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130 - Dr. Karen Davidson - "Breathe Through Your Nose, Don't Pay Through It"


On this podcast, we discuss medical diagnosis and procedures.

All of the guests express their own opinions.

You should always seek medical advice from a trained and credentialed professional when making decisions about your own health.

Welcome to the Sleep Apnea Stories Podcast.


I'm Emma Cooksey and I've been coping with sleep apnea since childhood.

I didn't know anyone in my life with a sleep disorder, so I decided to start this podcast.

I'm here to build community and provide a platform for people with sleep apnea to tell their stories.


Together, we can shatter stereotypes and raise awareness.

We'll be exploring all sorts of treatment options and lifestyle choices to help you live your best life with sleep apnea.

This is Sleep Apnea Stories, and I'm so glad you're here.


Hey there, it's Emma Kixie here, and I'm your host.

So how is your week going?

Mine's pretty good.

I'm interested to know how weird and wonky my accent sounds, because my parents are here staying from Scotland.


Like they've been here a week and they've got one more week to go.

And so I feel like the more time I spend with them talking to them, the more my accent just kind of like Go doesn't really know where it lives anymore.

So I'll do my best to be understood.

So today's episode, I am trying to figure out putting all of the videos from my new episodes on YouTube, but I am only one woman.


So I think that this one was a little bit more complicated because we had a couple of Wi-Fi issues and some things happening.

So I think I'm going to have to get some help with the video for this one.

So there isn't a video up on YouTube right now, but it is available.


The audio is available on all the usual podcast platforms where you're listening to it right now.

So hopefully at some point I'll get the video fixed and it'll be up on YouTube as well.

So before we get on to today's guest and ResMed, the CPAP manufacturer asked if I could let everybody know about some upcoming product research panels that they're putting together.


So they're looking for patients diagnosed with obesity, hyperventilation or COPD or neuromuscular diseases that are being treated with non invasive ventilation.

And they were saying it doesn't matter what brand of machine you're using, just any people using non invasive ventilation with those conditions.


So if you're interested in that, I'm going to put a link in the show notes for this episode.

And if you're listening, some people do listen on my website where you can't really access the show notes.

So if that's you and go to either Apple or Spotify, they have the show notes on their web version as well as the app.


So even if you don't have those apps, you should be able to look at the show notes.

And so the link will be in there that's of interest to you.

So on to today's guest and I'm really glad I got to have Doctor Karen Davidson on the podcast.


We've been going back and forth for such a long time trying to make, you know, like the date work and we had a really good conversations.

Doctor Karen Davidson, RN, is a renowned expert in the field of nasal function, objective nasal measurements and interpretation of the data for treatment options and clinical progress.


For more than three decades, she has held several positions in the medical device industry, various clinical nursing positions and specialty certifications in the private sector, as well as time in the US Air Force Reserves.

As a flight nurse and critical care nurse, she has conducted numerous workshops and seminars sharing her insights, research and techniques with fellow professionals in the dental and medical fields.


She's also, we talk a little bit in the conversation about her new book, which is called Breathe Through Your Nose, Don't Pay Through It, the impact the healthcare industry has on nasal function, how we Breathe.

So without further ado, here is my conversation with doctor Karen Davidson.


Listen, thank you so much for joining me.

I know.

Do you want to just start out and tell everybody a little bit about your background and how you got gosh noses?

Well, this is a 33 year history, so we'll give you the Reader's Digest version.


So you'll get like 5 minutes or so many.

I'll do it in one minute or less.

So no, I went into the medical field back in 1990.

He started at UNC Chapel Hill School of Nursing, graduated in 92, found my way to Charleston, SC as their first new graduate ever in the recovery room.


I didn't have my CCRN certifications of time for critical care, but they took a chance, and it was a good chance.

Did that for a couple years, got my Commission, the Air Force as a flight nurse and did submissions with the Critical care Air Transport team, also known as AC Cat team, which is a lot of fun then.


We had different ideas of your funnest, but.

I see what you're saying here.

It's been a it's the best job ever.

Then I found a way into infusion therapy.


Kind of a different.

Way out of critical care and still in flight Nursing.

Found my way into nurse practitioner school.


And then after a little bit of time in that, I switched over to maybe an MBA, which turned into an MSA master's degree.

I did finish it, but in the clinical nurse specialist role.

And then got a master's in education and a master's administration.


And I was too old to be a medical doctor, so why not a PhD?

Why not?

So I promised myself by the time I was 50 I would start that journey, and I did.

So I did a three-year track in 2 1/2 years at Central Michigan University, focusing mainly on health policy, which I now teach at Liberty University at the graduate level to the doctoral level.


And I also teach, and they have you as well.

As everything else.

They call it the subject matter.

