#62: The Secret to Better Sleep? Stop Doing This One Thing with Dr. Mark Burhenne
I want to hear from the broken brain podcast today's episode we have my dear friend mark hanna a dentist who's passionate about the connection between our oral health and and sleep apnea super fascinating conversation stay tuned to learn more welcome to the broken brain podcast where we dive deep into the topics of neuro plasticity epigenetics mindfulness and functional medicine with the goal of helping. You understand how your brain is not broken. I'm your host droop road in each week my team and i bring on a new guest who we think can help you improve your brain health. Feel better and live more this. Week's guest is a new friend of mine. Dr mark burr hannah dr be nose. The the mouth is the gateway to health in the rest of the body. He's the author of the number one bestseller. The eight hour sleep paradox and is a practicing sleep medicine. John dentist in sunnyvale california dr has been practicing dentistry in the greater san francisco area for over thirty years. He's a speaker and his advice regularly regularly appears in media outlets c._n._n. C._b._s. yahoo health the huffington post the washington post and men south. He received his degree from school of dentistry in san francisco. Oh and as a member of the american academy of dental sleep medicine academy of general dentistry american academy of oral systemic health and and the dental board of california dr is passionate about helping people understand the connection between oral and overall health. He also spends a lot of time educating educating patients and readers about the importance of healthy sleep. Which is what we're going to talk about. In today's podcast dr be welcome to the broken bring podcasts through a pleasure. There's all mind. This is a great show. You've done a lot of great things with their show. I'm happy to <hes> we've just recently met in person but we've been a big fan of your work and ask dennis dot com and <hes> your team has been a great support to our team and vice versa and you share such great knowledge. It's why i'm so excited to have you on here and go deep into a topic that we've kind of skimmed dimmed upon but we haven't really broke it down so thank you for coming down here. I'm excited jumping to it now before we talk about sleep apnea and the connection between oral oh health and brain health and how structure upper respiratory syndrome and all those topics. I want you to sort of set the stage to help our listeners understand the type of person that you art. You have a great story that you shared before about how you got fired ten months into being a young dentist working at your first <hes> practice. Can you tell that story right well. That's not a story. I'm <hes> i'm proud of but i it was my daughter who actually said you know. This is a great story. Dad you need to share this and it does tell a lot. What about what. I was back then i did. I got fired from a big clinic that i was working with. It was great experience. <hes> based on the education i had received i was getting all the root canals more difficult cases which was kind of nice to to experience and all that but a lot of the stuff i was being told to do actually by a non dentist who was is part owner of the clinic and i was somehow able to refer some of this work out for example. If you build a bridge that's a big lot of crowns on some teeth and if if the gum disease has not been addressed then it's like remodeling the kitchen. You've got dry rot on the floor. I mean it was it so. I would sneak this patient out. Give them my personal card card without name written on the back of local predominant and that worked for eight or nine months give them other solutions to really deal with what their issue was rather than up selling them or right getting right the business sort of side involved exactly so and that was taking more x-rays and i was very careful with my root canals and and i was saying things to them that you know the administration of who obviously was concerned about production wasn't very happy with but for eight or nine months hung in there my systems were <hes> were with me on that oughta it was it was a it was a good time. It was stressful. You know being a young dentist and anytime a young dennis comes out of school and that's a very stressful time but i look back to it. I think it is a great story. <hes> if it wasn't for my daughter i probably wouldn't put it on our website but what's really beautiful about is that it starts to show that early inclinations of wanting to do things right and also differently going against the grain a little bit even though everybody might be telling you and that's the foundation of all the work that you do and the resources that you put on your website and education you bring to people <hes>. Where do you think that that came from. You know that's a good question. <hes> probably from my upbringing probably from my dad who was a physician. He was a radiologist <hes> talk about root cause. I mean they're looking for things that the visual effects of systemic disease and and <hes> you you know it's <hes> to reiterate that story part of that part of that was my education <hes> being an idealistic dentist having gone to a good school half at that was not what i was thinking it was what i learned and being thrust into a more commercial environment there were there were there were conflicts you know there. Were you know times where they didn't want me to do. What i was trained to do so that was part of it but i think it probably came from my dad <hes> wanting to really do everything for the patient not just fill the cavity find out wh- at this cavity come from what can we do to prevent that started early because i think a lot of our listeners can agree. There's always that fear that the general public has when it comes to dentistry is that is this necessary and you have to do it. It's almost like it's very there's there's questions and people still have a lot of things that they feel like they're in the dark about running comes dentistry era and there's also other avenues that are emerging that we talked about in our broken. Bring docu doc you series and we we've touched upon a little bit in some past interviewed some dentists that we'd have on here where we're really bringing back the importance on oral health both and you said something really beautiful last night at dinner when we were catching up you're saying that oral health and early signs of some challenges his when it comes to our own health can catch issues that can become major issues in our health long-term. Tell us about that well. <hes> i mean there are many different ways to look at that but i'm first of all. I'm very glad that the oral health is now merging with you know medicine and and the systemic health i mean it's always been there but now it's part of the discussion which is very very important and that's kind of what we're trying to do it. Ask the nets dot com is to educate people about that. <hes> dentistry medicine unseparated longtime ago in the late eighteen hundreds and that has not been good for our patients because oral health does contribute a lot to overestimate systemic health <hes> the study. We talked about last night. Was this columbia study. I think it was two thousand six twenty. One percent savings in the trillions of dollars of healthcare span if orel conditions are addressed early and prevent it like gum disease <hes> to me. That's something that cannot be overlooked. It needs to be addressed not just for financial reasons dozens but for the overall health of of any patient and one topic which is going to be the central point of our focus for today's interview is one of the biggest areas of the oil health and also brain connection and overall body connection and that's sleep apnea so twenty two million americans suffer from sleep apnea nia and yet many who have it never get diagnosed and there is the traditional sleep apnea that a lot of people think of an overweight older older male often who has the classic signs of of being overweight and other challenges that a doctor might recommend that they get a sleep study and and then would prescribe like a bunch of interventions including like a cpap machine but there's this whole other category of sleep apnea that dentists like yourself yourself a really bringing to the forefront so help us understand i with the basics what is sleep sleep apnea and what's actually happening in the body when somebody has it right so <hes> sleep apnea is came to me directly via you know getting a diagnosis for sleep sleep apnea that was about ten years ago and i always try and think back to what i thought of sleep apnea which was very little very little recognition of it to what i know now because it's hard to know oh and remember how a lot of people feel about this including physicians and dentists and other healthcare providers and that is that it's really not that big of a deal until it becomes a big deal but it happens much earlier than that. I think i've told you before that dennis oracle's recognize sleep apnea decades before a physician can cause. We're looking at a whole different subset of signs and symptoms so we can talk about it. If you want your going witten in functional medicine they call it. You're going upstream and you're seeing certain upstream. Factors offers that are causing yes the further upstream we can go especially in sleep apnea and going upstream by decades as a huge deal because you know that liver damage and brain damage. I mean that starts happening. At an early age it can even happen with children infants. I see seats a sleep. Apnea and other sleep disorder related breathing issues news in infants and that affects development. I can affect their brains confessed their personality a learning disorders it. It's a very broad subject so upstream upstream is important in this regard so when you talk about upstream issues with sleep apnea we talked about the classic case and mostly people would let's let's say lehman would look at sleep apnea and say that somebody might be a candidate or have risk for it when they are overweight. That's often the the big one for it so when you're going to these upstream factors to look at sleep apnea in a patient what are the things that you're paying attention to that are part of you've sleeper so that's a good question and it's mostly in the mouth or at least from the neck up. <hes> course i'm looking. I have a list that checkoff lists that i go through and do that with every patient because i assume everyone has the potential for any kind of sleep disordered breathing issue <hes> so as is i go to the list. There's the usual stuff on the list that physicians look at co morbidity of sleep apnea like high blood pressure knocked area going to the bathroom midnight <hes> there's a host of other things high blood pressure heart arrhythmias insulin resistance <hes> but when it comes to the mouth <hes> if you are struggling to gain air air at night there are things that happened in the mouth well before the effects of not being able to breathe at night and having hypoxia and slowly getting brain damage in the heart working harder than it needs to at night that all has a delayed effect the good news about the dental <hes> ramifications of sleep apnea the signs and symptoms of someone struggling for areas that we can. Let's see them much earlier. <hes> there are many. There's a gum recession at fractions. Were the side of the tooth is breaking off calving. I call it a calving having of the denton sensitivity in those areas too hot and cold a brook zing sleep wrexham is the term now. That's brexit nine grinding clenching her teeth. It can even be just clench and not a grinding motion t._m. J. sore muscles headaches in the morning dry mouth. You were talking about how many people have dry mouth well. If you're older a lot a lot of people have dry mouth. You're on medications a lot of people that are taking medications. That's very common. Side effect of most pharmaceuticals have dry mouth but there are a lot of young people that if their mouth is open open all night long. They're going to have a dry mouth in the morning sticky tongue. It's going to be a little. They're going to be thirsty at night. <hes> so dry mouth is a big one. <hes> a scalloped tongue. Hi melan alan patty scores <hes> actually physicians look at that as well <hes> there. You know it's it's a it's a combination of so many different things that if it all starts fitting together then we realized there's an issue a mouth breathing of course is a problem. A tongue tie can cause an issue with breathing at night the positioning of the tongue while you sleep <hes> <hes> <hes> if the patient can't breathe through their nose. That's again mouth breathing <hes>. That's that's all signs that something's going on. We also look at facial development. That's what i was referring to. From the neck up i can look at someone's face profile full full-frontal and have have some make some assumption as to what the size of their airway is. What the size of their sinuses this is our whether they're able to breathe or not lip posture tapering of the chen we have all different sorts of plus occasions of face type a clue asian. That's how the teeth come together a skeletal relationship of the inclusion <hes>. It's it's. It's a it's a huge list and the good news is that we can see it earlier. Then then we can <hes> you know diabetes for example ethic for those people listening on the podcast. I think thing that you're really trying to get across. Is that sleep sleep apnea which seems like if anybody has ever known somebody who has sleep apnea in the traditional sense it sounds <hes> it looks and it sounds like very <music> often aggressive right. They have a hard time breathing day. It's like it looks like a very <hes> over the top thing or whatever agr they have and you're really talking about a milder form of sleep apnea that he's often undiagnosed underdiagnosed. That's still there and many people themselves don't even know that they have it but they have it and they have all these different things including some of the things that you had mentioned this list and and before we talk talk about those things in detail. Let's just come back to sleep apnea a little further when people have sleep apnea even if it's not super severe but it's prominent what kind of long term impact does it have on our health right <hes> what you said previous to so that was very interesting. There is a threshold for noticing sleep apnea and the threshold is very low and dentistry <hes> we're able to catch it sooner and that's a very important important point. <hes> this disease starts very early in his very insidious in that way so what is sleep apnea <hes> it's again. It's it's it's very gray. <hes> there's no point or threshold where all of a sudden you'll sleep apnea. It can start from the time that you're born. <hes> it is a <hes> the the lack of the ability to breathe properly at night to the point where your sleep is interrupted and in a nutshell when we go into deep sleep muscles those are paralyzed when we reach that rim stage three stage four sleep <hes> there are some exceptions and rim of course but <hes> the muscles of the airway of <hes> become flaccid i mean they lose their tone and if you have an airway that is small to begin with chances are that the sides the walls of the airway will touch and fall together there and of course that's going to be a area of resistance for air coming through and exiting and of course that's where the storm comes from the flapping of that tissue and the more you snore or the more inflamed that tissue becomes. There's a team of the airway muscles. The muscles are <hes> have <hes> in women. They're the they have protective. Active hormones and women estrogen and progesterone protect them. That's why they catch up with men <hes> after menopause even peri menopause <hes> because they're low on those hormones i mean it is a lack of thriving at night and it it is something that <hes> is curious because as you know how did we get here i obviously we've been we look back at our ancestors and we can see from their skeletons in their and their skulls that they had different airways than we did and they didn't have these issues and there are a lot of reasons for it but but i assume i pretty much think it's very practical from my standpoint in in my practice too soon that everyone has asleep disorder breathing and <hes> and it's getting worse. There's this rising epidemic of sleep apnea and all the different permutations of how it's impacting people which we're gonna talk about a little bit but let's just chat about what you were sharing for second which is why are we heading in this direction. We're more people who don't know that they have apnea are getting apnea. You hinted at a couple of components are jaw. Structure is different so weiser jaw structure different now compared to our ancestors right. It is different. We know it's different. <hes> we have the archaeological record of of that and the question is how did we get here. It's <hes> there are many theories. They're very solid theories. <hes> it's lack of breastfeeding. Its lack of chew. It's it's eating processed foods as at at the right age when we should be eating something with more texture. It's the <hes> increase of tongue ties that could actually be eh from us pushing too much b twelve before <unk> prenatal before conception <hes>. There's a there's a better version of b twelve to be taking <hes> <hes> those are the mid line defects <hes> what else <hes> <hes> breastfeeding of taking one of those the even and the process food alone even when people eat a very healthy diet one of the things you were sharing last night at dinner is that the food arts kind coming predigested for them. It's blended or as a smoothie. It's chopped up in a salad and were no longer sort of taking things in having to use our teeth for what they were designed to do and when we're we're not chewing at that level are formation or muscles and our bones in our in our face just develop completely differently. It's actually the muscles of of chewing and swallowing and the oral posture of where we hold her tongue that shapes our lower face <hes>. It's tongue is pushing out an up if we're not chewing properly for for not using these muscles <hes> our faces will be different so whatever allows us to use more of those muscles in the right way will lead to better facial development. That's clear on extreme and we know that sleep apnea long-term people exposed to it. They're they're at a much higher risk of alzheimer's. <hes> talk about that yeah so sleep. <hes> is not the only thing in dentistry that can lead to alzheimer's and that's exciting for dentistry now. Oh by <hes> sleep is probably the biggest good sleep. Deep sleep is probably the biggest fixer of our brains the daily damage that we do to our brains. I mean the brains use a lot of energy. <hes> <hes> we we <hes> we need a lot of cleansing and detoxifying the brain at night and that only really happens the glenfiddich system. The glee will lymphatic system. These are something that was recently discovered in the brain and it was first discussed in a tedtalk. Remember were <hes> the speaker was talking about the brain shrinking and that <hes> a famous greek scientists for philosopher had actually discovered that in had mentioned it and i thought that it was fascinating but is confirmed. I mean the brain at night has a chance as does the liver has an opportunity to fix itself in clean itself and take away the waste and organs all of our metabolic processes create waste and the question is how do we how do we clean that out. The liver does its job. It does constantly during the day but the the brain only. It has a chance to do that at night. You're not getting deep sleep and you're continually being interrupted due to a small airway or collapsing our way and that brain is starting starting off not fresh in the morning and that damage that that lack of waste reduction is is accumulating and we said long-term that can lead to that can increase crease your likelihood of alzheimer's and and in the short term it could be you just wake up feeling not rested. You feel tired. You feel sluggish. There are instances this one. I'd love to touch on. There's a whole sort of group of <hes>. Can you talk about like women <hes> and and sort of like the nervous system and and the the connection there have like sleep apnea and the nervous system for out of a young women especially well well <hes> i mean there's at one study in sweden. I think it was <hes> two thousand and four <hes> where they randomly selected from over one hundred two thousand women just women across the board from twenty seven years old seventy years old and fifty percent of them had some form sleep disordered breathing now of course if you're overweight. You're older her obese high b._m._i. Made it runs in the family. You would certainly see it there but to see it in a twenty year old woman or twenty five year old woman who's fit and then and healthy that was that was a real wakeup call for women and i don't want to pick on women of course that happens to men as well but <hes> a lot of the mood disorders and and actually tim tim j disorders tend to be more prevalent in women and a lot of that has to do is sleep. How do i bring in t._m. Jada neurological and mood disorders it's because they're all related to the grinding clenching which is trying to keep the airway open. It is a factor in or a sign that that person is struggling to sleep at night so so if you're not fixing your brain at night and you're grinding at night to keep your airway open. You're gonna you're gonna suffer from depression. Perhaps mood disorders and t m j. They seemed to be paired together together and you're also not processing oxygen correctly inside the body. Can you talk about the relationship between like oxygen breathing. I think will jump into a couple of years topics slot to discuss their nitrous oxide and breathe your nose versus your mouth give us an overview on roy while it's very exciting <hes> and so when we when my daughter and i wrote the book <hes> we did some research and and in my clinical practice practice i noticed that people that can't breathe through their nose first of all let me back up. Dennis are great at knowing who mouth wreaths and who knows breathes now he's why because when we lay the patient down and start throwing water in their mouth and putting our fingers in their mouth they can't breathe. They're the ones who get up and spit a lot of the customer. They're the ones that gag a lot. If put their hand up once they compete with the knows they intolerate having that little pool of water in the back of their throat right and they can breathe passed it so it's very obvious to me too. I mean i was joked with patients. Dentistry dennis probably invented waterboarding right. I mean it's it's why people don't wanna come see us. It is a it is a <hes> a panic moment. It is a fighter flight response when you're airways blocked and you can't breath your notes i mean it's a lot like how we sleep at night. If we're not breathing night we're gonna wake up a little anxious in the mornings. We've been fighting for a life at night if you have twelve interruptions it's like i did at night before i treated my sleep apnea per hour. That's twelve grizzly bear sightings at night. I mean that's that will out your glance. Your body doesn't know the difference. I i just is wanna touch on that for a second. I'll interrupt your story. That's okay is literally at night when you have a version of sleep apnea and there's a spectrum of how severe it is your body. He is actually feels that it's at risk of dying. Yes and it can increase like <hes> cortisone. The body economic shot of adrenalin inside the body. That busy says like something's attacking me. I can't sleep properly and there's often. Have you know somebody that has severe c-pap c-pap dion who hasn't been treated. You'll see these major gasps for air in the middle or night. I had a cousin who i recommended. Gophers sleep study it came back and in the course of an hour he was stopping to breathe forty five times on every but in forty five times in our and some awesome sixty seconds and some people can't even hold their breath at long and then you know the body will wake you up. It's a it's a it's fear of of a thriving thriving. I mean it's a it's a guttural gut. Instinct of i'm going to die and and you know does that. Come through you know if you've been sleeping absolutely <hes> <hes> that's where a lot of the anxiety comes from. It's not just from the hormonal problems in the brain not being able to fix itself at night. It's from the anxiety. It's from feeling that away at night <hes> and it it's <hes> it it can really i the the enjoyment i get doing. What i do is that we can turn that around. In a matter of six months we can see people we see people and we see and we take a little interview with them. We write down some notes on how they feel in the morning and then six months after we've treated them we <hes> we interview them again and it's remarkable to see the difference. I feel a little happier. I can't close my eyes after a wake-up. I feel like getting out of bed. I feel a little bit better about a day but if you're if if you're fighting for your life at night you don't have time i mean you're you're the glasses half empty. I mean you're having a tough time. You're challenged the minute you wake up and that's the exact time a a day when you should feel rested restored and ready for you know life in general yeah and i couldn't think of anything more to put that attention on would sleep it's even but if you have the perfect diet like really put attention in your sleep first of all there's no perfect i and we don't believe in that of course but i'm just saying i'd rather have somebody just having credible sleep <hes> the not have their diet one hundred percent tuned in because that's how fundamentally important sleep is so going back to your story because i interrupted you you were talking about. Dentists are often the first to know now about that about whether or not somebody's good and you're explain the mechanism of how oxygen is processed inside the body and and and what and what happens exactly when we're breathing through the mouth versus doing what we were designed to do which is breathing through the nose so could you continue down that path so it's very interesting. I'm and i didn't know this until about five years ago <hes> and it started with the simple act of mouth taping <hes> people that for example if i make an oral appliance ans- which is something that just keeps the chin from falling back when they go to sleep that keeps the tongue in the airway open their cpap therapy apep therapy. That's the little machine that people put on these. These are the main solutions for sleep apnea. It keeps positive press pressure in the airway and keeps it from collapsing. Those things work well if the patient is able to breathe through their nose so oh that's how i i ran into this. I would make an oral plans for someone and the results were not quite would expect it and then i learned of course that well. They can't breathe through their nose. It's not gonna work doc as well same thing for a cpap so so that's how i kind of came across it then a deal