Sleep, Weight, And The Airway Link

How Does Weight And Lifestyle Impact Airway Health?

Rethink the story you’ve heard about sleep apnea and weight. We unpack why airway size and breathing mechanics often spark sleep problems first, and how disrupted deep sleep then reshapes hormones, hunger, and metabolism. Drawing on research in Chest and insights from airway-focused dentistry, we explain why facial growth and jaw position can predict risk more powerfully than BMI—and what that means for both prevention and treatment.

We walk through the physiology of N3 sleep and the hypothalamus’ nightly pulses that regulate growth hormone, insulin, and glucagon. When airflow is limited, those pulses falter, cravings surge, and inflammation rises. You’ll hear how reactive oxygen species, cytokines, and sympathetic overdrive keep the body in a stressed state that nudges weight gain, even when you exercise and try to “eat clean.” We also get practical: nasal breathing basics, lifestyle levers that reset the autonomic nervous system, and how whole-food antioxidants support recovery while you fix the real problem—airflow.

We don’t stop at adults. Kids rarely start life overweight, yet mouth breathing, snoring, and restless nights can appear early and push BMI up over time. We outline red flags to watch for and how early airway-focused care can guide healthier facial growth and better sleep for life. Along the way, we discuss the role of weight loss in reducing tongue-base fat, where CPAP, oral appliances, and surgical options fit, and why timing and necessity matter.

If you’ve hit a wall with diets or feel chained to a mask without a plan, this conversation offers a clearer path: start with the airway, protect deep sleep, and let metabolism follow. If the ideas resonate, subscribe, share with someone who snores, and leave a review to help others find the show.

To learn more about Dr. Mark A. Cruz, DDS. visit:
https://www.MarkACruzdds.com
Dr. Mark A. Cruz, DDS. 
32241 Crown Valley Pkwy #200  
Dana Point, CA 92629  
949-661-1006 

Transcript

Welcome And Show Setup

SPEAKER_00 0:03

Welcome to Airway Focused Dentistry with Dr. Mark A. Cruz, the show where better breathing leads to better living. If your nights sound like a lawnmower chorus or your energy stuck on low battery, you're in the right place. Hosted by Dr. Mark A. Cruz, we explore how the airway impacts your sleep, your health, and your smile. So you can breathe, sleep, and be well. Take a deep breath, and let's get started.

Do Weight And Habits Drive Airway

SPEAKER_01 0:32

Airway problems don't always need surgery, but when they do, timing and necessity are critical. Welcome everyone. I'm Julie Schwenzer, co-host and producer in the studio with Dr. Mark A. Cruz. Dr. Cruz, thank you for joining us.

SPEAKER_02 0:46

Oh, it's my pleasure. Thank you, Julie.

SPEAKER_01 0:48

It's always fun to chat with you because you go really deep into the um content and we learn so much from you. So we could jump right into this one. Sure.

SPEAKER_02 0:59

Sure.

SPEAKER_01 1:00

How does weight and lifestyle impact airway health?

Rethinking Obesity As Effect Not Cause

SPEAKER_02 1:04

Yeah, so the orthodox way of thinking it is the way the physician, seat physician, pulmonologist would focus on is that the weight gain, like if you're obese, that is highly associated with uh sleep disorder bringing the obstructive sleep apnea. Therefore, it's really that increased body mass index or BMI or obesity that's really causing the problem. And I will argue, based on understanding the evidence in the physiology, that it's actually a product or consequence of the sleep disorder breathing, not the other way around. And I'm not making this up because the data is actually very clear about that, but it's been largely ignored. So giants in sleep medicine, like Kristen Guimano, has written about it and talked about it. And if we understand that the problem may start, the risk for the problem may start as early as at birth. He would say that children are rarely born fat. And yet you can end up having pediatric sleep apnea and then eventually have weight gain. So you could even start seeing this at four or five years of age where the body mass index of the kid is starting to increase. But certainly uh after that, uh in the teens, twenties, thirties, et cetera, et

Facial Structure As Major Risk Factor

SPEAKER_02 2:32

cetera. There was a study that was published in 2004, that was a group of pulmonologists, see physicians. It's published in the journal called Chest, which is the official journal for that specialty, where they actually looked at this question. And what they looked at is they looked at a group of males, 205 males, that all were within the spectrum of sleep disorders, from just snoring all the way to end stage severe obstructive sleep apnea. And they looked at the factors of body mass index, and they looked at the facial skeleton, and mostly what they were looking at, you know, males that were low to normal body mass index. And one of the main conclusions from the study was that the projection of the facial skeleton from the skull base was a major risk factor in comparison to obstructive sleep apnea. In fact, what they found using a very specific measurement that quantified the projection of the downward and forward growth of the facial skeleton, that if it was a certain measurement or below that measurement, the risk for acquiring a sleep disorder was five to seven fold greater than an individual that was obese, with that same measurement being above that threshold. In other words, obesity was less than half of the risk factor in comparison to how the facial skeleton was configured. In other words, the size of the airway. And so that's been uh pretty well documented. We know that um uh that that's very integral. And why growth and development's important. I think in another podcast we talked about, and I showed some facial skeletons to show the difference between uh optimal versus suboptimal, and the optimal also looks more aesthetic.

