258: Dr. Douglas Krohn, An Award-Winning Primary Care Physician: Why Sleep Apnea Often Goes Undiagnosed/Untreated

 Welcome to the Sleep As a Skill podcast. My name is Mollie Eastman. I am the founder of Sleep as A Skill, a company that optimizes sleep through technology, accountability, and behavioral change. As an ex sleep sufferer turned sleep course creator, I am on a mission to transform the way the world. Thinks about sleep.

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Each week I'll be interviewing world-class experts, ranging from researchers, doctors, innovators, and thought leaders to give actionable tips and strategies that you can implement to become a more skillful sleeper. Ultimately, I believe that living a circadian aligned lifestyle is going to be one of the biggest trends in wellness, and I'm committed to keeping you up to date on all the things that you can do today.

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To transform your circadian health and by extension, allowing you to sleep and live better than ever before.

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Welcome back to The Sleep As a Skill Podcast. When it comes to sleep optimization, here's the reality. If a sleep disorder is in the mix, no amount of perfect sleep habits will fully land until you address what's happening underneath the surface. So if you've ever wondered whether your snoring. Daytime fatigue or mild sleep apnea diagnosis actually matters.

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This episode is for you. So today I am joined by Dr. Douglas Krohn, award-winning primary care physician, clinical professor at New York Medical College and a sleep apnea patient himself. We talk about the real patient journey. The confusion, delays and frustrations that often keep people from getting help and how his own experience inspired him to rethink how sleep apnea care can be more accessible and modern.

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We also unpack a key truth. Sleep apnea doesn't have a look. Doug shares how treatment transformed his energy, mood, and overall quality of life. Plus, we explore options beyond the traditional mask or bust approach and practical steps for anyone feeling stuck. So we're gonna jump right into this episode and a quick reminder, we'd love to have.

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Everyone listening sent up for our Sleep Obsessions newsletter. It's been going out every single Monday for over seven years. We've never missed a Monday. Uh, and by we, I mean me, like I am writing this thing every single week. So would love to have as many of you on there. I respond to every single email.

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It does take me a minute, but I do respond to all of them as of now. So get in there at 

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Sleep is a skill.com and sign up for that newsletter. But let's jump into the episode. 

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Welcome to the Sleep is a Skill podcast. There are lots of things that we can discuss in the area of sleep and sleep optimization, and yet if you are dealing with sleep disorders and there's over a hundred sleep wake disorders that we know of, we can't go much further in optimizing your sleep until we address.

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Those disorders or uncover them. So if you're listening and whether you've identified that you're dealing with sleep disorders or you suspect you are dealing with sleep disorders or your partner or your kids or a loved one, et cetera, this is an episode for you and, and we'll probably talk about all kinds of other things.

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So we'll see what we get into as well. But certainly with that commitment to support in the venturing into sleep disorders, a whole world of it. So Doug, thank you so much for taking the time to be here. Hey, 

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it's my pleasure. Thank you, Mollie. 

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Yes, yes. Excited to dive in and thank you too for sticking around.

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I know we had on my end scheduling stuff and whatever, so we're, we're here the two of us and it's gonna be great. And I know you've got exciting things that are gonna be unveiled at the time of the release of this podcast, so lots to get into. But maybe we're starting at the beginning of how you found yourself as a real leader and expert in this area.

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Right. So as the founder of a lot of businesses and not those that are necessarily limited to health endeavors, um, I was a customer, or in this case a patient, and I went through the journey and. The journey I'm talking about is getting diagnosed and treated with obstructive sleep apnea. 

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Ah, yes. 

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Like most people, um, I kind of knew I had the diagnosis for about 10 or 11 years before I did anything about it, and part of the reason that I was hesitant to do anything about it is that I was kind of intimidated by what the treatments available were.

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And absolutely I saw the treatments as possibly being worse than the disease itself. Yes. Um. And I was also kind of intimidated and dissatisfied with what the journey was. There were a lot of consultations. There was a lot of testing. You needed to wait for prior authorizations from your insurance company.

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You never knew what anything costs until after you had it done. And then the bill was coming in the mail. Finally when I decided to go out and get diagnosed and treated, guess what? Um, most of my concerns were validated. Hmm. It was an uncomfortable process. Yeah. There was surprise billing and I ended up founding CON or con sleep.

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Yeah, 

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because. Like a lot of people who start businesses, I said to myself, you know what? I think I could build a better mousetrap. 

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Ugh, 

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totally. Yeah. I think I can do this, but I think I can do this in a way that's convenient, that meets the accuracy thresholds, the accuracy bars of the traditional pathway, and I think I could do this cheaper.

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And I, uh, I can't do it cheaper than Medicare, but I think that I could do it cheaper than private insurance, and I think I could do it with cost certainty. 

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Hmm. 

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And so that's what I came up with. And one of the things that I came up with was, well, can we approximate the accuracy of overnight sleep studies?

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People who are, have a high suspicion that they have sleep apnea even before they go to the doctor, and we can get into pretest probability later on in the show and why that matters. Sure. But can I approximate that? Can we approximate that with an adaptive logic questionnaire that asks the right eight to 20 questions and waits them?

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Yeah, and use these historical norms and empirical data to come up with a diagnostic tool that approximates the accuracy over of an overnight sleep study. That is basically what we did. We took clinically validated questions. We that, uh, we added some of our own and, and continue to do that. And, and we can talk about that, um, that approximates, uh, other biometrics that are associated with obstructive sleep apnea.

