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Sunday, May 19, 2013
Biting my tongue in sleep
I constantly bite my tongue while I sleep and its getting worse. It doesn`t happen every night, but 2 to 3 times a week. Can you tell me what should I do or what can be done?
Just like biting your tongue accidentally while awake, you may do the same during sleep. A disproportionately large tongue or a crowded or misaligned set of teeth can result in excess tongue injury during wakeful time, as well as during sleep. However, mainly three conditions can lead to tongue biting exclusively during sleep. These three conditions are nocturnal (nighttime) seizures, rhythmic movement disorder of sleep, and bruxism (also known as teeth grinding). I will go over each condition in more detail.
Seizures (especially generalized ones) are typically associated with erratic uncontrollable limb movements, and loss of bladder and bowel control. Frequently, with a generalized tonic-clonic seizure, tongue biting occurs. However, seizures can be very quiet as in the case of frontal lobe epilepsy. Seizures are usually followed by a period of confusion, also known as a “post-ictal” state. The usual way to diagnose a nocturnal seizure disorder is to perform prolonged brain wave monitoring along with a sleep study with simultaneous video recording. If a seizure disorder were to be diagnosed, treatment consists of controlling the seizure focus (usually with medications), and this will take care of the tongue biting. If tongue biting is your only nighttime symptom, I would suspect a seizure disorder to be less likely than the other potential causes.
Another type of undesired event that may occur during sleep is the stereotypical movements of the head, trunk and extremities. These activities have been well described in healthy children and are called rhythmic movement disorders. When severe, these repetitive movements may appear as head banging, body rocking or leg rolling and can rarely result in injuries including fractures, and brain and eye injures. Although uncommon, repeated tongue injuries have been described as a consequence of rhythmic movement disorders.
Bruxism is characterized by tonic and rhythmic activity of the masticatory (chewing) muscles that is accompanied by a loud and grating or clicking sound. Repeated tongue nibbling during sleep has been reported in association with bruxism.
For rhythmic movement disorders and for bruxism, medications may control the movement and therefore the injury. If medications fail to stop the tongue biting, an inter-dental plate that sits between the teeth can be designed by a dentist to prevent jaw closings during sleep, therefore preventing tongue injury.
Additional information, and an examination, will be needed to accurately diagnosis the cause of your problems. A close examination of your mouth and probably a sleep study are indicated as part of the evaluation. Please discuss this issue with your physician. A referral to a sleep specialist may be indicated based on the findings.
Additional information regarding sleep, and a listing of sleep centers near you, is available at the website of the American Academy of Sleep Medicine. I wish you best of luck.
Ziad Shaman, MD
Assistant Professor of Medicine
School of Medicine
Case Western Reserve University