A Hidden Sleep Killer That Flies Under The Radar (And What You Can Do About It).

In this episode of the Ben Greenfield Fitness Podcast, when you're having apnea, you're.

Basically closing off your throat unconsciously, and then unconsciously you're trying to breathe against an obstructive airway until finally you get a big surge of adrenaline. So you should see a good chunk of delta sleep or deep sleep. And typically, if it's an accurate unit, it'll show you that most of your deep sleep is happening in the first hour to two of your whole sleep period. And then as the night goes on, you should get longer and longer REM episodes until your last hour of sleep is mostly rem. That's part of the insurance reimbursement. So this is a valid therapy that most insurance companies cover. Don't wait till your kid's 12 to do braces. If they have narrow jaw or crooked teeth, get in there early and go to a functional orthodontist.

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Hey folks, it's Ben Greenfield here. And a few weeks ago I actually got a really interesting email from a podcast listener. And the email was a little bit cryptic, but it was basically about or response to something I had mentioned regarding tracking sleep and improving sleep on a podcast. And this email contained the following quote. It said you could improve sleep also by a simple screening of oximetry to rule out OSA in your adrenal fatigue clients. And then the email went on to talk about something called OSA and some issues that this individual, who was a certified sleep specialist, had actually observed in many of the folks that they'd worked with regarding this sleep disruptor that I was actually unfamiliar with. So I wrote back to this guy, this board certified sleep specialist, and we kind of went back and forth about blood oxygen saturation and something called obstructive sleep apnea syndrome and a lot of other things regarding sleep and how sleep can get disrupted and some of the things that kind of fly under the radar when it comes to insomnia, jet lag, disrupted sleep, narcolepsy, and other sleep disorders. So I figured that I should actually get this guy on the podcast to talk about this stuff with us. And so I did. He's here with us now. His name is Dr. Joseph Zelk and Dr. Zelk is the medical director of something called the Sleep Medicine Group, which you'll hear all about in this podcast. But if you've ever wanted to get better sleep or fall asleep faster or get deeper sleep or beat insomnia or manage jet lag a little bit better, this is gonna be a really good podcast for you to listen into. So, Joe, thanks for coming on the call, man.

Thanks, Ben. Good to be here. Love the podcast.

Awesome. Awesome. Well, it sounds to me like you've got this sleep thing figured out, so I'm pretty happy to get you on the show because we get questions about sleep all the time and I guess my first question is I've never actually heard of the Sleep Medicine group and don't really understand or know what you do. So can you give a little bit of your background and what exactly the Sleep Medicine Group actually is?

Sure. Sleep Medicine Group is an interdisciplinary sleep disorder center. We have, surprisingly, a dentist who's board certified in something called dental sleep medicine, believe it or not, sleep specialist. We have an ear nose throat surgeon who is available to assess nasal flow and do less invasive surgical procedures for soft tissue. We do diagnostic testing. We used to be an in lab facility where you go spend the night and do what everyone's probably heard of, a polysomnogram or a PSG where it takes an hour to hook you up and go through the whole process and hopefully pray to fall asleep or, or we'll just give you a little sleeping pill to force you to go to sleep. But nowadays I've gotten into, and very early on in the technology of diagnostics, I went into home sleep testing where you can actually assess sleep staging and oximetry and of course breathing disruption in sleep in the comfort of your own home. And so we do that as well as provide home diagnostics, consulting on insomnia, primary sleepiness disorders like narcolepsy, and of course the most prolific, which is obstructive sleep apnea where the airway tightens up on you. And we provide dental appliances which are essentially retainers that go on the upper and lower teeth to hold the jaw slightly forward to avoid airway collapse. Auto adjusting CPAP devices, or the abbreviation is for continuous positive airway pressure. Basically you're ballooning the back of the throat open throughout the night so your airway doesn't collapse on it. And of course less invasive, what we call phase one soft tissue reduction procedures. There's lots of surgeries you could do on your quest to cure your sleep apnea, but many of them have not Panned out to be very consistently effective.

So this in home sleep monitoring that you just mentioned, what exactly is that? How does that work?

Yeah, so there's different channels of data that you collect when you're looking for sleep disorders. And in the sleep laboratory, there's 15 channels. There's electroencephalograms, electro oculograms, your eye movements, EMG to see for bruxism, ECG for cardiac rhythm, what we call inductive plasmithographic bands, which are basically bands over the chest and the abdomen to see what your breathing pattern is. Just a whole slew of things, which is overkill for the vast majority of people who just want to stay on top of their game and are not just really chronically ill. So home testing does a limited version of that, anywhere from, say, two to sometimes five or even more channels of data. And typically it's looking at, depending on the unit, you have a limited level of what we call a montage or, or an electroencephalographic configuration where you do just a couple sensors to look for sleep staging. You look at airflow through something that looks like an oxygen cannula, but it's actually a nasal pressure cannula. It looks at airflow limitation as you breathe in and out through the nose, oxygen levels. So we're looking at pulse oximetry to see how the red blood cells are saturated with oxygen. And of course, there's also plasmathography, where with some of the sensors, we can actually see when the blood vessels, like the small venules or the terminal portions of the veins actually bulge during a sleep apnea event. And the reason they would do that is when you're having apnea, you're basically closing off your throat unconsciously, and then unconsciously, you're trying to breathe against an obstructive airway until finally you get a big surge of adrenaline to what we call fragment the sleep or cause what's an arousal, where the brain wave activity gets from a slower wave to a faster wave where you can actually tone up the muscles and breathe again. Most of these you never know about. The vast majority of patients have no clue. They're like, oh, I'm late. I happen to be snoring and peeling the pain off the wall, and people can hear me in the next room, but I sleep great. And that's the interesting.

