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Sleep Disorders

Nocturnal Tongue `Stripping`

06/02/2009

Question:

I have not found my exact issue. I do not "bite" my tongue in sleep, but I wake up "dragging" or "stripping" my tongue between my not-quite-closed-teeth from back to front. That is, there is no up and down chewing, but a tightening down on the tongue then pulling the tongue back into the throat tight enough on the teeth to cause a deep "scratching," or "scraping" on all sides as the tongue sort of "flattens out" in the process. Even after it wakes me up I have to struggle with myself to stop doing it as there is a sick pleasure in the pain, and when I can not stop myself it usually goes on for a minute or two until the tongue gets too sore to continue. I take ambien and that is the only thing I do differently at night that I don`t do other times of day, and this practice only occurs while I am asleep. It occurs whether I drink in the evening or not, and no process of elimination seems to affect it. I do sleep with my mouth closed and breathe clearly through my nose. Any clues? Thanks

Answer:

Your description is quite interesting. It is true that you do not bite your tongue; however, I am not sure that there is a difference in the causes of your type of tongue “stripping” and the usual causes of tongue “biting.”

Three conditions may generally lead to tongue injury during sleep. These three conditions are nocturnal seizures, rhythmic movement disorder, and bruxism. I will go over each condition in more detail.

Seizures (especially generalized ones) are typically associated with erratic limb movements, and loss of bladder and bowel control. They are also followed by a period of confusion. However, seizures can be very quiet as in the case of “frontal lobe epilepsy.” And, a person may not loose consciousness during some types of seizures. Seizure-related movements are not usually under our control. In your case, the movements seem, at least partially, to be under your control.

Stereotyped movements of the head, trunk and extremities are considered undesirable if they interfere with sleep. Such activities have been well described in healthy children and are called “rhythmic movement disorder.” When severe, these repetitive movements may appear as head banging, body rocking or leg rolling and can result in injuries including fractures, and brain and eye injures. Although uncommon, repeated tongue injuries have also been described as a consequence of rhythmic movement disorders. These movements occur more often at sleep onset, which is opposite of what you have mention.

Bruxism is a tonic and rhythmic activity of the muscles responsible for chewing, during sleep. They may be accompanied by a loud and grating or clicking sound. Repeated tongue nibbling during sleep has been described in association with bruxism, but stripping movements have not been reported in the published medical literature.

Of the three possibilities described above, rhythmic movement disorder seems most likely. This needs to be confirmed and the other causes need to be ruled out before a treatment is recommended. Treatment options for rhythmic movement disorders and for bruxism include medications. If medications fail to stop tongue injury, a plate (also known as an oral appliance or mouth guard) that sits between the teeth can be designed by a dentist to prevent jaw closings while sleeping. If the tongue injury is related to seizures, this can be discovered by monitoring brain waves during sleep. Medications are usually prescribed for seizure disorders.

Due to the rarity of these conditions, the best course of action is a close examination of your mouth and teeth and probably a sleep study. 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 American Academy of Sleep Medicine website.

I wish you restful sleep.

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Response by:

Ziad  Shaman, MD Ziad Shaman, MD
Assistant Professor of Medicine
School of Medicine
Case Western Reserve University