Sleep is a fundamental component of our daily lives. A good night’s sleep allows your brain and body to slow down and engage in the process of recovery. Your body is able to repair cells and control its use of energy. However, for some individuals, the bliss of slumber can be interrupted by a rather painful and perplexing experience: biting their tongue during sleep.
This surprising phenomenon, known as nocturnal tongue biting, can leave individuals puzzled, uncomfortable and concerned for their health.
“Anybody who has ever bitten their tongue accidentally knows how extraordinarily painful it can be,” said John Comisi, DDS, an associate professor at the Medical University of South Carolina James B. Edwards College of Dental Medicine.
Dr. Comisi, who relocated to South Carolina after successfully practicing general dentistry in Ithaca, New York, for 35 years, knows on both a professional and personal level how debilitating sleep-related dental issues such as teeth grinding and tongue biting can be.
The tongue biting itself is a side effect of what’s going on,” Dr. Comisi explained. “It’s a symptom of an underlying potential problem.
“I suffer from sleep apnea myself,” Dr. Comisi remarked, referring to the sleep breathing disorder in which breathing repeatedly stops and starts throughout the night. “There is no single answer – you have to peel the onion back to find the clues.”
In clinics at MUSC, Dr. Comisi and his students evaluate patients who struggle with biting their tongues in their sleep. They examine patients for signs of a potential airway issue: a scalloped tongue, enlarged tongue size, overall wear patterns on teeth, breakage of tooth structure or an oversized uvula or tonsils.
“The tongue biting itself is a side effect of what’s going on,” Dr. Comisi explained. “It’s a symptom of an underlying potential problem.”
Many factors come into play when struggling with tongue biting. The issue could be related to malocclusion, neurologic in nature or a sign of sleep apnea.
To get to the heart of the matter, Dr. Comisi asks his patients a variety of questions about their nightly sleep patterns, which range from the straightforward (Do you snore?) to the surprising (How many times a night do you get up to go to the bathroom?).
“The heart has only so many beats, and if you’re running a race all night long, your heart continues to pump, your kidneys continue to function and your bladder continues to fill up,” Dr. Comisi clarified.
Because sleep disorders such as sleep apnea often go unseen, they often are left untreated, which can potentially take 12 to 15 years off an individual’s life span.
“This is a hiding-in-plain-sight disease,” Dr. Comisi shared. “It’s insidious and it’s an underlying problem that needs to be recognized.”
To treat this problem, Dr. Comisi works with an individual’s health care provider to personalize the patient’s treatment.
“Dentists come in after the patient has been diagnosed by a medical professional,” Dr. Comisi explained, emphasizing that while dentists can evaluate patients to determine treatment plans, they do so based on the physician’s diagnosis and recommendation. “I always have a referral from a physician who has done a sleep study and provided a letter of medical necessity.”
The treatment plan may come in the form of an oral appliance that often is personalized to fit the patient’s specific needs.
While devices such as CPAP – continuous positive airway pressure – machines, which use mild air pressure to keep breathing airways open during sleep, can be beneficial to many people, Dr. Comisi stated that normal devices may hide other underlying issues.
Tongue biting often is correlated with the tongue enlarging and pushing forward over time in the body’s attempt to open airways for more regular airflow. The dentist can evaluate to see which oral appliance will best address the issue of a swollen and tender tongue. Mouthguards are often effective because they open up the bite slightly and move the jaw forward slightly, relieving pressure on the jaw joint area and allowing the airway to open.
When it comes to the issue of tongue biting in your sleep, Dr. Comisi emphasized the importance of contacting your health care professionals.
“The occasional tongue biting is something that just happens,” Dr. Comisi said. “But if this is a constant traumatic injury, and the patient is not aware until they wake up and see the trauma, then there is a problem.”
For Dr. Comisi, communication is key: “With enough conversation, we should be able to find what the source of the problem is and eliminate it. The medical and dental profession is here to be of service to you. You are not alone; we are all here to help.”
By Catherine Kauffman