113: Pat Mc Bride, PhD, Clinical Sleep Specialty: Revolutionizing Airway Disorder Treatment l Sleep Apnea

Welcome to the sleep as a skill podcast. My name is Mollie McGlocklin and I own a company that optimizes sleep through technology, accountability, and behavioral change. Each week I'll be interviewing world class experts ranging from doctors, innovators, and thought leaders to give actionable tips and strategies that you can implement to become a more skillful sleeper.

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Let's jump into your dose of practical sleep training.

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Welcome to the sleep as a skill podcast. My guest. Today is Pat McBride, and she has spent 41 years as a full time clinician and educator in the fields of dentistry, respiratory medicine, and sleep medicine. Just a quick aside. I actually met Pat at a very cool event at Stanford. I was incredibly grateful to be invited to this event where we looked in particular at.

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Sleep apnea and some of the latest research and some of the goals in that domain that were being kind of defined in that community and Pat McBride was clearly a leader in that area. A little bit more about her, her extensive experience in clinical laboratory research and educational arenas has led to the development of interdisciplinary care model delivery systems used by physicians and dentists around the globe.

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Her treatment protocols encompass the lifespan with particular attention to treating the whole patient, not just. They're disorders. Pat's publications span both medical and psychosocial spectrums. She has a unique ability to intervene into global systems, developing protocols, which can be translated across demographics and cultures into improved clinical outcomes.

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She sits on the board of directors for the American Academy of. Physiological medicine and dentistry in New York is a facilitating advisor for my mask movement. org, a company that uses 3d scanning through a simple phone app and digital fabrication to create reusable, custom fitted respirators for men, women, and children of all shapes, sizes, and ethnicities affordably quote.

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It is never too early to start. And no child is too young are the mantras of her care practice. She's also the executive director for the foundation for airway health. I think you're going to clearly see that Pat is a leader in her field, and you're going to really appreciate some of her outlooks and approaches to this topic of sleep apnea and really a holistic means, but also from her years and years of experience in the field.

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So I get a lot of questions around sleep supplements, and I'm very hesitant to just throw out a whole laundry list of possibilities. One, I don't think it's the most responsible thing to do. I really do believe in testing to see what types of supplements make sense for you. And two, because I really, truly believe that most of the things that you can do to improve your sleep are behavioral, psychological, environmental, and nature, and often don't cost a dime.

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However, there is one supplement that I personally take every day and that I do feel quite comfortable with suggesting for most individuals to experiment with because of a couple of reasons. It's high safety profile and high rates of deficiencies in our modern society. Some put the numbers as somewhere around 80% of the population being deficient in this one area, and that is magnesium.

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So magnesium has been called the calming mineral, and some report that magnesium can increase GABA, which encourages relaxation on a cellular level, which is critical for sleep. Magnesium also plays a key role in regulating our body's stress response system. Some, those with magnesium deficiency, usually have higher anxiety and stress levels, which negatively impact sleep as well.

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Now, before you go out and buy a magnesium supplement, it's important to understand that most magnesium products out there are either synthetic or they only have one to two forms of magnesium when in reality your body needs all seven forms of this essential sleep mineral. So that's why I recommend a product from my friends over at BioOptimizers.

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They have created something called the Magnesium Breakthrough. And taking this magnesium before bed helps you relax and wake up refreshed and energized. And while we don't recommend that you go too nuts on looking at all the sleep stage classifications on all your wearables. I will share anecdotally that many clients have reported improvements in their deep sleep trend numbers.

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Again, I don't want you going nuts on the sleep stage classification numbers on your wearables, but I do want to let you know about that because I know that many of you do reach out on questions of how to improve your deep sleep. So I also love that BioOptimizers offers free shipping on select orders, and they offer a 365 day money back guarantee on all their products.

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Plus, they have a customer satisfaction rating of 99. 3%, very impressive. And you can get 10% off Magnesium Breakthrough, again this is the same magnesium that I use every single night. And finally you can get 10% off Magnesium Breakthrough, again that's the magnesium supplement that I use every single night, by going to www.

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mag. com. M A G, so madbreakthrough. com forward slash sleep is a skill. And be sure to use the code sleep is a skill for 10% off. And welcome to the sleep is a skill podcast. My guest today, Pat McBride. Thank you so much for taking the time to be here. We originally met at an event that was happening at Stanford and really just was so in awe of your knowledge in this area, your wisdom, and I'm really excited about the things that we're going to learn.

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Thank you. more together in the area of sleep. So thank you just so much for taking the time to be here. Oh, you're more than welcome. It's a lot of fun. I'm actually in California here in the, in the middle of the flood zones in the Bay Area. So I'm not going anywhere today. We've got a captive audience.

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Okay. I'm a captive audience of one. Yes, exactly. Well, maybe that's a good place to start. Before we hit record, we were chatting about some of, you know, what brought you into this world of sleep. And you mentioned you're sort of an N of one as a unicorn. So tell us a little bit more about that. How did you end up in this position?