out of research started reading up on it read these pulmonologist analogy books <hes> spoke to a lotta pulmonologist about it and a lot of ear-nose-and-throat <hes> m._d.'s and understood that things like for example <hes> <hes> when you breathe through your mouth only you're not able to deal with your otis your c._o. Two to mix in your blood. There's there's oa-to ah co two as a waste product. It's coming out oh to what were breathing in and we wanna get oh to oxygen to our bloodstream but if there's too much c._o. Two or if you you are in acidosis. I mean the analogy i use for patients. If you add carbonic acid to water to make bubbly the ph drops it becomes very acidic and we talked about it a lot and dentistry because that's a drink that can dissolve enamel in your mouth so <hes> it's the same thing with blood too much c._o. Two acidifies the blood and that actually harms or or prevents as much oxygen going from the lungs to the blood so that's a big deal breathing. Your nose is a better regulator of c._o. Two in other words if you breath your nose most the time your c._o. Two levels will be optimal important thing in that. I didn't realize us until five years ago and it really made me think the body is measuring. Is controlling your breathing. It's the it's the brain stem that is regulating the subconscious briefing. I think that the that part of the brain stem is looking at c._o. Two on the blood not oh too so it's not responding too much oxygen. You have which you would think that would be the process. This is responding to a much c._o. Two in your blood so that's where we get this panting short breathing which makes it worth get dizzy these early short-term effects of hyperventilation ventilation and all that i mean i the the old yogis were right. I mean breathing is so important and we somehow forgotten to breathe. Maybe it's related needed to our airways became breath your nose of course and you have a lot of allergies. Due to your environment. I mean that will turn you into a person who can only mouth breath breathe and then it's difficult to breathe so the ph of your blood as it is anywhere in the body is key to <hes> you know keeping your blood pressure trillo <hes> <hes> regulating heart rate through breathing and also just a general feeling of happiness and wellness and a lot of top athletes. I mean like when i first heard about mouth taping in the context of and we're gonna talk about what that is but when i first heard about mao taping the context of helping out with sleep apnea where people that were having troubles or certain symptoms come up from not sleeping properly i thought of sort of the history of a lot of the athletes when they work out they would often have some of them would have trainers who would say oh yeah i tell them to like take their mouth when they train because that teaches them they couldn't explain the science awesome at all but there's no they just got better performance smirk longer endurance from these these athletes that were there so there was a whole history of now taping sort of elite athletes and performance <hes> it's the same thing in mountaineering and this has been around before we know how it works but <hes> when you're climbing on high altitude you're lacking oxygen so if you do what's called the pressure of pressure breathing and rest step. It's a combination of resting your limbs so you would pause between each step. Lock your leg but the breathing between is very important. It's designed to help oxygen it your it's really venting c._o. Two it's a person of the lips breathing in your nose pushing it out but that process alone if you're partial pressures are lower like ten fifteen twenty thousand feet <hes> you're able to push more oxygen to your blood which is going to your muscles and which is what you need so we just visualize it for those that are listening when you're talking about people mouth breathing so imagine you're sleeping at night. You're talking somebody who has their mouth open right and it's just breathing through there so now. Let's talk about the sort of solution side of it. Which is you are. Somebody who is a big encourage her of mouth mouth taping so tell us exactly what is mouth taping sounds pretty crazy. Doesn't it l. <hes> you know <hes> it is i do. I presented differently now. I would just tell patients. Listen you gotta mouth taped for these reasons and half of them will take that advice and the ones that do are typically very pleased but the other half just won't do it. <hes> i use it in my practice as a diagnostic tool firstly i want to know the patient can can no sprees and you actually read your nose or resit clogged as does the tape. Stay on the text me back a few days and at the tape stays on all night long and they're peeling it off the morning then i know what i'm dealing with when it comes to treating for sleep apnea and other the other things so but in general that concept mouth taping it's it's a reminder it's not creating this impermeable seal that you know could could frighten people and maybe you know they would stop breathing at night. It's not about that. It's a reminder it is a gentle reminder to keep your lips closed and there are a lot of people out there that can do do that on their own and that's the way it was meant to be when we go to sleep and we're relaxed all the air coming through our nose out of her nose should be enough and there are a lot of advantages of of doing that breathing through your mouth though a lot of us cannot do that but a lot of us because we mouth tape or are better at it and and and what i tell people is that you may not be good at it first breathing through your nose right breath your nose and mouth taping but pushed through at work on it and at some point because you start using her nose again and there's some borderline there are a lot of borderline cases i would say most of us are borderline. <hes> then you know you're pushing warm air past the nasal sinuses again the mucosal there. You're building a bio home nasal biofilm <hes> you are creating a demon <hes> you're going to get less of a historic response when you come across an allergen pollen but it takes time but if we stop using our nose to breathe while we're not getting the nitric oxide were not a production were not getting a filtration humidity of the air <hes> and there's a a a temperature gradient between breathing air in through the nose as opposed to the mouth for the lungs and i would think that we wanna keep that you know i mean at a healthy level right. I mean you don't want to and also we dehydrate more often. We can lose up to lead a water <hes> by mouth breathing. So if you're you're feeling dehydrated i would look at if your mouth is open a lot of course i'm not talking about talking and eating and all that but but at nighttime the mouth should be closed and the tape ape is a great reminder and you're not talking about packing tape or anything that there's actually specific smell at eight not to duct tape right so people who get scared when they first heard idea like oh my gosh like dying. It's not anything like that. It's strong enough to maintain a closure in the mouth but it's weak enough that if you forced to you could just force it off very easily. Even if you were sleeping it would come off in just in so easily with just an opening of the mouth would come off the fundamentally first and foremost i think is just important thing this again is that it's a tool to see. Can you breed the way that we were evolutionary. Evolutionary designed to bring us and if you can't now it's digging a little bit deeper. I had dear friend of mine who <hes> was waking up in the morning which is severe heart palpitations. You'd wake up in the morning. She had severe heart palpitations. There was all the things zaidi she'd text me in the morning sometimes and say like i just feel super anxious just everything that and it's right around that time <hes> my dear friend steven lin semi bunch of resources including some of your resources and other stuff and said great you know because we just just happen to be talking. He's a past guest on the podcast. He said you know you should just really. I overheard you talking about that. We had a conference together. You should really look into this area like does she breathe at night with her mouth open. I know this sounds crazy. 'cause she eats healthy. She's fed everything like that but this severe anxiety it could be that when oxygen is not properly regulated night and she's breathing through her mouth. It basically never lets her nervous system feel like she's fully lee at rest so she's in firefly's. The whole night wakes up and immediately feels this sort of extreme anxiety. Have you heard that example from payoffs impasse. I have many patients that are that way and they do wake up in a panic and their blood pressure's elevated not just from the fighter flight but from the acidosis from from the bloodstream from <hes> mouth breathing means. You're going to store more often. You're pulling a lot more air past the smaller way. If it comes into the knows it's baffled it slows down it's warmed and as it gets pulled past the airway less of it's coming through at that one time and that's less likely to pull it close. That's the newly newly principle essentially <hes> so there. Yes absolutely it's. It's an in a in kids is even more phenomenal a._d._d. The a._d._h._d. <hes> <hes> cavity rates that are just sky high <hes> and they're the ones that are developing and growing so breathing through your mouth while all your faces developing <hes> that's a big deal because that is what you're set with for life in terms of your facial type. If you don't grow properly here for up to age ten the the the box called the box the nasal box the airway box those all tend to be squashed and made to be much smaller so and remember over kids don't develop their sinuses until age four. Can you imagine being mouth reading all those years and then the sinus comes online while it's not gonna feel needed so why develop up to its full potential because the kid is breathing through their mouths. It's almost like them being like a wheelchair not using their legs in their legs develops some some level of atrophy lilies and being used and that's happening from a breathing standpoint right and that continues the rest of their life that can lead to all sorts of challenges as we you're sharing earlier <hes> speaking of kids. We have a mutual friend. Mike muscle was a past guest on this podcast. We talked about kito and other things like that and <hes> recently he shared how you've been a big inspiration by by him deciding to now tape of their daughter yes <hes> and he's been pretty open about that on social media and everything like that so i don't think we're sharing information that he wouldn't wanna be shared but when a parent is thinking about <hes> how to support the muscle of breathing for their child. What are some of the signs that they should be looking for. Is it as simple as hey is. My go into my kid's room at night. <hes> uh-huh bring their mouth breathing through their nose right. That's exactly it. That's the first thing i'll say you have to kind of sneak into your kid's room when they're asleep and and find out whether that mouth is open or closed most parents know it's one of the first things i ask <hes> even before see the child or the oral cavity <hes> i mean there are all site all sorts of signs that the child is mouth breathing other than the fact of seeing their mouth open all the time. I mean you can watch them while they're watching t._v. Or studying <hes> that certainly is is doable. <hes> you know i mean boogers lots of snot coming out of the knows. I mean you know if they can't breathe through their nose if they have allergies all the time that's a dead giveaway. <hes> posture is a big thing. <hes> the difference between nasal breathing and mouth breathing has an effect on on all these cervical bones and <hes> pulling an air for example past <hes> the the the knows. I mean the <unk> glenn the <hes>. The hypothalamus is there. The those organs begins can probably see light that would affect the circadian rhythm of the child is ca the child's spinning in bed. I mean it's it's a lot of it's related to sleep apnea or they snoring <hes> <hes>. It's just one big multifactoral package you have to look at and mouth breathing is part of it but the number one way to do that is exactly what you said. You got a sneak in and sit there so i recommend recommend that parents take their kindle and they're not their phone because that's blue light may wake up the kit and just sit there for fifteen twenty minutes. There's a chair in the room. That's great. If you're leaning up against the back of the bed and you can hear it you don't even have to see it and i would do that often. <hes> now obviously if they have a colt that's a different story but when they're not sick and they don't have a cold make sure your child is is breathing through their nose at all opportune moments that would not be during exercise not if they had a cold and eating and talking and that would be it <hes> mouth breathing is an emergency state. We mouth because we just need to bring in more air. Our normal state is breathing exhaling and inhaling through the nose and when it comes to actually getting tape and let's say with kids keeping down that story line and we want to implement it and start using with them just walk us through that what type of our mouth tapes equal quoted on amazon exactly when they get it so they began and do you have any tips on sort of explaining it to right <hes>. I don't hesitate eight telling parents to mouth tape <hes> but most parents will hesitate mouth taping their