Empowered Sleep Apnea

Season 1: THE ISLE. Episode 4: CROSSING THE RIVER

• David E McCarty, MD FAASM & Ellen Stothard PhD • Season 1 • Episode 4

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Empowered Sleep Apnea: THE PODCAST
Episode 4: CROSSING THE RIVER
All content © 2022 Empowered Sleep Apnea, LLC
www.EmpoweredSleepApnea.com

For a PDF transcript of this episode, COMPLETE WITH LINKS AND CARTOONS (HUZZAH!)  click HERE!
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...the plates sit in satisfied disarray at the Coffee Hut...

       ...a mysterious phone booth beckons...

              ...a deep and turbulent River awaits...

Join Dave and Ellen in an episode of some...um... portent...

      ....after the Coffee Hut discussion, Robert understands that treatment is necessary...

          ...after the Coffee Hut discussion, Robert has his head wrapped around the WHY? of treatment...and RISK figures prominently...time to set some goals...time to decide on passage across a deep and turbulent river...THE RIVER OF DECISION...

            ...but how does one decide WHICH treatment to embrace? I mean...is it all just about Positive Airway Pressure and Oral Appliances? What about...um...everything else?

Let's get to it! Step up! Step up! We'll check out every boat, raft, skiff and floaty-thingy we can get our hands on!

Dave also steps into the Empowered Sleep Apnea Phonebooth, to get the straight story from Alise Ojay, the creative genius behind the Singing For Snorers project! Everything sounds better with a British Accent, and this stuff actually has research to back it up!
 
Who knew that only a few weeks of SINGING can improve snoring and daytime sleepiness?! 
 
Also mentioned in this episode...

Breathing, Man! Seems it's IMPORTANT somehow!

How Rad is that?!

Showcased Cartoon: Great Moments in Engineering History

Our Website: https://www.empoweredsleepapnea.com
Official Blog: "Dave's Notes" : https://www.empoweredsleepapnea.com/daves-notes

To go to the BookBaby bookstore and view the BOOK, click HERE!

Empowered Sleep Apnea: THE PODCAST
Episode 4: CROSSING THE RIVER
All content © 2022 Empowered Sleep Apnea, LLC
www.EmpoweredSleepApnea.com

