Breathe Sleep And Smile Podcast
Welcome to the Breathe Sleep And Smile Podcast—the show where better breathing leads to better living. Whether you’re battling restless nights, chronic fatigue, or unexplained health issues, this podcast connects the dots between your airway, your sleep, and your overall well-being.
Hosted by Dr. Mark A. Cruz, each episode delivers practical insights, clinical wisdom, and empowering strategies to help you Breathe, Sleep, and Be Well. From snoring to smile design, we explore how small airway changes can lead to big life transformations. Take a deep breath… and let’s get started.
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
Breathe Sleep And Smile Podcast
The Hidden Airway Problem: What Your Face, Teeth, and Sleep Reveal About Your Health
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What if chronic fatigue, teeth grinding, headaches, poor sleep, and even changes in mood are connected to something most healthcare providers overlook: your airway?
In this episode, Dr. Mark Cruz reveals how dentistry can extend far beyond treating teeth and become a window into breathing, sleep quality, facial development, and whole-body health. He explains why some people can sleep for eight or even twelve hours and still wake up exhausted, how facial features may reveal an underdeveloped airway, and why clenching and grinding should not automatically be blamed on stress.
The conversation also explores warning signs parents should watch for in children, including snoring, mouth breathing, restless sleep, and behavioral difficulties. Dr. Cruz shares his perspective on early intervention, GLP-1 medications, mouth taping, nasal breathing, and why popular sleep solutions may help without addressing the underlying problem.
If your laboratory results appear normal but you still feel tired, wired, or unwell, this episode may help you start asking better questions.
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
Wired Yet Exhausted
SPEAKER_00And take a nap. They're not sleeping. They're just tired and fatigued. For those patients, I would say, let's find out why. Do you have a reason? They've just accepted it. They've attributed it to their work and their family life and the bots and the traffic and the stress of the day. And I'm just going to say, maybe, maybe something else is going on. Really, how well do you do sleep? How well do you breathe? If you are having to take a yoga class on a weekly basis to feel good, you know how you're supposed to feel at the end of the yoga class. That's a confidence of how you should always feel is the missing way.
Why A Dentist Talks About Airway
SPEAKER_00Welcome to breathe, sleep, and smile. Breathing, sleep, patient growth, and help connect. This is the airway conversation beyond buzzwords and connecting the dots that are off of it. Hi Ember, good to see you again. Thanks for watching. Thanks for having me. Yeah, absolutely. I look forward to your questions.
SPEAKER_03Absolutely. So I am putting you in the hot seat today, Dr. Cruz. Okay. We have a list of questions that have come in from other patients or even just the general public people that are just curious and uh given your area of expertise, you're the best to answer. So I've got a couple of questions here. Sure. A couple of pages of questions here, actually.
SPEAKER_02No problem.
SPEAKER_03So let's start with number one, you went to dental school to work on teeth, right? That was that was the goal. But at what point did you realize that you were actually in the business of saving lives?
SPEAKER_00Oh wow. Yeah, that almost sounds hyperbolic, but the truth is, I mean, uh to a great extent, um, yeah, that's what's happening. Yeah. So, you know, when I went to dental school, my dad was a dentist, and I actually uh was pre-med, I was gonna go into medical school, and um I worked in uh in a hospital. I worked as a in the ward and then eventually uh in the emergency room. And I wanted to see what the lifestyle was like. It's kind of like doing an intern, right? To really see what's going on. And and at the time I had a little bit of a problem with blood. Like I look at blood and I pass out and I said, I've got to get through this. It's no better place than the emergency room. So um, and and I got through that. But one of the things I found was that the lifestyle was um really at odds with raising a family. And I was brought up in a family, uh, you know, a big family where my dad was around, we'd go on vacations, and and it was a good experience. And I wanted that for myself and and for my future family. And I was really good friends with a number of the nurses that were there, and a lot of them were not really happy that they weren't seeing their dad. In fact, they were in the hospital to be near their dad more. There were two of them specifically, and they would just kind of say, Yeah, it's just like my dad wasn't around, I want to see him, and and that was something that really made me change my mind. And um, my dad took me to a lecture of an oral maxillofacial surgeon doing like joint surgery, and I go, Oh my gosh, you could do that as a dentist. And so that was uh the start of my um deciding that I was gonna go into dental school. That, you know, it wasn't about drilling holes in teeth, it was much more than that, potentially. And so then I went to UCLA and and uh started learning that it was very different, even than what the public really thinks that dentists do in our training. Um, our training the first uh year is like the same as the medical students, and then you kind of uh start going uh and spending more time in the head and neck area. And so um, yeah, we do work on dental structures like the teeth and all that, and that's all fine and good, and that's great. And um I graduated and started a practice with my colleague who also um became chair of the restorative department at UCLA some years later, uh, Rich Stevenson, who's in one of our uh podcasts. And um, we started really going down the path of really looking more globally at the stomatonathic system, it's a fancy word for looking at all those structures in the head and neck area uh that include the teeth. And and so did that, had mentors and study groups, we did that, and about 25 years into practice, I always was unsettled with some of the questions and some of the dogma and answers that I got from my mentors. It didn't make complete sense, but you know, you kind of accept it, and now I'm in clinical practice going, that's not really making sense. And around 200 um eight, um I started connecting some dots. And around 2010, I had the situation with my son that ended up in the emergency room at the time he was four years of age, and that's where I really accelerated looking at a more whole-body global way of looking at um health and wellness. Understanding that breathing, gas exchange is the most important uh aspect of any mammal, no question about it, moment to moment. And guess what? The structure that we work in every day, the mouth, is part of that system. And I started looking at it differently. I started looking at the tongue differently. You know, when I was in dental school, I always joked that you know we didn't learn that much about the tongue, the anatomy, of course, but it was kind of, we always say it's just a big wet thing that got in the way of our work, so we'd use rubber dam, so we could work on the teeth. Not really realizing that its main job is to dilate the airway for what to breathe. And and then, you know, swallowing and chewing all those things, the tongue is really important for that as well. Where I started connecting the dots with breathing. I was not that interested in the sleep part. At the time, um, sleep apnea and addressing sleep problems in dentistry started becoming uh a bigger and bigger thing, but it was boring to me. I don't care. What does that have anything to do with what I'm doing as a dentist, other than to make an appliance that you know would be able to provide a service and fine, that's good, but that's not what I was interested in. And when I started realizing with my my son's situation that it was really a breathing problem, and started really realizing that with a lot of physicians that they were very siloed in their thinking, that they were not able to have this global integrated uh view of what was going on with the dental structures. So the dental structure is kind of an it's a window, if you will, for global health when you start understanding that they're refluxing, or they're clenching and grinding, or they have these chronic headaches. Um they can't breathe through the nose. Um, and then you start getting into um you know the the other things that we get into that are airway related. So I went through this this process and it just accelerated. At the time, this is now 15 years ago, you know, a lot of my colleagues, a lot of people, they weren't talking about airway. It was a it there were very few people that were, everything was focused on sleep and sleep dentistry. Um, this is very different. This is really looking at the structures, the facial skeleton, daytime breathing, um, and and then looking at myofunction and things like that. And so then that's where I started teaching courses and bringing on colleagues, and a lot of people were like poo-pooing it, nah, there's nothing there. Uh, even when I was recommended to speak and uh in uh in academy meetings, it was nah no, it's not that not that interesting. And then all of a sudden, you know, I was just doing my thing, and then it started becoming awareness started coming on, and now it's just exploded to where everyone's talking about airway, which is great. The problem is that it's still an incomplete, siloed picture, and the purpose of this podcast and this conversation is really to understand, you know, what's going on with the patient, whether it's a child or an adult, and how does that affect their general health and wellness? It's amazing how many people don't breathe that well through their nose, and that's a huge problem. Um, and then they snore. Well, it doesn't matter. And so you start connecting the dots and you started understanding, you know, metabolic problems, cardiovascular problems, inflammatory problems, and so then you're off and running, and that's where we are right now. I think it it's it's great in that we can integrate medicine, dentistry, and allied health to the benefit of the public's health.