children. There's something called vertical taping where you can tape in vertical mode. That were the the sides of the mouth open. <hes> there's a special tape that i recommend which i'll mention <hes> but i do have a lot of patients that tape between the ages of one and a half to age age eight or nine and <hes> the story i like to tell was this one kid who started h two and he had these nightmares and the mother maybe about two years later year and a half later. The mother said johnny you know his name is johnny. <hes> <hes> tell them what you told me and he turned to me and he told me the story it was it was not just a comment was a long story about his dreams were getting better and he loves mouth taping and he gets upset when his mom doesn't have it for him and so i hear a lot of stories like that from improvement of of dreams. I'm not sure how that works but <hes> fewer cavities is a big one. <hes> i have a lot of kids that have a high rate of decay. We've identified that they are mouth breathing and we tell the parents listen you can spend two to three to four thousand dollars fixing just baby teeth <hes> deciduous teeth <hes> which i hesitate to because that's a traumatic experience for child typically <hes> it stressful <hes> or you can just. Let's stop this right now. So there's some diet management <hes> counseling going on but mouth taping is the big one. That is a big big factor in decay. I've seen it firsthand and what's the relationship between cavities and rebounding <hes> or breathing through mouth so <hes> you know the the mouth is this this has this incredible bio dislike the gut right in through exactly it's it's finally online very excited to read about it now and and it's basically just the headwaters of the first stop on this long train line with many stations and a bacteria in the mouth of course a little different than the gut but <hes> you know there's a sensitive population of bacteria in the mouth and one of the things that will turn it into a despotic kind of environment in which you've heard that term before the gut it can happen in the mouth. <hes> there are many ways of doing that. One of the major ways is by just as in the gut is by changing the ph when when you mouth breathe in your mouth becomes dry the saliva is not present the ph drops that is easily measurable measured we we've known this for a long time but what it does in the mouth is it allows the decay rate increase for a variety of reasons. It's like a slap in the buffering of the saliva but the slava has phosphorus in it and calcium and and hydroxy appetite it has all these ingredients that are required to keep the tooth remain realizing faster than it's demoralizing ether like bones. They just have a shiny outer her shell but they are dynamic. They're always changing and a few nights of a few weeks of very dry mouth. <hes> that equilibrium wool switchover to the demonization side and then you'll start seeing the decays that the decay and the curious lesions forming on the teeth and no dentist no parent parents should ever underestimate what that's going to cost you in terms of just just talking about cavities not about airway development or facial development just that alone it's great expand span on that story because the just the traditional story that we all grew up is all cavities is sugar <hes> and i can remember even a few friends of mine that our parents like listen my kid doesn't eat any sugar and all and they saw these cavities and being perplexed and where's it coming from and so it's great to include this component to see. Is it part harder piece of the puzzle. That's going that's going on. Your diet is definitely number two but i have a lot of patients a lot of patients. That have a really good diet. <hes> uh parents in my area of where practice you know they're doing paleo and all that but they still have to k- and that's because they're breathing through their mouth or mouth is bone dry from <hes> <hes> maybe midnight one o'clock on could also be some missing key nutrients which will talk about in a little bit. Let's <hes> let's continue down that path so so let's say now. You've taped the mouth of either yourself. Your spouse would recommend that by the way don't ever tape your partner's mouth. It's it's so you you should taper off. Mouthwash tape your own mouth. They get excited. They want to try it. They can do it on their own absolutely but you can let them. Do you ever suggest that couples you know noticed or checking checking on each other. If they're breathing through there usually they already know sleep. Partner reports are very important. <hes> and the problem is with mary couples. You'll get a lot of disagreement like i. I don't snore but you snore and it goes by so i have to. I take that with a you know a very work on yourself very soccer right and then do whatever you wanna do. That's where we start mentioning the the phone apps and sleeping alone room for a few nights and getting some good data right so you've taped your mouth now is that it you know is mouth taping now the end all be all of building back that muscle up or do sometimes people have to look deeper root issues that are going on that are chronically. Gli keeping them from breathing right who they're a really good question because i mean that's not it. That's not the end of it for some people can be but <hes> for example if you have a tongue tie if you start right there because a lot of people especially parents. I don't think they even know what it's a tongue. Explain tong tight right. Well turns out our little granddaughter of eighteen months. Now had a tie and the hospital snipped it. You know they do a little quick. Procedure takes <music> all of thirty seconds and tongue tied literally is what's. It's a mid line defect. It's tissue that is along the mid line and it was supposed to do in utero following was supposed to necrosis away so that it's redundant tissue and the tissue underneath the tongue and it's like a little little it's like a string or like a rope that <hes> very thin of college and freedom and it's pulling the tongue down it pulls the tongue down in a certain position it can pull it from the back it can pull it down or can prevent issue from sticking it out moving around essentially if it is held in place there are positions of the tongue coral posture now that are her that we need to see in deep sleep because if we don't if we can't let the tongue move forward and spread out and push upwards than the airway could be block because then it's going to go in that direction so that little tie-down is very important and there's more awareness of it now. There's a whole group generation of people that unless if there wasn't that awareness in the past as much as there is now i would say yes that's true. There's a lot of people that are adults who are walking around with a very strong tongue-tied. Yes i know i know a lot of them and you know the question to them is and they asked me. Should i do it as an adult and and i i would say yes for optimal sleeping. They have asleep issue. I will refer them out for tongue-tied surgery and it's very simple operation is typically as if it's a posterior tongue tie could be a little bit more difficult than with lasers now <hes> it's. It's a compared to <hes> sleep apnea surgeries <hes> it is much easier. It is a ten fifteen twenty minute procedure. It's outpatient shen. It's usually done with local anesthesia so and there's a healing period but it's it's. It's very doable because there's traditionally in dentistry and in medicine there was this focus on like oh does. The patient have like a deviated septum. This is it that and there was all these very complicated or if somebody suffering bring with like a deep sinus issue but some of that stuff can be influenced heavily by just how he breathed this and this is a lot simple of an operation. Obviously they have to see if if somebody they can literally go to the mirror ordinance show somebody else probably hard to see your own dose and somebody trained. Yes i mean you can go on youtube. You can go to image views and you can see lots of great photo some tongue tie and if you have good lighting a flashlight and you look in the mirror you won't be able to tell hell to what degree the tongue tie is with state. It's end but you'll you'll be able to know but you know when across your dentist he'll be able to diagnosed for you and refer to the right people so only question is if they're trained he or she in whether or not that's affecting their sleep. Yes yes might say well. You have a tongue tie but if you're fine and you're right it's no big deal right and that's not a good place to to go especially. If you have a sleep disordered breathing issues need to find somebody who's trained in yesen condition diaz and talk about resources and how to get there so that's a tongue ties is is one component sometimes it's how jaws shaped and you mentioned earlier <hes> something called a dental device <hes> but let's talk about what that is and when you typically he would bring that infrared so that's for someone like myself that <hes> has a class to classification. That's a slightly retreated chen and you know where the chin tongo that's. Let's were what it goes back onto the airway and people that have developed that way <hes> whether it's through like breastfeeding or mouth breathing as a kid could also just be crazy orthodontics improperly done orthodontics i mean there are many ways to get there but it doesn't matter because if that happens i mean the the jawbone all bone itself in the tongue or quite heavy when you lie back and recline and the muscles disengage from holding that in place that's a lot of tissue that can sit on the doc in the airway the nasal ferrings nearly pushing up and closing exactly or it's getting very close to where when that muscle the back of the news of eric's the post your region of it starts it's collapsing and the tongue is loose and if you have a dry mouth all those tissues back there get become very dry too and when they're dry they tend to stick together if they're moist they get they pull away from each other more likely so that's another kind of concern with dry mouth but <hes> <hes> i mean that that is a simple way of doing it doesn't work on everyone but if the if you can and there's a way to preview this it's called the miller's maneuver while looking at what mandela advancement it does its little nasal endoscopy that goes into the nose i i've actually worked with an e._n._t. That that i kind of had tell him what to do and and he was glad to do it and i sent him some research and some studies on it but it was not in his typical specialty training and he's one of the few guys that can do it and he can literally from the top see the opening of the nasal ferrings is the farrington the folks will narrow as it goes down to the sophists and all that but if that opening wide and if you do this to the aw let listening you're pushing your job back exactly right <hes> then if they see the tongue push back into that space and that patient may be a very good candidate candidate for nor appliance because the plan simply prevents that from happening so as you lie down not only does it prevent it from falling back up against the back of the throat but it actually progress. It'll be over time we adjusted so we can actually push the jaw out <hes> now. If you have a tongue tied you can't breath your nose. I mean these are all things factors in the same that are factored into into the equation but if all that is good than these devices can help and friend of mine who's listening who's like a mouse taping and dental devices and all these things i mean when did life get get so complicated and it's really if we zoom out and remind everyone we are sort of making up for the fact that our facial structure has changed inch because our diet are lifestyle. How we are brought up <hes> has changed more in the last you know two hundred three three hundred years caesarians caesarean sections <hes> and all the different chemicals and foods that we eat that change the oral microbiome and that has left us in a place where we are not really how we originally designed so even our body is fundamentally built on the fact that we were designed to breathe through our nose as one component were sort of trying to figure out how to just get our by to do what it was doing naturally so that's we're all these tools and devices come in because the flip side is if you have severe issues with your sleep anybody who's list podcast knows were huge fan asleep. We didn't entire show with shawn on stevenson just a couple of ago when you don't have proper sleep it increases your risk of obesity and and so many of the challenge that are there we talked about alzheimer's alzheimer's and so you're somebody who thinks that your sleep is being affected or you have these other symptoms that are associated with poor sleep. This is the time to take this topic topic quite seriously because it could be the answer when you're searching out there for the right supplement or this change this other thing could be as fundamentalist fixing sleep right and that's why argue that we everyone should get a sleep study. You know at age five <hes> sooner. If you are showing symptoms at age ten we need a quick easy the alternative to measure our sleep even nightly would be nice and i've worked with different companies on that but <hes> the p._s. G which is the gold standard the police and mcgrath. That's where you go into clinically. Worry you up. You sleep in someone else's bed. You have your own room that still the gold standard but we need something besides that because it's not really available the insurance companies push back on it even a