How Do You Know if You Have Sleep Apnea

Sleep Apnea with David Shirazi

[00:00:00] Rebecca: Today's guest. Dr. David Shirazi is a TMJ and sleep expert. Dr. David holds too many degrees and certifications for me to list, but to read his bio, please visit thatorganicmom.com/sleep-apnea. Dr. David is a dentist and acupuncturist, a sleep expert, and lots more. If you have a sleep issue or sleep challenge, chances are Dr. David Shirazi knows how to diagnose and treat it. I hope that you'll stick around for the end of this episode, as he shares his expertise. And you can find out more about Dr. David and his work with TMJ and sleep therapy at his website, which is TMJLA.Com. 

[00:00:47] Announcer: Welcome to a healthy bite. You're one nibble closer to a more satisfying way of life, a healthier you and bite size bits of healthy motivation. Now let's dig in on the dish with Rebecca Huff.

[00:01:02] Dr. David: So I'm a dentist. I'm an acupuncturist for five years. I was a sleep technologist and I have a master's in psychology. I got into sleep because my focus was TMJ disorders and and chronic pain. And, you know, we found out that one of the reasons why we clench our teeth is because of sleep breathing disorder. And so I decided, okay, well, I should, I should learn. I should know more about these sort of things,, for example, things like TMJ and sleep, you know, sleep apnea. These are things that can't be fixed with acupuncture and herbs, right? Because if someone has a TMJ problem, if it's acute, it can be. But the problem with, with someone, with the jaw problem, If they continue to clench their teeth every night and sometimes during the day that, you know, you're never going to resolve it with acupuncture, even lasers or what have you, because the patient's going to go back into what we call parafunction.

[00:02:07] So as I was studying the sleep; the dental courses for dentists treating sleep apnea were all basically learn how to make this appliance, you know? And then buy our appliance, it was basically the gist of about 90, 95% of them. And then 

[00:02:28] Rebecca: and by appliance, do you mean the, 

[00:02:31] Dr. David: yeah, yeah. That's, that's how we treat. So the conventional treatment for sleep apnea is C-PAP machine. Yeah, you take, you know, you put this mask on and it blows air like a balloon to open up your airway and it works great, but it has a less than 50% adherence rate. So, you know, the next best thing is an oral appliance, FDA approved oral appliance. And in fact, all respectable medical bodies have all admitted that from mild to moderate apnea an oral appliance is preferred.. Cause what patients are going to stick with it. 

[00:03:07] Rebecca: And by oral appliance, can you explain what you mean by that? 

[00:03:12] Dr. David: Yeah. So, whereas a C-PAP is a pneumatic splint. It's literally putting positive airway pressure in the throat to blow it out like a balloon. And our oral appliance is a splint . It's like a physical splint.

[00:03:25] So the top and bottom pieces are attached. So that one, your jaw can't fall back and you know, when you're on your back and it can keep your airway open at a certain spot. And now we've we, we have additions to it. We can put little shelves in there that lift the tongue to help the patients swallow on the roof of their mouth.

[00:03:47] We can, we can actually have what's called the posterior tongue restrainer, which literally is like a false uvula. That's hard. And it keeps the tongue down, from falling back and rubbing up against the soft palate. And we even have ones that have like a little To kind of help open up the nasal valves as well.

[00:04:05] And of course my focus, since I know how bad the clenching and the TMJ problems can be as a result, mine always have a TMJ sort of twist to them to help control the clenching. And help minimize the clenching. I always, I almost always add that to my plan. 

[00:04:23] Rebecca: Are TMJ and sleep apnea always related?

[00:04:27] Dr. David: Okay. Not always. No, but it's hard to find a separation; reason why my office and my office by the way is a franchise we have over 65 in the world. We're all over the us, Canada, all over Australia and New Zealand, England, Bahrain, and Dubai. The, you know, and that's unprecedented for, the private sector, having a methodology to treat TMJ disorders, let alone sleep apnea.

[00:04:52] That's a whole other thing. But yeah, so we wanna make appliances to treat a TMJ disorder, to help minimize the clenching and keep the jaw in a very neutral position, what we call centric relation. And we'll actually bother to take an x-ray to find out if we did it or not. 

[00:05:08] Wow! 

[00:05:09] Dr. David: That's one of the, that's one of the ways that, you know, internally, I would tell another dentist, if a dentist said, what makes your place different than, you know, the other places that are doing it?

[00:05:20] We'll tell them, well, we do a proper neurological testing to find out if we can, the, the origins of their TMJ disorder. But externally, we, you, as a lay person, you could see, does the person not just take an x-ray to see what my jaw looks like? Do they bother to take an x-ray to see where they're putting it? Okay.

