Dr. Dave Shirazi: "The Science of Sleep" | Talks at Google

Dr. Dave Shirazi:

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Thank. You dr. Shirazi for coming in today and I'm excited to be moderating, this discussion. With you I'm so grateful to be here it. Is about sleep hygiene and. That is important, today, however our focus, is on sleep, disorders and. Interventions. That can be made which are gentle. And minimally, invasive. So. My, first question for dr., Sherazi is. Based. On all of these credentials, I'm especially. Interested in your traditional, oriental medicine mm-hmm, degree, and also the spiritual psychology and just to find out how that. That, informs. Your practice today oh thank. You a great question, so. The. Dental component. Allows. Me to treat things in, a functional, way with oral appliances, but. Of course we're not just structural, beings right we're energetic, beings we're emotional. Beings were spiritual. Beings so when, I apply, acupuncture. And the, philosophies, of Chinese medicine for people, with just straight insomnia, right, it seems to be a great adjunct when treating they're storing or sleep apnoea problem. Very. Interesting, yeah, so. I wanted, to just give you an overview of, what. Dr., Sherazi is going to discuss today and. It. Includes, snoring. And sleep. Apnea. Especially. Obstructive. Sleep apnea. Which, is more, common than I knew I've. Been learning, a great deal just, discussing, this talk with dr. Sherazi also. Related, are migraines, and headaches. Bruxism. Or teeth grinding, jaw clenching, and. The. Resulting, craniofacial, pain or TMJ. Pain. So. What. Is sleep do you want to give us a little lesson. Here yeah, so it's a state of consciousness that. Every. Mammal needs, it's. Not just that every where mo has but every mammal needs. It. What we say it's absent, from consciousness, even though there. Is mental, activity, being done. It's, a way for our physical, bodies to actually, shut, down and rejuvenate, and in, fact the only time we ever get growth hormone, is during. One specific, stage of sleep called Delta, and. It's a stunt it's a time for mental. Emotional, repair. And processing. And including, memory which, happens predominantly, in REM sleep and. Moving. On why. Again. Do we sleep what does it do for us yeah. So, so, those are the main, things it restores, our physical, mental and. Physiological well-being. Okay. And what's. Really was, just thinking about this the other day about, how. Evolution. Deemed that. Being. Vulnerable for, eight or more hours in the dark every single. Day is so. Necessary that, we, would even still, have that while still being vulnerable to attack so, that, that tells me evolutionarily. Speaking that. Sleep must be absolutely. Essential the the over, the years. We, could not think of a better way of getting our, mental emotional, rest and our physical rest yeah, so this is really a need, and I I just want to plug a book that I read. Or listen, to because I only do audiobooks, called why we sleep and it goes into this a lot more why. Would we voluntarily, choose to make. Ourselves this, vulnerable, or, such a long period of time, you'll. Be fascinated and, it was a great book change, the way you think about sleep. This. Is, a. Map of sleep, deprivation, published. In a 2015, study, by, sin sleep, health, what. Was surprising to me is I I expected. To see a lot of the dark areas, in urban. Centers. And that's. Not what we necessarily see, across this map can, you speak a little bit to what's significant. I'll. Do my best right because it's one metric, sleep deprivation of, course there can be a number, of reasons why I wear sleep right but, the occupation. For example, that, is most, susceptible to sleep deprivation, or, shift, workers people. Who work, at night and they get and they're, sleeping, when it's light outside and, they're awake when it's dark outside that's not natural. Physiologically. Speaking you'll.

Notice That the that. Map also over, lights over, the, the. Rate of your BMI in, your, obesity, level and it, seems to match it pretty well in, the that whole sub. That Panhandle, region, is where we see the most of these and we. Know that obesity can, cause sleep. Apnea but, more oftentimes it takes whatever snoring, and sleep apnea level, you have and exasperates, it which, will of course deprive, your sleep even more so. As, we, go through the slides here we're gonna see that there's a really. Big connection, between weight. Gain and. Sleep. Deprivation or, sleep fragmentation even. Absolutely. There. Is a correlation, for sure. Here. Are some statistics a. Third, of the u.s. population suffering. From sleep disorders, seventy-five, million. Individuals. Who are chronic sufferers and, ten percent only. Ten percent have been diagnosed. And treated that's. Right so three different, things to mention so one-third of the population suffers, from sleep disorders that's true could even be a little bit more by, the time this study, has been out. Insomnia. The number one sleep, apnea is number two and then a myriad, of other neurological. Issues associated, with sleep, and. Of course the, seventy-five million that's for sure war and, now than before what's. Interesting about the 10% that's been treated and, that's been diagnosed, with sleep apnea yes, it's true 90%, haven't been diagnosed yet but, even in that little 10%. Sub-sect. Almost. Entirely, of that 10% they've, been offered a CPAP for. Treatment and only, about 50%. Of it hold, to, the deck stick with the CPAP right so, it's really more 95. Percent, of the population, when Slee at snoring and sleep apnea do. Anything about it or even know about it I'm gonna talk about the, types of sleep apnea there are two main, areas, and. Then. As you. Discuss. The problems, that are associated with this can you also tell us a little bit about why. Our palate, is important. In. The treatment, absolutely. So the. Most common kind of sleep apnea which is like 85, 90 % of all. Breathing. Disorders in our sleep is, obstructive. So. That. Has to do with the way our air flows, all mammals. Are supposed to breathe in and out through their nose exclusively. Even. When exercising, this, comes the you know both people who are brothers will say well that's impossible but no actually that's what we're supposed to do and, I'm not saying I do it I'm just saying that's what, we're supposed to do with mammals so. The. Size and, width, of our, palate.

