Episode 110 - Doug Toombs - Improved Sleep Apnea with a Vivos DNA Appliance

1:06

Hey there, it's Emma Cooksey here and I'm your host, so some of you have been listening for a really long time.

Might remember that I was talking about writing a book.

And I know particularly like last summer is really when I started buckling down to write and it's taken me this amount of time to actually get something finished.

1:27

So we're almost at the stage of having, you know, an actual finished book available and for people to buy on Amazon.

It's going to be a little while longer, but I'm really excited about it.

1:44

So essentially what I decided to do, I came up with really like 3 different book ideas.

But this summer I really decided to double down on one and just focus on getting something out there so that it can help some people.

So what I put together is called the Six Week CPAP Solutions Workbook.

2:04

And I've really tried to create what I didn't have right when I started CPAP.

So it would have been so helpful for me to have all the answers to all these CPAP problems in one place.

2:20

So my idea is for people who are new to CPAP, or even people who have been struggling and, you know, maybe have abandoned their CPAP and they aren't treating their sleep apnea.

Maybe for those people, they can follow along and fill out all the information for six weeks and it will allow them to, you know, go back to their doctor and either, you know, report on how well things are going or go back and say, hey, this is what I've been trying.

2:53

I tried all these different things and you know, ultimately Cpap's not for everybody, right?

So I'm hoping that this gives a tool to encourage people to go back to their doctor and continue the conversation until they find a treatment option that's going to work for them.

3:11

So one of the things that comes up in today's episode of the podcast is just how dangerous untreated sleep apnea is and how we really want to get the message out to people that you know.

Of course, like, you know, CPAP isn't the easiest therapy to get used to and so it's totally understandable if people don't do well with it.

3:32

But I think rather than just giving up, we want people to then go back to their doctor and say what other options do you have just so that they are not leaving their sleep apnea untreated.

So I'll stop ranting on about that, but it's like my favorite subject, so there's going to be an opportunity.

3:53

To preorder this workbook and so I'll keep you posted on that.

But the best way to find out about it is to join my e-mail list.

So to do that you just go to sleep apneastories.com.

4:09

You're going to Scroll down to the bottom and it says you know site put your e-mail here for e-mail updates and you're going to do that.

And that will just get you on the list.

So that when I send out the first announcements about.

You know, like the preordering is ready on Amazon.

4:26

You can be one of the first people to know.

And so, yeah, so I'm kind of excited just to have something out there that I think is going to help a lot of people.

So on to today's guest.

So today I'm joined by Doug Tombs, who is just like one of my favorites.

4:46

I know that it's not cool to have favorites, but it's really great.

We had a really good conversation.

I think people who are considering using Bvos appliances like you've probably listened to.

If you haven't listened to my episode about how my experience with Bvos appliances essentially failed after I used them for like 15 months.

5:11

So that's one episode that you might want to listen to.

And there's also another one that we reference with Chandra Hartman, who had a really good experience with her VVOS appliances.

And then Doug today is sharing about the improvements to his sleep apnea using the DNA appliance.

5:31

So I think for anybody who's setting out on that journey, there should be a lot of information and there are a lot of different studies, LinkedIn, the show notes you might want to dig into.

And so I'm just really grateful to Doug for coming on.

5:47

So a little bit about Doug.

Doug Timms first got a clue about his sleep apnea in his mid 20s, but then promptly ignored it for two decades.

After a heart rhythm issue landed him in a cardiologist's office, he decided it was time to get treated 1st through CPAP and currently through attempting A maxillary expansion with a B bus DNA appliance.

6:11

One of the things we love to talk about because we're pretty nerdy, me and Doug, and we love talking about surgical success rates and how those are determined and whether people are using the sure criteria or whether they're using cure rates.

6:29

So if anybody out there is considering a surgery, you might want to listen to this as well just to kind of know some questions to ask your surgeon.

So without further ado, here is my conversation with Doug Tombs.

Thanks so much for joining me.

6:48

Doug.

Hey, it's good to be here.

And so you sent me a whole bunch of links and stuff about your journey ahead of time.

So I think from what I was reading earlier today, do you want to start by sharing with people that story about when you're in Portugal?

7:08

Is that really, is that the kind of the beginning like you didn't have a diagnosis before that, right?

Yeah, did not have a diagnosis before that, so it's in the rearview mirror.

It's kind of a funny story, but at the time it absolutely wasn't.

So my wife and I, we were on our 10th anniversary in Portugal.

7:28

It was just lovely.

We were having a wonderful time.

I'd had sort of, you know, hints and clues not only from my wife but from, you know, previous girlfriends before I'd gotten married, It said, well, you know, sometimes you stop breathing in your sleep and it's a little scary, but, you know, mostly, you know, kind of got up, could get through life and work and things like that, so.

7:49

Kind of.

What did you think when they said that?

Did you know about sleep apnea or not really?

I think the first time I was given that clue I was about 20-6 years old.

That was I'm, I'm over twice that age now.

So.

But that was around the time that Internet access was starting to be a lot more common.

8:07

So I was able to kind of quickly look around a little bit and figure out what's on that.

And then you see the pictures of the big CPAP machines.

And I was like, oh, hell no, I I don't want to.

So I was like, I get up, I'm, I'm, you know, I'm fine.

I'm like, yeah, I'm a little bit sleepy sometimes, whatever.

I have some coffees.

8:23

So.

So yeah, it was just really easy for me to put my head in the sand for for decades on this side, OK?

So, so that happened, but you hadn't really followed up with it.

You hadn't seen a doctor later and they?

Correct.

So, so Fast forward twentyish, so years after that and on that last morning, so we'd woken up in our hotel, it's like okay.

8:45

We got to go drive couple hours to get to the airport, things like that.

We're packing up and I get this sort of unusual feeling.

A little heartbeat.

You know, whatever.

And you know it's lifting like a heavy suitcase at the time.

So it's kind of like, OK, I just straining myself and then about 20 minutes later I got another one like.

9:06

Felt like an extra heartbeat almost or like your heart was beating fast or.

What it ended up feeling like was like, I kind of got like a sudden spurt of blood kind of in my neck a little bit.

So it's kind of like it was a little bit unsettling, you know, when you're normally just sitting there unless you like.

9:24

Put your your fingers on, your on your carotid arteries.

You don't really feel your heart beating, but suddenly I felt one of them.

And so it, you know, kind of caught my attention.

But you know, again, just trying to ignore it, It's like, OK, you know it we, it's our last day of our anniversary celebration.

9:39

We had a lot of wine and cocktails and stuff like that.

I was like, I just need some water and some Gatorade or something.

So so we go and we kind of pick those things up.

But I told my wife and I was like, well, I'm having this kind of like strange and funny heartbeat that I'm a little bit worried about.

That continued for the two hour drive every like sort of 1520 thirty minutes and have one of these things and that started to get really unsettling overall.

10:01

So eventually got to the airport and Lisbon like okay.

Now at least there's no medical attention and on the road somewhere and still kind of going on, got on Our flight was a little bit delayed because it was delayed, the funny part of the story.

10:18

When we landed, we had to lay over in Heathrow to get back to to the East Coast where I live.

When it landed, there was a a gate agent there for our airline and just kind of checking with pastors Okay, where you flying, go to this gate, whatever.

And he asked where we were flying and I told him our airport and he just looked up from a sheet of paper and he's like run.

