Robert Lufkin 00:00
Welcome back to the health longevity secrets show and I'm Dr. Robert Lufkin. Today we look at a possible strategy for heading off the next generation of Alzheimer's diagnoses by recognizing sleep, breathing and airway issues early. We are joined by Scott Saunders DDS, an expert in periodontal wellness and obstructive airways disease as applies to cognitive health. He is co founder and president of healthy mouth media. Dr. Saunders Reese received his DDS degree from Georgetown University School of Dentistry and practice general dentistry and periodontal wellness disturbed by the gap between mainstream dentistry and cutting edge research. Scott moved from clinical practice to writing for dental consumers and clinicians, blogging and collaborative publication and authoring of peer reviewed journal articles. And now, Dr. Scott Saunders. Hey, Scott, welcome to the show.
Scott Saunders 01:00
Thanks so much for having me on. Rob. It's always a pleasure to chat with you.
Robert Lufkin 01:03
Yeah, this this is going to be a lot of fun and dealing with some very interesting and important topics. And we're going to take a take an unusual look at them from a perspective that that a lot of people aren't, aren't approaching it as that it's important to get out there. Before we do though. I wondered if you would like to take a moment and just share with our audience how you came to be so interested in this fascinating area?
Scott Saunders 01:30
Sure. Well, I am a dentist by training, I wanted to become a dentist since I was 14 years old. I shared my dream with my dentist at the time and he encouraged and mentored me. I saw him as the role model for the type of dentist I wanted to be the health care professional who cared about my patients whole body health. In fact, my senior project in high school was titled preventive and therapeutic dentistry. Unfortunately, I was unprepared for the reality of how dentistry is practiced. It became apparent to me that there was a huge gap between my dream and the reality of mainstream dental practice. I wanted to be a healer, because that my core that's who I am. My dream was to help people become healthier. When I was a practice, I wanted not just to treat immediate problems, I wanted to look at the whole person and advise them how to improve Total Wellness. This went well beyond the old brush and floss lecture but one no one really listens to anyway, I even advise my patients on certain dietary changes and the supplements that might help them my patients appreciated my caring attitude as well as my dental skills. Unfortunately, the practices I worked for did not they want to be simply to treat the immediate problem and move on to the next patient. This production based approach to dentistry has come to be known as drill, Phil and Bill. And that's still how most dental practices work and more disturbing that still how most dental students are educated. That wasn't what I wanted to do. That wasn't why I chose the industry. That just wasn't me. So I left, I turned to writing about the latest techniques in dental treatment, mostly in regenerative periodontal procedures and plants and prosthetics. And I've been blessed to have worked with some of the top dentists in the country in these areas. I started with their research and case studies with my writing and editing of their information, I turn their findings into published articles for peer reviewed journals. Even then, because of other contacts I have in the dental field I was immersed in the developing awareness of just how pivotal proper breathing, sleep and airway health truly are to the superior outcomes of the complex interdisciplinary treatments these doctors were providing their patients. Importantly, these doctors were already using Cone Beam Computed Tomography or CB CT to assess patients and their practices. One of the key diagnostic advantages of this 3d X ray technology is seeing how well developed or how poorly developed the patient's airway and ability to breathe really work. As a result, my editorial input frequently focused on how the airway aspects of what they republishing would add value to what their readers would learn. And they appreciated that from a continuing education perspective, because it made sense to them as clinicians and help keep them on the cutting edge of their fields. But I was still frustrated. This sort of writing about cutting edge information was not only failing to reach consumers, it was also only reaching that small fraction of dentists who actually had the time to read journal articles. Six years ago, while discussing my frustrations with my partner and co founder of healthy mouth media, Bonnie Benjamin, who comes from a medical family and has extensive experience in communications. She suggested that we conduct some surveys to find out what information shouldn't people really wanted from their dentist and other health care professionals? After serving over 5000 people? The answer was clear. These people had four top interests airway, sleep, heart health and brain health. Armed with this knowledge, we began interviewing dental and other healthcare experts. Those interviews formed our first functional oral and airway health summit. Since then, we as co founders of healthy mouth media have produced a total of four such summits that were enthusiastically received by both consumers and somewhat to our surprise clinicians, even though we had designed them for consumers. So this interest on the part of healthcare professionals did surprise us. It turns out that these practitioners who didn't have the time to read journal articles or trade magazines, discovered that our interviews, each focusing on a very specific topic and under an hour, gave them an easy quick way to learn more about specific topics. They really liked that often we got comments like, I never learned this in dental school, or