The hidden danger of sleep apnea: Impacts on heart and cognition

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Hello, it's Dr. Deborah Durst and I want to welcome you to the channel. If you are a return viewer then I want to thank you and if you're new to the channel then I hope you enjoy the wellness and sexual wellness topics that we discuss here. Little history about me is I'm a double board certified physician, did ER medicine for greater than 20 years and now I have a wellness and regenerative medicine practice. If you're on a journey to having better overall comprehensive wellness and maybe even in non traditional ways, then this is the right podcast for you. So please like and subscribe and enjoy the videos. Welcome to the podcast with me, your host, Dr. Deborah Durst. And then I have a Special guest today, Dr. Mock is on with me and I'm going to let him say a few words. But Dr. Mock has multiple locations in multiple states and runs a hugely successful business and all of them and has written a book on sleep apnea and all of the information and actually you know how it's an epidemic now with lots of health concerns and he's going to talk to us today about that. And so if you want to say a few words and introduce yourself, that'd be great.

Charles Mok I'm in Michigan, I'm born and raised here and we have practices in Michigan and North and South Carolina. In the apnea was something I really didn't pay attention to early on in the practice, but we had gotten a fotana laser that we use now to treat apnea back in 2015 and I had a little snoring back then and I did a snoring protocol treatment. The story pretty much went away for about seven years. And then recently I started having interest in apnea because some doctors had done research showing that if they use a snoring technology on people that apnea and they did a more aggressive treatment, it could actually significantly reduce patients apnea. And one of my employees, he was a 63 year old man and he had severe apnea, didn't want to use a CPAP machine which is very common. And he's going to a concierge cardiologist that told me you really got to deal with this. I'm like, well we had this, let me just kind of brush up on it and there's techniques we can do to reverse your sleep apnea. So I read the literature again, modified our protocols and we treated them. And if sleep apnea went from severe to clinically insignificant and his cardiologists called me and told of was like shocked that There was something available that could resolve sleep apnea. And he explained to me what a big problem it was something I wasn't paying attention to as a cosmetic surgeon. And he explained to me that his patients are typically middle aged and he has more men than women and sleep apnea incidence is more than 50% and they will not adhere to using the machine, the CPAP machine, to improve their CPAP and the huge economic cost and health costs associated with untreated sleep apnea. That's what kind of started me down this interest. And this was just a few years ago. So since then my thinking has changed about sleep apnea and our practice being a cosmetic practice as our roots. For 20 years we've evolved more into helping people that want to look better on the outside, looking better on the inside. We have a whole regenerative portion of our practice. We do things such as hormone replacement therapy. We do regenerative medicine in the form of stem cells or platelet rich plasma for joints and injuries of tendons. We treat advanced venous insufficiency where people get swollen legs. We regenerate that. Now sleep apnea as a regenerative surface as well. Because the procedure we're doing involves remodeling the tissues inside the throat in the airway so they're tighter and more youthful. There's no cutting, there's no downtime. So that leads into the idea about sleep apnea. What's its impact? The book I wrote was try to bring awareness of the fact that most doctors do not try to diagnose sleep apnea. The United States Preventative Healthcare Task Force that advises the government of what to pay for has recommended against routine screening for sleep apnea.

It's a huge incidence and so the.

Original incidence, in 1988, the government, through the NIH National Institutes of Health, commissioned the University of Wisconsin, Madison to try to figure out what is the incidence of sleep apnea and not just that. So what? So they, they tested 1500 people that were 30 to 60 years old in the state of Wisconsin, were working for private companies and they had 1500 people service controls that did not get tested. And they found about 25% of men 30 to 60 years old and 10% of women 30 to 60 years old had sleep apnea at that time. And then they didn't do anything for 20 years. They went back 20 years later in 2008 and they looked at the death records where they found where the people that had sleep apnea with a score with 30, which we considered severe, were three times as likely to be dead. And again they were, they started 30 to 60, so now 20 years later they're 50 to 80. And there were three times as likely that be dead, in fact that the people that had sleep apnea with a score over 30, 64% of them remained alive 20 years later. And people with a sleep apnea score less than 5, 94% of them were still alive. And the other ones fell. In between, there's scores of mild, moderate and severe. This was really the first time we realized that treating sleep apnea impacted people's life, their mortality. Because previously, problem of the story, what.

Was the incidence with women in that study? You said 25%.

