Mouth shut, nose open, day and night. If you don't have that, you can't sleep how you are meant to. In this episode of ADVENTing, learn the recipe for a good night's sleep and the ripple effect it can have on your life.
The gift of a good night sleep. So that's hard to quantify and I feel like the only way to really know that you got a good night's sleep is relating to a really crappy night's sleep. A really bad night's sleep, right? But that's something that's changed, we're talking about my career or the time course of ADVENT, is something that's changed massively in society is the recognition, the realization the fact that sleep is cherished now. Versus not that many years ago, five, ten years ago, kinda, sort of but now it's both within the medical community but especially I think outside the medical community. Sleep and a good night's sleep and how important that is, is more and more recognized.
I would say it's definitely, I agree with you, I think there's a better body of knowledge or just media talking about it and things, but I would challenge it in the sense that I think that people might be aware of it but it still hasn't changed what they're doing day to day or what their daily grind is. They might know it's more important but still I don't think people are initially accomplishing that yet.
Yeah, it's not happening yet for most folks. I'd say especially, talking about this country in particular I think that there's sort of a lag time between when something's recognized as oh, this is important and what are you gonna do about it. And then I feel there's also, sometimes a recognition of this is important and then a sort of drift away from that thought process. I'm thinking about when back in the old days, back in the 80s and 90s how this whole no fat, low fat, kind of craze came in the mix, which was all about health and oh you need to be healthy, you need to eat right and marketing. I think that's a really interesting story how like no fat, low fat, actually is the thing that's hurt this country. If you want to look up the new obesity epidemic, you track it from when people stop eating fat and started eating carbs big-time. And not that carbs are bad either, so now there's this, "oh carbs are bad, you should never ever touch a carb." I'm just saying that sometimes the pathway towards good leads you through some weird journeys, until you kind of come back to that pathway. I'd say the fundamental pathway, so from a sleep stand point, I don't think that anybody would argue that sleep is crucial. Sleep is important, sleep is an important, important part of who we are and you have to sleep to be functioning well. And then there's nuance around it, there's stuff that's like the low fat stuff, that's in this sleep thing between all sorts of nuances that you could talk about. But one thing that nobody can argue with, and I challenge you, anybody out there, bring me some counter evidence to that, is if you cannot breathe properly you can't sleep properly. If you're snoring or you have sleep apnea, that's your body crying for help. That's fundamental. There's nothing more fundamental to a good night's sleep than a adequate ability to breathe.
And I think there's two factors in play there for patients. There is the long term health risk, right? And then there's also the daily how you feel. And I think that what's challenging sometimes, or just a kind of a journey you walk with patients when you're in the room with them, is that a lot of how, they started here, and maybe they're great when they're 20, now they're 40 or 50, or 60 and they're here. But the journey there took such small tweaks at a time that you're here and you're really far away but they don't notice the change, right? Because things gradually happened, right? So now you're here and you're like, "well, what did it feel like to get a good night sleep?' And, "I think I'm okay, and I think I breathe okay." And so you're having this longer conversation with patients about, "Look your nose should work well, "it should feel really good. "You should feel great when you wake up in the morning, "ideally, assuming, "there's other factors that play a role in sleep, "but your breathing shouldn't be one of them," let's put it that way, right? So you can feel like that again, it's hard to remember what it felt like. So patients, I always joke, like when you take the blue pill you can never go back to that again. It's like once you're eyes are open again it's really hard to take steps backwards and so maybe, reset them. Patients are pretty darn happy when they're starting to breath better. I feel like quality of life, know that their health risk is taken care of long term cause their sleep apnea is treated. Let's put it this way, I have had patients in the room after doing a 15 minute or 20 minute procedure in the office, get their sleep apnea controlled that have said this has been life changing for them. And my answer to them is, typically, I didn't do anything other than get your nose working again, and then we got your sleep apnea cured. It wasn't like we were doing this crazy 15 hour surgery, right? We're doing things that are simply getting their noses working like it should work.
Which for a lot of folks its never worked that way. And we do tend to diminish the impact of that to some extent because, at the end of the day, both you and I, and every ENT surgeon at ADVENT has been trained to do exotic, convoluted, complex procedures.
You mean the breath of our training?
In the breath of our training. And yet the challenge sometimes for us, at ENT generally, is the simplest things that we do are the most impactful. When you take somebody who's nose isn't working, which the nose is the start of the airway, you take somebody who's nose isn't working, and you flip the switch there, you get it working, you've changed somebody's life.
When we say working, you should be able to breathe well through your nose freely, day, night.
