The Seattle Protocol – Tom’s Story

By: Dr. Elizabeth Eggert

How Did This Start?

Tom’s journey began in 2014 when he came to us as a new patient looking to improve his oral health and the appearance of his teeth. During his comprehensive exam, Dr. Elizabeth found the main areas of concern to be the excessive wear, erosion and fracturing of Tom’s teeth. Dr. Elizabeth recommended Tom go through the records process (you can learn more about the records process here) and based on the information gathered during that process, she recommended a full-mouth reconstruction to address his uneven bite and rebuild his broken teeth. Throughout the process of reconstruction, it became clear that the amount of force in Tom’s bite was putting too much pressure on even his temporary crowns, which resulted in the temporaries cracking or falling out on more than one occasion. Dr. Elizabeth was concerned that even after completing the full mouth reconstruction, Tom would have underlying issues. Given Tom’s other symptoms, including difficulty breathing through his nose, dry mouth and use of a CPAP machine, Dr. Elizabeth recommended Tom complete the Seattle Protocol to help address his airway patency.

Tom Before

What Was Involved?

The Seattle Protocol is a six-step process that helps patients with symptoms of sleep-disordered breathing and other conditions determine whether a compromised airway is contributing to their ailments. Each step builds upon the last, but patients don’t necessarily need to complete the entire process as the purpose of the protocol is to determine the phase that provides the best relief of symptoms. You can learn more about the Seattle Protocol and each of the steps here. Throughout the process, Tom noticed improvements in his symptoms such as dry mouth, decreased clenching and grinding, and less waking throughout the night.

What Have Tom’s Results Been?

After completing five of the six steps of the Seattle Protocol, Dr. Elizabeth fabricated a sleep appliance for Tom to continue to improve his airway patency, reduce his bruxism and help him sleep better. Tom has now been using his sleep appliance for over a month and says the results so far have been great! He’s noticed less clenching and jaw pain and experienced an overall improvement in his sleep. Tom said that going through the Seattle Protocol helped him better understand the connection between his sleep and airway issues and he appreciates Dr. Elizabeth’s thorough explanation and care throughout each stage.

Tom After

Google Review

What is the Seattle Protocol and How Does it Help Pinpoint Airway Obstructions?

By: Dr. Elizabeth Eggert

When a patient with symptoms of airway issues first comes into our office, we often recommend the Seattle Protocol. This six-step method helps us identify where the issue lies by pinpointing which jaw positioning alleviates our patient’s symptoms. This allows us to create a custom night appliance for our patient that opens up their airway and curbs any inflammation or damage to the teeth, jaws or soft tissue. It also helps ward off serious systemic issues like high blood pressure, stroke or heart attack.

Before you embark on the Seattle Protocol, we may suggest an at-home sleep quality screening device or a sleep study so we solidify our starting point.

Seattle Protocol Step 1: Nose Breathing and Mouth Taping

The first step in the Seattle Protocol is to gently train your body to breathe through your nose, not your mouth. Breathing through your mouth during sleep can lead to snoring and a dry mouth. The Seattle Protocol encourages nose breathing by adding a strip of paper tape vertically across the center of your lips. The light adhesive of the tape keeps your lips together but is easy and painless to remove.

Step 2: Temporary Splint for Lower Jaw and Mouth Taping

Once you’ve adjusted to the mouth taping, the second step of the protocol adds a temporary splint for your lower jaw while you sleep. Adding this splint increases the vertical dimension of your jaw and allows more airway space.

Step 3: Temporary Splint for Lower Jaw with Lower Jaw Pulled Forward and Mouth Taping

If adding the lower splint only isn’t giving you the restful sleep you deserve, we move onto the next stage of the protocol. In this step, we add an element that pulls your lower jaw forward. This realigns your jaw and increases your airway space not only vertically, but horizontally as well. This also can give your tongue more of the space it requires.

Step 4: Temporary Splint for Lower and Upper Jaw with Mouth Taping

With all steps of the Seattle Protocol, if you aren’t getting relief from the previous step, we move on. In this step, we remove the forward jaw posturing component and add a splint for your upper jaw. You then go to sleep with splints on your upper and lower teeth and your jaw is free to move. This stage allows for additional vertical height, opening up your airway, but without restricting the jaw muscles into any one strict position.

