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Episode 92 - Ken Hooks - AHI Too Low for Sleep Apnea Diagnosis...Now What?

1:06

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

So I wasn't sure if I was actually going to get this episode finished in time but I think I've just about managed it.

So I just came back from three days in Orlando with my eldest daughter, Katie who was playing in a volleyball tournament so it was a really exhausting few days.

1:33

It was really fun, you know, and they played really well and the girls had a lot of fun but for me it was very tiring.

Um, so I had a couple of well-placed CPAP naps there in between some of the games, so I made it through but it's going to take me a couple of days just to kind of reset.

1:52

So, on to today's guest today, I'm joined by Ken hooks.

He's the founder of true Sleep Diagnostics based in Greenville, South Carolina and they offer home sleep test for providers and also via mail order.

2:11

He is a registered respiratory therapist with 10 years of experience and the registered polysomnographic and technologists.

Not sure if I can really pronounce that.

And for adults and Pediatrics with nine years of experience, he's the former sleep medicine representative for Bon Secours.

2:33

St.

Francis in Greenville South Carolina and former Clinical Director.

And instructor of the Ali, Salman a graphic, technician course, at Greenville Technical College.

So one of the reasons I was really glad to have, can come on the podcast was that I'd heard from a lot of different people like myofunctional therapist, especially that if they have clients or patients who have had a sleep study, And they've been told you're a chai is too low for a diagnosis of sleep apnea, they will send that patient to can and he will either do another sleep study or he often can just look at the sleep study, that was already done and he's looking for slightly different things.

3:32

So he gets all into the nitty-gritty about this.

But one of the things about a diagnosis with sleep apnea is they've picked.

Picked this is a certain level that insurance will pay for you know, CPAP treatment of a person if they have a high enough ehi.

3:50

But it's not looking at things like upper air resistance syndrome, which a lot of you know, young thin fit women and have where they don't have a high enough hii for a sleep apnea diagnosis, but they very much have a lot of the symptoms.

4:10

And That you know, they're super tired and they really are looking for treatment so and we get definitely get into all that and about how there's other parameters that are in sleep studies but but we're not looking all the data often when making a diagnosis of sleep apnea or not.

4:31

So I think I was really grateful to Ken for coming on the podcast to explain a lot of this and so I'm hoping this will be helpful especially Really for people who have been told, they don't have sleep apnea but they know that there's something wrong with their sleep and they have a lot of the symptoms.

4:49

So without further Ado, here is my conversation with Ken Hicks So Ken, welcome and thank you so much for joining me.

Thank you, thank you for having me.

So I have heard your name a lot over there were like that ever since I started doing this whole stuff with sleep apnea mainly for my approach to a therapist but particularly so my friend Kaitlyn Shrum who is here in Jacksonville Florida.

5:19

Okay he was always like whenever we would talk about clients of hers who had Add a test for sleep apnea and it has been negative.

And they kind of been told like, you know, you don't have sleep, apnea, you're fine, go home, she would always say, well, you know who you should call, you should tell them to go and speak to Captain Hook's.

5:41

So, that's kind of, like, what I think of, when I think of you.

But I'm interested to just kind of get in, to talk to you a bit about what you do.

So do you want to start by just telling us where you are in the country and a little bit about your background?

Grind and how you got into sleep.

5:56

Yeah.

So I'm in Greenville South Carolina and I hum was a respiratory therapist and when I was graduating coming out of school, there wasn't a opening for a sleep lab.

I thought I'd go check it out.

Just kind of diversify, you know, my specialty and I ended up loving it and really is because I was lazy, and I could just sit down and watch to patients all night.

6:19

So, glad I ended up really, really loving it.

I had a better connection with the patients.

More so than I did in the hospital and then one night I saw a patient's EKG completely changed, my put therapy on the moment that open my eyes and so I wanted to do more putting CPAP on them.

6:36

Yes, yeah, yeah.

His, his EKG look pretty bad.

There's a lot going on.

And then after putting CPAP on them everything cleared up in his heart look.

Fine.

And I thought that was extraordinary, you know, as you never really know until you see it.

6:53

Yeah.

And So then I want to do more and I moved to Greenville to manage to sleep labs.

And I met my mentor was a dentist and he brought me into the world of facial architecture and how that makes a difference.