For a PDF of this transcript (including CARTOON--Huzzah!) click HERE.
~~~~~~~~~~~~~
00:00: Empowered Sleep Apnea BOOK promotion

Empowered Sleep Apnea: The Book is now available, in both the hardback, which is just beautiful and really showcases the art nicely, but also in e-Book form, for Apple iBook and Kindle. Are you tired of guessing? Try on some Empowerment for yourself. We’ve got just your size. Want more information? Good! Go to www.EmpoweredSleepApnea.com and click the tab that says BOOK.

…and hey!...many thanks!

00:30 Change the Channel! (opening sequence)

00:51 DISCLAIMER: Empowered Sleep Apnea is an educational podcast, which is a bit different from a medical advice show. Clinical decision-making can be complex, and even EMPOWERED patients need a partner. So: play it smart, and make sure you discuss your case with your healthcare provider before making any changes to your medical treatment plan.

And now…on with the show!

01:15 Empowered Sleep Apnea: THE PODCAST. Episode 4: CROSSING THE RIVER.

ANNOUNCER: From a certain vantage point in space, the Earth appears to be no more than a speck. Move closer, and one can see that its shape is spherical. Closer still, and we see its bluish green glow, its spiraling storms, its polar ice.

As we draw closer, passing through the stratosphere, we see, within a vast expanse of brilliant and glimmering ocean, a small speck of green. 

Closer still.

We see an Island with a crescent shaped bay in its southwest corner, an enormous mountainous lake feeding a steady river draining into a breathtaking delta on the south shore.

To the west of that river, we see an alabaster titan of a building, with five gigantic columns, each one thirty feet in diameter.

Five impossibly large stairs out front, each bearing one word: RISK, SNORING, SLEEP, WAKE, COMORBIDITIES.

Inside the building, within a cavernous chamber, deep within its labyrinthine understructure, sits a single Denver & Rio Grande railroad dining car. From the dining car comes the sound of clinking plates and sweet unnamable music.

From the dining car comes the smell of coffee and fresh bread.

It is inside the dining car that we last left our friend Robert. It is inside the dining car that we find him now.

Robert is still dreaming…if that’s truly what this is……this state…this astral projection. 

He still has his tape-recorder. 

He is still telling his story for posterity. 

As we draw closer to the table, we notice that the plates sit in satisfied disarray. The clink of forks and pleasant hum of conversation have faded. The sweet unnamable music seems to have slowed down. 

Robert pats his mouth twice with his napkin, folds it in half, and places it on his plate.

He then picks up the recorder, pushes the button, and begins to speak.. 

[TAPE CLICKS]

03:56 ROBERT SPEAKS 

ROBERT: Hi again…uh…this is Robert. I’m speaking to you now from my booth at the FIVE REASONS MONUMENT COFFEE HUT. 

I had coffee, and a lemon scone. And then my server talked me into a piece of the Lingonberry Pie, and…mmm…it was…WORTHY 

[TAPE CLICKS]

 ISLAND MAGIC: You can do it Robert! Time to Go! You can do it!

[TAPE CLICKS]

 ROBERT: If I’m being honest, there is something about this place. As soon as I walked inside, I just started to feel…calmer. My server seemed to have all the time in the world…you know…I never felt…rushed. 

 When my coach and I had my FIVE REASONS discussion, I felt like…I’ve got this! You know? 

 Anyway…what I learned is that the most difficult of the FIVE REASONS to talk about is the first one…which is RISK. 

 And that’s because hypopneas are a really slippery subject! First of all, they can be obstructive or central in mechanism, but almost everybody groups them into one generic category. Secondly, I learned that as a person gets older and collects more medical problems, the central mechanism events get more common. 

 …and that’s probably why I had central events on my study…because I have Atrial Fibrillation…

 ...and that’s especially true if you live at altitude.

 I also learned that there are two different definitions for hypopnea. That means that it’s possible to have two different scores for your AHI--the Apnea Hypopnea Index--depending on which definition was used. 

 The bottom line is that I learned enough to understand that, for ME anyway, the first reason to treat, meaning RISK, is pretty important.

 I also got a clearer understanding of the other four reasons to treat BESIDES RISK which are SNORING, SLEEP, WAKE, and COMORBIDITIES. 

