Welcome to Aim For Health – Root Cause Conversations with Dr. James Biddle. All content from the conversations in this podcast are created and published for informational purposes only. This is not intended to be a substitute for professional medical advice and should not be relied on for personal medical decisions. Always seek the guidance of your doctor with any questions you have regarding a medical condition.
Hey, this is Dr. James Biddle, otherwise known as Dr. Jim Bob, and this is the 18th of June, 2020. We’re going to talk about sleep apnea! And this is our new patient coordinator, Joy Lambert, to help me out with this. If our voices are a bit muffled is because we’re sitting across the desk from each other with masks on because we’re still in the pandemic. So we are doing our physical distancing, not social distancing, but physical distancing, and protecting each other by wearing masks. So sleep apnea.
>> Right? What is sleep apnea? Because it really provokes an emotional response from people. And I thought, maybe we should understand that.
Yeah, nobody wants to have it, right!?
Nobody even wants to be tested for it, because they don’t even want the risk of having it. They don’t want to find out about it. Well, apnea is the absence of breathing. And so sleep apnea is when you stop breathing when you’re asleep – not to be confused with insomnia, which is when you don’t sleep, you only have sleep apnea when you’re asleep. So therefore you usually don’t know you have it because you’re asleep and you’re not there to watch it.
>> Now, when you say stop breathing, what does that mean, exactly? How long?
Well, it can be anywhere from about 15 seconds to almost two minutes.
>> Almost two minutes?
>> But at three minutes without oxygen, isn’t that when you start having problems?
Yeah. Yeah. And I had one patient in his thirties forget his C-PAP machine when he went to spend the night at his girlfriend’s house, and he slept on her couch and woke up dead. Well, she found him dead in the morning. So this can be…..that’s an extreme case…but this can be lethal. My own brother will not go to sleep without his treatment device because he wakes up gasping. But that’s rare. The vast majority of people with sleep apnea don’t know they have it. And that’s the big problem. Because then they’re in denial and all they know about is they don’t want to wear this mask on their face that they associate with Darth Vader.
>> Well then the question stands, if you don’t even know that you have it, if you’re not aware of it, you’re not waking up gasping in the middle of the night, then why do we need to be concerned about it?
Right, why bother? Yeah, I guess it wouldn’t matter except it causes a whole host of medical issues. So when you block your airway off at night, and most apnea is obstructive sleep apnea where the base of your tongue blocks the back of your throat, and we’ll talk about the other type (central sleep apnea) a bit later, but most of it is obstructive sleep apnea. And when you’re in the deepest stages of sleep, then your muscles of your jaw and your neck relax, and the base of your tongue blocks your airway and you stop breathing. And then you come out of deep sleep in shallow sleep, you kind of roll and flop around and you open up your airway and you know, SNORT, right, to start breathing again.
>> Yeh, the gasping.
But usually that does not wake you up. It just keeps you from getting deep sleep. But if you don’t have long stretches of deep sleep, like at least 20 minutes at a time, you don’t transfer your your short term memories into long term memories. So now you have a cognitive deficit cause you can’t remember what happened yesterday very well. And you have learning difficulties, and you know, your job performance is going to go down and your school performance is going to go down. So that’s the tip of the iceberg. The next thing that happens is a stress response. So this is as if I sneak into your bedroom and choke you and then right before you die and you start to flop around and wake up, I let go and hide. And then I choke you again.
And this, this might just happen, you know, the cutoff is five times per hour to treat people, but I’ve seen people where it’s happening every 45 seconds.
>> That must be an incredible adrenal response.
Yeh 30 -40 seconds. Exactly. So you’re having a stress response. You’re releasing cortisol, you’re releasing adrenaline, which is epinephrine and norepinephrine. And so the cortisol is causing weight gain, it’s causing blood sugar spikes, it’s causing pre-diabetes and diabetes, it’s causing high blood pressure…. So untreated sleep apnea is one of the leading causes of fatigue, obesity, high blood pressure, diabetes, and strokes. So these have major health consequences when left untreated. So it’s a big deal, and it’s a really under valued problem. It’s under recognized by conventional doctors. And we talk about this over and over again, whenever we ask the question, why is this not recognized enough by conventional doctors? And the answer is always…
>> Because there’s no money in it!