The Mouth As A Health Window
SPEAKER_00Yeah. So that's what I'm excited about.
SPEAKER_03I love that. I mean, that was a great response, and also gives the audience a little bit more of a deeper dive of where you've come from and how you've evolved into the space that you're in now. So this was fantastic. Thank you. Um how many people sitting in a dentist chair right now have a serious health problem that nobody has actually connected to their mouth yet, would you say?
SPEAKER_00I I think that it is super common uh as it pertains to airway. Um it's actually the majority of our patients, but because they're high functioning, because no one's really told them that they have a problem, um the dentist doesn't know which questions to ask. So you can't just go, hey, how do you sleep? Oh, I sleep great. Uh what does that mean? It's too subjective. You've got to get into a more um clinically based approach to that. Um and so now with my patients, where people are coming specifically seeking this out, it's a self-selected population's high probability. That's why they're coming here. But looking back even at my patients for many, many years, um, not realizing looking back now, a lot of the problems that I was dealing with were airway problems, was super common. And uh it's difficult to talk to a patient when they've been in your practice for a long time, why all of a sudden now? Um, so that's a problem in and of itself. But um it's it's very common. What we're trained in, for example, is if someone's clenching and grinding, breaking teeth, what do we do? We make them a night guard.
SPEAKER_02Yeah.
SPEAKER_00And so that's what we were taught. And I did that for many, many years, where I start saying, well, all that does.
SPEAKER_03Why are they clenching? Like, why are they clenching? Why are they clearing?
SPEAKER_00Exactly. The why part of it, and we start seeing when we get into sleep medicine, physiology, there are very well documented reasons for that, and not only at night, but also during the day. So in dentistry, what we tend to do is put a lot of science and research into material science to make our restorations stronger and stronger and stronger. Where I'm saying, well, why are we doing that? We shouldn't need that strength. Our patients shouldn't be putting their teeth together that much. We can't just explain it by saying it's stress. Well, what does that mean? What does that mean? Is it psychological stress? Is it your boss? Is it your spouse? Is it the traffic really? Uh it's it's more than that. It's nuance. And until you really understand how it comes together, and that's why we teach uh the mini residency, um it's it's very um um it's very difficult to parse out. But I could tell you as the docs go through it, they go, oh my gosh, why didn't I learn this? This makes so much sense. And you can't go back and see the patient the same way. And because you know that uh there there's a good reason for it, and that your orthodox way the way you're trained is all it's gonna do is manage the problem, continue to kick the the can down the road or whatever. And in healthcare, we really should be able to try to prevent problems and be minimally invasive by really good diagnosis and prevention.
SPEAKER_03Yeah, yeah, I agree.
Airway Clues You Can See
SPEAKER_03I mean, uh what is the one thing that you see on somebody's face in the first 30 seconds that tells you that they actually have an airway problem before they even open their mouth? Can you actually tell that?
SPEAKER_00I at this point, yeah, I could see it across, you know, the parking lot.
SPEAKER_03Uh that must become addicting.
SPEAKER_00Yeah, it's it's you know, I don't get invited to many dinner parties anymore. So um but part of it is is and and people, you know, colleagues that have gone through the course, they go, you can now not un you can't unsee it. Right. Once you see it, you see it everywhere. So you're looking at profiles, you're looking at facial balance, you're looking at the smile. Um, there are very, very specific phenotype markers. One of the chapters in our our our book has, I think it's like 30 uh phenotype markers that are indicative. Not any one by itself tells us a story, but it's a compilation of many. Like, for instance, scleral shine. When you start seeing the uh the scler of the eye, where the eyelid's not coming up to the iris, that's an underdeveloped midface. Um, Dr. Gieman or Dr. Stupak and Park, these two NTs that I talked about in another podcast, talk about the hump on the nose. It's super common. That's a cartilage being bent down and back, and yet the plastic surgeries will fix that, fix that as part of a nose job to make the nose nice and straight and uh more attractive. I joke that they're removing the one part of their face that's in the correct place. But it's a uh downward and backward um growth that actually is driving the jaw back into the airway, and then you have this head tilt to try to breathe and all these uh issues. So that's a phenotype marker. You're looking at flat cheekbones when you look at the at the side of the face, so the bridge of the nose should actually be mirrored in parallel with the cheekbones and profile. So there are all these markers that are validated that are in the plastic surgery literature, the oral maxillofacial literature, they're in the uh sleep literature now, more and more. So we call those phenotype markers. And in my examination, I take a standardized gallery of images that are diagnostic and I show the patient, and they will understand, they see it, they go, Yeah, I know that all the time, but you know, I tried to fix that with uh fillers, right? Or Botox or Botox or things like that.
SPEAKER_03Yeah.
SPEAKER_00Uh, you know, even plastic like a facelift is subtractive. What they're doing is they're just, you know, pulling the tissue in, the uh facial drape tighter and suturing it and throwing out, you know, uh and you now you look like this tight face. Actually, it should be additive. You should be expanding and making the face, um the facial skeleton uh more pronounced where it should be, because as we age, we lose more and more bone mass. And so you see an elderly patient, they're kind of hunched down because they've lost bone mass. So the more that you can actually maintain that uh that bone mass, you'll age more gracefully. So you'll see people that are in their 70s that look really like they're in their 40s, and you'll see people that are in their 50s or 30s that look like they're in their 70s.
SPEAKER_01Yeah.