 …and as I inventoried those reasons…I realized that…all of them kind of spoke to me…

 So after picking it apart like that, I grew to realize that I had quite a few reasons to think about engaging on some sort of treatment plan.

 [TAPE CLICKS]

 ISLAND MAGIC: Time to go, Robert! It’s time to go! You can do it!

 [TAPE CLICKS]

 ROBERT: …ha!...as I look up, this Island seems to have pulled another fast one…a minute ago this place was full of people, and now it’s just deserted…it’s amazing…it’s like a Twilight Zone episode….it’s just weird… 

 Hello?! (laughs) Hello?!  Huh. Nobody...nobody answering. This place just keeps getting weirder.

 [TAPE CLICKS]

 ISLAND MAGIC: Robert! Robert! Robert! Rob—

 [TAPE CLICKS]

 ROBERT: Hello? What is this?... 

 There’s a phone booth over there, and the door just opened up…um…on its own??

 Huh…I think I’ll head over there and take a look.

 Let’s see…there’s a brass plate on the door, let’s see if I can…clean it up a little bit, take a look at what it says…

 …OK, here it is…huh!

 “DIAL “0” for Escape”

 That’s AWESOME! Great. Maybe ESCAPE is like the name of the Island UBER company or something. Sounds like just what I need!

 Just get in here, pull the door closed.

 [dial tone]

 OK. Pushing “0” now! 

 Oh, that’s odd. I can’t see my feet! Oh, lord, that’s a strange sensation—it’s almost like I’m stretching, whaaa…wooooohooooo!

 [TAPE CLICKS]

 Dial tone.

 [TAPE CLICKS]

 ROBERT: laughing…oh my goodness…OK…wow!...that was the…trippiest and most unusual elevator ride I’ve ever been on! Just after I dialed “0”, it felt like the world sort of…turned inside out? No that’s not right. There was nothing scary about it. 

 It was like that moment of perfect exhilaration as you’re dropping on the rollercoaster, after all the fear of heights has left you.

 And there were bright lights, and a beautiful smell of sandalwood.

 And then, I found myself…here.

 On the bank of this…DEEP and TURBULENT river. It must be a mile across and I don’t see a bridge anywhere.

 [TAPE CLICKS]

 ISLAND MAGIC: --GOING ROBERT! KEEP GOING ROBERT!

 [TAPE CLICKS]

 You know, at first, when I first got here, I was thinking that perhaps I could just walk in the direction the water is flowing, as I looked closer, though, I could see that the water seems to be going…both ways at once. 

 That’s not possible…but there you have it. 

 It’s going both ways at once.

 I think I’m starting to understand that bit about not being able to swim home…

 WHITE RABBIT: Hey…psst…hey…you lookin’ for pleasant dreams beach? 

 ROBERT: Who said that?

 WHITE RABBIT: Hey you! I’m talkin’ to you! 

 ROBERT: Oh, my goodness…

 WHITE RABBIT: Ain’t you ever seen a talking rabbit before?

 ROBERT: Um. Uhhh…..

 WHITE RABBIT: Oh, hey, don’t worry about it. Happens all the time. Listen, if you’re like most Shorefolks, you’re prolly lookin’ to find Pleasant Dreams Beach!

 ROBERT: Oh, yeah! Pleasant Dreams Beach! That sounds like exactly the spot that I wanna go to.

 WHITE RABBIT: Well you’re not gonna find it over here, dear Hoa, Pleasant Dreams Beach is all ta’ way on the other side of the Island! You gotta cross The River.

 The River of Decision.

 [wink noise]

 ROBERT: Holy smokes, you just winked at me! OK, that’s a first. Well, listen, friend…

 WHITE RABBIT: Hold on there, ya’ old Shorefolk! It’s HOA, now! H-O-A, HOA! It’s a Tahitian word that means trusted companion. Listen, you made it past the Coffee Hut! You’re family now. 

 Welcome to the tribe!

 ROBERT: Well, uh…thank you!

 WHITE RABBIT: Don’t mention it, don’t mention it. Thank YOU, dear Hoa. Listen! Here’s the secret to getting across the River. You have to concentrate REALLY hard on the discussion you had at the Coffee Hut. As you hold YOUR REASONS in your heart, they will reveal specific GOALS OF THERAPY.

 Once these GOALS OF THERAPY are clear, dear Hoa, the ways across the River will reveal themselves to you!

 ROBERT: Well, wait a minute, wait a minute. I’m not sure that I get that …all I have to do is set GOALS of THERAPY, and the ways across will just APPEAR?

 WHITE RABBIT: (fading) something like that, dear Hoa, something like that…

 ROBERT: No no! Don’t leave! Wait! Wait don’t leave! Rabbit! Come back! White Rabbit! Come back!!!

 10:46 CUE MAJESTIC THEME MUSIC 

 DAVE: Welcome back to Empowered Sleep Apnea, the Podcast where you learn about Sleep Apnea through the power of stories, from a patient-centered perspective. I’m Dr. David McCarty. I recently went back to the studio with Dr. Ellen Stothard, to talk once again about our friend Robert, who has now found himself magically transported to the bank of a deep and turbulent river.

