One important piece is the neck. The upper cervical spine contains a dense network of proprioceptors that help the brain understand where the head is in space. When the head sits forward for long periods, the small joints and muscles of the neck can become overloaded, tight, and less reliable as “position sensors.” The result can be a mismatch between information coming from the neck, the eyes, and the inner ear. That mismatch is one of the leading explanations for cervicogenic dizziness — a type of dizziness that feels more like imbalance, floating, motion sensitivity, or being “off,” rather than dramatic room-spinning vertigo. (PMC)

Now add the jaw. Chronic TMD often brings with it muscle guarding in the jaw, temples, sternocleidomastoids, suboccipitals, and upper trapezius. That means the jaw is not just hurting locally — it is affecting the entire head-and-neck system. Vestibular symptoms such as dizziness, imbalance, tinnitus, or ear fullness are reported more often in TMD populations, especially when pain is more severe. The exact mechanism is still debated, but the overlap is real enough that dizziness should not be dismissed when it appears alongside jaw pain, headaches, and neck tension. (PMC)

Then there is breathing. Nasal obstruction often drives mouth breathing, and mouth breathing tends to change tongue posture, mandibular rest posture, and head-and-neck posture. Multiple studies and reviews describe more forward head posture in mouth breathers than in nasal breathers. In other words, the body may be pulling the head forward not because someone has “bad posture,” but because it is trying to create an easier path for airflow. (PMC)

This is where sleep apnea enters the picture. OSA is associated with more vestibular complaints and measurable vestibular abnormalities, and current reviews suggest several possible mechanisms: intermittent drops in oxygen, autonomic dysregulation, fragmented sleep, and downstream effects on vestibular processing. So if a patient has poor sleep, snoring, dry mouth, morning headaches, clenching, and dizziness, it makes sense to think beyond the jaw alone. (Frontiers)

Put all of that together and you get a plausible chain: nasal obstruction can push a person toward mouth breathing; mouth breathing can reinforce forward head posture; forward head posture can distort cervical proprioception and provoke dizziness; poor sleep and OSA can worsen pain sensitivity, fatigue, autonomic stress, and vestibular complaints; and chronic TMD can add even more muscular guarding and sensory overload to the system. That is why some patients do not get lasting relief until both the jaw and the breathing pattern are addressed. (PMC)

This does not mean every dizzy patient has a jaw problem, and it does not mean posture is always the cause. Inner-ear disorders, migraine, medication effects, cardiovascular problems, and neurologic causes still matter. But when dizziness shows up with neck tension, chronic TMD, mouth breathing, snoring, fatigue, or forward head posture, it is worth asking a better question:

Is the body compensating for an airway and jaw problem that has never been fully addressed? (PMC)

If that pattern sounds familiar, the goal should not be to chase dizziness in isolation. The goal is to evaluate the full chain: jaw function, cervical mechanics, nasal breathing, tongue posture, and sleep-disordered breathing risk. That is often where the real answers live.

Can jaw problems, bad sleep, mouth breathing, and posture make you dizzy?

Yes — they can.

Not in every person, and not with every kind of dizziness. But in some people, dizziness is part of a bigger pattern involving the jaw, neck, breathing, and sleep. (PMC)

Here is the simple version:

Your brain uses three systems to help you feel balanced: your inner ear, your eyes, and your neck.

If your neck is tight, strained, and living in a forward position all day, it can send your brain faulty information about where your head is in space. That can make you feel off-balance, foggy, floaty, or motion-sensitive. (PMC)

Now add jaw tension.

If you have chronic TMD, you often also have tight muscles in the face, temples, neck, and base of the skull. That can increase headaches, neck stiffness, and that “off” dizzy feeling. Some people with TMD also notice ear fullness, tinnitus, or imbalance. (PMC)

Now add breathing.

If your nose is blocked, you may start breathing through your mouth without even realizing it. Mouth breathing can pull your tongue down, change your jaw’s resting position, and push your head forward. So what looks like a posture problem may actually be a breathing compensation. (PMC)

Now add poor sleep or sleep apnea.

Sleep apnea is linked with more dizziness and balance problems, possibly because of sleep fragmentation, autonomic stress, and effects on the vestibular system. So if you are dizzy and you snore, wake with dry mouth, clench, grind, feel exhausted, or get morning headaches, the sleep piece matters. (Frontiers)

So yes — these can all connect.

A common pattern looks like this:

blocked nose → mouth breathing → forward head posture → neck strain and balance-signal problems plus poor sleep / sleep apnea → more pain, fatigue, clenching, and dizziness plus TMD → more jaw and neck muscle tension

That is a pretty miserable recipe. (PMC)

It may fit this pattern if:

• your dizziness is worse after computer work or long days sitting

• you also have neck tightness or headaches

• your jaw clicks, aches, or feels tired

• you breathe through your mouth

• you snore or sleep poorly

• you wake up feeling tense, tired, or foggy

It is probably not something to shrug off if:

• the room is spinning hard and suddenly

• you faint

• you have chest pain

• you have weakness, numbness, double vision, slurred speech, or a severe sudden headache

Those need medical attention.

Bottom line

Sometimes dizziness is not “just an ear problem.” Sometimes it is your body telling you that your jaw, airway, posture, and sleep are all tangled together.

That is why the right question is not just, “How do I stop the dizziness?”

It is: Why is my body compensating in the first place?

Give us a call or send us a message!

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I hear some version of this almost every week: “I sleep 8 hours every night. I do everything right. I go to bed early, I stay off my phone, I don’t drink caffeine after noon. But I wake up feeling like I never slept at all.” If this is you, I want you to know something important: you are not imagining it, and it is not a willpower problem. Sleep duration and sleep quality are two completely different things — and modern medicine spent decades obsessing over the first while largely ignoring the second.

The core issue

Hours in bed ≠ hours of restorative sleep

When we talk about “getting enough sleep,” we typically mean hitting 7 to 9 hours. That number matters — but it only counts if the sleep you’re getting is actually doing the job. Sleep is not a single uniform state. It cycles through distinct stages throughout the night, and it is the deeper stages — slow-wave sleep and REM sleep — where the truly restorative work happens.

Slow-wave sleep is when your body repairs tissue, consolidates memories, and clears metabolic waste from the brain through a process called the glymphatic system. REM sleep is when emotional processing, creativity, and hormonal regulation occur. If anything is repeatedly pulling you out of these stages — even briefly, even without you fully waking up — you will feel it the next day regardless of how many hours you logged.

“A person with untreated sleep apnea can spend 9 hours in bed and achieve almost no slow-wave sleep at all. Their brain registers the night as a series of micro-arousals. They feel wrecked in the morning and have no idea why.”

Restorative vs. non-restorative sleep

What does your morning actually tell you?

Your morning is one of the most honest reporters of your sleep quality. Here is what restorative sleep looks like — versus what many of my patients describe before we identify and treat the underlying issue.

Restorative sleep

• Wake up without an alarm, or gently

• Feel mentally clear within 30 minutes

• No headache or jaw soreness

• Energy is stable across the morning

• Mood feels baseline or positive

Non-restorative sleep

• Hit snooze multiple times, feel groggy for hours

• Morning headache or tight jaw

• Dry mouth or sore throat

• Energy crashes mid-morning

• Brain fog that lingers into the afternoon

The right column is not just “not a morning person.” It is your body signaling that something disrupted the restorative stages of sleep — and in many cases, that something has a name and a treatment.

Common culprits we treat

What’s interrupting your deep sleep without waking you up

Upper airway resistance: Your airway narrows during sleep, causing your breathing to become effortful. You don’t stop breathing completely — so it often flies under the radar on standard sleep questionnaires — but your brain briefly arouses to restore airflow, over and over throughout the night.

Sleep bruxism: Grinding and clenching during sleep is not just a dental problem. It is a sign that the nervous system is dysregulated during sleep. It also physically fatigues the muscles of mastication, which is why so many bruxers wake up with jaw pain and headaches that feel like they started before the day did.

Poor tongue and airway posture: If the tongue falls back toward the throat during sleep, it can partially obstruct the airway even in people who do not have a formal sleep apnea diagnosis. Nasal breathing and proper tongue positioning at rest are foundational — not optional extras.

Cortisol and nervous system dysregulation: Chronic pain — including the low-grade pain of TMJ dysfunction — keeps the nervous system in a mild state of alert even during sleep. The body does not fully downregulate. Deep sleep becomes harder to reach and maintain.

The key takeaway

If you consistently wake up feeling unrefreshed, please do not accept that as your normal. “Tired but functional” is not the baseline you deserve. The question to ask is not just “how long did I sleep?” but “did my sleep actually restore me?” — and if the answer is no, there is almost always a reason we can find and address.

At our office, we take a whole-body approach to sleep. If you or someone you love is struggling with non-restorative sleep, chronic fatigue, or morning headaches, let’s talk. You might be closer to answers than you think.

Warmly,

Dr. Kristina Wolf, MS, DMD

TMJ & Sleep Therapy Centre of Cleveland

TMJ & Sleep Therapy Centre of Cleveland · 5005 Rockside Rd, Ste 1225, Independence, OH 44131

Questions? Reply to this email or call our office.

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Every spring, patients ask us the same question: “Why does everything feel worse right now?” Pain flares up, sleep falls apart, and jaws feel tighter. The answer is often hiding in plain sight — seasonal allergies.

When allergens like pollen trigger your immune system, your nasal passages swell and congest. That congestion forces you to breathe through your mouth at night, which disrupts your sleep, increases muscle tension in your face, neck, and shoulders, and puts extra strain on your temporomandibular joint (TMJ — the hinge of your jaw). Poor sleep then makes pain feel worse, which makes it harder to relax — a frustrating cycle.

The good news: reducing your allergy burden can meaningfully improve your sleep quality and reduce TMJ symptoms. You have more control over this than you might think.

Step 1: Treat the congestion directly

The most effective first step is clearing your nasal passages so you can breathe through your nose at night.

• Nasal sprays: Flonase, Nasacort, and Rhinocort are corticosteroid sprays available over the counter. Astepro is an antihistamine spray. Xlear is a natural option combining saline, xylitol, and grapefruit seed extract.

• Nasal rinsing: A simple saline rinse (like a neti pot or squeeze bottle) can flush out allergens and thin mucus. Always use distilled or sterilized water — never unsterilized tap water.

• Oral antihistamines: Second-generation antihistamines are less likely to cause drowsiness than older options like Benadryl. These include Claritin (loratadine), Zyrtec (cetirizine), Allegra (fexofenadine), and Xyzal (levocetirizine).