And actually he's the one that kind of pushed me, proud of me into looking more into a sleep study, versus what we normally have in mainstream sleep, which is at me and I'll pop Nia.

7:22

So that's really where it started.

He introduced me to all of right back.

Yeah I feel as though I talk to so many people with sleep apnea all the time and I feel like we're focusing all the time on a hi and what that number is.

7:40

But there's so much more on the sleep study right there.

Is there is so we're gonna got totally into that.

Do you have your true Diagnostics?

Mainly that is your own business, right?

Yes, yep.

So When did that start?

7:55

Like how did that come about?

What what needs to did you see out there?

Yeah, um so was my mentor.

He I was actually trying to get him a position in the hospital to do, dental sleep.

And so I created a whole business plan for him and all this stuff because I believed in, you know, what he was doing when he was showing me and then kind of what are you?

8:15

It also you saw like anybody can see easily that we desperately need more integration for patients to Offered all of the different options that might suit them.

Yes!

All that.

And you're like, how do we get that happening?

Yes.

8:31

Yeah, I was trying my best to do that and it didn't happen and he was trying to send patients to the hospital.

The hospital was just like, no thanks.

Yes, pretty much.

Yeah, pretty much.

Yeah, and they were like, no thanks.

Oh, that didn't work out.

8:48

So what I ended up doing was just trying to get a relationship between him and hospital where they would send him orders for All Appliance, but they wouldn't because he, when he didn't want to network with insurance providers or payers, and as I've grown, I've learned that we could do certain things Gap waivers and things like that too.

9:09

But so, they didn't end up doing.

And I said, well, I think I'm going to start something because there's a piece missing, if a dentist does want to get into this, he doesn't have an easy route into medicine, and the guys have met And don't look at any other field of medicine the same.

9:29

So I started changing, do you think that acceptance of oral Appliance therapy into medicine is changing or no?

Like, clearly has to happen more quickly, but I feel like it's starting to change but yeah, it's a, it's a weird space because it's as far as Orthodontics has come, as far as Appliances and things like that, mainstream medicine or sleep is just kind of at the beginning.

10:00

So, just like the original oral, Appliance is kind of where they are now.

They're like, yeah, you can pull it out and that'll work, but the advancements that are made the outside of the hospital and Medicine are far superior, you know, they're far ahead of the time right now, so to take a while to catch up, but there's starting to be a little bit more.

10:21

Focus on that.

Yes, I I definitely am seeing things be like, change being driven by patients.

Yeah, yes, the ones getting educated about what the options are and asking for them.

10:37

And I think like that eventually has got to change what's being offered to them?

Yes, yes, definitely help.

It is, I mean, I really think patient-driven medicine is, is the way to be if you're strong and you're Nation with what you want to have done.

10:52

And your knowledge base that goes a long way, even with insurance providers and it just changes can be made.

If you are like, I don't say on it, but if you stay on top of everything.

Yeah.

Yeah.

11:08

And so when you started out, did you start out with offering home sleep?

Testing for people, one of my best friend's is my functional therapist and we kind of partnered up and she was really helping me kind of get a methodology to the way the business would run once covid.

11:26

Hit, I just went full force on the home sleep test.

Yeah, which I feel like, in some ways, some of the positives to come out, covid are like, it feels like that gave telemedicine and home, sleep testing and and anything where you didn't have to be in person.

11:44

I kind of boost.

Yeah, definitely telemedicine before Cody was something, I was also trying to integrate into our sleep system at the hospital and they Insurance payers were like we're not paying for anything to him.

I mean it was in South Carolina, it was kind of slowly slowly catching to a Where we actually have billing codes for it but no one reimbursed for it until covid have.

12:06

Yeah, so that was good on that front.

That's awesome.

So here's what I want you to speak a little bit to about.

So I talk to people all the time and who are usually women but can be anyone, but a lot of women especially kind of women in my neighborhood because they can and know that I'm like the sleep apnea snoring lady So I had like recently, I had one of my neighbors who said to me oh what should I do?

12:38

I just went and had an in lab sleep study, they said nothing to worry about your age.

I is, I mean, I think she's you know, was under five anyway.

And they but then they sent her home, right?

And they're kind of saying nothing to see here.

12:55

Like anything under 5 is normal.

Yeah.

Oh, can you explain?

Because I talk to me.

All the time and they're having really quite severe daytime sleepiness and other symptoms.

