Joint pain snoring
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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One of the most common links between joint pain and snoring is fibromyalgia.
Fibromyalgia is a form of soft tissue rheumatism characterized by tender points that occur in stereotypical locations and that are painful when pressure is applied to them. Patients often have sleep disturbance and non-restorative sleep (feeling exhausted despite having a good night’s sleep).
Common locations of the tender points are:
-the base of the skull and back of the neck.
-the soft tissues over the shoulders.
-the chest wall, just below the clavicles (over the pectoralis muscles).
-along the lateral aspect of the legs, both above and sometimes below the knees.
Fibromyalgia may be associated with other symptoms such as:
-Headaches; TM joint syndrome.
-Irritable bowel syndrome.
-Complaints of weakness.
Some factors that worsen fibromyalgia are:
-Repetitive motion, excessive exercise and poor posture.
-Anxiety and depression.
It has been called the most common cause of chronic, widespread musculoskeletal pain. It is more common in women and tends to "run in families".
It has been known for many years that patients with fibromyalgia tend to have poor quality sleep.
Early studies noted excessive amounts of alpha activity (the normal waking EEG rhythm of the brain) persisting during sleep: making the person appear as if they were awake and asleep at the same time! However, this finding of persistent alpha activity is not always present, and it has been noted in patients without fibromyalgia.
Fibromyalgia sufferers tend to lack normal amounts of slow wave sleep (stages 3 and 4 of non-REM sleep, also called delta sleep). These stages are the deepest, soundest stages of sleep are felt to be important for the restoration of the body during sleep.
It also was found that if one deprives normal people of slow wave sleep, they develop fibromyalgia symptoms. The more pain, the worse the sleep quality, with less stage 3 and 4 sleep--which then makes the pain even worse.
At least one study found sleep apnea to occur in more than 80% of fibromyalgia victims. Sleep apnea fragments sleep, thereby reducing slow wave sleep. Sleep apnea is extremely common. It is also potentially serious, with complications such as heart attack, high blood pressure, stroke, heart failure and sleep-related highway crashes.
Three steps need to be followed:
--Detect any sleep disorders. Controlling sleep apnea often causes a dramatic improvement in fibromyalgia symptoms.
--Practice good sleep hygiene.
--Ensure an optimally comfortable sleeping environment with attention to room temperature, elimination of disruptive light and sound, and a maximally comfortable bed and pillow..
Another connection is the following:
J Am Dent Assoc. 2000 Jun;131(6):765-71.
Treating obstructive sleep apnea and snoring: assessment of an anterior mandibular positioning device.
Clark GT, Sohn JW, Hong CN.
Section of Orofacial Pain and Oral Medicine, University of California-Los Angeles School of Dentistry 90095-1668, USA.
BACKGROUND: Dental devices have been used to help manage snoring and obstructive sleep apnea, or OSA. This article reports on patients' compliance with and complications of long-term use of an anterior mandibular positioning, or AMP, device. METHODS: The device used was a custom-made, two-piece, full-coverage, adjustable acrylic appliance, connected with Herbst attachments. The appliance was used nightly and advanced the mandible by 75 percent of the patient's maximum protrusive distance. Patients were telephoned to determine whether they were still using the AMP device. If not, they were asked when and why they stopped using it. The study sample included 65 consecutive patients with mild-to-moderate obstructive sleep apnea and snoring. RESULTS: Long-term use (three years or more) of the AMP device in these patients was 51 percent (27 of 53 patients). Of the 53 responding patients, 40 percent reported jaw/facial muscle pain, 40 percent had occlusal changes, 38 percent reported tooth pain, 30 percent reported jaw joint pain and 30 percent experienced xerostomia. Of the 27 long-term AMP users, 22 rated themselves as being very satisfied and four as somewhat satisfied; one was neither satisfied nor dissatisfied with the appliance. CONCLUSIONS: It was determined that with use of the AMP device, 40 percent of patients will develop some minor complications of jaw, mouth and/or tooth pain, and approximately 26 percent of long-term users might experience a painless but irreversible change in their occlusion. Annual follow-up office visits with the dentist appear necessary for early detection of these changes. CLINICAL IMPLICATIONS: Patients with mild-to-moderate OSA who receive a two-piece, adjustable AMP device should be informed that 50 percent of patients quit using the device in a three-year period and some will experience shifts in their occlusion.
PMID: 10860328 [PubMed - indexed for MEDLINE]
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