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  • Writer's picturelaurenjanowiecki

Sleep Apnea & Grinding Teeth

Hearing the tooth-on-tooth sound of a night grinding may be likened to the same feeling of fingernails down shrieking a blackboard. For a person fast asleep and grinding, it might be a habit that they don’t even notice. However, teeth grinding could have far deeper health implications than simply driving your bed partner insane. In this article I have included multiple articles from different Doctors and Dentists, including Steven Lin D.D.S., Shyam Subramanian, MD, Dr. Burhenne, D.D.S., & Kalpalatha Guntupalli, MD, who have all done relative studies. I found the results unbelievably parallel.

Often attributed to stress, new understanding of sleep and the airway reveal the reasons that people may grind their teeth could be the sign of nighttime breathing difficulty. Conditions that may be linked to this problem are upper airway resistance syndrome (UARS) or even obstructive sleep apnea which both indicate a frightening lack of oxygen while you’re sleeping.

I have included several articles below that i found helpful as well as quite intriguing.

ScienceDaily (Nov. 5, 2009) — There is a high prevalence of nocturnal teeth grinding, or bruxism, in patients with obstructive sleep apnea (OSA), particularly in Caucasians.

New research presented at CHEST 2009, the 75th annual international scientific assembly of the American College of Chest Physicians (ACCP), found that nearly 1 in 4 patients with OSA suffers from nighttime teeth grinding; this seems to be especially more prevalent in men and in Caucasians compared with other ethnic groups.

It is estimated that 8 percent of the general US population suffers from bruxism, a condition frequently associated with a preexisting dental or jaw disorders, as well as stress.

“The relationship between obstructive sleep apnea and sleep bruxism is usually related to an arousal response. The ending of an apneic event may be accompanied by a number of mouth phenomena, such as snoring, gasps, mumbles, and teeth grinding,” said Shyam Subramanian, MD, FCCP, Baylor College of Medicine, Houston, TX. “Men typically have more severe sleep apnea, and perhaps may have more arousal responses, which may explain the higher prevalence of teeth grinding in men. Besides, men characteristically tend to report more symptoms of sleep apnea than women, such as snoring, loud grunting, and witnessed apneas.”

Other factors that might help explain the relationship between sleep apnea and teeth grinding include anxiety and caffeine use.

“High levels of anxiety can lead to bruxism, and untreated sleep apnea is known to cause mood disturbances including depression and anxiety,” said Dr. Subramanian. “Daytime sleepiness from sleep apnea may cause a person to ingest caffeine, and this has also been associated with a high risk of bruxism.”

Through a retrospective chart review, Dr. Subramanian and his colleagues, from the Baylor College of Medicine, Houston, TX, assessed the prevalence of bruxism and gastroesophageal reflux (GERD) in 150 men and 150 women with OSA. Each group consisted of 50 Caucasians, 50 African-Americans, and 50 Hispanics. Results showed that 25.6 percent of patients suffered from teeth grinding, while 35 percent of all patients with OSA complained of nocturnal heartburn and GERD symptoms.

The researchers also examined the influence of gender and ethnicity on OSA, GERD, and bruxism. They found that bruxism was higher in men than in women — 69 percent vs. 31 percent. Caucasians had the highest rate of bruxism compared to other ethnic groups — 35 percent vs. 19 percent in Hispanics. African-Americans have the highest prevalence of GERD — 40 percent vs. 31 percent in the Hispanic population and 34 percent in Caucasians. Overall, no correlation was observed between the presence of self-reported GERD and bruxism.

Untreated bruxism can lead to excessive tooth wear and decay, periodontal tissue damage, jaw pain, and temporomandibular joint or TMJ pain, headaches, and sleep disturbances for patients and their bed partners.

“Bruxism can be both a daytime syndrome as well as a nighttime syndrome, but it is bruxism during sleep, including short naps, that causes the majority of health issues,” said Dr. Subramanian. “Studies do suggest that when sleep bruxism is related to OSA, certain therapies, including continuous positive airway pressure, may eliminate bruxism during sleep.”

“Sleep disorders such as sleep apnea can lead to many secondary health conditions,” said Kalpalatha Guntupalli, MD, FCCP, President of the American College of Chest Physicians. “When treating sleep apnea, clinicians must also recognize and address secondary health conditions, such as bruxism, in order to fully manage a patient’s sleep disorder.”

Also, This article is VERY interesting:

sleep apnea: the real reason you grind your teeth

Last updated on November 2, 2018 BY DR. BURHENNE

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.

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 grindingThe consequences of grindingThose who are most at risk for sleep apnea-related grindingWhat 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.