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We waited them, we came up with female specific normative values, which. Almost, which nobody is using. Thank you. You came up with something that really approximates the accuracy of an overnight sleep study, um, and getting to pretest probability. If you think you have a, you have obstructive sleep apnea, you know, based on on what the numbers say about who goes to a sleep center, there's an 80% chance that you're right.

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Exactly, yes. 

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Give. An automated positive airway pressure machine to everybody who shows up at the door and just be right 80% of the time. If you. Ask the right eight to 20 questions, weight them properly, you can get that accuracy up from about 80% to about 90%. And now you're, you're in the ballpark of an overnight sleep study.

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Very few studies, very few modalities are gonna give you greater than 90% accuracy. 

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Totally. Wow. So important. I love how you articulated that 'cause it's just so well said of the prevalence of this, but also the barriers and the struggles. So how are you approaching this differently for people and you know, what do we need for people to know in this very kind of confusing venture in the journey of whether diagnosing sleep apnea and or treating of that apnea?

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Because certainly we have. Many people that will also tune in and they're like, yeah, I did a sleep test. I think they said it was like mild, but I didn't wanna wear that mask. And then nothing happens with it and or they suspect. So of these different types of individuals, 

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yeah. 

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What do we need for them to know?

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Okay. So I think what we need people to know is number one. They can listen to themselves. Mm-hmm. Um, and if they think they have a problem within the sphere of sleep health, 

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yeah, 

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they probably do. Yes. Um, none of us have a crystal ball and I think it's important to get validated by a professional with experience.

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Um, but when it comes to a sleep problem, um, if you think you know what it is. You're almost certainly right? 

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Yes. 

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You know, if you think the cause of your insomnia is anxiety, um, I think that a person who comes to that conclusion, I think, I'm not sleeping because I'm anxious, is probably right 90% of the time.

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Yeah. 

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And if you think that you're not sleeping well or you're waking up. With sleepiness, without a feeling of restful sleep. And you think it's because you have obstructive sleep apnea. And by the way, it's not just that you think that, you think that because your wife is telling you that you snore. 

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Yeah.

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Yes. 

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Uh, or, uh, that you're always in a bad mood, or even though you're not overweight, you've developed high blood pressure. Like we said, you, you're gonna be right about 80% of the time. Sure. So the first thing I would say is that, um. The patients can trust themselves and the constantly platform offers them an avenue to trust themselves.

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Yeah. Um, what we have to offer, um, is a, an adaptive logic questionnaire, and by adaptive logic we mean that the way you answer question one. Might change what question two is, or change the way in which we wait or evaluate question two. And using an adaptive logic questionnaire, we can get you diagnosed with somewhere between 85 and 90% accuracy in under 10 minutes.

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And so we are bringing that hymns and hers or RO experience. To sleep and we offer people the ability to get diagnosed quickly and then have their um, uh, their diagnosis confirmed or. Perhaps even challenged by a physician who's licensed in their state. 

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Yeah. 

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Within 24 hours. So we're, and we do this by offering something that nobody else in the sleep space does, which is virtual, asynchronous healthcare.

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So what's the, what's the difference between virtual synchronous care and. Virtual asynchronous care. Well, what you and I are doing right now is synchronous, we're on a video feed or we're on a telephone talking to one another. When somebody has a, uh, a telemedicine video conference with their primary, that's synchronous care.

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But when you give the information, uh, and, and you enter it into a database, and then either an hour later, four hours later, one day, day later, a doctor reviews it. And then comes to a diagnostic conclusion and a treatment plan that would be considered asynchronous care. 

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Oh, good. 

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Um, people are be getting very comfortable with that, with hims and hers.

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They're getting very comfortable with that, with Roman now called Roe. 

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Hmm. 

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And what that allows people is a lot of privacy. 

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Yes. 

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The ability to do it whenever they want. They don't have to coordinate a visit with their doctor. 

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Sure. 

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They don't have to be there at the same time. They can do it at seven in the morning and the doctor can do it at seven o'clock at night.

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And then, uh, through texting and email, in our case email, we can communicate with everyone, um, and get the diagnosis fulfilled. Um, so that's, that's, uh, another thing that people should know. And then right now. Um, con is a single platform that is focused on, um, prescribing automated positive airway pressure devices, so positive airway pressure devices that don't need to be programmed.

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You don't need a titration test. Afterwards, they detect your airway resistance and then in real time go up and down as you need and deliver the minimal effective pressure. To people which improves compliance and, and, and also saves people time because they don't need, uh, follow-up titration studies. Um, our platform is dedicated to that, but by the time this airs, um, we are also going to be, um.

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Answering a desire that we found in our beta testing, one is that people would like the option of medical treatment for obstructive sleep apnea. 

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Yeah. 

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And another is that people would like the opportunity for the oral appliance therapies or what's also called the mandibular advancement, uh, devices that the sleep dentists provide.

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And by the time this shows. This show airs, uh, we will have a second platform, conc Slim, that will offer Zep Bound Tirzepatide, which is the first GLP one receptor agonist, uh, that has been approved for the treatment of obstructive sleep apnea. Uh, and, uh, we can arrange for drop shipping of Zep Bound, not a copycat.

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Not a compounded drug, a quality controlled, verified zep bound in a sterile syringe with, I'm sorry, in a sterile vial with sterile syringes and sterile needles. And we can get that dropship to their home, and we are going to begin to address the desire that some people want medical therapy, or at least try it.