So when you're doing this kind of home sleep monitoring, how does this compare to a lot of the apps and the wearables that are out there that are giving sleep data? I mean, have you ever compared the data that you're getting to data that a lot of these wearables are giving? Or is this completely apples and oranges?

I'm so glad you asked that. Don't get too involved in the technology that's in the apps right now. They're very limited. Very few have actually been clinically validated. The only one that I know actually has any decent data on it is the my basis Watch by Intel. Most of them are just going to give you a really limited activity. And if you don't have anyone in the bed or no dogs, no family members, they can give you a fairly decent amount of data feedback on if you're moving a lot throughout the night or if you're just simply doing the most common problem in America, which is insufficient sleep syndrome, just not getting enough sleep. If you track that and you see that your average for the week is, you know, below, say, seven and a half hours of sleep, then obviously you know that you're not at your peak game. And if you're tossing and turning a lot, that might be a little bit of a data plug, but you really.

Don'T want to go by the deep sleep phases versus the light sleep phases. That's something that a lot of these wearables will tell you when you wake up. They tell you sleep latency, how long you were in deep sleep, how long you were in light sleep. Is the system that you're using different than what they're using as far as, like accelerometers and things of that nature?

Yes, definitely different. So when you use home testing that has an electroencephalographic waveform observation, you're looking for those changes from beta to alpha to changes in muscle tone with rem, along with heart rate variability.

So are these actual, these electroencephalopographs you're actually wearing, like electrodes that are hooked up to you as you're sleeping?

Yeah, there's one really great small unit called the Aries Unicorder that basically is a headband with a computer the size of a small box. And it has two electrodes on the frontal, basically on the frontal part of the forehead there, and a little oxygen sensor that reads your blood oxygen through a non invasive sensor on your skin. And it has a nasal pressure cannula. So you're literally looking at the brainwave activity in some of these units. Now, not all of them do that, but many of them do.

Gotcha.

Which is pretty cool.

So why is it that you would want to measure. And this kind of leads into why you first wrote me. Right. You mentioned using a pulse oximeter upon waking. Can you explain just really quickly? I think some people understand pulse oximetry, some don't. So explain what that is and then why you would want to actually use something like that as a way to measure quality of sleep.

So you are really into quantifying health. And I love this about a lot of the latest up and coming health podcasters. I love that you're getting information on exposure to heavy metals and heart rate variability and advanced biomarkers. Those are really great tools. But we're really missing the boat here. If we don't look at the most common disorders that can rob us of our highest performing state of health. And so if you don't look at the one third part of your life that you're totally unaware of, you're missing a big part of your performance. So oxygen saturation can easily be robbed from you when you're unconscious. And it's extremely prolifically just out there. Everyone's, you know, a ton of people have this. And so like I talked to you before, a ton of people who have airway disruption and snoring. It's not just a social problem. You're actually depriving yourself of good oxygen flow. You're becoming hypercapnic. Or because you can't ventilate, you're getting higher carbon dioxide levels in the blood, which makes you acidic. So then you're obviously not metabolizing well. So if you cause unconscious arousals or fragments of sleep, you won't get the performance that you need. So the easiest and simplest way to rule out at least a significant problem, like a moderate level of apnea or a severe level, because you're unaware of it, is to buy some of these lower cost oximeters to wear at night, at least for a few nights, to at least get a good peace of mind. And that will let you know if you are having any of these oxygen dropping episodes. And a lot of these, these oximeters you get on Amazon, or even the one I like is SPO Medical, which is actually a wristband that has a very fast oxygen sampling rate.

That's a wristband.

Yeah, it's a wristband oximeter. It's got a computer in it and you can plug it into. It's a little more expensive, it's probably a couple hundred dollars. But there's another one on Amazon, I forget the name of it, D5 or something super cheap.

And this one's called, this one's called an SPO Medical.

SPL Medical is the manufacturer and there's several manufacturers that make really good quality ones.

So what we're looking for is an oximeter that's able to actually keep track of your pulse oximetry or your blood oxygenation levels during the night. So it's not just giving you a one time snapshot when you wake up, but you're somehow able to download the data that you've gotten during the night.

