The Link Between Grinding Your Teeth and Sleep Apnea

With respect to nighttime teeth grinding or bruxism, researchers can say that it typically results in tooth and jaw pain, most people don’t know they do it unless their partner tells them so or a visit to the dentist reveals the evidence. It’s also thought that stress may be a contributing factor for the condition.

Beyond those particulars, there’s little else they can say definitively. The question that remains largely unanswered about nighttime teething is “what is the connection between grinding your teeth and sleep apnea”—if there is one at all.

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And there’s the problem when it comes to sleep apnea and teeth grinding; researchers are facing something akin to a chicken and egg type of conundrum. “Does sleep apnea cause teeth grinding” or “does teeth grinding cause sleep apnea?”

“Sleep Bruxism is prevalent in about 12.8% of adults,” notes Dr. Nayantara Santhi. “The criteria for detecting sleep bruxism are typically based on polysomnographic (PSG) recordings, which allow for the identification of rhythmic masticatory muscle activity (RMMA) on electromyographic (EMG) or muscle traces.”

“We now know that the cause of Sleep bruxism is complex and involves many factors including biological, psychosocial, and lifestyle factors.”

Ahead, this article examines nighttime teeth grinding or sleep bruxism and its relation to sleep apnea. We explore risk factors for teeth grinding, as well as a few working theories on the connection between grinding your teeth and sleep apnea. And finally, we offer some information on possible therapies for these conditions.

What Is Sleep Bruxism?

Sleep Bruxism is the clinical term for teeth grinding and jaw clenching during sleep. Considered a sleep-movement disorder, Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source  it is estimated Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source 8% of the population suffer from sleep bruxism. That number is only an estimation because those with sleep bruxism are usually unaware that they’re grinding their teeth at night. More often than not, the condition only comes to light when a partner points it out. Sleep bruxism is more common among younger people, and it tends to fade away with age.

There are two types of bruxism, awake bruxism or sleep bruxism. Of course, for the purposes of this article, we will focus specifically on bruxism as it relates to sleep or sleep bruxism.

Teeth Grinding and Sleep

One of the more interesting things about sleep bruxism is when episodes of teeth grinding occur during the sleep cycle. Remember there that there are four stages of sleep. Stages one, two, and three are considered non-rem sleep stages, and stage 4 is known as the REM sleep stage.

Research has shown Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source that most teeth grinding episodes tend to occur in the light stages of non-REM sleep or stages 1 and 2. Only rarely do some people grind their teeth during the REM sleep stage or stage 4. When that happens, it’s typically in association with sleep arousal, and it’s often only momentary—more on this later.

Common Signs of Teeth Grinding in Your Sleep

As we pointed out earlier, most people who grind their teeth are unaware that they’re doing so. If it’s not the complaints of their partners that clue them in, it could be pain and unexplained dental issues that enlighten them. Some common signs of teeth grinding include:

• Unexplained loose teeth
• Attrition or the wearing away of tooth enamel
• Tooth pain/sensitivity
• Cracked or chipped teeth that are not a result of trauma
• Feeling tired or not well-rested
• Headaches or jaw pain

What Causes Sleep Bruxism?

Researchers are still trying to fully understand teeth grinding so much so that the exact cause of sleep bruxism is yet to be determined. That said, there is some research to indicate a link between teeth grinding and stress. One study, Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source for example, showed that patients who ground their teeth at night were more competitive and felt more anxious than those on the baseline.

Yet another study Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source found that patients with both awake bruxism and sleep bruxism also exhibited substantially more anxiety, depression, phobic anxiety, and hostility than participants who didn’t grind their teeth.

However, it is uncertain whether this association implies causation, and whether bruxism might affect mental health rather than vice versa, making nighttime teeth grinding a risk factor for anxiety, depression, and hostility. In other words, more research is needed to determine if personality characteristics are truly a risk factor for bruxism.

Beyond stress and personality type, other risk factors for bruxism include:

• Age
• Genetics
• Other health conditions, including Parkinson’s disease Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source and gastroesophageal reflux disorder Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source (GERD), just to name a few.

