Tinnitus from Musculoskeletal Misalignment & Imbalances — Achieving Better Sleep

I will preface this discussion by advising you not take any one thing I suggest out of context. make you aware that these things may not work for everyone, alert you to the fact that the information given below should not be used diagnose or treat any health or medical condition, and strongly recommend you consult with your doctors before attempting some of the less conservative treatments and strategies I outline.

I am now wrapping up Month 3 of my treatment plan for tinnitus likely caused by TMJ/Bruxism and associated Musculoskeletal Misalignment and Neuromuscular Imbalance. Several people have expressed interest in my treatment plan and learning more about it. I have achieved much relief with this treatment plan thus far, and its first priority and highest tenant is achieving better sleep. I am a innately curious and mildly obsessive Oceanographer and Physical Scientist who employs a holistic and systematic approach to most things including my tinnitus treatment; an example of which is demonstrated below. From my investigations, this seems to be ideal approach to perform in a nested and iterative manner for the diagnosis and treatment of tinnitus. When trying to achieve better sleep, it is important to understand cause-and-effect relationships and distinguish between upstream (primary/causes) and downstream (secondary/symptoms) when it comes to disentangling your own sleep issues and your own tinnitus diagnosis and treatment. A compilation of my notes, recommendations, and specific details of their implementation for my specific case are included below. Hopefully, at least one other person will find some relief from their tinnitus using some of the recommendations I put forward in their own journeys with this horrid condition or at least will be in a better condition to deal with it a daily basis because they are getting more higher-quality sleep.

Educate Yourself About Sleep

@boliston suggested this book in an earlier thread which I bought and read which has helped with my sleep issues - https://www.amazon.com/Sleep-Solution-Why-Your-Broken/dp/0399583602. Also I subscribed to Dr. Michael Breus's weekly email list here - https://thesleepdoctor.com/. Ignore all of the products he endorses and tries to push on his subscribers. Regardless, this has led me to a lot of useful information (including the attached sleep guide), free sleep courses, and podcasts that have helped since my tinnitus onset in July 2019. Several of my work colleagues with tinnitus listen to these podcasts at night which help them drift off to sleep - https://www.sleepwithmepodcast.com/. The host basically rabbles on about useless stuff that is so boring it puts people to sleep. It works so well, he actually holds live events for people to attend to catch some Zzzs (see below video). It does not work for me, but may work for others.

This Podcast Might Be Stronger Than Ambien (HBO)

Track Your Sleep to Increase Sleep Awareness & Understanding

I started tracking my sleep which helped me understand my sleep fragmentation and architecture and develop my sleep strategies that I employ at present. I use this - https://www.amazon.com/Withings-Nok...&s=hpc&sprefix=withings,stripbooks,329&sr=1-3. Others devices include the Dreem 2 Headband - https://dreem.com/en - and the Oura Ring - https://ouraring.com/ - that @Phat Tuna has had some success with. If your inability to sleep stems from stress or anxiety, some device like those listed above help improve sleep awareness which is generally one of the first steps on the road to understanding and overcoming any issue. I stressed most about sleep itself and dreaded the when the time came to fall asleep. Now that I track my sleep, I stress a lot less about it and sleep better. Pairing a sleep journal with a sleep-tracking device can help you validate what is working and what is not over time.

On a normal 8-hour night, I strive for 20-25% (90-120 minutes) REM sleep (helps with emotional processing and memory consolidation; the less REM sleep I get, the more irritated I am and the more my tinnitus bothers me), 25-33% (120-180 minutes) Deep Sleep (body heals, fight inflammation, restore immune system, etc...; the less deep sleep I get, the more sore and fatigued I feel in the morning), and the remainder Light Sleep. I have pretty good attainment for these goals at present. If you sleep a lot but do not feel refreshed upon waking up, chances are you are stuck in the Light Sleep phase, your sleep is fragmented, or you may have a pre-existing sleep disorder.

Make Your Sleep Space into a Comfortable Space

Make sure you are comfortable in bed. Get a comfortable mattress or mattress topper that is optimized for your sleeping style and preferred sleep position (https://www.onhealth.com/content/1/best_sleeping_positions_sleep) and try a weighted blanket if necessary over a conventional comforter. Set the temperature to a comfortable one; some like it warmer and some like it cooler. Find the one that works for you. I also like to have air circulating when I sleep so I run a ceiling fan or tower fan on a lower setting at night and run a HEPA Air Filter as well. This is not a complete list. Considerable what a comfortable sleep space is oo you and create it. If you are not comfortable in bed, you won't be able to relax.