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Before they move on to positive airway pressure. And the other thing is that we're going to expand our flagship platform, which is con sleep. And this'll be more of a B2B, a business to business kind of arrangement. Um, but we'll provide the diagnosis to dentists who custom fit. So dentists could just send their patients to our site.

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We can get them diagnosed, and we can write a treatment plan. Uh, that includes oral appliance therapy and mandibular advancement devices. So the patients who want to try that first before a positive airway pressure, uh, device, either alone or in conjunction with a GLP one receptor antagonist. Agonist rather, yeah.

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Yeah. 

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Indicated. Um, we can offer that. Um, and we can do that expediently and we can get people diagnosed in under one business day and then get that prescription out to the dentist and we can let the dentist go and do their work. Now we cannot. Follow the guidelines of the American Academy of Dental Sleep Medicine and do everything completely, virtually.

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Those guidelines call for an in-office evaluation with your dentist for an in-person fitting. Um, they do not endorse these off the shelf devices or the devices that get sent to you and you boil them. Uh, in water in your kitchen and then bite into it. 

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Yes. 

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So we really can't do more virtually than provide people with an accurate diagnosis and then get them to the appropriate dentist.

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Sure. So we will, we're not doing that yet. That's gonna launch in about three or four weeks, but by the time the show works outta a 

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time. Oh my gosh. That's exciting. Ugh, 

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thank you. 

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Yeah, that need, because I think, well, one, this paints a picture for people that aren't aware of the fact that 'cause for many, there's just an assumption that it's kind of like you got one option, you got the mask or bust, and then you're pointing to.

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Not only do you just, is there a bevy of options available, but that sometimes it might be this kind of collection, uh, mosaic of many different things that we'll bring in to reduce the severity of those apneas throughout the course of the night. So it might take some lifestyle approach, it might take a kind of a peptide approach.

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It might be oral appliance, and we might test certain things to find what fits for them, maybe that particular oral appliance. Had a certain component to it that, but now we wanna try the mask, et cetera. So is that accurate in that if someone's coming in they can, it can be like a one-stop shop for the sounds of it, where they can test, where they can then take some of these different steps available and find the one that makes the most sense for their anatomy.

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And I guess that would bring me to, I often do this as, I'll often give people like five questions in one, so apologies, but, but would this also kind of point to that? The ENT component of this, of identifying where their root kind of obstructions or source of their particular problems with their apnea, whether it's more nasal base airway, both myofunctional supports, like is it kind of identifying and addressing all of those things all in one place?

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So the answer to that is yes. Although if there are ENT surgeries. No, we're not involved in that. Okay. So if you're talking about a, um, UP three, A U plo, pharyngeal, PALOP, plasty Sure. Or something like that, we don't get involved in that. And that person, uh, a person who is interested in that surgery, which, and, and those surgeries are being performed less and less 

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Yeah, sure.

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As other modalities, uh, are becoming, um, more and more. Popular and their efficacy are being established. So no, the ENT part, um, we would not be addressing, although, mm-hmm. Although the, the mechanisms of obstructive sleep apnea, um, tend to be with neck and airway diameter and thus affected by weight. So we'll be addressing that.

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Uh, with the GLP one, with zep bound. Um, they will be also, um, uh, n circumference and airway, uh, resistance would be addressed by positive airway pressure. Oh, really? Um. Lack of, uh, of muscular responsiveness, you know, of the pharyngeal constrictors, which is another, um, mechanism, um, that gets treated bluntly mm-hmm.

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By a positive airway pressure device. Now, by the time I, perhaps not by the time this airs, but shortly after, there's a company called Aped. Hmm. Which may have a medication that, um, just had a successful clinical trial. Hmm. That includes, I believe, oxybutynin and, uh, acetazolamide in it and the oxybutynin, um, might address, uh, pharyngeal constriction, um, to be determined if we get into that game.

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Sure. Um, but, um. Then of course the people who are having tongue occlusion 

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Yes. 

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And oral maxillofacial occlusion. We will be addressing that by being a feeder to the dentist. Great. We can provide diagnosis and prescription. 

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Sure. The 

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dentists are generally states not permitted to diagnose and come up with the treatment plans.

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Uh, but we have, uh, medical doctors who can, and then we will. Forward that to the proper expert, which is a dentist and, and preferably a dentist who's taken additional, um, course training in sleep dentistry. 

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Okay. And would you say for most of the people that are coming outta this, speaking in generalities, but for a big chunk of people listening.

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Well, a big part of the heavy lifting is likely going to be the first testing and then testing out whether it's the CPAP or the oral appliance that those two often can really support a large swath of the population. Or is that too general of a question? 

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No, I don't think it's too general of a question, so.

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You know, your, your five part questions started with, are we gonna be doing combination therapies? 

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Yeah. 

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Or are we going to be doing sequential therapies? 

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Yes. 

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And the answer to that is, well, kind of whatever the patient wants. I mean, we, we know, for example, with the GLP one, with Tirzepatide. Zep, yeah. Um, we know that it is.

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Incredibly effective at reducing the severity of obstructive sleep apnea. But for most of the patients in that study in the New England Journal of Medicine, they still had residual obstructive sleep apnea. 

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Sure, sure. 

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So I think that what we're going to see is. Somebody who's using monotherapy non combination therapy, but then combines it with either a positive airway pressure or mandibular advancement device.

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Yes. If they realize that the GLP one is not sufficient. 

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Totally. 

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I doubt, I doubt that We will see, um, people who give up on the GLP one, they'll probably lose weight and feel better in other ways. 

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Mm-hmm. 