Yeah. And you can download it and you'll see throughout the night if you're having any oxygen changes. And you can if, say, most people who are younger and healthier might start finding the apnea creeping in when they end up on their back unconsciously or maybe when REM happens. REM sleep, and let's talk about that a little bit. Sleep comes in cycles. Right. And I think you've talked a little about this in the past in some of your other podcasts. It goes into a, what we call N1 or non REM1 sleep. Very unrefreshing, very short period when you first go to bed. Then it goes to N2, which is stage two sleep, kind of intermediate. And then you'll get a big surge if you're younger, of delta sleep or deep sleep. And that's when you get your growth hormone surges. You do a lot of gluconeogenesis in the liver and lipoprotein metabolism in the liver in that period of time. Plus you get healing in the muscles in the body. Most people dream when they're in REM that will recur every 60 to 90 minutes throughout the night for about four or five cycles. So when you have REM muscles relax throughout the body so you don't do something freaky like act out your dream and whack the person next to you.

Now a lot of times when you're, when you're using these type of sleep quantification devices, you know, like I've used the Move X20 by Timex, for example, because I race for Timex, you know, I have one of these that they sent me. And when I wake up in the morning after using this, I'll get a graph of time spent in deep sleep versus time in light sleep versus time in rem. Is there a standardization? Should we be looking for an ideal scenario in terms of the number of deep sleep phases that we go to or the amount of time spent in deep sleep?

Sure. The standard cycle should be around 4 to 5 cycle. So you should see a good chunk of delta sleep or deep sleep earlier in your night. And typically, if it's an accurate unit. It'll show you that most of your deep sleep, or we call slow wave sleep with delta waveforms, it's happening in the first hour to two of your sleep cycle, your whole sleep period. Sorry. And then as the night goes on, you should get longer and longer REM episodes until your last hour of sleep is mostly REM sleep. So if you see that sort of textbook, you know, sleep graph, or we call hypnogram, then you can feel confident that you have a pretty accurate unit. Very likely. If there's no one else in the bed with you, if there's no dogs, no children. It's all based on accelerometer movement and actigraphy. So if you have these confounders, it's gonna totally throw off what those units say to you.

Okay, gotcha. So you recommend, in addition to looking for those cycles, when it comes to sleep phases, some kind of an oximeter. And I'm taking some notes here, by the way, for those of you listening in. If you go to BenGreenfieldFitness.com sleep, that's BenGreenfieldFitness.com SleepDoctor I'm taking some notes on the oximeter that Dr. Zelk recommends, along with some of the other things that we're talking about here. So you need an oximeter that will take a good sampling rate and something that you can download data from in the morning. And you're going to look for a drop in oxygen saturation when you look at that oximeter. Does that oximeter actually measure anything related to heart rate as well? Does it measure if your heart rate speeds up, up, or slows down?

It does. It does. Pulse oximeters look at pulse to pulse variation and you can see what we call a tachy brady pattern, where when your airway's being closed and you're having problems breathing, where you basically get a vagal nerve stimulation and that will cause an artificial lowering of the heart rate or bradycardia. Then as the airway opens and you get the arousal, you'll get oxygen flowing in the body and adrenaline surging through the body, and you'll see what we call a tachy or a faster heart rhythm. And if you see that sort of tachy Brady syndrome, even if you don't have a whole lot of oxygen deprivation, which milder cases of apnea do not necessarily have oxygen, pulse oximetry drops, yet you're catching it way early. You might see that in these, what we call tachy brady episodes or brady tachy.

Now, what happens to I Know, these don't measure your heart rate variability, but what would technically be happening to heart rate variability if you were also so keeping an eye on that or measuring that during these periods of obstructive sleep apnea.

So what you'll typically find in the morning if you are using a heartmath unit or one of those other units for heart rate variability is you'll find that if someone's having brady tachy or tachybradia, whichever you want to call it, or apnea problems where you're in a high level of oxidative stress, you typically will find a reduced heart rate variability upon awakening. So that might be kind of a clue too. If you're doing everything right and you're sleeping fine or you're sleeping durations that are appropriate and your heart rate variability is not in the nice zone of variability and it's less variable, you might want to think, oh, I should be looking into my sleep quality. What's affecting my sleep quality?

Gotcha. Okay. Okay. So in terms of obstructive sleep apnea, I got to tell you that in most cases I have seen this associated with things like obesity and a sedentary lifestyle. What can be said in terms of healthy folks, which really a lot of the people listening to this show are relatively healthy. They're fit, they're exercising, they're not struggling with huge amounts of obesity. What about people who are fit and lean? Are you seeing osa, this obstructive sleep apnea in these folks? And why would that be?

Oh, I love that you ask that. One third of patients who have obstructive sleep apnea are within what we considered essentially a normal body mass index, around 25 or thereabouts the standard deviation. And those folks won't know about it unless they hear the prevalence on a well informed show like this. And so I'll give you my case, for example, I'll share with you. I have obstructive sleep apnea. I don't know if you saw the the pick I showed you for my before and after when I started doing moreless carbohydrate, but even at my highest I was at 27 body mass index. Okay. Even one or two standard deviations can dramatically of body mass index could dramatically change your level of not having sleep apnea or having sleep apnea. Right. So if you're within that 25 to 28 BMI, which you kind of look at yourself and say, oh, I'm pretty, pretty typically normal, great, you might have apnea more prevalently than if you were at say even at a peak performance weight of like 23, 24, but a ton of folks have it even at very lean body mass. And I was telling you about my picture. Even on my follow up picture, I was 9% body fat. I still had an obstructive sleep apnea score of 7. Okay. And my typical at my higher weight at 27 BMI, which is not heavy, is 19.

