From Mouth to Mattress, Oral Health’s Overlooked Role in Sleep Wellness

Hello and welcome to the Sleep Reimagined Show with Nyree Penn. And today we have a special guest, Nyree, right?

Yes, we do. I'm so excited.

Well, before I have our guest introduce herself, Dr. Sokolina, I just want to give a shout out to our listeners because last 30 days our show has made into top 10 in 3 countries and top 20 in 6 countries. And we are in Nigeria, Ukraine, France, Sweden, US, Australia, United Kingdom, Germany, Canada, in medicine category, in health and fitness category, and it continues to grow. So congratulations, Nyree. Great job.

Thank you, viewers and listeners. So appreciate you. Sleep, health, and wellness is so important. So affects every aspect of your life. So thank you. Thank you for the support. Education, please continue to watch and follow. Especially when we have great, great guests like Maria, Dr. Maria today. So let's jump right into it.

All right. So Dr. Sokolina, tell us a little bit about you before we jump into the conversation.

First of all, I'm very honored to be here. I really like Nuri and I find our meeting a special gift, really precious gift. And I'm a dentist, actually. I have a training in 2 different schools. I'm trained in Russia as well as in United States in NYU. And then while I was searching on my path through the dental world, I faced a lot of challenges. I really didn't understand how all the pieces of that puzzle fit until I discovered sleep. And with that particular knowledge, it's really start making sense. And a lot of cases, what I didn't understand, how come that happened and that happened, I realized everything's so connected. And it connected to the airway, connected to the sleep health, and it's very important journey. And now I'm practicing dental sleep medicine for last 15 years, and I'm a diplomat. So I have a special board. And as well as I'm very passionate about educating the public about that topic. I have a strong social media presence. I have a channel on Facebook regarding the sleep apnea and Instagram and so forth. And I'm writing the book right now about the sleep. And I want to see the world more rested, to have more energy. And I see how my patients struggle every day and I really, really want to help them.

Welcome. And this is the reason this show exists and we Always like to say it on this show that feel restful, right, Nyree? That's the most important thing that we convey. And so let's start with you, Dr. Sokolina here. So you started as a cosmetic and restorative dentist and what pulled you into the world of sleep medicine?

I usually give one-word explanation, fear. I really was scared what my restoration gonna fail, what people gonna break whatever I'm doing for them. And it can be cosmetic dentistry or veneers in a different way, or it can be orthodontic treatment. I also move the teeth. And I noticed what people doing something against all the possible precautions I put in the mouth. You know, I try to position the teeth in the right way. I try to use the best material, but they're stronger than that. So I was really looking for the answer why people break my work. But then during my orthodontic training, I took some orthodontic courses. I heard about sleep and I start doing sleep also. You know, it was oral appliances, oral appliances, but I didn't see it as a full story. It only happens when you practice. And then later on, I discovered myofunctional therapy, and that really put the connection to a lot of unknown puzzles. And yes, I'm passionate about temporomandibular joint treatment because I see a lot of people who sleep bad. They also suffer from pain here, from the headaches. So now I become— I believe I become much better practitioners. So you can see the picture as a whole. And then not only about head is so separate from the rest of the body. So I do a lot of collaborative work with other doctors as well as with the practitioners. I'm talking about physical therapists, craniosacral therapists to kind of put, you know, to kind of make my patients happier or explain them what is possible. So that's my journey.

Wonderful. And Nyree, so as someone who's Completely different field though, but what surprised you most when you first learned about the connection between oral health side and sleep? Talk to us about that.

I think what surprised me most was how much they overlap and how much we actually, as anesthesia providers, we look at the jaw, the airway, as far as airway specialists, in the sense of Putting people to sleep under anesthesia, right? However, even if they're not under anesthesia, the same rules apply, right? So it's not like you know. So when I when I met Maria, you know, at the Philadelphia Sleep Conference, it was just our conversations were so interesting because they overlap so much, and we are concerned about the same things but in a different way, you know. And so it was really exciting. You know, I'm sorry, but you know, I geek out over sleep and then anesthesia, and she understood. And so it just. So, we had to break them up, but it was just so good. And then, we realized, hey, there is an opportunity for synergy here. At ProSomnium Sleep Health and Wellness, we require virtual initial consultations so we can see their airway first. We do have to check the jaw and the beards and the recessed chins. Those are all things that we look at in anesthesia. And so, it's the same concept, just in a different industry. And that's why it's so great that Maria and I are partnering and talking about this together, so we can provide comprehensive sleep solutions. So, that's what surprised me the most in an exciting way.

