November 14, 2016

CURE For Obstructive Sleep Apnea

Cure for Obstructive Sleep Apnea?!

Mighty big words for an ailment that inflicts millions of people around the world today and with millions more being diagnosed every year. If you read my blog posted a few years ago on obstructive sleep apnea (OSA) and the other on AM re-positioners then you have the history of how I became introduced to the treatment of OSA. Of course, there are no guarantees in medicine that every treatment will resolve your medical problem because of patient compliance, anatomical differences, and severity of case.  This is why it is very important to be properly diagnosed by a Board Certified Sleep Physician and be treated by a licensed and certified dentist. No guarantees of success are implied in this article.

Essentially, there are only a few ways to treat OSA:

  1. Lose weight. Some people are obese enough to cause their neck/tongue to enlarge with fat limiting their airway while sleeping.  Sometimes in these individuals all it takes is to loose a few pounds (some others need to loose much more.)Cure Obstructive Sleep Apnea
  2. CPAP (and all it’s mechanical/pneumonic relatives) blows open your windpipe with an air pump and mask assembly. People find it uncomfortable and eventually abandon it or learn to tolerate it. If you are reading this blog you know what I mean.
  3. Oral appliance therapy (OAT). This is a dental treatment for a medical problem. In other words, the sleep doctor  prescribes an OAT for patients who have mild or moderate OSA or severe patients who cannot tolerate CPAP.  The dentist fills the prescription by manufacturing a custom oral appliance to protrude the lower jaw forward during sleep. Pulling the lower jaw forward, pulls the tongue forward which open the back of the airway. This doesn’t work on all airways because of anatomical differences.
  4. Maxillary/mandibular advancement. This is radical facial surgery. By pulling both the maxilla and mandible forward surgically the posterior airways can be opened, appreciably. Very few people go to this extreme to cure their OSA. It is both cost prohibitive and invasive.
  5. Biomimetic oral appliance therapy (BOAT) see below.

I’ve personally tried to lose weight and wear an OAT for years and was unable to permanently resolve my moderate OSA this way.

Cure Obstructive Sleep Apnea, studio beauty portrait of twins hair conceptSo, how did I do it? I did it with a new approach to the problem, epigenetics. Inside every human being the DNA that they inherited from their parents is the code for the normal human body. In other words, unless you have a defect in your genes, you have the blueprint for a normal looking face. Epigenetics is the turning on and off of genes in the very long sequence of genes that makeup the human genome. For instance, when you are a young child you normally don’t have the genes turned on for hair under your armpits and so on. Identical twins with the exact same genome look slightly dissimilar as they age because they are influenced by different internal and external epigenetic stimuli throughout their lives. This happens to all of us. Our modern lifestyles have stimulated our genome in ways we have not foreseen until recently. To understand these epigenetic changes better we will have to Cure Obstructive Sleep Apnea 12948134 - a wacky take on sushi, red lips getting ready to eat a live grasshopper with chopsticksjump into a time machine and go back to prehistoric times. Back before humans planted the first seed in the ground.
Back to the preagricultural era of human development. Back when every human born was breast fed (different oral mechanics from bottle feeding) and then given food scraps of the everyday diet of meat, fat, vegetable, fruits, tubers/roots, nuts, the occasional honey hive and of course, lots of yummy insects (whether they be found in the food spoiling process or sought out in their own right).

Dr. Weston Price was a dentist who back in the 1930’s showed how the modern diet of grains, flour, processed sugar/vegetable fats had caused many dental issues not seen in the more primitive cultures that still existed on Earth.  He noted, following couples who raised children in a primitive homeland that their children grew up with straight teeth, well developed jaws and no breathing problems. The children were breast fed (often for an extended period) and then fed a course diet of available foods. Not bottle fed (or “pumped” breast milk from a bCure Obstructive Sleep Apnea, 10623083 - new guinea, indonesia -december 28: the woman of a papuan tribe in traditional clothes and coloring in new guinea island, indonesia on december 28, 2010ottle), not fed processed baby foods from the jar.  No diet high in carbohydrates or trans fats (processed vegetable oils). The modern vernacular would include the term “Paleo Diet“. Parents that moved from their native primitive culture to an industrialized nation (high carbohydrate diet) and their latter born children grew up with crooked teeth, caries and breathing problems. What happened?