 The River of Decision.

 It is here that Robert must make his own set of decisions. Should he engage in a treatment plan? Should he try to cross the River over to TREATED TERRITORY?

 And how about that Island Magic? The White Rabbit threw down a delicious slice of Island Wisdom when he told Robert to consider his FIVE REASONS carefully, so he can make his personal GOALS OF THERAPY.

 See, you can’t talk about treatment options until you are clear in your own mind what you’d like your strategy to accomplish…for you.

 At the Coffee Hut, Robert explored the FIVE REASONS TO TREAT: RISK, SNORING, SLEEP, WAKE, COMORBIDITIES. He realized that each of these reasons, individually, mattered, to HIM. He also realized that RISK, for him, was a major player. His AHI (apnea hypopnea index) based on the 4% oxygen desaturation hypopnea criterion was 36! This carries a strong signal for RISK of earlier death from multiple sources, including cardiovascular disease, stroke and cancer. 

 As Robert stands on the shore of the River, his goals of therapy begin to occur to him. 

 For RISK, we’d like to see some objective reporting on his AHI, with the goal being to lower it, and the LOWER THE BETTER. Ideally, we’d like to see this weighing in, less than 5. 

 Robert doesn’t know if he snores, but he feels congested, with a sore throat in the morning, which he suspects may be Snoring AFTERMATH. For his SNORING goal, therefore, he wants to stop coughing and sneezing in the morning. 

 Picturing his SLEEP goal was easy: He feels like his sleep is light-stage, with frequent awakenings to urinate, and usually waking up too early, and not being able to get back to sleep. His goal is that he’d like to sleep more deeply and continuously. He’d like to sleep through the night without having to get up to pee. He’d like to sleep for at least 7 hours.

 For his WAKE goal, Robert thought about how he feels at afternoon meetings. How he has to stand up to stay awake! He thought about how he feels when he tries to watch movies with his wife after supper. 

 CHORUS: MR SANDMAN!

 DAVE: He realized that his goal was that he’d like to feel effortlessly awake in these situations.

 Finally, Robert thought about his COMORBIDITIES. He had to think about this one for awhile. 

 At the Coffee Hut, Robert learned that Sleep Apnea makes all kinds of other health problems worse or harder to manage. The “fight or flight” stimulation that occurs from Sleep Apnea events is contributing to his atrial fibrillation and high blood pressure. His chronic sleep restriction is likely to be a factor in his depression and anxiety symptoms. 

 Robert decided that his goal in this domain was more expectant. He resolved that he would follow up on all of these issues carefully, to see if perhaps they improved, or might require less medication, once he was on treatment .

 As Robert stood silently on the riverbank in Untreated Territory, a calm washed over him. The ways across the River were starting to appear to him.

 
14:35 The Headspace of Readiness

 ELLEN: The thing that I find really interesting when I think about this is How do I approach my own medical conditions? Sometimes…when you have an issue…you just show up at the doctor, and you say “Fix me!”

 DAVE: Right! “Tell me what to do.”

 ELLEN: Exactly. And…that’s what we’re trying to avoid here…and it’s interesting to me that Robert has to make this mind-set shift…

  …I’m just trying to connect the thought that I have of the experience of a patient who comes in with insomnia symptoms and ends up with a Sleep Apnea diagnosis….

 …it’s important to have these Goals of Treatment, and these other conversations, so they can see how those nighttime experiences sit in the context of the rest of their health.

 DAVE: From the vantage point of a new visitor to Untreated Territory, a simple visit to your friendly neighborhood Dr. Google will show you all kinds of modes of transport across that river!  

 There’s all sorts of flavors of PAP therapy (positive airway pressure therapy). There’s the mandibular advancement device style of oral appliances. There’s various surgeries. There are implants. There’s supine avoidance. 

 There’s even airway rehabilitation strategies like myofunctional therapy, singing therapy, and didgeridoo practice therapy.

 The list keeps gettin’ longer! 

 A practical way to sort through all this is to consider two basic categories of treatment:

TRADITIONAL (which means that most healthcare plans will provide some sort of coverage) and NONTRADITIONAL (which only  means that if you want to do this, you’ll probably have to fund the process yourself).

 

16:01 Positive Airway Pressure Therapy

 Now would be a good time to talk about the first of those traditional treatment options, our stalwart friend, good ol’ Mr. Positive himself, Positive Airway Pressure Therapy!

 When RISK is what it’s about, put a CPAP on the snout! That’s a helpful mindset to have, because it reminds us that, of all the pathways across the river, we have the most robust response, in terms of AHI-lowering deliciousness, with positive airway pressure therapy. 

 For this reason, it sits proudly at the top of the list, when RISK is featuring prominently amongst the REASONS TO TREAT. It is considered the gold standard of treatment options for adult patients.

 Stated simply, PAP therapy is a machine that blows room air under gentle pressure into the airway, to prevent its collapsing like a milkshake straw when you inhale.  

 Major advantages of PAP therapy: as a general rule it is capable of normalizing the AHI, control over snoring is almost always complete, and there are large well-designed studies that demonstrate improvement in things most people care about, like how well they sleep, and how good they feel in the daytime.

 The major disadvantages: It’s a MASK, man! For some folks, just having something on the face is so bothersome, it can prevent sleep. Also: it requires electricity, it’s expensive, you have to maintain regular visits with your provider to maintain insurance coverage of the equipment, and sometimes PAP can exacerbate central apnea physiology 

 (this is a problem called Treatment Emergent Central Sleep Apnea, listeners…and we’ll learn more about that later!)

 Despite these drawbacks, most experts would agree that Robert’s best first choice of treatment, right out of the gate, would be positive airway pressure therapy, given his concerns about RISK.

 

18:06 Oral Appliance Therapy

 Let’s turn our attention to the other “traditional” treatment option: mandibular advancement oral appliance therapy. In the world of Sleep Apnea, dentists have made remarkable advances in how sleep apnea is treated. 

 ELLEN: So, a mandibular advancement device or oral appliance therapy…they are devices that people use in their mouth…to advance the mandible—or move your lower jaw forward to create more space in the back of your throat, so that you can breathe better at night.

 DAVE: Various sizes, shapes and materials are on the market, and more options seem to pop out each week. Some insurance companies will only cover devices of a certain type. For example, Medicare still requires that the upper and the lower pieces are connected by a METAL attachment, because this is the description of the device that was used to justify Medicare funding for this treatment, for the device that was in the efficacy study. 

Since then, the science, materials, and practice habits of most dentists has evolved, to use more comfortable and pliable materials. 

Medicare still requires you to use the metal-hinged one. 

So it goes.

The point is: this is a complicated landscape. 

Mandibular advancement devices must be adjusted over time. Most dentists who do this will tell you to increase the advancement slowly, perhaps even stretching it out over weeks or even months, before it’s in the fully therapeutic setting. 

The major advantage of oral appliance therapy over PAP therapy: It’s not a MASK, man! So it’s much easier to travel with, you don’t need electricity, and you can even take it camping. 

The disadvantages? This form of therapy doesn’t have AS GOOD of a track record for AHI normalization, compared to PAP therapy. Also, pound for pound, compared with PAP therapy, oral appliance therapy is less likely to completely resolve your snoring.

Some things to know about oral appliance therapy—you really have to be able to breathe through your nose for oral appliance therapy to work well for you. If you can’t breathe through your nose, you’ve got some work to do, before trying this.

Also: oral appliance therapy tends to function best IF YOU ARE AVOIDING THE BACK-SLEEPING POSITION. Another way to think about this is: sleeping on your back will probably worsen your results with this therapy. If you HAVE to sleep on your back, you know, for comfort reasons, that’s something you should know…

