9) Biofeedback

Biofeedback is one of the two most direct pattern interrupts which many people find helpful in reducing or eliminating bruxism (the other being mouth guards). In biofeedback, the action of clenching activates a mechanism (either electronically or mechanically) that provides a sensory alert (usually audio). Some bruxism biofeedback instruments also provide a measurement of the level of clenching activity. One of the beauties of biofeedback is that it has the potential to bring awareness to a habitual behavior which we are not normally aware of. As we build awareness of a habit, we increase our ability to build a different pattern.

Biofeedback can be used either while awake (wakeful biofeedback) or while asleep (sleep biofeedback). There are potential benefits of wakeful biofeedback which are not available from sleep biofeedback, and there are potential benefits of sleep biofeedback which are not available from wakeful biofeedback, so both will be discussed below.

It is also useful to examine the very different psychologies between thinking of the biofeedback signal as a punishment, and thinking of the biofeedback signal as a friendly helpful reminder. We will examine both of these possibilities (and the benefits claimed by proponents of each) below.

Types of Biofeedback Instruments

Until recently, biofeedback instruments capable of detecting bruxism were all bench-type instruments, which cost thousands of dollars, plugged into the wall, sat on a tabletop, and connect it to the person being monitored through a wiring harness which essentially tethered the person being monitored to the instrument, and restricted movement. These types of instruments were typically used in sleep labs, and connecting to such instruments was typically uncomfortable enough that one might wonder if connecting to the instrument actually caused some of the undesirable behavior patterns which the instrument wound up measuring.

In recent years, two forms of self-contained battery-powered wearable bruxism biofeedback devices have become available. The price of these devices is only hundreds of dollars rather than thousands of dollars, and because these self-contained biofeedback instruments do not require the person wearing them to be tethered in any way, they can both be worn while doing daily activities, or while asleep.

The first type of self-contained biofeedback instrument is an electronic headband (worn like a runner’s headband) which electronically senses the electromyographic (EMG) signals given off by your jaw muscles as you clench. The unit works by giving off an audio tone when it detects that the person wearing it is clenching harder than a certain predetermined amount, which is user selectable. These units not only give an audio tone when you clench, but they also electronically count the number of times you clench, and the total amount of time you clench between the times you reset the unit.

The second type of self-contained bruxism biofeedback device has a portion which goes in the mouth, and a portion which attaches to the ear. The earpiece makes a sound when the person using the device clenches harder than a certain threshold on the mouth portion of the device. This type of device does not have any event clenching counter or timer in it, so it can’t be used to monitor the effectiveness of other treatments.

In choosing between a headband-type biofeedback device and end in-the-mouth type biofeedback device, one issue to consider is personal comfort. Some people don’t like to have something in their mouth (and as mentioned above in the mouthguard section having something in the mouth actually causes some people to clench or grind more). Also some people find that they can’t really close their lips around the plastic tube which connects the in-mouth biofeedback sensor to the earpiece (and thus, some people find the in-mouth type of biofeedback device causes them to drool all over their pillow). On the other hand, some people don’t mind having something in their mouth (and may even grind less when they have something in their mouth) but prefer not to have something around their head while sleeping.

The second basis on which to choose between these two types of self-contained biofeedback devices, is whether or not you want to use the device to measure your progress in kicking the bruxism habit (including measuring the effectiveness of other methods you are experimenting with to interrupt your clenching and grinding pattern). The in-mouth biofeedback device does not measure your progress by counting and timing clenching, while the headband-type biofeedback device does.

At the user’s option, it is also possible with the headband-type biofeedback device to turn the biofeedback tone off and just use the unit to measure how much clenching and grinding you do in a night. This allows this type of unit to be used to measure how effective other pattern interrupts are at reducing your particular habitual clenching and grinding pattern. Thus, these units may be used to measure how well you are responding to hypnosis, a particular type of mouthguard, changing to a different sleep surface, playing soothing sounds in your sleep environment, etc..

Waking Biofeedback

One of the advantages of using biofeedback while awake is that it may help you discover situations and circumstances under which you clench your teeth, where you did not previously know that such circumstances or situations led you to clench. This knowledge may allow you to specifically tailor psychological techniques such as hypnosis in a way which can more quickly reduce or eliminate your bruxism.

In examining the circumstances under which you find yourself clenching, it is useful not only to look at what is going on in your environment which you are responding to, but also to look at the specific thoughts and feelings you were having just before you began to clench.

The other major advantage of wakeful biofeedback is that while you are awake you can consciously intend and practice your response to the biofeedback signal. In addition, you can also consciously intend in practice the way you relate to the biofeedback signal. Let me explain what I mean by each of these.

Your choices on how you intend to relate to the biofeedback signal could be anything from relating to it as a punishment, to relating to it as a friendly reminder. In making this choice, consider which you tend to respond better to in life, and which you tend to cooperate better with. Many people find that if they relate to the waking biofeedback signal as a punishment, they just learn to sleep through it during sleep.

Your choices of how you respond to the biofeedback signal are as varied as you care to imagine. Some people find they get great results from training themselves to deeply and completely relax their face and jaw muscles in response to the biofeedback signal (or deeply and completely relax all the muscles in their entire body). Other people claim they get good results (meaning a good reduction in bruxism) by doing the deliberate action of getting up from wherever they are, going to a sink, and washing their hands. I’m not sure who first thought of this as a possible response to biofeedback, but it was used in one of the published dental studies.

Whatever way you train yourself to respond during wakeful biofeedback will carry over through Pavlovian conditioning and be very influential on the way you respond to sleep biofeedback. Thus, wakeful biofeedback can be used to make sleep biofeedback more effective.

Sleep Biofeedback

The main advantage of sleep biofeedback is that it has the potential to directly interrupt the habitual bruxism pattern you are trying to interrupt and give you a reminder to practice the alternative pattern that you are trying to introduce (for instance, relaxation).

Some people believe that more rapid progress is made with sleep biofeedback if the person is actually waked up in the biofeedback, while others believe that for many people, being waked up just leads to exhaustion and poor sleep.

The designers of the in-mouth biofeedback system seem to have gone in the “it’s preferable if you wake up” direction (by choosing to provide a loud and abrupt biofeedback audio signal). On the other hand, the designers of the headband-style self-contained biofeedback devices seem to have gone in the “it’s preferable if you don’t wake up” direction (by providing a biofeedback audio signal which comes on softly and then gets louder over a period of a couple of seconds), though special-order headband-type units are available with a more abrupt and loud audio tone for people who prefer that.

People’s ability to respond the way they intend to when they hear a biofeedback signal in their sleep seems to vary considerably from person to person. Some people find it easy to train their response, and are able to use sleep biofeedback to completely kick the bruxing habit in less than a month. These people tend to find that the sleep biofeedback gives them more restful sleep from the beginning. At the other end of the spectrum there are some people who are such light sleepers, that they find that any type of biofeedback during sleep just doesn’t work well for them.

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