• Natural antihistamine supplements: Vitamin C, quercetin, stinging nettle, butterbur, and bromelain have all shown promise for reducing allergy symptoms.

Step 2: Support your gut to calm your immune system

This one surprises many people: your gut health has a direct impact on allergic reactions. Research shows that people with seasonal allergies tend to have an imbalanced gut microbiome, which can make immune responses more reactive.

Probiotics help restore beneficial bacteria, strengthen the gut lining so fewer allergens slip into your bloodstream, and calm immune overactivity through the connection between your gut and your respiratory system.

Well-studied probiotic strains for allergy relief include Lactobacillus paracasei, L. acidophilus NCFM, L. rhamnosus HN001, L. reuteri, Bifidobacterium lactis Bi-07, and B. lactis Bl-04.

Step 3: Eat to reduce inflammation

What you eat affects how your immune system responds to allergens. A diet rich in whole, minimally processed foods helps reduce the inflammation that drives allergy symptoms — think of it as setting your immune system to a lower alarm threshold.

• A wide variety of fresh fruits and vegetables, especially local and seasonal produce

• Fatty fish like salmon, sardines, and mackerel 2–3 times per week for omega-3s

• A small handful of nuts daily — walnuts and almonds are especially beneficial

• Fermented foods like yogurt, kefir, and sauerkraut

• Olive oil as your primary cooking fat

• Less processed food, margarine, and excess red meat

Step 4: Check for nutrient deficiencies

Certain nutritional deficiencies are strongly linked to more severe allergy symptoms. If your symptoms are particularly bad, it may be worth asking your doctor to check your levels of vitamin D, zinc, iron, vitamin A, selenium, and magnesium.

Vitamin D, zinc, and iron are especially worth looking into — deficiencies in these are common and often go undetected. Correcting them can help shift your immune system toward a calmer, less reactive state.

Questions about your jaw pain, sleep, or allergy symptoms? The team at Cleveland TMJ & Sleep is here to help. Visit us at clevelandtmjsleep.com.

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Most people come to our office because something hurts. Their jaw clicks. Their head aches. Their neck is constantly tight. They wake up sore. They chew on one side. They feel tension in their face, temples, or shoulders all day long.

So we look at the jaw. We assess the joints. We evaluate the muscles. We start treatment. And many people improve.

But some patients get only partway better.

They are no longer miserable, but they are not truly well either. Their symptoms flare when life gets busy. Their headaches return after a long day at the computer. Their neck tightness never fully leaves. Their jaw feels better for a while, then starts pulling right back into the same old pattern.

Over the years, one of the biggest reasons I have seen for this plateau is simple: too many people have had their jaw evaluated in isolation, while the rest of the system was ignored.

Because the truth is this:

Your jaw does not function independently from your head posture. Your head posture does not function independently from your airway. And your airway does not function independently from the way you breathe.

They are all in constant conversation.

When one is off, the others adapt.

And when the body adapts for long enough, that adaptation starts to feel “normal” — even when it is quietly driving pain, joint overload, muscle tension, sleep fragmentation, and forward head posture. Research on temporomandibular disorders shows a meaningful relationship between TMD and posture, although the literature also makes clear that this relationship is complex and not reducible to a single cause-and-effect rule. In other words: posture is usually part of the picture, not the whole picture. (MDPI)

The big picture: the jaw is part of a chain, not a standalone structure

The jaw is connected to the skull, the tongue, the hyoid bone, the cervical spine, the rib cage, and the muscles that help stabilize your head and neck. That means jaw position, tongue posture, breathing pattern, and neck posture are constantly influencing one another.

If the head drifts forward in space, the muscles at the back of the neck, under the jaw, and around the face have to reorganize to keep the eyes level and the airway open. That altered head-and-neck position can change how the mandible rests, how the teeth meet, how the tongue sits, and how the jaw muscles fire. This is one reason patients with TMD frequently also report neck pain, upper trap tension, headaches, and fatigue. Reviews of the literature support an association between the cervical spine, craniofacial pain, and TMD, even though not every study shows the same strength of effect. (jofph.com)

That distinction matters.

I do not think every case of forward head posture is caused by TMD.

I also do not think every case of TMD is caused by posture.

But I do think that when a patient has chronic jaw symptoms, neck tension, headaches, poor tongue posture, mouth breathing, nasal obstruction, or poor sleep, it is a mistake to treat only one piece and hope the rest of the system will magically cooperate.

Forward head posture is often a compensation, not just a “bad habit”

Most people think forward head posture is simply the result of looking down at phones and computers all day. That is certainly one contributor. But it is not the only one.

Sometimes the head comes forward because the body is trying to solve a different problem.

A restricted airway can drive that compensation.

Several studies in obstructive sleep apnea have shown that head posture differs in people with OSA compared with controls, and that more severe OSA is associated with a more extended natural head position. There is also evidence that small changes in head and neck posture can significantly change upper-airway dimensions on imaging. In one 2023 CBCT study, tilting the head up increased the airway’s minimum cross-sectional area, while tilting the head down reduced it. That helps explain why the body may drift into a more forward or extended head posture when breathing is not working well: it is trying to create space. (ScienceDirect)

That is a huge clinical point.

If forward head posture is partly acting as an airway compensation, then forcing someone to “stand up straighter” without addressing the breathing problem is often a losing battle. The posture keeps returning because the body still believes it needs it.

The same is true with nasal obstruction and dysfunctional breathing.

When nasal breathing is impaired, people often default to mouth breathing. Mouth breathing changes tongue posture, lip posture, mandibular posture, and the position of the head and neck. Contemporary reviews note that mouth breathing is associated with altered head and neck posture, and classic airway literature has long described forward head positioning as a common compensation for restricted nasal breathing. (ScienceDirect)

So now we have a loop:

• Nasal obstruction can promote mouth breathing.
  Mouth breathing can promote altered tongue posture and head posture.
  Altered head posture can change jaw mechanics.
  Jaw dysfunction can increase muscular guarding and pain.
  Pain and poor sleep can then reinforce the whole system.

That is why these patients often feel like they are chasing symptoms without ever reaching the root.

How TMD can contribute to forward head posture

Temporomandibular disorders do not just live inside the joint capsule. They affect muscles, movement patterns, cervical loading, and sensorimotor control.

When the jaw is irritated, the body often starts guarding. The muscles of mastication, suboccipitals, sternocleidomastoids, scalenes, and upper trapezius may all become more reactive. The patient changes how they hold their head, how they chew, how they swallow, and how they brace through the neck.

Over time, that can feed a forward-head, chin-jutted pattern.

The literature here is nuanced. High-quality reviews generally say there is an association between TMD and cranio-cervical posture, but they also caution that the relationship is not uniform and the older studies were methodologically mixed. That is the honest interpretation. Still, there is enough evidence to justify evaluating head and neck posture in any patient with persistent TMD, especially when neck pain and headaches are part of the presentation. (jofph.com)

And importantly, posture-based intervention is not just theoretical. In a randomized study of patients with muscular TMD, posture training plus self-management outperformed self-management alone, with meaningful reductions in both TMD and neck symptoms. (PubMed)

That should get our attention.

Because it means posture is not just a side note. In the right patient, it is part of treatment.

How obstructive sleep apnea and airway dysfunction can drive posture

OSA is not merely a nighttime snoring problem. It is an airway stability problem.

When the airway is vulnerable to collapse, the body often develops compensations to preserve airflow. One of those compensations is altered cranio-cervical posture. Studies in OSA populations have found greater cranio-cervical extension and different head-posture measurements compared with controls, and worsening OSA severity has been linked with more pronounced extension. Researchers have also described cervical hyperextension and altered posturo-respiratory coupling in OSA syndrome, suggesting that the postural changes are not random — they are part of a respiratory compensation strategy. (PubMed)

In plain English: sometimes the neck is working overtime because the airway is unstable.

That matters clinically because these patients do not just show up saying, “I think my airway is unstable.” They show up saying:

“My neck is always tight.”
“My jaw is sore in the morning.”
“I clench.”
“I get headaches.”
“I am exhausted.”
“My posture is terrible.”
“I cannot seem to hold myself upright.”

If we only treat the jaw joint and never ask how they breathe, sleep, and hold their head, we miss the engine driving the pattern.

How nasal obstruction and dysfunctional breathing fit in

Healthy nasal breathing helps support tongue-to-palate posture, lip seal, diaphragmatic function, and more stable head-and-neck mechanics.

When the nose is blocked or breathing becomes inefficient, the body adapts. Mouth breathing tends to drop the tongue, reduce lip seal, and pull the head and neck into a more compensatory position to improve airflow. Reviews and observational studies describe differences in head posture between mouth breathers and nasal breathers, and the airway literature has repeatedly linked nasal obstruction with forward head posturing as a functional adaptation. (PMC)

This is also why I do not love telling patients to simply “do chin tucks” and call it a day.

If the patient cannot breathe well through the nose, cannot keep the tongue supported to the palate, and is using accessory neck muscles to compensate all day, then posture drills alone are often too shallow a fix. Helpful, yes. Sufficient, not always.

So what does this mean for treatment?

It means that if you want forward head posture to improve and stay improved, you often have to address the reason the body adopted it in the first place.

For some patients, that means treating the jaw.

For some, that means treating the airway.

For many, it means treating both.

That might include:

• evaluating TM joint mechanics and muscle overload,

• addressing clenching or parafunction,

• screening for sleep-disordered breathing and OSA,

• assessing nasal obstruction and mouth breathing,

• retraining tongue posture and oral rest posture,

• improving cervical and thoracic mechanics,

• and using collaborative care when needed.

This is why the best outcomes often happen when TMJ care is paired with physical therapy, myofunctional therapy, airway evaluation, ENT input, or sleep-focused care. The body usually does better when we stop arguing over whether the problem is “jaw” or “posture” or “breathing” and admit that, in many patients, it is all three.

What this looks like in real life

Your posture may be fueling your jaw symptoms if:

• your jaw pain is worse after desk work, driving, or long computer days,

• your neck and upper traps are always tight,

• your headaches start at the base of the skull and wrap forward,

• your jaw treatment helps, but only temporarily,

• you tend to breathe through your mouth,

• you wake up with facial tension, dry mouth, or morning headaches,

• your tongue rests low in your mouth instead of gently up against the palate,

• or you feel like you can never quite “hold good posture” no matter how hard you try.

Often, that is not laziness or poor discipline.

It is compensation.

Three smart places to start this week

1. Notice your breathing before you notice your posture.
Ask yourself during the day: Is my mouth open? Am I breathing quietly through my nose? Is my tongue resting up, or sitting low? If you cannot comfortably maintain nasal breathing at rest, that is worth evaluating.