Can I add something to that story? Very often people come Um, on, you know, in my office and they talk about what anesthesiologist, actually the person who put them under anesthesia, changed their life because they were the first one who noticed problem with breathing. Sometimes, and you know, it can happen, you know, luckily if it can happen on a prior to anesthesia appointment, but sometimes it happened during because sometimes it's really hard to really estimate what this patient might have sleep apnea. So anesthesiologists actually saving the life. It's kind of more common knowledge than a dentist who see a lot of signs of sleep apnea. And just like Nuri, I want to add what dentists really see a lot when patient open the mouth. Things like Tori's next to the bottom teeth inside. They can be designed a certain way, tongue position, we call it tongue tie. Or another way, tongue can be really high and really crowd the airway. What you ask patient to say, ah, but then you don't see anything there. And you keep pushing, pushing the tongue, but it's not pushable. And I can imagine what happened at night. in such a landscape. And also wonderful sign, what I saw yesterday on my patient, that sign of acid reflux. It's also such a red flag when something is happening at night, what can lead to apneic episodes when people cannot breathe. They usually go together for whatever reasons. So we kind of— we're in a different field, but we pay attention to the similar red flags. I don't think it's such a common knowledge. I don't think everybody knows about that, what dentists and anesthesiologists can save the life that way, but it's true. And I see that in the practice every day.

Absolutely. Yeah.

It's like, I was going to say like, and Nyree, we talked about this in one of the previous episodes that, you know, all of a sudden we are seeing something doctors like Dr. Sokolina and even you, you are bringing this knowledge. And I was telling you, oh, I just saw that 3-finger test to put in the jaw and measure it. I saw that TikTok video and I was like, I had to put my fingers in and see if my jaw is like for alignment. And that was the thing, right? So it's coming up. It's just started to get a little bit of attention, which is good. But more importantly, I think Nyree has spoken a lot in the show in general, that especially about how do other specialties collaborate. And I think this is great. We are starting with this show to almost prove a point that we are not just talking, we are actually making events in that direction.

Absolutely.

Nyree, question for you here. When you are telling patient, when you're checking their mouths and when you found something with the airway, And when you tell them, tell me a little bit how patients are taking it, because I don't think patients come to you thinking that, oh my God, you're going to tell me now it's a problem with my jaw or with my airway. Just fix me like your sleep therapy, right? So tell an incident how they— tell me about the reaction here a little bit on your side of things.

It's both.

It's either, yeah, my wife tells me that all the time. Or, you know, or, you know, what do I do about it? So ironically, you know, and to your point, right before I bring them into a surgery, I actually have to score them on what I believe is their chance of having obstructive sleep apnea, just based on their preparation before surgery. However, let's frame this for what it actually is. You're about to go into surgery.

Mm-hmm.

to have your gallbladder removed. And I'm telling you, you have obstructive sleep apnea, right? Even though we're trying to be very proactive, it may not be the most appropriate time or place to inform people of that. That's more information for us on the anesthesia side so we know how to prepare and care for them during their procedure. Obviously, we give them information on where to go after your surgery on how to treat this. But I think there's some room for improvement to streamline that.

Mm-hmm.

If we do get the opportunity to say, hey, you know, get this checked out, it's really severe. Or, you know, we tell a family member after their procedure and then they proactively follow up. You know, that's kind of where we are now.

But I think we get this space to do a little bit better.

especially when we can definitely identify potential issues.

Can I add from my side? I'm so sorry.

I was going to ask you that, why do you think, why is it such a missing puzzle? Obviously, when patients come to you, Dr. Sokolina, then I'm sure even at times you are discovering all this thing and you tell us, right? I guess there are 2 questions here for you. One is, why do you think it's like such a missed opportunity? Like it's caught, it's rarely caught, and then it comes to you and then you tell, then how do your patients react? Talk to us about that.

