Let’s talk about melatonin. It’s in the news, uh, almost every day. It’s a popular influencer subject, but what is melatonin? Why is it useful? Where do we get it? How do we find it? Let’s go from there. So most of us think of melatonin as the sleep hormone, and it is true that some of our melatonin is produced in the pineal gland inside the brain. And melatonin is produced in response to the circadian rhythm, exposure to bright light that’s controlled by an area of our brain called the Supra kay nucleus, the SCN, that literally controls our awake and sleep cycle. And as you’ve heard me write about, as you’ve heard me speak about our circadian cycle is completely screwed up these days. In fact, some people probably correctly say that Edison is the cause of many of our modern ailments because he invented the light bulb and prior to the invention of the light bulb, which had the incandescent light had a great deal of blue light that wasn’t present in the lighting systems prior to incandescent light bulbs.
Speaker 2 (01:57):
For instance, think about it. Even if you look at old movies or recreation of old movies where candlelight or firelight or lights from kerosene lanterns or oil lamps of various types, whale oil was a popular light source. These were all in the shades of yellows, oranges, and even reds. The incandescent light brought in the spectrum of full sunlight with a lot of blue light. Now, blue light is great for activating this awake cycle, but it’s the absence of blue light that actually starts the production of melatonin in your pineal gland, which should signal the onset of sleep. And that was a really good system. And think about it, even if a hundred years ago you eight by firelight or even read a book by firelight, you had no blue stimulation to stop the onset of melatonin production. Now however, all of our devices, almost all of our lighting are heavily blue light.
Speaker 2 (03:18):
Your screen that you’re watching this with right now is a blue light emitting screen. Your television screen is a blue light emission screen. Most of the lights in your house are blue light emitting. So we’re constantly bombarded with that waking signal rather than the absence of that blue light with sundown normally would start the production of melatonin and that would flow with the normal sleep cycle. So melatonin’s pretty good if that old system works well. But the other thing I think people are missing is melatonin is not just a sleep hormone. Melatonin is actually only one of two antioxidants in your mitochondria just to refresh your course. Mitochondria are the energy producing organelles in almost all of your cells. They produce a TP. Now, I’ve written books about this. Producing a TP in your mitochondria is hard work. It’s very damaging work to the mitochondria.
Speaker 2 (04:28):
And there are two antioxidants within your mitochondria that either undo that damage or try to prevent that damage. One of those two antioxidants is melatonin, the sleep hormone. The other is glutathione. And don’t get me started about glutathione infusions. So those are the only two antioxidants in your mitochondria. Antioxidants like vitamin E, like vitamin C. Yes, they’re antioxidants but they have nothing to do with the or mitochondria protection only melatonin and glutathione. So one of the things I want you to take away from this today is that melatonin is not the sleep hormone, but melatonin is really the mitochondrial antioxidant that you want. In fact, as I’ve written about in the energy paradox, there’s good evidence that the reason your melatonin production goes up at night is because you need repair of your mitochondria in the neurons of your brain during sleep. And it’s the melatonin production that actually facilitates the repair that goes on during the sleep cycle.
Speaker 2 (05:55):
And let’s be clear, you have to have sleep. No one can go very long without sleep, without their brain sputtering and going on overload. Believe me, the longest I have ever gone without sleep. Uh, as a surgical resident with four days without sleep, I do not recommend it. Luckily in the modern era of training doctors, there are prescribed times when just like an airplane pilot, we have to go to sleep. Alright? So melatonin is a mitochondrial protective and the more we think of melatonin in that way, the better we’ll have a better feeling of how to use melatonin. Now, melatonin protects mitochondria. So what happens when you don’t have enough melatonin production? And quite frankly, as we age, our melatonin production slowly goes down. So your repair of your brain slows down, your sleep initiation slows. Many studies show it is harder the older we get to start the sleep cycle is that because we’re not making enough melatonin or because we are so exposed to blue light that we never get the message to let me melatonin be produced.