Directly. Correlates, to our. Breathing ability, through our nose the, roof of the mouth is the floor of the nose so if we have a nice wide palate, or, nasal. Breathing will be much more patent, and we can both inhale, and exhale, much more freely as soon. As we have a limited, ability to, breathe through our nose be it through a cold be, it through environmental, allergies or even some food sensitivities, are our. Mouth has to dynamically, change in, order, to breathe because. We. Need to breathe to survive so as soon as this starts closing up our mouths open and. Our. Mandible. Rotates, backwards which. Limits our ability to breathe that makes sense absolutely. So basically. What you're saying is the body is gonna find a way to breathe no matter what and. It. Doesn't really matter what happens to the. Alignment. Of the head or other parts of absolut of the face as we talked about bruxism, below that'll become most evidence and, that's what I realized because I definitely, have bruxism, but I I said how can that I mean. My mouth is closed how can I also have sleep apnea, so, this nasal, breathing and the, nasal airway is, it's, truly important. And the source of sleep apnea as well absolutely. It could be causal, so. We're, gonna roll, a video, here that just gives, you a visual. Of a person, experiencing. Sleep apnea. Do. You want to speak about the opening eyes yes. I absolutely will, I'll talk, through the, video okay that's perfect, so you'll notice the first thing right the move video hasn't started yet but. You'll notice on his hand he has a home sleep. Study device. I actually, prefer, home, sleep study devices, because, it's done obviously in your own bed, and, we get a more realistic response, of what's going on if, I'm more concerned, about. Your. Legs moving or insomnia. Or something, more associated, with the central component, I want to do it in a lab. So. You saw that his eyes just flicked open just a moment so we're. Actually not waking. Up when our eyes open, during an episode we're, actually just going from a deeper stage asleep to a lighter stage asleep so, we're, supposed to breathe in and out through our nose in this video shows exhaling through the mouth but that's wrong. But. When we have an airway collapse, those. Drop, and oxygen, causes, the brain to tell, the intercostal, muscles to just sort of like the mini CPR, and breathe, you need to breathe restore the airway you, see how his eyes opened up right there he, didn't wake up all. Right so he could do that 400, times in a night and not remember, a single one because. He's still technically. And through. EEG, we can see it happening he's still technically, asleep right, and then, you hadn't came up with that wonderful query, which was well, if the mouth is opening and I'm choking how. Am i clenching, my teeth right, so, in the studies that we see. We. See in about half the time on people that clench their teeth we, actually see the airflow starting. To decrease and then, we've seen the masseter, activity, increase. And then, when the airway is restored, the masseter stop clenching that. We consider, is the muscle that opens, and closes the mouth, correct, correct. So we we. Can even, classify. It as a reflex, to. Breathe right, and we, see that about 50%. Of the time as the cause of clenching. Even. On the very same patient, that clinches their teeth because, their airway as a response, will, see them clenching, with, no every disturbance, whatsoever, and and, that, other 50%, if you will we put it under the category, of stress, you know mental stress emotional stress or even physiological.

Stress. And. That is but that is still a sleep, apnea then, in that, second, in the second category no, no, no you could that's what I'm saying in the absence, of an airway disorder, you can still clinch 50%, the time, and. But you can still help with that yeah. We can the devices, through the devices, we can reduce your ability to, 20 50 to 100 percent that's right, so. This, slide. Shows us some clinical. Signs of. OSA. Obstructive, sleep apnea, and then, what. Are called comorbidities. I had to look that up so you blame. Comorbidity. And yeah, all the things that we see overlapping, whether, it's correlational. Or it's causal, so, you, know the first one you see up there is menopause, right, so, we definitely see, a. Differences. In in what. The patient's. Hormonal. Balance, is as, it relates to snoring, and sleep apnea so someone. With a high testosterone, content. Is going to be more predicated, to having storing in sleep apnea and that's, why when women go into menopause we, see a shift in the balance of their hormones more into testosterone, and then we see more. Apnea, typically. Hypertension. It's very common, people. That have uncontrolled. Hypertension meaning. They tried one, or two or more medications, and it only puts a dent in their, blood pressure very. Commonly, at least eighty percent of the time it's the apnea, that's causing the hypertension. Obesity. It goes both ways like. I mentioned you know being obese can cause you and a snoring and sleep apnea but, can actually, take. Whatever you have and make it worse that's we see that more commonly, but, also when you're getting interrupted, sleep it. Went, you wake up you're more tired and therefore. You want to eat more and you're, not conscious, that you want to eat more you just eat more and that contributes, to obesity. Because. You're eating more calories that's a hormonal changes, that occur and that's a hormonal change as with ghrelin exactly, morning. Headaches that can go in two different directions if, you, have if you have the kind of headaches where you wake up feeling kind of like an empty head that's, usually more from an oxygen, deprivation I, find. Tension. Type headaches which is the most common, headaches. In the world that's, predominantly. Caused, by clenching your teeth and how it pinches on the nerves in the back of the skull and like, I said the number one cause of clenching, is some, form of upper, airway disturbance. Type, 2 diabetes we have direct. Not, just correlate, correlational. But causal, research. That shows that the. Inflammation that's, caused from, sleep apnea can, lead to. Type. 2 diabetes, and we'll, actually see these very same patients, being treated with either CPAP, or oral, appliance therapy, and their blood Sugar's coming down without medication, so. We know there's a causal relationship, we don't say it's the only cause but, we definitely see a causal relationship so. I went ahead and skip to this slide that it's a good one shows that the. Correlation. Just since we're discussing that we got back after that but, this. Shows. Some. Of the hormones that are released. Or, disturbed. That's right so. It's so, this this slide is very much, a condensation. There is a whole physiological. Cascade, that's going on but. So from, the oxygen. Deprivation we, have the repetitive. How vaccine you go through moments of low oxygen but.