Because there’s no money in it for Big Pharma, right!? Now, there is going to be money in it for doctors who test and treat sleep apnea who do sleep studies and such, and we’ll get in… when we get into the treatment we’ll talk about ways you can avoid paying out the big bucks, you know, and treat it more effectively yourself, for the most part.
>> Now, can this set you up with inflammation throughout body as well?
Sure. Yeah, absolutely. You know, all that cortisol and excessive…it can cause inflammation, all the obesity does that, for sure. But fatigue…when people are dealing with fatigue, which is the number one complaint and why people go to the doctor’s office is chronic…having fatigue. This is one of the things you got to test for. So let’s talk about testing.
>> Yes, how do we do that?
The usual way to do that is to go to a sleep center and spend the night in a lab with all kinds of wires and cameras hooked up to you, and it costs $1,500 to $2,000 and you get observed and that works very well. But it’s expensive and there’s often a wait time. And then even if you’re positive, you have to go back again to get treated. We do a $35 overnight pulse oximeter which is just a little machine you wear on your finger. It’s a finger clip! But this one has a little computer hooked up to it. So it graphs your oxygen all night long. And we print that out and we can see if your oxygen is remaining normal, in which case you’re fine. Or if you’re having a zigzag pattern because your oxygen is dropping below 90% every time you’re going, SNORT!
So, you know, that’s just a screening test. It’s not perfect, but it’s good enough that we can identify, separate out who is a high risk versus who is a very low risk for this.
>> Well, it sounds pretty noninvasive then as a way of getting started.
Yeh, it’s very noninvasive. Getting started and an inexpensive way to do it. And then there are conservative ways to treat it. So you can pull the base of the jaw forward by using dental devices. And if you go to a dentist, these cost around $1,500 to have made custom fitted, but you can get them for less than a hundred dollars over the counter that are semi-custom that you kind of adjust it to yourself, you boil it, you fit it, you bite it. And about half of people can treat their sleep apnea that way. Now you have to have good teeth. You can’t have bridges. If you have implants, you’ve got to check with your dentist first. You can’t have missing teeth, loose teeth….I can’t do that because I have gum recession and I tried that and my teeth moved on me, because they’re not rooted deep enough, but that can work for a lot of people.
>> So that just physically holds your jaw in place so that it doesn’t slide back and block your airway. Right?
Right, because the base of your tongue is attached to the jaw there. And the other thing you can do is side sleeping. For most people, their sleep apnea is much worse when they’re flat on their back, but much better when they’re on their side. And we like to distinguish between forced side sleeping versus hopeful side sleeping. Every day somebody will tell me, “Oh, I sleep on my side, I go to bed on my side and I wake up on my side.” And I say, “but look, your PulseOx shows that you have these four times in the night where you have about a half hour to 45 minutes where you’re having a really dense sleep apnea. Guess what, you were on your back, you rolled over, you rolled over you’re asleep!” You don’t know. So that’s hopeful side sleeping. Forced side sleeping is where you actually position yourself so you can not roll on your back. And ways to do that are big pillows and the weighted blankets, or wearing something. We like people to get a tight t-shirt and a sock and three or four tennis balls and stick the tennis balls down the sock. And then sew it or staple it to the back of the t-shirt. So you looked like a dragon, and then you’re not going to roll…you’re not going to lay flat on your back then.
>> No, no, you wouldn’t be able to!
People also sell these things that look kind of like a bra worn backwards that have blow up balloons that you put back there and they can do the same thing. But that can help a lot as forced side sleeping, and then you can use tongue devices. So I actually use one of these. It is kind of a little suction thing and you put it on your tongue and there is a part that sticks out in front of your teeth and it basically holds your tongue forward. And if I do that and forced side sleeping, then I can treat my sleep apnea. And I did that for years until I had shoulder surgery a year ago and then I couldn’t sleep on my side. So then I went to the standard treatment and that is a C-PAP, which stands for Continuous Positive Airway Pressure.