primary care physicians push back on it. They're they're actually incentivized not to do too. Many diagnostic tests and this is a good one to push back on if your patients since then and healthiness not complaining of being tired or tiredness or napping and then then that person doesn't need the sleep study. Do you have a you have a practice <hes> up up in the bay <hes> and you have a lot of patients who you've worked with to sort of help them navigate that <hes> so for those listening her like you know what i really do need a sleep study any any pointers you can give to them to navigating the medical system especially if they're not a typical candidate who would be <hes> typical candidate for sleep apnea nia overweight older male what are some key things that they can bring in besides asking nicely to their doctor to get a sleep study need to happen. I'm asking nicely. Your physician doesn't always work so let me tell you my story quickly <hes> <hes> i was very healthy very fed. I mean i would summit fourteen fifteen thousand peaks. I would ski down them. I would mountain bike for six hours straight. <hes> i still do some of that <hes> but <hes> and so i felt very very fit and then one day we dropped my oldest off to college. We are all in the same room. It had been awhile in the hotel room of course and i live at my daughter's woke me up the next morning. Glad you're just like a freight train. What's going on and that was mine. Winky wright well they could wake me up but i was tired and i was snoring and <hes> they couldn't sleep sleep so it turns out was actually my wife who was doing most of the storing so we both realized at that point in time and we're both medical professionals <hes> <hes> who would have thought right <hes> <hes> that there was a problem and the next morning we're having you know or free continental breakfast and which wasn't much much choice there but and this older man he had overheard us talking about it and he pulled aside this older gentleman no medical brown and said listen you gotta get a c. Pap you gotta get on this right away and i have to hand it to that guy because we did do that and we we did it but we then discovered how difficult it was and again. We're seasoned professionals my wife's and our n cheese and biotech biomed. I'm i'm a dentist. <hes> we do see. We have good physicians. It became a very difficult process. We felt like we weren't getting the information that we needed to make the right decisions and and through the web was there of course but there really wasn't a very organized clean concise way of dealing with this and remember these people like my wife and i we're tired. The these patients are tired. They don't know where to go and the advice that they were getting was from each singular. <hes> you know a specialty the primary care physician would let's say you're probably fine. Maybe you're depressed. Maybe you should take a psychotropic drug. <hes> you know pull pull down the blinds. Make sure your room is dark. You know that kind of stuff <hes> and then if you enter in t- <hes> i refer a lot to tease a lot of them will say well listen. <hes> the adenoids tonsils leave men. They'll get better over time but the if the patient can't breathe pass them <unk> narrowing the airway so there's a lot of pushback i talked earlier about the cost of it the insurance companies not liking it and the incentivize device medical doctors that are pushing back on diagnostics the cost of diagnostic so so we'd navigate it this whole system and that's really the genesis of y wrote that book my daughter said dad. You know you've learned a lot. Let's get that out to to our readers and and she was absolutely right so so in that book i am in my ted talk. I just i just trying keep it very simple and concise and still to this day. If they haven't read the book i get people they're very confused are being given different information from different specialties <hes> even from other other dentists and and so it's it is it's a difficult system to navigate. I'm not saying it's that way on purpose. It's just there's so many factors in diagnosing and treating and then verifying <hes> sleep that <hes> it's really it would be nice that there was a one stop shop for that kinda nothing and <hes> reading the book will help <hes> the stuff on the internet about it <hes> i would tell people don't get discouraged and you know maybe your dentist has a solution may be they can unsturdy through it and a lot of dennis now are being trained in this and they can simplify this <hes>. I'm actually you. Dennis are not allowed to diagnose sepia that is in the realm of medicine and that's fine are part of it is early screening for it. <hes> and we're happy to do that and we're good at it <hes> but when it comes to treatment we do our oral appliances. That's <music> a after a prescriptions been written by the physician and that sometimes in conjunction with the c. pap pap but i wouldn't hesitate to ask your dentist. Your dentist may have some answers for you. The thing that i am i talked about this before is i'm looking for this quick not quick but very accurate at home study that costs very a little money 'cause when i- titrate my vice my early clients i need data from that i need data from every night sleep and where that best position is for the mandible and i also need need to know for my sleep and for my wife sleep. I need to verify my ability to sleep properly because the devices are in place but if you gain weight as you age as you get older if you're a woman if you have menopause when you get menopause all these things will change your sleep so this is something we need to be checking in at least i mean daily nightly would be nice and i don't want to sound onto obsessive about that but you know we have lots of devices that can do that <hes> but at least yearly i would definitely check in with your sleep and make sure ask yourself the question. Am i getting deep sleep and kim fynt can individuals just pay out of pocket to go get a sleep study yeah yes. That's a that's getting a little bit of resistance out there. <hes> you can look gop sleep center nearby and you can choose to just go down that row right <hes> democracy how much they cost do i have set up a relationship for that interesting that you brought that up <hes> for that reason i work in live in a very affluent area and there are a lot of people that you know don't even wanna try to go through the system. They just want to sleep study. You're right away and that's fine. I have a conduit to a sleep lab that i can actually refer patients to <hes> and the cash prices thousand dollars as opposed to a p._s. G which is can be twenty five to forty five hundred dollars unless you wanna have it at the ritz carlton which is available. I don't know what that cost but that's expensive love but ultimately you know this is something that as we raise more awareness because not everybody has those resources not everybody is in a privileged position to be able to pay out of pocket doc it go do it just raising awareness morton and have you even had patients take your book in suggest if they're dentists is open minded <hes> in reading a little bit yes and kind of dig into it yes and that book's been given to a lot of dentists and that's very gratifying to hear but there's plenty of resources out there for dennis now and they are they. We are in the american academy of dental. Medicine is my favourite and that's where i learned most of what i know about sleep apnea and that's a fantastic resource and if somebody's looking for a dentist that can help them with this. Can they go on their website. They have database soccer david database by zip code and radius and it works quite well so <hes> you know i always love stories. You know there. Is there a patient of yours. <hes> we think about when they started implementing these things and really focusing focusing on it just the cascading effects. Is there anybody that comes to mind a story at testimonial that you wouldn't mind sharing with the listeners here of just what's possible when we really dialing are sleep my fixing these corn without a lot of stories and to. I don't wanna sound redundant. I've said it <hes> before <hes>. I'll give you a few real quickly. One is the woman who had the strength to leave. Her husband was a domestic abuse issue because she we helped her get her sleep. In order she she had an h. i. of thirty nine thirty nine interruptions per per hour and it was about appear of twelve months where she came in and we were all in tears whereas but she finally announces she was able to leave her husband. She was had gained the courage to do it. She was too anxious and too afraid and and wasn't feeling well. <hes> <hes> <hes> another i have is this young man who came in as a new patient jumped in the chair. I was marveling at his perfect bone structure and teeth eighth no crowding room for the wisdom teeth or future room for the wisdom teeth great airway <hes> knowing zayed at all <hes> after the exam <hes> <hes> he ran his mother jumped into her lap pulled off her sweater and latched on he was about five years old. He was still on the breast. <hes> was a patient. I'm from a african country and <hes> i mean i. I'd never seen anything like that. I didn't know that it was going to happen and then of course i made that correlation. It's like well. Of course i mean they weren't eating emigrated. They weren't eating a western diet. I mean i mean western price but just <hes> talked about that in the nineteen hundreds early seventeen hundreds so just unpack that one because i think a lot of people who are not familiar with that. They don't know if you're saying that. Is that a good thing. It's a great thing it's a great thing. I'm not sure it was a good thing for mom but she didn't seem to mind but a lot of sort of other societies kids might breastfeed for a lot longer <hes> they may breastfeed for a lot longer longer like four five years old because of their off the breast they're living in nutritional poverty and so it's a great thing because because he had breastfed longer he his bone structure was it was in fact i didn't even at at first. It was an anomaly to me. It's like you know what is is the the two barassie wet the width between the two upper second molars and the the horseshoe shape of the arch and and the room for the tongue. I mean the time when it rested just fell away. It was below the plane of inclusion but heath were pearly white. I mean it was it was an amazing thing i i it really threw me at. This was many years ago but to it but to talk about it. A little further is not here. Advocating people breastfeed to that level not possible never say that to a woman absolutely not no is not possible in modern society eddie and there's all sorts of like socio aspects. It could have been his diet as well. It could have been the way was i mean living in another country outside of the u._s. I mean there are other factors so the factor yes but but that seems like the breastfeeding is the one that made me think wow now i get it. It's a different kind of upbringing. Rights different of that was the kind of a kind of a tipping point like that. That's you know i'm sure he was born badgley. I mean the old fashioned way <hes> floor i in the right no flora in the water lots of bio everywhere yeah it was it was a formative moment for me. Let's touch on a couple of the topics here on just overall dental dental health oral health or microbiome because we stay focused on the sleep apnea and sleep component and mao taping keeping and some of the root factors that cause it and the problems with it but that's not the only thing out there when it comes to dental health and oral health what what are some other big things when you talk about dentists looking upstream and being able to see things that will come down the road ten twenty years down the line line. We talked about sleep apnea and how that could lead to a whole host of things. What are some other components that when you catch them earlier like this is an address. This could be a major major issue for the patient. The big one is gum disease pair. Donald aziz and let's talk about that. When you talk about gum disease what's what's the definition ride souls ooh that the mouth is unique and that it has these bony like protrusion is coming through this protective barrier the the mouth is very similar to the gut. It has a stratified layer. It's got a lot of mucus. It's a little thicker but it has also permeable like the gut is it is it is the beginning of the gut but since it opens and there's a lot of trauma of you know like tortilla chips and sharp things and hard crusty foods and and it the mouth can dry <hes> <hes> it it it it it it needs a slightly tougher kind of nature to it so it's pulling in a lot of air we use it to speak and to smile and helps with mating and and it helps pickup biomass we traveled through the vaginal <hes> you know through our mothers <hes> birth canal i mean they're the mouth is very unique in that way bud cut its most unique aspect is through that barrier think of in your test in seattle tooth poking through that would be very difficult to maintain from being permeable poland from allowing bacteria from the outside to get inside and in fact it is a very <hes> very vulnerable. <hes> kind of barrier or it is a barrier barrier so as a teeth come through this thick layer of mikasa <hes> we need to prevent the bacteria in the mouth from getting inside the body and it does a pretty good job until certain things happen in that is essentially what gum disease is. It's a breakdown of that barrier and the immune system in in that area. It's very attentive very <unk> a proactive <hes> it even becomes more