What If Your Fatigue Was Misdiagnosed with Dr. Andrew Cohen

Welcome to Integrative Medicine with Dr. Leland Stillman, the podcast where we explore the best of East and West, old and new, conventional and unconventional, in search of answers to medicine's toughest cases and most difficult problems. This podcast is for informational purposes only. Diagnostics and therapeutics discussed on this podcast may or may not be right for you, so talk to a qualified practitioner before taking action based on what you learn here. If you'd like to become a patient at at my practice, go to stillmanmd.com to schedule a complimentary discovery call. Thank you for listening and welcome to today's episode. Hello everyone. Dr. Stillman back with another episode of Stories of Hope, Stories of Healing. Today I am joined by Dr. Andrew Cohen, who's a dentist and an expert in sleep medicine, and he's here to share his story of overcoming fatigue and metabolic dysfunction. And it's quite a story. We've talked briefly about it, but I haven't heard the whole thing, so I'm actually really excited to get all the details. Dr. Cohen, thank you for joining me.

Thank you, pleasure to be here.

So I always start by asking people who they are and where they're from.

Yeah, so, uh, Andrew Cohen. I am from the suburbs of Philadelphia, born and raised. Didn't make it very far in life. I am 1 mile from my childhood home, and, uh, I started out in 1998. I became a restorative dentist, and through my own personal struggles, I found that I had a sleep disorder. So eventually I became board certified in dental sleep medicine in the hope of trying to fix myself and also fix patients. And, uh, now I would say my practice is probably 60% dentistry, 40% sleep and airway disorders.

You mentioned to me before we started recording that the first manifestation of this, all this was fatigue. Yeah, when did that start and how severe was that?

So I was probably the most frustrating roommate you ever could have. I was the person who would hit snooze 9, 10, 11 times.

Are we talking about college?

Childhood, high school, college.

I started in childhood.

Oh yeah, yeah, but no one was looking, no one saw. I mean I had no medical issues. I just was tired. And, you know, it just kept getting worse and worse through life. It was so bad. Have you ever seen a Cirque du Soleil show? Yeah. I fell asleep in O in Vegas. Like, I don't know how that is even possible with all that visual stimulation, but let alone the music, which is very— let alone the music. Felt weird out. And I could not keep— I mean, couldn't keep my eyes open. I used to say, uh, when I was working on patients, if I could just close my eyes in between patients for 5 minutes, I would feel better. And I never did. I was always tired, always tired.

What happened next?

So, um, my best friend who I went to dental school with in 2000 and 7, was diagnosed with multiple myeloma. I think—

how old were they at the time?

Uh, we were 33 at the time.

Wow, that's very early for that.

Yep, yep.

Did they ever find a cause?

Well, 17 years later, I know the cause, but no, they did not.

Yeah.

So he was the one who— I was about a year later, I was about to— I was burnt out. I was, I was ready to quit dentistry. I never felt like I had. It always felt like I was trying to convince patients of what to do. And instead of them understanding what was, what I was trying to do.

What is that? What do you mean by that?

So a patient would come in to my office and I would say, you know, you have a broken tooth or your tooth is breaking down. You need a crown. And they may say, well, it doesn't hurt. And I'm like, no, I mean, I know, but you know, you see the dark one in the back? Oh, I don't care. It's in the back. It was frustrating. I'd be like, okay, well, you know, we'll watch it. 'cause you know what, you didn't want to like argue. Um, like it wasn't, it wasn't even my problem. I'm just trying to help. Um, and I get it, you know, I understand how people feel about the dentist. So my best friend called me and he is like, Andy, I, I want you to come with me to Arizona in this place called Spear Education, which is an advanced education center. And, uh, I went there and 15 minutes of sitting there and hearing this icon, his name was Frank Spear, said, I'm home. He gave me a voice. He gave me like an understanding what I was doing wrong and how I needed to talk to patients. And literally on the flight home from Arizona, I revamped my entire practice. And the key to that was a camera.

What in a nutshell did he say that resonated so strongly with you?

Literally by taking a picture and showing patients and giving them, helping them understand the consequences of not treating something. And what that ended up doing was taking all the pressure off of me being the bearer of bad news and say, here's your situation, here's how we can handle it. The choice is yours. And it's from that moment I now was meeting patients at where they were. I became an educator of what I saw. And that became the foundation of how I practiced from that point forward.

That's so interesting because I, I knew that that resonates very strongly with me. I think the toughest thing going into practice was just what you said, you know where this is gonna end, particularly when you have 5, 10, 15 minutes and you're trying to manage, you know, we gotta basically manage multiple expectations here. I always looked at it as, and basically what I realized is human psychology is people are looking for an explanation. What is going on with me? Why am I sick? And what does it mean? They're looking for a prognosis. Am I gonna die? Am I gonna lose a tooth? Am I gonna be able to chew my food? And then they're looking for some kind of like next step solution. And what I realized is the insurance industry basically compressed the visit as much as possible to the point where doctors were overprescribing, overimaging, overtesting, overtreating, because it's much harder to like explore, well, why might you have reflux or why might you have weight gain? That takes a lot of time. You know, our history taking is very meticulous. It's very detailed because if you miss details, people will not get results. Small hinges swing big doors. And what I realized is they'd compress the visit as much as possible. And it was driving practitioners nuts who had any conscience. And those who were sort of, I don't know, out to lunch, ready to just kind of like be— what is the phrase that chiropractors use? Crack 'em and stack 'em or churn and burn. People would say in the hospital, you just gotta churn and burn through your patients because you had to. It was like, if you didn't— if you had 30 patients to see in a day, you had to figure out a plan for everyone. You had to see everyone, you had to talk to everyone, you had to talk to the family, you had to talk to the consultants. If you didn't move fast, you were underwater. And what I think is so awful about that is that it's resulted from the sort of like, well, we've got to shop for the best price, which I totally respect. We all want a deal, man. It turned into such a monstrosity of people letting dental decay get so far that now they can't chew their food, and instead of needing a crown or whatever, they need complete dental reconstructive surgery. It's a heart attack or a spinal surgery instead of a small change to their diet and their lifestyle. And it's the whole problem with the medical system. And so I totally get it, and I love that, you know, it resonated with you. And it's— I think it's often when you find those people who are speaking your language, it is like finding your tribe. You're like, oh, I've been looking for this. I've been like a man in the desert. Didn't even know what I wanted was water, and now I found it.