10:36

It's just.

Like you're going to miss it if you don't run.

Yeah, yeah.

And it was the last flight of the day getting out of Heathrow.

We'd have to spend a whole nother night like trying to find a.

I've had to do that before on missed business flights and it's just lousy.

11:04

So tell me about that, though, because then you're sitting on a flight over the Atlantic with a potential heart issue.

So I'm like, you want me to run through this airport.

I'm having some strange heart thing and you want me to run through this airport.

So I don't know why, but I ran through the airport, we made our flight, we got back.

I was very happy to be.

Yeah, yeah, it's.

Kind of terrifying.

There were just so much thought process in getting to the airport that my brain didn't really put two and two together on that one until the door closed and I was like, I'm over the Atlantic for seven hours.

11:25

I was like, I just, this might be it.

So it it was it was very scary.

I'm not going to lie, it was it was really scary.

So we touched down.

We got back home like, OK And that just that huge relief off, like the stress is clearly not helping.

Whatever's kind of going a little funny with my heart overall, so get a.

11:45

The point with a regular doc, get a referral to a cardiologist, go through a whole litany of tests.

Eventually during a stress test, we caught it once and it was like you just had a PAC, a premature atrial contraction, and you were able.

12:00

To say that's the same feeling I had before.

Yeah.

Well, as we're so the stress test is they get you on a treadmill either running fast or uphill or maybe both and they want your heart rate like way up there and when we did that.

That absolutely.

I mean I've done the 24 hour Holter Monitor and it didn't catch anything.

12:16

So the stress test was the last thing.

And that caught.

They're like oh that's a PAC like OK and you know went home did some doctor Google and it's like oh, untreated sleep apnea could be a contributor to PAC's.

I was like.

What does PAC stand for?

A premature atrial contraction.

12:34

OK, got it.

Yep.

So, like, okay?

Well, I guess it's time we stop ignoring the thought that you know, well, sometimes you stop breathing when you sleep and did.

The cardiologist say anything about it?

Did the cardiologist say maybe let's do a sleep study or yeah, any of that okay?

12:52

Once I said that, I got the referral and my cardiologist's office is also a sleep lab, so they're just referring you to. 2 doors down.

So they just immediately got me on the schedule for that and then went and did that and then got my diagnosis.

13:09

So tell me about was it an inlap study with the stuff on your head?

Yes.

And So what did that show like?

High.

Severe.

Was it?

And.

Yeah, so the way that ended up rolling out was they hook you all up to that and then he's like okay, gonna try to sleep with all of this stuff attached to me.

13:28

But they had said.

Be like, we want you to sleep on your back.

And I kind of already knew.

It's like I sleep lousy on my back.

It's like I don't ever sleep on my back.

Why are you making me do this?

Like, yeah, we want you to sleep on your back.

So I was basically forced to sleep on my back the entire time and then so.

13:45

The entire time of the study, not just for a part of it.

Yeah, but here's where.

So but what ended up happening was they came in at about 2:30 ish in the morning.

They woke me up and they were like.

You have very severe sleep apnea.

14:01

We need to put you on CPAP right now.

Oh, great.

So, you know, I was kind of hoping I'd be going and be like, oh, you got like a mild case or whatever.

And and here, you know, woken up groggy and I've got this technician sayings like, yeah, you're really severe.

We're putting you on CPAP.

So they my, my test became then a split test, a split night test.

14:19

So first half do you have it?

And it was just clear the text that they were there, like, Oh yeah, and then the second-half.

Correct.

Yep.

So then they strap you up to the jet fighter mask and you're like okay, try to sleep like okay, So and then that all rolled out and.

14:35

So how did you feel like so at the beginning you said you didn't really feel like CPAP was for you as a young man.

How were you feeling at this point?

Had had this sort of PAC thing made you think, well, maybe I need to treat it?

Yeah, Okay.

14:51

So you were a bit more on board at that point?

It it was mildly terrifying to have that happen, number one.

Number two, it actually trailed for months for like two or three months.

So on the the first day it happened, it was like every 20-30 minutes or something like that.

It started to trail out to, you know, twice an hour, once an hour, once every few hours.

15:12

But this literally happened over like 3 months to the point where it was just getting to be like I you know, if my wife was out and I was just going to take a nap on the couch, this before I had the sleep test.

I would.

I'd go and unbolt the deadbolt to the front door and make sure I had my phone right on the coffee table in case I like me, had to call 911.

15:29

So I was like, yeah, this is pretty life and scary.

So yeah, so it was time to face it and say I going to have a new bed partner for potentially the rest of my life.

So what did they say about CPAP?

Like, did they, you know, how do they introduce it to you?

15:48

Did you have someone talking you through it before they sent you home with it?

Or.

Yeah, it's great.

It's fine.

It's easy and it does good things for you.

Yeah, it's just wonderful.

And like, that was not my experience.

So, like, there are, there are those people.

Like, I've interviewed those people.

They have really short interviews.

16:04

They go, yeah, I went home and I figured it all out right away.

And I had a great night's sleep that night and I never looked back.

That's, you know, like that happens for some people, but that's not.

The norm, I don't think like, I think I talked to way more people that had a bit more of a learning curve than that.

16:20

Yeah, that's that's a nice way to describe it.

Learning curve So, so they they're like, OK we'll get you a machine.

It was going to be an auto bi pap just based on what they saw during the study and the and the titration and then they send you a tech to your house.

This was in late 2018.

16:35

So they sent a tech to your house to kind of show you some things and help you try some masks.

And like I I kind of always had like a lot of nasal congestion.

So I was like, I'll just, you know, I'll just do the full face mask or something like.

That so, so they leave me with one of those and then it's like there you go.

So the first night plugged it in, filled it up with the water and stuff like that and that was awful night, awful night, awful night it was, you know if you don't get those straps just right in terms of the pressure readings, you know if it's not on tight enough the mask just gets loose.

17:04

If it gets too tight based on the mask, it can actually create little folds in the in the material and then.

These little like and and the way this mask was shaped I would get these like like blasts of air into my eyelid and like, boy that'll wake you up in no time.

17:21

So I like the first night I looked at the machine, the data on the machine and said hey your AHI is 25 and I was like that sucks.

So, like, but I got to get used to it.

A couple more nights and I just couldn't do it and I just.

I I practically called my my.

17:38

Equipment supplier crying and I was like, do you have anything else I can try?

This is ridiculous.

I clearly have a problem and the medicine doesn't work for me.

I I need something else.

Help me.

And over, you know a few years I've probably gone through four or five different mask configurations until I finally found one I liked.

17:55

The one I went to immediately after that first one worked a lot better and I got the numbers down pretty quickly after that.

And then there's.

Tweaking pressures and stuff like that.

So a couple months to get it to where I was regularly under A2 on the machine.

Okay.

But you got there, it just took a lot of frustration.

18:14

So is there any advice for other people going through?

I would, I would say like call them right away if you're having the issues like, you know, change out, like do whatever you need to do that first couple of weeks because I feel like I went for months with like massive leaks and you know, really wasn't working.

18:32

And just nightmare.

But like, you know, I did finally call someone in tears and say like, you know, because I think that you think it's just you, but nobody else is.

Everybody else is just using this thing and it's fine with it, but.

And you're new to it, you don't really realize that there's probably 50 different masks, sizes and shapes and configurations.

