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Episode 120 - Bob File - Former MLB Player with OSA on Optimizing CPAP Settings


1:04

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

1:08

So before we got on to today's conversation, when I listened back to it, I thought to myself, if somebody doesn't know who Jason Suzanna is, they're gonna be, like, really confused for half of this episode.

So Jason Suzanna is a sleep tech and he has a really successful YouTube channel called the Lanky Lefty 27 where he posts all about CPAP and CPAP settings.

1:37

He also was on my podcast before, so if you if you haven't listened to that episode, I really encourage you to go back and find it.

I'm going to put a link in the show notes as well to this episode.

And so yeah, Jason's a great guy and me and Bob, Bob being today's guest both worked with Jason through his company AXG Diagnostics and Jason was able to help us to kind of fine tune our CPAP settings.

2:09

I would never recommend any of you doing anything to their pressure settings without talking to their Doctor Who prescribed the CPAP.

So that's just a little bit about who Jason is.

In case you're listening to this episode going, wow, this Jason Suzanne guy sounds really great.

2:27

I've got no idea who he is.

So on to today's guest.

So today I'm joined by Bob Phel, who is a former Major League Baseball player.

And so for any of you who have listened for a while, you know that I love interviewing professional athletes with sleep apnea just because I think it sends a really powerful message about who can have sleep apnea and that they don't need to, you know, be overweight and out of shape to have a diagnosis of sleep apnea.

3:02

There's that.

But also, we just got into this really great discussion all about how Bob's getting on now that he's got his diagnosis.

Adapting to CPAP was pretty rocky in the start, and he talks all through that and a little bit about working with Jason.

Bob was at Jefferson University and he played baseball and is one of only four Rams to have their jerseys retired by the school.

3:27

And then in 1998, he was drafted in Major League Baseball by the Toronto Blue Jays and went on to appear in 3 1/2 seasons playing for them.

In his career after baseball, he has focused on IT and Computer science, and he's now the VP of Solution Engineering at Sorcero.

3:53

So without further ado, here's my conversation with Bob File.

So Bob, thank you so much for joining me.

Great to be here, Emma.

So whenever anybody reaches out to me and they mentioned that they've been a professional athlete and they have sleep apnea, I'm always extremely excited to interview them.

4:19

I think when I first started the podcast, when I wrote my list of people I wanted to interview, I was just like anyone.

That doesn't fit the stereotype We have.

The only older overweight men have sleep apnea.

So I was like athletes, women, parents of children, like, you know, all sorts of people you wouldn't think of.

4:38

So maybe you can just start before we get into all the sleep stuff, do you want to just start and explain to people a little bit about your background and being a kid growing up?

Like how you got into baseball, all of that?

Yeah, I mean, I mean the short version I'll give like the abridged version, but you mean plenty of sleep apnea time, so.

5:00

Yeah, so give us the the brief intro.

Yeah, I mean, I grew up in Philadelphia, middle class, blue collar.

Family.

Not not.

I mean both my parents were blue collar.

Never.

Neither one of them, I mean barely finished high school.

So when it came to you know.

5:17

It was all about athletics, of course.

And then my my dad was a professional softball player and kind of got into a couple different sports when I was younger.

Wound up picking up baseball at like 4 or five years old again, growing up in kind of, you know, low middle class Philadelphia.

It was a nice neighborhood, but we didn't have a whole lot of money at all and kind of just played on the field in the local neighborhood and was a pretty good athlete.

5:42

My athletes are myself a late bloomer.

I started school early.

But ultimately, got into baseball.

Baseball is my primary sport.

I played.

I played all the sports.

I played a lot of basketball as well.

So I've always been to athletics and then went on to high school, did well in high school, got scholarship to play Division Two baseball in the Philadelphia area, and then ultimately wind up getting getting drafted into professional baseball after my senior year.

6:07

But at the heart of everything, I've always been a student.

First I actually chose the school I went to which is now Jefferson University, for their computer science program.

It is an engineering school and I went up graduating before I got drafted into professional baseball.

So it it worked out.

As of today it worked out pretty well.

6:24

But I I preface that because as we get into the conversation talking about sleep apnea and how close I am to like analytics and and computers and technology and how things, how far things have come today with sleep apnea and how I really dug in and and being a student.

6:40

Wanting to know everything, every, anything and everything about sleep apnea is kind of what brought us together, because I've learned a ton in the last 6-7 months.

But ultimately, again, sports was #1 Growing up, my family, my neighborhood, there's not a whole lot of professional athletes that come out of where I grew up in Philly.

6:57

But that being said, I had a lot of luck as well.

Hard work and luck, kind of.

That grit kind of got me to the major leagues.

Of course, growing up, where I did that grit got me there.

I wasn't necessarily the most talented.

About being able to to be consistent and disciplined and and work hard kind of kind of got some luck but but made it and had a had a pretty good story to tell now these days.

7:18

Yeah that's awesome.

So tell us about when.

So all the different people I've interviewed will kind of approach this really differently.

But I don't know whether you want to start with your sleep as a kid or a teenager or looking back now when you think maybe some symptoms started.

7:38

Because I know often times, in retrospect, it's easier to take that out.

Yes, I think that's that's key, right?

Like I look back even every day.

I just think about different things as a kid and I listen to a lot of different episodes of your podcast.

And a couple and and we'll get into like how like the the Youtubers I'm really connected with that are really experts in the field and it's funny, I look back now and I've always.

8:04

Who?

Victoria beer.

I might have.

I'm I'm pretty much locked in with the lanky lefty with Jason.

Yeah, I love Jason.

I've actually met with Jason.

He actually made a huge difference with everything as of a couple weeks ago.

Huge huge difference I mean.

He he's what made me find you and and we'll talk about that.

8:23

But for me, I've always been called a light sleeper.

And I I talked to my mother about this a little bit when I was first diagnosed last last I guess I took the sleep study last January and then March I was on on a on a on a CPAP machine.

But I asked my I was talking to my mom about it.

8:38

And she's like, yeah, she's like I remember you had some breathing issues as a kid.

You always had asthma.

Allergies like bad allergies, terrible allergies, light sleeper.

Never slept through the night my entire life.

Ever.

I remember being in school now, looking back, being in school, even in college, being the one that always needs a power nap before practice.

8:55

Like always.

I could never.