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I, well, when I started out as a young woman, I certainly didn't expect to be here now as I'm going this, you know, my seventh decade. Um, it's a very interesting, I, my husband was a general reconstructive dentist back in the early seventies. And we had a little practice in Burlingame, California, and he worked at the faculty clinic up at UOP, and we kind of toddled along, and then all of a sudden, about the mid 2000s, in the mid 2000s, um, he was getting more and more failed reconstructive dentistry cases to rebuild.

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And he, one after another, he'd be watching the patients, and all of a sudden, he kind of had an aha moment, and said, these people don't breathe. So at that point. He, um, decided to go back to school and when it studied in pulmonology, and so from about 2007 or 8, 9, we had one of the only dental sleep medicine practices in the San Francisco Bay Area.

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And we started doing, we were early adopters. We were the first people to beta test WATCHPAD from Itamar back in the day. We beta tested sleep image when it was. First coming out, it didn't have any kind of FDA approvals, but we looked at heart rate variability. We looked at cardiopulmonary coupling where we kind of were interested in knowing everything that we could because at that time, physicians didn't want anything to do with us.

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All of our lives, my husband and I were kind of creatures of two people living in a pod. So I was his study buddy all the way through. So there wasn't a course he took or a place he went that I didn't go. So I just kept started out getting an x ray license. I was a teacher to begin with. And I got an x ray license, and then I got a RDA, and then I went into pulmonology, and I went into respiratory care, and I kept getting these credentials along the way so that I could keep helping him.

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And when, as he transitioned, what he was able to do back in, uh, 2010 was to actually connect with the sleep community and at Peninsula Hospital with these folks who realize that this was not just some dentist who was down, that he was genuinely concerned about moving the patients transitionally through any and all sleep apnea therapies in order to improve their lives.

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So whatever modality of treatment they chose, It suited them. It suited them. So, that, you know, in 2010, I read, uh, Dave McCarty's article, Occam Grazer, and he talked about the five reasons why we treat sleep apnea patients and how we need to interface with them and that was Our aha moment. And at that point, we changed the entire way that we practice.

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Um, sadly, in 2011, he passed away suddenly. And so I had, you know, I had kids, I practiced, I had all this stuff I had to keep doing. And I thought, Oh, I got to have my own degree. So, and then, you know, raising kids, putting two, three jobs, making sure everybody got to college. I PhD along the way, and have had spent time in different modalities.

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To understand how all of the disparate fields of medicine treat sleep. So I've done everything from a mini residency and facial growth guidance with Phil Pang. I was the only non dentist to ever graduate back in the day. And they were like, well, you're not a dentist. I'm like, yeah, but I know exactly where to put this.

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And I know why you put up there. But why are you opening? Why do you want to open space behind the forest? When if you open the space behind the threes, you can do proper sagittal cuts. Just makes sense. . Wow. Just makes, so for me, I'm very, um, I do prefer to stand in the shadow. Uh, I prefer to stand in the forest behind the trees and kind of just push people out in front of me because that's kind of my comfort zone and I've done that for so long.

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I've just kind of, I'm the, in kind of an end of one and all of my colleagues call me the unicorn. So cuz I just, can, I walk in and I can do or understand and have a sense of what it is that they're passion is. Um, and I bring to their table to help them learn how to do something differently, properly, either not necessarily properly, but differently, or look at a situation with a different lens.

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Because all of medical, medical providers, medical, dental, um, scientists in general tend to be hyper focused on what they do. Um, this is the algorithm for it. This is this. And, and this is how we go about what we do. The difference. for me is that patients are the focus. They're the center. So what works for one patient is most assuredly not going to work for another because they're not in the same place in their journey to run, accept their diagnosis, whatever it is.

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Can you understand why it's important to treat? Why should you treat? Make this rational. Not just say you're going to die. You know, we're all going to die, you know, someday, you know, I mean, it could be tomorrow. Nobody knows what day it's going to be. So we're all going to die. So using that as a threat over somebody's head or damaging their self esteem in a way that says you are no longer a healthy person.

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You now have this disorder. No, you have something wrong that you need to fix and you need to manage it, which means you need to be more mindful of this. uh, warehouse that you reside in. Well, she's got to clean the window, she's got to wash the doors, got to make sure the floors are clean, the bathroom's clean.

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That's it. You got a warehouse, you have to take care of it. Certain warehouses require different things. And then integrating psychosocially, how a patient adjusts to coming in, being thrown a test, being told they have this disorder, then getting mailed a CPAP machine, for instance. Yeah. With no interpersonalized care about like, so how do you feel?

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How does this sit with you? How does this sit with your bed part or not? Can you integrate this into being part of who and what you are without feeling like you're a lesser being because of it? If you get it, that kind of clinical empathy is so necessary because it's a word, a gesture or a touch often that changes the trajectory of the patient's outcome.

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Absolutely. So well said, you know, since as we know, if we're speaking to sleep apnea in particular compliance being such a struggle for. So many people. So you're bringing this human element that I think is so clearly missing. And with that, I know you mentioned too, that that article had really kind of made a huge difference for you.

