Page 77 - Journal of Special Operations Medicine - Fall 2014

baseline and treatment phases (see Figures 9 through Figure 12 Frequency distributions for all phases of the study
11). The SD scores, rendered in a boxplot graph (Fig- illustrating a normal representative sample for each.
ure 12), further support the strong negative correlation
between treatment and baseline phases seen in the previ-
ous line graphs.

Figure 9 Scatter plot of nightmare scores and effect of RNM
in phases A1 and B1 with regression line.

Speculated Mechanisms for Action of the RNM
PTSD and mTBI/PTSD are associated with increased
sympathetic activity. The sympathetic nervous system is
activated under the conditions of physical, psychologi-
cal, and psychosocial stress. This activation may also af-
fect motor function by modulating afferent activity from
Figure 10 Scatter plot of disrupted sleep and effect of RNM muscle spindles that are highly concentrated in jaw-clos-
in phases A2 and B2 with regression line.
ing muscles. 24,27 Emotionally stressful states measured by
urinary catecholamines may affect the development of
bruxism. It is known that rhythmic masticatory mus-
26
cle episodes, seen in electromyographic studies of sleep
bruxism, are preceded by physiological activation of the
central nervous and sympathetic cardiac systems. Tran-
29
scranial magnetic stimulation of sleep bruxing patients
suggested that an abnormal excitability of the central
jaw motor pathways may be present in sleep bruxing
patients and that this increased excitability could derive
from an impaired modulation of brainstem inhibitory
circuits and not from altered cortical mechanisms. The
authors indicated that this supported the contention that
bruxism is mainly centrally mediated and that it involves
subcortical structures. In a nonhuman primate study, it
28
Figure 11 Box plot graph of disrupted sleep levels across all was suggested that the onset of rhythmic masticatory
phases of the study. muscle activity and sleep bruxing episodes during sleep
are under the influences of brief transient activity of the
brainstem arousal–reticular ascending system contrib-
uting to the increase in activity in autonomic–cardiac
and motor modulatory networks. One such network is
29
the central pattern generator in the trigeminal nucleus,
which produces masticatory movements during mastica-
tion. The output of these neurons is modified by inputs
that may descend from higher centers in the brain and
by feedback from sensory receptors. 25

Mechanoreceptors in the muscles of mastication, and
the periodontal ligaments around the roots of the teeth
have particularly powerful effects on movement parame-
ters. 34,35 It is possible that periodontal mechanoreceptors

Neuroprothesis for PTSD-Associated Headaches and Sleep Disturbances 69