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Episode 94 -Dr. Jill Ombrello-Developing Healthy Airways in Kids & Oral Appliance Therapy for Adults

1:06

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

So before we get onto today's episode and I just wanted to update you guys on the shop section on my website, has another affiliate link for you guys and it has a discount when you order with sleep play.

1:26

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1:45

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2:10

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2:29

It's down there in the show notes and you can go any time to sleep apnea story.

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2:45

So I really appreciate anybody using any of those links.

So, on to today's guest today, I'm joined by Dr.Jill ombrello, who is a dentist in Dallas, Texas, and I just love her.

3:00

I wish I lived closer to her.

I think we would like have a real giggle if we got together.

I think you'll really enjoy this conversation, she talks all about different, you know, patients that she's had and and some really interesting stories and so briefly,

3:18

Dr.Jill ombrello and is a holistic Family, Dentist, certified, functional medicine practitioner and a special needs Patient.

Advocate.

And her special interests include holistic, health, sleep, and Airway management early Interventional growth and Development therapy.

3:36

Collaborating with like-minded health care providers, including pediatricians ENT Physicians, chiropractors and nutritionists functional medicine.

Doctors and many more.

So we talked all about the need for collaboration and I just really enjoyed our conversation.

3:53

I hope you do too.

Here's my conversation with Dr.Jill ombrello.

I'm fangirling a little bit because I follow you and I've heard so much about you.

So I'm just so so honored to get to chat.

So thank you.

Well thank you so much for joining me was what I was going to say.

4:10

I really appreciate that.

So M I feel like oftentimes when you're podcasting you put all the stuff out into the world and you just assume that everybody is listening to every single episode and they're not.

So every time I do an episode on a different treatment option, I get a ton of people saying, I don't really even know what that is in the first place, so I want to be sure to not get ahead of myself.

4:38

So I wanted to start by just I've done some episodes on oral Appliance therapy before but I just hope she could start from the very basics for anybody who hasn't even heard that.

That's the treatment option for sleep apnea.

4:53

If you could, maybe tell us a little bit about what oral Appliance therapy is start from there.

Absolutely, well, I think that's a really great point because as we get Start talking about are development and snoring, it all of these symptoms and which, which appliance do you like?

5:11

It is a bpa-free we can get so overwhelmed.

We forget that, just sometimes the mom off the street or, you know, as parents were so overwhelmed, at least for me as a mom, I'm so overwhelmed with information, let alone, disinformation stuff, that's not even, right?

5:28

That I'm, you know, it's hard to know where to look or if I'm if I'm even interested.

So I think it's important if we really get Back to Basics.

I think it's important to understand maybe a little bit about my background and why I landed here in this.

Yes, base great.

And then I'm a fourth-generation dentist.

5:43

And so I had the privilege of being treated by my father in the 80s as a child with removable oral appliances to help fully develop my upper and lower jaw.

And in the eighth and when we were doing that, it was really as an alternative to braces.

It was for yes, whole body help.

6:01

But but my parents challenges in the 80s of raging children are quite different Then the challenges.

Now we have in 2023, part of that has to do with the water sources with the quality of food with the electronics, I grew up thankfully in a Cell for cell phone free childhood.

6:18

So, yes, I was, I benefit from these oral appliances in the 80s to prevent having to have braces, who wants metal braces.

But what happened long term is that I do have a fully developed are way.

I sleep beautifully, I go to bed at night.

I wake up in the morning with a Fresh brain.

6:36

I would like a cup of coffee because it's fun, just how you're able to have four children and righty isn't exactly.

And I'll tell you this life is so good.

I actually got a puppy.

So like what planet right what planet does that makes sense?

But I, you know, I enjoy a cup of coffee but I don't need it.

6:55

And as I am, you know, looking at my mom friends who are my, you know, for 30s and 40s and I'm seeing how they're functioning it is.

Concerning because like I said, I sleep beautifully and I'm barely making it.

7:11

Let's be honest, right?

Luckily I only left one kid on a curb last week I only forgot to pick up a kid one time, right?

And that's just because I was an organized.

Not because I'm tired.

So it builds a lot of empathy within me looking friends.

And I'm like, how are you guys doing this?

7:26

Not only that before I even had mom friends before.

I was a mom, I had three children, very, very quickly.

I have three kids in three years.

Wasn't exactly the The plan but that's what happened.

And we knew we wanted a big family, so there we go.

And I saw my own children start start to compensate for underlying root causes, so my daughter was having night terrors yelling in the middle of the night.

7:49

My son was mouth-breathing, I'm seeing these symptoms and I'm looking for Solutions, and I'm being told by the pediatricians that I had partnered with and trusted.

And by ents that I've trusted, I'm being told by my trusted group of people that, you know what?

8:05

Totally normal, they will grow out of it and what became frustrating for me as a parent is no, I don't want to wait until they grow out of it.

I don't want to wait till it gets worse and then have to do something more aggressive or invasive to correct?

8:20

The problem.

Listen, I'm I am a ferocious Relentless mom who wants the best for my kids like right now, I don't want to wait for something better.

So I think that one my own personal journey and not having Going to deal with this as a child but still having to, you know, compensate work hard, just because life is life, is hard.