Practice Good Sleep Posture

Be mindful of your sleep posture. Try to keep your spine in a neutral position. Invest in a cervical neck pillow for back and/or side sleeping and consider using a lumbar support pillow. My recommendations for back sleepers - https://www.amazon.com/YourFacePill...ds=my+face+sleep+pillow&qid=1579936156&sr=8-4 - and for slide sleepers - https://www.amazon.com/Natures-Gues...ical+neck+pillow&qid=1579936247&s=hpc&sr=1-17 or https://infinitemoon.com/product/the-curve/. I rotate between these three pillows for sleep. It is good to have a pillow that is the right height for your neck depending on your preferred sleeping position(s) - https://www.spine-health.com/wellness/sleep/pillow-support-and-comfort, so purchasing a pillow you can add or remove fill to and adjust pillow height is a good approach. The human neck curves slightly forward (to sustain the weight of the head when upright), and it’s important to maintain this curve when in a resting position and take care not to hyper-extend forward neck curvature when sleeping. Sleeping with the neck in a forward-flexed position can trigger or worsen musculoskeletal misalignment, cause neck and back pain, worsen sleep disordered breathing due to narrowing the airway, and trigger bruxism. I noticed this was part of my default sleep posture and now set my pillow further back to keep my head over my shoulders where it belongs when sleeping on my side.

Treat Bruxism and Teeth Clenching/Grinding

If you suffer from bruxism, raise the temperature or try sleeping with a humidifier. Incorporate mindfulness or meditation as part of your sleep strategies to relieve stress before bed. Use a night guard to reduce the strain of grinding and clenching on your teeth. Invest in a TMJ orthotic to treat your bruxism. My orthotic keeps my jaw in a relaxed position, transfers the strain of clenching and grinding from my molars to my front teeth, and prevents my lower jaw from shifting backward; the latter two can trigger or worsen sleep disordered breathing due to narrowing or collapsing of the airway. Sleep with your mouth taped shut (I use this - https://www.amazon.com/Sleep-Strips...ywords=sleep+mouth+tape&qid=1579937428&sr=8-4 - to facilitate and encourage nose breathing to reduce prevalence of mouth breathing which can in turn in trigger bruxism and teeth grinding and clenching. When applying the tape, curve your lips inward which will keep upper and lower jaw slightly apart and help bruxism, grinding, and clenching further. Try using something like a Breathe Right Nasal Strip (https://www.amazon.com/Breathe-Right-Snoring-Drug-Free-Sensitive/dp/B001G7QPX2) to keep your nasal passages open, minimize chances of nasal valve collapse, improve nose breathing, and reduce prevalence of mouth breathing that can trigger bruxism. I have a slightly deviated septum so I use these every night. Try to treat your bruxism, clenching, and grinding early on to prevent further issues down the road.

Normalize & Manage Stress Hormone Levels

Consider your cortisol, adrenaline, and norepinethrine (stress hormone) levels and their diel variability. I only focused on cortisol for my purposes (more info on cortisol - https://www.webmd.com/a-to-z-guides/what-is-cortisol#1) which is something that helps control sleep-wake cycles. Cortisol is produced and released by the adrenal glands. Sustained and chronic long-term stress can exhaust your adrenal glands. I am scientist working in government and academia with two advanced degrees who needs to publish and secure funding to continue my research so I fit that description. This led to me Adrenal Fatigue Syndrome (AFS) which conventional medical docs cannot come to a consensus on whether or not it is a real condition. Naturopathic docs and folks working in alternative medicine definitely agree it is a real condition. More info on AFS - https://www.annelemonswellness.com/blog-1/2017/12/31/adrenal-fatigue-what-is-it-and-how-do-i-fix-it - and a two good book I bought and read - https://www.amazon.com/Adrenal-Fati...yndrome&qid=1579463404&sr=8-4&tag=tinntalk-20 and https://www.amazon.com/Adrenal-Fatigue-Century-Stress-Syndrome/dp/1890572152. Cortisol should be highest in the morning when you wake up and lowest when you go to bed at night. Depending how stressed you are and if you have AFS, cortisol can be chronically high, chronically low, and/or out-of-phase with your circadian rhythm. For me, cortisol levels were always on the higher end and roughly 3 hours of out phase with the nominal normal times I try to go to sleep at night and wake up in the morning. I currently live on the US West Coast but spent several years on the US East Coast, and due to poor sleep hygiene, prolonged computer use, or whatever reason, my circadian rhythm defaulted to US East Coast time. Once you understand how cortisol is changing with time of day, it may offer hope for addressing part of your sleep issues and possibly have a positive influence on your tinnitus or at least to improve sleep to better deal with it on a daily basis. My treatment was very conservative and included daily exercise and meditation to relieve stress, and practicing good sleep hygiene and syncing circadian rhythm with my diel cortisol variability to improve sleep and slowly move it from US East Coast to US West Coast Time (still working on this part). I drink tea containing herbs with adaptogenic properties like holy ginger, rooibos, and ashwagandha at different times of day that help raise cortisol levels if they are too low or lower them if they are too high throughout the day as well to help normalize my cortisol levels and reprogram my diel cortisol cycles. If interested in exploring this treatment pathway for your sleep problems, seek out an Endocrinologist who ascribes to AFS and/or similar conditions or a Naturopathic Doctor. LESS CONSERVATIVE CORTISOL SUPPRESSION & CONTROL TREATMENTS ARE VERY CONTROVERSIAL AND DANGEROUS IF NOT DONE PROPERLY. DO NOT SELF-DIAGNOSE AND PURSUE ANY SUCH TREATMENTS FOR THIS ON YOUR OWN.

