Why Airway Might Be The Most Overlooked Biohack In Modern Health

In this episode of the Breathe, Sleep, and Smile podcast, Dr. Mark Cruz and Amber dive deep into one of the most overlooked topics in modern health and performance: airway function.

From sleep quality, HRV, stress response, cognitive performance, fertility, metabolism, and athletic recovery, this conversation explores how breathing and airway health may quietly influence nearly every system in the body. The discussion breaks down why so many people are tracking sleep scores, glucose, recovery metrics, and biohacking trends while potentially ignoring the very foundation of human performance: proper breathing.

Dr. Cruz explains the science behind nasal breathing, mouth taping, jaw development, airway-focused dentistry, sleep-disordered breathing, and why chronic mouth breathing may contribute to long-term health issues. The episode also explores how elite athletes, esports competitors, military professionals, and high performers are now using breathing optimization and CO2 monitoring to improve performance under stress.

This is a thought-provoking conversation about the connection between airway health, modern chronic disease, sleep optimization, and why breathing may be the missing piece in today’s healthcare conversation.

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

Biohacking And The Airway Claim

SPEAKER_01 0:00

What do you think is the number one biohack? Is it airway-focused industry? There's a lot of biohacks in the show.

SPEAKER_00 0:05

So I will ask you, as an expert in this area, define biohacking.

SPEAKER_01 0:09

It's finding something to optimize in your health, in your well-being, and finding the best way of doing something without, you know, having medical intervention and doing it in the most healthiest way to optimize it.

SPEAKER_00 0:21

So to answer your question, no question. Airway is the best. Airway focus on this case for wellness. My mission is to help you transition from disease management to walk. Live fully and smile freely. What's up? Mark A. D. S. Breathe Sleep and Be Well. Well, welcome to the Breathe Sleep and Smile podcast, formerly known as Breathe, Sleep, and Be Well. Let's jump in. I think we've got a really interesting topic. Can you introduce it, Amber?

SPEAKER_01 1:11

We really do because airway and biohacking is something that I think the internet is blowing up talking about, right? And uh it's the most underrated performance tool that you have. So people are wearing aura rings, they're tracking HRV, they're optimizing every variable in their sleep and performance, and they're completely ignoring in one thing that might be the undermining of it all, and that is airway.

Wearables HRV And Breathing Red Flags

SPEAKER_00 1:35

Yeah, it it's interesting. Again, I see it as a sign that the public at large is taking control more of their health. I mean, we don't have to stop there. We can also look at the glucose monitors. They're on the gym, and you see the glucose monitors people are are looking at. They want to get data. And they want to get data and they want the telemetry to be able to make better decisions for their health, and I think that's great. Um, we could talk a little bit about um you know each one of these, and maybe I can add one, but like heart rate variability is definitely a marker for wellness. So you want to have a wide range of heart rate variability, meaning that your heart and autonomic nervous system is healthy enough to um to meet uh a stress challenge. So you want to have a relatively low heart rate that's efficient, but that if you needed a moment's notice to be Johnny on the spot to run away from that cave bear, if you will, it can jump up very, very high. And the thing about sleep disorder breathing in its end stage, like obstructive sleep apnea, it decreases heart rate variability. So essentially, that individual is not so well. They're more sick. So heart rate variability is a way of finding out how healthy am I.

CO2 Tracking For Stress Performance

SPEAKER_00 3:02

Umetry, we know oxymetry um is is a way of also checking your uh gas exchange, your efficiency of uh oxygen. Uh we talked about glucose monitoring. One that people aren't really talking too much about is capnometry, is CO2. In fact, this morning I was on uh a Zoom call with my good friend Peter Litchfield, who's uh a world-renowned researcher in this space on capnometry, which is a lead in a sleeps in sleep studies, looking at uh your uh your uh uh gas uh the CO2 exchange, the it's a byproduct, it's a waste byproduct. And uh super important as a marker. In fact, the anesthesiologist will monitor N title CO2 when a patient's under general anesthesia even more carefully than oximetry. It's super important because it's a moment-to-moment marker, if you will. Um so I see the public really starting to learn about this, but what Peter was saying this morning was that it is really huge in esports. So esports is the largest sporting domain of all sports. It's huge, and yet a lot of people don't know about it. But you'll have these gamers that will have a tournament where the purse is like $150 million.

unknown 4:29

Right.