8:42

I mean, it's beautiful and I love life, but it can be challenging.

And then you partner that with some of the challenges that my kids have, I really just started to become obsessed with root causes and I found, you know, a lot of some of these root causes originate within the oral cavity within the upper, and lower jaw.

9:02

And so I became more aware of that I started.

Asking different questions.

I started looking at children in a different way.

Gone were the days that they had cavities and I just shook my finger and said you know brush your teeth floss your teeth eat better, right?

We had some violent at the benefit of meeting.

9:19

Some really, super healthy patients, their have low inflammatory diet, sugar-free gluten-free dairy-free.

God bless their mothers, Right For Preparing that and brushing their teeth and flossing their teeth and using the best products and still coming in with a mouth full of cavities.

So I would became Relentless and finding what that solution because of that, open my breathing and not sleeping properly at night, right?

9:44

And the reason and ultimately where I found is Hey listen, these kids are so healthy and they're so strong their ability to compensate for the underlying root cause is is incredible.

But we don't want to take advantage of that because just because they can get away with it.

10:00

Eventually it catches up with them which is really started my passion for helping.

Adults, with some of the, in stage, sleep disorder.

Breathing, that are grinding teeth with, you know, job, job, pain, and headaches and all of those things.

It's a different set of solutions.

But it's the same underlying root, cause it's just 40 Years of poor oral habits that have led them to their.

10:21

So, that's where I love the kiddos because we can actually not that they're broken, don't get me wrong, but we can actually fix them and save them from a lifetime of risk, or it gets to that stage where they get there.

So, You know, sometimes when I meet parents, I meet them all different versions of their Journey.

10:39

I'm meeting them in.

This is absolutely all brand new Concepts.

But man, it really helps them understand what their child is doing.

Sometimes I meet them, you know, all the way through their Journey, where they've gone through traditional Orthodontics, or they've had tonsils and adenoids out.

10:56

They've gone through a more traditional Western approach to helping with their symptoms.

And so, I think what's so important as as Dennis and us Spiders is that we really listened to the family, listen to what their goals are and then help align with that in a way that really educates them so that they can choose what's best for their family.

11:16

You know, the first 10 years of my career traveling the country and the world.

Quite honestly educating Dennis about oral Appliance therapy or, you know, working with like-minded providers.

Whether that's a chiropractor an ENT or functional medicine.

11:35

Listen doctor and nutritious whoever that team should be how to build that team.

And what I found quite, honestly, I am a dentist, so I'm kind of talking badly about myself.

Here is, Dennis are so overwhelmed with everything else.

We have to keep up with that.

That didn't make the impact that I wanted.

11:50

So, my audience has changed now, who I want to talk to now who I want to empower our, these moms these moms who are seeing their kids every day compensate, whether that's bedwetting or thumb-sucking or, you know, prolong thumb-sucking to, you know, five, Well, I had a 14 year old, this just this morning, sucking their thumb, whether it's people ask me when I stop sucking my thumb.

12:12

I'm like hey and like you hesitate to admit that, right?

Because there's a lot of Shame and there's a lot of maybe embarrassment associate.

And now I realize like I've been played into all that happens.

Yeah, now you realize that you're a genius, it is it is brilliant that you figured out that if you suck your thumb.

12:35

Um, and you bring your lower jaw forward, you're actually getting more oxygen into your body.

So your body can function, the way it's supposed to.

It's genius.

I'm so happy.

You suck your thumb till 10, you know, I'm sorry, you felt the shame and that's what I told.

The little boy, this morning I said, you buddy, you are a genius.

12:52

I am so proud of you and kind of saw the shame lift off of his shoulders.

Now, that being said, know that we can't suck her thumb for during her teenage years, we know that goes exactly opposite of the down word for word growth that we want of the job.

So hey, we're not going to break a habit because your instinct to breathe is stronger than anything else.

13:11

What we need to do is replace that thumb with something that allows you to still breathe, effectively and grow the way you're supposed to, because your body is perfect.

It's can compensate when it doesn't get what it needs to get.

And when you change that verbage children are a little bit more, open-minded to oral Appliance therapy or any treatment.

13:31

Whether it's appliances are not.

There are more open to what that Uncle treatment could be which, you know, sometimes when when parents are sitting too fat, and we're talking about solutions for their kids, they have concerns are, you know, will my child be compliant?

Will they wear this?

Appliance?

13:47

And what I found is just like anything else with a kid.

It takes a little bit, right?

It takes a little bit down.

Let's be also depends on the candle, I think, as well.

Right.

But what I found is, if you explain it to the child, yes parent.

14:04

I know parents are listening to me, but if I sit across with from the child and I say, hey this is how you're sucking your thumb, your rent.

But this is how I can help you.

Not suck your thumb but still feel really good.

Long term short and long-term compliance goes way up.

These kids want to feel better.

14:19

They if it feels good, they want to do it and so really helping them empowering them as kids.

Give them credit for understanding how their works is really important.

16:00

One example, I like to give a lot for kids because this tends to just kind of ring true and I say, hey, imagine if you wake up in the morning and you have cotton candy and Coke for breakfast, and they're always like, oh my gosh, that's day, right?

And like Lilah, not at all.