Now I actually recommend not getting a C-PAP, but instead getting an auto titrate bipap, and the bipap part of that means you have a higher pressure when you’re breathing in and a lower pressure when you’re breathing out. So you don’t feel so suffocated on the machine and you’ll still keep your airway open much easier to breathe with that. And the auto titrate means there’s a pressure range. So the settings on these are measured in a column of a centimeters of water. So an average pressure would be like 8 to 13 centimeters of water of pressure. But my inhale, for example, might be set at 8 to 13 and my exhale might be set at 5 to 10, so that I’m never having that same pressure on the inhale exhale, but yet it changes should I gain or lose 20 pounds, or be on my back versus my side, the little computer on the machine can change it minute to minute.
>> It’ll adjust with you!?.
It’ll just all night long, yeah. And that makes complaints way better. It makes it more comfortable. Because the biggest problem people have with the C-PAP is feeling claustrophobic or suffocated with it, and this really helps reduce that.
>> And they’re not what they used to be, not at all!
They’re not what they used to be! They’re smaller, they’re quieter, they have humidifiers, and I’ll tell you what, when I first got mine about a year ago, I felt so much better. When my sleep apnea was even better treated, I wake up in the morning with a clear head rather than this foggy head and with more energy and kind of ready to go. And that makes a big difference for people.
Makes a huge difference. But it is amazing…this is the area I get the most pushback from clients even wanting to test them. A vast majority of people are like, Oh, I don’t have sleep apnea. Well, how do you know? Well, I, I just don’t. Because there’s the psychological resistance because they just don’t want to think they have it…because they don’t want to end up with a CPAP machine, or they’ll never try the CPAP machine because they’re assuming that they won’t tolerate it. But people…actually the vast majority of them love their C-PAP machines!
>> Right! So much better.
Do you know anybody who does?
>> Absolutely. Yeah. I have family members who use it and they just cannot believe the difference it makes…and that it’s quiet! You still have to run a fan if you like the white noise at night, because they’re so quiet that it doesn’t keep anyone else up. And I have to admit, I fell into that category the first time you asked me to do the overnight PulseOx. I was like, no, I don’t have sleep apnea, because I never was told that I snored or anything like that, and I just didn’t feel like I was not breathing at night. But I was surprised to find out that I did. And now I can do something about it.
Yeah. Exactly. Now I guess the next thing to talk about maybe is the central sleep apnea.
So central means it’s coming from your central nervous system, or your brain. And so the obstructive sleep apnea, the blocking of your airway, the central sleep apnea is where your brain forgets to breathe. And this is almost exclusively caused by prior head trauma like concussions and such, whether that’s blows to the head or falling down, or football or soccer or car wrecks, domestic abuse…whatever it is that people have suffered, those blows to the head can cause post-concussion sequelae that can show up as a brain that’s not functioning right to send signals to keep you breathing. And so you just stop breathing. And the problem is the C-PAP doesn’t treat that effectively because the C-PAP waits for you to initiate a breath and then augments it, you know?
And so if you don’t initiate a breath, it’s not going to initiate one for you. So that has to be diagnosed, and you have to get a special type of …it’s almost like a ventilator, obviously they’re not putting a tube down your throat, but it’s kinda like a pacemaker where if you don’t breathe for a while, it will start a breath for you, right!? It’ll kick in. But even better than that is to get rid of the central sleep apnea. And this is another thing that conventional medicine misses, because the only way I know of to treat central sleep apnea and reverse it is with hyperbaric oxygen therapy.
>> So you’re saying it could actually be cured?
You can heal those parts of the damaged brain by doing an extensive series of treatments in an HBOT.
>> And how does that work?
Well, this is a chamber that you get into, and it has higher pressure and higher oxygen, and it pushes that oxygen into your bloodstream. And if you just breathe oxygen that goes onto your red blood cells, but the problem is your red blood cells never leave your bloodstream. So they don’t get into those wounded areas of the brain as good. But, for example, when you open up a beer or a soda pop, those bubbles come out, and why are they dissolved..those bubbles of gas dissolved into the liquid? It’s pressure. It’s a gas law. And by having higher pressure we can actually push oxygen into your serum or plasma. And the serum or plasma exchanges across the capillaries with the interstitial fluid and that actually does get increased oxygen to your brain, especially to the mitochondria in those brain cells.