More Important, to that is that sleep. Fragmentation. Right. What we call the arousal. Index, it's, the arousal. That, actually caused the inflammation what, we're finding so. Your arousal can come from your own snowing, or sleep apnea or they can come from your bed partners snoring, and sleep apnea can, come from a noisy neighbor's dog, construction. From a dog or cat in your bed that's constantly, jostling, or they, themselves are, snoring that. Can cause the fragmentation, so what, the fragmentation, does is it causes the, sympathetic nerve activity we we go into fight or flight and that causes well you know the cytokine, release toll with cytokine, is just an inflammatory, cascade it, could be not, just cytokines, could be interleukins. It could be C reactive protein and, could be TNF alpha but, all of those. Inflammatory. Markers, will cause us to become hungrier. Will cause our sugar despite will cause like. We said hypertension. Can. Lead to we now are discovering, that depression, is more, an inflammatory, disease than it is anything else, so. Really, a lot of us are walking around with a low level of inflammation that we're not even aware of a high level of inflammation and that and not aware of it and then on top of that this inflammation causes, our blood-brain barrier to, open so. Now all these inflammatory, markers and whatever. You eat ate that day or drank that night that you maybe shouldn't have eaten or drinking is now, has, the ability to get up into the cerebral spinal fluid and. Then, you and then you have the weight gain the internal resistance to type 2 diabetes but then that, also contributes. To more sleep apnea because, you can either have the weight gain from just gain of fat or, you can have the weight gain because you're retaining, more fluid and if, you have more fluid in your upper Rijal area or your tongue that, will also collapse your airway at night more so. All. Right well let's look at that airway, and go. Back on some. Of these slides here so this, is some of the. Points. Of obstruction. And then we'll, look. At the, machinery, that you use to diagnose. Patients, yeah. So you, know we're four points, of occlusion in obstructive, sleep apnea, we, have our. Nasal breathing and predominantly, in my observation nasal. Breathing has to do with, the internal nasal valve and, the turbinates, face the. Adenoidal. Soft tissue soft, palate area the, tongue and the, inferential, space, or thing so. Any or, all of those can, be causal. Or affected, and they're, all related to each other right, so like we talked about if someone that can't breathe through their nose they automatically, mouth breathe which, shifts the position of their tongue and their, jaw that, makes sense mm-hmm, someone, has a cold. Or flu and their, tonsils and adenoids are inflamed there's going to be a change as well so, one obstruction, can lead to another it's essentially, it's it's an instantaneous. Physiological. Change in order. To survive and to breathe. And. What. Is. This so, we just have you know I can't, scan in our office, it's what's called a cone beam cat. Scan so it uses just a fraction, of the. Radiation of. A traditional, cat scan it's pretty clever instead. Of a traditional cat, scan that has like two or three thousand micro stay with the radiation this, machine, goes around your head and neck puts, a tiny, burst. Of radiation as, it goes throughout and then, it. Extrapolates. That data into a three-dimensional, rendering. That, is, about. Sixty mic receivers, of radiation, so, in a one-way flight to New York is 100, micro sieverts of radiation so we're talking many. Really tiny levels and then we have the ability to then look you can go to the next slide to have a look, at the nose and, the, throat and, the airway now about. This slide and about why. This is just gives. Us a picture in time so, what, I'm actually more so than the airway in this, particular slide that you put out that I'm looking at I'm looking, at the position of the jaw, because. I'm thinking if that's what they look like when, they're wide awake and. You. Know sitting. Up I'm thinking. What are they doing when they're on their back and. Sleeping. Because in this case they're they're wide awake not sleeping, so, more. Important, to me is what's. Actually happening. In their sleep right, and, in their own home environment. So that's why I like to do home sleep studies I like to recommend that for my patients, so, they can find out what is going on so.

That Would be the first step before you get to the dead cat scan no we do this we, do this on the initial as well just to kind of see what we have to work with because. Some people are just going to be a straight surgical, case okay we've got to take these things out or we gotta fix your nose or whatever the case may be and, some people you, know if they're very very severe. Unfortunately. CPAP it becomes, their best option right, but the vast majority of, the people in the public that have snoring, and sleep apnea fall, under the mild or moderate category so. They're well within a Dennis scope of practice to treat with oral planes, that's. Good news yeah, it, just means not too many words I just see Pat yes. And. Actually. We were talking about this just before we. Came on stage was. A, lot. Of people won't even do the sleep study even at home because. They're afraid their end goal is going to be only see, Pat so. They're afraid to even just get started even having their sleep evaluated, and and that, is not their only option, I like to go over the whole thing with me I like to give the patient every single option I know of and, then, let them decide what's good for them. Now. We've. Got. Some slides here on the sleep cycle a, couple of them that's right so. This first one. Shows. Our REM non. REM cycle, and then what's. Significant. And this, is it's the same timeframe right as the, other side it is, this one just goes into a bit of detail it's. Actually, an older slide because currently, we're not measuring what's called stage four we're kind of mixing, stage 3 and stage 4 into one but, we're actually discussing. Going. Back into measuring. Stage four again so I'm putting. It up so the different stages that we have so stage one is alpha wave we. All go into alpha waves as soon as we close our eyes Stage. Two is a slightly, deeper stage asleep Stage, three and, in this slide stage four is the, only time where we get our delta, sleep which is where growth hormone comes from so. In children, 50%. Of our sleep is is Delta, because. Obviously, we need to grow but, after, we've reached, our our. Ability. To no. Longer grow we, now greet need growth hormone, to repair, so, growth hormone, is still essential, for our survival but. We're just using it to repair instead. Of growing, and. Of course REM like we discussed, those are the peaks and that, you see on that graph where, we get our mental emotional, rest our ability, to retain things. That we learned that day to, process, things that we think, are, significant. For survival, both socially, right, so, the brain is aware of not just our physical, survival but. Our emotional. Survival, so sleep fragmentation is. Going, to deprive. Us of a lot, of intelligence. Ultimately, yeah that is true we actually see that in children we actually see a difference in, intelligence in children that have compromised, sleep due to a few this. Has been a. Thing. That I don't understand, because that no I'm I'm a parent, so I have to take my kid to school and I don't understand, why they have to start at 8:00 that's, right and and. The. Book I referred, to says, you know a 9:00 a.m. start time for schools is really a lot wiser and, better for, kids so. Something. To think, about and maybe push. For as a society, the data, definitely. Supports, that on schools, that shift their morning time, to 9:00 a.m. which. Allows children to get more sleep because children need more sleep than we do they, have better outcomes. Less. Sick days better. Performance, in class we. Were talking last week and again this morning about the importance. Of breastfeeding. For. The development, of the. Palate right and. When. We look why we've why, we've done. A disservice by a bottle. Feeding babies. Twofold. Disservice, because when we look at skulls, before, the Industrial, Revolution. Most, of them had straight teeth most. Of them had very very wide palates, they, had relatively, small sinuses, and big nasal. Turbinates space and. We, know that. The, average. Breastfeeding. Period was between 3 to 5 years, right. Now when you're breastfeeding the. If you can imagine if the nipple is inside the child's mouth the, tongue, pinches. The base of the nipple and then, makes this little rolling, action. Over. The palace squeezes, the nipple and gets the milk that way right, and when, they, stop breastfeeding, they, still swallow, this way and while, we're growing, it's the tongue that, actually, develops, the palate naturally.

