The Link Between Snoring, Sleep Apnea & Teeth Grinding

Snoring, sleep apnea, and teeth grinding are all interconnected sleep disorders that can have a significant impact on an individual’s overall health and well-being. Though these conditions may seem separate, there is a strong link bond and relationship between them, with research indicating that sleep apnea and teeth grinding coexist and share common risk factors, such as restless sleep, stress, anxiety, and even diet and lifestyle choices. The connection is particularly strong in patients with less severe sleep apnea or who suffer from particular loud or persistent snoring.

This article explores the connection between these three conditions and sheds light on potential causes, risk factors, and available treatment options for sleep efficiency and quality.

Definition of Snoring, Sleep Apnea, and Teeth Grinding

  • Snoring refers to breathing sounds  produced during sleep caused by the partial collapse, or narrowing, of the airway during sleep. The airway collapses as the tongue and tissues of the airway relax during sleep. This relaxing of the tissues is most pronounced during rapid eye movement sleep (REM). The relaxed tissues vibrate as air rushes by as you breathe through your mouth. Chronic nasal congestion or a crooked partition between your nostrils (also called deviated nasal septum) and the condition of your nasal passages make matters worse, because the obstruction of the nasal passages encourage mouth breathing.
  • Obstructive Sleep apnea is a disorder characterized by pauses in breathing during sleep due to a complete collapse of the airway. This collapse causes you to struggle to breathe against your own tissue that has created an obstruction. Your body responds to the inability to breathe by  briefly awakening you to take a few gasping breaths only to fall asleep again, and the process repeats. These pauses happen between 5 and 30+ times per hour, and are often accompanied by loud snoring and the fragmented sleep patterns lead to excessive daytime sleepiness.
  • Teeth grinding during sleep, also known as sleep bruxism, involves the excessive clenching or grinding of the teeth during sleep. Sleep bruxism and simple snoring commonly coexist.
Understanding the relationship between snoring, sleep apnea, and teeth grinding is crucial in order to identify and treat these disorders effectively, improving overall sleep quality and oral health.

Overview of the Relationship between Sleep Apnea and Teeth Grinding

Snoring, sleep apnea, and teeth grinding are all health problems that are related to the muscles ligaments and soft tissues of the mouth and throat. All three commonly occur unconsciously during sleep. You just don’t know you are doing it. These issues are interconnected, with one another, often leading to or exacerbating the others.The association between sleep bruxism and simple snoring means it’s likely to escalate  to obstructive sleep apnea. Factors such as being over 50, male, overweight, diabetic with excessive alcohol intake can increase the risk of these conditions. Sleep apnea and teeth grinding can further disrupt sleep quality and have negative impacts on overall health.

Addressing these upper airway related health problems is important as they can have significant consequences for overall health and well-being. Seeking treatment for snoring, sleep apnea, and teeth grinding can improve sleep quality, reduce the risk of cardiovascular diseases such as coronary artery disease, stroke, diabetes and prevent complications related to oral health, such as gum disease and tooth damage.

Loud Snoring as a Risk Factor for Obstructive Sleep Apnea

Loud snoring is often associated with disrupted sleep or lack of sleep (for the sufferer and for the bed partner) and can serve as a risk factor for obstructive sleep apnea (OSA). OSA is a very common sleep disorder characterized by the repeated interruptions in breathing due to the collapse of the tissues of the upper airway during sleep. These interruptions in breathing can lead to high blood pressure, stroke, cardiac arrhythmias and early death. 

While not all individuals who snore loudly will develop OSA, all individuals with OSA snore. Large, population-based studies, have shown a positive correlation between frequent snoring and the presence of OSA. Snoring is  caused by narrowing of the airway during sleep leading to vibration of tissue in the back of the throat at the base of the tongue, which can block the airway and  create an impact on snore intensity. Snoring is the sound a collapsed airway makes.

Daytime Sleepiness As a Side Effect of Sleep Apnea and Bruxism

If you often feel tired during the day and grind your teeth at night, there’s a connection between these issues and your sleep quality. Sleep apnea, a common sleep disorder, can cause daytime sleepiness and is also linked to teeth grinding (bruxism). Understanding how sleep apnea contributes to your daytime sleepiness is crucial, as it directly affects your daily life, work performance, and even your long-term health.

Direct Impact on Your Daily Life:

Daytime sleepiness can significantly affect your ability to concentrate and perform well at work or school. Feeling tired during the day makes it harder to stay focused and complete tasks efficiently. This can lead to decreased productivity, making it challenging to achieve your goals. Moreover, excessive sleepiness increases the risk of work accidents, as it impairs your judgment and slows down your reaction time. It’s important to address the underlying causes to ensure you can stay alert and attentive during the day.