Testing efficacy of oral appliance therapy traditionally has required repeat sleep testing. Home sleep apnea testing has made this process easier, and new diagnostic devices are getting introduced every year. One new device, called the SleepImage is a wearable device the size of a Ring Pop that you wear on the base of your thumb. 

Devices like this have the potential to revolutionize the home sleep apnea testing industry because they’re so easy to use, and they can give accurate results in minutes. 

 Such convenient access to data could be very useful, to an EMPOWERED PATIENT…don’t you think?

 

20:50 SURGERY

DAVE: Another traditional approach to treat Sleep Apnea is surgery…lots of different ones. Surgery on your nose to unblock the nasal airspace, surgery on the back of the throat, to remove bulky or dysfunctional soft tissues, surgery to remove tonsils and adenoids, maxillofacial surgery, hyoid suspension surgery...

 Whoa, there! Let’s just slow down.

The good news is: MOST folks with Sleep Apnea really aren’t gonna need any kind of surgery. That’s for two reasons:

 Reason 1: Surgery alone doesn’t usually solve the problem.

Reason 2: Nonsurgical means often can.

That’s it. That’s what you need to know. 

For example, if you have giant kissing tonsils that are always getting infected, well, dear Hoa, it’s likely you’ve got seventeen reasons OTHER than the Sleep Apnea to kiss those tonsils goodbye!

  It would make sense to get the tonsils out, and then check another sleep study after you’re healed. Maybe you’ll be one of the lucky ones, but don’t go in expecting everything to be solved.

 That’s just not usually how it goes.

 

22:00 NONTRADITIONAL TREATMENT OPTIONS

 DAVE: NONTRADITIONAL treatment options for Sleep Apnea include all kinds of interesting things. 

 For example: Supine avoidance therapy is jargon for “stay off your back, Jack!” 

 CHORUS: Stay of your back, Jack!

 DAVE: and it’s helpful for folks who only really tend to obstruct when they’re sleeping on their back. Most sleep study reports will break it down for you, so you can tell what the AHI is, by position. If your event rate is negligible when you stay off your back, this could be a legitimate option…

 You remember that our upper airway—that space that makes up the area doctors see when you say AHHHH—it’s made of muscle, covered in mucuous membranes, with some lymph tissue thrown in for decoration. The muscular components can get lax, especially when they start getting abused by the vibrational trauma of snoring every night.

 I bet Jack LaLayne himself would support this notion: if it’s muscle, we can rebuild it. And there’s a few ways you can try to build up those floppy tissues back there. 

 One way: play the Didgeridoo! Some zany researchers in Zurich showed that a four-month Didge habit was enough to significantly improve both the AHI and the  Epworth Scores. Some caviats? The subjects were middle aged, and non-obese. This may be a group for whom the upper airway motor tone is an important “moving part” for Sleep Apnea, in other words…

 Another way? How about Singing? For this subject, I thought it would be a great idea to call up my friend Elise Ojay.

 Elise Ojay is the creative genius behind the Singing For Snorers programme. This is a programmed series of vocal exercises that you do by singing, that can actually improve snoring!

 So, I’m just gonna walk over here to the Empowered Sleep Apnea Telephone Booth…get on in here…pick up the receiver…and [dial tone]…let’s see, how much do I need?...Seventy-eight British Pounds…OK, putting [coins clink, bells ring]…seventy eight British…that’s a lot of…OK..I think that should do it…OK! Press PLAY! [dialing noises] …it’s dialing…

 [vocalization answer tone]

 DAVE: Hey! Alise! I love your answer tone! Welcome to Empowered Sleep Apnea! It’s Dave McCarty calling! Welcome to the program!

 ALISE OJAY: Thank you very much, Dave! I’m really honored and delighted to be here!

 DAVE: Singing For Snorers! This program was designed…for snorers…and yet…you’ve had some people have some improvement with their Sleep Apnea. Can you tell me about that?

 ALISE: Yes, that’s right! I created the exercises for people who were snoring to some degree because of loss of tone and strength in their throat muscles. 

 And very soon after I released the program, people with Sleep Apnea spotted it and started trying it…hoping that by exercising the very muscles whose job it is to hold your airway open, by giving these muscles extra tone and strength, then their airway would be less prone to collapse at night.

