In the last month there has been a noticeable increase in individuals consulting for jaw pain, tension headaches (including upon waking) and neck pain. One of the main things that stands out is when asked if they have had increased stress or anxiety, they respond ‘yes’, which isn't shocking given that the pandemic has increased stress and anxiety in many. Tension headaches and neck pain can be attributed to many factors but today we will talk about the increase in cases of Bruxism that I have seen lately.
Bruxism is the clenching or grinding of your teeth and can occur while awake or asleep. Nocturnal (Sleep) Bruxism is involuntary and often you may not be aware you are doing it unless your dentist or a partner has told you or you have developed morning tension headaches along with jaw pain. Many people walk around with asymptomatic (painless) temporal mandibular joint (TMJ) disorders or asymmetries and can go their whole lives without pain if they are lucky. This can be due to misalignment, hypermobility and other reasons and is usually known to the person through an audible click upon opening or closing of the jaw or during chewing. Bruxism, along with dysfunctions of the TMJ can be placed into the category of Temporal Mandibular Disorders (TMD). They can occur together and can also occur on their own. Disorders of the temporal mandibular joint can be corrected through manual therapy and appropriate exercises, which I will discuss in a second post later on. Bruxism, which is the clenching or grinding of the jaw and teeth, can occur in anyone with or without a dysfunction of the TMJ and can be very painful for the muscles of the jaw and neck. Those with an underlying TMJ disorder may experience heightened pain if they also suffer from bruxism (if they suffer from the two together). And it is unfortunate to report that some studies have shown that prolonged bruxism over time can cause TMJ disorders due to the wear on the joint.
Nocturnal (sleep) bruxism can occur in any stage of sleep but is most commonly experienced in the early stages of sleep (non-REM 1 and 2) as well as during a change in sleep patterns, specifically at times of microarousal (not fully waking). It is often seen, but not limited to, sufferers of sleep apnea.
Sleep Cycles:
Non-REM sleep
Non–rapid eye movement sleep has 3 stages:
Stage 1 occurs right after you fall asleep and is very short (usually less than 10 minutes). It involves light sleep from which you can be awakened easily.
Stage 2 lasts from about 30 to 60 minutes. During this stage, your muscles become more relaxed and you may begin to have slow-wave brain activity.
Stage 3 is deep sleep and lasts about 20 to 40 minutes. During this stage, delta brain activity increases and a person may have some body movements. It is very hard to wake someone in stage 3. During the deep stages of Non-REM sleep, the body repairs and regrows tissues, builds bone and muscle, and strengthens the immune system.
REM sleep
Rapid eye movement sleep is associated with the brain restoring its supply of adenosine triphosphate (ATP) and is important because it stimulates the areas of the brain that help with learning and as it is associated with increased production of proteins. One study found that REM sleep affects learning of certain mental skills. People taught a skill and then deprived of non-REM sleep could recall what they had learned after sleeping, while people deprived of REM sleep could not.
During sleep, a person usually progresses through the 3 stages of non-REM sleep before entering REM sleep. This takes about 1 to 2 hours after falling asleep. The cycle is repeated three to four times each night. An adult spends more time in Non-REM sleep than in REM sleep. Usually, REM sleep happens 90 minutes after you fall asleep. The first period of REM typically lasts 10 minutes. Each of your later REM stages gets longer, and the final one may last up to an hour.
Clenching most often occurs in stage 1 and 2 of non-REM sleep and is least likely to occur during REM sleep. So if you are clenching throughout the night enough that it is causing you to wake up with jaw pain or a headache, it could be an indication that you aren’t spending enough time in the deeper stages of sleep (stages 3) or in REM sleep, both of which are crucial to body and brain health.
An osteopath can help you with your underlying TMJ disorder as well as help you with the discomfort you feel from bruxism. If you have the two issues together, it may take longer to help relieve your pain symptoms but relief can be attained. If your jaw or neck has been more sore lately and you’ve been under increased stress and may think you are experiencing nocturnal bruxism there are things you can do to lessen your symptoms. A lot of times the pain associated with bruxism comes from muscle tension in the neck, jaw and at the base of the skull. Some of this muscle tension can lead to stiffness in the neck and the grinding directly affects the temporomandibular joint and the teeth. Easing the tension in the muscles of the jaw and neck as well as mobilizations of the TMJ and at the base of the head and neck can give you some relief from pain. For longer term management of the condition itself, discussion with your dentist about obtaining a mouth guard to further protect the teeth from wearing down and to reduce some of the grinding at night is prudent. The mouth guard can protect further wearing of the teeth but doesn’t always help with the pain from clenching. Together, as well as being able to achieve deeper sleep, can help you manage your bruxism. Reduction of stress and anxiety through exercise and mental health and wellness are also complimentary to trying to stop bruxism as it may help you sleep better. If you have any questions about how osteopathy could help you with your suspected or known bruxism, please send me a message.
Sources:
Beddis, H., Pemberton, M., & Davies, S. (2018). Sleep bruxism: an overview for clinicians. British Dental Journal. Vol. 225, (497-501).
Messina, G., Martines, F., Thomas, E., Savago, P., Menchini Fabris, G.B., Poli, L., & Iovane, A. (2017). Treatment of chronic pain associated with bruxism through myofunctional therapy. European Journal of Translational Myology. 27(3): 6759.
Wieckiewicz, M., Paradowska-Stolarz, A., & Wieckiewicz, W. (2014). Psychosocial aspects of bruxism: the most paramount factor influencing teeth grinding. BioMed research international, 2014, 469187.