Teeth Grinding at Night: Is It Just Stress, or Could Your Airway Be Involved?
Waking with jaw ache? Morning headaches? A partner who hears you grinding all night?
Teeth grinding, or bruxism, is something I see regularly in practice. For many people, stress is the first explanation that comes to mind. And it can certainly be part of the picture. But as an airway-focused dentist, I don't think it's the only question worth asking.
The more important question is often: "Why are you grinding, and could your breathing or sleep be part of the reason?"
Bruxism is widely understood to be multifactorial, meaning several things may be contributing at the same time: stress, sleep disorders, certain medications, lifestyle habits, and breathing and airway function.¹ So while stress matters, focusing on it alone might mean missing other pieces of the puzzle.
Are you stuck in sympathetic drive?
You may have heard of the fight-or-flight response. That's your sympathetic nervous system. When you're in sympathetic drive, your body is on high alert: heart rate up, muscles tense, breathing shallow and fast. Useful in short bursts, but when it becomes a constant state, it takes a toll.
Many of the patients I see are living in sympathetic overdrive without realising it. It's been their normal for so long that they've forgotten what it feels like to truly rest.
Here's the connection to grinding: sleep bruxism is linked to microarousals, brief awakenings or shifts in brain activity during sleep. These are associated with activation of the autonomic nervous system, the same system that controls your fight-or-flight response.² So when your body spends the day in overdrive, your sleep becomes fragmented too. And your jaw muscles, already primed by that heightened activity, respond by clenching or grinding.
Hypercapnia: could CO2 be part of the picture?
When you breathe, your body takes in oxygen and produces CO2 as a waste product. Normally, your breathing keeps CO2 levels in a healthy range.
But if your airway is compromised during sleep, CO2 can start to build up. This is called hypercapnia. Your brain monitors CO2 continuously, and when levels rise, it triggers an arousal response to restore breathing. You may not fully wake up, but your sleep is disrupted, and those disruptions can set off the muscle activity that leads to grinding.
Think of it as a chain reaction: restricted airway, CO2 buildup, arousal, grinding. Your teeth are at the end of it.
This doesn't mean hypercapnia causes all bruxism. But it helps explain why breathing and grinding can be connected.
Recessed and compressed
When I talk about airway health, I often use two words: recessed and compressed.
"Recessed" refers to jaw position. If your lower jaw sits further back than ideal, there's less space for your tongue and your airway. The tongue needs room to rest in the palate. When the jaw is recessed, the tongue may sit further back in the throat, narrowing the airway.
"Compressed" refers to the airway itself. When the structures around it are crowded, the airway becomes compressed. You might not notice this during the day, but when you fall asleep and your muscles relax, that compressed airway becomes more vulnerable to narrowing or collapse.
The wear on your enamel might be the most visible sign, but the underlying story could involve jaw position, tongue posture, airway space, and how these interact during sleep.
What does the research say?
A scoping review found that concomitant sleep bruxism and OSA occurred in approximately 39% of adults and 26% of children, though most adult studies found no statistically significant association.³ In children, an association appears more plausible.³
One large-scale polysomnographic study found that approximately 50% of adults with OSA had comorbid sleep bruxism.⁴
This doesn't prove grinding causes sleep apnoea, or vice versa. But when grinding is present alongside snoring, mouth breathing, dry mouth, morning headaches or unrefreshing sleep, the airway is worth considering.
What I look for
During an Airway & Myofunctional Assessment, I look at breathing patterns, tongue posture and function, lip seal, swallowing, jaw and TMJ function, bite and dental development, oral muscle tension, and sleep-related signs.
Depending on your findings, your plan may include myofunctional techniques, breathing retraining, addressing muscular tension and jaw function, appliances, or collaboration with other healthcare professionals. Assessment comes before treatment.
When should you seek help?
Consider seeking advice if you experience persistent grinding, tooth wear or sensitivity, jaw pain, morning headaches, snoring or breathing pauses, dry mouth on waking, unrefreshing sleep, or feeling constantly in fight-or-flight mode. If you witness significant breathing pauses during sleep, seek medical advice promptly.
See the whole picture
Teeth grinding is rarely just about the teeth. And it's rarely just about stress.
If your body has been stuck in sympathetic overdrive, if your jaw is recessed, if your airway is compressed, and if your sleep is fragmented because of it, grinding might be your body's way of telling you something isn't right.
The aim isn't to blame everything on the airway. It's to connect the dots.
Take the next step: Book an Airway & Myofunctional Assessment or Discovery Call.
Dr JJ | Airway-Focused Dentist
Camberley, Surrey • Berkshire • Hampshire
References
Wieckiewicz M, Paradowska-Stolarz A, Wieckiewicz W. Psychosocial aspects of bruxism: The most paramount factor influencing teeth grinding. Biomed Res Int. 2014;2014:469187. Available at: https://doi.org/10.1155/2014/469187
Lal S, Sankari A, Weber KK. Bruxism Management. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024. Available at: https://www.ncbi.nlm.nih.gov/books/NBK482466/
Pauletto P, Polmann H, Réus JC, et al. Sleep bruxism and obstructive sleep apnea: association, causality or spurious finding? A scoping review. Sleep. 2022;45(7):zsac073. Available at: https://doi.org/10.1093/sleep/zsac073
Li D, Kuang B, Lobbezoo F, de Vries N, Hilgevoord A, Aarab G. Sleep bruxism is highly prevalent in adults with obstructive sleep apnea: a large-scale polysomnographic study. J Clin Sleep Med. 2023;19(3):443–451. Available at: https://doi.org/10.5664/jcsm.10454
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