Page 49 - JSOM Summer 2025

Use of an Intraoral Neuroprosthesis for the Treatment of Posttraumatic

Stress Disorder (PTSD)-Associated Nocturnal Behavior Disorder

Case Series of Four Patients

Donald R. Moeller, MD, DDS, MA *;
1
Karen Parker Davidson, DHA, MSA, MEd, MSN, RN 2

ABSTRACT
There is a noted bidirectional relationship between sleep and Introduction
posttraumatic stress disorder (PTSD), often associated with
nocturnal behavior disorders contributing to sleep disturbances The bidirectional relationship between posttraumatic stress
and impaired daytime functioning. Furthermore, disruptive disorder (PTSD)-associated nocturnal behavior disorder and
1,2
nocturnal behavior (DNB) significantly impairs quality sleep sleep disturbances is complex. Trauma exposure can lead to
among servicemembers and their sleep partners. Psychother- the development of PTSD with and without military sexual
apy, pharmacotherapy, and alternative, integrative health in- trauma, which can exacerbate sleep problems with continuous
terventions, such as meditation, are not particularly useful in hyperarousal and intrusive thoughts further interfering with
1–4
achieving significant and durable remission of DNB. The use nocturnal behavior. The prevalence of comorbidity of PTSD
of oral dental appliances has demonstrated clinical success in and sleep disorders among military members can be as high
5
the role of adjunctive management of sleep disorders. How- as 70% to 90%, exacerbating somatic and physical health
ever, the use of these devices in managing the symptoms of problems and decreasing overall functioning and mission
6
mental health issues most often seen in this patient cohort has readiness, especially among Special Operation Forces (SOF).
not been elucidated. This case series describes the attenuation Understanding and addressing the interconnected nature of
of DNB while using a highly modified intraoral mandibular PTSD and sleep disturbances, such as night terrors and associ-
splint for the treatment of nightmares, sleep disruptions, and ated parasomnias, is crucial for providing effective and holistic
6–9
other sleep parasomnias associated with PTSD and PTSD / care to SOF members dealing with the aftermath of trauma.
traumatic brain injury. Four Special Forces Veterans and Op- Furthermore, this interconnectedness emphasizes the impor-
erators previously diagnosed with PTSD and experiencing tance of a multidisciplinary approach involving mental health
disruptive nocturnal behaviors, including night terrors, and professionals, sleep specialists, dentists, and other healthcare
having failed first-line, traditional intervention, were included providers working collaboratively to address the diverse needs
10–12
in this case series. A custom-designed, intraoral neuropros- of individuals with PTSD and comorbid sleep disorders.
thesis was used as the intervention. All four patients demon-
strated a notable and significant reduction in DNB. Subjective The literature on sleep medicine has not proposed a link be-
assessments and observations indicated enhanced sleep quality tween PTSD-associated central nervous system (CNS) upreg-
and reduced PTSD-related nocturnal disturbances. Patients ulation of the stomatognathic system and the maintenance of
reported overall improvement in daytime functioning and re- disruptive nocturnal behavior (DNB) or trauma-associated
12
duction in PTSD symptom severity. These first-of-their-kind sleep disorders (TASD). The extent to which the literature
findings support the intraoral neuroprosthesis as a novel, is lacking is in the clinical assessment of the stomatognathic
innovative therapeutic approach for managing two patholo- system, which describes the masticatory muscle trigger points
gies simultaneously: sleep disturbances and DNB with PTSD. (minimum of eight potential muscles), evidence of excessive
This device shows promise as a non-pharmacological inter- dental wear, jaw pain, and the number of patients who pre-
vention to enhance mission readiness and improve treatment sented with intra- and extraoral masticatory muscle trigger
13
compliance. points associated with nocturnal headaches. Additionally,
patients with PTSD had higher prevalence rates of painful tem-
poromandibular disorders (TMD), awake bruxism, and sleep
Keywords: PTSD; neuromodulator; mandibular dental splint; bruxism (28.4%, 48%, and 40%, respectively) compared to
sleep disruption; night terrors; airway function
the general population (8.0%, 31%, and 15%, respectively).
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The final common pathway of clinical symptoms of traumatic
*Correspondence to molar543@aol.com
1 LTC (Ret) Donald R. Moeller is affiliated with Moeller Oral and Maxillofacial Surgery, Columbus, GA. Dr. Karen Parker Davidson is an adjunct
2
professor at the Central Michigan University, the Herbert H. & Grace A. Dow College of Health Professions, Mt. Pleasant, MI, an adjunct pro-
fessor and a subject matter expert at the Liberty University, Division of Public Health, School of Health Science, School of Business, Lynchburg,
VA, and is affiliated with the Nurse Corps, United States Air Force Reserves.
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