[00:05:46] That's something you can do because traditional oral facial pain doctors won't do that. And what's called neuromuscular dentist, won't do that. And they're just kind of. Crossing their fingers going. We got it. You know, sort of thing, which we don't, we don't. Yeah, 

[00:06:02] Rebecca: it's just, I'm a little hung up on this though, because if someone's clenching their jaw, it seems like it would be really hard to have, you know, snoring or whatever.

[00:06:13] I think of when I think of sleep apnea as like mouth open. And when you think of TMJ as , mouth closed. So can you explain it? I mean, to me, I'm like I'm stuck there. 

[00:06:25] Dr. David: Yeah. So there's been a couple of studies done and I'll go into more detail about what we think the origins of it are. So a polysomnogram, which is a an overnight sleep study, like in a lab with like 20 leads all over your head, face, arms, chest, and legs .

[00:06:44] And we can see what's happening in real time. And what these studies have found is that when someone's airflow was starting to slow down, Right. They didn't lose oxygen. They didn't hold their breath completely. They just had very shallow breathing like that. What they found was as the, the airflow was tanking on the thermistor, their patients were clenching their teeth.

[00:07:14] They were using their masseter muscles, right. And the clenching muscles going up. And then when the airway was went back to normal, it was no longer restricted flow. The master stopped. Right. So we, we see that. And then we also see that, so that particular condition is called upper airway resistance.

[00:07:36] When we look further and find out when there's a nasal obstruction and someone is mouth breathing and then they're, what's called entitled CO2 drops. Well, we actually see the clenching reflux happening after that. So what will happen is they'll, the mouth will be open and they'll what we say out gas, too much cO2 they'll get rid of too much CO2 and believe it or not. I know it's gonna sound shocking. CO2 is more important than oxygen as far as your body's concerned . Okay. Whereas we have one or two oxygen sensors in our body. We have close to a thousand CO2 receptors in our body right now. Evolution does not do that for fun.

[00:08:18] Right. It doesn't leave empty spaces and it doesn't create sophisticated receptors for no good reason. CO2 must be important if, if we have that many receptors in our body, right. And of course, just from, from physiologic, from physiology and medical physiology textbooks, we know that when you're sleeping, if, if you get rid of too much CO2, your body will create what's called central sleep apnea, where your brain tells your body not to breathe.

[00:08:53] Right. It's not, it does it, it does it conscious. It does it. Well, I shouldn't say consciously it does it deliberately. And what it does is because your metabolism is still rolling when you're having these APNIC events. And so when your metabolism is done and your CO2 level creeks back up, then it'll, re-engage breathing.

[00:09:15] Right. It can also be caused by excessive opiate morphine use, but that's less frequency than, than mouth breathing. I mean, mouth breathing is really the most common, the most common challenge, right? 

[00:09:31] Rebecca: Yeah. Right. Mouth breathing at night. So I know you have a quiz on your website. What this quiz is basically finding out if you are at risk of sleep app.

[00:09:43] Dr. David: Yeah, to basically say, Hey, does this apply to you? Do, do you see it in your children? And, you know, we know that sleep apnea is causal to so many common diseases like type two diabetes, hypertension, stroke, potentially that if you have that in your medical history, even pre-diabetes or pre hypertension, knowing that your sleep apnea may be at the root of it could get you,

[00:10:13] if you decide to go get a treated, gets you possible a resolution of those health problems. 

[00:10:19] Rebecca: So how. And this, forgive me if this is a dumb question, but how are sleep apnea and diabetes related? 

[00:10:28] Dr. David: So the, the main explanation is inflammation. Okay by retarding our sleep. So we have four stages of sleep stage 1, 2, 3, and REM.

[00:10:39] So stage three is Delta where we get almost all of our growth hormone. And, you know, REM is where we get mental and emotional resolution. And there's still, we're still learning about REM. Like we only learned like five, 10 years ago. We have a lymphatic system in our brain called the glymphatic system.

[00:11:00] And specifically during REM it cleans out the beta amyloid plaques in our brain, right? So this is not known sleep apnea. We've only known about it for 40 years. It's not, it's a pretty new science for us. So, and, and interestingly, so Western medicine itself is well under 250 years old. Right? Chinese medicine, 5,000 Ayurvedic medicine, 6,000 years old, you know, they didn't have these obesity problems and these sleep apnea problems in that we know of in the days of Ayurvedic and Chinese medicine.

[00:11:37] Right? So solutions clever solutions, from acupuncture and arms didn't exist back then. And so we're trying to be creative with them. Now, when it's a physical problem. So, so when you have an APNIC event or when you have those upper airway resistance, where you have the shallow breathing and then you do that, you kick yourself out of those deeper stages of sleep into a lighter stage of sleep.

