The Link Between Sleep Apnea and Teeth Grinding

Is There a Connection Between Sleep Apnea and Teeth Grinding?

With a broad definition, OSA has been estimated to affect approximately 15-30% of males Trusted Source National Center for Biotechnology Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source and 10-30% of females Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source . Using a more restrictive definition, 2-9% of adults Trusted Source Merck Manual First published in 1899 as a small reference book for physicians and pharmacists, the Manual grew in size and scope to become one of the most widely used comprehensive medical resources for professionals and consumers. View Source are affected and up to 5% of children Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source at any age. However, it is often believed to be underdiagnosed Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source .

In addition to looking at their prevalence independently, studies have found that a surprising number of people have both OSA and sleep-related bruxism. In fact, one of the main risk factors for sleep-related bruxism is OSA. To date, though, it’s still unclear whether there is causation or only correlation.

Epidemiological studies, which examine patient records and datasets, identified that many people with OSA were also prone to grind their teeth Trusted Source SpringerLink SpringerLink provides researchers with access to millions of scientific documents from journals, books, series, protocols, reference works, and proceedings. View Source . Though not all of these studies have found the same rates of co-occurrence, a general pattern emerged showing a correlation between teeth grinding and sleep apnea.

The same correlation has also been found Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source in studies using polysomnography, which is a type of in-depth sleep study done in a specialized clinic. Because it involves close observation of a sleeper, polysomnography provides greater confidence than some other studies that rely on surveys of self-reported sleep apnea or teeth grinding.

Possible Explanations for a Relationship Between Sleep Apnea and Sleep-Related Bruxism

While research studies have shown a correlation between sleep apnea and sleep-related bruxism, they don’t clearly explain the underlying nature of that association.

Sleep scientists have formulated several hypotheses about how these conditions are connected. It is important to highlight that research so far has not been able to establish any of them as definitive Trusted Source SpringerLink SpringerLink provides researchers with access to millions of scientific documents from journals, books, series, protocols, reference works, and proceedings. View Source or to show conclusively that there is a direct connection between teeth grinding and sleep apnea.

Obstructive Sleep Apnea as a Risk Factor for Sleep-Related Bruxism

Some argue that when the airway becomes constricted from OSA, movement of the muscles of the mouth that are involved in chewing, may help to reopen it Trusted Source Wiley Online Library Wiley Online Library is one of the largest and most authoritative collections of electronic journals published by Wiley, as well as a vast and growing collection of reference works and other books. View Source leading to teeth grinding. Another possibility is that the clenching and grinding helps to lubricate the tissue in the back of the throat that can become dried out from labored breathing from sleep apnea.

In this view, sleep-related bruxism is seen as part of the body’s response to try to protect itself from the effects of OSA. Even though it may not apply to all people with OSA, this hypothesis may describe a subset of OSA patients who experience teeth grinding subsequent to disturbed breathing episodes during sleep.

Sleep Bruxism as a Risk Factor for Obstructive Sleep Apnea

A less common view is that sleep bruxism may be a contributing factor to sleep apnea. The underlying mechanism by which this may occur has to do with signals from the nervous system that affect heart rate, muscles around the jaw, and the nasal passages. Signals that initiate teeth grinding may also increase congestion and airway restriction, creating disordered breathing Trusted Source American Academy of Dental Sleep Medicine (AADSM) AADSM is the leading national organization representing dentists who treat sleep-disordered breathing, which includes obstructive sleep apnea (OSA) and snoring. View Source .

A challenge to this view is that sleep studies of people with both sleep-related bruxism and OSA have found that teeth grinding episodes precede OSA-related breathing episodes only about 25% of the time.

Obstructive Sleep Apnea and Sleep Bruxism Occur Independently

Another potential explanation is that OSA and sleep-related bruxism are correlated but that there is no causal link from one to the other. Instead, the two conditions arise independently of one another, although they could both be related to another, separate cause.

An argument in favor of this hypothesis is that a consistent pattern of OSA and teeth grinding hasn’t been found Trusted Source SpringerLink SpringerLink provides researchers with access to millions of scientific documents from journals, books, series, protocols, reference works, and proceedings. View Source in studies to date. While it is more common for teeth grinding to happen shortly after disrupted breathing, it can also happen before and at other points during sleep.

Given this inconsistency, a separate mechanism may influence the development of OSA and sleep-related bruxism and make them more likely to co-occur. Early research has identified abnormalities in pathways of dopamine and serotonin, chemicals of the nervous system known as neurotransmitters, as one possible underlying mechanism Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source .

Obstructive Sleep Apnea and Sleep Bruxism Have a Multifaceted Relationship

According to some expert opinions, there is a multifaceted and complex relationship between sleep apnea and teeth grinding that can manifest in distinct ways in different individuals Trusted Source SpringerLink SpringerLink provides researchers with access to millions of scientific documents from journals, books, series, protocols, reference works, and proceedings. View Source .

OSA is a complicated disorder that involves the nervous, cardiovascular, and respiratory systems. Similarly, there can be diverse contributing factors to sleep bruxism, including both genetic and environmental factors as well as a person’s weight, anatomy, and sleeping position. The complexity of each of these conditions could explain the inconsistent and inconclusive findings in research studies conducted so far.

What is the Significance of the Relationship Between Sleep Apnea and Sleep Bruxism?

Until future research uncovers the exact nature of the relationship between these conditions, people who have OSA or sleep-related bruxism should be aware that they may occur together. This can help them be on the lookout for symptoms and raise the issue with their doctor who can determine whether further testing or treatment would be beneficial.

When both conditions are present, their identification may play a role in optimizing treatment. For example, a case study revealed that therapy with a positive airway pressure (PAP) device, successfully treated both conditions Trusted Source Elsevier Elsevier is a publishing company that aims to help researchers and health care professionals advance science and improve health outcomes for the benefit of society. View Source . In addition, some mouthpieces, such as mandibular advancement devices (MADs) that hold the tongue and lower jaw forward, may help treat OSA and also reduce teeth grinding Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source .