Experts, I'm like thank you for your vote of confidence and I also teach medical billing and coding as well at Liberty University and I teach at Central Michigan University some of the graduate level courses and I write papers and do research and.


Author books.

So normally I get really twitchy about if people are talking about a company they work for or things that they're potentially selling, but I don't really know anyone else that knows a lot about nasal patency like you do and testing for it.


So I just was like I've just got to have her on.

So my experience as a patient and from interviewing all these different people for like the last 3 1/2 years is people are going with symptoms of sleep apnea to usually sleep specialists and their nose most of the time doesn't really factor into the conversation.


I've been for several intakes where they would lick in my throat and say, oh, you had your tonsils removed.

Nobody's testing my nose, nobody's looking in my nose.

So let's just start out for anybody listening who is thinking, well, sleep apnea is all about what's happening in the back of your throat, so why would your nose be part of that?


Do you want to start?


So out of the nursing field, I thought it'd be kind of cool when I was in the ORI, saw the reps, I thought that'd be kind of a cool job.

So I found my way into the medical device pharma industry in 1997.

So it's been, you know what, 26 years?



It's been a minute.

Or two, And I found my way back into the OR, which I absolutely love in the ENT world in 2002.

Now at that time, I was telling the vagus nerve stimulator, so that was a little bit different.

We're just sleeping depression and clinical trials, weight loss, appetite suppression.


So it was really interesting what we're going to find behind the after effects of stimulating the vagus.

Nerve vagus nerve stimulator they they do for.

That's right.

The indication of the time when I was there was for epilepsy, refractory epilepsy, and remind me on that point about nasal breathing and refractory epilepsy because there's something really interesting that they found in research.


I just heard a doctor sneak about that.

I can't.

Wait, yes, yes it does carry on.

So inadvertently, Gyrus ENT, formerly Smith and nephew Richards Ear Tube Company found me through a recruiter and I'm like, sure I love ENT.


It was my favorite cases in the OR.

When I would circulate my favorite in the recovery room.

I loved my ENT and even when I did my nurse internship at UNCI, just loved all the ENT cases.

So why not quite a journey.

So I was with them for a little bit and to your point, everything was subjective.


Can you breathe?

How are you breathing?

And I would see all these different sinus surgeries.

I've seen probably hundreds and hundreds of sinus surgeries just from a vendor perspective as well as a clinician perspective and didn't think much of it.

Got into the home sleep testing industry and I sold a particular device which was very cool and was sitting there during and then service about sleep studies and what they meant.


And of course in my infinite wisdom, I raised my hand and I said, ahi, let's think about that for a minute.

Apnea Hypotonia index.

This is the dumbest thing ever.

Why do we wait till someone can't breathe to help them breathe And everybody in the room was like, did she just say that?


Yes, I did.

So Fast forward to my travels with contracts with an oral appliance company helping themselves to the government and boom, here I am at without any promotion, GM instruments.

Now I have to mention because they're the only ones in the US that have a four phase random manometer.


Well, I'll be imagine that after 25 years of clinical practice, I was someone in contact with this machine called a rhinomanometer.

What is this?

What does it do?

And we all understand what is it?


And the.



So the founder and the owner was Eric Gregg.

And I thought this thing is so complicated.

It's looking at nasal flow, nasal function.

It's a 15 second test and then you get this data, you get a beautiful graph and that's all this numeric data.


And I'm a numbers girl and I'm thinking, OK now what?

And I said to Eric, what does all this mean?

Well just look at the colors that tells you how much obstruction.

But in medicine we do everything with, you know, a number, you know, blood sugars, how much insulin do you give blood pressure, things like that.


So what does it mean?

And he said well we can't really practice medicine and you know kind of divulge what is normal.

We can't really tell people what's normal and not normal.

OK, I will.

So that's where I ventured on my journey of 5 1/2 years to find out what's normal, what's not normal.


Not only in rhinomanometry that looks at the nasal flow and function while you're breathing, while you're awake.

No drugs involved.

We had acoustic rhinometry and that looked at the geometry kind of like a ship.



A sound wave would come on, you know, come through the tube into your nose and then ping and then go back down the sound tube and go through the measurement to tell you what's normal or not normal.

And so I studied it for 5 1/2 years intensively And then over 10 months I created this whole interpretation platform called DAFNE.


It's DAFNE so.

That's like the software that helps us pull the data out when you do the test.

Yeah, I created this software from the device software to the actual measurement software that's called Instacow to Dafny, that's it's a web-based platform with software functionality.


So it's like being in my head for a year learning what's normal, what's not normal, what treatment do I do.

Because everything we do is going to be based on the amount of pressure and the ability to breathe.

So if you look at the nose and the oral cavity, so if you do any kind of manipulation with soft tissue or bone by just 1 1/2 millimeter, it can completely change the aerodynamics and how you breathe.