SPEAKER_00 4:29

And you get from all over the world these gamers that will be playing a game and their headsets and and they're highly paid. And the difference between who wins and who loses are measured in milliseconds. And so while I was on this call with Dr. Litchfield, he actually received a call from the health minister at the UK that's very interested in looking at uh the use of uh capnometry, which he has it now as a wearable, that you can actually monitor how you're breathing. And uh but what they did with these gamers and their studies to actually show that when you're gaming, which is a very, very stressful uh in any sports that's competitive, it's stressful. And the difference in your performance is how well you're able to monitor your breathing, not over-ventilating. Because when you over-ventilate, it stimulates a stress response, and then your muscles don't function quite as well, ironically. And so what they're able to do is they're able to monitor the CO2 levels where your finger movement on the keyboard or in the mouse, the difference between having a really good antital CO2 and one that's a little bit off, can be you know, 350 milliseconds, which is the difference between winning the tournament or not. And so they're all in right now. Um Peter also has very, very big contracts with the Department of Defense, um, looking at jet pilots, looking at performance, so looking at CIA agents and FBI agents that are in stressful situations that are making decisions in nanoseconds, all based on how you're breathing. So, okay, we may not be in that domain, but I still want to be ventilating as optimally as possible. So in during the day when you're feeling a little bit anxious, I'll suggest that maybe you're overventilating. You're breathing too much, you're blowing off too much CO2, and maybe you kind of slow that down because it's affecting your blood chemistry, your blood pH. And so you start becoming more asymptomatic. So these are all things that the public is starting to understand for performance on a day-to-day basis is using these wearable rings on their sleep. It's great.

SPEAKER_01 6:46

That's that's what

How To Read Sleep Scores

SPEAKER_01 6:47

I was seeing here. I had um a question down for you that if someone is wearing an aura ring and seeing poor sleep scores or low HRV, they've tried everything. You know, what should they actually be looking at first?

SPEAKER_00 6:59

You know, I always say jokingly, and yet not so jokingly, but it makes the point measure twice, cut once. Another way of saying is gather a lot of data before you make that decision. And so I think we do that, and again, something that we get into in depth in setting up our clinical practices in airway is get that quantitative data by measuring and let it tell you what's going on versus just a subjective uh report that is important, but still nonetheless you want to have that data. And so um I I think having some form of data to kind of give you some insight. So the Rings, patients are coming in now and they're looking at their sleep efficiency and they're saying, Yeah, you know, uh, I I you started doing this treatment on me, and I could just tell you, I'm getting these reports that my sleep efficiency is improving. My heart rate at night now is dropping down to 50 beats per minute, whereas before it was always around 70, 80. Um, and it kind of explains a little bit about how I feel. So I say, well, that's exciting. It's consumer level, you know, I'm not gonna have you make any decisions on that, but it does give you a little bit of insight of something that we're measuring.

SPEAKER_01 8:16

Yeah, yeah. So I'm thinking now, if the fact that my kid wakes me up multiple times a day or multiple times through the night, does that mean that my sleep is

Night Wakings And Long Term Health

SPEAKER_01 8:25

is affected? Am I am I going into those deep sleeps, you know, as much as I should be? If you're if you're a parent and you're being woken up through the night?

SPEAKER_00 8:32

Well, that's a problem. First, on two route on two domains, one for your child and the other for you. Right. So as a mom, I would say, why?

SPEAKER_01 8:40

Because if you start habit, I would say habit.

SPEAKER_00 8:42

Well, uh yeah, maybe it's a habit, but not really, because when you sleep, we're meant to sleep all the way through the night, especially during a critical time of growth and development, because again, the hypothalamus in the brain releases the metabolic hormones, glucagon and insulin, growth hormone, the sex hormones, three to five times a night in spurts of seven to nine minutes during deep, deep sleep. If you're not getting that, then it will affect growth, um, metabolic function. Um, we know that fragmented sleep will also affect IQ. There are neurocognitive correlates. So for your child, I would ask that question, that should not happen. For yourself, it's also affecting you. Really not that different than having a spouse that snores. Your sleep quality is affected. So I'll just cite the Thompson study was the first study to actually show a dose response in women in acquiring the risk of breast cancer based on sleep quantity and quality. So the less sleep you have and the poor quality of sleep, the greater linearly the risk was for expressing uh an oncogene, having cancer, breast cancer. So, not like this loose association, actual causation. So those are kind of some things where um nature would not invest a third of our life in a state that we call sleep unless it was super important. Now, the fact that we don't know that much about it and we're learning more about it, doesn't change that nature knows what she's doing. And and so I would be very careful and say why. Now, if it's a you're on vacation or it's a short stint because the kid is sick or you're sick a week or two weeks, okay, fine.