[00:12:07] Right? So you could do that 400 times a night and not even know it. Not even know it because why? Because you're asleep. Right? So by getting kicked out, so once we're done growing, the purpose of growth hormone is to help you repair. And if you can't repair yourself, this is going to cause inflammation in your body.

[00:12:31] Cause, cause the purpose of inflammation. Is to repair, right? That's why we talk about the omega threes and the omega six fatty acids. Right? Omega threes are very anti-inflammatories and omega six are very pro-inflammatory and you think, well, why the hell would I want omega six? 

[00:12:50] Right. But you're recovering from an injury and exercise is an injury, right? There's repair involved. You need, you know, inflammatory markers to help you repair. Right, but on a chronic level, these are supposed to be short-term repairs. You're not supposed to be in a perpetual level of repair. So that kicks up your insulin resistance and your blood sugar.

[00:13:16] Rebecca: Wow. Very interesting. 

[00:13:17] Dr. David: Now with blood pressure, it's actually a little bit different. So when we're having the hypoxemia during the night, yes, our heart rate and our heart pressure must go up in order to get oxygen to our vital organs. That's of course it's extremely important.

[00:13:38] And you would think, well, after you wake up, why would you still have hypertension? It's already done. It's already done the deed. You don't have a sleep apnea when you're awake. Well, we have an autonomic nervous system and our autonomic nervous system, you've heard of it as fight or flight or rest and restore.

[00:13:56] Right. We've got the sympathetic and the parasympathetic. When we are in sympathetic mode. Right. And our, by the way, just so you know about the autonomic nervous system, it's either or. And we don't have a mechanism. That's like, okay, well, we're going to run away from this predator. And we're also going to digest this lunch that we just have.

[00:14:17] Right. If there is none of that, it's like, we're all, that's our focus right now is running away or fighting, or right now we're vulnerable, but we're repairing and we're digesting and we're restoring. Makes sense. 

[00:14:29] So when you're in that fight or flight mode from constantly being, what's called aroused in your sleep from those deepest stages of sleep, you get into this autonomic mode.

[00:14:41] Right. And and that autonomic mode is what shifts you into hypertension. And the reason I say curative for those diseases is because we have countless number of sleep studies and studies themselves where we've taken patients with both diabetes and sleep apnea, treated them with sleep at a C-PAP or oral appliances.

[00:15:04] I'm talking thousands of studies in both and their diabetes either goes away or is totally resolved. Type two. Wow. Same thing with hypertension right now with hypertension. There's so many diseases, right? Diet chronic pain though. There's a lot of reasons why someone can have hypertension, but this is what I tell my medical colleagues.

[00:15:24] I go, listen, if you've got your patient on three industrial strength diuretics, and you're basically barely keeping them below 140/100 or 140/90 . It's pretty guaranteed that they have sleep apnea, just do a test and you'll find out. Right. But if someone has just, you know, Mild hypertension.

[00:15:48] And they can get it resolved with some diet and exercise or lightness, you know, safe medication use then in not necessarily sleep apnea, but it could be the way you find out is you test. 

[00:16:03] Rebecca: So as far as say, like someone who snores, but they really don't seem to, or they don't know of any other health issues, is that snoring.

[00:16:15] Dr. David: Snoring is enough because snoring still causes the arousals. They did a huge study out of the Cleveland clinic. They started with 1100 patients and they did sleep studies on both bed partners, husband, and wife. And what they found was the, of the people that had sleep apnea, they had 27 arousals an hour. Okay.

[00:16:43] And of the, the bed partners with no sleep apnea, they had 21 arousals per hour on average. So they started off with 1100 people and they whittled it down to 150 that could tolerate the C-PAP. And of course the people on the C-PAP benefited, you know, they have a lot of improvement, but then they asked it interesting studies, but they asked the bed partners, how are you doing since your partner has been on C-PAP?

[00:17:14] And they're like, wow, my headaches have been gone. My mood is better. My children tell me a much easier to deal with a little bit of my aches and pains have gone away. 

[00:17:24] Rebecca: Oh, totally. Yeah. That's crazy. I mean, honestly, It's I'm sure it's life-changing for so many people. I know a lot of people who will like my friends, their husband will have a C-PAP machine and my friends will say that they get better sleep.

[00:17:41] My husband and I don't sleep in the same bedroom because he snores and he doesn't appear really have any, I mean, he's a healthy person. You know, he's he's in a good w And I don't know, but anyways, I do think it's very interesting because it is so disruptive and that's part of why we don't sleep in the same bed is because the snoring disrupts my sleep and I am a. It does it ruins my 

[00:18:06] Dr. David: life. 

[00:18:06] Rebecca: Honestly, that sounds so harsh. And people sleep in the same room with my husband. I love him to sleep.