Yep. And that's really how I practice. We don't do anything in my practice without understanding the why first. Very Simon Sinek, starts with why. And, you know, it really was liberating. It was freeing. And as freeing and awesome as it was, I was still exhausted. Yes, I was still tired.

You mentioned that you, you came home and you got a camera. What did you do with the camera?

I started taking pictures of patients.

Oh, and you show them before and afters?

Yeah, no, not even before and afters. I would take photos of their current health, current situation, and then I would bring them back and I would do what's called a tour of the mouth. This is what I see, here are your problems that need addressing now, your potential problems, your aesthetic problems. And now once they are educated, they can make a proper decision instead of being told what to do. We can have co-diagnosis and achieve what's best for them at this point in their life. And it also created a baseline that I could compare change moving forward. Oh, you know, a picture's worth a thousand words. And now when I could show a patient, this tooth is broken, it's just not broken off. If you decide to watch it, here's what potentially can happen. It could break off and you need a crown, or it can break into the nerve and you need a root canal, or it can split the tooth down the middle and you lose the tooth, and now you're talking about a missing tooth or getting an implant. So what would you like me to do? How would you like me to help you? You have two schools of thought, reactive we're proactive. And the funny thing is that mentality that I started in 2009, 2010 is exactly how I feel healthcare should be, where we take a more proactive, a more preventive approach instead of a reactive approach in which healthcare is throwing medication or surgical procedure when oftentimes that inflammatory process is already so far downstream, it's hard to bring about resolution.

I couldn't agree more. Yeah, we, we have the same, very similar approach in the practice, even though you and I have never really talked about this. The word that actually comes to mind a lot for me is stewardship. The other term that comes to mind is shared decision-making, which is that I really, I think patients sometimes want me to be more prescriptive than I am, but I'm also very honest about the limits of what I know. And there's a lot of uncertainty. In what we do. I, there, I'm tempted to say there might be more in the mouth and dentistry, but I don't, I don't know. And the reality is that patients need someone they can come to that they trust, who's going to really have a conversation with them about, because the thing that we find is that it can take so much bandwidth to do all these changes to diet and lifestyle that we'll talk about what you did, that for some people they just say, look, I'm trying to manage something else right now and I'd really like to postpone this. We just want them to be clear on what the potential cost of that is.

Yep. 100%.

Because it can be very high. And a lot of the time I think that people are sort of deluded into thinking, well, I'll get around to that next quarter or next year. And you know, that turns into next decade and then it's the heart attack, the stroke, the cancer, the full-blown autoimmune diagnosis, whatever it is. And it's so much easier to win early and stay. And our philosophy in our practice is get patients healthy and keep them there. And that's why we actually have ongoing monitoring every quarter at least, and every month. In the one of our tiers of service, because I want to know where is, where are the patients in the practice? It's almost like I'm looking at it as like the vital signs of the practice. If everyone says I'm doing great, awesome. Or some people are sort of drifting down in their, their wellness. And we do this with labs and so that it's quantifiable. And that also gives me something to say, well, you know, you might feel bad, but hey, your labs look good. Or hey, you might feel good and think you're in good shape, but your labs are terrible. We need to fix these. So You were tired, you were young, you were still feeling miserable despite having awoken to this new opportunity and paradigm. What happened next?

So we were going out to Arizona together and, you know, we would share a room. We were trying to spend as much time as we could and he was going through some really rough phasing of his treatment. He was having a really hard time sleeping and my snoring had really started to become a problem. And, uh, And I didn't want to keep them up. So yeah, I ended up making myself a snoring appliance. And I woke up the next day and I was like, oh my God, like someone pulled like the mask away or the fog. Like I felt rested. Like I'm like, wow, this is what it's like to sleep. You know, I believe in fate. And my first patient of the day happened to be a board-certified sleep physician, pulmonologist. And I said, I said, Sam, I said, you'll never guess what happened. I made this snoring appliance and I feel like amazing. And he, he chuckled and he had been trying to get me into doing dental sleep medicine a few years earlier. Mm-hmm. And, and he said, you know, you might have sleep apnea. Let's, let's test you. So I did a sleep study and I had mild sleep apnea and I figured, okay, you know, dentistry can make appliances and I made myself an appliance and for 5 years it was great. Can we, but in that 5-year period, I want to pause for a minute.

Yeah, I like to quantify things, so as well as I possibly can. If 10 is so sleepy that you can barely function, like you could fall asleep maybe standing up at 11, and 0 is I have the energy of a 5-year-old, where were you on a daily basis before any appliances?

I used to plan my day around when I could take my nap.