Exercise

There are several benefits to regular exercise which I will not re-state here. For me exercise helps relieve stress and manage my cortisol levels which has the downstream effect of improving my sleep. I also mention this because if you have suspect you have AFS or stress hormone regulation issues, be conservative with your exercise and start slow. I went from walking at a brisk pace for 45 minutes 5x a week to interval training alternating between walking for 0.5 miles and running for 0.5 miles for 45 minutes 5x a week for one week with no transition period and was out of commission with chronically fatigued legs for about two weeks before I resumed my walking routine.

Boost & Expedite Sleep's Natural Restorative Functions at Night

While you sleep, your body heals, fights inflammation, sustains proper bone metabolism, and restores your immune system along with several other important restorative tasks overnight. @engineerLA postulated that inflammation plays a part in most people's tinnitus onset and progression, and I tend to agree with this assertion. In my case, I had inflammation in my temporomandibular joints, my sinuses, and probably my Eustachian Tubes as well. He put forward several suggestions for fighting inflammation in this thread - https://www.tinnitustalk.com/thread...-—-new-protocols-and-supplements-to-try.6514/. I perform several of his suggestions every morning after I wake up and before going to bed at night. Sinus irrigation and use of saline nasal spray are especially useful for me. It is my opinion that taking steps on your own to reduce inflammation and promote healing will further quicken and improve the effectiveness of good sleep's restorative powers; this is however purely based on my own observations and the improvements I have seen in my own tinnitus. I would take this one step further and encourage others to perform necessary tasks to combat muscle soreness and fatigue to quicken recovery and improve sleep as pain is also something that interrupt sleep. I will leave this open-ended for others to reflect on based on their own health. In my case, there is a battery of gentle stretches and releases I perform every night before going to bed to stretch and lengthen muscles that chronically contract during the day and decompress and work out knots of tension elsewhere. I continue to have problems with fatigued legs on and off, and I use a massage gun (https://www.amazon.com/Professional..._6?keywords=massage+gun&qid=1579945380&sr=8-6) to stimulate the muscles in my legs, increase delivery of oxygenated blood to the muscles, and flush out any lactic acid that has built up in the muscles over time before bed. Be sure to hydrate after doing something like this. I have noticed gradual improvements with my fatigued legs over time since doing this and achieving better sleep. I also use the massage gun on important postural muscles as well.

Detect & Treat Sleep-Disordered Breathing

Sleep-disordered breathing manifests as partial collapse of the airway (hypopnea) or full collapse of the airway (apnea) while sleeping and is measured using the Apnea-Hypopnea Index (AHI - https://www.sleephealth.org/ufaqs/what-is-ahi-represent/). Its most serious forms are Obstructive and Central Sleep Apnea; both of which can cause tinnitus as well thru several different pathways but not limited to triggering bruxism, suppression of blood oxygen levels, and reduction in the delivery of oxygenated blood to ears. Certain things predispose individuals to developing sleep apnea like high stress, obesity, and craniocervical misalignment (e.g., forward head posture). If sleep-disordered breathing is suspected, please consult your doctor and get a referral to a sleep doc and schedule a sleep study to help get a definitive diagnosis. Then, discuss sleep apnea treatment options with your docs like APAP/CPAP, orthotics, and lifestyle changes to name a few. My sleep tracking device also tracks sleep-disordered breathing (which I had) and detected several periods at night early on when I would wake up at night without knowing it (would not remember in the morning) before returning to sleep shortly thereafter. Both are hallmarks of sleep apnea. I took this data and information to my doctors who referred me to a sleep doc who then ordered a polysomnography test (another name for a lab sleep study). I was diagnosed with mild sleep apnea. I now take steps to address things like my bruxism and forward head posture when sleeping using those approaches detailed above, use a TMJ orthotic that doubles as a more conservative sleep apnea orthotic, and made several lifestyle changes that have helped me go from 235 to 195 lbs at 6'2" since my tinnitus onset in July 2019. My sleep tracking device now captures fewer sleep-disturbed breathing events and periods when I wake up at night without knowing it which has reduced sleep fragmentation and improved sleep quality and duration.

