Sleeping better with TMD

The role of sleep quality:

Sleep is fundamental to the body’s restorative and healing mechanisms. Sub-optimal sleep quality can compound TMD symptoms, as interrupted or insufficient sleep may prolong inflammation, thereby escalating pain and dysfunction. Poor sleep can also indirectly affect pain perception through fatigue, emotional stress, and a reduced ability to cope with daily demands.

The impact of sleep position:

The position in which you sleep may influence TMD symptoms. Certain postures—such as sleeping on your stomach or with your arm beneath your head—can place strain on the jaw and neck muscles, potentially triggering or worsening TMD. In contrast, optimal sleep postures like lying on your back or side with proper head and neck support may help alleviate pressure on the jaw joint.

The role of bruxism:

Bruxism (teeth grinding or clenching) often occurs during sleep and may contribute to TMD. The excessive forces generated by repeated clenching can irritate the TMJ and surrounding muscles, leading to pain or altered function. Dental devices such as night guards and lifestyle changes can help reduce the impact of bruxism on jaw health.

The link to sleep apnea:

There is growing recognition of the connection between obstructive sleep apnea (OSA) and TMD. If you experience symptoms such as loud snoring, frequent waking, or excessive daytime sleepiness, consult your doctor. OSA may contribute to fatigue, poor pain tolerance, and jaw tension during sleep.

Supporting better sleep for TMD management:

Prioritising good sleep hygiene and habits is an important part of a self-management approach to TMD.

Sleep preparation

• Avoid heavy meals close to bedtime and establish a calming wind-down routine 60–90 minutes before sleep.

• Dim the lights and avoid stimulating activities such as television or phone use.

• Disconnect from screens and social media.

• Consider a warm caffeine-free drink such as herbal tea or warm milk.

• Avoid caffeine, alcohol, and nicotine in the evening.

• Do any strenuous exercise earlier in the day.

Sleep hygiene

• Keep your bedroom cool (around 18–19°C), quiet, and dark.

• Use your bed only for sleep—avoid TV or phone use while in bed.

• Remove clocks if clock-watching causes anxiety.

• Sleep in a bed, not on a sofa or recliner.

• Wake up at a consistent time each day to stabilise your body clock.

• Don’t panic about occasional night wakings—acceptance can ease frustration.

• Limit or avoid daytime naps.

• Use blackout curtains or blinds to reduce ambient light.

• Ensure your mattress and pillow support good posture and comfort.
  

When sleep problems become chronic:

If sleep problems persist and develop into insomnia, cognitive behavioural therapy for insomnia (CBT-I) may be needed.

Long-standing sleep issues can create a learned association between being in bed and feeling anxious, frustrated, or wide awake—especially in those managing persistent pain. Breaking this cycle is essential for re-establishing healthy sleep.

CBT-I is an evidence-based treatment that works by reducing the amount of time spent in bed to the average time you currently sleep, plus an extra 30 minutes. This process, while demanding, eventually increases sleep pressure, helping to reset your sleep-wake association. It’s crucial to maintain a strict bedtime and wake time and avoid napping during the day.

A gentler version involves staying in bed only when sleeping or feeling calm. If you find yourself lying awake, get out of bed and return only when relaxed. Over time, this weakens the connection between being in bed and feeling distressed, promoting a more restful sleep environment.

Final thoughts:

For individuals with TMD, sleep can be both a contributing factor and a therapeutic opportunity. Addressing sleep-related behaviours, optimising your environment, and seeking help when needed – such as through CBT-I – can significantly improve overall wellbeing and pain management outcomes.

References:

1. Herrero Babiloni, A., et al., Sleep Disturbances in Temporomandibular Disorders: A Narrative Review., Oral Surgery 13, 1-10. 2019.

2. Mortazavi, N., et al., Is Bruxism Associated with Temporomandibular Joint Disorders? A Systematic Review and Meta-analysis., Evidence-Based Dentistry 24, 144-150. 2023.

3. Sánchez Romero, E. A., et al., Association between Sleep Disorders and Sleep Quality in Patients with Temporomandibular Joint Osteoarthritis: A Systematic Review., Biomedicines 10, 2143-2155. 2022.