The Neuroscience of Sleep Hacking Dan Levendowski #520

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You're listening to Bulletproof Radio with Dave Asprey. Today's cool fact of the day is about how the way we sleep is hijacked. It turns out humans are the only mammals that willingly delay their sleep. And shift workers are at an increased risk for almost every chronic illness, including heart disease, problems with your gut, and your body never really adjusts to shift work. Snoring is the primary cause of sleep disruption for about 90 million Americans, and 37 million have that problem on a regular basis. And it turns out that English bulldogs are are the only dogs that have sleep apnea. And that's because their unusual airway anatomy, basically short snouts and underbites, causes the problem. And it turns out the first CPAP machines for sleep apnea were made from vacuum cleaners, and those were for humans, not bulldogs. And insomnia isn't defined by the sleep you lose each night, but but by drowsiness, difficulty concentrating, headaches, irritability, and the other things it causes in your life each day, if you have it. And because I've been practicing the art of foreshadowing, you could probably guess that today's episode's gonna have something to do with sleep. Today's guest is Dan Lewandowski, who is returning to Bulletproof Radio after his first appearance in 2014. He's the president and co founder of Advanced Brain Monitoring. They're a neurodiagnostics device company that's been working on human sleep for about 20 years. When he first came on the show, they had a new sleep apnea device called Night Shift. And today we're going to talk not about that, but we're going to talk about why so many people don't get good quality sleep and what we can do about it. And the reason that this matters so much, as you probably read in Head Strong or the Bulletproof Diet, is that sleep quality is at least as important as sleep quantity, and probably more important. I'd rather get six hours of total rockstar sleep than eight hours of crappy sleep. And we have this ridiculous thing we do as people where we oftentimes will say, you need eight glasses of water a day. But we don't say, how hot is it? How heavy are you? And how big is a glass anyway? So we just pick random numbers and we say that they're good, but we don't also say, well, what kind of water was it? Was it sparkling? Did that matter? So there's all these variables that it turns out can change the quality of everything, but they're just ignored in the interest of simplicity. And when you talk with a real scientist who's going in and looking at this and saying, all right, what do we do about quality of sleep first? That makes me super excited. And that's why Dan's back on the show. Dan, welcome to the show.

Thank you, thank you for having me.

I'd like to understand what made you. I'm just going to use the word obsessed with sleep. Not a lot of people spend 20 years of their life looking at that problem, getting quantified things. What motivates you to do that?

Well, actually I started out looking at sleep disorder breathing. We talked, you mentioned earlier that one of our products was a sleep apnea therapy. It was really. We've been doing EEG measuring the brain's electrical activity for over 20 years and most recently starting in about 2010, started looking at higher quality measurement of EEG during sleep. Because you really need to understand all of the micro architecture of what's going on with the brain during sleep to get, get the sort of variables that we're now being able to use to look at the effect of sleep, for example, on neurodegeneration or being able to phenotype. Phenotype is where you have a very distinctive characteristic. And we're beginning to phenotype insomnia, for example, to identify what type of patients who have insomnia that may be better, taking hypnotic medications and which would be better for other types of therapy as a treatment.

And you're doing this by gathering medical grade sleep data on people and then doing a lot of analytics on it in a way that really wasn't possible even 10, 20 years ago. You had to be in a hospital to get that. And every time I've spent a night in a hospital, I can tell you my sleep wasn't very good because these nurses kept coming in and poking, prodding, bright, bright lights like it's the worst sleep environment on earth. And so I feel like all that data is junk data, to be perfectly honest. So you're doing this though now at home with clinically validated devices so we can see what people's sleep actually is like in a normal environment.

That's correct. So when you discuss sleep, there's really two aspects. One is what they call architecture and that's where many of your listeners may be aware of. They have lighter sleep and deeper sleep and rapid eye movement sleep. And we have a total of four stages of sleep. And then there's sleep continuity and that's the part where if your sleep is getting interrupted or fragmented, then you don't get as much continuous sleep and those two pieces work kind of together to where if you get quite a bit of slow wave sleep, that's good. If when you're on your back or enduring REM sleep, if it's fragmented, you may wake up not quite as refreshed. So these are all parts of looking at the entire aspect of sleep and breaking it into different parts to say this part may be normal, this part may be abnormal, and that could explain symptoms.

