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Episode 96 - Dr. Pat McBride - Collaborating for Best OSA Patient Outcomes


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

So, I don't think I have any major announcements today, and I had a really big weekend, because my daughter was playing volleyball for three days in Orlando.

So I just kind of got back and got this episode ready to go, and but thank you to everybody who sent in a whole bunch of questions.


And I put a little sticker on my Instagram and I'm waiting through those and recording a bunch of answers.

So if you're not already, You follow me on Instagram, it's sleep

Apnea stories is the handle there, and I'm doing a bunch of videos, just replying some of your questions and there's some really good ones.


So I hope you'll join the discussion over there.

And so on to today's guest, I was joined by Dr.Pat McBride?

And Pat has spent 41 years as a full-time clinician and educator in the fields of Dentistry, whisper ettore, medicine, and sleep medicine, her extent Experience in clinical laboratory research, and educational Arenas has led to the development of an interdisciplinary care model and which it is used by physicians.


And dentists around the globe, she sits on the board of directors, for the American Academy of physiological, medicine and dentistry in New York and she continues to work Hands-On in a clinical setting as the executive director for the foundation, for Airway health.


And so I I was really, you know, Blown Away by by my conversation was Pat.

She's so I knew that she was going to be really knowledgeable, but I think all of her experience working directly with patients means she just has such a great grasp of, you know, sleep apnea and had difficult to navigate can be.


And so, I hope that you'll find this a really helpful episode.

So, without further Ado, here's my conversation with Dr. Pat McBride

Well, Listen document, right.

Thank you so much for joining me sure.

Happy to be here.

I really appreciate it.


So here is a funny thing.

So I am attended a collaboration cures the conference by the a PMD, probably like not last year, but the one in Atlanta, Georgia.


I always assumed that you were a dentist, just because like, a lot of the people on that board or dentist, but you're not a dentist.


So, tell me a little bit.

About your background.

No, I actually I started in dentistry.

My, my husband was a general reconstructive, dentist, who went into sleep back in the late 80s and 90s.


When there was probably only about four people doing, it wasn't in the Bay Area.


There was basically.



And we considered Heretics and worked in his practice and as he continued to educate forward, I had to do it too.

So I really didn't have a choice in order to be really effective.

So I just You just kind of pile on my education with his and in 2011, tragically he passed away very suddenly and I had this only Dental sleep medicine practice in the Bay Area going and I had to find and train somebody to do that before I tried to figure out where I was going to go.


And so I mean, that's life just, you know, changing your path and you have to either decide to go with it or not.

And so, I kind of had two kids in college and had to figure It out and I really wanted to focus on the airway part of the practice.


I found a lovely young guy who took over the dental side and then in the year and a half that I stayed we trained him up and got him board certified in Dental, sleep medicine so that he could take that level with him and fairly hospital-based which was great.


So in the early early days, the one thing that made our practice difference was we were 100% physician referral that's unheard of and it was because of the advanced.

My husband's Advanced Medical really unheard of, that's exactly day.


She's part of the problem now.

And so having the pulmonary degree made a big difference in our Acceptance in the medical community and then just being an all-around, we're not trying to sell you anything, but figure out what's wrong.

So you can move down a the pathway of your choice.


Never said, CPAP was bad.

We never said educate people on all of their choice right that this is that we have a tool back and there's lots of tools that but one or two might work for you, all of them might work for you.

None of them might work for you and that comes from everything.

Anything as simple as lip taping back in the early days they taught.


They told you you'd kill people and so you could get sued and that stuff we're like hourly nobody ever died from that and, you know, your natural tendency would be to pull it off.

Anyway, I was going to say, like, I always feel like when I read those articles of people saying, you know, it's so bad to tell people to lips.


Hey, I feel like those people haven't ever tried it because you have to cover the whole lips into my own state run, the outside around the last night and you can do the thing with the valve in the middle.

There's this, like, 10,000 things that are out there for the public, and if you're really cheap, you just buy a roll of paper tape and you cut a hole in the center, you're good, you know, like it's not and so it's really not that hard.


And so and it was but we also back in 2010 I was, I'm an avid clinical reader.

I, you know, I'm a researcher by Nature, my PhD, I, you know, tons of research and and I research across interdisciplinary Fields.


So I've done everything from adult.

I meant one of my dissertation pieces is on emerging adults age, 19 to 29 and how they fit in the medical system and had it seems that deal with grief.

We don't talk about grief, our culture doesn't talk about grief.


But it has nothing to do with buying it has to do with loss in your life.


And loss of thought process loss of Paradigm, you know, your fundamental shift in your mind.

All of those things and how I started, I read this article by Dave McCarty about Occam's razor and how we go about delivering Medical Care.


And our system is, was it back in 2010 was broken in terms of the way we deliver care especially to sleep disorder.

Breathing patients and children were even in the in the mix at that point.

And I realized that this is, this is my bailiwick.

This is what I've been thinking all this time.


I believe in patient Centric approach, figure out the person that's sitting in front of me, established a partnership with that person based on trust and empathy.