Speaker 2 (07:25):
I fall into the second camp that it’s the blue light exposure. That’s the problem, not the fact that we’re just not capable of making melatonin. Now melatonin is available over the counter and there’s two if you will, competing versions of melatonin. First of all, it does not take much melatonin to initiate the sleep cycle. Very small doses of oral melatonin or sublingual melatonin, like 0.1 to 0.3 milligrams is really all you need to initiate the sleep cycle. And that’s not much. On the other hand, you will see three milligrams, five milligrams, 10 milligrams, you’ll even see higher doses. What’s up with that? Well, twofold. These higher doses will absolutely put you to sleep for most people. But in my patient population, what I usually see from these standard higher doses is yes, you will go to sleep, but when that dose wears off, you wake up usually one, two o’clock in the morning and you can’t go back to sleep.
Speaker 2 (08:42):
That seems to be universal in so many of my patients. That’s why if you want to try melatonin for sleep, I either recommend the tiny amount or the timed release melatonin like three milligrams and always look for the word timed release. When we use that, it usually results in a much longer sleep cycle and it doesn’t wear off. Now some people are very sensitive to the lingering effect of melatonin and they notice that they wake up groggy. If you are one of those people, then by all means think about the small doses, the 0.1 or 0.3 milligram and try that out first. As I’ve written about in the energy paradox, there is some fascinating evidence that melatonin because it’s so critical in repairing mitochondria and that the mitochondrial dysfunction theory of cancer is a very reasonable theory, theory of cancer causation, that there are some interesting animal studies showing that high dose melatonin certainly used across the day can have an anti-cancer effect.
Speaker 2 (10:06):
And I have used this in one of my dogs successfully and I have used it in several of my patients successfully. And I do think it’s because it’s not the sleep hormone, it’s actually the mitochondrial repair and defense hormone where that’s important. Finally, melatonin is present in large amounts of foods. And in my last two books I’ve given a list of where the most melatonin rich foods are. And one of the intriguing theories of the benefits of the me of the Mediterranean diet has always been, well the Mediterranean diet is rich in polyphenols. And if you follow me, you know, polyphenols are plant compounds that are now recognized as prebiotics for our gut bacteria and are gut bacteria. Then change these polyphenols into absorbable compounds that protect our mitochondria by becoming mitochondrial on couplers. On the other hand, almost all of the foods in the Mediterranean diet that are rich in polyphenols are also rich in melatonin, including olive oil, including red wine.
Speaker 2 (11:32):
And I could go down the list including spices. So a companion theory to the Mediterranean and diet is good for you because of the polyphenols is that the Mediterranean diet is good for you because of the melatonin content. Why? Because both of are actually working at the mitochondrial level to protect your mitochondria. Fun fact, pistachios have the highest melatonin content of any food and you are correct. I have a bowl of shelled pistachios every afternoon right before dinner for number one, they tastes good but I’m eating them for their melatonin content and no, they don’t put me asleep. Good news. Alright, how do we boost melatonin production naturally? Well number one is eating these melatonin rich foods. Number two, you gotta dim your screens. There is a blue light dimming feature on every phone. Make sure to switch it on. Please change over to non blue light lights, particularly in your bedroom.
Speaker 2 (12:49):
And particularly if you’re gonna watch TV or if you’re on a screen device, put on a pair of blue blocking glasses. A lot of ’em are really cheap, a lot of ’em you can wear over your glasses. I have several blue light glasses with prescriptions in them, but don’t hesitate to put them on. Nobody’s gonna see you. You can, you can look kind of cool and gorky in the privacy of your own home. The other thing, try, try to get out early in the morning and get bright sunlight. That bright sunlight starts this circadian cycle and get a dog. The dog will assure that you get out in bright sunlight. If you don’t have bright sunlight in the morning. If you live in the northern United States, then consider getting yourself a bright light source for a morning and looking at that. There’s also very good evidence that this really helps with seasonal effective disorder supplement strategy.