Right now you've had research with darpa, the Advanced or the Department of Defense Advanced Research Projects Agency, and what, a few dozen patents and $32 million in clinical research. So this comes from large amounts of data. We understand that architecture. But when you boil all that down, it sounds like what you're saying is that people with kids and people who sleep with a spouse are pretty much screwed.

Well, not necessarily, but we're mammals, we adapt. It's simply a question of what potential risk does it pose down the way. So, for example, there's a. The Alzheimer's and Dementia conference is ongoing right now, last two days. And one of the studies that they presented was talking about sleep interruptions during the night and increased risk of neurodegeneration. So you may have kids, hopefully they grow up and you don't continue to have them over multiple relationships to where you, you know, 20 years down the road, you get a break, they're not interrupting you so much. So there are, there are things that you can do that may affect you for three or four years, but being conscious of the interruptions and the fragmentations as well as the total amount and how it's distributed. Slow wave sleep is very, very important. You're better off having an hour of slow wave sleep every night than having REM sleep for the aspect of managing neurodegeneration.

There have been times in my life, especially about eight, 10 years ago, when I used to use a device called the M Wave. Sorry, not the M Wave, the Zeo that you could sleep with. It was this really dorky looking headband and my wife didn't really like how I looked in it, but I would sleep with that. And I heard, had nights where I get five minutes of deep sleep. And now if I use the right stuff before I go to bed, if I'm wearing the glasses, the truedark sleep glasses before bed, I can get one to two hours pretty reliably. And it seems like I have to get multiple variables Stacked up. But I'm not using clinical grade tech. I'm using my OURA ring or I'm using a wristband and all that. And so I'm really interested in testing the TrueDARK glasses and using the ABM technology or actually it's not called abm. What's the technology called that's doing that?

Well, it's the Sleep Profiler is the product that we've developed for this purpose.

I'm going to get one of those after the show and validate how the bulletproof sleep mode supplement works, how the glasses work. And right now my practice that seems to work is dim all the lights in the house. If I'm up after dark, I have red lights in my office, I wear the TrueDark glasses. I take sleep mode before bed and I tend to sleep like a baby every night and I don't wake up ever. And I've also trained my kids who are now 8 and 11 to not wake me up in the middle of the night. And they sleep in blacked out rooms. So they tend to sleep all night long and have never really had a problem after they were maybe two. So I want to get more data on that. But for people listening, it's pretty tough to get a good night's sleep, especially if your spouse kicks you a lot or has a snoring problem, things like that. And I think my wife Lana, if she does snore, I sleep so deeply I don't really know, which is a really good thing. I also use software when I'm traveling that helps me sleep better as well, called sonic sleep. So I guess I'm a weird example. I'd like to see what my sleep waves look like from, from a clinical data like in a hospital sleep mode. And you're the only guy out there who's got that level of detail. So I use good data but not great data on a regular basis. So I'm really interested in correlating that. And that's something I think for everyone listening, you need to be doing something to know how well you slept. And if you know you sleep like crap or you know you have apnea or you know you snore or you wake up feeling like a zombie the way I used to, then I would say getting clinical grade data is probably worth it. You agree?

I do. And one things you can do with the clinical grade data is you can put on your OURA ring or whatever else that you're using that is we'll call it simple or less sophisticated. And you can Wear those at the same time that you're wearing our medical grade device to get a baseline. If, if your Fitbit is off by 15 or 20% and you know what the gold standard is, then you can look at the Fitbit on a day to day basis and maybe only go to medical grade once a year just to get recalibrated, if you would.

What I've learned over 20 years of quantifying various things is that you can usually get really high quality data, but it's a serious pain in the ass to do it. And that means that data that's pretty good but is effortless is more valuable on a regular basis than the hard to get stuff. And so just like you're describing there, I tend to say I'm going to work on this and we get all the data and then I'm just going to go into sort of background mode and just collect what's easy. But it's, I think either you're a super geek like me, but if you go to bed with 15 different devices on you just because you have to have the data, you probably have a problem that's maybe related to anxiety or similar to an eating disorder, like a fear of not getting enough sleep. And that's a real thing. It's not in the DSM to be diagnosed, but there are people who are terrified of being tired, so they can develop this. But if you're just curious and saying how do I improve it? And I'm going to stop gathering most of that data as soon as I've improved it and I am where I want to be, I think that's what the people who are evolving the most do. And having a new tool like the one you just, just talked about is actually a real gift because you couldn't do this before. And that's one of the reasons I wanted to have you on. The other reason is you've just had a new paper come out about something we talked about in our 2014 interview. And there's a sleep position that leads to neurodegeneration. And what is that sleep position and why does it suck so much?

