[Equipment] Fatigue and TMJ issues... nasal mask/tape recs?

[Uphold9887]

I have posted a couple times before, but wanted to give an update and see if anyone has some new suggestions...

After about a year of CPAP therapy i began developing terrible TMJ pain.  I have facial hair and I suspect the tightness of my cpap mask has been pushing my jaw back each night which has now resulted in complete disc displacement on my right side and partial displacement on my left.  A surgeon consult has been scheduled, and I am also talking to a dentist who is suggesting crowns and/or braces to fix my bite.  Anyway, that's (sort of) a separate issue, but I think the context is important.

In an effort to reduce pressure on my jaw I've switched to a full face AirTouch F20 mask which I find seems to allow a decent seal, while requiring less tightness on the straps.  However I still have many mornings of extreme fatigue, days filled with brain fog and sluggishness, and sometimes i wonder if there could be more I could do to tweak my therapy.

I'm also considering switching to a nasal mask with mouth taping to eliminate pressure on my lower jaw altogether?  Im absolutely a mouth breather at night.  Does anyone have any recommendations in that area?

 Posting last nights data as I've had a particularly bad day today in terms of fatigue and brain fog.  Thanks for any input.

[SystemF]

Sorry i dont have any helpful suggestions, i just wanted to ask, was the mask that was giving u tmj issues the F&P simplus?

[emmylouwho]

You have a lot leaking from this shot. That alone can cause arousals resulting in your next day symptoms. Is that typical night for you?

[Uphold9887]

@SystemF - I have tried many masks, only the more recent one before the AirTouch F20 was the F&P Simplus.  I did use it for probably the longest period of time, however I think the TMJ problems probably started before it.  I dont think the TMJ issue is specific any one mask, I think its mroe a result of the full face mask style plus my facial hair resulting in a level of mask tightness that pushed my jaw back each night instead of allowing my jaw position to reset naturally while i slept.

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@emmylouwho - I think perhaps that was an atypical night.  Here is last nights data, and today i do feel quite a bit better compared to yesterday.  However there is still some nagging fatigue, mild headache, brain fog, etc.

[Cpapian]

Before I  say anything  I say hold off on crowns and surgery.   

You should breathe through your nose.  That's the way our anatomy is designed.   To work properly breathe through your nose.   That being said it may sound impossible.   There are exercises you can do to train this change.   In the meantime there are devices to help keep your mouth closed.  There are a variety available on the internet.   Before you buy one,  check back here for feedback from forum members.  Two popular methods are a cervical collar and mouth taping.  You will find good advice here on both here on the forum.   The cervical  collar prevents your mouth from dropping by blocking it, and the tape holds the lips together.   

The tongue exercises are available here on the forum as well.

You should do the exercises because your tongue in it's proper position blocks air flow into your stomach (aerophagia)

 Now back to your TMJ dysfunction.  I have had TMJD for 40 or 50 years.  It has been treated successfully with a TMJ night guard.  Stress can cause TMJD.  Perhaps the stress of having sleep apnea contributed to it. 

I haven't heard of a complete jaw displacement or a partial one either but if it were me I would avoid surgery and crowns.  Surgery can take months to recover and crowns are uncomfortable,  never as good as regular teeth,  more susceptible to gum loss and expensive.   Even if you have extended health insurance they generally only cover 50 percent. 

If your jaw is out of place, they put shoulders back; why can't they put your jaw back?   If you get a night guard and they put your jaw back, could that fix your problem?   I once had acupuncture.  It was amazing.  

Another suggestion what about shaving your beard.  Is it more important than surgery  ... crowns?

[cdplatt]

I'm a TMJ sufferer also.  Recommend you visit the TMJ Association web site and get informed before you let a surgeon or dentist do anything irreversible to your jaw or teeth.  There are few proven, universally acceptable procedures to resolve TMJ issues.  Treatment should be very conservative at first - no dental work or surgery.  Stop doing the thing that is causing or aggravating the condition.  Switching to a nasal mask and tape is a great idea.  Mouth splints help, but you don't need to spend a fortune on them through a dentist.  Advil or Aleve help.  TIME helps.  Once you avoid putting backward pressure on your jaw, give yourself time to improve.

[Uphold9887]

@Cpapian:

Thank you for your input.

Unfortunately, it is my discs which have become displaced, and not the bone in the joint itself.   So there isn't really any bone to manipulate "back" into place.  When my jaw opens, there is no longer a disc to cushion the bones from rubbing against each other.  The MRI also revealed what they described as "possible osteonecrosis" due to the damage being done by the displaced disc.  I'm told that this is very likely to be more or less permanent and the joint isn't likely to simply recapture the disc on its own.  Surgery can sometimes reposition the disc, or you can replace it with other tissue, but again, that's surgery... its not something i'm looking to jump into right away.

My TMJD is severe enough that if I dont wear the full-time orthotic for even a couple of hours in the day, the pain starts to come back.  What i'm using now is not meant to be a permanent orthotic, so I dont really have many permanent treatment options left at my disposal.  It is either surgery, crowns, crowns+braces or an actual full time orthotic that stays in my mouth 99% of the time.  None of these are good options but without some intervention i get excruciating pain.  I dont know of any other options that can help with this severity of disc displacement.  Right now i'm leaning towards the full time orthotic and not the crowns, but I am waiting to see what the surgeon says first.

I just had my first night without the full face mask and instead used a nasal mask with tape.  Today I feel quite exhausted, yet my stats look good.

@cdplatt:

Yes I have looked at the TMJ association website.  I am trying to proceed carefully.  Thank you for your input.  I hope the nasal mask helps, but after my first night I feel very exhausted.  Feels like I can't win.  Hope i can fine tune the nasal mask settings with some assistance from the board and maybe I won't feel terrible with it.  I posted a new thread with some charts and questions, hopefully I can get some responses there.