Speaker 2 (13:55):
Hey, pistachios are great, Turkey is a great way. Melatonin is manufactured through the tryptophan pathway, same pathway, the serotonin’s manufactured. And isn’t it interesting that people really want to take a nap after Thanksgiving dinner because of the tryptophan in Turkey being converted to melatonin? That’ll help. Finally, short term use, low doses. If you want to experiment with melatonin, if you find it’s useful, then consider the timed release melatonin. You’ll bathe your mitochondria with melatonin throughout the night. So these are melatonin 1 0 1, but think of melatonin not as the sleep hormone, but think of melatonin being produced to repair your mitochondria during sleep. And any time you can repair your mitochondria is a good time. So go have a bowl of pistachios and please buy them in the shell. It’ll slow you down. Don’t eat them by the handful outta the bag already. Shell could fixing your sleep extend your lifespan.
Speaker 2 (15:07):
Okay, you wash your car, your clothes, your house, your dog, your dishes, you, but do you wash your brain? That’s right. If you are not getting enough sleep, you are not giving your brain the proper cleaning cycle. And I’m not telling you anything you don’t already know. But without at least seven hours of sleep each night, it’s literally cutting years off your life and sadly it’s probably cutting years off of your memory. So how in the world does losing sleep shorten your lifespan? Well, let me count the ways studies show a higher risk of cognitive decline earlier than normal. Chronic lack of sleep can lead to depression, which can lead to skipping exercise and quite frankly, poor eating choices. There have been phenomenal research on the lives of shift workers. The lack of sleep correlates strongly with insulin resistance, metabolic inflexibility, overeating and dramatic increase of cancer in shift workers.
Speaker 2 (16:30):
Now let me give you a personal example. As a resident in surgery and heart surgery in the United States, uh, particularly as a chief resident in heart surgery, the chief resident was literally on call 24 hours a day, 3,365 days a year. That meant if someone came in with a heart attack in the middle of the night, uh, and you were asleep, that meant you were doing that operation and if you had a full schedule, uh, the next day. So what, uh, you didn’t sleep? Uh, the longest I ever went without sleep was four days. Um, and then I got three hours of sleep and went back at it. So, uh, during that time I kept myself awake by eating carbohydrates. I cannot tell you the number of times I went to the snack machines at the hospital and bought ding dongs and hostess cupcakes and candy bars and uh, I gained a lot of weight.
Speaker 2 (17:43):
I then went to England to do my pediatric heart surgery fellowship and the was night and day. The chief resident, the the senior registrar, was only on call every third night and was only on call every third weekend. So two out of every three nights you were at home, you were not allowed to be called two out of every three weekends. You were not allowed to come into the hospital and imagine my shock, you know, type a personality showing up on Saturday morning, my first weekend off after I had operated on little babies and children the day before to see them. And I was literally stopped at the ICU door by my colleague who said, what are you doing here? And I said, well, I’m here to see my babies. And they said, no, you’re not allowed in the hospital. We’ll see you Monday. And I said, but I, I operated on these kids.
Speaker 2 (18:45):
They said, no, you trust us, we trust you, you’re off. I dealt with guilt for a few weeks, uh, but then I got used to it. I lost 30 pounds in one year just by getting adequate sleep. Those two weekends off, two out of three nights just the lack of sleep was killing me because I was killing myself trying to stay awake by eating sugary foods. Dramatic example that I’ll never forget. But sleep is one thing. It’s the type of sleep that makes a huge difference. There’s essentially three types of sleep. There is light sleep. Now first of all, light sleep is good for you because we’re now beginning to realize that sleep is the time when your mitochondria, those energy producing organelles, factories in all of you, but particularly in the neurons of your brain do the repair work. And we’re beginning to realize that the reason melatonin is produced during sleep and right before sleep is not so much to put you to sleep, but it’s been discovered that melatonin is one of the two antioxidants that actually repair your mitochondria.
Speaker 2 (20:19):
So as I talk about in unlocking the keto code, we need to stop thinking about melatonin as the sleep hormone, but talk about it as the brain neuron, mitochondrial repair hormone. So even light sleep is when this takes place. Now many people have heard of REM sleep, rapid eye movement sleep. This is the time when you dream. Now what’s important about dreaming is that dreaming is the time when memories are taken from basically our short-term memory bank and deposited into our long-term memory bank. And it’s the time that neurons send out what are called dendritic processes to connect up with another neuron to solidify this memory. So without REM sleep, you’re going to lose a lot of the memories that you should be storing. But perhaps the most important is deep sleep. Now deep sleep usually occurs early in the sleep cycle and during deep sleep we now know that the brain undergoes a wash cycle.