[00:18:16] Dr. David: I bet you want to sleep in the same room with him . I bet you prefer to do it. If he. 

[00:18:21] Rebecca: Well, I would like to sleep in the same room with him , but not as much as I would like to get a good night's sleep every night, which is like…

[00:18:28] That is a very self honoring thing to do, there's absolutely nothing wrong with that. 

[00:18:32] Rebecca: For so many years, you know, I tried and I've, I know other people who snore and I know how disruptive it is for them. Like when you can hear someone in the next room, you don't want to be sleeping in the same room with them. 

[00:18:44] Dr. David: You don't wanna be sleeping in the same house. No, I, I get it. So yeah. I, you know, I encourage people to do something about it.

[00:18:52] Now, some of the challenges, what patients have shared with me is that they're afraid to tell their doctor because if they go and do an in-lab study, they're going to get the C-PAP machine and they don't want it. 

[00:19:05] Rebecca: Right.

[00:19:07] Dr. David: And I'd tell them it's okay. You can get an in-home study. Okay. It's okay. If you're in the mild to moderate range, which most people are.

[00:19:17] Or if you just have story, you can get an oral appliance. Okay. So, you know, I mean, obviously they're already in my chair, so they're already here to, to get the treatment, but I want people to know that, you know, don't be so afraid to bring it up to your physician . And if a physician have any sense, they should know that being in a lab is,

[00:19:43] you know, not the funnest thing in the world. So I should tell you, so I, I must think that I have my own lab, like a three bed lab. We also do in home studies. But my lab is dedicated to research. I'm not so focused on doing sleep studies cause there's like six places in my neighborhood that have in and they all take insurance and I don't.

[00:20:03] Right. So I'm not here to compete with them. I'm here to do research. And I have the best sleep apnea equipment in the world bar none, it costs two and a half to five times more than all the other competitors. Right. And one of the qualities that makes them so great is rather than, you know, you have to wear all those leads.

[00:20:27] Right, right. You have to be tethered to a nightstand. That's collecting all this data off of you. So basically you're stuck, sleeping. Like a rolled up rug, right? Like this on your back. So with mine, it's Bluetooth. So everything is on the person, it's on that little shoulder pad. They, you could roll over in your bed.

[00:20:49] You could walk to the bathroom and come back without being unplugged, and replugged it's great. Wow. And one night we're doing, we were doing an insomnia study and one of our machines crapped out. And the, and the and then we had a repaired and then we got the new one and, you know, we couldn't give the new one to a research subject without testing it first.

[00:21:17] Right. So I said, you know, I'll do it, I'll do it. You guys can do a sleep study on me. Right. So. I was, I was a patient. My sleep technologist at the time is now the president of the board of sleep technologists. Okay. And the tech, the person from the company that, you know, that sells , they were setting it up and they were doing what's called bio calibrations on me.

[00:21:41] Right. So I had all this stuff on me, the nasal cannular. And I told them, I said, so, Hey guys, this is the best equipment in the world for measuring sleep apnea. Right. They go, yeah. And I go, and it's the most convenient for the patient because it's so minute, so much of it is wireless. They go, yes, I go. I'm not comfortable!.

[00:22:02] Yeah. You know what I mean? They just laughed at me or whatnot and went about their business? Right. So I understand there is a difference between an in-home and an in-lab study. Even the best in lab study is not the most comfortable thing in the world, but you know, it's one night. So it's really not the end of the world.

[00:22:22] I did it. I slept through the night with all that stuff on me. And it was fine and it's, it's okay to do it in the lab. You get the most amount. Of data now at the same time, I'll say if you're the kind of person that when you go on vacation and you're staying at a hotel and the first night you're not getting a good night's sleep, you're kind of getting used to the room, the air conditioning vent and the, and then the people honking outside, whatever.

[00:22:51] And then despite the second, third, fourth night, you're more comfortable and you can sleep better if that's you, it's probably better, you do the sleep study in your room. You follow why? Because you're going to get a more realistic sleep study. 

[00:23:07] Rebecca: That just seems to me like it would be across the board, you know, for people like it's more accurate if you're at home.

[00:23:15] Dr. David: Well, it's more accurate if you're at home, but also when you're at home, you're only getting, what six channels of data, whereas in a lab you're getting at least 20. 

[00:23:26] Rebecca: Okay. 

[00:23:27] Dr. David: And a big chunk of it is the EEG, your brainwave, pleads, and your autonomic nervous system, your heart rate variability. These are incredible tidbits of information.

[00:23:36] You get more data in one night of a in-lab study, then you're doing any blood test. 

[00:23:45] Rebecca: Hmm. Wow. Okay. 

[00:23:46] Dr. David: It's an incredible amount of data, incredibly useful amount of data. 