Does That make sense mm-hmm, so when we go to bottle, feeding we, have a two-fold, problem because one the nipple itself, is now suppressing. The tongue down. And to, you're, using your bucks inator muscles. That's your cheek muscles just. To swallow like this which, then narrows the, palate which then raises. The arch which makes you, really don't even have space for your turn to go up there anymore because it's, so narrow. And high arch does that make sense yeah, so we could reduce a, whole lot of this sleep apnea just by, having children breastfeed. For a longer period absolutely. For sure. Would. You say right here can sometimes, be completely. Fixed, when when it when. You discover, it early enough so, that is I'm, not. Sure about the date I don't know if we've had longitudinal, studies you have to realize, understanding. Snoring, and sleep apnea has. Only been going on for 40 years you, know before that it was just Pickwickian, we. Talked about the the jolly old fat man that, snored and could sleep standing up but, we didn't have knowledge of it back then and probably who, knows they may not have even existed you, know in that, kind of numbers but, but the point of that slide, that sentence, is the. Only time, we, can, technically. Cure, sleep. Apnea, without. Surgery, is in. Children, through what I call what's, what's called functional, orthodontics, where we develop the palate develop. The tongue develop. The mandible, forward, that. Makes sense yeah. And so in adults, what we're doing is. Trying. To just. Improve. What, we can improve it the the data, is not as conclusive as it is for children for, adults doing, functional genomics, and. This are these are just some of the symptoms of sleep apnea in, kids, so yeah so, you have kids, may have noticed. Some of these and it might be something you want to explore, yeah, the most common. Side. Effect if you well or symptom, of snoring. And sleep apnea and children are interrupted, sleep is. Hyperactivity. And a. DD that's, the most common one. Of all and it's. Because pediatric, neurology, is opposite. Of adults, so when, adults get tired from, sleep fragmentation. Children, get amped up and wired and have difficulty, processing, things, and sitting. Still, you, know defiance. Has actually been you, know overlapped, with this as well, and it's. The. Number of studies that have shown that, correcting. Sleep. Apnea or sleep disorder breathing in the child with a DD or ADHD and then it resolves, it is in the thousands, it's. Not it's not a secret, it's not talked about unfortunately. Most pediatricians if, you ask them about it they would be kind of blase about it but. It's. Something that's well established in the literature and, every.

Child Should be screened for snoring and sleep apnea without, exemption. Okay. Now. What about in the elderly. Yeah. The elderly. Of course named snoring, is sleeping. As well sorry, but, they, need less sleep than children, or even adults do but, they're but their sleep has changed, depending. On how, active they are so. When we see the, elderly population but. They're still teaching, at a university level they're, still physically active they're, still getting good amounts of REM and Delta the, ones that aren't we. See much less sleep and in. That population, we're seeing a lot of other, neurological. Diseases being overlapped, to it because instead. Of getting hyperactivity, and a. DD we're, seeing in the elderly neurodegenerative. Disorders, like Parkinson's and. Alzheimer's, so. We could avoid some of those potentially. Yeah so Alzheimer's, has been called in, the last ten years type. 3 diabetes. Because. Of the relationship, between their inflammation, and their sugar levels which my father had by the way. So. We know we, already know the relationship, between insulin. Resistance, and diabetes. With. Sleep. Apnea it's, not a far, cry to, say okay here it is relationship, with Alzheimer's, so, taking care of this now can really help us in the future yeah, this is hard to read so I'm just gonna skip, by it no worries. Moving. On now to the the, TMJ, or TMD, can, you clear, by what. What. Is the appropriate term, to talk about so Chavez with you here, so many times I have TMJ, okay so TMJ, is just the name of the anatomy right. Temperament. Everyone, has a TMJ. TMJ. Disorder. Is, some, sort of dysfunction. Associated with, it whether it's a, dislocation. A. Broken. Jaw. Like a fractured jaw neck. Arthritis. Effusion. It's swelling, of the joint it could be a disorder, that falls in there all. Right so that's that nomenclature. Wife, the word TMJ, just, means the anatomy and TM they D, is the actual that's harder, the problem, with it right and then it's sort of it's sort of like cancer, where you have stage 1 stage 2 stage 3, min. Estatic or not it's like we. Subdivide. Different, TMJ disorders, and, we. Kind of spoke about this but. The tongue, moving. Appropriately. In the mouth is definitely. Connected, to this. TMD. Problem, yeah, so if you can imagine if you're swallowing, properly. If your, tongue is coming, forward and swallowing. Properly, it's going to bring the mandible, with it right. But if on the other hand while, you're sleeping let's say your, tongue is tethered to your mandible, while you're sleeping on your back you've effectively, doubled, the weight of your mandible, which will close off the airway a bit more does that make sense mm-hmm yeah that's, very very hard to decipher through, literature, but, we but we but, we see it that there are a countless number of studies where they actually, do what's called myofunctional therapy, where they train you how to swallow properly when your tongue is too low, and your mandible and they'll. Show a 50%. Reduction in HIV, and. After snoring and sleep aah, ice course so, that's. Our metric, for measuring sleep apnea a stands. For apnea, when your airway is closed, for 10 seconds or longer H. Stands, for hypopnea. When, your breathing, is so shallow like. That. Causes your oxygen to dip 3 percent or greater and, the, I stands, for index, which is the number of times per hour you do the both. So. Then correcting. This problem, what, what really surprised, me is is, that, the posture, can change so. This forward head posture that I work on a lot, can. Actually be mitigated, by. Addressing. Tmd, it depends, if you have both that posture, and you, have a tmd at the same time so if this, is your economics. Like all day I don't, know how much TMJ, therapy is gonna help you right, but, if you have a TM problem, if you are mouth breathing which is one of the main reasons, why we have forward head posture and then, you add a, port, economic, situation, when you're doing this or you're on your phone like this all the time that is definitely, going to compound, it so. We have a study. Here, and showed. That a, higher proportion of headache patients diagnosed. With TMJ pain they. Also reported. More. Frequent, and intense tooth, contact. More masking, to Tory muscle tension stress and pain in the face head and, other parts of the body then the non headache controls, yeah this. Is something we also commonly. See in, the, literature again we're probably past 2000 studies as well where, we see those with - both tension type and migraine, type headaches, have. Much more TMJ. And clenching. Problems. Than, norms. Like with. Just. People in the normal population and, then. We also see studies that, show that when you address, the TMJ disorder, they're.