Okay, 25% men is actually 9% in women. So one out of 11 women. Okay, now that was in 2000, 1988. So 1980. What's happened since then? Well, we're bigger now. So two studies since that time, one is in Sweden called the Hypno Laos study, in one in Germany called the Ship Trend study, they put the incidence right around 64% of men and about 25% of women. Based on our current body habitus, which is a little bit bigger. And one might say that, you know, these GLP drugs that are helping with weight loss, that number might go down. But probably it's more like one out of four women and one out of two men have obstructive sleep apnea over 30. And this obstructive sleep apnea impacts their longevity. So I'm looking at it from a longevity and a health standpoint. So we look at the numbers. The first numbers we determined were sleep apnea directly causes cardiovascular mortality and disease. So again, a 20 year study starting at 30 to 60, the most likely thing to go wrong when you're now 50 to 80 is going to be a heart attack or stroke. And people that have sleep apnea and don't treat it are five times more likely to have a heart attack than people that don't have sleep apnea. We don't know the incidence of sleep apnea and treated based on that study. So then several more studies were done in the last 10 years looking at this. So for example, one study looked at Medicare beneficiaries that had, we had statistics on them and the people that had sleep apnea and treated the sleep apnea and had known cardiovascular disease were half as likely to be hospitalized than those who did not treat it. Hospitalized with that, they have the number of events. So the data is pretty compelling on the cardiovascular disease that if you have sleep apnea, you're three times more likely to have a heart attack or a stroke between the ages of 50 and 80, then somebody doesn't have treated it and you're going to have more health care costs, more hospitalizations, more events. Then the next big things we start thinking about is metabolic syndrome and obesity. So metabolic system syndrome or obesity can be tied together. And it turns out sleep apnea is kind of bi directional. So those with obesity have a much higher incidence of sleep apnea. I talked to you before about how the original study, 25% men, 9% of women, newer studies, half men, quarter of women have sleep apnea. But a heavy man is older, is more likely to have sleep apnea than a young thin woman. So there's variation for shades of gray. So women have less than men, thin people have less than heavy people, and older people have more than younger people. But there's young thin women that have sleep apnea. But in general that there's kind of.

A standard, you know, body like or obesity is definitely tied to it.

And.

But there's exceptions.

You would you occasionally see thin people with sleep apnea. It's more likely in men because they have a bigger neck. They have a neck circumference greater than 16, mine's 18 and a half. Then they're more likely to have sleep apnea, obesity. Now if somebody has sleep apnea and they treat it, does the weight fall off? The answer is no. The flip side is if somebody has obesity and they don't treat the sleep apnea, weight loss efforts do not work. So weight loss efforts work with treated sleep apnea, but they do not work very well with untreated sleep apnea. But the sleep apnea treatment alone does not cause weight loss. So somebody's going on semaglutide or going to go on diet and exercise and they have sleep apnea. They'll fare much better if they treat their sleep apnea and really by any means. So I talked about the night lase procedure, which is the laser procedure that we do. And I like that the most. I don't recommend that over other things. Cpap, which is a device you wear at night, breathe. That works just as good.

Those are some of the traditional treatment being CPAP is like number one. That's the first cpap.

Number one. Recently there was a surgery developed. So it's called.

Inspired philosopher.

Inspired. Yeah, inspired. So it's like a pacemaker device that goes.

I've read the book. Like, okay, you have great.

The wire goes up, it stimulates you to breathe so that Works. It's about a $40,000 insurance surgery. Insurance generally doesn't cover it. You could have coverage. And then there's night lays, which is not covered. So obesity leads to more sleep apnea. Sleep apnea prevents weight loss, so we should think about that. And our patients are overweight. So when we're prescribing some of glutide, we're doing a sleep study. The sleep study used to be complicated where you'd go to a lab and they'd hook you to wires and somebody be watching you sleep. But now there's wearable devices that are FDA approved or covered by insurance that you put a wristwatch on. There's a little sensor going on your finger and a little sensor in your chest. It hooks up to your phone and you go to sleep. And in the morning you hit a button and it goes immediately to your doctor. And that's what we use. It's called the Watchpat Watch Pat. And those cost us about $106 and insurance can reimburse them. We usually have people just buy them because they don't mean they don't have any medical indications. We talked about the cardiovascular disease and obesity. Then there's neurocognitive decline or Alzheimer's. So it took a long time for us to realize the importance of sleep and neurocognitive decline because quite frankly, 15 years ago, we realized that people were dying that had sleep and they weren't treated. And it was only 30 years ago we started recognizing that sleep apnea was a potential treatable disease. So recent studies are looking at people that have sleep apnea and how does it affect neurocognitive decline? It is linear. So if somebody has more severe sleep apnea, the rate of neurocognitive decline accelerates. And on average, people that have untreated sleep apnea that are going to get Alzheimer's get it 10 years sooner than those that treat their sleep apnea. Additionally, people that have mild neurocognitive decline or even changes on the brain, MRI without symptoms can be reversed if they also have sleep apnea by treating their sleep apnea. So currently we can do MRI and predict who's going to get Alzheimer's about a decade in advance. We can also impact that and start working on reversing that. And it's not just purely sleep apnea. They might have a APOE gene that's harmful. There's things that you do in our lifestyle to control that. But sleep is a huge component of brain health. Our brain Needs to have deep sleep in order to kind of clean itself out.