Love this question. I really am so appreciative for that question because whatever Nyree is saying, I can say from my side. Yes, you know, patient had gallbladder removed and come for anesthesia. He doesn't want to, I mean, He's not inclined to think about obstructive sleep apnea. It's like too much. Same thing when patient come to the dentist and I see those signs and it's, you know, in my field, they're so close to my eyes. They like talking to me. Okay, here I am. And I ask patient, oh, how do you sleep? Yeah, I've been told I snore, but I don't snore every day. How this this patient who sleep knows about every day or not every day? That means what the partner just doesn't want to get into the argumentative discussion. But no, the patient believe I don't snore every day, so it's not important. And then we start that conversation, and patient, you know, patient can react in two ways. Some people can be say yes. Yes. Yes. I understand it's important, but then they leave and they do exactly nothing because they don't want to hear it from the dentist. It's a little bit stigma towards my profession. What dentists have to focus on the teeth. Teeth are your thing and that's it. And the second, people can get defensive. You know, they can express what I'm here not for that. I'm not here for that discussion. I know what to do. And if my primary care mentioned, then it's gonna be the topic of the conversation. But I'll tell you the severe truth of that story because, you know, different from Nari, I have a continuity of care.

Right.

So I can prove myself being right in a very sad way. Uh, it actually happened last week. Uh, we have a patient and, uh, my team, my team is really strongly supporting me in the sleep apnea awareness. Uh, my hygienist spoke to the patient about this test because she saw all the signs and patient said he was that patient, just like I described. I don't have time for this conversation. I'm not going to do anything. And guess what? In the last 6 months, He got mini stroke, and now he started the conversation himself. He said, "Remember you mentioned to me about sleep study? What should I do now?" Because funny enough, this patient who had the mini stroke and was diagnosed with mini stroke and placed on medications for that did not have sleep study. Oh, he should be sent to Prasomni and had a sleep study done. But Yeah. No, the conversation about sleep was not in the, you know, in the agenda for the doctors. And it was very sad. And, you know, and just like I mentioned, I'm writing the book based on the true story in my practice. And unfortunately, I describe some, you know, real things. And one episode or one hero in my story did not make it. Another one had a cardiac arrest, but You know, with a lot of help, he was able to survive. So it's not, it's, it's a matter of life and death. And it's not the death gonna happen from sleep apnea. It's gonna happen from stroke or from heart attack, which sleep apnea is a, you know, that's the consequences of sleep apnea. But the messages, you know, it's not a common knowledge what the dentist or anesthesiologist is gonna talk about the topic.

Right.

And it's not a pleasant topic. And I'm sure from 10 patients you see, 2.5 of them do have sleep apnea. So for us, it's very often.

Yeah. There's a lack of support, I think, you know, and access to resources. That's why, you know, I think that, you know, what Maria and I are trying to do as far as, you know, providing that as a service to, you know, send the home sleep test to people's homes. So that's what we do. We'll definitely, we'll send the home sleep test out to the homes. They don't have to go to a hospital. They don't have to go to another sleep center. They can do it right in the comfort of their own home. Once we identify if there's a sleep issue, we'll definitely send them to Maria or our group of networks and they can provide that dental care that they have to get and everything that Maria does on her side. And then that way we can offer comprehensive services and actually get people to start recognizing that there you have options and treatment options available.

And Dr. Sokolina, this is, you are doing this oral therapy now to eradicate or manage this thing. How is it different from the CPAP route? Because everybody will ask who's already using it. This is more for people who are aware and who are already doing it. Talk to us about that a little bit.

You know, it's a wonderful question. Thank you very much. Oral appliance therapy is a therapy with such a small appliance like this. That's what we do. And they look like clear aligners. But what oral appliance does, it moves the jaw forward and opens the airway. It's in that movement, you know, it's actually mechanical movement of opening the airway, but in the same time, it's also tone the muscles because we stretch the muscles. CPAP machine, it's a great therapy as well, but it works very differently because it pushes the air to keep the airway open. When people do oral appliance therapy, they breathe just like they usually breathe. With the CPAP, you have to— you have a learning curve. You have to breathe against the current of air. And for a lot of people, it's claustrophobic, and/or they have to It takes time for them to adjust to this new reality. But I always, you know, there are studies which show what combination between CPAP and oral appliance, that's actually the best therapy to manage the high blood pressure.

And you showed this device just now, just so for our listeners who are not watching the video, does it go in the mouth and you place it in the mouth for a few days or a few hours? How does this work exactly?