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Uh, but they make one that they need. Combination therapy with the mandibular advancement device? Well, people may get better without being a hundred percent addressed.

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Mm-hmm. 

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Uh, they may wanna add on a GLP one in combination. They may wanna switch to a positive airway pressure device after trying the mandibular. So in that case, it could be either combination or sequential. Hmm. And the other one could be that I tried my positive airway pressure device. It's working.

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I'd like to try something else in which I, in which I don't have a device on the entire night. So we will be the two platforms together. Sleep, which will offer positive airway pressure therapy and a prescription to go to a sleep dentist. 

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Mm. 

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And Conc Slim, which is what our other platform will be called, which will offer a GLP one receptor agonist.

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We're going to be able to offer people sequential therapy, more combination therapy, and of course, I have my fingers crossed as do all the. Patients out there that they're gonna get it right on the first try and not need either. Combination therapy or sequential therapy. If that works out for people, we will all be satisfied.

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Nobody's gonna argue with that. 

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So good for people listening that maybe they have a current treatment, but it's, you know, they were tested and maybe just kind of felt fly by the night, where now they have a mask. Sometimes they're using it. Or maybe they got an oral appliance and they're questioning, I don't know, is this solving my problem?

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They're kind of unclear. Are there methods or steps that are available that they could kind of do some follow-up testing or how do you approach that? 

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Okay, so I mean, certainly they can use. Our digital clinical interview or adaptive logic questionnaire. But if they already have the diagnosis mm-hmm.

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That's probably not gonna add very much. Okay. Um, and if they already have the diagnosis. Plus they're wearing their Apple Watch 10. Yeah. Or their Samsung Galaxy Watch. 

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Sure. 

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And those consumer wearables are telling them that they probably have obstructive sleep apnea. I don't know how much more our diagnostic platform will have to offer them.

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Mm-hmm. But there is a third offering on our con sleep platform. 

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Okay. 

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And that's called conc. Second chance. There are lots of people who've been diagnosed. They have the positive airway pressure device and they're not compliant, or they're not comfortable, they're floundering. They never receive the proper support.

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And for one flat fee, we will give them a respiratory therapist onboarding. Uh, we will give them a reboot. We will give them 90 days of support with respiratory therapists and sleep coaches. Wow. And we'll monitor their device use. For 90 days. So for those who are already on positive airway pressure therapy, who believe that it may be the right thing for them, but it just didn't work out.

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Um, we have con second chance. Um, let's give it a try. I think with, uh, the right amount of TLC, 

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yes, 

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we can make it work. For people who have it and don't like it and wanna try something that they perceive to be more palatable. Either a mandibular advancement device book, 

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no pun intended. Yeah. 

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Yeah. No pun intended.

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Thank you. Oh, you got that. I'm used, I'm used to being the one who makes the clever jokes. Molly, you're not. Um, 

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I like dad jokes over here. Love a good pun. 

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I look like the person making the.

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For people who don't find that agreeable, let's not call there, 

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go. Yeah. So good. 

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Then we can, um, we can explore. Certainly if they have the diagnosis, there's no reason. Um, why we couldn't confirm that and send them to a sleep dentist. Um, sure. Or they can go on our co slim, uh, uh, platform. They can enter the fact that they've already been diagnosed and now we go into other aspects of their medical history.

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Um, have they been diagnosed with obstructive sleep apnea, you know, height? Weight. Um, we would like to work in status of polycystic ovarian syndrome. Hmm. We would like to work in status of menopause on our flagship platform. We ask those questions of women. 

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Oh, good. We, 

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well, we ask about, uh, menopause. We also use different cutoffs for BMI, we use different cutoffs for, um, next circumference.

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Um, so anyway, I'm, I'm answering a lot of things at once. 

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I, I encourage it. Yes, I love that. 

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Yeah. But we, if you're already on a therapy and you, uh, on positive airway pressure therapy or you wanna move to mandibular advancement device or vice. Versa, or you're on either and you wanna try a GLP one and whether you wanna do it sequentially or in combination therapy.

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The two platforms together will offer all of those combinations, uh, as an option. 

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So good. Now, I love that you hit on genders and curious if you can help break down for us, why is this a factor when we are looking into sleep disorders, like sleep apnea, and do you hit on upper area resistance syndrome often in your work as well?

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Well, so we don't, we don't ask about that specifically. Okay. We are kind of, we are just focused on the general diagnosis of obstructive sleep apnea Okay. And what that person's phenotype is. Um, we don't get into that. Specifically. 

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Sure, sure. 

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Um, home testing doesn't either. 

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Yes. 

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Some sleep overnight, sleep labs polysomnography under the, the guidance of a, um, expert sleep medicine doctor.

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They can get into phenotypes and things like 

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that. Great, great, great. So yeah, talk to us about gender. How does this play a role? How do we think differently depending on who we're talking to? Male or female? 

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Right. So. Similar to cardiovascular disease prior to menopause, uh, sleep apnea. Obstructive sleep apnea is predominantly a male disease.

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Sure. Uh, you know, two thirds or three quarters of all patients prior to onset of the ages in which most women enter menopause are men. 

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Hmm. 

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But as you get five to 10 years past menopause, you know, as you begin to get somewhere between like the 50th and the 60th birthday, just like cardiovascular disease, it's no longer predominantly a male illness.

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It's 50 50. 

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Yes. 

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And if you're asking questions in your screening that are kind of aimed at a man, so for example. The very first que we, we don't ask the question. We see it with our own eyes, but the very first question we ask people is, are you a man or a woman? 

