Brain Fog

On this episode of ADVENTing, Dr. Kandula and Dr. Handler discuss the issue of Brain Fog and how sleep can be your best option to combat it.

- Hey, it's Doctor Madan Kandula with ADVENT, your host of "ADVENTing". I'm here with Doctor Ethan Handler. Hello, how're you doing?

- I'm doing well.

- All right, so what's new?

- What is new? You know, I was in Appleton this last, yesterday, actually.

- Have you been listening to the radio on the way?

- I was listening to the radio on the way, yes.

- And you heard our ads.

- I have heard the new ads, yeah. Why don't you tell us a little bit about them? They're hitting home, I'll tell you that.

- Oh yeah, yeah. So I guess, conceptually new ads, we just throw them out, not that long ago. Specific focus on giving the action to the person who's annoyed by it, they're bed partner. Like, basically to do something about the person in your house who's snoring. The typical model is you have to do something to initiate action for that person versus now with the model we've rolled out is if you have somebody in your house, or somebody in your bed that's snoring, you have a snorer then there's something that you can do to take action which is actually reach out to us and we'll actually set up an appointment with you, the non-snorer, to talk about the snorer to figure out how significant of an issue. Is this a serious issue, is it worth following up on, should we go ahead and help to set up an appointment, that kind of stuff.

- [Dr Ethan] Yep.

- But that is that story. So it's really trying to give folks something tangible to be able to do with the frustration, 'cause it's frustrating. I mean, as you see and I see, it takes a long time for a lot of folks to find their way into see us because for snoring, specifically, because they're asleep. They don't necessarily know they have a problem because they're asleep and so they have to rely on other to kind of tell them that.

- And we see a lot of patients who are there because of their significant other has encouraged them to finally do something about it, or they're just forward like, "I'm here because of my wife, or my husband says I need to be here."

- Right, right, yeah. How was Appleton? So Appleton we opened earlier this month, I guess.

- Yeah, it was cool. It's nice to be in a new community. It's an easy drive up there. Good people. So it was a busy clinic and you know, a lot of the business I saw, obviously nasal congestion is a big part of this, but also sleep quality. I mean I feel like we can really make a difference in peoples lives, especially those that don't sleep well, know they don't sleep well, wake up in a fog, live their lives that way. It can be so empowering for them to kind of take back their restful sleep.

- Yeah. Yep, no doubt, no doubt and then that kinda dovetails to brain fog which is this concept. I mean, I guess it's been around for a while, but sorta something I think people talk about a little bit more. It's not a medical term. What does brain fog mean to you?

- I mean to me it means living where you feel like you're not totally present in what you're doing. And it's fatigue, it's a tiredness, it's feeling not sharp, like your mind's not there. And one patient yesterday, this is like the typical, typical story is a patient who may be slightly overweight, is being accused of being lazy, or just doesn't really have much motivation to do anything, knows they have a problem, knows that they wanna do stuff, but they just don't feel up to it and they're tired, and they just don't quite have the mental sharpness that they want and so there's a lot of people out there like that. That is the perfect person that we can help if they take that first step and say "Okay, let's try to do something". And it all starts with sleep and sleep quality.

- I mean there could be other reasons for brain fog other than sleep, but sleep, I mean pretty much you take anybody, somebody that gets normal sleep and you take a night of sleep away from them and they're... I mean, I've been there before where you're just dragging, you're just not, you're not yourself, you're not on your A game.

- And then imagine going to sleep every night knowing that what is supposed to be restful for you, won't be and so you dread going to sleep every night 'cause it's not gonna be good and then repeating that like "Groundhog Day".

- Yep.

- I mean that just seems like torture.

- Yeah, absolutely. And I think the challenges, like if you, or I, choose to miss a nights sleep then you're gonna pay the price for that. The folks that we're talking about don't have a choice. It is what happens when their body goes to sleep because the throat shuts down, they might snore because the throat's tightening up and shutting down, they might stop breathing, all that stuff. They're not in control and so a choice is being made for somebody and so I guess flip that around, at least when we're seeing folks who are suffering from just fatigue, maybe they just say "I'm just tired". Whatever they might say to kinda put words around that, they probably don't even know the half of it as far as how actually impactful whatever's going on is. Partially 'cause it's probably always been going on and partially 'cause they're asleep and partially because they just don't know any better.

- Right. Well and they're targeted by all sorts of different devices and ads and beds and whatever it might be, right? So whereas none of those things really treat root cause and I feel like, again, we can get people on the right path. It doesn't cure all ailments, but certainly sleep that is regenerative, that you get good rest, that's the best place to start.