SPEAKER_01 10:26

Yeah, but if it's every night or something.

SPEAKER_00 10:27

If it's every night, it is, I mean, we worry about going to the gym and eating right and doing all these things. We also should be uh concerned about our sleep and importantly asking the question about our breathing. Right.

SPEAKER_01 10:39

So let's uh transition a little bit about mouth taping.

Mouth Taping Benefits Risks Alternatives

SPEAKER_01 10:45

Okay. Okay, so mouth taping is everywhere right now. Um, Huberman talks about nasal breathing constantly, and I mentioned you had mentioned the last podcast about keeping your mouth closed and actually breathing through your nose 90% of the time, is what we're supposed to be doing. So, what does an airway dentist actually think about that trend when it comes to mouth taping?

SPEAKER_00 11:03

Yeah, it's funny. Well, when I was talking about mouth taping back 15 years ago, people thought I was crazy. At the time I was using like medical tape, scotch tape, things like that. There were very few of us that were really talking about it, but it was kind of a crazy idea. And now you've got companies and podcasters and influencers that are talking about KT tape for the lips or for the mouth and all these alternatives, even like for the nose and to dilate the nose. It's crazy. I mean, I I had um colleagues that were really upset that I was talking about what's the science about that. And yet I was actually involved in an IRB institutional review board clinical trial that I was asked to help in at uh at a Northwestern uh in Chicago uh many, many years ago. And one of the um uh uh investigators, primary investigators, was an ENT, and we were doing this design. And one of the things I said is, well, we should have a group taping and not taping. And you say, Yeah, that makes a lot of sense. Um and so we know now that the reason for that is I said in another podcast, is that all mammals exchange gas through the nose. Why is that? Well, when you're breathing through the nose, you are purifying the air through nitric oxide that is only produced when you're breathing through the nose. It's a transient signaling molecule that affects the entire endothelial system or cardiovasculature of the body. Um, the three physicians and physiologists that won the Nobel Prize some years ago was for discovering this transient signaling molecule. It also kills viruses and bacteria. So it helps to sterilize the air. It brings it up to body temperature, it humidifies it, it conditions it before it goes into the lungs, which is super important, and then it optimizes it. So your blood pressure, your heart function, your whole vasculature is affected differently when you're mouth breathing than when you're nose breathing. Any athlete is going to be breathing through their nose during stressful times for having their optimum um function. It's not to say that they're not sucking wind, mouth breathing, some, but it's very important that we breathe um through our nose. So um I hope you know that addresses that.

SPEAKER_01 13:35

I think it did. I mean, when I think of mouth taping, you're literally just like taping your mouth and that's how they're going to sleep.

SPEAKER_00 13:41

Yeah, yeah, I I'm concerned about that for a couple of reasons. Is I always used it as a diagnostic tool. It was never really meant to be the end game. You know, that you'd have a product that you would depend on. It was to give you an insight as to what's going on. No different than a breathe right. Every anyone's ever used a breathe right. Athletes use it just to get a little bit better uh flow through their nose. Um, their performance is better, less stress. But when you mouth breathe, if you have a deviated septum or congestion and you're a kid, you're gonna freak out when you can't, when you are trying to sleep. So I always say, you know, be careful, do it during, you know, during the day, see how they are, make sure that they're breathing through the nose very, very well. And um and ironically, mouth breathing also fosters nasal congestion. So um I think that it is something that for me, how I used it was to kind of kind of give insight. Another thing that I do now more for like a kid is I'll do the two-minute test. Can they sit still for two minutes, keeping their lips together? So they're in there and in front of mom, we'll do that. Let's see if you could do it. Put on the timer. And if they can't, they open constantly. No, close them out, they can't. They start becoming fidgety, you start seeing the stress, that's a problem. You don't want to tape that pay that person. And and so if they're doing that, there's flow limitation at some level that maybe is not that detectable moment to moment, but when you start doing that test, mouth mouth taping can do the same thing. Now, if they could do that, no problem, then that's great. They're breathing the way they're supposed to, and then they shouldn't need the mouth tape. You shouldn't need the mouth tape if you have myofunctional uh if if you have good myofunction, meaning that the lip muscles, cheek muscles, the oral posture is functioning properly with good strength, and that's where myofunctional therapy comes in, is you have lip competence. It's one of what we call the five competences, which is nasal breathing always, lips together, tongue on the roof of the mouth, non-collapsing pharynx during sleep and diaphragmatic breathing. Those are competences that all of us should do easily, have no problem. When any one of those are perturbed or there's a problem, then you're gonna have a compensation, of which mouth breathing is just one of them.

