How to relax in dreamland and wake up feeling good?
February 7, 2011 9:08 AM   Subscribe

I'd like to hear from anyone who has overcome excessive tension in the jaw, neck and upper back during sleep. I wake up feeling very stressed and tense and it's a drag.

For most of my adult life (I'm a 51 y.o. female) I've lived with sore, knotted upper back and shoulder muscles. All the massage therapists I've seen can't believe how rock-hard and knotted that area is. The past few years have brought headaches from clenching my jaw in my sleep, tinnitus which I think is related to all this tension in the area, and unrefreshing sleep due to waking up throughout the night feeling clenched, tense and tight. I can’t seem to find a way to make it stop. I now dread mornings because I wake up feeling worse than when I went to bed. I have discussed the problem with a chiropractor, my rheumatologist and several psychiatrists and on their recommendation I have tried massage (works for a few hours), muscle relaxants (make me very mentally foggy/sleepy but not relaxed), deep breathing and meditation, listening to guided progressive relaxation CDs (worked for a few hours), and Klonopin (again, unacceptable daytime sleepiness). Have also tried and still do exercise, which works for a while but the next morning I wake up clenched and tense all over again. Hot baths help a lot while I'm in one but it's kind of tough to sleep in a tub of hot water. I know YANMD, but I’m asking for anecdata from anyone who might have successfully overcome this type of problem, and also suggestions as to what flavor of medical professional to try next. Has anyone tried hypnosis or acupuncture for intractable muscle tension and inability to relax when sleeping? Thanks much in advance.
posted by FormerMermaid to Health & Fitness (18 answers total) 20 users marked this as a favorite
Dentist. Dentist dentist dentist. Talk to them about a biteplate (custom, NOT the over-the-counter kind). I was skeptical, but at least in my face, jaw and neck, having a custom biteplate has worked wonders. It has also been expensive -- not typically covered by insurance, so mine cost about US$500.
posted by chesty_a_arthur at 9:13 AM on February 7, 2011 [4 favorites]

Best answer: I've got a fitted mouth piece/nightguard which may help with your jaw pain/tension. I still clench my teeth, I just can't get them as close together and that seems to help make sure I can, for example, open my mouth in the morning. It may be very helpful to you for your tinnitus and headaches.

But I don't think that really is related to the pain you have in your shoulders/back when you wake up. I have that problem come and go and I think it's got to do with how I'm sleeping - what position, where there are pillows, etc. Once or twice I've woken up halfway through the night with the beginnings of a tension headache, removed a pillow or rolled over so that my neck was in a more relaxed position, and the headache was gone by morning. Meditation and relaxation CDs seem to me like they would help in the long run, but perhaps not as a one-off before-bed thing. And I can't say if even that really would help, because I haven't been willing to make that kind of major life change - I'm too invested in the adrenaline/stress in my life.

I wonder if a physical therapist or sleep therapist could help figure out ways you could stand/sleep/walk/etc that would help reduce the tension in your shoulders?
posted by Lady Li at 9:31 AM on February 7, 2011

Yep, this is what mouth guards were invented for. I clench my jaw pretty hard, especially at night, and used to frequently wake up with severe headaches. My dentist fitted me with a mouth guard for my upper teeth and adjusted it so that even though I still bite pretty hard, I don't get headaches anymore. They're a little awkward to wear at first, and definitely not attractive, but they do exactly what they're supposed to.

It's important that you talk to a dentist about this because clenching or grinding your teeth can damage them. I've fractured several teeth from clenching so hard, so the mouth guard not only stops my headaches, it's also protecting them from further damage than what I've already done.
posted by just_ducky at 9:33 AM on February 7, 2011

Hold-You-Over-to-a-Dentist-Visit-Answer: Are you a stomach, side or back sleeper?

If you are a stomach sleeper, try switching to a very thin & cushy pillow. A thin down pillow (try removing some of the feathers if necessary) works wonders.