- Yeah, absolutely. And I know we've talked about it before, but the fundamentals there, what's the starting to get out of the starting blocks from a sleep standpoint, you've gotta be able to breathe, you've gotta have an open airway and so to hammer this home is if somebody is snoring, or somebody's pausing breathing at night, they don't have an open airway, that's not normal, that's not okay, that's not funny, that's not, it's a problem. But people don't recognize it as that simple and it is relatively that simple. It's not the only reason for somebody to have sleep issues. It is the only reason for somebody to snore, or to have sleep apnoea, obstructive sleep apnoea, is if their airway is problematic. Your nose is too tight, or the throat is too tight, or both of those things are there. So that's a truth and I think fortunately, or unfortunately, we have to say that repetitively because nobody else in the world is making that simple statement and there's a reason for that. The reason that people don't make that simple statement is if you're selling coffee, if you're selling mattresses, if you're selling all sorts of things that rely and require the populous to be sleepy, you don't wanna talk about root causes. You wanna talk about band aids, you wanna talk about the giant cup at Starbucks, you wanna talk about this, that and the other thing because if you treat root causes, you don't need band aids.

- Oh yeah, I mean you think about industries like 5-hour Energy, or Monster, or any of those things, it's all geared towards trying to wake people up and yeah, you're right, they thrive on people being exhausted.

- True. And part of it, certainly some of that could be our own doing as a society. Globally and in this country where people I think previously discounted the impact of sleep and if it was the choice between seven, or eight hours of sleep, or watching a movie, or doing some work, or whatever. Then the choice was easy, you can always catch up on sleep, but I can only catch this thing right now. I think things are shifting. It's not like 100% shifted, but I think people recognize the importance of sleep more so than they did even not that long ago. I think it's important and yet there's still this disconnect. I mean there is a reason that there's a Starbucks on every corner and it's not because of... I guess I'd say the reason there is, we tend to be walking around tried as a population and part of that's some of the choices we make, part of that's the fact that we're just not breathing the way we were meant to breathe and therefore we're sleeping not the way we're supposed to sleep and so we're just kind of dragging. So it's nothing good about that and it's just a matter of ending those dynamics and I think that's where, at least when you look at it kinda wholistically, you come out to that starting block and you say what we've just said. "If you can't breathe properly you can not sleep properly and nothing else really matters beyond that". Once you've you've spilled that, once it's done, once it's out, you can't unwind it unless we identify that issue and fix that issue and then, then on the flip side and say "Whoa, okay we fixed your airway" and it's not like the world is full of unicorns and rainbows and all that stuff, but--

- Wouldn't that be nice?

- I have seen folks who kind of have seen the unicorns and rainbows--

- Well, the fog's been lifted.

- Right!

- I mean, that's a reality.

- It is, and it's a big deal. Like if somebody's always been in the dark and always been in that fog and all of a sudden you get them breathing properly and they start sleeping properly and they wake up a different person, they wake up, it's not like magic in one night, but it's usually catching up on some of that missed sleep and that restoration. A lot of times the first thing we'll hear from somebody is "I'm dreaming for the first time that I can ever remember." And that right there is very, very--

- And there might be unicorns in there.

- Right! And I mean, if you think it very literally, you take somebody's dreams away, you take somebody's vitality away, that's not good. Now, if you can bring that back, then yeah, you could dream about whatever you want and unicorns and rainbows. I think in order to have a full life, sleep is a prominent component of that. If you wanna have a diminished life, diminish your sleep. If you wanna have a full life, have robust sleep and we can, when we find problems, fix those problems to restore that airway to get somebody back to some place they may never have been. And so if you've never been, just imagine a world where you've never had a dream, or you don't remember your dreams and all of a sudden it's like a technicolor boom, that'd be pretty, I imagine kinda almost a world where somebody's color blind. I've seen these videos where they're color blind and they put the glasses on and all of a sudden they see in color and it's seen people in tears because of that. I'd say this isn't really any different than that concept. It's taking a world that's blunted, and diminished, and fogged out, and you lift the fog, you restore what it's supposed to be and it's a big deal. It's a big deal and we usually don't talk about it like this. We usually are like, you know, it tends to be more focused on what's in front of us which is what we need to be doing, but we hear the domino effect of what we do in a positive way every day. Every day we're at clinic those are the stories we tend to hear.

- Because everybody's life, everything that somebody wants to accomplish when they're awake in their life hinges on their ability to sleep to be able to accomplish those goals. Whether its work, whether its family, whether it's running a marathon, who knows? Everything that we do, you have to have good sleep and those people that don't, they try to nap and get through it. You can't catch up because the quality of your sleep, whether you're napping, or whether you're taking a 10 hour overnight sleep, whatever it is, it's sucky quality so that you can't catch up, so you're always behind. So you have to treat root cause because these band aids just aren't gonna help, aren't gonna fix things.

- Yeah, no. And you, I guess, I know we've talked a little about your shout out. I mean I don't wanna steal your shout out, but what's your shout out today?