And I proved that back in September.

That paper is coming.

A lot of people say titrate the mandible like when they would do oral appliances.

But the studies show, hang on a minute, you can have a baseline rhino manometry reading and then go about 50% protrusion of the mandible and it will decrease that nasal resistance and open up the nose.


It'll decrease resistance by 23%, but on the flip side, you can do too much manipulation.

So there's effective at 50% and then there's the targeted protrusion at 75%.

And when you hit that 75% from baseline, you increase nasal resistance by 43%.


Well, congratulations, Now you have a mouth breather and now you have somebody that's not to be too happy with their appliance and it's much like CPAP as well.

And this is all proven in the studies.

So you can look at the, there's a normal value of resistance.

I hear a lot of people say you don't want nasal resistance.


Well, we do because we need that.

Yeah, there's a normal level.

You want a little bit of resistance because if you don't have that resistance, you have what's called empty nose syndrome and you feel like you're not breathing, right?



You've probably heard that before, But even with CPAP, it's the same thing.

We know at a certain level of transnasal pressure that it won't work for some people.

And I saw that at my stepmom and she had a sleep study and it was horrible.


I'm like, Mama severe OSA and beeline to the CPAP machine.

And I said it's not going to work for you.

And she said, well, why not?

Had you already tested her nasal resistance?

Yeah, it's not going to work, Mama.


And she said why?

And I talk about this in my book, that it's not all about CPAP.

We've got to look at other different options and how they work together.

And sure enough, she had C spot issues, scoliosis, high nasal resistance, forehead posturing.


And guess what?

After three weeks, it ended up in the corner.

And I saw this sometimes with my patients in home care because after they would get their sleep study, the home care nurses like us would come in and teach the patients about CPAP and to see the wandering eyes appear like, what is this machine and what am I doing?


And I think that that was part of the problem, that maybe there was too much nasal resistance, too much blockage, that it just wasn't getting the air into the nose like it should.

I love this, but for people listening, I always assume everybody's listened to all 123 episodes, but there's actually people that just listen here and there, so we can't assume a lot of knowledge.


So for people that are just tuning in who think they might have sleep apnea or just got tested for sleep apnea, can you explain what does nasal resistance have to do?

Why is nasal resistance important?

Because I think often times people think of sleep apnea just as being like wherever the actual collapse or the blockage is happening and they don't realize that how your nose is functioning has so much to.


Do with And that's part of the reason why I wrote my book.

Breathe through your nose.

Don't pay through it because people just didn't know.

And so I tried to keep it as simple from the 3rd grade level to a PhD.

That means you could take a little bit of Nuggets of information that would help you.


And so if you look at this whole cycle, it's a cycle.

First you have to understand that 80% of our air flow to the lungs comes through the nose.

I call the nose it's own little reactive organ.

It reacts to allergens.


It reacts to smell even We choose our partners by the look of their face and if their nose is too big or it's too small, we just seem to know.

Is it crooked?

Is it straight?

You know, there's some different things we look at, but from that 80% you look at upper airway resistance and you hear that a lot UARS upper airway resistance and over 50% of upper airway resistance occurs in the nose.


Now we break it down a little bit more.

That 2/3 of resistance in the nose occurs in the nasal valve area.

Now that is the first one inch, just the first one inch part of your nose from your nostrils to about one inch back.


And there's a little valve in there.

It's like a little flapper, like a damper and sometimes it collapses with age or lack of collagen in our skin.

Or maybe in my recent study we found that the elasticity of the of the nasal walls, they collapse when you breathe in and you might see her and you can do.


It's easy to do.

You can look in the mirror and look up.

Yeah, and see is.

'Cause as we know.

My nose doesn't work, yes.

And so when we look at that little valve and there is a principle called, and it's in physics called Bornelli's and Bornelli's looks at the velocity or the speed of the amount of air we can get in that nose and that valve can play such a huge part in it.


And so when the air comes in and it has flow limitations as we call it, the flow limitations are there.

So you have low flow that creates higher resistance.

Remember, air is like water that it will follow the path of least resistance.


So we breathe in through our nose over 2 seconds.

We breathe out or exhale over 3 seconds.

So as we're breathing in and we have a flow limitation, we'll get higher resistance.

Now that affects the esophageal area or the area in our throat.


Those pressures, the technical term is called P crit or critical pressures.

So between the trachea and the nose, that's where a lot of the collapse occurs.

Now people will say that sleep apnea is a structural problem.

No, it's a pressure flow relationship that's affecting the structure and how the structure responds to the pressure changes.


So that's we're kind of flipping the script from what's been said to what's really happening.

So when our tracheal pressure is lower than our nasal pressure, we get collapsed because the air is coming down.

