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TMJ & SLEEP THERAPY CENTRE OF RALEIGH-DURHAM
 

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TMJ & SLEEP THERAPY CENTRE OF RALEIGH-DURHAM
Charles Ferzli, DDS, FAACP, DABCP, DABCDSM, DABDSM

1150 NW Maynard Road, #140
Cary, NC 27613
Telephone: (919) 323-4242
www.RaleighTMJandSleep.com

Your Sleep Can Shape Your Health:
For Better or Worse

“We spend a third of our lives sleeping,” notes Dr. Charles Ferzli of the TMJ & Sleep Therapy Centre in Cary, “and there’s a good reason. Sleep—in all its stages—is essential for every aspect of our health, providing the foundation for healing, growth, and cognitive processing. (see box)

Dr. Ferzli, here with a patient, frequently measures bodily functions related to proper and healthy breathing in order to determine causes—and solutions—for sleep problems.

“And the consequences of sleep deprivation,” he says, “are profound. People who lack sufficient, healthy sleep are not just tired, it affects their mood, their patience, their ability to remember and learn new things. And they’re more likely to be sick because they’ll have more inflammation and more pain.

“Lack of sleep increases the risk of depression and anxiety,” observes Dr. Ferzli, “and the reverse can also be true. One reason may be anti-depressant and anti-anxiety medications, which can cause dry mouth. Mouth breathing can lead to dry mouth and interrupted sleep. But medications are far from the only cause of sleep problems.

“Environmental factors, allergies, and anatomical problems are among many factors that often cause mouth breathing,” Dr. Ferzli explains, “since they can trigger nasal congestion.”

All of these factors— mouth breathing, sleep deprivation, allergic response, and temporomandibular joint syndrome (TMJ)—add up to higher levels of cortisol, the “fight or flight” stress hormone. “And the more cortisol you have,” Dr. Ferzli stresses, “the less likely you are to fall asleep and stay asleep. This vicious cycle of ill health drives poor sleep and vice versa—making recovery even more elusive.”

Making Connections

By far the most common sleep problem is insomnia, notes Dr. Ferzli, “affecting 60 percent of those with sleep disorders. But there are many, many causes of insomnia—including stress, life traumas, physical pain, or even low vitamin D levels—which makes it a challenging problem to treat.

“Understanding the roots of a particular patient’s problems is key,” he says. “They may come in complaining of insomnia or headache or jaw pain, but the symptom doesn’t necessarily reveal the underlying problem. That requires a comprehensive evaluation. “We begin by having patients identify their symptoms and rank then in order of importance,” explains Dr. Ferzli. “And then the first thing we do is educate them on how it’s all connected.”

Understanding
“Sleep Architecture”

“To understand the importance of sleep to health,” observes Dr. Ferzli, “you need to understand the truly remarkable structure of a healthy night’s sleep—known as ‘sleep architecture.’

“Sleep includes four stages— each with a unique role in maintaining cognitive health and performing physical repair. The first few stages are known as non-rapid eye movement (non-REM) sleep. Stage one is light sleep, or the transition from wakefulness to sleep. The body slows down more in stage two. Stages three and four are deep sleep stages also known as delta, and the dream stage of sleep is the REM stage.”

Stage two makes up 50 percent of the sleep cycle, and he points out that it’s during deep sleep (stage three) that the body heals itself. REM sleep furthers the process of memory consolidation, and readies one for learning.

“During the dream stages of sleep, the brain basically hashes out the day and makes room for new memory and cognitive skills,” says Dr. Ferzli. “REM sleep also supports emotional processing.”

A typical sleep cycle is non-linear, he notes. “As people sleep, they move from stage one to two to three to two to dreaming in REM stage. And a person cycles through those stages four to five times per night.”

For the patient with jaw pain, for example, Dr. Ferzli draws connections between that pain and excessive muscle activity. “It’s happening because they’re not getting enough oxygen into the muscles,” he explains, adding, “and then we connect that to his sleep issues. If he can breathe well while sleeping, then his nervous system will be calmer, his airway will remain more open, and he’ll wake up feeling more rested.”

Conversely, air flow interruptions can lead to multiple sleep arousals throughout the night. “And that’s when people wake up feeling like they didn’t sleep at all,” explains Dr. Ferzli. “But they don’t know why they slept so poorly.”

Treating the Problems

“Sleep issues are challenging,” notes Dr. Ferzli. “And they are frustratingly complex. Poor sleep, for example, can cause pain, inflammation, depression; and pain, inflammation, and depression can affect sleep. Poor sleep slows healing and impairs memory. Poor physical and mental health result in poor sleep.

“So, healing is, by necessity, a complex, methodical process. And it’s customized for each patient. We need to find out why they’re not sleeping well. Over time, we may address many components: diet, breathing, dental issues, medications, even surgical interventions. But our starting point is always to find out what’s most important to the patient—and that’s where we begin.

“For those with sleep-related breathing problems,” he says, “we want to find out what’s causing the disruption. It might be an air flow problem or a nasal passage obstruction causing mouth breathing. Allergies could play a role.”

For a simple test, Dr. Ferzli has patients tape their mouth shut to see if they can breathe from their nose for three minutes. If he finds the nasal passages are physically blocked, he refers them to an ear, nose, and throat doctor.

“Sometimes, it helps to increase nasal volume to improve airflow,” notes Dr. Ferzli. “In other cases, an oral appliance can help keep the airway open during sleep, while also decongesting the nasal passages.

“If they’re mouth breathing, we might use an orthotic or an expander for the palate,” he explains. “Oral appliances can serve a variety of purposes, in some cases decompressing jaw joints to protect people from clenching at night.

“When mouth breathing has become habitual, breathing ‘retraining’ can help,” he says. “And some very simple interventions—such as spraying the nose to keep the tissues clean and supple, or just ‘cleaning up’ the diet—can be very effective.

“Everything’s connected,” emphasizes Dr. Ferzli. “Allergies—to food, dust, humidity, environmental pollutants—can create inflammation resulting in nasal congestion. And we can’t underestimate the critical importance of diet, so we also want to address the dietary or digestive issues that underlie mouth breathing and other symptoms.

“But, ultimately, whatever the reason for breathing problems, they profoundly affect the quality of sleep.”

Mouth Breathing: A Surprisingly Harmful Habit

Mouth breathing affects more than sleep, Dr. Ferzli points out. “For example, mouth breathers are more likely to have TMJ problems, since they clench their teeth while sleeping. And those with TMJ may experience headaches, neck pain, and more—in addition to jaw pain and locking. The less efficient release of oxygen to the muscles can further exacerbate pain and inflammation—continuing the cycle of pain contributing to poor sleep.

“On the other hand,” he says, “proper nasal breathing helps clear the sinuses and release nitric oxide to the lungs. It also helps the body filter and defend itself against germs.”