Because a lot of these brain injuries, what happens is that part of the brain isn’t actually dead or there’s a little part that is dead, but there’s an area surrounding it called the penumbra. And the penumbra is in shock. It is idlingIt’s stunned. It’s not dead, but it’s not working. And we can wake that back up again. So for example, in stroke victims, we can see a 25% to 50% recovery and functioning with hyperbaric oxygen, even years later, sometimes the earlier the better. It has great promise for brain healing. Again, unfortunately, conventional medicine won’t let you use their hyperbaric oxygen chambers for brain conditions. They only use it for non-healing wounds or gangrene, right?
>> Mmm, it’s that approved for that.
It’s not FDA approved for that, but then neither am I. But I still work!
>> Hahaha, Yes!
But HBOT still works to heal injured brains. So that is how we treat central sleep apnea.
>> How long do you think someone would need to do HBOT treat the central sleep apnea?
I think you need at least 40 to 60 treatments for a good start. So it’s an investment for sure. But you know, having that recovered brain is amazing. Because people see other things change in their life that didn’t even realize. They can see depression and anxiety get better, their thinking get better….all kinds of things that they didn’t even realize had happened because of that brain injury can get better.
>> And is there a chance then that they may not even need to use a C-PAP? If it’s central sleep apnea?
Yeah. If it’s primarily central and non-obstructive, that could happen. Most people have a combination though. Yeah, for sure. All right. Let’s also talk about the treatment. Again, the usual treatment is to go for a sleep study and then get a CPAP. And usually people are trying to use Medicare or their private insurance to pay for all that.
>> Right, it’s expensive!
It’s expensive. And sometimes if you have a high deductible and if you have copays, you can still end up with thousands of dollars out of pocket with all that. And you’re never going to get the bipap or the auto titrate bipap. You’re only going to get the straightforward C-PAP cause that’s all that Medicare or insurance are going to pay for. So a lot of the times what we’ll do is have people buy their own machines with cash out of pocket, and you’ve got to buy a machine, you’ve got to buy a mask ,and you’ve got to buy a cleaner. There’s an ozonator cleaner called SoClean and that is $300. So all together that’s going to be somewhere between $1,200 to $1,500 investment, but that can be less than your copay. And you’re going to get a better outcome from it. This is what I did is I didn’t mess with my insurance, trying to get them to cover all this. I just paid for it. And I got the best thing, the best, most up-to-date machine out there and works really well.
There’s a company called second windC-PAP, there’s a few others, but second wind C-PAP dot com. And they’re really good at walking you through this. And then you’re not tied to, you know, going to see a physician every six months to make sure it’s all good and paying vendors a huge amount of money. So it saves you money in the long run also.
>> I was impressed, I had a family member need to get a newer bipap and got it from second wind C-PAP, got the first one from there, and the price was almost half as much in a matter of three years… recently got one for about $500.
Is it going down, like a calculators, back in the day.
>> Oh yeah. Right.
And by the way, we don’t own stock in a second wind CPAP. We don’t make any money off of them.
>> No! Just glad to have access to it.
Just glad to have access to it. Yeah. So it’s good that people can have that. Now, I would like to go back to the question of why in the world do we have sleep apnea because I don’t know the exact prevalence, but I’ll tell you it’s way more common than people think. And one of my patients is a retired high school biology teacher, and he couldn’t believe that he’d have C-PAP because he was like, it doesn’t make sense for us to evolve, to have sleep apnea. That doesn’t make any sense. Well, maybe we didn’t evolve that way. Maybe it’s a condition caused by our environment. And in fact, there’s a dentist named Weston A Price, who 110 years ago traveled the world because he wondered why in the world Americans had to have their wisdom teeth pulled and had crooked teeth and had to get braces, because it didn’t make sense to him…it didn’t make sense to him why that would be the case. And when he studied indigenous peoples all over the world who ate primitive diets, rather than refined Western diets, he found that their jaws are bigger than ours. And they had a room in their mouth for all their teeth, including their wisdom teeth. And they had broad faces. They were universally very happy, no anxiety and depression. You have no mental health issues. Of course, you know, they also lived in tribal cultures. So they were connected. So social disconnection is the cause for a lot of our psychological issues. But I believe that that very same problem of having small jaws is why we have sleep apnea. Now. I had four wisdom teeth pulled.
