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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.

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 teethTeeth that are worn flatAbfractions, or tooth tissue loss along the gumline.

At home, you can also consider symptoms like:

Sore muscles in the jaw or faceA friend or partner telling you they can hear or see you grinding at nightIncreased tooth pain or sensitivityTMJ 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 TMJWaking 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 forwardA Tongue Retaining Device, which pulls the tongue forward at nightA 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, &/or 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.

The Following By: STEVEN LIN, D.D.S.

Sleep and Rejuvenation

When you picture someone clenching their jaw so tight that they are grinding their teeth, it doesn’t give you the picture of a peaceful nights rest.

Researchers are uncovering the vast contribution of sleep to our health. Probably most significant of discoveries is the role of good sleep on the function of our brain. The development of neural connections and clearing metabolites in the brain during sleep show that degenerative diseases like dementia may stem from poor quality rest.

When we sleep, our body rests most of the systems it uses for day-to-day function. The only thing required, that is normally controlled by our consciousness, is breathing. Delivery of oxygen is crucial for our body to maintain its processes during sleep and makes any disruptions to our airways a particular concern to sleep.

Upper Airway Resistance Syndrome (UARS)

A lesser-known consequence of breathing complications during sleep is Upper Airway Resistance Syndrome (UARS for short). It refers to the condition where increased resistance to breathing can lead to disruptions in sleep. Characterized by daytime tiredness, UARS is not associated with lowering oxygen levels in the blood seen in sleep apnea.

UARS is caused by narrowing of the upper airway may be described as trying to breathe through an opening as small as a straw. Whilst it can present similarly to its bigger brother, sleep apnea, UARS is not as easily identifiable. One particular difference between UARS and sleep apnoea is that an equal proportion of women suffer from UARS unlike the heavily male-dominated sleep apnea which is almost always associated with snoring.

Night Grinding and UARS

Recent studies show that half of women aged 20 to 70 suffering from disruption of sleep. While snoring is the hallmark of obstructive sleep apnea, night grinding may be the hallmark of UARS.

We’re all familiar with people who snore in their sleep. The mechanisms of snoring show what happens to our airways during asleep. As the muscles that hold open the upper airways relax during sleep cycles, they cause the tongue rest back into our throat, which can partially block the airways. The lowered volume can cause vibration in our throat, due to air having to pass through a smaller passage, or otherwise known as snoring.

Research has linked night bruxism as a risk factor for sleep apnea and for similar reasons, is likely to be heavily associated with UARS. Teeth grinding is our body’s mechanism to deal with over-constriction of the airway muscle relation during sleep. Clenching our teeth is the result of the body pushing the jaw forward in order to open the airways to allow us to breathe. It also explains the higher women-to-male ratio seen in UARS as compared to sleep apnea, which is typically associated with overweight, middle-aged men.

Signs of Night Bruxism

If you’re suffering any of these symptoms it may be an indication that you’re grinding your teeth at night 

Chipped or broken teethTooth sensitivityToothacheHeadachesMigrainesJaw pain or temporomandibular joint disorders (TMJ)Stressful job or family life

Even though night clenching may help us breathe at night, the damage to our teeth and jaw can be disastrous.  

What to Do If You Suspect Teeth Grinding

An appointment with your dentist will be able to tell you whether you’re a night grinder or not. Once this is established it may be necessary to undergo a sleep study in order see if breathing difficulties are causing you to grind your teeth. If you are experiencing any of these symptoms, call us today- 937-898-8990.



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