They've done some studies, you know, again of that decline with age, you know, so many different things. If somebody's comprehensively treating sleep apnea, alcohol, hormones, you know, with that brain volume, there's been a lot of lot more metabolic studies at the brain, you know, with.

Yeah, it seems they have. If you look at what's the common denominator. So the brain has what's called the glymphatic system, kind of like a lymphatic system. And it drains out these amyloid and tau proteins at night into our plasma, which we're not good at getting rid of those in our plasma. At least it's not in the brain anymore. And it only occurs during deep sleep and maybe to some degree during REM sleep. And we look at people who have disrupted sleep from sleep apnea or other reasons, such as alcohol or obesity. Their deep sleep is the thing that your brain sacrifices first. And the REM sleep is usually pretty consistent and light sleep's pretty consistent. So if somebody thinks they're sleeping well, but we measure them, they might be only getting, you know, 4% of time with deep sleep. Their brain can't clean itself out in that. Those few minutes a night. So when we do the sleep studies, it tells us how much time they spend even. I'm wearing an ORA ring. O U R A ring. And it tells me my deep sleep, my REM sleep. I want to make sure my deep sleep is at least an hour a night. Otherwise my brain is not fixing itself. So we have everything that happened during deep sleep, but we also have the.

Brain basically cleaning itself up, recovery during deep sleep. And so you're wearing. You have a wearable device that kind of tells you. Do you recommend that for patients too?

I do. So the Oura ring is about $300, and it's really pretty accurate. It's not cumbersome. I have an eight sleep bed, so it's a mattress cover that has cooling temperature through it. And I found that to improve my deep sleep. And it also gives me a number of my deep and REM sleep, which matches to my aura ring. So they're pretty consistent.

That's awesome. That's on my list. I want mattress. It's a cover.

Right. So I think both Joe Rogan and Peter Tia have discount codes. I paid full price for mine then.

I've heard that they have Huberman too, because he talks about it as well. Yeah, so they all talk about it. Well, I was going to go back to because we'll come to like tracking sleep. But I feel like sleep apnea versus snoring because a lot of patients have questions about that.

Right.

You know, is all snoring, sleep apnea, you know, in the relationship.

Great question. So we can think of snoring as being sort of that the canary in the coal mine for sleep apnea. Most people with snoring have sleep apnea. Sleep apnea can occur in the absence of snoring, but it's not too common. Snoring can be very quiet, like 30 decibels. You might not. Your partner might not recognize that you're snoring. So some people say, I don't snore. We have them use. There's an app called the snore lab that you can put on your iPhone sleep by yourself. And it's tell you how much you're snoring. And that correlates pretty closely with sleep apnea. So severe snoring is more associated with severe sleep apnea, and mild snoring is more associated with mild sleep apnea. Again, that being said, there are people that have obstructive sleep apnea in the absence of snoring, but it's not too common. You know, there's this thing called a stop bang questionnaire. That's one of the questions. Do people witness you stop breathing at night? That's clearly, if you do that, you have sleep apnea. But loud snoring is also related. And I recommend anybody at snores just get a sleep test done. They're a little over $100. And even the Oura ring will tell you if you have sleep apnea. It can't give you a score because the FDA wouldn't allow it, but it gives you these little cross hatches and you can tell if you're having sleep apnea episodes. I noticed that if I drink alcohol at night, I do have a little tiny bit of apnea, but if I don't, I don't have any.

If they snore, you recommend, you know, that they have a sleep study because most likely they have sleep apnea. And definitely, and I've heard you talk about this before, that if somebody is witnessing, you know, a loved one that they say stops breathing, you know, 100 of the time.