I don't have to have had your experience to be able to have it resonate with me.


I don't need to have had that happen to me or to be suffering the same way you are but I certainly can Empathize with it and find a means by which we can plot a pathway out of where you are into somewhere better.

And then from there somewhere better and from there somewhere better.


So the one of the things I loved was you wrote an article for dental sleep magazine and I just sleep practices that asleep practice.


I've been.


And I love that because you're talking, maybe can speak a little bit to that because you were In about empathy.


And and I think all of what I do is entirely from the patient perspective, right?

So we just are deal it.

Like I hear constantly from people who are going from provider to provider and it's like, you know, it's not only that I think you really covered it.


Well in the article when you were talking about it's not just coming up with the plan.

It's reading between the lines of what the patient is.

Telling you whether that's verbally or sometimes by their body language.



Oh, body language is huge.

Yeah, body language is huge and I know sometimes people are so disenfranchised by the time they get to you, when I was working in this gentleman's, I went once I saw the practice and went on a friend of my husband's from dental school reached out to me, and was like, I want what you had over there?


Can you help me?

So I thought, well sure, I mean, I don't really Ali know, if I want to continue doing this I was at a point in my life I wasn't really sure but into so in 2011 I went over and started building his sleep medicine practice over there.

And I realized that more and more of the patients I was seeing was a different demographic.


They had a different experience.

There was more HMO type based stuff, which is Health maintenance organization, which is rationed basically rationed care.

And that's the nicest way to put it.

Anyway, there's a lot of Pride, there's a lot, there's a lot of stuff there.

It's a hot potato.


I'm not going there so yeah, I don't blame you sir political, I'm not going there, but I realized that if you can't get to the source, Of the disenfranchisement that they're angry, they're upset, they paid a lot of money for whatever they've gotten so far.


And they don't feel like getting value for their dollar because basically don't feel better.

And the number one thing I would say is they don't feel hurt.

I'm telling my doctor that I'm using my CPAP every day.

The number say zero on my me machine with a smiley green face and he's like, you're fine.


And I realize here, you're fine and he's like, yeah, but I feel like like death.

I feel, yeah, that's my story basically.


And I can't do this, I can't do that.

So I really look at it as somebody who has really spent the last 15 plus years.


Doing nothing but dealing with clinical sleep.

How do we look at this?


How do we understand their Journey?

What they've done.

How do we figure out that maybe this didn't failed for you?

This therapy feel, you mean that they were in the traditional system with going to a sleep, specialist getting seasick, that's the end of this getting it.


Yeah, it's some of these patients had seen that wanted an oral, Appliance, nobody check their CPAP and seven or eight years.

They never even met back.

Will they gave it to me?

I've been fine.

Okay, Alden, you realize how much bacteria is in that hose?

Oh my okay.

So Colvin changed a lot of that.


Thank goodness for the better because all of a sudden CPAP machines were getting recalled for various reasons.


And then people were like, oh, you mean I have to wash the hoses.

I have to do this, right?

And here to change the filter.

I remember, people like when I'm on it.



And, yeah, and distilled water and all that.

But like, whenever I post about replacing the replaceable filter on a CPAP machine, I get lots of mess.

Just from people saying I didn't nobody tell me, there's a replaceable filter and I'm like yeah, you're supposed to be replacing.


It like, at least once a month like and people are like, I've had it for seven years, I've never done that.

I'm like and it's black to that is back and you're thinking, okay?

So all of those particles have been going in your Airway and your sinuses all of them and now they figure out why they have chronic allergic, sinusitis, or science or pack impacted sinuses or whatever.


So, surprising enough for some Buddy who's been highly involved in the dental, sleep medicine field?

I think one of the reasons that I was invited to be one of the original board members and part of that collaboration cares, in the American Academy of sleep physiological.


Dental sleep medicine.

Was that I'm agnostic.

Is that him completely agnostic?

There is no one therapy that fits everybody.

There is what?

No mentality that fits her twins.

Yeah, like yeah.

And that's so unusual.


Like yeah, there's very few people in this realm who truly don't have an invested interest in what people pick, right?

I feel like the and I mean, I don't I don't want to go into the insurance thing either but Think that there is often this thing where people are clinicians want to do the best for their patients.



But there is also the fact that they make money from, you know, they're oral Appliance or I sleep specialist, who makes money because they own this, you know, like the DME Company.

So that is the kind of conflict of interest if you think about it, but its more common than not oral.


Appliance, I mean, the dentist's.

These days, the most of them are sending to outside labs for things to be fabricated, they're not creating them in their own Labs.

Although there's a few guys that I know that have the room, my incident and do beautiful jobs and they're very it's about as customers.



So which is fabulous.

Tell me about so.

So why I'm interested about when the a a PMD first was formed.

So it was Michael Gallup and how weekend until we hinden?

I like a Gallop.

They were the do that to people.


Literally came up with the idea for it, on a napkin, in a restaurant, we still have, what was the impetus for that?

Like, what were they seeing?

That that wasn't there that they wanted to create this new organization, was that there was no organization in our country that welcomed and try to promote collaborative, care interdisciplinary, care model Delivery Systems, using all of the resources available working.


