Sleep Apnea: The Real Reason You Grind Your Teeth?

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 could 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 might 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 bruxism
• The consequences of sleep apnea with 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 sleep apnea symptoms

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.

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How Sleep Apnea Might Cause Grinding

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

To understand exactly how sleep disorders like sleep apnea may 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, some cases of grinding may be caused by 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 might be 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.

Consequences of Sleep Apnea + Bruxism

Grinding saves our lives—forcing us to breathe again even in the stage of sleep where we’re paralyzed. But the long-term effects of bruxism as your only protection from sleep apnea are very serious.

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
• Chronic kidney disease
• 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)
• Anyone with chronic kidney disease. There’s an intrinsic link between chronic kidney disease and obstructive sleep apnea, although it’s unclear which causes the other (or whether they’re just so closely linked that both are true). (20, 21)

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 Ways to Treat Sleep Apnea + Resolve Bruxism

Not treating bruxism can lead to excessive wear and tear on teeth, leading to tooth decay, periodontal tissue damage, jaw pain, and headaches. If that grinding is caused by sleep apnea, the list of chronic diseases you may be at risk for goes up exponentially.

If you have even mild sleep apnea, you should pursue some form of treatment. Here’s a list of the treatments found to be most effective at reducing sleep apnea and its related bruxism.

1. Mouth Tape

The practice of taping your mouth shut at night may sound a little crazy, but it’s actually a great way to reduce mouth breathing at night. I’ve even seen mouth taping help some people reverse UARS or mild cases of obstructive sleep apnea.

If anything, mouth tape is a great diagnostic tool for those who aren’t sure whether or not they have a sleep breathing condition like OSA. The average person might sleep with an open mouth on occasion (or even frequently), but unless there’s an underlying sleep condition, that person should be able to sleep through the night wearing mouth tape.

If you mouth tape and find you wake up with the tape off every morning for more than a week or so, it’s a sign that your nasal breathing could be obstructed.

That’s why mouth taping is my first recommendation to patients who show signs of bruxism, especially if they aren’t able or ready to get a full sleep study.

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

2. Positional Therapy

It might sound oversimplified, but positional therapy to correct sleep apnea obstructions can help out a lot. If your sleep apnea is contributed to sleeping on your back, the change in gravitational force on your tongue and jaw when moving to side sleeping will make a big difference. (22)

Some devices are available to provide biofeedback therapy to gently get you back to a side sleeping position. However, the easiest ways to practice positional therapy are generally home-grown. For instance, I’ve seen patients have great success wearing a backpack for several nights or fastening a tennis ball to their back to avoid back sleeping.

3. Tongue Retention Device (TRD)

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. That’s why I suggest using a tongue retention device instead.

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.

Instead of a night guard, I prefer a tongue retention device (TRD). A TRD is a relatively inexpensive, over-the-counter oral appliance for sleep apnea that can help to reposition the tongue so that your airway is more likely to stay open while you sleep. (23)

4. Mandibular Advancement Device (MAD)

I’ve already mentioned one type of oral appliance therapy for mild sleep apnea: the TRD. Although this product is great for some cases, more severe sleep apnea may require the use of a mandibular advancement device (often in combination with a CPAP/APAP and positional therapy).

A MAD is custom-made to fit you and must be ordered through your dentist. These devices help to position your jaw in a more forward spot so that your airway is less likely to become closed and interrupt your breathing. MAD and TRD devices have similar positive results in clinical trials. (23)

If you’re prescribed a MAD, keep in mind that it takes time to get used to these devices. Give yourself a few months to stick with it before trying a different therapy.

5. CPAP/APAP

For cases of moderate-to-severe sleep apnea, you may be prescribed a positive airway pressure machine by your sleep specialist. While these machines can be intrusive at first, proper uses of CPAP or APAP machines can do wonders for correcting the symptoms of sleep apnea. (24)

Because of the possibility of mouth breathing when you first start using your CPAP or APAP, it’s a good idea to incorporate mouth taping as well. This will help you get the most out of your new routine.

6. Myofunctional Therapy

The use of myofunctional therapy can improve sleep apnea by quite a bit, reducing its severity up to 50 percent in  adults and 62 percent in children (according to a 2015 meta-analysis). (25)

This type of muscle exercise helps train the face, jaw, and neck muscles to rest in a way that allows for proper airway position.

A good friend of mine, myofunctional therapist Sarah Hornsby, writes more about some of her work with children and sleep apnea here and here.

7. Lifestyle Changes and Weight Management

While there are some lifestyle changes that can help improve sleep apnea, these are meant to be practiced along with other sleep apnea treatments. They aren’t going to solve the problem all alone.

These include:

• sleeping on your side instead of on your back
• quitting smoking
• reducing alcohol consumption
• managing allergies
• losing weight

In addition, losing weight may be a way to reduce the severity of sleep apnea in overweight or obese people. (26)

8. Surgery

Some forms of surgery can alleviate airway obstruction, like tonsil/adenoid removal or the repair of a deviated septum. In these cases, the anatomy of the airway can be corrected and may be a straightforward cure for sleep apnea and the related bruxism it can cause. (26)

However, another surgery that used to be a common treatment for sleep apnea, known as UPPP (uvulopalatopharyngoplasty) is much less effective than previously thought. For that reason, it’s rarely a first line treatment for sleep apnea these days. In fact, even after this invasive, painful surgery, patients may only experience a success rate of 50% and will likely still need a CPAP or APAP machine. (27)

Although UPPP surgery is unlikely to cure sleep apnea, it may be a necessity in certain cases. Make sure you understand the risks of this surgery if it’s recommended by your sleep specialist, and go in with realistic expectations.

Unproven Sleep Apnea/Grinding Treatments

Laser therapy has long been touted as a possible solution for sleep apnea, but results don’t measure up to the hype. (28)

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 for nighttime grinding or sleep apnea (although they can help with some types of awake bruxism). (29)

What To Do If You Think You Have Sleep Apnea

The first step, if your dentist notices signs of grinding (or you have other sleep apnea symptoms), is to examine your sleep quality. You can do this 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. Plus, this app is free (although they offer premium upgrades).

There are other apps and devices that can track your sleep, but I find that getting a handle on snoring is one of the most accurate ways to test sleep at home.

A sleep study or sleep test may also determine whether you’re missing out on key health benefits that result from deep-stage sleep. Home tests are great, but in order to determine if you have sleep apnea, you’ll still need to see a specialist about a full sleep study.

Speak with your dentist and doctor in order to determine which treatments might be most effective for you. If you’re grinding as a result of sleep-disordered breathing, you might be able to get rid of the problem altogether when you resolve that underlying problem.

Frequently Asked Questions About Sleep Apnea

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—s/he will leave that to the sleep medicine MD. But s/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. Your dentist may also recommend a MAD or TRD to improve sleep breathing. These can work great in conjunction with a CPAP machine, or even as a single treatment, 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.