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I'm wondering if you can share more about the articles. We haven't had anyone speak to that. So I'd love to learn more. Sure. And it's, uh, you know, David McCarty is a, uh, he was at LSU at the time, back in 2010. He's now in, I think, Denver somewhere. And he's just written, written a fabulous book called Empowered Sleep Apnea.

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Yeah. And it's cartoons and it's got, it's just very people friendly. And you talk about the reasons, you know, so here is your problem. So you're like in a coffee shop and you're, or you're on an island. So how do you get from the coffee shop conversation to the island to, to, so that people. understand what is wrong, why are you treating, what are your choices, how do you interface all of these things, and then you look at what are things, do they have circadian rhythm disorders, what is the actual breakdown of their disorders, so that you can, you can actually do a multi pronged attack towards facilitating change that's appropriate for the individual.

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Oh, and he says it so eloquently and he, you know, you can't just um, commercialization of sleep having to be where you can order a sleep study online and you can order a CPAP on eBay and you can do all of these things and just have this stuff thrown at you. is without the interpersonal piece of the puzzle is why there is such high levels of resistance.

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I can tell you, uh, for all the years I've worked with the folks at Contra Costa Sleep Lab in Walnut Creek, um, Dr. Cohen's group, uh, especially are, they're dear, dear people and they've been doing this for like 50 years. You'd think they'd be really stuck in their ways, right? Early adopters of uther, early adopters of, hey, this guy doesn't wear CPAP, doesn't want to try and feel it.

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Well, how about we go with an oral appliance? Don't necessarily think they're going to work, but hey, if I don't offer him something and say this is a tool, I'm not going to guarantee it works. But what I'm going to do is give you a step, help you change lanes in your journey right now, so that let's give this a whirl.

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We may get five or seven years out of it. You're either going to move your body. It's going to change. I've got to deal with that later. You do have to deal with that. It happens. It just happens. And for a lot of folks, and not every dentist. Who takes a weekend course and learns how to make appliances can manage those by changes and to move it well, it's, it's provider, it's centric, you know, there are really on top of it.

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People that are really trying to understand what's happening to the TMJ, all of those things at the same time. So, and every piece of your body is an integral part. of this molecule that, you know, you look at chemistry class and they had all the molecules and they turned around and all these things were attached by this little, um, what did we use when we were kids in school?

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We didn't use toothpicks. We used like straws or dowels, little wood dowels. We built these models and we painted them. We're all really proud of them. But looking at those kind of, uh, models, uh, molecules allows us to see that at some point everything connects. I may recommend, we may say, sure, CPAP is the gold standard therapy and if introduced gently, very gently, a lot of people can be very, very successful with it.

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They can, but most of the time they throw an auto pat machine at you that just ramps up while you've got the thing on. The next thing you know, you feel like your face is being sucked out by an alien or you're having gas blown into your belly or you just can't see. So there's no, um, psychological interface.

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with that kind of a care paradigm. So what requires is that the care providers themselves who are so tremendously overwhelmed, we have to be able to spend time or have adjunctive people in their office who are able to introduce therapies. And if this doesn't work, but we have this, this, this tool, and this is this tool and this tool.

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And if you don't want to go, there are people that are clearly surgical cases. Their faces, their jaws are way too far back in their head. Everything is closed off and small. You look at them, you know, they have no chin, and they have bad jaw joints, their bites are bad, their teeth are bad. All of those things, you look at them with an eye and you're like, Oh Lord, that is a surgical case.

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But not every person in here or up here is a surgical case. So I've had, I have a patient I'm writing a story about right now for a narrative for, um, a conference that we're submitting to have it be more of narratives from providers with patient care. And this patient that I, that I'm using is somebody I started with in a dental sleep medicine practice.

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Who failed CPAP, wanted an oral appliance, did, you know, numbers came down, still didn't feel better. So that's the point. You can have your numbers come down to perfect and you still feel lousy. Yeah. That's, that's a big issue. Big issue. And so we tried, then we went on to, um, and I knew looking at him day one, guy was a definitely needed an MMA.

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He needed it. Not something you just throw on the table your first business. Right. We went through CPAP therapy, combination therapy, oral appliance therapy. He had Inspire, which was hypoglossal nerve stimulator implant and was also doing very well with it. Every time we treated him, he was treated well and his numbers, you know, with all mighty numbers, his went down.

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He still felt lousy. Seven years into this journey, he calls me up a year and a half ago, still had my cell phone number. I said, will you meet me for coffee? And I'm like, sure. Of course I'll meet you for coffee. Drove out to the city he lives in, met him for coffee and he's like, okay, you told me five years ago I needed an MMA.

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I'm ready. There has to be more. There has to be more. Then my job at that point is to navigate him through that process successfully. And he was clearly a sleep apnea patient who the box was just too small. They fixed the box, he feels fine. Yeah, for some of those things that you're mentioning, just in case people aren't as familiar, uh, Inspire, MMA, if you can just kind of, um, define some of those.