Both They're either their tension, type headaches completely, go away or, they're migrant, type headaches can potentially, reduce, substantially. So. We definitely see that overlap. That. Was great, so. Here. You, might want to talk, a little bit about this slide and. What. Is a migraine. As compared, to another headache, yeah, very different so. A tension. Type headache, when, we're actually clenching. Imagine, all these muscles not just the clenching muscles but of the neck it's all going, like this we, actually see a compression, of the greater Accelerator. Occipital and great auricular nerves, at the base of the skull and it, comes across here. And it can feel like a vise grip right, and sometimes. People will experience they'll say oh I went to my chiropractor, they, adjusted my neck my attention, type hadn't went away immediately and then, I slept then the next morning it came back it didn't hold right, but, when it was in fact the clenching, that kind of led to it migraine. Type headache so. A migraine, is what we call a centrally, sensitized. Disorder, and what, that means is you. All understand what what referred pain is right you have a pinched in your neck and it makes your arm hurt right that's referred, pain down your arm central. Sensitization is, where you have a chronic, repetitive, pain. That. Causes actual. Physical, plastic, changes to your brain then. That causes other parts, of your brain to have create. Problems, I can in the in the case of migraines making blood vessels open and close is, that where the visual disturbances. Can be that's right that's going v1 absolutely, but, it could also be other things you can have burning. Mouth syndrome, you could have triangle, neuralgia, these are all essentially, sensitized, disorders, right, and what, determines which, one you could potentially, have is your, genetics, but. Then it's what, is creating. The response, of your genetics, to do that because. Your genes aren't just gonna I find, the whole argument of migraines being genetic only, is absolutely, preposterous because, someone. Can go their, whole life forty, years they. Have obviously the genetic markers for migraine they never have a single, migraine and then, something, changes, they change their diet their sleep they have sleep fragmentation they, get a job problem they have a dental problem they have a sinus, problem and then, they start getting migraines, right. So, it's. Not we had we can't look at the genetics, that's the cause of that mm-hmm we have to look at it and go okay what was it in their environment that that created that right and so, migraine, is if you if that is what your genetic, predisposition. Is then, having, chronic, inflammation. Or, chronic pain induced by your jaw by. A nasal airway issue by. Filling, the brink and the thing that's connected to the charge a little nerve can. Then create I'm angry now why is it trigeminal, nerve. Go. Ahead it's an extremely. Special. Cranial. Nerve it's easily the biggest one it's both sensory, and motor it. And, asked the most is with other. Cranial. Nerves and. It's just really, essential, to our survival it's related, to our, vision. Our, nasal breathing and, our chewing and master, Moses could you I'm sorry the word anastomosis, means, kind of merging, together. So, you can have a couple more it's like for example along, the face in an ass the most is with the facial nerve right. So you can have a constant, facial, pain that, then causes, the central sensitization and the trigeminal there because. They're all connected, right there's nine nerves that actually pass through the jaw right yeah that's. Right that's. Right several. So. This one goes back to our reptilian. Brain as do most of the cranial nerves but, there. There's, the anastomosis. Right, well no that's not the anastomosis the anastomosis is really is predominantly. Happening, outside, where. It starts, to kind of merge together over.

Here You can kind of see how close they are to one another and how they're so close to the brainstem, right. You, see the olfactory you see the second let's say they all just that's a big compared. To everything else it's, it's much much bigger and, that should tell you something the the brain is all about real estate. Anything. That's in the brain is there. Because it really really needs to be so. If, we have something that it. Has a takes, up a lot of real estate that means to bring put a lot of value on it. That. Make sense yeah yeah. And. Then, I put. This one in from, your deck because. So. Often times people are coming to me with, head. Neck shoulder, pain because, they've been at the computer, yeah, and yet, it could, all be related to the jaw or at least a good portion of, it yeah, so. Addressing, that could help a lot of this yes. Absolutely, just, stopping. The clinching we're stopping your ability to clench during the day while you're working you know trying to control the situation will. Go a long way to relieve, either the most pay Mira that referrals, to other parts of your body as trigger points. Now. There's. Another picture, of the, difference of a before and after what what was this patient yes, oh so, this, is a patient, that had both a, sleep, apnea issue and a TMJ issue right. So what. We're looking at a number thing so in my there. Are many reasons why we can have. Forward. Head posture one, of the ergonomics, like you mentioned, is in today's, climate. A big big problem but, if your mouth breathing, in. Order, to mouth breathe you just. Consciously, unconsciously, break, your jaw forward, so. You can breathe through your mouth does that make sense, uh-huh. Because when your nasal breathing the air has, a nice little, passage, of flow but, when your mouth breathing the air has to make a 90-degree, shunt. And you, have to kind of open it to make it more arced. Does that make sense so, we just unconscious, there's you you know the, brain has many, reflexes. Built into it many. Protective. Mechanisms so it doesn't have to constantly, be reminded. Of, things that it doesn't consider important, so if you walked. Into a room that smelled very very bad. After. About five minutes you stopped, realizing. That there is a smell because. That that the, frontal lobe, doesn't need that information that's not relevant to your survival, at that point however, if you have a sprained ankle your, brain needs to unconsciously. Know that. If we have to run away in an emergency, and put all the weight on the other leg right. So you oftentimes, don't have to think about, limping. Because your brain automatically. Does it same, thing with breathing, when, we have to breathe the brain can't constantly, be reminded that, oh, by the way hold your head here because your nose is blocked okay. It just automatically, does it and then we come to swallowing, which, is what we do two to three thousand, times a day, when. We do it our teeth, come in contact and if we have a job problem, that's when we're putting the, most amount of pressure into the. Nerves of the jaw during, the day so. Then what the brain can do is, unconsciously. Reflexively. Hold, the jaw a little bit different a little bit away from where the pain is coming from right, but then we have to swallow again. So, but. By the way I just recently, learned myself within the last couple of years, swallowing. Is a survival, reflex because, it tells the airway that it's safe to breathe the. Saliva that passes, tells the brain ah we're good to breathe now carry on right. So. When. We swallow, and our, teeth come together and the jaw goes back there if we, have a job problem up here with TMJ disorder that's hurt hurting, much. Like the limping on the other leg our jaw, goes and by exaggeration. Our jaw goes, forward. But then we have to swallow again and when we swallow our teeth have to contact so, when we do we do a pigeon, maneuver, like. This so. If you can imagine a couple thousand times a day of doing this pigeon maneuver. You're. Gonna have and they end up with forward head potentially. Yeah and the, muscle memory that is associated with that clenching, too right. Well the clenching that we do with with our teeth in together, in the, back. So. The CPAP I just I just want you to know I am NOT anti, CPAP, the, CPAP, works, it, has something, like a. 98.7. Success. Rate, in treating, sleep. Apnea, period. The. Problem, with with CPAP, is that it has a. Huge. Failure. In patient, compliance like forty to sixty percent depending, on which study you look at, I. Am, NOT a fan I should say I am NOT a fan of CPAP, in children in the growing child I'm very much against.