Notably, research also shows Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source that people with sleep-disordered breathing or sleep apnea are at a higher risk for experiencing nighttime teeth grinding.

What’s the Link Between Grinding Your Teeth and Sleep Apnea?

While there is evidence Verified Source Oxford Academic Research journal published by Oxford University. View source to show a link between Verified Source ScienceDirect One of the largest hubs for research studies and has published over 12 million different trusted resources. View source grinding your teeth and sleep apnea, it’s important to note the line between them it’s still a bit fuzzy.

One problem in making a definitive connection between teeth grinding and sleep apnea is underlying comorbidities. Quite often, patients with obstructive sleep apnea also have other health issues such as obesity and diabetes. The presence of these conditions tends to blur the line as they may point to sleep bruxism being more coincidental than establishing a direct link to sleep apnea.

Why or how obstructive sleep apnea contributes to teeth grinding, however, is still largely unknown. And very often, any discussion of the two invariably comes down to which one is the cause and which one is the effect. Ahead we take a closer look at some of the working theories.

Obstructive Sleep Apnea Causes Bruxism

One theory on the connection between your teeth grinding and sleep apneas is that obstructive sleep apnea syndrome leads to sleep bruxism. Researchers contend that arousals caused by upper airway restrictions (or apneas) cause a stress response in the body. Once the patient wakes due to the apnea, their autonomic nervous system kicks in, causing heart and respiratory rates to spike. In the domino effect of the body’s stress response, the jaw clenches and grinds.

Though feeling fatigued the next day is a common concern with sleep apnea, the condition goes beyond just tiredness, leading to more significant health issues. Sleep apnea is associated with low blood oxygen levels, high blood pressure, and heart problems, increasing the risk of developing diabetes, eye issues like glaucoma, and certain metabolic syndromes. 

Addressing sleep apnea symptoms is crucial for overall well-being, as it not only impacts nighttime rest but also plays a significant role in preventing daytime sleepiness and associated health issues. Custom-made and easy-to-wear oral appliances actively position the lower jaw forward, providing stability to the tongue to prevent airway blockage—an excellent alternative to CPAP machines for individuals with mild sleep apnea.

In essence, sleep apnea is more than a lack of good sleep; it’s a serious disorder that requires attention and treatment.

Bruxism Causes Obstructive Sleep Apnea

This theory holds that the signals from the body’s nervous system (increased heart and respiratory rates and muscle activity in the jaw) initiate first. The muscle activity in the jaw or what we know as teeth grinding, in turn, leads to the restriction on the upper airway causing the apnea or the pause in breathing.

A systematic review on sleep bruxism sheds light on comprehensive insights into this dental condition characterized by teeth grinding or clenching during sleep. Sleep bruxism is suggested by some researchers as a contributing factor to sleep apnea. 

This occurs when your nervous system releases signals affecting muscle tissues, including jaw muscles and nasal passages, potentially intensifying the airway restriction caused by OSA and leading to impaired breathing control.

Neglecting medical issues about teeth grinding can result in morning headaches, jaw pain, tooth decay, gum disease, chipped teeth, and disrupted sleep.

The grinding motion during sleep bruxism may also aid in lubricating your mouth and throat, preventing dryness caused by labored breathing. Research studies say that bruxism could be a defensive response, helping the body protect itself from obstructive sleep apnea (OSA), and this idea aligns with certain cases.

Teeth Grinding and Sleep Apnea Occur Independently

Yet another theory holds that sleep apnea and bruxism may be related, but neither one is the cause or the effect; they’re both merely factors of an entirely distinct cause. Interestingly, a good amount of research supports this theory, with researchers finding plenty of cases where sleep bruxism and obstructive sleep apnea Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source do not run concurrently.

Primary sleep-related bruxism occurs when teeth-grinding during sleep can’t be explained by an underlying medical condition or medication use. On the other hand, secondary sleep-related bruxism is linked to an underlying medical condition, like gastroesophageal reflux disease (GERD), anxiety, or depression, or it may be a side effect of medication.