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So maxillomandibular advancement, that's where you take somebody whose jaws are kind of back, they have no chin, and it's an advancement of the lower The two jaws are advanced surgically forward and counterclockwise rotated so that as you move the lower jaw forward, because the tongue is attached, it comes forward out of the airway.

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Most people's airway collapse happens at either the top by the velopharynx, which is the top of the airway or at your tongue base. Those are the two big kickers where people's glass shuts off your airway and the only way you can either blow air in there to keep it open or whatnot. So that's a surgical intervention that most sleep doctors for years and years and years said, no, it doesn't work.

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It has a lot of failures, et cetera, et cetera. In the last 15 years, it has changed remarkably. And I mean, they have innovate new innovations and new surgical techniques and all kinds of things that have made it by far and away for some patients, the correct patient, absolutely the right therapy. And inspire for those patients who either don't want cranial facial surgery, it won't don't use their CPAP can't tolerate an oral appliance or won't use one or don't have enough teeth.

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For instance, hyperblastal nerve simulator is it's no longer considered a novel approach. It's been around for quite a while. And there's tons of thousands of people who have it. And it is think of it like a pacemaker for your breathing. So a small incision is the hypoglossal nerve runs, you know, underneath your chin, a tiny little incision is made to place a cuff around that nerve because that's the nerve that makes your tongue go forward.

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It's a motor nerve. Not a pain. It's a motor nerve. So they capture the part of the tongue that makes it move forward and they fish it down. They fish a wire down to a little generator that sits out right here and there's a respiratory sensor that's underneath it that senses every time you breathe. So what happens is when you start to inhale.

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It sends a signal up to this little cuff that moves the tongue forward out of the airway automatically. And then as you start to exhale, it switches off. So it goes with the breathing, unlike CPAP that just kind of, you know, a lot of these therapies go continuously. A lot of nerve stimulators, back stimulators, that thing just goes constantly.

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This has an off on based on what the sensor feels the body is doing. And again, for the right patient, it's the right therapy. But, obviously, the insurance companies who drive so much of this. Yeah. Will say, you must have tried and failed conservative therapy treatments first. Granted, it's a given. Sure. But, patients that try a CPAP mask two times and they're like, I'm gonna die.

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I'm not gonna do this, I feel like I'm gonna die. And they try. I even have them sit up at home while they're watching TV at night and just hold it gently and try while they're awake and just try and relax and breathe it just so that they get the idea so they can get over the anxiety. Yeah. So there's many different ways that we do it so that people can try and adapt to it.

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But there are those individuals who simply cannot. And we have to respect that as care providers. We can't be treating people like, well, you're a failure. Because this didn't work. You're not in failure. The fail, where the failure happened is that that treatment is not tailor made for your body. Hmm.

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Nothing to do with you. Sure. And what do we do for the fact that you're taking this human approach and really looking at each individual and thoughtfully kind of working through in a triage kind of approach and finding what works for them and what place in life they're at and when they're finally say, okay, I'm ready for the MMA or what have you.

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You're working with them. So many people complain about not having that experience, and then they're just kind of thrown the oral appliance or the whatever, and off they go and years go by and they haven't really found the right fit, no pun intended, . So how can they find a pet when they don't have a pet, you know, in their backyard?

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How do we navigate this? Or just as a systemic problem? It's a systemic problem across all of medicine. systemic problem across all of medicine and we have very high levels of practitioner burnout in every field, every field right now. I've been in the operating room with 32 year old surgeons and they're already talking about a way out.

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And I'm like, you're younger than my child for a while. You know, hate to tell you I'm still working, which means you're going to be looking at doing this or something else like it for quite a long time. Right. And the kids, I've worked with lots, the last four or five years, I've worked with tons of residents, tons of fellows.

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I love the kids. Because if I can intervene early, I can change their thinking before we unleash them on the public. Yes, thank you. But it's not about their skills. Their skills are immaculate. It's not about teaching them how to. It's about how to think. How to take institutionalized medical care and make it individual.

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Even if you just use a couple of, you just catch the patient's eye and look at them and say, I hear you. I hear you. I'm going to do my best to address. your issues, I can't guarantee you this is all going to happen today. Right, right. Instill confidence and hope, two things that are critical for a patient to move forward in anything.

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So this is a, sure it's about sleep, it's about sleep because it's a play game. The world, you know, sleep, bad sleep, sleep apnea, the numbers are staggering, which is ridiculous. And with all these kids that are, all this downward and backward growth from hanging their mouths open constantly, looking like groupers when they walk around, all this downward and backward growth, gravity, gravity is just making these little tiny airways.

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And malocclusion and all of this stuff and so much of it comes from just not closing the baby's mouth, you know, starting to come out of the womb to make sure that they're using their nose to breathe and they're, you know, that you're mindful of making sure of all of these things. So, um, how do you find somebody who's going to be super care intensive or whatever?

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You know, I've been involved with the American Academy of Dental and Physiological Medicine for 13 years now, something like 13 years. We put on a conference every year. We educate thousands of providers from all different medical fields. There is a website where people can go to find a provider because if you're interested and you attend these kinds of continuing education things, you're passionate about sleep.

