Obstructive sleep apnea affects around 20 million Americans and can lead to hypertension, heart attack, stroke, depression, muscle pain, fibromyalgia, morning headaches, and excessive daytime sleepiness.

Friday, July 13, 2012


Jacque: I am a 51 year old woman and have snored most of my life. Sleep study said Chronic Obstructive blahblah and the doc told me I had the WORST sleep patterns he had ever seen. Tried CPAP...NO WAY...couldn't stand it. Had shots in the back of my throat...didn't work. Tried a mouth appliance about 5 years ago and it flared up my TMJ terrrrrribly. So I was just wondering what my options are or if you mouth devices don't flare up the jaw?

DR SHAPIRA RESPONSE: Sleep Apnea and TMJ disorders have the same underlying causes, functions and problems. Usually we treat patients with TMJ disorders with an appliance that is worn 24 hours/day 7 days a week. This is done to stabilize the jaw joints (Temporomandibular Joints, TMJ), relax the muscles and control facial pain, TM Joint pain, headasches, migraines, sinus pain, ear pain, stuffiness in the ears, tinnitus, and other numerous symptoms.

For sleep apnea patients we usually use an appliance that is only worn at night and give the patient exercises that return the jaw to its original pathologic position. The original position is pathologic because it does no perform the single most important function of maintaining a patent airway. This works well for the majority of patients without problems. Patients with TMJ disorders may need their appliances adjusted with design changes or alterations based on symptoms.

Long Term research has shown bite changes but not negative changes to the TM Joints. Most symptoms of TMD from oral appliances to treat sleep apnea will be only during initial treatment. Long term problems are rare.

The best treatment would be combining TMJD and Sleep Apnea treatment.
This is accomplished with a small comfortable diagnostic neuromuscular orthotic during the day and a MAD sleep apnea appliance at night. Most TMJ problems are caused by the jaw healing at night but the muscles resist going back to your original pathologic position in the morning. This combination treatment allows the jaw joints and muscles to heal at night and supports this healthier position during the day. It no longer requires the patient to return to their original pathologic position.

An interesting fact is the changes in bite seen with oral appliances is actually healing.

Dr Shapira Response:
"Life is not about waiting for the storms to pass - it is learning to dance in the rain!"

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posted by Dr Shapira at 8:54 AM