SPEAKER_00You know, so a lot of them is they've had orthodontics, they had teeth removed, and then they're retracted, and their faces is um uh diminished, their profile, you look at it as if someone punched them in the face, you have that uh um uh concave profile. So those are a lot of the things that we fix with double jaw surgery and surgery to fix the uh airway breathing problem, but they're also what are called aesthetic phenotype markers as well. Forum follows function. I don't treat the patient per se for the aesthetics, I treat them for the health, wellness, breathing part. But when you fix that and you look at their face before and after, it almost takes your breath away, you go, oh my gosh. And the patients will say, I feel healthier, I feel better, I I have more energy. I had a patient yesterday, I finished, in fact, he gave me a text today, it's going, I'm so glad I'm at the end of this uh this journey, but I'm so happy. I just feel more chill, the quality of life. I pop out of bed, I'm always in a good mood. Plus, I love my smile, I love the way my face looks. It's not like I like my teeth, I like the way my face looks. I happen to be treating um his daughter like with many patients, and she's super happy. And she had a lot of anxiety and and central sensitization, and I talked to her earlier in the week, and she's just loving life. So that's really exciting in for the dental profession, is that we can now really address deeper problems that have to do with longevity and wellness. Because I always say wellness is different than not being sick. And so that's what I'm excited about, if that makes sense.
SPEAKER_03Yeah, absolutely. And it's so great that they can come in and feel amazing. So you're treating them from the inside out, but then it's it's almost like they got a complimentary facial facelift or surgeon they didn't have to go through plastic surgery.
SPEAKER_00Right. And I call that the icing on the cake. Yeah. Yeah, I say that's the icing on the cake, because what they'll all say is of everything that I've gone through, what I love the most is how I feel.
SPEAKER_02Right.
SPEAKER_00Um, you know, I'm getting along better with my spouse and my kids. Um, my uh I I I don't have the mood swings, uh just my energy level where I feel like I'd be a little waning at two in the afternoon. I just power through and I've got enough energy in the tank. Um my head hits a pillow, I I have really good sleep quality. I mean, that's really the way it should be functioning, but we're in a disease management healthcare system, and how I started figuring this out is in my patient pool, which is a favorable demographic here in South Orange County. How many patients were on so many medications, anxiolytics, antidepressants, proton pump inhibitors for reflux? You know, a lot of them had um quote unquote allergies and a lot of these other uh problems that just didn't make sense to me, but in isolation, that's the way they were being treated. Right.
SPEAKER_03So is there um or there is a version of tired that sleep does not fix. So what is actually happening in somebody's body when they spend eight hours in bed? And we even talked about it on the previous podcast, somebody sleeps for 12 hours and they still wake up and they feel exhausted.
SPEAKER_00Right, right.
When Sleep Does Not Restore
SPEAKER_00So that's typically upper air resistance syndrome. We call that sleep fragmentation. So sleep fragmentation is when you're not getting the appropriate percentage or ratio of the sleep stages. So there are there are the different sleep stages, and you you need to have um consistently the appropriate amount of it. So we now know that there um are Fitbits and you've got the Ring, and people are getting more into it. I'm I'm I'm so excited about that. At the consumer level, that people are becoming more consciously aware of it, instead of just their traditional Starbucks stop on the way to uh work, that is like they require that, which is kind of like this is what we do, I call those cultural compensations, not to say that's bad, but if you're saying, eh, I really don't need that, you know, uh I don't need that vente, I could just have a tall. Um and um in fact I get too wired when I have that vente was before I needed it, as an example. Um, and their stomach isn't as upset. Um, but those people can be people that don't have sleep apnea, they just have sleep fragmentation, where maybe you should have, say, 50% of your sleep would be light sleep, 25% would be N3 sleep, which is that deep, deep sleep. It's super important. That's when the brain recovers. Uh, and then uh about 25% RAM, that dream state, where they may be spending 75% of it in light sleep, and maybe they only get 10% of RAM and you know, 5% or not much of non-RAM deep sleep or slow wave delta sleep, they can sleep 12 hours, they'll wake up, I feel like I got hit by a Mac truck. They're not ever to, they're not able to regulate. Moreover, the consequences of that, if you really understand the literature, like the Thompson study was the first study, and I've talked about this before to show that for women, that um there's a dose response regarding sleep quality and quantity and their risk for acquiring breast cancer. So not even having obstructive sleep apnea, just less sleep or poorer quality sleep actually upregulates their incidence of breast cancer. Not only that, is it makes the breast cancer a poor prognosis? It makes it worse without getting into all the molecular biology of why the immune system turns on itself as a result of this fragmented sleep. So the stakes are really, really high, especially if you have the gene. And the the study is uh, you know, looking at the gene as a big risk factor, but even those that don't have that, so that's just one example. But there are a number of other cancers on a long list that Dr. Gozal and Dr. Nieto in Spain and these multi center studies have actually shown causal of poor quality sleep and risk for many different cancers. So For me, yes, it sounds hyperbolic to say that as a dentist, you're saving lives. But I'm going to say when you really get into understanding the details, not really, if you really understand the importance of sleep quality, and that has to do primarily a breathing problem. It's not to say that there aren't other conditions and narcolepsis and parasomnias, but the vast majority of it really has to do with our ability to breathe easily. And so when you can't, it's really difficult to get that really deep, deep sleep.
SPEAKER_03Wow.
SPEAKER_00Yeah.
What To Do About Snoring Kids
SPEAKER_03Um what about uh if somebody listening to this right now that has a child who snores, which we had we've had a little bit of this conversation in a previous episode. But if they have a child that snores, breathes through their mouth, and wakes up looking more tired than when they went to bed, what do you want that parent to actually do? What would be their first step?
SPEAKER_00So I I always say it starts with education.
SPEAKER_01Right.
SPEAKER_00And and I'll say, well, like I said in another podcast, get a couple of videos.
SPEAKER_02Yeah.
SPEAKER_00Become aware of, you know, how they're sleeping, sleep position. So sleep position is a compensation. So I oftentimes will ask the kid, you know, well, how do you sleep? Well, I sleep on my side or on my stomach. I go, well, can you sleep on your back? Um, well, no, not really. Well, why? I don't know. Um, well, have you tried? And it's just not comfortable. I go, do you understand why? No, it's just not comfortable. So I start talking to the parents and I start talking to them about what are called positional cap apnias, where gravity starts working against you as the muscles relax as you fall asleep, the tongue starts obstructing. And that flow limitation from the turbulent airflow stimulates the brainstem to say, not good. Move over onto your side. So these are the kids that do what I call the fish dance or flip-flopping all night long, trying to get comfortable. Why? To breathe. They're hyperextending, they can't breathe through the nose, maybe they're mouth breathing. Um, and again, it creates a lot of problems in their studies to show uh decrease in IQ up to 15 IQ points. Dr. Dougazal did that study. Um cognitive problems, focus, you know, behavioral problems, kids that get into risky behavior, they don't have impulse control, that's prefrontal cortex. So the prefrontal cortex does not get that deep sleep. It's a newer part of our brain that just doesn't function while it's super inefficient. And that's classically what you see with functional uh in functional MRIs in patients that have AD to ADHD. It's not that they need to have a stimuli like Adderall or Vivants or Ritalin to get them to focus, although that works, just like coffee works for an adult, it's really understanding that the brain, the prefrontal cortex, is not working properly. And so then now their behavior can be misinterpreted when an adult, I understand an adult, we have mature brains. It's evolved to where we understand and can think like an adult. A child, all the way through adolescent brain, not only are you developing fluid intelligence and and uh all these things, but there's also impulse control. And the the brain matures to understand the do's and the don'ts, right? And sometimes that is stunted if you have fragmented sleep, and it gets treated as a behavioral problem. And these kids, you find out they're anxious, and and sometimes they'll get into bad, risky behavior. They start, you know, um smoking weed or or popping wheelies. Popping, yeah, popping wheelies. That's another thing. They need the dopamine.