One study conducted in 2019 Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source found that only one-third of patients with obstructive sleep apnea also demonstrated sleep-related bruxism. Yet another study was only able to find a weak connection Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source between sleep bruxism and obstructive sleep apnea. In that study, polysomnography results show that conditions only ran concurrently in about 50% of the subjects.

Researchers, intrigued by the potential connection, investigated the co-occurrence of bruxism and OSA through clinical studies. Patient data from epidemiological studies revealed that many individuals with OSA also grind their teeth during sleep, and polysomnography sleep studies indicated a possible relationship between OSA, snoring, and teeth grinding in some patients.

Therapies for Nighttime Teeth Grinding

Mandibular Advancement Devices (MADs) offer a personalized approach to tackling obstructive sleep apnea by repositioning the jaw to enhance airflow during sleep. These custom-made mouthpieces, fitted by dentists, not only address sleep apnea but also protect against the adverse effects of teeth grinding. 

Doctors often pick MADs as an oral device to treat OSA, and besides treating sleep apnea, MADs can also shield teeth from the impacts of grinding.

Sleep studies involving patients with both obstructive sleep apnea (OSA) and sleep-related bruxism have discovered that bruxism seldom initiates before the occurrences of nighttime breathing issues. This finding challenges the hypothesis, making it inconsistent with the observed patterns in sleep studies.

There are no specific treatments for teeth grinding per se. More often than not, each person must be individually evaluated and treated. That said, therapies for nighttime teeth grinding typically fall into two categories: dental therapies such as mouth guards and non-dental therapies, such as lifestyle changes, and CPAP therapy.

Dental Therapies

Oral health for good sleep is important. Dental therapies for nighttime teeth grinding often include tooth restoration or prophylactic measures such as splints and mouth guards.

For mild cases, your dentist may fit you for a mouthguard. These items are often made of hard acrylic, laminate, or thermoplastic materials. They typically fit over the upper and lower teeth, and they’re designed to keep the teeth separated, preventing further damage.

In progressed cases of bruxism, your dentist may need to reshape your teeth or even use dental crowns to repair severe damage.

Lifestyle Changes & Weight Loss

Remember that sleep bruxism typically doesn’t occur in isolation. Quite often, it is tied to sleep apnea. Sleep apnea, in turn, seems to be inextricably linked Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source with obesity.

From this, we can deduce that weight loss may lead to an improvement in nighttime teeth grinding.

Stress Management

You may be able to find some relief from bruxism by taking the proper steps to reduce your stress and promote relaxation. Stress relief looks different for everyone, but here are some things to consider as a jumping-off point for making your own lifestyle changes.

• Avoid stressful activities before bed. For example, instead of watching the news, which can be pretty stressful, try reading a book instead.
• Try to avoid screens around bedtime, as electronics can affect sleep.
• Add some exercise for better sleep to your daily routine.
• Implement a relaxing bedtime routine and stick to it.
• Prepare a cup of herbal tea for sleep.

CPAP Therapy

CPAP therapy is the gold standard for the treatment of sleep apnea. For those who are unfamiliar, CPAP devices use the air from your room and deliver it back to you, sending a steady flow of pressurized oxygen into your nose and mouth as you sleep.

A CPAP machine not only keeps your airway open but it creates enough pressure to prevent an airway collapse in the first place. But interestingly, patients with bruxism, even without sleep apnea, have also benefited from CPAP therapy.

Multiple studies have shown that CPAP therapy Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source drastically improves breathing and virtually eliminates teeth grinding even in moderate to severe sleep apnea cases. One notable study Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source not only showed a significant improvement in the patient’s bruxing as a result of CPAP therapy, but it also showed that CPAP withdrawal led to a recurrence of teeth grinding and apneas.

When to See a Doctor

Like anything else in life, isolated incidents are usually no cause for concern. However, if you find that you’re experiencing regular headaches, unexplained facial or jaw pain, or you feel like you’re not getting enough restorative sleep, it may be time to speak with your doctor and your dentist.