Cure Obstructive Sleep Apnea, 16834780 - funny cow looking to a camera with green rural meadow on the backgroungThe subject of human diet isn’t difficult to understand and you can even ask a child, “What does a cow eat?” Their answer usually comes swiftly, “Hay.” Then ask them, “What does a tiger eat?” and you will get the answer, “Meat.”  Then you ask, “What if you fed a cow meat or a tiger hay?” You usually get a smile and a giggling answer something like this, “Silly, cows don’t eat meat and tigers don’t eat hay!”  Human beings were never made to eat carbohydrates just like a cow doesn’t eat meat or the tiger eat hay. Our basic physiology is not made to use carbohydrates as we do today. It is as simple as that.

Cure Obstructive Sleep Apnea, 55415035 - afro kids greedily eating cake. three boys devour small cake. welcome to our humble party. celebrating together is fun.So why have our modern lives been contaminated with so many carbohydrates? This question can be answered by asking another question, “Why do people like carbohydrates so much?” Because we are addicted to it! Way back in time carbohydrates were stored as fats in our bodies as a reservoir for calories to help the primitive man survive from feast to famine to feast again. Until recently we didn’t understand human nutrition very well. Even if you look at our own government guidelines for nutrition you will see complete foolishness designed by self serving politicians to guide the economy of the mega-farming industry. Wheat, corn, rice and sugar farmers are now a HUGE portion of our economy and heaven forbid we tell everyone in the country that these are “poisoning” our bodies over time. What? Poison? Preposterous! Really? Does high blood pressure and diabetes ring a bell?

Cure Obstructive Sleep Apnea, 44990370 - doctor measuring obese man waist body fat. obesity and weight loss.How do you think carbohydrates are metabolized in our bodies? I can’t help but remember this joke I saw in a diet magazine. It went something like this: There is this fat doctor talking to a fat patient in his office. The doctor said,”Mr. Jones. Do you remember 20 years ago when I put you on that low fat, high carbohydrate diet? My bad.” This illustrated just how much we didn’t know about human nutrition. Funny thing, we feed our pets better than our own children. What did your children eat for breakfast? Cereal, pancakes, waffle, chocolate milk. What did they eat for lunch? Sandwich, chips, soft drink, surgery snacks. What did they eat for supper? Pasta, bread, fried foods, corn, rice, soft drinks, dessert. If you go to your medical doctor for your annual physical and your cholesterol is high, you have high blood sugar/pressure and you are over weight. Over 50% of the time statins are prescribed to control your cholesterol! Carbohydrate are directly metabolized in the body into cholesterol, not the animal fat we eat in our diets, but the donuts, cup cakes, soft drinks, candy, cookies, breads, and pastas which constitutes more than 60% of our modern diet. Wow, no wonder the politicians don’t want to tell you this. This is a HUGE part of the economy and the lobbyist just wouldn’t allow it!

