Facial Pain Conditions and Sleep Disturbance
Temporomandibular Disorders and Sleep Bruxism
A significant proportion of patients with Temporomandibular Joint Disorder (TMD) pain (60%) report sleep disturbances, as do many patients with bruxism (37%). However, Sleep Bruxism (SB) may not be associated with clinically evident disturbances of sleep continuity or sleep architecture, and many SB patients do not report insomnia. Sleep Bruxism has been consistently linked, however, to more subtle sleep microstructure disturbances, including arousal and autonomic activation.
Bruxers with pain frequently report that they experience the highest levels of pain in the morning, whereas TMD patients more often report higher levels of pain in the evening. The number of patients with a low frequency SB events who reported pain the next morning was higher than the number of patients with a higher frequency of jaw muscle activity during sleep who reported pain.
Studies show that clinicians treating TMD patients should look at referring patients for formal sleep studies if the pain complaints are associated with poor quality of sleep, snoring, or other breathing events such as cessation of breathing, wake-time sleepiness and drowsy driving.
Burning Mouth Syndrome and Persistent Idiopathic Orofacial Pain
Patients with burning mouth syndrome often report (70%) that sleep relieves the pain. Sleep disturbances and awakenings, however, are reported more frequently by patient with burning mouth syndrome than by matched control subjects but are apparently not directly related to the oral burning pain. Persistent idiopathic orofacial pain also appears to have a limited influence on sleep.
A toothache is one of the orofacial pain conditions that can interfere significantly with sleep. Patients with acute pulpitis or apical periodontitis often report awakenings and lack of sleep due to the intense pain. Epidemiologic studies have affirmed the influence of toothaches on sleep. Periodontal pain after adjustment of orthodontic arch-wires is reported to have little influence on sleep.
Patients with migraine have changes in the quality of sleep a few days before the onset of a migraine attack but have fairly normal sleep patterns outside the attacks. Cluster headaches, which involve attacks of severe unilateral orbital, supraorbital, or temporal pain lasting 15 to 180 minutes.
Tension-type headache and chronic daily headache are also frequently associated with sleep disturbances and poor sleep quality, but to a lesser extent than in myofascial TMD pain patients. Although the relation between sleep bruxism and pain remains unclear, it seems justified to assess a possible linkage between tension-type headache and SB and sleep-disordered breathing.
Although the literature is scarce, at least one study found that patients with trigeminal neuralgia rarely complain about sleep disturbance related to the pain. However, higher pain severity scores have been associated with greater interferences with sleep in patients with trigeminal neuralgia.
It is important to establish the correct orofacial pain diagnosis and establish appropriate pain management because these are likely to have a beneficial effect on sleep, although they may not be sufficient to completely restore normal sleep. Your doctor should also consider and target sleep disorders (insomnia, sleep-disordered breathing, and periodic limb movement) in the treatment plan.