Ask HN: Has anyone fixed their own bruxism?
I’ve clenched my teeth for 9-10 years. It either happened from a bike accident hurting my left jaw, wisdom teeth extraction, or stress from starting a business. All three happened pretty near together. It is not malocclusion, dentist ruled that out.
I clench. No longer damaging my teeth as I have a guard. But I still have tight masseters and neck pain.
I would like to eliminate or reduce the habit. Has anyone succeeded in doing so?
232 comments
[ 79.1 ms ] story [ 3612 ms ] thread1) Physical source
The source could be physical, so you should go to an orthodontist to get a professional perspective. I've heard of people doing a minor surgery to solve the problem.
2) Emotional source
The source could also be emotional, as you mentioned. Then, you should seek professional help (from a therapist) to learn how to deal with the stress you are feeling. This could mean simply rewiring how you deal with stress, exercising more often or take medicine.
Sometimes, you simply need to pay attention to how physically tense you are due to work and try to relax your whole body.
I suffer from the bruxism as well and I got significantly better by going to therapy.
My stress seems to manifest mainly by muscle tension. I don’t really have what you would describe as anxious thoughts.
I’ve managed to reduce stress by focussing on my breathe, and relaxing certain muscles if I notice them tensing. This seems to happen when I’m deep in thought.
But I don’t really worry about things, have racing thoughts, or anything like that. Can therapy help this kind of situation?
It could help you answer:
- What I feel when I'm deep in thought?
- Why I manifest muscle tension in those periods?
I would give it a try for 3-4 months.
Dr David Burns (Cognitive Behavioural Therapist) talks about this in some of his Feeling Good podcast episodes, patients who say they don't have anxious thoughts. His position is that they do[1], but they aren't aware of them.
One of his ways to identify them, is to get the patient to identify a specific time or event when they were anxious and tense (e.g. walking into a meeting, etc.), and draw a cartoon character in the same situation with a thought bubble, and then has the patient come up with any reasons why somebody - anybody - in that same situation might possibly be feeling anxious about anything. They do.
"... and are you feeling any of those things?" "yes, that's exactly how I'm feeling".
He's described it at least twice in different episodes, as a very simple but effective way to dig out the thoughts people have, that they aren't aware of having.
[1] His approach to therapy is based on the idea that life events lead to thoughts which create moods; people who have unhelpful thoughts get stuck in unbalanced moods; methods to identify and change the thoughts is what changes moods and "cures" people.
a) having a softer pillow.
b) having a hard guard. Before that I had a gummy-like guard. According to the new dentist the was making the bruxism worse.
I have less pain. But I won't risk sleeping without it
Some of the principles involved in changing your posture (often involving which muscles are kept relaxed and which stretched) might very well apply to helping you relax your jaw muscles.
Well worth trying to cut it out completely for a few weeks.
It may be that you're well-informed already and it really is impractical, in which case I hope I didn't offend you. It's just that my impression is right now a lot of people are putting off treatment unnecessarily due to covid concerns.
https://news.ycombinator.com/item?id=23435964
The sleep test is definitely worth doing. However keep in mind that if they say you don't have it, then it doesn't mean you won't.
To find out why, see the "Jaws" book I mentioned in that thread.
Anecdote: I told my neighbor she had sleep apnea. She got a sleep test from Kaiser, and Kaiser told her she didn't have it. Two years later, her dentist recommended the mouth guard for bruxism.
Neither the dentist or Kaiser seem to understand that sleep apnea and bruxism are related. But it's obvious to me that she went untreated for 2 years and the symptom became worse.
And did you use pen + paper, or digital?
Note: If you get this brand, notice that the dosage is 2 pills/night.
[0] https://amazon.com/gp/product/B000BD0RT0/ref=ppx_yo_dt_b_sea...
I’ve had several night guards from dentists but chewed through them pretty quickly and it gets expensive.
Expect to spend over an hour getting it fitted just right, minimizing stress concentration points.
Well, two actually; one of the top and one on the bottom. It prevents the jaw from clenching at night.
Probably a bit of a stretch to pursue dental aligners to fix your bruxism, but hey!
I fixed my sleep apnea by sleeping with an oxymeter on. When breathing was obstructed, my blood oxygen dropped. The oxymeter beeped and woke me up. I changed positions, and went back to sleep, ultimately changing sleep habits to the point that I can get through most nights without awakening. I was able to avoid using a CPAP that way.
Perhaps a muscle tension sensing device, such as https://www.sparkfun.com/products/13723 could serve a similar function. Place the sensors on your jaw muscles while you sleep (may only need to be one of them) and if you clench, it beeps or buzzes and wakes you up. May take some inventiveness to integrate it with power and alert, and then to get it comfortable enough to sleep in. And you'd want to avoid any cords that could wrap around you.
It may not lead to a cure, but might give you an idea of what's going on when you clench at night.
