OVERVIEW OF TONGUE BITING
Tongue biting during sleep is a common problem, especially for kids. All you will feel is a sudden pain on your tongue that might wake you up. Despite the lack of statistics on this topic, experts believe that everyone experiences tongue biting from time to time. The incidence is higher in people with concurrent medical conditions, such as seizures and facial muscle spasms. Unfortunately, and besides how benign this condition may seem, it could lead to several complications, including ulcers, oral infections, and scalloping of the tongue. In this article, we will cover everything you need to know about tongue biting during sleep, including its causes, treatment, and preventive measures.
THE CAUSES OF TONGUE BITING DURING SLEEP
There are numerous causes that trigger tongue biting in your sleep, including:
Bruxism
Teeth grinding (i.e., bruxism) is a condition characterized by recurrent grinding and clenching of the teeth . Patients with this condition may have one or both of the following subtypes:
- Awake bruxism (teeth grinding that occurs during the day)
- Sleep bruxism (teeth grinding that occurs during sleep)
Sleep bruxism (teeth grinding that occurs during sleep)
Interestingly, individuals who have sleep bruxism are far more likely to have coexisting sleep disorders, such as snoring, tongue biting, and sleep apnea (i.e., interruption/pauses of breathing).
In many cases, mild bruxism does not require any medical treatment. However, some patients experience severe forms of teeth grinding that precipitate other jaw disorders and headaches. The chronic nature of this condition can also compromise the structural integrity of teeth. Unfortunately, many people have bruxism without realizing it, as the initial signs and symptoms can be quite subtle. Over the years, researchers identified dozens of bruxism triggers, which may include:
Psychological distress and anxiety
People who are constantly going through psychological stress or those with anxious personalities are prone to develop teeth grinding even without realizing it (sleep bruxism).
Pharmacological drugs
Researchers identified several medications that lead to teeth grinding as a side effect. For instance, antidepressant medications, such as Selective Serotonin Reuptake Inhibitors (SSRIs) , are particularly associated with bruxism.
Some generic drugs that belong to this family include:
- Fluoxetine
- Sertraline
- Paroxetine
Sleep disorders
Bruxism is more likely to occur in people who also have sleep disorders (e.g., obstructive sleep apnea, snoring).
More risk factors related to sleep include:
- Talking during sleep
- Jerky movements during sleep
- Sleep paralysis – a temporary inability to move your muscles or speak
- Recurrent hallucinations
Other triggers
This category does not necessarily include the conditions that cause bruxism, as many of the factors listed below can exacerbate a preexisting condition.
- Excessive alcohol consumption
- Smoking
- Recreational drugs (e.g., ecstasy, cocaine)
- Binging on caffeinated beverages (e.g., coffee, tea)
THE SIGNS AND SYMPTOMS OF TEETH GRINDING
Contrary to popular belief, the vast majority of people with teeth grinding are not consciously aware of this habit . Consequently, many patients present to the dentist’s office with complaints that seem unrelated to bruxism.
Here’s a breakdown of the most common signs and symptoms associated with bruxism:
- Tongue biting
- Headaches
- Jaw pain
- Ear pain
- Painful teeth (especially in the morning)
- Stiffness of the face and temples during the morning
- Difficulty chewing due to jaw pain
- Teeth Sensitivity to low and high temperatures
- Cracked tooth enamel
- Loose teeth
- Clenching teeth the jaw when stressed, anxious, angry, or concentrating
Facial muscle spasms
Facial and jaw muscle spasms can lead to tongue biting during sleep. The incidence of facial muscle spasms is especially high in children, causing the chin to tremble uncontrollably. When an episode of these spasms occurs, you will not be able to control the muscles of your jaw and face, which leads to tongue biting.
Illicit drug use
MDMA, also known as ecstasy, is an illegal drug that triggers an extreme feeling of euphoria. However, the drug also causes bruxism, which leads to tongue biting. Researchers believe that MDMA intensifies the desire to chew and bite. According to one study on rats , MDMA interferes with the ability to keep the jaws open, which causes bruxism.
Lyme disease
Lyme disease is a poorly understood infectious disease that presents with a variety of signs and symptoms. Unfortunately, when the infection is not treated promptly, it leads to abnormal reflexes and troubles with the central nervous system. Occasionally, this could precipitate tongue-biting episodes.
To suspect Lyme disease, your doctor may look for other typical symptoms, such as:
- Frequent diarrhea
- Vision changes
- FatigueSlurred speech
- Generalized pain and tingling
- Abnormal sensitivities to heat and cold
Rhythmic movement disorder
Rhythmic movement disorder occurs when a person is feeling drowsy or asleep. As a result, you may experience repeated body movements that produce humming sounds, banging your head, rolling. Rhythmic movement disorder is mainly present in children and often causes them to bite their tongues during sleep.