they don't teach this in medical school. Thank you for producing this summit. The information is clear, concise, and I plan to incorporate it into my practice. One of the people I've now interviewed three times is Dr. Dale Bredesen, neurologist and best selling author who developed the Recode program to prevent and reverse Alzheimer's disease. Part of that protocol addresses sleep and breathing disorders, as well as having good oral health as essential pieces of Alzheimer's prevention and reversal. I was honored that he invited me to teach to the modules in the Recode training program from my experience as a dentist and as a result of knowing and interviewing experts and all these critical areas, I realized that no one was looking at or addressing how sleep breathing and airway disorders could and do often begin in childhood dentists are uniquely qualified to look for oral airway and sleep disorders in kids, as well as adults, whom they can then refer to the appropriate specialists for testing and treatment. But no one was informing patients, parents and clinicians about this critical clinical information, we can help our kids actually prevent Alzheimer's before it starts by looking for the earliest warning signs and addressing them. We know from research that Alzheimer's starts decades before actual signs or symptoms of cognitive decline appear. So why not treat the potential causes that we know about as soon as they're discovered at any age, but ideally, maybe toward the beginning of that very first decade in kids, when so many of these signs are jumping out if we know what to look for. So that's been my roundabout journey. And now Rob, my mission and the mission of healthy mouth mediate is to send a clear message that preventing Alzheimer's is everyone's job with the goal of raising awareness and both patients parents and dental and medical practitioners to the importance of earliest possible diagnosis and treatment of these early warning signs and oral airway and sleep health, what I call the seeds of Alzheimer's,
Robert Lufkin 08:14
something we're not used to hearing yet at least and that is Alzheimer's and childhood in the same sentence. But as you say, the the seeds of Alzheimer's begin very early. I mean, we we started with it used to be that Alzheimer's was people began worrying about Alzheimer's when they had cognitive impairment. And that was that was the trigger for it. And and now we're learning as you say, you know, 10 years before 20 years before cognitive impairment occurs, there can be changes in the MRI scan, and even further going back into childhood. As we're going to talk about today, some some significant things that we can look at and some actions we can take.
Scott Saunders 09:04
Yes, that's true. And we have come up with the catchphrase, for lack of a better term the seeds of Alzheimer's because that's something that I think a lot of people can can relate to, before you can see a visible sign. That's the time to start intervening because once you do have a sign of you know, even mild cognitive impairment, which is actually an early, early Alzheimer's disease, you have subjective cognitive impairment, and by the time it's mild cognitive impairment. I've heard Dr. Bredesen caption that is early Alzheimer's disease and not that you can't do anything at that point. But you know, it's much better to roll the odometer back 10 or 20 years and think what you can do from a preventive standpoint, you know, before you have something that you actually have to actively work at reversing.
Robert Lufkin 09:44
So as as a dentist who's been in clinical practice as well as you've been deeply involved with research on oral and airway health you you have a unique perspective and experience to bring to the table specifically, looking at Alzheimer's, how we can prevent it, beginning in childhood and in you use the phrase the seeds of Alzheimer's that begin in childhood. What is exactly does that mean? What do we what do we need to look for in in children that that can let us begin to help prevent Alzheimer's in them?
Scott Saunders 10:25
Well, I think the first thing that we need to look at Rob, and this is where we need the support of parents and adults. I mean, getting to one of the most basic functions of human physiology is of course breathing. And there have been a couple of best selling books recently published on breathing and breath. And how basically, as a species, we have lost the capacity to breathe. I think parents watching their kids, how they breathe, are they breathing through their noses? are they breathing through their mouths, watching them while they're sleeping? Are they sleeping with their mouths open? Are they snoring, making sure a child or an adult or teenagers are a specific study in themselves, making sure that they can breathe, which presupposes that they have a good sized airway, a well developed airway to breathe through is the first seed second stage would be sleep. And, of course, Alzheimer's, as you know, is a global pandemic. Obstructive Sleep Apnea is also a global pandemic. And kids can actually people can actually be born with with obstructive sleep apnea. And it's not on every parent's radar. That's something that if they know what it is at all, and something that affects adults, actually affects kids. But I've heard estimates, I've seen estimates, as many as 25% of children actually have obstructive sleep apnea. So looking at how the child is sleeping is bedwetting going on that's a red flag is does the child wake up with with the bed intank the covers and tangles and the room a mess? Is the kid tired during the day? Is the kid having behavioral problems at school? And we'll we'll talk specifically. I have some some thoughts on actually behavioral disorders that maybe we can get into in greater detail. But behavioral behavioral disorders can be a red flag of, of a lack of good sleep.
