Sleep Apnea: 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

sleep apnea
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If you grind your teeth at night, you know 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.

And if you still struggle with grinding even after you’ve tried wearing a night guard, practicing stress reduction techniques, or eliminating alcohol and caffeine, this brings hopeful 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)

In short, if you’ve been struggling with grinding and haven’t been able to successfully treat it, you may need to determine whether sleep apnea is behind your grinding, too.

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?

This is a question that I am asked often, especially since writing 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. As opposed to just filling cavities and doing twice-yearly cleanings, functional dentists address diet and other lifestyle factors to help prevent tooth decay, gum disease, and other issues.

And as it turns out, sleep quality has a big impact on the health of your mouth—whether mouth breathing is causing your mouth to dry out and leading to an imbalanced oral microbiome, or sleep apnea is triggering nightly grinding.

The term given to this area of dentistry is dental sleep medicine. And, since 1991, the American Academy of Dental Sleep Medicine (AADSM) has been educating dentists on the importance of treating sleep apnea, snoring, and other sleep-disordered breathing conditions.

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

I’ll explain more later in this article, but first, let’s take a look a closer look at how bruxism and sleep apnea are related.

How sleep apnea causes grinding

To understand exactly how sleep disorders like sleep apnea can cause grinding, it’s important to have 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, the soft tissues of the mouth and tongue become so relaxed that they block the airway, making breathing difficult.

Researchers studied brain scans of people with partial blockage of their airways while they slept and noticed that it was grinding that was associated with the reopened airway and likely was a factor in participants to being able to breathe again.

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

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 might have a full 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 severe.

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

  • Obstructive sleep apnea This is the type of sleep apnea we’ve been discussing so far, and it is the most common type of sleep apnea. Obstructive sleep apnea is when the throat relaxes to a point that it blocks the airways. It ranges from a mild form, which may cause grinding or light snoring, to more severe cases that cause friends or loved ones to suggest seeing a doctor.
  • Central sleep apnea 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 This is a combination of both obstructive sleep apnea and central sleep apnea.

While people with serious sleep apnea may get the attention and treatment of a doctor, people with milder forms of sleep-disordered breathing may 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, and when I see signs of grinding it becomes clear that the patient is likely suffering.

The consequences of grinding

Grinding saves our life—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, which also happens to be the most restorative and beneficial stage of sleep.

It’s during deep sleep that 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.

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

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

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, and weight gain.

Additionally, 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, and lead to permanent jaw pain and damage to the jaw point.

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 as we hold firm to these outdated qualifiers—even as the latest science shows that many more populations are at risk—people who don’t fit this description are falling through the cracks and going undiagnosed.

If any of the below describes you, and you are grinding your teeth, you may also 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.
  • 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, and 40 to 60% of children with sleep apnea have some form of ADD or ADHD.
  • 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. (3)
  • 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. (4)
  • People with anxiety and depression. A lack of quality sleep can have severe effects on mood stabilization, and 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. (5,6)
  • 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.

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

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 and 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 mouthguard to protect your teeth from wear and tear—but that’s based on the old standard of care.

In fact, wearing a mouth guard to protect your teeth from grinding may 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.

However, that is not to say you should ignore your grinding. 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.

Treatment may come in one of the following forms:

  • A dental appliance like the Mandibular Advancement Device (MAD), which is designed to keep the lower jaw jutting forward
  • A Tongue Retaining Device, which pulls the tongue forward at night
  • A CPAP or APAP machine, which forces 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

There are other treatment techniques that offer big promises but don’t seem to deliver. Laser therapy has long been touted as a possible solution for sleep apnea, but results don’t measure up to the hype. (7) Stress relief techniques have also been popular, especially in the days when teeth grinding was thought to be related to stress, but they rarely provide sufficient relief.

The first step, however, is to examine your sleep quality, whether through a formal sleep study or an at-home sleep test. This step will confirm whether the grinding is your body’s way of opening your airways during episodes of interrupted nighttime breathing.

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

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 will stop on its own.

Final thoughts on sleep apnea and grinding

Now that teeth grinding is considered a marker of sleep apnea and no longer dismissed as simply a sign of stress, patients can take charge and have the underlying cause treated. This will not only stop the grinding and improve dental health, but it will also lead to deeper sleep and improve the health of the whole body.

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, 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 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 the old way of thinking. And even though it can protecting your teeth, it may make sleep apnea worse.
  • 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.

Go ask your doctor for a sleep study, or try an at-home sleep test as a first step.

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.

Dr. Mark Burhenne

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

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