Sleep Apnea Demystified: From Symptom Management to True Resolution

Hello and welcome to Reading for Better Sleep. I'm Dr. Eck, your host, and as always, we're exploring the root causes of sleep apnea, snoring and airway. One of the most common questions people ask is can sleep apnea actually be cured? A lot of other questions that they ask, is it something you manage for life? Can the airway change? Does it progress and get worse? And how do the different treatments fit into that conversation? Today we're breaking down what cure really means when it comes to sleep apnea and what patients should realistically expect as an outcome. Dr. Eck, how are you doing today? Doing great. How are you? Good, thank you. Nice to be here again. And we've been speaking a lot about different treatment options for sleep apnea. We spoke about CPUP and how it's been used as a gold standard and your thoughts on it. So when patients ask if sleep apnea can be cured, what do you say? It can be cured in many people. It can't be cured in everybody, but it can be cured in many people. And is sleep apnea something that is always permanent, or are they situations where it can improve or resolve? You mentioned it can be cured in some people and not in others. What does that depend on? Or why is that? There are situations where it can improve or resolve. I wouldn't say resolve or cure, but it can improve on its own. Certain medical conditions can be improved, certain lung situations. There are things, weight, for instance, can help improve it. It's very rare that weight makes it go away, but affected sleep apnea does not have to be a permanent condition for everyone. Many people, as I mentioned, can be cured. This is one of the keys to catching it early. The earlier it is treated, the more likely it can be resolved or cured. We have patients in their 70s and 80s every single month that we see that eliminate the need to wear anything. So our idea of cure means you're treating the condition and getting the condition to a point you no longer have to treat. So you no longer have to wear something. And does that depend on the specific root cause for that person? What's causing the sleep apnea for that person will determine if it can be cure for them? Yes, determining what the root cause is and the severity of the case goes into that. So we gotta start by defining what the difference is between managing and curing or treating. Okay? So an analogy that I always use is that if I break my arm, what is the cure? What is the treatment? The treatment is a cast, right? Now, management side of things can be pain medications, anti-inflammatories, etc. But if I just did those things without the cast, then I don't cure it, right? I'm not actually treating it. So we got to make sure we're treating and not just manage it. In the world of sleep, managing symptoms would be things like taking sleep aids, medications, right? Wearing a CPAP machine, wearing a traditional mandibular advancement appliance. These are all things that manage symptoms, okay, but they don't do anything to cure the problem or treat the root cause. They're essentially masking the issue, right? Addressing the underlying cause that aimed is aimed at improving the airway, improving the muscle tone and the size of the airway. There are surgical and non-surgical ways of doing this. But we've focused in our office primarily on the non-surgical because that's what most people choose. But for everything that we do non-surgically, there is a surgical alternative for, which we always review with our patients, both the surgical and non-surgical, because we we work closely with a lot of providers for some people who want to do the surgical alternatives. And so how do treatments like the famous CPAP fit into that distinction? You you mentioned it's management, right? You would call CPAP. CPAP. Yeah, CPAPs would fall under the management and not treating. And I'll go back to the garden hose analogy that we've used in the past, right? If I have a garden hose and it has a kink in it, I have two options. If I want to fix it, I have to go unkink the hose, right? And that's ultimately when we do things like epigenetics, myofunctional therapy, certain surgeries. We're looking to unkink the hose, unkink the airway. Okay, what's the other alternative that I have with that kink in the hose? To leave the kink in the hose and just go to the faucet and turn it up all the way. Get as much water through that kink as possible. We're not fixing anything, right? So that's what a CPAP mask does. It doesn't change the anatomy, it does not improve the airway, it leaves the kinks in the airway and just tries to force as much air down the kink as possible. So you're managing, you're not curing anything. And in terms of factors that determine whether someone's sleep apnea can improve, I know you mentioned weight and muscle tone, airway structure. Are there any other lifestyle factors that can determine whether someone improves? There are certain lifestyle and other conditions. For instance, the how well your nasal passages work is a big contributing factor that can make a difference in the success of people's treatment. If they have what's called a myofunctional problem, which means they just have a myofunctional is how your mouth and muscles and swallowing and breathing techniques all work together. And so, but those are things that can be corrected as well. The size of our midface, we've talked about this a little bit in the past. Our skulls, as a species, human skulls over the last three or four hundred years are getting smaller. And there's lots of reasons for that, but when our