Car Accidents:

Feeling drowsy due to sleep apnea can also pose a danger when you’re driving. Daytime sleepiness is similar to being under the influence of alcohol, reducing your ability to react quickly, stay in your lane, and avoid accidents. Falling asleep at the wheel due to untreated sleep apnea can be life-threatening, not only for yourself but also for others on the road. So, it’s crucial to seek proper diagnosis and treatment to reduce the risk of car accidents caused by sleepiness.

Health Implications of Untreated Sleep Apnea:

Apart from the immediate impact on your daily life, untreated sleep apnea can lead to severe health problems:

  1. Heart Disease: Sleep apnea increases the risk of high blood pressure, heart attacks, and strokes. The frequent pauses in breathing strain your cardiovascular system, leading to serious heart-related issues.
  1. Diabetes: Sleep apnea is associated with an increased risk of developing type 2 diabetes. The disrupted sleep patterns and the body’s reduced ability to regulate insulin levels contribute to this connection.
  1. Obesity: Poor sleep quality and daytime sleepiness can disrupt your metabolism, leading to weight gain. Sleep apnea and obesity have a bidirectional relationship, as excess weight can contribute to sleep apnea, and sleep apnea can worsen weight gain.
  1. Early Death: Untreated sleep apnea has been linked to a higher risk of premature death. The strain on the heart and other health complications can reduce life expectancy if the condition is not addressed.


Treatment for Bruxism Linked to Sleep Apnea and Loud Snoring

Sleep disorders that prevent deep sleep, such as sleep apnea, insomnia, or bruxism, will require medical treatment from your doctor to help ease your symptoms. You might use medications, apps that are used to register sleep patterns and sleep quality, and devices such as a mouthguard, CPAP machine, or even psychotherapy.

Some treatments might include:

Regular Visits to Dentists

A dentist trained in treating bruxism and sleep disorders, will undertake a thorough examination during regular visits and guide the patient through a customized treatment plan. Here’s an outline of what a patient can expect:

  1. Patient History and Symptoms: The dentist will begin by discussing the patient’s medical and dental history, lifestyle factors, and any symptoms they’ve been experiencing. This discussion could include sleep patterns, daytime sleepiness, facial pain, or morning headaches.
  2. Physical Examination: The dentist will perform a comprehensive examination of the patient’s mouth, jaw, face, and neck. This examination includes checking the teeth for signs of wear or damage caused by grinding, examining the jaw for signs of misalignment or discomfort, and assessing the facial muscles for tension or tenderness.
  1. Computed Tomography(CT) Scan: Depending on the initial assessment, the dentist may recommend dental X-rays or other imaging tests to get a clearer picture of the teeth and jaw structure. This will help identify any underlying issues that may be contributing to the bruxism.
  2. Treatment Discussion: Based on the patient’s symptoms and the findings from the physical examination and any imaging, the dentist will discuss the most suitable treatment options. This could include dental appliances like night guards or occlusal splints, lifestyle changes, stress management techniques, or in some cases, more intensive treatments like Botox or dental correction procedures.
  3. Follow-Up and Recall: After initiating a treatment plan, regular follow-ups are crucial. These appointments allow the dentist to monitor the patient’s progress, make any necessary adjustments to the treatment plan, and assess the effectiveness of the treatments. The frequency of these follow-ups will depend on the individual’s condition, but typically, patients with bruxism might be asked to revisit every 3-6 months.
  4. Patient Education: Throughout the visit, the dentist will provide education on bruxism and associated headaches, explaining the causes, potential triggers, and prevention strategies. The aim is to empower the patient to manage their condition effectively and understand when to seek additional medical attention.
Remember, effective treatment of bruxism and associated sleep disorder is a team effort involving the patient, dentist, and sometimes other medical professionals, and regular check-ups play a critical role in this process.

Night Guards, Splints, NTI or OTC

The choice of dental appliance for managing bruxism has several options available. The differences lie in their design, material, customization, effectiveness, and cost.
  1. Night Guards: These are often the first line of defense against bruxism and resulting morning headaches. Custom-made night guards are fabricated based on a dental impression of the patient’s teeth, providing a precise fit. They create a physical barrier between the upper and lower teeth, reducing the wear and tear caused by grinding and clenching.
  2. Occlusal Splints: Like night guards, occlusal splints are custom-made for the individual and are designed to fit over the upper or lower teeth. However, they are typically made from a harder, more durable material than night guards. Their design not only prevents tooth grinding but also guides the jaw into a neutral position, reducing the strain on the jaw muscles.
  3. NTI-TSS (Nociceptive Trigeminal Inhibition Tension Suppression System): Unlike traditional night guards and occlusal splints that cover all the teeth, the NTI-TSS device fits over the front teeth only. It prevents the molars from contacting, thereby reducing the force of the clenching. It can be particularly useful in preventing tension headaches caused by intense jaw clenching.
  4. Over-The-Counter Boil and Bite Devices: These are widely available at drugstores or online and are often the cheapest option. They are made from a thermoplastic material that softens in hot water and molds to the shape of the user’s teeth when bitten into. While a counter pain reliever can offer some protection against tooth wear, they lack the precision fit and durability of custom-made appliances.