18:54

So my advice would be #1.

Ask your supplier Hey, what if I don't like this mask?

What are my options?

#2 Mentally prepare yourself for maybe you'll have to buy some out of pocket to try and and you may just end up throwing them away afterwards.

19:10

And I use other resources.

So you interviewed Jason.

He's awesome at doing the reviews on the face masks on YouTube.

Good old lanky lefty there.

So yeah, hey, if you hit it on the right one, right of the gate, God bless you.

But be prepared that it may be a little bit bumpy at the start.

19:29

That's cool.

And so eventually you kind of got so that after a few months that was working.

And how did you feel at that point?

So you said your AHI was like the machine was showing it was under two and like were you feeling a lot better or how did you feel?

19:45

I felt better.

I didn't get the, you know, oh, I put it on the first night and I felt amazing.

I felt like I was a teenager again.

I didn't get that, and I don't think I ever really have.

So, but it was, it was improved, definitely.

So the one thing that changed immediately and and it took me, it took me weeks to even recognize this is one of the things that I'll talk to people about sometimes on this is I'll ask him, I'll say if they're like, well, I do.

20:11

I wonder if I have it, you know, because I snore or whatever.

And I just ask him one simple question.

It's like, do you get up to use the bathroom in the middle of the night regularly?

And a lot of people say yes to that question and, you know, if you're a female.

Your anatomy is a little bit different than a male.

Male could be other reasons, prostate issues.

20:30

But if you do that regularly, regardless of gender, that could be.

That's something worth looking into.

And and what happened for me, and this is how I knew I was sleeping better, was like it was like a month or so later, you know, I just had like a lot of water or something because I was super dehydrated.

20:46

And then, like in the middle of the night, I had to get up and use the bathroom.

And I realized like.

We haven't been doing this.

I haven't done that.

Yeah, I haven't done that in like a month.

I like used to do that five times a week or whatever.

So so there was that and then there was the return of REM sleep.

I, you know, it's very rare that I dreamt before then.

21:02

So I saw those things happening and like this is better than this is what should be.

I had like a pulse oximeter I could use to log and see my oxygen levels were OK That made me feel a lot better.

So, but it was never it was amazing that just that just never happened.

Yeah, me neither.

21:18

So how long did it take before you started?

Reading and researching and trying to figure out like why do I have this in the 1st place and what might be able to be done about it.

Yeah, so probably a little over a year on that one because what the what I started with at first was I I kind of knew I was like, I haven't always had this my entire life.

21:43

I didn't have it in high school.

I didn't have it in college.

My, my roommate, my freshman year of college, he was a nursing student.

He probably would have told me if I had, you know, like you don't breathe in your in your sleep roommates that I had in apartments after college.

Like nobody had said that until like my mid 20s.

22:00

And so I thought, okay.

Well, you know, maybe if I get my weight back to like, you know, the first few years after college I was like and so I got.

So I got the CPAP machine sometime in in late August, mid-september, I got a health club membership, and I was in there six days a week for most of the next year and even the year after that.

22:20

But I was, you know, doing what I could to try to get in better shape.

I'm like, Yep, I'm gonna beat this.

I was, you know, studying like well, you know, what's the published research on BMI and sleep apnea and things like that.

Had you talked to your doctor about, like, was your doctor just like the treatment for this is CPAP?

22:37

Go and do that.

Like have you kind of asked the questions of your doctor?

But why do I have this?

And you know what else can be done?

Or or did you just kind of take the CPAP and go home?

Yeah, I talked a little bit back and forth with my sleep doctor for it, especially since I was like, well, I'm going to go to the gym and stuff like that, Yeah.

22:56

And I just kind of asked if she'd seen anybody who ever got off of this.

And she said, well, pretty much the only patients I ever see get off of this are my very, very, very chronically significantly obese patients who go through like a geriatric, A bariatric surgery and things like that and and other things you know, diet, exercise I'm sure as well and and they in some cases beat that.

23:18

I was like, OK, well that wasn't really me my my BMI was just a hero 30 at the time.

I was like, yeah, I don't really qualify on that one.

So but I was like well, but I'm, I'm going to give it a shot.

But that was that was basically it my my provider just kind of like that's that's that's it You got this machine for the rest of your life.

23:34

So, so, yes, so.

But then you started looking into stuff yourself one day.

I stumbled across is actually I think it was a Reddit post from Karen Batt, who had done a lot of the research on the craniofacial kind of issues and stuff like that.

23:53

Is it because of bicuspid extractions that a lot of us had when we were kids?

Yeah, just a lot of feelings that that may be a contributor certainly.

But then what I quickly realized is like, if I have a skeletal problem, you know, no, there's no amount of half marathons or marathons I can run to deal with that.

24:12

So, so I started looking into Okay.

Well, you know, there's, I've heard of this jaw surgery thing, so there's that.

So were.

You were you reading papers and different things, thinking, you know, high narrow, arch, palette.

24:28

And you know, like the different things that you were reading, you were seeing in yourself and thinking that really sounds like me.

I had never thought to myself before.

I was like, gosh, my palate feels very high in arch.

I mean it's just like it's just my mouth and my teeth and I use it to speak and I put food in there and it functions.

24:48

So I never thought much about any of it.

There's signs in retrospect I was like oh, that was kind of maybe something so so but it was just this whole sort of, you know, there was this sort of growing field in terms of airway focused, you know, dentistry and orthodontics certainly moving into that space as well.

25:07

Neither, you know, neither schools like had really trained providers on that specifically.

So it was all very sort of emerging.

It was hard to know what to look at.

There was of course always sort of the the jaw surgery option.

Well, you get jaw surgery and it's 90% effective and we need to talk about that one a little bit.

25:23

Later or is it Doug?

So did you seriously look into MMA surgery early on or you just kind of like saw that along the way but didn't really consider it?

Well, I saw some of the sort of the appliance based approaches and started getting kind of curious and interested on that and there were a few out there.

25:47

So this was very, very late 2019.

So I've been on, I've been on CPAP for about 15 months probably at that point and and so I I started just initially looking out and I have a extended family member who's a retired oral surgeon.

26:07

So I had a a very, very good resource to kind of be like, hey, here's this thing and you know you know enough about this space.

You can imagine what the reaction was like when I kind of was like, hey, they got this thing, this Vivos DNA of that as a as a family member, this person was, you know, as loving as they could be.

26:30

And and basically sort of summed it down too.

It's like, well, that's interesting, but that basically goes against, you know, 50 to 100 years of medical research, right?

OK.

And that was actually that was really, really useful for me because that made me realize I needed to dig way into this.

26:47

So I started.

So tell people listening like, I know I always assume everybody's listen to like every podcast, but they totally haven't.

So explain to people listening who haven't heard of these pal expansion or removable pal expanders and.

27:03

Like what?

What they're kind of like claiming that they can do and you know a little bit more about like what they actually look like and what they do.

Because I think a lot of people are just like.

What are they talking about?

Yeah, yeah.

I mean, I'll give you sort of my background and how I arrived at where I arrived.

27:24

But I mean, and this will be a good time for me to reiterate the same types of things that you said on your disclaimer intro coming in the podcast.

I am not a medical professional, right?

No, this is me just relating my story and and what I went through and and what went through my mind on this.

So at the time I started looking around, so there was, there was jaw surgery and but some of these other approaches were, you know a Vivos DNA appliance which you had one of those.