This is an 8. 7 to at least a 5?

I mean, I was thinking 7, 8. Okay, you know, I never felt good at guessing this.

I asked this question a lot.

Yeah.

Okay, and so then where did it— where did it go after you added the appliance?

Well, it didn't drop that much.

So a 20%, 30% improvement?

Maybe it dropped to a 5, but still noticeably tired.

But you were still really amazed?

I was. And my AHI went from 7 to 0 with an appliance.

AHI. Yeah, so for People at home not hip with the lingo, that's apnea hypopnea index, which is the severity score we use for sleep apnea. So that's a good shift that he had, which correlates with his improvement in symptoms. Okay, but and then what?

So then I was great in the sense of I wasn't snoring.

Would you respond to coffee? He said as he had his third cup of the day.

No, I, I only have— I have, I have my two. I stop at 12. No, not really. I mean, I had to drink coffee, but it never brought me to normal.

Interesting. Did you ever try drugs? Never. Really? Did anyone ever offer you drugs? No. I mean, I don't know why I'm laughing. I guess I'm laughing because it's so easy to make people with fatigue feel better with drugs.

I didn't know that. I thought my fatigue— because I'm not educated at this point, I just know I can make— I'm a dentist, I can make an appliance, uh-huh, and I can stop snoring. And fix sleep apnea on a certain level. Mm-hmm. But I never correlated my fatigue. I thought it was because I worked crazy hours, had young kids.

What were crazy hours?

I used to work 7 to 5 straight, no lunch, double, double.

Okay, so 10 hours a day, 5 days a week?

Yeah.

Catching up on weekends?

Uh, no, I would golf.

You would golf. Well, at least you did that. So you had a 50-hour work week and then you had kids and a house to manage. The thing is, you know, it's like, I just— because you come from a medical background, right? I mean, do you want to share about how medically qualified your family is? I don't know if you care to, and I don't mean to put you on the spot.

That's okay. Uh, my father was a periodontist who went out on dental disability and then became a child psychologist. My sister—

what an odd career move.

I know, right?

Huh. That's a story.

And, you know, my sister is the dean of the medical school at Penn, and my mother has been an educator, uh, on a collegiate level.

So, so my question to you is this: why did anyone think that 5 out of 10 fatigue in a young professional who's golfing on the weekends was normal?

I think it was always the thought of there was an anxiety-depression component.

Interesting, huh? I feel like the medical community, particularly with the psychiatrists, has really medicalized— and when I say medicalized, what I mean is that it's like this, well, it's anxiety, it's depression, it's this, it's that. But the reality is when you really dig beneath the surface of all disorders, there's a lot of common factors. There's chronic inflammation, there's what we call repair deficit, there's nutritional imbalances, you know, there's all these things. That's why, you know, the average patient in the practice reports that their energy is 70% improved. Is 10— if 10 is where they want to be and 0 is where they start with us, it's 70% improved in the course of program and membership. And it's really not that complicated. A lot of it is just what I now look at as very bread and butter medicine, which is— but, you know, anyway, I feel like I keep getting sidetracked and I don't want to—

it's okay, you know. And that's, that's why I'm so passionate about doing what, what I do, because you can set them up to live the perfect daytime life. Mm-hmm. But if they don't get the proper level of sleep and the proper quality of sleep, mm-hmm, they're in a vicious cycle because their body never can repair and recover.

Absolutely.

Which is why sleep is such a key component to this equation. And that's how you and I ultimately met. Right. You know, I was coming from, you know, from the sleep side as I, well, let me go into my story and tell you how I got here. And then how we met. So, so over the next 5 years, I wasn't really snoring. I still feel very tired. Anxiety, depression was always something I fought chronically, and, you know, was pretty significant in my life. And then, you know, I started gaining more weight, but that was normal. All my blood work looked great. I was told it was normal.

You just need to diet and exercise. Didn't you know that?

What's that?

You just need to diet and exercise, right?

Yeah. Okay. Well, I was, you know, but I did have, I did have my 3 Ps, you know, pizza, pasta, pretzels that I love. But, you know, I was, I could do any diet. I would lose 10 to 15 pounds and then 6 months later I would yo-yo back up because I never addressed the true cause. So then I got, you know, my, my blood pressure started to creep up. Okay. That was considered normal because it's in my family history. So they put me on a blood pressure medication. Then a few years later it was a second. And my snoring started to come back. Mm-hmm. So I tried additional treatment, which was I did a soft tissue non-ablative laser treatment that fixed my snoring for a little bit.

How long?

I did 5 sessions. Mm-hmm. And it fixed my snoring for like a year. Okay. And then my blood pressure went up higher and now they put me on a second medication. And then finally now 10 years later, my HI, which was was, you know, up to 13, even with an appliance, with nasal dilators and mouth tape, with laser treatment. And my snoring was coming back. They wanted to put me on a third medication, and I had lost my bite from the appliance. If your jaw is held forward, at some point your brain, your body will say, I can breathe better more forward, and you can't get your back teeth to touch. It's called a—

no kidding—

posterior open bite. Yeah, it happens. I mean, it's a, it's a, it's an issue. For sure. I mean, it's not a bad problem. The only one who's, who's going to be upset by it is a dentist because not all your teeth are hitting. But I tell my patients, I'm like, I'd much rather have you alive with a bad bite than dead with a good bite.

Yeah, absolutely. Yeah.