16:16

I said you're going to have to go to school.

You have to be with your friends, you have to listen to your teacher, you're going to have sports after school, you're going to have homework.

Imagine how hard that's going to be because you're gonna have this cotton candy and Coke this delicious breakfast about 84 T5 boom, you're going to run out of energy, you're going to be cranky, you're going to have a headache but you still have to live that day.

16:37

Now, imagine the same kid wakes up and has a healthy breakfast.

Whatever that means is that, avocado toast is that pancakes eggs, what a smoothie whatever saying kid, but just very different version.

The child, who gets that healthy.

Breakfast wakes up, clear-headed has energy all day long.

16:55

Not just for school, but for after-school, Sports and homework.

And so kids, understand that dietary.

But I think it rings true with parents to when they don't have a thorough understanding of how, you know, oxygen saturation through their Airway.

So, yeah.

And so here's one of the things I wanted to touch on.

17:12

I watched all of your videos that you did with Airway management like they have something, which I loved.

And so, one of the things you were talking about on there, which I'd never heard somebody describe it this way.

But it's exactly perfect.

17:29

As you were talking.

Talking about people needing like a quarterback of care, like somebody to kind of, like, overview the whole can you?

Well, first of all, I had to ask my husband all exactly what a quarterback did.

Because I know but he's just like, well, you know, like they're looking at the whole game and they're, you know, having to switch up plays, depending on what's Happening.

17:53

And, and I was like, that's perfect.

So, do you want to explain a little bit about that and how it works?

I didn't.

Yes, absolutely.

I it's not an international example.

You're exactly right.

So I should work on that.

But, you know, here in America where we call football, you know, American football.

18:12

No, that's not soccer.

Where where we play football, the quarterback is the leader of the team.

The quarterback is not only in charge of seeing the whole field but changing the plan and being dynamic as the plays, and as the game goes on.

And so the the quarterback is someone that Everyone on the team can trust the quarterback doesn't know.

18:33

Any doesn't know everything, but knows enough to kind of put everything together to hopefully, move the whole team forward down to score a touchdown, right?

They want to keep things moving down the field.

And so, as I started talking to these parents.

Yeah, so they've seen all the best providers and towns have seen the best chiropractor, the best ENT, the best everything and and they still didn't have a solution.

19:00

So ultimately what their issue was.

And so they've spent on fo but of money writers, kind of really talking to each other, right?

Is part of the problem, you know, there's there's always exceptions but in my experience, no one gets their, you know.

19:15

No one gets out of their kind of day-to-day Zone and opens up the blinders and said, what is actually going on here.

And so it as I'm trying to learn more when I first started doing this, you know, 15 years ago and I'm trying to learn more and I'm trying To really understand what's going on with these, especially in little kids adults as well, but really understand what's going on with their body.

19:37

Listen, there's plenty of Dentistry to do, I don't need to look for issues, but it was something that I provide isn't going to help them.

Let's get them to the next place that can help them.

I want these kids to win, hopefully, I can help them win but if not who can parents were coming in with you know, spending time spending money spending energy thinking about inviting these plans and feeling like they gotten anywhere, It made sense to me.

20:02

Okay, tell me what you got.

Tell me, everything, you know about your kid and what is working?

Well for family, what answers are still not answered.

What can we, how can we put this all together to ultimately help your kid and what I found more, I did that the more parents would look at me with these wide-eyed.

20:19

A, I can't believe you're spending this time, talking about my kid, what does their bedwetting have to do with her mouth breathing?

Well, we knows those are linked, right?

And and we have stories of patients that they were Are nor Appliance as soon as their auction is stabilized, guess what?

They wake up dry, you know what is this very nosy, dentist asking about what we have for dinner if we don't have sugar.

20:40

Okay.

Leave us alone and I understand.

But your child to say to block of cheese, that's really inflammatory.

Now, they can't breathe through their nose.

Of course, they're going to mouth, breathe.

Let's, let's put the little bounces cheese away, right?

So, there's so many different ways we can look at book, behavior, modification, and treatment options to treat that whole kid, rather than just treat the Symptom that they're looking for.

21:02

So I found parents were just overwhelmed with food that I've spend the time to talk about it.

And then, and then what I learned was is some of the top doctors, some of the people that get the most recognition aren't necessarily the best fit for everybody.

So, that really just began a tireless campaign to find like-minded providers.

21:22

So that as we're putting these, I'm quarterbacking this carrot.

As we're putting the picture together, we know exactly who to send them to to solve the underlying issues.

That they're dealing with.

And so I think that's probably what I'm most proud of and the last 15 years of sent being at Central dentist, here is creating a team of like-minded providers who ultimately I can refer to and really help provide solutions for these kiddos.

21:45

And for these parents, that are lifelong Solutions.

It's absolutely the best thing ever.

That's really great that you do that because I think that there's something going on with the health care system in general, but specifically to do with it.

Things to do with sleep apnea, it's almost like different providers.

22:03

Think that somebody else is coordinating the care.

But really, oftentimes nobody is primary care physicians.

You would think would be in a good spot to do that but I feel like because they're not really well trained in sleep and I kind of, you know, will refer to a sleep specialist, but that's kind of all they really know to do.