Doctors, I take it one step further than if we have a. We have a condition that is treatable, that accelerates aging, that triples your incidence of mortality, that increases the instance of Alzheimer's brings Alzheimer's on 10 years earlier, makes it hard I would screen everybody. Okay, okay. We're talking about 100 test. So my threshold is we have an anti aging program and it's an automatic. We're doing a sleep study because it doesn't make sense not to know if you have it. If the incidence is half a men and a quarter of women in our typical patients, you know, women in her 40s. And so her instance of sleep apnea is 1 in 4. So we want to detect that. And again, the barrier to entry is so low. You know, it used to be really hard where you have to go to a hospital and get all wired up, take a watch home, $106 our wholesale cost, put it on and you got the report the next morning. I mean, there is no friction to getting that done. And then, you know, so we do the questionnaires and you know, ask people the question you're supposed to ask. But I just recommend they just pay out of pocket for it. If your insurance doesn't cover because you don't have severe symptoms, it's $100. And you know, if you have a condition that can shorten your life. Did life expectancy gain by treating sleep apnea? If your score is over 36.4 years, I got $100 test standing between you and 6.4 years of longevity.

Yeah. And when we talk about that. So the insurance, like the implications with insurance, you know, why. So right now it's not a standard part of screening for sleep apnea.

Right.

It's not covered. What would get it covered? And why do people not want to do a test and have an official diagnosis for sleep apnea? Because that happens quite a bit. Or at least I hear about that.

Yeah. So there's a few reasons for that. So first off, there's what's called medical necessity. So if you meet medical necessity for Medicare, it's like a three page questionnaire, then they'll pay for it. Pay for it. The other thing is the sleep labs are about nineteen hundred dollars. So the sleep tests that doctors are motivated to do, which is in the hospital, very, very expensive, whereas these wearable devices covered by insurance. But sleep doctors were very reluctant to do these tests because it kind of put their sleep lab out of business a little bit maybe. I think Covid gave us the gift of realizing that we can do stuff from home. Whereas previously these watches have been out, approved since 2014. There was a reluctance to uptake them. So that's number one is that there's a 2000 hour charge associated doing a sleep study. And then once you're diagnosed with sleep apnea. It is something that the traditional method had been you go on a CPAP and you do a periodic sleep study in a lab for $1900. So there's really a big cost. We're talking about something that's much less expensive and we're doing a watch and we're doing a treatment to make it go away. So traditionally this was an expensive disease to treat. So that's one. The second thing is your family doctor, if they diagnose you with chronic diseases and don't manage it, they get a little ding from Medicare. So they know their patients. Only one out of three patients will wear their cpap, which means two thirds of the time the doctor's being penalized that you're not following directions. And the third thing is you might have a life insurance policy that says, well, you have sleep apnea, we're going to maybe raise your rates. So the way we've gotten around that is we do the sleep study, we do not use insurance. So there's no reporting of them having sleep apnea. We just make it go away. So if it's gone, they don't have it. So this is kind of a way to fly on a radar, get rid of your sleep apnea. We have guys that are truckers, truckers, 84% of them have sleep apnea and they're mostly men. And they might, to keep their cdl, they might have to prove they don't have sleep apnea. So we'll treat them before they do that study. Then once it's gone, it's gone. So that's the thing, if you make it gone, you don't have it anymore. So getting back to that, it's considered a chronic disease. We know it has morbidities associated with it. So there's sort of a old school method of having a very expensive testing, complex treatment and having impacts on your, on your numbers, more or less.

The old school insurance, the insurance issues like again, so it's not always covered. So out of pocket expenses that can be huge, you know, again, a hit to primary care doctors if they make the diagnosis. And, and then even costly treatments. Right. So I'm sure that the treatment also has, you know, an out of pocket.

Expense to it, about 2,000 a year for your consumables for CPAP.

Okay. If it covers it. Right.

And covered is there's still a cost because you got to buy the supplies and some of you might have the golden insurance where it covers everything. But again, only one. So the statistics Are only one out of five people with sleep apnea know they have it. So we miss it 80% of time. And only one out of three people with sleep apnea treat it. Which means 6% of people with sleep apnea are treated.

And I wonder, and then of those, you know, 6% or, you know, one out of three that are treated, do they stay on treatment? I wonder how many of those actually continue treatment. Do we know?

Yeah, so the one out of three is considered that they're compliant. Compliance is measured by using it four nights a week, four hours a night for over a period of years. So that is like, it's a low bar for compliance. But you know, there's a lot of people that bought a CPAP machine and not used it. Talk about the 1 out 3. 1 out of 3 people are compliant where they routinely use it over time.

Then the other treatments. So like CPAP would be the number one again. Have they ever looked at. Because to me, you know, whenever I would see you know, patients in the er, especially on CPAP machines, most of them couldn't sleep once they had it. So even if they're now, and if we talk about sleep apnea, how does that, like, what is that officially mean? Because we talked about the snoring versus sleep apnea, but what is the official diagnosis, you know, definition of sleep apnea? So people know because.