If your doctor or dentist can’t say for sure that your bruxism is causing sleep apnea or that your sleep apnea is causing your bruxism, they may recommend that you see a sleep specialist skilled in treating sleep apnea. You likely will need to participate in a sleep study to get a more definitive answer.

Now, you may be able to do an at-home sleep test, rather than a sleep study in a laboratory setting. At-home sleep tests for diagnosing sleep apnea are portable and user-friendly alternatives to in-lab studies.

Typically, a healthcare provider provides the equipment, which usually includes a portable monitor worn overnight. The device measures parameters like airflow, oxygen levels, and breathing patterns. Users follow instructions to attach sensors and wear the device while sleeping.

After the sleep apnea test, the equipment is returned to the provider for analysis. The results help assess the likelihood of sleep apnea, but further evaluation may be needed for a comprehensive diagnosis and treatment plan. If the results are unclear or inconclusive, a healthcare provider may recommend a follow-up sleep laboratory study.

In a sleep laboratory study, also known as a polysomnography, individuals spend a night at a sleep center where trained technicians monitor various physiological parameters, including brain activity, eye movement, heart rate, and muscle activity. This in-lab study provides more comprehensive and detailed data, allowing healthcare professionals to better assess sleep patterns and accurately diagnose sleep disorders, including sleep apnea.

Frequently Asked Questions

Does CPAP therapy stop teeth grinding?

While continuous positive airway pressure or CPAP therapy is primarily used to treat sleep apnea, it may also help with teeth grinding. Teeth grinding can be caused by an obstructed airway or other breathing issues related to sleep apnea. Therefore, treating sleep apnea’s symptoms with a CPAP machine can help stop the grinding.

However, it’s important to note that not all cases of teeth grinding are caused by obstructive sleep apnea. So if the source of your teeth grinding is another issue, CPAP therapy will be ineffective.

How do you test if you grind your teeth at night?

Seeing if you grind your teeth isn’t something to test at home. It’s best to speak with your doctor, who can examine your teeth for signs of damage from grinding, such as inflamed gums or worn teeth.

Your doctor may even refer you for a sleep study, which can not only help determine if you grind your teeth but if there’s a sleep disorder causing it. Other diagnostic tests you may be referred for include X-rays or an MRI to check for any underlying structural issues in your face.

Can bruxism go away?

While it is possible for bruxism to go away on its own, the underlying causes need to be addressed. Bruxism is often linked to stress or anxiety, and treating these issues can help reduce symptoms. In some cases, treating an underlying sleep disorder can also take care of bruxism.

Can teeth grinding cause sinus problems?

Yes, along with jaw pain and dental damage, teeth grinding can cause sinus problems. The pressure of grinding your teeth can cause sinus pain and inflammation. The inflammation can lead to a buildup of mucus over time. This mucus buildup can result in congestion, postnasal drip, and even sinus infections.

In some cases, the sinus symptoms may be the primary issue, with teeth grinding being a secondary symptom. The effects of teeth grinding can even be mistaken for sinus or ear infections, so it’s important to speak with your doctor if you notice anything amiss with your sinuses or ears.

Are there alternatives to mouthguards?

Yes, there are several alternatives to mouthguards to stop teeth grinding. Since stress is a common cause, practicing relaxation techniques such as breathing exercises before bed can help with teeth grinding. Switching up your sleeping position is another tactic to try. Teeth grinding can be worsened by sleeping on your back, so try sleeping on your side instead.

Sometimes teeth grinding is caused by an underlying medical condition, such as sleep apnea. Treating the condition may help reduce teeth grinding. Talking with your doctor can make it clear what is causing your teeth grinding, which helps you to better target it with treatment.

Conclusion

While there may be a connection between grinding your teeth and sleep apnea, there are plenty of things that muddy the waters for researchers trying to show a cause-and-effect relationship.

The takeaway for anyone reading this article is that if you’re waking up with many of the symptoms commonly associated with sleep bruxism, it may be worth an appointment with your doctor and your dentist to determine the cause. Keep in mind that each condition would likely be treated independently, and any recommended therapies would not be based on a cause-and-effect relationship between the two.