SPEAKER_03That's an orange county.
SPEAKER_00That's all of no, that's national. That's that's now we've infected everything. But but yeah, they start getting into risky behavior, and I say and tell the parents, you know, I think they're just trying to self-medicate, really no different than adults do. Right. And they just don't know what it is, they're just feeling a certain way, and they're just thinking it's hormones or it's I'm a kid, or they don't even think that. They just are going by feel, right? The limbic system.
SPEAKER_03So Yeah. Oh, this is such a such a great topic and an area of conversation. I mean, um we uh had looked at this um this sort of study, and it said 80 percent of jaw development is done by age seven. Okay, so what does that mean for the window to fix this and what happens to a child when that window closes? So if we know that 80 percent is by the time they're seven, are they too late when they come to as a a teenager?
SPEAKER_00Yeah, yeah. There so there are different studies that cite percentage of of growth uh at different ages, and really it's a moving target, it depends, because if you're not getting good quality sleep, that kid may be dentally delayed, where they're seven years of age and yet they've got the mid phase of a four-year-old still. Their teeth aren't falling out there uh because they're not really developing. So, you know, those statistics are you know um kind of guidelines. Um we know that the six-year, the six-year molars, um uh at six years of age, the brain is pretty much done, completed as far as its growth. Um, and then by the time the wisdom teeth come in, uh, 19, 20, 21, the axioskeleton has finished its growth. And then the 12-year molar is about halfway in between. So you could say at six years of age, kids are about 60% grown. Why that's important is it depends on where along what we call the airway timeline, from birth all the way through growth and development, what interventions looking at structure, function, and behavior you would have in your toolbox to fix uh deficient uh uh skeletal growth of the face. So you can have what we call a hyperdivergent um growth pattern, meaning that they're way behind, or someone that's just kind of nuanced, they're just off a little bit. And so that will affect the decision as to how much time you have to grow the guy, uh uh uh the uh guide the growth. Um, and so it it really depends. For me, roughly there's like the first epoch is that first two to three years, and then after that it's what we call LTS, less than six, um, where there is a very, very specific protocol in addressing um the growth pattern. The first thing is get the kid out of distress and they're breathing in their sleep, and then the second part is growth guidance, right? It's not just palate expansion. And we talk about sleep hygiene, nasal hygiene, we talk about do's and don'ts, and you educate. And then from about six to about 10, 10 and a half, there is a window before the um the all the baby teeth fall out that you can use uh orthopedic remodeling or growth guidance with bioblock and and and other approaches. And then once you're past that age, then it's more difficult because a lot of the facial skeleton has grown. Then you could start getting into skeletal expanders and clear aligners and elastics and mechanics to get them caught up. And then uh 18 on, then you are looking at a combination of uh surgical interventions from surgically facilitated orthodontic treatment all the way to orthodonathic surgery. So it depends on how early, that's why early intervention is really, really important. For me, again, it's less about the dental interventions and addressing the dental structures as much as is understanding the medical comorbidities, because for me, the outcomes that I measure are tangible to the patient versus what typic typically is in healthcare is it becomes tangible to the doctor, like they'll have a number that they want to expand to that's meaningless to the patient.
unknownRight.
SPEAKER_00You know, uh what they all they know is how they feel, how they're sleeping, you know, the anxiety, the anxiousness. That's what I'm treating too. Um, not to say that I don't use those other what we call surrogate markers as guides as to where they should be. So I hope that answers the question on that growth.
SPEAKER_03And it does. And when you're saying about all the different interventions that's required as they grow older, so if they come to you as a child of four or five, six, they don't actually need like surgical intervention? Yeah, yeah. No. No.
SPEAKER_00No, typically not. And in fact, I'll tell them, even with tonsils and adenoids, um, we try to shrink the tonsils and grow them out of it, right? And the studies actually show, even if you remove tonsils and adenoids in the odolaryngology literature, that within six years uh they're still either residual disease or uh it reappears again. Right. Right? Because the underlying problem is really a facial growth problem. That's what Stupak and and Park wrote about is let's get to the root cause. Now, if the tonsils are really fibrotic in grade four and the kid is really that's a different story, but that tends to be the exception. So uh the earlier you catch it, the better the chance and less invasiveness, if you will. Right. And then the last thing is if I can get a kid early enough, I'll, you know, and get them back to where we get their facial skeleton growth where it needs to be, um, although it's gonna take many years to complete that. I'm obviously not gonna follow them all the way through in treatment, although I do follow them, is that by the time they get to the braces age, they will be the kid that won't need braces.
SPEAKER_02Right.
SPEAKER_00And they will see everyone else's in braces and they won't need it because they won't have the crowding because they've grown, and then they can finish, just have the most gorgeous face and and and uh smile as a result of having like that high cheekbone, that big square jaw, that straight profile, that nice posture because they they can breathe well. We
The Treatment Window For Growth
SPEAKER_00call that the Paleolithic face. This is the way we evolved to be since the dawn of man, essentially. I mean, at least going back some 60, 70,000 years, it's really well documented in the ancestral uh literature, the uh anthropological uh literature. And that's where I always go back to. I'm gonna treat them to their ancestral, really genetic, full potential, not to the compensated potential of some contrived number number that I was taught is the number that really didn't mean anything.
SPEAKER_03Because we look back into those ancestries, you know, times 20, 30, 50,000 years ago, and they all have those big jaws and the big old big facial features that everything is. Thousand years ago. Thousand years ago.
SPEAKER_00Five hundred years ago.
SPEAKER_03And so everybody just kind of like narrowed, narrowed out?
SPEAKER_00Yeah, we we have gotten uh no question, um, those studies are very well documented. It's just been ignored because it's anthropology. It doesn't, it doesn't translate into medical dental. Right, but now it's starting to. Um there's data that's coming out, but digs that have been uh uh performed all over the planet, we never saw dental crowding. It's very rare, even tooth decay. Um, and it there was enough growth even for the third molars and even the space between the two front teeth. They were polar. Look at those jaws, they're just uh they're they're beautiful. They're they're um um, yeah, it was it's the way, and it's been a nanosecond from an evolutionary point of view, the change that's happened, and it's actually accelerated really even in this last 100 years. Look at the disease, chronic disease epidemic, even in the last hundred years, type 2 diabetes, you know. Now my concern is all the um mental problems that are occurring, that a lot of it is attributed to our electronic devices and things like that. I'm gonna say that's contributing, but there are other things that have been somewhat ignored. And it's not just the food supply, certainly hasn't helped. Now we're kind of learning about uh whole foods and eating correctly. It's not just what's in the food, it's how it's being chewed.