27:51

I have one sitting right next to me at the desk here and it kind of looks like an upper and lower version, kind of like the retainer you had when you know you had your your orthodontics as a teenager except it got expansion screw in the middle of it and or maybe 2 expansion screws depending on the configuration.

28:07

And the theory was you just sort of put this in for a while, take it out, you do this for a certain number of days, expand it just a little bit and over time it's going to reshape the upper and lower jaws so that there's more room and and better nasal breathing.

28:23

So I kind of thought I was like more room for the.

Tongue right?

Which is really a big part.

Yeah, absolutely.

30:00

OK.

And so you're the, the oral surgeon was just like this doesn't seem right.

So then you dove into all the research and the papers and everything.

Yeah, I I so, so I'd looked at that and then also there were a few other techniques that were kind of being discussed at the time.

30:17

So there was the MSE technique which which basically it kind of they they put 4 screws in the roof of your mouth and and they sort of like basically my interpretation again not a medical professional, they induce a stress fracture into that that Ridge that that suture line on the top of your palate and the roof of your mouth.

30:37

And then they just slowly move the halves apart just slightly ahead of your body's ability to heal it completely and and you expand that way.

So that was another one that was out there.

There was a technique called Aga, there was one called Alf, and that was pretty much the extent of what I'd taken look at the time.

30:56

Now, at the time, there wasn't a ton of evidence, published evidence on any of these things overall but for.

Feels like the Wild West, right?

Like, I mean, I know, like when I was in the same situation, I was kind of like I was really trying to avoid like doing MMA surgery or doing any sort of surgically assisted repital expansion because I do, you know, like if there was an option that was.

31:24

A removable, more gentle, less painful thing.

I was like, well, I'd rather try that.

But when I looked into, you know, like the evidence around it, I didn't.

I mean I wasn't like, oh, this is definitely going to work like you know, I was kind of like well, you know, I hope it works, but you you have to, you have to suddenly get really good at trying to understand clinical research, which is not my background in training.

31:49

So, yeah, yeah.

So, So of those basically five that I'd taken a look at, you know, the jaw surgery being one.

But of those four, I could not find any published clinical evidence for the the alpha approach, which is just a very light.

32:06

Why are they putting behind things?

And that sounds super easy.

But there was literally 0 published research on use on that in adults whatsoever.

And because my family member, who's the oral surgeon had basically said they're like that defies medical, you know, research, it was pretty easy for me to kind of just miss that.

32:23

Like I can't just take it on the word of treating dentists, saying it was like, Oh yeah, our patients sleep.

That is like I need more than that.

The Aga one was was kind of the same thing.

There's all sorts of, you know, before, before and after photos of people's faces.

32:38

But as there, there's no radiology, no sleep tests at all that I saw at the time.

Again, this is late 2019 and so I I just eliminated that one.

And then the only one that was kind of left was the Vivos DNA1 and then MSE.

Now the MSC cases, at the time, they were mostly single patient cases, case studies overall, which you're going to publish.

33:00

You spend the time to publish paper, you're going to publish your success stories.

So they're good to see, but you got to take them with a grain of salt.

Vivos had a couple small multipatient studies.

They were, you know, a little bit more obscure medical journals.

And and I don't even know if I'm, I'm the best person to understand, you know, what's the leading journal and what's not.

33:19

But you know, you looked at some of these things.

But what really kind of made it interesting was there was one study that the inventor had published in 2014.

And what they did was they took a bunch of patients and they ran them through the the treatment and they took the the CBCT, the, the 3D, you know, cone beam scan and they basically segmented out kind of the top part of the upper jaw, the maxilla on that.

33:45

And they just measured it, how much bone volume before, how much bone volume after, and it was like a 10% increase on that.

And I was like bone, that's what that study seemed to be implicating.

That was in 2014.

34:01

I was like, maybe there's something to this.

I don't know.

So I was like, all right, well, I'll give this a shot.

So I found there were basically 3 providers in my geographic markets that had experience with this.

And I picked one.

34:18

And I've been working with that provider since January 2020.

We've made some progress.

I'm not finished yet, but I have, you know, good progress.

I sent you my sleep studies.

You know, I've made, I've made a lot of progress.

On that, So for everybody listening, do you want to talk about where you started from and like where your sleep study, your most recent sleep study was and how you're feeling?

34:41

And just tell us all about Okay.

So are you able to see the the numbers on there?

Yeah, so so I tried to basically sort of in a quick format put together basically all of my quantifiable sleep data.

So this is 3 sleep tests so far. 4th one hopefully hopefully coming at the end of the year.

34:59

Yeah three sleep tests so far.

So my original one in August of 2018 that where I had my my supine AHI of 41.8 so severe sleep apnea.

I didn't and.

So this is because they made you sleep on your back.

35:15

So we don't have an overall one, we just have like when you're on your back.

Got it.

Yes, exactly.

My percent time that my oxygen was below 90% was 12% of the time, which was kind of was staggering.

So it was, you know, 23 minutes out of a three and a half hour sleep study.

35:32

That's a lot of time.

It's just tough on your body and a lot of obstructions and hypopnias and 0% REM sleep, not surprising.

So part of the way into treatment, I ran another set of sleep tests, the first one being a watch pad.

So I did it at home and surprisingly my supine AHI had gone from 41 down to 12.913 and my percent of time with my oxygen below 90% was a lot smaller.

36:02

So based off of that, I wasn't sure.

I mean, I I trusted the watch Pat test, but I really want to be sure.

So I talked to my sleep docs and I said, hey, I'd like to rerun this because I think I might be, you know, on to something here.

And fortunately, my benefits was pay for it.

36:17

So you were still doing CPAP though through this process, were you Correct?

Correct.

Yeah.

So you're wearing.

The appliance and the expansion appliance overnight, but also wearing the CPAP, which is the same as what I did, yeah, exactly.

So I've been on CPAP.

36:33

I had a period where I was off of it for a little while, but I've basically been on it since late 2018 overall.

Okay, got it.

So I followed that up two months later with an in lab sleep test.

So the exact same lab, exact same you know, machine they hooked me up to and this was what I feel is a better confirmation.

36:52

So my supine AHI at that one was 18.6.

That's a 55% reduction in that.

And my sleep doc was ecstatic about the the percent 90% oxygen.

She was just over the moon.

37:08

She was like your percent time below that was like 3-1 hundredths of a percent.

So that got knocked out.

My obstructions got knocked way up, still have some hypopnias although it's down.

And I was getting REM sleep finally.

So this was a positive sign for me.

I was like, I'm not even done.

37:23

I'm like halfway through my providers protocol which which is a little bit longer than the standard one I was like this is encouraging so.

How long do they expect?

How long were you expecting to do the expansion for?

You're doing about?

Are you doing 15 hours every 24 hours wearing the appliance?

37:40

Yes.

Yeah.

So yeah, generally between 12 and 16 is what my provider told me.

He says if you can hit 16 a lot of the time, you know the process to go faster.

He's like, if you're kind of just barely getting in 12, he's like, this is just going to take longer.

I've been averaging between 13 and 14.

Okay, Yeah, I'm trying to move that up now, just.

37:58

And so when you started, well, how long did we think it was gonna take?

I thought I was gonna be in and out of this thing in a year.

So there are two problems on that one.