This appliance is to manage sleep apnea. It's not to cure sleep apnea. This little small retainer, what goes over the teeth, top and bottom jaw, and it holds the jaw forward. And yes, you have to use it every night until you have sleep apnea. And, you know, believe in a combination therapy, and it can be combination not necessarily with the CPAP. It can be combination with nutrition counseling. It can be combination with medication, GLP-1, for example. It can be combination with myofunctional therapy. And that's the combination what we do. And another one I love very much, it's a combination between oral appliance and orthodontic therapy when we make jaw bigger, we try to move it forward, and at the same time we retrain the muscles, but they become toned, and people learn how to breathe through the nose and hold the tongue on the roof of the mouth. And this way they can sleep like that through the night without airway collapsing. Because I really believe what tongue is, you know, very important organ in that Scenario.

That makes sense. All right, thanks for clarifying. And Nyree, this is mostly like your insights to people like you who do not have access to a dentist like Dr. Sokolina, but you are now doing this treatment on your side, the REM sleep. What question is like, how do you manage that situation if you don't have access to a dentist like Dr. Sokolina? Is there certain things that you can still do, it can still work, or you are just like, you know what, we are able to do this procedure now, but we recommend now after this, I will tell the patient that you need to go some way to get your jaw alignment or check for at least where it is, what's the issue? Talk to us about that a little bit.

To answer your question, it's both. It's all of the above. Like I said, When we do our initial consultations, I first have to identify physically if you have, physically you pass our anesthesia guidelines as to your physical body type. I believe you do not suffer physically from obstructive sleep apnea because that's number one. We cannot and do not make it a habit of putting people who sleep, who are diagnosed with obstructive sleep apnea. Right. However, a lot of people have sleep apnea who are not, who have not been diagnosed with obstructive sleep apnea. So it is our job to help them identify. If we do not feel like you have quite met the recommendations that we need for you to have a prosomnia sleep session, we will 100% then send out the home sleep test and identify if this person has obstructive sleep apnea. We will then follow up with them with our sleep. We will get them identified as to what, how, or what they have or not, and then move forward with their course of care. If we feel like they're good candidates for an oral device, we 100% will send them to Dr. Maria or a local dentist in their area. We have a group, we work with a network of different dentists because we are huge advocates of oral sleep devices. That is our number one go-to. If we do have patients that do have obstructive sleep apnea and do have an oral device, they can bring that with them, no problems for a polysomnia sleep session. However, if we use the machine, you know, we have to do other type of sleep therapies for them.

And Dr. Sokolina, this is, you know, there is a good thing about social media that You can get your information, you have channels, you're doing a great job. Nyree does a great job with her podcast and her social media. But then also there is still too much noise. There is other things there. There are things like, yeah, everybody knows about the CPAP machine, people who are problem aware, but then there are people who are not aware, right? Social media is a great starting point for that. Like you had snoring, so maybe you have something or the partner noticed something, But then there are so many things. There is tapes now, there is dental side of things, and then there's a whole bunch of things. What is the advice from Dr. Sokolina to starting point? Where does it start? If you notice or a partner notices in their partner this at least bad sleep patterns or snoring and those things, what should they do as a first thing?

That's number one. I'm so thankful to social media because it's actually democratization of the knowledge. If before you only have, you know, I would say one way, you talk to your primary care physician, but in the way system works, primary care— I'm advocate for primary care physicians that they busy. They have so much on their shoulders. It's very hard to address every single issue of every single patient. So number one, patient have to be the advocate for their own health. And yes, if your partner notice, it's not a ground for joke. Don't dismiss it. Listen to that. Do your little research and then try to get an answer. Yes, primary care provider did not pay much attention. He dismissed. He said, you're not going to have apnea. And Uh, I'm gonna go back a little bit in the story. When I just start practicing, it was sleep apnea, it's only for overweight and obese men. What I learned, you know, like a biggest surprise in my practice, my practice is 90% very physically fit. Not overweight at, I mean, you know, 10% maybe overweight, but the rest of it, people are very well.

Mm-hmm.