If you are a side sleeper, try putting a moldable (down or foam) pillow between your knees.

If you are a back sleeper, ditch the pillow and try rolling a towel lengthwise, then tucking this "bolster" under your neck.

But definitely see a dentist.

Side note: I suffered from similar problems as a stomach sleeper and had great success by switching to a thin down pillow and adding a daily upper body weight workout to my routine. Nothing Hulkish or complicated - just 10 pound weights and a few minutes each day. The difference was immediate.
posted by muirne81 at 9:38 AM on February 7, 2011

As everyone has said, you need a mouth guard. If this is severe enough to be diagnosed as TMJ rather than Bruxism, medical insurance sometimes will cover the mouthguard rather than dental. All insurance companies try to avoid paying for things, but it's at least worth looking into.

I've had a mouthguard for about 10 years. I don't view it as a total cure, but it's a huge help.
posted by mcstayinskool at 9:40 AM on February 7, 2011

Best answer: I have this. I have always had this. My upper back, neck and jaw get like that when I don't do yoga for a few weeks on end. If you do 15 minutes of relaxing hip openers and a few minutes of aggressive upper back stuff (as much as I hate/d downdog for years and years, that is the #1 pose that helps with upper back/neck stuff over time) and do this consistently, it will help.
Nothing else does the trick. All of the other stuff (acupuncture, muscle relaxers etc) can help unknot an acute spasming situation, but consistent yoga is the only thing that keeps it at bay.
PM me if you want more detailed suggestions or pose guidelines.
posted by 8dot3 at 9:56 AM on February 7, 2011 [1 favorite]

Best answer: Note that there are different types of custom mouth guard. The full mouth guard did not work for me, because I would still clench on it in my sleep and get headaches anyway. An NTI mouth guard works for me because it fits over just the two front teeth and does not allow me to clench my jaw at all. I got both types fitted by my dentist, and my dental insurance paid 80% for each (as opposed to 50% for a crown).

Magnesium supplements at bedtime have partly helped me and some other people in being able to relax muscles. Magnesium oxide, the form of magnesium my drug store carries, is not absorbed well enough to work, but magnesium citrate or magnesium malate are good. It's not enough by itself, but it makes a noticeable difference for me. Don't take more than 100% of the recommended daily intake as listed on the label.

Muscle relaxants are not all alike, and which ones work best varies from one person to another. For me, Flexeril at bedtime made me tired the next day, while Skelaxin did nothing at all, but carisoprodol at bedtime helps me a lot. I don't like to take it when I'm awake, but it's helpful at bedtime. Ask to be prescribed a different type than you've taken before, and if it doesn't work, ask for a third type. Do not ask for carisoprodol by name, as apparently some drug addicts like it, and you don't want to look like a drug seeker. Besides, you might do better on a completely different one than I do.
posted by Ery at 9:58 AM on February 7, 2011 [2 favorites]

If warm baths help, what about a heated mattress pad? I have seen some with three different zones - shoulders/back, hips, and legs.
posted by muddgirl at 10:18 AM on February 7, 2011

Best answer: i have the tightest neck + shoulder area knots any massage therapist i've seen has ever encountered and occasionally go through long periods of waking up with stress headaches induced by jaw clenching. like 8dot3, the only thing that's really worked for me long-term is doing yoga; i love bikram yoga in particular because the room's so hot that your muscles have no choice but to relax and stretch, whether they want to or not.
posted by lia at 10:20 AM on February 7, 2011

Has anyone ever tried TENS on you, for pain relief and muscle relaxation? Trigger point injections? Physiotherapy? Stretching exercises to go with the massage, as well as strength-building exercises to get the knotted muscles working the way they should?

Have you been through a sleep study?

Did the chiropractor take a look at your jaw?
posted by galadriel at 10:30 AM on February 7, 2011 [1 favorite]

Seconding the bite-plate / mouthguard option from a dentist.