Okay, so I'm going to back off a little bit on what you stated because I am a scientist. So we'll start out. Chris and I went to a conference in Torino, Italy in February that was on Alzheimer's and Parkinson's. And we have a large National Institute of Aging study that's underway right now where we're looking at the awake EEG and the sleep EEG to come up with predictors of neurodegeneration. And from this research, we found that the patients who had mild cognitive impairment or Alzheimer's, and now we've added patients with Parkinson's dementia to the group. What they all had in common was they tended to sleep more on their back than, we'll say, age matched, healthy controls. So we, the paper has currently been submitted. I'll be presenting the data in Germany this fall at their sleep conference. And it, we're not saying it causes it. We say that there's an association, which means there could be an increased risk. It's very early in the discovery phase, but there is good scientific evidence that how the brain clears the neurotoxin proteins during sleep. There was a rat study in 2015 that showed that the rats anesthetized on their back did a poor job of moving these toxic neuroproteins during sleep. And we've just been the first ones to discover this in humans.

It's fascinating because when you look at conditions like heart disease, autism, Alzheimer's, it's highly unlikely that there's a single cause. And it's sort of like, what's the cause of bread? And you get this scientist who says, well, I baked the yeast and then I baked the water and I baked the flour and nothing happened, therefore there is no bread. Well, it's a system. And I think it's safe to say to your point, that no poor quality sleep or sleeping on your back doesn't cause Alzheimer's, but it is certainly a risk factor for it and it's probably contributing to the system of it. And that's to say, if you slept on your side all the time, you could still get Alzheimer's. You just lower your chances of getting it.

That's very correct.

All right. What else do you think causes Alzheimer's?

Well, the most common factors are the same ones that are associated with sleep apnea, hypertension, diabetes, obesity. And as you get older, one of the other things that happens as you get older, you get less slow wave sleep, almost by definition. And it's during slow wave sleep that the beta amyloid is cleared from the brain. So that's one of the reasons why when you were talking about some of the different products that you, that you have that could increase slow wave sleep, I get excited wanting to be able to prove that it actually does increase slow wave sleep because that is a way to reduce the risk of beta amyloid accumulation that they believe is associated or they, that's associated with Alzheimer's disease. Now we, we don't know that by clearing it more efficiently you won't get it. But again, a lot of us, we exercise, we eat in certain ways to try and help reduce risk and increasing the amount of slow wave sleep and sleep spindle activity are the two characteristics in sleep that have been associated with Alzheimer's and Parkinson's disease. Meaning more is better.

There was a time when I was, in fact I did this coinciding with the birth of my second child. I said, you know, I'm really not going to get more than five hours of sleep every night anyway. Any new parent discovers that pretty quickly. So I said, I'm just going to restrict my sleep to five hours. I'm going to eat about 4,500 calories a day and see if I can make myself fat. But I'm going to get less fat than the amount of calories I'm eating. And I'm going to show that different calories do different things.

Things.

So I went through this time where sometimes I get two hours of sleep a night. And I said, I'm just going to do it. And I started bulletproof. While working full time at another company, I put the time to good use and I definitely burned the candle at both ends and in the middle. And on the nights when I got two hours of sleep, I would run a 1.5 Hz alternating electrical current between my ears, which coincides with deep wave sleep. And I'd wake up feeling like a great golden God. Good plan, bad plan.