In in unison site, for the patient's well-being.

And there was no such place for people to go, there was no educational forum for people to go.

So I've been the head of on the Ed committee since for at least the last five years, I went from the minion part of the board to the executive board about five years ago.


But actually it was more work putting on collaboration, here's Steve Carstensen.

Who's one of the 4?

Most people in the industry and I and how he is.

One of the nicest people, you people of the planet to favorite people, you know, we they made us that head of the Ed committee about three years ago now or so.


And Stephen, I have, we believe, we are tireless workers, trying to change a paradigm to try and turn a ocean liner around in the Panama Canal.

That's our job, you're talking, right?

Just to break it down for people who are listening, who have no idea walk this organizations for, and everything.


So what you're talking about is this traditional system of people going to their primary care, physician then asleep specialist then the sleep lab, a DME Company being given a CPAP not being given any other options not seeing an ENT in myofunctional therapist and then a dental sleep medicine.



You want to bring together all of these different people who can have a bearing on what's going on with that person together is what you're talking about and it's not just a dentally.


We have nutrition in there.

We have ear, nose and throat.

We have Cardiology specially when we're dealing with children.


Allergy allergy ENT allergy.

That's huge.

Specialist in, you know, it's very important that we get to systemic disease.

People and sympathetic overdrive.

What we call fight or flight mode.

Anybody with a sleep disorder is in fight or flight mode basically 24/7.


Even if they use CPAP, even if they use their oral Appliance, that's why they still don't feel good because the systemic issues Issues have not been addressed.

That can be as simple as not, having enough co Q 10 or not, how your vitamin D levels are subnormal, you start normal animation, inflammatory process, inventory, diet, all of these things.


People are like, well, I have these aches and pains it's like, yeah, you got your, there's a million things to eat.

However, these 12 things are not on the list and those your inflammation.

Now, can we provide you with some sort of a nutrition plan that you can Can live within do every day that you don't feel like you're being deprived, could God forbid, you feel deprived.


You can have an Oreo or a glass of wine or something like that.

I feel like you're speaking specifically to me, you know, it's like God, forbid, you feel deprived.

If you feel deprived, it's going to last about a week and you're going to bring okay.

I don't have the luxury of having the patient's hate me.


I don't have that luxury because Sometimes I'm the last route door and the hall for a reason.

There's no after me there is nobody after me, who actually is going to Care.


And so I run honestly, like, from the number of people I've talked to even just the last two and a half years since I started doing my podcast, that so many people, it's who were just in.


In this despair, I've just abandoned Hulk and abandoned treatment because nothing worked and I'm, you know, So, that's a lot of people.

And in a major health care System, the Sleep doctors there are far too.

Few board-certified sleep positions for the number of patients waiting.


There are like none practically for kids, there's 300 in the whole country which is outrageous.

And, you know, from my perspective, they are so overwhelmed in the systems that they're in trying to get X.

Number people through a day in a 15-minute schedule, they don't have time to listen to your concerns.


I actually had a patient told me that she was told by the nurse who set her up in the room that you can talk about one problem with him today.

I was like no.

So you write your grocery lists down, we talked about it when she came in for her Point.

She was crying and upset and I said, okay, Finish finish.


Let's just you you must see so many people into yours.

I can't even imagine, it's just a way of life and as most people just appointment I just let them blow out for 15 minutes and you just talk.

And I and I'm like, hmm and I don't take written notes, I don't turn my back and type in a computer, which is terrifically Road.


But there is not a or operatory in this, but honestly, that's the norm, it's the norm, because the building's aren't designed for face-to-face.

They're designed for doctors to write their notes as quickly as possible with their burn to the patient, which is disrespectful horrible.


You're not only not only, you're not listening because you're concentrating on your typing, so you're not taking in what it is, what is really resonating with the Border saying.

But let alone what the body language is like me like that before.

Yeah, feeling are they tearing up?


Are they doing a knife?

You know, they've lost hope or they feel like their spouse doesn't think they're beautiful anymore or and believe me plenty of guys for that, right?

So and I just actually, when it comes to CPAP think that even oral appliances like, all right.

Yeah, all of it.


It's all of it.

It's having a spouse complain about your inspire, you know, the beep going off and on during the night that, you know, you can turn the beep off.

But, you know, when I was working with patients with inspiring, like you keep the Beat Bop.


Yeah so tell me all about it.

So this is a whole thing I want to ask you about.

So we connected through Karen Woolfolk who was I was just sharing with you before.

We started, the Karen was the first guess I had on my podcast so many so long ago and she, you know, told me a little bit about how you had worked Inspire and were really instrumental in her journey.


So tell me a little bit about that experience.

So yeah, I was with Inspire for just over or we like four years and I was a senior clinical for the west coast and did lots of work with them.

My favorite piece of the puzzle, of course, is working with the patients in the clinic.


And I met Karen at Stanford and they had Stanford being a teaching Hospital.

There's constantly different people there, you know, in the product, or the residents, or the fellows or whatever.