Speaker 2 (21:48):
And during this wash cycle the brain can shrink by as much as 25% very much like squeezing out a sponge. And as that brain shrinks, the brain squishes out all the toxins that can accumulate like amyloid, like tau, like bacterial toxins. And it’s this wash cycle, this deep sleep that’s really critical long-term in protecting your brain. Now here’s the problem. This wash cycle requires huge amounts of blood flow. That blood flow needs to be available early in the sleep cycle, but lot eating and digestion requires huge amounts of blood flow. And so after you eat for about three hours, maybe four, most of the blood flow in your body is directed down towards your gut to do digestion. I’ve said this over and over again, but when I was a young kid, if you ate lunch your mother would make you wait for one hour before you could go swimming because everybody knew that if you went before that you would develop cramps and die.
Speaker 2 (23:13):
Now there was some truth to that old wise tale that is that during digestion all that blood flow went to your gut and it wasn’t available to your muscles to go swimming and you could get cramps. Would you die? No. But the point’s well made, what happens if you are eating near bedtime, your brain is going to get a cramp because it’s not going to get the proper blood flow to do the wash cycle. And this system called the glymphatic system is now really one of the cornerstones of why you really need to stop eating about three hours before you go to bed. Now we are a nation of late night snackers, but part of the reason we have an epidemic of dementia, of Alzheimer’s, of Parkinson’s is that we have created the perfect storm for not allowing our brain to recover every night in the way it’s supposed to recover.
Speaker 2 (24:26):
Finally, we have inundated our eyes with blue light. Almost all of our light bulbs emit huge amounts of blue light. Our computer screens, our TV screens emit huge amounts of blue light. That blue light literally tells our brain not to shut off, not to do the things it’s supposed to do. So what do you do? Try not to look at a screen before bed. If you are gonna look at a screen, get yourself a pair of blue light blocking glasses. There’s number of them out there that are really good quality. You can wear ’em over glasses, you can clip ’em on glasses. There’s no excuse not for wearing them. Darken your room as much as possible. Get light blocking shades, get light blocking mass. Try time to release melatonin. Start with a small amount, say three to five milligrams if you need to work your way up to 10 milligrams. But make sure you buy time to release melatonin, not the straight stuff.
Speaker 2 (25:43):
So let’s talk about sleep apnea. Something that I deal with uh, with a lot of my patients and I wanna help you kind of make it through the muddy waters of what sleep apnea is, why you probably ought to know about it and probably why you ought to do something about it if you have it. So have you ever woken up in the middle of the night gasping for air or noticing that your mouth is incredibly dry or worse have been told that you snore like a chainsaw? Well you might just have sleep apnea. Now quick statistic, an estimated 1 billion people worldwide suffer from sleep apnea and many are undiagnosed. So before we dive into this global epidemic discussing what causes sleep apnea, why it’s so common, what treatments work and which may not, and whether new high tech devices like inspire are worth considering, please rate and review this podcast on the platform you’re listening on and make sure to tell your friends and family so they can enjoy it too if you like it.
Speaker 2 (26:53):
So the definition of sleep apnea is actually repeated pauses in breathing during sleep. It’s often due to the tongue falling back into the back of your mouth blocking your airway. Now there are many other causes of sleep apnea including what’s called central sleep apnea, which we’re not gonna talk about today ’cause it’s a totally different treatment. But most sleep apnea is caused by a disturbance in the upper airway. Now this can be caused by multiple factors. Sometimes it’s as simple that you have not a very large lower jaw and that your lower jaw interestingly enough, has been getting smaller and smaller with the passage of years in studying humans like I do, we used to have a pretty big lower jaw. But one of the theories of why our lower jaw in particular has become smaller is we no longer need an aggressive jaw to eat the food we eat because most of our food is cooked and then pulverized into a fine powder or we’re drinking a smoothie.