But when they're going to the doctor, the doctor saying you don't have sleep apnea because they're not fitting this narrow test.

13:14

So can you explain a little bit to people listening about what that what they're looking for?

And what like what the test is that they're looking for, for it to be sleep, apnea.

And also just I just want you to talk us all through all of Of that data honest, sleep study and like what you can actually see is happening with people that maybe we're not aware of because you're just told you're a chai is really low go home.

13:41

Yeah.

So insurance has to have requirements for which they reimburse for therapy.

They chose a chai.

The think maybe 15 years ago already?

I was the score.

They used respiratory disturbance index.

So with that you would have apneas and hypopneas and airflow Imitation lead into arousal.

14:03

So many people qualify for sleep apnea.

The requirements change to a chai, which less people qualify for that.

Push you in a certain demographic where you're going to probably already have.

Comorbidities you probably already have kind of a wrecked type of steak architecture and pattern.

14:20

So the hi isn't necessarily the degree of sleep disorder, breathing or nocturnal breathing disturbance.

It just is a diagnosis of Rarity of what they feel is sleep apnea.

So really the patients that will have sleep apnea.

14:39

I don't like it.

I don't and it's You know, it is a business medicine is a business.

And in this one yeah, it is kind of course, like, you know, it's not like doctors do for the good of their health, their they're paid but it's a very different system from the system we have here in the United States, like it is definitely run like a business.

15:08

Yeah, it definitely is and so if we look at the Way reimbursements are.

If you go to a physician and you have a sleep study and you're a child, doesn't fit the requirements of sleep apnea is a diagnosis.

15:24

The Physician doesn't know what he can do for you, because anything, he does, you're gonna have the cash pay.

You won't have insurance reimbursed.

So to him is done.

Our to her is done.

You don't have a Hi-5.

There's nothing I could do for you or you have a child 5.

15:40

What do you want to do?

You're probably fine.

I can give you some Edge to I can put you to sleep and I can keep you awake.

I can give you Adderall or something for focusing attention and stimulant to kind of keep going during the day and I can also give you something to put you to sleep.

15:56

So in the instance that you do have a nocturnal grieving disturbance and is hard for you to go to sleep or stay asleep, but we can make that happen with medication.

So actually addressing the problem, right?

That's right, that's right.

It's the a Band-Aid or mask.

16:13

That's put over the So if we take a look at a sleep study and we have a patient with the HIV 0, but they have 100 arousals.

And they have airflow limitation that leads to these arousals.

16:28

And their pulse rate is spiking all night long.

That looks exactly the same as a patient that has moderate to severe.

Sleep apnea.

Exactly the same.

The pulse is the same, their Rivals are the same but the outcomes are different.

So we are behind on the Fact that there still is a problem there.

16:47

You know, we really should look at the way the physiology reacts to what's going on during the sleep.

Not necessarily the numbers that are there for sleep.

You know?

That's cool.

So I feel like this is just, I mean, it's not all about me but and this is this is probably a lot to do with like that, it's my experience, right?

17:08

So I always kind of come back to this, but I just really feel like we need to like asleep.

Specialist the Nativity in this Arena, we need to listen way more to What patients are saying because I feel like, especially with my most recent sleep specialist like and and fair play, like, I would hate to have me as a patient like so I get it but, you know, I go to him and I say, you know, like my you know CPAP compliance is perfect like where my CPAP every single night all the time.

17:44

My H.

I like, you know, is really low.

He looks at the numbers and he is just like, this is amazing, great job.

And this looks so good.

And, and I do well and, you know, and I'm saying, yeah, I'm so really tired because I, and I think a lot of - to do with like this arisal threshold of the, it really doesn't take very much to wake me up, right?

18:09

So I think that it's one of those things where there's a lot of doctors kind of going, oh, Well, I did a good job and what more do you want from me?

You know, like when you're saying.

Yeah, I'm so tired though.

Yeah, I mean that's the line of question is, are you wearing it?

18:26

Okay, let's look at the report.

Yeah, it looks like you're wearing.

It looks like everything's down but that really doesn't tell the tale.

And I there's a Blog that I wrote on my website where a patient was on CPAP pressure of 84, maybe for years but he still was falling asleep at a like his Apnea was controlled so to speak.

18:47

So we're going to do a multiple sleep latency test on to see if he has narcolepsy.

And in order to do that, we'll even see tasks for people listening is the daytime portion.

