The Connection Between Headaches, TMJ Disorder and Obstructive Sleep Apnea (OSA)


Officially, there is no one definitive cause of obstructive sleep apnea (OSA). One factor that’s often indicated is obesity. When there’s too much bulk in the neck, airway has a hard time staying open. The weight is too much. That’s why neck circumference is considered a risk factor for OSA.

Chronic swelling of the nasal cavity and tonsils/adenoids is also cited as a possible cause. When you get used to breathing out of the mouth during the waking hours, your body becomes over-dependent on the oral airway when you sleep, which leads to snoring and apnea. You essentially forget how to breathe through the nose. This is terrible for your whole body, as you get less oxygen than you should.

However, more and more scientists and doctors are becoming open to the possibility that there is a connection between temporomandibular joint (TMJ) disorder and obstructive sleep apnea. The airway’s ability to remain open and unobstructed at night is influenced by the position of the soft tissues of the throat, which are influenced by the way the upper and lower jaw fit together. This is no surprise to those of us in dental sleep medicine! If a patient improves his or her breathing at night with an oral appliance that subtly realigns the bite, it’s obvious (to us) that anatomical features of the jaw can make a person more vulnerable to OSA.

Personally, I believe there are many possible causes; and sometimes you get the “pot of beans” effect. Lots of minor factors work together to create a situation that makes nasal breathing nigh impossible. Effective treatment is just a matter of determining the possible causes for the obstruction and trying to address them all.

The Role of Pain

Where it gets tricky is the fact that symptoms, especially pain, can sometimes get so tangled up in the wheel of cause-and-effect that you can’t be sure whether apnea or TMJ are the cause of the pain, or vice versa.

TMJ disorder is characterized by painful symptoms. Stress and overuse of the jaw muscles can lead to headaches and pain in the temples and the neck. Migraines may even be attributable to TMJ disorder is some cases. Clench your jaw (right now) and put your fingers on your temple. You’ll feel the temporalis muscles engage. Imagine the effect of constant overuse of the jaw on those muscles. It’s not pretty.

Pain, especially headaches, can also be a symptom of OSA. If you’ve ever had a headache correlating with a period of sleep deprivation, imagine the kind of headaches you would get when chronically deprived of good sleep. OSA deprives you of both the restorative properties of sleep and oxygen. Low oxygen levels cause the blood vessels to widen, which can lead to vascular headaches.

There’s also the issue of tossing and turning in the night and the unusual head and neck position that untreated OSA patients sometimes must rely upon just to be able to breathe. The head and neck should be aligned properly with the spine when you sleep at night. Hours and hours of poor neck alignment can also lead to chronic pain.

To sum up, sleep apnea can cause headaches, but so can TMJ disorder—and TMJ disorder may contribute to or cause sleep apnea. Where do you start to untangle this mess?

Don’t Ignore Your Symptoms – Get Tested!

The bottom line, I suppose, is that you should never ignore pain, especially mysterious headaches. And you should never ignore symptoms that point toward sleep apnea or TMJ disorder.

On its own, untreated TMJ disorder can lead to degeneration of the jaw joint and serious dental problems. Not to mention the chronic pain that can spoil your quality of life. The fact that it may also be a factor in OSA should make you especially willing to seek help!

If you experience any of the following symptoms, see a TMJ specialist:

  • Difficulty chewing or opening and closing the mouth
  • Popping or clicking sound coming from the jaw
  • Pain in the jaw, face, ear, head, or neck
  • Jaw clenching or teeth grinding (bruxism)

Likewise, if you have symptoms or risk factors for OSA, see a sleep specialist and invest the time to have a sleep study performed. Untreated OSA can kill you, folks. It ruins your health. When your body is chronically deprived of sleep, the cognitive and regenerative benefits of sleep are lost you. Chronic oxygen deprivation can damage all your organs’ ability to function. Cardiac disease, stroke, diabetes, cancer—all of these health conditions have been connected with OSA.

See a sleep specialist if you have any combination of the following:

  • Loud snoring
  • Constant waking in the night
  • Gasping or choking in your sleep
  • Unsatisfying sleep
  • Headaches, dry mouth, or sore throat upon waking
  • Daytime sleepiness
  • Inability to focus or concentrate
  • High blood pressure
  • Depression, mood swings, irritability

While we’re talking about OSA, you should also be aware of the risk factors. While anyone can develop OSA at any age, the following factors put you at greater risk:

  • Being overweight
  • Being male (men are twice as likely as women to have OSA)
  • Having high blood pressure or diabetes
  • Chronic nasal congestion
  • Asthma
  • Smoking

Unexplained Headaches? See a Doctor!

You’d be surprised by how many people think chronic headaches are just a fact of life they have to live with. If you or someone you know regularly pops painkillers to deal with “stress” headaches, do them a favor and encourage them to see a doctor. There are a lot of undiagnosed OSA and TMJ disorder sufferers out there, and these conditions are both treatable!


About the Author: Dr. Mickiewicz owns a private practice in Sacramento and lectures across the nation on TMD treatments. He is a diplomate of the American Academy of Pain Management and holds membership in many professional associations for dentistry, sleep medicine, and TMD. In addition, Dr. Mick, as his patients call him, founded Pacific Orofacial Pain Consultants, a team of experts in various disciplines, who tackle the issue of TMD pain and treatment, to help sufferers find relief from chronic pain. To talk with Dr. Mick, call his Sacramento dental office at 916-469-9178.

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