so and i would classify gum disease actually as an autoimmune disease <hes> i really do believe that's where we're going doing with gum disease <hes> and at that to all the other autoimmune diseases these of the diseases that seven or ten a seven or six or seven of us out of ten die of and live with so again if this disease diseases very invisible beginning you know your gums don't necessarily bleed. There's no sign of it. There's no gummer session <hes> dennis measure pockets by depth in millimeters <hes> and we start at at age five or six and we get good baseline readings in those pockets that they start getting deeper. The collagen is breaking down. The body is attacking itself. <hes> it is <hes> like cytokines <hes> they're pro inflammatory cytokines they they're released in in response to an inflammatory in salter actually an invasion of bacteria and then the inflammation formation comes and that's how it works with it but there are some cytokines that actually attack parts of the body that we need and that's that little collagen layer of those little fibers that keep keep that girdle of tissue around that protruding tooth and preventing that seal from breaking and that seal is crucial to when it comes to alzheimer's. That's the the big news recently in a study out of san francisco in japan <hes> that if those bacteria get through they can enter the bloodstream and actually pass across the blood brain barrier but can also enter your spinal fluid so that now could be a causative agent in alzheimer's <hes> and that's something that sixty. I may be seventy percent of us. Having this country is ginger vitus or different stages appeared on titus that is an endemic inflammatory disease that a a lot of us. The majority of us are getting and if it contributes in that way to systemic diseases that can contribute to diabetes insulin resistance <hes> and other things too as well <hes> and sudden-death. I mean factory mia's heart infections heart muscle stuff <hes> that's a pretty serious thing so <hes> and mouth breath breathing of course contributes to that i had for throw that in exceleron accelerate because the by on changes because everything's dry the p._h. Dropped and that's just gonna make things worse. I'm not sure which comes i again. It's multifactorial but so gum disease is a big one and i think it's very important <hes> take home message for that is make sure you never get gum disease. It's very difficult to to solve. Its we arrested essentially backwards tough to go backwards. Yes it is and so it's prevention is key and are there other factors that make us more likely to have gum disease at our ancestors have that that prevalence of gum disease there there are no signs of that <hes> so it is probably diet related it could be environmentally related could be the chemicals and and the inability to build breathe through our noses and it could even be related to sleep apnea because that sleep apnea can affect the immune system but it is definitely tied to the oral microbiome and even the gut microbiome we talked about mao taping and we've talked a lot about diet and importance of certain <hes> foods in the podcast for and you know what that diet looks like and how to personalize it and what inflammatory foods are that are out there what what are some so those are the two big pillars that can contribute to a gum disease <hes> let's talk about like some other ones that are out there that not only can contribute gum mm disease but can have other challenges so let's talk about water and the water that people drink right from home and the other products sort of environmental until factors and erotics that we use mouthwash u._p. Suisse first start off with water. Most of the water in this country is treated <hes> and then it goes through a whole system of pipes some which have not been replaced in years so they can have lead contamination and other things have metals flint michigan and michigan erin brockovich even friend of ours ars and been part of our broken docu series. She says there's you know three hundred four hundred flint's that are happening around just haven't been discovered if not more not more. Maybe maybe not at that full severity but are on their way over so water. Let's let's start off with water and the way that it's treated in what you recommend your patience well also also when catherine was born my oldest <hes> she's thirty now so that was thirty thirty one years ago we <hes> one thing i wanna do is get the fluoride out of my water and the only thing thing at that at that time was <hes> distillation distillation distilling water. We bought a distiller. It was an expensive item and all our kids were raised on distilled water. I didn't want my kids to unjust floyd actually have type one fluorosis. I grew up in san francisco. There was fluoridated water and a little white spots on my teeth which is the first sign of fluorosis too much fluoride in the teeth and just one question when you were doing the distilled water realizing it and yeah. I wasn't too worried about that. I mean it's easy to remain realize but if i didn't get minerals from other sources i mean if you eat a good diet. You're getting tons of minerals. <hes> <hes> you can also add trace elements and mason minerals likely right. Yes the now it's a lot. There's a lot more. Do you recommend reverse osmosis reverse. Osmosis seems to work well yes to get out fluoride and other heavy metals and other aspects still like a distilling water because that's pretty pure i mean once it evaporates some reforms in the container. That's pure rainwater. That's pretty good garden and so that was one thing that you did on that. Let's touch on a touch on a different topic and you recommend pretty much for all of your patients who have filtered water. Yes oh absolutely that's it's a must i won't go to a friend's house their tap water unless i know how they're filtering <hes> we have friends that live on lake tahoe and they drink the water from from the lake. It's untreated <hes> we drink. We have a place up in tahoe that gets spring water from an a. Aquifer and we see the reports. It's not chlorinated. I still will filter that water. I think you have to be very careful. I mean with water. Water is very important. We drink a lot of it. <hes> there's a lot of water n._s. Were made up of a lot of h. Two hello and <hes> it better be the as clean as possible and our water supplies very contaminated. I mean don't don't listen to the government and <hes> it's not a conspiracy. Of course it is the fact that they're overwhelmed. They have to add chlorine and when you do things on on large scales. There are some compromises vices. It's that simple and even if they're testing the water treatment plant. They're not looking implications like this building that we're in right now that her office in santa monica it was built in nineteen eleven right and we used to share an office space with dear friend of ours <hes> next door before he moved into this bigger space and he kept on saying you know my stomach feels weird. Something's going on. That's where stuff finally some party members asked him. <hes> do you like are you drinking. The water here or is again the morning i went to fill up because we didn't have the water system installed yet right right and he would like do this. Building is so old for probably getting all sorts of things he got. He stopped drinking the water from the burning. His cut issues went away. Now we filtered water. There's tons of great filters that are out there. Erkki system aqua true is water filter. We offer. I commend zero. Slaughterers goes yes expensive. Yes you've been bothering. You have to be careful with bottle. Answers not bottled water micro-plastics no so yeah there's <hes> zeno estrogens that are inside of it that can confuse the body body also an n._c._a._a. Free is ridiculous. It's onto the regulus. That's not the answer environment right and also there are things called over defeats. I think that's the term where a municipal water supply will add too much fluoride and warning goes out but by the time the warning goes out the kids have had too much fluoride and that gets incorporated toll your <hes> calcified tissues including teeth the waters the first fundamental statin have clean water in your home. Yes let's go to products that people use the first obvious one. Let's talk about toothpaste jump right so people grew up they thought florida's great and there's even still the stance american dental association's affluence cool. Yes i just talk brief for well. <hes> so many dennis would disagree with me. Although there is a growing concern and there are new studies <hes> <hes> on <hes> you know <hes> what it does to the brain health of your child if you ingest floor two ways of getting forward ingesting the fluoride through water ingestion and that going into the blood let's remain going into teeth or forming and bones that are forming and then there's topple topical application of fluoride and we have fluoride toothpaste. It's not a at a very strong level <hes> <music>. I think it was mostly a marketing ploy that when the fluoride was added to the water and florida was the big deal in the sixties and the toothpaste company said listen. We've got an are toothpastes well one more reason to buy it so but <hes> i would be very wary of fluoride. I had been as you just heard for thirty plus years and my kids don't have <hes> fluorosis and they don't have any kathies <hes> they had a good diet not a perfect diet and it's possible <hes> the the fluoride solution is is a kind of a mass kind of approach to large communities that don't have access to good diet or can't afford a good diet i mean that dental handle care or regular dental care exactly and or any three of those and and that's to me is not a good solution that doesn't address root cause issues and it misleads us over time for me back then i have more data now and i would recommend viewers <hes> going to the floride action network <hes> that is a great group of p._h._d.'s and physicians that are gathering all the data against <hes> of to a ensuing actually the government on flora for dacian and so far. Everything's going very well. <hes> the lawsuit has jumped a few courts and moving upstream so <hes> the fluoride i would be wary and and my argument thirty years ago was it was a lesser of two evils. If any one of those things that i had heard about that floor could do like you know hip fractures and and luring the child's i q and all that if any if any of that was true i would feel bad because by taking out the fluoride i was risking only a few cafes and of course that was dentist could fix that but i don't want my kids to have cavities i would want any ca dabney cavities but when you weigh those two things i think have risking a few cavities is it's something you can sleep at night and long-term exposure floride is can have brain health implications and we just don't know right now we do. We do know a lot. <hes> i mean there are a lot of european <hes> water supplies that have not gone for dacian or reverse therefore dacian <hes> is the same story with chlorine chlorinated water supplies so the bromine that they add now <hes> the nation seems to be big in europe an- an- in australia as well so not everyone's florida eating the water and the americans are big on on that some other countries are but there are a lot of countries that are not and <hes> i think the jury is out as to the efficacy of fluoride and i think the jury on what it can do to you when the risks of too much fluoride or any floyd ingestion is mounting a great page on asked the dentist i i shared actually on my instagram this morning. <hes> 'cause. I always have friends asking me. <hes> people always love practical stuff. I know there's a couple of companies that you're a fan of when it comes to toothpaste instead of going down the route of colgate fluoride alright and everything like that and what are some to pacer out there that you do like right well. I mean it's our fault. Dennis have been promoting these he's carpet bombing type of toothpaste with emulsifiers and chemicals and pesticides and soaps and ingredients that have nothing to do with oral health are have everything to do with making big batch defaced and marketing right exactly <hes> so there are plenty of toothpastes author now the the choice back when i was a young man that was it was very few. Maybe four or five different types of toothpastes now you could probably pick from over one hundred and that's wonderful <hes> i love. I love earth paced. <hes> i like <hes>. I'm not a big fan of minty flavors of but they have a citrus flavor radius. I was using radius toothpaste this morning. <hes> and and to face isn't that important. If you're eating a good diet i mean you can use very little of it and you can skip it. Sometimes <hes> the brushing influencing probably the most important things if you have a a diet that's danger teeth may have to use the toothpaste that slightly more abrasive <hes> those alternatives. I just mentioned have versions of whitening. Jason's makes a good product. Dr bronner's makes a good product. These are very natural toothpastes but they're probably being made in smaller batches and that's how they're able to to make it with safer ingredients so there are lots of alternatives other now now mouthwash mouthwash nothing to say don't like it <hes> even a bad mouthwashes terrible. Even good mouthwashes a waste of time it. It just doesn't do anything <hes> it's not. It's not active enough. It's like you could rinse with saltwater and it would be it would have to sell her baking soda right yeah and we'd be better for you and we preserve the we're all microbiome exactly well. Let's look