So most people are familiar the listen to this because it's all about sleep apnea is the nighttime, sleep study.

19:04

But then the MSL T to say it right.

That's right, that's right.

People then stay there and then they it sounds awful.

But they Basically take net multiple naps and they guess, you know, that they're looking for how fast they fall asleep.

19:20

Essentially.

That's right.

That's right.

I saw the normal.

It used to be six minutes was normal.

Anything less than six minutes will be hyper somnolence, but it has been changed to eight minutes.

So, eight minutes is the normal amount of time to go to sleep.

But so he comes in and course he has to have the night study.

19:38

We have to make sure the apnea is controlled, which is Asia is zero.

And I'm going through the study and I see all these Rouses.

I see, all this airflow limitation and in my mind I'm thinking limitation is, I guess a narrowing of your anyways.

19:54

So it's not, you're not getting full like the amount of oxygen.

You're supposed to be getting, so it kind of varies because if you have a hypopnea, you'll have a reduction in oxygen saturation in your periphery, but you can have airflow limitation and your oxygen saturation, doesn't even move it kind of pens on your heart rate, variability.

20:14

How, you know, how?

Well your heart is pumping because the heart will take the brunt of the problem.

Pulse rate is the most important statistic on the sleep study because the heart will change to give more oxygen to the body as it needs to.

Now, if there's a continual Airway narrowing and you can't even get air in, then the heart doesn't have any Oxygen to pump out.

20:35

So things will start changing then also in this is kind of get a little Louise but if your nasal architecture is off, And the back pressure that keeps the lungs little air sacs in the lungs.

Open.

If that is off, then you potentially can have a lower oxygen saturation because there's not enough pressure to keep all of these little air sacs open.

22:26

So in this instance, he had no D saturations, but he was arousing all night long.

So of course I'm thinking, of course, you're tired.

And the way that we would fix it or should fix, it would be to put him on a BiPAP so we can stabilize the airway.

We never think about, if you put a full face mask on a patient that pressure that's coming in has to fight everything here and it has to fight the tongue to get down the airway.

22:50

Yeah, the nasal mask is always the way to go because it goes behind the tongue but So things can change, if you sleep on your left side of your right with the tongue moves.

And now the pressure has to push the tongue, may push it back in the throat.

So he goes, He we do that study and I'm run over to the physician.

23:09

I said, hey look, I mean, I we really shouldn't run this test because I understand why he's tired.

We can look at the study together and he goes no running running.

Anyway, so we run the daytime and the nighttime.

We ran a nighttime study right?

23:26

Make sure.

Yeah.

Six hours.

Yep.

Yep, sleep.

And so the next day has come and I'm in talking to the patient and so he's going to have five naps and in those five naps, if you fall asleep in less than eight minutes and all of them, you have hypersomnia means if you have two naps, where you go into REM sleep, that's one type of narcolepsy.

23:53

And so, What they're doing is trying to see if they need to give him medication or stimulant to keep him awake.

During the day is this is despite him having trouble at night.

So we run the test and this is kind of give you an idea of the landscape, and I don't want to call any Physicians out, but the physician called and said, okay, we shouldn't even have done this.

24:15

We should have gave me medication from the beginning, because why did you put CPAP on them on the MS?

LT.

Well, you're supposed to tell a patient.

Any time.

You take a nap?

You wear a seat.

Yeah.

So, this is part of the guidelines from.

Yeah.

So I said, Hey, listen, we put him on, bypass will fix all this.

24:33

Nope.

No, no.

Just throw this test away and we'll give them will give them medication so just looking at sleep as a whole because because his H I wasn't high enough and they didn't think the insurance would pay for it.

He felt like we should give him a stimulant because he was still tired, even though his sleep apnea was quote-unquote treated.

24:56

Yep.

And so if you take that instance and you take the CPAP away, then we do have the patience with the upper Airway architecture.

Deficiencies and airflow limitation is exactly the same.

They have exactly the same size of the symptoms but because they don't fit the mold of a sleep apnea patient.

25:16

They'll be giving medication or saying everything is fine.

Despite what's going on with their life?

So why are you in the position to help you sighs?

I guess what I'm trying to understand is so for a person with a low ehi who their doctors saying you don't have sleep apnea, you know, you don't you nothing to see here.

25:39

You don't need any treatment.

What can you do?