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You're passionate. Providing personalized, integrated care. So the folks who take the time out of their busy schedules, because the minute you close your office, your income just went down. You still have to pay the staff. You still have to keep the lights on and the phones on. And people there working while you're off getting an education costs you money.

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Not only do you travel and get there, it's the days that your office is closed, the days you're away from your family. Those are costs that practitioners incur, but when they come to collaboration cures, which is once a year, usually in the fall, um, the numbers we started with 100 people the first year, and before COVID we, in Tennessee, I think we had 1100.

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This year we're shooting for, even after COVID, we're shooting for over 1500 in Florida in the fall, which means. There's more and more of these practitioners who have our touch points for this philosophy are going to be going back into their communities and teaching their own staffs and, you know, understanding that they have to work with the demographic they serve.

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And that's really critical that we understand that care provision in a poverty level is PPOs.

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The attitudes are different. The, how they staff the patients is different. Personalized care is, in some places, non existent. In and out because, quote unquote, you're not paying for it. But that child deserves everything that a child that comes from a wealthy family deserves. So good. Okay, so then from this vantage point that you have that is very unique and you've been in the field for so long and you really have established yourself as this expert in a wide ranging and reaching kind of place in this topic of sleep and sleep apnea.

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I'm curious if you can share just some of the things that you're excited about that you've seen on the horizon, uh, whether it's coming or newly kind of come to market, what you're seeing that, and of course, as you've been sharing this exciting only if it fits the actual individual. And certainly we're getting that takeaway that that's what's so required is understanding the unique situation for that individual.

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But just for the listener that might just have it, well, there's only CPAP or BUST or, you know, sometimes people just are not educated on all the exciting new things that are coming. So I'm wondering if you can just share what you're seeing. Sure, sure. I mean, there's so many things that are exciting out there that have to do with sleep.

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Obviously, there's all kinds of e products. There's all kinds of wearable devices, caveat and Thor on the wearable devices. A 29 pulse oximeter is not going to tell you a lie. Okay, Amazon, a 399 one and possibly a little bit better. Any and all of these things that are wearables, they're good. They do give you some information.

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Is it precise? Not necessarily. So if you understand that your sleep, you know, your aura ring or your, I mean, which is great. It helps. I used an aura ring. I beta tested aura ring back in the day and I was like, Oh my God, I have lousy sleep patterns, but, but then I'm like, okay, now I'm going to look at this thing every day.

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Oh my God. You know, and if you're kind of like me, which is can't help it. I'm not a type B. I'm just not. Yeah. self aware enough to know that I'm like up every morning and looking at this thing right away. And, um, but I will not do that with my phone. Interestingly enough, um, never touch it. And so, but wearables are wonderful because they give patients on the good side, an understanding that something isn't quite right.

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Yeah. Now, if they improve their sleep hygiene and those numbers improve, then they have essentially self cared themselves towards a better life. Now, if they've done self care things, they don't want to go to the doctor, they don't have the money for a sleep test, all those things, you can now order a home sleep test online.

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Yeah, literally. You can do that. Now, what you're going to do with it remains, you know, it's kind of a moot point. If you're going to get a sleep study and it tells you maybe you have a problem, well, that's the key as far as I'm concerned, that you need to go and get appropriately evaluated. This is an indicator that yes, you have sleep apnea, for instance.

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your apnea came in at 15. Okay, that's fairly moderate, but it could be 15. Good. Kind of like easy type hypo apnea, you know, hypopnea type apnea, or guess what? It can be 15 obstructives and your oxygen goes down to 60% and you could die. Mm. It just says, oh, it's 15. I'm okay. I can choose to treat. Yes, you can choose to treat, but that doesn't give you a true understanding of what you're seeing.

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Yeah. That's when taking that to your doctor and saying, I realize I probably have a problem. Can you explain this to me in a way that I will understand how it actually fits me? Do I really need to worry? Because they say, my insurance says that if my HI is under 15, I don't need to treat. They don't have to pay for it.

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You need to treat. Well, because they changed it to a 4% scoring guidelines a few years back. So when you score an apnea of 18 at, you know, that comes in overall at 18 at 4%, if you scored at 3%, it's substantially higher. So, but the insurance companies want to go with the 4% so they don't have to pay for treatment.

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Conversely, I would say. It's really not good medicine medicine because it's penny wise and dollar foolish all of these people this whole generation that are your age coming up my age. We're already over on the other side of the hill, you know, we're already down. So, um, that's I mean, once you get past 65, it's like looking at you like you're skating on the door.

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Which, by the way, anyone that's not watching our video would watch this and be like, what? This woman looks like an actual model, just like, so crazy to hear you say that. Yeah. Okay. But yes. So what I was saying is that, you know, understanding that you've got something going on is can be very serious. Then you have to come sit with it and figure out, well, what am I going to do?