[00:23:53] Rebecca: Okay. So it will be more, it would be more in depth information. If you weren't getting the test done in a lab, 

[00:24:02] Dr. David: truly, it would be okay, but always. In, in home is better than no lab study. Right. And if you're, and I would say anecdotally, I would say, I mean, if your chief complaint is insomnia, you might need to go in a lab so they can see your brainwaves. A lot of the studies that are in-home don't measure your brainwaves. Great. But yeah, anecdotally, if you're the kind of person that doesn't sleep well in a foreign bed the first night, you know, that's another reason to do it in your own bed and don't be afraid to ask them.

[00:24:37] Rebecca: Right. I feel so bad for people who can't sleep in. And honestly, even, you know, I was talking to my husband this morning because normally I get up at about six o'clock, five between five and six. So I go to bed earlier. That's another one of our sleep differences, you know? I mean, we have quite a few, but anyways, so I usually make his coffee and bring it to him in his bedroom in the morning.

[00:24:59] And then, you know, we chat or whatever. And then You know, we go on about our day. We get up and go on. But this morning it was five till seven. And I woke up and I was like, oh my gosh. You know? And so I got up and I was like, sorry, I'm late to make coffee and everything. And he's like, oh, you must've slept really well last night.

[00:25:18] Well I wear this Oura ring that measures your heart rate variability and all of that stuff. So I showed him the, the graph of my sleep last night and he goes, wow, all those ups and downs, I guess you didn't get a good night's sleep. And I'm like, what are you talking about? Look at all of that REM sleep I got last night.

[00:25:34] I think I got like two hours of REM sleep. Do you know what percentage of your sleep? Cause that sounds like a lot. Did you get hours? Well, did you get eight hours of sleep? And let me grab my phone and I'll tell you so that's okay.

[00:25:47] Ironically in that yeah, it's just, you know, I thought it was pretty decent. I usually get eight hours of sleep, but I can tell you exactly. Because I don't really have too many sleep problems. I feel like, I feel like I sleep pretty good. Let's see. percentage. Okay. I got it. 21% REM sleep.

[00:26:10] Dr. David: Okay. The ideal is 25. So 21 is okay. Obviously it's gonna vary night by night. So the, it could improve a little,

[00:26:21] Rebecca: I mean, we had a 92 on my sleep score last night, so I felt like that was decent. 

[00:26:26] Dr. David: So ju just so you know, these Fitbits and these they're not, they're not, they're not at all. Like the Fitbit is actually, it's borderline worse than useless, You know, worse than nothing, right. Sleep for sleep. Yeah. The Oura ring is, you know, you can get some decent data to show you the origin. No, no. I mean, it's, it's, like I said, it's one of the better ones, but like, like anything it's like, unless you have a proper medical device, it's not going to tell you.

[00:27:00] Rebecca: Do you know what I mean? I know like, I mean, the thing about it is I think if you have a sleep problem, clearly you should get a sleep study done. But for me, I feel like I get good sleep most of the time. And so for me, it's more of a curiosity than anything else I'm like, Ooh, you know, last night was great, you know, the other night wasn't so good.

[00:27:19] The main thing that, for me, it helps with my sleep hygiene is that once I started using a tracker, I was more inclined to go to bed and get up at the same time every day, as opposed to, well, I can watch one more episode of this or I'll just, you know, go out with, you know, I got into more of a habit of keeping a pretty regular sleep routine.

[00:27:45] So that was the way it helped me. 

[00:27:47] And so I think that there are a lot of people out there. Maybe they don't realize that they're snoring and that maybe they're not getting really good sleep. They know they go to sleep, but then they feel like crap. The next day, they don't know why. 

[00:28:02] Dr. David: Yes exactly. Well, I was going to talk about that. You had touched on a tangentially and I wanted to bring it up. So men and women past menopause with sleep apnea will complain of fatigue, not when they. They'll complain of fatigue around four or five. O'clock like sometime in the late afternoon, they'll have a little crash. They need a little pick me up, right. A little sugary dish or a red bull or coffee or something that is very typically unsound sleep.

[00:28:36] Right. Whereas women of childbearing age, they'll be based on the estrogen levels when they wake up, they're like, Ooh, I'm exhausted . You know, they feel the fatigue right away. 

[00:28:48] Hmm. Yeah. That makes a lot of sense. Not to keep harping on this with my husband, poor guy. I'm like throwing him under the bus entirely here, but know, it's so common though.

[00:29:01] I wear an appliance. 

[00:29:03] Rebecca: Well, he he drank energy drinks for years and then his blood sugar, I would test his blood sugar. In the morning, I'm like, oh, I'm just curious if your blood sugar is high. Because some of the things he was saying to me made me think maybe, maybe his blood sugar is out of balance. So I checked and it was a little high one morning.

