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29 episodes with uars
2 episodes with uars
4 episodes with uars
2 episodes with uars
2 episodes with uars
2 episodes with uars
Kristen has been practicing dentistry for almost 8 years, but during the last 5 she has been narrowing her focus to airway dentistry and adult laser tongue tie release. She prides herself on being a root cause doctor and really understanding WHY certain issues such as tooth decay, clenching/grinding, jaw pain, etc. are occurring to really find solutions on an individual basis. Several years ago she was struggling with exhaustion, lightheadedness, anxiety, and trouble breathing before she was properly tested and diagnosed with something called Upper Airway Resistance Syndrome (which is on the sleep apnea spectrum). After realizing how life changing it is to BREATHE and sleep well, she has spent the last 5 years focusing and learning and is able to work with physicians to help others with UARS and sleep apnea. She lives in upstate NY with her husband, son, and 2 adorable rescue pups. She's excited to spread some awareness! What we talk about in this episode: Chicken. Banana. Chicken. Banana Teeth and acid reflux Should you wait 30 minutes after eating to brush? 5 things you should be asking your dentist Geographic tongue Underlying causes of gum disease Should you change your dental care in pregnancy?! Alternate nostril breathing Does mouth breathing cause weight loss resistance Shit your mouth breathing is causing you had NO IDEA about What isn't actually normal in your child (hint: crooked teeth and more) How do find a airway minded provider Tonsils…all the controversy Mouth tape who should be doing it?! Learn more about working with me Shop my masterclasses (learn more in 60-90 minutes than years of dr appointments for just $19.99) Follow me on IG Learn more about working with Kristen Follow Kristen on IG
In this episode, Jonathan Kiel Jensen joins Evan H. Hirsch, M.D., to explore whether Upper Airway Resistance Syndrome (UARS) could be the hidden cause of your sleep issues. Jonathan Kiel Jensen is a dedicated patient advocate specializing in Upper Airway Resistance Syndrome (UARS) and sleep-disordered breathing. After years of struggling with chronic fatigue and unrefreshing sleep, he discovered that subtle anatomical factors were contributing to his sleep difficulties. This realization led him to dive deep into research and advocacy, helping others recognize and address the often-overlooked signs of UARS. Based in Denmark, Jonathan now consults with individuals worldwide, providing knowledge and personalized strategies to improve sleep quality and overall well-being. Want to learn more or work with Jonathan? Reach out to him directly at jonathankiel01@gmail.com and take the first step toward better sleep and improved health! . We help you resolve your Long Covid and Chronic Fatigue (ME/CFS) by finding and fixing the REAL root causes that 95% of providers miss. Learn about these causes and how we help people like you, Click Here. For more information about Evan and his program, Click Here. Prefer to watch on Youtube? Click Here. Please note that any information in this episode is for educational purposes only and does not constitute medical advice.
Is Upper Airway Resistance Syndrome (UARS) robbing you of your health? In this eye-opening episode, Dr. Sinicropi sits down with Dr. Barry Krakow, author of Life Saving Sleep, to uncover the hidden world of UARS—a stealthy sleep disorder that's often ignored or misdiagnosed. From chronic fatigue to brain fog, anxiety, and metabolic disruptions, UARS wreaks havoc in ways you might not expect. Dr. Krakow explains why standard sleep studies often miss UARS and shares how advanced diagnostic tools, like esophageal pressure monitoring and RERA detection, can make all the difference. He also breaks down why BiPAP therapy may outshine CPAP for UARS patients, offering a more comfortable, effective treatment option. This conversation is packed with actionable insights, including lifestyle tips, treatment innovations, and how to advocate for the care you deserve.
Somewhere between normal nocturnal breathing and sleep apnea exists a strange entity. This condition, often debated in terms of its mere existence is upper airway resistance syndrome, and knowing about it can be the difference between solving your sleep-related breathing woes and continuing your struggles. In this episode we will:define upper airway resistance syndrome (UARS)review the concept and pathophysiology of upper airway resistancecontrast how this disorder is defined in comparison to sleep apnealearn the difference between an AHI (apnea-hypopnea index) and an RDI (respiratory disturbance index)understand how different sleep studies (in-lab studies, home sleep studies/home sleep tests) might differ in their ability to diagnose the disorderlist the various treatments that can be applied to the diagnosisProduced by: Maeve WinterMore Twitter: @drchriswinter IG: @drchriwinter Threads: @drchriswinter Bluesky: @drchriswinter The Sleep Solution and The Rested Child Thanks for listening and sleep well!
Kristen has been practicing dentistry for almost 8 years, but during the last 5 she has been narrowing her focus to airway dentistry and adult laser tongue tie release. She prides herself on being a root cause doctor and really understanding WHY certain issues such as tooth decay, clenching/grinding, jaw pain, etc. are occurring to really find solutions on an individual basis. Several years ago she was struggling with exhaustion, lightheadedness, anxiety, and trouble breathing before she was properly tested and diagnosed with something called Upper Airway Resistance Syndrome (which is on the sleep apnea spectrum). After realizing how life changing it is to BREATHE and sleep well, she has spent the last 5 years focusing and learning and is able to work with physicians to help others with UARS and sleep apnea. She lives in upstate NY with her husband, son, and 2 adorable rescue pups. She's excited to spread some awareness! Learn more about working with me Shop my masterclasses (learn more in 60-90 minutes than years of dr appointments for just $19.99) Follow me on IG Learn more about working with Kristen Follow Kristen on IG
Emma is joined by Lindsay Scola who speaks about her journey to diagnosis with Narcolepsy and Upper Airway Resistance Syndrome. In this episode: * Lindsay shares about her childhood and moving into politics after college. * Working on the Obama campaign and for President Obama in the White House. * Moving to LA to work in the entertainment industry. * How sleepiness symptoms showed up in Lindsay's life and how difficult it is to spot a sleep disorder when everyone is talking about being tired in work settings. * Getting a diagnosis with narcolepsy and how different symptoms felt to Lindsay compared with media portrayals of that sleep disorder. * Testing negative for sleep apnea in home sleep tests and during an in-lab polysomnogram. * Eventually receiving a diagnosis of UARS (upper airway resistance syndrome). * Finding a dental sleep medicine provider because she was married to her sleep doctor. * Lindsay's experience of dealing with the stimulants shortage. Connect with Lindsay: https://www.instagram.com/lindsay.scola https://www.linkedin.com/in/lindsay-scola-a75b431/ Connect with Emma: Get on the email list here Follow the podcast on Instagram: @sleepapneastories Email Emma at sleepapneastories@gmail.com www.sleepapneastories.com *NEW* - Order "The 6-Week CPAP Solution Workbook" by Emma Cooksey now! I took everything I know about CPAP and solving CPAP problems and I put it all in a short, easily accessible workbook for new and struggling CPAP users. Click here in the US or search your Amazon store for the title in your country. Librarians and bookstore owners, the workbook is also available to order on Ingram Sparks now and it comes out on that platform on 1st October 2023. Emma speaking at the virtual PCOS CON event: https://www.pcoscon.org/ Emma speaking at the Carolina Sleep Society: click here US and Canadian patients affected by the Philips CPAP recall. Please complete this survey: https://survey.ucalgary.ca/jfe/form/SV_cM7jj2mP2RapabY Disclaimer: This podcast episode includes people with sleep apnea discussing their experiences of medical procedures and devices. This is for information purposes only and you should consult with your medical professionals before starting or stopping any medication or treatment. --- Support this podcast: https://podcasters.spotify.com/pod/show/emma-cooksey/support
Renowned sleep doctor, Dr. Barry Krakow, battles dismissive doctors, empowers patients, and transforms lives through the power of proper diagnosis and treatment for sleep disorders, unlocking the key to improved mental well-being.My special guest is Barry KrakowBarry Krakow is a seasoned medical professional and a celebrated figure in the world of sleep science. With over three decades of dedicated service, Barry has helped countless individuals navigate through sleep disorders, from chronic nightmares and insomnia to Restless Leg Syndrome. As a board-certified internist, his work has shed light on the intricate relationship between sleep quality and mental health. Barry is currently a professor at Mercer University School of Medicine, where he oversees the training of future psychiatrists in the field of sleep medicine. His life's work and distinct insights make him an invaluable guide for those struggling with sleep disorders and mental health issues.By having these problems with your sleep, it's not just all psychological. You end up with cardiovascular diseases, neurologic problems. Sleep is a huge deal. - Barry KrakowIn this episode, you will be able to:Gain insights into how sleep disorders intertwine with mental health, illuminating a side of psychological resilience few have considered.Learn about the successful methods used in dealing with long-term nightmares and sleeplessness, and the prospect of finally getting that elusive good night's rest.Appreciate why taking stock of sleep quality is paramount and the significant benefits it brings to your day-to-day activities.Understand the challenges in securing good care for sleep disorders and strategies to navigate them.Delve into the sleep needs of teenagers, and the profound effects sleep has on their overall development and well-being. Emphasize the importance of addressing sleep qualityMaintaining quality sleep is essential for both physical and mental health. It's an area that often gets overlooked, but poor sleep quality can result in deteriorating mental health conditions and reduced alertness during the day. Therefore, prioritizing sleep quality by seeking professional help when needed and implementing beneficial habits can dramatically improve overall well-being.The resources mentioned in this episode are:Purchase Dr. Barry Krakow's book Life Saving Sleep: New Horizons in Mental Health Treatment to learn more about the relationship between sleep and mental health.Visit Dr. Krakow's website to find resources and information about sleep disorders and treatment options.If you or someone you know is struggling with sleep and mental health, consider seeking help from a sleep doctor or specialist in your area.Explore the various treatment options available for sleep disorders, including medication, therapy, and alternative therapies.Take steps to improve the quality of your sleep by establishing a consistent bedtime routine, creating a sleep-friendly environment, and practicing relaxation techniques before bed.Consider using sleep tracking devices or apps to monitor your sleep patterns and identify any potential issues.Prioritize self-care and stress management techniques to reduce the impact of mental health on your sleep.Educate yourself about the connection between sleep disorders and mental health, and advocate for better understanding and treatment within the mental health community.If you suspect that your sleep problems may be related to an underlying mental health condition, consult with a mental health professional for a comprehensive evaluation and treatment plan.Reach out to support groups or online communitiesJoin his SUBSTACK URL FOR FREE SLEEP NEWSLETTER: https://fastasleep.substack.com/The key moments in this episode are:00:00:02 - Introduction, 00:03:11 - Connecting Sleep and Mental Health, 00:08:28 - Importance of Sleep Quality, 00:12:18 - Sleep's Impact on Mental Health, 00:14:57 - Long-term Consequences of Untreated Sleep Disorders, 00:16:26 - The Importance of Sleep Technology, 00:19:14 - The Life-Changing Impact of Proper Treatment, 00:23:04 - Non-Medication Strategies for Improved Sleep, 00:25:45 - Finding the Right Sleep Center, 00:32:17 - The Impact of Nightmares and Insomnia in Adolescents 00:34:09 - Nonpharmacological Treatments for Nightmares and Insomnia 00:35:16 - Changing Perspectives on Sleep 00:38:05 - Finding Therapists for Treating Insomnia and Nightmares 00:48:02 - Gratitude for Sleep Expert, 00:48:24 - Making a Difference in Lives, 00:48:40 - Unique Research and Profession, 00:49:20 - Join the Difference Maker Community, 00:49:35 - Farewell and Gratitude, Stop counting number of hours of sleep and look at the fact that there must be something wrong with the quality of your sleep itself. Sleep does this amazing brainwashing technique in the middle of the night, so to speak, where it cleanses the brain of toxic molecules. - Barry KrakowTimestamped summary of this episode:00:00:02 - Introduction, Introduction to the podcast and guest, Dr. Barry Krakow, a sleep medicine specialist, and his expertise in treating sleep disorders related to mental health.00:03:11 - Connecting Sleep and Mental Health, Dr. Krakow discusses his groundbreaking research on the connection between sleep disorders, such as nightmares and insomnia, and mental health conditions like PTSD. He emphasizes the importance of recognizing and treating sleep disorders as independent issues.00:08:28 - Importance of Sleep Quality, Dr. Krakow highlights the significance of sleep quality over the number of hours slept. He explains that fragmented sleep with disrupted brainwave patterns can lead to feelings of unrefreshed sleep and daytime fatigue.00:12:18 - Sleep's Impact on Mental Health, The discussion delves into the various mechanisms by which sleep affects mental health. Dr. Krakow explains how sleep improves energy levels, cleanses the brain of toxic molecules, and its correlation with the glymphatic system, which may influence the risk of dementia.00:14:57 - Long-term Consequences of Untreated Sleep Disorders, Dr. Krakow emphasizes the wide-ranging consequences of untreated sleep disorders on both mental and physical health, including cardiovascular and neurological issues. He warns against prolonged reliance on medications or ineffective advice, urging individuals to seek proper treatment for their sleep disorders.00:16:26 - The Importance of Sleep Technology, The guest discusses the importance of having advanced technology in sleep centers to accurately diagnose sleep disorders. He shares a story about a single mom who was constantly tired and struggling at work. After being dismissed by other sleep centers, she found relief through a specific technology that measured her breathing in a unique way.00:19:14 - The Life-Changing Impact of Proper Treatment, The guest recounts the story of the single mom who experienced a miraculous improvement in her life after receiving proper treatment for her sleep disorder. Despite having a mild form of upper airway resistance syndrome (UARS), her symptoms disappeared and she regained her energy and ability to function normally. This case highlights the transformative power of sleep medicine.00:23:04 - Non-Medication Strategies for Improved Sleep, The guest suggests various non-medication strategies for individuals who heavily rely on sleeping pills. He emphasizes the importance of addressing sleep quality and exploring potential breathing issues. Simple interventions like nasal saline drops or nasal strips can significantly improve sleep. Dental devices and surgeries may also be options for those with specific conditions.00:25:45 - Finding the Right Sleep Center, The guest acknowledges the challenges in finding a sleep center that provides comprehensive care. He advises individuals to ask specific questions when contacting a sleep center, such as whether they treat upper airway resistance syndrome (UARS) and whether they use Bi level devices instead of CPAP. Being informed and advocating for oneself is crucial in navigating the sleep medicine field.00:32:17 - The Impact of Nightmares and Insomnia in Adolescents Nightmares and insomnia are common problems in adolescents, especially during the teenage years. Nightmares can be a red flag for anxiety, depression, and trauma, while insomnia can have a significant impact on sleep quality. Therapists who specialize in treating nightmares and insomnia can help adolescents overcome these issues.00:34:09 - Nonpharmacological Treatments for Nightmares and Insomnia Imagery Rehearsal Therapy is a leading nonpharmacological treatment for chronic nightmares, but it is not widely known or practiced. Cognitive Behavioral Therapy for insomnia is another specialized program that can help individuals improve their sleep quality. Both therapies focus on changing behaviors and patterns associated with sleep.00:35:16 - Changing Perspectives on Sleep Two important paradigms to consider when addressing insomnia are stopping clockwatching and understanding the difference between feeling sleepy and feeling tired. Clockwatching can worsen insomnia, while recognizing the feeling of sleepiness and only getting into bed when feeling that way can improve sleep quality.00:38:05 - Finding Therapists for Treating Insomnia and Nightmares Therapists who specialize in Cognitive Behavioral Therapy for insomnia can be found through sleep centers or online programs. However, finding therapists who practice Imagery Rehearsal Therapy may be more challenging. Military sleep centers often have mental health professionals trained in IRT due to the high prevalence of PTSD and nightmares among military personnel.00:48:02 - Gratitude for Sleep Expert, The host expresses gratitude for Dr. Krakow, an expert on sleep who has been working in the field for over 30 years. She encourages listeners to check out his resources and share them with others who may be struggling with sleep.00:48:24 - Making a Difference in Lives, The host emphasizes the goal of the podcast, which is to make a difference in the lives of listeners. She encourages them to share the episode with anyone who could benefit from learning about sleep and mentions the exclusive content available in the Difference Maker community.00:48:40 - Unique Research and Profession, The host expresses gratitude for Dr. Krakow's unique research and profession in the field of sleep. She highlights the valuable information she has already learned from him and hopes that listeners will also find his insights helpful for improving their sleep and the sleep of their families.00:49:20 - Join the Difference Maker Community, The host invites listeners to join the Difference Maker community for extra content with Dr. Krakow and other experts. She emphasizes the importance of sleep and encourages everyone to spread the news about how to sleep better by sharing the episode with others.00:49:35 - Farewell and Gratitude, The host concludes the episode by thanking listeners and bidding farewell. She encourages everyone to have a great day and to continue making a difference in the world.When you treat somebody's sleep disorder, not only do they sleep better, but their mental health improves. Patients have been walking into doctors' offices for decades saying, 'Doctor, if you can fix my sleep problem, my depression is going to get better.' - Barry KrakowEmphasize the importance of addressing sleep qualityMaintaining quality sleep is essential for both physical and mental health. It's an area that often gets overlooked, but poor sleep quality can result in deteriorating mental health conditions and reduced alertness during the day. Therefore, prioritizing sleep quality by seeking professional help when needed and implementing beneficial habits can dramatically improve overall well-being.Become a Difference Maker and enjoy exclusive content. Join our exclusive membership club for as little as $5 USD/month at Difference Makers.**********The A World of Difference Podcast is brought to you in partnership with Missio Alliance.Join us to discuss this episode, previous episodes or for other thoughtful conversations at our Facebook group. We'd love to have you stop by and share your perspective. Stay In Touch: Connect on Facebook and Instagram with thoughts, questions, and feedback. Rate, review and share this podcast with anyone that would love to listen. Find Us Online: @aworldof.difference on Instagram A World of Difference on Facebook, Linktree,on Twitter at @loriadbr or loriadamsbrown.comLoved this episode? Leave us a review and rating. Click here to reviewMentioned in this episode:Join Difference MakersJoin us in our membership community for exclusive content for only $5/month at https://www.patreon.com/aworldofdifference. We go deeper with each guest, and it makes such a difference.PatreonDo you want to go deeper?Join us in Difference Makers, a community where we watch and discuss exclusive content that truly makes a difference. Give us $5 a month (the price of a latte), and join in on the conversation with our host Lori and others who want to make a difference. We'd love to have you join us!PatreonThis podcast uses the following third-party services for analysis: Chartable - https://chartable.com/privacyPodtrac - https://analytics.podtrac.com/privacy-policy-gdrp
Renowned sleep doctor, Dr. Barry Krakow, battles dismissive doctors, empowers patients, and transforms lives through the power of proper diagnosis and treatment for sleep disorders, unlocking the key to improved mental well-being.My special guest is Barry KrakowBarry Krakow is a seasoned medical professional and a celebrated figure in the world of sleep science. With over three decades of dedicated service, Barry has helped countless individuals navigate through sleep disorders, from chronic nightmares and insomnia to Restless Leg Syndrome. As a board-certified internist, his work has shed light on the intricate relationship between sleep quality and mental health. Barry is currently a professor at Mercer University School of Medicine, where he oversees the training of future psychiatrists in the field of sleep medicine. His life's work and distinct insights make him an invaluable guide for those struggling with sleep disorders and mental health issues.By having these problems with your sleep, it's not just all psychological. You end up with cardiovascular diseases, neurologic problems. Sleep is a huge deal. - Barry KrakowIn this episode, you will be able to:Gain insights into how sleep disorders intertwine with mental health, illuminating a side of psychological resilience few have considered.Learn about the successful methods used in dealing with long-term nightmares and sleeplessness, and the prospect of finally getting that elusive good night's rest.Appreciate why taking stock of sleep quality is paramount and the significant benefits it brings to your day-to-day activities.Understand the challenges in securing good care for sleep disorders and strategies to navigate them.Delve into the sleep needs of teenagers, and the profound effects sleep has on their overall development and well-being. Emphasize the importance of addressing sleep qualityMaintaining quality sleep is essential for both physical and mental health. It's an area that often gets overlooked, but poor sleep quality can result in deteriorating mental health conditions and reduced alertness during the day. Therefore, prioritizing sleep quality by seeking professional help when needed and implementing beneficial habits can dramatically improve overall well-being.The resources mentioned in this episode are:Purchase Dr. Barry Krakow's book Life Saving Sleep: New Horizons in Mental Health Treatment to learn more about the relationship between sleep and mental health.Visit Dr. Krakow's website to find resources and information about sleep disorders and treatment options.If you or someone you know is struggling with sleep and mental health, consider seeking help from a sleep doctor or specialist in your area.Explore the various treatment options available for sleep disorders, including medication, therapy, and alternative therapies.Take steps to improve the quality of your sleep by establishing a consistent bedtime routine, creating a sleep-friendly environment, and practicing relaxation techniques before bed.Consider using sleep tracking devices or apps to monitor your sleep patterns and identify any potential issues.Prioritize self-care and stress management techniques to reduce the impact of mental health on your sleep.Educate yourself about the connection between sleep disorders and mental health, and advocate for better understanding and treatment within the mental health community.If you suspect that your sleep problems may be related to an underlying mental health condition, consult with a mental health professional for a comprehensive evaluation and treatment plan.Reach out to support groups or online communitiesJoin his SUBSTACK URL FOR FREE SLEEP NEWSLETTER: https://fastasleep.substack.com/The key moments in this episode are:00:00:02 - Introduction, 00:03:11 - Connecting Sleep and Mental Health, 00:08:28 - Importance of Sleep Quality, 00:12:18 - Sleep's Impact on Mental Health, 00:14:57 - Long-term Consequences of Untreated Sleep Disorders, 00:16:26 - The Importance of Sleep Technology, 00:19:14 - The Life-Changing Impact of Proper Treatment, 00:23:04 - Non-Medication Strategies for Improved Sleep, 00:25:45 - Finding the Right Sleep Center, 00:32:17 - The Impact of Nightmares and Insomnia in Adolescents 00:34:09 - Nonpharmacological Treatments for Nightmares and Insomnia 00:35:16 - Changing Perspectives on Sleep 00:38:05 - Finding Therapists for Treating Insomnia and Nightmares 00:48:02 - Gratitude for Sleep Expert, 00:48:24 - Making a Difference in Lives, 00:48:40 - Unique Research and Profession, 00:49:20 - Join the Difference Maker Community, 00:49:35 - Farewell and Gratitude, Stop counting number of hours of sleep and look at the fact that there must be something wrong with the quality of your sleep itself. Sleep does this amazing brainwashing technique in the middle of the night, so to speak, where it cleanses the brain of toxic molecules. - Barry KrakowTimestamped summary of this episode:00:00:02 - Introduction, Introduction to the podcast and guest, Dr. Barry Krakow, a sleep medicine specialist, and his expertise in treating sleep disorders related to mental health.00:03:11 - Connecting Sleep and Mental Health, Dr. Krakow discusses his groundbreaking research on the connection between sleep disorders, such as nightmares and insomnia, and mental health conditions like PTSD. He emphasizes the importance of recognizing and treating sleep disorders as independent issues.00:08:28 - Importance of Sleep Quality, Dr. Krakow highlights the significance of sleep quality over the number of hours slept. He explains that fragmented sleep with disrupted brainwave patterns can lead to feelings of unrefreshed sleep and daytime fatigue.00:12:18 - Sleep's Impact on Mental Health, The discussion delves into the various mechanisms by which sleep affects mental health. Dr. Krakow explains how sleep improves energy levels, cleanses the brain of toxic molecules, and its correlation with the glymphatic system, which may influence the risk of dementia.00:14:57 - Long-term Consequences of Untreated Sleep Disorders, Dr. Krakow emphasizes the wide-ranging consequences of untreated sleep disorders on both mental and physical health, including cardiovascular and neurological issues. He warns against prolonged reliance on medications or ineffective advice, urging individuals to seek proper treatment for their sleep disorders.00:16:26 - The Importance of Sleep Technology, The guest discusses the importance of having advanced technology in sleep centers to accurately diagnose sleep disorders. He shares a story about a single mom who was constantly tired and struggling at work. After being dismissed by other sleep centers, she found relief through a specific technology that measured her breathing in a unique way.00:19:14 - The Life-Changing Impact of Proper Treatment, The guest recounts the story of the single mom who experienced a miraculous improvement in her life after receiving proper treatment for her sleep disorder. Despite having a mild form of upper airway resistance syndrome (UARS), her symptoms disappeared and she regained her energy and ability to function normally. This case highlights the transformative power of sleep medicine.00:23:04 - Non-Medication Strategies for Improved Sleep, The guest suggests various non-medication strategies for individuals who heavily rely on sleeping pills. He emphasizes the importance of addressing sleep quality and exploring potential breathing issues. Simple interventions like nasal saline drops or nasal strips can significantly improve sleep. Dental devices and surgeries may also be options for those with specific conditions.00:25:45 - Finding the Right Sleep Center, The guest acknowledges the challenges in finding a sleep center that provides comprehensive care. He advises individuals to ask specific questions when contacting a sleep center, such as whether they treat upper airway resistance syndrome (UARS) and whether they use Bi level devices instead of CPAP. Being informed and advocating for oneself is crucial in navigating the sleep medicine field.00:32:17 - The Impact of Nightmares and Insomnia in Adolescents Nightmares and insomnia are common problems in adolescents, especially during the teenage years. Nightmares can be a red flag for anxiety, depression, and trauma, while insomnia can have a significant impact on sleep quality. Therapists who specialize in treating nightmares and insomnia can help adolescents overcome these issues.00:34:09 - Nonpharmacological Treatments for Nightmares and Insomnia Imagery Rehearsal Therapy is a leading nonpharmacological treatment for chronic nightmares, but it is not widely known or practiced. Cognitive Behavioral Therapy for insomnia is another specialized program that can help individuals improve their sleep quality. Both therapies focus on changing behaviors and patterns associated with sleep.00:35:16 - Changing Perspectives on Sleep Two important paradigms to consider when addressing insomnia are stopping clockwatching and understanding the difference between feeling sleepy and feeling tired. Clockwatching can worsen insomnia, while recognizing the feeling of sleepiness and only getting into bed when feeling that way can improve sleep quality.00:38:05 - Finding Therapists for Treating Insomnia and Nightmares Therapists who specialize in Cognitive Behavioral Therapy for insomnia can be found through sleep centers or online programs. However, finding therapists who practice Imagery Rehearsal Therapy may be more challenging. Military sleep centers often have mental health professionals trained in IRT due to the high prevalence of PTSD and nightmares among military personnel.00:48:02 - Gratitude for Sleep Expert, The host expresses gratitude for Dr. Krakow, an expert on sleep who has been working in the field for over 30 years. She encourages listeners to check out his resources and share them with others who may be struggling with sleep.00:48:24 - Making a Difference in Lives, The host emphasizes the goal of the podcast, which is to make a difference in the lives of listeners. She encourages them to share the episode with anyone who could benefit from learning about sleep and mentions the exclusive content available in the Difference Maker community.00:48:40 - Unique Research and Profession, The host expresses gratitude for Dr. Krakow's unique research and profession in the field of sleep. She highlights the valuable information she has already learned from him and hopes that listeners will also find his insights helpful for improving their sleep and the sleep of their families.00:49:20 - Join the Difference Maker Community, The host invites listeners to join the Difference Maker community for extra content with Dr. Krakow and other experts. She emphasizes the importance of sleep and encourages everyone to spread the news about how to sleep better by sharing the episode with others.00:49:35 - Farewell and Gratitude, The host concludes the episode by thanking listeners and bidding farewell. She encourages everyone to have a great day and to continue making a difference in the world.When you treat somebody's sleep disorder, not only do they sleep better, but their mental health improves. Patients have been walking into doctors' offices for decades saying, 'Doctor, if you can fix my sleep problem, my depression is going to get better.' - Barry KrakowEmphasize the importance of addressing sleep qualityMaintaining quality sleep is essential for both physical and mental health. It's an area that often gets overlooked, but poor sleep quality can result in deteriorating mental health conditions and reduced alertness during the day. Therefore, prioritizing sleep quality by seeking professional help when needed and implementing beneficial habits can dramatically improve overall well-being.Become a Difference Maker and enjoy exclusive content. Join our exclusive membership club for as little as $5 USD/month at Difference Makers.**********The A World of Difference Podcast is brought to you in partnership with Missio Alliance.Join us to discuss this episode, previous episodes or for other thoughtful conversations at our Facebook group. We'd love to have you stop by and share your perspective. Stay In Touch: Connect on Facebook and Instagram with thoughts, questions, and feedback. Rate, review and share this podcast with anyone that would love to listen. Find Us Online: @aworldof.difference on Instagram A World of Difference on Facebook, Linktree,on Twitter at @loriadbr or loriadamsbrown.comLoved this episode? Leave us a review and rating. Click here to reviewMentioned in this episode:Join Difference MakersJoin us in our membership community for exclusive content for only $5/month at https://www.patreon.com/aworldofdifference. We go deeper with each guest, and it makes such a difference.PatreonDo you want to go deeper?Join us in Difference Makers, a community where we watch and discuss exclusive content that truly makes a difference. Give us $5 a month (the price of a latte), and join in on the conversation with our host Lori and others who want to make a difference. We'd love to have you join us!PatreonThis podcast uses the following third-party services for analysis: Chartable - https://chartable.com/privacyPodtrac - https://analytics.podtrac.com/privacy-policy-gdrp
A large proportion of mental health professionals misunderstand the nature of sleep problems in mental health patients, according to sleep specialist Barry Krakow, MD, who has worked in the field of sleep research and clinical sleep medicine for more than 30 years. Such professionals view sleep issues as a symptom of mental health disorders, rather than as a distinct disorder that needs to be addressed. Healthcare professionals fail to understand that treating sleep problems can help to alleviate mental health issues. The sleep medicine community itself also struggles with how to serve the mental health community. Many sleep centers are still discounting or ignoring the significance of upper airway resistance syndrome (UARS). According to Krakow, many sleep doctors are uncomfortable treating patients with mental health conditions, such as PTSD, depression, or anxiety, and will refer them to therapists or psychiatrists rather than addressing their sleep problems. This lack of understanding and training in the connection between sleep disorders and mental health leads to patients not receiving proper treatment and being left with the impression that sleep medicine cannot help them. Sleep medicine needs to recognize that insomnia and sleep-disordered breathing are prevalent in this population and that effective treatments, such as advanced PAP machines, are available. With regard to bureaucracy surrounding treating mental health patients, Krakow advises that sleep centers can implement efficiencies using modern technology, and offer reimbursable services, such as PAP Naps, to assist with the business aspects. Krakow's new book Life Saving Sleep: New Horizons in Mental Health Treatment explores the link between sleep and mental health, and how the quality of sleep is often overlooked in mental health treatment. Mental health patients with sleep complaints are typically prescribed medication to help them sleep, without addressing the quality of their sleep. Many patients are unable to describe the quality of their sleep beyond the number of hours they sleep each night. For further information: https://barrykrakowmd.com/ https://www.lifesavingsleep.com/ https://fastasleep.substack.com/ Follow Sleep Review on LinkedIn, Facebook, Twitter, & YouTube.