Can you explain those scores real quick just for people who need to get their heads wrapped around how you're quantifying this?

Yeah, so the way you quantify obstructive sleep apnea is you look at your breathing disruption episodes and the minimum Criteria is a 10 second cessation of breathing while you're asleep. Almost no one has 10 seconds. Typically they be 25, 30, 40. I've seen some minute long episodes where you're not breathing. Okay, this isn't, oh, I'm holding my breath, I'm going to take a big gulp of air. This is you're slowly exiting airflow out of your throat involuntarily. Right. So a fancy word for suffocating is apnea. So if you think of sleep suffocation now, all of a sudden you can see, whoa. This would obviously affect performance, Right? So if you want to grade how it's going to affect you, at least cardiovascularly and part of an oxidative stress sort of spectrum, you want to see how many times per hour your airway is relaxing on you. And you can do that through, like I said, with the pulse oximeters, with an oxygen desaturation index. How many times per hour does your oxygen level drop? At least three or four points of pulse oximetry, which is pretty significant.

So that's what, three or four points?

Yeah. Well, and you're also going to frequency, right? So less than 5 would be considered normal. You're allowed to have up to five suffocating episodes for 10 seconds and still be normal, which is weird to me. But that's sleep. If you pass that and you go five to 15 times per hour, that is considered a moderate level. And when you pass 30, basically not breathing every two minutes. Right. For at least 10 seconds, but usually 30 seconds at that point in time, that's a severe case of sleep suffocating. And that's why I want to get on the airways here and talk to you. We need to really take away all this confusing medical mumbo jumbo and make it into something that people can really identify with. And so if you have an 80% undiagnosed problem that's affecting a huge swath of the population. You need to start unwrapping, you know, some of the confusing aspects that would leave us, you know, not willing to look into this problem. So one third of us have no weight issues causing sleep apnea. 70%. As you gain weight, you can definitely develop sleep apnea. And the way you think about this is anatomically, the tongue is a big part of the obstruction of the airway.

Okay.

Since we can speak, we're a unique animal where we have to have phonation and have a very flexible pharynx. And larynx is the cartilage supported area, but the pharynx is very, very collapsible. And right above the epiglottis, you have what we call the hypopharynx, where the biggest part of the tongue is situated. And as you gain weight, your little filet mignon lean tongue base starts to turn into a juicy ribeye steak, basically, if you want to think of it in those terms. And now as you're gaining weight, you have a little bitty airway that's only about 12 millimeters. When it's really, really wide, is slowly but surely encroaching on itself. Nine, eight millimeters, even less. And so when you fall asleep and your airway naturally relaxes a little bit, if you lose that dimension, you're going to have a dramatic change in the way you don't breathe. Basically, when you're sleeping and it sneaks up on you, you don't have to be the guy crawling, Even though they may be very significantly impacted with oxidative stress due to high frequency of not breathing, which is what sleep apnea is.

Okay, gotcha. So in terms of pulse oximetry and some of these home sleep monitoring systems that a professional sleep organization like yourself would kind of send someone home with. What about blood testing? Are there ways that you can recognize via blood and biomarkers issues that might be affecting your sleep? Like if you don't sleep well and pulse oximetry seems to be affected and you're not quite sure why, what can blood tests tell you?

Well, so to get the gold standard, and I think that's where you kind of try to look at, is you want to look at what the physiology of the problem is. So first and foremost, if they want to go get an oximeter, great. If they don't want to do that and they want to get the gold standard, have them get ahold of a sleep doc who doesn't want to just rush him into an in lab test which is super expensive. Have them talk to a sleep doctor who's open to more home testing and then get that done first. Right. So that's very simple. You know, like our group, we're doing more and more online consultation and basically FedEx mailing of home testing. And you know that really.

But so you're actually doing that, like someone could call you up, they could have, you could send them this like unicorder and the electroencephalographs and all this jazz. They put it on, they sleep with it and then they send it back to you.

Exactly. And that's where this is progressing. This whole Internet connection makes it a lot easier to have access to someone who is expert at this and can give you a lot of that information just like you're say doing with wellness effects and advanced biomarkers. But honestly, focus there.

But I'm just curious just to interrupt you real quick before you keep going, how much does something like that cost?

It varies widely. Some practices are just barely getting in the home sleep testing and they're really, and I can't speak for everybody, but across the nation it could be anywhere from. In my practice I charge 200, $250 depending on the unit. That includes the consultation and the interpretation of the study. And some practices could charge you for the same unit as high as 12. So be a good consumer of your sleep diagnostics and try to do a.

Little work window shopping. Does insurance actually cover stuff like this?