2. Stop thinking of posture as a pose.
Good posture is not military stiffness. It is a balanced position your body can actually sustain without strain. If you are forcing your shoulders back while your head still lives in front of your body and your airway still feels restricted, you have not solved the real problem.

3. Get the right system evaluated.
If you have persistent TMD, forward head posture, neck tension, headaches, mouth breathing, poor sleep, or snoring, do not settle for a narrow exam. Ask for an evaluation that includes jaw function, tongue posture, nasal breathing, airway risk, and cervical mechanics.

A note from Dr. Kristina

This is one of the biggest reasons I believe in comprehensive, collaborative care.

The jaw is connected to the airway. The airway is connected to posture. Posture is connected to muscle tension. And muscle tension feeds right back into the jaw.

So yes — if forward head posture is part of your picture, we absolutely want to improve it.

But in many patients, the solution is not just “sit up straighter.”

It is:
breathe better, support the airway better, reduce jaw strain, and restore the mechanics that the body has been compensating around for years.

That is when the changes stop being temporary.

That is when patients stop plateauing.

That is when the body finally has a chance to calm down.

Sources

1. Minervini G, Franco R, Marrapodi MM, et al. Correlation between temporomandibular disorders (TMD) and posture evaluated through the diagnostic criteria for temporomandibular disorders (DC/TMD): a systematic review with meta-analysis. Journal of Clinical Medicine. 2023;12(7):2652. doi:10.3390/jcm12072652. (MDPI)

2. Armijo-Olivo S, Bravo J, Magee DJ, et al. The Association Between Head and Cervical Posture and Temporomandibular Disorders: A Systematic Review. Journal of Oral & Facial Pain and Headache. 2006;20(1):9-23. (jofph.com)

3. Armijo Olivo S, Magee DJ, Parfitt M, et al. The Association Between the Cervical Spine, the Stomatognathic System, and Craniofacial Pain: A Critical Review. Journal of Orofacial Pain. 2006. (jofph.com)

4. Wright EF, Domenech MA, Fischer JR. Usefulness of posture training for patients with temporomandibular disorders. Journal of the American Dental Association. 2000;131(2):202-210. (PubMed)

5. Sökücü O, Okşayan R, Uyar M, et al. Relationship between head posture and the severity of obstructive sleep apnea. American Journal of Orthodontics and Dentofacial Orthopedics. 2016;150(6):945-949. doi:10.1016/j.ajodo.2016.05.011. (ScienceDirect)

6. Coppelson K, Summersgill I, Hatcher D, et al. Does Head and Neck Posture Affect Cone-Beam Computed Tomography Assessment of the Upper Airway? Journal of Oral and Maxillofacial Surgery. 2023;81(6):721-733. doi:10.1016/j.joms.2023.01.016. (ScienceDirect)

7. Clavel L, et al. Cervical spine hyperextension and altered posturo-respiratory coupling in patients with obstructive sleep apnea syndrome. 2020. (PubMed)

8. Kandasamy S. Mouth breathing and orthodontic intervention: Does the evidence support keeping our mouths shut? American Journal of Orthodontics and Dentofacial Orthopedics. 2025. doi:10.1016/j.ajodo.2025.02.005. (ScienceDirect)

9. Jaiswal S, et al. Comparative evaluation of the relationship between airway inadequacy, head posture, and craniofacial morphology in mouth-breathing and nasal-breathing patients: a cephalometric observational study. Cureus. 2023. (Cureus)

10. “Understanding Nasal Breathing: the key to evaluating and treating pediatric sleep-disordered breathing.” Summary snippet noting forward head posture as a common compensation for nasal obstruction. (amchealthgroup.com)

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• Early intervention to guide craniofacial growth

• Encourages nasal breathing and proper tongue posture

• Minimally invasive and supports full maxillary development

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Has anyone ever commented on your posture, or told you to stand up straight? What if I told you that your poor head, neck and shoulder posture may be connected to improper oral resting position?

Many people are often unaware of their oral posture or how it may be impacting their health. Take a moment to think about what your mouth is doing right now. How are you breathing - through your nose or your mouth? Where do you feel your tongue - on the roof or the floor of your mouth? Do you feel any tightness in the face, jaw, or neck?

What is proper oral posture?

Oral posture refers to the resting position of the jaw, tongue, and lips during daily activities like working, watching tv, riding in the car, and even sleeping. Proper oral resting position helps to guide the development of the jaw and facial structures —especially during childhood, fosters functional (nasal) breathing, prevents dental or orthodontic issues, supports clear speech and normal chewing & swallowing patterns, aids in proper digestion, and more.

Components of proper oral posture:

• Tongue Position: The tongue should rest gently suctioned against the roof of the mouth (the palate), not on the bottom of the mouth or against the teeth. The tip of the tongue should rest just behind the upper front teeth.

• Lips: Lips should remain closed at rest, creating a seal without tension.

• Teeth: The teeth should be slightly apart (a few millimeters), with no clenching.

• Breathing: Breathing should occur through the nose, not the mouth.

• During function: Chewing should occur on both sides of the mouth with the lips sealed. Swallowing should occur without the tongue pressing on the teeth (tongue thrust) and without accessory muscle involvement.

When any of these muscle patterns become dysfunctional, it can lead to a wide variety of issues that impact our basics functions of life, such as nasal congestion, enlarged tonsils and adenoids, allergies, asthma, frequent colds & infections, ear aches, ear congestion, ringing in the ears, teeth grinding or clenching, sleep disordered breathing, snoring, jaw, head & neck pain, narrowed palate, recessed jaw, digestive issues, and more…

Signs of poor oral posture:

• Mouth breathing

• Lips that don’t close naturally

• Tongue resting at the bottom of the mouth or pressing against teeth (tongue thrust)

• Coated or scalloped tongue

• Crooked or crowded teeth

• Forward head posture or neck tension

• TMJ pain, headaches, or facial strain

• Dysphagia

• Snoring

• Frequent dry mouth upon waking

• Drooling

• Teeth grinding or clenching

Application of Oral Posture 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]. Assessing oral posture is a priority with each patient that comes to our office, whether it be for pain, sleep, or both.

Temporomandibular disorders (TMD) are often closely linked to oral posture, as improper tongue, jaw, and lip positioning can contribute to muscle strain, joint misalignment, and dysfunctional movement patterns which can exacerbate pain, noises in the jaw joints, and even restricted jaw mobility over time. Maintaining proper oral posture reduces strain on the TMJ and supports overall jaw stability.

Oral posture also plays a crucial role in sleep quality and breathing function. When the tongue rests in a low position or the mouth remains open during sleep, airway patency is compromised, increasing the risk of upper airway collapse and sleep-disordered breathing, including obstructive sleep apnea (OSA). Poor oral posture can contribute to nasal obstruction, altered craniofacial development, and dysfunctional breathing patterns that reduce oxygenation and disrupt restorative sleep. Optimizing oral posture supports nasal breathing, improves airway stability, and enhances overall sleep quality.

We work diligently with our patients on self-training proper oral posture and focusing on functional (nasal) breathing. In more complex cases, reinforcing these habits may require myofunctional therapy, which consists of nasal breathing re-education and targeted exercises to strengthen the tongue and facial muscles in order to maintain proper oral posture.

How We Can Help:

If you are experiencing TMJ pain, headaches, fatigue, sleep issues, or are struggling to maintain proper oral posture, reach out to our office to schedule a comprehensive evaluation to get you one step closer to achieving optimal health.

What is Magnesium?

Magnesium is an essential nutrient that the body requires to maintain overall health and well-being. The human body should contain approximately 25 grams of magnesium, making it the fourth most abundant mineral in the human body. It is primarily found in bones (about 50-60%), and the remainder is found in muscles and soft tissues, leaving less than 1% of total magnesium in the blood serum.

Unfortunately, 1 in 5 people are experiencing full blown magnesium deficiency while up to 80% of the population is suffering from subclinical, or insufficient, levels of magnesium. An estimated 25% of children are also presenting with deficiency.

Why is this so important? 

Unlike medications that target a certain pathway to impact a particular physiological function in the body, magnesium (like most vitamins and minerals by the way), is necessary for hundreds of pathways in the human body.

Magnesium serves as a cofactor for over 300 enzymatic reactions that regulate diverse functions in the body, impacting every single one of our biological systems. We require this mineral for energy production, blood sugar control, oxidative phosphorylation, muscle & nerve function, bone health, protein synthesis, hormone regulation, digestion, brain function, and more…

This is why low levels of the mineral can cause symptoms that are seemingly all over the place.  Symptomatic insufficiency or deficiency can contribute to issues including chronic pain, headaches or migraines, sleep issues, high blood pressure, blood sugar issues, muscle twitching, cramping, or spasming, tremors, PMS, menstrual cramps, vertigo, anxiety, depression, cognitive decline, tinnitus (ear ringing), sensitivity to loud noises, hearing loss, constipation, acid reflux, loss of appetite, nausea or vomiting, immune dysfunction, osteopenia — the list goes on….

More severe cases of deficiency have been associated with conditions including hypocalcemia (low calcium), hypokalemia (low potassium), malabsorption syndromes (such as Crohn’s disease, ulcerative colitis, celiac disease, etc.), heart disease, metabolic diseases (such as type-2 diabetes or hypothyroidism), neurological disorders, seizures, pre-term labor, and osteoporosis.

Dietary surveys conducted in the United States consistently show a significant portion of the population consumes less than the recommended amounts of magnesium. A whopping 75% of Americans are not getting enough magnesium in their diet.

The reason for this is a combination of the dramatic decline of magnesium content in our foods, as a result of nutrient depletion in the soil, and the Standard American Diet which is high in ultra-processed foods, starch and sugar, all of which deplete magnesium.

Consumption of alcohol, caffeine, and certain medications can also play a role. To name a few, acid blocking drugs (PPI’s), diuretics, calcium channel blockers, beta-blockers, antibiotics, steroids, chemotherapy drugs, and calcineurin inhibitors are all medications that can impact magnesium status.

Recommended Intake

The Recommended Dietary Allowance (RDA) for magnesium varies by age, sex, and life stage. For adult (ages 19-30) women, the RDA is 310–320 mg/day, while for adult men, it is 400–420 mg/day.

The established RDA for children varies mostly with age and not as much by gender, recommending: 30 mg/day from birth to 6 months, 75 mg/day from 7-12 months, 80 mg/day for ages 1-3, 130 mg/day for ages 4-8, and 240 mg/day for ages 9-13. For ages 14-18, boys should aim for 410 mg/day, while girls require a bit less, at 360 mg/day.