It Unless we're talking about a central, problem potentially. Or or some other kind, of, either. Brain, of genetic malformation. But, for the majority of the people if you can tolerate the CPAP as an adult I'm never. Going to tell anyone not to do it okay, so let's look at what the other options the other options, are exist - you have oral appliances, that, do so whereas, a CPAP, is what. We call a pneumatic. Splint, it, literally, pushes, it the air pressure, is not designed to help you breathe the, air pressure, is designed, to blow up your airway like you blow up a balloon to. Keep your airway patent. Mm-hmm right and so, you're inhaling your exhale kind of fights against, again the pressure but, at the same time it doesn't allow the airway to collapse, because you're blowing it open you're. Basically, you're allowing the, air pressure to blow your tongue forward. Does that make sense yeah yeah, so, an oral, appliance is, actually called a splint. Like a physical. Splint as opposed to andaman explains where we can potentially bring the tongue forward bring the jaw forward lifted. The. Tongues like instruct, the tongue to go on the roof of the mouth help, with the nasal breathing, by. Opening up the nasal that we're talking about this type of a splint not the kind that they form around your teeth no that's the kind of talking about the kind of custom into your to your teeth no this, kind of device that you have showing, is what's called an Alf an advanced LightWire functional, okay, this, is a kind of what we call functional. Orthodontic. Device that we can use in children to, expand. Their palate, and literally. Cure sleep apnea in most, okay. In adult, it also acts by the way as a mild functional, appliance because that little Center loop that, you see on there actually helps, train the tongue where to be right. You know if we get like a little hair in, our mouth we go nuts until we get it out right the tongue becomes acutely aware of, that tiny little piece of air because we have so many nerves on our tongue, the. Tongue actually seeks, out that loop and it. Helps, train the tongue on where to swallow 24/7. But then we. Can activate, it and then develop, the, palate itself. So. If I were to use this instead of my splint. That I have because, I find my splint I just want to clench more on it yeah okay, so so could I stop, clenching. Potentially. So let's let's discuss, that for a moment there was studies done and I think you may even have the slide here where. They took subjects. That had, sleep apnea and clench, their teeth and didn't, use their, CPAP they use a night guard instead and, we found that it made their apnea worse and, it. And then they also clenched, worse because we found that they, were clenching, harder in order to breathe, it's. The presumption so. In in this we actually have seen studies just with my own functional therapy. There's less clenching. Just from knowing where your tongue is. With. The with, the ALF we're also finding, that it, changes. Your autonomic tone it. Allows your, sympathetic, nervous system to shift more, into parasympathetic, and allows, more calm. Which allows more natural. Physiological reactions. To happen and less of a response to the clenching that. Makes sense it does yeah I'm, wondering Cleo. Do you want to speak about your experience, since you do actually have this device I do. Yeah. So I have an elf device installed, one thing that you said actually was that you're, like you you can put it in children I'm, an adult child apparently. Because I have one of these too and. And. What, it's been doing is it's it's definitely, physically. Widening. My palate. Which, has been amazing but even before I was doing, anything like when he first installs, it. You. You, don't have any he doesn't like try to make it, do, anything it you just let your body adapt, to it initially, and and. It's exactly what he was saying about how my tongue was, immediately, attracted, to the, metal part on top, right. There and, and. Then I started sleeping with my tongue on the roof of my mouth and all of a sudden I was sleeping through, the night I used to think that I, was. Waking up three or four times a night to. Go to the bathroom and I thought it was because you know I need to cut off my water earlier, and earlier at night and it wasn't helping and of, course I'm blaming, the cat for some of this too because he's 21 I mean it's, kind of a pain but but.

It Turned out that it wasn't I wasn't, waking up because of the bladder problems I was waking. Up and noticing, that I should go to the bathroom and thinking that that was like the causation, but it wasn't the cause it was it was actually that I just, was not getting good sleep and I was getting 9 and a half hours of sleep and waking up tired. Thinking. Well I'm just gonna spend more than the third of my life in bed because I can't seem to get enough sleep and now, that I have this device I wake up after like seven seven and a half hours and I'm like ready to go so it's, been pretty personally. From my perspective it's been very effective at, dealing, with my snoring and my bruxism that was basically. What we were trying, to target and I went to see dr. Sherazi, because I used to have a night guard which would prevent me from winding, my teeth at night. Didn't. Prevent me from grinding my teeth at night what it did was it prevented me from doing damage to my teeth when, I was grinding at night it didn't help me sleep it just helped me reduce. The amount of damage I was doing and and. Now I don't wear that anymore because I don't clench. At night anymore grind, my teeth so, yeah it's been fantastic, outside. Of the time where you might be sore from adjustments, does the device. Bother. You does it do you notice, it I don't really notice it anymore it. When I have the adjustments, my teeth will be a little tender for a few days and sometimes chewing. Certain things it's more difficult but. It's not a lifelong, thing like I'm probably gonna wear this for 18, to 24 months depending on how, quickly my, palate. And my teeth allow the movement, to happen because that's you have to let your body accept, the change and then after that it'll just be a night, retainer, to, keep things in place so there was to be something, that at least reminds. Your your. Body thank you I think you had the little loop right now yeah yeah and I and I will say that um you know what I was really fascinated about with this was that I. Know that I only, breastfed, for about two weeks as a baby because my mom had developed an infection and she had to take antibiotics so, she couldn't breastfeed, me anymore, I also, know that I sucked my thumb until I was seven I remember. Because my sister's made fun of me. Older. Sisters you know how they are and. That, was because and, you'll see this in children the place where you're sucking your thumb that. Spot, is the the place, of where your tongue is supposed to be that's like this central central. Location. Where you it's like a calming, center in your brain is how you had explained it to me right yeah, actually it was interesting is in Chinese medicine you, know how we we. Have that yin-yang, symbol we. Actually, think as we call the back the young and the front the yin the moment. Where the young meets the yin is right. There in that spot in the in the soft palate right it's, right there where you're where a child sucking their thumb they're actually looking to comfort themselves and, and. And that, trained, my brain. You know bottle-feeding trained my brain, and trade my tongue that just rest on the bottom of my mouth and that, caused the snoring because I was choking off my airway and the teeth grinding, because my body was like freaking. Out cuz it's like oh you can't breathe now you're gonna die. So. It's great, does. Anyone have any questions or, do you have another slide I have, the, one slide will says he did bring tons, in I think, I said the whole tongue, reading, this. Because of the, the, traditional, oriental medicine I noticed. That there were slides where they showed the scalloping, of the tongue which means that. Essentially. An inflamed, tongue, is resting. Against. The teeth and the, teeth are making impressions on it my, knees medicine that has a diagnosis. But it also is significant, to, this. Whole issue of apnea, and TMJ, or TMD, what, was really interesting is in. When. The whole tongue diagnosis. Phenomenon. Began it, was first documented 2500. Years ago but it can go back three or four thousand years the whole tongue diagnosis.

