Conditions

Sleep Apnea: The Real Reason You Grind Your Teeth

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Grinding teeth used to be attributed only to stress. But sleep apnea might actually be the root cause. Let’s look at the signs of sleep apnea, how it’s connected to teeth grinding, and what you can do about it.

by Dr. Burhenne

sleep apnea
Disclosure:
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If you grind your teeth at night, you knowt the pain and damage it can cause to your teeth, gums, and jaw. But you probably don’t know that your grinding may be related to sleep apnea.

Do you still struggle with grinding after trying these techniques?

  • Wearing a night guard
  • Practicing stress reduction
  • Eliminating alcohol and caffeine

If so, I’ve got some great news:

Treating sleep apnea or other sleep disorders can improve—or even eliminate—your grinding issues.

Sound hard to believe?

A 2014 study examining the relationship between sleep apnea and bruxism (the medical term for grinding) compared two groups of participants. One group consisted of patients with sleep apnea, while the control group was comprised of healthy adults with no sleep breathing issues.

Results showed that instances of grinding was higher in the sleep apnea group than the control group. Additionally, the overall risk of grinding was higher in those with sleep apnea. (1)

If you grind your teeth and haven’t been able to fix it, sleep apnea might be the culprit.

In this article, I will further explain:

  • The link between sleep apnea and grinding
  • The consequences of grinding
  • Those who are most at risk for sleep apnea-related grinding
  • What you can do to ensure a good night’s sleep and improve your own grinding issues

Why is a dentist talking about sleep apnea?

As you might have guessed, sleep quality and dental health are closely related. But the reason I’m talking about it is much more personal: It all started when my wife was diagnosed with obstructive sleep apnea.

That experience led me to write my book, The 8-Hour Sleep Paradox. In it, I give an in-depth explanation of how poor sleep can lead to a host of health conditions, including weight gain, brain fog, and even cavities.

I practice functional dentistry, which means that I take a proactive approach to oral and dental health.

My job isn’t just to fill cavities and do twice-yearly cleanings. As a functional dentist, I address diet and other lifestyle factors to help prevent tooth decay, gum disease, and other issues.

As it turns out, sleep quality has a big impact on the health of your mouth. For one, mouth breathing can cause dry mouth, which leads to an imbalanced oral microbiome.

And, as we’ve established, obstructed breathing in sleep apnea can cause grinding. (It also leads to other consequences, which I outline below.)

The term given to this area of specialty within functional dentistry is “dental sleep medicine.”

Since 1991, the American Academy of Dental Sleep Medicine (AADSM) has educated dentists on the importance of treating sleep apnea, snoring, and other sleep-disordered breathing conditions.

Treating these issues is important for maintaining oral and dental health. Because what happens in the mouth happens in the body, treating sleep conditions can also decrease the risk of other diseases, including high blood pressure, stroke, and depression.

First, let’s take a look a closer look at how bruxism and sleep apnea are related.

How sleep apnea causes grinding

The official apnea definition is “temporary cessation of breathing, especially during sleep.”

To understand exactly how sleep disorders like sleep apnea can cause grinding, you need full context for how your body changes when you sleep.

During the night, the brain cycles through lighter and deeper stages of sleep. The deeper you sleep, the more relaxed the muscles of your body are.

And for people struggling with sleep apnea symptoms, the soft tissues of the mouth and tongue become so relaxed that they block the airway, making breathing difficult. This can lead to an interruption of breathing entirely for several seconds at a time.

Researchers studied brain scans of people with partial blockage of their airways during sleep. They found grinding was associated with the reopened airway and likely was a factor in participants to being able to breathe again.

That means that, by grinding their teeth, patients were able to reopen their airway.

Once the participants were given something to keep their airway open all night long, the grinding stopped. These include things like a sleep apnea machine, such as a CPAP or dental appliance that holds the jaw in place so the tongue and jaw can’t block the airway.

The “apneic” events, which refer to the loss of breathing during sleep, stopped as well.

Essentially, grinding is the body’s natural reflex to force the airway open when breathing is hampered.

But looking for signs of grinding isn’t just for people who have a diagnosis of obstructive sleep apnea. Grinding can be an early indicator that your sleep breathing is being compromised, even if your sleep apnea isn’t considered “severe.”