Cure Obstructive Sleep Apnea, 23239476 - illustration of human evolution and eating habitsCarbohydrates are metabolized with the help of insulin from the pancreas. During prehistoric times the pancreas had a small but very essential job of controlling the small amount of carbohydrates in the daily diet. The small amounts of carbohydrates eaten each day (fruits, tubers) were either used as energy that day or it was sent to fat cells->triglyceride->cholesterol.  Cholesterol is an essential compound that is used in many pathways such as in the production of enzyme CoQ-10, vitamin D and sex hormones. So taking statins to suppress cholesterol has other consequences that most doctors don’t even have a clue about. Cure Obstructive Sleep Apnea, 21879375 - portrait of a asian doctor wearing green scrubs looking at a speech bubble drawn on a blackboard.Next time you go to your medical doctor who prescribed you statins, ask them if your vitamin D3 levels are good. They will not put one and one together to get two. Medical doctors have 2 hours of nutrition in medical school and think they are experts. The fat from carbohydrate metabolism was used to help you not starve between feasts and was NEVER part of the main diet. Today your poor little pancreas beta cells are in overload at every meal forcing excessive sugars into fat which eventually leads to all kinds of diseases like high blood pressure, diabetes, and a myriad of inflammatory diseases. Sugar is actually a toxin at higher than normal doses and inflames EVERY cell in the body provoking disease processes in every organ system.

Now lets get back on point. Why do so many people have OSA today? Actually, people have had OSA throughout history. My wife and I recently went on an ABC tour down the Rhine River. ABC stands for “another bloody castle”, “another bloody church”, it was beautiful!  We visited the inside of one of the better restored castles and noticed how small the beds were in the bed chambers. Not only were the people shorter back in the day, but they actually slept sitting up. It was thought if you sleep lying down, death would come visit you. Not only that, but if you snored, this was your soul pouring out of your body at night. So sitting up in the bed to sleep was actually their remedy for sleep disorder breathing like OSA. Interesting? It has become more clear that the reason we are seeing more OSA today is because of epigenetics. There’s that word again! Now that you have the above information under your belt, follow this:Cure Obstructive Sleep Apnea 37822667 - like a baby. funny young man with big eyes and pacifier in his mouth staring at camera while standing against white background

  1. Breast feeding develops the proper maxillary/mandibular jaw relationships
  2. Eating non-processed table food after being weaned off the breast helps develop the proper jaw relationship.
  3. Sucking the thumb or using a pacifier causes jaw distortions
  4. Eating an inflammatory diet containing grains (wheat, corn, rice, oats), processed sugars, trans fats (processed vegetable oils) and peanuts (high in inflammatory omega 6 fatty acids) can cause the nasal cavity to swell and the child to become a mouth breather which distorts the jaw relationship making a narrow maxillary arch that constricts inward and downward (a condition called klinorhychy). Mouth breathing can cause the tonsils and adenoids to enlarge and prevents valuable nitric oxide (not laughing gas, nitrous oxide) from flowing out of the sinuses and assisting in infection control and better breathing. This constricted maxilla then causes under development of the mandible by pushing it downward and backwards, pressing on the TMJ and closing off the airway.

In a nut shell epigenetic early lifetime changes and eating carbohydrates causes the maxilla to develop down and back contributing to:

  • TMJD (TMJ dysfunction)
  • OSA (Mandibular retrusive pharyngeal breathing)
  • Crowded teeth
  • Impacted 3rds
  • Mouth breathing (deviated septum, constriction of nasal turbinates)
  • Long face syndrome (vertical maxillary excess)
  • Dorsal nose bump
  • Night time bruxing
  • Abfraction lesions
  • Gummy smile
  • Gingival recession
  • Sanpaku eyes (showing whites under iris)
  • Bags under eyes (retro venous pooling)
  • Asymmetrical nostrils (deviation)

So how did I cure my obstructive sleep apnea? I reversed my epigenetic klinorhychy changes with biomimetic oral appliance therapy (BOAT). Biomimetic means mimicking biology. Stimulating the bodies stem cells to grow according to their genetic potential. BOAT was invented by Professor Dr. Dave Singh and it is a revolutionarily new oral appliance that if worn correctly has the potential to resolve OSA in the majority of healthy individuals in 18-24 months. He has cleverly called the main appliance the DNA and the OSA appliance mRNA. Seeing that biomimetry involved epigenetics and both DNA and mRNA are two main parts of genetics, the names makes fun of their close relationship to each other. Actually in this case DNA stands for “Day-Night Appliance”, and mRNA stand for “Mandibular Retrusive Nighttime Appliance.”