I won't comment on that because I haven't demonstrated objectively that it's right or wrong. What the evidence suggests is if you're sleeping less than six hours a night, there are just numerous ramifications, long term on increased mortality and the quality of life. And again, I turned 60 a year ago. And so I'm starting to think about how I want to live and the sort of energy that I want to have in my late 60s and 70s and whatnot. And so some of the decisions that I'm making now is what's going to protect me 20 years from now. And so that's part of what I'm trying to incorporate in understanding the sleep. And again, if I could increase the amount of spindle activity or slow wave sleep and I knew it worked, I'd be doing it religiously. Just like I know a number of people who I say, if you stay off your back, it'll treat your sleep apnea with our product. But they don't wear it. But I tell them, but if you Stay off your back. Maybe it's going to reduce the risk of neurodegeneration. And it's funny how people will not sleep. Apnea is not important, but neurodegeneration is. And they have kind of a different perspective that way, even though it's part of the same circle that you're talking about.

About 10 years ago I used to make it a habit to sleep on my back. And it's because there's meditation stuff I would do when I was going to sleep that worked better when I would do it and I'd get perfectly aligned and it actually felt pretty good. But I was also sleeping with a bite guard that held my lower jaw forward so it wouldn't fall back and cause me to snore. And it was because of your interview in 2014. I said I'm just going to sleep on my side. The evidence is in that side. Sleeping is just, just better. My goal is to live to at least 180 years old, so I'm paying attention to long term effects just like you. And I do get six hours and five minutes of sleep on average now to be above that six hour limit, actually that's just what I get. But I feel pretty remarkable when I do that. And maybe I should get seven, I don't know. But I, you know, right now I don't know what I would do without that extra hour. So I'm not doing it. Do you think there is merit to getting more sleep than someone needs to feel good?

Well, I think that. And again, being a scientist wanting to say how much sleep are you actually getting? Because if it's what you think it is, there, there is what they call sleep state misperception. It is very difficult to actually know how much sleep you get, how quickly you fall asleep. We think we fall asleep. We might remember one or two times during the night waking up and going back to sleep. But it's not uncommon to have five or six what they call awakenings per hour where your brain is awake for 30 seconds, you won't remember it at all. It's called sleep apnesia. But those brief interruptions occur. And that's part of what your true sleep is that very few of us really know. And that's what our device will quantify. How many awakenings per hour do you have? How many cortical arousals per hour do you have? How does that compare to the normative database? Based on age and gender, are you in a normal range?

It's funny you mentioned that when I was developing the Bulletproof diet. I wanted to stress test it and I went on a three month extreme keto. This is before keto became popular the way it is now. In fact, it might have been part of, part of how it became part of the blogosphere. I did an Eskimo like diet. I ate one serving of vegetables a day. The rest was pretty much pure fat and some protein. And towards the end of that I was not feeling very good. And my sleep monitor at the time I was using a Zeo which isn't on the market anymore. I found that I was waking up a dozen times a night and I had no idea I was doing it. I knew I didn't feel good when I woke up, but it was completely invisible. And that is an example of what you're talking about where I just wouldn't have known. I would say I slept the whole night. I don't know why I feel like a zombie. And it was one of the reasons that I recommend a cyclical ketosis diet. Because if you are in ketosis some of the time or you're using an external source like brain octane, you have ketones. But if you're just unending, no carbs, I think it wrecks sleep and it wrecks sleep in women before it does in men. And I'm hoping that the kind of tech that you've got can help people who are doing ketosis without end see what it might be doing to their sleep and know, oh, my sleep quality is going down, maybe I should have some starch already and then go back into ketosis so that their sleep is rescued. Have you seen any data on an extreme, either carb restriction or fat restriction or anything else on what that does to sleep?

The only research that I've seen is work that people are doing on fragrances to try and improve. So one of our customers was evaluating different fragrances to see what might improve sleep quality that way. But you know, up until the development of product, you had to go to a sleep lab in order to be able to get these sort of measurements. And so it just wasn't readily available to do these sorts of, you know, kind of. You're talking about little mini petri dishes where if you have the device, you could wear it and get your baseline and then the next night you could try something different and the next night try something different and begin to compare across those and try and decide, well, this did make a difference and you factor that in and then make your next round of what else do you want to try?

What I mean You've been doing this for 20 years. So things have shifted in our culture around sleep over the last 20 years. What have you seen on the front lines for that amount of time? What's different now than we had 20 years ago?