So I think one of the things you do is look at people sleep, studies to give like a second opinion.

Is that, is that right?

Can you talk a little bit about how that works?

Yeah, if you had a sleep study anywhere before and no one explained anything to you, or I do do a lot of kids, if your son or daughter has had a study and, you know, something is wrong.

26:04

But the sleep study doesn't show that or the interpretation doesn't, then we'll review the study together.

So I'll get the study, I'll make notes, and then we'll come together and review everything on the notes and how it relates to that sleep study.

And so that helps to explain what's actually going on.

26:22

And and then from there, like What treatments are available, are you putting them in touch with dentists or what then happens.

So my function therapists are always my first line because it's that portion is out of my scope.

26:39

I know that they are peas that are out there, but it's out of my scope to recommend one of the other.

So I do the test and I see what's going on and I can kind of give you an idea of what the face may look like where the problem may be in.

Then I'll say Hey listen either go back to your provider, which will be a dentist or my functional therapist, or let me recommend them are functional therapist for you so they can do an assessment.

27:02

And they'll have a better understanding of where you should go next for therapy.

And so, oftentimes, you're looking at kids are you where they can get into some expansion and functional therapy and all these different things?

27:18

Yeah, a lot of kids and a lot of women too.

A lot of women and so for people with upper are reverbs resistance syndrome, join explain a little bit about that.

Do you see a lot of those women?

Yes.

27:33

Yeah, I'm here from a lot of those women.

Yeah.

Yes.

Because I think the stereotype of what a lot of medical professionals are looking for for people that might have an airway issue or have sleep apnea, right?

27:50

So this right they I've talked to her A lot of people with those kind of issues who have really gone to doctor after doctor and they're not getting anywhere and even if they manage to get a sleep study, then they're just told to go away because they don't have sleep apnea.

So can you explain a little bit about what upper air resistance syndrome is and how it might show up for people?

28:12

Yes.

So we're supposed to breathe in, through our nose and the flow is supposed to be laminar, just a nice smooth flow.

Coming through the nose, going straight, down to the lungs.

If there's any sort of impeachment of that are obstruction, so we can have, you know, a large turbinates deviated septum.

28:30

There's congestion that can block this airflow from coming in.

You may open your mouth to breathe in out of your mouth.

But if there's something wrong up here and if the tongue is kind of hanging out in the airway, for instance of a patient, has some chin recession or retrognathia, the time is going to be closer to the back of the group.

28:49

If the mouth is a little bit smaller or the Roof of the mouth is vaulted and tongue didn't have space to actually fill them out the way it should.

It'll just hang out in the airway and so there's a partial obstruction already there as that air is trying to come in is being blocked.

29:05

And so the body now goes into, it's fight or flight because he thinks you're in danger.

You're not breathing the way you should.

It's going to take action.

The pulse rate of Spike things will start to shut off.

Things will change as that goes on.

So the upper air resistance is anything in this upper Airway from your epiglottis on up to you.

29:22

Those that may impede the natural flow of air coming into the body right on.

And so, because that doesn't necessarily show up on a sleep study, as a high h, i often times these people are just going without a diagnosis, right?

29:40

Yes.

Yeah, that's right.

And so what again, like?

So with those people as that similar, your just advising them to, you know, start with myofunctional therapy or go to other providers that It can help with that.

That's right yet.

My functional therapy is extremely potent.

29:58

I don't know what other way to describe.

I mean, it it works tremendously.

Well, just the basis of, if you do any consistent with it, I've seen numerous patients have physical changes, as well as physiological change, so that in, and of itself is pretty strong.

30:17

And, you know, if there's some other things that can be done, we can do still Orthodontics on adults, one of the things Really interesting about the interview did on the airway circles podcast, like I listen to that and I thought it was super interesting because I recognize myself and one of the stories that you were talking about.

30:37

I think it was a boy, I think it was a child anyway.

Who had had a tongue tie release?

And it was almost I think I can't remember exactly.

You need to remind me, but I think what you were saying was was that the time being released?

30:56

You then need pal expansion to have somewhere for that tongue to go.

So it's almost like it made his tongue more mobile and able to fall back in.

These are way more, you know, I'm talking about.

Yeah.

Yes.

Yeah.

You definitely sucks because part of what and you know my experience with pal expansion was and was so ahead of time I It's my function of therapy and then I did tongue-tie release.