the reason that people often use mouthwash which we were talking about last night. <hes> people have issues with bad breath. What's the root issues of bad brats bios <hes> mm-hmm clearly. It's a despite office and it could be g._i. Issues as well but <hes> it's it's not mouthwash can be a harmful. It is more harmful than it doesn't good as not addressing the root issue exactly it's not addressing the root issue and is sasha masking everything that is wrong in your mouth and it masks except for ten fifteen minutes and i have patients that i know of that used to <hes> think of gotten to them by now they used to rent with <hes> listerine on top of the hour at work it was it was a you know or scope these in the bathroom and one guy even had a little what's that little whiskey flask and it wasn't whisky it was <hes> any wasn't swallowing and he was an alcoholic hollick. He was swishing that every every hour on top of the hour at work he felt that was the best way to get along with his co workers and that that is the biggest band-aid <hes> ever mouthwashes a waste of time. Don't don't invest in. It's better not to use anything and work on brushing glossing and eating well and working on on your oral microbial and to look maybe deeper at some gut despite osas mouthwash mouth <unk> back breath could be a sign that there's <hes> candida could be also some other good issues. You know think about doing a gut protocol working with a functional mass doctor and i was really getting into your gut health if there's some severe issues with that absolutely i want to go back to your book and sleep and then you for touching on those those are always topics that people ask you about what should i be using using toothbrushes teigen whitening and and we're happy to talk about let's let's let's touch on that because one other part of gum disease and oral microbiomes people brush two hundred <hes> mhm so let's let's come back to that and say you know why are people brushing so hard and and why are you such a big fan of some of the new companies that are out there like electric brushes out there even one that you did some work with a little bit. I have no problem pro plugging because they're a great company but let's talk about rushing hard. I just wanna wanna share little personal anecdote. <hes> i've had my personal dentist dr rosetta russian on the podcasts and ford and just realizing that she was like oh oh yeah you're right handed and you like when i first met her like oh yeah you're right hand and you brush too hard and i'm like oh wait. How do you know she. If you've gone recession on your side and you just you know do that. Sawing emotion and brushing too hard you gotta chill the bio mechanics of it and it's very observant of her to notice that because there is a difference between right and left handed right. You're going to be a bigger bigger risk of montgomery session. Indeed sensitivity immediately graft yasha graft wrote all sorts of other challenges there so <hes> just talk a little bit about brushing too hard so it's it's how we brush. I mean if you watch any typical movie and an actor is rushing. You'll see the sawing motion. You'll see that they you know all the t._v. As we've been brainwashed to put all this toothpaste based on our toothpaste a on toothbrush the other factor is how often you replace your toothbrush head. <hes> those nylon bristles are polished and end rounded. It's a it's a process process they call and rounding and they're smooth out of the factory but after a while you're taking nylon up against an animal enamel star harder surface you're wearing down the nylon. The nylon becomes very abrasive so <hes> you really need to replace your toothbrush. I would say every month every month. Yeah i mean you know. The standard seems to be three three months now but for a long time we weren't discussing anything it was it was when the little blue indicator would go down to a certain point or when you're bristles were angled outwards <hes> i would just be on the safe side. Take your teeth. That's the last set you're gonna get it and don't over brush and don't brush with a very warrant toothbrush and there there are companies that will send you a toothbrush head off automatically and that's wonderful. There's one that you are associated with quip. Yeah granted solution for a lot of people that are absolutely small portable. Don't over think your toothbrush but be careful foale in how you brush and how often your place your head's that's the key. I think their toothbrushes great. I'm not sure about the toothpaste but you've a bunch of other options but it's okay. I want to go back to your book. Since at your book you have a three step program for improving sleep and overall health and you're in for the eight hour sleep paradox and people looking at that would love to just cover for those three steps because i know we've kind of already covered it in some of the things here but just as a recap concern import is so important and i wish i had had this knowledge in my my journey through treating my sleep apnea would have been much easier but the first the first step in it's probably the most important step is to recognize that it could be you know a lot of patients that are still telling me they don't have sleep apnea but i know they do and <hes> that's difficult and typically men. Women are our best patients and they when a doctor says something to them. They will say you know what i'm going to look into that and get tested almost like weird pride that sometimes we'll have when it comes to sleep like what are you gonna. Tell me about sleep like i know how to see exactly right and you don't wanna knit or something is off. I noticed that a few towns well sleep is innate but it's not guaranteed and we all think were good sleepers sleepers and being able to notice in when we come from being children we sleep like babies most of the time and and then you know for sleep changes a little bit those changes angels are so small plus were not conscious while we're not there to be able to analyze her own sleep. You cannot verify your own sleep. I keep saying that to people you cannot be the decider of who tells you whether i mean you can't be that person. I sleep well. I don't sleep well. I was that person. I felt i slept well. Obviously i didn't it was was have having twelve interruptions per hour so that is that first step is the the diagnosis part of the of the of the of the three steps and that is is that before you get a diagnosis you have to be willing to get the diagnosis. You have to be open to the fact that you may have sleep apnea. Your father may be snoring. Mother may be storing. They may have high blood pressure sure or simply. Just wake up with dry mouth exactly where you're up at night right or your napping or you're getting up and going to the bathroom. That is a co morbidity of sleep apnea. We're we're designed to go to sleep and wake up and feel there are morning. People are evening people but you're designed to wake up in the morning and field rest ride vested in exactly in my case. I was very good at going to bed late. I get that second wind was a night owl. I could stay up to one or two. Am get a lot of work done. Get up the next morning at six or seven but i was burning the candle at both ends in my adrenal glands were due picking up all the pieces and you can only do that for so long but if i had known earlier that that was happening i would have gone better earlier would solve my airway issue and and i would have do what i do now and i would just get up without an alarm. The best time to set an alarm is when you go to sleep. Make sure you go to bed at the exact same time every night. Typically that will solve a lot of problems uh-huh sleep hygiene sleep hygiene. That's the number one sleep hygiene tip. I can give his just set that alarm mindset at ten <hes> my own ring will remind me as well <hes> there are a lot of apps that can do that <hes> and <hes> and also give in to that tired feeling but if you're napping <hes> i my wife was very proud of the fact that she you could sleep on trains and planes and she traveled a lot earlier in our career and and she could sleep in a matter of minutes anywhere <hes> at the dentist getting a haircut that is sleep latency and that is a severe issue. That has nothing to be proud of. It should one of the one of the things i there's one thing. I didn't like about three months. Sleep apnea now takes about twelve minutes to get to sleep but that's normal that is sleep latency. That's how long it takes you wind down and free to get into that first stage that i five percent and one stage <hes>. It's interesting interesting because i've always fallen asleep very quickly. <hes> i have both done mouth taping and nandan mile taping and i haven't seen an extreme difference difference my sister's doing it right now to and <hes>. I think you guys even send her. Some melted rueda. Thank you so much for that and <hes> she's noticing a big difference for herself. Self right <hes>. I did have a shift in my dental structure and i started having a lot of t._m. J. biting my tongue allotted sleeping at the same time time my dentist recommended that i go in and visit line <hes> to my bike to fix my bike that was showing up 'cause my tongue was kind of pushing out on my right and for the first time i would have dry mouth but since i've been on invisible line that's kind of gone away alert wrote right. I think it's helped a lot with his long can't help in those areas definitely right. It's almost like mouth guarding away ver- for that <hes> but i do wake up in the morning rested but you're saying there could be some sleep issue there hospital because you only know what no i mean your baseline. What is your baseline for me. What's the answer. Should i go do a study reduced study. Okay absolutely everyone needs to get that study though <hes> that that we will pick things up on that study and even if it's a perfect a sleep study then at least you have a baseline because your sleep will degrade over time it would be nice to know oh exactly how long your brain is in delta wave sleep for that's an important thing that is the most important stage asleep and it would be nice to know what that number is. That's an important number of the aura ring and other testers. They the the extrapolate from the data. I'm not sure how accurate it is but i can use it from day to day to compare one day to another one night to another but to know that is is key. If we know what happens in delta wave the liver of the brain everything's fixing itself wellness <hes> happiness you know fitness no cravings ravings for crazy foods during the day the villain and leptin hormones and all that <hes> being affected all of that if we could just know and have that peace of mind that we are we are getting sleep and you have really nothing to worry about why not know that the hamburger and that's a great recommendation. I wanna toss it. We were going through the three kind of talk about the price one before you that i wanna toss in two of the things that i've seen have made a huge impact on my sleep. We talked a little bit about it with shawn stevenson when he was on the podcast anybody interested it can go snap beside bodley's episodes work harmoniously because we didn't really talk about sleep apnea in him and our dental health and everything this is really something that you've been a big champion and advocate for for wanna. Thank you for your work in space. You really raising a lot of awareness so <hes> temperature played a huge role i <hes> i know that when my room mm-hmm isn't cooled down and or when i don't use <hes> why am i blanking on the device that i use bad better slips underneath them after not not that it there's there's jet which i tried for a little bit but i get something a little bit more cooler. <hes> is it is not the chilly pad. Is it chilly battle. That was dig- the name was changed to something bad which maria frigging product and <hes> it really helps ton. I have no affiliation with them at all but i noticed that if i sleep in the temperatures off significantly disturbed or corban temperature needs to drop a few degrees for us for a half a degree and renter's leader within the women just like big picture and person is a little bit different so sleeping with a with a chilly pad has made a huge difference answer me the other one which i notice a lot more for have been recommending to my friends is <hes> an air filter at night a lot of people who <hes> have trouble breathing through their nose. I find that there's this one category of people that they're overall pretty okay except they're just noses stuffy lot but especially at night and they could be moving off gassing from their bedding could have other furniture. They moved into a new house of our paint carpet my indoor. The air is typically so much worse than outdoor air so often. I encourage people to open the window if they're in a place or just get a good happe- air filter her keep it on at night. You've been on at night little white noise doesn't matter white noise at soothing and for one of my close friends we just i sent air filter. There's a company that sent me a couple of them. It's called air ear doctor again no strong affiliation with them but just a cheap air filter that works that we recommend it a few times and that's been a big help for some friends that i know here's the problem when you lie down if there's inflammation the sinuses for example when we take out a tooth we tell patients not to lie down that night when you lie down all the blood goes to that air the blood pressure gradient gradient to that wound changes inflammation and nasal inflammation is such that so that when you lie down that's