It's it's just pushing down everything and everything collapsed.


So when our nasal resistance is lower than our tracheal pressure, everything stays open.

So when you look at sleep apnea, yes, the diameter and the size of the airway does make a difference, but not as much as the pressure that's causing the collapse.


Now when you look at the nose and you have the flow limitation that results in resistance, how does the body respond to something when it's going, when something's going wrong?


Remember, the nose is so reactive that an allergen, which you'll see like in the inferior terminates, they swell up.




If you have a cold, a virus, you know viruses will take up about two to 3% of the nasal mucosa in our nose.

And if you can't breathe, the nose functions on the trigeminal nerve Tri, meaning 3.


There's V1 Ophthalmic, V2 Maxillary and V3 Mandible.

Well, V1 and V2 are sensory and V3 is motor.

When the sensory doesn't work, the motor responds and so that's the mandible and you clinch and you grind.


And then it's like this whole cycle of events.

But in sleep, once we hit those flow limitations and we increase nasal resistance, what happens?

The mouth opens because the air has nowhere to go.


And then you get the the saturations, you'd get hypoxic and then you wake up and it's just this vicious cycle and that's what's happening.

That's why I say the nose, nose.

That was a really, really good explanation.


So I guess what I'm trying to understand this.

So right now people are not like like are there certain practitioners out there who are using these devices to to measure nasal resistance?

Just not very many.


So allergy, if you look at the history of rhino manometry, it's it's quite fascinating.

I mean it goes, we measured in pascals.

So you have Pascal in like 1654 who proved in engineering the the concept of pressure and changes to 1966 when Doctor Klaus Vaat invented the first four phase rhino manometry.


But Doctor Caudill in 1968 he was the 1st president of the American Rhinology Society and he was the first to bring rhino manometry to the world of rhinology.

So there was an acceptance and there was this.





Rhinology is noses.


Anything with Rhino is a nose.

Got it.

And so over time the the whole technology progressed.

Now what had happened in the 80s and the 90s and there was a standardization committee who said this is what you do, these are the normal values.


Here's who can use it.

So it's really big in the ENT world.

And then it found its way into allergy and plastic surgery.

Because, I mean, you think about your whole, you're redesigning the entire nose and plastic surgery and that's another paper that's the one that just came out, how we have to not only look at the visuals, but we have to look at the function, but predominantly in the US and sadly, the US is about 40 years behind in Europe and the Asian markets.


It's hugely popular, almost the standard of care, but the US is about 40 years behind in adopting this, so it it kind of goes back to, is it an academia thing?

Is that down to the way the American healthcare system set up and it's all very divided and in silos or or what do you think the reason for that?


Two things.

I think there's a lot of misconception on it I've heard.

Oh, right.

Among trees for research only says who?

Oh, it's not reimbursable, that's who, because I did three years of research on that and there's only two insurance companies.


One is, you know, just kind of inconsistent and one is consistent on saying it's experimental investigational even though it's FDA cleared in 1992.

So it doesn't make any sense, but there's a lot of misunderstandings and I think that's my role is to say, hey, wait a minute, the old obsolete kind that came out is gone.


Now we have 4 phase rhinomenometry and four phase means we're looking at the four phases of breathing in one respiratory cycle.

So we can really get a nice, you know, a clear picture as to how you're inhaling and exhaling on the right side and the left side.


And when you look at it from a facial perspective, we grow into our face.

So that amount of airflow is going to be indicative as to is our face symmetrical?


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Now that's Sleep


We have the device, we have the equipment to measure all the physics of our breathing.

But is there a quick way to see what's happening physically.

So we have a new term in our medical circle here called Rhinopathia, rhino nose, pathia, pathology, things that are affecting the nose and we broke it in down into a phenotype and you've heard OSA phenotype, endotype.


Now we have a rhinopathia phenotype which is any physical structure.

We're going to see, for example, a dentist can walk in and see like over jacked.

That's a sign, teeth crowding, that's a sign with the nasal breathing problem.

But then we have the endotype and that's the actual physical portion, the nasal resistant and what's it doing.


And now we have a genotype.

Yes, our noses have genes that can dictate the size.

If it's a button nose, a square nose, you can go down a rabbit hole.

I knew, I knew this was going to be like really all of I know, but this is a lot.


So, so once I guess what I want to know is once you've done the testing, so say you have a provider who uses all of your software and and tests everybody.

How does that help you?


Like does that then tell them this person needs nasal surgery or what does that?

Then help.

So when you you do your test and the entire test itself is about four minutes long.

The actual test with the mask on and watching the curves, that takes 15 seconds.


And then all the numbers pop up based on the resistance numbers.

That's going to tell you C PAP responder, oral appliance responder, mouth breather at certain levels of resistance something is happening and a therapy would be appropriate or not appropriate.