And I thought it was just because my brain was always working, always thinking over, analyzing everything.

Anxiety was creeping in at that point.

Looking back on, it was probably anxiety.

It got, it's gotten worse as an adult prior to CPAP therapy, really.

And so being the light sleeper, you don't think anything of it.

9:13

And again, going back to where I grew up and the family I grew up in.

I mean, they didn't go.

We didn't go to the doctors for any.

I mean, sleep apnea, we didn't go to the doctors for allergies, let alone sleep apnea.

Go to a sleep doctor.

They didn't know.

So the allergies thing, like, I I feel as though, like when I go to sleep conferences, I speak to a bunch of doctors and they kind of look at me like, so you weren't like taken to an allergist.

9:37

And I'm like, I don't really remember that being a thing.

Like, I had horrendous allergies.

But it was just one of those things in my family where we were like, we still had a rabbit and a Guinea pig that I was really allergic to.

But it was just kind of like get on with it.

9:54

Yeah, yeah, exactly.

And you know, it's all, like you said, it's all retrospect now.

But I look back and I'm like all those, you know, light sleeping.

It's just something I just dealt with.

And then when I got into professional ball, I kind of got really.

Deep into fitness, like really into it because we have the best resources.

10:10

We had you know top tier people when it comes to, you know, training and things like that.

And it was around 98 to 2005, six I played.

So that's when tech started to come into the game a little bit and me being a techie at heart, I was all about you know looking into that and I would, I would do different tests with running and and my breathing.

10:30

I always thought I had because I because I would work harder than anyone.

I always prided myself that, and I would still.

Not be able to keep up in terms of long distance running and I have, I would just be dead in terms of like my breathing.

I thought my breathing was off and I just never thought anything of it.

I just thought that's the way I'm built whatever and kind of just push through everything.

10:47

So looking back on it now, I'm like maybe there was a connection.

I don't possibly.

And so, so even the early I I feel like so much has changed.

But even that long ago, like I feel as though there weren't the sleep trackers and the focus on sleep.

11:05

Like now I feel like sleep and athletics is a much bigger thing, but maybe not then.

Like they're they're tracking more like your athletic performance and and different things, but not.

Yeah, exactly.

Exactly.

And then when I got done playing in 2005, it it's interesting, I I jumped right into the pharmaceutical world.

11:24

I worked as a pharmaceutical sales Rep in the field.

And I worked for AstraZeneca and I sold Symbicort, Pulmicort, respules, Pulmicort, all the different asthma and allergy drugs.

And so I got to know a lot of pulmonologists in the tri-state area really well.

I took this day.

I'm still close with a lot of them.

11:41

And I remember I would meet with some sleep specialists.

I didn't know the thing about it.

I would meet in there.

I would do these preceptorships, they're called.

I would I actually stick the lab and watch and we would you know you you you pay the positions or the practice to kind of a learning.

And I would learn a lot about Sleep Medicine.

I remember talking to a pulmonologist back in 2007, in 2007 or 8.

11:59

I talked to one that I was friendly with over at lunch.

And he's like, you ever think about just doing a sleep study just for the for the hell of it?

And I was like, sleep study like, like sleep overnight in your office.

Like, there's no way I'm the lightest sleeper ever.

I won't get any sleep.

And he's like, yeah, you should try, just just get a baseline.

And I just never thought anything of it because I was telling him at the time, like, I'm like, I'm exhausted midday, like all the time.

12:20

And I know I'm an early riser.

I work out in the mornings early.

But again, is it just getting older And at the time I was like 30 and yeah, not that old but but but again, I never really took him up on the on kind of the offer.

But, but I learned a lot about, you know, the respiratory system and how things work.

12:39

And I'm So you learned about sleep apnea at that?

Point Not really.

It was more around asthma and allergies, OK, which are?

Kind of LinkedIn the same way, but the pulmonologist I called on some of them were sleep.

Terminology offices and they and they dealt with any type of respiratory issues but so I kind of learned kind of adjacent just my own learnings just being in conversations about sleep and and and and sleep labs and how they operate it.

13:04

And then I went up changing companies, sold different types of medication to different doctors, and then I, Long story short, jumped back into tech.

But.

I kind of looking back on it now, it's like oh, OK I and some of those Pulmonologists I'm still close with today and I'll get into that of how I contacted a couple of those folks.

13:24

And it's interesting the conversations we have versus a conversation I had with like Jason, Jason from from from YouTube and you know it, it's there's a combination and you know from listening to your podcast, there's a combination of a lot of things that are not optimized in terms of the healthcare environment in the US in terms of like time if you're a systems geek like Oh my God, like we've got a system for you to sort out.

13:51

And have I ever dug into that?

There's a lot there that could be a lot better.

So how it ended up is I go to this regenerative sports medicine out of California.

They're like my primary.

Kind of go to everything doctor and a couple people recommended to meet them a couple years ago through through athletics very top notch at based in California and we do a lot of virtual appointments I get blood work done every three to six months like clockwork just because like full panels and he had mentioned two years ago like you ever think about getting a sleep test your your your red blood cells and hemoglobin and your and your hemocrit are elevated and I bet you have a breathing issue at night.

14:27

I bet you have.

You might have.

He's like, I'm not saying, but you might have sleep apnea of some sort.

It might be mild, but it could cause.

No raises in these levels.

I'm like, yeah, that here, no way.

So, So what was it about that?

That's super interesting to me?

What was it about that that made?

14:42

Was it the idea that the only people that have sleep apnea are older, overweight men or like, what is it?

Why weren't you like, quick to say, oh sure, let's test for that.

You just did kind of.

That could apply to you.

I thought it was just uneducated on the subject.

14:59

I figured you know.

Like wearing a machine.

Like, like I just didn't know enough about it to even even look into it.

Like, I just really didn't even know.

I didn't.

I just didn't know anything.

I mean, one thing I did do was get a get a get a a mouthpiece because I was always a teeth grinder.

15:17

That was another symptom I look back on.

Terrible teeth grinder, like terrible.

And I wore it.

I wore a mouth guard forever, just the bed.

So my dentist recommended about six years ago and I just always I'm used to it.

But it wasn't.

So just to be clear, it wasn't a mandibular advancement devices treats like that.

15:34

NIA.

It was a mouse guard like.

Big guard like, but but both, yeah.

It keeps my teeth.

Kind of input.

