMJ flaring up again.

Not sure if this is happening with you, but you may want to see what your saturations were during your study. Do you think you are clenching/grinding your teeth trying to keep your mouth closed? I worked in dentistry for many years for both oral surgeons and DDS (both clinical and as manager ). I can see how those oral appliances they use to treat apnea can mess with a person's TMJ but I am not sure how a cpap can, unless again, if the cpap is causing you to grind/clench your mouth to keep it closed. Either way discuss it with your doctor and see what he/she has to say. I would be interested to see what they think.

I hope you start feeling better soon.

Thanks for the reply, been meaning to update my progress, so now is a good time to do it.

I know my sleep apnea is not a oxygen related in the manner you are speaking of only because of what lead to the apnea diagnosis. Basically this time last year I was in Intensive Care following a very serious motor vehicle accident resulting in around 10 operations covering a multitude of injuries. In fact 1 year ago I was just being released from the coma they placed me in whilst I recovered from some of the operations and initial injuries. The shopping list was two broken legs, rupturing every tendon in one knee (reconstructed five weeks post injury), five broken ribs, punctured spleen (removed), punctured lung, bruised kidney plus a few more other less serious complications. As you would probably guess just about everything going in and out of my body was monitored constantly and oxygen saturation was never an issue, even with the serious level of apnea I suffered. Even during the sleep testing where O2 levels are monitored. the saturation levels were satisfactory.

As for my TMJ issue, after having a couple of old fillings replaced I spoke with my dentist about updating my splint since due to its age and having had a root canal and new fillings it did not fit very comfortably. The sticker price of a new one had me looking into alternatives and I found a snoring splint at the local pharmacy that you can self mould using hot water. So I have been using that now for about 5 weeks and also realised I needed to use the chin strap over the mask straps and mask, rather than under it so it did not foul the mask fit. So far everything is working really well and I am very happy with my outcomes. I have also tinkered a little with the settings as the tech who set the machine up had the max pressure setting at 20 when my max according to the studies was 15. Now I know I need higher than 15 as a precaution, but 20 was too high and I would find myself removing the hose so the machine would shutdown and reset back to a lower pressure and stop hissing air from under the mask and at times actually blowing air into my stomach. Over time I will be gradually increasing the max setting until I find the limit where the previously noted issues crop up again.

Thanks everyone for your replies and suggestions to date, its been helpful.

[nmbugs]

Thanks for the reply, been meaning to update my progress, so now is a good time to do it.

I know my sleep apnea is not a oxygen related in the manner you are speaking of only because of what lead to the apnea diagnosis. Basically this time last year I was in Intensive Care following a very serious motor vehicle accident resulting in around 10 operations covering a multitude of injuries. In fact 1 year ago I was just being released from the coma they placed me in whilst I recovered from some of the operations and initial injuries. The shopping list was two broken legs, rupturing every tendon in one knee (reconstructed five weeks post injury), five broken ribs, punctured spleen (removed), punctured lung, bruised kidney plus a few more other less serious complications. As you would probably guess just about everything going in and out of my body was monitored constantly and oxygen saturation was never an issue, even with the serious level of apnea I suffered. Even during the sleep testing where O2 levels are monitored. the saturation levels were satisfactory.

As for my TMJ issue, after having a couple of old fillings replaced I spoke with my dentist about updating my splint since due to its age and having had a root canal and new fillings it did not fit very comfortably. The sticker price of a new one had me looking into alternatives and I found a snoring splint at the local pharmacy that you can self mould using hot water. So I have been using that now for about 5 weeks and also realised I needed to use the chin strap over the mask straps and mask, rather than under it so it did not foul the mask fit. So far everything is working really well and I am very happy with my outcomes. I have also tinkered a little with the settings as the tech who set the machine up had the max pressure setting at 20 when my max according to the studies was 15. Now I know I need higher than 15 as a precaution, but 20 was too high and I would find myself removing the hose so the machine would shutdown and reset back to a lower pressure and stop hissing air from under the mask and at times actually blowing air into my stomach. Over time I will be gradually increasing the max setting until I find the limit where the previously noted issues crop up again.

