What Is the Link Between Bruxism and Sleep Apnea?
Many people who grind their teeth at night also snore. Some also have obstructive sleep apnea (OSA), a condition in which the airway repeatedly narrows or closes during sleep. It is natural to wonder whether the two are connected, and whether treating one helps the other.
The honest answer is that they often overlap, they share some features, and researchers have not proven that one causes the other. That is why this page focuses on what you can do with the information: know the signs, ask the right questions, and make sure a night guard does not hide a breathing problem that needs a physician.
For general background on grinding, see our overview of bruxism. This page covers only the sleep apnea connection.
Sleep Bruxism vs. Awake Bruxism
An international expert group defines sleep bruxism and awake bruxism as muscle activities that occur during sleep and wakefulness. Sleep bruxism can be rhythmic or non-rhythmic. Awake bruxism involves repeated or sustained tooth contact, or bracing or thrusting of the jaw.[1]
The same group said that in otherwise healthy people, bruxism should not be treated as a disorder by default. It is better seen as a behavior that can be a risk factor for some problems, such as tooth wear or jaw pain, and sometimes a protective factor for others.[1]
This difference matters for the sleep apnea question. Awake bruxism happens while you are conscious and is often tied to stress or concentration. The sleep apnea link, if there is one, applies mainly to sleep bruxism, because both take place during sleep.
What the Evidence Shows About Sleep Bruxism and OSA
Studies disagree, and the quality of the research is often limited.
The Arousal Connection
During an apnea event, the brain briefly wakes the body to restart breathing. These micro-arousals can be followed by muscle activity, including jaw clenching. A systematic review of sleep-lab studies found that two of three studies showed grinding events often occurring during the micro-arousals that follow breathing pauses. The review concluded there were not enough data to define a clear causal link.[2]
A sleep-lab study of 110 adults found that 86% had OSA and 50% had sleep bruxism, and that the two commonly occurred together. Grinding episodes were more frequent in people with mild or moderate OSA than in people with severe OSA. The people in this study were referred for testing, so the numbers do not describe the general public.[4]
A Large Meta-Analysis Found No Clear Association
A 2024 systematic review and meta-analysis pooled 14 studies. The odds of sleep bruxism in people with OSA did not differ significantly from people without OSA, and they did not rise with OSA severity. The authors cautioned that the quality of most studies was low, and that the lack of a link may change with better research. They also said the results should not excuse clinicians from checking for both conditions.[3]
Put together, the research supports a cautious message. Sleep bruxism and OSA can occur in the same person and are worth screening for together, but grinding is not a reliable sign that you have sleep apnea, and a lack of grinding does not rule it out.
Why a Night Guard Alone May Not Be Enough
A night guard, also called an occlusal splint, is a plastic cover for the teeth. It protects enamel and can reduce strain on the jaw. It does not open the airway. If sleep apnea is present and untreated, a night guard leaves it untreated. You can read more in our guide to the dental night guard.
There is also a safety question. In a small randomized crossover study of 10 adults with OSA, average breathing events per hour were slightly higher on nights with a hard upper stabilization splint (17.4) than on nights without one (15.9). The authors concluded that a splint is associated with a risk of worsening OSA, but they also said the effect was small and of limited clinical importance.[5] The study was tiny, so it is a reason for care, not alarm.
The practical point is this. If you have signs of sleep apnea, get tested before or along with getting a night guard, and tell your dentist about any snoring or breathing pauses so that the right type of device is chosen.
Options When You Have Both Problems
Once a physician confirms OSA, the treatment plan is built around the airway first. The American Academy of Sleep Medicine and American Academy of Dental Sleep Medicine guideline supports oral appliances for adults with OSA who cannot tolerate CPAP or prefer another option, using a custom, adjustable device with follow-up by a qualified dentist.[7]
A mandibular advancement device does double duty in some cases. A small crossover study in 12 young adults with frequent sleep bruxism found that an adjustable advancement appliance reduced grinding episodes per hour by 39% to 47% in the short term. A standard mandibular splint reduced them by 34%, but that change was not statistically significant. The authors suggested it as an option for people with both grinding and breathing problems during sleep.[6] This study was short and small and did not test people with diagnosed OSA, so it does not prove that a sleep apnea device is a cure for grinding.
Which approach fits you depends on your sleep study results, your teeth, and your jaw joints. Your physician and dentist should decide together. For a broader look at grinding treatments, see our pages on sleep bruxism treatment and teeth grinding at night.
Screening Signs to Discuss With Your Doctor or Dentist
You cannot diagnose yourself, but you can notice patterns. Sleep apnea symptoms noted by the National Heart, Lung, and Blood Institute include snoring, gasping during sleep, and excessive daytime sleepiness.[9] Grinding signs are usually noticed by a partner or found by a dentist. Consider raising the issue if you have a combination of these.
- A partner hears grinding or clenching, and also hears loud snoring or pauses in breathing.
- You wake with a sore jaw, a dull headache, or a dry mouth.
- Your dentist sees flat, worn, or chipped teeth.
- You feel tired during the day even after a full night in bed.
- You gasp or choke at night, or wake up often.
- Your child grinds their teeth and also snores or breathes through the mouth. See our page on teeth grinding in children and ask your child's pediatrician about testing.
Who Diagnoses Sleep Apnea
A physician diagnoses OSA with a sleep study, either in a sleep lab (polysomnography) or with a home sleep apnea test.[7][9] A dentist can screen for risk and refer you. An orofacial pain specialist can evaluate grinding and jaw pain. Orofacial pain is one of the 12 dental specialties recognized by the ADA. Dental sleep medicine is not a recognized specialty.[8]
If you also have jaw pain, our page on TMJ and sleep apnea explains how those conditions overlap. Because jaw problems are common in people with bruxism, a review by an orofacial pain specialist may be helpful.
How to Find a Dentist Who Provides Oral Appliance Therapy
Get a diagnosis first. Ask your primary care doctor about a sleep study if you snore, gasp, or feel unrested. If you are diagnosed with OSA and want an oral appliance, ask your sleep physician for a prescription and a referral. Then look for a dentist who provides oral appliance therapy and has training in dental sleep medicine.
Use the MSD provider directory to find dentists and specialists near you. When you call, ask each office whether it provides oral appliances, how it handles grinding, and how it coordinates with your physician. Browse our list of dentists who provide oral appliance therapy, grouped by state.
Search Orofacial Pain Specialists in Your Area