20 years ago, nobody even knew about sleep apnea. Now the amount of people that are getting diagnosed and treated is so much greater than it was 20 years ago. So I think, for starters, it took a whole generation of people to tune in to sleep apnea and be aware of it. But now with all the wearable devices, there's just been this new emphasis on sleep and it's really great. The only thing that those simpler devices have is, I mean, they claim that they can do some staging of light and deep sleep. We do have a university that's using our device, as I mentioned earlier, that's going to be comparing them to see how accurate they all are. But for example, the Fitbit, when it was first evaluated, you could look at sleep efficiency, which is the amount of sleep time that you get for the total time that you're in bed. It matched the gold standard polysomnography. It was within 10% in only 40% of the people. So what that essentially means is if you want to be within 10% of being accurate, you're a flip of the coin likely of whether or not you're going to get that with some of the technologies that are on the market. And I think that the phone apps will probably be worse than some of the actigraph based ones, which are the ones that you wear and they just look for movement.

It seems likely that the ones that are using a microphone on your cell phone are going to be lower quality data than something strapped to you. And I was CTO of one of the wristband companies, the first company that could get heart rate variability from the wrist. And it's the same sort of technology that's used in the Apple Watch today. And even then you can, from heart rate, you can determine respiration. So you know basically how someone's breathing and how someone's breathing and how their heartbeats are well correlated with sleep. But there's just one problem. When using a microphone, you might not get great data. And if you're using something on the wrist, you might have movement artifacts. We move when we're asleep and you have skin tone differences, you have moles and you might say, oh, seriously? Or maybe it's positioned over a vein and it wasn't before. But this can make a big, big difference for an individual. And so you don't know how big of a difference it is. And I believe that if you're using any of these technologies and you use it consistently, the actual score is probably meaningless. But the change in the score over time is useful. So if you get a score that says I'm getting an hour of deep sleep, you might really be getting a half hour or an hour and a half. But if you know that when it says you're getting an hour, if the next night you got an hour and 10 minutes, you probably did better than the night before. So looking at that delta, that change is something that everyone can do. And if you're doing it with the lowest common denominator, which frankly is probably a microphone on your phone because you set it next to your bed, put it in airplane mode, for God's sakes, you don't wake up. And if you do that, okay, better than nothing. But if you were to correlate that with a clinical grade scan, then you would know. And I'm not sure how many of us need to know, but if you feel like a zombie all the time and you know, you don't sleep well and your spouse kicks you all the time because you're snoring, well, you know, you have a problem. And you should dig deeper than just what you're going to get from, from any of these other technologies. That's my algorithmic, that's how I think about it. Can you poke holes in that? Or, I mean, you know more than I do by a long shot. So tell me where I'm wrong and where that's right. So people listening can know what's the lowest thing I should do, what's the best thing I should do?

So I totally agree with you that calibrating whatever you choose as a monitoring device and knowing how it measures up against the gold standard is where you start. And I, and I totally agree that looking at relative changes, once you've taken whatever device you choose to use and once you've calibrated it to the gold standard, then you can look at changes, relative changes for that. And the only thing you want to do is factor in, I would say every couple of years, because we're going to age and things are going to change, or if you put on weight, things are going to change. Now, for your audience, just to be aware, we're not talking about a sleep apnea test. This is, somebody jokingly named it a Zio on steroids because it is worn on the forehead. It looks similar to the Zio, except it's cleared by the FDA and has published accuracy for being able to measure these sleep characteristics.

Longtime readers of the Bulletproof blog or listeners of the show will know that when Zio first came out, this. This was the first company that could get EEG data from the brain. So instead of looking at heartbeat or breathing, they would literally say, here's the electricity coming off your head, which is a gold standard for what's going on in your sleep. And it was this ugly headband that you would wear that was definitely not designed by Victoria's Secret, but it gave you shockingly good data. And Zio went out of business a while ago. As often happens with some of these technologies, they're ahead of their time, which makes them expensive and a little bit harder to use. But it really changed my life to know how I slept so I could get better sleep. And what you have now, Dan, it's definitely a headband, and it's got an even bigger bump in the middle of your forehead. So I definitely wouldn't qualify it as lingerie, but people wear it for three days, so it's okay.

That's exactly right. The alternative is going into a sleep lab. So let's say from that perspective, it's quite a bit sexier.

You ever think about doing some red satin coverings or anything?