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Yeah. Yeah. 

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And if the answer is woman, well, you've been denied one of the criterion for diagnosis.

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Mm. 

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So good. On our digital clinical interview, if you answer, I'm a woman. The very last question we ask you are, have you experienced menopause or perimenopause? We give you another opportunity to address the fact that you may have a different risk factor than a man, um, that nevertheless puts you. Within the same risk category as a man.

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Yeah. Um, this is part of our secret sauce. We also do not subject women to the same cutoffs for BMI or next circumference that we do for men. A lot of the screening uses one value for each, um, that is silly. Uh, a thick, a thick neck, and a woman. Looks very different than a thick neck in a man. You shouldn't use the same cutoffs.

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A thick waist in a woman 

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yeah, 

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looks very different than a thick waist in a man. Um, and to hold women to the same normative value cutoffs as men. You're just going to be missing women both in your screening and your diagnosis. And then one thing that, um, uh, some of our users will have noticed, um, is that in this last month, we have now added on a biometric that shadows, um, not BMI, but FMI Fat Mass Index and specifically abdominal fat mass index.

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Great. Um, and we are asking people, uh, about their. Waist circumference amazing. And in the coming weeks, um, this is going to be in our engine behind the scene. Um, if you have somebody's height, weight, neck circumference and waist circumference, you can also approximate their body morphology and you could kind of.

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Build up what some people call A-B-R-I-A Body roundness index. 

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Sure. 

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Um, you know, right now, um, doctors, when we ask these questions, um, we look at our patients as if they're built only in two dimensions. Right. And by the time this airs, we will be looking at our patients three dimensionally. 

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Yay. Exciting and so innovative.

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I know. I would love to see a future where DEXA scans are involved in this process too. So we have that whole body comp rundown. So the fact that you're doing this is just so, so important. 

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What if you had all the biometrics on somebody? 

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Yes. 

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Okay. And you couldn't equal the accuracy of a DEXA scan. 

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Sure.

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But you could approximate it pretty close. 

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Yeah. You get the 

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general, that's what con, that's what Conk is looking to do. Yeah. We are looking to use, um, empiric data and easily self-reported signs and symptoms that could kind of approximate, um, technologic offerings. So 

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good. 

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Great. Oh, and by the way, another thing we do that nobody does is we incorporate the data from your consumer wearable.

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Right now we only incorporate the Apple Watch 10 and the Samsung Galaxy data because that's the only one in which it's FDA approved. Not just for sleep tracking, but for sleep apnea. 

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Sure. 

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But as more and more of these consumer wearables, um. Get FDA approval for flagging high risk of sleep apnea. We'll begin to incorporate those two.

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Amazing. Uh, yeah, we're at quite sleep renaissance, uh, period of time. So, you know, just it feels like month by month, more advancements, more kind of information available, and then people like yourself that are finding innovative waves to blend this all together and give us a beautiful full picture of what's going on for each individual is just.

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Very exciting. Now, before we shift gears into how you're managing your own sleep, I know these are huge topics that we're discussing. Is there anything that you wanna make sure that we kind of put a bow on or address? And, and again, I know that we've only just scratched the surface on this huge topic, but was there anything we didn't hit on?

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No, I mean, we, we hit on a lot now. This is, this is what I would say. If our platform, if the con platform can't definitively diagnose. You as having sleep apnea and, and I, and I know, um, that, uh, you are kind of familiar with this aspect of our platform. Yeah. Um, uh, uh, from an acquaintance of yours, um, that we're involved in, if we 

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AKA, um, I'm happy to share that.

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I'm very grateful to have my husband go through the whole process. I often use him as kind of a example. I have all the permission to share from him and. He is someone who, I mean this process of having the opportunity to work with trained individuals like yourself to kind of discern what's going on with his apnea, and he is an interesting use case in that he's an example of someone that wasn't snoring egregiously.

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Most likely, if not for the fact that, you know, I'm getting sent sleep stuff over the years, all this, you know, that he wouldn't have probably ever thought to test because it just wasn't this huge thing. He wasn't wildly overweight. He didn't have, you know, some of the key signs that we might think of right off the bat.

‍

And yet, lo and behold. Comes back a sleep apnea diagnosis, but then kind of on this cusp. So to have a skilled, thoughtful practitioners like yourself to be able to weigh in on what's going on for him and provide expert guidance, it's just really important. So appreciate that. 

‍

So what, so what are we gonna, what are we gonna say if we don't, um, if we can't confirm the diagnosis, I just wanna say, that doesn't mean you don't have it, and those are the areas.

‍

In which con feels very strongly love it, that you should go to the sleep center. 

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Yeah. 

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That you should see a sleep doctor. 

‍

Yes. 

‍

It's in those equivocal cases, um, where we're. Not going to be overly bold Renegades. Yeah. And say, Hey, we wanna sell you something. We're going to say we can't take your business right now.

‍

But we think you really need an expert in the field for in-person evaluation. I also wanna point out that on the con slim platform in which we will be doing, um, offering GLP one therapy. Yeah. That is going to be synchronous.

‍

You know you're taking a big medicine. 

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Yes. 

‍

You have to have the dose slowly advanced once a month for up to six months. 

‍

Yes. 

‍

And so for that titration period in the first six months, we think it's very important you know, that you see a human. Um, you talk to them and you have an exchange. Remember when we diagnose you on the con sleep platform and we send you a positive airway pressure device, you also get a team of humans.