So for example in allergy you we when we do this test we want to do decongestion.

So when you look at the American Academy of Allergy, Asthma and Immunology, also known as Quad AI, they already have a a practice standard that says when you look at obstruction and congestion in the patient, you do a baseline test and then you do a spray and then you wait 10 minutes, not 9, not 7, not 15-10 minutes, and then you retest the patient.


If you see a decrease in resistance by 35%, that tells you it's a mucosal problem.

Off to the allergist, you go.

If it's less than 35%, now we're getting into a structural problem.


Off to the ENT you go.

If you're seeing the palate issues, off to the orthodontist or dentist, you go.

And if they really need, if they're having a problem as far as C PAP, that's where you're, you know, and you can do a sleep study as well.


Like when I plug in the data on the inspiratory resistance, when I put that into Daphne, I'm just about 100% right that Daphne will simulate a sleep study.

What does that mean?

That the amount of resistance will pop up as mild, moderate or severe obstruction?


And I'm finding that's correlating to mild, moderate, severe OSA.

Which providers do you think?

I know you said like our system probably needs to, You know, like we're saying it's kind of different from Europe and everywhere else.

But so ideally in the future, who is it that's going to be doing this testing?


Would it be a sleep specialist or a dentist or what do you see?

I think, and this is just my opinion, I think dentists are such in the driver's seat, and I'll tell you why.

I mean, usually kids see doctors for vaccinations at a very young age, but the dentist, we want to make sure that the teeth are coming in correctly and they do more of a of a whole facial examination to see what's happening, right?


Well, Welker Borski did a study, it was published last year in 2022 and he said that with validity, with predictability, with repeatability.

So we are able to predict, validate and repeat a test in children as young as three years old.


Now October 28th of this year, there was a press release where the academic hospital said start measuring these kids and screening their nasal breathing at three years old.

Now that's over in Germany.

So you can see how far ahead that thinking is.

So imagine if we had every pediatric dentist doing a baseline test on these children at three years old, what we could do and how we could make a difference.


And that's why I created this campaign based on that study in the press release is that you hear, you know, fixed by 6, which is very true, but now we can see it's three.

So that's my new campaign.

We can see at 3:00.

And if the airway dentist, even pediatricians, if the pediatricians would even do this, there's a whole host of information and like I learned in nurse practitioner school, you know, prevention, prevention, early intervention, we could really flip the script on healthcare, maybe save some money in the system, but I think it'd be dentists and pediatricians and but right now, the current market is allergist.


Now this was introduced in, in the dental world 2018, in the orthodontic world in 2019.

It is great interaction and we lost 2 1/2 years during COVID.

So now we have to set that reset button and start all over.

But it's really gaining track.


I mean, I get messages, No lie, I get messages.

Where do I get this breathing test?

That's what.

That's what the public calls it.

I want this breathing test.

I just got messages.

So is there a way?

So is there a way for just an order to remember the public who wants to test their nasal resistance?


Like is there a way you have for them to find a practitioner or can they?

Yeah, so they can.

Contact me through Instagram and my Instagram handle is under score the nose nose.



As a side note, I am by contract the VP for GM instruments so we do have global distributors.

I'm not having so much luck, but I am trying to work with another provider who has a functional airway directory so I can start funneling patients that way.


You know, we're trying to keep this simple, but it's just such a novice concept to have a.

Yeah, it's a tough job, right?

Because you're trying to completely change the way the people are.

Yeah, exactly.


And and then I'm trying to help people find, you know, providers and that's what I'm saying.


I had, I had request Indonesia South Africa and Australia and England so far yesterday.

So there is an uptick in requesting.

I'm trying to get providers as quickly as I can and trying to rally my my corral of of people to say look we've got to get this initiative going because people want tested.


I try to point them in the right direction based on their location to get testing.

It's usually a dentist or.

This is just one of my favorite subjects.

So I thought I would pick your One of the things that I've seen so much is just people who are struggling to get any sort of diagnosis because they don't fit the narrow test of sleep apnea.


Like they go and they'll have like apneas that last 9 seconds, not ten seconds.

Or they'll have you know like flow limitations that don't show up as enough to be part of an HI.

But they're very symptomatic.


They have like their their daily life has really impacted.

And so I know there there's been various people talking about is HI the only thing we should be looking at and when we could be looking at a lot of other things, you know, like whether it's hypoxic burden or RDI or you know like looking at how often people are arise from sleep.


So what's your take on?

That so my opinion.

Do you have an?

Opinion of course.

Of course I was going.

To say I'd be really surprised.

My opinion, and this is what I've been trying to teach over the past six years, you know, bringing on this Goliath as I call it, is to teach people that like, look, y'all we have to breathe before we sleep and it's only the dictionary that breathing comes before sleep.