Speaker 2 (28:06):
So we really don’t have much use for a large jaw anymore, be that the case many people who do have a smaller lower jaw do suffer from sleep apnea because quite frankly there’s not enough room in your mouth for your tongue and that as your tongue rests literally on the back of your lower jaw, in some people when they sleep, the tongue tends to drift backwards closing off the airway and that causes oxygen levels to drop in your blood. And if you are lucky that fall in the oxygen level suddenly stimulates you awake and you take one of those sudden deep breaths if you are lucky. Unfortunately a great number of people because it’s happening for so long and so often that that reflex of either oxygen falling or carbon dioxide rising no longer is very vigorous. And so many of my patients with sleep apnea, when we do oxygen tracking on their sleep, we’ll have spo twos, uh, partial pressure of oxygen in the seventies or eighties, whereas really the lower limit of normal is about 90 to 92.
Speaker 2 (29:29):
And they’re totally unaware that half of the time they’re asleep, they’re profoundly hypoxic, they’re deprived of oxygen and they’re totally unaware of it. Uh, in fact, I have a good friend who is a cardiologist who his wife really hated sleeping with him because he snored so bad and we happened to have gone on vacation with him and they were in the bedroom in the hotel next to our bedroom and we could hear him through the room. And because he’s such a good friend, I said, do you know you you have sleep apnea? He said, oh no, I don’t have sleep apnea. Are you kidding? I said, I’m telling you, you got it. Go get checked. Well, so he got sleep study and the doc who did a sleep study said, you know, quite frankly I can’t imagine why you’re alive and how you could possibly function as a cardiologist because you have some of the worst sleep apnea that I’ve ever seen in my life.
Speaker 2 (30:31):
And he had become so chronically used to this that what he thought was a normal day and how he felt going throughout the day and how tired he was was because he was a very busy cardiologist. But the point is he had severe sleep apnea and now that he’s on a CCP a P machine, luckily his wife now sleeps with him again ’cause she couldn’t take the snoring. But his activity at work is sterling compared to what he thought. He was just tired all the time from a bi busy practice. And I owe his success to me. ’cause if I wasn’t sleeping next to him in the hotel room, I wouldn’t, wouldn’t have known I first started getting into sleep apnea when we used to have a really fantastic blood tests for very subtle myocardial ischemia. That means the heart muscle is not happy. Many of you know that if you think you’re suffering from a heart attack, you go to the emergency room, we draw some blood on you looking for troponin T, which is a measurement of heart muscle damage.
Speaker 2 (31:35):
And if we see it above a level or if we’re seeing it rising, boom you have heart attack. Well a particular company that’s now out of business invented a test called Troponin I, which was a hundred times more sensitive to this heart muscle damage than the test we use in the emergency room troponin T. And we used to get it on all of our patients. And one of the early striking findings is we’d have people with absolutely normal coronary arteries by a stress test, by ct coronary angiogram, by a cardiac catheterization. And yet they’d have these low grade troponin eye. And so I said, gee, I wonder what else could be causing this. It’s certainly not coronary artery disease. And lo and behold, there were several papers implicating sleep apnea with elevation in troponin levels in patients. And so I started taking my patients with this elevated marker, getting a sleep study and finding almost universally these patients had sleep apnea.
Speaker 2 (32:42):
And the minute we started treating their sleep apnea with A-C-P-A-P and showing that it was working, lo and behold their troponin eyes went down to normal. And who would’ve guessed that every night their heart was basically having a mini heart attack that they were completely unaware of. And certainly I would’ve known about it without that sleep test. The other reason I see it is we have another hormone that your heart makes called N NT pro BNP. And I promise there won’t be a test. We call it the heart happy hormone because it’s a really good subtle way of seeing how hard your heart’s working. And we can use it to pick up leaks and valves. We can even use it to watch who’s exercising, who’s not exercising. We can use it to look for myocardial ischemia. But we also notice that patients with this el slightly elevated BNP that we assume, eh, they’re just getting old and you know, maybe they got a little leak in a valve when we diagnose sleep apnea with them and put them on CPA.