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My doctor's just going to throw this. Okay, you can get a CPAP machine. I'll write you help me understand this. So if you can't find somebody who can help you understand it, there are many, many online blogs and online. I look at it. I don't believe in Dr. Google because I think people self diagnose. They get the wrong impression.

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They think they should treat. They think they shouldn't treat. They need this. They need that without somebody who's really qualified to look at them in their entirety. Yeah. to see, you know, well, actually, no, that's not your problem. Okay. And how do you, you know, many of these home sleep tests really don't break out what we call the central component of sleep apnea.

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That's essentially just checks out and doesn't send the signal to breathe. Your respiratory cycle is interfered with because there's no breathing signal being sent. And the home tests are not so great. They're okay, but they're not so great. And if I have a suspicion of a patient, especially if I know it's a heart patient, Heart patients have a tendency to become congestive heart patients at some point.

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And central sleep apnea kind of go hand in hand. I want to treat the right thing. We want to treat the right thing out there. But beyond that, using wearables is a fantastic thing. There are sleep mattresses out there that can help talk to you. There are devices you can wear on the back of your neck that you glue on there at night or stick on there with tape and it will buzz you if you roll onto your back.

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So a positional sleep apnea, there's pillows that you put on your side sleeper pillows to keep you off your back, keep you breathing airway open, keep your neck straight. All of these things are, I'm a huge fan of Amazon because if it doesn't work, send it back. Yeah, exactly. Get the label, send it back, it didn't work.

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That's all you have to do. Type in the thing. Doesn't work. Make sure you order something. You're going to try a lot of different stuff. So I tell patients that all of these lip, you know, the lip taping, the nasal plugs, all of that stuff, the valve openers and all these things, they're all not one size fits all.

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It's kind of like picking out your underwear. Okay. It's really personal. It's really personal. It's not like you just buy the stuff, you know, you just throw something in and it's going to be okay for somebody. It's not. Try it. See if it fits. And if it's good for you and you feel like This might be good.

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Stick with it and see what the changes are. Don't try it for two nights. Stick with it. Give it an honest trial and then say, you know, I did this for a month and I don't feel like I'm breathing any better through my nose. Okay, so now we've done the most conservative. So how at this point now, would you like, you know, I've explained to you how necessary it is to breathe through your nose properly and keep your lips closed.

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Are you willing now to consider a visit with the ENT so we can look up there and see what's going on? Because it might be a simple fix. Mental surgery does not knock you out for two weeks and you don't go back to work. You get it done on Friday and go back on Monday. You'll be okay. Right. There's procedures, there's coal, coalation, there's lasers, there's you name it.

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Technology has moved forward and has assisted us in sleep apnea management consume. So you don't want to just say, but you can't just say, okay, your nose is plugged to the NT. How about we try something conservative so that you can at least say to yourself, I get it. I can't breathe through my nose even when we are mechanically trying to open it conservatively.

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Now I can store that information as. We tried it and it didn't work. What's next? Somebody has to be there to guide you. Yeah. But if you have questions, just basic questions, you got to use your common sense. If you're going online and you're on blogs and you're always, it's like everything, everything you hear about when you talk about the facial certain cranial facial surgery, you can read horror story after horror story about tonsillectomy.

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You can read horror story after horror story about tubes in the ears. You want to find a horror story. You will find sure. What you want to look for is reviews and, and things that are talked about from accredited facilities. Doctors who have reputations, you want to look at what those outcomes are. You can use something like Google Scholar is something everybody has access to and doesn't even know it's there.

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Yeah. So if you type in your Google browser, you type in Google Scholar, up comes Google Scholar, you click on it, it opens up all of refereed literature on everything is in there. Now, some of the articles you may only see what we call the abstract, which is basically this is what this is about. In the conclusion, this is what we found.

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Most people, that's all they care about. They don't want to read the fine detail and the, you can look at that free. Some articles you can even download, they're old enough, you can download PDF for free, they're open. So if you've got a disorder like sleep apnea and you want to know more, you have tools that you can use to self educate so that you can ask educated questions and be a partner with your physician, not just somebody who comes in to get advice.

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Yeah. Your physician is your collaborator. They're there to work with you to solve your problems in a way that works for you. So good. Oh, well, I'm so appreciative of you sharing it in that way because part of our mission is to help give people agency as they're navigating their. sleep journey, ensure that they're connecting with the right people, the right experts, you know, really just hopefully taking on sort of this experimenters lens and discovering and learning and testing things mindfully and with the right people on their team.

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So I so appreciate you sharing that and helping us to feel empowered and take those kind of educated steps. steps towards finding that solution that fits for them. Did we leave anything out before we hear about your sleep specifics, your routines and all of that? Did we leave anything out that you want to make sure you share?

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No, I don't think so. Other than reading is good, uh, talking to your doctor is good. There's no reason why if you're looking at some of these other therapies like, um, hypoglossal nerve stimulator or the craniofacial surgery, ask your doctor if they have a patient who has what was there because many of the folks who go through these therapies can give you the real life.