Keeps my jaw forward though.

But it not not one of those ones you can adjust.

It was more for teeth grinding.

They usually get one on the top or bottom.

They gave me one with both, which I which I have a couple of them now, and I'll talk about how I use that now with the CPAP and it's the wonders for for things.

15:57

But yeah, look, looking back on that, that's another thing.

But like, ultimately, I just didn't know enough about it.

And I and again, back to the stereotype of that's for older people, really elderly people.

And I was like, you know, I asked somebody about their like, and you're like, I'm an athlete.

I'm like, I'm in great shape.

16:14

I take care of myself.

I I I don't snore.

That was a big one.

Do you snore a lot?

That was even my doctor said, do you snore a lot?

I said not at all.

I'm not never been to snore at all.

Me.

Never.

And so that was another piece where I was like, I'm not a snorer.

I didn't know enough about it.

I didn't do research at the time, 'cause I it wasn't that big of a problem for me.

16:32

I was sleeping the way I always slept.

I was still.

So it's.

Mainly, I wasn't tiredness.

So you're grinding your teeth and you're getting tired midday, but otherwise you're not.

Are you having morning headaches?

Like, are there any other things?

Well, what this is.

So this brings us kind of Fast forward a year later.

16:48

So back to like December of last year.

Before I had the sleep test, I was having night sweats a lot.

And I finally I said he mentor.

He recommended a sleep study and you can do them at home now.

So I was like, let me just look up some things and I saw sleep apnea.

And what triggered me to get sleep study was I wasn't having headaches.

17:06

The teeth grinding.

It was it was the night sweats as a symptom.

And I was like, I was like let me just and I contacted him I was like it was more annoying than anything the night sweats.

So I was like, let me just let me ask him about the home sleep test and he's like set it up in a day.

17:21

He's like two nights at home, be a piece of cake.

And for a lot of people I think that that's the difference between oh fine, let's just do it then, right?

Like I've talked to lots of people who are like, well, I'm not going to like a lab and having them, even the.

17:39

Pulmonologist, I know they said it was like 6 to 8 months to get in the lab for a sleep study.

I'm like, oh, and you know, in today's environment, I want it now.

So I was like home sleep test.

At least I'll get at something, get some, you know, Peace of Mind.

And it was really, it was obviously really easy.

So I decided in January to get that sleep test done, and that was January of this year.

17:57

Yes, January of this year and it did it.

And then a week later the results came back.

I sold the whole sleep report and I came back as mild sleep apnea.

That's what it says at the top.

You know, I, I at the time, I didn't know enough to read a sleep report and understand what HI was or anything like that.

And I was looking at it like mild.

18:14

When you hear mild, you think that's not a big deal and it was like 12.8.

Events an hour.

So 12.8 and then you know knowing what I know now I'm like it.

There's AI mean.

So I talked to my doctor he's like listen, he's like it's recommended you try CPAP out.

I'm like hey, if it's going to help me sleep better and I'm at this point between the sleep study and before I got on a CPAP that like month in between there I joined like Facebook groups started digging through the Internet and YouTube videos between like Nico the Australian guy and left and lanky Lefty.

18:43

Those two I I.

I just dug in and start to learn a lot more.

And I think that really opened my eyes to the possibilities.

And I'm thinking, oh, everybody, these Facebook groups.

I mean, there's some great information there and some very, like, uneducated folks in there.

And they're saying, I put it on one night I was like a superhero.

19:02

The next day I'm like, this is going to be great.

I'm like, because in terms of discipline and consistency, I knew I'd wear it and I'd just do it.

I go to bed early.

I'm pretty regimented.

And I was like, I'll give it a shot.

So when I got the machine in March, March 16th was my first night never forget.

And I tried it on during the day and they're like, where do I watch TV, blah, blah, blah.

19:22

And I was like, I tried it on and I put it on.

I remember, I remember the experience like thinking it's going to be like fresh air coming in my face.

And I was on a range from like 5 to 15 on a on like AV pap So and we can talk about all that as well.

But not no one I know put it on.

I'm like, oh, just automatically this is going to be great.

19:39

I put it on I'm like, whoa.

I was like, how am I going to sleep with this on my face?

Like, I it's one thing breathing in.

It's the breathing out part.

Even with a when you've never done it before.

I was like, I feel like I'm suffocating.

I was telling my wife I'm like, I feel like I'm suffocating.

So I was like, I'll try it tonight.

19:55

I don't remember the first I tell people the first the first I would say two weeks maybe like 12 days where absolute hell hell.

I mean, thank God for my like, my discipline, and my like grit.

I wouldn't.

20:10

I can totally understand how people are like screw this.

I'll take my chances because it is.

So it's so daunting when you put that and you're trying to sleep and you're like first of all having something in your face that makes you hot and you're like and I'm using a full face mask.

I tried the nasal pillows.

Forget that.

I can barely breathe out of my nose anyway.

20:27

And and I was like, and you know, and and backing up a step, getting going through the healthcare system for all this.

I mean the DMA I was using, it was like, OK, your mouth breather, OK we'll send it.

I got in the mail.

No, no, direct.

No nothing.

Thank God.

20:42

I'm like a smart guy.

Like I looked up how they'd, like, turn it on and use it and put a mask on to fit myself.

But I remember those first couple of nights I said to my wife, I was like, I don't think I'm sleeping at all.

Like I felt like I was three days, three nights straight.

I felt like I didn't sleep for three days straight at all.

Like I was just laying there and just being like this.

20:57

I can't.

I'm trying to adjust my breathing.

I'm like, this is absolutely a nightmare.

But I forced myself, you know, with compliance with the insurance, 4 hours a night for I'm like, that would be a piece of cake.

In the beginning, I forced myself at least six hours, 6 to 8 hours.

I was going to keep going no matter what.

21:13

And I was pretty consistent for those first two weeks.

And then two weeks happened and then I had to go to Nashville, TN for a conference for work and I had to bring it with me.

Two weeks in, I'm like, I have to travel with this thing.

Yeah, and I went on the road and it actually was easier because I was in a room by myself, not with the family at home, my wife that like it was just I could just focus on like trying to routine.

21:32

I shouldn't put a podcast.

I don't know about you, but did you?

So I definitely felt like when I first started CPAP and I was having a lot of problem.