In fact, there are three different types of sleep apnea, each with varying degrees of severity:

  • Obstructive Sleep Apnea (OSA): This is the type of sleep apnea we’ve been discussing so far, and it’s the most common type. Obstructive sleep apnea is when the throat relaxes to a point that it blocks the airways. It ranges from mild, which may cause grinding or light snoring, to more severe cases that causes total breathing cessation many times throughout the night.
  • Central Sleep Apnea (CSA): This type of sleep apnea occurs when the brain improperly sending signals to the muscles in your body that control breathing, telling them to stop working. It occurs frequently in people who are sick for other reasons but is significantly less common than obstructive sleep apnea. Central sleep apnea is likely accountable for less than 20% of all sleep apnea cases. (2)
  • Complex Sleep Apnea Syndrome (CSAS): This is a combination of both obstructive sleep apnea and central sleep apnea.

Another disorder that doesn’t meet the criteria for obstructive sleep apnea is upper airway resistance syndrome (UARS). It’s considered less severe than OSA, but UARS does cause short periods of wakefulness from obstructed breathing that you probably won’t notice.

People with serious sleep apnea easily get the attention and treatment of a doctor. But people with milder forms of sleep-disordered breathing are often not be treated with the same urgency.

I believe that’s a mistake.

According to the American Sleep Apnea Association, 22 million Americans suffer from sleep apnea. What’s worse, 80% of cases of moderate to severe sleep apnea are undiagnosed.

Grinding is the canary in the coal mine when it comes to sleep-disordered breathing.

When I see signs of grinding, my first instinct says that they should be examined for sleep apnea symptoms.

The consequences of grinding

Grinding saves our lives—forcing us to breathe again even in the stage of sleep where we’re paralyzed.

So, what’s the problem?

There are many problems, actually.

Tensing up the muscles to grind bounces the body out of deep sleep. That happens to be the most restorative and beneficial stage of sleep.

It’s during deep sleep that human growth hormone (HGH) is released, which helps to build muscle mass and regulate body fat.

The deep stages of sleep and REM sleep are responsible for helping with:

  • Consolidation and improvement of memory (3)
  • Weight management (4)
  • Athletic performance (5)
  • Preventing heart disease (6)
  • Reducing risk of type 2 diabetes (7)
  • Limiting chance for depression (8)
  • Immune function (9)
  • Chronic inflammation (10)

A lot of people mistakenly think that being asleep for eight hours means they’re getting quality sleep. But that isn’t always the case.

Quantity isn’t quality, especially when it comes to sleep.

What happens with untreated sleep apnea?

In fact, untreated sleep apnea that results in a loss of restorative sleep can contribute to:

  • High blood pressure
  • Heart disease
  • Stroke
  • Automobile accidents
  • Diabetes
  • Depression
  • Anxiety
  • Weight gain

When it comes to your teeth, grinding caused by sleep apnea can cause many problems.

Years of grinding and clenching caused by sleep apnea can:

  • Damage your teeth
  • Cause tooth decay and tooth sensitivity
  • Contribute to premature aging and yellowing
  • Lead to permanent jaw pain and damage to the jaw joint

Who’s at risk for sleep apnea?

Old, overweight, and male: This is what we’re trained to look for in medical and dental school to diagnose sleep apnea.

But these qualifiers are outdated, according to the latest science. People who don’t fit this description are, sadly, falling through the cracks and going diagnosed.

If any of the below describes you, and you are grinding your teeth, you may be experiencing some form of sleep-disordered breathing.