A large proportion of mental health professionals misunderstand the nature of sleep problems in mental health patients, according to sleep specialist Barry Krakow, MD, who has worked in the field of sleep research and clinical sleep medicine for more than 30 years. Such professionals view sleep issues as a symptom of mental health disorders, rather than as a distinct disorder that needs to be addressed. Healthcare professionals fail to understand that treating sleep problems can help to alleviate mental health issues. The sleep medicine community itself also struggles with how to serve the mental health community. Many sleep centers are still discounting or ignoring the significance of upper airway resistance syndrome (UARS). According to Krakow, many sleep doctors are uncomfortable treating patients with mental health conditions, such as PTSD, depression, or anxiety, and will refer them to therapists or psychiatrists rather than addressing their sleep problems. This lack of understanding and training in the connection between sleep disorders and mental health leads to patients not receiving proper treatment and being left with the impression that sleep medicine cannot help them. Sleep medicine needs to recognize that insomnia and sleep-disordered breathing are prevalent in this population and that effective treatments, such as advanced PAP machines, are available. With regard to bureaucracy surrounding treating mental health patients, Krakow advises that sleep centers can implement efficiencies using modern technology, and offer reimbursable services, such as PAP Naps, to assist with the business aspects. Krakow's new book Life Saving Sleep: New Horizons in Mental Health Treatment explores the link between sleep and mental health, and how the quality of sleep is often overlooked in mental health treatment. Mental health patients with sleep complaints are typically prescribed medication to help them sleep, without addressing the quality of their sleep. Many patients are unable to describe the quality of their sleep beyond the number of hours they sleep each night. For further information: https://barrykrakowmd.com/ https://www.lifesavingsleep.com/ https://fastasleep.substack.com/ Follow Sleep Review on LinkedIn, Facebook, Twitter, & YouTube.
This is episode #39. Nicole Heiser a fellow fitness enthusiast, a mother, and she is also a Myofunctional Therapist. Myofunctional Therapy is designed to help patients that suffer from sleep disordered breathing (snoring, OSA, UARS), speech problems, tongue thrusting, tongue tie, mouth breathing, jaw pain, oral habits, and orthodontic relapse, just to name a few. Today, is an opportunity to learn a bit about our oral health, and how our daily breathing practices can affect our overall lifestyles. So, stick around to meet my friend, Nicole and dive deep into breath work, oral health, and some tips to encourage great sleep!
Download Transcript ✅ Are you still struggling to control your acid reflux? Have you tried all the suggestions on YouTube with only a little relief or no help at all? In this video, I'll reveal 7 natural and surprising ways to control your acid reflux that many experts don't usually talk about. ✅ CHAPTERS 00:00 Introduction 01:12 7 typical YouTube acid reflux tips 04:18 1. Stress 07:27 2. Making too little acid 09:14 3. Stuffy nose 11:02 4. Treat OSA or UARS 12:24 5. Vitamin D 13:12 6. Low carbohydrate diet 13:28 7. Melatonin ✅ LINKS MENTIONED Love, Medicine & Miracles Upper airway resistance syndrome video Breathing exercises proven to reduce acid reflux Cancer stats US 2014 The effect of psychological stress on symptom severity and perception in patients with gastro-oesophageal reflux Effect of proton pump inhibitor (PPI) treatment in obstructive sleep apnea syndrome: an esophageal impedance-pHmetry study Sleep apnea video Nasal CPAP Reduces Gastroesophageal Reflux in Obstructive Sleep Apnea Syndrome The role of vitamin D in obstructive sleep apnoea syndrome The effect of vitamin D deficiency on eradication rates of Helicobacter pylori infection Vitamin D and stomach gastrin secretion Effects of high doses of vitamin D3 on mucosa-associated gut microbiome vary between regions of the human gastrointestinal tract Solar ultraviolet-B exposure and cancer incidence and mortality in the United States Melatonin for the treatment of gastroesophageal reflux disease; protocol for a systematic review and meta-analysis Non-health benefits of melatonin Reactive Oxygen Species-Induced Gastric Ulceration: Protection By Melatonin The association between severity of obstructive sleep apnea and prevalence of Hashimoto's thyroiditis Role of hypothyroidism in obstructive sleep apnea: a meta-analysis Abnormal thyroid hormones and non-thyroidal illness syndrome in obstructive sleep apnea, and effects of CPAP treatment A Very Low-Carbohydrate Diet Improves Gastroesophageal Reflux and Its Symptoms Melatonin video Endocrine disorders in obstructive sleep apnoea syndrome: A bidirectional relationship ✅ PRODUCTS & SERVICES How you can sleep great, have more energy and mental clarity. Dr. Park's The 90-Day Sleep Diet. Want to un-stuff your stuffy nose? Read the e-book, How to Un-stuff Your Stuffy Nose: Breathe Better, Lose Weight, Sleep Great (PDF) Your Health Transformation Workbook: Refresh, Restore, & Rejuvenate Your Life (online format) Want to have more energy, sleep better, have less pain, and enjoy living again? Reserve a Virtual Coaching session today with Dr. Park ✅ CONNECT WITH DR. PARK DoctorStevenPark.com doctorpark@doctorstevenpark.com For inquiries about interviews or presentations, please contact Dr. Park through his website at doctorstevenpark.com. ✅ DISCLAIMER This video is for general educational and informational purposes only. It is not to be taken as a substitute for professional medical advice, diagnosis, or treatment. Please consult with your doctor first before making any changes to your health, exercise, nutrition, or dietary regimen. Certain product links above will take you to Amazon.com. If you then go on to buy the product, Amazon will provide me with a small commission, which will not cost you anything.
Have you tried all the tips and hacks on Youtube to get rid of your chronic fatigue, with only some results? Are you too tired to focus on your work or to be present for your family members? In this video, I'll reveal one condition that almost no one on this platform talks about, not even the experts. Stick to the end, and I'll give you 5 simple tips to finally have the energy to be more productive at work, school, or to enjoy life again. ✅ Timeline 00:00 Introduction 01:09 Common YouTube recommendations 02:32 The problem with sleep apnea 04:57 Coverage criteria for mild sleep apnea 05:25 Upper airway resistance syndrome (UARS) 06:04 Sleep endoscopy in UARS 07:15 Smaller jaws, smaller airways 08:04. Five simple tips to get you started 08:09 1. Shut your mouth and breathe through your nose 09:08 2. Avoid eating or snacking within 3-4 hours of bedtime 09:36 3. Find your best sleep position 09:28 4. Avoid all screens before bedtime 09:49 5. Prioritize your sleep length 10:04 Energize Your Day Starter Guide PDF 10:44 90-Day Sleep Diet Course ✅ LINKS MENTIONED Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. AASM clarifies hypopnea scoring criteria. Why Zebras Don't Get Ulcers by Robert Sapolsky. Sleep, Interrupted: A Physician Reveals The #1 Reason Why So Many Of Us Are Sick And Tired. 7 Long-Lasting Ways to Clear Your Stuffy Nose – ENT Doctor Approved. Should You Tape Your Mouth For Better Sleep? Energize Your Day Starter Guide. The 90 Day Sleep Diet. Lose Weight Naturally Without Cardio Or Calorie Counting. ✅ PRODUCTS & SERVICES How you can lose weight naturally without cardio or counting calories. Dr. Park's The 90-Day Sleep Diet. Want to un-stuff your stuffy nose? Read the e-book, How to Un-stuff Your Stuffy Nose: Breathe Better, Lose Weight, Sleep Great (PDF) Your Health Transformation Workbook: Refresh, Restore, & Rejuvenate Your Life (online format) Want to have more energy, sleep better, have less pain, and enjoy living again? Reserve a Virtual Coaching session today with Dr. Park ✅ CONNECT WITH DR. PARK DoctorStevenPark.com doctorpark@doctorstevenpark.com For inquiries about interviews or presentations, please contact Dr. Park through his website at doctorstevenpark.com. ✅ DISCLAIMER This video is for general educational and informational purposes only. It is not to be taken as a substitute for professional medical advice, diagnosis, or treatment. Please consult with your doctor first before making any changes to your health, exercise, nutrition, or dietary regimen. Certain product links above will take you to Amazon.com. If you then go on to buy the product, Amazon will provide me with a small commission, which will not cost you anything.
Upper Airway Resistance Syndrome (UARS) is the often misunderstood sleep problem that you may be dealing with, particularly if you are one of those people that wake up in the middle of the night and have interrupted sleep or daytime sleepiness and brain fog. In this episode, Betty gives insight into what UARS is, how it differs from OSA, and the importance of getting this problem resolved sooner rather than later. Surprisingly, correcting this issue allows for your weight-loss to become easier, as well as allows your blood pressure, headaches, IBS, and other things to all get better. Listen now for more insight into what may be fracturing your sleep! Key Topics/Takeaways: What is UARS? How does UARS differ from obstructive sleep apnea? Stages of sleep How do you know if you have upper airway resistance syndrome How to get rid of UARS How sleeps problems affect your health and what happens if the problem is not resolved Memorable Quotes: “People that have upper airway resistance syndrome will suffer with metabolic disorders; i.e., leads to weight gain and metabolic changes like insulin resistance and risk for diabetes, and cardiovascular consequences. So it actually causes strain on the heart.” (3:31) “Women are more likely to be diagnosed with upper airway resistance syndrome because of our structural smallness. We are smaller in size and stature. The other things that can lead to this is placement of the jaw and how your teeth align and the alignment of the palette.” (4:28) “So the important thing to know here is that this is not gonna be the person that's sputtering and wheezing, and sounds like a freight train. They may not be making noise at all. Like I said, it often gets missed because no one says anything about their breathing problems or what's really going on.” (12:24) “Obviously, the sleep study is very important. But one of the other ways you can look at it is a cone beam scan. So a cone beam scan is a scan of your head. Many sophisticated dentists, particularly the ones that do this kind of work, have one in their office.” (17:36) “This is not just a, I wanna sleep better - It's a quality of life. And then long term cardiovascular consequences. So, if this is going on, you've gotta get it fixed.” (21:20) Connect with Betty Murray: Website Living Well Dallas Hormone Reset Betty Murray Socials Facebook Instagram
Upper Airway Resistance Syndrome (UARS) is the often misunderstood sleep problem that you may be dealing with, particularly if you are one of those people that wake up in the middle of the night and have interrupted sleep or daytime sleepiness and brain fog. In this episode, Betty gives insight into what UARS is, how it differs from OSA, and the importance of getting this problem resolved sooner rather than later. Surprisingly, correcting this issue allows for your weight-loss to become easier, as well as allows your blood pressure, headaches, IBS, and other things to all get better. Listen now for more insight into what may be fracturing your sleep! Key Topics/Takeaways: What is UARS? How does UARS differ from obstructive sleep apnea? Stages of sleep How do you know if you have upper airway resistance syndrome How to get rid of UARS How sleeps problems affect your health and what happens if the problem is not resolved Memorable Quotes: “People that have upper airway resistance syndrome will suffer with metabolic disorders; i.e., leads to weight gain and metabolic changes like insulin resistance and risk for diabetes, and cardiovascular consequences. So it actually causes strain on the heart.” (3:31) “Women are more likely to be diagnosed with upper airway resistance syndrome because of our structural smallness. We are smaller in size and stature. The other things that can lead to this is placement of the jaw and how your teeth align and the alignment of the palette.” (4:28) “So the important thing to know here is that this is not gonna be the person that's sputtering and wheezing, and sounds like a freight train. They may not be making noise at all. Like I said, it often gets missed because no one says anything about their breathing problems or what's really going on.” (12:24) “Obviously, the sleep study is very important. But one of the other ways you can look at it is a cone beam scan. So a cone beam scan is a scan of your head. Many sophisticated dentists, particularly the ones that do this kind of work, have one in their office.” (17:36) “This is not just a, I wanna sleep better - It's a quality of life. And then long term cardiovascular consequences. So, if this is going on, you've gotta get it fixed.” (21:20) Connect with Betty Murray: Website Living Well Dallas Hormone Reset Betty Murray Socials Facebook Instagram
Giving us all the details about the EASIEST to use WatchPat home sleep study, Glennine Varga. In today's episode we will talk all about the spectrum of sleep disordered breathing. Starting with mouth breathing, snoring, upper airway resistance (UARS), and sleep apnea. She will walk us through how to use a WatchPat and most importantly how to read and understand what it means. The WatchPat can tell you about respiratory disturbances based off body position and Non REM vrs REM sleep. It can also clue you into the easily overlooked sleep disorders that may not be apnea, but you still feel like garbage. These can be UARS or lack of enough deep sleep due to constant sleep arousals. Today's episode is also invaluable because so often people are tired and seek a sleep study only to be told, “You don't have sleep apnea” and that's it. No other options given. The wonderful thing about understanding your study is to be able to make changes that can help you sleep better, such as myofunctional therapy, whether to go for expansion to give you more tongue space, or an ENT evaluation to check for airway obstructions. To get set up with a sleep study directly through Glennine her email is VGlennine@Itamar-Medical.com www.itamar-medical.com To get set up for a virtual myo consultation with Megan Van Noy www.orofacial-myology.com mention the podcast for $25 off! To get set up for a virtual myo consultation with Kimi Nishimoto www.mouthmusclememory.commention the podcast for $25 off!
In this episode, Hallie talks with Ken Hooks who analyzes Hallie's recent home sleep test. They discuss what to look for and make sense of all the raw data. Ken discusses the importance of all forms of airway resistance and sleep apnea, and highlights they are ALL of concern, not just obstructive sleep apnea.Hallie's diagnosis is upper airway resistance syndrome or UARS. Ken dives into what UARS looks like for Hallie; you might be surprised! He also provides recommendations and shares how easy it is to get an at home sleep test! Visit his site to order a home sleep test: truediagnostics.comPlease click here to download the show notes.For more episodes visit www.untetheredpodcast.com See acast.com/privacy for privacy and opt-out information.
When it comes to the Comet Elenin controversy—I fear that I may end up in the same corner as all those who have said that the comet is actually a doomsday comet that will hit the earth. I have never said it will hit the earth but I most certainly know that all comets, asteroids and other celestial bodies that pass near the earth can cause all sorts of chaos. The whole idea of comets being harbingers of doom dates back to biblical times and the legends of bearded stars, dragons and flying boars of Celtic lore.I see Elenin as an opportunity for a counter intelligence cover for other activity going on in space as there have been several things to pay attention to lately. Comet Honda hasn't captured the imaginations of the fringe crowd, there wasn't too much fanfare for the UARS or ROSAT satellite fall and neither has 2005 YU55 an asteroid that will passing near the earth sometime in November.Originally Broadcast On 09/30/2011
Dr. Simmons is Triple Board-Certified by the American Board of Clinical Neurophysiology, American Board of Psychiatry and Neurology, & American Board of Sleep Medicine. As a Neurologist, Dr. Simmons treats patients with a wide range of neurological conditions but he spends most of his practice evaluating and treating patients with sleep disorders. He has dedicated his career to provide the highest level of diagnostics testing to identify the full-spectrum of sleep disorders. He has been on the cutting-edge of implementing new technologies in the sleep laboratory, including esophageal pressure monitoring (Pes) to diagnose patients with the Upper Airway Resistance Syndrome (UARS), a sleep disorder characterized by airway resistance to breathing during sleep. Dr. Simmons evaluates pediatric patients as well as adults, and is among the few sleep specialists in the United States who can competently diagnose children who have Hyper Activity Attention Deficit Disorder caused by a subtle sleep disturbance such as UARS or Period Leg Movements of Sleep. Implementing state-of-the-art technology has been a passion of Dr. Simmons and he is actively working to implement new technology in the field of medicine and more specifically, sleep disorders medicine. Nicole is a Speech Pathologist and Certified Orofacial Myologist in San Diego, California. Nicole is currently on the ADA assigned Child Airway Initiative Task Force, a small national team developing the universal screening tool for all dentists to use to screen for sleep disordered breathing as per the 10/2017 ADA proposal that all dentists should screen all patients for SDB. Nicole received intensive and advanced training with the nationally renowned Certified Orofacial Myologist, Katha Phair. Katha trained Nicole in her unique, specialized, and unmatched techniques that she had developed and refined for over 45 years, and in 2014 she selected Nicole to take over her large myofunctional therapy practice in San Diego. Nicole has presented all around the United States on myofunctional therapy as it relates to sleep-disordered breathing, orthodontics, and dentistry.
In this episode, Hallie talks with Dr. Steven Y. Park, board-certified ENT surgeon and sleep doctor, blogger, podcaster, and author of the Amazon best-seller, Sleep Interrupted. Dr. Park shares his personal journey as it relates to UARS. Their discussion covers the signs and symptoms of UARS, how UARS differs from sleep apnea, a common condition that's usually missed by sleep doctors and ENT's that can mimic UARS and the reason UARS is so hard to treat. Dr. Park gives tips on how patients can advocate for treatment of their UARS, especially when a sleep study comes back "normal."Please click here to download the show notes.For more episodes visit www.untetheredpodcast.com See acast.com/privacy for privacy and opt-out information.