No, but we have considered paint. The original version actually started out as a silver color, and we changed it in the Next Generation to black because people said the silver looked like it was heavier and bigger. So we changed it to black just to make it give it a more svelte look.

You know, if you could make it look like Jordy's glasses in Star Trek the Next Generation, I would wear it every night because that's just in my house. That qualifies as lingerie. I'm just saying.

I got nothing for you, man. In order to make it work, you know, there has to be some compromises along the way, and this is just one of them.

Fair point. Is there something that people. People should do, speaking of lingerie? If they're sleeping in a bed with someone else regularly to improve their sleep quality?

Well, temperature is a big one. The colder the room, the better. And I think going beyond that, I would arguably say that women going through menopause is very disruptive to their sleep. And it may be just like men with sleep apnea. We kind of have our different. The men in their sleep apnea will develop at a younger age. What most of your listeners may not be aware of is that most women will not their. Their sleep apnea will not evolve to where they actually stop breathing until after menopause. So it's they'll snore, but they'll snore much, much less than men. But as they age, they kind of catch up to where both in the amount of snoring and sleep apnea, but after menopause. So there's that that early 50s age for women in particular that they have the night sweats and everything else where the colder the room the better.

Do we know what percentage of women over or past menopause get sleep apnea?

They've always said that half the number of women as men have it. And the numbers have changed. I mean, back when the first study came out, we said that 2% of women and 4% of men had sleep apnea. Those numbers are now they've reported as much as 50% if they're over age 50 and going in for surgery, so admitted to a hospital for general anesthesia. So the numbers, nobody really knows the actual numbers. It's just the research that we've done in looking at the relationship between snoring and severity. We found that after menopause it comes on and becomes much more distinctively changes in the breathing pattern where they could be loud snorers. But there's also a lot in the literature where they talk about women who are pregnant, where they develop sleep apnea in the third trimester. And that creates a number of risks for the child with increased risk for cesarean and low birth weight. And all of those are where they didn't have sleep apnea, but because of the weight gain in the third trimester, they have it on a temporary basis.

What the heck would a pregnant woman do if she knew she had sleep apnea? To solve the problem, to have a healthier pregnancy. I mean, my first book was about that, but not about sleep apnea, but about healthier pregnancies. I didn't know this fact. So how do we hack that for pregnant women?

Well, start out by staying off their back and it depends on the severity. It's worth finding out. So so many women simply aren't aware and it's preclinsia, for example, they'll get diagnosed with temporary hypertension. They'll be bedridden. But all of these things have been associated or go back to this temporary sleep apnea. So looking at the quality of sleep, looking at snoring is a good way just to check it out. If the snoring increases as they go through the trimesters, then they're at increased risk and There's a number of tests that could be done that are home based just to see if they are severe. If they're severe, they'll probably need to be on CPAP for the rest of that trimester or for the end to the to term.

Doesn't CPAP totally wreck your sleep quality anyway because they're sleeping with a Darth Vader mask on?

For some people it's the best thing that could happen to them, so it'll save their life. So it depends on the severity. Most of the focus of my research has been on technologies that could be as effective as CPAP but not having to wear the Darth Vader mask. So for example, I wear an oral appliance. I've worn one for 10 years to manage my sleep apnea. If I for a while I had shoulder pain and I was sleeping on my back. So then I would put on our night shift to remind me to stay off my back. So the combination of staying off your back with an oral appliance makes them on average twice as effective as either one by themselves. So there are ways that you can combine technologies to for some people and not have to be on cpap.

Now, a lot of listeners may not know that a major cause of apnea is when your lower jaw sinks back and changes the shape of your airways. And one of the early first hundred interviews that I had on the show was with a guy named Dwight Jennings who does jaw alignment and neurological dentistry. And I actually have a square jaw, thanks to aligning my jaw. And I think my sleep quality is much better as a result. But he made a custom appliance for me that had a wire that went over my front teeth so my jaw could not fall back when I slept. And I wore that for a long time until I kept cracking it. And now I sleep with a night guard every single night. But it doesn't keep my jaw from falling back because I never sleep on my back. And I assume that's good enough. Is it good enough or should I still have something that holds my jaw forward?

