Never Underestimate the Power of a Good Night’s Sleep

Knowledge is key to making empowered decisions about your health. We’re dedicated to making your health a priority by keeping you informed on how to achieve your optimal well-being. In this month’s newsletter, we discuss a key foundation to health: sleep.

Connection Between Sleep, Health and Disease

Sleep is more than just a want to rest and recharge – it is a basic human need like eating, drinking water, and breathing. Sleep is vital for long-term health, as it is essential for maintaining both physical and mental well-being. It plays a critical role in supporting physiological functions like metabolism, immunity and cognitive performance. When we sleep, our bodies are able to repair damaged cells, regulate important hormones, solidify memories, detoxify, reduce stress, process nutrients and so much more.

When we sleep, the brain cycles between two different types of sleep: non-rapid eye movement (non-REM) and rapid eye movement (REM). Non-REM is the first part of the sleep cycle and consists of three stages. Stage 1 (N1), lasting several minutes, marks the transition from wakefulness to sleep, during which our heartbeat, breathing, eye movements, and brain waves slow. Stage 2 (N2) accounts for 45% of your time asleep and involves light sleep with limited eye movement. The heart and breathing continue to slow, muscles relax, and body temperature drops. Our brain waves slow but have brief bursts of electrical activity, believed to be from the brain consolidating memories. Stage 3 (N3) is characterized by deep sleep and is required to feel energized in the morning, support immune function, and repair injuries. Babies and children need more time in stage 3 sleep.

Most people spend about ⅓ of their lifetime sleeping, which amounts to about 25 years in an average lifespan. Despite this, many people struggle to achieve enough quality sleep. In the U.S., more than 35% of adults are getting less than the necessary amount of sleep per night to support our health. Additionally, up to 38% of adults suffer from sleep-disordered breathing.

It is important to not neglect that sleep issues do not have any age boundaries. Research estimates that 35% of children in the U.S. are not hitting the recommendations for sleep duration and this number continues to increase as they grow into their teenage years. As well, around 27% of adolescents suffer from sleep-disordered breathing.

General Sleep Requirements

Newborns (0-3 months): 14-17 hours
Infants (4-12 months): 12-16 hours
Toddlers (1-2 years): 11-14 hours
Preschoolers (3-5 years): 10-13 hours
School-Age Children (6-12 years): 9-12 hours
Teenagers (13-17 years): 8-10 hours
Adults (18-64 years): 7-9 hours
Older Adults (65+ years): 7-8 hours

What is Sleep Deficiency?

Sleep deficiency can occur if you experience one or more of the following:

You do not get enough sleep (sleep deprivation).
You sleep at the wrong time of day (out of sync with your circadian rhythm).
You do not have good quality sleep (fragmented sleep, trouble falling asleep and/or staying asleep).
You do not achieve all the different stages of sleep that our bodies need (N1, N2, N3, and REM sleep).
You have a sleep disorder or sleep-disordered breathing that prevents you from meeting your sleep needs.

In the short term, inadequate sleep hampers cognitive function, impairs memory consolidation, worsens attention and negatively impacts decision-making abilities. This can result in decreased productivity, increased irritability, and heightened stress levels, impacting mental health and ability to function to complete daily tasks.

Long term sleep deficiency can have even more profound consequences such as increased inflammation, oxidative stress, and damage to your DNA. Those who meet the criteria for sleep deficiency are significantly more likely to develop one or more chronic condition(s) such as heart disease, high blood pressure, type 2 diabetes, neurodegenerative diseases, chronic pain conditions like TMD/TMJ and even anxiety and depression.

Sleep deficiency in adolescents can result in severe complications as well, because our bodies require oxygen for development and the release of growth hormones. When left untreated, risk of delayed development, impaired intelligence, dysfunction of the nervous system, memory loss, behavioral issues and depression, increases.

Although sleep deficiency is an increasingly prevalent public health issue, an estimated 85% of individuals with underlying sleep-disordered breathing don’t even know they have it, leaving a shocking number of cases remaining undiagnosed.

Many cases of sleep breathing issues remain undiagnosed as a result of the narrow criteria used by healthcare professionals to screen for conditions like obstructive sleep apnea. The stereotypical patient is considered to be an older adult male, often overweight with a large neck circumference and who has loud snoring. This leads to individuals being overlooked and misdiagnosed, especially women and children who typically present in less traditional ways.

What are sleep-related breathing disorders?