22:26

I feel like it really involves dentists and And like other professionals primary care, physicians.

Haven't, you know, like made those connections with.

So, right, don't think you're doing that for people?

Well, thank you, and I have a lot of, you know, I have a lot of Sympathy for the primary care physician because they're, they're looking at everything and they have, you know, tip is 7 minutes or so, major Insurance driven model, and it's really difficult.

22:53

Especially the past few years is people's fear of, you know, all things going on in the world and You know, they've had a lot to deal with.

I also feel very strongly and I work very closely with board certified, sleep MD's and and they have a set of criteria that they're looking for, and those patients are very well treated by those board-certified sleep.

23:13

Docks right in that space.

But what if the patient's over here and doesn't qualify?

All right, because it matches my next question.

Well, avenge few, a number of people by this but I just interviewed asleep, Tech all about people who don't fit the criteria.

23:30

A afore like there, a chai is not high enough for a sleep specialist to want to put them on CPAP or to really want to give them any treatment.

They just pretty much get told your each eye is within the normal range and they get sent home.

23:46

But so tell me about because I talk all the time especially to women who are might have low H eyes but they have a lot of symptoms.

And so I feel like that's somewhere.

Are especially oral Appliance therapy.

24:02

But some other things too, you can really help.

So can you tell me a little bit about some patients that you seen and how you see that you're right?

Those are my people.

You know there's there's those the people we can really help.

Now there's people there's some patients that when they when they have their in Hospital sleep test, their polysomnogram their age is a certain number and they really need interventions that those empties can provide but the patients that we really look for Oh, these young, we call them young fit, females, right?

24:32

So they're in their 30s and 40s.

They have every reason in the world to be tired, they have a family.

They have children they're working.

They have maybe adult parents who aging parents, who aren't healthy.

So they're just running a million miles an hour.

Of course, they're exhausted, right?

24:48

But also in addition to that they're not getting the restful sleep that they need.

And so they're presenting with symptoms, like like headaches in the morning not from caffeine but from this oxygen desaturation all night there Grinding their teeth really hard.

And so they have TMJ issues.

25:05

Not necessary, from anatomical bony issues.

But from muscular issues, they're having muscular dysfunction.

And so, here in Dallas, Texas, the number one thing they do is they put Botox, they freeze the muscle.

So they take a dysfunctional muscle and make it even more dysfunctional by putting Botox in it.

25:22

So, we see all of these symptoms.

Well, now, if I have the privilege of being your dentist, of course, I don't want you grinding your teeth, but I want to understand, Why it is you're grinding those teeth?

Is it because you have a parasite in situation and we do a parasite cleanse and now you don't grind your teeth.

25:38

That's always a weird conversation.

They come to the dentist and I talked about, you know, worms and parasites that they're going to pass.

We'll save that for another talk, but anyway, you know, if they're grinding their teeth because their tongue is falling back into their Airway, the very last thing that we want to do is make them an oral appliance that that's on the top or just on the bottom because that presence of material, then Is the jaw posteriorly even further.

26:02

So what your we have to be super clear about you're talking about, if you go to a regular dentist and you grind your teeth, they'll give you.

What I would call a mouth guard.

Like yeah, something like give you a lesson to stop you grinding or like to stop the wear on your teeth from the grinding but it doesn't really solve the underlying issue the require.

26:25

Its it does it.

And so if so I had patient last week that came and had She was a new patient because why have this night guard?

And it was torn apart.

I said, oh, did your dog get ahold of it?

And she goes, oh no.

That's just me.

I'm like, oh, I mean it was just ripped to shreds, I was almost concerned.

26:42

I couldn't believe she put it in for fear that she would aspirate a piece of it.

I mean, it was just torn good and I said, oh, how long have you had that?

She's about six months and I'm like, oh, okay, so you had this Appliance for six months.

Do you mind have?

If I ask how much you invested in and she's like, well it was like two thousand dollars, it wasn't bad and and this one Going to May last longer because I've had to get a new one every year for the past eight years.

27:04

So I'm like doing the math on this.

I'm like, who is your dentist?

I'd love to take a sales test or class from him.

How is he convincing you to get this appliance that isn't working and doing the same thing?

That's why I have this crown.

And, you know, he just said if I didn't get it that I was going to grind with a crown understand.

27:21

But the one with this patient, I said, let's about this a different way.

You're grinding your teeth, right?

Your teeth are only supposed to touch each other.

When you talk, And when you eat during the day at night, they're supposed to relax.

So all night long, you're grinding on it as evidence.

I mean, you're telling me because look at your mouth guard, these forces so that Force has to go somewhere.

27:40

Where is it going to go?

It's going to be absorbed a little bit of that night guard that they made.

It's going to go into the teeth that's going to go into the gingiva.

It's going to go into the muscles.

It's going to go in the TMJ is going to the muscles back here.

It the body is so miraculous it absorbs, that Force.

So this patient when she came in, had horrible inflammation, had periodontal disease.

28:00

Oral hygiene had levels of inflammation that you would expect from, you know, someone not taking care of themselves and that's because the force of that grinding was so strong, it was causing inflammation even in the gums.

