Impact of Postural Correction and Self-Care in Sleep on TMD Patients: A Clinical Trial

Objective: To evaluate the effects of posture during sleep on otological symptoms (such as tinnitus and ear fullness), psychological factors, bruxism, and sleep disorders in patients with temporomandibular disorders (TMD) undergoing an educational intervention based on self-care Methods : Prospective single-arm clinical trial with 36 participants diagnosed with joint TMD and self-reported otological symptoms. Patients were stratified into three groups based on self-reported sleep posture: “Never Had the Habit” (without mandibular support), “Kept the Habit” (with mandibular support), and “Quit the Habit” (with mandibular support, but quit). The intervention consisted of an initial 90-minute session and two 40-minute reinforcement sessions, focusing on sleep hygiene, self-management strategies for bruxism, and management of psychological factors. Data was collected at four time points: baseline (T0), 30 days (T1), 60 days (T2), and 180 days (T3). Statistical analysis used a repeated-measures ANOVA with the Greenhouse-Geisser correction and post hoc comparisons with Bonferroni. Effect sizes were calculated using partial eta-square (η²p). Results: Baseline characteristics showed high prevalence of otological symptoms (>70%), bruxism (61.1%), sleep disorders (66.7%), and psychological distress (77.8%). There was a significant reduction in tinnitus intensity over time (F (3, 99) =56.2; p<0.001; η²p=0.61). The time × postural group interaction was significant (F (6, 99) =12.3; p<0.001; η²p=0.31). The “Quit the Habit” group showed a 58.1% reduction in tinnitus, whereas the “Kept the Habit” group showed a 40.5% reduction (difference at T3: 1.08 points; p=0.003). Otological symptoms improved in all groups, with significant main effects for ear fullness (F=6.3; p=0.015; η²p=0.18). Psychological factors, such as anxiety, and sleep disorders, such as insomnia, decreased, with a positive correlation with postural habit abandonment (p<0.05). Nocturnal bruxism was more prevalent in the group that kept the habit (63.6%). Conclusion: Posture during sleep significantly influences otological symptoms, psychological factors, bruxism, and sleep disorders in patients with TMD. Discontinuation of ipsilateral mandibular support was associated with greater symptom relief. The self-care-based educational program showed significant clinical improvement in overall symptoms and should be integrated into conservative TMD management strategies. Self-care here refers to patient-empowered strategies including sleep hygiene education, bruxism management, and psychological coping techniques.