31:27

So we waited until my myofunctional therapist was happy that you know, I had the right kind of strength and tone and knew where it was supposed to all be and everything.

And then I had my tongue tie release and it was a big old times.

I really like people talk about like a little snip or you know like mine was like surgery and it was had really been holding my tongue.

31:52

Very low down for, you know, the whole of my childhood and Life to that point.

And and so then we did more, my emotional therapy and then she was like, oh now is the time to start with the pal expansion.

32:08

So then I did that for like 15 months, I guess.

Okay.

And essentially like a lot of things went wrong, but one of the things that I know.

Is that the end was when we did more sleep studies, my sleep apnea was significantly worse.

32:30

And so, I guess I'm trying to, so part of that was a perimenopausal weight gain, which is not ideal.

And but I feel like a big chunk of, it might be that.

My tongue was just able to block my Airway even more.

32:46

What do you think about my theory?

Oh, so it is possible.

Going through therapy.

I mean, you did it the right way, you got to do my own before the tongue-tie release and then after, but there's so many factors that go into it.

33:02

And so it's hard.

It's hard to say where things may go wrong or is hard to.

It's hard to pinpoint, unless she doing scans all the time.

Like, if you doing comb beams to see actually what changes are being made?

I mean, you really would have to do a lot to see and everybody is different and I think The I think the biggest struggle that we have are there so many things that can be done but not one path is for everybody, right?

33:32

And so it's hard to this hard, I feel like that's kind of like I think that's why for me so so so I can you already know, right?

This is what's funny.

If I talking to you you already know from looking at my face, what happened to be a child, right?

33:51

You're just Looking at my big old long face and you're like Gap.

So, you know, I had that but for I feel like for people listening and we've talked about this a lot on the podcast, but I feel like for people listening who have children.

I'm always like, let me be the poster child and let no other child turn out like I did.

34:12

And I mean, no, no in general, but in facial reconstruction and and so I had like really bad allergies.

And I had a really severe tongue tie and my tongue, never rested in the roof of my mouth at all.

34:32

And in fact, when I first started my functional therapy and Caitlin was like so.

Now I put your tongue on the roof of your mouth, I was just like, what are you talking about?

Like how is that possible?

So yeah all of these things together over time, you know.

34:48

Like really?

Yeah, it's definitely like Is a lot of different factors that go into it, for sure.

It's, it is an tongue-tied as a gift and a curse for a patient that is architecture, lead efficient because it potentially is holding.

35:05

Its not PB your tongue out of the airway but it's keeping it from going back.

Yes, you know if there's not enough space in the mouth for the tongue, it's a good thing.

You know, when you release it, now, they're the tongue has all this motility Mobility.

35:21

That it can do things.

Things.

But you got to create that space, so it doesn't kind of go back.

Hey hello.

Do you want to talk a little bit about the I thought maybe you could speak to people about the kind of home testing that you do and, and like the levels of Home tests and that kind of thing, because I think sometimes people are a bit confused, especially with the more like, there's wearables and there's, there's, you know, different levels of Home testy.

35:57

And I think that can be a bit confusing for people.

So you want to explain a little bit about what happens in the lab versus what you do with with home test for people.

Yeah, so in the lab, there's about 13 leading eats on the head and face the E.

GK G, we do guys Shin for grinding, things like that.

36:15

And then we'll do two belts for respiration for effort.

The effort to breathe will have leg leads for leg.

Movements will have the EKG pads, and then we'll have a nasal cannula with two things in mind.

Nose and then you will have a thermistor for temperature change and then a finger probe.

36:32

And so with that, you get a large amount of things that you can look at on the sleep study, as far as physiological changes on a home sleep test, believe it.

And you have to forgive me because I can't even remember there's like four types.

But usually everybody is the type, you know, the ones that you do this.

36:54

I'll forget and almost everything traditional sleep.

Is so usually everyone uses device, you get the most reimbursement for which is the highest type.

So you'll have air flow monitoring, you'll have effort and you'll have a pole, I think is 44, different monitors, pulse, heart rate, air flow, and then effort.

37:14

So this is one with a cannula up your nose.

That's right.

That's right, that's right.

Go back down.

A bunch of different home tests at this point.

And I've done a bunch where it's just like, you know, like the watch Pat one or the or The ones that are just our tier.

Like it's just your finger or yeah.