So number one, I think my case is becoming a little bit more complicated and we can talk a little bit about that.

38:16

But #2, the provider I chose, had a long history in TMJ, which is kind of a very niche field.

Also, maybe sometimes a little bit Wild West.

So I thought, so, yeah, so the TMJ dentistry space can feel a little Wild West sometimes.

38:38

So, yeah, So what I thought in January 2020 when I went into this provider's office that I was going to walk away with you know, a DNA appliance or a mold and we're going to get one in a few weeks.

He wanted me in, he he scanned my joints and he's like, yeah, your jaw joints are like way back and and everything's returned.

38:58

He's like we need to get your mandible forwards first.

And so we're going to use a splint to do that.

So I thought, oh, okay, couple months in a splint and then 12 months in a DNA appliance.

Well, couple months in a so.

Is that like do they call it?

And orthotic.

What exactly does the splint do?

39:15

Yeah, a lot of different names.

Yeah, that's what's so confusing about this whole thing.

I feel like every dentist uses different terminology.

And you're like one.

Yeah, right.

So I'll describe it for for the folks here.

But it was basically just a lower.

When he brought it out, it looked like a lower, like Invisalign Tray.

39:32

And I was like, oh, OK And he put it in my mouth and couple little spots where it rubbed a gum a little bit and he sanded those down.

He spotted him instantly.

I was like, oh, this guy knows what he's doing.

And I thought, oh, this will be easy.

And he's like, OK, hold on.

And then he goes out of the room and he comes back in the room and now the like, Invisalign sort of lower appliance.

39:49

Suddenly it's got all this sort of like translucent white material on the back.

It looks like toothpaste, almost like the thickness of toothpaste.

He's like, OK, he's like, now put that in your mouth and and he gets the chair registered just right in your head and he thinks it's the right position.

40:06

And he's like okay, we're going to register a bite and he has you just sort of bite down a little bit on it, then you take it out, then he drives it in the kiln and then we remount it again.

And So what they're trying to do is, is what your, your mRNA appliance is trying to do with the the occlusal pads.

40:22

It's trying to untrap the mandible and get that to come forwards a little bit.

So this is sort of a neuromuscular dentistry technique.

You'll also see the providers that that do Aga will will tend to do this first.

It's interesting.

40:37

I think I maybe would have just preferred to just start in a DNA appliance and and see how that went.

But once I started this kind of had to see it through overall.

So this was supposed to take six months.

It ended up taking about a year because this exacerbated a range of motion problem I had on my left side.

40:54

And what my provider was kind of saying, which I I think I definitely agree with, is like you know, the jaw bones connected to the every other bone in your whole.

Body.

Yeah, so, so I'd had like a little bit of range of motion issue on my left hand side for a few years before all this kind of started and I just never worried about it too much.

41:14

Like yeah, you're just getting older.

But once we it was really within a couple of months of when we started with the splint, suddenly like I had a lot more like I I don't have a better way to describe it in in an audio form.

But basically in terms of raising my arm forwards, the most I could do was like the Heil Hitler kind of pose.

41:33

That's as far as I could get my arm up.

And in terms of getting my arm back, my external rotation, I could barely reach my belt loop and I was straining, straining to do that.

So my doc's like, we have to get this resolved.

So he referred me to an osteopath he works with.

41:50

I ignored that for a while because I had a physical therapist.

I was like, I'm just going to go do regular PT.

Spent six months on that and didn't make any progress.

Went and saw his osteopath and we eventually got that cleared and now my left arm it probably has about 90% of what what I would expect so that's good so so he wanted to get that stabilized and but the problem with moving your your lower jaw forwards what my my cleaning dentist who's a different provider basically said I told them everything I'm doing.

42:20

I was like, if you see any concerns, you let me know, And he hasn't seen any.

He basically posited that we moved my lower mandible forward at least three millimeters to quote him directly.

Now, your teeth and your jaws, they fit together, even if it's not great, but they fit together, You know, they figured something out.

42:38

When you suddenly move that lower jaw forward several millimeters, what you end up with is a pretty significant, what you'd call a posterior open bite.

So when we got done with the splint phase one, I could not make contact with my rear molars at all.

42:56

It wasn't even close.

Now this is something that I've seen that some of the patients that have gone through some other techniques.

I don't want to name specific ones cuz there's like there's like lawsuits in this stuff and we should be clear on here, This is all experimental.

I mean, my provider made me sign a waiver.

43:12

It's like this is experimental.

People don't like the word dentistry to begin with.

You don't like the word experimental in front of it either.

So got to be really, really careful on this.

And there are people that have really, honestly been damaged and and there's lawsuits out there.

So, so I've seen it happen where like, hey, they couldn't close the posterior open bite and and now you know, we got to do surgery or something.

43:33

So I was a little freaked out, but we went to the next stage, which was splitting the time during the day between the lower splint.

Now the lower splint, I should also mention this, the lower splint for me was basically a 24 hour a day thing.

Take it out for you, take it out for cleaning and brushing your teeth.

43:51

And that's about it.

So I was eating on that, which I actually think is kind of interesting because you're creating a false occlusion and you're leveraging the muscles in that sort of way.

But we got the lower jaw forward, but now there's a very significant gap between the posterior teeth and if I'd gone to any sort of orthodontist's office or whatever, they were like we gotta get you into jaw surgery immediately.

44:12

So the next stage was alternating between an upper Schwartz appliance of modified Schwartz that had a sagittal attachment screw to it.

So, so that one right there.

This also had some of the occlusal, you know, you know, he'd grind it a little bit here or there and make sure the inclusive contact was right on the molars.

44:33

But there's also a spot for the upper incisors that the lower incisors could kind of like clamp onto.

And I've seen some other providers do the same thing and I was like, okay, well, we'll give this a shot and when.

I think you're at SO Doc.

44:50

What I love is because obviously my results with the Viva stuff.

We're a bit different and, but I think that our attitudes are exactly the same.

Like, I feel like I was just kind of like, all right, I mean, I guess let's try it like, you know, like you're just kind of in it.

45:08

Yeah.

Well then I'm in good company cuz you were very, very warm and and and caring attitude.

So, yeah, so you know, so now it's just splitting it.

So the the upper one was basically the 16 hours a day, so late in the day and then overnight.

And then the lower one was just during like working hours or something like that.

45:27

And and when I started, I mean if I tried, if I tried to use my muscles and pull my jaw, you know, just pull my my bite back and try to close those posterior teeth, I literally couldn't.

But then, you know, six months later, eight months later, something like that, one day I kind of tried again and I could just barely make contact with the posterior teeth and I was like, oh wow, this is actually working.

45:48

And then by the time we got done.

So that was a year long process, you know?

Then basically my provider was saying he's like, OK, Stage 3 is going to be the lateral expansion, the DNA appliance.

I was like, I was like, so I don't need these two anymore.

He's like, no, I was like, I had been eating on a false occlusion for two years at that point on the lower splint.

46:07

And so I I told my wife I was like, I might need like really soft food.

I don't know what I can chew on my own.

Like let's get a bunch of eggs and stuff and pancakes.

And I had my first meal and I was kind of like, that was fine.

I had another meal that was fine.

Then like like a day and a half later, it's like, let's go get a steak.

46:23

So in terms of functional use of my teeth to chew food, it was all back to normal.

