Bruxism (Teeth Grinding) & Sleep Apnea

The new paradigm is that the incessant grinding may be the brain’s instinctive (and subconscious) way of trying to move the lower jaw or mandible forward to clear your airway so you can get more oxygen when you are deeply asleep.

You of course don’t know this because you are sleeping, but airway and tongue muscle sometimes cause trouble during the deepest stages of sleep. At any point when the airway obstructs, your brain has no other choice than to arouse you back into lighter, less restorative, stages of sleep.

The grinding motion your brain initiates pushes the lower jaw forward, manipulating the tongue and other soft tissue just enough to assist with compromised airflow. If your protective brain stops calling for grinding, less oxygen reaches your lungs, body, and brain.

Brilliant, right? The brain first tries to reposition the jaw and soft tissue. If that doesn’t work, you arouse out of deep, healing, and restorative sleep and feel unrested in the morning. Sound familiar?

Gone are the days where our only options are forced-air machines like CPAP or AutoPAP. There are now many options to choose from, but a sleep diagnostic test is always required to determine the best course of action.

Take home message: A history of teeth grinding is a red flag for our clinic to order a sleep study to evaluate for sleep apnea, disordered sleep, or an upper airway resistance syndrome (UARS).

Yes, the right device for the right person can be the solution, and we do sometimes suggest these to patients if a sleep diagnostic test indicates this is a viable answer. However, take note of the fact that I said, “right device” for the “right person.”

A poorly designed apnea appliance can be disastrous. So, one needs to work with a qualified dentist that really cares about the device they are making and ensures it will keep your lower jaw forward and minimize pressure on the TMJ joint and dynamic muscle masses that act on the jaw.

A poorly fitting appliance can also dramatically interfere with the vital response that you use every night to prevent arousing out of deep, restorative stage 4 and REM sleep.

The standard for our practice is treating the root cause of our patients’ conditions using precision diagnostics and careful, conscious decision making for those who have entrusted us with their health issues. We do not recommend night guards for grinding unless they are designed by an expert dentist familiar with how grinding relates to sleep apnea.

As I mentioned, grinding may be happening to clear your airway during the deepest stages of sleep. Our primary concerns in such cases are 1) to protect your teeth from the strong vertical forces without damaging the jaw joints and muscles; and 2) either diagnose or rule out sleep apnea using sleep diagnostics that can determine if there is clinically relevant apnea and whether or not this is due to central (i.e. brain) or obstructive mechanisms. A sleep diagnostic test needs to be order and interpreted by a medical clinic, such as ours, to determine the best course of action.