Mouth shut, nose open, day and night. That's the tool box, that's what you should have as a human being. Many folks don't have that. I would venture to say, really, in talking to enough folks and seeing enough folks as patients, is that, most is a strong word, it is shocking how many people don't have that. If you don't have that, you can't live the life you're supposed to live. You can't sleep the way you're supposed to live. You can't. There's been plenty of studies looking at this both in humans, and in primates, and in other animals you want to mess up somebody's sleep you plug their nose. Simple. The opposite it simple. You take a cloths pen, you take a clip you put it on somebody's nose, have them go to sleep and somebody's who's nose was working somewhat functionally all of a sudden is gonna have the worst night sleep that they've had in either a long time forever. They'll wake up with headaches, they'll wake up with the dry mouth, they'll wake up feeling fatigued, they'll likely be sweating all night, they'll probably grinding their teeth at night, they're going to be fighting, and what is all that? That's your body fighting to breath. What's more fundamental, and we say this often, but I don't think you can say it enough how important breathing is to every animal in the world including human beings. You want to set somebody up for life that's less than it should be, that's worse than it should be, that's limited is you start constricting somebody's airway. You want to set of the most active flight or fight mechanism for somebody, you take a piece of stake and I'll throw it in your windpipe and you'll go through all sorts of contortions and motions and even though you can't talk, we'll get that thing out of there and make you feel better but folks are doing that multiple, multiple times every single night, and because they're sort of kind of asleep nobody's really recognizing how big of a problem it is. But if you dealt with that one time, one time where you're trying to breath and your throat shuts down and you can't breath it's going to be a memory that haunts you. That's weird, it's not weird it's true. If I did that to you, you would never forget that. Yet if that happens to somebody a hundred times or more, a few hundred times every night, they forget it because it's just sort of their norm. It doesn't make it not shocking, it means that the shocking thing, the thing that's like anti life, is the thing that their body just somehow got used to, because bodies get used to a lot of things unfortunately.
And I would say to patients, "Don't underestimate the ability to feel better." And I mean that in the sense that people are afraid to ask the question often. We talk about this a lot, because people think that the only solution is a CPAP machine because that's what the rest of the world tells them, essentially. People are afraid to ask the question. They feel like they can't get ahold of it because like, "hey, I'm not going to wear that CPAP machine this is just going to be my life." The reality is there are many options that are out there, we go through the gambit of them with patients, and you can do this study at your house. We talked about, or kind of revamping, and looking at how to bring the best technology to patients, to be able to get that diagnostic sleep study in their own bed. You can ask the question, find out the answer, and then take control of what you're going to do there. CPAP machine, sure it's one option, but it's not the only one. There are other ways to get over the goal line, that way, and feel better. And when you're on the back end you'll be like, "why didn't I do this before?"
I think, generally speaking, not 100% of the time, but pretty darn close, if somebody comes in with a concern, that something's not right, that something isn't likely right kind of a thing. Sometimes, rarely somebody will come in and everything looks just fine. We'll do a home sleep study, everything's looking okay, and there are other reasons to have poor sleep other than just sleep apnea or snoring. Sleep apnea and snoring coexist with other conditions often, like insomnia. Insomnia, just to kind of clarify, insomnia is where you have a hard time falling asleep or you wake up easily. That's a problem. Sleep apnea is when you're going to sleep you're trying to breath, and you're throat is shutting down, which doesn't let you breath. Now, lone and behold, there's a really high correlation, if you have untreated sleep apnea it's very likely it's going to create some degree of insomnia to some extent because you're going to sleep you're getting strangled therefore you're body doesn't want you to go to sleep and once you do fall asleep it wants to get you up immediately because it doesn't want you to die. That kind of simple, from a mind set stand point, is your body, the first thing on the check box is can it breath. If it can't breath, everything else down that check list, it's not that it doesn't matter but it's going to be impacted by that because your body is going to be thinking of that first thing always.
But think about the way that coexisting at the same time, insomnia, Restless Leg Syndrome, obstructive sleep apnea. Think about, what is the most common way to tackle those issues for most patients are, "let me give you sleeping pill to treat your insomnia. Let me give you something like Gerand or Gabapentin or some of these other medications to treat your Restless Leg Syndrome. Hey, sleep apnea isn't being treated. You're never going to get a hold of these other issues. The reality is, to get your sleep apnea treated now maybe your insomnia improves or might go away. Because now you're actually getting good sleeps. You're not getting ripped up out of sleep. And maybe your Restless Leg Syndrome be an issue anymore because you're sleeping. But if you think about outside of here the way patients are treated elsewhere, they'll just get a bunch of meds thrown at them and they'll be on their sleep pills and their Trazodone and everything else to try and get to bed and still it doesn't matter because the quality of your sleep sucks.