So I told her, you know, we took, I'm very proud that we have a 3D, CT machine, in my office and were able to take a 3D cbct and visualize the volume of that are way in a standing position.

28:22

She are the size of her Airway was was teeny tiny, right?

So I showed her the posterior third of a ton.

I showed her.

How this it was difficult to get air into that, apply into that Airway and then if we introduce an appliance that has even minimal thickness, that's going to push the job backwards into the air right now, she has to compensate or grind when you're saying our clients are talking about my cards, right?

28:46

I'm just because we're about to talk about oral appliances and people are going to be like, what?

Well, I think, I think, you know, you, but there's so many different words that you can use.

Yeah, the night guard, a retainer and a plant.

I think.

What's really important Gordon.

What differentiates the things that I'm not happy with versus the things?

29:04

I do.

Like the appliances that we do, like, change the relationship of the Jos to help you breathe.

They're not, they're not just a single thing.

I'll tell you what, you can't buy them over the counter.

You can't buy an Amazon.

There are customized titratable 3D printed appliances, that change the change.

29:26

The formation, not the formation change.

The position of the Jaws.

And so, So, I know I'm probably making it confusing, but these patients, this is this, this is what it's called.

Yeah, call it all different times.

Yeah, they do definitely, which is walk away and so confusing, right?

29:43

You can't just go in and say, I'd like an appliance.

There are are, you know, when we go to fill up the prescription for them, to the lab to make this applies, there's a hundreds and hundreds of appliances that we can meet.

So, the concept is, I think the important takeaway that your listeners should understand is We're not just looking for something to put in the mouth, we're looking for something to treat the root cause that's causing the symptoms that are concerning because if we treat that root cause, so if we get the tongue out of the airway, then then, guess what?

30:13

The symptom resolves.

And by the way that looks a lot of different ways to put, depending on where you go, I was in Hong Kong, lecturing at the University of Hong Kong about six years ago, five or six years ago, and the way that they treated it, if they sutured the tongue to the tip of the nose.

And so that does it.

30:29

That's awesome.

The tongue is out of the airway, they're breathing beautifully.

The problem is, is these children were hospitalized and on a feeding tube, so it really affects the quality of life, right?

So, you know, the there's ents one of the top ents here in Dallas uses them cuts off the posterior, third of the tongue.

30:46

Awesome opens up the airway but again you just had your tongue cut off.

So there's lots of different ways.

I think the most important thing that patients keep in mind is Is the understanding I got to keep my tongue out of the airway.

Yeah.

If I can bring that forward, I'm going to bring me so I know there's all sorts of different types of oral appliances or mandibular advancement device has or whatever you want to call that.

31:12

But so essentially what we're talking about is an appliance that fits on the teeth upper and lower and then some high by different mechanisms.

The lower jaw is position slightly forward.

So that it brings Tongue and soft tissue out of the airway.

31:30

Yeah.

Absolutely.

I do.

Yeah.

Absolutely.

That tongue attaches to the lower jaw to muscle and so if you bring and you couldn't you can even feel that even if you don't need one, if you could just test it on yourself at home if you bring your lower jaw forward.

Hmm.

Here you're bringing your tongue.

This isn't a very cute demo but bear with me.

31:48

Bring It Forward.

You bring the tongue out of that are way you can take a deeper breath doing that now, these appliances don't bring it that far forward.

We have to keep in mind that we want to protect the TMJ and the muscles and and all of that.

But yes, that's essentially the concept is bringing that lower jaw forward.

32:03

There's a ton of different appliances that are out there that can help.

You know, I don't really have any Appliance loyalty.

I like to use the one that works best for each patient.

I have found and I haven't used them all, I would never venture to say that but I've used quite a few of them.

32:20

What I found is using like, utilizing in a an appliance that changes that relationship with an attachment in the front.

So it's uniform on either side.

Here's your uniform pressure forward.

That brings that tongue forth its titratable because meaning adjustable because we do see these patients as they begin to sleep better or breathe better and ultimately, sleep better.

32:40

We see them heal and take advantage of these natural.

How the body naturally detoxes itself at night?

And so where they are today, may not be the same adjustment as to, where they are in the future because of, because they're healing and getting better, which is super exciting.

32:56

So essentially Really like, so a person who has had has that we just talked about that's gone to have a polysomnogram, and it's fine that their age.

I know the doctor says it's too low for a CPAP or whatever treatment, so that person can go to a specially trained, dentist, like you and get an oral Appliance.

33:19

Essentially is what we're saying?

Yeah, yeah, absolutely.

So other things, you know, there's I think the doctors and dentists are All fighting over exactly which metrics are most important and I love participating in those conversations to favorite subject.

33:35

Yeah, it's great favorites.

I love your nerdier than we are.

I love I'm so much nerdier like I could just be like let's talk because especially the more people that I talked to who.

And and it's not necessarily always women but especially people with lower each eyes who know that the He is improving were realizing, you know, from home, sleep test and different technology that these people are waking up.

34:06

Like every time they have any sort of apnea or hypopnea and right?

So they're not getting deep restful sleep, like they may not be hitting the hi.

But doctors would consider sleep apnea, but your life is disrupted, you know, right.

34:22

Which those are my favorite patients.

Because when we see this fluctuation in oxygen, They then have to compensate.