‍

Yeah. Where you, where you're getting a respiratory therapist onboarding for 45 minutes and then access to the respiratory therapists and sleep coaches for 90 days. Hmm. So when we make that diagnosis. You are then getting a human, um, when we, um, make the diagnosis and you, um, and we send you to a sleep dentist because you want a mandibular advancement device.

‍

We're sending you to a human who's going to spend, um, several hours with you over the course of several weeks. On the GLP one side, we hit you with that synchronous human interaction. Through a video feed right away. Um, these drugs I think are um, must be taken very seriously. Yeah. 

‍

Um, 

‍

and until we establish that you're comfortable on them, um, we want, we want face-to-face contact 

‍

so wise, so Great.

‍

Well, thank you for walking us through that because it is just a kind of often confusing landscape to have that. Sherpaing along the way can really, really support and make such a difference for people's experience and their outcome and compliance rates and just their results and their experience of their sleep and their health.

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So, so appreciate that. 

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On the Kunk Sleep platform, you get your Sherpa on the back end. 

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Yes. 

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On the Cog Slim, you get your Sherpa on the front end and the back end. 

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The sandwiching of Sherpaing. 

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Yeah. 

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Yes. Fantastic. So good. Well, fantastic. So as someone who clearly has thought deeply about sleep and has gone through your own journey with sleep disorders, excited to hear how you're managing your sleep.

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And people always do seem to like to learn right on the ground of how people, what they're doing. So our first question is, what is your nightly sleep routine looking like right now? 

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So my nightly, uh, my nightly sleep routine actually begins in the morning. Yes, I clean my automated positive airway pressure.

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I, I clean the nasal interface and I clean the water chamber, the humidifier, and I 

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clean every morning. 

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Every morning. 

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Yes, 

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I clean. It's not, I give it a thorough cleaning every Monday, um, with. Back then and all of that. 

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Sure. 

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But I do a cleaning every morning. Right. Um, I usually at around at nine o'clock at night, I begin to read.

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Mm. Uh, 

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and then I, um, I don't watch. Television, um, in bed. Um, uh, I have a bedmate who does, and, uh, there are some arguments, but, but some earphones and headphones have solved that problem and we're not fighting. There 

‍

we go. Yes. And certainly you're not alone. One of our most popular podcasts to date has been with Dr.

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Wendy Drexel, who are sharing the covers and speaking to rebranding, sleep divorces as sleep alliances, and looking at the research around sleeping in bed with partners, pets, kids, et cetera, and what that can do for two sleep and ways around that. So I love that you pointed to 

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that. Oh, putting a couch.

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Putting a couch in our bedroom. Yes. So 

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the 

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dogs sleep on the couch and don't wanna be underneath our feet or jump on the bed. That was a brilliant move, by the way. Oh good. I didn't even, that's alright. So then I put on my CA machine after I'm done reading 10, usually about quarter to 10. And I, I sleep solidly and I dream and I feel great.

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But for whatever reason, almost every night I wake up after about five hours of sleep. 

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Yep. 

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What I've learned to do is then I leave the room, I go into our guest room, I sit in a chair, I close my eyes. I have both feet on the ground. I put one hand on my chest, one hand on my belly, and with my eyes closed, I just anchor in on my breathing.

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And I do for whatever, for as long as it takes until I calm down. Sure. Um, on a good night. It'll be 10 or 15 minutes. Last night it took me almost an hour. 

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Sure. 

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But I went back and I slept another two and a half hours. 

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Yeah, absolutely. Well, thanks for sharing about that, since that is, there's an overwhelming percentage of the population that's dealing with wake ups and what to do when they wake up and difficulty falling back asleep.

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And do they get up, do they stay in bed, do they this, do they that? So appreciate you sharing that. And then anything else that we missed in your nightly sleep routine, or did we capture that? 

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That's the, the nightly sleep routine. Okay. I mean, there are other aspects of my life that I'm very conscious of Yes.

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That I do to make sure that I sleep well. Um, and maybe we'll get into that, but that's, I was just 

‍

gonna say that. Yes. That was perfectly said. Yeah. 'cause, and I love how you started with, you know, to get great sleep, it kind of begins in your morning. So that's one of the reasons why we speak to it as your morning sleep routine with the idea that how you start your day can impact your sleep.

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So what might we see in your morning or stretching into your day? 

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Okay, so I exercise six days a week. I concentrate on cardiovascular. You know, I ride, I ride my Peloton, um, five or six times a week when the weather's nice. Um, I will. Go on a 30 mile bike ride, uh, sort of in that zone two, that endurance.

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Yeah. Um, kind of pace where I'm not killing myself. Uh, and on the Peloton I'll mix it up. I throw in, um, I throw in a run. Usually on a treadmill about once a week. So doing variety in my exercise. And then after I exercise, um, I usually do, uh, yoga or stretching for, but only for 15 minutes and usually only floor exercises.

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It's really more about. Flexibility so I'm not stiff during the day or when I go to bed and getting leg cramps and things like that. And I'll do some lightweight lifting once or twice a week. So that's a big, um, that's a big part of what I'm doing too. I don't know if you wanted to follow up with other questions, but another thing that I did, um, is that of, um, I, I cut back on my drinking.

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Oh, totally. Yeah. 

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Um, I was never a particularly heavy drinker. 

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Yeah. 

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You know, one drink on a Thursday, one drink on a Friday, two on a Saturday, and one on a Sunday. And it's very easy to do that and, and, and not even realize what you're doing. 

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Yes. 