We're in this multibillion dollar industry of sleep, but I think we're losing our focus.

So to your point, before an AHI occurs, and this was in the Hoel study, HOEL in 2022 and then 2023, well, they found that patients that have more hypopnias than apneas, that's a red flag.


They are predisposed to OSA in children.

When they get to a certain level of nasal resistance, they are predisposed to OSA.

That's why if you can see it on the breathing and the resistance, you're going to see it.


In fact, I did a clinic with veterans with PTSD in Columbus, GA And I did my test and I looked at the veteran and I said, oh, moderate OSA based on the graph, based on Daphne and the metrics.

And he said no, ma'am.


And I said you have moderate OSA.

And he said no, I don't.

And I asked him, have you been tested?

Yes, ma'am.

And I said a year, five years ago.

He said no, three months ago, three months ago.

And I see this so often to your point, no diagnosis of OSA, but Daphne and rhino manometry show mild, even severe.


And a funny story is I got a director of a sleep of a sleep center.

He's like this is cool.

Can I try it.

Sure you can try rhino manometry.

And he we we were on Zoom because he was in another state.

And so he did the test and I looked at all of his numbers on rhino manometry his flow and his resistance plugged into Daphne and I said, oh severe OSA, your your AHI is above 30 isn't it?


And he looked at me and he said, he said, quote, Karen, if I didn't think you walked on water, I do now.

And I said what what did I do?

He fell back in his chair and he said, you're scaring me.

And I said, well what happened?

He said, let me show you, show you my sleep study.


And of course I said well couple years ago.

And he said no, in anticipation of our meeting together.

I had a sleep study done two days ago and my AHI was 42.

You called it.

So this is the whole concept of picking these things up.


Our body talks to us through symptoms and and what do we do with that.

So I think the, the rhinomanometry, if we can see the upper arrow resistance through rhinomanometry, we know we're predisposed.


Something is happening and I call it my Da Vinci Code.

When you look at the disease progression and rhinomanometry readings and the AHI versus RDI, you can see there's a sweet spot that the the early intervention will capture more people.


Because remember, when you hear that 80% of people don't know they have sleep apnea, right?

Well, 80% of those people haven't had their Rhinomanometry test done either.

The more experts I talked to as well the the idea of like the sort of progression starting with mild breathing, then it becomes upper air resistance syndrome.


Then it becomes like mild, moderate and severe sleep apnea.

Like I feel as though often times people are being turned away if they're you know, sleep study doesn't show sleep apnea, it doesn't mean like that they're they have super healthy sleep and no events that often times means that they just don't meet the criteria.


So those people would be great people to start treating.


I mean, I even have.

So when I see something like this, I I can.

I tell people a couple things happen when we start to recline.

When you hit 60° recumbency, our resistance increases.


Our daytime nose is not the same as our nighttime nose.

But when you go backwards by 60°, you can actually feel the pressure change in your nose.

Now conversely, when you're lying down and we can do this test sitting or supine, which is wonderful, you can do it with your oral appliance in.


So you know kind of what that picture looks like in your sleep, right when you come up 30° from laying down, that's when resistance begins to decrease.

So a lot of people get frustrated like, well, what do you think?

I don't think that there's a 11 kind of treatment specifically, but more of an adjunct for example like in CPAP, why could we do CPAP and an oral appliance, why could?


Well, that's why I do you.

And is it working?

It's better so when I started perimenopause.

We could talk.

For three hours and gained weight like seemingly out of nowhere like over a pretty short period of time my sleep apnea got more severe and so my CPAP pressure had to go up.


Well then I find I mean I've been a CPAP user for 15 years, right.

You know I was pretty much in a groove and I was used to sleeping with it and didn't have that many problems with it.

But then suddenly when the pressure, well, I mean part of the from the fact I can't breathe through my nose and you know it's not great, but like it's in terms of like my mask and everything, I would just sleep fine.


And then when the pressure went up, I was suddenly messing about with my mask and taking it on and off and all of that again.

And so that's when I got an oral appliance and we did a titration study afterwards with me wearing neural appliance and they were able to reduce my pressure back down again.


So for me that's helped enormously.

But I do think that for a lot of people, we have to get out of the mindset of like looking for one that's right.

Like you don't go into other illnesses or diseases and say what's the one treatment they're going to say You're going to take a combination of drugs.


Or you're going to do.

You know for mental health you're going to do talk therapy and antidepressants.

I think that with sleep apnea we just because of the way the insurance companies.


We're trying to boil it down to one thing when often times the combination is much better and like.


I just somebody anybody in the audience please e-mail me, call me.

But I'm dying to know and I've never been told nor I could find who said C Pap has to be the first line of therapy who says is that because of back in 1974 and the 1980 Emma, I sit on the NIH and I absolutely adore the director of the NIH Doctor Brown she's she's she's amazing.


