Dr. Vetter received her formal training in dental sleep medicine by completing a Sleep Medicine Mini Residency at UCLA in 2016. This mini-residency program is one of only a few literature review, case study, and clinically based programs in the country. She has continued to explore sleep medicine and how it relates to dentistry over the past years furthering her education at the Spears Institute of Learning in Scottsdale Arizona. Dr. Vetter is currently using the Seattle Protocol to evaluate sleep quality and design the sleep solution that is right for her patients. She has treated patients with mild to moderate obstructive sleep apnea who cannot tolerate the CPAP very successfully with oral sleep appliances. For those patients with severe sleep apnea and who refuse to wear the CPAP there has also been some success with the right oral appliances.
Sleep Quality is a huge factor in overall health. By using the Seattle Protocol Dr. Vetter can evaluate sleep and partner with specialists to get her patients the help they need to enjoy a healthy life.
Three common types of sleep disruptions Dr. Vetter sees are:
- Upper Airway Resistance Syndrome (UARS)
- Obstructive sleep apnea (OSA)
Snoring the sound created when air flows past relaxed or loose tissues in the throat, which causes the tissues to vibrate and thus creates an irritating sound. Snoring is an indication that some type of resistance is occurring in the upper respiratory system.
Upper Airway Resistance Syndrome (UARS) occurs when the breathing effort crosses over from just being harmless snoring to a possibly troublesome disorder.
Obstructive sleep apnea (OSA) is believed to be a progressive disorder that causes breathing to repeatedly stop and start during sleep. This occurs when your throat muscles intermittently relax and block your airway during sleep. A noticeable sign of obstructive sleep apnea is snoring..
Common symptoms of sleep apnea include:Loud snoring
Observed episodes of stopped breathing during sleep
Abrupt awakenings accompanied by gasping or choking
Awakening with a dry mouth or sore throat
Difficulty concentrating during the day
Experiencing mood changes, such as depression or irritability
High blood pressure
Common symptoms of UARSFrequent nocturnal awakenings Difficulty going to sleep/maintaining sleep Chronic insomnia Daytime Sleepiness Unrefreshing Sleep Cognitive Impairment Depressive mood Attention deficit disorder Lack of concentration Limited physical performance
Causes of UARS
- Causes of UARS are similar to OSA. It can be caused by a naturally narrowed air passage, loose fatty tissues of the throat collapsing back into the airway, or the position of the tongue (falling back) during sleep.
- Patients with UARS require a greater effort in breathing to get past obstructions. Not all patients with UARS snore, and their symptoms may sound more like heavy, labored breathing during sleep. Sufferers of UARS often describe their breathing effort as "trying to breathe through a straw".
- Similar to OSA, the brain has to arouse itself from deeper stages of sleep to increase respiratory effort. When the brain is constantly being aroused from the deeper stages of sleep, it's not able to perform other important tasks that it needs to complete so that you can feel refreshed in the morning. This can lead to symptoms of chronic fatigue and excessive daytime sleepiness, which are also present in obstructive sleep apnea.
- Patients can move from snoring to UARS as a result of aging (as muscle tone decreases in the throat) and weight gain (increase of fatty tissues in the throat, which can increase material resistant to airflow). Women in their third trimester of pregnancy are also more likely to develop UARS as a result of weight gain.
What is the difference between UARS and OSA?
One of the key differences between upper airway resistance syndrome and obstructive sleep apnea is that apneas (pauses in breathing) and hypopneas (decreases in breathing) are either absent or very low in patients with UARS.
Patients with OSA are often overweight or obese (although they can be of normal weight), whereas patients with UARS are often of average weight.
Obstructive sleep apnea is related to many more long-term health conditions as a result of apneas and hypopneas due to the decrease in blood pressure during apnea/hypopnea events, which can lead to increased risk of high blood pressure, heart disease, heart arrhythmias, stroke, and heart failure. Patients who fail to treat UARS can end up developing OSA and find themselves at risk for many of these health problems
*It is important to figure out what is the cause of the sleep disruption so that the proper treatment can be done. Many sleep problems will manifest in clinical dental signs such as worn teeth and a scalloped tongue. If you have been diagnosed with obstructive sleep apnea (OSA), suffer from excessive sleepiness and lack of energy, habitually snore, or are unclear if you suffer from OSA, call Dr. Vetter's Office to schedule a sleep consultation and screening. 949-248-5205