Sleep-related breathing disorders are conditions characterized by abnormal breathing patterns during sleep, affecting airflow, oxygen levels and sleep quality. Mouth breathing, snoring, Upper Airway Resistance Syndrome (UARS), and Obstructive Sleep Apnea (OSA) are all on the spectrum of sleep-breathing issues, but they differ in their severity and impact on our health.

Mouth breathing during sleep can lead to poor oxygenation, dry mouth, and increased likelihood of snoring, as the air taken in bypasses the nose's natural filtration and humidification processes. Mouth breathing during sleep can contribute to snoring and lead to airway instability, especially in cases of nasal obstruction.

Snoring occurs when airflow causes vibrations in the relaxed tissues of the upper airway (throat), and may be an early sign of airway obstruction, although this is not always the case.

Upper airway resistance syndrome (UARS) involves increased resistance and narrowing of the airway that leads to frequent arousals, unrefreshing sleep, and daytime fatigue, but without the full apneas seen in obstructive sleep apnea (OSA). UARS is commonly seen in younger women that do not have excess weight.

OSA is the most severe on the spectrum of the sleep-breathing conditions and has mild, moderate and severe variants. Obstructive sleep apnea occurs when the airway becomes partially or completely blocked, causing repeated pauses in breathing, significant drops in oxygen levels during sleep, and fragmented, unrefreshing sleep.

Risk Factors, Signs, and Symptoms

Expanding diagnostic criteria outside of male gender, excess weight and neck circumference, to consider a broader range of risk factors will help reduce the underdiagnosis of sleep breathing disorders. Risk factors often neglected to be taken into consideration include:

Jaw or facial structure abnormalities: Presentations may include underdeveloped jaw, narrow dental arches, crooked teeth, scalloping of the tongue, tori, and/or a narrow airway dimension.
Nasal pathology: Chronic congestion, inflamed nasal tissues, septal deviation, concha bullosa, and/or compromised nasal valve can lead to mouth breathing and contribute to airway obstruction during sleep.
Hormonal changes: Conditions like pregnancy, menopause, and polycystic ovary syndrome (PCOS) increase risk of sleep breathing issues in women and are often overlooked in screening, especially when women present with less traditional symptoms such as insomnia and daytime fatigue.
Gastrointestinal (GI) Issues: Individuals with sleep issues are more likely to suffer from GI issues, especially gastroesophageal reflux disease (GERD). Breathing obstructions can promote the backflow of stomach acid into the esophagus, leading to heartburn, acid reflux, and nighttime regurgitation. GERD can also worsen sleep breathing by creating further irritation, inflammation, and narrowing of the upper airway.
Mood disorders & behavioral issues: These conditions often coexist with sleep-breathing issues, however treatment is often focused on the mental health or behavioral related symptoms rather than exploring that dysfunctional breathing might be causing the issues in the first place.
Family history of sleep disorders: Genetic predisposition plays a role but family history is not consistently screened for.

Adult Signs & Symptoms May Include:

Loud or Chronic Snoring
Pauses in Breathing
Gasping or Choking Sensations During Sleep
Excessive Daytime Sleepiness or Fatigue
Morning Headaches
Bruxism (teeth grinding/clenching)
Difficulty Concentrating or Memory Problems
Irritability, Mood Changes, or Depression
Dry Mouth or Sore Throat Upon Waking
Restless Sleep or Frequent Nighttime Awakenings
Insomnia or Difficulty Staying Asleep
Frequent Nighttime Urination
Decreased Libido or Sexual Dysfunction
Night Sweats
GI issues, Heartburn or GERD

Children Signs & Symptoms May Include:

Snoring or Mouth Breathing
Periods of not Breathing
Restlessness
Odd Sleep Positions
Bed Wetting
Night Terrors
Headaches
Bruxism (teeth grinding/clenching)
Attention Deficit/Hyperactivity
Mood Changes, Aggressiveness, Depression
Withdrawal or Social Isolation
Poor Concentration or Learning Problems in School
Frequent Infections

Transforming Sleep Health in Our Practice

At the TMJ & Sleep Therapy Centre of Cleveland, we specialize in treating chronic pain conditions including craniofacial pain [pain in the head, face, jaw, and neck] and sleep-related breathing disorders [snoring, adult & pediatric OSA, UARS].

Our team is committed to addressing the growing epidemic of sleep deficiency, misdiagnosis of sleep issues and the negative impacts on health. This commitment starts with the patients that walk through our doors.