Well, I would say that if you were a sleep profiler, I would look at the patterns and I could give you the answer because I could look at whether or not your snoring is increasing with each snore and then stops or. And then if your heart rate is going up. So these are patterns of sleep apnea. There's no reason to protrude the jaw forward unless you have sleep apnea, because there's. Okay, there's side effects from wearing a Custom oral appliance, you can have tooth movement and other factors. So there's no reason to do something as a precaution other than maybe not sleeping on your back. Sleeping on your back is the death wish. You just don't want to do that.

Okay, got it. And in my case, I actually did want tooth movement. Okay. So that was. That was part of my appliance. And now I don't need tooth movement because we made enough space in my mouth for my jaw to come forward without impinging my trigeminal nerve. And that's something that a shocking number of listeners have a problem with. And if your bite during the day when you chew is creating jaw tension without you knowing it, I didn't know it was happening because it always felt normal. That reflects in your vagus nerve, which causes sympathetic or fight or flight response every time you chew, which is completely ridiculous. And if you grind your teeth at night, it causes that as well. So you're pretty much always ready to hit someone at a cellular level, and that's not good for anyone. So I would say moving your teeth is a different thing. But what we're talking about here is the ability to just hold your jaw forward if you need it for sleep. And you make something. Or ABM makes something called apnea guard, and that's an oral appliance that holds things forward. Is that commercially available for people or is that a doctor's thing? And there's ones at the drugstore. How do I know what kind of a guard I should use if I don't want my jaw to fall back?

So, realistically, if you're trying to treat sleep apnea, you should have a custom appliance made. There just isn't much else available. The. The apnea guard that you mentioned is a product that can be fitted by dentist. It is not something. It's not a boil and bite. It's not designed for somebody to wear or to fit themselves in their home. It's a. It's a medical product. Again, not over the counter. I. I would suggest if. If you. If you're aware of products, if you're aware of mouth guards that. That reduce sympathetic drive during sleep, then that's, you know, kind of. That's a separate avenue of medicine. Because strong sympathetic drive was another characteristic that we saw in those patients with neurodegeneration. And it's also ones that we see that have hypertension. So there are certain factors that, if you could. If you find that a mouth guard gives you more. What we'll Call high heart rate variability, which is good that there is that you should wear it. And so I guess what I'm trying to say is a mouth guard isn't a mouth guard. If you're treating sleep apnea, that's one avenue. If you're wearing it for modification, as you were talking about, that's a second. And if you can do it to, you know, reduce vagus nerve drive, that's another one.

Right now, a good number of listeners are having some lights go off saying, oh, I want to do this. And I've never had a really clear answer for this. If someone wants a bite guard for apnea or for relaxing the jaw at night, can they go to any dentist? Or do they need to go to a specific kind of dentist to get this?

I would suggest going to a dentist who's experienced doing this. We did research. Our National Institute of Health gave us. One of the studies that we did back in 2009 was looking at how to improve outcomes with oral appliance therapy for sleep apnea. And when we got done with all of this research, what we concluded was it doesn't matter what appliance you wear. It depends on how well the dentist is trained to get the outcome that you want. So in most major cities, there's already a dentist who specializes in this. A lot of them are running commercials on tv, Many of them are targeting men. Those appliances work great. The only issue is for some people, it's not enough. So you mentioned the apnea guard. Where people use it is because if you have the facial characteristics and the size of the, of the neck, it decreases the likelihood that just pushing the jaw forward and bringing the tongue forward will be enough. So some people have what they call facial morphology that is good, that you can be treated with an oral appliance. And some people, they're going to be stuck wearing cpap. Now, if CPAP doesn't work, they're still better off with the oral appliance than staying off their back, than nothing at all.

I've historically recommended people might want to see what you can call a neurological dentist, someone who's looking at the impact of the teeth on the nervous system, because some of them look at apnea. But you're saying now that there's enough change over the last 20 years that you can Google around and find a dentist who specializes in these sorts of things, which is really cool. And I'll give a shout out to Dwight, Dwight Jennings in the Bay Area in Alameda, who did the work for me. He was a very early innovator in this space. Even before I think we knew that there were effects on apnea, he was looking at the neurology of this. So he's Northern California craniofacial something something, I'm sure. Or just listen to.