And I felt somewhat lucky because I had seen some people that had gone through another technique and nothing closed up in the back and then they're going to jaw surgery.

46:40

Yeah.

So for the third.

Phase that you're talking about you were doing, was it upper and lower DNA appliances or was it mRNA or what was it?

Yes.

So stage 3 with my provider is upper and lower, but a lateral only because of the sagittal screw that was in the Stage 2 appliance on the upper.

47:06

So that covered that portion of things to the extent that he wanted to.

So we're just working on lateral now.

So lateral for anybody not familiar is meaning like going from the midline out towards your ears, yes.

I can't think of another way to say that and rather than like forward, right, yeah, sometimes kind of thing.

47:27

Sometimes you hear it references anterior posterior that basically means front to back and then the lateral is, yeah, you're left to right overall.

So we've been working on that.

So I mentioned why this didn't just take me like 12 to 18 months and it's taking longer.

So first was my provider that I really wanted to go through the TMJ process.

47:46

Now I did have my scans looked at two it by looked at by two other providers and they both said, yeah your joints are centered now.

So I was like OK well that's a good thing.

Another another really weird thing just on that was during the the pretreatment before he even like made you know had that first appliance, that lower appliance made for me of that lower splint.

48:04

He had me pushing my jaw through all these like range of motion things and like one of them was like OK now see how far you can move your jaw over to the right.

And I was stunned because I didn't really do that normally but like as soon as I try to move it the right the whole jaw was just tremoring and and the right joint had more you know more damage and stuff to it overall.

48:25

So I was like that was that was really kind of disappointing you know now I can move it over there just fine.

So at least in terms of my joints those are those are better.

I never thought of myself as ATM J person, but when I saw him on the the CT, I'm like, yeah, I can kind of see what you mean.

They're they're out of position and that I think honestly that a whole other story for another time maybe, But I think that happened to me overnight one night.

48:46

My jaw went out of position while I was sleeping and then I didn't do anything about it.

I think the right joint went out of position because I woke up one morning, Valentine's Day 2017, and like my bite was off, like teeth were like colliding against each other just slightly where they never had before.

49:03

That's weird.

And I had a little bit of a tinnitus in in my ear.

Tinnitus.

I don't know because I think so.

I have a friend in the UK who says tinnitus, and I want to say Americans say tinnitus.

But I might be totally wrong.

49:19

I think your UK friend is actually correct because I've heard, I've heard enough other medical professionals say it that way.

I just call it tinnitus.

Yes, I know.

Yeah.

So, So what I think was, I think the joint sort of displaced, but I didn't do anything about it and I just kind of kept eating and stuff like that.

49:35

And then I think the other one displaced and stuff like that.

And then my apnea got worse in, in 2018.

So.

So, yeah, so got through all of that.

And now we're into this one, trying to work through the lateral phase and I'm getting so .2 on why it's taking a little while.

I'm getting gaps in spacing.

49:51

I have a little diastoma.

It's about 1 1/4 millimeters between my front 2 upper incisors.

Yeah, explain that a little bit cuz in case people are like, what does that matter?

And so the, the general, you know, belief on that is the only way you have that happen is if you have bone development happening in that suture line that runs down the the roof of your mouth there.

50:13

And that's the big debate.

The big debate is, well, your sutures, you know, by your late teenage years, those are completely fused.

They're like cement.

Nothing's going to move.

But the dentists who treat with this seem to think they're like we don't, we don't agree with that.

50:28

And that's why my family member, who's an oral surgeon, was basically saying like, and this theory goes against 50 to 100 years of medical research.

So, yeah, So for anybody listening who wants to kind of listen to more about that, like I I interviewed an orthodontist who was essentially, I mean, she was really interesting because she kind of talked about how she thinks that things are changing.

50:52

And like perhaps this really fixed idea of there can never be any movement to the Paddle Suture.

You know, maybe we'll see a change to that over time.

But she certainly was like, it's you know, dentists and orthodontists are trained that the PALS palsal suture is fused by adulthood and you can't get any of this kind of movement.

51:16

But then also I I deliberately the next week interviewed Dr. Jasmine Elmore was on the podcast talking about the Soma and and so she talked a lot about.

And you know, like some of the thinking around, she's definitely one of the dentists that believes that there is movement there and like if you go slowly over a long period of time.

51:42

But anyway, so there's different schools of thought.

Yeah, So what what I sort of kind of ponder looking at this.

So if you look up the treatment protocol for just a standard, you know, RPE done on on a pediatric patient and you try to look at the rates of expansion they push into there.

52:00

Yeah, I mean, there's a number of different ones.

I haven't found one that I think is a general rule of thumb, but you can look at the Wikipedia page on that and it's like, well, you're expanding half a millimeter to a millimeter a day.

Yeah.

And I'm like, wow.

And So what I kind of ponder is, is it something where it's like, oh, you know, if you try to throw that same protocol on an adult, Yeah.

52:21

It's not going to work and you just going to push the teeth out?

Yes, absolutely.

But, you know, I'm, I'm, you know, I'm doing a millimeter every six weeks or so right now, right.

So when you do it a whole lot sore.

So the question is like, yeah, there's a whole bunch of, you know, you're growing and stem cells or whatever in all these sutures.

52:39

But you know if you if your some cells are, you know, 5000 parts per million or something, some sort of measure on that.

When you're a kid, does that suddenly go to zero at age 18 or does it go down to 500 or something like that, in which case we can still push but we just got to do it really, really slowly.

52:57

So that's that's thing number one that I sort of, you know, just always keep in my mind.

Again, not a doctor, not medical advice, just my thoughts.

But the other thing that I find amusing is, you know, you can go, you can go to a dentist or an orthodontist or an oral surgeon if you have a bone spur, a Bony growth growing outside your teeth, so a buckle extosis or a lingual paddle, the Torah or something like that.

53:25

There are some people that get these as adults.

My wife has started to develop one.

One of our best friends developed one, just had to have it removed.

And so you could talk to this provider and say, well, what is that?

Oh, well, that's a bone growth.

I thought we didn't grow bone as adult.

53:43

So, you know, OK, so you're going to tell me that, well, this doesn't work because you absolutely can't grow bone as an adult.

But this thing growing out the side of, you know, right on the side of my wife's teeth right there, that's an adult.

She's been going the same dentist for 30 years.

That's an adult growing bone right now.

53:59

Just because biologically that can happen, it does not mean we've learned how to harness it and that's where this is very experimental and people need to be very careful.

And also just like I don't know about you, but my feeling is just how much it depends like on the specific person and their entire like what they have going on, their entire medical history, like exactly where, how their.

54:28

Jaws grew and you know, like, I think that that part of the problem and the lack of certainty is we just don't know a lot of that, right.

And who does well with this and who doesn't like it?

It's not, you know, So some of it is kind of like a try and see, which is why it feels a bit wild westy, yeah.

54:49

And and that's and that's exactly it.

The patient selection is, is the most important thing and just nobody, nobody knows enough.

So in terms of patient selection, gosh, there should have been some way that we could have seen for Emma.

Oh, because this or that or the other, this isn't going to work on you.

Let's not spend 18 months and and your money on that.

55:06

Same thing for Graham, but for Chandra, it worked out just fine.

I'm somewhere in between, you know, you and Graham and and Chandra on that one.

Chandra.

You're headed for a Chandra, though.

I'm super hopeful and I have everything across for you.