So then in 2023, following what I had been taught for the last 14 years— anatomy is the problem, fix the anatomy, fix the flow— and I did something that's called Marpie, which is I expanded my top jaw and broke my top jaw. So if you can imagine my hands are a towel.

You were how old at this point?

53.

Okay.

52, 52, 52 or 53. And by widening your jaws, you're lifting the towel to ultimately try to lift the soft palate, make more room for my tongue.

So to be clear, they— because my understanding of this procedure is they literally cut your upper jaw off of your skull. No, and they—

that's a little—

don't do that.

No. So I— when you do what's called MAP, uh, Marpi, you are putting mini implants on the roof of your mouth and you turn and you can open the mid-palatal suture. It is not—

yeah, okay, I didn't know that.

So it's technically non-surgical because there's no cutting, though some people do. They do score the bone to make it easier to open.

That doesn't sound—

I did not at all. Uh, I opened in 6 days, and oh my God, then I turned and I had a space between my 2 front teeth of about 10 millimeters, which is like, whoa, size of my little finger. So I kind of looked like a huge amount of real estate. Oh yeah, I looked like Alfred E. Newman. No, it was, uh, it was a monster space. And, uh, as soon as I opened, I could breathe. I mean, amazing.

Like, through your nose or your mouth?

Because your maxilla and your nasal cavity are connected.

Yeah.

So when I opened that, I was able to bypass my deviated septum. So when you get Morpi, you have to then, once you get to the desired opening, you have to hold it for 5 months to let the bone regenerate into that spot. And while this is all happening, I feel— I'm still snoring, but I feel amazing. I'm like, where's your energy? I have to be healthier.

Where's your energy, your blood pressure, all that?

Yeah. So if I was feeling at the time when I did Marpi, my fatigue was back to a 7. And after I did Marpi, I was probably down to a 5 again. Mm-hmm. But I could breathe. I was never congested anymore. And I thought because I could breathe through my nose that I was gonna be healthier. Now I was still bi-jaw deficient, meaning my top and bottom jaws were set back. So they wanted to do, well, Hold on, let me get half a second. So then I took a course in California on doing a tongue tie release. And while I took that course, they did sleep studies on us and my sleep apnea went from mild to severe. So I improved my anatomy and I got significantly worse. So for me to understand, my HI went from 13 to 37 and I spent over an hour below 90%. Desaturation. So like, I had to do something. And they told me, okay, well, now you need to do double jaw surgery. That is where they would have cut both my jaws off of my skull and moved everything forward, widening my airway.

Wow. For reference, for people who don't understand what a 90% desaturation means, it would take multiple minutes, like 3, 4, 5 minutes if I held my breath for me to desat to 90%. And if you've never tried to hold your breath that long, let me give you a frame of reference. The guy who owns the world record for static breath hold is, guy, when guy last I checked him, Erwin Le Corre, and I think he set the record at like 7 minutes, 7 minutes and change. Maybe I'm doing, not doing him justice. Don't quote me on that. But the point is for you to desat to 90% is really extreme. And if you were at a 90% saturation and you were awake, you'd probably be feeling like you would be feeling like you were suffocating. So the fact that you would do that during sleep explains a lot. So then what happened?

Uh, well, that was, that was a real gut punch because I had just gone through 6 months of expansion with a monster space in between my teeth. And I called an oral surgeon from class who I'm very friendly with. He's the top oral surgeon in the country in Santa Barbara. And I said, Mike, I'm, I'm in big trouble. And he scheduled me for maxillomandibular advancement for December 11th, 2024.

The theory being that you hadn't yet had enough manipulation of your jaw and mouth?

Correct. But now I'm sitting in class and I'm like, I don't— this doesn't make any sense to me. Yeah, I can understand that I didn't get better, but why did I get worse?

Uh-huh.

And I figured, well, you know what, let me try to improve. I had a friend, his name is Doug Sanquest, he's a dentist in Las Vegas who's been telling me about light water magnetism for like 6 months. I thought he was crazy. I ignored everything that he said, and I called him, and he says, Andy, I don't think you should do surgery. I think you may get actually a lot worse if you do it. And I'm like, how is this possible?

Interesting.

Everyone's telling me I'm gonna get better, but yes, nobody could tell me that surgery would fix me. Maxillomandibular advancement is a pretty brutal surgery, and getting it done at 54, there's a chance I would never feel my face again. Oh, you know, because they cut the nerves, you know, you're numb. And I said, well, there's gotta— let me try something else. So I, I started trying to improve my metabolic health, and I entered the paradigm with getting more sunlight, but not knowing about the different signals, and getting a constant glucose monitor. So when I got a constant glucose monitor, within 2 weeks I stopped snoring. Oh no, it was 4 weeks, excuse me, 4 weeks I stopped snoring. 2 months later, my severe apnea with being at— because it was the summer, so I was outside a lot. Like, a lot.

Spell it out. What does that mean?

I was getting outside for sunrise. Okay. I was getting— and then I would spend 2 hours a day in midday sun.

How are you able to do that while practicing?

Well, after COVID, I changed my hours to be more present with my children, so I work until I start early, and now I work until 1:15, and then I come home, and I have a second job at home, which I can do on a laptop, which I would bring outside with me.

Nice.

So I could be outside.

Nice. Great. Okay.

Now, this is only part of the story, which I'll explain to you in a second. So I was feeling better. I was getting more energy. I was posting, like, oh my God, look at this. I was using SnoreLab, and I was watching when my sugars went up. I would snore, and as soon as my sugar went back into range, I would stop snoring. And it started making me understand there's an inflammatory component about this. And I would post it in my dental circles, and they would all tell me, you're misleading everyone, telling them that this is about sugars, and like, you shouldn't do this. This is a gaslighting. Yeah, yeah, yeah. I took some bullets. So then about—

well, the first guy through the door always gets shot up, so I got a lot of scars.