  • Women. Health professionals have long recognized the role of weight in sleep apnea. Yet it’s become clear that women, regardless of size, are at risk for sleep-disordered breathing. Both pregnancy and polycystic ovarian syndrome increase the risk of sleep apnea, and the weight gain and hormone changes that accompany menopause can also trigger the condition. (11, 12)
  • Children with ADHD and other learning disabilities. Hyperactivity, forgetfulness, moodiness, and trouble focusing can all be signs that a child isn’t getting quality sleep. Over 50% of children with sleep apnea may already have been misdiagnosed with ADHD. (13)
  • People with a long neck. A long, thin neck can mean you’ve inherited a narrow airway, which provides less room for air to flow when your throat muscles relax as you sleep. (14)
  • People who did not breastfeed as infants. Bottle feeding, sippy cups, and even how long a child breastfeeds can affect how our mouths, teeth, jaws, and airways develop as we grow. Bottle feeding, in particular, creates a high palate and narrow arch in the mouth, which are risk factors for sleep apnea. (15)
  • People with anxiety and depression. A lack of quality sleep can have severe effects on mood stabilization. One study found that 48% of people with obstructive sleep apnea suffered from depression. People suffering from anxiety and depression may be more acutely suffering from a lack of deep sleep. (16, 17)
  • Anyone who grinds their teeth at night. As discussed, grinding is the body’s way of opening the airway when it’s blocked. If you’re grinding your teeth, you could have a form of sleep apnea. (1)
  • Those who are overweight or obese. People with obesity or overweight are at an increased risk of developing sleep apnea. (18)
  • Smokers. Those who currently smoke are much more likely to develop sleep apnea. However, after a smoker stops lighting up, that risk goes away. (19)

How to know if you’re grinding your teeth

Often, the simplest way to know if you’re grinding your teeth is to ask your dentist if they see any evidence of grinding. Some of the things they’ll be looking for:

  • Wear on your teeth
  • Teeth that are worn flat
  • Abfractions, or tooth tissue loss along the gumline (grinding contributes to receding gums)

At home, you can also consider symptoms like:

  • Sore muscles in the jaw or face
  • A friend or partner telling you they can hear or see you grinding at night
  • Increased tooth pain or sensitivity
  • TMJ pain (TMJ is a disorder of the temporomandibular joint, which connects your lower jaw to the base of your skull in two points. This joint is responsible for helping you chew, speak, and open your mouth to breathe. Pain can present as jaw joint pain, ear pain, neck pain, or even a headache.)
  • A jaw that clicks, which can also be a sign of TMJ
  • Waking up with a headache, which can also be a sign of sleep apnea

The best way to treat grinding caused by sleep apnea

The only to treat grinding is to treat the underlying problem.

And in many cases, that underlying problem is sleep apnea.

If you grind your teeth, you may have been told that you need to sleep with a night guard to protect your teeth from wear and tear. However, that’s only a stopgap measure—it doesn’t solve the real issue.

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

For the short term treatment of grinding, here’s the night guard I would recommend:

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Good Morning Snore Solution

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

In order to treat teeth grinding, you have to treat the root cause that is causing you to grind your teeth

That’s very likely obstruction of the airway.

Sleep apnea treatment may come in one of the following forms:

  • Mouth taping (this can help to correct mild sleep apnea and may be a useful diagnostic tool to identify more serious cases)
  • A dental appliance like the Mandibular Advancement Device (MAD), which is designed to keep the lower jaw jutting forward
  • A Tongue Retaining Device (TRD), which pulls the tongue forward at night
  • A CPAP or APAP machine (these breathing treatments force air into the airway to keep it open)
  • Surgery to correct a deviated septum or have tonsils and/or adenoids removed
  • Practicing tongue exercises or getting myofunctional therapy
  • A change in lifestyle factors, including:
    • sleeping on your side instead of on your back
    • quitting smoking
    • reducing alcohol consumption
    • managing allergies
    • losing weight

I use Somnifix Sleep Strips every night while I sleep. Theirs is the most easy-to-use mouth tape I’ve found and there’s never any residue left on my lips in the morning.

Order using code “DOCTORB” for a buy one, get one 50% off coupon.

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Sleep Strips by SomniFix

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Laser therapy has long been touted as a possible solution for sleep apnea, but results don’t measure up to the hype. (20)

Stress relief techniques have also been popular, especially in the days when teeth grinding was thought to be related to stress. However, they rarely provide sufficient relief. (21)

The first step, however, is to examine your sleep quality, whether through a formal sleep study (a sleep apnea test at your doctor) or a home sleep test.

This step can help confirm whether the grinding is your body’s way of opening your airways during episodes of interrupted nighttime breathing.

For all my sleep patients, I recommend SnoreLab. One screenshot tells me more about one night of their sleep than any application could just a few years ago.

A sleep study or sleep test may also determine whether you’re missing out on key health benefits that result from deep-stage sleep.