Speaker 2 (33:53):
Lo and behold this heart happy hormone returned to normal. So the reason I’m telling you about all this is this is a real silent killer of your heart and your brain and not just a problem with you snoring like a, like a sailor, like a chainsaw. So that’s why you should be interested in finding out if you have sleep apnea. Why doesn’t everyone have it? Well, everyone doesn’t have a small jaw. But one of the other factors that has prompted me to get sleep studies through the years is that amazingly early on when we started having success in weight loss in my clinics, and again I’ve been doing this for 30 years now, six days a week, lo and behold the spouse or significant other would say, you know, the big biggest benefit is yeah, he feels better but he doesn’t snore anymore. And so one of the first things we did with people who we diagnosed sleep apnea is put them on my weight loss program.
Speaker 2 (34:56):
Or people who were, who hated their CPAP machine and wanted to get off of it. How did we do that? Well we like to store a lot of fat in our mouth, in our neck and that fat literally narrows the airway and makes quite frankly our tongue fattier and just reducing that fat in the neck and the tongue area has significant benefit for a large number of people with sleep apnea. What else can do it? Well, alcohol is notorious for causing sleep apnea sedatives or notorious for causing sleep apnea because they really relax the airway muscles and a poor diet reflux can certainly contribute to sleep apnea. And one of the first things I do with my patients is I get them off of their back sleeping. Because think about it, when you’re on your back sleeping, one of the first things that can happen is that your tongue can roll backwards.
Speaker 2 (35:59):
On the other hand, if you sleep on your side, particularly the left side and there are now pillows that are specifically designed that you can order on Amazon, that will force you into a left-sided sleeping position that not only keeps your tongue from rolling in the back of your mouth but also is very effective at preventing reflux which can cause spasm in your lower airway. Enlarged tonsils, enlarged adenoids. This is more a problem with my younger patients, but many people still have their tonsils and adenoids and this can be a factor as well. Now interestingly enough, women seem to not get this until they become postmenopausal. Now whether that’s because so many postmenopausal women start to gain weight that they didn’t have beforehand, that may be a factor or it may be estrogen is a useful hormone to keep muscular tone in the head and neck and I think the research is not clear yet.
Speaker 2 (37:02):
So what are the red flags? Well, I’ve told you all the ones that I see in blood work, but again, snoring is a classic. You’re not supposed to snore, gasping, choking sounds. Morning headaches is a classic. Waking up with a dry mouth is almost certainly a sign that you are mouth breathing rather than nasal breathing. Daytime fatigue, poor focus, irritability. Again, my very good friend, the cardiologist thought that was a normal part of his busy cardio, you know, cardiac lifestyle. It was fact, it was his sleep apnea. If your partner is complaining, please listen. Do not say, ah, you’re making it up. I don’t snore. In fact, I always have the significant other in the exam room with my new patient because that’s one of the first questions I ask. Does he or she snore? And they usually say, yeah, like a chainsaw. And they, I do not.
Speaker 2 (38:02):
I’ve never snored in my life. So ask your partner, do you snore And ask for an honest answer. Restless legs can be a sign of this tooth. Grinding can be a a sign of this. And really weird mood swings can be a sign of this. Do you want to do a sleep study? Yes you do. Now let’s be frank, most sleep studies are a pain in the neck ’cause they want you to come into a sleep lab. And I’ve never understood how anyone could possibly go to sleep in a sleep lab wired up. Luckily there are many sleep labs that new now do. At-home studies, there are several companies that make some very interesting monitors to look for sleep apnea. There are even tracking devices like an aura ring or like a whoop band, which is buried back here that will look at oxygen changes during your sleep and quantify it and show how long it happens, how often it happens.
Speaker 2 (39:01):
Recently I had one of my patients who had these devices and the devices weren’t really giving her much bad information. She got one of these oxygen trackers sleep trackers and brought it in to show me. And this is a very healthy, energetic woman. She had some of the most impressive drops in oxygen saturation in this healthy female that I’d ever seen. So need to say we’re getting a sleep study on her. This is actually new information. So there’s lots of ways now to start looking into whether this is happening, but one of the best ways is your partner telling you you snore. Okay, so what are the treatment options? So the traditional treatment option is CPAP. That stands for continuous positive airway pressure C pap. It’s a machine that delivers pressurized air to a mask or to nasal plugs that keep the airway open and it’s titrated to exactly the amount of pressure that you need to keep your airway open.