So now 4 months later, it's, it's October. And what happens in October? Daylight savings. And I lost the light. And all of a sudden, my snoring, which was under 10 every night based on SnoreLab, started jumping up into the 20s and the 30s.

Wow.

And I'm talking to my friend and I said, something's going on. He goes, well, Andy, I appreciate you thinking that getting UVB and Fixing your sugars, that's not really where the problem is. You have to start with getting sunrise, anchoring your circadian rhythm, getting UVA, blocking blue light. And I went all in on light and I didn't care what temperature it was. I was outside. I had blood work done. My triglycerides were terrible.

How terrible?

And, uh, I, well, for me they were terrible. I was like 172.

That's out around that neighborhood.

And then, I told my physician what I was gonna do cuz he was asking me, why do I want all these tests that I was asking for? I wanted vitamin D. I wanted reverse T3.

Yeah.

Leptin sensitivity. And he goes, well, what would you do with this? Literally, that's what he said to me. And I said, well, I, if it comes back bad, I would do more sunlight and more blocking blue. And he laughed. Like, laughed at me. He goes, that's ridiculous. And I said, okay. I said, well, it doesn't matter. I just, let's get the test. And I didn't, yeah, I knew enough just not to go there at this point. Yeah. And then 3 months later, my triglycerides were under 100. Um, I stopped wearing my CGM because I had learned enough about what I needed to do to keep my sugars in range.

And let me talk, let's talk about that because I got patients on CGMs. Yeah, not a lot. I don't use them that often, but I'm so curious. What did you notice changing your CGM, both food and dietary choices and the light?

Yeah, so, um, my goal was to stay in range. Most of the companies want you to stay in range, let's say between 70, 120, 130, depending on where they put you, 85% of the time.

My goal was over 90, and I was able to do that over 90% of the time.

Over 90% of the time. Okay, so as the weight was literally just peeling off of me and I was not changing How many pounds per week were you losing? I lost 40 pounds in 6 months.

But did you keep it off?

I put 10 back on over this winter. So a year and a half, I kept 40 pounds off.

You live in Pennsylvania. That was your first mistake.

Yeah, I said I'm trying to figure that part out. Okay. I know I need to get near the ocean. So, um, I didn't stop my portion at all. It wasn't about portion for me. It was just sometimes the order at which I ate, or if I ate something that had more sugar, I would wait 30 minutes and I would just take a walk around the block.

Order in which you ate, do you mean like which food you ate on the plate?

Yeah, the order in which I ate. Like, so I would start with salad, then I would eat my protein, and then maybe the last thing I would eat would be a little— I would never eat bread, like just plain bread, you know, to start my meal. And I would never start with that. Even if I would sneak a little bread, it would be at the end of the meal when I already had a salad, vegetables, and protein.

The free bread at the restaurant is a metabolic Trojan horse.

Oh yeah, for sure. And then very quickly I started to notice I, I didn't— my cravings for sugar went down.

Did you change your diet during this period of time?

I just modified my sugar. I did not say no to anything.

Get out of here.

Yeah, nothing.

If I was an example— be honest, give us an example of something you didn't say no to.

I can't say no to soft pretzels. I can't say no to pizza. And it's really hard for me to say no to pasta. But those two, I can't walk by. I get it. So, but, but I learned what it did to me. And when you see your sugar skyrocket, and for me, the sugar going up was disease. It was inflammation.

Yes.

And it wasn't like I was going up to 220, 230. I would go up to like 160, 170, and I would stay there for like 6 hours before I started this.

Yeah.

Well, then what I noticed is once I got because I was getting the morning sun and UVA rise, I was fixing my leptin sensitivity. I could eat sugar and I could process it. So I would spike for 30 minutes and then it would go back down. It would be normal.

Yeah.

It wasn't these longstanding spikes.

Have you ever heard Jim Laird's story about, uh, his pancake breakfast experiment?

No.

It's so funny. So Jim's a strength and conditioning coach, good friend. People who listen to me, follow my work, know Jim well, and Jim had a CGM and he ate a pancake breakfast inside of his artificially lit, you know, indoor gym, right? And he watched his CGM and it was a disaster, right? I mean, like way out of range. Then he strips down to his underwear another day and goes outside.

I heard this.

Yeah, has the pancake breakfast and CGM is like rock solid.

Yeah.

And it's just, that's why the gaslighting is so hard to deal with. It's like, guys, I literally have a device that is designed to be reliable enough for us to make medical decisions on, and I can show you the data and I can tell you what I did, and you're telling me it doesn't work? What planet are you on?

Well, anyway, so I was also using that in work, and I would notice that when I got stressed out— a dental office is a blue light toxic terrible— and I mean, the light, it's also a terribly stressful job. That is true.

A friend of mine was like, can you imagine if every single person you approached every single day was afraid that you were going to hurt them in one of the most sensitive areas of their body?

Right?

Like, you know, that would definitely make one stressed.

Yeah. But I would notice that if I had 5 or 10 minutes between a patient, I would walk around the block and my, my CGM would drop 10 to 15 points within minutes. Just being outside. Wow. So, you know, by keeping my sugars in line and going all in, you know, anytime I was on a computer, you know, blue light blockers. Now, the reason why I'm not wearing them now is my window's open right behind me.