Speak with your dentist and doctor in order to determine which treatments might be most effective for you. Once you correct the sleep disordered breathing and remove the need to grind, the grinding may stop on its own.

Frequently Asked Questions About Sleep Apnea

Q:

What are the warning signs of sleep apnea?

A: Some of the ways you can tell if yourself or a loved one may have sleep apnea are:

  • Snoring
  • Teeth grinding
  • Waking up tired
  • Mouth breathing
  • Audible cessations of breathing during sleep
  • Daytime fatigue
  • Choking or coughing throughout the night
  • Headaches
  • Nocturia, or waking up to urinate throughout the night (in deep sleep, your brain shuts down that urge)
  • Symptoms of ADHD in children
  • Daytime attention issues
  • Irritability
Q:

Can a person die from sleep apnea?

A: The interrupted breathing in sleep apnea doesn’t last long enough for suffocation.

But a long-term study of almost 11,000 patients found that those with obstructive sleep apnea are more likely to die of sudden cardiac death. (22)

That risk goes up to almost two times the likelihood of death from heart attack depending on the severity of sleep apnea.

Q:

Can sleep apnea go away by itself?

A: Typically, sleep apnea must be treated in some way to be corrected. For mild cases, this can be done with methods like adjusting sleep position or using mouth tape.

But in moderate to severe sleep apnea, treatment with various sleep apnea machines or methods is probably warranted.

Final thoughts on sleep apnea and grinding

Sleep apnea used to be a disorder people thought happened to only overweight, aging men. However, the research shows that women and people of all ages often live with undiagnosed sleep apnea.

Many times, your dentist may be the first person to notice you show signs of sleep apnea. This is because s/he will see the grinding that can occur when your nighttime breathing is interrupted.

When your sleep breathing gets interrupted, your body’s instinct is to grind the teeth to restart breathing.

This evolutionary development is good for basic survival, but bad over a long period of time. Sleep apnea is associated with a decline in many long-term health markers.

Here are a few steps to take if you think you may be grinding your teeth as a result of sleep apnea or another form of sleep-disordered breathing.

  • Talk to your dentist. Your dentist can’t make a sleep apnea diagnosis—he will leave that to the sleep medicine MD. But he 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. These can work great in conjunction with a CPAP machine or even by itself in mild cases.
  • You may also want to find a dentist in your area who practices dental sleep medicine. This directory is a great way to get started, as all dentists included are AADSM-certified.
  • 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 participating in a sleep study, or doing an at-home sleep test. This is the first step for getting an official diagnosis of sleep apnea.
  • Reconsider the night guard. Prescribing a night guard is based on outdated science and should only be used as a temporary measure to protect teeth. And even though it can protect your teeth, it may make sleep apnea worse. If you use a night guard, it should be in conjunction with treating the underlying sleep problem.
  • Read my book, The 8-Hour Sleep Paradox, which includes my 3-step program to help you breathe better at night. I’ll show you how to 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.)

So, is the real reason you grind your teeth actually an untreated sleep condition?

I’ll leave you with this, which is what I tell all of my patients: It’s at least worth further examination, especially if you fit into one of the risk categories above.