And they do have sleep apnea. So very often primary care physicians look at the people who not overweight and say, you don't have to worry about that. It's just stress. You're drinking too much coffee. So go ahead, do the relaxation technique. But the person himself have to search for answers because for stroke and heart attack, nobody gonna say, oh, my physician dismissed me. That's why. you know, for cardiac arrest. You have to search for answers. You can ask your dentist. A lot of the— as a dentist in our state, we're not allowed to do the sleep study, but we have prosomnia we can refer to. We have, you know, a lot of physicians have access to home sleep study. It may be cardiologists, it may be different physicians, but you cannot— Leave the topic alone. That's your health. Also, I want to talk about big population of women who feel tired every day, but sleep study does not show AHI above five upper airway resistance syndrome. First of all, for people like that, there are different sleep study. It has to be lab sleep study with a cannula, and they might have. different diagnosis. But also that upper airway resistance syndrome, it's a disease just like sleep apnea and that needs treatment as well. So if you feel tired but your sleep type study doesn't show, talk to your dentist. They might find a solution for you in that case. Myofunctional therapy is also a great choice for that. So I think the caveat of my presentation, you have to be advocate for your health. You can find a lot of resources on the social media. You can talk to experts, ask them questions and get direct answer. And then keep looking for solutions because it's the most precious thing we ever had, our health.

If you don't mind, I'd like to also chime in a little bit about what Maria was, especially with women. Identifying sleep apnea among women. And I think something else that's secondary to— once you identify and be your own advocate, and I do absolutely tell all of my patients, you are your number one best advocate, period. And especially in the day of social media and internet, there's so much information. But secondary to that is once you do identify and you are your own best advocate and you identify a potential solution, Compliance is secondary. It's nice to say, okay, great, you have sleep apnea, you're going to get your device, but you have to use it. I think, and that's another big reason why I'm a fan of oral sleep apnea devices because they're not so intrusive. Just yesterday, I don't mean to say it, but just yesterday, I had to put a patient to sleep for atrial ablation. Totally healthy 55-year-old beautiful woman, healthy, fit, cycles, does everything amazing, amazing mom, wife, all of that. Her only issue is that now she's on the operating room table for atrial ablation because she has— the only thing she has been diagnosed is obstructive sleep apnea. She's not overweight. She does not have an outside of the norm BMI. She just has been diagnosed with obstructive sleep apnea and she uses the nasal device, but it's not sexy. Those are her exact words. It's not. And I'm not saying sleep should necessarily be sexy, but it's a little intrusive. And she says, I use it. When I use it, I have great sleep. All of the things it's supposed to do. It's just if she had another option. Like an oral sleep device, that may be something she uses on the nights that she doesn't want to use the machine instead of—

I was going to say—

On the operating room table for atrial ablation.

Yeah, I was going to say the sleep might not be sexy, but it makes you sexy once you get it. Right. So, it's super important in that way, right? So, it is like putting the reps, you want to make sure you get that Right amount of sleep. And this is why all these things are so important, especially when it comes to sleep. And Dr. Sokolina, I know that there is this concept of one size does not fit all, right? And especially also in sleep dentistry specifically. Can you talk about that? What does that mean?

Oh, that's a customized approach to every patient. And that's how I look at that because most of my patients, they come to me from medical providers for oral appliance therapy. I usually start with oral appliance therapy, but I look at the oral appliance therapy as a bridge. That's my bridge between sleep apnea and the patient. So I want patient to feel better, to become alert. And with the oral appliance therapy, that's possible. But they feel better, they don't wake up that many times at night. And then I start a real conversation. I start the conversation after we do second sleep study with oral appliance to see if it's working for the patient, the patient in a good shape. I start talking about long-term. And what I mean by long-term, it can include orthodontic treatment, it can include expansion like Marpi. It can include orthognathic surgery, myofunctional therapy, just like I mentioned. So there are several different options. And always during my oral appliance therapy, I always talk about the nose. So it has to be the nasal breathing. So we're talking about nasal oral appliance therapy combination to start. And then we talk about more towards facial development because, you know, I'm a dentist. We have to remember, I only can talk about upper airway. You know, if it's collapsing much lower, then that's not my area of expertise. But in that area, most of the time we see the obstructive sleep apnea in that area. So we talk about future treatment, what patient, how patient visualize long-term stability. You know, for people who have extra weight, it's kind of become a little bit easier because with the medications, you know, we can move towards the goal. Uh, for people who already fit myofunctional therapy and orthodontic treatment and surgical treatment towards, uh, arch development, and that would be the solutions. So based on a patient anatomy, physiology, complaints, symptoms, we form the treatment plan what actually fit to this particular patient because not everybody gonna jump into the surgery. We have to look at this person, what this person need. And I always ask this question, if I have magic wand, how can I change your sleep? And people express. And then they express how far they ready to go to have that magical sleep.