Stress, Metabolism, And Poor Sleep

SPEAKER_02 4:45

Um the other interesting thing is that that um we have to understand that weight gain very often is a stress response. So the body is in a stress, stress situation. I'm not talking about necessarily emotional stress, because that's what we think about, like your boss, your spouse, the traffic, your to-dos, your job, et cetera. Yeah, those are psychological stresses. Well, I just call that life, right? We're all in the situation of a hectic lies. But the part that's ignored is the physiologic stress, especially as it pertains to breathing. So our bodies will become stressed if there's limitation in flow. Like just think of the next time you have a cold and you can't breathe through your nose, you just don't feel well, you think it's okay, generalizes because I'm sick. But when you start thinking about it, it has to do a lot with the breathing and it upregulates the fight or flight response. So you're just burning a lot of energy, and the body's saying, metabolically, we're going into stressful times, therefore hold on to fat. And that's an evolutionary um adaptive response. And so if you're sleeping with uh if your sleep is poor, then uh it can uh turn into this chronic stressor.

Deep Sleep Hormones And Weight

SPEAKER_02 6:15

The the other thing to keep in mind is that metabolic regulation occurs during uh mostly uh most importantly uh during sleep three to five times in the night during deep, deep, deep sleep. Um it's called N3 sleep. So it would be it would be something like um uh right before you go into REM sleep, your your your hypothalamus, which is a structure in the brain, it releases the growth hormones and regulates glucocon and insulin, which are the major um metabolic hormones, if you will. It also regulates growth hormone, estrogen, testosterone, so the sex hormones as well. And that's in spurts of seven to nine minutes throughout the night, three to five times. If you're not getting that deep, deep sleep, which you're not, if you're doing a lot of snoring and uh you have obstructive sleep apnea or even upper aerosistant syndrome, your hypothalamus cannot regulate metabolically. Added to the fact that you also have this chronic low state um state of chronic stress, it will stimulate holding on to uh to the fat. So it starts affecting the ghrelin and uh the um the the other uh uh other other factors that are involved in fat metabolism, if you will. Uh leptin, ghrelin, and we're not getting into the the details. So um it's super important when and I treat patients like that. They'll uh I'll I'll even say like a kid coming in here, poor poor quality of sleep, they're starting to gain weight, and I'll

Cravings, Brain Fuel, And GLP Drugs

SPEAKER_02 8:07

tell the parents, just wait, wait till he's getting really good deep sleep, and that that weight will naturally go away. And think about it also, if you're in a chronic stressed situation, you get stimulated to eat a lot. You're snacking, you're constantly, and the reason for that is metabolically you're burning fuel very fast. And the brain takes up um 20% of that caloric intake, even though it's a fraction of the rest of the body, it disproportionately requires more caloric intake. And so you're ruminating, you're thinking, and so you're eating, you're snacking, and so you're feeding the brain, because the brain is not gonna say, well, eat a celery stock and I'll wait till the sugar comes out of that from digestion. It's gonna say, no, I'm not, I need that sugar now, simple carbohydrates. And so you're feeding it. It's a donut, it's you know, it's a bagel and et cetera, et cetera. So you do that day in and day out, slowly but surely you start getting heavier. Even if you're exercising, people exercise, it's just like they hit the wall, they can never get their weight down. And it's all has to do with uh metabolic processes. And of course, the GLP uh family of drugs are kind of a workaround pharmacologically to get around those metabolic pathways. I say that's cheating. Okay, it could work and it's got its indications, but if we could get the body to function the way it's supposed to metabolically, diets are really unnecessary. You're just metabolizing.

Weight, Inflammation, And Airway Crowding

SPEAKER_02 9:51

Of course, you know, you want to be careful when eating whole whole foods, et cetera, et cetera. That's always great. But um I think it gets overplayed. Let's just get our bodies to function the way they're meant to. And sleep is critical. And of course, it's all about breathing. Breathing's the most important, brings the most important ingredient to metabolism, which is oxygen.

SPEAKER_01 10:13

Yeah, it seems like we're, you know, consistently in these podcasts are very informative, going back to how key it is to have good sleep and then go back to breathing and just being more aware of, you know, do we have an issue or not with our airway? This is uh really interesting.

SPEAKER_02 10:32

I always joke it's it's like called sleep-disordered breathing. I think actually it's the other way around. It's breathing disordered sleep. And there was data very early on suggesting that, that the sleep problem, now there are other what we call parasomnias that could be involved that are different, you know, narcolepsy and and uh sleepwalking, there are other things, right? That but just looking at generic uh sleep disorder breathing, it's mostly a breathing problem first. And that also was fleshed out by Kristen Guimino, Stephen Park, Stephen Stupak. These are two uh well-known ENTs that wrote a lot about this, that we kind of got things flipped around backwards. Uh, but that's just the way, and it's difficult. If you go to the average physician, sleep physician or pulmonologists, they're in their own orthodox world of this is the way I was trained, this is the way it is, and that's why that's it's it's kind of frustrating. And by the way, you have to wear this face mask the rest of your life to stay alive or to, and I think that's ridiculous.

