Dr. Cruz Discusses How Untreated Airway Issues Erode Brain, Heart, And Sleep

What Are The Long-term Effects Of Untreated Airway Issues?

Ever wonder how a “simple” snore can reshape your brain, stress your heart, and drain your energy over years? We dig into the hidden toll of chronic intermittent hypoxia and show how airway problems progress from noisy nights to life-altering consequences when they go unchecked. Dr. Mark A. Cruz breaks down the biology in plain language, connecting the dots between inflammation, neural injury, and cardiovascular strain—and why fewer symptoms can actually signal a failing alarm system rather than true health.

We map the real-world clues you can spot even without a bed partner: frequent nighttime bathroom trips, reflux, morning headaches, anxiety, depression, and stubborn fatigue. From the dental chair to the primary care clinic, we reveal how siloed treatments can mask the upstream airway cause. You’ll learn how reflux and worn teeth often point to labored breathing, why brain fog links to nighttime oxygen drops, and how to pursue smarter evaluation with sleep testing, nasal airway assessment, and collaborative care.

Parents, we go deep on kids’ airway health. Mouth breathing, snoring, messy beds, and belly-sleeping with neck extension aren’t just quirks—they’re signs of fragmented sleep that can derail growth, learning, and behavior. We explain why enlarged tonsils are often a symptom rather than the cause, why many children relapse after removal, and how guiding jaw development, tongue posture, and nasal breathing builds a stable airway for life.

The takeaway is simple and urgent: early, airway-focused intervention reduces inflammatory load and protects the brain and heart. We share practical steps across the spectrum—from nasal hygiene and myofunctional therapy to oral appliances and CPAP—so you can move from “not sick” to truly well. If this conversation helps, share it with someone who snores, subscribe for future episodes, 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

Setting The Airway Agenda

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's 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.

Why Long-Term Matters

SPEAKER_02 0:32

When breathing problems go unchecked, the body does not just adapt, it pays a price. Welcome everyone. I'm co-host and producer Julie Schwenzer in the studio with Dr. Mark A. Cruz. Thank you for joining us again, Doctor.

SPEAKER_01 0:46

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

SPEAKER_02 0:48

It's our pleasure too. So let's jump into today's topic. What and we know it's a broad one, but what are the long-term effects of untreated airway issues?

SPEAKER_01 0:59

You know, that question, Julie, is is a very good question, um, in that you're you're making a call out for long-term. And when it comes to airway problems, we know that the longer that they exist, the more cumulative damage uh that affects the long-term prognosis um occurs in in most situations. And as a result, um, you can have many different manifestations of different uh medical symptoms. So this is one reason why uh early intervention, identification and intervention is super

From Snoring To Sleep Apnea

SPEAKER_01 1:49

important. So, for example, if we're looking at the sleep disorder spectrum that may start as an innocent occasional snore that eventually progresses through upper aloe resistance syndrome, sleep fragmentation, and end stage, moderate to severe obstructive sleep apnea, the reason why it progresses is due to the long-term what's called chronic intermittent hypoxia. So that means that when you're stopping your breathing and having drops in oxygen saturation that return and it cycles over time, that that is super pro-inflammatory, that stimulates compensations, that manifests as symptoms that may change over time. And um, as Dr. David Gozal would say, you know, one of the stalwart researchers globally in this domain, that inflammation is the body's way of saying that something is wrong, that something needs to be fixed. So that may be addressed

Inflammation And Brain Injury

SPEAKER_01 3:00

by the host or the individual's compensations. But the longer, for example, um, you have chronic intermittent that affects the brain, let's just look at the brain. Many, good, many studies will show that it damages uh the brain, and there's loss of structure throughout all the different structures or many of the different structures in the brain that may get past a point of reversibility. So all you could do at that point is just manage. Um, and and so it makes it very important early intervention. So the earlier you you um you get in there to stop this inflammatory cascade and and and uh all the symptoms, the better the long-term prognosis. So with our children, we want to catch it very early. And unfortunately, what's what ends up happening is there are these compensations that um oftentimes result in a subclinical state that makes it very nuanced to say that there's anything that's wrong, but that may pop its head out a decade later and type two diabetes or cardiovascular disease, you know, hypertension, et cetera, et cetera. So um yeah, it's it's it's a good question because long-term affects, it kind of in a summary.

