Alan G. How do I overcome TMJ at night?

This question was submitted via our Ask a TMS Therapist program. To submit your question, click here.

Question

How to approach TMS-related problems that arise in your sleep?

I am taking the liberty to take bits and pieces of my story that can be found around the forum. I will just focus on the question that I feel is hindering my progress by completly freezing me. I am stuck.

What bothers me is TMJ (temporomandibular joint problems)/CMD(cranio muscular dysfunction). I can't get rid of it. My doctor says it's to be expected, after having a traumatic accident and being hit in the jaw. It wasn't broken, though according to the CT and x-rays, just badly sprained with swelling and such. It's becoming unbearable.

I cannot sleep, I wake in extreme pain in my jaw joint, my muscles and my teeth. My ears hurt, even, after waking up - from the strain because my jaw muscles are tense all throughout the night.

And now my jaw is acting out like never before - minus directly after the accident. But back then, I was on pain meds so... I refuse to take pain meds right now. I don't know what else to do. I struggle to find relief because most of the grinding and clenching happens at night. I feel like I have no control whatsoever over it. And I can't "face my demons" and throw myself into the activity (which, I believe, Dr. Sarno reccommends to unlearn your conditioned fear and pain response) because I am not aware of when it happens! It's like my mind and body decide to let it all out when I am asleep. Makes it much harder to actively arm myself for battle. I can't fight a ghost that only appears at night...

I recognize TMS: I am afraid of going to bed because I know I am going to do bruxism/teeth grinding and will wake up in extreme pain. I wake up throughout the night, as well, in pain. I feel so sore and tired after waking up. I haven't gotten a good night's rest in about two weeks. I feel adrenaline shooting up in my body when I am lying in bed, trying to sleep. Thoughts plop into my head "it'll be terrible tomorrow" or "how are you going to function properly if you can't sleep?" or "you are going to do some serious damage to yourself tonight" ...

I just don't really know how to work from here. I would love to throw myself into the activity that causes my pain. I just don't know how to do that if it works mostly when I sleep. I wake up tense and sore and in pain. How can I re-programme my brain if I am not in control of it during those periods?

What would you recommend?

 

Answer

Hi Linda,
Go to your dentist, have them mold something to your teeth and create a night guard for you. Once you have this in place, you can be assured that you're not doing any damage to your enamel when you grind them at night. (The damage from heavy teeth grinding is minimal, but can accumulate over years.)

Once you've done that, relax. You're fine. You don't need to stop yourself from having pain or symptoms when you sleep. You're working so hard to stop this behavior that I imagine every time you wake up to find yourself doing it, it throws you into a state of despair.

Buddha said that most suffering is caused by the gap between what is and what we think should be. You don't need to stop this grinding. In fact, I'd bet that the pressure you're putting on yourself to stop this grinding is one of the primary things that's generating the stress that's causing the grinding.

Let go, Linda. Just let go.

Once you've accepted this pain that you generate while you sleep, and you've stopped working so hard to undo it, you can start looking at the underlying stress you accumulate throughout the day that necessitates such an outlet at night. Listen to this:

http://www.tmswiki.org/ppd/TMS_Recovery_Program#Mindfulness

Practice mindfulness, it can help to calm your mind, and bring you out of this state of fight or flight.

---

Any advice or information provided here does not and is not intended to be and should not be taken to constitute specific professional or psychological advice given to any group or individual. This general advice is provided with the guidance that any person who believes that they may be suffering from any medical, psychological, or mindbody condition should seek professional advice from a qualified, registered/licensed physician and/or psychotherapist who has the opportunity to meet with the patient, take a history, possibly examine the patient, review medical and/or mental health records, and provide specific advice and/or treatment based on their experience diagnosing and treating that condition or range of conditions. No general advice provided here should be taken to replace or in any way contradict advice provided by a qualified, registered/licensed physician and/or psychotherapist who has the opportunity to meet with the patient, take a history, possibly examine the patient, review medical and/or mental health records, and provide specific advice and/or treatment based on their experience diagnosing and treating that condition or range of conditions.