I’m trying some electrode gel on the one I have. If that doesn’t work, I’ll look into the sensor you linked. The process you described is exactly what these devices do: biofeedback.
* grindcare: has studies, out of production
* bruxrelief: no consumer product yet. No biofeedback
* sleep guard: trying to get it to work
Uses 2 AAA batteries. Good for 3-4 nights.
If you can spend more, I'd suggest the wrist type. The fingertip can be a little uncomfortable being clamped to your finger all night.
This one does have an alarm: https://www.amazon.com/Wellue-Fingertip-Saturation-Batteries...
Presumably yes it would need support in WatchOS 7.
Would that still be true of a more expensive device, like the Apple Watch?
Was this a problem for you? I have a feeling a sleep medication would help with this but won't that interfere with the study?
At the end of the day, you will eventually fall asleep and hit deep sleep and they'll get the measurements they need.
No one sleeps well knowing they are being watched and hooked up to all those sensors. :)
It's possible that you're experiencing collapse in both areas; and it's also possible that neither device will work, depending on the severity of your sleep apnea; namely if you're overweight. I had "mild" sleep apnea that left me VERY fatigued because it was characterized by mild hypopneas (slight secessions in breathing) at an incredible frequency which stopped me from reaching REM throughout the night. The devices helped.
To ameliorate the situation completely I found a great doctor out of USC who ended up performing 4 procedures and 3 surgeries. I had my uvula cut, my tongue burned, my palate ablated, and a few other things. It was an incredible headache during the time but well worth it and now don't need a CPAP. Also worth mentioning that I had some gut dysbiosis at the time which can masquerade as sleep apnea. Good luck to you.
[0] https://www.amazon.com/Eliminator-Sleep-Custom-Bruxism-Mouth...
> This may sound crazy, but for those who can't tolerate a CPAP, an effective alternative is playing the didgeridoo.
They linked a study [1] that actually tested this and found it to be helpful.
0: https://news.ycombinator.com/item?id=23430332
1: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1360393/
0: https://pubmed.ncbi.nlm.nih.gov/12119224/
Long ago, I suspected it and was able to adjust by just sleeping on my side.
Then years later, I was having more trouble. I took the test and found I had mild sleep apnea and they gave me a machine to try.
I hated it and gave it back (looking back they gave me a terrible default setup and a huge facemask that most people immediately switch out)
My solution was to get a mouthguard. The way it works is it keeps your jaw aligned at night, so airway+tongue are less likely to obstruct your breathing. Just search for "boil and bite" type mouthguards on amazon, they're inexpensive and pretty easy to use.
What I found interesting during the mouthguard stage is that I probably have had bruxism all along. I have one part of the bone structure in my mouth that grew bigger possibly from clenching over the years.
In the end, that only worked well for maybe 6 months before I started noticing the trouble again, so I went for the cpap. I had to make it work and ended up working with a heated hose and the nasal pillow style nosepiece. I'm pretty good now. (one more piece of advice, keep it clean with alcohol and you'll be much better off)
I tried all sorts, from mouthguards to oximeter alarms, and nothing really helped, if anything, they generally worsened my sleep - I'm a light sleeper at the best of times.
A visit to the doctor revealed that I was pre-diabetic, and he advised that I shed some weight - I was 250lbs, and I brought myself down to 180lbs over about six months.
The sleep apnoea and bruxism both went away with the weight, and a decade on, haven't returned. I suspect that the additional weight was making my airway collapse in the night, and that would then result in me bruxing as I quietly asphyxiated in my sleep, before I'd wake up gasping in a puddle of sweat.
I had thought for the longest time that the root cause was stress, and that it was therefore untreatable without major lifestyle changes which weren't tenable at the time - but the stress went on for years after I lost the weight, without bruxing or apnoea. I suppose, at root, the stress was the cause, as I sure as hell comfort ate my way out of my misery and into size 40 jeans.
I do, once in a blue moon, still do the choke and grind routine, but it's usually only if I've gone to bed really quite drunk.
Obviously this isn't a one-size-fits-all solution, as sleep apnoea and bruxism can be brought about by any number of causes, but this was a solution for me, and might be for others who are in the same situation I was in.
I’m a grinder myself and my weight yo-yos between 200-250LB. My grinding is definitely related to weight. If my BMI is below 25%, the grinding stops. Pop back up and it starts again.
Stress plays a role in daytime clenching but it is far less when I’m in better shape.
These can work but feel pretty horrible to sleep with. If you can afford it, your dentist can make you a slim fit top guard that is far more comfortable. I wear one and it's 100% fixed my jaw tension and tooth grind damage problems.
There is also a new type of fitted double guard which holds your jaw slightly open to alleviate apnea. They're expensive but depending on your country's healthcare you may get a rebate if prescribed one after a sleep study.