In this episode of Ask Dr. Park, Dr. Park gives a 30-minute presentation on the State of the Art on obstructive sleep apnea, after which he takes live questions. Questions answered include: Do you see the Homeobloc as an effective treatment for OSA/UARS? What are the clinical guidelines for pediatric sleep disorders? Is it normal to get congested when lying down at night? What about MSE promoted by Dr. Moon? Relationship between tinnitus and obstructive sleep apnea What do you think of Xylitol for nasal congestion and obstructive sleep apnea? What do you think about the 4% desaturation rule for diagnosing sleep apnea, which doesn't help women? My nose is stuffy and I have trouble using CPAP. I tighten the mask and it doesn't help. What can I do? Can most pediatric ENTs perform DISE? What's the sleep study criteria for UARS? Do older toddlers who have OSA rock back and forth even banging their heads on the crib? What's more important, AHI, heart rate variability or sympathetic stress? I underwent septoplasty, turbinoplasty, tonsillectomy and UPPP. My nose is still stuffy. What do I do? My toddler sleeps with his but in the air. He had oral tie release x 2. What do you recommend? Are there many doctors that address epiglottis problems in adults? Link between Ehlers-Danlose Syndrome to sleep apnea and epiglottis problems. To watch the video, click here.
Spaceflight news— First Perseverance sample collection (spacenews.com) (nasa.gov) (nasa.gov) — “Where Is The Rover” map, featuring Ingenuity (mars.nasa.gov)Short & Sweet— Shenzhou 12 crew returns to Earth (spaceflightnow.com)— Vande Hei to remain on ISS (spacenews.com)— NASA awards five companies for Lunar Lander studies (spacenews.com)Questions, comments, corrections— From the intro: Inspiration4 (spacenews.com)— Are you free Sep 21-23? Sit in on a NIAC session! (nasa.gov)This week in SF history— 24 Sept, 2011: UARS burns up on re-entry (en.wikipedia.org) (directory.eoportal.org)— Next week (9/28 - 10/4) in 2001: A first from the last frontier.
Like most of TMD and DSM's foremost thinkers, Dr. Mayoor Patel's journey started in Zimbabwe, led to Arkansas, and eventually to finishing dental school at the age of 22. Oh, wait, that's a crazy, outlandish story - but truth is stranger than fiction. Don't believe us? Then wait until you hear what Dr. Patel has to say about the ONE thing he's observed in all his courses that separates successful Dental Sleep Practices from those that fail to take flight. I'm just going to give you a hint - the initials are “RDH.” And there's more folks. COVID, depression, and parafunction - Is there any overlap? What effect does perimenopause have on sleep? I'm asking for a friend, by the way... Do bite splints really make apnea worse? What about UARS and headaches? Orofacial pain, TMD, and sleep - Is there really a connection? Get your listen and learn on with The ZZZ Pack and Dr. Mayoor Patel, the dentist that is in the process of LITERALLY writing the textbook on Dental Sleep Medicine.
Upper Airway Resistance Syndrome (UARS) brings more focus on the function of the nasal passage in an individual. While UARS may share many of the same symptoms with obstructive sleep apnea, disturbed sleep and consequent daytime impairment, and excessive daytime sleepiness #EDS, the testing results and treatment options can be different.Join us for Sleep Apnea Awareness Day March 20th! All month sleepapnea.org will discuss the less common types of apnea, like UARS. We're trying to raise awareness for all people, of all ages, to become empowered advocates for quality sleep for themselves and their loved ones!If you have questions or comments about this (or any episode) we'd like to hear from you. You can reach us at: stories@sleepapnea.org.AWAKE: The Sleep Apnea Podcast, is (usually) presented on Thursdays by sleepapnea.org, the American Sleep Apnea Association.The podcast is available through Apple Podcasts, Spotify or wherever you get your podcasts, including our podcast archive where every episode is available to stream right from your browser. It is the mission of the American Sleep Apnea Association to improve the lives of sleep apnea patients. We accomplish this mission through education, services, peer-support, research, and advocacy.Sleepapnea.org depends upon donations from people like you to continue its work. You can help! Making a tax-deductible donation through our secure server is fast and easy. When we receive your donation, we will mail you a written acknowledgment for tax purposes. Click here to contribute. Thank you for your support!Theme Music: Deliberate Thought by Kevin MacLeodLink: https://incompetech.filmmusic.io/song/3635-deliberate-thoughtLicense: http://creativecommons.org/licenses/by/4.0/Support the show (https://www.sleepapnea.org/donations/please-donate-to-asaa/)Support the show (https://www.sleepapnea.org/donations/please-donate-to-asaa/)
If you mouth breathe, struggle sleeping, snore, or have eustachian tube issues, then check this out! Mouth breathing is linked to sleep disorders, tooth decay, eustachian tube issues, and so much more, what do you do about it? Could the answer be myofunctional therapy? That's what I sift through with Myofunctional therapist Melissa Mugno. In this podcast, you'll learn: Why Steph Curry chews on his mouthguard the way he does Why do we clench and grind our teeth? The importance of breastfeeding on orofacial development What myofunctional therapy is and where it belongs in the healthcare system The two causes of the mouth breathing epidemic and how to tackle this problem How behavior change plays a crucial role in a successful outcome The intersection of physical and myofunctional therapy Why belly breathing is totally overrated The myofunctional therapy intervention process The link between swallowing and eustachian tube dysfunction and TONS more If you are ready to make your upper airway healthy as can be, then definitely check this podcast out. Look here to watch the interview, listen to the podcast, get the show notes, and read the modified transcripts. Learn more about Melissa Since becoming an Orofacial Myofunctional Therapist in 2014, Melissa has improved the lives of hundreds of patients and lectured around the country. Melissa treats patients of all ages suffering from a wide range of conditions stemming from adverse myofunctional habits. Her background as a Dental Hygienist and experience in the fields of Orthodontics and Pedodontics contributes to her success. Melissa works in Las Vegas, NV, and is a Breathe Associate at The Breathe Institute in Los Angles, CA. Her website Show notes Here are links to things mentioned in the interview: Joy Moeller - One of the foundational people in the field of myofunctional therapy. Sandra Coulson - Another foundational person in myofunctional therapy. Myobrace - A possible way to improve teeth position. Dr. Tara Erson - A great dentist in Las Vegas Dr. Hockel - My dentist who is doing my palatal expansion. Dr. Kareen Landerville - She is my go-to optometrist in Las Vegas The Breathe Institute - Where I got my tongue-tie release done. Dr. Soroush Zaghi - The doctor who did my tongue-tie release. AOMT - That's who I took my myofunctional therapy course through. You can peep the review here. Bill Hartman - Daddy-O Pops himself. My mentor. The Enduring Impact of What Clinicians Say to People With Low Back Pain - A great article that goes into how maladaptive beliefs can manifest. Modified Transcripts Why Steph Curry chews on his mouthguard Zac Cupples: So, Steph Curry walks into your office, and he asks you, hey, Melissa, why is it that I like to chew on my mouth guard so much? Melissa Mugno: So, the chewing is because of his airway. Zac: Mm-hmm. Do tell. Tell me more. Melissa: So, in sleep dentistry or airway, we've really come full circle to understand that like chewing and clenching, has a lot more to do with a deficiency in the airway than it does anything else. So, there are habits that are created, that actually kind of stimulate the jaw to come forward, and there's a feeling that feels good. It gives us more air, more serotonin overall, and it actually will give you a lot more clarity. Get some good oxygen, you feel better. So that's actually what's happening. So, the chewing couple times you do it, you're like, it feels good, right? Most humans continue to do things that feel good, stop doing things that feel bad. So, please stop doing that. But the thing was, Steph Curry that's quite interesting is he doesn't just chew on it. He doesn't even - more interesting, he flips it out of his mouth and holds it. And what I was saying to you before was, again, I have not worked on Steph Curry so I do not know. This is just me looking at it, I was intrigued by it. My husband brought it up and said, ‘'Hey, this guy's really known for doing this'' and I was interested. I've always thought there was a big sports connection. I started looking at how thick his mouth guard was and I'm like, "oh, it's at least two millimeters, two and a half." One of the things we do, the dentist will do or to help patients that have sleep issues, is they'll actually open up their bite, open up the jaw, so they can't close all the way, which naturally will allow their jaw to come forward, and that does is it opens up the airway and allows for the air to flow easier. So, he's holding it, and he's protruding his own bite and you can see it's literally bringing his jaw forward. I started looking and then I watched some YouTube video and I saw that Forbes I think it was? It might be off one of the bigger publications that did an actual survey or did some type of research of how many free throws that he made when the mouthguard was out versus when it wasn't. He shot significantly better with it in! It was a no-brainer to me. he's breathing better. Oxygen will absolutely get you focused and therefore he is more comfortable. So why wouldn't you keep doing it? Yeah, so now it's become this whole thing. Now, I guess like, tons of athletes do it and I was like, yeah, of course, yes, it protects your teeth, but there's a lot more to it. Zac: But when you're clenching as well, how does that open up the airway then? Because I would think... Melissa: Clenching and grinding are not opening up the airway. It's a side effect of having a reduced airway. I love my analogies. So, I call it the body's fire alarm. And so, it triggers something and what's happening is the body knows it's getting a reduced amount of air, so it acts to check that. It's going to create some type of function, some type of habit to make sure everything's good down there. So, this, the grinding, and I have this little theory that we grind when we're kids because we're carefree and we clench when we're older because we're trying to control it. [caption id="attachment_13634" align="alignnone" width="810"] Grinding, but not like the Clipse :( (Photo credit: Free Dental Photos)[/caption] Zac: Gotcha. Melissa: It seems that way more adults clench than kids and I realized some of my, I mean, it's not absolutely proven, but my adults that grind are usually my cool cats. They just grind it out, let that jaw flow. The adults are like they're trying to control, they don't want that feeling. It's they're trying to control that bite. They don't know why their jaw wants to move. So, I believe the clenching has a lot to do with trying to contro Zac: Prevent it. Melissa: Exactly. It's also connected to the mind--anxiety and all like so much more mental health and stuff like that. I think it's a natural thing that happens as we become adults that we just want to control. Zac: Yeah. Melissa: That control leads to me building some type of subconscious behavior, to take it out on, and activating the buccinators and we're straining out all in here. No nasal breathing. Breastfeeding Melissa: That's one reason why breastfeeding is so important. Yes, it has a lot of cool nutrition value, but one of the coolest things is that happens is it actually teaches you how to breathe and eat at the same time. The tongues pushes the nipple up, and then be able to help extract the milk, and then the baby's actually letting the mom's body know, hey, you got to keep producing. When moms don't produce milk, they automatically assume it's their fault because they have mom guilt. So, then it's like, I just got to make my baby free to be able to eat and stuff. And they think that the formula is doing the trick but what's not happening is that then the bottle goes in, and now the tongue goes down. Zac: Then you can't control the rate at which the liquid is coming in when it's a bottle versus when you're breastfeeding. Melissa: Then nipple companies make it go quicker, the older you get, make it easier, it just flow it in there, no work needed. Then we don't learn how to breathe nasally really young, then problems ensue. Teeth clenching and grinding Zac: From my standpoint, when we see someone clenching or grinding on the PT side of things, usually that's done to restrict available movement. So, you almost make the system more rigid. And to your point when you're talking about who is this it's those type-A people and a lot of times, I forget what book it was where they talked about the chairs in the waiting room of a cardiologist. Melissa: Oh, yes in the armrests. Yeah, because like they're gripping way hard; fight or flight. Zac: Yeah, and maybe it's just to change the pressurization that's going on in the airway. The importance of breathing Melissa: I laugh a little bit, when people will be like, airway dentistry, PT, speech, what has that have to do with it? "I'm like, Oh, yeah. Who needs air?" Oh, we don't have enough research and I just want to be silly and be like, so we don't have enough research on how important oxygen is? Or seeing the interconnectivity of the body? We all heard that elbow bone is connected to the wrist bone song as a kid, right? Zac: Yeah. Melissa: I just paid you to tell me to breathe? I am breathing! Well, I mean, that's left to be decided, right? [caption id="attachment_12187" align="aligncenter" width="250"] Then you end up looking like this guy #gross[/caption] Myofunctional therapy Zac: Well, and I think most people don't even know that your specialty exists; myofunctional therapy. Melissa: I don't know if I'm the best representation of myofunctional therapists. Zac: You're just my favorite. Melissa: Because it's been more about connecting the dots for me and I think myofunctional therapy happened to be a vehicle that I could I drive that allowed me to go to all these places and I don't think that would maybe be the same for most. I think most love the skill and the passion of myofunctional therapy and what it is day in and day on and how to make the exercises better and that one on one with the patient. I love my patients, don't get me wrong but it's more of this bigger thing for me. I like looking at the teeth, tongue, and more. It opens the door to another place. It's probably my ADHD. The beginning of my journey was untraditional. I was an orthodontic assistant for a long time, hygiene, whatever but I ended up not really even practicing all. My real calling was running a business, selling dental stuff, and making sure the patient and being that liaison to connect everything but at the end of the day, what does that mean? It means making sure the numbers and production and collection were good and I was good at that. We had this really amazing pediatric dental program, but we had this hole in our practice. We would get these referrals for kids who we couldn't start because they didn't have all their molars in yet. How do I make that work? So long story short, I'm from New Jersey, we don't have a very long summer there. And the doctor comes in and he's like hand me this thing and he's like, we're going to go to this course, I'm like, in August in New Jersey, no, thank you, and ended up being a Myobrace course. There was this patient with a class III bite (where maxilla is behind the mandible). These presentations can occur either genetically or because the tongue sits low, pushing the jaw forward instead of the maxilla. The only real way to fix it is to do surgery (or so I thought). Zac: Yeah, a lot of times they'll break the jaw and pull it back. Melissa: Yes. That's a whole other thing. Zac: I had a friend who did that and I didn't know him at the time. He was a coworker and I told him ahead of time, my buddy was like, don't do this. If anything, you got to bring the jaw forward. Melissa: Did you know that? This was before you started doing? Zac: Yeah. Melissa: so, you were already? Zac: Yeah. I knew like a little bit of airway stuff and like some of my earlier things, it was more about using splints to change occlusion. I started with a gelb splint. [caption id="attachment_13637" align="aligncenter" width="375"] Ah, the classic[/caption] Melissa: Really? Zac: Yeah, because my wisdom teeth were still in and I had no truce of movements in the jaw and so we use the gelb to try to get me a little bit extra just for moving perspective but then the fix was to get the wisdom teeth taken out. So, then we went that route. I wasn't really having sleep issues, then but as I got older, it was - Melissa: Well, you did your sleep study show sleep apnea? Zac: No, I got upper airway resistance syndrome. Melissa: I wonder because of your athleticism and all those things that because you – elongation in the sense you did, it would look like you might be more of a sleep apnea patient, but really, you're UARS? Apparently, you and I are in the same club. Zac: I know right? Melissa: So we had this mom who all three of her boys had an underbite. She challenged us and asked if there was really nothing I can do besides surgery? We ended up implementing myobrace and started to notice some decent changes, but the execution was rough; we didn't know what to look for and how to progress. So, the journey then, long story short, kind of went in that I really started to crave the need of like, okay, who created these exercises? Where did they come from and that actually kind of brought me full circle to Sandra Colson and realizing she was a huge part of working with them. Her husband was an orthodontist, she was a speech therapist, and they were getting amazing results. Learning from her made sense to the cases we had that relapsed. And it was important. I didn't hear tonsils and adenoids so much like we weren't bringing like was sort of doctors doing an orthodontist is doing his you know console, he's usually rattling off stuff, that type of by you know, class one class two, upper post for your class or whatever, convex all the different profiles have any they might say, you know, within normal limits, but I noticed we started seeing WAY more enlarged tonsils. [caption id="attachment_12197" align="aligncenter" width="500"] Tonsils are the bottom read and white spot thingy. Looks like a solid "3" there, Bob. (Photo credit: Spider.Dog)[/caption] My real aha moment was working with this amazing orthodontist who produced incredible smiles. It was my first job assisting, so I didn't know any different, but he used removable appliances, nothing cemented. Zac: Really? Melissa: And we always were doing early expansion, twin blocks maras, we would use anything, everything was removable, prop that bite up, pull it forward, and expand the heck out of it. Zac: Wow. Melissa: Now he - how do I say this a nice way? He had, I guess back then I probably would have called an arrogance. He commanded the room. Right? Like you didn't question. He just carried himself in a way. There was no option but the one he gave. Like if Bobby didn't wear it. Like that's your problem, then you shouldn't make him wear like, so that level of expectation. So why that's important to understand. So, I go through and I remember one day we're in the office and I know nothing, right? Like, I'm just figuring out how to do this. He walks by, and the patients are humble, we do and he's like God, somebody should cut that kid's tongue out of his mouth. It's messing up my teeth. It sounds dramatic but now I totally understand but I didn't. I was like, wow, what a jerk. Right? Like, he doesn't care. So, come all the way full circle, I'm now inMyobrace class, I'm doing it, and it was like this light went off, I was like, oh my gosh, this is what he was talking about. The kid was tongue-thrusting. No matter what he did to that bite, he couldn't close it. Zac: Because the tongue kept pushing on the teeth. Melissa: Yes, that's what he meant. He's like God, that tongue is going to destroy everything. So, he knew it. But the crazy thing is if you go back into his story, he was originally an engineer. He was a mechanical engineer prior. Then after had gotten married, went back in dentistry and became an orthodontist. Essentially, orthodontics is engineering. It's all about force and movement and I think that's what makes most orthodontists very specialized is because they can see things in a different way. With Myobrace, we could take it to another level. Years go by and I go back to school and all those things. And I noticed, almost every orthodontist just cements everything in and they just, I didn't even know you cemented it. It allowed me to basically see all aspects of dentistry, and I needed this whole journey to see it. That myofunctional was the most powerful thing. Oh, that's why the teeth keep relapsing because we didn't address the tongue thrust or we didn't retrain the tongue, we would maybe tell the kid hey, Bobby, try to put your tongue up or we put a habit in there or something. Well, anyone that's ever had a real habit, thought was very easy to overcome, right? Especially if you don't even know why you're doing it. And mouth breathing and tongue posture, I mean, if you're drinking all the time, you kind of know what you're doing is wrong, right? Well, you know what the culprit might be, like this is what's causing this? But if you don't even know that it's wrong to mouth breathe and have a low tongue posture, now I tell you, oh, you have a breathing issue. It's because of your tongue. What? Like how do you do that? How do you fix that? Zac: Especially considering how common mouth breathing is. Melissa: Well look at how it's changed. So, you look in Disney movies, so if you go back to like Snow White, the older ones, all of the characters are lips closed. Zac: Really? Melissa: And now you go to Frozen, she's drooling with her mouth open. Zac: Wow. I never even noticed that but that totally make sense. Like sleeping beauty, was she snoring? Melissa: No, no, lips closed, breathing through. Zac: If you have this epidemic of mouth breathing, and maybe this is where you are realizing the limitations of myofunctional therapy. Just like I have limitations as a PT that's why I talk to you and work with a ton of other people who have skills that I don't. Where myofunctional therapy starts Melissa: In a perfect world, you'd start with breastfeeding. Every baby that's born would address whether or not the baby has a tongue-tie, and has a tongue tie to the new protocols and standards. Unfortunately, the system makes that hard. So now we go out longer and longer. Now, time starts dwindling. So that's in the perfect world, that becomes the standard and protocol. Zac: Interesting. Melissa: Just like, when you have a baby, they come and they check hearing and they've checked all the other stuff, like, we'd want to have the tongue checked as well. I also think we could put protocols in and say what we should all do but I think maybe just the real simple of somebody when they come in and they talk, the lactations will come and I know when I had my first daughter, and they talk about why it was important to breastfeed, they definitely talked about how important it was for connection and they talked about the nutrition value but they didn't tell me that hey, by the way, she might have some breathing issues, she might not be able to latch, she might not be able to really eat, could change the way her diet is, it could change her airway positioning. There is some research out there now that shows that unchecked could send somebody down the road of having sleep issues. Possibly, we know that there's a correlation in connection to ADHD with kids that snore. I wish I would've gotten that information because I did not breastfeed my first daughter. I mean, I have lots of my own reasons, but I don't know I had made my decision but I didn't feel like I was given all the information, right. So, don't we have the right to know everything? So, if we don't educate the parents, how can they make an educated decision? I don't know so I think education is probably the first thing that would make the biggest difference. [caption id="attachment_13638" align="aligncenter" width="600"] Get your knowledge up, yo! (Image by Sasin Tipchai from Pixabay)[/caption] It's all about building these programs, implementations, having standards and I mean, listen, when I first started and it's been like 11 years, 12 years now, and where we are today is leaps and bounds. But as you grow new issues happening, like places like the breathe Institute, Dr. Zaghi, I mean, the whole industry change from Dr. Zaghi chose sleep, airway, tongue positioning to become his passion and his drive for research. It opened the door for so much. So, I mean, you have all these pioneers that are pushing limits and doing things all the time. Myofunctional therapy is what you guys do, in a way, but in the mouth. So, it's like physical therapy in the mouth. That's really all it is. And I feel like maybe we should also use maybe some of your standards, more to standardize what we do. So maybe I have a question for you and your fam is this. I was just like, I don't know, anyone that ever has had a rotator cuff surgery and then they go, yeah, maybe do PT, maybe not, like I don't know, like, it's not an option, right? Zac: Well, they're doing that for total hips now but sometimes you get a total hip replacement, and they will not recommend physical therapy. Melissa: And can I just be honest, like, is that because they have insurances? Like, where does it come from? Zac: I'm not sure. Yeah, I don't know. Melissa: I am sure if we went down that rabbit hole, we could find out. Zac: I have my suspicions. I think part of it is, you know, and in some cases, they're not showing physical therapy as having good outcomes. Melissa: Because it's not quick. You got to put work into it. Zac: Definitely. Melissa: We have to train the tongue just like we do any muscle. You must address the structure, function, and behavior. So, fixing the structure, and not addressing how the structure got there, to me is kind of stupid. like, I don't get it. You have to put in the work. Zac: Yeah, and that's the hard thing because really, any type of major lasting change has to do with a change in behavior of some kind. Melissa: Oh, absolutely. Zac: That is what makes our jobs that much harder as we really have to find ways to induce behavioral changes in the people, when, as humans, we inherently, if we can be lazy, we will and I don't think that's a fault, like a character flaw. It just, it takes work and work takes energy – Melissa: and let's give everybody a break. Be honest, is like what is expected of humans and for us to survive and add some kids in the mix and the house and a spouse and a dog and, you know, podcast and two jobs and or whatever it may be, to level up or do what you needed to get your hustle on or whatever, maybe there's just not a lot of extra time. And then you also are then to do to overcome these lifestyle changes, these behavioral changes that are going to have a Long Lasting structural and functional behavior change require self-assessment, looking in the mirror and taking time to evaluate and understand, oh, wow, I did not realize that was affecting this and connecting those dots. And when that doesn't, so you barely have time to do these basic little exercises that we're doing, and yet, you think you're going to have a behavior change? You worked with my mom. I'm going to use it as an example and my mom's good with this because she doesn't know what she doesn't know. So, she came out and she pretty much just wanted to have surgery. Yeah, that was her goal. I mean, she was excited. Now here's me, and I'm like, you even know why you're going to have the surgery? So, tell me exactly what's going to change after the surgery? And I was like, No, no, you're going to go see my buddy. And my mom is - she knows what I do for a living. She's seen me lecture. My mother's gotten some decent gifts of any little success I have. So, you would think she's like, of course, I'll go see your friend and she found out you're out of network. And she's like, Oh, he's not covered by my insurance and I was like, and that's exactly why you are going to see him. I was going to pay for it but think about that mentality, and I'm like, Oh, my God, it's touching nothing and then so now she comes back. She's like, wow, how amazing. I saw her really, you know, try and working and she started to feel better. She's like, it's so weird. I feel better. What do you mean, it's so weird? I get like, so here's somebody and I'm using this as an example. Like, it is my mother. How is she not getting and yet when something successful happens, it's like, I wonder without, what do you mean I wonder without? She knew but it was like, she almost had to be reminded. It's because, in her mind, the only thing that was going to fix her is if you did the surgery, or whatever it may be, right. So, if you can play on that, like not to go into her stuff, but I feel like isn't that across the board some of the stuff we're dealing with? Zac: Absolutely. Well, it's because it requires you to have some autonomy and you to have some ownership and almost intrinsic motivation to better yourself. It's within your control. Melissa: And most people don't want to believe anything they're doing or what they could do could better it because then it's on them. Zac: Or something that they're doing is causing it. [caption id="attachment_13639" align="alignnone" width="810"] But I'm not the problem. (Image by S. Hermann & F. Richter from Pixabay)[/caption] Melissa: I could easily change destructive habits, but it made me struggle having empathy for people that couldn't do that. Where does myofunctional therapy belong? Melissa: I think it belongs in lots of different areas: in speech therapy, dental offices, and physical therapy. I mean, it's everywhere. I mean, it should be bodyworkers, there are so many people because it affects - it's part of the whole thing if your mouth is weak, and your tongue is out, your mouth opened, you're going to be mouth breathing with the oxygen is going to change, you're not breathing through your nose, it's going to cause sinus issues, you're going to be more likely to have sinus stuff. It's going to affect your face; it's going to affect your cranial facial development, and then that can affect not that I don't know, but neck, the shoulders, your posture. Mom's will be like, if so if your teeth are off like this, I was like, so how's this constipation? And