Many insurance companies do. And that's the other really cool thing that I've tried to commit to in my practice is we work really hard to grab the insurance information, verify it, see where the benefits are and whether it's a diagnostic assessment consultation or even an intervention where you want to do say an oral appliance or a dental orthotic or a CPAP machine, or look into a surgical referral or even just nutritional recommendations for antioxidants that might help out. That's part of the insurance reimbursement. So this is a valid therapy that most insurance companies cover.

Doctor. Interesting. Okay, so you were getting into some of the blood and biomarkers.

This is pretty exciting stuff. So again, you guys nerd out really well on this show. And I love it. I love it, to be honest. So don't apologize to anyone listening when you start nerding out because I think a lot of us who are listening to you love it. Keep doing it.

Good.

Again, I can nerd out a little bit on some of the sleep insufficiency stuff and how it's affecting inflammatory markers. So what we're looking at is we're looking at inflammatory markers. Okay. So when you're looking at advanced biomarkers, if you're looking at someone who's got a high APOB or a marker on their lipoprotein to APOA ratio, that could be an indirect marker. It's not 100%, but something gets you thinking about whether there might be an oxygen deprivation problem, right? Or what we call, you know, intermittent hypoxic episodes or low dropping of oxygen below 90% of oxygen. Where you want to be, your brain is the a student. It wants 90 greater. And more importantly, it would love like 95% because you breathe slower and more shallowly in sleep. So you're not going to have 98, 99. Okay. There's also APOE. So if you have the APOE4 gene, there was a study done out of Stanford where 28% of patients with moderate to severe obstructive sleep apnea had a positive APOE4 gene. So it's not 100%. But if you found that, that could lead you to want to look into whether you had a genetic susceptibility. Okay. If your oxygen levels are really dropping down and you're having significant frequency like 30 times, 40 times, 50 times, I've seen 112 times in one hour where a 37 year old guy had severe sleep apnea and he was totally wiped out. That's wild. You'll see probnp, which is a peptide that spilled off from the left ventricles when they're exposed to very high intramural pressures. So when you're holding your breath and your oxygen levels are dropping and the heart is being injured, it will start spilling this out. You've probably seen some articles where some, some guys after Ironman will see elevated troponin levels, or you would see pro BNP as well. Troponin I is also something that will be in the blood sometimes. Interleukin 6, interleukin 10. Those are inflammatory markers, cytokines that are telling you there's something going on with the endothelium that can be elevated. And there's more and more data showing that if those are elevated, you should be looking into sleep apnea. Tumor necrosis factor alpha. TNF alpha is also if that's elevated. If you see all three of those elevated, there's a very high possibility. There's even a urine test that looks at the prostanes where you basically do A urine catch. And if that's elevated, you're basically beating your body up from the inside out. Wow. High sensitive C reactive protein that with interleukin 6, interleukin 10 and TNF alpha. If those are elevated, start looking for apnea because oxygen's really gotcha.

This gets me thinking. A lot of these are inflammatory or oxidative biomarkers.

Exactly.

By addressing inflammation from a dietary standpoint, like a low inflammation diet or a diet low in refined sugars, caffeine, high amounts of commercial dairy, red meat, et cetera, or by including traditional natural anti inflammatories like, like curcumin or antioxidants or vitamin C or things of that nature. Are these actually strategies that you use when you see obstructive sleep apnea, or are you relying more upon kind of like the biomechanical manipulation of facial features, like the implants and the mouth guards and things like that?

It depends on where the patient's at mentally. You know, if they are. If there's no. If there's a obesity problem where their body mass index is greater than 30 and they want to address that nutritionally and with antioxidants. Absolutely. I want to try to address that with ways to improve nitric oxide. Maybe they need to take L arginine. Maybe they need to be. Maybe they're low in their minerals. A lot of sleep apnea patients are low in selenium and copper. Those are signs of oxidative stress. A lot of folks with obesity and sleep apnea tend to have lower testosterone levels. Things that we can do to try to improve those and to try to mitigate it with antioxidants. Absolutely. Great idea. You're only doing part of the job. You know, you're trying to deal with, you're doing, you're not doing, you're not 100%. You know, if you don't open the airway up and you're just using nutritionals, you're. I haven't seen any studies where it actually reverses the problem. Right. So you might be trying to mitigate it, but you got to look at the underlying problem, which iswhich is supporting the airway when you're unconscious. Think about with cpr, if I cram them full with glutathione in the IV and I give them a bunch of, you know, IV solution and I don't do anything for the unconscious person whose airway is obstructed. I don't open their airway and breathe for them. How well am I Gonna, you know, save them.

Doctor? Yeah. So how do you open the airway? How does this work?