Robert Lufkin 12:28
Sure. Sorry. Before we get into those, and I want to I want to get into those behavioral disorders. I think that's that's a very important point. Before we get into that, just for our audience, the obstructive sleep apnea, as you describe it, that that I could see how it would interfere with sleep. And that's the problem is that the main mechanism for damage being done or what is obstruct obstruction of the airway, cause how does that cause pathology,
Scott Saunders 13:00
obstructive sleep apnea, we're not sure as to all of the causes all of the all the etiology, but simply put, obstructive sleep apnea is a condition in which a person ceases to breathe while he or she is asleep. And I myself suffer from severe obstructive sleep apnea until I met bunny, I didn't have anybody to tell me that I was stopping breathing while I was sleeping. But turned out I was. And there are various components to this, there was a central form of sleep apnea, which is different from obstructive sleep apnea. OSA, or obstructive sleep apnea results from an airway that is probably too small that is frequently related to a compromised cranial facial development with jaws that are too small and in conjunction with that an airway that is that is too small. And what happens is the airway collapses during sleep, when sleep occurs, the autonomic nervous system takes over and if it's not, if you don't have the the right sized airway, it's going to it's going to collapse. And your brain will get that message and say, you know, it's not gonna be able to differentiate, you know, is this my airway collapse? Am I drowning? Am I being choked? And it's going to wake you up. And very often that takes the form of waking up with a gasp and sometimes you don't wake up fully and sometimes you do but sometimes it can remain hidden and you just don't know that that that you have this. So compromised breathing during sleep that is beyond the person's control. That's basically what obstructive sleep apnea is.
Robert Lufkin 14:31
In you mentioned several the factors that affect children's breathing the cranial facial proportions on the airway and as I understand it, due to evolution or perhaps maybe the Industrial Revolution The a number of factors are I've heard it reported are making our our faces jaws and airways actually shrink over time. Well, can you can you elaborate on that? Sure.
Scott Saunders 15:03
The usual time guideline that's given for that Rob is over the last 300 years where you've seen the advance the advancement of feeding kids a soft diet and not getting them on a hard diet that forces them to chew, probably by age two or three of the latest, which, you know, in our early hunter gatherer days, I mean, that was just standard operating procedure. Due to the, the introduction of a huge portion of a grain, a huge presence of a grain based diet, cereals, softer foods, and a lot of those being fed to children, when they should be learning to exercise their jaw muscles, and chew. Those drum muscles are not getting exercised. And during the formative years, the facial cranial facial components, the maxilla, the upper jaw, the mandible, the lower jaw, particularly the tongue and the the oral musculature, and the swallowing muscles are not getting the workout that they would normally be getting, where were the kids to be eating solid food. And instead of getting infant formula are another big factor here is the lack of breastfeeding, women are under pressure to get back to work. They don't want to breastfeed, it's you know, it's inconvenient. I've heard, the most common estimate that I've heard is that children should have on demand breastfeeding for the first year of life. And of course, you, you wrote that to the to the average American woman who was, you know, on the go juggling multiple things. And, you know, unfortunately, she'll laugh at you. However, I see that there is a bit of a shift happening. And one of the things we're trying to do is educate people that proper breastfeeding, proper suckling is essential for, again, the development of the oral musculature and the tongue, getting the tongue in proper position, which is up toward the roof of the mouth, such that it is putting pressure on the palate, being an early form of a palatal expander, which is one of the functions that the tongue was was designed to do, expanding that. And while it's doing that, expanding the floor of the nasal cavity, which of course is right above the palate. And of course, all of this is taking place within you know, an inch or two of the brain. And the developing brain is going to be affected by that, too. So, yeah, well, long story short, we have, we have had evolutionary changes that have been driven by socio cultural changes, a lot of them diet related, a lot of them having the unwanted side effect of having the tongue, muscles and bones of the face, and the airway that lies right behind them not developing properly. Hence, we're having smaller and smaller faces, shrinking drawers, and shrinking airway, which is shrinking our ability to breathe, and sleep. So that's that, unfortunately, is the spiral that we're in. And that's what we're trying to educate people to reverse. And I'll admit, it's, it's not easy, you know, we've been educated to do stuff, that's, that's easy and convenient. But unfortunately, that is not the most therapeutic way to, to grow healthy adults starting with our kids.