And so if they do a screening like a pull oxygen saturation, screening, it'll show us how often and how severe that oxygen dips.

34:40

And if it dips a little bit or a lot, their body has to compensate.

So we're seeing a resting heart rate, you know, very healthy has helped resting heart, rate, double and sometimes triple.

When that auction dips and that reaction is a sympathetic reaction.

34:57

And that's driven by cortisol.

And so if that's happening frequently, not necessarily of the sleep apnea severity, but still happening, then we're seeing that cortisol driven, sympathetic reaction happening throughout the night.

And then these women that are waking up in the day, they have altered cortisol levels, and they're already living these big, beautiful lives as mothers.

35:18

And, and this is men to, I'm just honing in on, women can because I am a woman, but we're seeing, you know, they're living these big beautiful lives during the day where they actually need the cortisol.

Well, guess what?

Of course, their adrenals are exhausted and they're suffering from adrenal fatigue and brain fog and altered hormonal levels, right?

35:36

Exactly, like the levels of anxiety or just through.

We have it.

We have enough to be anxious about like legit, we don't need more old people alive.

Exactly.

And then the world were living in, we don't need this additional cortisol.

35:52

Activity at night, we're supposed to recover at night for the big, beautiful life, we live during the day.

And so that those are really great patients that can benefit from opening up that Airway through oral Appliance therapy because we can keep their oxygen stable.

36:09

If their auction doesn't dip throughout the night, they don't have to compensate for it.

They can actually take advantage of all the sleep cycles.

So their bodies can really reset detox and repair before the next day.

And so people that you see, like, I feel like my email inbox is Filled with people that go, I love my CPAP and then next person's like I hate my CPAP and then, you know, like one person's like I got an oral Appliance, it's just amazing.

36:37

And then the next person is like didn't really work for me.

So are there particular rules or are there particular types of people who do well with oral?

Appliance therapy, over other things or is it never Ellen error thing?

That's a really great question.

I love that.

36:54

Yes, absolutely.

There's some people that, you know, it kind of depends on Jean what their reality is and what they're willing to accept and that always astounds me, you know, when when people say well, this is just the way my life is and that's wonderful.

But I'm like, but you know that's just because that's how you're accepting it.

37:11

You like you can change your reality, you can change your work in a heartbeat, you can make everything different in a heartbeat so that always astounds me when they accept those types of things, you know a CPAP was they don't even want to venture into treating their Fleet.

37:28

Just throw everything because yeah, yeah.

Are they say?

You know, All Appliance therapy for example, you have to be able to breathe, through your nose.

And so, if your nose is stuffy, we've got to do something to open your nose, whether it's nasal lavage, whether it's diet, elimination for 30 days, hunting down the cheese.

37:44

The early voters, don't want to change.

They do want to change, which is, by the way, I don't I, I know because I feel for those people because I don't do well with dairy or with glue, Eaten like I, you know, I'm constantly in this, like, trying to reduce inflammation, but I feel like I just, I love Dairy and I love gluten but it's true, you don't like that.

38:10

It doesn't love me back, right II.

Hear you.

But here's the thing, it is not my job or anyone else's job to tell you what to do, right?

So the whole purpose of educating them on what's Happening.

So for example, I am gluten and dairy and Sugar-free now last night, it was, you know, 70 degrees.

38:32

I'm sitting in the backyard with my family and I drank a beer and it was delicious.

And I wouldn't take it back, but my face will be read from right from the glue next, three days.

Yeah, I know that, and I'm going to accept my beautiful red face for three days because you're so damn good.

But the point is, if I didn't understand that, then I would love for someone to explain, that's my reaction.

38:54

Yes.

I don't care what my patients decide as long as they, Stand both the pros and the cons of what they're deciding.

So by the way, or play therapy, both in children and adults is fabulous.

If they want it, it's not all rainbows and unicorns, right?

There's negatives to it for an adult, for example, wearing one of those appliances.

39:13

Hey buddy.

You have to wear it every night for it to work.

Yeah.

Right.

That's a disadvantage to it.

There's other approaches out there that other really talented doctors are doing whether it's surgical or Tad's, you know where they're expanding Jaws.

All those things are great and by the way, those approaches aren't perfect, either there's pros and cons to each.

39:33

So, it's our job is providers to educate.

Now, I'm not an oral surgeon.

I don't do the surgery, but I can talk about the advantages and disadvantages on a superficial level to see if the patient may be interested.

And if they are interested, guess what the best surgeon in town is right down the street.

39:49

Let's get you in front of him so you can ask those questions.

So I think it's important to understand CPAP users.

For example, some people love their CPAP and I'm so happy E for them.

Other patients.

Yes, we're getting the the quantity of air.

It's blowing it through their Airway, but they're not getting the quality because it's blowing it at such a pressure there, their nose, can't humidify, and get that purifying get that are ready for the body.

40:11

So understanding, why they may or may not like like it and then providing a solution that may be answers.

What those art can be really helpful for a patient.

And I'll tell you, I find that these doctor, a lot of doctors aren't necessarily taking the time To have these conversations.

40:29

And so now more than ever patients, have to be their own Advocate.

They have to ask questions.

They go online.