Speaker 2 (40:07):
And so most sleep studies, if they find sleep apnea, automatically do A-C-P-A-P test and titration to see what will work for you. Quite frankly, many people don’t like initially that feeling of that pressure. And so a good sleep study center will actually titrate your CPAP to what will work for you but will also be tolerant for you. Now it is the gold standard. It’s proven to reduce sleep apnea episodes. It lowers blood pressure, it improves daytime energy and there’s no doubt about, there are definitely cons. Some people hate the mass, they almost feel like they’re smothering again, there are other options. Now there’s nasal CPAP, which is becoming more popular. There’s fitting issues and you’ve gotta find a mass that’s comfortable and fits and compliance issues. You gotta keep the dumb thing clean, you have to travel with it. Luckily there are many portable CPAP machines.
Speaker 2 (41:11):
You probably see them going down the aisles of most airlines these days. They’re easy to travel with, but there’s no doubt about, you’ve got to get the benefit. You actually have to see the benefit either on blood work or how you feel for you to stay with it. It’s safe overall. It reduces cardiovascular risk and you gotta use it consistently. There are certainly other approaches. Like I said, I’m amazed at how many people we can get off CPAP by simple dietary changes by putting them on their left side by weight loss. Even such things as mouth taping can be useful to force you to breathe through your nose. There are devices that trained dentists can develop and use to pull your jaw forward. I’ve even had one patient take the extreme effect of breaking both of his jaws and expanding his jaw to open up his mouth.
Speaker 2 (42:15):
Now that’s extreme, but it worked incredibly effectively and he had a very small lower jaw. So there are all these alternative approaches. Surgery can sometimes be used for taking out if it’s lymphatic tissue, adenoids and tonsils that are the trouble. But that’s really way down the line. Now you’ve probably seen all these commercials for the new kid on the block, the Inspire implant, and there’s a bunch of these guys on CPAP having a meeting and there’s this young healthy guy saying, oh geez, I don’t use that anymore. And everybody’s incredulous and they’re tearing off their mask and he says, I’ve just got the inspire. What the heck is it? Well, it’s an FDA approved implant that actually stimulates a little nerve in your neck called the hypoglossal nerve. And it actually is what stimulates your tongue. Now I know a lot about the hypoglossal nerve because as a vascular surgeon in the head and neck, in the carotid artery, we always identified the hypoglossal nerve, which runs in the carotid sheath because if we damage that nerve, your tongue on that side didn’t work.
Speaker 2 (43:28):
But clever researchers learn that if you periodically stimulate that nerve, you will actually contract the tongue and the tongue will not fall in the back of your throat. There’s a sensor implanted in your chest under the skin. Now the sensor detects breathing and it sends mild electrical signals to keep the tongue moving forward. Now the pros, there isn’t any mask now. It improves quality of life and people who can’t tolerate CPAP and the evidence shows, and the reason it’s been approved is that it does have a significant reduction in these apneic episodes and in daytime sleepiness. Are there cons and limitations? Well, yeah, it requires surgery, it requires follow-up programming. It’s not for everyone. The FDA has strict requirements. There are BMI body mass index requirements and you right now only qual qualify for moderate to severe sleep apnea, not just the everyday. And it’s expensive and so far it’s iffy whether insurance will cover this.
Speaker 2 (44:35):
So you gotta have to check. There are safety concerns. It does use mild electrical stimulation and like any implant, and I can tell you having put thousands of pacemakers in implants in my patients, there are risks of infection with these devices. There’s risk of discomfort from these devices and hardware can malfunction, but it uses a good principle that kind of pulling the tongue out of the way maybe useful. But in the meantime, lifestyle modification is still the number one thing I do with my patients with sleep apnea, with my CPAP dependent patients who want to get off CPAP. And it all comes down to, you know, take care of your body with the food you put into it and your body will usually reward you by taking care of you.
Speaker 1 (45:35):
I hope you enjoyed this episode of the Dr. Gundry podcast. If you did, please share this with family and friends. You never know how one of these health tips can completely transform someone’s life when you take the time to share it with them. There’s also the Dr. Gundry Podcast YouTube channel where we have tens of thousands of free health insights that can help you and your loved ones live a long, vital life. Let’s do this together.