Develop and Maintain Good Sleep Hygiene

Sleep hygiene is listed last because considerations for sleep strategies from the above items are ultimately what will end up comprising your sleep hygiene plan. The few sleep specialists I have spoken with all say that your sleep hygiene plan should begin after leaving work. I tend to disagree and consider my sleep hygiene plan to start upon waking in the morning. Most important for good sleep hygiene is to go to sleep and wake up at the same times each day and not to deviate more than 60-90 minutes from those times you adhere to during the week on the weekends so try to resist the urge to sleep in. Also, be mindful of the fact that just because you spent 8 hours in bed does not necessarily mean you slept for 8 hours; another thing sleep tracking can help with. A rough example of my sleep hygiene plan when not at sea with accompanying info below to help with designing your own -

Mornings - 0615 to 1200 - Wake up at 0615. 45-60 minutes of Cardio 5x a week and stretches other 2x a week. Breakfast with tea with one tea bag of each - https://www.amazon.com/Yogi-Tea-Blu...keywords=yogi+slim+life&qid=1579948049&sr=8-3 and https://www.amazon.com/Tulsi-Origin..._1_4?keywords=tulsi+tea&qid=1579948091&sr=8-4 - for caffeine and cortisol control. Transit to work. Work between 0845 and 1200.

Afternoons - 1200 to 1745 - 1200-1300 - 20 minutes of stretching, 10 minute shower, 30 minute Lunch with tea - https://www.amazon.com/Yogi-Tea-Tan...rds=yogi+stress+relief&qid=1579948366&sr=8-14 - for stress relief and cortisol control. Work between 1300 and 1745.

Evenings - 1745-2130 - Transit home from work. On the way home I take 1000 mg each of Taurine and NAC on a daily basis on a relatively empty stomach to calm my mind that is always thinking. Dinner at 1830 followed by a anti-inflammatory smoothie. I usually follow this recipe - https://ohmyveggies.com/kale-smoothie/. I usually add fresh pineapple, turmeric extract, and sometimes mango as well. I am still fine-tuning my own version of this smoothie. My latest versions of the smoothie contains almond milk, kale, ginger, cinnamon, pineapple, and turmeric; all of which are anti-inflammatories and the smoothie is not overly sweet. In my case, this really further calms the nerves and helps reduce stress in the evenings. After dinner, I do my 30 minutes of light stretches which are not enough to elevate my heart rate before bed. Before showering, I take 1 mg of melatonin and 1000 mg of L- Tryptophan (be sure to take these types of supps 60-90 minutes the time you want to fall asleep). After showering I irrigate my sinuses and drink more tea - one tea bag of each https://www.amazon.com/Celestial-Se...keywords=sleepytime+tea&qid=1579949556&sr=8-5 and https://www.amazon.com/Tulsi-Origin..._1_4?keywords=tulsi+tea&qid=1579948091&sr=8-4 - for stress relief and lower cortisol levels to prepare for sleep. I am usually in bed by 2045. I am usually asleep between by 2130. Between 2045 and 2130, I usually decompress in some way whether it is watching Netflix, reading, using this facial massager to relax - https://www.amazon.com/gp/product/B07Z7P7FJX/ref=ppx_yo_dt_b_asin_title_o06_s00?ie=UTF8&psc=1 - which is extremely useful if have TMJ and sore mastication muscles around your temples, or performing meditation/deep breathing exercises using my BrainTap/Sleep RX combo (https://braintap.com/sleep-rx-bundle/). I do not like any noise when I sleep so I wear soft foam earplugs to block out the louder noises.

On weekends, my times for going to bed and waking up usually move later by 60-90 minutes and learning to do nothing on weekends is essential for learning to decompress and retain your sanity when you have tinnitus.

Remember not to eat anything heavy at least 2 hours before bed and avoid strenuous exercise before bed as well.