And she initially did, Find an early days and then she started to not do fine and she felt like she wasn't getting the kind of care she needed or concern or whatever and one of the nurse practitioners and I they don't do it anymore this way.


But at that time a couple of years ago, we started a HS Fridays and so then they were able to pile all of these Inspire patients on those Fridays.

For this kind of direct touch approach, so you're meeting.

So you're actually kind of work.


To educate and to help, right?

We'll treat you train and you're in the surgery, as you make sure everything goes fine gate, you train.

The doctors, they're trained by a training staff but your they are guiding them and helping them.

As they do the cases, there's always somebody from the company there during a case.


And then after, you know, six or eight weeks later, you're going in your helping their activate, the patient's device, teach them how to use the remote control have stand.

What they should expect, etcetera, etcetera, and then you follow them and some patients just sailed through another patients.


Don't like anything like any other.


Everybody's going to tell you 70% or 69 or you know, they turn this on.

They marched up the steps in their perfect great.

But there's Still, you have the rest of the population that doesn't guarantee.

With one of the ones who started out that way and then ended up having other systemic issues that were not being addressed that.


And then she covid came and she really struggled.

And so I just started her over from scratch.

And we also brought in a Cardiology Department, we brought in, you're looking at all, everything else going on with her, not just focusing on the Inspire you're looking at like, everything is of my Clinical sleep, background, the vast majority of people that are working in the field in any med tech device are trained on the that device and that's it, right?


So they or they know how to do a catheter or they know how to do a pelvic sling or they know how to do whatever we're is, you know, like the multifactorial like you know like it's just too many different.

Yeah it's a different skill set and and it would be nice if there were more people with the same skill, set or so.


Similar strategy will require some but they're few and far between if they really and they still, you know, many of like again, Medtech, they have algorithms for how you want.

They want this to interact with the patients, they want the facilities to become, autonomous to not need you so that their own people can take care of the patients, that's their job and there's nothing wrong with that.


It's just that some folks don't do that well with it and they need something extra and so, yeah, and Karen.

Like the poster child for the grade Inspire patient and the great ambassador to the world.

Yes, about this therapy because she's the right patient.


Who you know?

The therapy is fantastic.

I will never say it's not, it is the right therapy for the right patient.


And all of those dots need to connect just like skeletal surgery.

I'm very highly involved in skeletal surgery and correction some people just need that.


I have another Insight double jaw surgery.

I will just surgery and That is if the box is just too small and there's nowhere for the tongue to go and the airway evening with Inspire sometimes you end up.


Five years later are getting down the path and saying, okay, I've done everything else.


I still don't feel better, they get, they flee, get their MMA and guess what?

They finally feel better.

So that is a journey.

I'm actually writing an article with Dave McCarty about this patient that I've been tracking for seven years, from CPAP through Inspire and Finally, through medically manage weight loss and then the MMA and it's a difference, but it's taken us seven years.


Yeah, distant touches and excluding you know that two years of covid-19 everybody was fell off the wagon for everything.


And so talk to me about.

So I've interviewed a lot, quite a few people who have had MMA surgery and all the different things.


And so, Talk to me about like the affordability part of that because there's a lot of people that I've interviewed where I wouldn't say money is No Object but like, you know, they're able to say Bill hang is the best person.


I'm going to fly to California because I want to go and see, Bill hang, or I want to go to Dodger overhead overhead, right?

And so I guess my question for you is just where are we on?

Making these kind of treatments affordable for most people like, is there.


How are you doing with, like Insurance?

Like, I've just heard a lot of people who, you know, their shirt at their insurance isn't going to pay for double jaw surgery or you know.

And for some people they can say, well I'm just going to pay for it myself, but that's not most people.


So where are we on insurance, actually covering a lot of these things.

And, and not just We'll do a surgery like also and, you know, I know my functional therapy like I did myofunctional therapy for a while and, you know, and it's not obviously is huge event, but it's very out of pocket.


Like there's no insurance that's going to cover that.

So I guess I just wanted to get your take on where we are.

Like hopefully that will change in the future but like, what do you think?

So I think so.

I think slowly it's starting to go that way.

I know that there are trying to get billable codes for Hence, for myofunctional therapy.



And I think it's going to go the way oral Appliance did it took pounding on the doors for years and years and then finally, they accepted a code.

Yeah and finally you can bill.

I may not be what you want to build for it but it's better than nothing on a patient's insurance.

If you have a double jaw surgery, as there are obviously lots of Maxillofacial Surgeons in this country who do it.


Are there a lot of Maxillofacial Surgeons in this country who do it in a way where What we call counterclockwise rotation.

So, they open like 3 hits, they move every there's there's not so many of those bright and that is much higher risk.


Those surgeries and the double joint surgery is those are all much higher risk.


Can't I know at the VA in San Francisco, you at the VA, you can not only get an MMA, but there is also a oral maxillofacial surgeon out there who does joints.


So they do do it.

What their success rates are and what their outcomes look like.

I don't know, I do know that it's available, I dunno Kaiser which is an HMO.

If you need it you can get it so.