the dad's like, well, now you fix constipation. I was like, Oh, well, I mean, if you can't chew your swallowing whole, so hard for you know, go potty. And the mom was like "oh my god, he goes to the bathroom three times a week when that happens." It's really hard. I'm like, Oh, yeah, you can't? Yes. Yes. No contact back there. He's trying to so texture food is going to change the way he swallows the food. How quick he eats, how slow. I mean, it's like cutting scissors that don't line up. And he doesn't even know to tell you. Hey, Mom, I don't have any occlusion. I can't chew that meat. And we're like, eat your food, Johnny better eat your food, close your mouth. And literally, he's like, I can't breathe, I can't chew but I got to do it all so I'm just going to swallow it and real quick, get that down. It's going to make it a lot harder for us to digest food and then digesting now sleep, right? Now that's going to affect other things, I mean, long term and I can't imagine that. Me talking about this, that we can't go connect us that people that end up in your position with you are suffering from my stuff. And the people I see that are suffering from this need to be seeing you. Right? So, it's important to keep the connection going. Zac: Yeah, well, with that, the tongue is one component of the airway and, we've kind of talked about this a little bit where, you know, with you, you kind of specialize in the airway that's more upper whereas a lot of the PT stuff that I do is more airway lower. So, you really have to, I think, blend all of that in order to elicit or to maximize respiratory capabilities, which has wide-ranging effects. You know, we talked about vagus nerve, and you look at all the influences that I have across our physiology and - Melissa: anything when you say like your family or people I mean, that's, that's your place. You guys are all cool with that. So, the fact of like, your people and my people, while we haven't all sat down had dinner, like, you know, I mean until today. That's important because I think there's so much, I should learn from you and you should learn from me. And I hope one day that there is a course, that helps us all connect the dots and my stuffs included in your education and your stuffs vice versa, right? Like, the idea is to up the ante and build the specialties, and really help teach the students how to connect the dots. It shouldn't be something you have to learn once you get out of school. Zac: Yeah. 100%. Melissa: That should be taught in the beginning. Zac: Yeah, it's almost like you need a different profession that combines it all or you need a team and this is kind of where I think you are. You are realizing that you are one piece of a greater - Melissa: Oh, yeah, I mean, I've known that. That's always been but sometimes you got to do all the work to prove that you need help. Zac: Absolutely. Melissa: You got to show where you're falling weak and collaboration is everything. But with collaboration, also will bring some other hurdles. Patients, like we were saying before, don't like hard work. Well, they also don't like being told they have to go see nine people. Zac: Yeah, no, I and that's an issue that I've ran into with some people and I think I struggle with me, referring people into this space is, when I have that conversation of well, you might need a few different things, that's hard. I even just look at like myself, I've seen, I've been to Lincoln, Nebraska, and then that took me to getting wisdom teeth pulled in Phoenix, Arizona, and then that took me to getting the roto rooter done in Memphis, Tennessee. And then now I'm in San Francisco getting this and then working with you and it's just and then Zaghi cutting my tongue. Melissa: How do you build the ultimate practice? So, the question is, does that practice look like an airway-focused dentist? and you know, this airway focus dental thing has become like, who is this person? I mean, I hope that one day, it's just all dentists, because it's not about maybe others you know, they'll be Specialists of who does what technique, but the idea of, that's how you treatment plan. So, they actually, when you go get your six-month cleaning, it's discussed of what your airway looks like, or, hey, if you're mouth breathing, you can cause more decay, tell me how many of most people know that? When people are like, if you mouth breathe, your mouth is dry. If your mouth is dry, you have no saliva, you have no saliva, no antibodies, you have no antibodies, you have nothing to protect your teeth, you're going to get more decay. [caption id="attachment_13640" align="aligncenter" width="354"] But can you nasal breathe tho? (Image by Klaus Hausmann from Pixabay)[/caption] You can brush your teeth all day long. Yeah, like, where somebody else who has tons of saliva, and, you know, it goes like, so these are things like, we should always treatment plan to, hey, your tongue is not sitting where it's supposed to, have you noticed this? And not wait till it's to the point where now it's like, right now you mouth breathe, you snore, you this, you have to go and drop, you know, I've seen my money insurance doesn't cover. I mean, that's a shock to the system. So hopefully that will come to a point of that. But for now, seeing groups come together and it might have a PT, it has a myofunctional therapist, it has a dentist, a body worker, but now it's also a lactation consultant. We could go across the board. I hope that we'll be there and hopefully, we'll have these great little medical many places that can offer all of that, but you got to get your group, you got to get your crew. And I feel like also as a collaborative group, you got to talk finances with each other. What are your patients looking at? What's it going to cost for one patient to see everybody? Already, how many people know that? Like, if you refer, what's the end of the day out of pocket? I don't know. I've always been curious. I always think of that, like, so if I'm going to send the nine people. I think it'd be like, thank you for the $50,000 journey. I don't know. Zac: Yeah, that's quite conservative. Melissa: Yes, and I've just seen because those are uncomfortable areas, right? You don't want to talk to your fellow colleague and be like, what you charge them. But what do you think about us working together? These are awkward conversations and I don't know if they're realistic. I don't know but I feel like no one ever says it, no one ever wants to talk about it. Zac: Yeah, but it can be a big barrier to, like, if you know so and so's going to charge 10k for an appliance and that's not in the cards for someone because they're on Medicaid or something. Melissa: It's just not in the cards. Zac: Yeah, you have to find a different avenue for that person to get better. Melissa: And I mean, like, again, going back to the things like what is wrong with you? What do you do? Well, you know, money. Zac: It's an unfortunate thing with our system. Melissa: Yeah, but let's be honest, I think even in other systems, do you think they're really addressing this? Zac: Probably not. Melissa: I have to say, I don't think there's any system that's looking at truly getting into what's really going on, which I'll tell you, in all systems do. I think I could sit here and tell you that if we were more aware of some of these breathing issues, we would see a decrease in multiple things like heart issues, Alzheimer's, I mean, we could go down the line. It's about more than fascia Zac: I think all of the tissues adapt and accommodate to ensure our survival and I think if you isolate it to one specific thing, then you're probably missing the boat. And not only that, it's like, say you do a fascia treatment, so you mean to tell me that nothing else changed you and you were able to isolate fascia, you were able to bypass the skin? Not create a ton of changes within the muscle. Melissa: Well, you literally had to go this whole journey to get there but nothing else was affected? Zac: Yeah, you can't isolate the tongue, because you're probably going to also have influences on the teeth, the nasal airway, it all works together. Melissa: And I think from your community and your family to ours, most people, and let's just get medical professionals out of here, let's just talk about our patients, the glaze people, right? You know, if you tell somebody like there's something that's connected to their toe all the way up to their tongue, they're like, no, and I'm like, No, really? Because we sometimes also forget, most people have no concept of what the body actually does, or how it actually is affected. Like, really, I find that to be - they have no understanding how if I walk one way with one shoe funny for a long period of time already, that's going to affect something. That helps us try to explain a little bit easier to patients, how come the tongue position can affect other things? Yeah. So, learning where other systems would only make it better for us to talk about it. Coaching breathing mechanics Melissa: Let's talk about breathing. We're always hands-on, like, when you breathe, you need diaphragmatic breathing, right, like you want to breathe in. And so the beginning, we kind of tried to keep it simple for kids, it was just like a very basic of, you know, put your hands on your stomach and chest, sit up straight and don't let your chest move. Because it's really hard to do if you slouch. So, it just became like, sit up straight, shoulders back, head up, because it felt like, at least opened it. But you would actually kind of had said, you know, it's not always about sitting like that. So, what would be that something to kind of show them that we can help each other? What would be a way that you would fix that? Zac: From my standpoint, when I look at that, you have to look at the actions that should happen at the rib cage. So, the rib cage should move as you breathe in and breathe out because if you think about it, when I take a breath of air in the tissues are filling our lungs, so the rib cage has to make room for the lungs and so it has to stand in all directions so we have these actions at the rib cage called the bucket handle, which would be lateral expansion, pump handle, which is anterior and superior expansion. And then you have posterior expansion. But I think what you were trying to do with the belly breath is trying to mitigate an accessory muscle breathing strategy, where I'm lifting the rib cage up as a unit with muscle such as the scalene, the sternocleidomastoid. We don't want that. I want the rib cage to stretch out. Melissa: Yes, but you would normally want to be more about explaining how it's rounded out and how you want to see it go like here and there. But we're keeping and trying to be simple because oftentimes, I most of all, say like take a deep breath and it looks awful. Zac: Well, when you demonstrated that you emphasize a lot of inhalation. Most people can't get an effective exhale. Melissa: Okay, yeah. Zac: So, you have to get as much air out as humanly possible and then guess what? So, if I am just doing a belly breath, I'm not getting any expansion of the rib cage. Well, you can think of it as like my mentor, Bill Hartman, he has a toothpaste analogy. So, if I take a toothpaste tube, and I squish the top of the toothpaste tube, I get all of the toothpaste going into the bottom. Well, the same thing happens with belly breathing, when I take a breath of air in and I do not allow expansion of the rib cage, I have greater downward pressure into the abdominal contents. So, the diaphragm will actually descend to the point where it's flat, which creates a negative pressure environment in the thorax, which causes compression, too much outflow into the abdominal contents, which is the same thing you see in sleep apnea. But now - because what is that? I have a negative pressure environment that I can't maintain the integrity of the upper airway, it collapses. When you're coaching belly breathing, you're creating the same environment, but now you're doing it in the lower part of the airway. Melissa: Wow. Zac: So then now I have a mismatch of intra-thoracic and intra-abdominal pressure. Melissa: So that is 100% correct. So, where we struggle with this is, most people I've noticed, I say breathe and they really do not know what the feeling is, like they really do not understand what it means to truly get a diaphragm out or like to really get that because that, like you see it in their eyes like to calm them down. So, they can't feel that difference. So sometimes, the way we kind of were like not saying, it's being picked from different kind of systems, and that we've been trained on, we got to get them to at least feel it before you can critique it. And that the more the deeper that professionals getting, is, how do we evolve it, to also get them to feel it, but do it properly to promote positive and like, also children versus adults is going to be very different. How we do that, how we teach it, how long that habits been into play. And I am hands down. If you can't get the breathing, right. I think miles doesn't have a chance to stand. So, to me, breathing has always been the biggest, has been a huge part and I have a lot of theories of like people, there are two ways that you end up with mouth breathing and one is like, there was something wrong with a structural situation with the nose early on and then that created low tongue posture because you had to breathe through your mouth. Or Yes, you had a tongue tie, right? And that tongue tie was tethered. You could have been breastfed, but it was further back. Tongue keeps pulling down and then eventually just slowly opens and then you start to mouth breathe anyway and then you stop breathing through the nose and then that changes the way the air comes in, and now the nose becomes a face ornament, and it's just hanging out and therefore, it's very hard for people. They think they're breathing through their nose, and they're not. And you know, the ones that are like [whoo] like, though, like, you put like one of the boom, boom sticks. You're trying to incentivize some type of nasal breathing. When you're stuffy, you should be doing nasal sinus rinses, 24/7 trying to force yourself to clean out your own sinus, but we go, Oh, no, I'm stuffy. Okay, you know, that's - Zac: It's not normal. Melissa: It's not normal. You need to breathe more. I'm sick. I'm taping my lips up even more, forcing myself to breathe and it's hard, don't get me wrong, but you got to push through it and you will absolutely always overcome something sinus-wise; a cold or something quicker if you force more nasal breathing. Treating adults with myofunctional therapy Zac: Yeah. So then with your treatment process, why don't you talk us through the - And I know it's going to be case-specific and I hate protocols. Like that was one of my - it was a little bit of a beef with I think when you're first learning some of this stuff is, they say, first, you do this, then you do this. You do this, do this and I think there are some case-by-case variants. Yeah. I mean, we're doing weird stuff with me. But say someone comes to you, and we'll say it's an adult, because most of the family - hopefully now that you know, we're talking about some of the stuff that. Melissa: you'll see with kids too Zac: if an adult comes to you, and let's say they have these issues, they can't attain a palatal tongue posture, they have difficulty breathing through their nose, they have the gamut but it's not a surgical case and maybe it's someone that could just - they just need you. Melissa: They just need myofunctional therapy. Zac: They just need you. Where do you start? And maybe we could talk into your assessment and Melissa: So, I always have to be like, well, I do myofunctional therapy very different right off the bat than most. I only do it in conjunction with dentists. I mean, almost 5% of I mean, there's a couple of patients, I'm close with that end up knowing they're going to go into an appliance because they're going to somebody, but I very rarely not do that. If I could get tongue space, probably tattooed on me. I would. For me, that's my objective. If you don't have enough space, I mean, anyway, if you have a lion and the little cat cage, yeah, doesn't really matter what we do. Right. And so, I get really frustrated sometimes. I don't know, I guess also, I don't love to do things myself. I mean, you'll get changes and there's always benefit, like even myself, if I didn't do myofunctional therapy, I probably would have a way worse situation than I have. The therapies done quite well. I should use myself as an example and I struggle with space, but because at least I have tongue strength, I am able to hold at least what I have so I don't collapse so much and it's funny a CBCT scan, if you look, my tongue is like flat up, because I have like a little cocktail straw. I have like three, four millimeters in my airway. It's really tight. And so, I don't have an option. My tongue can't go back. I mean, game over, right? Zac: Yeah, low resting tongue posture. Melissa: Yeah. And so that's why I can nasal breathe because I had no choice. Right? It was like, this is what it was going to be because it felt so much in my throat. So, you can do myofunctional therapy, just to be able to abstain from what you have if you don't want to fix it, right and so, what would be the base? If someone is really good at nasal breathing, they can breathe, that's fine and keep their lips closed and you can do an easy test like, someone just puts a popsicle stick or they hold and just breathe through their nose for two, three minutes and they're able to do that, then yeah, I would definitely do some therapy and starting off with just doing tongue, just getting to understand where the tongue supposed to be sitting and then from there, you kind of go into being able to move the tongue and then compensation comes into play of can we separate the jaw from the tongue? Because that's when we really start to work the tongue muscles themselves because a lot of people think they can do things with their tongue but really, their jaws were doing it for them. And I mean, I'm no way in speech, but I always like, I asked parents all the time. I'm like, does he mumble and they're like - we'll say, well, do they have any speech issues? Or even adults? Oh, no, I go. Someone ever told you, you, you mumble Oh yeah, all the time. It's kind of a speech issue. Because the mumbling is if you do not have a lot of range, you'll notice someone will say like 123 their upper lip, like the inadequate movement of the upper lip because the lower jaw just kind of - well the tongue is down so you have to bring it up, right? So, they reduce tone. So, they'll talk quicker to get it out or they'll change the words because they're modifying. Humans are amazing. We're going to figure it out. So those are areas that we might work in just to help you build awareness and then body scanning right? What does that feel like? Does that affect your neck? Do you feel that down in your back? Does it feel weird? Like, where do you notice it? Because if I don't build awareness so that you feel the difference of where the tongue is? What's going to keep you in the long run? But I got frustrated with some cases that I wasn't getting better. In 2017 I was pregnant and watching everything Dr. Zaghi is putting out and what's this guy up to, whatever and I was like, oh, okay, I'm going to get this guy, I asked this guy, what about these patients? So, I actually started paying for consults for all my patients, just so I could get on this. So, I could introduce the patient, present it and ask him why they can't go any further. I know the joke is that eventually what I was like, sorry, on staff, like, Hi, like, I was just being me and I'm presenting patient and that and now I felt like oh, my God, someone was finally able to say like, oh, the tongue, he's tied, etc. And now I had somewhere to send them. And I was like, ah, and now listen, the tongue tie got released and we were able to overcome it but the ones we couldn't, which, unfortunately, were more I shouldn't say my patients were, I was lucky enough, I already had the tool in my arsenal. There was expansion going on, right? Like I was working with doctors so if it was a BWS, which I know - Zac: What's a BWS? Melissa: So BWS is a Bent Wire System, which comes from the company Myobrace and they use BWS, and then they have you wear the brace over it to kind of help do with [unsure word 1:06:10] The theory was to kind of do with the crows that did right, so. So whatever may be Crow's out all of these different things. I was lucky enough that I had somebody that we knew we needed to make t space like that's how we were showing that we were getting results. Or then if I would have somebody that would get good expansion, then they would relapse. That's how long I was keeping them so that they were relapsing with me. Because I was on this journey, I needed to know where is going. So then now, I was able to show Dr. Zaghi like, okay, we've done this, we've expanded, we've done, and now this has happened. And like everything happens for a reason. That's how I was able to really so grateful for that situation. So now I was able to see, then you had that tongue-tie release in there, huh? Zac: Because it really takes a team. Melissa: It does. Yeah, and I know I have a hard time being like I could do the therapy, but we don't have enough space so I don't know. But that's me, right? There are a lot of therapists do it. And then they only need tongue ties in there to expand and that's fine. This is just my vehicle and that's what I saw. And I really do think we now finally are like getting into a community. I mean, people are talking about tongue space more and we're more aware of the structure and that you need to be able to withhold all this, be able to have a place for the tongue, the tongue is able to be somewhere so that it can be in the right position. So, it is more and that's what's uneasy about it. And then you know, they're finally in a good place, they've had the release, they go home and now they have anxiety, they're depressed, I don't know, they get divorced, whatever their life comes into play. And we didn't really get into the fact of what the behaviors are, and then they come creeping back, or they get a little new doggie that they're highly allergic to, and they don't realize it and they're mouth breathing again. So, the body or they're doing you know, they have neck issues, or I don't know all these different things, I feel like you also have to bring that aspect into it, and you have to be able to address all of it. So, the treatment planning is complex so most of the time, when a patient comes, I feel confident, I'm able to quickly say to them, okay, this is what you present with, I know your low tongue posture, you have this, this is where I would go, I would start with probably looking to get some type of an appliance. Let's open up that bite work on that structure. While we're doing that, let's work on nasal breathing but while you're getting your structure fixed, let's work on nasal breathing. Let's see how you feel comfortable getting your lips closed. Seeing how that becomes comfortable and then once that structure is done the right thing, then kind of come in, let's bring that tongue up, start noticing where the tongue spot is, and then kind of prepare for the tongue release. Because if I'm setting a patient up, I don't want them to go get the tongue release done until they have tongue space. So then now, I'm going to focus on that, I'm going to keep it pretty structured, there was that tongue ties done. Now we go in and we do some swallowing techniques and we really kind of bring it all around, and hopefully now they're able to keep it and now they don't have their teeth moving and they're not functioning as much. And if they do move a little bit, they know why they have the tools in their toolbox to go back and do the therapy again and do things on those lines, Zac: Which again, gives them a locus of control. So then is it fair to say nasal breathing, space. Step one has to have that, range of motion, I'm assuming would be second and a little bit of awareness of the palatal tongue posture, because I would think if you don't have the range of motion available, it's going to be really tough to attain that position. Melissa: Well, so right if I go back, so I don't know for me range of motion. Okay, so it depends on so, like, we have four grades of tongue-tie, right? Then a two-step release might be the first thing to do. Zac: Interesting. Melissa: Yeah, just get up there. We got now we got to just do that. Then once we do that therapy, work on nasal breathing, work on the structure, then we go back and prepared for the functional frenuloplasty. Zac: Gotcha. Because I have a client who I'm working with right now, he's potentially a candidate for a second step. But so, they do anterior first, and then the posterior tongue tie second. Melissa: So, the concept of why the therapy is so crucial for a tongue tie release, specifically functional for any of us, is because they need to be able to do certain exercises, certain motions and movements, and hold it during the procedure. So, they're numb during the procedure so, they better have really good muscle memory, and know how to do these things, to hold it when you're numb, right. So, you better be able to do a cave suction really well and also, that's going to help build muscles. So now when the doctor goes in, and does that release, you're going to see the separation between fascia, you know, fascia fibers muscles, it makes it a lot easier for the surgeon to get in there and see that difference. Zac: Absolutely. Melissa: Now anyone that's ever worked for a doctor, anything we can do to make their jobs easier is always a win. A win for the patient, win for the doctors, win for everybody. So that's what's crucial for that beginning step. So, if you're so tied, right, anteriorly, which is a lot of people that are out there that will say, Oh, I had a -you know somebody that had a tongue tie release 20 or 30 years ago, I promise you, they still need another one. Because that was a snip. They saw that it was so tongue-tied, they couldn't move it. So, they were just doing what we do with the first step to prepare for the second one. I mean, that's how I look at it. Yeah, yeah. So, you know, look, I was like, Yeah, we got to give you enough rope so we can at least get you to move in, so we can get you to hit this, hit the tongue spot, and be able to then hold that cave, workup, get a little muscle tone, be able to, work there. So, we can get some identifying and be able then to get you ready for healing. And also, it's a lot easier to do therapy exercises for healing, when you already know them and you've gotten muscle memory when you're sore and in pain than it is to learn them when you're in pain. So, I'm like, Well, why would you not do it before the procedure? Because who wants to be learning something when they're also sore? and it's crucial afterward. Once the sutures off, you're doing therapy, I mean, every four hours, six hours. You know you've regimented; you don't want that stuff to reattach. You want to keep that moving. I mean, you want to use this amazing moment, and ability to - now your range of motion being so much wider, you want to continue and that's not going to happen. You can see it become worse, tethered up if they don't have a really great regimen and they didn't have good muscle tone to begin with. Zac: Yeah, and that's something that even in PT, like, if we have someone who's going into surgery, we try to see them - in a perfect world, you would see them pre-op for the exact same reason. Melissa: Yeah Zac: It makes it so much easier on the backend. Melissa: Of course. Zac: They have those concepts in place. Melissa: It's not new. And most of it all, it goes back to the implementation and trying to make sure people understand it. I think that's going to be a battle but I think more conversations like this, more people using their mind and opening up and finding unique places to educate patients. We talk about something earlier, but not to go into I but I believe people are a little bit - I'd like to give them more credit than we do. I think people are able to make decisions. I think we make a choice, unfortunately, to choose what information pertains to them and what they need. Because we don't think that they have the ability to always maybe make the right decision for themselves. I don't know. I feel like all people, this just should be spoken out. They should know, every option. Hey, if you choose not to do it once you've been given all the information. Okay, cool. It's your choice. I have an issue when you weren't presented with the side effects if you don't do it like I'm sure if I was going and having that hip. If no one came in and told me Hey, listen, okay, you don't you know, you couldn't do therapy. You could do PT prior, you know, pre and post. This is the benefits, whatever. If you don't, you know this can happen, this can happen, this can be a little bit more challenging, not everybody, but it does happen, and you truly set the expectations and limitations of both, let the patient choose. Once they're educated, they know, hey, do whatever you want. I have an issue that it's not. We don't do that. Educating patients on airway without inducing maladaptive beliefs Zac: Yeah, which makes sense, because then you're not making them an informed consumer. The thing that I struggle with, and I see this a lot, and I especially see this online is sometimes when you give someone a story, and you give them the doom and gloom of what could happen, a lot of times the maladaptive beliefs that they develop from that, become an issue. So, there was this article, this guy was named Darlow, and I forgot the name of the title is I'll link it in the show notes. And he had this thing that this patient says basically interviewed all these patients based on what doctors had told them. Okay. And I don't know what the doctor specifically said but the patient's interpretation of what he said was, he was so afraid of back pain. He was so afraid of the disalignment of his back that he thought that his spinal cord was going to sever and that led to tons of anger, fear, anxiety, lack of movement, and things like that. And I especially think in this domain, because it is a huge rabbit hole and there are some scary procedures that some people may have to go down like, sure. We're talking about appliances and myofunctional therapy and things of that nature but what if you got someone who needs the MMA surgery? How do you balance not instilling fear and maladaptive beliefs that this is, like, if I don't do this, my life is screwed versus informing them? Melissa: This is what I know, I'll just live with it. And I mean, I truly understand that. So, I said to you like I have a formula for an airway. I do this for a living. I'm aware of what I should do, right. Like, do I know that I should have surgery? It's scary