Great. Yeah, yeah, great question. So sleep apnea is central or obstructive. And we're really talking about it's obstructive. There is a type of sleep apnea where the brain's not functioning for certain conditions. So that's more about severe medical conditions. So obstructive means you're laying down and your tissues relax and your airway gets pinched and you either under breathe called hypopnea or stop breathing apnea for 10 seconds with a drop in your oxygen count of 3%. So again, you stop breathing or under breathe for 10 seconds and the oxygen drops 3%. So a normal oxygen concentration in our body is 96%, maybe drops down to 93 or 92. And the way it's measured is called a ahi apnea hypopnea index. And it's a score. And the machines or the sleep lab or the watch tell you how many times you had a 10 second pause of breathing or under breathe and your oxygen count, and the score goes like this. Under five is considered normal. We do five times an hour, we stop breathing for 10 seconds, that's considered normal. Five to 15 is mild, which is generally Considered clinically insignificant. If you do not have other chronic diseases, such as heart disease or something else, then 15:30 is moderate and over 30 severe. So over 30 means every two minutes you stop breathing or underbreed for 10 seconds. We've seen people scores 60, which means every minute they stop breathing. As it gets over 30, the risk of death in cardiovascular disease and neurocognitive up dramatically. And that's mostly who we're seeing in our clinic, because the early adopters to treat their sleep apnea were people that knew they had sleep apnea and hate their CPAP machine, but know they need to use it and they want an alternative. The second phase of people adopting this will people that want to live longer. And they'll test themselves and pay out of pocket 100 to see if they have sleep apnea, and then do this for wellness so they can preserve the brain.

And then I wonder, because again, if they're actually on the sleep apnea machine, the CPAP machine, and now their oxygen saturations are up, but how is their sleep? Because sleep is still important. And so I wonder because I never hear that they sleep well.

The clinical studies have suggested that they are getting deep sleep. So we know that when somebody's complying with cpap, their rate of neurocognitive client actually goes backwards. And there was a study where they took men that were 35 to 45 years old that were of severe obstructive sleep apnea. And they did MRI of the brains, and they had brain lesions, they had spots in their brains and the white matter, several of them, and they put them on cpap. Well, about half the guys are compliant and half were not. The ones that were compliant, one year they were all gone. And the ones that were not compliant, they got worse. So clearly, even a year can reverse these things. Then they've done studies on people that have early neurocognitive decline, and they put them on cpap. Their deep sleep goes up and their brains actually reverse a little bit. They actually grow brain tissue back. It's called neuroplasticity. And the water decreases. So even though it might be cumbersome, the CPAP machines clearly work. And that's something I want to really make clear, is that I'm not promoting night lays over cpap. I'm talking about you should do something. I think that's the most important thing. So if you want your insurance cover everything, go traditional, go to hospital to study them, wear a CPAP machine. This is more of a luxury item to pay out of your pocket. Get it done. So you're not wearing that machine. But they, it definitely works. It reduces the sleep score by about 65% and that's enough to get them to where they're not clinically significant. And their, their sleep, their deep sleep does go up even though again it's of kind cumbersome and they roll over and knocks off. They were getting worse sleep before even though the machine wasn't bothering them. And I tell you, I see people all the time that say I sleep great. My wife sent me in because I snore all night. I keep stopping breathing. They're sleeping great because they are so freaking exhausted when they get to bed, just pass out. But we measure sleep. They're getting poor, poor quality sleep, but they're sleeping six or eight hours so.

Not waking up tired. And they keep the spouse up because.

That'S a frequency keep the spouse up where they can't sleep in the same room.

And so no, I've heard you speak before about this. Again, it's more or less like you've always promoted that it's treated because of all the adverse health effects. So in some way shape or form. So 65% improvement with CPAP. And it sounds like it is like things that they can reverse.

So what's interesting is that The Inspire the CPAP and the Night Lace all have about a 6, a 65 reduction in sluice course they're within the 2%. They're all about the same. So there is no superior one. It's more about, you know, if you have insurance and you're okay with the pacemaker in your chest. That's, that's something that you know works reduced by 65. If you. I know people that have CPAP, they kind of like them. That's they should stick with it. Since we know most people are not compliant. That's where I think the night maze is an option. You do a much less expensive procedure, non surgical. The downsides are you have to do it three to five times to get, get the result. So it's three times for the ordinary sleep apnea and five times for people that have been on CPAP because their tissues get a little relaxed, score over 30 or they're obese. We need a couple more treatments. In a way we make it easy for the patient is we guarantee the results. If your score is not clinically, it's a net or done, it's on us. We'll take care of it.