midface is smaller, our airway is crowded. And so how deficient or small the midface is one of the biggest contributing factors to our root cause. Myofunctional is really related to habits, the habits that you've developed when it comes to breathing and swallowing and posture even. Yeah, is that correct? Yes, posture is related, but keep in mind uh the perfect example of a myofunctional issue is mouth breathing. As humans, we are designed to breathe through our nose. We are not designed to breathe through our mouth. And in fact, if we are mouth breathing as a child, okay, we are altering our growth patterns. We are growing asymmetrical, we are growing more narrow, we are creating jaw underdevelopment, which creates our orthodontic problems. But mouth breathing would be a myofunctional issue, right? So when we're treating kids in particular at a young age, our treatment sometimes simply revolves around myofunctional therapy, breaking the habit of the mouth breathing, re-establishing nasal breathing, and then they start to grow again. That's super interesting. So it's like how the body develops according to your behavior or your habits. What you do also signals the body on how to develop and grow. Yeah. Your body knows what to do if you let it. And with the mouth breathing, you got to realize that something caused it. Okay, I don't care if it was a one-time enlargement of the tonsils, if it was allergies, if it was a one-time sinus infection, something happened at some point that made it difficult to breathe through our nose, and we started to compensate by mouth breathing. The problem is mouth breathing is a habit and it be can become a habit. So if you have a child who goes through six months of allergy issues, they develop the habit of mouth breathing, we now have to break that habit of mouth breathing. That's the myofunctional therapy. The whole aim is to break the habit of mouth breathing and develop and redevelop nasal breathing again. So the body's really smart, it has its own intelligence, right? If you're not able to breathe, like you said, properly through your nose at one point, then the body starts guiding you to you need to breathe. That's the most important thing to survive, right? But it's trying to solve that problem for that moment. But if you're not aware of it, then it just it can become a habit that then changes the structure of your face and then causes you to change the whole functioning, right? Then you're sleeping and you're breathing mouth breathing, and then that causes all the sleep apnea and sleep issues. And from your experience, how often do patients underestimate the structural component of their airway? Most patients that have a breathing issue, they're not aware that it is a structural issue. That's one of the things that we educate them on. So I would say it's not so much as underestimating. I wouldn't expect them to know that up front. However, uh, I can tell you that most doctors underestimate it. Most doctors are ignoring the root cause and just masking everything with symptoms. I was I'm gonna comment on that, how you mentioned, I think it was our previous episode, that when you were in a conference and you're speaking about these things, certain doctors like colonologists are never show up. It comes down to if the only treatment, let's go back to the garden laws analogy, right? If your only treatment option for somebody is a CPAP mask, then the why and the root cause doesn't matter because you're not addressing it. All you're doing is masking the problem, right? For anybody just doing a CPAP mask, they're not gonna take the time and the energy to get any of the 3D imaging or get any of those root causes figured out because there's nothing that's gonna be done about them. But if we want to get away from masking the problem, we want to get away from a mask, then we have to figure out those root causes. Yeah, when we talk about these things at conferences or I-10, lunch and learns, yeah, there's just certain doctors that just don't ever that just don't ever make it. And I when we had just had a patient this morning who came in for a consult who's really mad because he's been struggling with a sleep app for 10 years. And he had a recent sleep test done, and it's way worse than what it was when he started. And I said, explain to him, that's normal. Sleep apnea is a progressive problem if you don't do something to stop it. Okay? So each year I redo your sleep test, your numbers get worse, right? They get worse by the year. So yes, your numbers today are definitely going to be worse than they were 10 years ago. And the CPAP mask is masking symptoms, it is not doing anything to stop that progression. And he really got mad because nobody's ever talked to me about alternatives. Nobody's ever told me that this wasn't going to fix the problem. This was not going to stop it from getting worse. And now his pressure on his machine has to be so high in order for it to work, as the problem has progressed, that he just can't tolerate it. But nobody's paying attention to it. They're just turning the pressure up and trying to swap out mask and continue to manage the symptoms. And I don't know, this just goes to show how segmented medicine really is. Because sleep is a perfect example of when different doctors would come together, then there would be a very effective and powerful treatment for sleep issues. If an ENT and a pulmonologist and a dentist and even a psychiatrist were all informed in the same way, they could probably m make a better, a bigger difference in terms of the advancements of sleep treatment. If everybody would work together and