All About Sleep Bruxism

Although there are no official statistics available on sleep bruxism, it is thought that 10% of the UK population experience the condition at some point in their lives. Because many people are unaware that they clench or grind their teeth during their sleep or never visit a doctor or dentist to receive an official diagnosis, the official figures could be much higher than is predicted.   

Today, we are going to look at sleep bruxism in more detail, including the common causes and the possible treatments.

What is Sleep Bruxism?

Sleep bruxism is involuntary teeth grinding and teeth clenching that happens while you are asleep. It occurs because the masticatory muscles (that are responsible for chewing) are activated during your sleep. Because these muscles are activated unconsciously, the individual is unaware of the strength they are using. Someone who grinds or clenches their teeth in their sleep uses significantly more force than is typically used during chewing actions. 

Although bruxism can occur when awake, sleep bruxism (teeth grinding and clenching that occurs involuntarily during sleep) is much more common. Sleep bruxism can also be much more problematic, as you are not aware of the unconscious grinding or clenching. Depending on the amount of force, pressure and friction that is being applied and the frequency of bruxism episodes, sleep bruxism can cause significant damage to your teeth and jaw. 

The majority of people with sleep bruxism do not grind or clench their teeth all night. Instead, they will have bruxism episodes during the night. These episodes usually last from a few seconds to a few minutes. Some people experience one or two episodes a night, whereas others experience as many as 50-100 episodes per night. While some clenching or grinding is normal, frequent or persistent episodes can be extremely damaging.

Sleep bruxism is a common condition, particularly during childhood. Many children stop grinding their teeth as they grow, their mouth develops, and their adult teeth come through. However, for some people, sleep bruxism still occurs during adulthood. The majority of bruxism episodes occur during non-rapid eye moment (NREM) sleep, specifically during Stages 1 and 2.

What Causes Sleep Bruxism?

There is not one singular cause of sleep bruxism. Instead, multiple possible factors could be causing you to clench or grind your teeth during your sleep, including:

Stress and anxiety

Stress and anxiety are significantly related to sleep bruxism. Teeth grinding and clenching are both involuntary, automatic reactions to negative emotions, including fear, anger, stress and anxiety. This means that somebody who is experiencing negative emotions or has a mental health condition, such as depression or anxiety, is more likely to experience bruxism (when awake) or sleep bruxism (when asleep).

Sleep problems

Sleep bruxism often occurs in conjunction with other sleep problems and sleep disorders, including:

• Snoring.
• Obstructive sleep apnoea (OSA).
• Sleep talking.
• Sleep paralysis.
• Breathing pauses while sleeping.

For children, sleep disorders such as sleepwalking, bedwetting and sleep talking increase the likelihood of them developing sleep bruxism.

Medication

Taking certain types of medication can increase the risk of sleep bruxism. This can include:

• Selective serotonin reuptake inhibitors (SSRIs).
• Serotonin-noradrenaline reuptake inhibitors (SNRIs).
• Noradrenaline-dopamine reuptake inhibitors (NDRIs).
• Antipsychotic medications.

Lifestyle factors

There are multiple lifestyle factors that are connected to sleep bruxism, including:

• Smoking.
• Drinking excessive alcohol.
• High caffeine intake.
• Taking recreational drugs, including methamphetamine, ecstasy and cocaine.

Oral issues

Certain oral issues can cause you to grind or clench your teeth, such as:

• Misalignment of the jaw.
• Missing teeth.
• Crooked teeth.
• Issues with the temporomandibular joints (TMJ) that connect your lower jaw and your skull.

Genetics

Research has identified a genetic component to sleep bruxism. Multiple studies have shown that teeth grinding and clenching have a genetic basis. If you have a close relative (e.g. a parent or sibling) who grinds or clenches their teeth, there is a higher likelihood of you also experiencing episodes of bruxism.

The Signs of Sleep Bruxism

Many people with sleep bruxism aren’t aware they grind or clench their teeth. They may be told about their bruxism by a partner or family member. 

