Page 72 - Journal of Special Operations Medicine - Fall 2014

Use of a Removable Mandibular Neuroprosthesis for the
Reduction of Posttraumatic Stress Disorder (PTSD) and

Mild Traumatic Brain Injury/PTSD–Associated Nightmares,
Headaches, and Sleep Disturbances

Donald R. Moeller, DDS, MD, MA; John M. Duffey, CrS;
Angela M. Goolsby, AS; Jesse T. Gallimore

ABSTRACT
Introduction: Posttraumatic stress disorder (PTSD) has Introduction
been associated with nighttime headaches (HAs), night- Approximately 22% of armed services personnel who
mares (NMs), and difficulty falling or staying asleep served in Iraq or Afghanistan between 2002 and 2008
(sleep disturbances [SD]). The authors of the current were diagnosed with PTSD. The most commonly re-
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study evaluated the correlative elements of using a re- ported symptoms of PTSD include reliving an event
movable mandibular neuroprosthesis (RMN) and the through NMs and SD. Previous research has indicated
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reduction of these symptoms in participants diagnosed that about 61% of persons with PTSD may report expe-
with PTSD or mild traumatic brain injury (mTBI)/PTSD. riencing NMs and about 74% may report experiencing
The RMN device is a form of specialized dental splint insomnia. 3
that has a potential to reduce the painful stimuli of brux-
ing and potential upregulation of threat response systems SDs are a frequent residual complaint after treatments
that may occur during sleep. Method: A sample of 32 in- of PTSD that are termed successful and may constitute
dividuals was selected through random assignment from a core feature of the disorder. As many as 48% of pa-
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a volunteer base of 200 volunteers for examination by tients who no longer meet PTSD diagnostic criteria after
self-report according to an A-B-A-B design. The sample treatment with cognitive-behavioral therapy may still
included 25 men and 7 women between the ages of 21 report insomnia. Implosive therapy, involving system-
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and 65; 21 had military experience and 11 were civilians. atic exposure to traumatic memories and skills training
Participants were asked to rate the frequency and inten- interventions directed at improving social competence
sity of their HAs, NMs, and SD during each phase. Their in interpersonal interactions, has been shown to im-
responses were scored using a custom survey (equivalent prove some outward symptoms of PTSD, although sleep
forms reliability) that provides ratio-scaled results for symptoms may still occur. SDs are associated with an
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symptom frequency and intensity. The original number increased risk of suicide ideation and attempt, and im-
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of participants was 35 with three participants dropping proved sleep has been correlated with improvement in
out before the conclusion of the study. Results: Survey the severity of PTSD symptoms. 8
scores for PTSD-related sleep symptoms were relatively
–
high at baseline (x = 0.52) and significantly lower in the In addition, mTBI has been associated with depression,
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–
first experimental phase (x = 0.20). Scores in the second multiple neurological memory problems, and HAs in-
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–
experimental phase were likewise lower (x = 0.38). Sig- dependent of PTSD. Recent data indicate that approxi-
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nificant reductions in symptoms were reported across all mately 500 of every 100,000 persons visiting emergency
three dimensions. Discussion: All participants reported departments in the United States have an mTBI, mak-
some improvement in symptoms while using the device. ing it the most common neurological condition in the
No participants reported worsening of any symptoms as United States. Treatment of these symptoms is com-
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a result of using the RMN. Participants commonly re- plicated by a common comorbidity with PTSD. Sleep
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ported that improvements in symptoms were immediate difficulties may mediate the effect of a positive mTBI
and did not diminish over time. Data indicate that there screening on the later development of mental health dis-
is a negative correlation between the use of an RMN and orders and may act as an early indicator for risk of de-
the reduction of HAs, NMs, and SD in persons diag- veloping PTSD or depression. 14
nosed with PTSD or mTBI/PTSD.
Sleep bruxism is an arousal-related phenomenon that
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Keywords: PTSD, mTBI, nightmares, headaches, sleep dis- has been associated with PTSD. Bruxism leads to mas-
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turbances, DIMS, bruxism, bruxing, splint
ticatory muscle tenderness and temporomandibular joint
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