And Nyree, I know you mentioned in the beginning of the episode how you two are going to collaborate, but what is like from feasibility standpoint, right? Like how much is this the system supports right now? Is it any, are there any integrated care plans that Nyree can send patients who have more of a need for oral therapy to you and then vice versa. Where exactly it stand right now, just so we know, or is it all going to be just everything very limited out of pocket and that's how it is, all it is? Talk to us about that. Yeah.

And I actually think that's the problem, right? Everything. So you go over here, you go over there, you talk to this person, and a lot of times people don't even know who they're supposed to talk to, right? So most people don't even realize they need a dentist to get the oral device. You need a dentist. I don't want a dentist. I can go to my primary care. Your primary care is going to refer you to a dentist, period. But you know that, you know, so that's what we strive to do at ProSomnium Sleep. You know, we want to be that comprehensive one-stop shop for all your sleep, health, and wellness services. You're not sure which direction to go. I will tell you. You know, we will definitely guide you to people like Dr. Maria so you can get your oral sleep device to help you sleep at night. And, you know, whatever that looks like, what— there's so many other sleep therapies available, but that's what we're here for. We want to be that comprehensive one-stop shop. Yes, we offer REM sleep therapy. However, we offer the home sleep therapy. We have a lot of sleep specialists. We know Dr. Maria, you know, so we have options. And we want to help people, just guide them in the right direction.

What's your take, Dr. Sokolina?

Oral appliance therapy, it's insurance-covered procedure. Dentists have to bill to medical insurance. It's true what a lot of dentists don't know how to do that, but there are a lot of medical billing agencies who can help dentists to provide that insurance covered therapy. Medicare covered this therapy and a lot of medical insurance covered this therapy. I understand why a lot of dentists want to be the fee-for-service because it's totally different modality to work with the medical insurance. That being said, I want patient to know about that. If they really like the dentist, you know, dentists have to have a training in dental sleep medicine. Any dentist can do oral appliance. has a device, but to do the therapy, you need training and experience in this area. But second part of that conundrum, patients have to know what if the dentist cannot bill the medical insurance, they can submit to the insurance themselves and get reimbursed. That's also like you want this specific specialist, he cannot work with the medical insurance, but you can do it. you can get reimbursed for that service because for a lot of insurances, it's covered procedure. Yes, it's true, you need certain documents and it would be sleep study from ProSomnia. It would be the referral from medical practitioner. And it might be some supportive documentation what medical providers can provide. But it's absolutely realistic, reimbursable Service. So for a lot of people who— I want to talk about this very special group of people, so, so close to my heart. They heard what they're snoring. They stop breathing for air, but they're so scared of using the CPAP. So they avoid this topic altogether and they tired every day. So I feel for them so much. And I— it's not only one way. And you can get oral appliance therapy and feel better. And you can have other treatment modalities and it's gonna make you feel better. It's not only CPAP machine if you are so scared. And CPAP machine has a lot of, you know, different masks, different comfort tips. I write about it in Forbes. So it's doable. But if you don't want to do it, it's like not sexy, like your patient on ablations, then— Then there are a lot of other way, not only one way like a lot of people imagine. That's why they have to listen to podcast Sleep Reimagine to learn about different technique.

Yeah. Thanks for sharing. I think even from, and that was an important information, right? Like, I don't think I'm bringing the patient perspective here. I never heard that. Never heard that it is insurance reimbursable or not. So, but it makes sense that it should be and it's a choice people have. So they should take it when it is. And sleep is, you know, sleep is the biggest investment in the healthcare system too, right? Because it leads to all the other things that will happen afterwards.

Absolutely.

Don't forget that.

