A VICIOUS CYCLE: Sleep Apnea, Sleepiness, Anxiety, Caffeine and Bruxism

What is the Connection between Bruxism and Sleep Apnea?

We know there is a correlation between bruxism and sleep apnea. But how does the one contribute to the other? 

Systemic interdependence is demonstrated by the comorbidities of sleep apnea, 
which include acid reflux, high blood pressure and sleep bruxism.
12-18-13 HANDS ON HEAD
Nocturnal Bruxism
Nocturnal bruxism is characterized by nighttime teeth grinding, gnashing 
or clenching. 
People with this condition unconsciously grind their teeth during sleep. 
Many are unaware of their problem. 
Bruxism can happen to any adult or child at any point in their lifetime. 
Some identified causes are  a high level of stress or anxiety, excessive 
consumption of alcohol; caffeine; use of some types of antidepressants; 
smoking; abnormality in teeth alignment; effect of a condition like Parkinson’s, 
or it could be sourced back to earache or pain in another part of the body. 
Sleep disorders like sleep apnea and restless legs syndrome are found  to be 
concurrent during teeth grinding. 
12-15-13 Sleep-Bruxism
The clinical manifestations of bruxism are attrition or fractures of the incisal 
edges of anterior teeth, wear on the occlusal surfaces of posterior teeth and 
abfractions occuring on the facial sufaces at the cemento-enamel junction (CEJ).

Sleep Apnea
Sleep apnea is a sleep disorder with potentially dangerous 
complications. It involves repeated stops and starts in breathing. 
People with this condition usually snore loudly during sleep and feel 
tired when they awake.

There are two main types of sleep apnea: obstructive sleep apnea and 
central sleep apnea. OSA, the more common form, occurs when throat 
muscles relax during sleep. Central Sleep Apnea involves problems with 
brain signals that control breathing. Complex sleep apnea, a less common
form, combines the two.

Sleep apnea results from a narrow or blocked airway. The lapses in
 breath arouse the sleeper and reopen the airway. The process may repeat 
several times throughout the night even though most people do not 
remember awakening. Apnea events may occur many times during a night. 
The risk of OSA.may be increased by obesity, high blood pressure, 
medications, alcohol consumption and smoking.

Causal relationships   
It has been observed that a third of bruxism patients also suffer from 
sleep disorders like sleep apnea, restless legs syndrome, etc.
 Bruxism may be the effect or the cause of many types of sleep disorders 
including obstructive sleep apnea, snoring, daytime lethargy. 
The effects of stress, anxiety and caffeine ingestion are in play. 
Studies link high anxiety levels to bruxism, and the symptoms of sleep apnea 
itself may cause anxiety. Additionally, the daytime sleepiness caused by apnea 
may lead to high levels of caffeine consumption which, in turn, is linked to
 a high risk of bruxism. This is the vicious cycle.
Treatment Options

When bruxism is associated with OSA, certain therapies may treat both problems.
CPAP (Continuous positive airway pressure) and OAT (Oral Appliance Therapy) 
will keep a sleeper’s airway open to allow for normal breathing. 
It has also been shown to decrease sleep bruxism.  
Mandibular Advancement Appliances (MMAs) have been seen to reduce events 
of bruxism by as much as 50 to 83%.  

Studies have reported that sleep bruxism rarely occurs in isolation. 
In a study in Israel of sleep bruxism and risk factors in the general population, 
it was found that among the associated sleep symptoms and disorders, 
obstructive sleep apnea (OSA) was the highest risk factor for tooth grinding 
during sleep.  Two polysomnographic (PSG) recordings were carried out. The 
first showed 67 events of sounded tooth grinding, most of them appearing
as an arousal response at the end of apnea/hypopnea events in both the 
supine and lateral postures. The results of this study suggest that when 
sleep bruxism is related to apnea/hypopneas, the successful treatment of these 
breathing abnormalities may eliminate bruxism during sleep.



12-15-13 NOCT. BRUX man in bed


Sleep apnea and sleep bruxism: how it all happens
Most of the sleep bruxism events happen when a subject is lying on his or her back.
 This makes us believe that sleep bruxism could happen because of 
narrowing of airway or due to rise in the resistance from airways. 
Immediately after the apnea episode, when the ventilation process resumes, 
activation of the process of jaw-opening and closing begins which in 
turn dilates the upper airway and reduces the resistance in order to ease normal 
breathing.  The patient tries to force the tongue to move away from the air tract and 
forces it against the teeth. 

In a study on nighttime bruxism in patients who are affected by sleep apnea as 
well, it was found that there was a marked decrease of apnea/hypopnea 
episodes as well as events of night bruxism were completely eliminated. 
Therefore, it can be concluded that if sleep bruxism is caused by sleep 
apnea then correcting the breathing irregularities can significantly 
improve or even eliminate sleep bruxism. 







Research has revealed that increase of teeth grinding is directly 
proportional to the increase of frequency of apnea episodes. Since the 
link between arousals and bruxism during sleep is already 
established, it is fair to say that increase of nighttime bruxism is 
directly linked to arousals caused by sleep apnea. 
When an apnea event ends, various oral phenomena may occur:
snoring, gasping, choking, grunting and teeth grinding. 








4 thoughts on “A VICIOUS CYCLE: Sleep Apnea, Sleepiness, Anxiety, Caffeine and Bruxism

  1. I have to say last night is the third time my life I woke up choking and gasping for air. It is so scary. It took almost 30 sec for me to catch my breath. I wondered if that was sleep apnea. I usually don’t sleep on my back but when this has happened I was on my back. The end of your forum made me question this.

    Sent from Elicia


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