Thanks everyone for your replies and suggestions to date, its been helpful.

Wow, I can't imagine what you went through. So glad you are still with us!

As for the splint, do you have medical insurance? If so, medical should cover most of it. If your dentist is telling you otherwise go somewhere else. Also NEVER ever use a general dentist for a TMJ splint! They can do more harm than good. A TMJ splint needs adjusted every week, bi-weekly or monthly. Most general dentist give their patient a splint maybe adjust it once or twice and that's it and that is wrong!

The whole point of a splint is to retrain your bite and in order to retrain it and relax/reposition the jaw you need it adjusted every week in the very beginning, then bi-weekly then monthly. The TMJ specialist (the only dentist you should trust for this therapy) uses blue marking paper that you bite down on and the areas you hit hard, he or she will use their drill to shave away the splint in those areas until your bite is correct and your joint/condyles are no longer stressed. Usually this therapy is on conjunction with others like physical therapy and sadly dietary changes.

Since this is a medical condition, every insurance I have ever seen covers it. After spending 13 years working for dentists I went to work for the enemy, the insurance company (United Healthcare), so I have seen both sides. Sadly dentists/doctors tend to be cheap and because they can be cheap don't always hire staff that know what the heck they are doing. Because they don't know what they are doing they give patients incorrect information and if the claims get denied tell patients they are responsible (which is also wrong!!!).

If you truly have TMJ those drug store splints can, over time do more damage as your joint degenerates. Yes, you will get relief in the beginning because you are taking stress of your joint but it's a bandaid that will soon fall off. If you want, I can try to help you and see what your insurance covers and what they don't. It's only a matter of proper coding. Medical will not cover TMJ splints if the doctor writes "patient grinding teeth" because that is strictly dental (dental coverage usually sucks since it has such low yearly limits on coverage ). However, if it is coded showing medical reasons PLUS the doctor has to write a letter showing medical necessity then it should be covered.

I hope this helps and let me know if I can help

[ThatOtherGuy]

My insurance does cover it, sadly though insurance only covers so much and I'm not trying to be cheap about it, just trying not to let the outgoings (costs) overtake the incomings (benefit payments) presently. I know I will eventually pay to get a proper one but I have to do what I can do with what I have available. The S9 sort of tapped me out just before Xmas, I was looking to hire, but the machine I wanted was not available as a hire option, so I really need to wait until I am back working full time before I spend more money. My dentist is very good, my daughter also wears a splint and they do the adjustments for that free of charge in between the annual or six month visits. It took me a long time to find a dentist I trust and who talks to me like a person rather than down to me like some do.

Thanks again for the offers.

[me50]

My insurance does cover it, sadly though insurance only covers so much and I'm not trying to be cheap about it, just trying not to let the outgoings (costs) overtake the incomings (benefit payments) presently. I know I will eventually pay to get a proper one but I have to do what I can do with what I have available. The S9 sort of tapped me out just before Xmas, I was looking to hire, but the machine I wanted was not available as a hire option, so I really need to wait until I am back working full time before I spend more money. My dentist is very good, my daughter also wears a splint and they do the adjustments for that free of charge in between the annual or six month visits. It took me a long time to find a dentist I trust and who talks to me like a person rather than down to me like some do.

Thanks again for the offers.

Since we are talking about apnea and dental issues, I have been told that treatment of OSA can cause eye dryness and dental issues and I really believe that those things should be covered as medical for OSA patients. My insurance company, before medicare, denied a dental tray that my dentist said I needed to protect my teeth from further damage. My new insurance company did pay for the plugs that my opthamologist put in my tear ducts to help with the eye dryness. I would much rather use my machine and deal with what I call minor issues compared to organ damage or worse.