and I know, from the best. So now the other side, right? It's human. Like, I'm going to try this first one, it's a scary thought. And let's be honest also I go into like, do I have it in me to do, you know, my own insecurity of will I follow through? Will, I get it done? Will it truly make a difference? And I think it's just like, I'm always high energy. I'm always like, appear, right? My fight or flight? That's become part of my identity. It's who I am. Is there something inside of me that also scares me from it? Because I'm scared of who I'd be without it. I mean, I'm going a little dark here and a little deeper, but it's, I mean, it's my truth. Zac: Oh, or sure. Melissa: And I play in my own head all the time. I'm like, I can't do it this because my kids like, you know, and I can make every excuse not to do it because at the end of the day, it's huge and it's a leap of faith. I think I respect that and I hope that nobody thinks that anyone's saying it's easy, and it's one shot and, and do it but the question is - then the other comes back to is, maybe I just don't think it's affecting my life that bad. Yeah. Yeah. Even though I statistically notice. Zac: You know what you don't know. Melissa: But the other thing is, you know, maybe I'm comfortable like this, I'm not ready to, I haven't hit my place of like, I can't do this anymore. This is no law. I can't live like this. Right. So, I'm willing to go do that. Where I think like, in some ways, like, those are extreme cases, right? But, you know, kind of just go away. Like, let's go to rotator cuff surgery, right, like, so that's not something, my arms like I can't move it, I don't want to have a choice. That's bottom. I got to fix it. Well, I'm almost saying like, what are we doing? Why are doctors not - Of course, PT or - Like, why would that not be automatic? I mean, that's part of it. I feel like to say that if that's not the standard, that's scary. And I think things like you've had braces three times. Do you want to try something different. So, you've had braces three times and you also have sleep apnea and so there's a lot of things that have now are coming in your way that you'll pay for this, this, and this. Hey, do you want to also address these other issues? Then maybe we get through there? Just those kinds of conversations. Zac: Yeah. You have to give people options. It's funny you when you're mentioning the identity stuff because I totally run into some patients who will forever be a patient because that is who they are. That is their identity and that's who they become. Yeah, you do have to wonder like if I take that away from them, so your high energy. Well, if you – you get the chill pill and I think it was in Mark Manson's book, not the subtle art of not giving a Fuck but everything is, he talks about - I just read it the other day. Oh. In order to change who, we are, we have to mourn who we were. Yeah. It's such a profound quote and it's true. It's like some people just might not be ready to go through that grieving process of changing those things, those dark things that are about you. Melissa: Well, if you're anxious, you're living in the future. If you're depressed, you're living in the past and if you're content you're in the now. It's hard. Mental health is a big deal. Zac: In terms of like it being the X factor, or maybe the thing we're not addressing. Melissa: Actually, it's personal. So, that's like my connection to certain things. So, I had a patient, an office I was at and I walk into the room, they had the scan up. I mean, the kid has no airway. I mean, never mind, forget the cranial facial stuff and forget the teeth, who cares about the teeth? I like turned around and I was like, hey buddy, he was nervous. He's all these things anyway. So, I was like, great. I got the assistants taken out of the room and I said so any behavioral issues like the mom starts crying. I mean, anger issues, can't calm down, bathroom issues, can't eat and I'm like, I want to like, just cry, right? Because I'm like, this is a kid in my mind, this young man and the mom is like, she thinks it's just who he is, right. Like, you know, we have one bad seed because I'm telling you, I'm telling her things and she's like, so that has to do with that and like with a little bit of disbelief, right? Like, yeah. Right lady. No joke, the father was in there, he had a mask on, new design and I brought up one thing, I said, so is he really good in like science? And then all of a sudden, like he's reading and comprehension seems to be lower and the mom's like, yeah, he gets stronger grades. Then I asked if he keeps rereading the same page and the dad like takes on his thing, he goes, why he gets that from me. Dad pulls down and he has this crazy deep bite. And I go, I know he gets it from you. I agree. You just have the same habits. And he's like, what? I go, yeah. I go, you both, like you live in fight or flight. Like you just, I just start reading out loud. It will change the game. His dad was like, no way. So the mom's like, I go watch it. So the kid came back and we gave him one little snippet of thing. We told him to read it to himself. I gave him three questions. and read it aloud. He was able to get it! Zac: Essentially recruited another sensory system. Melissa: Absolutely. Zac: Well, and then that goes into, and I don't know if you've ever checked this with those folks. Like if they have any visual issues along with that. Because a lot of times - Melissa: I got to fix it, I'm fixing bathroom issues. Now I got to fix my eyes. Zac: Absolutely. Yeah. Which Dr. Kareen, if you're tuning, I got you! Melissa: Okay. I'm sending it right. I mean, and I'm so sorry, not that I don't know how important the visual aspect is. Zac: Well, to me, I think this all relates to airway because if I have to assume a particular head posture, well, that's going to change where my eyes are looking in space. And so, you could potentially see some changes in the shape of the eyes potentially, or the focusing type stuff or eye teaming. Melissa: Well, we look at it when they, when they - Well, actually I always look like I can. They always like my little last, super what do you call it? Like my tarot card thing is I'll walk and I'll be like, Oh, so you only true on the left side of your face, where I looked in their mouth. And they're like, what? I'm like, well, one side of your face is stronger than the other. I can tell you only work those muscles, but also like the moment you bring somebody up and expand them out their eyes, all of a sudden open up. because they were squinting like this. And so, I guess, yeah, I knew the eyes were part. Everything's affected. Eustachian tube dysfunction So, let's just wrap on the one last thing. I mean, now we've done ears, we've done eyes and mouth. So, kids that have had tubes in theirs. Okay. Kids that have tubes in theirs can't swallow, that's why they can't clear their eustachian tubes. So they have a swallowing issue. That's why it keeps building up fluid. Zac: Yeah, so wait, you're going to have to unpack that a little bit because this is - so if someone has you stationed to dysfunction, how does that relate to the swallow? So are you saying that - Melissa: So, normally what happens? Right. So, swallowing and I am not a hundred percent, but like if the idea of the concept of the swallowing is what helps clear it. Like it helps the fluid run through. So, the concept of like, if you can't swallow, so if your tongue's low, so swallowing for anyone who doesn't know, right. So, the tongue should be up, you should be able to swallow with minimal facial movement. The tongue should just go up,
Dr. Michelle Lee delivers a presentation on an array of temporomandibular disorders (TMD), the problems they cause for Dr. Lee's patients, and how different appliances can offer therapeutic solutions. Different facial muscles are affected by TMD and that in turn causes breathing problems, general and localized pain, and issues with biting and chewing. This is both therapeutic and diagnostic, and we need to treat it as such. The “why” of TMD treatment includes understanding and prioritizing muscle comfort, occlusion stability, and a free airway. Anterior (muscle) deprogrammers are a diagnostic tool and they can help correct some bite problems. Dr. Lee explains some of the risks involved with anterior only therapy and reviews the functions (and key symptoms) of the muscles of the face: the temporalis, the masseter, the digastric muscles, and the plerygoid muscles. Dr. Lee describes a patient named Emmy who suffered from a lot of pain in her back and neck, problems with posture, and mouth breathing. The science behind mouth breathing and how it can negatively affect facial development and healthy sleep are truly connected. Bite splints should fit properly or patients will play with them too much. A high resolution pulse oximeter can also be used to check for sleep apnea problems. She also shares a personal story of her six-year-old son, Nathan, and how his deep bite and tongue tie affected his sleep breathing and general development—UARS (Upper Airway Resistance Syndrome). Pankey's Cross of Dentistry: Know Yourself Know Your Patient Know Your Work Apply Your Knowledge Main Takeaways: You can use Appliance Therapy before, during, and after treatment. (3:30) We need to understand the muscles, the joint, occlusion, and the airway. (9:30) “For every 10 degree change in the angle of disclusion, there is a 30% change in the force applied.” (32:32) “We can be the change we want to see in the world [through our dentistry].” (43:45) “TMD and UARS are more linked than we previously thought.” (54:14). Quotes: “I've been able to stand on the shoulders of giants at the institute.” — Michelle “Do the clench test if you want to determine if your patient has a high anterior only risk.” — Michelle “The timing of the sound of clicks can give us a better understanding of occlusions.” – Michelle “In the war between muscle and teeth, muscle always wins.” – Michelle. “Mouth breathing is not a developmentally good thing.” – Michelle. “I know there's a big pause in our lives, but we can sharpen our skills.” – Michelle. “Start with a little bit of ramp and move up...that's why it's called therapy.” – Michelle. Snippets: How Michelle got into dentistry. (2:00 – 3:30) Michelle's philosophy. (5:00 – 6:00) Why we use TMD appliances in the first place. (8:20–9:40) Emmy's case study. (44:30 – 46:30) Michelle's son Nathan and his UARS. (51:40 –53:30) Bio of Speaker: Dr. Michelle Lee is very proud to provide all aspects of comprehensive dentistry which includes Restorative, Cosmetic, TMD, and Sleep Apnea treatment to the Fleetwood and Berks county areas. Dr. Lee is a graduate of the University of Pennsylvania School of Dental Medicine with a one year post graduate General Practice Residency Program at the Abington Memorial Hospital. Dr. Lee continues to be a life long learner herself and constantly keeps herself abreast of dental advancements by committing to hundreds of hours of advanced dental education. She is an active member of the Pankey Institute, American Academy of Cosmetic Dentistry (AACD), and American Equilibration Society (AES), and other courses for advanced education. Dr. Lee has advanced knowledge and training in the TMJ, Disorders of the TMJ (TMD), bite disorders, and Sleep Apnea. She continues to expand her knowledge in this field because she feels passionate about Dentistry based on the relationship of the Jaw Joint, Muscles, and Occlusion (teeth). She approaches dentistry with precision, accuracy,...
Our very own Megan Van Noy tells her story about going to LA to have Dr Zaghi at The Breathe Institute do her tongue tie release. She tells all about the process and how it felt. She did a home sleep study results, showing she had positional UARS or upper airway resistance syndrome when she is on her back. The Breathe Institute did a 3D jaw and airway image showing her bone structure is still deficient even with expansion as a kid and a small airway size. After the full work up she was cleared to do the release (note she has done myo for years, bare minimum is 6-8 weeks per our training). She has always had issues with: mouth breathing at night, GERD and acid reflux, digestive issues, clenching, headaches, had an expander as a kid, shin splints and tight back, neck tension, bedwetting as a child, colicky as a baby, allergies. She has noticed since her release: reduction in head and neck tension, chiro adjustments are easier, less myofascial tension with her massages, less acid reflux, sleeping well. We will make a recording and pre and post pictures for youtube so you can all see! Find Megan Van Noy for myofunctional therapy at www.orofacial-myology.com and insta and facebook NWMFT and Munch Bunch Myo Podcast Find Kimi Nishimoto for myofunctional therapy at www.mouthmusclememory.com and insta and facebook Mouth Muscle Memory and Munch Bunch Myo Podcast
Mein Gast in Podcast-Folge 14 am 06.11.2020 Dr. Darjusch Nadjmi HNO Facharzt, Allergologe, CEO Eurosleep GmbH Spezialist für: Schnarchtherapie, Schlafmedizin, HNO-Diagnostik und Therapie, Kinder-OP's, Allergologie Vorstandsvorsitzender Kitz4Kids Themen: Wie gefährlich ist eigentlich Schnarchen und wie ist kitz4kids e.V. entstanden? Im Schlaf entspannt die Muskulatur der oberen Atemwege. Die Atemwege werden schlaffer und vibrieren bei der Einatmung im Luftstrom. So entsteht das sägende Geräusch. Jeder zweite Mann und jede vierte Frau schnarcht. Die Wahrscheinlichkeit, nachts zu schnarchen, steigt mit zunehmendem Alter. Auch Übergewicht, ein vergrößertes Zäpfchen oder ein schlaffes Gaumensegel sowie Probleme mit der Nasenatmung und ein verdicktes hinteres Zungenende begünstigen Schnarchen. Da der Schnarcher meist mit offenem Mund atmet, leidet er morgens häufig unter Mundtrockenheit, belegter Stimme, Schluckbeschwerden und einem Kloßgefühl in der Kehle. Studien belegen: Schnarchen ist das wichtigste Leitsymptom für die krankhafte Verengung der oberen Atemwege. Häufig geht es mit nächtlichen Atemaussetzern, Apnoe, oder mit verstärkter Atemarbeit gegen einen erhöhten Atemwiderstand, UARS, einher. Beides verursacht einen flachen Schlaf, führt zu Tagesmüdigkeit und Kopfschmerzen. Langfristig steigen so die Risiken für Bluthochdruck, Herzinfarkt und Schlaganfall. Schnarchen ist mit 65 bis 90 Dezibel so laut wie der Lärmpegel in einer Kantine, oder sogar wie ein vorbeidonnernder Lastwagen. Das führt beim Schlafpartner nachweislich zu Stressreaktionen im Schlaf. Seltenes Schnarchen nach einer feuchtfröhlichen Nacht ist in der Regel ungefährlich
How a dentist can improve your sleep, breathing, and more If you have perfect sleep, NEVER mouth breathe, and have excellent tongue posture, then you can skip this post. But if you are like the rest of us, no doubt you or your clients struggle in one or many of these areas. What if all of these issues were related to the structure of your mouth? That's why I interviewed Dr. Brian Hockel, a dentist who I work with personally, and a leading expert in the field of dentistry and airway orthodontics. [caption id="attachment_12956" align="aligncenter" width="600"] The legend![/caption] In this podcast, you'll learn: How facial structure can impact breathing and tongue position Why a CPAP doesn't really fix sleep apnea How a well-trained dentist can improve mouth position to enhance your sleep and breathing How occlusion, tooth contact, may not be the exact science that people make it out to be What you need to look for to find a dentist who can best help your sleep and breathing If the health of your airway is important to you and you want to get your sleep on fleek, then you need to check out this interview. You can watch the interview here. Learn more about Dr. Brian Hockel His website: Life Dental & Orthodontics His practice is located in Walnut Creek, CA 64598. Bio As a graduate of the University of California, San Francisco, School of Dentistry in 1989, Dr. Hockel is a general dentist in private practice with a focus on orthodontics that aims to prevent or treat airway problems like sleep apnea. He aims for more permanent solutions to Airway-Friendly Smiles, going beyond the dental oral appliance approach, often having to reverse previous orthodontic treatments. He has lectured nationally and internationally on topics of facial growth guidance, orthotropic, and airway orthodontics, and is an orthodontic instructor for the Academy of Airway and Gnathologic Orthopedics (AAGO). He is also co-founder of the Team Airway Study Club, a co-founder and board member of the North American Association of Facial Orthotropics, and a board member of the AAGO. Show notes Here are links to things mentioned in the interview: Joe Cicinelli - He is our mutual physical therapy colleague, and a dear friend. ALF - A lightwire appliance that is often used when there is cranial dysfunction present DNA - An appliance that aims to expand the palate in multiple directions. It's akin to the Invisalign of palatal expansion AGGA - An appliance that is used for sagittal palate expansion A Randomized Crossover Trial Evaluating Continuous Positive Airway Pressure Versus Mandibular Advancement Device on Health Outcomes in Veterans With Posttraumatic Stress Disorder - A neat study that positively affected PTSD symptoms by targeting sleep. Upper Airway Resistance Syndrome Patients Have Worse Sleep Quality Compared to Mild Obstructive Sleep Apnea - If you have never heard of UARS, then this is a must-read Bruxism: A Literature Review - An excellent in-depth article on all things bruxism, grinding, clenching, and more. Modified Transcripts The difference between conventional dentistry and airway dentistry Dr. Hockel: I think a lot of it has to do with the understanding of how we get to where we are and what the underlying causes are of some of the problems that we're dealing with. And then the connections to what we're doing in the orthodontic world, the orthopedic world. By that I mean if you understand that our growth really affects our function, especially of the airway but certainly of the jaw joints and of the bite, how those relate to each other? if someone says “we are the way we are because of our genes; we're just going to grow.” “This is a set shape to the skull, a set position for the jaws and it is what it is and make the teeth fit within that confine of the skeleton.” That's going to lead you to a very definite approach in orthodontics. As opposed to the belief that the way we posture our mouths and the way we use the muscles of our mouth and head and neck, that's going to affect how our face grows at a young age. Then as an adult, it's going to affect the function of the airway, again of the joints and that maybe if we look for the underlying causes and address them, we can have other successes beyond just getting the teeth to fit. So it's looking beyond how the teeth fit together and looking at the overall structure; jaws, airway. It turns out that the roof of the mouth is the floor of the nose. The nasal airways are our next-door neighbor that way going up and the oropharyngeal airway is right behind the tongue. We're always looking at the back of the throat but we don't recognize that that's where the air has to go to be able to breathe. So there are neighbors in the dental world and it turns out that the things we do affect them. Zac: It's a lot more than making a pretty smile in terms of the impact that you can have on someone's health and well-being. What kind of implications or negative things have you seen from people who don't respect that? We've spoken before having this conversation about some people who are just doing retractable orthodontics which maybe you can talk about. They're just pulling teeth so things can fit and the smile can look nice. What are some of the implications of not taking into consideration the structure of the face? Dr. Hockel: It might be an overstatement to say that most orthodontists are focused on just making the teeth pretty because obviously there's a lot of science that goes into how we try to make the teeth fit. Jaw joints and even airway are in the conversation, though the latter seems to be lip service. The best way to answer your question would be to use a term that was coined by Dr. Bill Hang in Southern California, he calls it ERRS (extraction retraction regret syndrome). He purposely called it errs because it's based on the answer to your question, what are the errors that we've been forced to live with? The first is kind of an aesthetic one where people don't like the way they look and with a lot of traditional orthodontics. There's a feeling like maybe the teeth are further back in the face than they should be or the lips seem sunken in or thin. There might be a feeling like the face has lengthened after orthodontic treatment has been done. Then there's the whole functional side and this includes, both the airway and the jaw joints and also includes the bite, of course, the way the teeth fit together can be affected by that. How we chew and how we breathe, they can go hand in hand. If you bring teeth too far back in the face, the tongue doesn't have enough room, the chewing motions of the jaws can be affected and of course, the dimensions of the oropharyngeal airway can be affected. People who live with this for a long time and have been told this or that thing is all in your head and you just need to learn to deal with that. [caption id="attachment_12855" align="alignnone" width="810"] How embarassing[/caption] We who work in the orthodontic profession may be saying your bite is fine, everything fits together, it meets every possible standard that or criteria that I could have treated it to. So whatever you're not happy with, it's not what I did and maybe I did treat to the best standard of care that's out there. But we're learning now that there are things beyond what we've been held to and by ourselves and others and what we try to achieve that have really profound and far-reaching effects that we weren't even aware of. Zac: I mean you just think of this area of the body, you have most of your sensory systems there. There's a lot of prime real estate that could potentially be influenced in one direction or the other. It's intriguing that you're saying the wide-ranging effects that can happen on this. I remember a study I read years ago about people who had PTSD. They put an appliance in the person's mouth as treatment in this randomized control trial and it had a profound impact on symptoms. We can have large substantial changes on someone's health and well-being by affecting this area of the body in the way that you're talking about. Now you weren't always into the airway side of things so in your career what led to you appreciating this side of dentistry more? Dr. Hockel: I think it was contact with doctors like Bill Hang and John Mew. John Mew is an orthodontist in the UK who for many years developed treatments that were based on what he called the tropic premise. That was the belief that the jaws are going to grow to the position that they most commonly adopt, so keep your jaws closed, pointed forward they're going to grow forward. Keep them apart, pointed away from each other they're going to grow away from each other. It turns out that the treatments he was doing to get the face to grow to what was a better proportion, more aesthetically pleasing result; it was also making a difference with the airway. Initially, he didn't really even realize this so he's one of these people that looked at the results of what he was doing and actually saw something really good. There were a lot of us that looked at the results of what we were doing with more traditional methods and saw that we weren't doing things that were good. Bill Hang, who I already mentioned, is probably the biggest influence on how I've been able to connect the dots between the airway and what we do in the orthodontic and orthopedic world. I thought I had every answer that I needed at one point and I suppose sometimes we get that state of pride in our careers. At first it can be unnerving to learn something new but then you can get to a point where you're kind of in a zone, you feel comfortable and I felt like I had a tool to treat pretty much every type of bite problem that I could come across. It was right then that Bill Hang dropped into my life and taught me to look at things in a very different way that included growth direction, growth guidance, developing more space for the tongue, looking at the oral posture. Especially looking at what was happening with the airway and how things affected that. Like most of the people who've heard Bill Hang, there was some of it that I readily accepted and other things I was skeptical about. I had to go home and think “I don't know if he's really right about what he says about the herbst appliance” for example. I'm going to go home and look at my cases a little more critically and I just shook my head as he was right. There were things going on that I didn't want to have going on right under my nose because I wasn't paying attention to it. So now my attitude is “just don't cause any harm, don't do anything that's going to make anything worse.” “And if you're doing something that has made other people worse and you're not sure if it's going to make this person in front of you worse, just don't do it,” it's the safest thing to do. Zac: Yeah and I imagine too if you're not taking into consideration things like oral posture airway and things like that just because of how important respiration is. You could have wide-ranging effects of doing harm that you didn't know you were doing. Dr. Hockel: Right or at least miss the opportunity to do good, to me that's just as bad; if I had an opportunity to do something a lot better for someone and I missed the chance, I don't like that. Zac: Was that hard for you to have that kind of paradigm shift? Dr. Hockel: Yeah my wife would tell you, I was in a very difficult mental state during those years. It was a big paradigm shift and very emotional and around that time we had a lot of little kids around the house. It's hard to realize your professional foundation isn't as solid as you thought it was. I knew however, that I needed to keep growing and learning; not being foolish to where I thought I knew it all. Zac: Yeah, that's when you know you need to retire or quit. What types of patients would benefit from airway orthodontics Dr. Hockel: I think the people that search me out know that there are important ramifications of the types of treatment we do in orthodontics and in growth guidance. And they don't want something bad to happen to their kids or they're an adult that has already seen something that happened to themselves. We talked about extraction retraction regret syndrome and there's either an emotional component or an aesthetic component, more often I see the functional component. People will come wanting to know what they can do to improve their situation as an adult and some of them might come very bitter about what was done with them in orthodontics. It's unfortunate because the person who treated them was only treating what the standard of care was at that time and they probably did a very good job. [caption id="attachment_13014" align="alignnone" width="500"] Making kids unhappy in more ways than one since 1960 (Photo credit: Orthodontist101)[/caption] I don't see too many people who were treated by an orthodontist who did a bad job; they were just doing it with a very different philosophy of how to treat and why to treat. So there are the moms with the kids that want them to grow right, that's a group of people who have young kids and they want to catch them as early as possible. The earlier we get to kids the better. I'd rather get kids at six days old and talk to the parents at that point. Make sure there's no tongue tie, make sure you're breastfeeding as long as you can, try to switch to solid food as early as you can, and the whole concept of baby-led weaning. Take away bottles, pacifiers, and sippy cups. So it's not classic orthodontics to talk to a parent about their child when they're that young. And yet, if they follow what advice I'm giving them, it can help minimize what I might have to do later on. I think the goal would be for us to really find as far upstream as we can go to find the causes that can be addressed so that we don't have to treat them at the stage where we are. Even at age four and five when I'm treating a child that young in a way, it'd be better if I could have got them earlier. Tongue ties Zac: It seems like even the concept of having your child have a tongue-tie release is very controversial. I read stuff on the internet all the time where it's like “oh, we don't need to do that” and it's unfortunate because it can definitely negatively impact things like breastfeeding and things of that nature. Let's say I have a kid and I say “Dr. Hockel, do unto this child what we can do to minimize any negative effects,” where would you start? Dr. Hockel: Well those things that I just tossed off a little bit of a list when they handed me that little scissors to cut the umbilical cord in the delivery room for my kids. I look back on it now and think I probably should have just looked around like lifted their tongue going “okay, I'll just do that first! Tongue ties can affect speech and growth. When they're really bad and a lactation consultant picks it up and says you're not able to breastfeed because of the tongue tie, they deal with it. Or if a speech pathologist says your child can't make those sounds because he's tongue-tied, they deal with it. But there's a wide range of restricted mobility of the tongue that can come before you ever have any of those kinds of troubles and it does affect the tongue posture. There's research that's being done now by Souresh Zaghi, but it's going to take time to build the evidence body. They showed at Stanford that when you have a tongue tie, there's a correlation with narrow palates, and it kind of makes sense, it's common sense. The tongue is the scaffold of the palate so if it isn't able to posture up against the palate, how is it going to grow wide and up and forward? It's going to tend to be narrow and down and back. While we cannot expect adults who get a tongue tie release to grow differently, we do know that the muscles of the head and neck can be in better balance with good oral posture. I'm not an expert in cranial osteopathy but I'm told that the cranial bone and the balance of how they fit together and move, you know cranial bones move right? [caption id="attachment_12694" align="aligncenter" width="329"] Now I got the loosest tongue in the game...wait....