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

References

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  2. org. (2017). Central sleep apnea. Retrieved from: https://www.sleepapnea.org/learn/sleep-apnea/central-sleep-apnea/
  3. Ellenbogen, J. M. (2005). Cognitive benefits of sleep and their loss due to sleep deprivation. Neurology, 64(7), E25-E27. Abstract: https://www.semanticscholar.org/paper/Cognitive-benefits-of-sleep-and-their-loss-due-to-Ellenbogen/c9e1ef8948353146c9c581bad416872c94d22e46
  4. Cappuccio, F. P., Taggart, F. M., Kandala, N. B., Currie, A., Peile, E., Stranges, S., & Miller, M. A. (2008). Meta-analysis of short sleep duration and obesity in children and adults. Sleep, 31(5), 619-626. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2398753/
  5. Mah, C. D., Mah, K. E., Kezirian, E. J., & Dement, W. C. (2011). The effects of sleep extension on the athletic performance of collegiate basketball players. Sleep, 34(7), 943-950. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3119836/
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  8. Hayley, A. C., Williams, L. J., Venugopal, K., Kennedy, G. A., Berk, M., & Pasco, J. A. (2015). The relationships between insomnia, sleep apnoea and depression: findings from the American National Health and Nutrition Examination Survey, 2005–2008. Australian & New Zealand Journal of Psychiatry, 49(2), 156-170. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/25128225
  9. Cohen, S., Doyle, W. J., Alper, C. M., Janicki-Deverts, D., & Turner, R. B. (2009). Sleep habits and susceptibility to the common cold. Archives of internal medicine, 169(1), 62-67. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2629403/
  10. Kinnucan, J. A., Rubin, D. T., & Ali, T. (2013). Sleep and inflammatory bowel disease: exploring the relationship between sleep disturbances and inflammation. Gastroenterology & hepatology, 9(11), 718. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3995194/
  11. Vgontzas, A. N., Legro, R. S., Bixler, E. O., Grayev, A., Kales, A., & Chrousos, G. P. (2001). Polycystic ovary syndrome is associated with obstructive sleep apnea and daytime sleepiness: role of insulin resistance. The Journal of Clinical Endocrinology & Metabolism, 86(2), 517-520. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/11158002
  12. Pien, G. W., Fife, D., Pack, A. I., Nkwuo, J. E., & Schwab, R. J. (2005). Changes in symptoms of sleep-disordered breathing during pregnancy. Sleep, 28(10), 1299-1305. Full text: https://www.researchgate.net/profile/Grace_Pien/publication/7473865_Pien_GW_Fife_D_Pack_AI_Nkwuo_JE_Schwab_RJ_Changes_in_symptoms_of_sleep-disordered_breathing_during_pregnancy/links/55f2d68b08ae1d9803921c4b.pdf
  13. Sedky, K., Bennett, D. S., & Carvalho, K. S. (2014). Attention deficit hyperactivity disorder and sleep disordered breathing in pediatric populations: a meta-analysis. Sleep medicine reviews, 18(4), 349-356. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/24581717
  14. Mayo Clinic. (2018). Sleep apnea. Retrieved from: https://www.mayoclinic.org/diseases-conditions/sleep-apnea/symptoms-causes/syc-20377631
  15. Pittsburgh Dental Sleep Medicine. (2018). The prevention of sleep apnea starts with breastfeeding. Retrieved from: https://pittsburghdentalsleepmedicine.com/prevention-sleep-apnea-starts-breastfeeding/
  16. Rezaeitalab, F., Moharrari, F., Saberi, S., Asadpour, H., & Rezaeetalab, F. (2014). The correlation of anxiety and depression with obstructive sleep apnea syndrome. Journal of research in medical sciences: the official journal of Isfahan University of Medical Sciences, 19(3), 205. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4061640/
  17. Millman, R. P., Fogel, B. S., McNamara, M. E., & Carlisle, C. C. (1989). Depression as a manifestation of obstructive sleep apnea: reversal with nasal continuous positive airway pressure. The Journal of clinical psychiatry. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/2768203
  18. Punjabi, N. M. (2008). The epidemiology of adult obstructive sleep apnea. Proceedings of the American Thoracic Society, 5(2), 136-143. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2645248/
  19. Wetter, D. W., Young, T. B., Bidwell, T. R., Badr, M. S., & Palta, M. (1994). Smoking as a risk factor for sleep-disordered breathing. Archives of internal medicine, 154(19), 2219-2224. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/7944843
  20. Ferguson, K. A., Heighway, K., & Ruby, R. R. (2003). A randomized trial of laser-assisted uvulopalatoplasty in the treatment of mild obstructive sleep apnea. American journal of respiratory and critical care medicine, 167(1), 15-19. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/12502473
  21. Trakada, G., Chrousos, G. P., Pejovic, S., & Vgontzas, A. N. (2007). Sleep apnea and its association with the stress system, inflammation, insulin resistance and visceral obesity. Sleep medicine clinics, 2(2), 251-261. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2128620/
  22. Gami, A. S., Olson, E. J., Shen, W. K., Wright, R. S., Ballman, K. V., Hodge, D. O., … & Somers, V. K. (2013). Obstructive sleep apnea and the risk of sudden cardiac death: a longitudinal study of 10,701 adults. Journal of the American College of Cardiology, 62(7), 610-616. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3851022/

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