It was a fairly life-changing experience for a friend of mine.
posted by Cool Papa Bell at 10:48 AM on February 7, 2011

Best answer: Another strong recommendation here for yoga, best done in a class with a good "hands-on" instructor. You may think it's not doing much at first, but if you do it consistently, a year from now this problem will probably be ancient history.
posted by Corvid at 11:12 AM on February 7, 2011

Yes, you need to see a dentist or orthodontist who is experienced in treating TMJ.

But until then: Have you tried Xanax before going to sleep? Half a .25 mg Xanax helps me sleep without being groggy in the morning.

Also, cranio-sacral massage might be more effective for you than other modalities. Now, cranio-sacral massage therapists believe (what I think of as) a lot of bollocks about energy fields and what-not, but for people whose muscular tension focuses in their neck and jaw, the techniques work incredibly well.

Can you reduce the actual stress in your life? I presume that the rheumatologist has ruled out things like Sjogren's syndrome and metabolic issues, so.
posted by Sidhedevil at 11:13 AM on February 7, 2011

Best answer: The suggestion about mouthguards and yoga sound great, but I also wonder about whether this muscle tension can be attributed to stresses in your life that can be eliminated? May be easier said than done (or maybe mouthguards and yoga can see you through as you root out/solve the causes of the tension.)

I ask because I had many of the same issues you're describing all through my 20s and early 30s, and found to my delight that after I was done with college and grad school all that stuff went away.

I remember once going to a weekend-long bodywork workshop while in grad school and noticing to my great amazement that the muscles in my shoulders weren't tense, it was such a rare occasion. Nowadays, though I have job, marital, family responsibilities I am not nearly so stressed all the time and it's rare and notable when my shoulders *are* that tense.

Good luck regardless--that's a lot of stress to be carrying and I hope you find some ways to relieve it.
posted by Sublimity at 2:00 PM on February 7, 2011

Nthing a nighttime bite guard. FWIW, I prefer the soft rubbery kind, and never really understood the value of the hard plastic kind. YMMV.

And if that doesn't work out for you, maybe a sleep study?
posted by exphysicist345 at 3:31 PM on February 7, 2011

Seconding the tiny, rather than the full, night guard. Mine fits on my bottom teeth instead of the top, but same principal. I used to have debilitating migraine headaches at least once a month from clenching my teeth while I sleep. Now I get maybe two a year. I really can't recomend it enough. The price tag kept me from getting one for years and of course my insurance didn't cover it, but I paid out of pocket and it was the best $500 I ever spent. Oh, and it helps my TMJ, somewhat.
posted by santaslittlehelper at 3:59 PM on February 7, 2011

I totally agree with all the comments about dentists and mouthguards.

Also, are any of the exercises/stretches you've done specific to the jaw area? I had issues with TMJ disorder before, and I found that stretching my jaw down and side to side (along with massage) gave immediate relief and eventually made it clear up completely for me. Jaw and neck stretching seems to have helped my clients who have had more serious TMJD than me as well.
posted by rosken at 4:30 PM on February 7, 2011

I use to have a horrible problem with shoulder/neck tension. I never clenched my jaw but it would stick and be hard to open sometimes. I'd get tension headaches where a muscle relaxer was the only thing that helped.

It went away when I first became vegetarian and cut way back on the amount of protein I was eating. I didn't notice it at first but then thought I haven't had a headache in forever. It definitely makes a difference with me. I can tell if I've gone over board with protein because my neck muscles are tighter. I'm guessing if your muscles don't have excess fuel, than they don't have the energy to clench rock hard and stay that way.

You might try cutting back some on food with lots of protein (meat, seafood, dairy, beans, nuts, seeds) and see if you notice any difference. I've also found exercising if I've over done with protein helps burn it off and my muscles don't get knotted up. I can't promise it will help you but it made a huge difference for me.
posted by stray thoughts at 9:04 PM on February 7, 2011

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