Nighttime Grinding (Bruxism)

The Real Reason You Grind Your Teeth

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The answer to why you grind your teeth used to be stress or a bad bite, but the newest research shows that it's due to interrupted sleep breathing.

by Dr. Burhenne

grinding

Until recently, teeth grinding had been a mystery amongst doctors and dentists. The working theory used to be that grinding was caused by stress, but then again, this didn’t explain why we see that a fetus in utero grinds their teeth — and so, grinding remained a mystery among dentists, doctors, and researchers.

But thanks to the latest research, it’s now accepted that grinding is an instinctual response that helps us survive.

This powerful new research has flipped on its head how we both treat grinding and how we think about diagnosing sleep apnea.

For more, check out my #1 bestselling book The 8-Hour Sleep Paradox.

Why You Grind Your Teeth at Night

During the night, the brain cycles through lighter and deeper stages of sleep.

As the brain approaches deep sleep, all the muscles in the body have to fully let go and relax. This easily causes trouble for the airway — the jaw is heavy and easily blocks the airway and the tongue, when fully relaxed, expands to almost twice its size to block the airway as well.

Researchers studied brain scans of people with partial blockage in their airways while they slept and what they noticed is that it was grinding (also called bruxism) that reopened the airway and got the study participants breathing again.

As soon as they were given something to keep their airway open all night long — like a CPAP machine or a dental appliance that held the jaw in place so the tongue and jaw don’t block the airway — their grinding stopped and so did the “apneic” events, or the loss of breathing during sleep.

The Real Consequences of Grinding

If grinding is what saves us, then what’s wrong with it?

While grinding is effective at saving us at night, there are consequences to having interrupted sleep every night.

You’re not sleeping well if you grind your teeth. Even with slight sleep apnea, you’re waking up in a damaged state. Tensing up the muscles to grind bounces the body out of deep sleep, and all the health benefits of sleep you read about come from deep sleep. This is where human growth hormone (HGH) is released, reversing the aging process, tightening skin, improving memory, burning fat, and building muscle, and potentially warding off diseases like Alzheimer’s. Untreated sleep apnea can have serious and life-shortening consequences like high blood pressure, heart disease, stroke, automobile accidents, diabetes, depression, anxiety, and weight gain. Don’t fall into the eight hour trap — just because you’re unconscious for eight hours, doesn’t mean it’s quality sleep.

Damages our teeth and jaw joint. Years of grinding and clenching can damage your teeth, cause tooth decay and tooth sensitivity, and lead to permanent jaw pain and damage to the jaw point.

A mouth guard makes things worse. A mouth guard is put in place to protect the teeth from grinding, but since it can reposition the jaw, it can actually make the obstruction of the airway worse (more on this in a bit).

Bruxism: the New Red Flag for Sleep Apnea

Grinding is the new indicator for obstructive sleep apnea.

If you grind your teeth, the new standard of care is that you get a sleep study because you are likely having episodes of interrupted breathing during the night and missing out on all the health benefits of deep stage sleep.

Even if you’re otherwise healthy, sleep apnea is known to significantly increase your risk of high blood pressure, stroke, cancer, diabetes, depression, and obesity.

A Swedish study estimated that as many as half of women aged 20 to 70 suffer from some degree of sleep apnea — which can range from slight to severe. The old idea of an obese, middle-aged man who snores is no longer what we should think of when it comes to sleep apnea.

The New At Risk Groups for Sleep Apnea

  • Petite women
  • Children with ADHD and other learning disabilities
  • People with a long neck
  • People who did not breastfeed as infants
  • People with anxiety and depression
  • Anyone who grinds their teeth at night

The New Way to Treat Grinding

Treating Sources, Not Symptoms

Treating the airway cures teeth grinding.

To treat grinding, you have to treat the source of what’s causing it, and that’s a small airway.

If you grind your teeth, you might have been told that you need to sleep with a mouthguard to protect your teeth from wear and tear — and that’s based on the old standard of care.

Not treating teeth grinding can lead to excessive wear and tear on teeth, leading to tooth decay, periodontal tissue damage, jaw pain, and headaches.

The new understanding is that, in order to treat teeth grinding, you have to treat the root cause that is causing you to grind your teeth — and that’s the obstruction of the airway.

Once you remove the need to grind, teeth grinding stops.

If you grind your teeth, it should be considered first due to its seriousness that you likely have a small airway and the reason you’re grinding is to open your collapsed airway while you’re sleeping.

In fact, wearing a mouth guard to protect your teeth from grinding may even make you grind more, since a mouth guard repositions the jaw in such a way that the airway could be getting blocked more than it would be without the mouth guard.

Treating Grinding With a Mouth Guard: More Harm Than Good?

But how do you know if you grind your teeth if you’re asleep when you’re doing it?

Most people don’t know that they grind their teeth until their dentist tells them.

How to Know If You’re Grinding Your Teeth

  • Wear on your teeth
  • Teeth that are worn flat
  • Abfractions
  • Sore muscles
  • TMJ pain
  • A jaw that clicks

What to Do If You Grind Your Teeth

  • Talk to your dentist. Your dentist can’t make the diagnosis — she or he will leave that to the sleep medicine MD, but your dentist can screen you for teeth grinding and examine the beginning of your airway as you lie flat in the chair at your next appointment. There is an oral appliance your dentist can make for you that keeps the airway open while you sleep, which can work great in conjunction with a CPAP machine or even by itself in mild cases.
  • Find out if you grind your teeth. The telltale signs of a grinder are flat, worn teeth, jaw clicking, or jaw pain. Ask your dentist to be sure.
  • Talk to your doctor about getting a sleep study. Ultimately, you will need a sleep study to get a diagnosis for sleep apnea from a sleep specialist.
  • Reconsider the night guard. This is the old way of thinking and, even though it’s protecting your teeth, your night guard could even make your sleep apnea worse.
  • Read my bookThe 8-Hour Sleep Paradox, which is my 3-step program to breathe better at night so you unlock the kind of sleep that helps you slow down the aging process, lose weight, wake up happy and refreshed, improve energy levels and concentration, and beat brain fog. See what Dr. Mark Hyman and Gretchen Rubin had to say about the book.

Mark Burhenne DDS

read next: The Complete Guide to At-Home Sleep Tests, Plus My Favorite Way to Track Sleep

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