 The exercises use repetitive sounds and tunes to focus relentless exercises on the soft palate…

 …that’s worked up and down like a dumbbell, at the back of your mouth…

 …the arch at the back of your throat that your uvula dangles from…that’s worked in and out, and from side to side…your tongue gets a full workout…back, middle, tip…and up into your nasopharynx as well, where the back of the roof of your mouth connects through to your nose.

 One early adopter with Sleep Apnea was a gentleman who had regular annual sleep studies at a large teaching hospital, here in the UK. 

 And he really went for it!

 Cuz he was using a CPAP mask…absolutely loathed it…

 [record scratches…crickets!]

 ALISE: (laughs) and, in fact he put up a picture, he told me, he put a picture of his mask up in the room where he did the exercises to motivate himself…

 DAVE: (laughs) Do this or else THIS!

 ALISE: (laughs) Yes! That’s right!

 …He did the exercises for awhile and then he had his next sleep study. And he asked them if he could have it without his CPAP. And they agreed. And the result was…a good one! 

 But his consultant said: “Oh, no no no no! Because you didn’t come off the CPAP for a whole week, before hand—"

 DAVE: It’s a CPAP Honeymoon!

 ALISE: “--It could be a residual effect. You’ll have to sing for a whole year!” his consultant said to him, “…in order to test it, and then, next time, come of your CPAP, you know, a WEEK before, and then we’ll try it again.”  

 And he didn’t think my customer would! 

 But, my customer said it was like a red rag to a bull!

 [angry bull sound effect]

 ALISE: …and he said: “I’m going to do it!”

 …and he did! He sang for a whole year and he went for his next sleep study, and he was told to leave his CPAP at the hospital!

 DAVE: Wow! What a cool story Alise! Well, thanks for sharing and I’m sure we’ll have you back on the program soon. Thank you so much!

 ALISE: You’re very welcome!

 DAVE: What a great story that was! 

 For the purpose of keeping the show length under control, I had to edit out a lot of that great conversation. 

 It’s important to recognize that this stuff has research! 

 A randomized controlled trial published in 2013, in the International Journal of Otolaryngology and Head & Neck Surgery showed that 3 months of daily practice of Alise’s Singing For Snorers program significantly improved snoring, and symptoms of mild to moderate obstructive sleep apnea, including daytime sleepiness.

 Think about that.

 Three months of singing improved this problem to a significant degree.

 Can a singing program help you?

 That depends on how much these muscular structures of the upper airway are involved in YOUR obstruction. 

 Is it a lot? Or is it a little?

 Where do YOU fit in?

 You never really know, unless you look into it.

 If you’d like to learn more about Alise Ojay and her Singing For Snorers program, go to her website at www.SingingForSnorers.com . 

 

28:09  The Emerging Science of Airway Rehabilitation

 DAVE: It’s kind of a long walk back from the Empowered Sleep Apnea payphone, which always drops you off in a different part of our labyrinthine maze of hallways and filing cabinets. 

 I’m back here with Ellen in the studio now, and, man, let’s just talk about this for a second!

 …bottom line is…this is something that’s probably GOOD FOR YOU! Because SINGING is GOOD FOR YOU! On many levels!  

 …and…if this reduces your snoring and helps you feel better and breathe better, then why wouldn’t you tell somebody they should do this?

 ELLEN: It’s so interesting because it’s actually the opposite of the positive airway pressure treatment. So: instead of using pressure to…

 DAVE: …to…inflate…

 ELLEN: …to make things bigger, we’re going to support the structures around it, and we’re gonna develop that infrastructure, so we can try to make the problem better.

 …it’s how we usually try to fix things, right?

 DAVE: I love that. I love that. Yes, I love that idea! 

 And: the WHERE WE ARE in the scientific journey of this is…there are lots of people who are seeing a signal…and it hasn’t been ferreted out yet…

 ELLEN: …yeah, it doesn’t have…and well, this, to me, it comes back to the “How Do We Do Research?” …you know…we have someone who gives us money…who has a financial interest usually in finding out the answer to whether something is effective or not…and so…

 …do we have someone who has a financial interest in…The Didgeridoo…or…Singing For Snorers…?

 DAVE: Probably not! Or Buteyko Breathing…you know?...probably not…