Alright, so there's several tacks, right? So, so the first one is, and this is going to kind of go a little bit aside from just sleep problems. But since we are interdisciplinary, we have dental sleep medicine as well as sleep disorders. I understand more facial development. So you can start really, really early if you try to treat children. And I know how really avid you are about being an avid parent, being more present for them and nutritionally being more responsible. If you can monitor kids and look for a couple things. First thing, this might sound a little weird. Sleep apnea, breastfeeding. What do you mean? If your tongue is functioning against the palate of the mouth, you're going to get 80% of facial development within the first year of a child's life. And if you can have that tongue through that hard effort of breastfeeding, you're going to help grow the mid portion of your face or your maxillary bone. A lot of modern humans over the last 50 years, we know that there's a smaller maxillary and mandibular bone, and I think it's several fold. It might be more prolific allergies. So kids are more mouth breathing instead of nasal breathing when they're sleeping, less breastfeeding, obviously a higher exposure to xenoestrogens might be an issue. But the bottom line is if you can get facial development to get back on track, you might be able to head off some of the sleep apnea at the. So that's one thing. Now, in an adult, you really only have three options. The most commonly used one is continuous positive airway pressure, where you take a mask, you put it on the face and you just turn the pressure up and it starts blowing the airway open. That's cpap. Okay. Most commonly used, probably not the most liked by patients. And if you look at research back from 1988 or thereabouts, if you ask the patient do they want to wear a retainer or put a mask on their face, nearly 80% said, I'd love to do a mouthpiece. Let me try that first. Well, what's currently happening in the current, you know, practice patterns is every guy's like, hey, it's just easy to give you a box and just slap the mask on and you're. And I'm good, I got you covered. But I look at it differently. I think that we need to erode some of the barriers. And so if you just have a little mouth guard, that's very Portable and supplied by someone who knows how to do it so your jaw can't get sore, your teeth don't get hurt, like these snore guards online. Then you'll start getting more people motivated into looking into the snoring problem. So, like I said, the mandibular advancement device, or a fancy word for two retainers that hold the lower jaw from falling backward, is the second treatment. And of course, the oldest treatment out there, which has kind of lost a lot of its favor, is soft palate reduction or tompholectomy. Now, tonsils are very important in children because they're at their largest between the ages of 5 and, say, 9 or 10. And because we have smaller jaws, guess what? Our tonsils are going to act like they're going to act larger, and they'll stop and they'll obstruct good breathing patterns. So you want to get that fixed. But in adults, tonsils pretty much shrink in just about everybody because it's part of your immune system. You're trying to generate immune memory. So your thymus gland and your adenoids and your tonsils will pretty much shrink to almost nothing in, say, 80% of the population by the time you're 20, 25.

So are the tonsils actually necessary for anything, in your opinion? Like, is a tonsillectomy going to be, in the long run, damaging?

You have to weigh the pros and cons, right? So the tonsils there, if they're not obstructing you and causing you not to breathe and affecting sleep disruption and reducing your immune capacity by totally ruining your sleep quality. Yeah, they're really important. They're there to kind of be the sentinels. They're looking for that virus and that bug and that and that parasite and that bacteria, and then it shuttles it to the spleen, into the bone marrow, and you're able to find and catalog with antibodies what that was. And so when you get exposed to it in the future, you'll be able to attack it faster. But if you're not breathing, beeping, you can't get to that immunological cascade. So you have to balance that out. So in my opinion, if the kid's mouth breathing and they're not breathing well through the nose or they have allergies, look for those tonsils. They're hyperactive. They're not doing as much good as they could have if you had plenty of room in the airway.

Okay, gotcha. Is there anything else that you do to fix something like obstructive sleep apnea?