I mean, I feel like I had every problem, but I feel as though when I finally just was like, you're just going to have to go in the spare room to my husband.

21:52

It was easier to to make that transition and get used to it because I didn't have the added layer of I'm going to wake him up with.

All my shenanigans.

So for us, like it's been a lot better.

I mean, he doesn't always sleep in the spare room now that I'm super used to it, but like, you know, if the dog.

22:12

Yeah.

Anyway, that's the whole thing.

No, I know, I told.

The dog, I was just like, I'm not sleeping with the dog in here, you know?

But like, I think that that's something that, I mean, well, no one tells you anything about any of this.

But like, that's something that I wish that we'd kind of had that conversation earlier because I wouldn't have had that added layer of like now I'm interrupting his sleep and all of that.

22:36

It's a whole another.

I mean there should be like, I mean dank my God for like YouTube and like being a learner myself and being able to follow some videos and see like, oh, and then those Facebook groups and one thing they were good for, they're still good for today is like just getting feedback on a search and search for past things.

22:52

Because there's like 30-40 thousand people in these groups and they're just saying like oh did you experience this this or asking like how do you have your set up to where like I have a whole set up now where it's like the tube doesn't rub anymore on the bed like it's all quiet and then we use a noise machine so you don't hear.

So it's I don't I don't keep her up or anything like that.

23:09

So it's a very I have it down now to where again it's an added layer of like you care about the other person not disrupting them with this craziness you have going on with this Darth Vader mask on every night And but it but it's interesting because there's so many mask choices out there and I'm like I'm trying the first I use like an F30I use an F 31st and a ResMed F30.

23:30

And then again and we could you start looking at the app and numbers and I just look at AHI at the time and I'm like my first two nights I had an AHI of like 5 point something.

I'm like freaking out.

I'm like it has to be under 5 and I'm like let me change mass.

So then I went to an F30I again not knowing enough about pressures about the inner not not being completely educated like I am now or like more so educated.

23:55

So I switched to an F30I where the two was on top and I'm like, oh that's easier to move around on a side sleeper.

And I had pretty good numbers.

Like my AHI until a couple weeks ago, was consistently 1, 0 to three.

Like it never went above.

Besides those first few nights, it never went above 5 again, ever the Doctor at.

24:13

That point is thoroughly happy.

So here's the thing, so my doctors that they're not they're not necessary.

They're they're they're they do a little bit of everything.

They're kind of like an all-encompassing regenerative like holistic medicine practice.

But the pulmonologist that I know, I know two of them, one a friend of mine's really close with and I asked him to look at like look at my report.

24:35

I said, I printed out a report.

I said take a look at this, this everything looked good.

And he said this is one of the best.

Fantastic.

He's like, you're you're perfect.

You're perfect.

Just keep going as is.

And this was about a month ago and I'm think and now to kind of get into.

Feeling at this point, that's, you know, here's the thing, here's the thing.

24:51

So for the first, it was like the honeymoon stage, right?

Like it was the first after I got used to after the first couple weeks, I kind of got used to it.

Then I started waking up being like I felt like I when I took the mask off and I felt like I could breathe, like I felt like I could smell, like I just felt like better all around.

But it was, it was incremental, right?

25:07

Like I felt I always felt good because I take care of myself.

Like I I always felt decent, but I felt like, oh, I felt pretty good.

Like, I feel, feel it must be working right, But I told myself I'd give it a month of like really try it hard.

And then I would say for me now that I'm starting to learn more and more.

25:22

At the time I knew there was programs like Oscar Sleep HQ where you could really dig into the numbers.

And I knew being analytics, I work in analytics for a living.

I knew if I started to look at that I would get I I need to get a good sample size of data.

So I said I'm going to give it six months and then I won't even pull the same card out and for six months.

25:40

So that was about almost a month ago and I pulled the car out one day and I said I'm feeling OK, but my numbers are my average number was probably like one point something in terms of HI.

And it was mostly hypotenuse, rarely obstructives, but no, no centrals for the most part unless they were like false flags.

25:59

And I was like, all right, let me let me put this card in.

So I put the card in and after watching enough videos to kind of teach myself, I was like, I'm like, wait a second, OK.

So some of these nights I have like, let's say I have a 2.88 child, I'm like 8 hours.

I'm like, that's that's a lot of disruptions that that that the machines flagged me.

26:14

And then I'm looking at the data and I'm looking at the flow rate and I'm looking at now I'm starting to understand like there's more disruptions here than is being reported.

But, and I'm also not totally energetic all day, Not that you're going to be like superhero, but at least I'm seeing a difference.

26:30

But for the difference that I expect for doing all this work and effort I want to get, I want to optimize this.

So at this point, I've been watching enough of Jason's videos, the lanky lefty to know he offers services.

So I looked him up and I scheduled an appointment for him to sit because I knew talking to the Palms.

26:46

I know unless there's a great sleep tech that works there that's going to sit down with you.

He's going to sit with me and we're going to dig through this and and the difference between me and him, the biggest difference for me is I might be educated.

I might be able to understand this stuff.

But he has a reference point of hundreds if not thousands of patients that he can kind of in the back of his head compare and contrast and he knows different things.

27:05

You know what work.

What doesn't work though I.

And he also, so I would say from my experience, like I after I interview, I love Jason Suzanne.

I think he's great.

He said good things about him, too.

Oh, that's kind.

But I like after I interviewed him on the podcast, I was like, sign me up, like I want you to look at my data.

27:27

And it is kind of amazing just because he's done so much of this.

Like he can tell, you know, he can look at the data and say this isn't a central apnea, this is caused by a leak and I think what's happening is.

You know, like your chin is doing this and then you're getting a leak here and and he's able to see that from the data, which is kind of amazing.

27:50

But like, it is really helpful in terms of troubleshooting how you can make it better.

Exactly.

And he literally, we sat down about 3 weeks ago for like an hour maybe maybe an hour or more.

We got along so well.

So he played baseball Gonzaga.

So we got along really well and we dug into my data.

28:07

And, you know, at the time I was, I was the reason I scheduled an appointment because I thought about like, OK, I have to talk to the Palm.

And I knew he would say, like, oh, you're doing great.

But if I had like a recommendation, they'd probably say, OK, go for it.

So when I sat down with him, he was just going through things like, yeah, he's like, you can do a lot better than this.

28:24

A lot, lot better.