The RDA is determined by the Food and Nutrition Board (FNB), which assesses the amount needed to meet the nutritional requirements of 97–98% of healthy individuals based on available research. However, these values are set to prevent deficiency related disease and do not take into consideration other factors such as existing chronic health issues or challenges like stress, pain, poor sleep, and more, that would yield consideration for higher nutrient needs.

Dietary Sources of Magnesium

Magnesium is widely distributed in plant and animal foods such as beef, poultry, fish (i.e. salmon, halibut, mackerel), green leafy vegetables (i.e. spinach, swiss chard, collard greens, turnip greens, mustard greens), carrots, broccoli, legumes (i.e. lentils, black or kidney beans, chickpeas, edamame), nuts (almonds, cashews, peanuts or nut butters) & seeds (flaxseeds, chia seeds, pumpkin seeds), whole grains, white potatoes (with the skin), oatmeal, white or brown rice, yogurt, seaweed, avocados, raisins, apples, bananas and even dark chocolate (70% cacao or greater).

Magnesium in Our Practice: 

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

In our office, we recognize that magnesium is a powerhouse mineral—especially when it comes to its relaxation benefits, making it very beneficial for the variety of conditions we treat, such as TMJ issues, neck pain, migraine headaches, and sleep disorders. Deficiency and insufficiency is also common in those who suffer from chronic pain and poor sleep.

Through regulating muscle and nerve relaxation, and reducing inflammation, it can help reduce many types of pain. The mineral also interacts with the NMDA receptors in the nervous system, dulling the signals from sensory neurons to the brain and reducing the sensation of pain.

The hype around magnesium in our office isn’t just for pain relief — it also plays a pivotal role in sleep. Magnesium increases GABA, a neurotransmitter known as the “brakes of the brain,” slowing down nerve activity and helping the mind and body transition out of an active state and into the “rest and digest” parasympathetic state, while also decreasing cortisol and supporting melatonin production.

These benefits can help to improve how quickly you fall asleep, reduce how many times you wake in the night, and allow you to wake in the morning feeling more rested. Its calming effects extend to your muscles in the airway, which can improve breathing during sleep and help to mitigate parafunctional activity (i.e. teeth grinding/clenching).

Testing Your Magnesium Levels

Standard medicine protocols typically test for serum (blood) levels of magnesium. While this test can be useful to depict true deficiency of the mineral, this is arguably not the best representation of how much magnesium you have throughout your body.

Alternatively, there is red blood cell (RBC) magnesium testing. RBC magnesium is more reflective of intracellular magnesium and mineral status in the bones and tissues. This makes RBC testing helpful in determining if you are experiencing insufficiency, which correlates with clinic symptoms. Identifying insufficiency is also useful for preventing the progression to deficiency. In order to comprehensively evaluate your levels, more than one laboratory test might be recommended.

Magnesium Supplements

Supplements are available in a variety of forms, but the absorption and benefit from different kinds of magnesium supplements vary. Citrate and glycinate are the two most commonly utilized forms of magnesium in our office. 

Citrate is highly bioavailable and effective in preventing and resolving deficiency. This form is a mild laxative and is very useful in treating constipation, but not suitable for those with looser stools or certain types of irritable bowel. 

Glycinate is comparable in bioavailability to citrate and is known for its calming effects, relaxing the muscles and nervous system. It is suitable for sleep support, anxiety, stress, and pain. This form has been shown to be one of the safest options for correcting long-term deficiency. 

Other effective forms of magnesium include malate, L-threonate, taurate, and chloride. 

Carbonate, oxide, sulfate, and glutamate are not recommended due to their low bioavailability. 

*If you are considering supplementing, it is recommended to work with a trusted health care practitioner to ensure you are taking a safe supplement that is the best form and dosage for your individual needs. 

How We Can Help:

If you are struggling with chronic pain, sleep issues, or other magnesium insufficiency or deficiency related symptoms, reach out to our office to schedule a comprehensive evaluation to get you one step closer to achieving better health.

Subscribe now

Additional Resources:

• https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/

• https://pubmed.ncbi.nlm.nih.gov/34883514

• https://pubmed.ncbi.nlm.nih.gov/37954114/

• https://pubmed.ncbi.nlm.nih.gov/24206074/

• https://pmc.ncbi.nlm.nih.gov/articles/PMC1855626/

• https://pmc.ncbi.nlm.nih.gov/articles/PMC9496273/

• https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1002/prp2.829

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 another key foundation to health: functional breathing.

Breathing is something we do thousands of times a day without much thought. We breathe in, we breathe out. There is not much more to it right?

Actually, wrong… Did you know how we breathe can significantly impact our health?

For the most part, people remain unaware of their method of breathing and take for granted the ability to breathe correctly. Although breathing is a natural function of the human body, this does not mean that we are breathing in a manner that supports optimal health. 

What is Functional Breathing? 

Functional breathing refers to the practice of nasal breathing. 

Functional breathing has the power to change the trajectory of your quality of life, as it is essential for overall health. Nasal breathing encourages the body to work in harmony. Breathing through the nose supports cardiovascular health, balances the nervous system, improves digestion, promotes immune function, boosts energy, increases sleep quality, supports our mental health, improves cognitive function, reduces stress and even helps reduce muscle strain and tension.

The Difference Between Nasal and Mouth Breathing

The nose is uniquely designed to be our primary breathing organ because it filters the air we breathe, protecting our lungs from dust, allergens, and other particles. The nose also warms and humidifies the air, making it easier on our respiratory system and reduces risk of irritation or infection.

Breathing through the nose increases nitric oxide (NO) production, which supports our health in several ways. Nitric oxide (NO) is a natural vasodilator, which means that it helps dilate the blood vessels, improving blood flow throughout the body and enhancing oxygen delivery into the tissues. These factors help to regulate healthy blood pressure and improve cardiovascular health. NO also has antimicrobial properties, supporting our immune system and respiratory function by fighting against a wide range of pathogens.

If we can’t breathe well through our nose, the only other option is to breathe through the mouth. When we breathe through the mouth,  air bypasses these crucial filtration steps, allowing unconditioned, dry air to enter the lungs. Mouth breathing lowers NO, CO2 and O2, upsetting the delicate balance of gasses in our airways and blood.

Mouth breathing also engages our secondary respiratory muscles and sympathetic nervous system (SNS), also known as our fight or flight response. When the SNS is dominant, our immune system becomes down regulated, increasing our risk of infection. This method of breathing can contribute to a myriad of other factors that negatively impact our health including dry mouth, dental problems, daytime fatigue, poor sleep quality, sleep-disordered breathing, TMJ issues and more. 

The Importance of Functional Breathing 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]. In our office, we emphasize the importance of nasal breathing with both our pain and sleep patients, as it is an important component in healing these issues from the root cause. 

We utilize cone-beam computed tomography (CBCT)  imaging in our examinations to take a deep dive into each individual's health, not only to better understand their pain & sleep issues, but also to determine why this is happening in the first place. The CBCT scan can help to identify nasal obstructions such as septal deviations, inflamed nasal turbinates (tissues), and compromised nasal valves.

We also use rhinomanometry to evaluate nasal function. A rhinomanometer measures airflow and pressure in the nasal passages to assess nasal airway resistance. By quantifying how much air can pass through the nasal passages and at what pressure, we can determine the impact nasal obstruction has on airflow.

The Relationship Between Nasal Breathing, TMJ, and Sleep

When it comes to TMJ issues, nasal breathing supports proper jaw function,  stabilization of the jaw and maintains the integrity of the ligaments supporting it. Mouth breathing, on the other hand, promotes parafunctional activity like teeth grinding and clenching, which increases strain on the jaw and the surrounding musculature, and can stretch the ligaments over time, increasing the risk for head, neck and jaw pain as well as TMJ dysfunction. 

Nasal breathing also plays a crucial role in sleep quality. This method of breathing promotes uninterrupted, restorative sleep by increasing oxygen absorption and activating the parasympathetic nervous system, which has a calming effect that supports good sleep quality.  Mouth breathing during sleep increases risk of airway obstruction, which can lead to sleep-breathing issues such as snoring, upper airway resistance syndrome (UARS), and obstructive sleep apnea (OSA). 

As part of addressing the root cause of our patient’s TMJ & sleep issues, we utilize a combination of remedies to help promote proper nasal breathing including over the counter nasal sprays, nasal irrigation, nasal dilators, lip taping and nasal breathing exercises. We also take advantage of nutrition and supplementation regimens, as our nasal turbinates (tissues) are responsive to the things we ingest, meaning these factors can better or worsen our ability to nasally breathe. 

How We Can Help:

If you are experiencing TMJ pain, headaches, fatigue, sleep issues, or are having trouble breathing through your nose, reach out to our office to schedule a comprehensive evaluation to get you one step closer to achieving optimal health.

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!

Subscribe now

Additional Resources:

• https://www.ninds.nih.gov/health-information/public-education/brain-basics/brain-basics-understanding-sleep

• https://www.sleepfoundation.org/how-sleep-works/sleep-facts-statistics

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6473877/#:~:text=Sleep%20deprivation%2C%20which%20has%20been,medical%20and%20mental%20health%20issues.

• https://www.nhlbi.nih.gov/health/sleep-apnea/causes

• https://www.nhlbi.nih.gov/health/sleep-deprivation

• https://www.nhlbi.nih.gov/health/sleep-deprivation/health-effects

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6997082/

• https://www.nhlbi.nih.gov/health/sleep-apnea/causes

• https://www.nhlbi.nih.gov/health/sleep-deprivation

• https://www.nhlbi.nih.gov/health/sleep-deprivation/health-effects

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3703169/

• https://sleepeducation.org/insomnia-your-diet/

• https://pubmed.ncbi.nlm.nih.gov/25168926/

• https://pubmed.ncbi.nlm.nih.gov/25168926/

Chronic Pain Recap:

In the United States, chronic pain affects over 100 million people, surpassing the combined number of those with diabetes, heart disease, cancer, and stroke. Chronic pain conditions are notoriously difficult to treat, as it often leads to changes in the nervous system that heighten pain sensitivity, complicate efforts to find relief, and make it challenging to find the root cause. The pain can stem from physical factors such as injuries or conditions like temporomandibular disorders (TMD), and sleep-related breathing disorders. Chronic pain is also influenced by psychological stressors, lifestyle choices, and environmental factors, all contributing to a cycle of pain and discomfort.

Conventional healthcare approaches often focus on symptom management rather than addressing the root cause, leaving many individuals without answers and trapped in a cycle of ongoing pain. Our office employs advanced diagnostics and personalized treatment plans to identify and treat the root cause(s) of chronic pain and sleep issues, recognizing the intricate connection between the two. Effective management of chronic pain in this practice involves a multifaceted approach that considers the individual's entire well-being—mind, body, and spirit—aiming to break the cycle of pain and improve quality of life. 