Yeah, with the pediatric realm here, there's a cool movement. Orthodontics is an extremely, extremely young specialty. And I think without taking airway development into perspective, you miss out on what the actual most appropriate treatment is. So I would highly recommend, don't wait for your kids 12 or so to do braces if they have narrow jaw or crooked teeth, or if you have history of braces in your family. Or extracting your bicuspids is a very common thing where your premolars get extracted as well as your wisdom teeth when you're older. And then you wire down your jaw and make it smaller. Get in there early and go to a functional orthodontist that will right around facial development time. By the time you're 8, 90% of your facial development's done right, or 8 to 10. Basically, that's why a lot of orthodontists wait till you're 12. But if you can identify airway problems, tonsil problems, nasal allergy problems, and treat those very aggressively through nutritional monitoring modifications like avoiding inflammatory foods like high carbohydrates and processed foods and the like, and that helps great if they're having, you know, environmental allergens. Get that looked at right away. If the tonsils are huge, what we call a palate expander. If you go to a functional orthodontist, they'll actually look at that airway and they'll help guide that jaw development as young as, say, 5, 6, 7, 8. And you might actually correct a lot of that facial, what we call maxillary insufficiency or retrognathia, with the lower jaws too far back. And that's my problem. You know, I was a kid who had allergies. I grew up in Florida. And, you know, I sounded like this my whole life, you know, because my whole nasal passage was absolutely obstructed and I was constantly mouth breathing. So again, at 9% body fat, I have sleep apnea. Right. So if allergies aren't treated, your facial type becomes either too long. You see those longer facial types, that's called dolichocephalic. That means you have less space side to side. And of course, if you can get people who are obese to lose weight, that will very much reverse much of the sleep apnea. But once the fat tissue is applied in that upper airway, it's usually the last place to be applied and the last place to be removed. So typically, typically, once you get to a significant body mass, like say 30 or 35 or even, gosh forbid, 40 body mass index where you could be up to 80 pounds overweight. When you lose significant amount of weight, you're still going to have a significant amount of leftover. You probably won't totally resolve it, but you'll definitely make it less of a problem. And so that's what I do in my practice and that's very unique. I think a lot of sleep docs go, hey, here's a device, let's treat it, or here's a surgery, let's do that. If I see a patient where I can get them feeling immediately better by treating their sleep quality by improving their oxygen, I want to take that motivation. And if there's any weight problems, I'm going to throw in a good panel of antioxidants. I'm going to get them on appropriate dietary intake and help them get the tools to take that better metabolism that now is working because their oxygen's better and help them be more successful in that weight loss. Because if you tell someone who's overweight to lose weight weight and they have obstructive sleep apnea causing their sleep process to be so poorly, you know, they're fatigued constantly, their metabolism shot, you know, their leptin levels will be off, they'll be leptin resistant, so theytheir hunger levels are through the roof. Their ghrelin levels are up as well. I mean, and they're carb addicted at that point as well. You really have to give them every tool possible to be successful. Yeah, and again, you don't have to be wildly overweight. You can just simply be 20, a 28 BMI. And again, if you look at my picture, my Hawaii picture shows me at 28 and it looks significantly less healthy than my 9%. But it's average. That's the average for the average human being. And this is one more really cool fact we got to think about. In 1990, when they first started looking at obesity rates, only 10% of the population was over body mass induced disparity, which is considered morbid. Obesity in 2010, which is the last CDC state charts where they did the survey, it was almost 30% of the population and over 7 to 27 BMI, which is considered overweight. So the obesity epidemic, even if we're not severely obese, is dramatically increasing the prevalence of breathing disturbances in sleep.

So I'm curious about your own personal kind of habits. Knowing as much as you know, and we really only scratched the surface on some of the research that you sent over to me as far as like cancer and insulin insensitivity and blood sugar and appetite dysregulation, all the nasty things that happen with sleep deprivation. And perhaps at some point in the future we can talk again. Or maybe I can even twist your arm into a guest or article to go into some of that stuff because it's fascinating. But I'm curious about your own personal sleep habits. Do you have specific evening habits or morning habits that you use in addition to anything else that we've just discussed to actually optimize your sleep?

I try to practice what I preach. So the first thing is I've treated my sleep apnea with a dental appliance for the last 10 years. I feel like that was a good hack right there. And I'm not even a snorer. I'm just more of a mouth breather type patient, which is another misnomer. You don't have to be a loud snorer to have an airway disruption. What I also do is I try to avoid working up until the last minute. I try to give myself seven and a half hours of sleep time in bed because the average person only sleeps about 85% of the time they're in bed. So if you give yourself, you know, the average American only sleeps six and a quarter hours. So if you give yourself seven hours in bed, you're only sleeping six and a half hours, right? So if you give seven and a half or eight, then you'll probably sleep at least, you know, a decent amount, which is about 7, which is a good, good middle of the belt. You're probably going to, you know, help most folks get their optimal performance. I am big about touring at bedtime. Also, if I have any issues, I have a sublingual spray I like to use. It's got L theanine in it, a little bit of melatonin, tart, cherry. It's got some lemon balm and valerian root and passion flower in it, which is really cool. And since it's sublingual, it absorbs very quickly. I haven't, I'm not a bad sleeper, so I don't have to worry about the insomnia problem. But if someone did have an insomnia problem, they really want to be wary of some of that dirty electricity that you guys are talking about being exposed to. Their. I'm a big believer in that radiation, that Bluetooth radiation. Turn off your wifi at nighttime. I think that's a great idea.

Now, what about these sleep kits that you send out? Do those have Bluetooth or electricity, electrical signals? Or are those simply because they're being used temporarily. Not really a big deal.

Right. They're temporary. You're not being exposed chronically over time. You know, you don't have unknown amounts of chronic radiation yet you're being exposed to. So that's probably again, not a big significant problem because the chronicity of issues that give you a problem.

Gotcha. So it sounds like you're using many of the kind of like the traditional sleep nutrients that we've talked about in the past on this show. And then taurine is not something that we've discussed too much, but you're using taurine as like an amino acid prior to sleep.

Oh, it's great because I typically don't have time to work out until the evening. And I'm a muscle strength trainer. I don't do a lot of cardio as far as running, but I keep the pace up. And so sometimes you just need a little taurine for a little amino acid use because, again, it's not essential. But if I'm working, if I'm utilizing it and I'm exhausting and I want to replace it, and plus it's got a little bit of a calming effect. If I was having issues, I'd probably go for a little 5 HTP. I have tried the Gabawave, the Finabut, which has some research on it in sleep disorders medicine. But again, because it's so significant, we can get really geeked out on neurotransmitters. And there's newer neurotransmitters like Orexin, not just gaba. Adenosine is the biggest driver for slow wave sleep, and we block that every day with caffeine. Caffeine is an adenosine blocker. You can inject adenosine into the body, turn you into a deep sleeper in slow wave sleep and get growth hormone, but no one's doing that.