Speaking of which, so basically CPAP you said inspire both 65% improvement. But your again with the treatment because you can also get more focused in. And it's again started off when we learned to nightlace because we had the patona too wasn't as aggressive. But now you have aggressive protocols that, that your offices are doing and that you know that treatment that we're providing. So you basically are saying you can at least get 65% or do you feel like they can get complete resolution?

Okay, you're probably never get completed complete resolution because everybody has a little bit. But the clinical study that was done in 2020 by Dr. Shipman, using the pretty much the current protocol we're using, you get that 67 reduction in scores after just three treatments. Now he wasn't doing the five treatments on severe and he wasn't guaranteeing and doing it for free. So we can actually get it more than that if we keep going. But in three to five treatments we expect a 65, 60, 65, 70% reduction. So about the same, which is actually enough. So if you go from severe sleep apnea to mild sleep apnea, you pretty much have the same mortality as somebody without apnea. People that have mild sleep apnea and do not have other comorbidities, it's not considered clinically significant, but they might want to anyways because they're snoring. I did mine back in 15. My wife said I was snoring and I did three treatments and it was a much less aggressive protocol. And I measured myself in 2021 and I had an HI score of 1.9, which is considered normal. But I started snoring. So I did one additional treatment and my snoring went down by 70%. And typically that's the thing about snoring, we don't really talk about that much because we're treating a disease which is sleep apnea, the snoring gets better. What happens if you snore at 60 decibels six hours a night, you drive your spouse out. And if you snore at 60 decibels 30 minutes a night, you're way better. But you still drive your spouse out of bed. So we don't say we're getting started, we say we're cut it down, you get kicked less better, but you still.

Drive your home and we're going to keep you together like you guys can actually sleep in the same room, which is huge because actually it's a lot of times the spouse that sends patients into us for the treatments, you know that when they hear you, and that's.

In our practice we have mostly females as our base business for cosmetic and is we're treating their spouses, they're aware of it and what they're. It does help relationships obviously sleeping in the same room.

So when we're talking and we'll also put a couple clips of the actual treatment because we have some. And then I, you know, you have some images also in the book. So we can put that up there with the podcast just to. So that if people are watching the video, they can see what the treatment. Because again, if you want to talk a bit, little, little bit about it, it's painless. There's no downtime. You know, there's. It's an in office treatment and non surgical. And so if you want to talk a little bit about just how easy.

It is, we do, we call it the 360. We're going all the way around the airway. So the areas we treat on the back of the throat, you see that little thing hanging down, it's called the uvula. And there's the tonsils on the side. We shrink that tissue. We treat the base of the tongue, the back of the tongue on top to bring the tongue forward. And then we treat underneath the tongue to pull the tongue forward. So we're doing is pulling the tongue forward and shrinking the tissues behind. We're using two wavelengths of laser. So one laser is heating it up so this hyaluronic acid tissue melts, turns liquidy and using a secondary laser to pin it in place. And if we call non ablative means not removing or burning anything. It's just heating it up and altering the tissues. It's done with generally no anesthesia. Sometimes we spray a little numb running medicine in there. It gets a little hot, but most people tolerate with no anesthesia. It's like moderately uncomfortable. It takes about 30 minutes or so, but it's not painful. Then afterwards, people feel a little dry, but they can actually eat dinner that night. And that night, typically they're sleeping better, but the score doesn't go down right away. It takes about two months for the tissues to totally remodel. So we don't retest for about two months. We do typically three to five treatments, two to three weeks apart. And each time, you know, the first person, when they first get it done, they notice they wake up and they feel better. They felt like they breathe better during the night. Then the second time they do it, they're snoring a little bit less. Third time they're sleeping a little bit longer. And then over the next Two months. They continue to improve as the tissue is remodeled. Big question is, how long does it last? So there's been a handful of studies over the years looking at this procedure both for sleep apnea and for snoring. Looks to be durable if the patient weight stays about the same for three to five years and then typically after that, we don't study people past three to five years. So it's not good like 10 year studies, 20 year studies. And in my case, I did it in 15, and in 21, I started snoring a little bit more. So it was last for a long time. And I did one additional treatment. But I would say in general, you're looking at at least a couple years, probably a little bit longer if your weight stays the same, maybe even longer than that.

And then are you ready scoring all your patients, obviously to kind of get that objective number two months out?

We'll retest them with the watch pad. Some people that are just having. They had more mild sleep apnea and they were snoring a lot. We'll use an app called the Sleep lab on the phone. Just make sure to sleep the story better because if their score is already low, we know it's not going to alter their life lifespan. So again, under 15, you have mild risk, but it's not significant. But the more severe sleep apnea patients want to make sure that's gone. And then we'll probably test them once a year just to make sure it's not creeping back in.