But there has to be obviously medical necessity not has to be carefully document right now for patients with severe sleep apnea, most insurance companies unless there is a particular disclaimer against it in your policy.


They if you've got severe sleep apnea, you kind of automatically, get kicked into the qualifying batch.

You have cranial-facial issues, your jaws are too far back.

You have terrible sleep apnea, you can't can't won't, don't use your CPAP.

Whatever those patients have as long as you have an insurance policy that has a couple of things, one is no particular exclusion for TMJ surgery or or double jaw surgery, and that's usually on page 92 and size to font in the back.


Yes, I'm the policy.

That's so funny because I am I did hear from somebody.

Not long ago where you know, it's just it's like they try and make it as difficult as possible.


And like yeah, sometimes those things are just excluded and they are excluded and that's the time when well, I have to use my company policy.


Actually, this is an investment in your life and in yourself.

So I look at it.

As you have at least a year from the time that you decide to go down this journey to when you actually Up on a table somewhere.


Yeah, you have a year to have to like move and make space for the in s have to have proper.

If you're going to do it properly and you want the best outcome, you don't just do it without orthodontic, set up, creating space up, writing Roots.

So you're not carving into somebody to root tip on their tooth, things like that.


And you have to have a virtual surgical planning, which I think is the most conscientious thing.

You can do virtually surgically plan because then you can show the patient exactly where everything's going to move and potentially with their Face is going to look like big deal, big deal.

Yes, it's the biggest deal out of.


I mean I kind of think about it as a major big deal and yeah you ain't want to do, you know, do they want to do not get their jaws move?

Do they want to do surgically assisted Orthodontics?

Do they want to open up extraction spaces like they'll hang us and Dr.Hall, does that in California also?


That's becoming more popular but you still can't and you still can't expand a patient side to side most expanders expand in the kids Span the job, the upper jaw wider.

They want to make it wider, but the biggest problem is usually front to back is too short.


Yes, so you can't expand out of a front to back problem.

We call it.

An AP front to back, anterior posterior, and expand your way out of the Navy problem.

Well, I know, because I just tried it, and it doesn't work.

And, and I'm a surgically assisted Orthodontics person.


So it's base is open, and but I didn't have sleep apnea.

So it's a little different.

When you're doing it, for other reasons.

Yes, but it's, you're able to, at least talk to patients in a way that you can say, okay, this was the pros, this was the cons and, yeah, this is how I paid for it.


So I think about that.

Yeah, I think from a patient perspective, sometimes, this is just about finding the right people, right?

Like that seems to be the biggest problem, like, you know, it's one thing.


If you're like, I think California and New York, you know, like, I could, tell you right away.


Go to this wonderful Airway, dentist.

And, you know, they'll they're going to know, like, there's kind of groups of people that It together but I think we have a problem when it comes to like rural places in this country.


Like there's just not when I traveling.

Yeah but you'd be surprised you know maybe that's changing though.

It is changing because people think you know it's amazing if you really really need something or your child look parents parent.


I mean, God love it.

I would go to the ends of the Earth for my kids.

So, whatever cost, whatever it takes wherever we need to go, we would find a way to do it, right?

So, It's your child.

That's that's one thing if it's yourself.

Our tendency is to do with out for ourselves in order to make sure kids have what's better?


That's the psychology of parenting.

However, if you're dead, you're not doing your kids, any favor, that's true G.

And as much as we like, I think all of us believe, truly that craniofacial dysmorphia Orthodontics, skeletal surgery.

All of those things should just be part and parcel of your major medical insurance, but the insurance company Knees, who are the biggest Lobby in the country are fine.


A country, mile are so powerful.

And if you look at every Metropolitan build every Metropolitan City in this country, the largest building in the city belongs to an insurance company.

Just Google it.


Yeah, so it doesn't matter if it's Podunk, whatever the biggest building in that Podunk is going to be an insurance companies building.

So so how did invested its, you know, insurance and sadly isn't premiums refused.

All claims that is Auto.


And so you have to work around that we get patients, where I am now that are coming from out of the country who have had skeletal surgery done.

I'm on National Health and they boast about.


It would only cost me eight thousand dollars.

And yet you're well you're seeing us because we are come was killed too.

Maybe the plates, they used aren't the appropriate plates and they broke or three.


How about the biggest one?

Which three should be one?

You don't feel better?

I know it's such high stakes, you know, like my steaks and conscientious positions for not going to guarantee.

We're going to move us forward and you're going to be able to LEAP tall buildings in a single bound.


We're going to hear your sleep apnea, you're never going to need your CPAP again.

Our body is not static, right?

So whatever we do today is not going to manifest itself in the same result wise to three years from now, five years, from now, 10 years, from now many, by our patients that I saw over the four years that I work with them or MMA patients from 10 15 years before.


Where the Patients continued not to take care of their health.

They continue to open mouth.


They continue to and what happens is it false right back?

Yeah and their sleep apnea comes back it gets better and then it gets worse.

So you know Airway disorders are a lifetime Continuum and commitment by the individual to self care.