SPEAKER_02Yes.
SPEAKER_00That muscle pull on the bones that helps grow. And so we talked to our parents about you know the do's and the don'ts that um avoid texture aversion, where kids don't want to eat challenging foods and chew their food. Um, and so they never develop that good um um facial strength and competence. And so now what do we see? We see this phenomenon of mewing. You know, you see all these influencers talking about, starting to connect some dots about really that's all about myofunction and bringing the job forward and exercising. Honestly, it's kind of late in the game when you're already in your 20s. Um early intervention is real important, but at least, you know, uh the public is starting to learn about these things.
SPEAKER_03Yeah, and at least they're they're getting aware and knowing that they're you know, there is something. That's exactly it. And um Stanford actually published a study in nature medicine showing that one night of sleep data can predict dementia, heart failure, and stroke even years before it happens, which I thought was crazy. Um if you read that study, what does that research actually miss? Do you find?
SPEAKER_00Well, I mean, I I'd have to read the study, but none of that surprises me. No. I mean, it really underscores uh, you know, what I've been saying now for 15 plus years. Again, it's the medical comorbidities. Think about it, that we spend a third of our life in a state called sleep. And we've kind of undervalued that. We're a sleep-deprived country. That's very well, uh although now people are understanding about mattresses and pillows and and taping and all those things, uh uh nose cones and breathe rights and all that, and that's all fine and great. So they understand that that's gonna help with their sleep. But that third of our life, just because we don't fully understand what's going on, although we're understanding more, tells us that nature's invested uh in something, an activity that is super important. That's a huge investment. And and when you understand that you're not doing that very well, of course there are going to be consequences. And the fact that our medical system has yet to catch up to understand the importance of that um is where we're at right now. I'll just say that Dr. Bertrand DeSovo, who the critical care physician pulmonologist that um uh we interviewed at our last podcast, you know, we've talked about, and he actually has talked about the story where he offered the dean of the medical school at UC Irvine to teach the medical students a course on sleep. He says, I'll do it on my own dime. This is really important as a critical care physician, pulmonologist, boarded sea physician. These medical students need to know about this. And the dean says, not interested. Wow, we're too busy doing other things. So it's also one specialty in medicine that has found it difficult to fill all the matches and all the fellowships across all the medical schools across the country, like not that much interest in it. And so, because they don't understand, and then I'm just gonna even go back even further upstream, that really most of that is not a frank sleep problem. It's really a breathing problem first.
SPEAKER_01Right.
SPEAKER_00And uh, you know, I hate to say it, but our physicians by and large don't really understand that much about the facial skeletons. It's not their area any more so than I know that much about the liver.
SPEAKER_02Right. Right?
SPEAKER_00I mean, it's not a right or a wrong, it's just an is. And that's why we need to integrate, break down our silos. That we need to, like Sasha and Jane from uh the medical school at you know Stanford has said, and he's written about is it's time for medicine and dentistry to start really working together towards the uh uh wellness of our population. And so um the addressing these structures that we see as dentists every day, and I tell this to my dental colleagues, let's start looking beyond those pearly white things that we work on. Um, and and then we start understanding. But honestly, it's a little bit of an uphill battle, although we're starting to get more and more awareness. Right.
Why Modern Faces Keep Narrowing
SPEAKER_03Yeah. Um what about people that are on Ozempic? And now this is definitely a hot topic. There's GLP1, right? They're losing weight, feeling better, but some of them are being told that their sleep apnea is improving. So is a GLP1 drug actually fixing airway, or is that just masking something?
SPEAKER_00I am very concerned about the massive um incidence and use of GLP1s. I mean, I uh on the surface, yes, uh, it looks like it'd be helpful. Why? Because it's addressing obesity, which we know is causal for cancer.
SPEAKER_02Right.
SPEAKER_00It's not associated, it's high causal for cancer just by itself. And then, of course, cardiovascular disease and type 2 diabetes and the metabolic problems. No question about it. But we have to ask the question is obesity like dental crowding a problem to be fixed, or is it actually an expression of an upstream problem? And I'm gonna argue that that's mostly what it is. As Kristen Guimineau would say, a baby is rarely born fat.
SPEAKER_01Right.
SPEAKER_00They become fat. And again, the food supply can make it worse, no question about it. But the body will upregulate ghrelin and and and leptin and other things that hold on to fat when it's in a chronic state of sympathetic driver fight or flight, which most of us are now. That's what's making us sick, as Robert Sapolsky, the neuroendocronologist, has written about. And so we have become fat, and GLP1s will help that. Now we know that the condition of the airway, it's not just the size, the condition of the airway is also a risk factor uh in sleep disorders. And so if there's weight gain, it's gonna take that functional space that we breathe through and it's gonna crowd it as well with adipose tissue or fat, right? So we know, especially in males, there is more fat deposition at the base of the tongue that actually does constrict the airway. So, no question about those studies are clear. And yet, even in uh a number of studies, we've shown that that's risk factor of obesity is still less than half of the risk factor that craniofacial growth represents. That's the bigger, that that's really the fire, if you will, whereas the fat gain and obesity is maybe fuel on that fire. So it's multifactorial. So are we going to continue to treat symptoms? Moreover, I saw coincidentally that you asked this question, a patient earlier this week that was telling me that he um um had been diagnosed with prostate cancer, and that he um at City of Hope had been recommended to have a genetic uh uh panel taken on him. What they found is that he had a gene that was expressed that put him at greater risk for prostate cancer, and they had recommended, well, you should test your whole family. And it turns out that gene was found on one of his younger daughters.
SPEAKER_01Okay.