>> So did I.
And I had four premolars pulled for braces in high school. So I’m missing eight teeth. Imagine how much bigger my jaw would be with eight more teeth.
>> You would have to be!
I would have more room my mouth for my tongue, and it would not be pushed to the back of my throat and blocking my airway. So I believe that that is the reason. So this is why I give my preschooler a piece of xylitol gum to chew every day…when I think of it…to try to strengthen her jaw, because there’s two components, one is on a refined diet, you’re missing nutrients. And the second is you’re missing exercise of your jaw muscles, and all of our muscles grow bigger when you use them the right way. And even our bones will grow denser and stronger. So like if you have osteoporosis, what’s one of the primary treatments? Exercise.
>> Absolutely. Weight bearing exercise.
Weight bearing exercise, right!? To make those bones grow denser, even in elderly people. Well, when you’re young, not only do they grow denser, but they grow bigger. So you got to use that jaw and I’m not talking about flapping it talking.
>> No, we’re talking about gnawing on some carrots!
Talking about gnawing on some raw carrots. There you go.
>> Now, is that something that we could do as adults to try to help strengthen our jaws or would it not actually change the size of it?
No, it’s not going to change the size of it, and the dentists love to do surgery. So there are ways to…you can operate on people. For example, my sister in law and the Netherlands, she actually had a type of surgery done on the back of her palate that cured her sleep apnea. As far as I’ve seen in the United States, that only is successful less than half the time. And it’s quite an invasive surgery. The dentists like to split your jaw and advance your jaw and artificially lengthen your jaw. I’m not very interested in that procedure, but you know, there are some surgical approaches, but that’s, that’s not my niche. You know, my niche is trying to get things resolved as efficiently and with the least invasive….and the least expense approach. So that’s what, that’s what we’re after. That’s where we’re often using the conservative measures for this. So, what else….do you cover about sleep apnea?
>> Well, because you encounter so much resistance to it, and, and I hear about it a lot from people calling with questions, I was just wondering if you just had a, just kind of a message you wanted everyone to know, about how you really feel about it and why this is so important to you?
Well, breathing is fundamental…and at first I really got this the time that my brother said that he would not go to bed without his CPAP machine, because it scared him, he’s afraid he’s gonna die. And then I had that young patient die. And then I myself got diagnosed. So I’m a really healthy person. If I can have it, anybody can have it. And I’m not overweight. A lot of people think of Pickwickian syndrome, which is from a Charles Dickens novel, a guy named Pickwick who was a big fat guy, is the classic person with sleep apnea back then, and I know my grandmother had sleep apnea. We used to make fun of her. She’d fall asleep in her chair and go SNORT SNORT and we’d all laugh and stuff. But now I realize that was killing her. But you know, I’m not overweight, I’m at perfect body weight, and perfect health. And so if I can have it, anybody can have it. And you don’t even have to feel bad to have it, but it can still be aging you prematurely.
>> Right. It has such a detrimental effect.
Such a detrimental effect in the long run. And here’s the interesting thing about stress is that heavy people get heavier and thin people get thinner, because thin people deal with adrenal fatigue. So I was dealing with adrenal fatigue and entry to sleep apnea makes that worse. And then you actually lose weight and get even thinner. Whereas people who are tending towards obesity will get heavier.
>> From the cortisol.
From the cortisol. So stress kind of goes opposite directions for those two camps of people and sleep apnea is a fundamental stress that we’ve got to resolve to really have perfect health.
I think that’s about it, right? So don’t be afraid to get tested, but you don’t have to go spend thousands of dollars. You can do a simple, overnight pulse oximeter to get tested and screened, and you can often resolve it with conservative means. So this is Dr. James Biddle, aka: Dr. Jim Bob, and we’ll talk to you next week. Bye bye.