Therapy and Relaxation Techniques

Stress is a primary trigger for bruxism, tension-type headaches, and many sleeping disorders. As such, effective stress management and reduction techniques are crucial components to improve mental health conditions. This is where relaxation techniques and Cognitive Behavioral Therapy (CBT) come into play. Relaxation Techniques: These methods aim to reduce muscle tension and promote a state of calm, which can alleviate both bruxism and the resulting headaches. Examples include:
  1. Progressive Muscle Relaxation (PMR): This involves sequentially tensing and then relaxing different muscle groups throughout the body. It can be particularly useful for individuals who grind their teeth due to muscle tension.
  2. Deep Breathing Exercises: These techniques encourage slow, deep breaths, which can help reduce tension and promote relaxation. This may lessen the urge to clench or grind the teeth.
  3. Mindfulness and Meditation: By fostering greater awareness of the present moment and promoting a state of relaxation, mindfulness, and meditation can help individuals better manage stress, potentially reducing bruxism and associated headaches.

Make Lifestyle Changes

Bruxism is often the result of several lifestyle choices that can lead to poor sleep, stress, and anxiety, which is why physicians will recommend that the first step to fixing bruxism and sleep disorders are changes in lifestyle like the following:

  • Avoid caffeine and alcohol, especially before bedtime, as they can worsen bruxism symptoms and disrupt sleep.
  • Practice good sleep hygiene by establishing a consistent sleep schedule and creating a relaxing bedtime routine.
  • Keep the bedroom environment conducive to sleep, ensuring it is dark, quiet, and at a comfortable temperature.
  • Avoid stimulating activities, such as watching TV or using electronic devices, in the hour before bedtime.
  • Maintain a healthy diet and exercise regularly to promote overall well-being and reduce stress levels.
  • Avoid using over-the-counter sleep aids, as they can exacerbate bruxism symptoms and have other side effects.
  • Consult a dentist who understands bruxism and has training in sleep disorders for appropriate sleep aids or alternative treatment options.

CPAP Therapy

In particular, the current gold standard of care for obstructive sleep apnea is a CPAP machine which is also a very good treatment for a lot of sleep disorders related to OSA.

PAP therapy, also known as positive airway pressure therapy, is a commonly used treatment for obstructive sleep apnea (OSA). The purpose of PAP therapy is to keep the airway open during sleep and improve breathing.

There are different types of PAP devices available for OSA treatment, including continuous positive airway pressure (CPAP), bi-level positive airway pressure (BiPAP), and auto-titrating positive airway pressure (AutoPAP). CPAP delivers a continuous and constant pressure, while BiPAP provides two different pressures for inhalation and exhalation. AutoPAP adjusts the pressure automatically based on the individual’s needs throughout the night.

Using PAP therapy for OSA management has several potential benefits. It helps reduce daytime sleepiness and lower the risk of associated health problems like high blood pressure and cardiovascular diseases. However, some drawbacks of PAP therapy may include mask discomfort, dry eyes or mouth, and difficulties with compliance.

How Does PAP Therapy Help with Teeth Grinding?

PAP Therapy has proven to be an effective treatment for both sleep apnea and teeth grinding. By addressing the underlying issues that contribute to both conditions, PAP Therapy can help alleviate the most common symptoms and improve sleep quality.

One of the common factors in both sleep apnea and bruxism is muscle activity during sleep. During a sleep apnea episode, the airway becomes partially or completely blocked, leading to restricted breathing and increased muscle activity as the body tries to open the airway. This heightened muscle activity can cause teeth grinding and clenching.
PAP Therapy delivers a continuous flow of air through a mask, which acts as a splint to keep the airway open and reduce or eliminate episodes of airway restriction. By maintaining an open airway, PAP Therapy reduces the increased muscle activity, thus decreasing the occurrence of teeth grinding.

Get a Better Night’s Sleep by Treating Bruxism and Teeth Grinding

During sleep, our bodies engage in various activities, some of which may contribute to sleep disorders. While the exact mechanisms behind the relationship between activity during sleep, snoring, OSA, and teeth grinding are not yet fully understood, several factors contribute. These include structural abnormalities of the airway or jaw, alcohol consumption, cardiovascular diseases, and sleep deprivation. The impact of these factors on the quality of sleep, breathing patterns, and muscle movements during sleep may play a role in developing or exacerbating these conditions. Further research is needed to better understand the causal links between activity during sleep, snoring, OSA, and teeth grinding. By gaining a deeper understanding of these connections, healthcare providers can develop targeted interventions to improve sleep quality and mitigate the potential health risks associated with these conditions.
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