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lens of how it went for them. So good. There's nothing better than knowing somebody who has the same problem, who is looking at a similar solution, who has a solution you're looking at to see, did it actually work? What were the pros? What are the cons? Were there any pitfalls? And if so, how did they deal with them?

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Is that something? And then you can digest that and make that your And it allows you to any patient, it allows them to say, Well, I see that this is a possibility, or, you know what, I've now just taken this off the table. So, all of these other things we have to offer, you know, um, surgically assisted orthodontics to expand the arches, make room for the tongue, all of those things are options now.

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They didn't used to be. Now it's, it's like easy peasy. You want to, let's, let's start by just expanding your arches and seeing if we make more room for your tongue, your tongue will come forward because any, anytime you expand an arch and you open spaces up between the teeth, the tongue is, is just a border for real estate.

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Yeah. Um, a millimeter of real estate are going. So if you open up seven millimeters of space, which is for a lot of people, the width of the bicuspids they had taken out when they were kids, my age, when we were kids, everybody got four bicuspids out and your teeth go back to straighten them. So we took everybody's normal boxes and made them small.

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So where does your tongue go when you close down the box out the back door? So we know that retraction orthodontics for some people that causes the tongue to lose the real estate it used to have and the only place it can go is backwards. So now we open that up with surgically facilitated orthodontics or expansion orthodontics and all of a sudden your apnea of 65 is an apnea of 25 and that's more manageable.

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Wow. Life changing. Ugh. So important. It's about managing.

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And the day, there is no such thing as catharsis. with our body. There is no such thing. Every day you get up, you're a day older. Yeah. Your cells are a day older. Your cells change every day. So what worked today perfectly may not work a year from now perfectly. Body to change. So if you look at that, this is a, this is not just a, you do something, you get on the bike and you go, this is, you stop, you change the tire, you get a new chain, you fix the gears, you get back on and you keep going.

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And that's That is the process of any kind of chronic disease management is understanding that as you age and as you change So will your disease process? absolutely, so well said and as someone that has really taken the time to thoughtfully kind of pan out and, you know, really look at health and well being.

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I'm so curious now how you, and I'm sure people listening are going to be curious, how you've been managing your own sleep. So we always ask every person that comes on four questions. It started as three, then we moved to four. And so the first question is, and I'm sure this has evolved over all these years and maybe it will keep evolving from the sounds of it every day, you know, you're kind of taking a stock, but what would we see right now for your nightly sleep routine?

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That actually, I have to admit, once I didn't have little children anymore, my nightly routine has been pretty much the same. Okay. Yeah. What do we see? No, I've never had electronics on my body or in my bedroom or anything like that ever. It's a place of sanctuary and peace and quiet. So I have a book. You know, whatever I'm reading for the moment, um, right now, it's a real page turner as TMJ's features.

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I love it. A real page turner right now, an idiopathic condylar resorption, um, right now, but, um, and then my kids, uh, gave me, my daughter and, um, her boyfriend gave me a, uh, grogu, this little nightlight that goes like this with the colors. It's a little grogu. So, I now have little grogu. I push the button and the little different colored lights and stuff come on but that's great.

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So, it's a it's a place of peace and quiet. It's always a peace and quiet. Uh even the wall, it's very spare. The room is fairly spare. Um not a lot of of stuff to like, you know, keep you integrated. Um I'm a firm believer that uh you know, a hot shower at the end of the day. you know, get your favorite whiffy lavender soap or whatever it is that you use.

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Um, and it's just, I'm really a chamomile herbal tea person, sit down with my book and just at a certain point, I'm a, I'm a morning lark. So if I'm up at 5 30, the tendency is it's about 8 30 of day. Yeah. Sure. I'm up at 5 30. The dog's got to go out, you know, so then most of the neighbors and I have six o'clock in the morning around walking.

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I love that. Well, that might lead us into our question about your morning routine. So is that part of that morning routine that morning walk? Oh yeah. Oh yeah. And now with the weather, it's been everybody's kind of going nuts. We've been out here slogging through the rain night with dogs and we've had a few boycotts from the dogs.

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They are not going out in the pelting down rain but we managed to do it. And uh, it's very early, it's quiet, especially as the summer comes you can watch the sun come up. And I really feel, um, There are so many things in our life that we fail to, to appreciate, you know, you get up every day. My 90 some odd year old dad used to call me every day and I, or I'd call him in the morning one of the two and say, so how are you doing today?

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I woke up breathing. It's a good day. So, and it was about just something as simple as that for him, but there. I really have to look at, there's so many things we can let get us down. Sure. Looking at the news, you start, I'm like, I will not watch the news at night. I just won't do it because I'll be up ruminating about all the tragedies in the world and all that stuff.

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And, and, and leave me in my bubble at night. I'm perfectly fine. Just leave me there and everybody's different. You know, they have to be connected with their phone. I, I don't need to talk to somebody after nine o'clock at night. It's just not necessary. I don't want to intrude on people's privacy. I prefer they didn't recruit online.