37:31

So the one that you're actually sending two people to do at home has a cannula and bunch of different things.

Okay.

Yes, yep.

So the watch pad is getting really, really big right now.

It picks up, it picks up air flow, disturbance in the air flow, and also sleep stage and by Peripheral arterial tone, which is really sophisticated, but it's good technology.

37:55

The only thing I don't like about newer things that Automate is, I can't see the airflow.

I can't see the Dynamics of the Air Force because we don't have the cannula.

Is that why?

Yeah.

Okay, that's right.

And and I think they believe they do.

You can do something where you can look at the raw that I've never done it before.

38:12

The option is there?

But of course, no one does that because it's easy to just get the numbers back and say, this is kind of what it is.

So yeah, the watch pad is there.

There's multiple different types of home sleep test.

Like, the one I use, there's a Medi b, a lot of dentist will have I stiii a lot of dentists will have that as well.

38:30

ResMed has 12 at me Lincare, and then Alice night one is what I use.

Okay.

And so, that's a Phillips one.

Is it?

Yes, right.

That's right.

Yeah, right on is so you.

So basically people are putting on themselves at home.

So it does.

38:46

It just arrived in a box like that.

They go pick her up or you just send it to them anywhere.

Yes, so I am I was using the Postal Service.

I've switched over to UPS to have a better peace of mind.

It being delivered on time, instructions will be in there, you'll use it for one night, you put everything on, ship it back to me.

39:05

As soon as I get it, I'll review everything do an impression.

Then I'll have my sleep dog sign off on it.

Okay?

So that's what my next question was going to be.

So there's a sleep-like because my understanding of sleep tax is that the Sleep specialist is still the one that's doing the diagnosis.

39:24

Is that right?

That's right, you're interpreting.

The the tast, but then they're doing the diagnosis.

So you work with the sleep doctor?

Who can do that?

Yes, yes.

Oh, I mean I'm yeah it's been it's worked out really well for me because I have some guys that really believe in what I'm doing and they step outside of their practice in the hospital to sign off on what I'm doing and so and in the hospital it would just be asleep.

39:54

Tech would it?

Run the study?

They were score the study and then they pass it.

You know, there's nothing that they're going to really say that position would say anything but in my instance, it is, I do everything, impression everything and then the C physician will Overlook everything and make sure I'm not crazy.

40:10

And say yeah, yeah, it's good and sign off on it and then we're good to go.

That's awesome.

So, do you want addressed and finish up by just kind of talking a little bit about how people can work with you and like what kind of people you know you work with?

40:27

And like had nothing get in touch with you about kind of thing.

Um it's all my patients come from either, dentist or myofunctional therapist and they either come through the website or the provider will send an order and and then I'll fill the order.

40:44

There's a few offices, there's one in Texas, one in New York or New Jersey.

And then new one in New Jersey and office in Charlotte North Carolina that have devices allotted to them because Do so many and so, wow, I can work with someone that way, where if you do a certain amount of month device will be a lot of to you.

41:06

And I like that more because there's better pay as you control that way.

Yeah, I run into problems all the time with patients not return in advice on time and that kind of sets us back a lot of things.

So that's really a.

You go to the website, a direct referral from provider.

41:24

It can be anyone.

I just work with the majority.

Dentist in my professional therapist, occasionally ents, you know, every once in awhile, but the majority of them are.

So if people are listening and they recognize themselves like they've either, you know, had a sleep study, but they, you know, like didn't really get anywhere with it because they were just told, like, you know, they know that they have a problem, but the, you know, doctor was just like, you don't have sleep apnea, they could get in touch with you through the website and If you look at that sleep study or have you do another sleep study?

42:01

So I think what I'll do is put a link in my show notes so that people can find you that way.

Okay, thank you.

Was there anything else you wanted to chat about or mention know, if you think something's wrong, you're not crazy, no matter what they say, something really is wrong, and especially, I feel like people, with, with their children.

42:23

I especially think that, like, if you think there's something not right with your Child's sleep.

There's something not right with your child's sleep.

That's right, that's right.

And I feel like that's why I'm here is I'm here for backup and I'm here as proof and you know I don't provide any therapies, I don't provide any treatments or anything like that but I will provide you with proof and backup and whatever you need to for your case to be Well, that's great.

42:51

Thank you so much for the work you do now.

Thank you.

Thank you.


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