If your finances/healthcare don't permit the above, I recommend trimming down the boil and bite guard with scissors, you don't need most of that plastic. It will still suck compared a proper dental guard.
I was lots more successful with humidified air. If you have a raw throat, or if you have a stuffed up nose, humidity will take care of it. Another way to help is to drink enough fluids.
Note that I turned down the default temperature and humidity.
As to the cleaning - you need to clean it anyway. Your exhalations do go down the tube backwards. When I first started using it I would get tired of cleaning and put it off and got a really bad head cold.
Sounds like you've managed to address the first issue, but without a sleep study it's impossible to say for sure whether you've addressed the second problem.
Most apneas typically occur during REM sleep, when muscle tone is at its lowest and airways are more likely to collapse. If you frequently wake up during REM (even if it's a micro-arousal), your sleep architecture is broken.
It boggles the mind that sleep apnea severity is diagnosed on number of events (AHI) without considering when those events occur. Maybe you have an AHI of 3, but if they all happen during 2 hours of REM, you basically wake up 24 times during REM, which sounds a lot worse than 3 events per hour.
Sauce: have sleep apnea, hate the machine, but have learned to live with it.
Learning how to use it is a lot of "fun" (expect to spend half of the day vomiting until you learn how to insert it properly), but afterwards it works like magic.
I would recommend to try it, and verify by oxymeter how it works.
The product itself seems like it's supposed to be malleable to adjust to the individual, which kind of makes the fitting session + workshop seem like rent seeking. Just give me an instruction booklet with FAQ and warnings.
If you have a friend who is a customer, he could (this is cheating) buy one for you (pretending it is a replacement for him), and explain to you how to use it. You save a lot of money, but the disadvantage is that it is not fitted for you. I am not sure what difference it makes.
So, if that is an option, I would recommend buying one via friend, testing it (with oxymeter), and if you are satisfied, follow the official channels (through Hungary). At the moment you are sure the solution works for you, I think it is worth the money, considering how costly and/or inconvenient are the alternative solutions. (Then you can do an extra test whether having the wire fitted for you is an improvement.)
(It would probably also make sense to take photos of the wire immediately after you buy, so that you can try making duplicates later when the original piece breaks or loses shape.)
Yes, the wires are custom shaped. (But they work even if you use a version shaped for someone else with similar head size. I don't know how much difference it makes compared to shaping specifically for you.)
I gave a muscle tension based anti bruxism device called GrindAlert a serious try perhaps a decade ago, and it didn't help me.
That's basically what your body already does natively, though.
It stops me from clenching because it makes it uncomfortable.
One set of botox injections into the masseter muscles completely solved this. About $250 (a cosmetic type procedure performed by doctor). It has never returned, it’s been about 3 years.
Finally, which sort of doctor do you go to specifically: I’m assuming they need to specialize a bit in botox for bruxism.
Interesting it lasted three years and counting, as botox doesn’t last that long. Presumably your body simply lost the habit. Also interesting about the x ray, I’ll ask my dentist or doctor.
Botox in the masseter makes your face longer and reduced the squareness of the jawline for cosmetic purposes. I don’t think it’s safe to keep on going back to do it repeatedly, as your jawbone strength and regrowth is maintainer by the compressive forces of chewing and biting.
In my case, I think it was 60/40 physical/mental. I got into a really bad feedback loop of thinking about the jaw and clenching. The botox made it hard to do that, and essentially I “forgot” the feedback loop.
The results were nearly instant; I’d think maybe 24 hours and it stopped.
The botox dose was so low it didn't have much effect on my jawline, but it did "reset" or "break" the clench-pressure-clench loop which you seem to also suffer from. I found that if I tried to clench my jaw, I couldn't impart the same force as before. The relief and improvement was almost instant. It was injected in about 5 places either side.
If you look up botox + TMJD or TMD you can find info on the medical aspects of botox in the masseter muscles.
I would definitely look at the pillow you use also, if it's too firm it will influence your jaw position when sleeping. I hope this helps you and others reading this!
Learning to sleep on my back was really important too - I used to roll over onto my stomach a bunch - get a sleep study done if you can
I have no idea if it's bullshit or not, but it's compelling. Would love to hear from anyone that has insight into this.
I've asked every type of dentist about it and had one x-ray it. They all say unless it's painful it's probably nothing and I'll be fine. Which technically i am but it's really annoying.
The only satisfying theory i got was the bone in the joint got chipped when it got injured. During the healing process it didn't grow back smoothly. So opening it to it's widest causes it pop like that.
Following the advice of randos has a good chance of damaging your health worse than it is already.
Not to make light of your situation, but this made me chuckle.
I think earlier in my programming career I suffered a lot of anxiety from imposter syndrome. Learning to let go of that gradually over time has me experiencing a lot less work related anxiety, but I can definitely relate to your experience.