So that was going to be my next thing is so I think sometimes especially people that listen to this podcast get a little bit, I assume a lot of knowledge and then people will be like why are you talking about?

I don't know what an airway disorder is so can you just explain to us the narrow sort of?


I think that the sort of sleep apnea versus and Airway Center disorders covering all sorts of things?

Like, do you want to just explain that a little bit?


I mean are we just orders can be everything from not being able to breathe through your nose to severe.


Sleep apnea great.

It can be chronic allergic sinusitis.

It can be chronic open mouth breathing it can be chronic bronchitis, chronic environment, doesn't his kin doesn't fit their sleep apnea definition, but it's still not normal and according to the tests because remember the tests used to be scored more sensitively than they are now.


So if you Score a study at three percent.

It may, I mean, at 4% which is what the Medicare guidelines are.

Now, according to drop an oxygen of 4%, write a four percent while they know.

It's, yes, the 4% rule, it's the way that it's three percent versus 4% and but that can mean if they score your study at 4%, your acne is 5.


But if they scored it 3%, your apnea is 18, right?

Which one's right.

The house objectively what they're saying is if your acne is under 10 or 15, you don't have to do anything but I have had patients that we have seen or they have upper Airway resistance who actually feel worse and have never been.


So that's one of the maddening things is that that the language around it of mild moderate and severe doesn't have a bearing on people's symptoms, it doesn't have a bearing on like I've talked to, you know, man.


Have I don't even know like a a shy of 80 and then they, you know, I mean, they'll get on CPAP, but they don't really feel that Bad Azz and then, there's women who have, who are told, it's nothing wrong with you.

Have an H, I have four who were waking up every time.


They have automatically houses their brain.

And my wife is just the quality of life is so affected, right?

One of the neurologists that I've worked with for a long.


She's not a practice anymore.

Special Dominic who is probably the foremost researcher on vitamin D.


Be that biome and sleep.

But she and I talked about her early days.

We talked about really early days and she's the first person who said she had all these pain pattern.

These young women with came in, with migraines and she tried all the migraine materials and then she tried all of this and she says, I can't tell you how many patients.


I feel like I just totally was going the wrong way.

And then finally, she said, one day I just said I'm going to put give me a sleep study.

Their sleep studies.

All come back for what we would consider upper Airway resistance which is no Bap Nia.

You don't necessarily desaturate or something like that but she said, I just test drove half a dozen of them.


I put them on CPAP.

They all felt better.

They all had didn't have headaches anymore, they all felt better.

All of that, good stuff.

So it interestingly enough looking at what we call Micro arousals looking at kids kids.

Don't desaturate, but you got a kid.

That's what walking around.


Looking like a zombie.

Yeah, function in school.

They have a DD 0 DD, you know, anxiety, disorders.

You name it.

I do that stuff.

Comes from foundationally bad sleep.

It's not the kids guy Behavior, or any of that stuff.


So talk a little bit about kids, It's so I'm basically the poster child of what happens when you ignore all the.


Of course, when I was a child, we didn't know a lot of the stuff, right?

But so, I had really bad allergies, huge tonsils, huge tongue tie.

And you know, tongue would never sat on the roof of my mouth developed.

Like, super long face, never breed that my nose tall.


Nice breather all those problems then shockingly ended up with sleep apnea, right?

So talk a little It to parents listening about how important it is to catch all of this early and to work on prevention rather than trying to fix it when they're 40, you know?


Right, well, gosh, that would be great.

Fortunately, there are a lot of really good new books out by providers that are aimed at Mommy's, and Mommy groups.

There's my blog, there's all kinds of good stuff out there.

Something as simple as just watching your child.


I'll breathe in terms of do they hang their mouths open.

Are they hanging what can you do to just you know kind of gently purse your child's lips together right?

After they're done feeding as an infant to forget closed mouth breathing and having them use their nose.

Looking at.


How does a child sleep?

Are they rumbling up the covers are they, you know, they waking up Bunches of times a night or are they falling asleep while they're trying to at inappropriate times for a child, that's maybe just come up off of a nap or a child who was in, you know, little kids, Sleep a lot that's their job.


But as they, you know, you can tell if they've got big dark circles under their eyes, they're, they're constantly have allergic.

What we call allergic, shiners dark.


Your mouth is hanging, right.

Open their listless.

They're tired or they go from listless Tire to extremely hyper active.



And they're picky eaters, they have sensory issues, they have all of the stuff, lots of times that we have to start looking at different things.

We have to start looking.

Looking up systemic stuff.

We have to start looking at, you know, is your child sleeping enough hours?


Are they in an environment?

That's conducive to sleep, something as simple as taking.

All, the stuffed animals out of the bed that could be causing allergens and stuffy nose.

These are simple things, parents can do process of elimination, you know, things as simple as to take the Dario, okay?


They can have almond milk, cashew milk, ice cream.

They're not going to be deprived, right?

Cow's milk is for, you know, calves.

It's not for kids, right?

How about we?

Look at you know something simple you can do to make changes in your child's life.

One thing at a time, you can't just do 20 things at a time and then how do you fix it?