He's like, first of all, he's like the way you know, and you've talked about this since on your podcast and I've heard about it, where you get put on a range on these auto V PAP.

I mean, people don't know these auto machines where you're putting a range from 5 to 15, eight to 20, whatever it may be, and it just adjusts.

And that can cause disruption.

28:40

Must be a light sleeper, like pressure.

I felt like I was blown on my face some nights and I was crazy.

He's like, first thing we're going to do is put you on a static pressure.

Try it.

He's like, just try this, talk to your provider, try it and see what happens.

And then we meet in two weeks, so he follows up with you.

So we went through everything, understood everything.

28:57

So that night I put on a static pressure of 12 and and I reached out to my provider.

It's funny because he was like, yeah, yeah, good idea.

That's what the staff said and who knows if the doctor even, you know, heard about.

So I did that.

I put it on at 12 first and just for the help I I put on.

29:14

It was a lot of pressure, but I was used to the mask and everything At this point to where it wasn't that much of adjustment.

It actually felt more natural than than all the I felt like it was gasping for air early in the night all the time.

I wasn't on ramp or anything, but I felt like it was too low of pressure to start, which I know now.

So that's, that's all that you're describing is exactly what happened to me.

29:32

And I woke up the next morning and you know I just just for hell I want to see.

I opened up the, I used AI, used a Dream Station 2 right as of today.

And I opened up the app and I'm like, IS0HI0.

I was like, I've never had it.

I think I had a 01 time by a zero.

29:48

I'm like, is that even possible?

And then of course, I take out the the card, put an Oscar, I take a look and there's still some, some Veras in there, Veras, some yellow disruptions and I'm like, OK, there's some rare areas in there.

And he was explaining to me about stores, rare areas like everything in there, watching this video.

30:07

Treat efforts something or other related arouser related arouser there we go.

31:44

So I was like, OK, and when we talked, he said start with 12, try to get up to 13 or or was it 13.5 or 14 by the next time we meet?

And I was like, why don't I just start on 14 tonight?

Because I'm like impatient.

He's like trust me to start at like 12 and we're.

31:59

Working away and the next Major League Baseball player.

So yeah, I'm like, competitive.

I'm like, why not let's?

Challenge ourselves.

Though.

I try to stay patient.

I listened to his expert advice and I did 12 again.

The next night it was a zero again and then I opted to like 13.

32:14

The next night 000, I had like five straight nights of 0 that I could try and I'm like and I'm looking at the data and there's still some some blips.

I I you know we explained talking about R.E.M., deep sleep and and and all the different things to look for.

And I'm a perfectionist, which is not a good thing in this case because you're trying to have the perfect flow rate and it's just not.

32:31

Perfectionism is like literally the worst thing with sleep, because I feel like I sleep much better when I'm not tracking anything.

Like I had a couple of weeks where I was doing an inline sleep study.

I was.

Because I don't even know like wearing sleep image rings to track this and wearing an ordering, I sleep so much worse when I'm.

32:57

You know, like waking up in the morning and thinking how did I do, how did it go?

Whereas, like I said, I slept terrible, but I feel good.

Oh no, I should spill that.

Yeah, I check my order ring once a quarter, once half.

I wear it every night for sleep.

And I have like a whole four or five years of data there.

But I check it like once a quarter, see trends.

33:13

That's it.

Now is why I used to check it.

Same thing.

That's why.

My that whole everyday thing, the wearable especially with like like O2 rings that people wear.

There's no, no, I'll I'll lose my mind but I think but again going up and then using that static pressure and then I met with them again about a week ago not even.

33:32

And yeah it was compared to where I was prior to wearing a CPAP and then wearing a CPAP for those six months.

Of course it was better.

I was doing obviously I always told myself that even if it was like a three-point something AHI, it's still better than the 12 you were having every night basically.

You know what I mean?

You're still having less oxygen desaturation.

33:48

You're still doing better and better.

And then with this, I was like, I'm doing much better now.

I felt, I felt a lot better too.

And then he was like, OK, there's something still.

And then he wanted me to put on, you know, we were now we're finally ended on like getting up to a pressure like I think I'm on like 15 with with actually the the EPR on 3 because he was exciting to me about this is where it gets really complex, right, like about exhalation, about carbon dioxide and holding on the carbon dioxide and things like that.

34:14

And that was new to me.

I was like, oh, what are you talking about?

I thought he was doing great.

And then you'll get into Have you listened to my interview with Doctor William Noah yet?

Yes.

About the V com.

Is that the guy or no?

That's that's the first one I listened to because he told me to try V Com.

34:30

I did.

I tried the V com one night and I couldn't felt like I couldn't get air in like I could not.

And the first time I forced myself why I forced myself to wear it the whole night and I felt like I I could not and I forced it the whole first night and I had I can't woke up at like a zero.

34:48

And my flow rate looked decent.

But I'm like, man, that was brutal.

I felt like I didn't sleep well at all.

And then I tried it again the next night.

Well, yeah, the next night I tried it 20 minutes, took it off.

The next night I tried again 15 minutes, took it off and like this ain't worked for me because I felt like and then I read online again.

Some people have that issue where they don't feel like they're not getting enough in air in.

35:06

But the concept is makes sense And I read the white paper, that's how I found it through your podcast, that white paper.

And I read the whole white paper tour through that because I understand how to read those.

Things like we're basically twinsies.

Bob, it was so interesting to me.

Is your.

Wife completely sick of you because my husband is just like like.

35:23

It's not that he doesn't other end of the spectrum like.

She's just like sleeping.

No, not at all.

She's she was a former captain in the Marine Corps.

She's so much tougher than I ever would be.

Yeah.

So it's yeah totally opposite.

35:38

I'm the techie.

I'm the nerd and she's like the practical doer.

But yeah, so yeah.

But I do talk about it all the time to where and and again this is where I got to be careful not to tweak and and kind of like I have to find what works, stay consistent for a while and then look at trends rather than staying one day at night and be like freak out.

35:55

Yeah, that is one thing.

That when I just was kind of writing about the Oscar software like for the workbook that I just wrote and that is one of the things that I Oscar, it's like some people like to see data, but it's really important not to get super hung up on.

36:15

You know, like is my data better like this night than that night?

And that's just not really going to be that helpful longer term creating.