And The scalloping, and etc, but back then obesity, was not really a problem and snoring. And sleep apnea wasn't, really a major, problem as a transient, thing so. What was interesting was so they didn't they didn't know that so in today's time, we know that when someone is clenching, their teeth they're, putting. Neuromuscular. Tone back in their upper fringe or muscles and their, tongue and the, tongue only has one place to go which is forward which is opens, up the airway but it also presses, up against the teeth, and that's where you get the scalloped lines. Does that make sense so. We're. Seeing that sort of a different, thing but then still being relevant in, Chinese, medicine when, we see a swollen tongue because it's galloping against the teeth, that. Makes sense mm-hmm, and and inflammation, is a part. Of that picture too right because when we have inflammation we can have edema, we can hold on to a lot of fluid and we hold it in our tongue as well and our tongue is actually very interesting, so, if our tongue swells up because. Of weight gain or edema. Or what-have-you and we. Even have, the surgery, we actually have a surgery, that takes. The middle section, the tongue out and folds, the back in in, about six months when the pain starts going away in about six months it grows back to the same size it was before because. We use that tongue so religiously, in speech and in swallow and to, say nothing of eating that. Sensory. Neurons. Doing, something, like that pardon, the loss of sensory neurons when you cut the tongue yeah, it can potentially grow back because we just even-even, all of it we. Need incision we need it because we have a lot of what's called proprioception. Which, is nerves that tell us where everything, is you. Know our lips are sensitive, not, because of. Kissing, but, because we don't want to swallow or put anything in our mouth that's prickly, that, could potentially be a choking hazard when, we chew our, food we, need to taste the food to see if it's extremely. Bitter and therefore it could be poisonous. And we need to also double, check to make sure that it's not too sharp so, that we can we can survive so the, brain puts a lot of repair. Puts a lot of. Neural. Real. Estate again if we will into. The tongue and that's why we see more, so than any other part of the area when we get a cut it heals, the fastest so. Unfortunately. We have reached time and what's. Exciting to me as I don't see anyone leaving the room so. Maybe we need to have a second, talk just, about the ton who knows but, I wanted to put. Up a slide that shows. Where. You are and how to get. In touch with you the TMJ and sleep therapy Center is a worldwide franchise. Operation, it is it. Is it was founded by my mentor dr. steve, olmos. We. Do have I think as of today 57 centers, or 58th throughout the world I have, two of them here in Thousand Oaks Inn in Brentwood, Los, Angeles. But. We like I said all over US Canada, Bahrain. England. Dubai, all, over Australia, in Canada. We're. Here for you just you can go on that that first website TMJ, Therapy Center comm to find a center near you or.

You Can come to our site TMJ, LA or TMJ kaneto. And we'll, see if we can be a service to you great. Thank you so much dr. Shuren my pleasure this felt like five minutes I know. What fast we're. Gonna take a couple questions from the audience but let's give a round of applause to them in case people have to go to the next video. Thank. You for coming quick, questions so what are some active, decisions, or conscious, decisions I can make now. That. Would improve my sleep. So. What aspect of your sleep so I want. To give you the most relevant answers, it relates to you because, Clio, and Wendy told me that you guys have already had like little grew. Up a meeting already a Google, Talk on sleep hygiene so, I don't want to be redundant, I just want to be a service to asbestos what aspect of your sleep or what aspect, of sleep, would you like to address sometimes. Feel like I wake up with pain in my neck okay. That is associated, with clenching, your teeth. And clench your jaw like we were talking about today because. We don't just clench, these teeth we clenched the upper trapezius muscle. And then, depending, on where we sleep it'll it'll make your work so for example. When. People have one side of John problems, we see them sleeping, with, their hands right underneath their John they're just used to that and they. Clench and they shift their jobs their clenching which, hurts the John hurts the neck and shoulders as well if you absolutely have, to sleep like this tuck, it underneath the pillow and and, then do it but then have your, jaw. Assessed, have your airway assessed and see okay why am i car chi thank. You yeah my pleasure good question. Thank. You for all the great talk. How, is the this. Wire. Functional. That opens, up the ballot interacting, with let's say there the, aesthetic also don't think that many of us have yes. Okay so usually in a very very positive way so again. We talked about, what. People look like like, prior. To the Industrial Revolution they. Had the nice wide, Julia. Roberts style arches. Nice big wide arches and I find that attractive in Europe that's what most, people have they have nice big wide arches to Paris, longer the. Orthodontist, in Europe are not as eager.