In last month's newsletter, we outlined the intricate relationship between pain and sleep issues, and why we always assess sleep quality and breathing in evaluating each patient. We screen for all variants on the sleep-disordered breathing spectrum, and strongly believe that all sleep-related breathing issues, regardless of the severity, need to be addressed, as sleep and breathing are two foundational components to disease prevention and achieving optimal health.

We conduct a comprehensive evaluation utilizing questionnaires to measure sleep quality, daytime sleepiness, and how a lack of sleep may be impacting daily activities. To screen for all risk factors for potential sleep breathing issues, we collect a detailed health history, complete a physical and oral examination, and utilize cone beam computed tomography (CBCT imaging) to asses the upper airway dimensions and identify any nasal obstruction.

When enough risk factors are identified, we always recommend completing a sleep screening as a next step in our evaluation. Our go-to sleep screening tools include FDA-cleared SleepImage System and WatchPAT portable diagnostic devices that measure sleep quality from the comfort of your own home and ensure accurate detection of existing sleep-breathing disorders.

How We Address Poor Sleep

In our patient population, we are presented with a variety of sleep complaints and we seek to do more than just manage their symptoms. There are several factors that can contribute to poor sleep and sleep-breathing issues such as diet, nutrient imbalances, GI issues, hormone imbalance, lifestyle factors, and/or stress. Our approach to treating sleep issues integrates an understanding of the interconnectedness of our many body systems to uncover all contributing factors and develop an individualized treatment plan to treat the root cause(s).

Oral Appliance Therapy

When sleep-disordered breathing is a contributing factor, oral appliance therapy (OAT) is an effective, non-invasive treatment option that involves wearing a custom-fitted device in the mouth during sleep. The appliance repositions the lower jaw, and tongue to help keep the airway open, improve airway function, and enhance sleep quality. For individuals with OSA struggling to tolerate continuous positive airway pressure (CPAP) therapy, OAT is an effective and FDA-approved treatment alternative.

Functional Breathing (Nasal & Diaphragmatic Breathing)

Functional breathing plays a crucial role in improving sleep quality, whether or not sleep breathing issues are present. In individuals who snore or have conditions like UARS or OSA, nasal breathing can help reduce airway obstruction and improve oxygen flow during sleep. Nasal breathing encourages the use of the diaphragm which promotes better regulation of the nervous system. This helps to stabilize breathing patterns and reduce the frequency of apneic episodes. Even in the absence of sleep-breathing disorders, nasal breathing enhances relaxation, reduces stress, and promotes more restful, uninterrupted sleep by improving overall respiratory efficiency.

In cases where we have to train proper nasal breathing, consciously practicing nasal breathing in the daytime is a good place to start because it reinforces the behavior. It is also necessary to address nasal obstruction through interventions such as sinus rinses, nasal sprays, and nasal dilators or breathe right strips are used to address existing nasal obstruction. In cases of a deviated septum or other boney obstruction in the nose, an ENT visit will be necessary to further improve nasal breathing. Mouth taping is an additional technique that can be helpful in training proper nasal breathing both day and night, however it is important to ensure your nasal passages are clear before trying this method.

Nutrition Therapy & Supplementation

What you eat plays a crucial role in determining the quality of your sleep. Studies show that certain dietary patterns—such as excessive calorie and sugar intake, not consuming enough fruits and vegetables, skipping breakfast, caffeine later in the day and irregular eating schedules—are linked to sleep disturbances. The American Academy of Sleep Medicine also highlights that blood sugar fluctuations from refined carbohydrates can trigger sleep problems. Diet can also contribute to sleep issues in the following ways:

Poor diet can contribute to imbalances in nutrients and contribute to poor sleep. For instance, magnesium deficiency can interfere with the body’s ability to relax muscles and calm the nervous system, leading to difficulty falling asleep and staying asleep. Vitamin D deficiency is linked to poor sleep quality, as it plays a role in regulating sleep-wake cycles. Similarly, low levels of B vitamins—particularly B6 and B12—can impair the production of serotonin and melatonin, which are crucial for sleep regulation. Iron deficiency can also lead to conditions like restless legs syndrome, which causes discomfort and sleep disruption.
Poor diet can contribute to gut dysbiosis or other gastrointestinal (GI) issues, which in turn disrupt sleep by causing nervous system arousals and increasing nighttime awakenings. Inadequate fiber intake and consuming heavy meals or inflammatory foods with 3 hour of bedtime can exacerbate GI problems, making restful sleep harder to achieve.
Food sensitivities can also play a significant role. Undiagnosed sensitivities can cause inflammation, digestive disturbances, and discomfort, leading to poor sleep patterns. Food sensitivities can also contribute to nasal congestion, increasing potential for sleep-breathing issues.