Robert Lufkin 18:00
So so we have these cranial facial changes and and other factors that are causing an increased incidence of obstructive sleep apnea that you're seeing manifests with immediate, immediate symptoms and findings that that parents and and the subject itself can take. And also later on in neurodegenerative diseases and behavioral diseases and things like, like Alzheimer's risk, potentially, and some immediate media behavioral things. Could you speak to those
Scott Saunders 18:32
frequently, there are behavioral changes, if a kid is not breathing properly, if a kid is not sleeping properly, chances are there's going to be a behavioral component. Is that what you're referring to? Yeah, yeah, okay. And a big a big piece of this. Yet another pandemic, as I like to say, are yet another epidemic. I don't know if ADHD is a true epidemic, and quite probably is. The point is that there's a lot of it and it is on the rise. And there are key opinion leader, pediatrics, one pediatric sleep specialist guy by the name of Steve Sheldon out of Chicago, who is often quoted as saying that he doesn't think ADHD is a real neurological disorder, but rather a sleep breathing disorder. And I don't know when or if that will ever be proved. But I think it is a very viable very productive avenue of thought when the child that is diagnosed or looks like he or she most mostly more boys than girls is going to be that diagnosed with ADHD is, is given a breathing analysis or a sleep study as that should be one of the first steps. If we're talking ADHD, you know, before you before you do the psych eval, you should do a sleep study and get an assessment of whether that kid or that teen is breathing appropriately, because probably I don't know about in the majority of cases, but in many of those cases, you will be able to rule out an actual organic behavioral disorder. like ADHD and if parents know enough to have the child get a sleep study and either rule in or rule out a sleep related breathing disorder, then that diagnosis of ADHD can go out the window provided that child gets the the appropriate interdisciplinary care to grow the jaws to proper size, so they can accommodate all the teeth to develop the airway to proper size such that the child can breathe to get the appropriate orthodontic treatment. If this were more of a regular thing, how many? How many other great kids with great potential could we uncover rather than label them with with a behavioral disorder diagnosis when all they needed was to have their sleep airway and breathing evaluated, get the appropriate care? And then you know, the sky's the limit versus being labeled for life with a behavioral disorder that may not be factual at all?
Robert Lufkin 20:46
Yes, I'd like to come back to that that story. And in a little bit, you mentioned there was an age difference a gender difference and males and females. What does that do to?
Scott Saunders 20:56
That's a really good question, Rob. The short answer is OSA is more prevalent in males. However, there has been some recent research. And these next two slides that we're looking at here will show some of the more specific aspects of the differences. In the first slide. This is from one study that was published in 2019. And it starts out by saying yes, of course, there's a higher prevalence of obstructive sleep apnea in men compared to women, and that's been consistently reported. OSA is also more severe in men compared with women. And as far as symptomatic presentation, there is a difference in that women are more likely to report nonspecific symptoms such as headache, fatigue, depression, anxiety, all of which are major, major comorbidities with OSA. And whereas men frequently report snoring, gasping, snorting, apnea, more of the core OSA like symptoms that you would typically associate with sleep apnea. And this other study, which just came out earlier this year, talks about obstructive sleep apnea being under diagnosed and females. So there is a whole new frontier that is being researched now, to drill into more of the specific presentation of Osa and women, as opposed to men. And this goes down to actual sleep study polysomnographic differences between males and females, and talking about, you know, body type differences. The population, this was an actual clinical study where they looked at male patients and female patients. This was actually done in China, where sleep apnea has not been researched anywhere near to the degree that has, typically mostly in North America, but they are looking at it, it was a study in about 300 patients over 300 patients. And they found that the male patients were taller, heavier, had higher systolic blood pressure in the morning, shorter duration of slow wave sleep or deep sleep micro arousal events, and more complex sleep apnea events and of course, greater apnea hypopnea index, which is the main measure of how bad your Osa and they kept that off with, you know, understanding gender differences not going beyond, you know, how prevalent is it in males, as opposed to females understanding gender differences, the qualitative nature of the gender differences. And that is an area of research that will contribute to better clinical recognition of how LSA presents and women as opposed to men, and how that will affect the actual treatment plan of how we treat OSA in women as opposed to how we treat it in men. So long answer to a simple question. It's more prevalent in men, but it presents differently in women and this is a whole new area of research. So
Robert Lufkin 23:55
we we see these certain symptoms that they can present with now as a parent or as someone with these symptoms even who should I go to like go to my dentist should I go to my what how are dental practices position to handle handle these problems? Are most onboard for looking for airway issues?