And that's what we're here for. We're here to help people. You know, there's so many things people, I don't know why, just intimidated by the idea of sleep and getting proper sleep and rest. Maybe, you know, I know we've talked about Vivek, you know, our society and how they feel about it. But that's what we're here for, to help people understand, spread the word, educate people. Like Maria said, social media has been so great in spreading that information. Even people don't even know that oral sleep devices are optional, that even exist. They thought it was only machines. I hear that all the time. Oh, I don't want a machine. No, that's not your only option. So, I'm so glad we're getting this information out.

And Nyree, people who are listening probably, so what are 2, 3 things in your mind that will help them not only just improve sleep, but also breathing? Any suggestions on your side?

Well, for us, at the end of the day, like I said, you are your own best advocate, right? You have to just deal with the fact that you may have a sleep issue. If your sleep partner, your bed partner has told you or hit you or elbowed you in the middle of the night, you probably need to give a little bit more focus to that, right? And whatever that looks like. But again, at ProSomni Sleep Health and Wellness, that is what we're here for. No matter what your sleep disparity is, we are here to help people and guide people to a healthy sleep solution. So, you know, for the most part, just be your own best advocate when it comes to your sleep health and wellness.

Dr. Sokolina, from your side, any tips for the listeners?

Any tips on proper breathing at night? Tip number 1, you have to breathe through your nose. And the reason being, because when we breathe through our nose, we stimulate our parasympathetic nervous system. That's what we need to sleep. If we breathe with our mouth, we're constantly in a fight or flight response and we breathe through our chest, which makes us even more excited at night. We don't need that. So nasal breathing is a must. And I know most of my patients who are very well fit, but going through ablation, I have a whole bunch of people and I even wrote the article about them as well. They usually announce with a lot of pride, I'm a mouth breather. I'm a mouth breather because I have allergy. I'm a mouth breather because my nose is stuffed. So my second tip would be to open up your nose. I suggest different things for the patients. I love when they wash the nose, not just spray, but they wash the nose with Navage or NailMed. But a lot of people don't like that feeling of being drowned, so they can use sprays. And I recommend to open up the noseways, you know, these little nares. If they have— they talk about deviated septum. I'm a queen of deviated septum, but I recommend to use mute to open up the nostrils and maybe moisturize it with a special gel called air. So to keep the nose open during the night—that's my tip number two. And tip number three: to keep the mouth closed. It's true if you breathe through the mouth, your lip muscles—you know, actually our face have muscles, lip. other muscles and tongue muscle as well. So lip muscles become really weak if you're a mouth breather. I'm not talking about you have to bring your lips to the gym, which is true. You have to, you must, you must train them to stay closed. But if it's a very long project, you can use the mouth tape. And it's not necessarily you have to tape it like a hostage. You can tape around your lip and still keep the mouth Close. And another big tip number 4, if you want to breathe with your nose during the night, you have to start during the day and train yourself. Just like I mentioned, open up your nose with the different remedies and close your mouth. While you're driving, while you're, you know, watching, while you're on a computer, have that test. Put the water in the mouth and stay like that. Train your muscles to keep the mouth closed, and that's gonna make your good night's sleep better.

Maria, when we were at the conference, you made the statement: You eat with your mouth, but you breathe with your. I love that. Tell them what that was.

Yeah, that's a beautiful statement. What your nose is for breathing, and your mouth is for eating. We don't. you know, we don't sleep in the bathroom and we don't wash ourselves in the kitchen. We usually separate things like that. So when people talk about so proudly they breathe through the mouth, I said, but why do you have the nose? What is it for? Is it just to decorate the face or make certain statement with the nose? You know, God placed the nose there for reason. Nose is such a rich organ. Not only, you know, to filtrate the air, but, you know, with the smells and all of that. So, you know, give some respect to that part of your body.

Love it. Love it.

All right. This is great. Before we end today's wonderful conversation, one last question for both of you. So, there are so much innovation happening, right? Like I was mentioning, every day we see new stuff that is Oral appliances and there is wearable tracking, whatnot, right? So what are the kinds of tools or tech you separately, individually, personally excited about in, especially in what's impacting the sleep? Nyree, you go first and then Dr. Sokolina.