The general advice and information provided in this format is for informational purposes only and cannot serve as a way to screen for, identify, or diagnose depression, anxiety, or other psychological conditions. If you feel you may be suffering from any of these conditions please contact a licensed mental health practitioner for an in-person consultation.

Questions may be edited for brevity and/or readability.

 

Linda, you've gotten good advice from Alan Gordon.
I also find it helpful to get to sleep by (an hour or more before going to bed) I watch some YouTube videos on relaxation and sleep techniques.
Then I try to practice them as I try to get to sleep.
Besides deep breathing, I tell myself I'm going to put off worrying about things in the morning and instead think of vacationing on a sunny beach
or paddling a canoe on a quiet lake in the Minnesota northwoods.

 

It does seem that as I've reduced my other TMS symptoms (LBP, sciatica etc etc), the TMJ has gone down and gradually disappeared. I did get one of those mouth night guards that Alan recommends, but no longer need it. At my last dental exam a couple months back, no sign of grinding. All TMS symptoms, it seems to me, are part of the same ball of wax and that includes TMJ.

 

Much as I love poetry at times like this it's as helpful as a blunt kitchen knife. Sharp is good and brings precision and clarity.

The only thing that has helped my tmj is to dramatically reduce the physical tension in my body. I do this by swimming a mile twice a week (more often is better but not possible). When I don't swim, the tension builds and the night-time clenching can make an ugly return. You have to work out what method of tension-release works best for you. I also found swimming complemented calming down my entire nervous system. Read My Story for more on that.

I spent years going down the dental route to no avail. I tried many mouthguards and none helped, in fact I chewed them up. There has been a sea-change in dentistry and many dentists don't recommend guards or equilibration (filing down of the teeth. I had this too. Waste of time and money). Enlightened dentists recommend you de-stress and reduce tension.

Generally speaking I like Alan Gordon's posts but this one is a dud (for me at least).

 

I have had TMJ on and off since I started my University degree and I agree with Plum, it's stress based .. I find that having a bath with Epsom salts before bedtime helps me relax the muscles ... I empathise because TMJ pain is horrible ..
AH what also helps a lot is massaging some trigger points in the jaw ..you can find youtube videos on how to do this., it also works really well !

A lot of things can be improved through body tension release, for example I know someone who has Restless Leg syndrome and he does Alexander technique and meditation... the RLS is gone, he hasn't had it in 3 years ..but he does the Alexander technique everyday

 

I had TMJ for many years. It started when I was a teen and it got pretty bad. I went to the doctor because, at times, I couldn't open my mouth. It would get into a locked position and that scared me. Off and on, I couldn't open it enough to bite into an apple. It was stuck. That was the example I gave the doctor. And the doctor told me to "be a lady" and take "lady bites". Nice. As years passed, I tried to relax my jaw during the day and it got better. But it wasn't until I read Sarno's work for my back that I started applying the techniques to my jaw on the off chance that it could help.

What I did was, every time I would wake up (if I woke up) when I turned, or when I used the bathroom, or whenever I became conscious of my jaw at night, I would repeat "this is just my mind trying to distract me from repressed emotions" again and again. And I directed it to my jaw. And my jaw would just relax on its own as soon as I said this, and I would just let it do what it needed to. And I would repeat it again and again, whenever I became conscious at night and found my jaw clenched. Surprisingly, it worked for me. I won't say how long it took just so you don't feel like you have to stick to the same timeline (that adds pressure), but it worked really well for me. I hope it helps you as well.

 

My technique to stop clenching at night was to do a little bit of mindfulness meditation at night before going to sleep - consciously relaxing my jaw and opening my teeth, and telling myself that I could keep it relaxed throughout the night. As others have said, this is surprisingly effective (and my dentist confirms no signs of clenching anymore).