Taking these findings into consideration, a sleep-supportive diet would include an anti-inflammatory dietary regimen personalized to improve overall nutrition habits, and address existing nutrient imbalances, GI issues, hormone dysregulation or other dysfunction in the body that may be contributing to poor sleep or sleep-breathing concerns.

The addition of supplements to your nighttime routine such as magnesium glycinate, or herbal extract like valerian root, lemon balm, and chamomile are commonly used to improve sleep by supporting relaxation and regulating sleep-wake cycles. Magnesium helps relax muscles and reduce stress, while the herbal extracts have mild sedative properties, promoting calmness to enhance sleep onset. We recommend working with a healthcare provider any time that you add a new supplement into your routine to ensure you are using a safe product and taking the proper dosage for you.

Functional Testing Options

We offer a variety of functional laboratory testing to look at biomarkers associated with physiological imbalances that contribute to sleep disturbances and sleep-breathing conditions.

Nutrient deficiencies: vitamins, minerals, amino acids and fatty acids to assess nutritional status
Comprehensive stool test: markers of digestion, absorption, inflammation, immune function and microbiome balance
Allergy testing: environmental allergies and food sensitivities
DUTCH test: hormone, neurotransmitter assessment
Complete Thyroid Panel: thyroid hormone and antibodies
Cardio-Metabolic Testing: metabolic health, glucose regulation, insulin, and HbA1c
Neurotransmitters: neurological function and neurotransmitter imbalance

Lifestyle Modifications to Improve Sleep Hygiene

Improving sleep quality often requires making consistent lifestyle changes that support both overall health and our body's natural sleep rhythms. Good sleep hygiene is key, including maintaining a consistent bedtime routine and sleep schedule, even on weekends, to align with our individual circadian rhythm. We each have our own circadian rhythm, ingrained in us like our hair or eye color, so if you can’t seem to get in sync with your current schedule, you may be off your own clock! Avoid long naps in the daytime or close to bedtime to avoid disturbing your nighttime sleep schedule. Regular exercise during the day also enhances sleep by reducing stress and helping regulate your internal clock, though it's important to avoid vigorous activity too close to bedtime.

Incorporating relaxation techniques before bed such as meditation or journaling, along with creating a cool (68-70 degrees Fahrenheit), dark, and quiet sleep environment, can further promote restful sleep. Additionally, limiting screen time and exposure to blue light at least an hour before bed helps minimize sleep disruptions. By practicing these habits consistently, you can significantly improve both the quantity and quality of your sleep.

How We Can Help:

If you are battling with fatigue, struggle to get a good night’s sleep, or have sleep-related breathing issues, reach out to our office to schedule a comprehensive evaluation to get you one step closer to achieving more consistent, restful sleep.

Our mission to address the sleep deficiency epidemic and reduce the number of undiagnosed sleep-related breathing disorders, extends beyond the individuals who visit our clinic. Dr. Kristina Wolf and the TMJ & Sleep Therapy Centre International team are dedicated to educating healthcare providers about the importance of conducting sleep evaluations on all individuals. By identifying potential issues early and addressing the root causes of existing conditions, we all can help to reduce the prevalence of chronic disease in our communities and improve overall health outcomes.

What’s Next?

This month, we will be resuming our nutrition webinars! Our nutritionist, Carly, will be hosting the webinar, Eat to Sleep: Unlocking the Secrets of Nutrition for Restful Nights Sleep, via Zoom on Thursday, October 3rd at 6PM EST.

If you are interested in joining us, RSVP using the link below! We will send out an email with the link to the webinar on the day of the event.

Webinar RSVP

Next month, our TMJ Wellness Newsletter will focus on functional breathing – the benefits of nasal breathing for our overall health, sleep, mood, stress and more!

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Never Underestimate the Power of a Good Night’s Sleep

Connection Between Sleep, Health and Disease

General Sleep Requirements

What is Sleep Deficiency?

What are sleep-related breathing disorders?

Risk Factors, Signs, and Symptoms

Transforming Sleep Health in Our Practice

How We Address Poor Sleep

How We Can Help:

What’s Next?

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