SPEAKER_02 4:31

You know, you mentioned the cognitive implications, and then

Symptoms, Compensation, And Risk

SPEAKER_02 4:36

you also touched on the cardiovascular system. I mean, what kind of damage are we talking about if this goes undetected for the long term and you you know you figure out something's wrong when you're well into middle age or older?

SPEAKER_01 4:50

Yeah, um, so uh I the way I like to explain it is this is the more symptomatic that the individual presents, counterintuitively, the healthier they are, because they can actually mount a what we'll call an allostatic response. So they're very, very symptomatic. As it progresses to a chronic severe disease or end stage disease where the different organ systems are damaged, the neurology that tells the brain that there's a problem is less functional or blunted. So that individual goes along, seeing like it's not a problem. So the classic would be the middle-aged to older male that snores and they're unaware that their heart is stopping, you know, throughout the night, that they have these high blood pressure uh spikes that may result in a heart attack in the middle of the night or a stroke, um, or you know, other issues like that, because now it's end stage. So what makes obstructive sleep apnea very dangerous is that if it's not treated, it results in early death. I mean, severe. Um, so the the the last thing you want is to have a stroke or a heart attack as the first sign

Silent Nights, Deadly Spikes

SPEAKER_01 6:16

that you're aware from it's been around for a long time. Um, whereas, you know, if that same individual 30 years before was presenting with a lot of different symptoms that were um, you know, letting them know that they were miserable at some level. Maybe they medicated those symptoms away, it wasn't diagnosed, they were healthier, but eventually it just progressed due to this chronic intermittent hypoxia. So, yes, um stage manifests in very serious conditions, and it's very difficult to predict who and and when that will result with what patient or what patient population. So someone maybe survive a lot of that, but then towards the end, they start manifesting Alzheimer's. Okay, so Alzheimer's is more of a chronic, slow um circling the drain, right? It's a slow death, it's a chronic death that um I think it's cruel versus if someone just dies from a heart attack. In fact, 91% of the time when an individual dies of a heart attack, this is well documented, it's from sleep disordered breathing.

SPEAKER_02 7:36

Yeah, that's pretty intense and shock.

Spotting Clues Without A Bedmate

SPEAKER_02 7:39

I mean, this is great that you reveal this so people can look out for the signs. And what if somebody doesn't have a partner they're sharing the bed with, or you know, they don't have any witnesses that they may be having issues and their airway issues are progressing. What are signs that the person themselves may be able to look out for that, hey, I have a problem when I'm sleeping?

SPEAKER_01 8:02

Yeah, I mean, so that can manifest again in in in many ways. They may have anxiety, depression, they have may have nocturia where they're getting up to go to the bathroom multiple times. Those are all compensations that they may go see a specialist or a primary care physician that unfortunately may address that siloed symptom and may take care of that symptom by itself. It could be reflux. And so they may come in with a list of medications for all these isolated symptoms from three or four different providers, and no one's really talking about it. They may review, oh, I've got all these medications, oh, that's not in my area. You know, that's a gastroneurologist that's taking care of these problems. But let me just give you an example.

Reflux, Teeth, And Missed Signals

SPEAKER_01 8:50

What we know uh is that early on, uh, someone that let's say snores, that chronic snoring that may not bother the individual itself, may bother the bedmate, so they sleep in a different room. What it does, oftentimes, it is also presenting with reflux, acid reflux, because of the effort to breathe, actually brings up stomach contents. And many of them have dental damage. They have worn teeth, prematurely worn teeth. They've got chemical erosion from the acid that comes up from the stomach. So they may see their dentist who treats the teeth in isolation. So that's a problem. They may have temper mandibular uh joint disorders, but um those those symptoms um and those findings, say the snori and the reflux, cause damage to the back of the uh airway or the throat that damages the neurology that tells the brain that there's a problem. So they're not even aware of the bigger problem that they're not breathing and that the brain isn't getting oxygen, and uh that results in what's called reperfusion ischemia. So it's it's um reactive oxygen species in the brain that damage the brain every night, so that forgetfulness or that brain fog are also symptoms of that. And then you add on top of that the complicated layer of that individual's life, work, um, their boss, their family, that it tends to take the blame for a lot of that, those those symptoms. Um, it just makes it complicated. So ultimately,