Additionally, we have just cpap, which again is a big machine that people are sleeping with and not always that comfortably, but it sounds like at least it works. It's just the compliance is low because of the inconvenience. And then the Inspires, you know, minimally invasive case of surgery probably. Right. That will.

It's actually got a high complication rate. So that's an issue with Inspire. It's got a 2% major complication. Right. So that's kind of stymied. It's widespread adoption because you're going in some very tricky areas of the throat. So. And it could be a learning curve too, as it's kind of a newer procedure. But right now it's sort of one of those things that most people get by fine with it, but about 2% of people have major complications. Are those, Is it like vocal cord paralysis?

Mainly, yeah. That's. That's huge. So that's, you know, again, not something. So you don't have risk factors with the night lace. And again, contraindications. Are none. If you can open your mouth right, you can get it done.

Yeah. So yeah, some people, their tongue is a little big, so it takes more treatments to get that to shrink. But when we, when they open their mouth, you can actually see better on the second and third treatment because the tissues actually do get smaller. You know, we look at what's happened with our skulls over the last two or three thousand years because our food is softer, our airways and mouths have kind of shrunk. And it looks like people from prehistoric time probably had much less dental problems, much less, you know, underbites and much bigger airways than we do now. So there's been a change over time of how our airways are and we can see that airway getting more useful pairing after we treat them.

Well, it's interesting evolution, smaller mouse like a bigger airway. Because I'll tell you, working er, my big fear was seeing somebody very big with no neck, short neck, small mouth, minimal opening that wasn't breathing. And you know, us getting an airway on that patient was always, you know, again, nerve wracking if nothing else. Like we, you know, you would always get nervous when you saw that patient come through the door. So I know exactly what you're talking about. And obviously if we can decrease the risk of ending up in that condition, you know, by treating it in some way. And it sounds as if the cost really for night laces out of pocket, probably no different than your actual even testing for it in traditional matters.

I mean, the prices always change different clinic to clinic. But it's, it's three treatments is 2500 and five treatments is 3200. And that gets them to, you know, clinical resolution at least makes it clinically insignificant. And there's even been a learning curve for us. So we started, you know, training more and more aggressive protocols, protocol. But then we're running in more and more difficult airways and we've adapted. So now we're getting more consistent results. You know, we guarantee it. So we got treatment, they didn't get there. We're seeing less, you know, additional free treatments than we were say two, three years ago.

With your guarantee, you're talking about you're going to at least get a rescore and you're looking at at least a 65% reduction from the start, correct?

Yeah. Something along that line or the scene snoring, it should be a certain amount reduced. We want to see certain reductions and we kind of want to make them clinically insignificant.

Okay.

So yeah, kind of a low bar for treating it's like they're paying for the treatment and we're gonna get them to the end point. If they have a difficult airway, it's kind of on us. Let's take care of them.

Yeah, no doubt. I just was making sure that like again, if they're still snoring just a little bit, that there's, you know, you could probably go on indefinitely with that, but you know, a little snore.

Yeah, that's the thing is that we don't guarantee no snoring because, you know, people are going to snore, they drank too much or they sleep in the wrong position. So. And we're not really treating snoring, which we see that it does reduce snoring. But again, if somebody snores loud three hours a night, begin snoring loud 30 minutes a night, they're still snoring. So we don't ever promise they won't snore, but they do, they do see a reduction in that.

And just recapping that, there's a huge, huge risk, you know, morbidity wise, if somebody has sleep apnea. So it's significantly underdiagnosed. And you can, if I was to summarize, you can correct and chime in, but it's significantly underdiagnosed. It's expensive sometimes to diagnose, not standard for screening. It leads to lots of diseases and if treated, you're significantly improving lifespan and decreasing your diseases and hospitalizations, your incident of disease, especially neuro, cardiovascular and even obesity and then hospitalizations related to those conditions.

Right, that's great. Now just give you another one that's maybe a tangible number. Is that Snyder Trucking? They're a big trucking company. In 2007 they started thinking we should probably check these guys. They're driving these 50,000 pound killing machines machines. They have a high incidence of fatal accidents when there's an accident occurred. So they put this operation sleep in place where they would pay for all the treatments, all the testing. They'd pay for routine testing if they're not symptomatic and pay for all the supplies. And they found that by doing this, they reduced their fatal accidents that were caused by driver error, which is falling asleep by 70%.

Wow.

But that fatal accidents reduced by 70%. So now that's kind of ST standard in trucking industry is check these guys for sleep apnea because, you know, it's a job that's kind of boring. And they're driving these heavy machines down the road and they, when there is an accident it's got high fatality. But they also reduced their hospitalizations by 85% and they reduced their health care costs by $4,000 per person treated.