To read more about chronic pain and how we evaluate chronic pain presentations in our office, take a look at part 1 of the chronic pain edition of our TMJ Wellness Newsletter: Understanding Chronic Pain: A Complex and Personal Experience.

Chronic Pain Services 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].

In part 1 of the chronic pain edition of our newsletter, we listed the various treatment modalities offered in our practice to help chronic pain sufferers manage and heal from their pain. Let’s take a deeper dive into each of these treatment options: 

Oral Appliance Therapy

Oral appliance therapy (OAT) is a non-invasive treatment option that is highly effective in treating chronic pain, particularly craniofacial pain conditions such as migraines, and temporomandibular joint (TMJ) disorders. OAT is also a great option for treating sleep-related breathing issues such as snoring, Upper Airway Resistance Syndrome (UARS), and Obstructive Sleep Apnea (OSA), which we know to be linked to chronic pain conditions. The custom-fitted oral appliances work by decompressing the jaw to take pressure off the joints, reduce contraction of the surrounding musculature, reduce inflammation in the joints and muscles,  improve airway function during sleep and enhance sleep quality. Overall, oral appliance therapy provides a targeted approach to addressing the underlying mechanical and structural factors that contribute to chronic pain, offering patients a pathway to relief and better overall health.

Functional Breathing 

Functional breathing practices go deeper beyond just inhaling and exhaling. Simply put, functional breathing involves maintaining nasal breathing, as opposed to mouth breathing, both in the daytime and the nighttime. It is a necessary component to treating chronic pain conditions and sleep issues in our office. 

Mouth breathing alters the posture of the tongue, jaw, and head, adding extra weight to the  neck and upper back, whereas nasal breathing reduces forward head posturing and significantly lessens the stress on the neck that contributes to neck pain, back pain, jaw pain, headaches and more. 

Functional breathing practices are essential for improving sleep quality and treating sleep breathing disorders, such as sleep apnea. Nasal breathing ensures proper filtration, humidification, and oxygen delivery to the lungs, which promotes deeper, more restorative sleep. It also reduces the likelihood of airway obstruction, a common issue in sleep breathing disorders. In cases where bruxism (teeth grinding or clenching) is occurring, nasal breathing becomes even more critical. Mouth breathing can cause or exacerbate existing TMJ dysfunction by causing repetitive microtrauma to the jaw joints and surrounding muscles. By encouraging nasal breathing, especially during sleep, individuals can mitigate both breathing-related sleep disturbances and craniofacial pain, leading to improved overall sleep quality and pain relief.

Functional breathing techniques can also be effective in managing chronic pain by reducing stress and enhancing relaxation. These techniques encourage proper oxygen exchange and can activate the parasympathetic nervous system, promoting a state of calm that can help lower pain perception. Controlled, deep nasal breathing exercises can also decrease muscle tension and reduce inflammatory responses, both of which are often elevated in chronic pain conditions. Additionally, mindful breathing can help improve emotional regulation, which is crucial for those experiencing pain-related anxiety or depression.

Sleep Hygiene Practices

Sleep hygiene practices are critical for managing chronic pain yet often under utilized in treatment. We teach key foundations for good sleep hygiene in our practice which include maintaining a consistent sleep schedule, creating a relaxing bedtime routine, minimizing blue light exposure, and optimizing the sleep environment—keeping it dark, quiet, and cool. Limiting stimulants such as caffeine and alcohol, and avoiding inflammatory foods, especially before bedtime, will improve sleep quality. As well, cognitive-behavioral techniques, such as relaxation exercises and mindfulness, can reduce anxiety related to sleep and pain, aiding in the management of symptoms and making it easier to fall asleep. 

Laser Therapy 

Laser therapy is a very valuable tool in our office for managing and healing from chronic pain and inflammation. We often utilize MLS laser therapy, which uses synchronized wavelengths of light to penetrate tissue to reduce inflammation and oxidative stress, while also stimulat blood flow, all of which aid in alleviation of pain. This therapy also promotes cellular regeneration and accelerates the the body's healing processes without significant side effects like many pain medications, making it especially effective for chronic pain conditions involving musculoskeletal pain.

We also provide DEKA Nd:YAG laser therapy, which utilizes a neodymium-doped yttrium aluminum garnet crystal as a laser medium. This laser is known for its deep tissue penetration, and ability to promote cellular repair, reduce inflammation and alleviate pain. This laser can also help to increase blood flow, reduce muscle tension and enhance tissue and nerve healing, making it a powerful tool in our office for treating chronic pain conditions like musculoskeletal pain and even neuropathic pain. 

Prolotherapy and Platelet-Rich Fibrin (PRF) Injections

For chronic pain conditions, prolotherapy and PRF injections can help repair damaged tendons and ligaments, and stabilize joints, effectively resolving the biomechanical issues contributing to pain.

Prolotherapy is a regenerative treatment that involves injecting an irritant solution, typically containing dextrose, into ligaments, tendons, or joints to stimulate the body's healing response and repair damaged tissue. This low-risk treatment option offers a natural, non-invasive alternative for chronic pain relief by encouraging the regeneration of connective tissues rather than merely masking pain symptoms with therapies like Botox. 

Platelet-Rich Fibrin (PRF) injections are also a regenerative therapy that uses a concentration of the individual’s own platelets and fibrin from their blood to promote healing and tissue repair. PRF is a step up from prolotherapy because it contains growth factors and cytokines that accelerate healing at a cellular level, offering more potent regenerative effects. 

Nutrition and Functional Medicine

We offer nutrition counseling and functional lab testing in our office to provide an individualized nutrition and supplementation protocol to go with each individual’s treatment plain.

Nutrition is a crucial component in treating chronic pain, as a whole food, plant-centric approach can effectively reduce systemic inflammation, lower oxidative stress, improve metabolic health, enhance tissue repair, and more. Prioritizing vegetables, fruits, high quality protein, and healthy fats while limiting ultra-processed foods and addressing food sensitivities will help lower pain sensitization and improve overall health. 

Specifically, for individuals with craniofacial pain disorders or sleep-breathing disorders, nutrition therapy is especially important to ensure optimal nutrient intake despite chewing discomfort, manage bruxism, enhance nasal breathing and improve overall sleep quality, all of which support pain management and recovery.

Supplementation and Medications 

We utilize targeted supplementation as part of a natural regimen to reduce pain and inflammation, offering fewer side effects than prescription medications. Supplements such as turmeric (curcumin), grape seed extract (GSE), omega-3 fatty acids, magnesium, B-vitamins, and vitamin D are amongst the most commonly utilized in our practice because they are known for their anti-inflammatory and pain-relieving properties. 

Turmeric (curcumin), GSE, and omega-3’s for example, have been shown to inhibit inflammatory pathways; omega-3s are also essential for cellular health and tissue repair. Magnesium has an effect on reducing central sensitization, or our pain sensitivity response, while also playing a role in muscle relaxation, making it effective for pain and sleep issues. Vitamin D and B vitamins contribute to immune function and nerve health. Additionally, vitamin D has been shown to play an important role in sleep regulation as well as calcium absorption, making it important for optimal bone health.  These supplements, when used in conjunction with dietary and lifestyle modifications, provide a supportive environment for long-term healing from pain.

There are absolutely times when prescription medications are necessary to reduce inflammation as quickly as possible for relief from pain, particularly in acute situations or when other interventions have yet to take full effect. However, medications are not often our primary approach for chronic pain management. They are used situationally and in combination with root cause protocols that address underlying causes of inflammation, joint instability, and tissue damage etc. By integrating medications with lifestyle changes, supplementation, nutrition therapy, and other root cause treatments, we aim to relieve pain without relying solely on prescription drugs in the long-term, reducing the risk of side effects and other consequences of prolonged medication use.

Functional Lab Testing

Functional lab testing offers a deeper insight into what the underlying cause may be to an individual’s chronic pain by using narrower or “optimal” reference ranges and a more individualized approach than conventional lab tests. While conventional labs identify health conditions once they fall outside broad "normal" ranges, functional testing seeks to detect imbalances even before they become clinically significant. This allows for earlier interventions, especially in chronic pain conditions, by identifying underlying inflammation, oxidative stress, nutrient deficiencies, or gut and hormone imbalances that may be contributing.

Gut Health

Gut health is intricately linked to chronic pain, as imbalances in the gut microbiome can contribute to systemic inflammation, exacerbating pain conditions. In addition, gut dysbiosis and inflammation have been connected to impeded nasal breathing and bruxism, as well as sleep disturbances, all known to worsen pain related conditions and sleep breathing issues.

Testing options such as a comprehensive stool analysis or intestinal permeability tests can identify imbalances in gut bacteria, leaky gut (intestinal permeability), and food intolerances, all of which can affect inflammation and pain. Addressing gut health through targeted treatments can reduce bruxism.

Hormone Health

Hormone imbalances, particularly involving cortisol, estrogen, progesterone, and melatonin, can contribute to chronic pain, bruxism, and sleep disturbances. Elevated stress hormones, like cortisol, can worsen pain sensitivity and disrupt sleep, while low melatonin levels can affect the body's ability to regulate pain and sleep cycles.

Hormone testing, such as saliva or urine panels, can provide a comprehensive look at circadian rhythms and hormone levels, allowing for more personalized interventions to balance these hormones and improve associated symptoms. 

Acupuncture

Acupuncture is a well-established ancient Chinese-based technique that is particularly effective for treating a wide variety of health conditions by triggering different points on the skin with small, one time use, disposable stainless steel needles. It is based on the idea that a blockage, or disturbance in the body’s flow of qi (energy flow) can cause health issues. 

Our acupuncturist, Dr. Dickerson, practices auricular acupuncture, which is considered more modern Chinese acupuncture, by comparison to traditional acupuncture. Auricular acupuncture specifically targets the ear, where various points in the ear correspond to different organs and systems of the body. The ear is closer to the nervous system (brain), allowing for faster and longer lasting results with this form of acupuncture.

This therapy is particularly effective in treating chronic pain conditions, such as migraines, musculoskeletal pain, and neuropathic pain. By stimulating these auricular points, acupuncture can modulate the nervous system, reduce inflammation, and promote the release of endorphins, the body's natural painkillers. Additionally, auricular acupuncture has been shown to improve sleep by balancing the body's qi and reducing stress and anxiety, which are common contributors to sleep disturbances. This dual action on both pain relief and sleep enhancement makes auricular acupuncture a valuable tool in our office. 

