Sleep Disorders, Snoring and TMJ

A good night’s sleep is critical to your mental and physical health. Night and Day Sleep centers provide comprehensive sleep services at 6 locations in the New York / New Jersey area and also offer treatment options for sleep disordered breathing. At our sleep centers we work with you to comprehensively diagnose and treat your sleep disorder, so that you can get the quality sleep that you need.

Locate a Night and Day Sleep Specialist

Night & Day Sleep Services manages sleep labs in various hospitals. Each sleep lab contains private rooms and bathrooms. Most rooms have full-size temperature sensing foam beds, nightstands, lamps and televisions.

Our services include:
* Sleep Studies
* CPAP / BiPAP Titration Studies
* Fatigue Studies
* Matrx - oral appliance titration studies

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Snoring Aids in NY - Snoring Solutions To Help You Stop Snoring Today

New Techniques Offers Snore No More Cure For Some
If you awake in the morning feeling tired or exhausted, if you experience daytime drowsiness, or if your snoring is proving disruptive to family life, you have reason enough for concern, but studies also show that problem snoring can prove symptomatic of a more serious medical condition. Anti-snoring devices and certain snoring remedies may be able to provide relief.

Who Snores and Why
Surprisingly, almost half of us snore. According to the American Academy of Otolaryngology, 45% of normal adults are occasional snorers. Habitual or problem snorers account for 25%, the Academy reports  and these are the individuals who tend to have underlying sleep disorders. Studies show that males and overweight patients are most likely to develop a habitual snoring problem. These problems become more serious with age. If you have noticed these issues with yourself or your partner it is important that a snoring aid  or if possible a snoring cure, is found as soon as possible.

Most often the cause of snoring is simple. Obstruction to the flow of air through the nose as seen with a deviated nasal septum or polyps can cause snoring. Also, redundant tissue at the back of the mouth and nose can cause an interruption to the free flow of air through these passages. Specialists in the young and rapidly evolving science of sleep disorders explain that a long palate and uvula are usually the culprits. To discover what's causing your snoring disorder and find a snoring solution fast, contact a specialist with ENT and Allergy Associates, in the NY & NJ area.

At the end of the roof of the mouth the soft tissue of the palate spans across the back of the throat and separates it from the opening to the nose. Attached to its distal end is the "bell", like uvula. As those structures dangle in the airway, they can vibrate particularly during the relaxed state of sleep causing the irritating and disturbing noises of snoring.

If noisy breathing proves to be the only problem, simple and quick new procedures are proving to be effective cures. Unfortunately, not all snoring problems are simple and doctors need to rule out more dangerous sleep disorders including sleep apnea.

Sleep Study:

Evaluating Snorers for Sleep Disorders
Snoring can be a symptom of obstructive sleep apnea which disrupts breathing and poses a risk to life. Sleep specialists suggest an initial screening that includes the taking of an in-depth medical history accompanied by a physical examination.

History taking is aided by questioning the snorer's bed partner. Items explored include the patient's medical condition and the medications being taken, weight gain, alcohol intake and sleeping position. Daytime sleepiness is also explored. The degree and type of snoring is detailed to determine the severity of the problem and to look for sleep apnea. The physical examination will also include a detailed ear, nose and throat exam to look for contributing nasal conditions, the shape of the palate and the voice box.

Open mouth diagram

Based on the exam's results, some snorers may be referred for further evaluation with a sleep study. While patients sleep, a painless polysomnogram test monitors their brain waves, breathing patterns, heart rate, oxygen level and muscle movements.

In the event that sleep apnea is diagnosed, appropriate treatment can be planned. This starts by avoiding causative factors such as alcohol, sedatives or heavy meals late in the day. It may involve weight loss and techniques to change the snorer's sleeping position. The use of oral devices may be tried to keep the airway open. It will also include the use of Continuous Positive Airway Pressure (CPAP). However, the discomfort of these treatments and the need to sometimes use them for the rest of one's lives makes the compliance rate very low. Therefore, some patients end up choosing a surgical option. This may include surgery on the nose, such as a submucous resection and turbinectomies, surgery on the palate and tonsils, uvulopalatopharyngoplasty (UPP), or surgery on the base of the tongue.


Laser Lightens Treatment for Problem Snoring
If snoring proves not to be sleep apnea, but the simpler problem of excess tissue, you will most likely be an appropriate candidate for laser treatment.

Laser assisted uvulopalato-plasty (LAUP) was introduced in Europe and brought to this country several years ago. Thousands of treatments have been performed with excellent success in the reduction or elimination of snoring.

LAUP is performed in an office chair under local anesthesia, similar to that used for dental procedures. During each 15 minute treatment, a focused beam of laser light is used to vaporize excess tissue from the uvula and to resculpture the soft palate. Small incisions are used because the technique relies on natural healing process to elevate and tighten the palate. The snorer usually requires two to three treatments before snoring is eliminated.

Most patients return to work within a day or two. A sore throat can be expected for several days afterwards which is controlled with analgesics.

The Pillar®, Procedure.
A minimally invasive treatment for snoring and mild to moderate obstructive sleep apnea (OSA).