She was she was she so like you.

55:23

I Internet stalked her as well.

And I reached out to her after I'd gotten that input from my family member.

She's super nice.

Yeah.

So Chandra, if you're listening, thank you.

But she told me, you know, she's just very fair.

She's like, yeah, I was in the 40s.

And, you know, now she's done like single digits.

55:39

And I was like, wow, that sounds great.

So my, my family member had told me, you know, the the oral surgeon.

But I was like, but I'm seeing cases here.

So, you know, where's the answer?

And it's it's all about sort of efficacy rates and you know is it 0.

55:56

I mean my general feeling is like anybody who is gonna tell you something is 0% or 100% and especially if they're like super intense about it, yeah, take it in, but continue to look around a little bit there's but the question is like.

There's a lot of super intense people around this, and I think that a lot of that comes from people's need for certainty, and there really isn't.

56:20

A lot of certainty around the stuff, right?

It's like that's one of the reasons.

So I came across you on a Facebook group that kind of supports people going through this Vevos and journey.

And I think like that's kind of people are looking for certainty that it's going to work for them and we just don't have.

56:41

That information to give, right?

You can kind of just be like, this is what's working for me and this is what didn't work for me.

And, you know, like you can kind of help.

But I think that there's so many people on there saying, you know, being super argumentative, saying like this can never work, even though there's somebody there saying it is actually working for me.

57:00

Or like this always works for everybody.

It's like you don't, like we're not really there yet.

It's yeah well and and that's where you know in terms of sort of trying to engage with people and looks and that's where you can kind of quickly learn like you're you're not dealing with somebody who's who's arguing from from good intentions, they're arguing from a conclusion.

57:19

So they'll say like well biologically that's impossible.

So they're saying it's 0% efficacy Okay.

Well, here's a here's a patient case study.

Well, you know that's just a one of them Okay.

Well, here's a multipatient case study.

Well, they just picked the best cases and you can't make those two logical arguments at the same time.

57:36

You can't tell me it's biologically impossible, but then say, Oh well, they just picked the best cases because what you're going from is a 0% efficacy to something 1%.

Or another.

Yeah, exactly.

Yeah.

So, so the the published research on this for Vivo, some of the latest stuff that's come out of it over 200 patients and they provided, you know they, they did a write up on this.

57:59

This went into the journal Sleep Medicine, which I I think is is probably the best sleep journal out there medically.

Again not a doctor, but it based on the other leading minds that I've seen have their papers published in there.

This seems like it's a good journal and the efficacy rate for for Vivos and I think this is the other one of the things that I think you and I can help the audience out with a lot on this is understanding when you're maybe looking at these things, what you really, really need to look at is the clinical cure rate and and try to find that and try and understand what that is.

58:31

Because for Vivos, the clinical cure rate based on their publications is roughly 25%, so one in four.

The cure rate meaning that it's going from an AHI of I mean whatever it is something above 5 to being less than five meaning that no further treatments necessary versus let's get into surgical like success rates in general and how people are working those out and why it's super misleading for patients.

59:04

Yeah.

So I went and I pulled some of the stuff together before the interview here because I've seen these pieces and I and and we can hopefully link these as in the show notes for your podcast so people can go directly to the research.

But so for for Vivos, for what I'm using right now, it's an overall 25% clinical cure rate.

59:22

When you break that down into sub categorizations in a different study that was 87 patients, the mild patients.

So these would be patients for people not familiar with the diagnosis scale, an AHI of 5 to 15 that would be your mild category.

59:39

The clinical cure rate again getting AHI below 5 was 43% of patients.

So not even a coin toss there for moderate cases which is 15 to 30, 22% and for severe cases above 30 like me 5%, I'm, I'm kind of going for the one in 20 here like Chandragats and you know fingers crossed, but then there's other protocols that are out there.

1:00:02

So the the MSC that that that Marpi type of protocol that I'd mentioned, one of the studies that are around that one had a a published 35 percent, 36% I think clinical cure rate AHI below 5.

1:00:18

But then when you read the study, they basically say and they're like, well, we had three patients that didn't get a split or their teeth just kind of like flared outwards.

So we discarded them and I look at that, I'm like that's.

Doesn't really be how research works, right?

That's not quality research.

1:00:34

So if I add those 3 back in, it drops down to like 29% for MSE jaw surgery.

The one that we started and let off on, and this is, this is one of my pet peeves, this whole industry, and as difficult as this is sometimes one of my pet peeves is oral surgeons who will look at a patient and say, Oh yeah, MMA for sleep apnea.

1:00:56

It's got a 9095% success rate.

They will say that all.

What do they mean by success, Doug?

It's it's 455 on a Friday.

I'm supposed to be in a good mood going into the weekend here.

1:01:12

Okay.

All right.

So I I have heard this from at least three oral surgeons, at least three different ENT's.

This just propagates.

Everybody says this, this is just gospel MMA90 to 95% success rate.

1:01:29

And This is why I think this is helpful for all your listeners to understand.

Because as a patient, you would think, I would think, oh, success means I dumped my CPAP in the trash.

That is not what?

It means surgical success means when they say that.

1:01:47

So what ended up sort of becoming the standard criteria as I understand it, again, not a medical professional is there's Stanford, I think one of the doctors out there, I think by the last name of Shur, they came up with the Shur criteria Sher.

1:02:05

This was the, you know, sort of pass fail grade in terms of whether a medical intervention has been successful for a patient.

And the guidance on that is a 50% reduction in AHI overall and the posttreatment AHI being below 20.

1:02:24

Well, if you had 40 like I had going in and I had oral surgery and they're like, oh, and they got me down to, you know, 15 or something like that, they'd be like you were a.

But I'd be like I still need a CPAP machine.

I mean the other one that I I think if you haven't seen it before, we absolutely need everybody listening to see, everybody needs to anybody on this, listening to this that does not that knows somebody with sleep apnea or has it and is ignoring it needs to look up the Wisconsin Longitudinal Sleep Cohort Study.

1:02:59

They basically followed I think 1500 people for 20 years that had sleep apnea, only a small subset treated themselves of the non treated portion.

They're basically just tracking all cause mortality.

And over 20 years you see more and more people who have mild, a little bit moderate, more and severe.

1:03:21

They're dead, they're dying.

It's just, it's just stunning.

It's hard to, it's hard to fathom when you see numbers like that, somebody with severe sleep apnea who is not leaving it treated, they've got you know like a 30% mortality chance in the next 20 years.

1:03:37

People need to get treated on this so.

People need to get treated.

That's why we're here.

An oral surgeon who's gonna do this extensive procedure and tell me it's got a 90 to 95% accessory.

I'm like, yay, I can throw away my CPAP, but they would think that's successful if I was back 15 after.

1:03:52

Ten, Yeah.

And I think for people listening like Vic, Theor did a really good YouTube video that was about the share.

Yeah, it's really good.

So I might link to that as well.

And it's good because it's like he gives kind of questions to ask your surgeon like are you know, like what are the statistics about the number of people who are cured.

1:04:16

And by that I mean NHI under 5, right.

And not, I mean, I think like they needed to come up with some sort of.

Test or some sort of way to judge but the sure criteria just doesn't it's not very patient centered just because most people off the street would say well a success means I don't have to treat this anymore right like so we really need to be asking more questions of surgeons and honestly like MMA I've heard the same as you but also like you know people are still having U triple P surgeries and.