I limit my computer use on weekends and days off between 1000 and 1800 only (except for right now) and do not use my computers outside of normal business hours on weekdays. When I leave work, I am done for the day. I also wear blue light blocking glasses whenever using a PC now to combat suppression of melatonin production in the brain from blue light exposure. When using a computer, I maintain good posture and rotate between a kneeling chair, regular chair with a lumbar support, and standing desk.

I mostly avoid excessively sugary, spicy, and salty foods along with red meat and have adopted a more neutral diet. I also eat about 80% of my food raw now which also helps my transient and occasional acid reflux. Only meats, fish, and eggs are cooked and I opt to boil rather than fry. Raw vegetables are also steamed occasionally. I also abstain from alcohol and tobacco.

Positive thinking and retaining some sense of humor will go a long way to help with sleep also.

With a sleep hygiene plan, develop one and stick to it. Be consistent. After a couple of weeks, it will all seem involuntary and routine.

That is all for now. Wishing everyone luck with their sleep troubles and hopefully you find one bit of useful and beneficial of information in what is discussed above that will help treat and/or deal with their tinnitus

All the best,

-Oceanofsound26

 

Thank you so much for your post which is extremely complete and interesting.
I suffer from TMJ since 8 month and as well have constant pain in my neck. My night gutter helps me to not grind my teeth but unfortunately it causes me terrible pain in my neck since I am using it. Maybe because it creates some muscle tension...
As you are following this treatment, why are your tinnitus still there in your opinion ?

 

Sorry to hear about problems with TMJ and the neck pain. My tinnitus and TMJ worsened one night after eating a bit of tough overcooked chicken which elicited a pain response in my right masseter and temporalis muscles followed by pain that radiated down the left side of my neck down into my left shoulder and left flank. As muscles tense up and contract, other muscles have to compensate in some way by stretching, hyper-extending, or thru some other pathway.

Is this the same thing as a night guard? Night guards are only designed to ease the strain of bruxism/grinding/clenching at night and it sounds like you are still doing it. You should troubleshoot the root cause of your bruxism further and/or take additional steps to reduce its severity and prevalence. There are several things discussed above that you can try.

I originally developed tinnitus two nights after receiving my own night guard for grinding which ultimately set off the chain of events that led me here. I would check if you have a misaligned jaw because if you have constant pain in your neck you may have musculoskeletal misalignment elsewhere; in which case I would recommend seeking treatment thru Physical Therapy and maybe some upper cervical chiropractic treatment as well. Also, check your posture as well. Practicing good sitting and standing posture is paramount for the treatment of tinnitus caused by TMJ and associated misalignments/imbalances. My sleep recommendations is one of about a dozen aspects of the treatment plan I follow. You should look into combining several types of treatment to treat your TMJ that may resolve your neck pain and tinnitus as well. A good place to start would be to massage and release your SCM and see if that helps anything - if that muscle is rigid and tense, then there is a good chance you may have forward head posture (which often co-occurs with TMJ and tinnitus) and other muscles that need to compensate to keep your eyes on the horizon are probably tense as well.

HOW TO CORRECT SCM MUSCLE TRIGGER POINTS...

Orthotic therapy for TMJ will not yield immediate results and will often take 6-12 months or longer to achieve the best results. I am wearing a daytime orthotic for 12 weeks (on week 11) and nighttime orthotic for the rest of my life most likely. By week 4, my ear pain, jaw pain, and hyperacusis were gone and by week 10 my jaw stopped popping and TM joints re-entered the joint space so disc displacement is now minimal since I combined orthotics with other types of treatments. These ligaments will need time to heal and strengthen further so there is still degree of laxity to the ligaments and other parts of the joint (meaning they are still fragile and predisposed to displacement if not kept in the proper position) that will need to heal over time.

I go to sea about 10+ days a month for work which is stressful and requires a lot of repetitive twisting, lifting, pushing, and pulling and also causes my sleep to suffer as well on occasion. I do my best to follow my treatment plan when at sea, but I do not get the same results when on shore. I am switching jobs here shortly and am done with boats for awhile which will hopefully only help to further quicken my recovery.

I also suffer from forward head posture which I am still working on which causes tinnitus as well. Thankfully my combination of treatments has rid me of my neck pain, shoulder pain, back pain, and flank plain that still returns occasionally if my posture suffers or I do not get enough deep sleep one night, but the combinations of stretches, releases, and good sleep I do and strive far on a daily basis resolves any pain usually in a couple days; all of which will continue to help resolving TMJ. As I mentioned in my above post, a holistic and systematic treatment approach is ideal for tinnitus since its cause is often multi-factorial and most everything in the human body is connected in one way or another.