[00:29:21] And so I'm like, you need to do this and this and this. So I gave him some tips. And he gave up the energy drinks entirely. 

[00:29:29] Oh, that's wonderful. And I mean, he has thanked me terrible. I know he has thanked me so many times. He was like, I did not realize how much it was affecting my health and everything else.

[00:29:42] And so he's been off of them for several months now and he's eating protein more regularly and he knows something other things. But anyways, yeah, I feel, I wonder how much of it's related between, the sleep and needing energy drinks, but he does work really hard. 

[00:29:59] Dr. David: ,So yeah. So the, there is, what's it called four hour energy or five-hour energy.

[00:30:05] Those are the ones. The ones would be 12 that's. Okay. That's okay. I would prefer to have a methyl cobalamine instead of cyanocobalamin, but as that's what B12 is But, I mean, that's a vitamin source of energy, right. Eating a whole food, like a mango is a good source of getting those vitamins and getting it, picking up your energy, you know, but people don't usually cut open a sticky mango the end of the day.

[00:30:33] But it, you know, that is a much healthier alternative, you know, we're getting there. There was a time where, When colonists, and even to this day, colonists would go to quote unquote, third world countries, Africa, Asia, et cetera, aboriginals, and say, look at you guys, walking without shoes. Right now we're talking about the benefits of earthing and grounding, which are real scientifically proven things.

[00:31:02] And they would just look like, look how dirty you are; you have chickens running in, you know, around your house right now. Every rich, Karen wants a goddamn chicken farm in her backyard so that she can get her own eggs. Yeah. Okay. So for years we've been making fun of these people, but they've been around this planet longer than anyone and they know what works, right?

[00:31:29] Rebecca: Oh my goodness. 

[00:31:30] Dr. David: Back to the diet, addressing your issues with diet and good sleep. There is nothing higher than that. Right. There is. So one of the greatest forms of medicine is called nature pathic medicine. And one of my best friends is one is retired. And he, he was a nature path for so long. He was the fifth, the fifth person to be boarded in my state as a nature path.

[00:31:59] That's how old he is in the profession. He would tell me their motto, nature paths. It's first heal the gut, right? So they would do case studies with like, okay. Patient comes in clinically depressed, fibromyalgia, chronic pain, all over the body, rheumatoid arthritis. How do we address this patient? The answer is always their gut first.

[00:32:24] And then let's say, okay. Patient came in with bipolar, with gout and you know hypoxia like lack of oxygen what's w how do we work up this patient? Check the gut, no matter what it is, the first thing they do, because it's quite smart to do that. You know, we have several feet of stomach lining, right?

[00:32:47] You have to kind of think what I try to do in my practice is think of things in the context of evolution. Okay. So, If evolution has deemed so many things in our body that we must have in order to survive, there must be a darn good reason for it. Right. So for example, sleep, we are unconscious one third out of every day on a good day, but yes, one third out of every day.

[00:33:20] So as we evolved, that means. That we are evolution has decreed that it's okay to be unconscious and horizontal in the dark every day, because we need to restore ourselves. Okay. Think about this for a zone. When we sleep, everyone knows to go horizontal. No one ever told you to stand up, to go to sleep. You instinctively knew to lay down and you instinctively know to do it in a dark room.

[00:33:56] Okay. So we are to be unconscious in a dark room, lying down, vulnerable to attack and other eight hours out of every single day of our lives. 

[00:34:10] Rebecca: Yeah, crazy. 

[00:34:12] Dr. David: So that must mean it's pretty important. Yeah. we need to do it. So same thing with the gut. We have this extremely compound complex gut system, right? We have, we have processing, you know, Large molecules, macromolecules, and then we break it down with enzymes, our gut is filled with trillions of bacteria, which then further process our food and give nutrients that we wouldn't otherwise have.

[00:34:42] If it wasn't for those bacteria . Right. We have like a whole farm going on in our gut. And that's not even saying about how sophisticated our teeth are and chewing and the digestive enzymes in our saliva. So we've invested a huge amount because one we need to eat, right. And we need to, as best we can process different kinds of food, right.

[00:35:06] By the way. I've never seen a more controversial topic online in social media than are humans made to be vegetarian or carnivore? Like I've never seen, like people will have less arguments about religion, sexual orientation, and even vaccines. Okay. And just in today's time, then they will about that subject of, you know, carnivore or versus, yeah.

[00:35:36] And, and I don't even understand how, how that's logical, right? Because animals that are pure vegans, but we call them obligate herbivores. They have two stomachs. To break down the fiber, the cellulose fiber in plants. We don't, we don't have that. Right. Right. And, but at the same time we don't have teeth that are made for attacking, like, you know, lions and et cetera.