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Um, so I kind of have always lived a very structured, pretty structured life in my home. Love that. kind of a creature of habit, not like OCD type of habit, but yeah, just it's what's comfortable and it's what works. It's what works. I slept later, obviously in the mornings when I was younger, but I mean, it used to be seven and a half, eight hours.

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I'm like six, six and a half hours. And I'm like, I'm done over this laundry, get up, do whatever. And so I do, I just put her around my house, make my tea. Uh, I keep the electronics to a bare minimum until I get up and start working. That's great I love what you're speaking to too and the simplicity of all that and the consistency of all that as we know for sleep sleep Just loves consistency and these consistent habits and time givers So I appreciate that you've prioritized that and you've really set up your life to facilitate that love of the minimalism in your space and your environment and the intentionality by which you're Clear on what electronics are around and not around and ability to down regulate in the evening consistently.

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I think all those are really just beautiful rituals and habits. And what might we physically see in your environment now? I know you mentioned that it's very minimal. Anything we missed on your nightstand or proverbial nightstand? Uh, it sounds like we don't need to worry about apps or any other thing, sound machines, anything to throw out there, supplements or anything.

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Pencil. Yes. That's it. It's as straight, it's about as stripped down as it could be. I've never used any kind of electronics or anything in the bedroom. Right. I've been pretty fortunate in that when I occasionally have times when as you get older you have a tendency to go to sleep and then you pop awake and you might be well, but I've, I have learned that it's best to just kind of meditate and go back to sleep if, if I might, or if, if I'm up late.

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That really screws me up. I have a next day. I'm like, yeah, still pop awake at the same time. It's you know, when you have little kids and and back in the day, when you didn't when you have little kids, you go out with your friends and you party on the weekends and you sleep it off in the morning and all that.

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You're like, oh no, they get up at five. You know, you don't do that anymore because you know, your kids don't care. They're gonna get up at five. So, yeah, I I think that from early on, I we just kind of. realize that it's better to face the day in the early part of the day and uh, and be okay be with it. And when you're working in an OR, cases start at seven anyway, and if I have to drive to Stanford in the rain, that's two hours.

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You know, I'm leaving at five in order to get there by seven. Sure. Okay. And what would you say has made really the biggest change to your sleep game or the management of your sleep? Maybe even the biggest aha moment you've had in managing your sleep over the years? Oh, I would say years and years and years ago, just watching how the patients suffer.

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What other people go through, hearing their stories. Because you can, you can try and imagine it, that's part of clinical empathy is trying to imagine what somebody else is going through, but you don't have to have had that experience. Sure. Part of having good clinical empathy is being able to try and imagine what they're going through.

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And when you do, you're like, ooh. We are so lucky. Yes. I'm so lucky. I mean, you have to say, thank God, I don't have to deal with that. And so, I mean, that's, that was from exposure to these folks for so long. I just, you know, I take home people, you know, these people, they float around in my brain. People like my, people like my guy that I'm writing this story about for, um, this AASM course.

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These are people that stay with you. They make, people fail to understand and recognize. The power that the patient has to affect change in their physician Your life and what you go through touches them and changes them love that Oh, well, you are certainly a physician that I would want to have in my corner so appreciate the work that you're doing as a provider.

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It's just really, really so incredible. It's clear that you think deeply about your patients and how to support them. And I'm sure anyone listening is going to want to know how can they follow more of the work that you're doing, maybe some of these stories that you're writing, if they're available, what are the best ways to do that for people?

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Well, if you want to look at some of the journal stuff that I've written, that's in DSP Magazine, Dental Sleep Practice Magazine. I write for them fairly often, usually on non dentally related, but not really related. It's more about things like, my last article was on physician empathy, which is kind of different, uh, the AAPMD, aapmd.

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org. You can go on there. We have webinars that we put on aapmd. org. Um, every Monday night, pretty much, or every second, third Monday night, we have all kinds of webinars that are on, um, engaging in that there's a public forum called the Foundation for Airway Health, and you can go on there and you can look at all kinds of stories and whatnot.

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Simply googling somebody's name, you can get a lot of information. Absolutely. Get quick links. I try at this point in my life, I'm trying to stay more behind the scenes. Yeah. Yeah. So surprised that I'm here, but I, because normally I would not be. Oh, well, I so appreciate you being here. Even in the face of that.

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It means a lot to have someone that's representing or demonstrating what can be possible and how providers could really help support their patients in such a thoughtful and meaningful way and that can really transform the course of their lives so tremendously. I think few things can do this so clearly night after night after night and it's just so, so crucial, so important.

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So again, thank you for taking the time and for the work that you do and we'll be sure to put in the show notes all of those ways that people can follow the work that you are up to. So it really means a lot. Sure. Well, thanks so much for having me. It's been, uh, interesting. And, uh. Really appreciate it.

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Thank you. You've been listening to the sleep as a skill podcast, the number one podcast for people who want to take their sleep skills to the next level. Every Monday, I send out something that I call Mollie Monday obsessions containing everything that I'm obsessing over in the world of sleep. Head on over to sleep as a skill.

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com to sign up.

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