A few other threads you might find helpful -

https://www.tinnitustalk.com/threads/it-wasnt-tmj-it-was-just-a-misaligned-jaw.3858/

https://www.tinnitustalk.com/threads/how-do-you-know-if-tinnitus-is-from-tmj.36685/#post-501454

https://www.tinnitustalk.com/threads/hi-guys-new-here-tinnitus-in-left-ear.36914/#post-474216

I hope you can find some relief from your symptoms in the future.

All the best,

-Oceanofsound26

 

Thank you for you answer, I had a jaw surgery 4 years ago because of malocclusion. I was doing perfectly well and suddenly, 8 month ago, because of a long period of stress, my tinnitus appeared with an hyperacusis (not as severe as my tinnitus).

I have seen my surgeon who told me my occlusion was perfect but, because of my stress, it induced chronic muscle tension which could be the cause of my tinnitus.
I have a night guard (my English is bad and I used bad words to describe it).

I have seen chiropractor, osteopath, physiotherapist...I also had Botox in my masseter and temporal muscles but it did not work.

Nothing seems to be working for me, so I am happy to read you because it gives me some hope but I think it will be a long road to recovery in my case.

I don’t understand what happened because everything happened overnight!

 

Can you tell me what is orthotic therapy ?

 

Interesting. My path to tinnitus onset was also preceded by a very stressful period at work. Hyperacusis accompanied my tinnitus onset as well but went away within 6 weeks probably due to getting over the initial shock of developing tinnitus. Hopefully your hyperacusis will fade with time if it has not already. If tinnitus appeared after a long period of high stress and you use a night guard, I think it is reasonable assume stress is, at least in part, driving your bruxism at night. When operating under periods of sustained acute stress, the adrenal glands produce and release more cortisol to sustain normal bodily functions, so cortisol levels remain elevated most of the time. If you do not incorporate relaxation techniques like meditation or mindfulness and things like exercise that all help control cortisol levels throughout the day, the body looks for other pathways to release excess cortisol at night which include releasing cortisol via bruxism and teeth grinding/clenching. Bruxism can definitely induce muscle tension in mastication muscles around the jaw that can propagate further downstream to the neck and beyond.

Is your tinnitus worse on and/or isolated one to side? Do you have pain and tension on one or both sides of your neck? If both sides, is it all worse on the same or opposite side relative to the side where the tinnitus is worse?

For me, my tinnitus was worse on my right side and the neck/back/shoulder pain was worse on the left side. If you discern this on your own, you might be able trace the muscle compensation progression in the jaw and neck which can help inform your treatment in the future.

You have tried most of what I have and would have suggested in the future to try. Good to know you casting such a wide net as tinnitus is not a condition that proceeds linearly and whose progression is often not isolated to a single stimulus or cause. A treatment option I am considering is "Prolotherapy" where an irritant solution is injected into the TM joint space to that antagonizes the ligaments, facilitates the healing process and regenerates collagen to strengthen ligaments and the joint over time, and helps restore blood flow to the area. May be worthy of further consideration for you depending on where you are located and this type of treatment is offered.

Same for me. Woke up with tinnitus one morning and then the event I described in an earlier post worsened which made rethink my treatment.

Based on my own treatment, I can suggest a few other things to try. Please keep in mind I am shooting arrows in the dark right now so proceed with caution and do not overdo any of what I suggest. Info below -

1) Test branches of your lateral and medial pterygoids for tenderness and pain - These two muscles are often overlooked mastication muscles and help control the outward, downward, and side-to-side movements of lower jaw when chewing food. When folks suffer from bruxism, the majority of the force is absorbed by the back molars which can affect or damage these muscles. If your jaw hurts during or after consuming tougher chewy food like beef jerky, these muscles could be fatigued or contracted. Use this video as a guide -

Lateral Pterygoid Muscle - Trigger Point...

Follow his instructions on the first manuever. Open your jaw about half way on each side, place your middle finger over your index finger and gently press into the indicated area near the sphenoid bone. Gently move your fingers up and down while applying gentle pressure. If this area is tender or painful on either side of jaw when doing this, there is probably an issue with your pterygoid muscles - soreness, tension, or fatigue. If so, move on to gently try the release techniques discussed here - https://lifespa.com/tmj-jaw-pain-release/.

2) If your pterygoid muscles are sore, some neck muscle is sure to be sore as well. Locate the bulging temporal bones behind each ear. If you drew an imaginary line between the middle of those bones across the base of the skull. There are several suboccipital muscles traversing that line and muscles on the sides and back of the neck that support the skull found below that line.