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And you know that, you know, that's 260 drinks a year. Right.

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And I kind of. I mean, in the summer the number goes up 'cause we're barbecuing or going to the beach. 

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Sure. 

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Um, but I try to have one or two drinks a week. That's made a huge difference. 

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Ah, so good. Yeah. That, I will say that's one of the areas we've seen wearable data really shine too for the average individual is just seeing numerically, you know, metrics driven kind of assessment of the impact of alcohol on our.

‍

Sleep and certainly for those looking to optimize heart rate variability and HRV, among other things with their sleep, alcohol being such a clear one and how much of a difference that can make. And if anyone's listening and also kind of head nodding to the difference that, you know, kind of lowering alcohol can make.

‍

We often. Like to support people in alternative state changers, if you will. 'cause often if we're drinking, we are looking to change our state in some way, shape, or form. So we have a whole section on sleep as a skill of alternative state changers. Some of the sleep friendly ones, we've found hard ketones, so using ketones, but they're ethanol free.

‍

So it still has a way to get alcohol, but there's no ethanol in it, which it tends to be one of the biggest hitters of how we feel so uncomfortable the next day. But also the impacts on our sleep. So more sleep friendly alcohol. Kaba being an option. Controversially. Krato being an option, and then looking at other alternatives like Kana and then other things that you could bring in that won't necessarily mess with your sleep.

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So I love that. Thank you for that. And that's a great underscoring the difference 

‍

and that changed not just, not just the quantity, but. You know, also the, the quality and the timing. And the timing. Yeah. So I tend, I tend to just have a beer now. I mean, I make a mean Negroni, but I kind of stopped drinking them.

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Yeah. Um, if I just have something with a lower alcohol content and I'll only have one. 

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Sure. 

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Uh, or I mean, in the summer, maybe it's two 'cause we went to the beach, but 

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Yes. 

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Um. Definitely decreased the quantity, and I'm using a lower alcohol beverage, like a beer. 

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Yeah. 

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And then the other thing that I am totally strict on is the last one is at least three hours before my bedtime, I won't have even a beer after 7:00 PM.

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Absolutely. Yeah. And for our individuals that we're working with that, especially with sleep apnea, that alcohol timing, and then their meal timing, such a huge hitter. So love that you're addressing the timing piece of this from that chronobiology perspective. Just how much of a hit that will have and your sleep results and the severity of your apnea, so amazing.

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Then how about in your environment, on your nightstand or in your space, what might we see there? 

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So on my nightstand, I could tell you exactly. You will see an automated positive airway pressure machine. 

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Yes. Taking up a lot of the space there. The real estate, 

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you'll see a coaster with a full glass of water on it, and I do my best to keep that water full.

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That glass filled with water, because once you're a guy who's over 50, and this happens to women too, um, but needing to urinate in the middle of the night can really disturb your sleep. Yeah. So I want, you know, I want water there, particularly in the summer in case I get thirsty, but I only drink it if, um, you know, if thirst wakes me up.

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And the other thing you'll see on my nightstand is. It's the book. 

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Perfect. Love that. 

‍

Right now you'll see the things they carried by Tim O'Brien. 

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Oh, very nice. I have not read that, but I've heard delightful things. 

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Yeah, the Things They Carried by Tim O'Brien. It's also one of my son's favorite books, so 

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Oh, amazing.

‍

Love that. So good. And then the experience of just the tactile actually reading a physical book. It's not on a screen or whatever, so that's great. So good. 

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Yeah, I don't, I don't possess the technological know-how to use a 

‍

Kindle. 

‍

Yes. Like I don't 

‍

come on, 

‍

but I haven't, I, I didn't take that class yet. 

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I love that.

‍

Okay, so that gives us a visual. And then the last question would be, so far to date, what would you say has made the biggest change to your sleep? Or said another way? Biggest aha moment in managing your sleep. 

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Right. So actually. The biggest aha moment for me actually came before I was managing my sleep.

‍

Sure. 

‍

The aha moment was when I realized I needed to do something about my sleep and address my sleep, and that's when my wife confided in me that she thought I was a crab. Yeah. And, and my mood was bad and it was. Just affecting my relationship, you know, with the most important people in my life. 

‍

Totally.

‍

Which was my wife and children. And so that was, that was the aha moment. And then after I got treated, you know, I was in a better mood like the next day. 

‍

It's amazing. 

‍

And so then that was the aha moment. Like, why was I fighting the mess? Listen, I realize that a lot of people don't want the positive airway pressure machine.

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I'm only gonna speak for myself. 

‍

Sure. 

‍

It was right for me. 

‍

Yes. 

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I felt better immediately. 

‍

Yes. 

‍

I began to eat less. 

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Mm-hmm. 

‍

Like I wasn't eating to get through the day. 

‍

Exactly. 

‍

Um, I don't know if this is too much, Tim. I, but it turns out never. It turns out that my, my decreased interest in sex had nothing to do with me being yes, almost.

‍

It had to do with the fact that I was fricking exhausted. 

‍

Exactly. Testosterone, plummets and all of it. Yeah. 

‍

And then I treated my sleep apnea and guess what? Something that I thought was. Uh, an aspect of my life that I would look back on fondly. It was part of my presence again. And, you know, that was an aha moment in retrospect, looking back.

‍

Totally. 

‍

And then I was like, well, you know, why didn't I do, why didn't I do this seven years ago? 