Scott Saunders 24:22
Unfortunately, no, there is. There is an increasing consciousness especially among pediatric dentists for screening for airway issues and force for getting sleep studies for kids. And this is not all pediatric dentists, this is primarily those who have taken the time to keep educating themselves in the newer areas of airway consciousness. Looking for for a tongue tie, which is a tethered oral tongue that is tethered to the floor of the mouth and looking at getting that released and looking at providing appropriate orthodontic treatment. So a pediatric dentist you And we can we'll be providing a PDF that has a ton of resources as far as websites and societies that parents can can look at, to get them into consultation with dental and medical practitioners who really know their stuff. As far as airway is concerned. My first recommendation if you suspect a sleep breathing problem would be to find a pediatric dentist on that list. And if you can get that pediatric dentist to collaborate with your pediatrician, all well and good, because we do want a health care team approach. And we do want an interdisciplinary approach. Unfortunately, as I'm sure you're aware of medicine, and dentistry, are very siloed. And collaboration is still something that we're we're trying to kind of build from the ground up. But if you suspect that your child has a sleep breathing problem, I would approach the pediatrician in parallel with approaching a good enlightened as I like to put it pediatric dentist and get the child to sleep study. And there are pediatricians who will be very reluctant to order that. In some states, some dentists who practice Dental Sleep Medicine are able to order a home sleep test that can dentists cannot order a polysomnographic hospital based sleep study. But I would urge parents to continue to network themselves into you know, a physician, even a primary care physician who would be able to order that type of hospital based sleep study and just really get the nitty gritty data on how the child is sleeping and breathing. And the critical variable era was the apnea hypopnea index ahi which is how many times per hour you stopped breathing or your your your breathing sub optimally, and ideally in health should be below five. To give you an idea on my last home sleep test mine was 38. My last hospital based test which was put in after I had the Inspire hypoglossal nerve implant system put in it had dropped to 15. Unfortunately, I only slept at seven minutes, because I had a horrible problem with Restless Leg. But even with that amount of sports data, my surgeon was very, very pleased because he said look, you know, you've got an AGI of 15. Now, even with only 87 minutes of sleep, we were able to use those data and see a therapeutic effect with my remedy for sleep apnea, which is going to be different from someone else's. So the sleep study is is is a critical step. And if you can't get a hospital sleep study right away, get a home sleep test. And there are a Dental Sleep Medicine, dentists who depending upon the state, I'm in Pennsylvania and I had one ordered by a dentist up in New York, and Pennsylvania and New York, I know that dentists can order him sleep studies, it's not all 50 states. So you're gonna have to research that a little bit. But some dentists can order home sleep test, but not hospital sleep test. That's where your primary doctor or pediatrician comes in. And you may be you may need to be a little bit assertive, especially when getting something like this for a kid, because it's not really part of the vernacular yet, but it's getting there.
Robert Lufkin 27:54
And as I understand you mentioned that the American Dental Association at least has a policy statement on airway sleep breathing issues, so that it's it's in their policy to the dentists should be aware of them, although it always takes time for these policies to to reach it out into the community.
Scott Saunders 28:15
That is true. In fact, this is the American Dental Association, which is ada.org. And if you Google American Dental Association and sleep apnea, this will be like the number two result. And the banner headline this is this is a more recent follow up kind of a press release. And it says counsel on dental practice dentistry has role in sleep related breathing disorders. And it recaps and this happened in 2017. The House of Delegates approved an American Dental Association policy statement addressing dentistry is role in sleep related breathing disorders for SRB days, developed as a result of a 2015 resolution crafted calling for the action and the adopted policy statement outlines the role of dentists in trading SRB days. Key components include assessing a patient's risk for SRB days as part of a comprehensive medical and dental history and referring effective patients to appropriate physicians, evaluating the appropriateness of oral appliance therapy as prescribed by a physician and providing OAE oral appliance therapy for mild and moderate sleep apnea when a patient does not tolerate a continuous positive airway pressure or a CPAP device, recognizing and managing oral appliance therapy side effects continually updating Dental Sleep Medicine knowledge and training and communicating patients treatment progress with the referring physician and other health care providers. So this is the ADEA calling upon their member dentists you need to be screening your patients for sleep and airway disorders. And furthermore, you need To be collaborating with those patients physicians and getting them the diagnostics and the treatment that they need. And I mean, I applaud the idea for doing this. And this is tremendously progressive considering the ideas of typical history of, in many ways, not being all that progressive. But here, they have really done something that is, that is very, very beneficial. And they have a link that you can click, and you can you can download a PDF. And it's just two pages and talks about that summarizes of what was adopted by the House of Delegates in 2017. So we'll link to that in the show notes. Sure, sure. It's a it's a quick