How do you know what the sensitivity is?

And then spending time with pediatricians, they have a tough slug, they seem more kids a day than they ever have.

They don't have a lot of time for kids that have problems.

They you know, they basically need to get you in and out.


Out, seven minutes.

Yeah, if you got a lot of questions about your child's, let's dismiss or behavior, they may want to refer you to a Pediatric Sleep specialist and then you're going to wait, six months for an appointment.

So the urgency doesn't seem to be there for a lot of pediatrics at all and they say, Oh, They'll outgrow it, although I grow it, you know, and it's like, yeah, maybe, maybe not, but your child's brain is growing so rapidly during those times you are really trying to Stave off low ability to thrive and they're living them, you know, having them reach their potential.


Because if their brain cells are dying and they're not, they're not making You know, new new brain cells are not developing properly.

Then you're lifting their lifelong potential.


So I tell parents if something seems weird.

Your kids snores, your kids got their mouth hanging wide open breathing.


Your kid has chronic tummy problems or has prank allergy problems or any of these things that you just like this.

Just does not seem right?

Yeah, your God and you know when you're got my functional therapy and now the big thing is the tongue-tie release and all of that You know, I look at it from a purely clinical standpoint, there's plenty of research that says it says, well, there's plenty of research systems that it's, you know, maybe not so good for every kid.


It's not every patient.

It's not something that you just automatically do.

It's like you don't just rip out.

Everybody's tonsils at five like they did when I was a kid, right?

You know, I was back in the day but the important thing is those therapies require very high levels of compliance and And parent interaction.


Yes if kid is only doing the exercises on Zoom with the myofunctional therapist for that hour once a week or whatever it is you're three or four thousand dollars is just gone down a hole.

It's very, very expensive, but it requires a practice therapy if you stop doing lips together teeth together, tongue to the roof of my mouth.


If you stop thinking in the middle of it, where's my tongue?

And then suck it up to the roof of your mouth constantly?

It's not your Mantra, then you're not doing it and it's like going to the gym.

The middle.

We agree with you that don't that used to be in your trunk is now back. if you stop similar to breathing as well, like potato breathing or what, you know, mine have to do mindfulness required and Children do not reach the age of reasoning until they're about seven and they don't say this is good for me.


Let me know if they don't, they can't rationalize it.

Even as compliant and Sweden, nice as some of these little Czar and they'll do anything to make mommy or daddy happy.

Hmm, which is great.

Those are your favorite kids.

Those are not the vast.

I don't have any of those.

My kids are you know might might.


Well mine would have been like yeah, right.

Wow, that's definitely a good thing it.


So we I think everybody has one kid that might have done it.

I mean, but it's like when they get there Orthodontics on is like, how well are they cleaning their teeth?

How well are they?

Yes, it's how well, do they.


I find the kids that are more structured and organized and naturally want to have order in their lives.

Those are the kids that pick up their toys and they put their books just where they want it, things like that.

That is an ingrate, that is an internal.

That is an internal way that that individual deals with the world.


Yes, that when I see that in a child or I see that in an adult and I'm not talking OCD like it did for the adults, but I'm talking to somebody who likes structure and discipline the regularity of doing these exercises at the regularity of hey this is actually something I can do.


That's going to help me center.

It's going to help me feel calm.

It's going to make me feel like I can breathe better.

I can sleep better.

Those are things.

Those are the mantras that mentally.

Li you take with you a little bit harder with a five-year-old knots.

And I'm the first person to say, if it's a tool in the back and it works, go for it.



So for you but Caveat Emptor like anything you do.

You must really research it as a parent as an individual.

There really is no way around that, right?

Because I feel like you could find, you know, so many different Humes people in this area that have completely different opinions on what you should do.


So I don't think that there really is an alternative to just digging in and reading yourself and coming up with what your best idea of what you should do, is whether it's for you or your child, you know, right?

Yeah, right.


And so that's that's all there.

Yeah, yeah.

So what I really want to ask you about is the foundation for Airway have yeah.


Very is that quite a new thing that you're the executive director since I've september/october of 2022 so that, you know, that kind of landed in my lap unexpectedly, but that's okay.


It's okay.

So it's an adjustment.

We are really the foundation for Airway Health has kind of been piggybacked along the a a PMD for all of these years and it's hard to have traction when you're dealing.

What when you have something that is practitioner facing and they kind of matically.


The foundation for Airway health is kind of part and parcel of it.

The foundation for Airway health, is a community facing organization to provide education for nonprofit, right?

It's a 501 c, 3 non-profit, and the goal is to provide education and awareness, as well as hopefully, to help provide access to care to all demographics including the underserved.


So, we are revamping the website, we are revamping, how we go about doing this, you know.

Foundations to, in order to get corporate help corporations.

Definitely want to see what you're going to give them in return for what you're doing.

This is for the people, so it's a little bit different, it's a different kind of a risk.


So we're going to have their we want to be able to say here are stories of people from all over the country with different kinds of problems.

If you're an A A PMD member one of the things you know they automatically think they don't automatically give to the foundation but the Nation is patient-facing, whereas a a PMD.