How We Can Help:

If you suffer from chronic pain and/or sleep issues, reach out to our office to schedule a comprehensive evaluation to bring you one step closer to healing from your chronic pain and getting more consistent, restful sleep.

What’s Next?

Next month, we are eager to take a deeper dive into the sleep portion of our practice. If you are interested in learning more about how you or a loved one can get a better night’s sleep, make sure you subscribe to our TMJ Wellness Newsletter!

Additional Resources: 

• https://drstevenolmos.com/wp-content/uploads/2019/06/Technology-Olmos.pdf

• https://www.ncbi.nlm.nih.gov/books/NBK553030/#:~:text=These%20options%20include%20heat%20and,and%20transcutaneous%20electrical%20nerve%20stimulation%20( 

• https://pubmed.ncbi.nlm.nih.gov/10503851/

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3924606/ 

• https://www.ncbi.nlm.nih.gov/books/NBK597377/

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10373074/ 

• https://pubmed.ncbi.nlm.nih.gov/33500785/ 

• https://pubmed.ncbi.nlm.nih.gov/22254027/ 

• https://pubmed.ncbi.nlm.nih.gov/32049671/ 

• https://pubmed.ncbi.nlm.nih.gov/35893864/ 

• https://pubmed.ncbi.nlm.nih.gov/28783464/ 

• https://www.ncbi.nlm.nih.gov/books/NBK92054/ 

• https://pubmed.ncbi.nlm.nih.gov/16242364/ 

• https://pubmed.ncbi.nlm.nih.gov/29198932/ 

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9050311/ 

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7072911/ 

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10663097/

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3976599/ 

• Mayer, E. A., et al. (2021). "Gut-Microbiome-Brain Axis: The Impact of Gut Health on Pain and Neurological Function."

• Talbot, J., et al. (2020). "Hormonal Influences on Chronic Pain and Sleep Disorders."

Is persistent pain a constant companion for you or a loved one? You are not alone!

In the United States, over 100 million people live with chronic pain, surpassing the number of individuals affected by diabetes, heart disease, cancer, and stroke combined. 

Many who suffer from chronic pain feel stuck…chasing ways to manage their symptoms and feeling lost as to why they cannot seem to find long-term relief.

Discover the potential root cause(s) of chronic pain and the intricate relationship between craniofacial pain conditions and sleep-related breathing disorders.

What is chronic pain? 

Chronic pain is not the same as acute (temporary) pain, which you might feel from an injury, surgery, or illness. Acute pain serves as one of the body’s protective mechanisms, indicating that something is wrong and prompting the immune system to turn on. Acute pain is generally short-lived, lasting from a few seconds to a few months, and it usually subsides once the underlying injury or illness has been treated or has healed.

On the other hand, chronic pain is the type of pain that sticks around, and is present for more than three months, even after the initial injury or condition has been resolved. Chronic pain causes changes to our nervous system. These changes can cause the brain to continue to send out pain signals throughout the body, even where there may be no harm or damage. The signal pathway to the brain can then become oversensitive and amplify our pain sensitivity. 

Chronic pain is not always easy to understand due to its varied presentations and bio-individual nature, making it sometimes hard to determine the root cause(s). Common underlying causes to chronic pain include physical causes, lifestyle & environmental factors, and psychological & emotional causes.

Physical causation can be due to a past injury (i.e. facture, surgery, sprain), or a disease in itself, such as in cases of musculoskeletal pain (i.e low back pain) or migraines/headaches, or it can be linked with other chronic conditions such as: 

• Temporomandibular disorders (TMD/TMJ)

• Sleep breathing disorders (i.e. OSA, UARS)

• Arthritis (Osteoarthritis and Rheumatoid)

• Obesity

• Fibromyalgia

• Neuropathy (diabetic or chemotherapy-induced)

• Irritable bowel syndrome (IBS)

• Chronic fatigue syndrome (CFS)

• Endometriosis

• Lyme disease

• Autoimmune conditions

The common underlying thread for most physical causes of chronic pain is inflammation. This is why one of our initial tenets of care is utilizing a multitude of therapies to reduce inflammation as quickly as possible. 

Psychological and emotional contributors to chronic pain may include mental health disorders and unresolved emotional or psychological trauma. The research also tells us that there is a bidirectional relationship between these psychological stressors (like anxiety and depression) and pain, meaning that chronic pain can cause these mental health conditions. 

Lifestyle and environmental factors that may contribute to pain severity include poor diet, lack of exercise, body composition and poor posture (which can also be related to structural abnormalities or breathing dysfunction). 

This increasingly prevalent public health issue significantly impacts individuals quality of life, leading to emotional and physical challenges that may require long-term management and treatment strategies. 

Our conventional healthcare model often prioritizes treating the symptoms of chronic pain rather than finding out the root cause, and this approach is failing so many of us. 

Chronic Pain 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]. 

Temporomandibular disorders (TMD/TMJ) have been identified as a leading cause of chronic craniofacial pain. Untreated issues in the jaw can lead to involuntary postural changes in effort to alleviate jaw discomfort. These changes in our head and neck posture can lead to chronic pain in other areas of the body such as the shoulders, trap muscles, lower back, and even in the lower extremities such as the knees and feet. 

The #1 reason individuals come through our doors is due to their persistent pain complaints. In addition to helping these individuals get out of pain, our main goal is to figure out what is causing their pain in the first place.

A comprehensive evaluation that includes a deep dive into their health history, lifestyle and a full physical exam is necessary to identify all contributing factors to chronic pain. As part of our physical examination, we utilize cone beam computed tomography (CBCT imaging) to evaluate bony structures from the neck up to the top of the head and assess the upper airway, which includes the sinus, nasal cavities, and pharynx (throat). We also perform motor nerve reflex testing (MNRT), which is a method of evaluating the nervous system to identify the source of the pain. Often times, where the pain is being felt is not in the same location as the underlying injury. Our goal is not only to treat the pain symptoms, but also identify and heal the underlying injury, which is necessary to truly heal from the chronic pain.

During our evaluations, assessing sleep quality and breathing is never neglected. This often leads to us being asked why we treat both pain and sleep in our office. The answer to that is simple (sort of) …

Research indicates a significant overlap between chronic pain and sleep issues. According to various studies, 50% to 80% of individuals with chronic pain also experience sleep disturbances such as insomnia, sleep apnea, UARS and restless legs syndrome. 

Not only is this relationship indicated in the research, but also apparent in our daily practice. Of those individuals that see us for pain, we find about 90% of them have comorbid sleep issues. 

This high prevalence highlights the intertwined nature of sleep and chronic pain, where one condition often exacerbates the other, creating a cycle that can be challenging to break but cannot be neglected in treatment.

The Relationship Between Pain and Sleep

Evaluations on sleep and pain support a reciprocal relationship between sleep disturbances and pain complaints. This means that pain and sleep can mutually influence one another: each can be the cause and the effect. In other words, pain can lead to poor sleep quality and sleep issues can lead to more pain.

Chronic pain can significantly impacts sleep in several ways:

• Difficulty Falling Asleep: Pain can increase the time it takes to transition from wakefulness to sleep, known as sleep latency, making it harder to get a full night's rest. This can be due to discomfort and pain making it hard to relax and find a comfortable sleep position. The anticipation of pain can also create anxiety, further hindering sleep onset. 

• Nighttime Awakenings: Pain can cause more frequent awakenings during the night, leading to fragmented sleep. This can prevent individuals from reaching and staying in the deeper, restorative stages of sleep.

• Reduced Sleep Quality: Even if individuals with chronic pain manage to sleep through the night, the quality of their sleep is often poor. They may not experience enough deep sleep or REM sleep, which are crucial for physical and mental restoration. 

• Daytime Fatigue: Poor sleep quality and quantity due to chronic pain can lead to daytime fatigue, making it difficult to function effectively during the day. This can create a cycle where fatigue exacerbates pain, and pain continues to disrupt sleep. 

Poor sleep and sleep breathing issues impact on chronic pain:

• Sleep breathing issues: Untreated obstructive or restrictive breathing at night time or mouth breathing at night disrupts sleep by causing frequent awakenings and fragmented sleep, preventing the achievement of deep, restorative sleep stages. This can result in poor sleep quality, daytime fatigue, and decreased overall well-being. 

• Central Sensitization: Repeated sleep interruptions can cause changes in the central nervous system, leading to heightened sensitivity to pain.

• Inflammatory Response: Systemic inflammation in the body can lead to sleep disturbances and sleep disturbances also drive systemic inflammation. This cycle lowers the pain threshold and is a common underlying factor in many chronic pain conditions. 

• Impaired Healing: Poor sleep can hinder the body's ability to heal and recover from injuries and illness , leading to prolonged or unresolved pain.

• Neck hyperextension: Any obstructive or restrictive breathing at night time or mouth breathing can lead to involuntary hyperextension of the neck in effort to keep the airway patent. This can lead to impingement of the nerves in the neck. 

• Sleep Bruxism (teeth grinding/clenching): Obstructive or restrictive breathing at night time or mouth breathing is a major contributing factor to grinding/clenching of the teeth in an attempt to reopen the airway, leading to craniofacial pain such as headaches, jaw/facial pain, tooth sensitivity, etc.. It can also lead to exacerbated neck pain in the morning, which may lead to forward head posture and prolonged neck pain throughout the day.

• Stress and Mood Disorders: Chronic sleep issues can lead to stress, anxiety, and depression, which are known to exacerbate and maintain chronic pain conditions.

Addressing sleep issues in individuals with chronic pain often requires a multifaceted approach, but is crucial for effective treatment and improved quality of life.

How We Address Chronic Pain In Our Office

In our office, we choose to blend conventional and integrative wisdom to create individualized plans to manage and treat chronic pain from the root cause. Some of these treatment modalities include: 

• Oral Appliance Therapy

• Functional Breathing Re-education 

• Sleep hygiene practices 

• Laser Therapy

• Prolotherapy/PRF

• Nutrition

• Supplementation / Medications

• Gut Health

• Hormone Health

• Functional Lab testing

• Acupuncture

Additional considerations may include the addition of physical therapy, chiropractic care, myofunctional therapy, massage therapy, talk therapy, and/or ENT consultations into treatment. 

Our methodologies align with integrative and functional medicine principles of treating patients as a whole and taking into account all aspects of their lives–mind, body, and spirit–in healing the root cause of pain.

How We Can Help

If you suffer from chronic pain and/or sleep issues, reach out to our office to schedule a comprehensive evaluation to bring you one step closer to healing from your chronic pain and getting more consistent, restful sleep.