Imagining that you drew that line, use the same technique you used to test for soreness in the pterygoid muscles and gently feel around the area that traverses the base of skull and neck between both SCM muscles (found just below the temporal bone) between that line and where the trapezius fans out toward the shoulders. If you encounter any sore, tense, or tender areas, you are slowly isolating where the muscle tension could be localized to; at which time you should start stretching those muscles, using heat-and-cold therapy to help relax the tension away, and/or get massages to ease the tension out of those muscles as well. In parallel, you need to develop a strategy for reducing the severity and prevalence of your bruxism and take steps to de-stress if stress is driving your bruxism. I outlined several things to try in my first post in this thread. Also understand the difference between direct pain and referred pain meaning that pain you feel somewhere may not because of a muscle in the same. Best to stretch as many muscles in the base of the skull, neck, and shoulders as possible to cover all possible angles.

My stretches and releases I have used that may hold utility for you -

TMJ Exercises (you can find several videos on Youtube) -

Simple TMJ Treatments/Exercises You Can Do...

Suboccipital Release (Many videos on Youtube) -

SELF-OCCIPITAL DECOMPRESSION: FAST RELIEF FOR...

PFGP Self Performed Suboccipital Release

Restore Neck Curvature with a Reinforced Resistance Band (GAME-CHANGER FOR ME THAT STRETCHES ALL THOSE MUSCLES IN ABOVE PIC, but be careful with this one and maintain good posture while doing it) -

Pro Lordotic Neck Exerciser with Adam Fields, DC

SCM Release - See video in above thread.

More Neck/Shoulder Stretches -

Mastoid SCM Release Stretch for Neck Pain...

Wicked Neck Stretch for Fast Relief of Tight...

Forward Head Posture Exercises - http://posturedirect.com/forward-head-posture-correction/

Good Luck!

All the best,

Oceanofsound26

 

Easier just point you to some information that can explain it better than I could. More info -

https://www.health.harvard.edu/newsletter_article/A_new_way_for_TMJ

https://www.buffalotmj.com/procedures/tmj-treatment/orthotic-therapy

Orthotics are ultimately used to restore the jaw to its optimal functional position or phonetic position which will vary on an individual basis similar to what your jaw surgery did to fix your occlusion. Orthotics keep the jaw in a relaxed position and restrict jaw opening to prevent jaw hyperextension and further damage to the jaw and the temporomandibular (TM) joints. Orthotics are continually adjusted on a weekly to biweekly basis to continue to reposition the jaw to achieve that phonetic position while restricting jaw opening to facilitate healing of the ligaments and other parts of the TM joints. Of particular interest for you is to maybe get a TMJ nighttime orthotic to transfer bruxism impacts from the back molars to the front teeth. Might help your situation. See attached picture. When using this orthotic, the back molars touch just ever so slightly. Only the bottom and top teeth meet with reinforced and elevated parts of the orthotic to ease tension and impacts of bruxism and by extension TMJ. Seek a neuromuscular dentist or maxillofacial dentist for more info.

All the best,

Oceanofsound26

 

@oceanofsound26 so night guard helps with TMJ tinnitus?
I was told I grind my teeth and just got a night guard. I also have very and forward head posture. Guess it takes a lot of time to fix? You were saying six months to a year??

 

Your work on the subject is absolutely fantastic, i am really admirative ! Thank you for sharing it, it’s really helpful.

In France we have a very bad medical care for TMJ.

Even the surgeon who did my surgery (He is supposed to know perfectly my jaws anatomy as he worked on it) doesn’t know what to do with me...

I don’t know any neuromuscular dentist in my town unfortunately. In any case you’re right about cortisol and stress.

Actually I go to bed at 3AM and I wake up at 12AM.
I can’t work anymore since I have tinnitus and my journeys are meaningless as I do nothing but thinking about my symptoms and going to medical appointments.

I am studying right know the effects of electro sensitivity because in my case my tinnitus are ALWAYS aggravated by the using of my phone and the WiFi around me.

I try to not touch to often my phone and put it in flight mode when I don’t use it but it seems to be insufficient.

Concerning my neck and jaw, the pain i feel is at both sides.
My tinnitus is louder in my right ear, when I have a subluxation and a very light arthrosis but pain is “balanced”.