Yeah. We have a button.

Nighttime, sun goes down, wear my blue blockers, see the sunrise. You know, I don't even know where I am in the story, but ultimately, 2 years later, I'm on no blood pressure medications. I'm off all my reflux medications. I have no apnea. So I just tested about 3 or 4 weeks ago and my HI was 2.9 and I don't wear anything. No nasal dilators, no mouth appliance. My fatigue level is down to a 1. I'm never tired. I don't need to nap. Now if I want to nap, it's a choice. Okay.

So I love asking people this question. What gets the credit? And you have to divvy it up and you can divvy it up however you like. It's 20% the sun, it's 20% the blue blockers, it's 50% not eating this, not eating that, doing this, doing that. Divvy the credit up to take for what you took you from 7 out of 10 fatigue to 1 out of 10 fatigue, 40 pounds of weight loss, off your reflux meds, off your high blood pressure meds.

Okay. So I'm— I got to tell you what I believe in my heart. I think it's 90% sunlight, 9% blocking blue light, and 1% diet.

Wow. Okay. So then let's talk about that. We have lots of patients in the practice, and I feel like I pound the table about sunlight all the time, and maybe I haven't enough. But I think that there's two, two elements of this. The first element is that a lot of people are doing a job that, you know, can they be outside? You were able to modify your work schedule and create an opportunity to work from home outside. How many people can do that?

But like, I get that question every single day. Right? Because I get patients coming to me and they're like, well, I can just take, you know, a GLP-1, or I can't use CPAP. What are you gonna make? What are you gonna— and I tell them, I go, and they said, well, how am I supposed to get outside? Do you eat lunch? Yes. Just take your lunch outside and eat lunch outside. There's your 10 to 15 minutes. Do you drive during the day? Yes. Open your sunroof. Do you drive to work? Open your— you know, is it raining? Okay, open, crack your passenger side window. You know, there are workarounds. And when I work with patients, which I do, you know, I'm working with mostly dentists who are not in my practice. I work with a lot of dentists who have been struggling with their own sleep issue, and they've done all the anatomic things, and yeah, they're not— they're still tired, or they're still having sleep issues because no one's teaching them about this metabolic side. And so I'm working with, with docs all over the country I literally say, you know, like, this is what we have to do. Let's, let's figure out what you can do and see if that's enough. And if it's not enough, then you can figure out what else do I have to do?

Yeah.

So like, I learned quickly that if I missed light, I'll start snoring again, even now.

Absolutely.

Yeah. Okay. So in the winter, it's hard. And I was all set to buy a cold plunge. It's another whole story. And, and I, I do need to do that. Yeah. Because I, my anatomy is still not ideal. And if I become inflamed or if I don't have my energy system right, it doesn't take much for me to tip to the other. My wiggle room is so small. But I don't want surgery. That's like, I'm not doing surgery.

You've already been down that road.

Yeah.

Going back to that well, you expect it to have water this time?

Well, so again, it comes into, you talk about gaslighting, it comes into what we're teaching dentists and airway dentists when they say, oh, fixing the anatomy fixes the flow. Well, all the major studies that have ever been done on MMA surgery, they show an 86% success rate. Okay, well, that sounds good until you look at what success is. Success is a 50% drop in HI. That's under 20. So if you take someone that has an HI of 40 You do surgery on them, they go to 20, that's successful. What patient would have an HI in your practice that's moderate sleep apnea that you would consider successfully treated? No one.

It's an incomplete treatment. I also would question over what period of time.

Well, then that's the other issue, because there's relapse and there's documented relapse. The, the question is, if what happens when you are— and this is the question we need more time to figure out what happens when you expand someone or move their jaws. Does the tissue not grow into the area that you've just created space? Bi doesn't work that way. If there's inflammation, that soft tissue is going to fall into that area that you've just created, and it's just a matter of time before they get bad again.

There's so much to unpack here. I want to start with talking about procedures, because one thing that really has impressed me about human nature is that we're very apt— I'll never forget this conversation. So I had a conversation with this guy very early in my practice when seeing me was, it was like a $250 initial visit hour. He was dealing with severe knee pain. He'd done $5,000 of stem cells. And I was like, well, it's $250 to see me for an hour. I'd love to take your case. I'm sure I can help you lose weight. I know all this stuff, blue light, blue blockers, all the stuff you just told me helped you lose 40 pounds. I'm like, I can help this guy. And he's like, well, $250 an hour is a lot. And I'm like, you just told me you spent $5,000 on stem cells. In your brain, the $250 for an hour of my time is a lot, but the $5,000 for stem cells somehow made sense. I feel like I'm on the wrong side of this equation. But here's the thing that I found is that people are attracted to solutions where there's this clear before and end state, and it's predictable. They want a high likelihood of success. And, hey, come see me in my office for $250 an hour can turn into, you know, I'm a therapist and all I do is talk to the same 200 people every month, and, you know, that's my, that's my business. But you're not actually rehabilitating people. And I'm not saying that's wrong, but I also think that people are looking for— they, they're at once afraid of and they deeply desire transformational change. Like, nobody wants to spend $250 a month to have a perfect airway, to have a perfect night of sleep. They'll do it, but they would rather somebody says, "Hey, it's 5 grand for this procedure, and at the end of the procedure, you got an 80% success rate based on our literature," right? And I realized that a lot of people in integrative medicine were, to be blunt, kind of cashing in on this. And I, you know, I really don't begrudge them because the patients kind of demand it with their behavior. And I'm talking about this, and I'm speaking to you if you're listening to this, if you're a patient or your provider and you're thinking about how you get your medical care, You cannot let yourself fall into this trap because if you fall into the procedure trap, you're going to wind up like a lot of failed patients at my practice. Hey, Dr. Stillman, I flew to see you from this other state where you're not licensed. I've already seen the local functional medicine doctor. I saw my primary care doctor. I saw the expert at this hospital, that hospital. I've had all the scans. I've had all the imaging. I've had all the testing. I've tried all the drugs and I've tried all the surgeries. What have you got for me now? And every single time I face one of those cases, I think to myself, for the love of God, I wish I'd met you 10 years ago. And we've been able to do all these interventions and change your diet and your lifestyle. So we always find when there's this big mess of labels and diagnoses, and I get the notes from the other doctor and it's like, patient has 20 different ICD-10 codes and like 5 surgeries and all this stuff, I'm like, we are going to look at their habits, we're going to look at their diet, we're going to look at their lifestyle, and there's going to be bushels and bushels of low-hanging fruit for us to pluck. And then the question is going to be, will you do it? And I totally agree with your approach of, do you take lunch? Take a 10-minute walk or eat it outside. Do something. Even if you eat it in your, in your car, like in the parking lot, that's— I'm thinking of like a patient right now who's in Northern Virginia. It's not warm there. Well, it might be, might be now, but like a month ago it was not warm, right? They had some brutally cold— it's a brutally cold winter up in the Northeast, Mid-Atlantic this year.