Step 5: Temporary Splint for Lower and Upper Jaw with Lower Jaw Pulled Forward and Mouth Taping

If you need to continue in the protocol, step five again adds a horizontal component by linking the upper and lower splints together and moving the lower jaw forward. The intent, as always, is to continue to open your airway more and more.

Step 6: Temporary Splint for Lower and Upper Jaw with Lower Jaw Progressively Pulled Forward and Mouth Taping

If you still aren’t getting that good night’s sleep, we move to the final stage of the Seattle Protocol. In this stage, we keep moving your lower jaw forward, incrementally, until you feel well-rested.

In summary, after the initial two weeks of nasal breathing therapy and sleeping for 2-3 nights with each temporary night guard, once you experience relief of symptoms, we stop the protocol. This helps us identify which splint appliance/positioning alleviates the airway obstruction and allows us to fabricate your custom night appliance.

The further you progress through the steps in the protocol, the more severe your obstruction. If you progress into steps 4, 5 or 6, we may discuss the possibility of oral surgery to help you achieve optimal results.

If you’re concerned that you or your loved ones are dealing with sleep-disordered breathing, schedule an appointment with Dr. Elizabeth or Dr. Jeff by calling our office at 651.482.8412. Both Dr. Elizabeth and Dr. Jeff have the knowledge and experience to walk you through the Seattle Protocol and the best next steps.

Your healthy future starts today.

 

Confused by the Process? Learn How Sleep Apnea is Diagnosed

By Dr. Elizabeth Eggert

Do you deal with snoring, gasping for air in your sleep, a dry mouth, headache in the morning or daytime fatigue? Sleep apnea could be the culprit. It’s important to begin by making an appointment with Dr. Elizabeth or Dr. Jeff as well as with your primary care physician. Sleep apnea can be life-threatening and should always be carefully investigated.

The first time we see you for sleep apnea symptoms, we will perform an assessment for signs of structural abnormalities or any physical issues that could be contributing to airway obstruction. This could include an enlarged tongue or tonsils, a small jaw or a large neck.

If your primary care doctor is concerned that sleep apnea is an issue for you, they will refer you to a sleep specialist. A board-certified sleep specialist will evaluate you by performing an overnight sleep study. This will give them more insight into the severity of the situation and help them determine the best course of treatment.

There are two different types of sleep studies your sleep specialist may recommend: a polysomnogram test or a home sleep apnea test.

Polysomnogram test:

A polysomnogram test is a sleep study, performed in a sleep lab, that helps diagnose sleep-related conditions.

During your night at the sleep lab, you will be hooked up to equipment that will monitor your heart, lungs and breathing patterns, brain, general movement and oxygen levels while you sleep. In some cases, your sleep specialist will let you sleep all night long. If your physician detects signs of sleep apnea, they will more than likely wake you up in the night and hook you up to continuous positive airway pressure, or CPAP. A CPAP machine has a mask that covers the nose and/or mouth, that is connected to a tube and the base of the machine and that delivers continuous air pressure all night long, allowing the airway to remain open.

When your sleep specialist tests the CPAP machine on you, they will watch how it improves your airway obstruction and will calibrate it for your specific needs.

Home sleep apnea test:

In some cases, your sleep specialist will give you an at-home sleep apnea test kit that monitors and tests breathing patterns and sleep disturbances. This can be a good solution for individuals who find the polysomnogram test cost-prohibitive or difficult to coordinate. However, if sleep apnea is suspected from the results of your home test, your doctor may still recommend a visit to the sleep lab for further testing.

After you receive your results from your sleep specialist, if they indicate the presence of sleep apnea, we recommend you contact our office to set up another appointment. At this appointment, Dr. Elizabeth or Dr. Jeff will walk you through our records process.

During this comprehensive analysis, they will determine if a sleep apnea appliance would help alleviate your symptoms of sleep apnea. If they decide it would be helpful, Dr. Elizabeth or Dr. Jeff will confer with your general practitioner, sleep physician and lab to design a sleep apnea appliance, custom fit for you, that supports your jaw in the position that best improves your airway, often a forward position.

We may also recommend that you adjust your sleeping positioning or we may refer you to an orthodontist for another consultation if we believe that braces or other orthodontic treatment could help better keep your airway open.

If you’re experiencing sleep apnea symptoms, reach out to us at 651.482.8412 to make an appointment with Dr. Elizabeth or Dr. Jeff. They will perform a thorough assessment and collaborate with your other physician(s) to find the best treatment plan for you.