Although we get thousands of people a month looking for a provider on the a a PMD wets lots of times.

It's more the Ed, there's research and education.

That's provider focused.

This is for your.

So the a PMD is like looking at dentists and doctors and people that want to learn more.



It's a grating them and vital resources.

Yeah and we give we give webinars all month.

Long educational.

Webinars, you can get paste, you get C credit for them or task one of the two and the CE credit for the, a a PMD webinars.


We also have part of a PMD is the Endeavor, which is the 0272 month group.

They have a monthly webinar.

We now focus on a PT.

So these are providers that are going to a PMD.

Yes, the collaboration cures conference to for videos of all of this educational material and then we are kicking off.


Also, In college, which is a means by which providers can go and all of this material course material.

We have is going to be made available in an online course.

I also thank you to train in a and for any modality so you can get, you can get, you know, kind of build your pedagogy from any discipline that you want.


So that's less dentists and doctors and I keep saying dentists and doctors, but it's really like any all providers, all providers.

Like and the want to learning more about are way they can do that training.

That's awesome.

As I think that is the huge part of it is just having more providers across the country trained and who are even aware or who care?


Yeah, there's their kind of, you know, people are starting the young, my, my goal right now.

I want to provide a platform for the people who come behind us how he and Steve, and I were kind of the Elder Statesman of the group and where we want to provide Platform from which these younger people can stand on there and build it bigger.



On their own and I think you all have a few years left in you.


Well we have four years when I doing this.

Yeah, you're like at some point I might be done with this.

I might be done with this at some point, but and then the foundation for Airway health is, you know, been definitely facing the public wanting to capture the hearts and minds of the public eye.


We all see ads for Save.

The whales, save the polar bears.

So you know, kids how about your five dollar donation or whatever it might help?

Allow us to provide information to an underserved person about somebody who can get them care and that they can afford that they can actually pay for it and feel like you are a citizen.


They are worthy citizen of this.

Kind of care is so high to people listening and get involved what you're doing.

Like, is there a way?

I feel like you do you have a way for people to share?

Are there stories or they eat the foundation for Airway Health has a website you can go on its in the midst being rebuilt and all that but I think the functional at this point and you can contact, you can send an email out.


You can say you know, you can ask questions, we will do our best to field those questions.

And it's going to and look at what we're going to be putting up there shortly in terms of the videos because if I can have anybody look at three or four minutes snippet and say oh that's me.


Oh, that's my child's everything.

I know if people recognize then and, you know, mommy's groups and people who look at things like that and they say, oh that's me.

They know. 10 people more that it's them.


And then it's more of a ground Roots.

We believe that the foundation for Airway Health, that is a feet on the ground movement, think of Mother's for drunk driving.


It's the moms that made this happen and so we get the moms and the dads and the and the grandparents and All those people from the public who want to we'd like to a a PMD Liaisons.

They might provide Community, you know, some sort of a community effort where they can say, okay, I know 10 people in my community here who are aware of these kinds of issues and we want to put their name up here so that you can find them in perhaps, get help.


I also see, I don't know if you would agree with this but I I see a lot of every time I go and see my sleep specialist, they're just like Like, imagine being my doctor, it's a loss.

But, you know, every time I go I always have like a book that he needs to read.


Or, you know, I'm, I'm sharing about like somebody who I interviewed who you know, there's been all sorts of people but like you know, different things that have worked for different people.

And you know, or I'm sharing like you know, the ENT I went to see and, you know, he might want to connect with them and and and I feel like the more that that happens it's almost Like patients, some of that change can come from patients, just right.


Explaining what they're doing and and you know, like asking like, well, do you know a dentist that can make an oral Appliance for me and you know, like wish you would hope would be, you know, every doctor has that relationship, but they don't.

So I feel like really like the public can make a huge difference in this, and that's very true.


And from that very Thought process, I think, when you go to your doctor, I think the people individuals fail to realize how you impact and change your doctor in ways, you will never know.


That I'm funny.

I know just from my primary care physician.

She one time told me that everything she knew about sleep apnea she'd learned from me, right?

Because she was like in medical school.

I think we got Sleep disorders for like a day.


Yeah, dad and they're just not talk about it.

So yeah.


And so well this has been an absolute Delight.

Is there anything else that we haven't covered that you want to speak to you?

No, I think you know any type you have a blog or a webinar or anything like this, where you have going out on the Airways, it's that's your a missionary to the people in a really good way.


And I really appreciate just being able to kind of prattle along here about the World by work and live in and I really do believe that the more people who hear this will start thinking about people, they know and they love that are suffering.


Earring and may not even know it and take for granted that their suffering is just part and parcel of their of their now that you're now doesn't need to be.

This, your now is very different than your now was 10 years ago.

Let's figure out why.

And so, you can be your best person in your next 10 years and it takes the takes a village to have this happen.


But the more people who are willing to say, look, I want to talk to you about this to their doctor and say, you may not be interested, but you could help.

Save somebody else.

That's powerful.

It's a very powerful message.

So I appreciate what you're doing here.

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