[00:36:10] But teeth don't determine whether we're carnivores or not by the way, . They, they don't determine that. Because apes have giant fangs and they're vegetarian and they're, they're like herbivores. Right. So, but the fact that we have a complex digestive system tells us that we are omnivores 

[00:36:31] Rebecca: makes perfect sense to me.

[00:36:33] Dr. David: Yeah. And we can control that if we look at the greatest book. Ever written on nutrition and that will ever be written on nutrition, is called nutrition and physical degeneration by Western Price. Yes. Yeah. And so, as you know, he did research on, you know, in indigenous cultures and he did it twice, nine years, twice with a 20 year break in between.

[00:37:01] And he found 14 societies that on average live to be a hundred. And can still chop wood and carry lumber, chop wood and carry water at age a hundred and only one-on-one one of them was vegetarian. Okay. None of them were vegan by the way. There are, there are, there are known diseases associated with being vegan and not getting supplemental support.

[00:37:26] And the ones that were there were vegetarian and the ones that did eat meat. It really never went more than 10% of their diet. Like never like 10% was the max animal protein. And then they supplemented it with what we call a probiotic prebiotic. So they would take something fermented, like kimchi, sauerkraut, whatever, and eat it with the meat, which would help break down the meat.

[00:37:57] And also. Add fiber to help peristalsis in the gut. Right? So we have a lot of data, right. 

[00:38:07] Rebecca: Right. And it's a, it's basically the same. Like if you look at Western a price as any of the books he's written or the articles, and then like, for example is it David? I can't remember his last name. That wrote the Blue Zones.

[00:38:22] Yeah. And it's basically the same concept. I mean, if you look at Okinawans, they're eating miso with their moderate amount of protein meat it's, it's always a little bit of something fermented. So, I mean, I think it's a great point. And then Weston A Price also addressed the issue of like phytic acid in beans and all of that stuff.

[00:38:45] And like how to go about eating beans and reducing the phytic acid. So I, I, I agree. I think that, you know, all things in moderation and when I say all things, I don't mean like junk things in moderation. I mean, like, you know, food groups. Eliminating a complete food group, I feel like is it always comes back and bites you in the butt.

[00:39:09] Right. So that's a little off, I guess, a little, maybe 

[00:39:12] Dr. David: I am so glad to hear you're so like minded, 

[00:39:16] Rebecca: Yeah. I mean, I get a lot of people that reach out to me and then I'll go and look at their website or something; they're like really pushing a plant-based diet. And a lot of times I just have to turn down some of those because I don't want to push a plant-based diet.

[00:39:30] Now I did have a cancer survivor who says she eats a predominantly plant-based diet. She's been in remission for 30 years. I'm like I get it. She was diagnosed with stage four, terminal cancer at 17. She lived in a really bad environment. So anyways, you know, I think in certain circumstances that can be okay, but for general health, I feel like people have to eat at least a moderate amount of 

[00:39:56] Dr. David: No, I, I agree with you. There are certain things that plants don't give us. There's certain vitamins, B vitamins, that plants don't give us. And I don't know. And even bacteria, I thought we talked about the importance of the bacteria that we harvest, that we use in our gut.

[00:40:12] We get that from like raw milk, cheese and fermented plants. So. 

[00:40:21] Rebecca: Yeah. I mean, interestingly recently started supplementing with human milk oligosaccharides and it made such a huge improvement in my digestion. I could not believe because I eat prebiotic foods. You know, I eat asparagus and Brussels sprouts and all the prebiotics because I feel like I do a pretty good job of eating.

[00:40:41] Both, you know, fermented foods with probiotics and also prebiotics. But yeah, when I added the HMO supplement, I was amazed at how much better I felt. So apparently it takes quite a bit of prebiotics to keep your gut in balance. So that's just a little extra made me think about it when you mentioned it.

[00:41:01] But getting back to sleep apnea. Exactly. You said that you do sleep studies for research, like what's the goal of your research? What's the end goal? 

[00:41:13] Dr. David: It depends. So in the insomnia study, we were, we were, it was a double-blind randomized control drugs. Which now the drug has come to market because it was effective.

[00:41:23] I, I don't deal with the product. I, I do the studies, right? So, and a sleep study is a very benign study. It's like, we're not injecting anything in them where we're measuring their apnea and they're measuring the quality of their sleep. So right now we're about to start a study on Patients with sleep apnea, mild to moderate that if an oral appliance.

[00:41:50] Can be used at daytime oral appliance can be used with designed to tone the upper pharyngeal space. 

[00:41:58] Rebecca: Oh wow. 

[00:41:59] Dr. David: Right. There are for parental muscles. So there's been of course, anecdotal evidence of people, snoring and sleep apnea, mild to moderate sleep apnea, being resolved with this device. So we want to start off with like 60 subjects and see what happens.