1:04:54

You know, like a bunch of different procedures where the doctors kind of saying this will help you and we're not, you know, quantifying like are you still going to be on CPAP?

Would you then need an oral appliance?

Like you know where are we with actually what it'll look like post surgery.

1:05:13

So I think it's a really good point for people to consider.

Yeah.

And then you get those multi level procedures things like that you, you and I, we should do like a by the numbers episode someday and really unpack things so.

So when you look at the clinical cure rates as published for for MMA it's 38 to 40%.

1:05:33

So the big take away on everything that I've talked about there in terms of clinical cure rate, including for Vivos and MSE&MMA, it's all less than a coin toss.

My provider, you know, he got trained by Doctor Singh directly in 2013.

1:05:48

He's been doing it for 10 years.

Yeah, and my case has gone a little funny, so I didn't finish up.

The other reason why it's taking a while.

So I'm getting some spacing kind of all around, except I'm getting on my upper left.

I'm getting on my lower left, I'm getting on my lower right, but my upper right is really resistant.

1:06:07

So I'm getting an asymmetric response from my body.

Biologically, the body seems to cooperate.

It's like, sure, yeah, we kind of move things out and create some more bone.

And I don't have it.

I'm getting the, you know, diastoma between the middle 2 teeth.

But the right hand side is really, really resistant.

1:06:22

So we had to do some like different things with my appliance.

And and this goes exactly to the points, this is good.

You brought this back around to this.

If I had been into the care of a, you know, provider that just got on the board last year, they've done, you know, 6 cases or something like that, they probably would have just already given up on my case.

1:06:41

But I'm working with somebody who's been doing it for a decade and and he's, you know, he's not a point.

He says we're biologically can't try anything else.

So we've had to do some like I think nonstandard things.

But you know, I'm making progress.

I'm.

So my main question, sort of to finish up, is just like, how are you feeling?

1:06:59

And how how are you feeling like in comparison to when you started this whole thing?

Yeah, I mean, I'm feeling a lot better on a lot of levels overall.

There's just so many different things in terms of you know, things I was experiencing and stuff like that above and beyond just the sleep apnea.

1:07:16

So energy levels are good.

I I actually have now.

It's it's very weird.

I didn't have this during a lot of my original sleep apnea days with CPAP, but I have it now where breathing is a lot easier to the point where I use a nasal mask.

Now I have some nights, it's not every night of the week, but I have some nights where I can basically put on the mask and you know, I fall asleep at 11 or whatever, and the next thing I know it's 7:00 AM.

1:07:41

I literally have zero wake ups throughout the entire night.

I still have some nights like, yeah, I kind of wake up once in a moment or something like that.

It's not to go and use the restroom or anything.

Cuz you said you had significant nasal congestion in the beginning, the very beginning, and that's why you did the full face mask.

1:07:56

So that's great that you've gotten to the point that you can use the nasal mask.

That's the dream, Doug.

Yeah, well, my pressures are way down.

So you know, I was previously at like 10 to 14 and now I'm in a range of 5 to 9 and I'm averaging 6.

1:08:12

The machine won't do it.

Machine won't do anything below 4.

So everything seems on the right trajectory.

I don't know if I'll get all the way into the the end zone on this one, but I feel positive about it.

Here's an interesting sort of story to kind of potentially wrap it up with.

So over the weekend, there were some storms that went through our area and there's power outages that rolled through and we lost power for 12 hours.

1:08:34

And I didn't expect that to happen because, you know, I haven't been in a power outage for for that while.

And I'd kind of forgotten I was like, oh, I need electricity to breathe well during well, during my sleep.

Like, well, I guess we're I, I wish I had like an, an unboxed watch pad.

I would have broken it out.

1:08:51

This was last Friday night and we'd been out with some friends.

We'd had some beers and then a bottle of wine and so it's the worst possible thing in terms of trying to then sleep without a cpap.

If you've gotten used to that is okay.

I've been drinking.

It was hot.

1:09:06

It was.

I mean, you're in Florida, but it's up here.

It's.

So hot days even.

Like, yeah, you have hot.

You have hot tubs for oceans down there.

Yeah.

But I mean, it was like, it was like, it was like 80 degrees and the humidity was up and you're just sleeping hot in the bed and stuff like that.

1:09:23

And I was kind of like, oh, but I was like, OK, well, I I'm gonna try to sleep.

And, I mean, I I kind of woke up and I could feel like a little bit of coughing and gasping a little bit early in the evening and then kind of fell asleep.

My wife didn't realized.

She didn't put two and two together.

I didn't put two and two together until a little while into it.

1:09:39

But I asked her the next morning.

I was like, hey, you know, did you hear me like, you know, snoring or gasping or anything like that?

And she's like, no, why?

And she then she's like, oh, you didn't have electricity last night.

You didn't have your sleep app.

She's like, no, I cuz she wakes up at like 4:00 AM or something like that.

And it's just her sleep cycle is.

1:09:55

Is your wife?

Is your wife annoyingly good at sleeping?

She's better than I am.

Yeah, she can sleep without a machine, so that's that's good.

My husband too.

No, I'm very, I'm very jealous.

At times I I go, I see her just like she goes to bed before I do and and she just laying on her back and her lips are closed and she's breathing through her nose and I was like, it's just it's such a simple thing to watch.

1:10:18

And it's the same.

It's the same as when I start doing my functional therapy.

Like, I just remember my husband just being like.

Yeah, of course, My, you know, tongues on the roof of my mouth and of course my lips are closed and I'm breathing through right now.

That's just like totally, you know, he doesn't ever have to think about it.

1:10:36

He just does it.

So I'm like, that must be nice.

So I was mildly encouraged by my forced sleeping off CPAP a week ago.

And you know, I was kind of like, OK, like maybe.

But we still have, we still have a little ways to go I think overall so, so how.

1:10:53

About.

In terms of like months or years, how much longer do you think you have?

Gosh, every time you would have asked me that.

I would have said six more months.

So I'm gonna say about six more months.

No.

Yeah.

So we're at about 5 1/2 millimeters into my appliance, but we've been bouncing back and forth between 4:00 and 5:00 because my body's acting kind of weird on the upper right.

1:11:16

I'd like to get it to 7:00 or so on the appliance.

So I'd like to get a couple millimeters.

So just kind of expecting that by by the end of this year, my provider will probably just want to whoever we're at, we'll just say time for like an actual sleep test, a full scan.

Let's see if we I need to go a little bit further if I'm a 5.0 one or something like that.

1:11:38

So we'll see, but I'm kind of expecting that by the end of the year I'll probably have done at least another sleep test.

That's great.

I'll keep you posted well.

Keep me posted because I'm super rooting for you.

So thank you so much.

Doug.

I really appreciate you taking time to Share your story with us.

1:11:54

No problem.

Thanks.

So much anything else to share before we?

Go and start our weekend.

Yeah, I mean just you know you got to be careful out there.

So this is like I said you know nobody, most people don't like the word dentistry, nobody likes the word experimental in front of it all.

1:12:12

So you know, look for, look for the data, look for the evidence, look for the clinical cure rates and really make sure you understand those.

And then lastly, the most important thing is if you are untreated, go read that Wisconsin study and look at the numbers in there and think about what that means for the next 1020 years of your life.

Yeah.