‍

Yes. What a glowing recommendation for just, you know, testing, treating, taking that step because like you said, I mean, it just can be such an immediate difference and have such a bi-directional relationship to all these other areas of our lives, the choices that we're making in the kitchen, in the bedroom, and all over the place and believe.

‍

Right, right, right. 

‍

So, 

‍

um, sleep apnea could make you anxious and depressed. 

‍

Exactly. 

‍

Anxiety and depression can. It actually gives you sleep apnea. There's, um, yes. Data from, I believe it's Barry Krakow, uh, sh showed that, um, yeah, you, you have decreased, uh, pharyngeal constrictor tone and if you're suffering from anxiety.

‍

And so it's not just that the poor sleep is making you anxious. Anxiety can give you sleep apnea. Yes. That was another how bidirectional everything is. 

‍

Yeah. 

‍

And when it's moving in the wrong direction. It's a vicious circle. Yeah. Then you turn it around and now it's a virtuous circle. 

‍

I love that. Love that.

‍

And that was again, another kind of like retrospect, aha. Moment. 

‍

Yes. Oh good. That's, I love that. And just so there's this opportunity when we might be at some of our lower points in our journey with our sleep and life for often very often kind of tend to go hand in hand that there's this gift available on the other side if we really get curious to start taking action.

‍

And sometimes it takes feeling really not great to finally take that action. 

‍

Right. So 

‍

I appreciate you sharing that. 

‍

Yeah, no, I mean, listen, wearing a positive airway pressure device is suboptimal, but depression is worse. 

‍

Yes. Exactly. Exactly. Wow. Okay. So for anyone listening now that has gathered like the, whether it's sense of urgency to get tested or to be treated, or the second chance piece that you spoke to, or maybe incorporating kind of other modalities, peptides, et cetera, how can they work with you?

‍

We talked about how you know now when we air this. There will be whole, you know, slew of options. So what are those steps for that person? 

‍

Right. So for individuals it'll be, uh, just for those who are interested in either the con second chance or getting diagnosed initially and put on positive airway pressure, uh, www doko sleep, K-O-N-K-S-L-E e.com, um, for those, um.

‍

Dentists, um, can refer to our site. Um, and we'll, we'll have a carve out on the site, uh, in which we can diagnose people and then specifically, um, issue a prescription. Um. Issue a prescription for mandibular advancement device therapy, oral appliance therapy, and then that, um, that prescription could be provided to the patient so that the patient can give it to their dentist.

‍

Um, and dentists can reach out to us on the con sleep.com website through the contact us page, or, you know, can get to me through LinkedIn. Douglas. GLP one platform which hasn't launched yet, but will by the time the service is going to be called con slim.com, K-O-N-K-S-L-I m.com. Just get on the site that, I mean, you can get diagnosed.

‍

Quite easily in under 50 minutes. 50 minutes under five minutes? 

‍

Yes. 

‍

And well under five minutes. And we do ask, we ask a lot of questions about the other medications that you're on. We're not gonna treat you if you're already on a weight loss medication. Um, you need close in person follow up, um, if you're on insulin or a SUL funnel.

‍

U uria. Mm-hmm. Uh, you know, um. If, if you're on, um, some of those other, uh, diabetes related medications, um, but if you're not on those and you have a body mass index of at least 30 or a body mass index of 27 and then associated, um, comorbidity. Yeah. Um, we'll treat you, we will get the prescription, uh, to a, um.

‍

Certified retail pharmacy that will deliver you not just er tirzepatide, Zep bound, complete quality control. You will know what you'll be getting. 

‍

So good. Great. Well we will be sure to have all that information in the show notes, so definitely check that out. And just thank you so much for the work that you're doing and for making the time to share about this and for sharing vulnerably too about your own journey really helps you know the listener to see like what's available on the other side.

‍

Once we do treat that, and then it doesn't have to go so long for them. It doesn't have to be an arduous thing and that, like you said, like the next day you can be feeling better. So it's just so 

‍

hard. And there isn't a sleep apnea type. You know, when I was diagnosed I was in my forties. 

‍

Sure. Um, 

‍

I had run a marathon.

‍

I had run several half marathons. 

‍

Yes. 

‍

Um, I had a little bit more around the belly than I should, but I was not considered overweight. 

‍

Yep. 

‍

Um, but I had high blood pressure. I had chronic daily headache. 

‍

Yeah. 

‍

And I had a wife who had to sleep with earplugs in her. 

‍

Exactly. I love that itemization of the results that we can get if we don't treat these things or discover these things and Yeah.

‍

And, and it's so important because it doesn't necessarily just look like that archetype that we might've thought of falsely. So, so good. Well, thank you again, and really excited to follow all the innovations and advancements that you are behind in creating. 

‍

Thank you, Mollie. This is great. This was fun.

‍

Let's, uh. When I'm in, when I'm in Austin, let's have an alcohol free beverage more than three hours before bedtime. 

‍

Yes. Oh, I'm 

‍

down. We can share more, uh, sleep experiences. 

‍

Yeah, that's, it's let's make it happen. Totally. Okay. Sounds great. Thank you so much, Doug. Appreciate it. 

‍

Okay, thank you. 

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You've been listening to The Sleep Is a Skill Podcast, the top podcast for people who wanna take their sleep skills to the next level.

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Every Monday, I send out the Sleep Obsessions newsletter, which aims to be one of the most obsessive newsletters on the planet. Fun Facts. I've never missed A Monday for over five years and counting, and it contains everything that you need to know in the fascinating world of sleep. Head on over to Sleep as a skill.com/newsletter to sign up.

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