SPEAKER_01 11:40

The Hannibal Lecter mask.

SPEAKER_02 11:41

Yeah, exactly. Snuffilophagus is what I call it.

SPEAKER_01 11:45

Yeah, yeah, the snuff alophagus. Um, so uh also just a quick question for you too, Dr. Cruz. What about just losing some weight? Let's say you improve always will help. It always helps the airway and any possible obstructions. What about inflammation? That seems to be a huge issue, too.

SPEAKER_02 12:06

Yeah, yeah. No question about it. Okay, so on the weight, I'm not saying don't lose the weight. Yeah, it definitely adds. It's I make a distinction between the fire and the fuel that feeds the fire. So it's the fuel that feeds the fire. So obviously, if you lose the weight. So for instance, we know that weight gain, especially in males and some to females, that there's uh prevalence

Oxidative Stress And Antioxidant Foods

SPEAKER_02 12:29

to fat deposition at the base of the tongue that affects the um the uh the airway. We also have a term when you look at a face, you could see a face that's fat. We call that facial obesity. That's also a sign. And what it does is that adipose tissue really crowds the airway. So it makes it more difficult to stay patent or open. So, yes, weight gain is certainly uh a problem. Regarding inflammation, that's it. That's where it all starts, is having uh flow limitation where you have this stress is super inflammatory. Fragmented sleep is super pro-inflammatory. Many studies, some David Gozal, well-known pediatrician, seat physician, has written a lot about it. You have without without uh bear with me that I'm throwing these terms out, but you have upregulation of IL6, TNF alpha, IL1B, IL16, high sensitivity C reactive proteins, these are all what are called cytokines. They're what actually uh a sign of the body is trying to solve a problem. Inflammation helps with healing, but you wouldn't have that inflammation if you didn't have the injury, right? So it's a it's a natural response to heal, but when it's chronic, uh, it creates a lot of downstream problems. So inflammation, it is all about inflammation. That's why when you're eating whole foods, leafy greens, vegetables, fruits, it act, there are a lot of antioxidants. So if you think about it, when you're breathing and you stop your breathing, like let's say with an apnea, then you have what's called reperfusion, a rush of oxygen coming in. What happens is it creates what are called reactive oxygen species. Essentially, they're called it's unpaired electrons. Unpaired electrons are very reactive and they they they destroy the surrounding tissue. We have an uh ample supply of antioxidant foods that give up that extra electron, it pairs it and it calms it down so it's non-reactive. So our diet really can help mitigate some of the inflammation. But um it would be best if we can just prevent the inflammation to begin with.

Lifestyle Levers: Move, Sleep, Eat

SPEAKER_01 14:57

And we talked also about lifestyle. Um, what about improving physical activity? Or what are some tips that you give patients who want to improve their airway health, you know, without having to go to possible surgery?

SPEAKER_02 15:11

Yeah, no question. Not not trying to sound like a broken record, everyone's heard it, but our bodies were designed evolutionarily to be stressed. Our bodies require that. And when I say stress, we're talking about the muscle pull on a bone. That's stress. So that keeps the bones healthy by exercising. The intake of oxygen, it establishes a reset in our autonomic nervous system as well. So, I mean, some very basic keys to longevity, even going beyond diet. But let's just talk about exercise. Also, been well documented. How much exercise a week would be a minimum, but you need to stress your body. Sleep is key. Respect sleep. That third of our life that nature invested in this state called sleep, we tend to ignore it. Super important. Um, not too much, just like overeating, oversleeping is also a problem. If you're oversleeping, obviously it's because you're not getting good sleep quality, um, is one way of thinking. And of course, the fuel that you feed your body. But if you're doing the first two, the food that your body craves is typically a healthier type of food. It's easier to eat healthy. So those three things are are super important. And yeah, epigenetically or lifestyle, that's super important. So very basic, but um hope hopefully that that can shed, reshed some light on something that we already know.

SPEAKER_01 16:47

Oh, thank you for that, Dr. Cruz. I'm excited to talk to you in our next episode because this is all helpful. And sometimes we need a reality check, you know.

SPEAKER_02 16:56

Yeah, yeah, absolutely. You need to repeat it, repeat it, and hear it. Uh it's that broken record. But yeah, thank you very much, Julie, again, as usual.

SPEAKER_01 17:04

Yeah, we appreciate your expertise and uh can't

Closing Thoughts And Resources

SPEAKER_01 17:07

wait for the next podcast. Thank you so much.

SPEAKER_02 17:09

Thank you. Take care.

SPEAKER_00 17:10

Bye. That's today's breath of fresh insight from airway focused dentistry with Dr. Mark A. Cruz. Remember, small changes in your airway can spark big changes in your life. Breathe, sleep, and be well. For more information, visit markacruzdf.com or call 949 661 1006. If this helped you, share the episode and maybe give your fellow a quieter night. See you next time.