To Extract, teeth and and, bring everything back so the, Alpha appliance, is, devised. To actually, develop the, arch very very gently so it completely, transforms. I have a lot of before and after cases, to show you if you like it completely, transforms. The smile, right. Because you're it's getting that much wider don't. You get gaps yeah. Yeah, so it's not uncommon, after Alf. Treatment, to do a little bit of Invisalign, like, something, like or I should say a liners, and to throw a brand name out there that, will straighten. The teeth into. The where we put the palate does, that make sense so, we're using the teeth when we're using elf we're, using the. Teeth to. Help support, the palate and the mandible, to where we want it right, and as. Soon as we start to see teeth tipping, or that okay maybe we went too far or maybe we reached the body's limits right then, we can talk about okay do you like the way it looks or would, you like to do some. Kind of orthodontics. To straighten, or you could even be racist just straighten that last bit of it thank. You yeah good question. And. Then one in the corner is about to. My. Question, is does your excuse. Me, therapy. Center take medical, insurance so. It depends, it depends, we're actually in the process right, now of. Negotiating. With five major, PPO. Insurances. To be in, network, but. Historically. We've, been, out of network because, it's been such a hassle, with. The medical insurance and. Unfortunately. Medical insurance has gotten more challenging, over, time instead of less challenging. But. We're. Hopeful, that with, this, this. Becoming, in network with these five through, our biller that. We'll. Be able to cut through the red tape and you, guys were able to get, the benefits, you were so rightly deserve from. Your medical insurance. Thank. You. That's. K4. So. If I'm snoring, at night and. My sleepiness terribly there because of that or because my wife's telling, me is. It would, it be beneficial for me to practice breathing through my nose more is that, that's. One of the easiest thing within your control right. Putting the tongue on. The. Right behind your two front teeth where that bump is practicing. Swallowing. In this kind of rhythmic motion and, focusing. On breathing through your nose right Breathe, Right strips if you have nasal obstruction something. Like a Breathe Right strip or a nasal dilator is, very. Helpful to help to force you to breathe through your nose. Sometimes. We recommend, taping the lips shut again to force you to breathe through your nose, most. Of my patients that I recommend, that I want in a V so that you can actually have a little escape window but, you have a beard so you can't really do that. Those. Are the things that are within your control what about Gulf Kennison okay. What about Fenderson to help remove, any. Music. Sir Oh music, okay so if that's an issue if you're getting excess, mucus memory, you know mucus secretions, through your nose yeah, that's fine so for example things like nasal. Steroids, for, example.

It. Will shrink, up your nasal breathing. By. Almost. A hundred percent for, four hours and then. It has a drastic. Rebound. Effect where you're no swells, up and you can't breathe at all after. It wears off right, and plus the preliminary, studies showed that it actually changes your brainwaves your EEG signals from, the steroid that's in and we presume so, I'm not, a fan of nasal. Corticosteroids. Right if someone. Was, an athlete and they were allowed to do you know an isochoric with steroids and we, want them to breathe through their nose and they're having a flu, or something, that stops them from okay, go ahead do it okay, but. To. Me it's not a lifelong solution. I personally. Make my own nasal. Spray with essential oils just over-the-counter essential, oils and. Just. Anecdotally. I haven't done a study anecdotally. Eighty percent of my patients that were essentially. Addicted, to flonase, there's, had. Put it down and switch to my nasal spray and only, refer to the flonase as an emergency, and in, my personal, opinion steroids. Should only be, used in an emergency we. Don't it, depletes. Our. Adrenals. It has there, are side effects you're paying for it later when, you when you have chronic. Critical. Skills use whether it's topical cream nasal, or otherwise. It's, fine, for short term a week is fine but. We. Should only be using it on an emergency basis, in my opinion if. You have no other choice and. Back, to what you said about the Gua finesse and I would say that if you're chronically, having to use something like mucinex, or a decongestant. There might be something else going on there might be like some allergy, going on whether its environmental allergy. Or food allergy, that. You can you know investigate, to see why you're not breathing well at night and it, might even be the case that it's actually happening during the day too and you don't notice it because you're actually able to drain your. Sinuses. Better during the day, but. At night you're, lying down and everything. Can get clogged up excellent. Points I think that we have to take dr. Sherazi to lunch is there one more question okay. Okay, one, more question wait there's like there's like a fight arm-wrestle. Okay. After. III okay. How. Long do, you, recommend breastfeed. To Speaks babies, breathing. Problems for life so. That, I mean obviously there hasn't been any Studies on that. We. We definitely want in to. Me the absolute, minimum in my mind is one year we. Breastfed, my wife we my. Breastfed. Our. Son for almost two years, if. Someone, did it for two to. Three I'm okay with it too when. Teeth, come, into the picture we're. Supposed, to use those teeth, okay. So, we're supposed to have all our teeth, by age two or three okay, so all our baby teeth I should say we should be chewing, food with those teeth when, they come out because, whereas, the, the swallowing. Develops, our palate, this way our chewing. So develop, our jaws in this direction the vertical direction right so, I often, see this in my office someone, will come and see me and they look I don't mean this in a derogatory way now they look like a Japanese, animation character, because they have big eyes and a teeny teeny teeny mouth okay, I know that.

At A very young age they, ate predominantly. Soft food they. Did not they did not put their masseter activity to good use and when, they have a little little teeny mouth their jaws a little bit smaller and they come back up and they're more, propensity for a, TMJ, problem later on so. You, know in my mind it's at least a year two. Years better plus the other aspect, of it is the first year, of an, infant's, life they, do not, have, a mature. Immune, system, they. Get 100%. Of, their immunity, from their gut, so. Whether you're breastfeeding, and giving it to them or you're, adding probiotics. To their formula, and hopefully. You're using like a goat milk based formula over a soy that's. How they're getting it there. Sincerely, not, getting, immunity for, any length of time from, anything, else other than from their gut. Thank. You so much for coming and we really appreciate the talk thank you. You.

2019-04-18 00:14

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I don't know about you, but the resume of Dr. Shirazi (0:39) turn me off. I mean, it's publicized as the "science" of sleep, and not the "art" of sleep, which would been a more accurate association.

Referenced at 3:35 "Why we sleep", has a Talks at Google video as well: https://www.youtube.com/watch?v=aXflBZXAucQ

I liked this talk so forgive me for shitting on your style of delivery Dr Shirazi, you need to find a few other ways to say 'does that make sense'

Google may have the best IT engineers in the world, but also have the worst interviewers... This lady really sucks!!!

orthotropics + mewing may be a cure

Lol.. did you know there's a movie with that title? The Science of Sleep , great movie btw. Made by same guy as Eternal Sunshine.

Thanks for share with us the story

She is jus sleep deprived

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