SPEAKER_00And that younger daughter ended up, they tested her and they found out that she actually already had uh a type of cancer that had they not detected it a year or two years later, she would have had a very poor prognosis. So they caught it. And one of the things that he brought up was that GLP1s, very clearly as one of the side effects, has said if you have this gene or if you have this condition, do not take it. Because it actually upregulates the activity of that gene to increase your risk. So these are the things we don't know about. And I I was talking to him about saying that with GLP1s, we should be invoking what's called the precautionary principle. And and the precautionary principle is in science a principle that, if I were to summarize it, would be something like if there's less than 1% chance that something bad could happen, we should invoke the principle meaning that we don't do it. Yeah. Now that's different than an evidence based approach, which will say risk benefit. 1% chance for the benefit, not a bad uh uh decision. We do that all the time. And so we have drugs that we knowingly will take, but that we also know have side effects. And we take those risks of those side effects. So I say those side effects are because we're imposing our will on our body that we don't quite understand that results in the side effects that we may accept that aren't as bad as the condition that we're treating. Diarrhea, nausea, vertical, whatever the case may be, whatever the medication is. So the precautionary principle would be invoked in, say, uh global markets in the food supply, like, say, the use of a pesticide or of a uh genetic marker, GMO, on, say, wheat, that if you use it and there's a 0.5% chance that it may cause some medical condition in 5% of the population could be catastrophic when it's worldwide, when you're talking about the billions of people that are eating this food, and you can't take it back. So that's where there are international councils that will say, no, you know, on toxicology and and pesticides and things like that. So we're going to invoke the the um the precautionary principle, and yet there are stakeholders in um chemical companies, I'll just say Monsanto will probably be shot tomorrow. Um, but uh if I am, you know, you know that it came from this podcast that uh control our seeds and these decisions saying, you know, it's okay, it's a very small, we'll take responsibility, but the cat's out of the bag. So going back to GLP ones, I would say that it should be our decision making should be more akin to the GLP ones, because I think that if we took GLP ones and said, you're gonna take it for three months to kind of get you to that point where your weight is where you are, and then now you go to lifestyle change for the rest of your life, that's one thing.
SPEAKER_01Right.
SPEAKER_00But the way it's being marketed is you're on it the rest of your life. Right. So the stakeholders have a big stake in that. And and you can argue that if you decrease type 2 diabetes and cardiovascular disease and maybe even cancers by 20 percent, that's huge, that that may be a huge gain. But on the other hand, if there's 50 percent risk for any of a number of other conditions that we don't know about that we may not know for five or ten years, then I think those are things that we should talk about. And I'm not saying it's a right or wrong, but you asked me the question about GLP ones, and I do think that uh they definitely have their place. There's a definite benefit, but I'm not so sweeping in saying that it's something that we should do. Again, going back to disease management, the physician doesn't have enough time to really discuss this the way we are in a podcast. I think there should be more emphasis and incentivation, incentivization on lifestyle changes. But if you're a healthcare provider, honestly, there are no medical codes to do that. I mean, you're spending a lot of time. I mean, I spend a lot of time having conversations like that where I do it because I think it's the right thing, but in that period of time, I could have been doing surgical procedures, placing implants, and doing a bunch of dentistry and gotten paid a lot more.
SPEAKER_01Right.
SPEAKER_00And so, I mean, let's just kind of call it for what it is. Is there is a decision that a provider has to make and trying to take care of their family and their community and being fiduciary, uh have a uh fiduciary responsibility of their family and making these decisions. So I think that's where I want to be in Washington, D.C. with the policy uh makers and say, hey, we should really be talking about this and making some investment and maybe uh changing some thinking and early intervention for our kids and preventing that future continued epidemic of sleep apnea, just just that in and of itself. But also get let's get our kids off of you know these uh uh ADD ADHD medications. Let's not be so quick to um treat treat them for their type 2 diabetes, knowing that uh that's an environmental factor.
SPEAKER_01Right.
SPEAKER_00Let's not just go for that magic pill, but that requires many stakeholders to really look at this problem beyond you know just their day-to-day practice. And the academicians it's just not their wheelhouse, and for the clinicians, they're not getting paid for that. I mean, and so it's a little bit of a tough situation. My hope is that this podcast is heard by somebody that would say, let's talk a little bit more about that.
SPEAKER_03Exactly.
SPEAKER_00So thanks for bringing up that question.
SPEAKER_03Absolutely.
GLP-1 Drugs And Root Causes
SPEAKER_03And I know it's a lot, it's a question that a lot of people are definitely going to have and are thinking about it. So I think it's it's great, and we'll make sure that it gets out there. Thank you. Um I want you to walk me through what actually happens inside the body during one night of restricted breathing, not from a clinical perspective, but maybe like a story of what does a heart and the brain and the nervous system.
SPEAKER_00Sure. Okay. So let me just start by saying that with good organic sleep, where there's good sleep latency, what that means is your head hits a pillow and you're falling asleep at around 10 minutes, 11 minutes, 12 minutes, somewhere around that. So you're starting to have what's called good sleep efficiency. If your head hits a pillow and you're falling asleep in two minutes, you're sleep deprived.
unknownRight.
SPEAKER_00Plain and simple.
SPEAKER_03Yeah.
SPEAKER_00Or you just random marriage.
SPEAKER_0390% of the mothers out there.
SPEAKER_00Yeah, exactly. You're sleep deprived, right. And you're and and by the way, the depression and the mood swings and everything are related to that too. It's not a hormonal thing, although there is a factor there. If you're taking 30 minutes, 45 minutes or more, which is common with upper aerosistance syndrome, that means that you have an upregulated stress drive, sympathetic drive, too much cortisol, and adrenaline in the system that has to be metabolized before the body can start going into its normal sleep cycle. So it starts there because when the body lays down, the hypothalamus starts releasing a hormone called vasopressin, otherwise known as antidiuretic hormone, naturally as you're falling asleep. And the purpose there is to stop processing the fluids to where your bladder is full and you have to void, you have to go to the bathroom. Because the body does not want you to have to get up multiple times to go to the you should fall asleep, make it all the way through the night, by and large, wake up in the morning, you void, and you're off and running. Um and uh I mean, short of you drinking a liter of water right before you go to bed, best practices are hydrate the first part of the day. By two o'clock, you should have your two, two and a half liters, and then the rest of the uh of water. Uh and that's the other thing, people aren't hydrated enough. But let's say that your best practice is you hit the head, fall asleep, uh, 10 minutes of vasopressance released. Um, your heart rate is gonna start down regulating. So from your resting heart rate, it's gonna drop down. So let's say you've got a good resting heart rate of 70 beats per minute, right? Even 80 beats per minute. Um when you're getting into that deep sleep, your heart rate's gonna drop down to 50 beats per minute, 45 beats per minute, some people down to 40 beats per minute. I mean, you're slowing down. You can actually measure that's one of the things that we measure. And that's governed by the autonomic nervous system. And you're gonna go up through uh three to five sleep cycles, you know, N1 sleep, N2 sleep, N3 sleep RAM, and uh you're gonna repeat that. And during that period of time, your brain is detoxing during N3 sleep. Um there uh you're regulating your hormones, metabolically growth hormone, testosterone, uh, et cetera, et cetera. And you're gonna go through two or three of those cycles, you're gonna wake up naturally, pop out of bed, and maybe you have a cup of coffee, but you're good. You don't even need that, you're good. And that's the way it's supposed to work. You do that very well, that's a competence. Um you're gonna have you're gonna be very healthy. Your immune system is gonna be able to attack cancer cells, it's gonna be able to attack bugs that are invading that you may not know. You may have six hours later walked into a plume of viral particles from someone's sneeze that would otherwise cause a cold or a flu or whatever that your body can process.
SPEAKER_02Right.