Sleep apnea
Obstructive sleep apnea (OSA) is a prevalent disorder that presents with brief and repeated pauses in breathing during sleep. The medical community states that these pauses should last for at least 10 seconds to qualify for this definition. The main defect in obstructive sleep apnea is laryngeal muscle failure, where the muscles of your throat are unable to keep the upper airway open, precipitating temporary apnea. OSA causes some serious complications when not treated properly, including heart disease, neurocognitive decline, and metabolic illnesses. Of course, OSA is also responsible for tongue biting during sleep. According to the National Sleep Foundation , approximately 18 million people from the United States deal with sleep apnea. However, the report also includes the other type of sleep apnea (i.e., central sleep apnea). You should keep in mind that millions of people have some form of sleep apnea but do not recognize it. In fact, some reports state that 80% of people who have sleep apnea did not receive the diagnosis yet. Today, the gold standard method to diagnose is to use polysomnography (PSG) , which measures different functions (e.g., respiratory frequency, heart rate, muscle movements) to pinpoint any abnormal breathing patterns.
Note that the procedure is very complex and requires spending a night or two in a specialized laboratory.
Several technology companies are utilizing their extensive resources to develop devices that are capable of spreading awareness and facilitating the diagnosis of OSA. These devices use cutting-edge technological features, such as big data, the internet of things, and artificial intelligence.
THE SIGNS AND SYMPTOMS OF TONGUE BITING DURING SLEEP
In some cases, tongue biting occurs without waking you up during the night. As a result, you won’t necessarily recognize what is happening. However, researchers pinpoint many signs and symptoms that indicate tongue biting, including:
- Tongue bleeding
- Edema (i.e., swelling) of the tongue
- Unusual redness of the tongue
- Pain during the next morning
- Cuts or marks of teeth on your tongue
- Ulcers on the tongue
- Scalloped raw edges on the tongue
The chart below demonstrates the frequency of tongue biting symptoms:
HOW TO STOP TONGUE BITING IN SLEEP - TREATMENT
To effectively treat tongue biting, you need to address the underlying issue.
For people who suffer from sleep apnea, multiple approaches can be viable, including:
- Wearing a mouth guard
- Losing weight
- Quitting smoking
- Undergoing surgery
- Using a CPAP machine
On the other hand, if illicit drugs are the reason you are biting your tongue, expect relief after stopping the drug. Note that some illicit drugs may cause physical and psychological dependence, which is why you may need the help of an addiction specialist.
Anti seizure medications are the best way to deal with nighttime seizures. Even if you do not have epilepsy, you may benefit from taking anti seizure medication if you often experience muscle spasms in the face and jaw. Of course, you need to speak with your physician before opting for any of these solutions.
Fortunately, the vast majority of children grow out of rhythmic movement disorder. However, if the symptoms of tongue biting are severe, speaking with a pediatrician might be necessary.
Finally, patients with Lyme disease should seek the help of their doctor as soon as possible to prevent irreversible complications. You will most likely receive a combination of antibiotics with symptomatic therapies to control the symptoms.
As for the injuries caused by tongue biting, they usually heal quickly without the need for any medical intervention. Albeit, some cases require the help of a healthcare professional, especially when an ulcer, excessive bleeding, laceration, or pus develops.
HOW TO STOP TONGUE BITING IN SLEEP - PREVENTION
If you underwent multiple episodes of tongue biting during your sleep, there are several ways to prevent this problem. While none of the methods we will cover will prevent tongue biting by 100%, they will undoubtedly reduce the number of episodes.
Sleep study
As with all other sleep disorders, sleep study in a specialized lab monitored by a sleep specialist is the optimal way to address tongue biting. The data collected from your time in the lab will allow the doctor to understand the triggers of tongue biting, as well as the possible measures to stop it.
In most cases, you will have to spend 1–2 nights in the sleep facility. During this time, your body will be connected to several devices that monitor your brainwave activity, muscle tone, eye movement, breathing rate, and heart rhythm.
Mouth guard
Mouth guards serve as occlusal splits that benefit patients with sleep bruxism and tongue biting. These tools create a cushioning effect between your teeth to stop them from grinding against each other or bite the tongue while you’re asleep.
You can get a custom-made mouthguard at the dentist’s office, which is designed specifically to meet your anatomical features and provide the most protective benefits.
Additionally, some standard forms are also commonly sold in different stores.
If you’ve been diagnosed with bruxism or recurrent tongue biting, you need to get a custom-made mouthguard to shield your tongue from damage and reduce the strain on the muscles and joints of the jaw. While the cost of custom-made mouth guards is more expensive than over-the-counter versions, they are definitely worth it.
Depending on the size and shape of your jaw, the dentist will design the mouthguard to fit your anatomy. As a result, you’ll find that custom-made mouth guards are way more comfortable than their store-bought counterparts.