[/caption] Zac: Haha yes I do! Dr. Hockel: Some adults will report some wide-ranging improvements of symptoms and you got to be careful about that. Because they'll tell their story on the internet and somebody else thinks “oh if I go get my tongue-tie release, all my troubles are going to go away.” It is controversial probably because there's such a wide range of techniques in doing it. Back in the day, I got my laser in 1999 and I thought “oh, there's a tongue-tie, I'll just release that tongue-tie with my laser” and it's like getting a lightsaber on Star Wars. There's no bleeding and all of a sudden the tongue can just elevate really easily. Mainly, all I was treating was that flap of tissue on the outside not knowing that there were deeper fibers that of fascia or even the mylohyoid going deeper that needed to be dealt with. Then the scar tissue would come because I wasn't having them do exercises afterward and the scar tissue ends up restricting the tongue down even more than it was before. Doing it the wrong way is oftentimes going to make things worse and not any better at all so the data points that people have to compare to are very limited. The unfortunate thing is we currently lack a body of knowledge out there of training. It's changing slowly because people know improvement when they feel it. You can't put an idea in somebody's head that effectively after I do this all of a sudden you're just going to imagine that you have a tension release in your whole head and neck area. They're going to tell you stuff like that or you see a child who has a tongue tie and you get a certain growth direction improvement. Then don't treat the tongue tie and you see the growth direction tend to drop back, that's kind of the lost opportunity side of it. You want to get everything going in your favor for optimal mouth posture. Facial underdevelopment Zac: Now if you have someone who was breastfed, had a tongue tie release, did myofunctional therapy, addressed nasal patency, do you see a reduced need for orthodontic services down the line? Or do you think that our altered cranial shapes are generational? Dr. Hockel: If I had seen that happen here or there, that's such a small number of patients, it's really anecdotal and there's confirmation bias. I'm not sure how valuable that would be, I do know that I see patients who were breastfed very early on and their parents follow Westin Price. They feed them really well and try to avoid sugar and stuff, they avoid bottles and pacifiers, avoid milk, avoid wheat and they seem to be doing all the right things. Yet there are still issues there so there's so much that we don't understand about it. I feel like we're just at the tip of an iceberg and we're doing our best, we know certain things do affect it and we're trying to change those but we don't know everything. I can sympathize with the mother who says that “I've done all this, what else do I need to do?” Well, sell everything you own, give it to the poor and then maybe… I don't know. Zac: It's hard, especially in health and wellness. You want people to do everything right. They eat healthily, they're sleeping and they're doing all of this, but sometimes there are genetic factors, epigenetic factors, and exposomal factors outside of your control that are the rate-limiting steps. It's unfortunate. But life's not fair either so I get that. Airway orthodontics for children Dr. Hockel: Orthotropics can be used for kids in a particular age range. There's a narrow window because orthotropics is growth guidance, and if you're trying to guide growth you need growth to be able to guide. There are actually a couple of different windows where you can do it but for practical reasons, it tends to be a better fit somewhere in the 7-10 age range. In England, they'll say eight is too late, but in America, we tend to do it at nine or ten as well. The older you get, the less growth there is and the less cooperation there is to be able to do what's required for the treatment. So guiding growth and starting at that age; say seven or eight, you want to look at how the face is growing. You want to look at imaging to see how the airway might be restricted. Although you can't diagnose from imaging, it's a glimpse into what's going on in the nasal airway, the oropharyngeal airway, and tongue posture sometimes. Then you look at obviously orthodontic issues like how the teeth are fitting together, and how the jaws are fitting. If the jaws have not grown as far forward as they should and there's an oral posture issue, those are two things you can consider affecting at that age. Younger than that age, it's harder to make a change with how the jaws are growing with appliances and postural changes, and after age 11 or 12 it's very difficult, so during those middle years is prime time for treatment. I had two boys in my office yesterday morning. Both of their faces were tending to grow more downward and backward than they should, and I always say “welcome to our world.” That's all of us to one degree or another much more so than our ancestors a few hundred years ago. I looked at their imaging, teeth, questionnaires, and my notes from their exam and I thought I think they could really benefit from just simply widening out the dental arches. This would give their tongue and teeth more room. Then releasing the tongue tie could really help oral posture. Then I got their sleep studies. Both boys had overnight sleep studies and had sleep apnea at over 11 events an hour. For a child that's severe. For you and me it'd be 32, 35 or 40 times an hour (normal is less than 5 per hour). When I saw that, the scale was tipped WAY in favor of orthotropics. Meaning it'd be worth the cost, the time, and the hassle if the parents and the patients were candidates for it. Cooperation both by the child and by the family is so much a part of orthotropics. It's not like any other treatments that we do. Lack of family support, discipline, or money are all factors to consider. What I like to do is look at what are the problems; what are this family's capabilities and desires and then what's possible from a technical point of view. How can I put all that together in a way that's going to be a win-win and get a good result? [caption id="attachment_13015" align="alignnone" width="810"] Yeah, let's discuss airway later honey. (Image by Dimitris Vetsikas from Pixabay)[/caption] Had it been a family that came in where the kids were climbing up and down the chairs in the room, they weren't listening to me at all when I talked to them. The mom's on her phone trying to carry on a conversation at the same time talking to the dad who doesn't live with them and is trying to tell him “don't worry, I'll bring them over;” you know just a lot of other challenges in life for a situation like that. Even though I knew it would make a big difference for them, I wouldn't even mention the word orthotropics because it's going to be frustrating and in the end, not a fruitful endeavor. Airway Orthodontics for adults Dr. Hockel: Let's assume there's an airway problem, have sleep-disordered breathing, and don't want to be on a CPAP for the rest of their life. What are the options? Although everyone is different, there are a lot of commonalities. The three general approaches are: CPAP [caption id="attachment_13016" align="alignnone" width="800"] It saves lives, fam! (photo credit: myupchar)[/caption] Dr. Hockel: The first is to push harder on the air going into the airway. That's the CPAP option and usually, there's kind of an x through that option, but for a lot of people, it is a realistic option. If those boys from earlier had severe sleep apnea, I told them “you need to follow the doctor's recommendation.” CPAP is a viable first aid option. Whenever we do growth guidance, changes in the skeletal structure aren't going to have an effect overnight, so just get some good sleep and get healthy in the meantime. Oral appliances Dr. Hockel: Option two would be to open the airway temporarily at night time, and that's effectively what the dental appliances do. When you see dentists or orthodontists talking about how they treat sleep apnea, generally it's because they make appliances like this. There are over 200 different FDA approved designs for the appliances so there are lots of ways to try something and not be happy and then try something else and not be happy. Or you get a good fit, if somebody really knows what they're doing and making these appliances, they look at other things beyond just the appliance itself then they can be effective too. They have their place; everything has advantages and disadvantages and the big advantage of an oral appliance is you don't have to be married to this machine on the bedside table. You're not dependent on electricity, you could bring it with you when you travel a lot easier, it's less bulk in the mouth, it's not as unromantic as having this thing strapped around your head. It's got downsides too and that is it's not really fixing the underlying problem, it's not addressing the structural underlying problem for most people. The other downside is that it's anchoring a lot of force, pulling the lower jaw forward on the upper teeth. So there tends to be a reciprocal effect on the upper jaw of pulling it backward and over time that can allow for changes in the bite, how the teeth fit together or even on the jaws themselves. It may not be the end-all be-all for many years for everyone although there are people who've gone many years and have not had bite changes, but you just don't know if you're going to be that one. It helps with cardiovascular effects with sleep apnea which cpap does not. Zac: Why is that? Dr. Hockel: They don't know. Zac: It is so interesting. Dr. Hockel: It is. Zac: Because they say CPAP will save lives right, but if you're not getting the cardio protective effects... Dr. Hockel: When my dad heard that he said “what should I just give up on my CPAP?” I said, “no dad breathing is important, you need to be able to breathe and without that, you might stop breathing in your sleep.” “You will stop breathing and that's not a good thing,” but it's kind of artificial breathing, forcing the air in and out. And the parts of the brain that control your breathing are like “all, right don't need us anymore” and may become less responsive over time, but I don't understand the physiology of it completely. I know that it's better than not breathing and it does save lives when it works, but the compliance goes way down after six months or so and for a lot of different reasons. Feeling claustrophobic, drying out the airway if it's not humidifying it, restriction of movement in bed just the hassle of wearing it, the feel of it on the face, a lot of reasons why people might not want to wear it. For them, the dental appliance might be a good alternative and it's got the added bonus that it turns out it does help with the cardiovascular effect. Zac: Is it effective in severe sleep apnea? Dr. Hockel: It can be. Medical doctors will often tell you if you're over 30 on your AHI, the score of how severe the sleep apnea is, you should be on a CPAP. But if you're under 30, you can try an appliance. However, my friend Pat McBride has treated more people than I know using appliances like this, including a lot of people with very severe sleep apnea, and she's been very successful at it so I think a lot of it has to do with the skill of the person making the appliance and how they adjust it. It has to do with what else they do in addition to it: do they work on vitamin D levels? Nutrition? Overall body markers? Breathing mode? Are they lip taping? Is the nasal airway clear? There's a lot else that can go into it; the tongue-tie for some people can make a difference, so it can be a part of a good regimen for some people, but then there's that risk of the bite changing. Change the airway structure Dr. Hockel: Option three is to structurally open the airway; do something so that the airway is able to be more open by changing the structure around the airway. Ear nose and throat doctors do the same thing with different types of nasoseptal surgery or reduction of turbinates or any number of things there. But what we do in the dental world is either move teeth to a different position to allow more room for the tongue to come forward out of the way of the airway or work with an oral surgeon who's able to move the jaws themselves into a more optimal position. So in both of those cases, you're trying to change the underlying structure. They have the potential of being a more definitive change to the airway but they're also more involved. Going through orthodontics takes time and going through double jaw surgery, first of all, it has to be done right and a lot of times it isn't as effective as it should be, but even when it's done right it's still an expensive and invasive procedure. Everything has pros and cons. In our world, we ask what can we do to change the shape of the jaws? Either by moving teeth or by moving the bones of the jaws. Zac: I appreciate you listing out those options because I want people to know that if you do have some type of sleep issue. Like I had a guy reach out to me where he's like “I got my CPAP and my numbers are good according to my doctor, I don't need to do anything else,” it's like it depends right? If we're just looking at pure symptom management you're probably okay but if you want to fix the underlying structural issues maybe we do need to go down a different pathway. Using oral appliances and orthodontics to improve the airway Zac: So there are some people who would argue that they're creating bone growth with some appliances versus you're saying moving teeth. What is the underlying physiological way that an appliance like I have (Crozat) works and what is likely not happening? Dr. Hockel: It's a good question and it's a hard one that I don't have a fully comprehensive answer to, but I'll tell you what my thinking is on it today. Bill Hang calls it the alphabet soup appliances; we've got the AGGA, DNA, ALF, and all these different types of appliances that are out there. Zac: And they're all three or four letters, just like in our industry! Dr. Hockel: Right, yeah pretty much yeah so but like you say claims are being made about the growth of the jaws and I'm skeptical of that in the way they make it sound. When you move teeth, you don't just move teeth, you move the teeth and you move the bone around the teeth. Technically, that alveolar bone is part of the upper jaw and the lower jaw. So yes you're expanding the jaw by moving the teeth, but you're not really expanding the jaw when you think about the basal bone, the roof of the mouth, the hard palate. In a child, you can much more dramatically change the shapes of the jaws. You can apply to pull forward force with something that touches the chin and the forehead and rubber bands come forward out of the mouth and attach to that reverse pull headgear. Not like the old headgear that pulled things backward but a reverse pull headgear at the right age can bring the whole upper jaw forward; that's moving the base of the jaw. I think the bottom line is most of the time for adults; it's not a huge order of magnitude in terms of the growth changes. Now you're going the right direction if you keep your tongue on your palate, you push it up there and help your oral posture. Maybe you're going to slow the worsening of it. You're going the right direction if you expand both side to side and somewhat forward with any appliance; I mean to a certain degree if someone can get it done with an appliance that's different from the one I use then great. I think as practitioners we get better with specific appliances by using them a lot. We learn the idiosyncrasies of them and it probably makes sense for practitioners to stick with tools that they are proficient with. But on the other hand, I think there are some tools out there that don't accomplish the same thing even though a lot of times the people who use those appliances are talking about them accomplishing the same thing. For example, I'm asked a lot of the time what about the ALF appliance? Derrick Nordstrom developed this appliance from the Crozat, which was a lightwire appliance, just not as light of a wire as the ALF. He wanted to develop an appliance that was cranial compatible because he was looking at what was happening with the movement of the head bones. He found that with certain adjustments of the wires in the mouth, he could help the mouth posture and encourage the mouth posture to help develop the jaws themselves. It's a way of letting the body's healing potential come out on its own to help the body do the healing from within. As a pure mechanical tooth moving device, it's probably not as efficient. I know it's not as efficient as other appliances would be, but it's not really fair to compare the two. Because the objectives that a good ALF practitioner is going to have are cranial stability and health; likely working together with an osteopath. They're doing very different things than somebody like I am is doing. I'm trying to accomplish larger-scale changes in either lateral arch development or forward arch development by advancing front teeth. As for something like the anterior growth guidance appliance (AGGA), the claim is that it's stimulating the growth center of the premaxilla, that with that pressure behind the upper front of the jaw there that now the maxilla is going to grow further forward. I have yet to see either case, research or x-rays, where that kind of growth could be anything more than dental alveolar changes. A dental alveolar, meaning the teeth and the bone around them moving, and I think they're going in the right direction. I love to see the changes in advancing the front teeth with those kinds of appliances, but my question is what do you do after that? What about the side-to-side expansion? What about the lower jaw position? There's more to it than just bringing the upper front teeth forward. I think that's a good direction to go in. Do I think it's something that's happening with the epigenetic change now and activating the bone growth genes to grow? I don't know enough to say that it's not; I'll just say that I haven't seen the cases that have shown me the kind of bone growth that is making that kind of a claim. It's a very different order of magnitude of change compared to what you would do with orthognathic surgery, where you may be going forward 18 millimeters and able to change the whole plane of the occlusion at the same time. The ALF crowd would say, “but that's completely destroying the cranial mechanism,” now the bones are frozen and unable to move as they should. I'm not going to say that they're wrong about that. I don't know enough to say when they are and when they aren't, the osteopaths I know will say, “Yeah they shut down for a period of time, but they work their way back to normal. There's this inherent healing potential the body has and that it's worth it to be able to get the kinds of changes in the structural airway that you would get. However, picking the appliance you want to use for yourself is like telling your contractor he should use a Craftsman hammer. What do you know about the appliances? The consumer really is in a worse position than we are as professionals. We're going to lectures and hearing pro other experts talk about these things, it's confusing for us to try to piece together what's really going on. So for the consumer to be able to do that same thing and say, “well based on what this person said I want their results, so I want you to use this particular Craftsman hammer.” On the other hand, the consumer could say, “well to me the osteopathic angle is the highest priority and I want to work with an osteopath,” and so in the hands of that practitioner, the ALF appliance might be the best thing to achieve those goals. Zac: It's just funny because we have the same issue in the movement industry. You have these people who are in these different camps and systems, all three or four letters. But the tools themselves are irrelevant, it just depends on what you're objectively trying to achieve. I actually really like how you broke it up into different camps because this was one thing that I wanted to talk to you about a little bit. You have Alf, which is more cranial osteoporosis driven, you have the Crozat which I have in right now, which is more airway focused? Dr. Hockel: Well no, the Crozat started out as something that osteopaths like to do. In my dad's book, Orthopedic Gnathology, is the best textbook out there on the Crozat. The idea was that it was developing the potential that was there and the growth, both for the kids and for the adults and they knew there was an effect on the airway, not to the degree we know it now. There's a whole chapter in that book on cranial osteopathy and the pictures that are in that book are used in almost every cranial osteopathic lecture that I've gone to because they're well done. So the thinking by the osteopaths with Crozats was that they were also very cranial compatible. I'm not one to say how to compare Crozats versus the ALFS, but I know Derek Nordstrom's position as the very light biomimetic forces seem to be more cranial compatible. The Crozats to me having a larger body wire on them are more effective at getting transverse arch development, especially in the back in a more defined time period. An ALF practitioner will often go much longer periods of time than we would be comfortable in the orthodontic world wanting to have someone commit to. The objectives of the end of the treatment aren't what are focused on; it's more the journey along the way. Let's do the tweaking we need to do now, see if that's getting you going in the right direction and then nine years later maybe we're still doing the same tweaking and your bite is nowhere near fitting together. We've been looking at the symptoms and the cranial situation, it can go in a direction like that and maybe it's helping people, I'm not going to say it's not; it's just not what I do. I can't comment on it, except to say that I want to have a more defined period of time to accomplish certain objectives and in my world, I can do that. The Crozat is a common tool that I'll use, the sagittal designed by Bill Hang has been a very effective tool, as well as different kinds of other expansion screw appliances. They're different approaches depending on what you want to do and it's really hard to say, “I want this appliance.” The most important thing would be to say what it is you want as a result of your treatment? People say, “Well can you use the ALF appliance to do what you want to do with that particular appliance?” I'll say, “yeah I could use my kids watercolor brush to paint that whole wall over there too,” it's not the most efficient way to do it, give me a roller and I'll just go like that and there it's painted. I think certain things can be done in other people's hands if that's the way they choose to do it. How to seek better dental care Dr. Hockel: That's a really hard question because what job do they want to have done? What's their goal? I think if I could rephrase your question it might be “how could I help people know whether they're seeing a practitioner?” Who's going to do things that are not going in the wrong direction for the airway and sometimes for the jaw joint? Better yet, that they're going to be focused on ways that they can help improve the airway and there are other people around the country and around the world that focus on this and we all have our different approaches, but that's okay! I think asking questions like: “If you have a child and the front teeth seem to be a little bit ahead of the upper than they are on the lower, what would be your favorite way to try to correct that kind of a bite problem?” I can tell you that almost all the time the solution is going to be some type of mechanics that's going to end up pulling the uppers backward to a certain degree. We'll conceptualize in our mind that the appliance we're using is bringing the whole lower jaw forward, but that's a really hard thing to do. So dentists end up using things to pull teeth back. Back in the old days, it was headgear, now it might be the Herbst, the twin block, or the Carrier appliance, it could be the Invisalign with attachments on the side that brings the lower jaw forward. It could be class two elastics rubber bands going from the top to the bottom. There are all kinds of things: twin force bite correctors, jasper jumper. They've invented all these different things because it's the most common malocclusion, the class 2 malocclusion. [caption id="attachment_12200" align="alignnone" width="472"] #overrated (Photo credit: Rjmedink)[/caption] I won't say it's where the lower is too far back and I won't say where the upper is too far forward. I'll say where both jaws are too far back, but the lower is further too far back than the upper. So to do something that's going to pull it back even more is going further in the wrong direction, and it's not following the best principle which is do no harm. So if you found an orthodontist that had a way of leaving those upper front teeth where they were, not pulling them back and consciously trying to hold them where they are and do something to compensate for it with the lower, you have somebody who is really on the right track. For an adult when there's a big discrepancy between the upper and lower like that there really aren't a lot of things that they can do. I have a patient who went to a local department head of orthodontics in the local dental school because her dentist had told her before he did porcelain veneers that she really should just get her bite fixed, which was a class II malocclusion. They recommended that she take out two teeth on the upper and just pull the upper front teeth back to match the lower teeth, a very common way of fixing it that's been done for many years for many people around the world. It's considered the standard of care in many ways, but she felt that everything went downhill for after that: diabetes, hair falling out, she got atrial fib and more. She remembers having dreams while her front teeth were being pulled back of choking. So she thought that this is probably affecting my airway health, my sleep, and my breathing. This is all on her own, from her own research, and she told her doctor, “you need to do a sleep study for me,” it turned out she had sleep apnea. Then she was recommended to have laser surgery from the back of her tongue to reduce the size of her tongue. They recommended double jaw surgery to bring the jaws forward; of course, there was CPAP, which she wasn't able to tolerate. She attributes all of this to pulling the upper teeth backward. Reversing that for her opening up that space again and eliminated the sleep apnea! Her hair didn't grow back, but she felt overall so much better and people report little things that they notice along the way when you reverse that kind of extraction orthodontics. Our experience of patients reporting what negative things they went through, the extraction retraction, regret syndrome stuff, in her case it was functional, but it became emotional and aesthetic too. She didn't like how her face looked with those teeth further back. People generally look better when you bring the teeth forward. Their lips look fuller; they aren't sunken behind a line between their nose and their chin. She's a good example of an overjet problem. When people have this they have an overjet problem, but they call it overbite. Zac: Just so people have that definition and I know this is not correct. It's when the top part the top teeth appear to be further forward than the bottom teeth even though from a facial structure standpoint that's not the case, versus an underjet, commonly misnamed an underbite would be the reverse of that where the lower teeth appear further forward than the upper teeth even though both are back. [caption id="attachment_13017" align="aligncenter" width="255"] Overjet is front to back, overbite is top down (chrome spinnin') (photo credit: Nielson2000)[/caption] Dr. Hockel: Yeah exactly, even though both are back that's the key, you see people with these really big chins, they're probably too far back. Zac: Like Jay Leno? Dr. Hockel: Like Jay Leno, his chin is actually not too far forward, if you put an outline on his face and make a comparison to the ideal. You'd see that it's really mainly the upper jaw that needs to be more forward and his lower if anything is slightly back. [caption id="attachment_13018" align="aligncenter" width="272"] HE HAS AN UNDERDEVELOPED JAW?!?!?!?! (photo credit: Wikimedia Commons)[/caption] Zac: Gosh could you imagine if he worked with you, he would have the most prominent chin. Dr. Hockel: No he'd have a balanced face because we get the whole midface further forward. He probably has sleep apnea as a result because his tongue must have nowhere to go. You see in his smile, it's a very narrow upper arch. Poor celebrities getting diagnosed by us dentists all the time on TV. Another thing to ask a practitioner is: Do they think that there are times when it's worth taking teeth out and pulling front teeth backward? Are there cases they think that can be helpful for? If they say yes, I would probably just go somewhere else because if it's okay for an exception it's probably okay as a general rule. I'll tell you, the last time I took a tooth out and pulled things back it was when somebody had five lower incisors. Zac: Normally there are four. Dr. Hockel: There are four, so taking one out and pulling them together now we're just right back to where a normal set of teeth would be. Although there's a case to be made for leaving that tooth in there, allowing the lower arch to be that much bigger and then just making the upper fit bigger over the top of it. That would be a question to ask you: How do they know if there's an airway problem? If your medical doctor has told you have sleep apnea then I know you have an airway problem and you might want to ask: Is sleep apnea the only kind of breathing disorder that you address? What are the ways that you address it? If they say yes, that's the main kind of disorder we treat and we treat it using appliances that bring your lower jaw forward. Well on the diagnostic side, if sleep apnea is the main thing that's being treated they might be missing something that's even more prevalent than sleep apnea and that's upper airway resistance. It's a whole side to sleep breathing disorders that get missed for kids, for thin, fit adults; people like you or women especially. It isn't always apneas, although the sleep medical doctor I was talking to yesterday was telling me if you score the sleep study the right way you'll see the apnea is there. It's just not things that would be traditionally called an apnea, so finding upper airway resistance as a potential confounding factor of these patients who have problems is important. I think for the dental practitioner either working with a medical doctor who knows what they're doing with this or maybe helping the patient get the sleep study yourself. Another important question to ask would be: If they are finding the upper airway resistance, then what are the ways that you try to treat it? Are they doing expansion arch development, getting the tongue more room, and working with a myofunctional therapist, in either their office or somewhere else to try to optimize the oral posture? If that's not a part of what they do to try to treat it then they're probably not as deep into this rabbit