SPEAKER_00Right? That's why you know parents will say, yeah, everyone's always there at school and everyone's gone, they're passing their bugs around. Honestly, that's not what should happen. It happens, that's normal, but with a good, healthy kid that's sleeping well, breathing through their nose, their incidence is gonna be much lower. But of course, you're also building your immune system and things like that. So, but by and large, you won't get sick that often throughout the year. I ask, how often do you get sick? It's very common. Oh, I get sick three to five times a day, uh a year. Cold and flu, well, how long does it take? Oh, it takes me two or three weeks. That's uh, and yet those are perfectly healthy people.
SPEAKER_02Right. Yeah.
SPEAKER_00Um, if they say, well, I get sick once every couple of years, um, bad flu, okay. I catch a cold or two, I beat it in two, three days, I'm done. That's more the way it should be. But surprisingly, that's not always the case. And if you're sleeping deeply, sleeping well, uh the body will be able to regulate that from the immune system. Cardiovascular system is gonna be uh great, the uh endocrine system is gonna be functioning well, um, you're gonna be regulating, um, you're gonna be healing, the body's gonna repair itself. You're working out in the gym, you're stressing it, your body is um not gonna be sore constantly when you're conditioned. People say, Well, I work out all the time, I'm always sore. Well, if you're healthy and you're sleeping well, you the body knows how to repair itself. Now, if you're really training for a marathon, or for a triathlon, or a bodybuilding, different story. So that's what sleep is supposed to look like without getting into every organ system, but that's just not my experience of what I'm seeing with patients. But it's kind of like I'm sleeping, it's my life. I got three kids, yeah. I'm chasing dragons, and and uh then I come home, and you know, and so that's a day in the life in the United States, and that's why um we're not even in the top 50 health-wise. And if you think you could supplement your way out of this, it's a billion-dollar industry. I'm sorry, we talked a little bit about body hacking, a lot of people body hacking, but they're missing the elephant in the room, in my estimation. I'm not saying those other things aren't bad, but they should have a context and a foundation of good sleep beyond having a good pillow. Yeah. And we measure that.
SPEAKER_03Oh, and when you speak about pillow too, I've also noticed we get retargeted with all these fancy pillows. These, you know, would does that actually make a difference? It's it they're even pr they're even showing these pillows and then showing a before and after picture of the face of a child just from the pillow, that it goes from this like droopy, like almost like it's lost its chin to this predominant structure just because they slept on this pillow.
SPEAKER_00Yeah, that's hyperbolic. I mean, it it I I think you could say if many other things also occurred with that good sleep, that that's the result. Right. But don't give the credit to the pillow. It's not to say the pillow um is is gonna hurt necessarily, it can help if you have the main things going on. Right. It's just like certain supplements can help if you've got these other things, but if your body can't absorb it because it's always in fight or flight, it's a problem.
SPEAKER_03It's a problem, yes.
A Night Of Restricted Breathing
SPEAKER_03Um if you can look at someone's teeth and know things about their health that their own doctor doesn't know, then what are you actually seeing and what does that tell you?
SPEAKER_00So as a dentist, I mean I I again I'm I'm looking beyond the teeth. Um on a child, I'm looking for very specific things that the physician may not see, the pediatrician may not see, or you know, the ENT or the primary care physician may not see. Um but I report to them and and and we'll talk to them and and uh report some of the, like let's say for a child pediatric sleep questionnaire, a lot of the problems that they have, uh, and and send them a report and they kind of go, oh, I'm interested, that makes sense. Or I'll say, you know, your patient needs, you know, I'm gonna recommend a sleep study, I refer uh for, especially if it's the end stage. Um but when I'm looking at the patient, I'm looking at them from the face, and then I I work my way through. I look at clinical correlation, I'm asking them um questions about that, take a medical history and all that, what kind of medications are you on? Tell me a little bit about what happens. And oftentimes you'll find the history. This happens all the time with you know, patients that I'm I'm seeing, they go, they'll bring their kid in and they'll say, you know, this is what happened to me with my kid, uh with myself, uh, and I don't want this happening to my kid.
SPEAKER_02Yeah.
SPEAKER_00You know, I sucked my thumb and wet my bed till I was 12, and I slept on my stomach, and I snored, and I struggled in school till I was in sixth grade, and I did that. And this may be the CEO of a company now.
SPEAKER_02Right.
SPEAKER_00Made it through all that as a high uh functioning individual, but it was a harder uh, but now they're on cardiovascular medications. They have some metabolic problems, maybe they're on a GLP one.
SPEAKER_01Right.
SPEAKER_00So uh I I think I would want the patient to have the best opportunity to have their body tuned optimally throughout all their uh stages of of life. And and that's where we have this conversation of what that should look like beyond disease management and symptom-driven care.
SPEAKER_03Yeah. I mean that's that's fantastic. I mean, what about when everybody is talking about nasal breathing right now? Huberman mouth tape, the whole movement. What does this actual airway specialist think about all of that?
SPEAKER_00Yeah, I'd love to be on Andrew's um podcast. I think that there would be a very interesting conversation. So I uh was talking about taping 15 years ago.
SPEAKER_02Right.
SPEAKER_00Honestly, no one was talking about it. I was this crazy person using scotch tape at the time, and then I graduated to medical tape, and I talked to uh people about they thought I was crazy. But the point about it was is to actually show and assess that you can actually breathe through the nose, that our lips are supposed to be together. So now it's morphed into a whole industry of incomplete information and understanding about how tape is supposed to be used. Uh, it's not supposed to be a sub substitute for the underlying competence of the muscles that are supposed to naturally be able to do that. Um for the tongue to stay where it should be so it doesn't drop back and obstruct or limit flow during sleep. Um we should have a patent nose and a natural nasal cycle, easily breathing with no sound night and day, where we could sleep on our backs and supporting our axial skeleton and our uh our rotator cuffs, where a lot of these patients end up all night long on their left side and they have rotator cuff surgery on their left side or the right side, um, you know, years later, and it's blamed on their history of tennis or golf or whatever the case may be, that maybe just is fuel on a fire.
SPEAKER_02Right.
SPEAKER_00But the pre-existing risk factor was all their weight uh on those four delicate muscles that make up the rotator cuff that now have been damaged, and now you go and swing the golf club or the racket, and now you have microtears, and then it progresses to the bursa, and then you have this surgery, right? So we sure we were designed to seep on our back, and then our head turns to the left and to our right with our head um not hyperextended, but the cervical spine properly supported, and and yada yada yada. You know, so you're not having to go to the chiropractor for these adjustments. But that's what we do, right? And so there is certainly a way that we're supposed to do it. Now, the fact that it's common that people, you know, they have pillows that they hold on to now, unless you're pregnant, that's a different story. Um, I I think taping and nose cones and all those things are great, but let's understand the why. And it goes back to the five competences.
SPEAKER_01Yeah.