Wow.

So there's the health and then there's the car accidents.

Yeah. The implications for public safety. Right. Because those are accidents on the road and then hospitalizations, you know, insurance cost to the company. So it's huge. And so I wonder if at some point implementing, you know, a coverage for a night lace treatment too, because the compliance is probably a lot. Going to be a lot better than one third. Right. And Right.

Once you're treated, it's. Read it.

Yeah.

My books are available for free. If you go to Allure Medical. You Google Allure Medical Books, the sleep apnea books in there. And it's a downloadable version if anyone kind of dig into it more about the. The causes. And again, it's free.

Well, and we will actually put a link to that too as well on in the description notes as well. And anything else that you would like to add before we wrap up? I think that we. I had a lot of questions. I think actually one more thing just to stress this point, even though you brought it up because I think it's huge that people are looking for weight loss. Right. And so we're seeing a lot of patients, you and, and us here too that are seeking weight loss. And we don't have weight loss programs because we really kind of believed in the process, not just the end goal, but obviously peptides we use in conjunctions with that, conjunction with other things. But again, what you're saying and stressing, I think is so important that if you have obesity and you're looking for weight loss, you know, you really have to treat sleep apnea. So being tested for that, knowing whether it's there and treating it, because otherwise you're really not going to get the results you want. Right.

Yeah. So there was a specific study on this where they had a medical weight loss program and they screen all the participants for sleep apnea and they had half of them treat their sleep apnea and half of them they did not treat sleep apnea. And these were mild and moderate sleep apnea. And what they found were the people that had sleep apnea and did not get treated basically in the program was a failure. And the patients that got their sleep apnea treated, they were. They lost three times as much weight.

And that was a study that was done with weight loss program.

Yes.

All right, I'll have to look at that. Maybe if you. We can actually always probably Include that too in the description because I think that's huge for people to be able to look at stuff and know that if you have something underlying that's going to interfere with you getting the results you want, then addressing that is. Is crucial.

Yeah, we have exercise and diet, but what about our sleep? You know, that's such an ignored and.

In the fact that if you're not getting at the root cause of why you're not sleeping, then because we think there's lots of different things you can do to improve sleep. But if dropping your oxygen saturation, if you stop breathing, those are things that have to be treated. Melatonin won't work for that. Right.

So you know, I go to the sleep meetings and all these drugs they use to treat sleep apnea basically knock people out so they can get through it. And this is a horrible idea to doping yourself up so you don't, you know, you stay asleep while you have sleep apnea. It's doing a disservice to people. But doctors are frustrated because their patients won't use a CPAP machine, so they just dope them up. So again, downers at night and uppers in the morning and it's just accelerating the time to when they get neurocognitive decline. It's a great disservice to patients.

Well, and it's actually shown, just like alcohol, that any of those substances actually interfere with sleep. So. So probably doesn't get you. So it'd be interesting to see what the results are with deep sleep after medicated. Right.

So.

Well, good. Well, awesome. And so again you have Fotona that does a night lace treatment and we have that too. It's amazing. We really have not like actually probably promoted it from the science. I wanted to wait until we did a podcast too to really talk about it more because, you know, I wanted to understand the implications in the fact that this is a non invasive way to treat it. That probably is no more. It isn't any more costly. And probably and again, not probably, you know, way more, I guess more success with compliance because once you're treated, you're treated. So compliance is there and cost is not usually an issue when you compare it with what you are looking at out of pocket for traditional sleep apnea treatments.

I was thinking about it when I, you know, we have a lot of procedures that are not covered that have effect on people's lifespan and health and wellness and do you love your money more or your health more? That's an important question. We will ask themselves what do they love the most?

Yeah.

Is it money sells.

Yeah. And we have that conversation all day long. I go, we spend a lot time of money on cars, on yards, on houses, you know, and if we were with a 50 year old house and we did nothing to keep it up, we'd have a lot of renovations to do. Right. At the age of 50 or 60, if we just started, so. And yet we only have one body. So I agree with you. We need to change the perspective on how important taking care of ourselves is. Well, it was nice talking with you again. I am sure that I'm will see you soon at maybe one of the Fotona conferences. That was awesome. In Dallas. They do a great job of educating and getting people together for networking. They really know how to put on a party too, don't they?

They sure do.

I know, it's awesome. So. Well, thank you so much for being with us. And again, Dr. Mock and he wrote and it's sleep apnea, the 21st century epidemic. And we're going to put a link in the description. So thank you for being on today and sharing all your knowledge about this and you.