Children, Airway, And Growth

SPEAKER_01 10:49

we want wellness focused providers that go beyond just symptom management. The symptoms are a way of telling the provider that something is wrong, and that the magic pill answer is not always in the best interest of the patient. I always say there's a difference between being well and not being sick. And so our healthcare system is really more focused on not being sick. So I you know, hopefully that gives kind of a uh a global answer to um your question.

SPEAKER_02 11:29

And something that you touched on in previous podcasts that I find fascinating and scary at the same time is children and what parents can look out for in terms of airway issues, but how that can actually alter structure, like the facial structure and um, you know, the dental development. Can you explain more about that? And if um parents and you know don't get ahead of it, what can happen to children?

SPEAKER_01 11:57

Oh, yeah. I mean, so so that's a super complicated uh relationship, but I'll I'll try to uh give somewhat of a of a general answer because it always comes down to nature versus nurture, you know, chicken or the egg. Is the condition of how you breathe resulting in an incorrect way or less a deficient way of the way the face grows? Are the tonsils really causing the problem, for example? Or is it the other way around? Are the tonsils another sign, in large tonsils, another sign of a problem that's being missed? And the data's very, very clear on that. That it's really the tonsils are just the finding of an upstream problem. So I think I mentioned in one of the other podcasts, a very recent study from just a few months ago, that I think it was in November 2025, very large multi-centered study of physicians that actually looked at brain scans uh correlated with cognitive function and development and intelligence in the adolescents. So they followed almost 12,000 kids through growth and development. And what they found is that one of the one of the main findings is that the size of the airway, you know, from the turbinates down to the vocal cords, just to say that the airway um had a direct correlation with increased risk for having these cognitive problems. And of course, there are many other studies that have shown that uh different aspects of that main

Sleep Quality Over Quantity

SPEAKER_01 13:43

point is that the size of the airway from through which we breathe moment to moment has a material effect on our overall health. So a child that's snoring or sleeping in on their stomach, hyperextended, uh, messy bed, uh, axe out, uh, very audio tactile sensitive, um, all these it is not a problem to be ignored. And that's where it's starting. Now, they may go through a growth spurt, they may have their tonsils removed and then they'll better for a while, but the studies have shown that the vast majority of them relapse within five or six years of tonsils that are being removed because the underlying root cause was never addressed. And that's to do with how our facial skeleton grows. So the function of tongues, the cheek muscles, and all that is what helps to foster optimal growth of the facial skeleton, we call it creative facial structures. So it is a complicated question. Um, early intervention question is super important. And things like ADD, ADHD, more often than not, is related to physiologic stress versus psychological stress, which tends to be uh the focus because that's what we see, that's what we can recognize, right? It's the family environment. Yes, those are those are factors, but it's not the fire. It's I say that's the fuel. But most ADD ADHD, and it's well documented if you get into the literature, is due to fragmented sleep. The brain never really recovers for that kid. They sleep, but it's not the uh the right kind of sleep. The sleep quality suffers. And so we really need to spend more time in understanding the importance of not only sleep quantity, but also sleep quality and how we measure that. And you can't measure that on an RRA necessarily on a phone app. That can give you some idea. But um yeah, so green intervention, that's important.

Takeaways And Next Steps

SPEAKER_02 15:55

Well, Dr. Cruz, again, we appreciate you summarizing these big topics for us because it, you know, it's very helpful to see how important it is to have good airway function.

SPEAKER_01 16:07

Yeah, thank you. My my pleasure again. I I didn't make up this stuff, you know. I just read the literature I've been putting this together, and it's others that are uh really saying this, but it's it's the information doesn't seem to be translating into real-world practice, and it needs to. So, yeah, it's my pleasure. Thank you, Julie.

SPEAKER_00 16:31

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 markacruzdds.com or call 949-661-1006. If this helped you, share the episode and maybe give your pillow a quieter night. See you next time.