**7. Treatment of sleep-pain interaction**

The orofacial pain diagnosis is clinical, but sleep studies may contribute to the objective establishment of orofacial pain interference with disturbed sleep.

The patient's evaluation should include the identification of risk factors as higher levels of anxiety, alcohol consumption habits, use of long-term medication, sedentarism, stress, and a compromise in the quality of life. Patients commonly complain from non-restless sleep and higher levels of fatigue, headaches, sleepiness, and anxiety.

Differential diagnosis could be difficult because of the occurrence of multiple sleep disturbances, which may mimic some aspects of pathological interaction between sleep and pain, either clinically or in a laboratory-based evaluation.

In patients with acute conditions, the efforts should be directed to the improvement of nocturnal complaints in order to avoid chronicity. In chronic patients, symptom relief is associated to a better quality of life.

Whenever possible, identifying the primary disturbance allows an approach directed to the etiological factors and sleep hygiene as well as management of sleep disturbances should be objectives to pursue.

Pharmacological management not only should always attend to the possible interaction with pain- and sleep-related mechanisms, but also to the influences of circadian oscillations in the symptoms and in the treatment effect (chronopharmacological characteristics).