And that's that's where it would create more angst because then you wake up in the middle of night, like you wake up and like even me, like this day, like I always like change positions very, very, very methodically because I want to breathe in the stop and hold and be flagged to something Like, I'm so thinking that's how I think in the middle of the night, I'm thinking of like 2:00 in the morning, I turn over, keep breathing, don't want this to show up as a strep to apnea tomorrow.

36:47

Like that's the way I operate.

It's it's ridiculous, but.

You're very new to the whole process, so it's understandable.

I feel like you're going to calm down over time, right?

Like it's just that we're trying to you know you you only just got your diagnosis and I think in terms of.

37:03

People will sleep apnea.

It really does take months and months to kind of figure this out, get comfortable with it for sure.

And I think the other thing we we we talked about, I talked about that again that that mouth guard I had and 'cause I was having with my F30I mask, I was having cause again, that's the other thing.

37:21

Leak rate only shows up for large leaks on these apps.

And knowing what I know now, like yeah, the company's recommended to stay on the 24, but it has to be a really big leak to show up in.

Mine was always showing 100% no leak rates.

I'm think it's great.

Then I look at the data.

I'm like, there's some spikes here.

I could be much better with that.

37:37

So I switch back to the F30 mast.

I wear the mouthpiece and my chin doesn't fall back because that's why I was leaking at the bottom and that's where everything.

Changed the last three weeks?

Go back to So is it Amanda, of your advancement device that holds your chin?

No, it's it's it's it's a double piece.

37:54

It's almost like a snore guard.

Almost.

OK.

That's what people would call, 'cause it does, it does.

It keeps your teeth.

Like, yeah, it holds it from phone back, phone back.

But it can't be adjusted like a Mandalor device can be adjusted, 'cause I I got asked if I wanted one of those before or a teeth grinding, too.

38:13

They they, they just prescribe them for that as well.

But it's not.

It's more kind of like a molding that I got.

I got it one from the dentist.

It broke, but then I got one and molded my own teeth and it it keeps my jaw just like parallel.

It doesn't let me.

Yeah, which honestly I think that that's quite a huge thing that we're not talking about.

38:31

I think because of the dysfunction in the system and that you know doctors are prescribing CPAP’s and dentists are prescribing oral appliances.

But I finally got an oral appliance to wear with my CPAP like just a couple of months ago.

38:47

And I really think it's making a big difference, like the the.

The biggest thing like, and I know I talked with Jason about this as well, but the biggest thing for me is just that it holds my lower jaw stable so that it can't fall back.

39:03

And that just means that I have a lot less disruption to my sleep, I think, because there's no doubt about it.

There's not that thing of like and now I'm having a big leak and I have to kind of adjust my mask and it feels a lot more stable.

So yeah, there's the.

39:20

You know, I would love for more people to understand, and that's an option.

I think that, you know, like it's a sort of afterthought that people don't even mention, but and for me it's.

Definitely working well for me and I I didn't.

I didn't.

I don't.

I I used a night guard for years because of teeth growing up, so I was used to having it in my mouth like some people, especially top and bottom.

39:40

It feels like you're like, can't really, but I'm used to it.

I was wearing it anyway, and it doesn't have to be a $2000 one for your dentist, at least for me.

Like, I got this.

I think I got it on Amazon.

I just molded my teeth because I, my dentist, wanted like 1200 bucks for a replacement.

I was like, Oh yeah, I was like, I paid.

Like so I think for me it's maybe slightly different just because now I'm a bit further doing this than you.

40:02

So now I have severe sleeve apnea, so with an HI of sort of like in the 40s.

So for me having the.

Proper mandibular advancement device that's adjusted so that it keeps my jaw forward is probably like really helpful.

40:18

But yeah, people that have mild or sleep apnea, I'm not sure that that action is as important.

If they're wearing, yeah, I think so.

I mean.

It made a huge differently because like a full face mask, like Jason, we were talking about using a nasal pop so you could see and I just said, listen, I tried the nasal.

Like I sit there with it.

I'm like, I can't.

40:33

I tried to take my mouth shut and even though I have like a 5:00 shadow all the time, even even if I shade, I was like, I get sweaty And the humidity, he's like, well, you just turn the humidity off and try the nasal.

I tried to sit there and I was like, I can't imagine and I'm comfortable with the full face mask, but I was like.

I'll just stay with that.

40:50

And then my leak rates once I started wearing that mouth guard again, the different one, I had a couple different ones, but the one that was both top and bottom where I just kept my jaw kind of steady.

I mean, my leak rates I was looking this morning were zero last night.

Zero across the board, Zero with a full face matching.

41:05

Can I just?

I mean, it's the first person to give you a Gold Star, 'cause I feel like.

I feel like these are the things that, like, you know, your doctor probably doesn't care about this minutiae, but it makes such a difference when you get your leaks under control and are not waking up as much, like you just feel a lot better.

41:25

So that's.

That was the other thing that I was telling Jason in the last couple of weeks, since we made some adjustments, I was, I was that was another stiff that we came up.

I was getting up to go to the bathroom a couple times a night.

And I do drink a lot of fluids during that.

I mean I drink a lot of, I mean a lot, but I was still getting up quite a bit and but when I got on C5 it was like one time Max at night, but it was still pretty consistent one time at night.

41:46

The last couple weeks, like last night, I slept 9 hours straight last night.

Not one wake up nothing with a 0 hi.

Not that hi is the all that's the dream Bob right there.

Last night was my dream night.

I was like, what a perfect day to talk to him.

Like literally was the best night I've had.

And now again, if I was to sit there, in fact my mom sit there.

42:03

If I'm sitting with Jason, he's probably like.

See the spike here, you see the spike and then tear my dreams down.

But because because again we're talking to Jason, we talked about possibly the possibility going to bi level because the way I'm set up like these machines now they have that EPR where it only goes down to three, you know, you know the pressures with the three and he's like a four forward probably weak spot for you and and the machines don't do that today.

42:25

The only bi, BI levels do that.

So I'm possibly looking at doing that just to kind of again optimize and maximize everything.

I think that Jason feels quite strongly that the way that like, I think he wishes, I don't want to put words in his mouth, but just from what I've heard him say, I think that he wishes that there wasn't this.

42:44

Like normally what happens is people are put on these days A pap or you know CPAP and then you know if they have an issue with that they'll get put on bi pap.

