The potential damage from poor sleep has become increasingly known — it has been linked to dementia, heart disease and more. The causes of these sleep issues are often attributed to boogeymen such as increased stress, the consumption of coffee or alcohol in the evening, and screen time before bed.
While those are part of the story, many experts are flagging another common barrier:
“You can’t talk about poor rest without talking about craniofacial pain,” said Dr. Terry Billings, a Metairie dentist, referring to discomfort in the head, face, neck and jaw. Billings has been focused on craniofacial pain and its relationship to sleep for more than 20 years. “They go hand in hand.”
In fact, in September 2024, the Journal of Oral & Facial Pain and Headache reported that 83% of patients with chronic craniofacial pain experience sleep issues.
Some of this is intuitive: Pain disrupts sleep, and poor sleep depletes the body’s ability to tolerate pain. In other ways, the link between sleep and craniofacial discomfort is not so obvious.
Billings recalled one patient who, during a sleep test, stopped breathing for more than 10 seconds 37 times in one hour.
“If that happened four times, that would be considered ‘normal,’” Billings said, “but this guy basically suffocates 40 times every hour. To say that’s ruining his sleep is an understatement.”
Causing a bad night’s sleep
A nasal examination showed that the inside of the patient’s nose was inflamed, making it harder to breathe. Billings suggested he cut back on foods that contribute to this inflammation, including sugar and bread.
What followed was 2½ weeks of improved sleep.
“He told me he was feeling so good that he decided it was probably OK if he had a Whopper and Coke one night as a reward,” Billings recalled. “Within 30 minutes of the meal, he noticed he could no longer breathe through his nose!”
According to ResMed, a medical equipment manager, more than one-third of adults in North and South America are afflicted with Sleep-Disordered Breathing. It is estimated that more than 8 in 10 individuals are unaware they suffer from sleep apnea.
Billings said that actions many find common — ice cream before bed, pizza and beer with friends, or an evening espresso — all cause inflammation that lead to obstructed breathing, also triggering cortisol dumps that have the effect of winding us up before sleep, instead of allowing us to wind down.
This, Billings said, is where a vicious cycle leads back to craniofacial pain.
“Our brain’s number one objective while we sleep is to keep us breathing,” he said. “So if you can’t breathe through your nose, your brain will have you move your jaw, for example, to open the airway through your mouth.”
“When you do that all night, your muscles are overworked and tired,” Billings added. “Your posture changes and strains your head and neck and you end up with issues like temporomandibular joint disorders that can lead to jaw issues, teeth grinding, headaches, migraines and more. It destroys your sleep, your mood, and your long-term health.”
Sleep solutions
Deep sleep, also known as slow-wave sleep, is the stage of rest when your brain and body do their most essential work: releasing growth hormones that build and repair bones, tissue, and muscle; producing proteins that strengthen your immune system and control inflammation; converting short-term memories into longer-term ones; reducing the risk of obesity, Type 2 diabetes, and heart disease by controlling sugar and blood pressure; and cleaning the brain waste that can lead to Alzheimer’s and other causes of dementia.
“Not solving these sleep issues negatively impacts everything in your life,” said Dr. Paul Spring, a Metairie-based ear, nose, and throat specialist of almost 30 years. “Whatever maladies you have, it compounds those things, but it also makes you more irritable and less productive.”
Spring said that most people don’t even realize they are suffering from breathing-related sleep issues.
Dr. Paul Spring
PROVIDED PHOTO
“Honestly,” he said, “what usually brings them in is their partner eventually says, ‘Hey, do you know you stop breathing a lot while you sleep?’”
An appointment with a craniofacial sleep specialist will likely begin with a consultation and then an examination of the nose to identify potential breathing issues.
Possible mitigations could include minor surgery to solve anatomical obstructions to proper breathing, or the design of a customized oral orthopedic that can correct the position of the patient's jaw or teeth. CPAP machines are still widely used, though sometimes unpopular because of the cumbersome mask. In recent decades, the less intrusive Inspire sleep apnea device has gained approval by the FDA, acting as a pacemaker that keeps your airway open during sleep by sending tiny electrical pulses to the nerves that control your tongue.
Whatever solution is right for the patient, Spring said, will likely change their life.
He said, “The most common thing I hear from individuals when we solve their sleep problem is that they can’t believe they lived for so long in so much discomfort.”