Is that safe, though? Has that been looked into as far as the use of adenosine as a supplement or as an injection? I mean, would that technically shut down your own endogenous production of adenosine or anything like that?

You know, adenosine breaks down so quickly. No one does that. It's just like for experiments with animals and just with basic science for neurophysiology. But it just shows you that in the brain, neuroptic transmitters work very differently than in the rest of the body. Like histamine. Histamine is the most profound alerting neurotransmitter. No one's talking about that, but everyone uses a version of that over the counter with unisom with diphenhydramine, which is better. That's an antihistamine that crosses the blood brain barrier. And the way it makes you sleepy is it blocks histamine. Okay, Soso. I mean, again, there's so much more than just GABA and serious precursors. And I'm just trying to be part of that whole functional medicine root cause, natural medicine. I justagain the whole reason why I'm excited about talking to you on this podcast is not only does it get it out to people who are proactive in their health, but you get a lot of functional medicine practitioners and chiropractors who are functional medicine and natural pass. And they're probably not even taking this into their differential diagnosis for why they're treating fatigue and other problems with patients. Yeah, they understand that there's. There's this one other area that they're missing. Man, we can get so many more people at their optimal level of performance, you know?

Yeah, it makes complete sense. And it sounds to me like for people out there who are experiencing adrenal fatigue or sleep issues, I mean, for me personally, additionally doing something like a quantitative analysis of sleep using something like one of these kits that you sent out, or hooking up with something similar to what you do in the local area, and literally doing a sleep study that gets a little bit more deep into the data than something like whatever, Beddit or the Mybasis watch or any of these other sleep tracking devices. And then also looking at pulse oximetry, all of that sounds like it would be pretty prudent in a case like this. And this does indeed sound like something that kind of flies under the radar, this obstructive sleep apnea issue. So, first of all, I realized that we didn't get a chance to go into, like, half the stuff that you're an expert in. And so we either have to have you back on the show or, like I mentioned, you know, perhaps if you're listening in, you could look for a guest article or something like that at some point in the future to get go into this a little bit more. And second of all, I'm going to put resources to the stuff that we talked about, including your website over at sleep. I'm sorry, BenGreenfieldFitness.com SleepDoctor if you want to look into Dr. Zelk and what he does as part of the sleep medicine group, the pulse oximeters we talked about, et cetera. And then Dr. Zelk, thank you for coming on and for sharing some of this stuff with us.

Hey, Ben, thanks for everything you're doing out there. It's really opened up my practice. I don't want to just run to writing prescriptions anymore. All these, you know, this functional medicine movement's been great. And this quantitative, you know, self is really super. And by the way, I'm still wearing my encoder band. You've got me all paranoid about EMF and so nice.

So that structured water, those encoder bands that can really be used quite well. I've got actually two on my desk and then I wear one on my wrist. They're great for mitigating emf. Unfortunately, those got so popular that A, they're completely out of stock, and B, I still found that the wilder the lifestyle someone leads, including like obstacle racing and, you know, open water swimming and stuff like that, these things still, in my opinion, could be engineered to hold up even better under the rigor of those type of activities. So that's why you can't get them right now. If you own one of these encoders, congratulations. If you don't own one, I believe if you can go to superhumanencoder.com, there's like a wait list or something like that. But I'm probably six to eight weeks out of. I've got somebody actually over in India working on a newer version that's really able to hold up to rigors and also has a little bit more added to it in terms of copper tubing and some other kind of cool features. So total rabbit hole. But yeah, I'm glad you brought that up because I know a lot of people have been asking me about these wristbands and when they might be able to get them again. So soon. Hopefully at some point in the next year.

And just one last thing, on Earth, I'd highly recommend you do a podcast on that whole earthy movement. It's got some interesting stuff. I don't know if you're thinking it's a big woo thing, But I think Dr. Sinatra, that functional cardiologist, is big into that heart rate variability.

Yeah, I'm definitely into Earth. You know, I use the Earth pulse that I sleep on and then the biomat that I use has some of those same features. Features. And then, of course, you know, I walk around outside barefoot and I've got Earthing sandals. And I've talked about the Earthing or the grounding movie before on the show, but I don't know if we've done a full podcast episode on it. So we'll have to do that sometime, too. So many, so many different avenues to pursue when it comes to living the optimized, healthy lifestyle. So anyways, though, this is great information that you've provided. So thanks for coming on. And again, and if you're listening in, you can go to BenGreenfieldFitness.com SleepDoctor to access some of the resources that we discussed during this show. So, Dr. Zellk, thanks for joining us.

Keep up the great work. And thank you again for having me on. I really appreciate it.

All right, folks, this is Ben Greenfield and Dr. Joseph Zelk from the Sleep Medicine Group signing out from BenGreenfieldFitness.com have a healthy week.

Visit Ben Greenfield, BuildFitness.com for even more cutting edge fitness, nutrition and performance advice.

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