It wasn't fun.

No, no, no, not at all. And I really feel for my patients and people out there who, you know, someone created windowless offices in order to save energy. What a abysmal. I mean, talk about being Pennywise and pound foolish as an employer. Like, you know, the cheat sheet, the, the short version of how to make your health insurance premiums as high as possible is give no one any windows and feed everybody processed food and then bake them with EMF. That's the, that's the solution to, to bankrupting your company with, with medical bills. But I see people doing this with this, with the procedure mindset. And so when I'm looking at procedures, because I do refer out for procedures because they can be life-saving, life-changing. I'm absolute believer in procedures, but they've got to be implemented on this foundation of habits and daily choices. And I know you know this, when you still do procedures, when you cut into bone, into tissue, whatever you're doing, you know, I know that you know which patients are doing the habits, because the ones who do the habits, the ones who engage with the diet and the lifestyle change, they have the easier post-operative outcomes. They're the ones who are not calling you for extra pain meds. They're the ones who are not getting post-operative infections. They're the ones who are not having grafts or whatever. I don't know depending on exactly what procedures you do, but they're the ones who are not having these things fail, right?

Absolutely. And I think, you know, really at the crux of the issue, and there's no difference between the type of patient that you're seeing and ultimately the type of patient that I'm seeing.

Yes.

Because I believe whether it's cancer, Alzheimer's, sleep apnea, ADHD, autoimmune issues, they're all based in inflammation. So if you can't fix the inflammation, you're just managing. And we live in a society that patients now— people, not just patients, people— want the easy fix. They don't want to work at their health. And it's trying to help them see how much time they're saving in their own lives if they put the work in instead of waiting for the phone call that says you have cancer, or, you know, you need surgery, or you need CPAP.

And I would say how much time they're creating, because when you make healthier choices at a younger age with these daily habits, you will literally increase your lifespan, statistically speaking anyway. And so it's like, well, I don't have any time for that. It's like, oh, so you are going to not make time for the things that will increase the amount of time that you have on planet Earth? It's like saying, I'm going to save money when I'm rich. Hold on a minute.

And that's literally how I phrase it to patients. I say, I am fighting for you to have time. And what that looks like is quality of life.

I love that.

Because nobody wants to be a burden on their family, their friends.

No one.

They wanna enjoy life.

Yes.

And then you, once you have that problem, once you go from 100 problems to one problem, and that problem being health, that's, that's when you are willing to do something about it. And oftentimes it then becomes a question, is it too late? Or, How much better can we get? And that's really what was the impetus that made me decide. I actually was lucky in hindsight to have my jaw expanded because I got to see firsthand I was up against either getting more surgery or fixing my health. And I know that I'm in a better health spot now than I was 2 years ago, and I feel it and I live every day.

You're the most compelling case study possible about this.

Yeah.

And it's your own profession. It's your own specialty.

And that's what I try to bring to my patients and the people that I work with to try to help them if they want.