What’s Next?

Stay tuned for part 2 of this month’s chronic pain newsletter, where we dive in and discuss the various therapies that we utilize in our office to treat chronic pain. Part 2 will reach your inbox on August 23rd!

Subscribe now

Additional Resources: 

1. https://drstevenolmos.com/wp-content/uploads/2019/07/Current-Opinions-in-Pulmonary-Medicine.pdf 

2. https://www.nhsinform.scot/illnesses-and-conditions/brain-nerves-and-spinal-cord/chronic-pain/what-is-chronic-pain/#:~:text=Chronic%20pain%20can%20cause%20changes,meaning%20the%20signals%20are%20amplified.

3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4450869/ 

4. https://www.nccih.nih.gov/health/chronic-pain-what-you-need-to-know#:~:text=These%20conditions%20include%20chronic%20fatigue,vulvodynia%20(chronic%20vulvar%20pain). 

5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8859867/

6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4304360/ 

7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4046588/

8. https://www.nidcr.nih.gov/research/data-statistics/facial-pain#:~:text=The%20most%20common%20cause%20of,associated%20muscles%20and%20supporting%20tissues 

9. https://www.ncbi.nlm.nih.gov/books/NBK592390/

10. https://drstevenolmos.com/wp-content/uploads/2019/06/Technology-Olmos.pdf 

11. https://drstevenolmos.com/wp-content/uploads/2019/07/4-Bruxism-What-is-It-Really-Dr.-Olmos.pdf 

12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5058862/

Do you love the warm weather changes but dread that this might mean a spike in allergy symptoms?

Did you know that 24 million Americans suffer from seasonal allergies each year? 

The majority of us who suffer from seasonal allergies find ourselves stuck… relying on over-the-counter remedies to try to relieve our persistent and uncomfortable symptoms.

How Seasonal Allergies Impact our Practice:

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

There is no question that seasonal allergies can impact our ability to breathe through our nose. Generally speaking, research shows that there are multiple health benefits associated with nasal breathing, making it far superior to mouth breathing. The nose is designed to filter and humidify air for the lungs while also producing nitric oxide for improved circulation.

Emphasizing proper nasal breathing in our practice is an important component in treating craniofacial pain and sleep issues effectively. If we cannot properly breathe through our nose, the body defaults to mouth breathing (dysfunctional breathing). This increases risk for TMJ pain, sleep breathing issues, and adds to existing conditions. [1]

In cases of TMJ disorders, nasal breathing will help alleviate pain by reducing the strain on the joint and surrounding muscles caused by mouth breathing. [2] 

Proper (nasal) breathing during sleep ensures that your body gets the oxygen it needs while allowing for necessary filtration and conditioning of the air we breathe. This method of breathing has shown to improve sleep quality and lessen nighttime awakenings. It can also reduce sleep-breathing disorders such as sleep apnea and snoring. [3] [4] [5]

What are Seasonal Allergies? 

Seasonal allergies develop when the body’s immune system has a hypersensitive reaction to dust mites, pet dander, or environmental changes, like when certain plants pollinate. You may also hear this type of reaction called “allergic rhinitis” or “hay fever”. The body’s reaction to these allergens causes inflammation and irritation to the nasal passages. Depending on the type of allergy fueling your symptoms, you may only be reactive during certain months of the year, while others may experience an allergy season that lasts practically all year long.

Seasonal Timeline 

Spring (March-May): Tree pollen is the most common culprit of allergies, primarily oak, maple, elm, and birch tree pollen.

Summer (June-August): Grass and weed pollen tend to be the most problematic. Of the grass pollen, rye grass, bluegrass, and bermuda grass are common. 

Fall (September-November): Ragweed, burning bush, and lamb’s quarters are amongst the highest allergens. Other allergens include mugwort, cocklebur, pigweed, and sagebrush. 

Winter (December-February): Household allergens and mold are common in the winter. Molds can be particularly problematic in the Midwest, as mold continues to thrive in cool, damp environments. Spore counts can also spike during the warm periods throughout the winter season. 

Common Seasonal Allergy Symptoms:

• Runny nose

• Sneezing

• Nasal congestion

• Post-nasal drip

• Throat discomfort (typically a result of post nasal drip)

• Coughing spells

• Itchy nose (rhinitis)

• Itchy, irritated and/or watery eyes

• Swollen eyes

• Itchy skin

• Hives or rashes

• Headaches

Managing Seasonal Allergies Symptoms:

The go-to approach to dealing with pesky symptoms are typically over-the counter remedies and prescriptions, such one or a combination of the following:

• Saline nasal sprays: X-lear nasal spray is the go-to choice at our office

• Nasal irrigation or sinus rinses

• Corticosteroid nasal sprays such as fluticasone (Flonase Allergy), budesonide (Rhinocort Allergy), triamcinolone (Nasacort Allergy 24hr)

• Oral Antihistamines such as cetirizine (Zyrtec), fexofenadine (Allegra), or loratadine (Claritin)

• Oral decongestants such as pseudoephedrine (Sudafed)

• Oral antihistamine and decongestant combos such as  cetirizine + pseudoephedrine (Zyrtec-D), fexofenadine + pseudoephedrine (Allegra-D), loratadine + pseudoephedrine (Claritin D)

• Immunotherapy (allergy shots)

An Integrative Approach to Seasonal Allergies:

If you’ve tried the pills, shots, etc. and are still struggling, it might be time for a root cause approach. Root cause medicine aims to go beyond the mere alleviation of symptoms, focusing instead on discovering and treating the underlying causes of illness. Exploring potential root causes of your seasonal allergies can help you regain control over your health through integrative approaches to relieving your symptoms and ideally putting you at ease once and for all.

Potential Root Causes of Seasonal Allergies:

Histamine 

Histamine is a chemical molecule released from immune cells when your immune system is responding to foreign particles, playing a key role in your body’s inflammatory response. The symptoms you experience from seasonal allergies are due to an adverse response to the release of histamine. Depending on a variety of factors, the body’s ability to secrete histamine can be negatively impacted and cause systemic overload - this is when symptoms arise. Potential root causes of histamine overload include: 

• Undiagnosed food allergens (IgE), intolerances (IgG), and sensitivities (IgG), which can keep histamine levels chronically elevated.

• Exposure to various allergens in the home without proper air filtration.

• Nutrient deficiencies and insufficiencies such as B vitamins, vitamin C, vitamin D and more.

• Dysbiosis of the gut can negatively affect histamine tolerance.

The Gut Connection 

There is emerging evidence on the gut microbiome and seasonal allergies. One study found similarities in the gut microbiome profile of those suffering from seasonal allergies. It showed an overall decrease in microbial diversity, with an increase in particular microbes such as Bacteroidetes (gram-negative bacteria). Microbial diversity in the gut is essential in maintaining optimal health, especially when it comes to modulating immune responses. An overgrowth of gram-negative bacteria can lead to dysbiosis of the gut and trigger unwanted symptoms. One of the most profound ways that we alter our gut microbiome is through our daily dietary decisions. The foods we consume have either a positive or negative impact on our microbial diversity, so prioritizing intake of whole foods will support a well balanced microbiome. [8] [9] [10]

Nutrition 

Epidemiological, clinical, and animal studies have all shown that the lack of nutrient density and inflammatory nature of the Western diet promotes allergies and exacerbates symptoms, whereas nutritionally balanced diets, such as an anti-inflammatory diet, play a critical role in the prevention and treatment of allergic diseases, chronic pain and sleep issues. Following this nutrition plan would include prioritizing intake of fruits and vegetables (phytochemicals), dietary fiber, complex carbohydrates, high-quality sourced protein, and omega-3-rich fats. 

Reducing inflammation in the body through your dietary decisions can help mitigate the immune response and gastrointestinal response associated with the release of histamine that occurs as a result of an allergic reaction. In doing so, allergy related symptoms will improve in addition to a reduction in chronic pain and improvements in sleep quality. For some, reducing high-histamine foods or foods that stimulate histamine release can assist in reducing symptoms of seasonal allergies while the root cause is being addressed. [11] [12]

• Anti-inflammatory food favorites: berries, fatty fish, broccoli, peppers, avocado, mushrooms, dark chocolate, green tea, turmeric, ginger, bone broth, olive oil

• Mucus eliminating foods: ginger, garlic, carrots, leafy greens, cayenne pepper, onion, lemons, watercress, and more

• Quercetin rich foods: apples, parsley, sage, dark cherries, olive oil, blueberries, blackberries and more

• Bee pollen and local raw honey: have immune protective effects and anti allergy action [13] [14] 

• Vitamin C rich foods: acerola cherries, black currants, cantaloupe, citrus fruits, peppers (chili, yellow), parsley, strawberries, broccoli, brussel sprouts, Kadadu plums, rose hips, guava, mustard spinach, kale, collard greens, kiwi, lemon, papaya, banana, potatoes and more

• Omega-3-rich Foods: fatty fish such as salmon, tuna, sardines, nuts & seeds and more

• Fiber rich Foods: avocados, apples, beans, berries, broccoli, brussel sprouts, cabbage, celery, cucumber, figs, kale kiwi, lentils, nuts & seeds, tart cherry, passion fruit, olives & olive oils, pumpkin, spinach, fresh herbs

• Herbal teas: turmeric, dandelion root, nettle, marshmallow root, peppermint, ashwagandha

• High histamine foods: Fermented foods like sauerkraut, hard cheeses, mushrooms, chocolate, spinach, tomatoes, pineapples, avocados, and leftovers.

