SABERS Approach to TMD
March 26th, 2010
TMD is often misunderstood as CHVS
SABERS Approach to Management
Follow the SABERS approach:
- S is sleep
- A is awareness of arousal level (increased cortisol levels), How emotions, exercise, excitement and posture affects breathing
- B is breathing
- E is exercise
- R is rest
- S is self esteem.
By addressing all these aspects of a patient’s life the treatment is more likely to be successful.
Sleep – Do you know that sufferers of CHVS will complain: “I have nightmares and vivid dreams, my sheets are always tangled up in legs and my sleeping patterns are awful”.
- Sleep in fetal position with spine straight, teeth apart, tongue on palate, nasal breathing and employing deep abdominal respiratory patterns. Support jaw with the front of the pillow.
- A warm bath before bed can help to relax the body
- Resist TV flipping channels instead read a complex boring “how to” book to lull you off to sleep!
Arousal level of respiratory system- TALK TEST- if you can talk to someone while exercising, this is correct level of exercise because abdominal or lateral costal breathing can be maintained as well as nasal breathing This prevents the people from working above their anaerobic threshold which stresses the body and increase the arousal level (increased cortisol levels)
Breathing – What is good breathing? The cornerstone of this treatment is to practice deep abdominal breathing frequently. Practice TTTT… tongue on palate, teeth apart, lips together, shoulders ‘high beaming’ everyone and stand on the balls of your feet. I have a naughty jingle to remember this “Tongue, teeth, tits and toes lips together breathing slow!”
NOTE: The tongue tip should always be up on the palate even when standing and sitting. Say the letter “n” to know if your tongue is in the right place
- Practice every hour on the hour to take time to breathe 10 breaths slowly. Initially putting red stickers at your computer, on mirror in the car or sign “Just breathe” These all act as a reminder to breathe properly!
If this is hard hold the breath for 2-3 seconds anywhere in breathing cycle then do alternate nostril breathing
How does doctor know if symptoms are caused by HVS?
50-70% patients visiting specialists are habitual over breathers. It may be difficult to pick up the problem because blood gases fluctuate in CHVS. A simple 12 breath test can be performed. The patient is asked to stand and take 12 RAPID breaths, which many sufferers are amazed to find reproduces exactly their distressing symptoms!
Have you heard people say “I thought I was dying… having a heart attack” but when I went to emergency I felt better and the doctor could find nothing wrong. In all three types of chest pain below, many stresses (physical, social and emotional) may combine with hyperventilation to bring it on. Often these stresses are not found in the security of the doctor’s rooms.
There are 3 types of chest pain associated with HVS:
- Sharp pains felt while breathing in from pressure on the diaphragm from a bloated stomach, caused by “air gulping”, which results in spasm of the diaphragm and pain.
- Dull aching pain with chest wall soreness, most often after exercise. This is due to overuse of intercostals, and accessory muscles, which tire easily and hurt.
- Heavy pain behind the breast bone radiating to the neck and arms. This happens when the blood supply to the heart muscle itself is reduced by HVS stress/anxiety, and spasms of the coronary arteries.
Exercise – Do you find yourself saying “I can’t do yoga. It’s too slow. I feel too agitated. It’s torture to lie there and breathe!”
Hyper ventilators will often feel the urge to sigh, yawn (often seen at the beginning of a yoga /Pilates class) or ‘air gulp’. The body will try to loop back to hyperventilation.
In the book Hyperventilation Syndrome (HVS) by physiotherapist Dinah Bradley she says that, “There are 3 muscle groups used for breathing: Diaphragm, intercostals/ chest and the accessory muscles. In normal breathing 70-80% of the work of respiration is done by; the diaphragm (which is the most energy efficient and relaxing way to breathe); the intercostals which attach between each rib lifting them sideways, do 20-30% of the work and lastly the accessory muscles which include the shoulder and neck area. The body will overwork this area during extreme exercise, and STRESS. Chronic Hyper Ventilators, who tend to reverse this ratio using 80 % of effort in neck/shoulder area will as a result, feel pain in this region and can be one of the causes of headaches.”
Rest – Try to have 8 hours of sleep per night to help combat fatigue, and decrease arousal levels. Research shows this will also help control high blood pressure and improve overall health and feeling of well being.
Self-Esteem – Do something you love everyday!!