And I and I sit on the the the Advisory Board means that they have like every couple months and they're like we need a new way to.

I'm like over here I I got the answer over here and I want to jump out of my chair into the into the screen.

And so we're stuck.



You know and I think a lot of it has to do with academia now and no offense to academia but when I was in nursing school at Chapel Hill we didn't learn about nasal breathing.

We learned, you know our respiratory assessment and things like that.

When I went to nurse practitioner school at University of North Dakota, we had learned about there.


And then when I finished my program as a clinic owner specialist, it was more into education and what not in policy.

But even throughout that time when I was in clinical practice, I didn't say how's your nasal breathing.

So I just kind of looked to the UK just because like, yeah, race in Scotland and you know, that's like the system I'm most familiar with outside of America.


And like I don't know if you're familiar with their nice guidelines, but when they updated those for obstructive sleep apnea, they included, they certainly had C PAP in there, but they also included, you know, people that you would send to an ENT.

They also included people you would trial on a mandibular advancement device.


The difference with the UK is the National Health.


So you just don't have the same situation where the doctor doesn't really benefit either way.

Like they got paid anyway like they just need are trying to put the patients into the best solution for them, you know and I think that the the idea that the number of people who are abandoning CPAP it's just not acceptable.


And those are the few people who are actually diagnosing we're we're ending up with these people who were getting a diagnosis and then abandoning their treatment and they're just lost to the system like.


And that's the thing when you look at compliance, 75% of patients are not even compliant.


And as therapy goes on with any therapy, I'm just talking medical, just medical in general.

You know, in general when we do any type of medical therapy, 75% of patients are not compliant and that increases over time.

Now we're on to something here, and I don't understand why it's so hard to get out of our silos and say, hey, wait a minute, there might be something a little bit better.


I I don't understand it.

But I'm going to keep fighting on this.

I'm going to keep looking at it.

Saying I'll.

See, I I really mean that To do that, we have technology, we have data.

This is not Karen Davidson saying, I have a great idea and I have a great product to sell.


This isn't me.

This goes beyond me.

I'm just the mouthpiece and I'm standing between the medical industry and the way they've done things and the way we can do things.

I'm just, I'm the middle man and I'm standing in the way of that change.


Well, in a lot of ways, I think that's why I have such an affinity with you because in a lot of ways patient advocates are coming from the same.

We don't have like I don't have any agenda.

I just want the most amount of people to get diagnosed and treated and preferably preventing sleep apnea from happening at all that we can possibly do, right.


And we can't do that by not changing the system.

We just have to change the system.

But I do think patients and and the power of supply and demand, it's actually a huge force.

I think people don't.

Really think?

About because the number of people I've talked to who, like you said, like I get messages from all over the world and people trying to access different treatment options they've heard of on my podcast.


And so the more that you have people reaching out to the doctor saying I want to try this oral appliance I need to find.

A dentist.

I talk about that in my book.

I talk about the politics of breathing because we're stuck in this healthcare policy again, this silo that says this is the way we have to do things.


And one thing I love, love, love in clinical practice are the patient advocates.

When I worked in two runs, Mental Health in North Dakota, we it was called the partnership project.

It was a federal grant and our age range was from 3 to 13.


And our parents would go to Bismarck and they would beat the Tom Toms of change.

And let me tell you, we always had interdisciplinary conferences.

They were the warriors that had so many arrows in their back.

But I'll tell you what, they got policy changed in the schools for children with ADHDSED, you know, kind of things, opposition, defiant.


They were the voice of change.

And we also learned in nursing that, you know, the nursing profession has its ups and downs.

But again, the only way we got change in nursing was by the number of voices.

So the more the patients would say, doctor, I want that breathing test, and that's what they call it the nasal breathing test.


I want this nasal breathing test.

I want to know, is what you're doing working?

Do we need to change it up a little bit?

Do we need to add something?

There's so much value in that.

But I love my patient advocates.

In my book, I talk about patient advocates and you are on page 220.


You're kidding me.

I did a book about CPAP machines and I put at the the last paragraph in that, the chapter of the book right now, it's page 220.

But I said, you know, our patient advocates are the best voice and defense we have.

And if you need help on CPAP, go to sleep apnea stories.


Look up Emma.

Could see.

Well, was there anything else that we didn't cover that you weren't?

I't going to hear your perspective as far as nasal breathing and you've been on this journey with CPAP.

Tell me your story.

Like what is your opinion?


What is your story?

I feel like I've read way too much about empty nose syndrome, so I'm kind of terrified about things like and also just adverse outcomes some people have had.

So should I do it?


Yes, the the whole like trying to fix my sleep apnea is such an expensive endeavour.