According to one study, the maximum efficacy of mouth guards peaks after 2 weeks of use. In another study, researchers compared the effectiveness of gabapentin (a drug used for convulsions and neuropathic pain) with occlusal splints (i.e., mouth guards).
The results of the study showed similar effects on teeth grinding, and the authors concluded that “Both treatments significantly reduced the mean intensity of masseter muscle contractions during sleep bruxism episodes.”
Furthermore, studies confirmed the simultaneous effect of mouth guards on obstructive sleep apnea and tongue biting, which is especially beneficial for patients with both concurrent conditions.
As you can see, teeth grinding mouth guards are scientifically proven to help patients with bruxism and prevent tongue biting.
Reduce stress and anxiety
A key cause of tongue biting and bruxism is stress and anxiety .
The best way to prevent this issue is by practicing some anxiolytic activities, such as yoga, meditation, deep breathing, listening to music, exercises, et cetera.
Avoid taking illicit drugs
This one is straightforward. In order to stop tongue biting in your sleep, you simply need to avoid taking illicit drugs, such as MDMA. Researchers found a relationship between the frequency and doses of MDMA and the incidence of side effects.
Medications
If you are diagnosed with epilepsy and taking anti seizure medications, speak with your doctor about the best way to take these drugs to stop muscle spasms. You can also inform your physician about the episodes of tongue biting.
Some patients may still experience tongue biting even when trying their anti seizure medications correctly. In this case, it is better to consult a neurologist for a comprehensive management plan.
Takeaway message
Tongue biting is a common issue that often accompanies bruxism. How to stop tongue biting in your sleep is a multistep process that requires a plan to identify your risk factors and address them.
We hope that this article managed to shed some light on the necessary steps to stop tongue biting when you are asleep.
References
1-Benbadis, S. R., Wolgamuth, B. R., Goren, H., Brener, S., & Fouad-Tarazi, F. (1995). Value of tongue biting in the diagnosis of seizures. Archives of internal medicine, 155(21), 2346–2349.
2-Shetty, S., Pitti, V., Babu, C. S., Kumar, G. S., & Deepthi, B. C. (2010). Bruxism: a literature review. The Journal of Indian prosthodontic society, 10(3), 141-148.
3-Sutin, A. R., Terracciano, A., Ferrucci, L., & Costa Jr, P. T. (2010). Teeth grinding: is emotional stability related to bruxism?. Journal of research in personality, 44(3), 402-405.
4-Garrett, A. R., & Hawley, J. S. (2018). SSRI-associated bruxism: A systematic review of published case reports. Neurology: Clinical Practice, 8(2), 135-141.
5-Oksenberg, A., & Arons, E. (2002). Sleep bruxism related to obstructive sleep apnea: the effect of continuous positive airway pressure. Sleep medicine, 3(6), 513–515. https://doi.org/10.1016/s1389-9457(02)00130-2
6-Demjaha, G., Kapusevska, B., & Pejkovska-Shahpaska, B. (2019). Bruxism unconscious oral habit in everyday life. Open access Macedonian journal of medical sciences, 7(5), 876.
7-Arrue, A., Gómez, F. M., & Giralt, M. T. (2004). Effects of 3, 4‐methylenedioxymethamphetamine
(‘Ecstasy’) on the jaw‐opening reflex and on the α2‐adrenoceptors which regulate this reflex in the anesthetized rat. European journal of oral sciences, 112(2), 127-133.
8-Slowik, J. M., & Collen, J. F. (2017). Obstructive Sleep Apnea.
9-Lal, S. J., & Weber, K. K. (2020). Bruxism Management. StatPearls [Internet].
10-Huynh, N. T., Rompré, P. H., Montplaisir, J. Y., Manzini, C., Okura, K., & Lavigne, G. J. (2006). Comparison of various treatments for sleep bruxism using determinants of number needed to treat and effect size. The International journal of prosthodontics, 19(5), 435–441.
11-Dube, C., Rompre, P. H., Manzini, C., Guitard, F., De Grandmont, P., & Lavigne, G. J. (2004). Quantitative polygraphic controlled study on efficacy and safety of oral splint devices in tooth-grinding subjects. Journal of dental research, 83(5), 398-403.
12-Sadat Madani, A., Abdollahian, E., Azangoo Khiavi, H., Radvar, M., Foroughipour, M., Asadpour, H., & Hasanzadeh, N. (2013). The efficacy of gabapentin versus stabilization splint in management of sleep bruxism. Journal of Prosthodontics: Implant, Esthetic and Reconstructive Dentistry, 22(2), 126-131.
13-Landry, M. L., Rompré, P. H., Manzini, C., Guitard, F., De Grandmont, P., & Lavigne, G. J. (2006). Reduction of sleep bruxism using a mandibular advancement device: an experimental controlled study. International Journal of Prosthodontics, 19(6).
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