read, and my gut feeling robbed is that most dentists in private practice are probably not even aware of the success. I mean, I could be wrong, I would love to be wrong about this. But I've just my own experience with the way most dental practices operate. They're struggling for revenue, they're trying to, they're running a small business, they're trying to make it work. And sometimes when they touch upon when they find something that works, they develop tunnel vision and really don't want to hear about anything new or they don't want to be called upon to modify the way they practice in any way. And well, I feel their pain, I would also encourage them to, you know, kind of get out of their comfort zone. And if they're dying, if they're looking there, they won't be diagnosing, OSA. But there'll be screening and giving patients parents and physicians, a heads up as to you know, which of these patients might need a sleep study and some sort of therapy for for sleep apnea. And dental practices are uniquely positioned to be able to do this, because everything they do is around the head, the mouth and the face. The typical primary care physician spends, what seven minutes with his or her patient. If the patient doesn't talk about asleep breathing problem, and most patients with OSA don't know that I have it. Because most osa 80% of severe OSA in this country is undiagnosed, the primary care doc is not going to raise the issue. So dentists are much better positioned to get into the nitty gritty with this and give the patient a heads up that there might be a sleep breathing disorder, patients should talk about it. But by the same time, by the same token dentist should be doing what the idea is instructing them to do. It's not a mandate. But it's a policy statement. And it's it's a directive that they would really like their member dentists to do. And I would urge every dentist in private practice to be doing this, check it out on the APA website and, you know, develop some kind of a screening tool in your in your process in your process for your, for your practice, you know, it's nothing more than an Epworth sleepiness scale. Or there are screening instruments that are being developed by a taskforce of societies that I'm a member of working with the ADA to develop screening tools. And they too, are centering on screening tools for spotting sleep breathing problems early that is in pediatric patients. So you're gonna see a lot more development with us in the next, you know, three to five years, I would think.
Robert Lufkin 33:32
Yeah, that's, that's exciting. So it sounds like the sleep study is the defining study and, and if if a child has severe symptoms, or one of these behavioral things, then asleep studies probably indicated in your in your work with with Dale Bredesen and the Alzheimer's patients, obviously, is a sleep study part of the routine evaluation for patients with cognitive impairment.
Scott Saunders 33:57
It can be what Dr. Bredesen, the term that he coined is colonoscopy. And of course, this is checking checking out your brain the way that you would check out your colon with a colonoscopy. And the approach is customized since the presentation of Alzheimer's is not the same and any two patients. It is up to the doctor that is ordering that is performing the colonoscopy. But I would think that getting a sleep study provided that the doctor has elicited the appropriate response from the patient that kind of gets into the nitty gritty of you know, Hey, Doc, I'm not sleeping. I would think that that would be a standard part of of the workup. Yes. And most of the time, it probably isn't if it's if it's not, I would urge physicians implementing the Recode program in their practices, to be ordering sleep studies and to be working with the patient's dentist, who is we would hope airway literate to perform and interpret the results of those studies and communicating them to the patient.
Robert Lufkin 34:59
Now maybe We could circle back to that patient that you mentioned earlier with behavioral disorder. I know you were involved as an expert with with the patient, I think in the in the film that was produced about it in some fashion. But it's a beautiful tale about what happened maybe I got this maybe I mean correctly characterize
Scott Saunders 35:19
I was not involved. I was not involved in his care. I mean, that that would have been really mind blowing. But he did have a an extraordinary healthcare team of I think it was a total of eight practitioners, including an airway literate, a pediatric dentist to Dr. Kevin Boyd out in Chicago, whom I also recently interviewed and who has done just a ton of the real heavy lifting with this evolutionary perspective. He worked with the team to get the to get this person's orthodontic work done. Let's back up a little bit. Probably the best way to see this is to click the link in the in the PDF that you're going to be providing with the audience members. It's a very short film, and it's very, very, very professionally produced. And that chronicles how his mom saw that he was a difficult child from from the beginning. And he had anger issues, he had behavioral issues, he would, he would throw two hour long tantrums, and she knew that something was not right. And he was given a psych eval before he was given an airway and breathing evaluation. And unfortunately, he was labeled with oppositional defiant disorder, which is a very heavy duty psych diagnosis. But Valerie persisted in getting him to, she finally made the connection because he had a whole bunch of allergies too. I mean, this kid had a bunch of things that he had to overcome. And she was lucky enough to, to to consult with a pulmonologist, I think at the Lurie Children's Hospital in Chicago, and the pulmonologist got him on anti allergy medications. And that kind of opened the door for Okay, well, you know, how is he sleeping? How is he breathing, and that was the pathway the chief ultimately uncovered to get him a sleep study. And the sleep study revealed that he had, they don't come out and call it obstructive sleep apnea. I'm not quite sure why, but