The other thing you said that I think is so important, because I, I'm thinking of a case right now that I've been working on for 6 months and he's really frustrated and he's not getting the results he wants. And I always sympathize with patients frequently. That's kind of like patients come in, they feel terrible for 4, 5, 6 months, and then they feel all better. And most of our patients, I must say, I've already kind of gotten the memo on light. They're eating lunch outside, they're getting the morning walks, all that stuff. We, we really emphasize it. We say like, we wanna make sure that you're not just talking about it, thinking about it, you're really doing it. But in this particular case that I'm thinking of, one of the things that struck me was he doesn't live at altitude, but his hemoglobin's elevated. For his age, or not age, sorry, it's elevated relative to the, to the, uh, the normals, right? And that's one of the markers for apnea. And his chief complaint is fatigue that's been just crushing. I mean, just horrible fatigue. And when I say horrible, I mean, you know, he has tried everything, been to everyone, gone down the mold, Lyme, et cetera, et cetera, rabbit holes. I've got another case similar to it where there's also an elevated hemoglobin, sort of a similar story. We always find other causes driving the inflammation, but I'm actually sort of surprised at how many sleep study referrals I end up writing because I think it's more common for people than they realize. But I'm always a little bit wary of putting them in the hands of the sleep physicians because their answer is, we're going to give you an appliance, we're going to give you a device, we're going to see you back in 3 to 6 months or a year. We're going to make sure the device looks normal, blah, blah, blah. And I don't think there's an appreciation, certainly in the, in the physician or dental community, as we've talked about. But I mean, patients, I don't think understand, or they're, they're maybe tempted to think, well, because this is sort of obviously anatomical, there's nothing physiologic that can be done. And this is so far-reaching in its implications. Like, one patient will come in and their manifestation of metabolic dysfunction will be sleep apnea, which is then driving all these other problems— the weight gain, the fatigue, the high blood pressure, the reflux. Another patient will come in they have fatigue, but they also have anxiety. They have, you know, they wake up a couple times a night, but it's like they just think it's insomnia when really it's apnea. And what they don't realize is that it can affect their gut. It can affect— it's going to affect long-term things like their bone health, which seem very remote from how they're sleeping and their sleep quality and their airway. Can affect their brain health because, of course, the better you sleep, the more you're going to renovate and rejuvenate and repair your brain, right? So dementia, like, largely is a disease of artificial light and EMF and And I'm not minimizing the role of things like, you know, heavy metals and toxins and stuff like that, but it's, it's so remarkable, all these links between different organ systems, sleep, inflammation. And people will get tricked into thinking, well, I have an anatomical problem, when in fact, if you do the right things for the physiology, the anatomical problem will resolve.

So let me, let me, let me throw another one at you. Yeah, let's— because now I have a lot to unpack with you.

Good.

So what happens, or what, what do you think How do I want to phrase this? The possibility that maybe sleep apnea is protective in nature.

Yeah, I've heard this hypothesis. I think it's brilliant, and I think it's so interesting because it puts us in kind of a— I mean, it feels like a devil's bargain, right?

Oh, 100% is a devil's bargain, no doubt.

Yeah, you want the patient to feel better, so you give them the device or the oral appliance or the whatever, and all of a sudden you're the hero, right? Thank you so much, Dr. Stillman, you got the problem. Yeah, you know, basically we replaced your tires. So your car stays on the road, but your alignment is off. That was the real problem. You have abnormal wear patterns. You needed to get new tires, right?

So I'm looking at it from the standpoint that if a person is inflamed, what is toxic to inflammation? What does the body not want? Oxygen.

Yeah, right.

So if the body is trying to protect, let's say, apoptosis or autophagy, mm-hmm, well, how can it do that? Get rid of oxygen.

Yes.

If the body is inundated with non-native EMF and blue light, iron goes from F2 to F3, which is your methylhemoglobin. So now you're looking at a situation where the body can't even carry oxygen because it's trying to slough it off. And I think that's what happened with me. I think the reason why I got worse is I was so metabolically messed up. My sugars were just out of range for 6, 8 hours after I would eat. My body couldn't get— my body was trying desperately to try to save me, and in the process of trying to save me was killing me at the same time. Because when you're desaturating below 90% for over an hour, your body is in a sympathetic fight-or-flight survival mode to try to breathe. So it becomes this, this cycle of how do you get out of that cycle? And You know, that's what's frustrating when you— so as you're talking about that patient, I'm thinking to myself, wow, I wonder if when he smiles, is he narrow left to right? So when he or she— I don't know if what you said, but like, if you're too narrow and your tongue doesn't have enough room, the back of your tongue sits up high. If your jaws don't grow well as a child, your nose becomes deviated and you take on a mouth breathing posture. And you grow vertically. So if you grow vertically, your airway, your nasal passage starts to crack in like, you know, it starts to become narrow and now it becomes this never-ending thing. And I love how all of the— I shouldn't say all— many of the airway dentists are talking about getting the tongue to the right spot and myofunctional therapy and fixing the anatomy. But no one's talking why is the tongue in the wrong spot to begin with? Why are the jaws small to begin with? That's why it has to have a metabolic component. There has to be something that has been affecting growth and development from infancy. And what ultimately, how I look at someone is the child that has a problem becomes the adult that has a problem becomes the senior citizen that has chronic debilitating disease. They're all the same patient. We have to start looking younger and trying to find— let's try to fix or idealize anatomy on their kids. But if we don't fix their light, if we don't fix their nutrition, if we don't get them outside away from all the molds and processed foods, and then they're just going to get sick again. And relapse. And that's what we're seeing. That's my concern. That's my beating drum that I want to get across, that we can't just look at anatomy. We have to look at the total patient. And that's what I love that you do. It's amazing.

Thank you. This has been really fun. I've really enjoyed this conversation. Your story is incredible. Would you tell everyone how they can get in touch with you, whether they want to become a patient, they want to learn from you, they're a dentist, they're a coach? Uh, what are the opportunities for people to work with you?

Yeah, so My website is sleephealthypa.com. My Instagram is @andrewcohen_dmd. And if you're in the dental world or a myofunctional therapist, nutritionist, go to Airway Health Solutions. I'm launching a mini residency that will be on demand that is combining both the anatomic and the metabolic treatment options for your sleep patient, be it a child, Being an adult.

Wonderful. Thank you for joining me. Keep in touch.

Yeah, for sure. My pleasure. I loved it. It's great.

Good. All right, everyone, thanks for tuning in. See you next time. Take care.

Good day.