Like, I went through Vivos Pal expansion for 15 months.

That failed and it cost a lot of money.

And so that took a while to kind of, like emotionally get over that.


I spent all this money and it hadn't worked.

And I think that probably, like if I went to an oral maxillofacial surgeon, they would probably say I was a good candidate for MMA surgery or you know, like surgically assisted Raphael expansion.

Don't fancy those at all, don't really fancy nasal surgery.


But I feel like probably the other thing is I really, you know, like there's basic things like I need to lose weight.

I need to, you know, try and figure out this whole inflammation thing.

Like when I went to an ENT, they basically said you have so much inflammation.


They didn't necessarily say like, oh, we would rush to do surgery.

They were like do all these sprays.

And so I feel like I go through phases of doing really well with that and having a better time.

And then there's a lot of other factors with me.

Like right now it's terrible because we have, I live in Florida and most of the time it's just air conditioning all the time.


But then in the winter, if it gets really cold, we have to put on Central air, like heating, and it's all like dry and awful.

And I'm just like constantly putting saline up my nose.

It's better now.


I've got the oral appliance and the CPAP, but I still wouldn't say I'm getting great quality sleep.

Like, you know, I still because I can't breathe well enough through my nose.

I I know that my mouth is falling open and you just don't get good quality sleep that way.


I mean, I would say I'm kind of struggling, like, you know, I deal with daytime sleepiness still and but is my quality of life a lot better than it was before I was on any treatment?


So I'm not falling asleep at the wheel and.

Oh, that story.


I mean your story.

It touched my heart.

And then I started crying.

I thought.

I can't drive over a bridge without thinking about it.

Like it really changed my life.

And I think The thing is, like you, nothing really has changed.


That happened to me 16 years ago or 15 and a bit.

And when I really think about it, nothing has really changed in terms of how many women are getting diagnosed with sleep apnea.

So the thing that keeps me up at.



Well, the thing that keeps me up at night is the fact that there are people like me who are going to doctors for 10 years with all of these symptoms and not being tested and being told that they don't have enough risk factors for sleep apnea.


So that's really what drives my work.

We can do something about that.

And all it really is is awareness.

So the hope is just if if women hear that story and really anyone to, you know, like can can recognize those symptoms in themselves, they can actually advocate for themselves to get some treatment until we work to change the system.



Because I totally like, I started off with a really small goals and now I'm like, no, we just need to, we do need to structural.

Change the.


Global, you know, you mentioned the NHS and in my doctor program we had the the global public health health class.


And one paper we had to write was, you know, we looked at all the different healthcare systems in the world and we had to pick two and bring them to the US What would they be?

NHS was one of them.

And the Taiwanese and I love the NHS because you start everything starts at the primary care level and then works the way up.


We're here, we've got HMO, which of course you go at the primary care and have to have a referral to go to a specialist or APPL.

It's a free for all.

You don't need a referral to go to a specialist.

You can just, you know, skip step one and go to step 7.

In America, they've got some of the most advanced healthcare.


You know, like some of the hospitals are amazing and all the stuff, but you go and you'll go to like different specialists.

None of them talk to each other.


Maybe they'll send a thing back to your primary care physician if you fill that part out.


But sometimes they don't and you're you're filling out these basic health questionnaires every time you go to anyone.

One of the things that's great about the UK system is just that you have your primary, your GP, they have all of your records of anything that's ever happened to you.


So you go to the emergency room, they get a report, you go to, you have to have a surgery, they get all of the stuff back and they're communicating with all these different specialists.

I'm always stealing it from Jill Umbrella, but she has this whole quarterback of care thing where you have one person looking at the.


Whole thing.

And what's interesting, a couple things is that the Rhino Manometer was born in the UK, you know and it's it's very popular through a lot of the hospitals and whatnot.

It's very popular in the EU.


But the other thing that is really interesting is that we would have thought that a medical, healthcare, medical records, the whole EMREHR system was going to help with that communication.

And I teach us in my course at Liberty that it is gaggle and I'm being a lady.


It is everyone has to think, you know think change and think interdisciplinary, you know conferences and and interactions and collaboration.

I don't know if we get in the way of our, you know, if our egos get in our way.

I I I don't have the answer.


I don't, but we're working on it.

Thank you so much for your time this.

Has been a pleasure.

This has been a pleasure.

I really enjoyed it.


Thanks so much for listening.

I love hearing from you.

If you'd like to be featured in an upcoming episode of the podcast, please e-mail me at

That's also the place to get in touch if you just want to say hi or ask a question.


Alternatively, I'm over on Instagram.

My handle there is Sleep Apnea Stories.

If you're enjoying the podcast, please subscribe or follow, rate and review wherever you listen.

This really helps a wider audience find the episodes and I really appreciate it.


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