it was a sleep related breathing disorder. And they treated that and they treated his craniofacial complex, what is what some people call the cranial facial respiratory complex. And once they did that, the bad reports from the school stopped coming in, he stopped getting D's and F's and started getting A's and B's, he basically turned back into a normal kid behaviorally, you know, interacting normally with with his siblings, and being the affectionate teenager that his mom always thought that he could be. And it's a very heartwarming story. And it's something that I think every clinician and every parent should say, because the bottom line here is you need to evaluate the airway. Before you label someone with a behavioral diagnosis with a PDF, we have a version that we used with permission from the producer of the film. And I did a video intro and outro. And I kind of give people the backstory and kind of a call to action as far as you know, my two cents from a research report or expert at a dentist as far as you really do need to evaluate a kid's airway, the kid might the kid actually have organic ADHD, yeah, it's possible, it's possible that he could just have a sleep related breathing disorder, as was the case for this kid. So it's very, very valuable piece of education. And we're pleased to make it available to your audience. And just to give your audience a visual window into a few of the things we've been talking about. I'd like to walk everyone through some pictures mostly of kids that provide a clue as to some early or even not so early warning signs for parents to be on the lookout for and provide some tools for identifying specific factors that can affect airway, sleep, breathing, and the beginning of the path to chronic disease, including those that affect the brand, like Alzheimer's, what I call the seeds of Alzheimer's. One of the bonuses I'm offering here is my free 32 Page e guide to sleep, breathing and your brain. This IGAD does a bit deeper into the seeds of Alzheimer's. What's what they are and gives a detailed description and takes a detailed look at what's going on in some of the snapshots I'm about to show you. It gives you a list of things to look for, and provides good actionable information for you and your child if you see any of these things happening with his or her sleep, breathing or behavior. Importantly, this IGAD also gives you 23 reliable online resources to information health care providers and the societies they work with, that you can contact now to get the help you or your child needs. Now, the IGAD also gives you links to watch the amazing film Rob and I talked about an amazing story every parent and Doctor really needs to watch and what I'm really excited to share with everyone as bonus number two, I'd like to invite you to take my new proprietary sleep, airway and breathing risk assessment. It's a short series of multiple choice questions won't take a lot of your time to answer, but will provide you with a score, not a diagnosis, but it will give you an idea of what sleep breathing and airway problems your child or you might be facing, but addressing those issues could solve. And as always, the earlier you can start solving them the better. Taking a few minutes to do this assessment now could mean a healthier lifetime for you and your child, and could even help you steer around the seeds of Alzheimer's. So let's just take a quick look at some of the basics that you can look for in your child that could signal a sleep or breathing problem. So I'd like to show you some pictures that we're going to be going into in much greater detail. When you get your EEG guide. I'd like to acquaint you with a couple of basic things to look for when you're looking at your child and just you know, looking at faces in the crowd. Theme number one is profile. As you can see in this boy here have about five see how far back his chin is. That is not normal. That suggests a potential airway problem. He will end up like this young woman here. Notice how far back her chin is. She quite likely started out the way he did that suggest she may have an airway problem too, and likely doesn't even know it. Somewhere along the way. She may have had problems like this kid here from the UK, who looked pretty normal at age 10. Then somewhere between 10 and 17 He got a pet gerbil that it turns out he was allergic to this resulted in a stuffed up nose and constant mouth breathing. That steered his face down and back in totally the wrong direction. So at age 17, you can see how far back his chin and upper jaw are bottom line his jaws and his airway didn't grow right. This is not normal, and he needed help which he received from his dentist. Second thing is forward head posture and the non existent chin and profile and forward head posture sometimes go together. But take a look at this kid. This is a shot from my friend orofacial mile just ng lemon. picture on the left clearly suggests he has a potential airway problem on the right with his head now in a healthy properly aligned position, his airway is quite probably much more open. When I discuss this case with Angie she did indeed confirm that his airway was greatly improved. Also note the change in his chin position from left picture to right picture. As you can see head too far forward often accompanies Shin too far back. Both were corrected through myofunctional therapy exercises. Third thing, mouth breathing. This is a biggie folks. The nose is for breathing, the mouth is for eating no one, no one should breathe through his or her mouth ever. whether awake or asleep, like this little girl, both her mouth breathing and the backward tilt of her head indicate that she may have a potential airway problem that needs to be assessed by an appropriately trained airway specialist. Another example of mouth breathing again from Angie lemon. the before picture on the left, you see how this kid's mouth is open. You see where his face is kind of coming to a point. See how big his lower lip is. Now you see the picture on the right after your treatment. The whole shape of his face is different and we're