SPEAKER_01 16:11

Okay,

Jaw Alignment Shapes Your Airway

SPEAKER_01 16:12

all right. Um, so there is a growing conversation about how jaw alignment and bite affects not just your sleep, but also cognitive performance, stress response, even athletic recovery. You were talking about um how athletes, you know, will breathe through their nose in a stressful situation. So kind of walk me through that connection between the jaw alignment and how bite is affected when it comes to your sleep.

SPEAKER_00 16:35

Yeah, no doubt about it. It's kind of the same thing. Um, form follows function. The way our faces, our facial skeleton from when we're born all the way through growth and development is supposed to grow is downward and forward. Um, but oftentimes what's happening in our population now, and we talked about anthropology in another podcast, is that we're getting a vector more uh more vertical growth at the expense of that forward vector. So as the midphase grows forward, the caliber of the airway also gets bigger and optimized. So you have a forward and downward, as Dr. Donald Enlo, who's considered the uh grandfather, if you will, of craniofacial biology or craniofacial growth and development, did a lot of research. He's got a famous saying that the airway is the keystone for the face, meaning that it it's really the breathing through the airway that portends to proper growth and development. So the airway gets optimized in growth and development by the face because the face has this big functional space called the airway. That's what's interesting is that the airway is not an organ, and we tend to focus on air on organs, it's actually a functional space. It's the space that allows us to exchange gas, the most important moment-to-moment function of any mammal, and it's defined by everything that's around it. So how our face grows will change the shape of and size and function of that face.

Hidden Airway Clues Fertility Metabolism

SPEAKER_01 18:19

Um what would be the single intervention that makes the biggest difference for someone who has no diagnosed sleep disorder, but just isn't performing at their best and doesn't really know that airway might actually be the reason why.

SPEAKER_00 18:35

Yeah, because it can be nuanced, and you're listening to different podcasts, and you're saying, hmm, I wonder if I can be doing better. Or the opposite is I'm doing great, I have no problem. They just may be high functioning and they're well within their adaptive capacity. So this is like there's a lot to talk about there. But I I would say again, uh measure twice, cut once, let's get data, let's find out. And that's what we do with an airway-focused um approach in practice is there is a battery of questions that look at five of the seven organ systems. So dentists are licensed to look at five of the seven organ systems. Physicians will look at all seven. And we would look at those and look at the signs and the symptoms, and then we also do our clinical photography that gives us what we call the phenotype. They're markers for how the face is developed. And then, of course, we've got quantitative data. We talked about wearables, but there are also medical grade uh metrics to look at quantitatively how we're breathing. And then at that point, you could see that there may be some uh some issues there. So I recently had a patient that was asking about that, didn't report anything except for um she couldn't get pregnant. You know, there was uh a fertility issue. And uh uh OBGYN couldn't figure out what was going on, but everything was checked out, everything was working properly with her and her husband. And so we started talking about that. And I could just say that a mammal will not want to get pregnant if it's in an upregulated sympathetic drive, even if it's low grade, which is what a lot of us are under. We might blame the traffic, our boss, our spouse, our to-do list as to that low grade stress. It may not be a stress level like you're being chased by a cave bear, but it's still low grade, it's telling in the background the body to say it is not time to get pregnant. So you won't be able to, and it does affect fertility, and we can dedicate a whole podcast just on that. The other side of that, too, is that you can't regulate metabolically. So when the autonomic nervous system is telling the brain metabolically that you're stressed, it's saying hold on to fat. So no amount of dieting is really going to change that because you're uh you're regulating incorrectly. And so a lot of these background functions are affected by that. We're just talking about someone who looks perfectly healthy, um, what I call skinny woman syndrome, um, a young to middle-aged female that looks like the vision of health is uh a good BMI, and yet sometimes they're the most symptomatic patients, ironically, because they're very healthy. They're very symptomatic because they're very healthy, because their autonomic nervous system is screaming at them, telling them I've got problems, but they go into our disease management health care system, and it's a pill, chill pill, it's an antidepressant, it's you know, whatever whatever the intervention is pharmaceutically, and yet they have a sense of what's going on, and again, fertility is just one of them. Yeah.