They look at sites like yours, they're beautiful that.

Give them information, give them access to information.

So they feel more empowered to make a decision.

I actually just wrote a book.

40:46

It's coming out in mid-april it's called moms and the trenches because I do invited.

Hey, thank you.

We will see how it goes.

I can I preorder it.

It.

Well yes you I think you can't.

I'll have to ask my publisher but I think.

41:02

Yeah, I think you can.

But the exciting part is, you know, I used to travel around and educate Dennis or really try to share my perspective with Dennis and what I found was.

Dennis were so busy in their offices and and I get it.

I'm right there with them and I really found the people who are advocating for these children are the moms.

41:21

So the book is really targeted towards the mom who like the title says moms in the trenches.

They're looking for Illusions.

They're looking for information and and empowering them to now, make decisions based on additional information that maybe their providers haven't given them.

41:36

I'm just chuckling because my kids pediatric dentist, it's just like, like, every time I go I bring her a new book because I feel like eventually she something in one of these books is going to click for her and she's going to but I feel like, you know, she's the mother.

41:57

ER of three, she's running the santol practice and you know, like it's really, really busy and there, you know, it's a beautiful office and they're just doing their, you know, Drilling and filling and turning the kids over and all of that.

42:15

And I just hopefully at some point, you probably know.

There's, there's a place, there's a place for that.

We need to sit down and do a little bit.

We also need Or I would even say in this might be a little aggressive.

We owe it to our patients to look for more information to Ed to educate them.

42:34

I really want you to, so you're probably sick of telling the stories and stuff, but I love the story on that YouTube and see where you were talking about a mother of the marathon runner.

Does that ring a bell?

42:50

Yeah, yeah, yeah.

Do you want to tell that whole story?

Because I just want that.

Yeah.

Well good.

I love that.

You know what?

I actually have an even better story with my gosh, that story is that story is amazing, but another story because I'm really into not that I'm ever going to do it, but we will, but I'm really into the mentality of these Ultra Runners, right?

43:15

So they don't just go out and run a half marathon.

They're running, hundreds of miles in a row without stopping.

So they need this Peak Performance, right?

Their It has to be right, which I don't understand because the the story of the boy that I told the man that I told he would eat a whole cheese pizza and drink like a two liter of Coke just to get that immediate energy to keep running.

43:36

And and and what was always missing was the oxygen while they sleep.

There are these very high.

So this woman was running, there's a race and I won't say the name of it.

It's in Switzerland and it was a French name and so I won't butcher the name of it but it's a very famous run amongst Ultra Runners which I'm not.

43:55

Also remember I'm just a big fan apparently.

I just don't want to be ultra Runner, right?

Just to want to be ultra.

So so she was she was training for in her diet was impeccable.

Her mentality was impeccable, her training was impeccable and she'd never finished the race.

Now this part I think is important to tell, maybe not the most politically correct.

44:16

But I think it's important to enter the race alone is thirty two thousand dollars.

Then you must go early to train at altitude.

And get used to it.

You must bring a team, you must bring your own food.

It's completely self supported has right.

44:33

So when I go run a 5k at 11, they've got my Gatorade, they got my little snacks at the end.

It's great.

Right?

You just show up and do it.

So she really wanted to finish it.

So she's doing everything.

She can no one had ever evaluated her sleep before.

No one had ever.

44:48

Done a sleep test.

They now she's she's done you know her cardio Fitness so she's one of mask and tested her cardio Fitness not That but no one had ever looked after slept at night.

So she did a home sleep screening with one of our you she was extremely fit.

Her head resting.

Heart rate was 22 minutes resting pulse oximetry.

45:07

Oxygen was like 99%.

It's never 100% but like 99 fabulous.

So here is this incredibly fit woman who I'm trying to become best friends with and I'm trying to like join her support team to go to Switzerland and what we found at night when she sleeps is her off, she went from 99 down to 64 percent.

45:24

Now to give reference to that if she were on Grey's Anatomy, that very popular TV show.

If she agrees, not, if her option dropped below about 92, they would be like problem kind of go get it right?

They have registered brain damage at 84%.

45:40

So for this very, very fat woman to have a drop even lower than that, she had brain fog, she'd already forget she did triathlons to and she told me the hardest part of the triathlon is remembering where she left her bike.

So when she came out of the him to find her bike and like that literally is the hardest part.

45:56

She had this amount of brain fog that she just kind of dealt with and so we talked about that and by the way that her age, I was not anything that have that have sleep MD would be concerned about not.

Anything that would necessitate, you know, a CPAP or anything like that.

46:13

But something that was affecting her overall health and wellness and for an elite athlete.

You want to tweak that.

So we we made her an appliance that changed the relationship between your upper and lower jaw.

Her brought her tongue forward and sometimes you know the Sleep Disorder breathing patient can have a bit of a stigma.

46:30

Is it old fat?

Grandpa over on the recliner who's snoring during the be?

No football game.

She was a fit fit woman said a lot of muscle here on her chest, right?

Because he's a runner so perhaps that's why her.

Why her tongue fell back into her Airway so she didn't fit the classic mold of someone.

46:48

We would assume would have sleep disorder breathing we fed her with the appliance she Start sleeping with it man.