Supplements

Quercetin

As an antioxidant and anti-inflammatory, Quercetin is a great option for managing seasonal allergies. Quercetin has proven to suppress pro-inflammatory cytokines, which are part of the histamine release cascade. Supplementation has been shown to be effective in reducing pollen allergy symptoms. [15] [16]

Turmeric (Curcumin)

Turmeric has been shown to contain bioactive compounds (curcuminoids) that have medicinal properties. It is a potent antioxidant and anti-inflammatory. Curcumin has been shown to alleviate nasal symptoms (sneezing and rhinorrhea) and nasal congestion through reduction of nasal airflow resistance in those with allergic rhinitis.[17] 

Ginger

Zingiber Officinalis, commonly known as ginger, has been clinically used as a natural anti-inflammatory. A 2020 study showed that ginger extract was just as effective as loratadine (Claritin) in those with allergic rhinitis, resulting in reduced nasal symptoms and improved quality of life. [18]

Diamine Oxidase (DAO)

There are specific supplements that are geared at decreasing histamine by providing the body with DAO, which is the enzyme needed to break down histamine. If histamine intolerance is part of the root cause of your allergies, taking DAO may help reduce symptoms. [19]

N-Acetyl Cysteine 

NAC is a form of the amino acid cysteine. It is a precursor to the “master antioxidant” glutathione. Its primary mechanism of action is thinning mucus that forms in mucus membranes of the respiratory and gastrointestinal tract. Regarding seasonal allergy responses, this can help decrease congestion and mucus build-up. One small-scale study showed that a prophylactic application of topical NAC reduced nasal reaction to the late-phase response to ragweed. [20] 

Spirulina 

Spirulina is a blue-green algae (Cyanobacteria), that is known for its nutrient profile, antioxidant and anti-inflammatory properties. It has also been shown to be effective in the reduction of symptoms associated with allergic rhinitis. One study found spirulina to be more effective than cetirizine (Zyrtec) in reducing allergy symptoms and reducing inflammation. [21] [22] [23] 

Nettles

Stinging nettles, or Urtica Dioica, is a plant that has shown to improve symptoms associated with allergic rhinitis due to its natural antihistamine properties. [24]

Breathe-X by LifeSeasons

This supplement is a a well thought out blend of Vitamin C, Magnesium, Bromelain, Citrus Bioflavonoids, Astragalus Root, and Nettles, created to help combat inflammation, promote healthy mucosal cells, and regulate histamine production to support nasal and sinus respiration.

Lab Testing

Functional lab testing is often necessary in root cause analysis of health issues, as they provide extremely valuable insight into your individual health status. Below is a list of tests we may consider running on our patients when helping them with their seasonal allergies:

Allergen Testing

Often, there is more than one allergen that is the culprit for your symptoms. Allergen testing (IgE + IgG) can help determine environmental and food allergies that may be playing a role in triggering your symptoms.

Histamine Testing

Assessing histamine levels in the body can help define the severity of your allergic response. In addition to histamine levels, it is important to assess additional biomarkers such as DAO, LPS, and Zonulin to look at intestinal permeability, inflammation, and the body’s ability to break down histamine.

Microbiome Assessment

Stool analyses are a comprehensive approach to looking at your individual microbiome for both pathogenic and beneficial microbes in the gut to determine if there is dysbiosis that needs to be address.

Micronutrient Testing

Existing chronic inflammation and gut dysbiosis can lead to decreased absorption of nutrients essential to our immune system, inflammation reduction and overall health. Assessing nutrient status is a great way to identify individualized nutrient needs while addressing the root cause of allergic response.

How We Can Help:

If trying to find the root cause of your seasonal allergies, optimize your diet, and balance your gut microbiome sounds daunting, we are here for you! Reach out to our office to schedule a consultation with Carly, our nutritionist, who can help you find out which root cause might be contributing to your allergy symptoms, pain issues, and poor sleep quality.

What’s Next?

Want to learn about nutrition and how it plays a role in the development, maintenance and management of chronic pain? Attend our free webinar on Thursday, April 4th, 2024 at 6PM. Please RSVP using the link below if you are interested in attending! Also, stay tuned for our upcoming newsletter on chronic pain and our practice.

Webinar RSVP

Additional Resources:

1. Asthma & Allergy Foundation of America. (2024, March 14). Allergy facts. https://aafa.org/allergies/allergy-facts/#:~:text=How%20Common%20Are%20Seasonal%20Allergies,(5.2%20million)%20of%20children 

2. Farnsworth, C. (2023, November 20). Nose breathing vs. Mouth Breathing: What to know. Medical News Today. https://www.medicalnewstoday.com/articles/nose-breathing-vs-mouth-breathing 

3. Hill, C., Kelly, E., & Chin, K. (2024, January 8). 20 foods that are high in Vitamin C. Healthline. https://www.healthline.com/nutrition/vitamin-c-foods#bottom-line 

4. Kim SD, Jung DW, Lee JW, Park JH, Mun SJ, Cho KS. Relationship between allergic rhinitis and nasal surgery success in patients with obstructive sleep apnea. Am J Otolaryngol. 2021 Nov-Dec;42(6):103079. doi: 10.1016/j.amjoto.2021.103079. Epub 2021 May 14. PMID: 34020179.

5. NHS. (2020, August 3). Vitamin C. NHS choices. https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-c/ 

6. Nunez, K. (2021, February 1). Nose breathing: Benefits, how to, exercises to try. Healthline. https://www.healthline.com/health/nose-breathing#differences 

7. Prasad S, Aggarwal BB. Turmeric, the Golden Spice: From Traditional Medicine to Modern Medicine. In: Benzie IFF, Wachtel-Galor S, editors. Herbal Medicine: Biomolecular and Clinical Aspects. 2nd edition. Boca Raton (FL): CRC Press/Taylor & Francis; 2011. Chapter 13.Available from: https://www.ncbi.nlm.nih.gov/books/NBK92752/

February is already almost over… Not sure about you, but we feel that this winter season has flown by! The winter is such a dynamic time of year: the cold weather changes, busy holiday season, final exams, hurrying to meet end of the year goals and deadlines, New Years resolutions… the list goes on. 

This time of year, it’s not uncommon for things to fall through the cracks, especially when it comes to making time for our health and wellness.

Does this sound like you? You’re not alone! 

If you’re looking for a next step toward improving your health and longevity, we’ve got a question for you:

Have you been getting enough vitamin D this winter? 

What is Vitamin D?

Vitamin D is a fat soluble vitamin obtained from sun exposure, foods, and supplementation. It is important for mood, energy, sleep quality, thyroid function, bone health, immune function, inflammation, and more.

Our skin produces vitamin D3 when exposed to UV radiation from sunlight. Depending on where you live, the opportunity to get vitamin D from the sun decreases significantly during the winter months, leaving diet and supplementation the only way to maintain optimal vitamin D levels.

Research suggests that about 1 billion people worldwide have vitamin D deficiency, while 50% of the population has vitamin D insufficiency. [1]

Vitamin D comes in two main forms: 

• Vitamin D2 (ergocalciferol) - mainly sourced from plant foods and fortified products

• Vitamin D3 (cholecalciferol) - found in animal-sourced foods and is a byproduct of sun exposure

Vitamin D2 and D3 are not created equal. Although both are effectively absorbed into the bloodstream, they are metabolized differently by the liver. The majority of evidence suggests that vitamin D3 is more effective than vitamin D2 in improving vitamin D status and maintaining optimal levels. [2, 3]

Vitamin D and Our Practice:

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

Vitamin D plays an important role in our approach to treating our patients.

Vitamin D plays a significant part in bone health, as well as muscle and nerve function, alongside calcium. Existing literature demonstrates a relationship between vitamin D deficiency in patients with temporomandibular disorders (TMD), or more commonly referred to as TMJ. Ensuring optimal vitamin D levels in our patients can help improve pain, muscle strength, physical function, and healing of the TMJ, even in those presenting with osteoarthritis. [4, 5, 6]

There is growing evidence as well that vitamin D plays an important role in sleep regulation. Recent literature is demonstrating an association between vitamin D deficiency or insufficiency and shorter sleep duration, more frequent nighttime awakenings, and an increase in risk for sleep breathing disorders. [7, 8,]

How can you make sure you are getting enough Vitamin D? 

Nutrition:

Although dietary sources of the vitamin are rather minimal, foods most rich in vitamin D include fatty fish (such as salmon, swordfish, tuna, trout mackerel, and sardines), cod liver oil, egg yolk, beef, liver, and cheese. Plant foods like mushrooms (exposed to UV light) contain D2. There are also food products on the market that are fortified with both forms of vitamin D, such as certain dairy products and cereals. 

Vitamin D works synergistically with multiple other essential nutrients including magnesium, vitamin K, calcium, zinc, and selenium. Making sure that you have adequate intake of these nutrients can aid in absorption of vitamin D and help with maintaining optimal levels of the vitamin. 

Dietary sources of magnesium include root veggies, (beets, burdock root, sweet potato), leafy greens (kale, spinach, collard greens, turnip greens, mustard greens), nuts (almonds, cashews, pumpkin seeds, beans, avocado, fatty fish, dark chocolate (70% cacao or higher). 

Dietary sources of vitamin K include potatoes, winter squash (acorn & butternut), spinach, broccoli, beet greens, avocado, bananas, cantaloupe, oranges, coconut water, tomatoes, dairy milk, almond milk, yogurt, cashews, almonds, chicken, and salmon.

Dietary sources of zinc include shellfish (oysters, crab, lobster), beef, fish, poultry, beans, nuts, seeds, whole grains, eggs, and fortified food products.

Dietary sources of selenium include plant foods, garlic, brazil nuts, fin fish, shellfish, beef, turkey, chicken, liver, beans, lentils, eggs, whole grains, and fortified food products.

Supplementation:

Supplementation is often necessary in the winter time to maintain optimal vitamin D levels. When choosing to supplement, it is important to make sure you choose a high quality product because supplements do not require FDA approval before entering the market. To ensure good quality, always read the ingredients list and look for products that have received certifications from third party testing organizations, such as NSF, USP, and GMP certifications.

If you wish to start supplementation, we recommend working with a skilled practitioner to get tested and ensure you are taking a safe supplement at the dosage best for your unique health profile.

In our office, we utilize two methods of testing to assess our patients’ vitamin D status:

• Serum Blood Test: a standard blood draw with a phlebotomist near you and get results typically within a week

• Bio-PRF Rapid Test Kit: a novel way to test your vitamin D in office with a simple finger prick and get results within minutes

Additional Resources:

1. U.S. Department of Health and Human Services. (2023, September 18). Office of dietary supplements - vitamin D. NIH Office of Dietary Supplements. https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/#disc 

2. U.S. Department of Health and Human Services. (2021, March 22). Office of dietary supplements - magnesium. NIH Office of Dietary Supplements. https://ods.od.nih.gov/factsheets/Magnesium-Consumer/

3. U.S. Department of Health and Human Services. (2021b, March 22). Office of dietary supplements - vitamin K. NIH Office of Dietary Supplements. https://ods.od.nih.gov/factsheets/VitaminK-Consumer/

4. U.S. Department of Health and Human Services. (2022, October 4). Office of dietary supplements - zinc. NIH Office of Dietary Supplements. https://ods.od.nih.gov/factsheets/Zinc-Consumer/

5. U.S. Department of Health and Human Services. (2021b, March 22). Office of dietary supplements - selenium. NIH Office of Dietary Supplements. https://ods.od.nih.gov/factsheets/Selenium-Consumer/

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Our team believes that knowledge is key to making empowered decisions about our own health. We’ve created this newsletter because we are dedicated to making your health a priority and keep you informed on a wide range of topics to help you achieve your optimal well-being.

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