Well, naturally we speak a lot about the tech and that the possibilities for REM sleep therapy and persomniac sleep therapy Moving into a more very, very personalized approach with the utilization of the wearable devices. I'm super excited about that. However, for people who cannot get prosomnia sleep therapy because of whatever reason, I am super excited about the oral sleep devices. I'm excited about making that more of an option to the general public because they're just so much more easily available as well. It's nothing to ship a couple of devices and have them at our clinic. It has to be personalized, but it definitely provides a temporary approach just for people to get that initial rest. If you're not getting regular sleep at night because you don't know how to sleep properly with your mouth closed, you're definitely not getting into REM sleep.

Yeah.

So we can't negate the fact that the physiological aspects of proper rest and a resting structure and proper physical resting techniques to get you that REM sleep that you also need.

Any wearable you are excited about other than, you know, anything people can use to—

Well, in the near future, ProSomnia Sleep is looking to bring wearable EEG devices to the market. So, you know, that's what we're looking for in the near future.

Actually appreciate Nouri mentioning about oral appliance. I'm so thankful. I think it's going to help a lot of people to get their REM sleep and breathe through the nose. But what I'm excited about, wearables. I would say 50% of my patients wake up in the morning and they look at the Apple device Or whatever device they use, and they check for REM sleep. So people really understand what they need the REM sleep properly function with the memory, with the alertness, with the you know cognitive abilities. So people are aware about REM. They don't talk so much about slow wave sleep, which I think prasognos also make them aware. So.

Yeah.

That's another, you know, like next level of education. But going back to my favorite things, technology, I like when people use wearables and people become aware about sleep. You know, Oura Ring. Another ring what I like, it's not as high-end as Oura, but it's called SleepOn Ring and it shows AHI. So if people want to check how therapy working for them, they can buy SleepOn Ring can see the level of AHI they're getting. Uh, regarding the devices, I'm very big into wearables, and I have now on my desk AYO glasses, glasses what, uh, help with the circadian rhythm. I think that's the great device, and it put me in such a great mood when I wear it, and I think it looks so cool. And then I wear another glasses the night when I don't want the blue light. You know, it's not so technological device, but almost like I follow my ancestors' pathway. But regarding technology, I really like Intake. That's a magnetic nasal strip what open up the nostrils. I think that's the great technological device. But a lot of patients actually asking me, How can I get more REM? And I think that fact what portable EEG device will give answers to people. They can even do the observations if they can do this certain activity, REM increasing or not increasing. You know, like that's a very valuable technological advancement. So those are another thing what I want to mention for people who want to train the airway. It's not so much technology, but it's called relaxation. inhalator. That's to make airway more taut. You breathe against the resistance. I think that's also a really valuable device. But I usually, whatever I like, I put on my Instagram page under the, you know, Linktree. Uh, we have, let's call it, little store or little display of the product I support. Uh, Dr. Maria Sokolina. And then you can see what technology device I really like.

All right, fantastic. This has been great conversation. And before we conclude today's show, Dr. Sokolina, where can people reach out to you if they— what's the easiest way to get to you? Where?

I think social media is such a perfect opportunity. And first of all, as a gift to your audience, I have assessments, myofunctional therapy and sleep and TMJ assessment. And this is the website where people can write me directly, but through Instagram, Dr. Maria Sokolina. Or join my Facebook group, Sleep Apnea Briefing Snoring Help, and I definitely answer all the questions this way. And I would be very honored if you, your listeners join and at least, you know, know about their victory, their better sleep or challenges. I would be very excited to help.

Wonderful. We'll put all these links to wherever you get your show from and Last word, any last word, Nyree, before we close today's show?

I just wanna thank Dr. Maria for joining us today. It was such a great honor for you to be here and talk to you and meet you at the conference. Vivek, thank you for taking the time to accommodate us in this great meeting. I hope we really shared some valuable information for people, get them to understand that there's a lot of options for their sleep apnea issues. But again, by all means, please visit ProSomni Sleep. And we will be more than happy to guide you to the proper resources for sleep health and wellness.

And of course, we'll keep you updated on this future collaboration as it's going to progress hopefully from here even more to the next level. That's the goal. Once again, thank you, both of you. Appreciate your time. This has been incredible conversation just for— I feel like it's such a refreshing topic in a way for everyone. And I don't think there are many resources that exist anyway where we can bring 2 people from these 2 different fields and then talk about it. So thanks again. And we will be back with our next episode. Thank you.

Thank you. Stay rested, my friends.

Thank you very much. And thank you, Nyree and Vivek.