Jeff Langmaid talks with a clinical airway specialist about why primary-care doctors should refer airway cases to myofunctional therapists or airway-focused dentists first. An apneic event is any breathing pause longer than 10 seconds. Screening uses the STOP-BANG questionnaire for adults and visual posture assessment for children, followed by breathing retraining exercises like diaphragmatic and nasal breathing work.
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And since that's the first kind of step in the cascade, that would probably be one of the first people that I would refer to. Probably the best aligning with this, I think, I guess in my opinion, would be either a myofunctional therapist actually, or airway dentist, because they kind of understand the changes that are happening within the airway through their dental work. But they also realize, and when they're looking at these films, they even talk about the cervical spine with those. And a lot of the studies that have, I guess, proven this theory are done by airway dentists. And so I think that'd probably be the most likely to actually send referrals back. And then sleep medicine, they're probably likely going to go with CPAP machines and/or whatever type of treatment they do, Inspires and other sleep apnea treatments. So I imagine that'd be secondarily referring to a chiropractor because of their musculoskeletal complaints, maybe not necessarily working with you. Was there any others? Yeah, I think those are the main ones that I would think. So I couldn't really rank them in order of which one works best. It's more about what's going on with the patient at that time.
Yep, yep, yep. And if we pull it back to the beginning, for the docs that are tracking, they're seeing what you're talking about, they're understanding it, and they're just looking for that first few implementation steps. You mentioned a few things, analyzing, or at least visualizing, I should say, the airway, et cetera. Maybe I'll ask you, what are a few either specific questions and/or specific visual assessments, evaluations, examinations that you would recommend for somebody that's just saying, hey, let— I'm going to start taking a look at this. Where do I start?
Yeah. So once again, kind of goes down to either adults or kids with these issues. If you're noticing an adult, I would say a STOP-BANG questionnaire is like the gold standard for, okay, you meet enough of these criteria. As well as the same guidelines that the DOT has, you know, the neck circumference, those types of things. Now for kids, it's going to be— you're going to— I mean, when a patient walks into our office, we look at them, right? That's like the first part of the exam is just seeing what's going on. So I think if you're going to implement this tomorrow, it's just look at them, but look at them through a different lens. Like, could this be an airway case? Because if you're just looking at their posture, that doesn't tell the whole story if you have an airway mindset. So looking at airway screening type of mindset in that, in the sense of, okay, I'm gonna look in their mouth. Like I said, look in their mouth, look at how they're breathing. Are they chest breathing? Are they doing some of these tells? And then questioning them with the parents if their kids are with them, like, how'd you sleep? How do you sleep? Do you notice they mouth breathe? Are they snoring? Have you witnessed an apnea? You know, so these types of questioning would be kind of the second part of that. And then just talking with them about what you think may be going on and having that conversation of here's some avenues that you maybe want to look into, whether it be, you know, any of the providers we talked about or with chiropractic, like here's what we may be able to help with, with some of these issues that I'm seeing versus what I think another professional may be more appropriate to deal with.
Yep. No, that makes sense. I'll ask 2 pretty basic questions, but just so I make sure I get my terms correct, is technically apnea the stopping of breathing? And is there like over a certain amount of time. And then I'll ask you, follow up immediately on that, which is snoring. Is this one of the primary, secondary, or tertiary airway issues, reasons for snoring? I never really thought about it.
Yeah. Yeah. So apnea is anything over 10 seconds. So how they, like, if you're on a CPAP machine, it's gonna measure that every single night. They call it the AHI. So anytime you are not breathing or don't have enough breathing during that 10-second timeframe, it's gonna mark it as a, as an apneic event. There's hypoxias too, where, you know, obviously the, the Oxygen saturation drops. There's several other things they look at and that's more, like I said, the sleep medicine realm. But yes, and then snoring would be basically the body's way of opening that airway back up, right? The tongue starts vibrating 'cause you're not getting air in or you're not able to 'cause it fell back. So it's going to, you know, make that noise as it's forcefully trying to get the air back in there. So they're very correlated, probably honestly, probably one of the number one things you're gonna notice with somebody that may have sleep apnea, but you could snore without it too. So yeah,
got it, got it. So I'm going to recommend every doc listening or watching visit airwaybridge.com. We'll be sure to drop that in the show notes and down below as well. That's an easy way to connect with you, airwaybridge.com, and we'll drop that down below. Before we wrap up, what haven't I asked that you think is important for docs to know
about? Yeah, so I think that would be one thing that I would bring up is figure out a way that you want to speak to these professionals and speak in their language. So study it a little bit, like what do airway dentists do? What are they evaluating? And how can I present that I have a patient with these issues, or even make a template of, you know, whether it's sending out a report to them. Here's what I'm seeing. I wanted you to check them over. That just kind of builds that rapport with them. So that's, that's something that I would add. The other thing is we didn't really ask too much about like actually a protocol you would do in your office with somebody that has some of these issues. So for me, I think you have to start with the initial problem, which is breathing. So you want to, I guess I could give you kind of my protocol. So if somebody comes in, I'll call phase 1, the first week we're just gonna work on breathing. So we're gonna work on diaphragmatic breathing and nasal breathing. We're gonna make sure that they're doing them properly. So we're gonna have them doing, you know, 5 to 10 sets a day of a various, whether it's 90-90 breathing or crocodile breathing. We're gonna have them work on that for that first week without any sort of other therapies involved, as well as the adjustment, hopefully. Then that, that second visit they come in, we're gonna see if they're still doing it correctly, because we wanna retrain their brain to do it properly. So the next step I would say would be we do those, those breathing techniques, those breathing mechanics. Coupled with a stabilization exercise. So like a chin hold, for example, right? We want to disengage the SEMs, the scalenes while they work their deep neck flexors or try to make them so they're not hypertonic. But we want to be able to have them do that while breathing correctly because if they're breathing improperly while doing those, they're reinforcing that poor pattern. I guess if that, if that makes sense.
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