However, you may suspect bruxism because you are experiencing pain. Certain types of pain may indicate bruxism, particularly if the pain is worse when you first wake up. This can include:

• Jaw pain.
• Neck pain.
• Toothache – pain in one or more of your teeth.
• Earache.
• Pain in your face.
• Headaches (particularly in the morning).

Pain is one of the most common signs of bruxism. Grinding and clenching your teeth places stress on your teeth and jaw. This stress can cause pain and strain in your teeth and jaw and in the surrounding areas. Additionally, bruxism can cause damage to your teeth. Grinding and clenching your teeth can wear down the enamel on your teeth, which can result in tooth pain.

Aside from pain, other signs of sleep bruxism can include:

• Damage to your teeth with no other apparent cause. This can include teeth that are flattened or worn down, teeth that are cracked or fractured and loose teeth.
• Tooth decay or infections.
• Tooth loss.
• Tooth sensitivity – for example, when consuming hot and cold food or drinks.
• Damage to the soft tissue inside your mouth. This can occur if you also bite the inside of your mouth (particularly the inside of your cheeks) during your sleep.
• Experiencing lockjaw – when the muscles in your jaw spasm, making it difficult to open your mouth wide.
• Feeling like your face is tight, particularly when you first wake up.
• Clenching your fists during the night or waking up with clenched fists.
• Disturbed sleep.

To be diagnosed with sleep bruxism, you do not need to grind or clench your teeth every night and you do not need to have all of the signs listed above.

The Impact of Sleep Bruxism

Sleep bruxism can have a negative impact on many aspects of your life. The extent of the impact of bruxism can vary depending on the severity of the episodes, how long you have been experiencing sleep bruxism, your general health and your lifestyle. For example, someone who smokes, has a poor diet and has misaligned teeth is more likely to have more significant negative consequences compared to someone with good general health. 

Because of the strong force that is applied when you clench or grind your teeth in your sleep, you may experience significant damage to your teeth and jaw which can pose a risk to your oral health and bone health.

Somebody who experiences significant or long-term episodes of sleep bruxism may be more likely to experience:

• Damage to teeth that requires dental treatment, such as fillings, crowns and implants.
• Temporomandibular disorder (TMD) – Long-term issues with the temporomandibular joint (TMJ), such as jaw lock, chronic jaw pain, popping and clicking of the jaw and difficulties chewing.

Bruxism can also result in sleep disturbance. Grinding or clenching your teeth in your sleep can cause you to wake up multiple times during the night, and waking up with pain can result in you staying awake for long periods.

Poor sleep can have a negative impact on many areas of sleep, including:

• Adversely affecting your mental health – including increased risk of anxiety and depression.
• Adversely affecting your physical health – including a weakened immune system and an increased risk of long-term health conditions.
• Reduced cognitive function, including impaired concentration and attention.
• Irritability and mood swings.

As well as the physical impact of sleep bruxism, this condition can also impact other areas of your life. For example, frequent or serious bruxism episodes can be a potential issue in your personal relationships. Clenching and grinding noises can cause sleep disturbances for a bed partner and make it difficult for them to sleep well. This can be stressful for both you and your bed partner and can have a negative impact on your relationship.

How is Sleep Bruxism Diagnosed?

If you think you are experiencing sleep bruxism, you should arrange an appointment with your dentist as soon as possible. Your dentist will ask you about your symptoms and ask for more information regarding why you think you have sleep bruxism. They will also perform a dental examination. Following the examination, your dentist may make a formal diagnosis of sleep bruxism. 

In some cases, your dentist may diagnose sleep bruxism even if you have not noticed any signs of the condition. For example, you may make an appointment with your dentist because you are experiencing tooth pain, and during your appointment your dentist notices your teeth are flattened and worn down. 

Some people with suspected sleep bruxism are recommended to visit their GP or primary healthcare provider, for example, if their dentist is unable to make a diagnosis. Because doctors are not experts in teeth, your doctor may recommend you have a polysomnography – a sleep study typically done in a sleep clinic. 