SPEAKER_01 21:53

It's it's funny when you had said that. I um I was on another doctor's podcast and we were talking about biohacking. In the dental space with uh Dr. David Elfie. And we were walking the streets of downtown Houston, and he was saying how in that particular area was one of the largest medical areas in all of the U.S. and just how much billions and billions of dollars are put into treating and prescriptions and all that. And it really came down to understanding your sleep patterns and your airway, that that could actually that could actually wipe out like 70% of all these medical when you're saying about take a pill for this, take a pill for that, you know, right down to people who go to bed and they snore their whole life and they just think it's normal, right? I'm just a snorer, a deep sleeper, when actually it could be just uh it could be a you know a sleep pattern. They could have you know their their jaw open or they could have s some sort of surgery to to open up their airway and all of a sudden they're sleeping better, and then all those symptoms just kind of disappear, right? I got no more tension in my neck, I've got no more stress, I'm not feeling anxious.

SPEAKER_00 23:00

Absolutely.

Why Airway Beats Other Biohacks

SPEAKER_00 23:01

I say it's the nexus of health. That's why we have uh that other podcast called the Airway Nexus. It's the it's the foundation. And it gets overlooked because it's so obvious. I'm breathing, right? I'm breathing, breathing, I'm exchanging gas. As if being on a ventilator breathing is the same as yoga breathing. You know, they're not the same. Uh it's all that goes along with it. How efficient is it? And that's what really is causing chronic disease in our population that did not occur just even decades ago at the levels that they are. I mean, uh RFK is talking about, you know, when his uncle was in office that, you know, they never had all these problems as a kid, as obesity. Our kids are sicker and sicker. Yeah. And we're spending more and more, and we're missing the elephant in the room. And can it be that simple? Yes, it will be, because you have to understand how a mammal is supposed to function optimally. Now, the fact that you can work around and do all these other and supplement and do all this, fine. But it's not really intentional as it pertains to health care as to how we should be functioning. And I applaud the fact that we are looking at petroleum-based products in our food. Yeah, that's not good, it's inflammatory. But I'm just gonna argue that the food is not the problem. It is part of the problem, but it's not the fire, it's the fuel. The fire is all the stuff that we're talking about, and the evidence is super clear. It's just that because we're so siloed and specialized, we kind of lose that global view. And that's what this podcast is about. That's what being an airway focused dentist is about, is kind of stepping back and looking at and putting together a picture that really makes more sense. It's it's we're incentivized to learn more and more about less and less. Yeah. And you get paid more if you're more specialized. But you know, you learn you know, you you lose your way when you know more and more about less and less. I I my my partner, Barry and I talk about teaching partner that we teach, talk about don't be a barker, meaning like you're looking at the forest, and you could see the whole entire forest, but we're looking at the bark of one tree as if that's you know, we know everything about the bark in that part of that tree, but we know nothing about the forest. Yeah. And so I think in healthcare it kind of stands the same, if that makes sense.

SPEAKER_01 25:31

I want to leave you off with this at the end of this podcast. What do you think is the number one biohack? Is it airway-focused industry? Because there's a lot of biohacks out there.

SPEAKER_00 25:40

So I will ask you, as an expert in this in this area, define biohacking.

SPEAKER_01 25:46

It's finding something to optimize in your health and your well-being, and finding the best way of doing something without, you know, having medical intervention and doing it in the most healthiest way to optimize your.

SPEAKER_00 25:58

So to answer your question, no question. Airway is the best, but it's complex. You can't go ahead and take a weekend course on some widget and say that you're doing airway and the patient's better. First of all, you're probably not measuring anything that's of meaning to the patient. So I think again, we've got to be careful because it's complex. But that's the number one thing I think, and in the future that we should be really looking at is that very, very basic moment-to-moment function of breathing, optimizing it. And you really don't know what that is just by breathing. Yoga breathing is not airway. It's uh an effortful way of doing something that we should be doing naturally, competently. M-hof breathing, all these different types of cold plunges, all these things people talk about. You can show that there's a health benefit, you might call it a biohack, but it's to address something that you're not doing very well that you should be doing competently. And so I'd love to talk more and more uh about this specific topic because I know there are other podcasters, well-recognized podcasters, that talk about it. And I think that's really interesting. But I think again, you're missing the elephant in the room. Again, it's because of our siloed healthcare system. But I'll leave it at that. Yeah.

SPEAKER_01 27:23

We have so much more to talk about, Dr.

SPEAKER_00 27:25

Cruz. Yeah, yeah. Thank you. I'm excited. Yes, I'll see you on the next episode. Sounds good. Take care. Bye bye.