- Oh, so my shout out is I'm reading a book right now. It's called "Can't Hurt Me". It's by this guy, David Goggins, and he's well known to some and not others, but it was suggested from one of the PA's in clinic and you know, I mean the basic message of this book is no one's coming to rescue you in life and this guy had just the most horrific upbringing and he could blame a gazillion people if he wanted to, but he doesn't. But he'll own it. He'll own his upbringing and it's about seizing things for yourself, doing things yourself. You being the change in your life and you talked about that a lot, but this is to the umpteenth degree and it's inspirational as hell and a solid book. And this guy has no excuses and mental toughness. Failure is an essential part to him getting better and he owns all of it.

- [Dr Madan] Yeah, gotcha.

- So I mean in relation to us and sleeping, it's like you wanna do something about your lives, take back control of your sleep. Take that step. No one's gonna come do it for you. You have to do it. You have to be motivated and realize it's a problem. Own it and do something about it.

- Yeah, I agree. It's sorta disconnected, but I remember talking about him and his story, it is controlling what you can control. I would say part of that too is the reality of what's in the past is in the past, and so what can you do today? If somebody's been dealing with these issues for five, 10, 20, 30 years that's too bad and you can't get those back and so you can do something today that will make tomorrow a different tomorrow kind of a thing, which is that same concept. It sounds disconnected, but it's exactly the same thing. It's really ownership and getting kinda to the root of what's going on and then persevering kind of thing.

- Yeah and it's personal responsibility and I think that it's tough at times and people want to find other reasons why things might be happening to them and if it's sleep apnoea and it's weight and these kinds of things, I get it and I'd never tell a patient "Hey, go lose 50 pounds" 'cause that's not realistic. It's a matter of let's get you on the right path by you can decide to do these things to get your sleep quality where you need to be, so if you're motivated to lose weight, awesome! We've helped you get to that point and go out there and lose your 50 pounds, or 60 pounds and not you have your oral appliance, your CPAP machine 'cause you don't need to anymore. I think it's a cool message, it's a great book for anybody to read at any point in their life, whether you feel like you're wildly successful, or not, I think it has messages for everybody.

- Gotcha. And speaking of restoration, your favorite sport, baseball. They finally--

- 60 games, is that it?

- I don't know. It's interesting that whole negotiation dynamic has been dispiriting. It's typical of baseball, but anyway.

- I haven't followed it as closely, but yeah--

- I try not to follow too closely 'cause you've got no control over it, but it's just this back and forth of animosity which is gonna brew over. I guess the contract is up next year, so 2021 for major league baseball sounds fraught with danger, but 2020, I think it's 60 games, DH in the national league, they've got this weird extra innings rule where they put a runner on second. I don't know. To me the most interesting things about Covid as they relate to sports are these kind of rule changes around a periphery of each sport and also how they deal with the lack of crowds, like the lack of an audience. I was watching a soccer game this weekend where they piped in, I think it was the FIFA EA sports noise and it was actually, it just reminds me how sort of simple minded we are 'cause yes, if you watched a soccer game in silence, it's really bizarre, but if you watch the same soccer game with the piped in background noise, it's fine. And you can see the seats that are empty, but you don't, I wasn't sitting there like... I was doing something else, but I'm still saying it was like, it wasn't much of any different then when they're playing, but I do think that watching sports, part of it's that crowd, just hearing the roar of the crowd and all that stuff is kind of part in parcel.

- How do feel, what about for the athlete? I wonder if this will really tease out what athletes are truly of that competitive spirit, doing everything they do for the grind of the sport, versus those that do it for external purposes.

- I think, I mean we've talked about this before, but I think Michael Jordan would have killed it in silence. Kobe Bryant would have killed it.

- Yeah.

- You know what I mean? I think that those elite athletes can do it in silence and with the cheer of the crowd, or with the boos, or all the above. But still, I'm sure it's gotta take a little edge off of things when... Once they get basketball up and running, if you're in an empty arena, that's gotta be just weird. Other than practice, they've never played a game other than maybe when they were kids, but from college to pros, it's just a different experience.

- Yeah.

- So another, I guess it'll be the, it's a different brain fog analogy, but it's similar that what you're used to one situation that is what it is for your entire existence and all of a sudden you're gonna have to figure out what to do in a different situation, so it'll be interesting.

- I will say that probably it'll help players appreciate fans and the normalcy of what they had prior the following season. I'm sure they'll appreciate it a different way that they never had.

- Yeah, it'll be good to actually get back out to the ball park. I don't know when that's gonna happen. 2021, I think that's coming.

- Likely.

- So I think that's all we got. So thank you guys for watching. If you are liking this content, let us know. Follow us on whatever platform you're on, YouTube, or wherever you're seeing this would be helpful and we will see you next time. Take care!

- Have a good one.

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