CONGRESSO NAZIONALE - Avenue media

a b s t r a c t b o o k
G. LAVIGNE
Sleep bruxism and pain syndromes
Sleep bruxism: Eight percent of the adult
population grinds their teeth during sleep.
The causes of sleep bruxism (SB) are
unknown. SB is preceded by a rise in heart
rate, blood pressure and with big respiratory
breaths in a significant number of events,
suggesting a strong participation of the
autonomic nervous system in its genesis.
Then, SB may be secondary to brief,
recurrent (3–10 sec, repeated 10–14 times
per hour of sleep) sleep arousals
characterized by autonomic (cardiac and
respiratory) and brain activations. SB is
more prevalent in arousal phase of the Cyclic
Alternating Pattern, the phase A3. Stress
remains a putative factor: it may trigger
physiological activity increasing the
probability of SB generation. Some familial
history can be positive and only one gene
candidate has been suggested, replication is
not done yet.
Early detection of SB causes in children
includes history of tooth grinding, snoring,
attention disrupted behaviour, and an oralpharyngeal
examination. In adult, tooth
grinding reports, jaw pain and headaches are
signs and symptoms to be noted. Only
persistent SB cases with movement or
breathing or chronic pain disorders may need
a sleep laboratory investigation.
Sleep and pain: It is known that a sleeping
brain poorly discriminates pains. An intense
stimulus (nociceptive) during sleep will
trigger arousal to awakening, including a fight
or flight reaction, in all sleep stages. This only
occur if pain last long enough to be process
by a sleeping brain.
Chronic pain, according to various surveys, is
reported by 11to 30% of the adult
population. Complains about poor sleep
quality (e.g., un-refreshing sleep) is made by
50 to 70% of them. Poor sleep is a common
“per una medicina del sonno sostenibile”
complaint is musculoskeletal pain. Insomnia,
sleep apnea-hypopnea and periodic limb
movements and mood alteration are
frequently concomitant; they need to be
included in the differential diagnosis.
Morning Headache is also reported in
association with SB and with sleep apnea;
causes are debated (e.g., poor breathing with
low oxygenation-hypoxia, rise in CO2hypercapnia).
A circular relationship is suggested between a
poor night’s sleep and more pain the
following day, and between too much pain
during the day and a poor night’s sleep. This
simple relationship may be due to mood
alteration, stress-related changes in the HPA
axis, genetic predisposition, and other risk
factors.
In terms of management, clinicians need to:
1) exclude co-morbidities such as
insomnia, periodic limb movements,
and sleep disorder breathing or
neurological disorder (epilepsy, RBD)
and mood disorders;
2) identify if any pain result from
bruxism, these can include temporal
headache (tension type),
temporomandibular pain, cervical
pain and in some cases widespread
pain (fibromyalgia);
3) implement strategies to promote
stable or continuous sleep as part of
regular good sleep practices.
4) Clinicians could also work
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