And then if something shows up like on their sleep study that you know they can't deal with that they might get put on ASV.

43:04

But I think for for Jason he wishes that was more fluid and could could really match to what they could see in the data was happening with people so.

Yeah.

I don't know if we'll move towards that or.

I don't know.

It's tough without again having worked in healthcare for many years and and and the dollars and cents involved in the whole.

43:23

You know beast of healthcare, it is in the United States especially you know ResMed, I mean especially I don't use a resmed's machine now, but their BI pap machine can do CPAP as well.

So why not just have one machine and then patients fail on this, they can just get easily moved and why not have all three in one machine.

They could easily do that with technology today.

43:40

But I think it's more of a, I think there's a lot more involved money with money.

Well, it just has to be.

It doesn't make any sense otherwise, because it just makes sense.

Like it just would make complete sense because then you could.

You know, not have to do another sleep study before you had to get on ASP or something like that or not.

Like, were you done with explaining about like you that you've been to the pulmonologist and and what happened there?

44:01

There, yeah, yeah.

I went through yeah the everything was great and this and that everything was, was was was unbelievable but but again talking I I cannot recommend.

Jason enough to people like if you best couple 100 bucks I ever spent ever.

44:17

I got the advance kind of like I mean I told him I said listen after the next conversation I'm like how's this work now like I want to stay in contact with you.

I mean I want like like I'm going to follow up with you in a couple months again like how's that work because I'll because again it's not that I can't look at the data but to make informed decisions that are educated enough to with your experience.

44:37

I mean, I trust that.

And I mean, he was a difference maker.

He changed my whole outlook on everything.

I mean he he literally like I I mean not.

That I wasn't doing well before.

I talked to Jason and I and I felt like he just has a different level of experience and different things.

44:54

So he just asked a lot of really good questions and made me really dig into the data a little bit more.

But yeah, I'll I'll probably put since we've been saying how great he is, I'll probably put a link to him in the show notes for the episode.

So one of the things before I let you go is I wanted to talk to you a little bit about, I'm not sure exactly what it is you're doing with the AI and healthcare, but I wondered if you might want to speak a little bit to how things are changing.

45:21

I know, like I'm familiar with Enzo data and people that are using AI to like read sleep tests and things like that.

So what is it exactly you're doing?

Well, it's interesting I, I joined this company where tech startup about a year ago.

I've been working in the life sciences, pharma space for quite a while doing engineering work and and and sales on the commercial side.

45:42

But this company, we focus strictly on medical affairs pieces of these pharma companies which are which are the science people, the really medical folks that deal with you know?

All their all their, you know, whatever it may be, they're going for new indications or pushing stuff into clinical R&D, whatever it may be.

So our at this company we use AI, our our engineers, our, our founders, I mean they're, they're the best of the best.

46:04

Some of our best engineers in the world work at this company and they found a sweet spot to where we can kind of look at data sources that these companies operate in kind of silos, where we can take all these data sources and ingest it all, enrich it with AI.

And ultimately kind of give insightful information quickly for these medical folks, these medical affair folks to make decisions more efficiently and faster.

46:26

So it it basically takes like I always use the example as like of safety when I do a lot of demonstrations of our product for customers.

And I always use safety as an example.

Like there might be a safety concerned around a certain product with the company.

And it might be over here, over here or here, documented here, here, documented out of Congress at a conference, whatever it may be.

46:45

But our what our application does, instead of you having take all the information, meet with your team to kind of go through it, Oh, is this a real safety concern we have to address or is it something we need to like put on the label this and that our our system can kind of come through all that data and kind of give it within seconds, give it give kind of educated like recommendations.

47:04

And now we often say a human's always involved with this.

AI like human has to validate it.

But in that regard that's where it's like time, money, energy, like even for new indications of drugs like there could be all these off label users across the ecosphere and our system can kind of bring that all into one place.

47:20

And they could be like oh, a lot of physicians, a lot of KOLS, key opinion leaders across the country or across the globe are using it for this.

Why don't we do look into doing some studies for that and see if it's valid, valid, valid be a valid indication.

So things like that.

In terms of AI, now AI across the landscape has exploded, which I joined this company a year ago ChatGPT blew up about.

47:39

Eight months to a year ago to the mainstream.

And that has blown things up, because now everybody hears AI, they think ChatGPT, which we do some things not like ChatGPT, but we do like plain language summary where we summarize different pieces of medical information, make it more like readable on a. 8th grade level rather than you need a PhD to read it, things like that.

48:02

We do some really cool things like that.

But I think with ChatGPT blowing up like it did, it really opened the doors for all these companies especially in the farm and medical and healthcare to look at AI have initiatives like there's a lot of people I know that work a lot of these companies that say OK we need to look at the AI space and what can we do, where could it fit in our business, not necessarily our company here but like anything.

48:21

And that got me thinking when I was talking to a couple folks without, like, sleep Apnea's machines now being an engineer at heart.

The V paps, for example, the way these these, these or a paps for example, you know a lot of times they'll see an event and they'll make an adjustment after the event.

48:38

Whereas I look at AI if you bring in if you really if they focus on changing the algorithm of the machines to have AI involved where it can anticipate events like to like decrease system in in in breathing rate or things like that or other things you can whatever it may be and have the AI trigger then that makes.

48:56

That makes a an APAP extremely possible and work and work the way it should.

I mean, at least my understanding of it.

I mean, I understand you can titrate, you kind of get your exact pressure, but that's the way I look at it.

And because I see AI in another company I worked at work with imaging that's big in radiology now, where if you take a subset of millions and millions of, you know, breast cancer patients, you're looking at those images.

49:20

And the AI can come through an image and say, OK, this might be something.

This is not something because we have a reference point of millions and millions of images we're comparing against in real time in seconds rather than now, the radiologist says, hmm, maybe it's something.

So it's AI is really and it and it's it's growing exponentially, right.

49:36

It's it's crazy how fast it's moving, especially being in a company with AI and seeing how other companies are looking at different things across their business.

And there's going to be really.

Cool things to come out of this.

I think that's going to benefit you ultimately benefit patients.

I think as long as again back to our money conversation, the way you know things drive healthcare, as long as you know companies make the right decisions and they really make it truly beneficial to the patients which they all say they do and I hope they do.

50:03

I don't want to be jaded about that, but I think.