talking about maybe one two years, going from mouth breathing on the left to quite probably nasal breathing and a much bigger airway on the right. I also want to point out the general appearance of this child. On the left. He looks tired and his eyes are almost falling shut. On the right. His eyes are open and he looks alert and wide awake. In the Resources section of my IGAD there are resources for how you can get treatments from an orofacial mile just also called a myofunctional therapist like Angie did for this young man. What does airway size have to do with it? This is a cone beam Computed Tomography X ray shot. On the left, you see the airway and color on the right you see the airway in different colors. On the left you see a narrow airway. On the right you see a much wider airway indicated by the nice bright green color. And I think this is the same patient before and after. I don't know what treatment was rendered but The airway on the left is what you do not want the airway size on the right is what you do want. Compare trying to breathe through a cocktail straw. That would be what you see on the left to breathing through something more closely approximating a garden hose, which is on the right. Cone Beam Computed Tomography. This is a critical piece of information. If the dentist paediatric or otherwise does not do CBCT, find someone who does, period. And finally, the behavior problem. ADHD is being diagnosed in greater and greater proportions. And I'm sure most parents watching this can relate to this particular scene. If your kids are having behavioral problems, if they're throwing tantrums, if they're having problems at school, if they're not sleeping, if they're waking up with the bed covers and tangles, if they're falling asleep during the day, if they've got a potential ADHD diagnosis, get the airway checked out. Because ADHD, quite probably does have a strong underlying component of lack of sleep, lack of good breathing, and basically, inability to get oxygen to the brand. It's not exactly counterintuitive that that might produce a behavior problem, like ADHD. So before you get your kid a psych eval, get a sleep study, and see what might be underlying a behavior problem in the way of sleep, breathing, and airway. So these are just a few red flags to look for. And I'd like to invite you to take a deeper dive into what to look for in your child or even in yourself, that might suggest a breathing problem that could compromise your child's or your own brand down the road and be setting you up for the seeds of Alzheimer's. Again, that's why we're giving you these two bonus gifts here. Bonus number one is my free guide that summarizes what Rob and I have discussed 32 pages worth of valuable information and pictures, some of which I just showed you. And also a ton of resources to these organizations and doctors that you can contact to get you and or your child to help you or he or she probably needs. And again, bonus number two, my sleep airway and breathing risk assessment. Again, this is a short series of multiple choice questions. Taking a few minutes to answer these questions now could mean a healthier lifetime for you and your child and help avoid planting the seeds of Alzheimer's? Just click the link provided to access and download the free e guide and take the risk assessment. Your score will be provided upon completion of the assessment.
Robert Lufkin 47:45
Right? Yeah, we'll definitely link to that. And also, Scott, if people want to go directly to follow you on social media, how can they do that? And also, maybe you could tell us your website online here also.
Scott Saunders 47:59
Sure the website is www dot healthy mouth media.com.
Robert Lufkin 48:04
Thank you so much, Scott for taking the time. It was great to spend an hour with you today and get to know you and hear about this important area. It certainly changed the way that I think about it and it changes the way I think about Alzheimer's disease and obstructive sleep apnea in general and with children. It's it's been very, very eye opening.
Scott Saunders 48:30
One more thing, Rob? Yeah, absolutely. Yeah. And this was something that I actually forgot to ask the last time I interviewed Dale Bredesen, his new book, The first survivors of Alzheimer's, I think there's there are seven first person accounts. And I think it's four out of the seven of those patients have a significant history of obstructive sleep apnea. So you know, if we're not if I didn't do a good enough job of bringing Alzheimer's susceptibility and juxtaposing it with the presence of obstructive sleep apnea and the brain not getting the oxygen and detox that it needs, I would just like to emphasize that because even even in patients who are reversing their Alzheimer's disease, obstructive sleep apnea has been a huge part of their history. And getting that treated has been part of the multifaceted lifestyle approach that Dr. Bredesen advocates in the book and in his two previous books. So I just wanted to give that more of an emphasis that Osa and Alzheimer's are definitely related. They're both global pandemics. And addressing one of them necessarily must include addressing the other so for what it's worth,
Robert Lufkin 49:34
that's such a good point and we'll link to Dale's books in the show notes as well and his most recent one literally just came out a few weeks ago and and recommend it to everyone as you if you said it's fast. Yes.
Scott Saunders 49:46
Tremendous book tremendous eye opener, and I recommend it highly to everyone.
Robert Lufkin 49:51
Great. Well, thanks. Thanks so much again, Scott. And I want to keep in touch and hear about your next summit too and have you back on the program soon?
Scott Saunders 50:02
Yes, thank you very much, Rob. It's been a pleasure chatting with you, as always, and I hope that your your audience members find find the interview helpful as well as the materials that we're going to share with them on your Summit and the best best of luck with that, and we'll get that one out of the park as well.
Unknown Speaker 50:26
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