Yesterday, Bustle took on the topic of how to help people with anxiety overcome insomnia.Â
Anxiety disorders, according to the textbook Clinical Sleep Disorders, typically create sleep problems centered around “a sleep-onset or sleep maintenance insomnia, resulting from excessive anxiety or apprehensive expectations about life events.” It’s a specific problem that affects getting to sleep and then staying asleep in ways that will actually be refreshing.
This means that typical approaches to insomnia, such as avoiding all LED-lit devices an hour before bed because LED light has been shown to affect human levels of the sleep-wakefulness hormone melatonin, are necessary but not sufficient to help anxious people drop off. Aside from conventional techniques for better sleep quality, then, we have to look to science specifically targeted towards anxiety sufferers to improve chances of a good night’s rest.
Read more at www.bustle.com
Many of the patients I see that have difficulty going to sleep and/or staying asleep have a distally displaced mandible. The condyle (ball if the jaw joint) is sitting too far back in the fossa (socket of the joint). This pinches the many nerves in the space between the condyle and the ear.These pinched nerves constantly send messages to the brain causing an excited nervous system. This system cannot settle down to allow sleep. Certainly anxiety about unresolved issues adds to the excited nervous system. It is possible that with a condyle properly positioned in the fossa, and a more relaxed nervous system, the unresolved daily issues no longer keep the person awake.
I have many patients with long standing insomnia sleeping quite nicely when the mandible is supported in a healthy position. An oral appliance designed to treat OSA can give this support. An oral appliance to treat OSA should be considered in the case of insomnia even when OSA does not exist. The mandible only has to be supported in a healthy condyle-fossa position. It does not have to be protruded.
Dr Smith,
That is some very useful information. I’m curious to know as of now there is any literature showing this to be the case for some patients with insomnia? Also in your office, how are you diagnosing the fact it is indeed their condyle that to far back into the glenoid fossa, thus pinching nerves, that could be the cause of their insomnia? For instance are you using some kind of imaging? Look forward to hearing from you! 🙂
Sincerely,
Chia Wu
Thank you for your interest Chia.
In a healthy condyle to fossa relationship, the space from the condyle to the ear is much larger than the space anterior to the condyle.
This position is commonly referred to as Gelb 4/7. You can find more information about this in many locations.
Also page 138 in the handbook for assessment, diagnosis and management of craniofacial pain (available through the American Academy of Craniofacial Pain) is the best description of the ideal condyle fossa relationship. If you are interested in these things, this book is a must for your library!!!!
An image is necessary to confirm the condyle-fossa relationship.
3D Cone beam is excellent. MRI is an option. I find transcranial x-ray to be an acceptable lower cost option. The name of this equipment is Accurad. A pano is NOT adequate for this purpose.
I am not familiar with documented research in this area.
For further information about sleep, ADHD, and prevention of these issues, please obtain a copy of GROWING A HEALTHY CHILD. You will find it very helpful.
William P. Smith, Jr., D.D.S.
SleepBetterDoc.com