hole as they should be, because that's at the outer rim of the rabbit hole. That's the basics: create more room for the tongue however you're going to do it, don't close spaces generalized. You could ask them: If my child has a lot of gaps between his teeth, how would you tend to treat that? And whether you do it with Invisalign or braces or whatever to take spacing between teeth and close all that spacing up? You're talking about a friend who had a bunch of missing teeth, when people have missing teeth the jaws don't develop to the size they should. If you just close all the spacing where there were teeth missing the tongue is going to have much less room to fit into, it's going to go back toward the airway and there's going to be a risk for sleep apnea, so that's another combo. Zac: The big things are you want are: Moving teeth forward and outward Prioritizes expansion Appreciation of sleep disorders Focus on attaining palatal tongue posture and adequate lip posture Utilizes myofunctional therapy Dr. Hockel: Yeah it's the tongue posture and the lip posture: lips together at rest all the time breathing through the nose and the teeth either together or in near contact. so lips together, teeth together, and tongue to the roof of the mouth; those are the three things posturally that a good myofunctional therapist is going to work towards. Keeping Our Wisdom Teeth Zac: Now I want to talk a little bit about getting teeth pulled, the ones that I'm going to bring up of course are the ones that are old remnants from caveman days, wisdom teeth. I was recommended by a practitioner to get mine pulled out, I didn't get them pulled out when I was 18, I actually pulled them out in my late 20s. The reason why I got mine pulled out was because I had no lateral jaw movement. Are there instances in which you should have wisdom teeth pulled out? Dr. Hockel: In the ideal world we would not have to take wisdom teeth out. In the ideal world, our jaws would be further forward and we would all look way better than we look now. In the ideal world, our airways would be massively open, we'd be breathing through our nose, and our muscles would be much stronger to support that. We're not in an ideal world, so taking wisdom teeth out now it's not the best way to go, and our hope in developing more forward growth of the jaws is that there would be room for them, but sometimes there just isn't room for them. Sometimes they're at crazy angles and you really don't have much of a choice. I don't tend to focus too much on the wisdom tooth issue. As much as I'd like everyone to have 32 teeth in position with the way they should, once the growth is done (age 12-14), there's not as much that can be done to make a difference in how much room they have or whether they come in. In my family, my dad tended to have us just keep them in our mouth and he didn't want to take the wisdom teeth out. So I still have all four of mine, I've got all 32 teeth and occlusion, but it's still somewhat tight on space back there. I think it's the case that when you leave them in you tend to get more growth of the jaw. I can't prove this and I don't know if there's research to show this. I've had a lot of kids where they'll come in and maybe the general dentist has said take the wisdom teeth out I'm looking at them thinking, “you know what there might be room. You're only 18, go another seven years let's see how you grow.” I think that there's more and better jaw growth as a result of those wisdom teeth being there. We know that people like your friend with missing teeth get less jaw growth; why wouldn't having extra teeth back there help encourage more jaw growth? At the same time, as an adult, if you're wisdom teeth are sideways pointing forward, now it's a liability for the bone integrity around the back of that molar in front of it better not to take that chance. I know that there's a discussion of meridians attached to different teeth and I'm not an expert in that. People might tell you if you lose that tooth that's going to affect some other part of the body, that may be true, but I'm just not sure what the best compromise is. I'd rather not lose that second molar in front of it by having more bone loss there, and I'd rather just lose the wisdom tooth. Zac: Yeah because I think in my case, mine were pointing straight forward at least on the lowers. Dr. Hockel: There probably was nothing that could be done to try to straighten them yeah and even if you went and did heroic orthodontics to try to move them up then where are they going to go? There's no space back there. Occlusion Zac: When I was first getting exposed to this even being a thing because in PT school, we never talked about when you need to refer to sleep apnea or how teeth influence things or anything. My anatomy is still lackluster up here; what is occlusion? Is it from your perspective an important thing that we need to consider? I know that they make appliances to alter occlusion, if you could just give a little overview of that I think that would be amazing. Dr. Hockel: Sure, that's kind of where I started, I was a senior in high school and my dad said “I bet you could earn more making teeth than you could slicing salami at the deli where you're working, why don't you give it a try?” I was like sure, I don't know what it really involves but that was my start in dentistry. I was working as a dental technician doing full mouth reconstruction. We call it wax up where you create and wax how the teeth should fit together, upper and lower, and it's a very precise scheme of how the teeth should fit. Gnathology was where I came from and people who are in dentistry would know they're kind of different camps of different types of occlusions and gnathology is the one that really raised the bar for how teeth should fit together. There were certain principles you always tried to follow with it, and as a dental technician and as an early years in practice as a dentist, I focused a lot on the occlusion of my patients and trying to get the bite right. Gnathology means trying to get the bite right, but it turns out that some of the things we do to try to get the bite to fit right can work against the bigger picture. So I'm not against looking at how the occlusion fits and trying to be as precise with it as you can, but that's a tree. And if you don't see the forest, then you're way down a side path that's going to be very distracting. We'd always try to get the canines to touch each other to guide the jaw as it moves side to side. It's called canine guidance, and the thinking is that there's enough leverage this far forward in the jaw to separate the back teeth as the muscles are chewing side to side. It's got leverage against the muscles way back here if the molars right next to the muscles that are chewing are the ones that are mainly hitting when you go side to side, it's much stronger bite forces and it's a risk for wear or for the fracturing of the teeth. The idea was the front teeth protect the back teeth and the back teeth protect the front teeth; when you close, the back teeth should touch stopping the closing motion of the jaw. When you move side to side, the front teeth should touch so that you can bite through things and so that you separate the back teeth in those other positions. All this works great if you have jaws in a face that's in the right position so that now the joint is in a favorable condition and the airway is in a favorable condition. If you have jaws that are somewhat too far back, take the case of my patient who had the bicuspids extracted and the front teeth pulled back. They did that partly because it looks better but mostly because we're just taught that's how teeth should fit together; the front teeth should fit with overbite and overjet. Also close contact or maybe slightly away so that they can slide against each other to separate the back teeth during the chewing movements. The problem is her jaws were already too far back and by pulling front teeth backward to meet against the lowers for the sake of what we disclusion, the best functioning of the teeth against each other. It can be making things worse for the airway, it can also be making things worse for the jaw joint when front teeth are brought back so that you have that contact which in the gnathological occlusal philosophy you want to have. Then it can tend to cramp the style of the joint, the whole lower jaw can be held in a position that's too far back. That was one of the things in the early years of learning about the airway is how do I mix this with my occlusion...I won't say beliefs, but it's almost like beliefs. There's no research to show that this kind of occlusion is better than that kind of occlusion. Even class one, ever since Edward Angle the father of modern orthodontics came up with his ways of putting a bite together and one of them is the molars need to fit like this what we call class one. There's no research to show that that's any better functionally or any other way than any other kind of occlusion. So yeah I had to balance how do I mix gnathology with the airway, and I think that you always put the airway first. Michael Gelb has termed this ‘airway centric;' instead of having a centric relation which is what his dad and my dad and I would all be worried about. How do you make the teeth fit together when the jaws are in their center position? That would be the best connection of the two. The tooth home is the same as the bone home and they just work in coordination with each other. Well, maybe the bone home is pathologic, maybe there's something about that bone home that isn't right. Because maybe the lower jaw and maybe the upper jaw belongs further forward for the sake of the airway or for the sake of the function of the joint if the little disc gets displaced, then the lower jaw might need to be further forward. If we do things with the bite, the occlusion, that works against that, the results are never going to be what they should be. Another philosophy of occlusion might be to go to where the muscles in there are in their most relaxed or harmonious state and make the teeth fit there. Here again, in any philosophy of occlusion, if you're not looking at the airway function, you might be going down the wrong path. Zac: It's funny you mentioned Michael Gelb because that was the first appliance that I was exposed to. I wore it because we were trying to improve my jaw motion, and I definitely got some interesting changes within my body. Dr. Hockel: His dad Harold Gelb is the one who developed the appliance. It allows the bite to open and it allows you a lot of times to bring the lower jaw forward a little bit, which can decompress the joints. It can be good for a TMJ appliance and without knowing it, it was sometimes also helping the airway. Zac: Yeah, but it's also doing so without necessarily affecting the airway dimensions or the health of the airway, whereas it may be affecting other areas like you said the TMJ. Dr. Hockel: There are some people that when you put a thickness between the teeth, the lower jaw rotates as the lower jaw opens, it goes backward. There are some people that put a thickness between their teeth like that and it can make the airway worse, it'll make them grind their teeth even more so it isn't the same for everyone. Zac: Interesting, because they definitely said it would be bringing my jaw down and forward. An analogy in my domain is shoe orthotics. Sometimes, shoewear is something that we can use to influence someone's movement versus not. I've had people where we've put them in really supportive shoes and have a completely undesirable outcome from a movement perspective versus someone having those same shoes doing very well. It's just funny how you kind of have the same thing. Dr. Hockel: We call them the same thing; you call it an orthotic, we call it an orthotic. Dental pathology. Zac: There are a lot of other pathological processes that some people may be dealing with. Like people who have gum recession or crowns or veneers; I don't know much about this. Sometimes I'm sure that my clients and people are getting exposed to these things, how does that influence and play a role in the airway health? Tooth implants Dr. Hockel: Well you didn't mention implants. If somebody's thinking about getting an implant, but they also think they may have bite or jaw position or airway problems, they've got to be analyzed and diagnosed really completely first from the big picture before putting in an implant. Because once an implant's in, it's not going to move ever; it's just going to stay right where it is. I've had patients where I've had to do a lot of expansion of the arches and just leave the implant where it was. So in the end, the implants are like way over here toward the inside and sometimes you can work with it and just kind of warp a tooth out to where everything else is and leave it. But I've had other people where the implant has to be taken out and then put back in or another crazy way I've done it before is to have an oral surgeon just create corticotomies. Cut around the bone where the implant is and then I'll make an appliance so that after I've expanded everything else, he just cuts the bone around that section where the implant's sitting and then moves it out into the position where it belongs. Then we just let the bone heal there. Don't do an implant until you know where it's going to need to end up. I saw someone yesterday that's going to need one for an upper front tooth and their front teeth may need to be in a different position. I'd rather catch them now and say just don't do anything until it's in the right place. Gum recession Recession is the gums moving down the root of the tooth exposing some of the roots, and it's generally a function of some bone loss around the tooth as well. It's not a good thing, but you don't look at any gravestone and see recession as a cause of death, it's usually not even a cause of death of an individual tooth even when there's a lot of recession. It's the bone between the teeth that tends to hold the teeth in really well so it's not a crazy bad thing if somebody does have some recession. Having said that, you'd rather not have recession. So we look now at ways of expanding the upper jaw for example, that the base of the upper jaw will expand skeletally so that the teeth don't have to be moved in a way that might risk recession. Of course, there are procedures the periodontists can do to help minimize it or add bone back to those areas, different kinds of bone grafting procedures. It's sometimes a necessary evil. But it's often a sign that something's going wrong functionally with the tongue and the tongue space. You'll see people whose teeth don't even meet together in the front and they have recession. It's not from heavy bite forces or clenching or grinding on the teeth that caused it which is one cause of recession; it's like if you take a fence post and shakes it, the dirt kind of moves away and you're going to lose the support down where it's coming out of the ground. If the bite is putting forces on the teeth up where it comes out of the ground at the gum line, the bone may be getting lost and the gums may be receding. That would be like shaking the fence post but in the analogy another thing that happens you get a cow that comes up to the fence post and just leans against it all day long. That can also make it come loose and lose the support down below. That's the tongue on the inside without enough room putting constant force against teeth either forward toward the front teeth, sideways toward the back teeth and sometimes recession is the tongue's fault and the tongue just not having enough room. We've been talking about the airway and when you don't have enough room for the tongue, you often want to make more room for the tongue so that the airway can be healthy. But making more room for the tongue might be important to try to prevent further recession when there's already been recession. Zac: Have you ever seen a case where you improve tongue positioning and you give the tongue enough shape where you've had a positive change in gum recession? Because I think with Wolf's law you might be able to get some bony adaptation. Dr. Hockel: No I can't. What I have seen is sometimes if there's a little recession in the front and you bring front teeth forward, it just from the way that it's moving through the tissue, the recession seems to look a little bit better. Other times the recession just follows it along; I don't know if there's really a pattern to when you're going to keep it or see it get worse. For some people it will get a little worse, it's a risk of any orthodontics you could have some recession, but grafting is a possibility and trying to do things that avoid that. Moving slowly, lighter forces, and getting the tongue in balance too; get the tongue enough room so it's not going to be putting pressure on the teeth as well. Crowns and veneers Dr. Hockel: Those are the world of restorative dentistry and
Do you know the most important nutrient you need for healthy teeth and a healthy body? When you hear ‘nutrient’, you probably don’t consider oxygen, however, oxygen is by far our body’s most precious commodity—you simply can’t live without it. Yet, many of us do live without enough of it, and that’s due to our breathing habits and whether we breathe through our nose or mouth. In this mini-episode, Dhru speaks with Dr. Steven Lin and Dr. Mark Burhenne about how mouth breathing reduces the quality of our sleep, disrupts the balance of our oral microbiome, and makes you more prone to tooth decay. They discuss sleep apnea and upper airway resistance syndrome (UARS), and how it impacts our brain health. They also talk about the benefits of mouth taping for improved sleep and overall health. Dr. Steven Lin is a world leading functional dentist, TEDx speaker, and author of the best-selling book, The Dental Diet. As a passionate preventative, whole health-advocate, Dr. Lin focuses on the understanding of dental disease through nutritional principles. His work has highlighted that crooked teeth and the orthodontia epidemic are diet based problems, and the need for public health policy to prevent braces in the next generation of children. Dr. Lin’s work has reached millions of viewers worldwide being published in Esquire Magazine, Women’s Health, The Sydney Morning Herald, and is a regular contributor and expert at MindBodyGreen and VeryWell.Dr. Mark Burhenne has been practicing dentistry in the greater San Francisco area for over 30 years. Dr. Burhenne is passionate about helping people understand the connection between oral and overall health. He is a TEDx speaker, and the author of the best-selling book, The 8-Hour Sleep Paradox. His advice regularly appears on media outlets like CNN, CBS, Yahoo! Health, The Huffington Post, Prevention, The Washington Post, and Men’s Health. He received his degree from the Dugoni School of Dentistry in San Francisco, and is a member of the American Academy of Dental Sleep Medicine (AADSM), Academy of General Dentistry, American Academy for Oral Systemic Health (AAOSH), and Dental Board of California. Find Dhru’s full-length conversation with Dr. Steven Lin here: https://broken-brain.lnk.to/DrStevenLin/Find Dhru’s full-length conversation with Dr. Mark Burhenne here: https://broken-brain.lnk.to/DrMarkBurhenne/For more on Dhru Purohit, be sure to follow him on Instagram @dhrupurohit, on Facebook @dhruxpurohit, on Twitter @dhrupurohit, and on YouTube @dhrupurohit. You can also text Dhru at (302) 200-5643 or click here https://my.community.com/dhrupurohit.Interested in joining Dhru’s Broken Brain Podcast Facebook Community? Submit your request to join here: https://www.facebook.com/groups/2819627591487473/.This episode is brought to you by the Pegan Shake.How you start your morning sets the tone for the day. I’m a huge fan of morning routines, because I think they can transform your ability to focus, sleep well, and get the most out of your day, especially in this busy, modern world. What I’ve found is that the best way to begin your day is to feed your body the right information or the right nutrients. That’s why Dr. Mark Hyman and I created the Pegan Shake. It’s a nutritionally packed morning blend designed to support healthy blood sugar, energy, and brain power. It contains some of my most favorite brain boosting foods like MCT and avocado. It also features acacia fiber for healthy gut function and collagen, pumpkin, and pea protein to support muscle synthesis. Check it out at getfarmacy.com/peganshake. See acast.com/privacy for privacy and opt-out information.
Please join me as I welcome Mr. James Nestor, author of the New York Times, Wall Street Journal, and LA Times best-selling book, Breath: The New Science of a Lost Art. He will reveal the following: How and why did you write this book? How did you end up volunteering for a Stanford experiment to plug your nose for a few days? How do you deal with doctors and other patients that don't see poor breathing as a serious problem, especially if you're younger or thin? What's the one thing that you've implemented after writing this book? What are some tips for our listeners to improve their breathing and well-being? And much, much more.
You probably know her as “Sleep Coach Beth”, from either her https://amzn.to/32rOdC3 (Calm And Cozy Book of Sleep), the https://pod.link/1344335365 (Calm And Cozy Podcast), or her career as a sleep coach. Beth Wyatt has a Facebook group, too, where people with sleep challenges look to their coach and to each other. This week's episode of The Snooze Button podcast is a long one – and it has to be! The Coach – Sleep Coach Beth Wyatt We talk with Beth about what a sleep coach does when sleep doesn't show up. In addition, we cover meditation, the importance of comfort in sleep, and.. uh.. drawing faces on sleeping people, too. Her new book is less than two months old, and we're excited to pick Beth's brain about a variety of sleep concerns. The Expert – Dr. Atul Malhotra We're also answering a listener email this week from Aimy in the UK, who was looking for an expert's perspective on upper airway resistance syndrome (UARS), with some very specific questions that needed answers. We reached out to arguably the world's leading expert on sleep-disordered breathing, Dr. Atul Malhotra from the UC San Diego School of Medicine. Dr. Malhotra is board certified in pulmonary disease, sleep medicine and critical care medicine. (Fun sidebar: Did you know we have a panel of sleep experts who will answer your questions about a variety of sleep issues? And if you come up with something that isn't in our team's wheelhouse, we'll find an expert who can answer your question. Click here for more details.) The President – Dr. Michael Grandner And finally, we're excited to again welcome Dr. Michael Grandner from the University of Arizona. Michael, newly-minted President-Elect of the Society of Behavioral Sleep Medicine, keeps an eye on sleep research like nobody we know. He's been on the show multiple times to keep us updated. This week, he offers perspective on sleep staging that has changed the way we think about sleep.
In today's episode you'll hear from Dr. Stephanie Green, a family medicine specialist in Long Beach, CA Dr. Green has been practicing medicine for nearly 20 years, but in the past decade her practice has increasingly embraced sleep studies as she's seen the incredible impact that getting the right kind of sleep has had on her patients. You'll hear Dr. Green talk about how disturbed sleep can result in low oxygen levels and put you at an increased risk of breast cancer, heart disease, anxiety, depression and other health issues. You'll learn about sleeping patterns, sleep hygiene and you'll hear real life stories of her patients who have experienced life changing results just by treating their sleep. Dr. Green's interest in sleep and sleeping disorders started when her father was forced to complete a sleep study prior to surgery. Shocked that her father, a retired physician, had no idea nor recognized the symptoms of his own severe case of sleep apnea she began to research this area with Sleep specialists. The results have been so astounding that I couldn't stop listening to her. She has so much good information to share that this podcast became a two part series. In part one you'll learn: -What sleep apnea and UARS are -Who is really susceptible to sleep disorders...it's not you dad's syndrome any more -What a natural circadian rhythm is -How to practice proper sleep hygiene
In this episode, Kathy and I will discuss a very intimate topic: your sleep position. Over the years, I've seen a wide variety of explanations for why certain people like to sleep in certain positions, and even personality type differences. In this podcast, you will discover: Which sleep position is most healthy for you The one bad advice dermatologists are telling women Why hospitals can be dangerous for you or your loved one And much more. Show Notes Sleep Interrupted: A physician reveals the #1 reason why so many of us are sick and tired JAMA article on pregnant women and sleep position and babies born small for gestational age Positional sleep apnea article Sleep Position book Drug induced sleep endoscopy results in AHI < 5 CPAP increases fetal movement in women with pre-eclampsia UARS article in Bottom Line Health SlumberBump sleep positioner Antisnoreshirt Somnibel sleep positioner Night Shift sleep positioner Contour pillow for snoring
In this episode, we're going to explain why even if you think you sleep great, you're not. If you sleep like a log or can sleep anywhere, any time, this discussion is for you. We'll be talking about the hypersomnias—when people tend to sleep too much or too long. We'll be revealing the following: Why you can sleep 9 hours or more and will feel tired How you can stop breathing 25 times every hour and not have sleep apnea Which doctor to see if you suffer from this condition And much more..... Show Notes Sleep Interrupted: A physician reveals the #1 reason why so many of us are sick and tired Upper airway resistance syndrome interview with Dr. Guilleminault Insomnia as risk for future cancer U-shaped curve for ideal sleep length Sleep endoscopy findings in symptomatic patients with AHI < 5 Two things that go flop in the night blog post Shift work and cancer Sleep journal Sleep tracking apps and devices Narcolepsy vs. hypersomnias doctorstevenpark.com/hypersomnia Breathe Better Sleep Better Live Better Podcast on iTunes
In this episode, Kathy and I are going to be talking about another controversial topic that many of you have probably had some experience with at one time or another...and that’s the issue of sleeping pills and OTC sleep aids. In particular, we will be discussing: Why sleeping pills are usually the wrong way of treating insomnia Why insomnia may not really be insomnia How to wean yourself off sleeping pills A non-prescription therapy that's better than sleeping pills in the long run. Show Notes: Sleep aid market increasing Podcast: How to sleep better without medications Podcast: How medications are harming you Risk of complications for sleeping pills Sleep aids and risk of Parkinson's Sleep-eating Insomnia increases risk of dying Insomnia as a harbinger of mental illness Insomnia and future risk of heart disease Insomnia and increased risk of dementia Hip fractures with Ambien Sleeping pill vs. CBT-i study 3 Ps of insomnia Krakow’s OSA in treatment resistant insomnia study Dr. Krakow’s podcast on OSA and Insomnia Dreams about choking while sleeping Sleep endoscopy in AHI < 5 study UARS paper - Guilleminault SLEEPINESS 10 steps Podcast 65: How to sleep better without medications 3 Rs: Sleep restriction, reconditioning and relaxation Neck stretching exercises Two floppy valves videos Online CBT-i programs
This week, I’m thrilled to play an encore of the interview I had in 2013 with one of the greatest sleep physicians of our time, Dr. Christian Guilleminault from Stanford University. He first described upper airway resistance syndrome (UARS) in 1993. Along with Dr. Dement, he co-coined the term, OSAS. Sadly, he recently passed as at the age of 80. This episode is a tribute to his incredible contributions and legacy to the sleep community. Shownotes Original 1993 UARS paper
How many times have you chalked up weight gain, brain fog, and feeling tired to getting older? The many symptoms we assume to be a natural part of the aging process are far too often related to one single pillar of health: sleep. In fact, 22 million Americans suffer from sleep apnea, yet most people who have it never get diagnosed. On today’s Broken Brain Podcast, our host, Dhru, talks to Dr. Mark Burhenne, a practicing sleep medicine dentist in Sunnyvale, California. He received his degree from the Dugoni School of Dentistry in San Francisco and is a member of the American Academy of Dental Sleep Medicine, Academy of General Dentistry, American Academy for Oral Systemic Health, and the Dental Board of California. Dr. Burhenne is passionate about helping people understand the connection between oral and overall health. He spends a lot of time educating patients and readers about the importance of healthy sleep, and is the author of the #1 bestseller, The 8-Hour Sleep Paradox. In this episode, Dhru and Dr. Burhenne dive deep into the topic of sleep apnea and upper airway resistance syndrome (UARS). They discuss who is at risk for sleep apnea, how to identify the underlying cause, and the long-term health risks associated with sleep apnea. They talk about the difference between mouth breathing and nose breathing, and how mouth breathing reduces the quality of your sleep, disrupts the balance of your oral microbiome, and makes your more prone to tooth decay. They also get into the benefits of mouth taping for improved sleep and overall health. In this episode, we dive into:-The connection between oral health and systemic health (5:55)-The risk factors for sleep apnea (9:24)-Sleep apnea and brain health (18:15)-The connection between mood disorders, TMJ, and sleep apnea (20:42)-How sleep apnea can cause anxiety (21:55)-Mouth breathing vs. nose breathing (25:19)-How mouth taping can improve sleep and overall health (30:32)-Why mouth breathing is the #1 cause of cavities (40:52)-The connection between gum disease and autoimmune conditions (1:04:21)-Why we should avoid fluoride (1:10:10)-Dr. Burhenne’s toothpaste recommendations (1:17:05)-Mouthwash and the root cause of bad breath (1:18:42)-Dr. Burhenne’s three step plan for improving sleep and overall health (1:23:11) -Learn more about Dr. Burhenne and his work (1:42:23)For more on Dr. Mark Burhenne, be sure to follow him on Instagram @askthedentist and on Facebook @askthedentist. Check out his website https://askthedentist.com and https://www.drburhenne.com. You can find his book, The 8-Hour Sleep Paradox, right here. Sponsor: This episode is sponsored by our partnership with the AirDoctor Air Filter. To get exclusive access to this deal visit www.brokenbrain.com/filter See acast.com/privacy for privacy and opt-out information.
