Can a night guard for Temporomandibular Joint (TMJ) disorder worsen Sleep Apnea?

Night Guards for TMJ Can Worsen Sleep Apnea

Yes, a night guard for TMJ disorder can potentially worsen obstructive sleep apnea symptoms, especially if it's not specifically designed with sleep breathing in mind. 1

How Night Guards Impact Sleep Apnea

Night guards for TMJ (temporomandibular joint) disorder can affect sleep apnea through several mechanisms:

1. Posterior Displacement of the Mandible: Standard night guards, especially those that fit over the upper teeth, can push the lower jaw backward during sleep, which may:

   • Reduce upper airway space
   • Increase upper airway collapsibility
   • Potentially increase the frequency and severity of apneas 1

2. Tongue Position: Some night guards can affect tongue positioning, potentially causing the tongue to fall backward and obstruct the airway during sleep 1

Different Types of Oral Appliances and Their Effects

Standard Night Guards (Occlusal Splints)

• Primary purpose: Protect teeth from grinding and reduce TMJ stress
• Effect on OSA: May worsen sleep apnea by reducing airway space 1
• Risk factor: Particularly problematic in patients with existing sleep apnea or risk factors for OSA

Mandibular Advancement Devices (MADs)

• Primary purpose: Treat sleep apnea by holding the mandible in an advanced position
• Effect on OSA: Improves upper airway patency during sleep 1
• Efficacy: Recommended for mild to moderate OSA or as an alternative for those who cannot tolerate CPAP 1
• Success rate: Treatment success (AHI <5) in 19-75% of patients 1

Risk Assessment and Recommendations

High-Risk Patients for Worsening OSA with Standard Night Guards:

• Existing diagnosed OSA
• Obesity (BMI >30)
• Large neck circumference
• Retrognathia (recessed chin)
• Reports of snoring or witnessed apneas
• Daytime sleepiness

Recommended Approach:

1. Screen for OSA before prescribing any oral device:

   • The presence or absence of OSA must be determined before initiating treatment with oral appliances 1
   • Use validated screening tools and refer for sleep study if indicated

2. For patients with both TMJ disorder and confirmed/suspected OSA:

   • Consider a custom-made mandibular advancement device that can address both conditions 1
   • These devices can be titrated to find the optimal position that relieves TMJ symptoms while maintaining airway patency

3. For patients using a standard night guard who develop symptoms:

   • Monitor for new or worsening sleep apnea symptoms (morning headaches, daytime sleepiness, witnessed apneas)
   • If symptoms develop, refer for sleep evaluation
   • Consider switching to a properly designed MAD if OSA is confirmed

Important Considerations

• Follow-up is essential: Patients using any oral device should be monitored to ensure it's not worsening sleep breathing 1
• Objective verification: After final adjustments of any oral appliance for OSA, patients should undergo sleep testing to verify efficacy 1
• TMD concerns with MADs: While mandibular advancement devices can sometimes cause temporary TMJ discomfort, research suggests they don't typically worsen TMD long-term and may even improve symptoms in some patients 2, 3

Alternative Approaches

For patients with both conditions who cannot use standard approaches:

• Maxillary expansion devices: May help some patients with OSA without advancing the mandible 4
• Tongue retaining devices: Can be considered in select cases but are generally less effective and less well-tolerated than MADs 1
• CPAP therapy: Remains the gold standard for moderate to severe OSA 1

Remember that treating TMJ disorder should not come at the expense of worsening sleep apnea, as OSA has significant implications for morbidity, mortality, and quality of life.