 ELLEN: …and it makes it harder for us to have these large, expensive, extensive studies…

 DAVE: It does, it does.

 ELLEN: …Alise Ojay’s Singing for Snorers program reminded me of some recent work that’s been done with breathing resistance training.

Researchers at CU Boulder recently showed that a 6 week program of exercises…

...5 minutes a day…

...the exercises being inhaling against resistance using a special device…

...that this was able to lower blood pressure as well as any medication! Blood pressure came down by 9 points, systolic , Man! That’s in JAMA! 

DAVE: Fascinating!

ELLEN: Yeah! So it’s all consistent with this alternative ideas of…the didgeridoo, which is breath-control…and improving all of that physiology in that area…

DAVE: Yes! Trying to become more talented with breathing!…

ELLEN: Yep! Exactly…and this is the same, in a lot of ways…

 

30:37 Cartoon Showcase

DAVE: …and that sound is my reminder to showcase the cartoon that informed today’s discussion. I’ve been thinking a lot about how dentists, orthodontists, physiotherapists, and other creative geniuses like Alise Ojay have been approaching this problem like engineers. I keep coming back to that story about the Apollo 13 astronauts who would die in space on TV, if the engineers back in Houston couldn’t figure out a way to put a square peg into a round hole…rapidly.

So it’s with a huge helping of respect that I cast our own Ishmael Trodglampin in the role of the head engineer for this memorable scene from NASA history. Have yourself some fun and take a look at it on our website. I’ve got it posted to the show notes for this Podcast Episode!

Cartoon: Great Moments in Engineering History

31:46 OUTTRO

Well, that about wraps up another exciting episode of Empowered Sleep Apnea: THE PODCAST. I really hope you’re enjoying Robert’s little adventure, Ellen and I sure are! 

And I want to give another shout-out to my friend Alise Ojay, for taking time out of her vocal training schedule to tell us her special story.

 I think we did a good job of talking our way through some of the major ways across the River. Remember how that River flows from the Lake of Innovation? That means that there’s always more ideas that may come floating by.

 One totally exciting development in the field of Sleep Medicine is an emerging new discipline of dentistry known as AirwayCentered Dentistry. This is so brand-new, there’s only anecdotal evidence right now, and very little is published in the literature. I don’t want to give you any spoilers, but some of these pioneers have actually figured out how to change the shape of the bony elements of the face…without surgery…in adults…

 As I said…this is too much to cover in this episode…perhaps in Season 2…

 Cue music!

 

32:48 CUE MAGESTIC THEME MUSIC

 ANNOUNCER: Empowered Sleep Apnea: THE PODCAST is a production of Empowered Sleep Apnea, LLC. 

The show was written and performed by David E McCarty MD, FAASM and Ellen Stothard, PhD. All sounds on this podcast were either made by the performers, or were cobbled together from public domain sounds we found lying around the house.

 Theme song and special choral arrangements this week by 25% Fred.

 Dr. McCarty’s magnanimous behavior this week is enhanced by Box-Breathing…

 Dr. Stothard’s scientific curiosity brought to you by reading Banned Books.

 Cartoons this week were recovered from the wreckage of a dirigible at the top of the Empire State Building, completely unblemished and intact…whilst everything near them had burned to cinders…

 Don’t miss our next exciting episode, when we’ll catch up with our friend Robert, as he continues his efforts to find his way to Pleasant Dreams Beach.

 We’ll find out that it can be difficult to find your way around, and it can help to seek a little…guidance.

 It’s not the crossing you see…it’s the landing…

 Coming up next…your Sleep Medicine Dad Joke… 

34:10 SLEEP MEDICINE DAD JOKE 

DAD: Hey, hey, what’s happenin’?

 NOT-DAD: Hi Ho! What’s shakin’ Daddy-O?

 DAD: Hey didja hear there was a KIDNAPPING at the school?

 NOT-DAD: What? Ho..that sounds serious Daddy-O, I don’t think that’s something to joke around about…

 DAD: Ah, it’s OK, he woke up in time for the algebra test. Ya get it? Huh? Woke up? Huh?

 NOT-DAD: Whaaa? Oh! I get it. Kid. Napping. And he woke up! I get it! (Laughs)

 CHANNEL CHANGES

 34:23 END PROGRAM

 

 

 

 

 

People on this episode

Head Shot

David E McCarty MD, FAASM

Host
Head Shot

Ellen Stothard, PhD

Host