realize, and when I see a patient, I always tell them that I can help you, but me alone is probably not going to be enough. Almost always for most patients, there are contributing factors. If you have, if you need myofunctional therapy, if you need a tongue tie release, you there's you have you need a nasal or sinus procedure. So it's not uncommon for my patients. The reason why they get the success they get is because we're going in and identifying all the contributing factor, and there's usually, on average, at least three different doctors treating this person's condition to make sure all the contributing factors are being addressed. And I really think that's the way to go for successful treatment and cure of any any disease or any imbalance, really. And as a dentist specializing in airway treatment, what kinds of changes can occur when the airway is properly supported or expanded? Primarily we're trying to restore normal breathing, right? And in children, this is important to do as fast as possible. People's health will improve when you improve their breathing problems. The things that we see improved just routinely, psychological issues, anxiety and depression, chronic fatigue, memory issues, vertigo, TMJ and headaches, these are all things that can improve by treating your airway. When people are not constantly tired, it's amazing what a better mood they can be in. I always joke that when I'm flying, I can tell who has a breathing disorder by how they're acting. People are just always short, people always in a bad mood. They don't sleep well. Think about the little kid that doesn't get his nap, right? How does he act all afternoon? When you have a child acting like that all day, or even an adult that acts out all the time, they usually have breathing and sleeping issues. That is so true. You just made me reflect on myself even when sometimes when you wake up unmotivated or like blah, no emotion or not wanting to, you know, that feeling where it's like, okay, I'm alive, but I have no energy. I think it's like when I don't sleep well, or short fuse as well. You get really impatient when you don't sleep well. And that's true for anyone. So how do oral appliances or structural therapies differ from tradition traditional approaches in terms of long-term outcomes? The long-term outcome is based on whether we're managing or treating the problem, right? Whether we're managing symptoms or trying to treat the actual problem and reverse the situation. So with oral appliances, for instance, there's over 200 of them. They're not all the same. They don't all work equally. They don't all do the same thing. So success can vary from various appliances from somewhere in the 40 percentile range to the 80-something percentile range. So not all appliances are created equal, and not one appliance that works for you may not work for somebody else. We're able to treat based upon what your root causes are, and choose an appliance, or sometimes it's a combination of appliances in order to resolve the problem. And are these appliances that you use only uh at night and when while you're asleep, or are they certain things that you use during the day as well? It's most of the stuff that we use, you're using at night when you sleep. There are some certain situations where there are some daytime appliances, but I would say 90 90 plus percent of our cases, they only have to wear them at night, and then during the day, they don't normally have to wear them. If we're only it's also important to keep in mind that if all we're doing is managing the situation, we've had this conversation, right? The sleep problem will progress. So there will come a time that the managing of the problem no longer works for somebody. So we had a patient in yesterday who's been on ambient for over 10 years, right? A sleep aid, no longer working for him. So now he's added trazidon. Now he's added a second medication. And the combination of the two medications are not working for him. So he can't overcome the root cause now with the medication. We have the same issue with CPAP, right? So every few years, as your sleep test progressively gets worse, the pressure on your mask has to go up in order for it to keep working. So we talked about this in a previous episode about how when those pressures get too high, they can actually be bad for us. Okay, but there will come a time as the pressure has to keep going up that the patient can no longer tolerate it. Okay. Same thing with some of the traditional oil appliances. If I use an oil appliance that's designed to manage the symptoms by just simply moving your jaw forward while you're wearing it, okay, and then three or four years go to go by and your sleep apnea has gotten worse. Now you have to titrate that appliance. Just like on the CPAP, you've got to turn the pressure up for it to keep working. You got to move the lower jaw a little more forward for that appliance to keep working. I can only move your jaw so far forward, right? And you're going to start to have problems. So there does come an endpoint to where a CPAP and an endpoint to where a mandibular advancement appliance can work for you. And it just gets more uncomfortable as times goes by as well, right? Because turning the power up on the CPAP is just less tolerable. And having to move your jaw even more forward, it can hurt, even, right? It can hurt, it can change your bite. So that's why we always try to focus eventually on getting when we use Mandibular Advancement Appliances and/or when we use CPAPs, we're doing that to try to get a quick response to improve situations as quick as possible. But anytime that I look at