Was she mad the first?

She hates that Appliance.

So the first couple of days she hated it, you know, and I think, you know, I think I even gave it to her for free.

I'm like just do this and then because you're one of your friends.

47:05

So you're their best friend and I want her to thank me at the top of the mountain.

I did it.

Thank you Dr.Chillip.

No teasing actually.

I'm not.

That was legit or no.

That's Fran's.

I'm going to go to Switzerland and they've been running dreams come true through her.

So so I said just keep trying, keep trying so she kept trying.

47:22

Finally, she got used to it.

Good night sleep.

And her body went from this sympathetic.

Go go, go, go, go, go.

Go.

Which 20 lakhs a high achiever part of her?

Which, by the way, she is wired differently.

The fact that she can do these Ultra doesn't yet, but, but that go, go, go, go go.

47:37

Turned into a parasympathetic rested.

I just, so she felt terrible.

She felt worse than she did before she try the appliance.

And so, I explained to her, this is your body paying back that oxygen.

Des, hang back.

That sleep data stay with it.

This is just as important stay with it for 30 days, to see how Oh, you do.

47:54

Oh, she was mad.

She had her coach call me.

She had everybody call me.

They were mad.

I said, well, do whatever you'd like to do, but if you'll give me 30 days, this will make a big difference and I'll prove it through metrics.

So we did a creepy screening to show that her auction was stable.

You know we're proving through metrics that this is working for you're doing home testing and show.

48:12

And we're just yeah just been that that option saturation.

Screening is all we're doing.

Just thrown out on her finger to see what her options doing at night and as a screening test.

Improving its stabilizing 30 days.

Later, took her a little lesson.

Took about three weeks.

48:28

She turns a corner and she says that she has some thought that joyful, when she's running that she was kind of Step.

What was the word she's stagnant?

And her training leading up to Switzerland, but now she had a renewed sense of energy.

Uncle just had some option and in her muscles and that's it was helping Propel her forward.

48:46

So now she's I mean she won't leave without it when they when she stops to sleep because when you run that far you stop for an hour or two to sleep, every Only four hours.

So when she stops her support team gives her the appliance so she gets in her little feedback and where's the appliance that brings the jaw brings the tongue out of the airway and she's happy as can be now, it's a happy ending because she did great the you know, the follow-up is finished the race.

49:09

You finished the race and she actually, she retired from ultra marathon.

That was it?

That's the last thing she wanted to do know some, it's important because I was not invited to Switzerland and now she's retired.

So my ultrarunning dreams have been But you know, it was something that was that's amazing though and she feels great.

49:31

And now she is, you can't buy marketing like that for your practice.

You can't.

Unfortunately.

Now she sends me all kinds of people and I'm like, I can't.

Yeah, right, I can't help them with this.

They have chicken pox like, that doesn't, you know, but right to really change somebody's trajectory or to thank you.

49:50

So I've talked to people who have had sleep studies.

He's and I think that sometimes people are not getting like they're thinking percentages like a b and c or something.

So people are kind of like well I mean my oxygen desaturation was dying to like 72 and I'm kind of going.

50:08

Oh, and you know, like they're like, well, that's not a bad grade and you're like that's not how awesome desaturation works like a.

You're getting a, you're getting a c-minus but well you could also get an A-Plus so yeah, you know, I think one thing that has to change in the overall dichotomy of our thinking is there are a lot of patients that have sleep apnea and they should be treated with by an MD.

50:39

And and so far, people have therapy is gold standard.

Now we see some of those patients.

See, there's ways for us to work together.

There's there's a lot of patients in.

They have to be treated by the American people would really speaker, sleep apnea, like, you know, No, yeah, they need that help but just because you don't have severe sleep.

50:58

Apnea doesn't mean you're healthy, right?

There's a whole range of people clean who could benefit from from an intervention and so you know, another example, I like to give is, Hey listen, I don't need open, heart surgery, right?

51:15

I don't I don't need quadruple.

Bypass surgery, great so I'm totally fine.

Well but also could we have Lane Kim about cardio therapy, is there.

Are there any supplements or Pharmaceuticals?

That could help me.

I'm glad I don't have to have quadruple.

51:30

Bypass does that mean I'm completely healthy?

That example, Rings, true to patients.

And so, by the way, if you want to wait until you need quadruple, bypass that's one approach to life.

But if you're looking to be the absolute healthiest version of yourself and have everything working best way possible, there might be room for a conversation to improve how you breathe while you sleep at night.

51:51

Yeah.

For reals.

Listen, thank you.

So much for joining me.

I could talk to you for four hours.

I know.

Thank you so much.

You are so lovely on your and in person or, you know, chatting, so thank you.

It's such an honor to get to chat with you and I really appreciate respect what you're doing because people are coming to you for information and you are using your power for good.

52:11

So thank you.

Well, thank you and tell people real quick, where they can find you.

And give us a little luck for the book again.

Yeah, absolutely.

So I'm Doctor Jill umbrella at Central, dentist in Dallas, Texas.

You can find me on Instagram and @jumbrella, or @centraldentist

52:28

And my book, mom's in the trenches will be dropping mid-april on Amazon, or you can visit Central dentist.com in order it from there.


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