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Thursday, May 23, 2013
Jaw twitching & headaches
I currently have two main issues when sleeping, as I fall asleep I can feel my jaw twitching, sometimes even to the point where I clench my teeth and bite my tongue. I then also wake up with severe headaches (not as often) which remain throughout the day no matter what pain meds I take. It might have all started after being in a car accident about 3 years ago. I have seen a specialist who had given me a splint to wear while I sleep, this solves the tongue biting but I still wake up with headaches occasionally that remain throughout the day. He also determined that my joints are slightly inflamed but not too much, and I have followed all guidelines to relief the minor joint pains. Don`t know if it might be related but I do have a seizure disorder and have been taking Dilantin for the past 10 years to control it.
Your description is quite interesting though it will be difficult for me to pin down the exact cause of your problems based on just the information provided in your question. However, you are right to seek help. The possibilities for this “jaw twitching” and tongue biting include bruxism, night-time seizures and sleep apnea. Based on your description, I strongly suspect that this may represent bruxism.
Bruxism is a tonic and rhythmic activity of the muscles responsible for chewing that occurs during transitions to sleep or during sleep. They may be accompanied by a loud and grating or clicking sound. Repeated tongue biting during sleep has been described in association with bruxism.
Bruxism is also associated with oral and facial pain, headaches and dental wear. The cause of bruxism is not entirely known though may be more common in individuals who are “highly motivated,” have a “high vigilance” or are anxious. It can be brought on by stress. One of the treatments commonly used for bruxism is a mouth splint that helps to protect the teeth and lessen the grinding. It appears you already have one of these. Other treatments may include the use of muscle relaxants or sedatives to prevent the clenching during sleep. Bruxism has been associated with sleep apnea, so if you have other symptoms suggestive of this condition (see below), then further testing may need to be considered.
Seizures (especially generalized ones) are typically associated with erratic limb movements, and loss of bladder and bowel control. They are also followed by a period of confusion. However, seizures can present in unusual patterns and it’s possible that the tongue biting could represent a sign of uncontrolled night-time seizures. Since you have a known seizure disorder, this would be an important aspect to investigate.
Obstructive sleep apnea (OSA) is due to the recurrent complete or partial closure of the airway during sleep. As a result, individuals with OSA suffer from fragmented sleep and tend to feel unrefreshed upon awakening as well as sleepy and tired during the daytime. The main risk factors for the development of sleep apnea include being overweight and/or having specific anatomic abnormalities (such as large tonsils) that may narrow the airway. Aside from unrefreshing sleep and daytime sleepiness, individuals with sleep apnea often complain of loud snoring, headaches upon awakening, a poor sense of well-being, decreased ability to concentrate and reduced alertness. As mentioned earlier, bruxism appears to be more common in those with sleep apnea. It is important to diagnose and treat this condition as treatment can improve symptoms and reduce the risks of long term complications associated with OSA. The diagnosis typically requires a sleep study.
To further evaluate your problems, a thorough history and physical examination are needed. A referral to a Sleep Specialist by your primary care physician may be necessary to help sort out whether further testing is needed. Once a history and physical examination have been performed, the Sleep Specialist will decide if further evaluation by a sleep study is necessary. If a primary sleep disorder is discovered, you should maintain hope as all of these problems are treatable with a fairly high degree of success.
To learn more about sleep or other sleep disorders, please visit the American Academy of Sleep Medicine website. In addition to information, the website contains a list of Sleep Centers across the country so that you may locate one near you. The website SleepEducation.com also provides plenty of good consumer friendly information.
Dennis Auckley, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University