those two things, I'm always planning a long-term solution. Because those are not long-term solutions. And what should patients realistically expect when they begin treatment? Improvement, management, or resolution? It's it's so different from person to person. We'll give somebody, let's say, an epigenetic appliance, and they'll come back two weeks later for their first follow-up and say how much better they are, and they've been better since night one and everything else. And then other people, it takes three to six months. How fast people respond is variable. We know they'll all respond, they'll all get better over time, but how quick they go, it varies from person to person. And a lot of that has to do with what is your contributing factors and how many of those contributing factors do you have? And how much do you see within your patients that come in with the sleeping problem that they've been that they've tried to treat it in the past with other with a different approach? How many of them have you seen on sleep aids? Because I I know a lot of times they go to primary care doctor or they're sent to a psychiatrist or I don't know, and they give them an anti-anxiety medications because they think that maybe their anxiety levels are really high. So if they're they lower that, then they'll be able to sleep. Does that happen often or I would say more than half of our patients that we come in and see us for an exam are either on some sort of sleep aid or have tried some over-the-counter products to reduce snoring, to improve breathing. It's more than half of our patients have tried. And a lot of our patients that come in, they've just given up. And it's something we see very commonly is a patient was diagnosed years ago, couldn't tolerate the CPAP mask, didn't know, was not aware there was any other option. So they just didn't treat their sleep disorder. And then they get diagnosed with something like AFib, and the doctor said, You need to go get your sleep looked at. And I already did it. I I already know I have a problem, I just can't wear the mask. So there's a lot of people who develop medical conditions after going 10 or 15 years of not treating it, that then come in and say, Okay, I gotta find a solution because it's causing my cardiac issue or peripheral neuralgia or cognitive issues, etc. So they gave up at some point. But we're here to give this information out so that people know that there's a better future for them if they do suffer from something like sleep apnea. There are so many treatment options, there are so many things that you can do. So do not lose hope. And if someone is searching for a cure, what is the most important mindset they should have go going into treatment? Is everybody wants to go quick, right? Everybody wants everything done in two seconds. You gotta slow down and get the diagnostics right. You gotta get the images of the airways, did some measurements, slow down and get the diagnostics right so you know what the root causes are. And then address those root causes. And I think the biggest thing they have to wrap around their mindset is that there's no magic pill. You can't just take a pill for this, which people have tried, but it doesn't fix anything. So you gotta have patience and realize it's gonna take time. And the surgical options, the only reason why anybody ever does those primarily is because they're quicker than the non-surgical options. But we can get it, we can help you out. It just takes a little time. But a little time or some time, if you know that you are going to progress, it's so worth it. It's much better than having to live with a sleeping problem for the rest of your life because it is really detrimental to your health. It really affects all areas of your life. Like you said before, it affects your mood and that affects relationships and that affects your performance at work, and that you mentioned a different episode as well, how people are driving around all sleep deprived, so it can cause accidents. There's so many different things that can happen when we don't sleep properly that we don't even think about. So addressing sleep is very important. Just as much as we talk about nutrition and we all know the basics, right? We say, Oh, what are the pillars of health? Eating properly, moving, sleeping well. But then sleeping well just tastes until we go to bed early and wake up early and try to sleep for eight hours, and we leave it at that. But that's just and how many people want to sleep well for eight hours and are not able to? And that's the question. That's a real thing happening. How can we get there? We had a consult this morning who he drives a big truck, he's CDL license, and drives around in a big truck delivering stuff. And when he was in for his initial exam last week, fell asleep in the chair. And this morning, when my assistant went down to get him from the waiting room, he was asleep in the chair. Now, this is at 10 30 in the morning, and he's so tired he is sleeping in a chair. He is driving a huge truck around all day long. That's dangerous. That is really dangerous, not only for him, but everyone else on the road. Thank you everyone for being here today. Sleep apnea isn't always a simple yes or no condition, and neither is the idea of a cure. Understanding the difference between managing symptoms and addressing root causes can help patients make more informed decisions about their care. If you found this episode helpful, share it with someone navigating sleep apnea treatment. And to learn more about airway forced solutions, visit sleeptreatmentdirect.com. Better breathing, better sleep, better life.