 

@oceanofsound26,
Hello! I hope that you are well!
I have a little question ? I have posted a thread about the sound of tinnitus for people who suffer
From TMJ but I am not sure I will get many anwers. So I ask you, what is the tone of your tinnitus? Mine is very high-pitched like a “eeeeeeeeeee”. I have seen a dento-facial orthopedic who will give me a new treatment to change my night mouth guard and he told me the great majority of people who struggle with TMJ have a low-pitched sound which can be cured but, in my case he told me that, even if my TMJ is fixed, my kind of tinnitus won’t improve.
So I’m worrying a lot.

 

Hi @Laure Chauvin - My tinnitus is high-pitched as well and sounds like an electrical storm in my head with the eeeee sound. It moves between my head and both ears but is now mostly isolated to my right ear. The only stimuli my tinnitus responds to is lack of restorative (deep/REM) sleep and prolonged periods of poor posture which affects neck and postural muscles and misalignment. High-pitched tinnitus like this is can mainly be from hearing loss and noise damage or cervicogenic tinnitus from neck misalignment and associated issues. From my standpoint, C-Spine/Neck Misalignment and Forward Head Posture is the underlying cause that occurred in parallel with bruxism/teeth grinding that together finally converged to cause my TMJ and associated misalignment described above which are downstream symptoms of both of the aforementioned conditions. I have mostly taken care of my TMJ and continue to take steps to control it and reduce chances of it coming back. Now that my jaw is back is where it belongs and is relatively stable, other treatments like PT, chiro, acupuncture, and self-care are starting to improve alignment and also fortunately my tinnitus. I also pursued TMJ treatments together with other treatments to reduce pain from misalignment and imbalance. I can deal with pain or tinnitus but both at the same time were terrible. I am mobilizing for another cruise here shortly and have not responded to your previous post yet.

Your medical history diverges from mine quite a bit and sounds more serious than what I am going thru at the moment. With a history of neck pain you may well have tinnitus that may be linked to or caused by multiple issues. Except for sitting incorrectly at a PC for extended periods or sleeping in a funny position, my neck pain has mostly gone away since using my orthotics and sticking with treatment. I will not tell you whether to get the new orthotic or not as only you and your docs can decide what is best for you, but if you do and with other treatments if your neck pain and eventually your tinnitus starts to improve, you might be onto something. For me, TMJ then neck/back pain then tinnitus finally started to improve. If you can trace the origins of your tinnitus, then you will have a better chance of treating it effectively. One other thing I forgot to mention in previous posts check for pain in the digastric muscles and try to massage/release those as well. @Greg Sacramento has lots of good info on tinnitus possibly due TMJ and C-spine misalignment sprinkled thru his previous posts. Many things he mentioned were noted and further investigated by myself. I would recommend you look thru his past posts as well. I know we are all looking for answers with respect to our tinnitus but it is never easy or straightforward. Best advice I can continue to offer is adopt a hollistic view of your tinnitus and systematic and iterative approach to its treatment. Try to parse between upstream (causes) and downstream ( symptoms) issues like I have. Like me, all your problems had to start somewhere and finding that point may hold the key for the best way forward for you (depending on how serious they are).

Continued luck with the TMJ, neck, and tinnitus treatments.

All the best,

-Oceanofsound26

 

A night guard is different from TMJ orthotics I use at night. I developed my tinnitus after two nights with a night guard but I was predisposed to developing tinnitus in the first place with forward head pressure and an anterior pelvic tilt to name a few problems. Whether you use a night guard or a TMJ orthotic, grinding still happens to some degree but the wear and tear on teeth and jaw still occur. My TMJ orthotic (see above picture) transfers the strain of any grinding and bruxism to the front teeth rather the back molars located next the lateral pterygoid and other important mastication muscles as well as the TM joints. TMJ orthotics work for some but not everyone. My treatment with a daytime orthotic lasted 3 months but nighttime orthotic (in the above pic) use will likely last at least 1-3 more years. 6-12 months was an average treatment period for TMJ and related symptoms multiple specialists I saw gave me. Since TMJ and jaw issues were most likely secondary to other misalignment, I am addressing things that force my neck forward causing my lower jaw to slide back like my anterior pelvic tilt. If your tinnitus is due to solely to grinding your teeth, a night guard may provide some relief for you, but if your grinding/bruxism is downstream (effect) of a larger upstream issue (cause, e.g., forward head posture) using a nightguard may not yield the desired outcome. Also, doing things like relieving stress, controlling stress hormone levels, increasing room temperature at night, and taping your mouth shut while sleeping to force you to breathe your nose as described above are a few of things that can reduce prevalence of grinding also.

Good luck,

-Oceanofsound26

 

@oceanofsound26, how are you? It has been a while since we last « spoke », did you finally get rid of your tinnitus?