[00:42:14] Rebecca: That's fascinating. So I guess it wouldn't obstruct them from being able to perform daily activities, like talking on the phone. 

[00:42:22] Dr. David: Well, no, no, no, no. They don't wear it all day long. They were two hours out of the day and yeah. And then they do the and the next day. Right. And then we're going to do before and after in lab studies and both of the studies are going to be without the appliance in the mouth.

[00:42:39] So we're going to see, did we make effectual changes? Like long-lasting effectual changes. 

[00:42:45] Rebecca: and so how do you work with people? Like, do you work with people who have sleep apnea? 

[00:42:50] Dr. David: Yeah, no. I have a daily, chronic clinical practice and I usually get people that can't tolerate CPAP or they know they never want C-PAP. So we make them an oral appliance and there's over over hundred FDA approved oral appliances. So we will then go and evaluate them and see what kind of appliance we think will work for them. Make sure they're comfortable with it. Send them back to their doctor to get another sleep study done so we can see if it works.

[00:43:22] Rebecca: So do you work with people online or only in person? 

[00:43:27] Dr. David: And that can only be done in person that could only be done in person? Where are you at? I'm in the Los Angeles area. I have two centers one in Brentwood, which is just in between Santa Monica and LA and another one in thousand Oaks. 

[00:43:42] Rebecca: I see. So if someone wanted to get in touch with you or, you know, work with you, then 

[00:43:47] Dr. David: The easiest website, the easiest website to go to is TMJ LA.com 

[00:43:52] Right. And there's a lot of information. I have a bunch of videos on YouTube. I did a one hour Google talk. Those are all free to view on YouTube. 

[00:44:01] Rebecca: For people with any kind of sleep issues or mostly just sleep? 

[00:44:06] Dr. David: Well, I mean, there might be some overlap. We talk about sleep hygiene and we talked about pain and we talked a lot about children's pain and sleep, predominantly sleep issues.

[00:44:14] It affects children far worse than it does adults pain. No sleep apnea, sleep apnea. Okay. So you said that you also deal with people who have chronic pain. Yes. Pain issues that affect sleep or just chronic pain? No, just chronic pain from the neck up. Yeah. I am a dentist before I became an acupuncturist.

[00:44:40] So my focus is on jaw disorders, facial neuralgias, ticks, things that have to tension type headaches, migraine diabetic, things that overlap with dentistry. 

[00:44:52] Rebecca: I recently received back some, I had genetic testing done, and one of the interesting, rare genes I had was one that made me more likely to clench my teeth at night, which I thought was pretty interesting.

[00:45:10] I was like, I didn't even know that they could see that, you know, check that in a gene, but apparently there is a gene that makes you more likely to clench your teeth at night. 

[00:45:21] Dr. David: Yeah. You know, honestly genetics and epigenetics. So genetics is out of like our hardware. Right. And epigenetics is what happens, what we consume, what we think, what we do.

[00:45:37] That alters our phenotypic expression. Right. So, I mean, honestly, even if you didn't have that gene, you could still clench your teeth. Okay. Okay. But like for, like, for example, some people, the, the condition of migraine is what's called central sensitization. It's your brain that makes you have these migraine headache.

[00:46:02] Okay. But you can have a peripheral nerve injury that causes it like a TMJ pain. That's chronic. Okay. So, but why does do some people get a migraine and some people get neuralgia when they have chronic TMJ? That's their genetics. That makes sense. Right? That's sort of our milleu, but it's our environment as much more of an impact.

[00:46:26] Most people have markers to make cancer, but if, if they have a healthy lifestyle their chances go way down, right? Regardless of their genetic markers. And that used to be taboo, they used to be a taboo subject. You're not allowed to say that there was any reason to get cancer other than genetic.

[00:46:49] Rebecca: Interesting. All right. Well, I enjoy talking to you so much. I love the topic of sleep well, all things health-related, but I love to talk to someone and ask them questions about sleep, because I just think it's so important and I, I really appreciated you pointing out

[00:47:04] the fact that our brain does that detox work at night, because I think a lot of people skimp on sleep and they don't realize how important it is for their body to be able to take out the trash, so to speak at night. So I appreciated you bringing that up. And if people want to find you again, your website is the fastest way to find you.

[00:47:25] Dr. David: TMJLA.com. Is it it's such, it rolls off the tongue pretty much. 

[00:47:32] Rebecca: Love it. All right. Well, thank you David, for being here. I really enjoyed talking with you. 

[00:47:37] Dr. David: Thank you so much for having me. It was lovely to talk to someone that's so well, knowledged and well versed in all these health issues. 

[00:47:44] Rebecca: Well, thank you.

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