Absolutely. We've said it before. In an emergency situation EMTs, ERs, Fire Departments, they follow their ABC's, airway, is the A in the ABC's, airway, breathing, circulation, in that order. It's not BAC, it's A,B,C. I would agree, whether we're talking about somebody who's grinding their teeth, if we're talking about somebody who's got Rest Up. There's some downstream issues, that could be issues in their own right, but often times they're tied into an airway issue. If it's all kind of bound together, how do you get it unwound? You start at the top. You start at the beginning, you get the airway fixed, and the nice thing is, we can do that in a very simple and elegant manner typically these days, and then that's sort of that first, get that thing right and then let's see what those other things. Often times, shockingly enough, often times you get somebody's airway fixed and their breathing properly and often times, lone and behold, wow, they're not clenching their jaw when they're sleeping at night. Imagine that.
They're not posturing forward, they're not having back pain and all that stuff. All that stuff, which is challenging for me sometimes because each of these things is massively impactful. Forward head posturing is, normally when you're sitting, your chin should be back so that your head is sitting on your neck properly. Forward posturing is your jaw is moving forward. Why does your jaw move forward? Cause you can't breath. If your airway, when I move my chin back, that constricts your airway. If you've got a good airway doesn't matter. And therefore you're in a good position. If your head's forward, or if you have a poor airway, than what you end up doing is your mouth falls open, possibly, or you lean forward a little bit. And what ends up happening, you take this big bowling ball that's supposed to be sitting right on your neck and you put it forward a little bit. What does that cause? Cause all the muscles in your neck to be under tension. It's a domino affect. There's a lot of people who have neck issues who have TMJ issues, who have headache issues, who have visual pain issues, that have airway issues. And yet those downstream issues are the ones that get all the focus because, yeah, you're neck's sort of jacked up you're not necessarily thinking about your airway but if you don't get the airway part corrected all the other stuff is going to be, you're wasting effort there. And it doesn't mean, now could you have a perfectly functioning airway and have neck issues, TMJ issues, yeah you could. But if you have both of those things it makes sense, and it's the only right way to do it is to get the airway right at first. ABC's. Everyday of the week is sort of how it ought to be. As simple as that is, it doesn't really exist outside of our walls. It's part of our mission, part of our charge is making sure there's understanding and awareness of these realities.
It may sound cliche but the gift of breathing is the gift that keeps giving. Because it help all of these downstream effects for patients that are positive.
Yeah, absolutely. I think the challenge right now we're sitting in December, coming to the end of the year, I think for a lot of folks coming to the end of year, coming into a new year, will do new years resolutions. Many of them, not all of them, but a lot of them have to do with health and trying to be healthy and live better and what is more fundamental to living well and being well and living a healthy life than breathing properly? The answer is there is nothing. Nothing, nothing, nothing. I challenge anybody out there, that doesn't mean that these other things aren't important, because they are important. It doesn't mean that exercise, and diet, and the things that people typically put on the check list of, yeah I'm gonna to go to the gym, I'm gonna to start eating balanced diet, I'm gonna do these things, and those are great that's a good thing that you want to do those things. But again, I sort of say, "When you're thinking about that new years, or the new year and your wish list, if there's a question mark on your breathing I'd put that first." You can't do anything else unless that's working properly. The other reality with how we approach this is that this is a weird dynamic we're talking about a fundamentally, life impacting issue. To solve that, often times, is a simple, 10 to 15 minute office based procedure. It's almost unfair that that dynamic is that stark where you've got this massive issue and we can do something relatively simple to correct this massive issue. It's something we wanna let people know that it's worth seeking attention out for. On the flip side it's as gratifying as you get is seeing somebody who's been suffering their whole life or for a long time, and take the suffering away, take the boot off of their neck is what I often say. It's a harsh analogy but it's true. If your whole life you've been living with somebody with their boot sitting on your neck you can't breath, and you don't know you just think, "okay that's just normal." All of a sudden somebody comes by and lifts that off of your neck, you're thankful and you're appreciative and that's a good thing. Let's lift those boots off of people's necks and let them breath properly. It's the way it ought to be, and unfortunately for a lot of folks they don't they have a problem.
Right. Our charge has been to make a huge impact in people's lives in the least invasive way possible. I think that is what we recognize as our focus moving forward and driving that every day.
Yeah, absolutely.
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