Cure Obstructive Sleep Apnea, 36486450 - close-up mouth of crooked teeth with bracesFor over 100 years orthodontists have studies the skull to fit the best smile possible into the patient’s mouth. Sometimes they extract teeth, sometimes they use orthopedics and sometimes they recommend surgery, but for the most part the teeth are fit into the face and NOT the other way around. Now it appears that orthodontists have been getting the cart before the horse. Instead of forcing the teeth into the skull it seem it will be much more healthy and productive to reshape the skull to its genetic potential and then allow the teeth to fall into position on their own as nature meant it to be. Let’s call it braces for the skull 😉

I know when most dentists look at the BOAT for the first time they will inevitably say it is just a Schwartz or some other recognizable appliance already used in the lexicon of orthodontics/orthopedics, but they would be wrong. It is not a rapid palatal expander commonly used today. Have you ever gone to the doctor and they said you have osteoporosis? If you have they may have treated you by stepping onto a vibrating plate to stimulate the stem cells inside your bones to make more bone. This is also called biomimetics. Yes, the BOAT looks like an active/retainer of sorts but it function differently. First of all there are tiny axial wire actuators positioned on the linguals of the teeth, usually from canine to canine on both the upper and lower appliances. Secondly, the face bow is a lip bumper and lastly, the jack-screws are used to take up the slack (not force the arch open). The action happens only when you swallow or tap your teeth together. This tapping or squeezing of the appliance against the axial wire actuators gently stimulates the bone suture stem cells to grow and the appliance provides the space and direction to grow into.

Balderdash, right?! Where’s my evidence? Cure obstructive sleep apnea? Why aren’t orthodontist jumping all over this? Who in the world would use this thingie? Well, I used it. My moderately severe OSA with AHI 27 went down after 6 months of appliance therapy and low carbohydrate diet to a mild AHI 5.3 (normal is <5). Before I was biting only on my anterior teeth after years of using an OAT and now my bite is on my posterior teeth. I can breath better through my nose and I sleep better, too. My Epworth when from 8 to 2 and I still have at least a year of active treatment left.

Why are the orthodontists not jumping on this revolutionary new treatment for OSA? It is harder than you think to break away from a pattern of treatment you have trained your entire career to “perfect.” Until they see the overwhelming proof and it begins being trained in graduate programs their cart will still have to run before the horse.

Cure Obstructive Sleep Apnea

Resolving your OSA boils down to this, in my opinion, “get your life in order.”

Cons: Patients with active periodontal disease or not enough teeth for the appliance to work can not use this therapy. Implant consult may be needed.

J Biomed Sci. 2016 Nov 5;23(1):77. Biomimetic approaches with smart interfaces for bone regeneration. Sailaja GS1, Ramesh P2, Vellappally S3, Anil S4, Varma HK5.
Sleep Breath. 2009 Mar;13(1):19-24. doi: 10.1007/s11325-008-0211-9. Epub 2008 Sep 2. Craniofacial obesity in patients with obstructive sleep apnea. Banabilh SM1, Suzina AHDinsuhaimi SSamsudin ARSingh GD.

Cortes M, Wallace-Nadolski ME, Singh G Upper airway remodeling as a treatment for obstructive sleep apnea in adults with craniofacial deficiencies SLEEP 39 Supplement; A142, 2016

Wallace-Nadolski ME, Cortes M, Singh G Non-surgical upper airway remodeling as a treatment for obstructive sleep apnea. SLEEP 39 Supplement; A139, 2016

G. Dave Singh, Tammarie Heit, Derek Preble, Ravindra Chandrashekhar Changes in 3D nasal cavity volume after biomimetic oral appliance therapy in adults CRANIO: The Journal of Craniomandibular & Sleep Practic, 2016 34:1