i don't know if you've noticed you become more congested when you lie down so in addition to that the allergens and the things in the air that contribute to the information just made worse by lying down also where we need to sleep with ladder lider covers right or no covers have. I don't know if you've tried that but try getting used to sleeping with a cover sits difficult so used to it but i guarantee you will notice a the difference in the quality of your sleep and are you saying that because of the temperature. Are you saying that because of the material that it's made out temperature it could be. I mean down. I recently got rid of all my down comforters. We use a <hes> kind of bamboo product now in our concern because of dust my right eye was reacting to the to the down so but trysofi law covers not an easy thing to do and <hes> cleaner sheets a lot boil them you know high temperature of the europeans are good at that. I don't know boiling. You're sheets. It's i'm never heard of this. Their washers run at higher temperatures in the water. We just use the hot water tap and your hot water tap is set at whatever <hes> hot enough. Maybe for shower so so but boil your sheets. That gets doing said well. I have a german washer and and it heats the water and then cook some and they smell different sheets. I mean i don't know when you trouble to europe. You've just got back. I think that's something i've always noticed even from a kid the sheets smell and feel different in your staying in an airbnb and they were very generous with the fabric fabric softener. Usually i emailed them or my sister emails ahead of time and like no right no. We'll have to pay attention. I'm headed to italy in august with my chance or good. I'll have to go they are they're good at foiling their sheets so he took a little diversion. Let's go back to the three steps. Apsos first step is just recognizing that your candidate and this is something to pay attention bribe him second second step is the the treatment and that is a difficult trickle tedious steph for a lot of people and they're essentially three categories irs surgery. There's the cpap apep of the mask that people can wear and the oral appliance and when the people here that they don't like any of those most people would prefer the oral plans because they for that's more comfortable and more doable they can travel with it and seems easier and there's no stigma associated with it because at most your chin is sticking out a little bit but you can cover up what's inside your mouth c-pap a pat most people. I don't know why this exists but they are are deadly afraid of especially men. It's it's it's a. I don't know why but obviously it's uncomfortable. The problem with the sleep apnea pap is only thirty percent stick with it for the first year and afterwards. There's no follow. There's very little follow up. I see a lot of patients but the bulk of mostly practice for patients that have tried to c-pap have failed using a they either have sought me out or in by chance. I've said to them listen. I think you'll see apnea. <hes> do you wanna get treated for that and they go no no no i. I know i have sleep apnea. I wore my c-pap. Try to for a few months or for year and stopped using it and that was ten years ago and there was no follow up with this life threatening condition right right and so i- right away talk them back into the pepsi pappa make a deal with them at alum will make the oral appliance will get your airway partially open or fully open even by using that device and then the apep will be that much easier and also the machines have gotten better so now this is a because i've never won a c. pap. I recommended so many people go get a sleep study and also one little anecdote is one of my dearest friends had <hes> wanting to make some lifestyle changes and and loose wait as part of that process hopes and he had plateaued for so long and finally said you know that sleep study that we've been talking about go go get it your doctor and you're you're like a candidate he went and got it just continuing down the cleaning diet that he had already started and using the the c-pap the fifteen pounds and he couldn't lose they came off her that often s and i see it often and it actually happened with me i mean once i was able to get get control of my sleep apnea as able to drop sugar completely <hes> go paleo and the cravings are gone. I mean it really is a hormonal. We'll imbalance caused by the sleep. Apnea that allows that makes us crave for these foods are not good for us because his instant energy but it's bad if your teeth it's bad for your gut microbial and it's bad for your weight the one question for you so when people are put on a cpap machine <hes> that is helping them with their reading <hes> because i've never used it before. I've seen photos of them and another gotten a lot smaller. <hes> are you in addition to that mouth taping them. It depends if you're wearing in a full face mask. Perhaps not but you do still want to keep the mouth closed. They have chin straps. That was the old way of dealing with that but if you're wearing a nose pillow or knows <hes> you know if the arizona coming in through the nose if your mouth opens that pressure is released the pressures lost and there'll be a noise. It'll actually wake you up a so you. Mouth taping can be used used in conjunction with <hes> c-pap and and <hes> a pap therapy absolutely so you went down the line of number two which is all these interventions and figuring out the right of intervention for you uh-huh and the the challenge of really working with somebody knowledgeable because even in the instance of being recommended a cpap machine or interventions. There's a lot of lack cafa through earn physicians not checking in with the patient and so people try it and then they drop it because they think it in work or too inconvenient for us xactly or they can afford it and also i see that happen often insurance companies sometimes don't pay for c-pap which is amazing to me because they'll pay for heart surgery but they won't pay for one of the root causes of needing heart surgery. That's number two in often number. Two is really a commitment to your health because it's takes a little bit investigating and finding the right eighteen. We often talk about you. Got you're the c._e._o. Of your own health <hes> you got to build your team out so that can be finding the right. Dentists have to be communicating with each other. All those team members have to be on board board and really requires you to be an advocate. It's it takes work or about. What's the alternative is often the question road right what's alternative. That's number two and you kind of outline it in steps inside the book and i've talked about surgery and that's controversial and it's it's not a fun subject but in some cases surgery is required and as also <hes> orthopedic surgery where we have to break the jaw oral surgeon would do that and <hes> you can fix the jaw by moving forwards and but that's a pretty major surgery it takes longtime to heal from and there are complications and some of them are not very pleasant so but i would be careful surgery. There's no reason not to try c-pap a pep first and see if you can just do that and my my advice there would be to find someone who actually cares about fitting that mass to you and trying all the different asks <hes> the people that are very consistent and very persistent and tweak things at home and are good at adjusting things and tweaking things the ones that that make it through that first year and keep wearing it for the rest of your life number three number three is verifying the sleep ability and that is checking in <hes> if you have an appliance if you have a c. pap. You're the journeys not done. I mean things will change <hes>. You may get allergies. You're you may gain. Some white hope that doesn't happen. <hes> you're gonna get older. That's definitely going to happen. <hes> these things change <hes> that is verify your ability to sleep. Make sure that you are getting the sleep. You need do not not ever fall into the trap of saying what the c-pap seems to be working. Great machine tells me i have less than one h._i. Per hour <hes> and i feel good in the morning <hes> you cannot you cannot make that assessment yourself whether you're being treated or pre-treatment never have an opinion about your own sleep. Let someone else do that for you and and that's important beautiful so three step plan to put attention arguably the most fundamental thing that we do on a daily basis is besides breathing during the day you know even more fundamental than i mean the more that i talked to function medicine doctors our own clinic <hes> the doctor dr hammond and i have alter wellness center in massachusetts to physicians at the cleveland clinic that are part of the center for functional medicine over there. It's just becoming so much more aware of the importance of sleep <hes> because of just how bad it scott wonderful wonderful not that it's gotten bad but but that were <hes>. We seem to be more on top of this. I mean it's it's it's a very salient and very popular topic <hes> if you go to the internet and listen to podcast and everything a lot of people are talking about sleep dependence. It's a it's long overdue <hes> mark for anybody who's listening who's sort of feels like their sleeves so messed up and i'm sure you've talked to so many people who feel that way. They sort of feel hopeless or it has been something. They've gotten used to their entire life <hes>. What do you want to share to that person. Who's listening well you. You just said it. It's you get used to it. You get used to your life that way being tired sleeping nodding off not feeling great not feeling very positive and it takes a lot to get out of that state and you could change your diet you could <hes> you know take a pill. You could take a lot of vitamins or a lot of supplements. You could exercise more but you can't exercise and supplement your way out of this. You have to deal with your sleep so you really have to be kind of very first of all you have to get up and denial by your sleep and if there is asleep problem you have to be willing and open to thinking just. I just need that sleeps. I need to get that baseline and once i had that baseline and i'm fine align then i can move onto the other things so <hes> might advice would be just to be open to so someone tells you you're snoring. If someone tells you that you're seem to be yawning a lot and you're tired or you're getting grumpy and all that <hes> i would look to sleep. I would go there first and and do something about it. Get tested <hes> you know just buying these little little devices that you can wear a little watches and the the units that you can glue onto your forehead and put on your fingertips and you can start there. It's as simple as <hes> downloading putting a free app that if you can sleep in a room for a few nights alone in a quiet room and just record yourself i i've had probably thousands of patients do that and they come back and their shots like there was my wife never told me i was sleeping snoring and then they they do that and like oh my god who was was someone else in the room. It was them. I mean that's the kind of do now. We're dealing with in sleep. I was in that denial for a long time. I felt i'd never thought sleep was was going to be a problem for me or was a problem. Even though i showed all the signs of it has been amazing and i wanna thank you for coming on the podcast talk about such an important subject <hes> we have the show notes out to everything that you kind of talked talked about including your website but just remind people how they can find you. You put out a lot of great content you your team. Which is your daughter's also part of the team mazing shoutout to catherine <hes>. How can people find you and <hes> go deeper on these topics. You talked pretty much. Everything we've talked about today is on estimates dot com the website. I asked the dentist dot com. That's <hes> you can find the book there <hes> it's. That's one stop shop. You can find products that we talked about. There's an affiliate store <hes>. I think that's just the a simple way to get in contact with us and there is an email address. Their view have a question we try and answer all the questions that come in that's beautiful the eight hour sleep paradox if they can find that on your website to that's a great place to jump in for anybody who really really wants to take the next step highly recommend that book and mark thank you for coming on the podcast and sharing your wisdom with us and sharing your story. If it wasn't for what you went through wouldn't be here we would be in bed still and for those that are listening at home. If you're going through something this could be a great turning point to use it as fuel to accelerate everything that you're up to and everything that you want to give love attention fluid probably gonna show that's fun. John hi everyone. I hope you enjoy the interview. Just reminder this podcast. He's for educational purposes. Only podcast is not i repeat. It's not a substitute for professional care by a doctor or otherwise qualified. Medical professional podcast says provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for helping your journey seek out a qualified walla fide medical practitioner if you're looking for a functional medicine practitioner and can visit i f. m. dot org and searched there. Find a provider database. It's important that you have somebody in your corner. That's qualified. That's trained. That's a licensed healthcare practitioner helping you make changes. It's specially when it comes to your health.