You know there's there's a lot of room for growth there, but I I mean it's it's especially in healthcare that's a big space for this because it can really benefit in a lot, so many different ways.

I see it like I said like what we do here and there's so many other places to kind of apply it to.

50:23

So it's and it's.

I mean, I'm really interested to see just how it's going to affect.

I mean, I've already with Enzo data, like using AI to make it much quicker to score sleep studies.

50:39

I mean that's Yeah, exactly.

You know, it's going to it's going to be a huge change.

And I think a +1 because I think a lot of people worry about, you know, like I'm going to be speaking to a conference with sleep techs next week.

And I think that my message for them is always it's it's not that it's this negative thing where and suddenly AI is going to take away your job.

51:06

Because my hope is that then those people will be redeployed into one-on-one patient education and help with CPAP, which is what we really need.

Like I'd much rather have a sleep tech sitting one-on-one with a patient in a CPAP clinic explaining these are some really common problems, this is how to overcome them, These are some accessories you might want to use and just all these things that people deal with alone.

51:34

And I think that, you know, having the one-on-one help would be a way better use of those people's time.

It's it's exactly how I explain when I do presentations with clients like some of these companies are gun shy about like it's going to it's going to take my job and that's not.

51:49

It's actually going to make your job.

You're going to be so much more valuable now because the way we position this, and it's true, is those who embrace it, they're going to have a lot of the grunt work upfront, work done.

Like for sleep tech for example, they'll have, they'll be handed a basically a sleep tech that's already read.

They don't have to go through it and keep that painstakingly time.

52:06

Now they have that, but you still need a human.

To kind of send to another human and shack and make sure there's no, I mean it's not perfect AI, but it it might And then yeah, I think that their their accuracy is like 90 something percent, right.

So it's not 100%.

So you still need a person involved.

52:23

But.

And it never will be.

I mean it.

It probably will never will.

But if you have that person like you said, then it comes down to you can spend more time educating the patient and really explain to them exactly what this means rather than spending half of your time or 3/4 of your time actually scoring the study.

And then go into the patient and be like, OK, try this mask.

Yeah, yeah.

52:38

You have.

HI.

You know, and they're and they're pressed for time because they're seeing some patients.

And the sleep techs, I mean they take the brunt of everything.

That's where it's almost like nurse practitioners or PAS in the offices or respiratory therapists for that matter.

I worked with a lot of those in the past.

They're the ones that are really patient centric and they're the ones that mean everything that people like Jason like.

52:55

I can't say enough about him.

Like he spent hours with me.

I would never get that.

I would never get that kind of time and experience in a in a medical practice anywhere in the US unless there's more of him out there.

I'm sure there is.

People have pockets that that do that.

There's not that many there.

53:11

There's a few people, but there's not that many.

And honestly, I think we need a lot more people doing that, especially by telehealth, like able, you know, able to advise people in their own homes and actually see like this is what I'm using, this is how I'm paying on.

53:28

Like, you know, I think that there's so much that we could do with that for sure that would help people.

So is there anything else that that we need to touch on before I let you go?

I mean, I think, I think that's it.

It was, it was great kind of speaking with it because I was.

53:44

I'm a big fan because I I again, I started with that.

Some of the doctors you have on, especially some of the podcast you have about anxiety, because that was another thing too, My anxiety.

We didn't really talk all about that.

And we didn't talk a whole bunch about your feelings around your diagnosis.

53:59

And yeah.

Yeah, it's one of those things where it's the biggest thing I take away for that is in a short version is I had a daughter 3 1/2 years ago and I'm 46, my wife's 44, so we had a bit late and ever since we had a kid, it's like.

I became hyper focused on trying to stay alive forever, really, because he's so young.

54:19

And so that's kind of once I got to sleep out, if it's going to help me live longer, then I'm all for it.

Whatever it is, I'll do whatever, you know, I'll do whatever it takes.

That's kind of what.

How's the anxiety now?

Much, much, much better.

I've always been a nice person in terms of like being a perfectionist and being prepared.

54:35

Like I do a lot of client presentations for work I do.

I do like talks, like public speaking in terms of like things with athletics and things like that.

And I used to get to be a mess, like a real mess, like, you know, pretty common for folks.

But I would get to the point where I get like stick.

And that's completely gone.

54:52

Not that I mean it real, I mean it's been gradually decreasing as I got older.

Anyway, I think there's a combination of things there like where you actually just start to realize like you know how many people are really listening to you sometimes but but but but but ultimately I think it really has tapered off a lot in terms of like it's it's small it's small changes over the course of months rather than like it didn't happen overnight.

55:13

But I noticed like you know just having conversations like bigger conversations and it it's it's dramatically improved which I I I'm hoping it continues to.

As you know, I kind of get dialed in 'cause like you said, I'm still.

I'm seven months in.

I've learned that you're a newbie.

55:29

I am a newbie and it's like you know, you try to stay 16 years.

I heard that on I was like 16 years I was like but that's you know you the biggest thing for me is like the the compliance rates I totally understand and and it's funny, I was saying this to my wife the other day I was like.

55:46

If I was, if it was 20 years ago and I was just getting on baseball, I would totally try to be certified as a sleep tech right now.

If I knew what I knew, now I would totally.

It was right on my eyes, 'cause I like coaching, I like teaching.

And I think it's it's so undereducated.

Folks like, I look at my mom, I look at older folks, like how much I know how complicated is for me.

56:04

Like, how complicated is it for elderly people that really are diagnosed in their 60s and 70s?

Like, I don't know.

I don't know.

I mean.

So I think, and I think the technology, what I'm excited about is the technology's gonna change in the next.

I looked 20 years ago.

I looked back at like research and stuff and videos even, and where CPAP was 20 years ago, even 10 years ago.

56:23

And with wearables being such a big thing now and things like that, yeah, I think so.

I keep saying this, but I really think that wearables and home sleep testing is gonna.

Change the game, do you think about?

The wearable going to like Merge in the future.

Oh, they are.

56:38

And we're going to just have like an Apple Watch or an Aura ring, say please see your doctor and get, you know, a test for sleep apnea or this is how many events we noticed.

And that puts you in this range, go and get diagnosed.

You know, like, I do think that's going to be a really huge difference.

56:58

So listen, I could talk to you like for hours and.

Hours, but thank you so much for joining me.

I appreciate it.

Same.

I appreciate it too.

It's great.


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