SPEAKER_00Breathe through the nose because you get nitric oxide breathing through the nose that you don't get with mouth breathing, and all its benefits, lips together, because you can and they're competent, and because your jaw is in a forward enough position to be able to do that, the tongue on the roof of the mouth it's not dropping back, so then now you're snoring and obstructing and getting all these vibrations and the reflex that comes along and goes into your nasal passages, into your sinuses, into your and um diaphragmatic breathing that's super efficient versus chest breathing, which is secondary. Um, those are not as efficient with intercostal muscles and all that. We could do it, and we do it. I'm doing it now as I speak. I have a compensated breathing behavior right now as I'm speaking to you because of language, right? And that actually is stimulating an adrenaline response for me. So my stress response I brought on is upregulated by choice, because I'm doing this right now uh with you, but um, I'll be able to get into parasympathetic coherence and chill after I'm done here for a while, and that's really where I want to be. That's where I feel better. So um again, the five competences. So to answer your question on you know, tape and all that stuff, it's all good, but let's really understand what it means.
SPEAKER_03Right, exactly.
Mouth Taping With The Right Context
SPEAKER_03Um you founded the airway collaborative. What made you decide that someone had to build that and why did it have to be you?
SPEAKER_00Well, yeah, that's interesting. So historically, again, going back about 15 years ago, um I met an orthodontist, uh, Barry Rayfield is my teaching partner, and we were actually in a mini residency and went to lunch and we started talking about this topic. And we said, hey, we should collaborate and we should start um teaching together. I'd already been giving some some uh courses and he had too, and we uh started um giving these courses. And what we found is there was a lot of hunger for more information. And one of my colleagues was an attorney, I went to dinner with him, and he was already an early adopter in social media and in podcasting. Just uh Steve Jobs just unveiled uh I think it was the i iPod uh the concept of podcasting. And there was a free uh application uh called Spree Cast before Zoom. They came out. There was a video uh video conferencing. And so I told um Barry, my my teaching partner, then my attorney friend had turned me on to this thing, and he said, You should start doing that. I'm doing it with my attorney colleagues and everything. So I got into it, it was free, and we started doing the spree cast. And in that, we had what our theme was. And we went into it with a mission statement. We were gonna do just 25 um spree casts, and what we were gonna do is we were to talk about airway, and we were gonna interview different people and get their thoughts. And what happened is it started growing. And we would have it like on a Tuesday evening, and maybe we would have 30 people on, and then it was 100 people, and then it was 300 people, and people were coming on and from all over the world. I mean, we interviewed, I interviewed um you know, John Muun in England and Rosal Courtney in in Australia, um uh uh colleagues um uh from the East Coast, Robert Thomas from Harvard, who developed the um the uh sleep image, which is uh sleep screening, um, Ron Harper from the UCLA Brain Research Institute, Bert Trend to say, I can go through a whole list. And the interesting thing that we found was that everyone brought a different perspective into it, whether you're an allied health professional, physical therapist, malofunctional therapist, occupational therapist, or you were an ENT, critical care physician, pulmonologist, or you're an osteopath, you're an orthodontist, you're a general dentist, prostodontist. So we got all these perspectives. It gave this mosaic and there was a lot of excitement and built and built and built. 80 episodes later, we the company was then going bankrupt because Zoom came about and they didn't have private equity to really support them. And so poof, all those episodes went away. I was able, I think on my website, to have maybe a couple dozen of them. But from that, we called it the airway and facial collaborative. And we went through how our environment was changing, our facial development, and how uh where it started with the ancestral anthropologic standards. So we've been talking about this for a long time and have interviewed anthropologists on it as well. So it just grew and grew and grew. As we were teaching more and more of these courses, and so that was the first foray, and and so we were the first to do this. Uh at the time, dentistry was really mired in sleep group solutions, doing appliances and dealing with sleep apnea and working with sleep physicians. At the time, sleep medicine was fighting dentistry, turf wars about who should be dealing with this. We were not even thinking about the sleep as much as the breathing, and just raising awareness. And that's where I learned a lot. And I learned that this is too big a problem to do by yourself. We have to collaborate. And so that's kind of where it started.
SPEAKER_03Is that still is that still live and active?
SPEAKER_00No, no, that that that ended. Um, that ended, and then of course, with my bandwidth, the the the courses really took off. People started paying more attention to, and then that gave rise to uh finally gave up because I said you gotta write a textbook, you gotta write a textbook, you gotta put this all in. And so then I've been spending the last four plus years on that, and that's done. Um, and then um, and then just moving into my new practice, and then having this podcast, my son said, Dad, you're this guru that lives out in the hinterland, no one knows who you are. We're having everyone's repeating a lot of the stuff that you're talking about, and I said, That's great, open source, let's get that out there. Yeah, but they're you know not saying the right thing, and so he's the one that brought me to you need to be in social media, you need to be talking about it. And here we are.
SPEAKER_03And here we are getting the word out. Yes. That's fantastic.
SPEAKER_00Yeah,
Collaboration And The Final Message
SPEAKER_00thank you.
SPEAKER_03Um and I'm gonna I want to finish this off with one more question.
SPEAKER_02Please.
SPEAKER_03If you could say one thing to every exhausted person who has been told that their labs are normal and everything looks fine, what would you say to them?
SPEAKER_00Um so when you say the labs are normal, I would say um if you have fatigue, and we use the fatigue severity scale, which is a medically uh validated metric that's different than sleepiness. Right. So mostly our use of sleepiness scales. Uh those are medical surveys like the Epworth, the Stop Bang, the Berlin, they're all these that measure sleepiness. It misses the wired and tired group that is the upper airway resistance syndrome patient or the sleep fragmentation patient, is who you just described. They they can't take a nap. They're not sleepy, they're just tired and fatigued. For those patients, I would say, let's find out why. Do you have a reason? Have you seen your primary care physician? Do you have a diagnosis? Do you have a genetic condition? They don't.
SPEAKER_01No.
SPEAKER_00They've just accepted it. It they've they've they've attributed it to their work and their family life and their boss and the traffic and the stress of the day. And I'm just gonna say, maybe, but maybe something else is going on. And when you really understand some of the other health risks, it's something to take seriously and some find out and say, really, how well do you do sleep? Right, how well do you breathe? Um, if you are having to take a yoga class on a weekly basis to feel good, I'm gonna say you know how you're supposed to feel at the end of the yoga class. That's a competence of how you should always feel without having to put that much effort into it. And then that may be something that we need to look in a little bit more, and that's where we look at and do our examination, quantitative metrics, qualitative metrics. We put a lot of data, at least three to five data sets, and that gives us enough information. And what I found is in that process, the patients starts thinking and go, Oh my gosh, no one ever asked me those questions. That makes sense. They start connecting the dots and they go through that process, and then now it starts becoming clearer. Now it's not to say that it can't be other things, but again, this is a huge thing that's been missed.
SPEAKER_03And we're gonna continue it, right? We're gonna keep we're gonna keep going and yeah, we could go on forever.
SPEAKER_00But thank you. I appreciate Amber. Those are great questions, and I hope they help other people listening to the podcast. Thank you.
SPEAKER_03Thanks for listening, guys.