A sleep study takes place overnight and your sleep is monitored. Before the study starts, the technician will attach sensors to different parts of your body. These sensors will record:

• Your oxygen levels.
• Your brain waves.
• Your breathing patterns.
• The movements of your chest and abdomen.
• Your mouth and jaw movements.

Because episodes of sleep bruxism typically take place during Stages 1 and 2 of sleep, a sleep study will also look at your sleep stages.

However, a sleep study will typically only be recommended if your doctor thinks you could be experiencing a sleep disorder or another sleep problem alongside bruxism.

Treatment for Sleep Bruxism

Once you have received a diagnosis, there are multiple possible treatment options. Some treatments are focused on preventing and treating bruxism, including reducing or eliminating the occurrence of bruxism episodes and addressing the root cause of the issue. Other treatment options focus on repairing any damage to your teeth or jaw and preventing any future damage from occurring. Because sleep bruxism manifests differently in different people, treatment plans are highly individualised. It may be that you are recommended multiple treatment options concurrently, or that you have to try multiple treatment options to find the best fit for you. 

Some of the possible sleep bruxism treatment options include:

Bruxism Treatments:

Treatment for stress and anxiety

Because bruxism is closely related to stress and anxiety, taking appropriate steps to manage and reduce your stress and anxiety can reduce the occurrence of sleep bruxism episodes. Some treatment options can be prescribed by your doctor, whereas others are things you can implement yourself. These can include:

• Cognitive Behavioural Therapy (CBT).
• Medication.
• Relaxation techniques, such as deep breathing exercises, meditation, mindfulness and progressive muscle relaxation (PMR).

Lifestyle changes

Multiple lifestyle changes can decrease the occurrence of bruxism episodes, including:

• Avoiding alcohol and recreational drugs.
• Reducing your caffeine intake.
• Increasing your physical activity.
• Stopping smoking (or reducing how much you smoke).
• Eating healthily.
• Improving your sleep health – for example, by improving your sleep habits and your sleep environment.

Medication

For more serious cases of bruxism, your doctor may prescribe medication. There are different types of medication, depending on the aspect of bruxism your doctor wants to target. For example:

• Muscle relaxants – to relax the muscles in your jaw.
• Botox injections – Botox can be injected into the muscles that are responsible for moving your jaw. This can reduce the occurrence of teeth grinding or clenching.
• Medication to treat anxiety, stress or depression.

Muscle training

Muscle training can help to develop and strengthen the muscles in your jaw. For example, facial muscle exercises and relaxation techniques can help to reduce the automatic muscle movement that takes place during episodes of bruxism.

Biofeedback

Biofeedback is designed to make you more aware of activity in your jaw muscles. Auditory and visual feedback is used to help you recognise activity in your jaw muscles, control any activity and manage your teeth grinding or clenching. Although biofeedback is typically used for cases of daytime bruxism, it is thought that it could also be effective in treating sleep bruxism. However, it is likely to only be used when other treatment options have failed, as it has the potential to cause you to wake up automatically when your jaw muscles are activated, resulting in disturbed sleep.

Facial massages

Some people with bruxism find facial massages to be very beneficial. A massage of the head, jaw and neck area can reduce muscle tension and relax your jaw and the muscles in your face and neck. Not only can reduced muscle tension relieve any pain you feel, but it can also reduce the occurrence of bruxism episodes.

Dental Treatments:

If your sleep bruxism is caused by issues with your teeth, mouth or jaw, or if your bruxism episodes have caused damage to your teeth or jaw, dental treatment may be recommended. This can include:

Mouthguards

Mouthguards or night guards may be recommended while you sleep. They can help to protect your teeth from damage and can reduce the occurrence of clenching or grinding. Mouthguards provide a barrier between the upper and lower teeth and can prevent your teeth from becoming damaged. They can also reduce some of the pain associated with bruxism. You can get custom-made mouthguards that are designed specifically for your teeth, or you can buy a universal mouthguard over the counter.

Braces

Braces may be recommended if you have issues with your teeth that are contributing to or causing your sleep bruxism, for example if you have a misaligned bite or crooked teeth.