In our last podcast, Kathy and I talked about how many commonly prescribed prescription medications can either make you gain weight or ruin your sleep. I this episode, we will discuss 7 steps you can take to prevent ever having to need them, or begin to wean off these medications. Show Notes: Prioritize sleep like your most important appointment Optimal breathing while awake and while sleeping Sleep hygiene Upper Airway Resistance Syndrome Obstructive sleep apnea Eat a healthy, organic toxin-free diet Fed-Up Movie Eliminate environmental toxins or allergies Podcasts on home toxins (part 1, part 2) Light toxicity Phone and email restrictions Vitamins and supplements Reader Survey Link doctorstevenpark.com/medications
Prescription medications are the mainstay of modern medicine. But what we don’t realize is that many common medications have the potential to make you fat or ruin your sleep. Please join Kathy and me as we discuss 12 Medications That Can Make You Fat or Ruin Your Sleep. This is Part 1, and in our next podcast, we will go over various ways to avoid prescription medications. Shownotes: 3 reasons why we shifted from acute to chronic care for medications 3 pathways that medications aggravate sleep problems and weight gain High blood pressure medications (lower melatonin and nasal congestion) Acid reducers (proton pump inhibitors) High cholesterol medications Antibiotics Antihistamines Birth control pills Estrogen dominance, Dr. John Lee Wisdom of Menopause by Dr. Northrup Estrogen promoting environmental toxins podcast Endocrine disruption podcast (Trasande) Viagra and other medications for erectile dysfunction (nasal congestion) Oral steroids Antidepressants Reader comment about Paxil Mood stabilizers Upper airway resistance syndrome (UARS) 11. Stimulants for ADHD 12. Sleeping pills Interview with Dr. Karkow on treatment resistant insomnia Blog response on 7 Drugs That Can Cause OSA https://doctorstevenpark.com/medications1
In this episode, I have a discussion with Dr. Bill Hang, one of my original mentors who inspired me to connect the dots between dental crowding and sleep apnea. He will answer the controversial question, "Can traditional orthodontics cause obstructive sleep apnea"? Show Notes Sleep Interrupted: A physician reveals the #1 reason why so many of us are sick and tired Dr. Brian Palmer Dr. Bill Hang: Faceocused.com Shut Your Mouth and Save Your Life by George Catlin Corruccini book Esthetic line Evidence Supports No Relationship between Obstructive Sleep Apnea and Premolar Extraction: An Electronic Health Records Review Orthodonticsandosa.com (promo code: turning point)
As an ear, nose, and throat surgeon, Dr. Steven Y. Park sees many patients with chronic issues, but it wasn't until he started ordering sleep tests that he discovered many of these patients were also suffering from sleep apnea. Since then, he's continued to collect data on the connection between sleep issues and chronic ENT conditions, high blood pressure, anxiety, diabetes, and digestive problems. According to Dr. Park, breathing problems can be brought on by and contribute to a variety of factors, many of which could help us better understand, manage and treat common illnesses. He joins the podcast to discuss variations of apnea, how exactly it's diagnosed, what happens physiologically during episodes of apnea, upper airway resistance syndrome (UARS), fragmented sleep that involves restless legs and teeth grinding, how simple snoring can lead to apnea, and tips for handling different levels and types of sleep disturbances. Tune in and check out his book Sleep, Interrupted: A Physician Reveals the #1 Reason Why So Many of us are Sick and Tired for more.
What is the little-known problem that's causing a lot of people to be sick and tired, that many doctors miss? In this podcast episode Kathy and I discuss how the epiglottis may be the reason behind your chronic fatigue, anxiety, or headaches. In this episode we'll cover the following: Learn about the anatomy of the epiglottis 3 reasons why your epiglottis is more floppy How to diagnose a floppy epiglottis Non-surgical options How to find the right surgeon. ________________________________________________ Show Notes Epiglottis diagram Floppy eiglottis video The Little-Known Breathing Problem That Most Doctors Miss blogpost Glyphosate podcast Glyphosate and bone problems Joint laxity article Upper Airway Resistance Syndrome (UARS) Drug induced sleep endoscopy (DISE) in patients with AHI < 5 Mandibular advancement devices Swallowing problems after epiglottis removal paper Epiglottis obstruction after cervical fusion article Laryngomalacia in children OSA Surgery e-book Finding the right surgeon Myths about sleep apnea surgery Atrial fibrillation and OSA article
In this episode, Kathy and I go over 10 steps that I take to stay thin, healthy and happy. ____________________________________________________ Shownotes How Glyphosate May Be Shrinking Our Children’s Faces (Podcast 47) How Allergies Can Ruin Your Sleep (Podcast 22) Slow Death by Rubber Duck Pinterest DYI household cleaning products Environmental Working Group ADA history Eat Dirt Thrive Market Amazon Fresh Brian Palmer interview The Autoimmune Fix Plant Paradox Immune System Recovery Plan UARS Grain Brain Wheat Belly Food, Inc. Movie Dr. Gominak’s interview on Vitamin D
In this episode, we have Mr. Roger Price, who has more than five decades of experience and qualifications in multiple areas of human health, giving him a unique background and ability to ‘see the big picture’, as well as to spearhead the integration of previously unconnected disciplines into a Functional Health Program. He is internationally recognized as “The Man who connected Dentistry, Sleep and Breathing." In this interview, we discuss: What is the link between children’s teeth and the way they sleep? How did modern humans change the rules of life? How we changed our diets and feed our babies to make things worse Why the AHI is not a reliable measure of sleep quality The myth about nasal breathing Why 90% of asthma is not really asthma How to control an asthma attack The two genetic markers of asthma The truth about Buteyko Breathing Symptom management vs. educational program The 3 basic myths about breathing The Dental Diet by Dr. Steven Lin.
In this episode, Kathy and I will reveal "Why Better Breathing Doesn’t Always Lead to Better Health." Here are 7 of these reasons. Please listen to the recording to find out more. 1. You can’t control your breathing when you’re sleeping 2. You don’t know you’re not breathing well 3. You can’t control your sleep position or posture at night 4. Not all breathing is equal 5. The oxygen myth: Lack of breathing, not lack of oxygen 6. Despite high levels of oxygen in your bloodstream, it may not reach certain areas of your body under stress 7. Stress-Breathing Paradox _______________________________________ Shownotes Sleep positioners Neck positioners Pillows for snoring Wedge pillows for acid reflux Unstuff Your Stuffy Nose Free Report Buteyko Breathting - McKeown Podcast Interview Why Zebras Don’t Get Ulcers by Dr. Robert Sapolsky Breathing: The Master Key to Self Healing by Dr. Andrew Weil Stop Smoking for the Last Time by George Wissing
In this episode, we have a special guest interview with Mr. Joshua Thomas, who runs a fantastic website, fixyoursleeptoday.com. Joshua has an amazing story to share with us, describing his journey going through a maze in the medical system for years before being able to find help for his wife, by finally treating undiagnosed obstructive sleep apnea. In this 32 minute interview, he will reveal: 1. What motivated Joshua to start up fixyoursleeptoday.com? 2. How has this affected him personally, and what had to be changed to sleep better and be healthier in general? 3. What are the most common questions that he gets his readers? 4. What are some of the most successful options his readers have had for snoring? 5. What are some of his favorite over-the-counter (OTC) devices for snoring? 6. What to tell people that they don’t want to use a gadget, device or a machine for the rest of their lives? 7. How to help people who have “paralysis by analysis”? 8. The one thing that people usually don’t address about sleep that’s important to consider. ________________________________________________ Show notes fixyoursleep.com Sleep Interrupted: A physician reveals the #1 reason why so many of us are sick and tired Totally CPAP: A Sleep Physician’s Guide to Restoring Your Sleep and Reclaiming Your Life
In this episode, Kathy and I will talk about upper airway resistance syndrome, or UARS, as part of our “Back to the Basics” series. In this discussion, we cover the following: What is UARS and how is it different from obstructive sleep apnea? What are the most common features of UARS and how can it be diagnosed? Why most doctors are unaware of UARS What you can do to start treating UARS and when to see your doctor How to prevent obstructive sleep apnea and UARS. Show Notes Original UARS paper by Dr. Christian Guilleminault Sleep Interrupted: A physician reveals the #1 reason why so many of us are sick and tired Robert Sapolsky’s book, “Why Zebras Don’t Get Ulcers” The Sleep Breathing Paradigm (Podcast 39) POTS (postural orthostatic tachycardia syndrome) UARS and somatic syndromes: Dr. Avram Gold article
In this podcast episode, Kathy and I go back to the basics. We will talk about my sleep-breathing paradigm, the concept that all modern humans are susceptible to various degrees. Show Notes Sleep Interrupted: A physician reveals the #1 reason why so many of us are sick and tired Dr. Terrance Davidson: The Great Leap Forward: the anatomic basis for the acquisition of speech and obstructive sleep apnea Dr. Weston Price : Nutrition and Physical Degeneration Dr. Robert Corruccini: Anthropologist who found that soft diets are associated with more crooked teeth. Podcast interview. Video series on why we have malocclusion (crooked teeth) Dr. Christian Guilleminault. Podcast interview. UARS paper Unstuff your stuffy nose free e-book Dr. Brian Palmer. The first person to alert me to the impact on how bottle-feeding can alter facial growth.
In this podcast episode, Kathy and I will talk about links between various gastrointestinal issues and obstructive sleep apnea. We cover the following 5 surprising conditions: Irritable bowel syndrome Inflammatory bowel disease (Crohn's and Ulcerative Colitis) Celiac disease (or gluten sensitivity) Colon cancer Acid reflux Subscribe Shownotes: Sleep Interrupted: A physician reveals the #1 reason why so many of us are sick and tired IBS study Gluten-free diet and celiac diease Inflammatory bowel disorders and Celiac disease research study Upper airway resistance syndrome Why Zebras Don’t Get Ulcers Blog post on GI problems and sleep apnea OSA and cancer article Vitamin D Podcast (Part 1, Part 2, Part 3) Pepsin in ears, sinuses and lungs doctorstevenpark.com/gastro iTunes link
In this episode, I answer your questions that I get through my blog, email, and contact me page. This is completely live and unscripted. I have no ideal what Kathy will ask me. 1. How much do you charge for a office visit or procedure? 2. How can I make an appointment to see you? 3. Various questions about specific medical issues. 4. What’s the difference between upper airway resistance syndrome (UARS) and obstructive sleep apnea (OSA)? 5. Will sleeping pills work for upper airway resistance syndrome? 6. Does sleep apnea cause brain damage? 7. Are apneas more damaging on the brain than hypopneas? 8. What’s the relationship between depression and sleep apnea? 9. How do dental extractions affect sleep apnea? 10. Can nasal surgery cause sleep apnea later in life? 11. What’s the link between reflux and sleep apnea? 12. Can sleep apnea cause dizziness? 13. What questions should I be asking my doctor? Podcast 13: Which surgeon do you recommend? Sleep, Interrupted How to Unstuffy Your Stuffy Nose e-book Contact Dr. Park
Many people hate the idea of using a CPAP mask attached to a hose every night. Fortunately, a good alternative to this is a mandibular advancement devices (also called oral appliances) come in various models, but they all have one thing in common: The lower jaw is pushed forward against the upper jaw, moving your tongue forward, opening up your airway. In this podcast episode, I will go over the 7 reasons why I like using mandibular advancement devices to treat obstructive sleep apnea. 1. No headgear or straps around your face. 2. It’s silent. CPAP 26 dB. 30 is a quiet whisper 3. It’s small and convenient 4. More dentists are available to make these devices, and are usually covered through most major insurances. 5. Equal to CPAP for people with mild to moderate obstructive sleep apnea. 6. An oral appliance can used as a CPAP mask holder 7. It can be used effectively for snoring and UARS, even if you don’t have obstructive sleep apnea. Resources and links mentioned: 7 Reasons Why I Love Dental Appliances for Sleep Apnea 5 Reasons Why I Don’t Like Dental Appliances for Sleep Apnea 5 Things You Must Consider Before Trying An Oral Appliance for Sleep Apnea American Academy of Dental Sleep Medicine Photo of hybrid oral appliance / CPAP nasal pillow Unstuffy Your Stuffy Nose E-book Breathe Better, Sleep Better, Live Better Podcast on iTunes (#54)
Dr. Emerson Wickwire currently serves as Sleep Medicine Program Director at Pulmonary Disease and Critical Care Associates in Columbia, Maryland. He also holds the rank of Assistant Professor, part-time, at the Johns Hopkins School of Medicine, where he completed a two-year postdoctoral fellowship in sleep. Dr. Wickwire is board certified both in behavioral sleep medicine by the American Board of Sleep Medicine and in cognitive and behavioral psychology by the American Board of Professional Psychology. He is a pioneer in interdisciplinary approaches to sleep medicine and maximizing human performance. In this interview, Dr. Wickwire shares his wisdom about comprehensive approaches to managing sleep apnea, including cognitive-behavioral treatment to maximize success with CPAP . Some of the questions include: What are cognitive-behavioral treatments (CBT)? Have cognitive-behavioral treatments been applied to sleep disorders? What is the psychology of sleep apnea? What factors influence PAP use? What are Wickwire's Four Pillars of CPAP Success? What is a PAP adherence risk profile? What CBT interventions have been tested to improve PAP adherence? And much more…
On this Expert Interview program, Dr. Derek Mahony, a world renowned orthodontist from Australia, gives a special talk on: Nasal Airway, Snoring/OSA & Malocclusion in Children
Old shows from the Ground Zero Archive. http://www.groundzeromedia.org/uars-attacks/ (Contains some commercials)
This month, I've invited Stanford University's sleep surgeon, Dr. Robson Capasso to talk to us about his institution's philosophy on sleep apnea surgery. Here's a short list of questions that are answered on the program: 1. What's the success rate for sleep apnea surgery? 2. Can you wait until someone is asleep to image the site of obstruction? 3. What is the progress in getting UARS recognized as a real condition? How is it diagnosed and managed at Stanford? 4. How do you decide whether to recommend surgery or an oral appliance in a CPAP intolerant patient? 5. Can you explain the different techniques for performing the MMA, and how successful these are for reversing OSA? Is it possible to achieve an AHI of zero after an MMA? 6. Do you recommend adult jaw development as an alternative to surgery? 7. Is sleep apnea surgery covered by insurance? ….and many more.
In this Expert Interview, I talk with Mr. Eric Cohen and Mr. Jake McCabe of National Sleep Therapy on how their company achieves an 89% CPAP adherence rate. Besides revealing their secret to getting very high adherence rates, here are some other questions we covered: - Define compliance or adherence, and medicare criteria- What's the national CPAP adherence rate average?- Being compliant or adherent doesn't necessarily mean that you're sleeping better, right?- How does the patient, doctor, and DME work together to raise adherence rates?- How long do you stay with the patient?- Do you have any special tools to help the patient?- What would you say are some of the top things patients can do?
This month, I interview Dr. Christian Guilleminault of Stanford University, who is one of the pioneers in sleep apnea diagnosis and treatment. We're going to focus on Upper Airway Resistance Syndrome (UARS), which he discovered. Here are some of the questions we covered: - Describe to us what UARS is and how it's different from OSA? - Why is the AHI limited when it comes to picking up UARS. - How to diagnose UARS: Esophageal manometry vs. nasal cannula. - How UARS patients have intact nervous systems, whereas sleep apnea (OSA) patients have diminished nervous systems, and what may cause progression from UARS to OSA? - How do you treat patients with UARS? How is it different from treating sleep apnea? - What are the dental options for UARS? - How common is UARS in children and how can they be treated? - And much more…
In this month's Expert Interview, I interview Dr. Avram Gold, a pioneer in researching the link between upper airway resistance syndrome, chronic fatigue, and the functional somatic syndromes. Some of the topics will include: - What are the functional somatic syndromes and how are they related to sleep-breathing disorders? - What's the relationship between central sensitivity syndrome and stress? - How is sleep-disordered breathing related to stress? - How is anxiety or depression related to functional somatic syndromes? - How is chronic fatigue syndrome connected to the this condition?
For this Expert Interview, I'm honored to have Dr. Barry Krakow as my guest. Dr. Krakow is a world-renown sleep researcher, and author of numerous books, including Sound Sleep, Sound Mind, andInsomnia Cures. We're going to have a fascinating discussion about: - complex insomnia (insomnia and sleep apnea) - upper airway resistance syndrome - post-traumatic stress disorder - and much, much more… If you or your loved one has either insomnia, obstructive sleep apnea or upper airway resistance syndrome, you don't want to miss this.
In this Expert Interview program, Dr. Jeff Rouse gives a fascinating presentation on the relationship between TMD and sleep-breathing disorders. Click here for the PDF of his slides.
On this news-packed episode of Talking Space, we discuss the space shuttle Endeavour officially being handed over to the California Science Center, and also discuss the controversey of trying to bring a shuttle to Houston as well as Ohio. This segment includes a classic clip from a STS-134 briefing with a question asked by our own Gene Mikulka. We then discuss former Space Shuttle Launch Integration Manager Mike Moses, who will be leaving NASA to join Virgin Galactic. We also discuss the second drop test of Space Ship 2, which did not go as smooth as expected. We then get into a deep discussion of the next proposed NASA budget and some intersting areas which are being affected by the budget and others that aren't. We then talk about a possible 2013 abort test of the Orion capsule as well as a 2012 drop test of Sierra Nevada's Dreamchaser. We then continue with another satellite coming in for a reentry similar to UARS, except this time it's ROSAT. We finish off our discussions with the Soyuz getting NASA's ok to keep flying as well as a launch this week, for the first time, of a Soyuz from somewhere other than the Baikonour Cosmodrome. We finish off with an interview conducted by Mark with another amazing speaker from the 100 Year Star Ship Symposium, Chantelle Louis. For more information on the upcoming Soyuz launch from French Guyana, check outhttp://threelaunchersontheequator.com For more information on Chantelle Louis and to see her work, visit her website athttp://chantellelouis.com Host this week: Sawyer Rosenstein. Panel Members: Gina Herlihy, Gene Mikulka and Mark Ratterman Show Recorded - 10/17/2011
UFO landings across the USA, The UARS plummets from the heavens, Argentinean homes destroyed by fireballs, and the comet Elenin swings stops by for some barbecue down under.
On this episode, we invite back Aviation Week Senior Editor Frank Morring. With his 35 years in journalism, over 20 of those focusing in aerospace, we ask him about the current events around NASA. We begin with the discussion of UARS which recently crashed back to Earth and about space debris in general. Then we get his opinion of the Space Launch System, or SLS, NASA's future spacecraft to take American astroanuts to an unspecified destination. We then discuss the role of commercial companies and the possibilities that it may hold and if it can be viable. We then finish off with Wallops Space Flight Center possibly having manned launches and the implications at the Kennedy Space Center, as well as preview Mark's far-out upcoming trip and Mr. Morring's thoughts on it. Be sure to check out Frank Morring and all of the other amazing staff members at Aviation Week by visiting their website: http://aviationweek.com Host this week: Sawyer Rosenstein. Panel Members: Gina Herlihy, Gene Mikulka and Mark Ratterman Show Recorded - 9/26/2011
On this episode, we discuss the safe return of the Expedition 28 crew after their 6 month stay aboard the International Space Station. In doing so, we discuss the Soyuz and Progress 44 failure and the impact it will have on the ISS in the near future. We then get into a large discussion about the official announcement and presentation of NASA's new vehicle to carry humans beyond Low Earth Orbit, and that is the Space Launch System (SLS) scheduled for completion in 2017. We discuss the composition of the vehicle as well as the actual announcement itself. We then discuss our opinions on the vehicle and if we think it's going to fly. We them move on to ATK's new commercial rocket as well as an update on the UARS satellite scheduled to make a fiery return to Earth sometime this week. We then mention a discovery by the spacecraft Keppler of a Tatooine-type planet from Star Wars. Lastly, we mention that last week our show celebrated its 2 year anniversary and we reflect on where we've come, who's helped us, and where we're going next. Please feel free send us your comments regarding the SLS announcement or any other story. You can email us at mailbag@talkingspaceonline.com, send us as tweet at @talkingspace or post it on our Facebook wall at facebook.com/talkingspace Two images were inserted here. To view them, please visit http://talkingspaceonline.com Host this week: Sawyer Rosenstein. Panel Members: Gene Mikulka and Mark Ratterman Show Recorded - 9/18/2011
On this episode of Talking Space, we return from our three week summer break to catch you up on the latest in space news, starting with the successful launch of the Gravity Recovery and Interior Laboratory, (GRAIL) mission which successfully launched to study the moon and our own Mark Ratterman was there to cover the launch. Mark also gets a special interview with Kim Guodace, a former shuttle vehicle engineer for United Space Alliance. We then move on to the failure of a Progress 44 resupply ship launched aboard a Soyuz and how it may leave the International Space Station unmanned. We move onto the topic of space debris including the UARS satellite scheduled to crash back to Earth at an unknown location. We then discuss some stunning shots of the lunar landing sites taken by the Lunar Reconnaissance Orbiter, LRO. We finish off with pieces of metal on Spirit and Opportunity which were once a part of the World Trade Center towers which were destroyed in a terrorist attack on September 11, 2001. Two images were inserted here. To view them, please visit http://talkingspaceonline.com Host this week: Sawyer Rosenstein. Panel Members: Gene Mikulka and Mark Ratterman Show Recorded - 9/11/2011
NASA's Upper Atmosphere Research Satellite will fall out of orbit soon, with large pieces perhaps reaching Earth's surface, according to NASA's Nick Johnson at a telephone press conference. John Matson reports
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