Pillar®, Implant-site of implantation now there's a simple, safe, minimally invasive treatment for snoring and mild to moderate obstructive sleep apnea (OSA). Unlike other painful and invasive surgical procedures, the Pillar®, Procedure is a simple treatment that your doctor can perform in a single, short office visit or in combination with other procedures.

Site of Pillar implantation diagram

During the Pillar®, Procedure, tiny polyester implants are placed into the muscle of the soft palate. Over time, the implants, together with the body's natural fibrotic response, add structural support to and stiffen the soft palate. This structural support and stiffening reduce the tissue vibration that can cause snoring and the palatal tissue collapse that can obstruct the upper airway and cause obstructive sleep apnea (OSA).

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What is the TMJ?
You may not have heard of it, but you use it hundreds of times every day. It is the Temporo-Mandibular Joint (TMJ), the joint where the mandible (the lower jaw) joins the temporal bone of the skull, immediately in front of the ear on each side of your head. A small disc of cartilage separates the bones, much like in the knee joint, so that the mandible may slide easily, each time you chew you move it. But you also move it every time you talk and each time you swallow (every three minutes or so). It is, therefore, one of the most frequently used of all joints of the body and one of the most complex.

You can locate this joint by putting your finger on the triangular structure in front of your ear. Then move your finger just slightly forward and press firmly while you open your jaw all the way and shut it. The motion you feel is the TMJ. You can also feel the joint motion in your ear canal.

These maneuvers can cause considerable discomfort to a patient who is having TMJ trouble and physicians use these maneuvers with patients for diagnosis.

TMJ Overview:

How does the TMJ work?

TMJ profile

TMJ profileWhen you bite down hard, you put force on the object between your teeth and on the joint. In terms of physics, the jaw is the lever and the TMJ is the fulcrum. Actually, more force is applied (per square foot) to the joint surface than to whatever is between your teeth. To accommodate such forces and to prevent too much wear and tear, the cartilage between the mandible and skull normally provides a smooth surface, over which the joint can freely slide with minimal friction.

Therefore, the forces of chewing can be distributed over a wider surface in the joint space and minimize the risk of injury. In addition, several muscles contribute to opening and closing the jaw and aid in the function of the TMJ.


  • Ear pain
  • Sore jaw muscles
  • Temple/cheek pain
  • Jaw popping/clicking
  • Locking of the jaw
  • Difficulty in opening the mouth fully
  • Frequent head/neck aches

How does TMJ dysfunction feel?
The pain may be sharp and searing, occurring each time you swallow, yawn, talk, or chew, or it may be dull and constant. It hurts over the joint, immediately in front of the ear, but pain can also radiate elsewhere. It often causes spasms in the adjacent muscles that are attached to the bones of the skull, face, and jaws. Then, pain can be felt at the side of the head (the temple), the cheek, the lower jaw  and the teeth.

A very common focus of pain is in the ear. Many patients come to the ear specialist quite convinced their pain is from an ear infection. When the earache is not associated with a hearing loss and the eardrum looks normal, the doctor will consider the possibility that the pain comes from a TMJ dysfunction.

There are a few other symptoms besides pain that TMJ dysfunction can cause. It can make popping, clicking, or grinding sounds when the jaws are opened widely. Or the jaw locks wide open (dislocated). At the other extreme, TMJ dysfunction can prevent the jaws from fully opening. Some people get ringing in their ears from TMJ trouble.

How can things go wrong with the TMJ?
In most patients, pain associated with the TMJ is a result of displacement of the cartilage disc that causes pressure and stretching of the associated sensory nerves. The popping or clicking occurs when the disk snaps into place when the jaw moves. In addition, the chewing muscles may spasm, not function efficiently, and cause pain and tenderness.

Both major and minor trauma to the jaw can significantly contribute to the development of TMJ problems. If you habitually clench, grit  or grind your teeth, you increase the wear on the cartilage lining of the joint, and it doesn't have a chance to recover. Many persons are unaware that they grind their teeth, unless someone tells them so.

Chewing gum much of the day can cause similar problems. Stress and other psychological factors have also been implicated as contributory factors to TMJ dysfunction. Other causes include teeth that do not fit together properly (improper bite), malpositioned jaws  and arthritis. In certain cases, chronic malposition of the cartilage disc and persistent wear in the cartilage lining of the joint space can cause further damage.

What can be done?
Because TMJ symptoms often develop in the head and neck, otolaryngologists are appropriately qualified to diagnose TMJ problems. Proper diagnosis of TMJ begins with a detailed history and physical, including careful assessment of the teeth occlusion and function of the jaw joints and muscles. If the doctor diagnoses your case early, it will probably respond to these simple, self-remedies:

  • Rest the muscles and joints by eating soft foods.
  • Do not chew gum.
  • Avoid clenching or tensing.
  • Relax muscles with moist heat (1/2 hour at least twice daily).

In cases of joint injury, ice packs applied soon after the injury can help reduce swelling. Relaxation techniques and stress reduction, patient education, non-steroidal anti-inflammatory drugs, muscle relaxants or other medications may be indicated in a dose your doctor recommends.

Other therapies may include fabrication of an occlusal splint to prevent wear and tear on the joint. Improving the alignment of the upper and lower teeth and surgical options are available for advanced cases. After diagnosis, your otolaryngologist may suggest further consultation with your dentist and oral surgeon to facilitate effective management of TMJ dysfunction.

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