Episode 83 - Dr. Steve Lamberg - "Treat the Cause...Treat the Airway"

1:51

Hey everyone, it’s Emma Cooksey here and I'm your host.

So, I hope you guys had a really good Halloween.

It was pretty comical over here at the Cooksey.

Has my eldest daughter was dressed as an inflatable shark was running around the house and scaring the dog.

2:10

So bear, the dog did not know what to do.

He was terrified.

So we had like a ton of kids and I just a really good night so I hope whatever you guys were up to you.

Had a good one too.

So onto today's guest today, I'm joined by dr.

2:29

Steve Lamberg.

He's been practicing as a general dentist in Northport New York for over thirty nine years.

With a focus on comprehensive restorative Dentistry will also hear about his experience with dental, sleep medicine and he invented the Lamberg sleep.

2:46

Well oral Appliance and holds several related patents dr. Lindberg also lecturers Israel's internationally on topics related to dental, sleep medicine, and wellness, and has published both adult and Pediatric Sleep, screening questionnaires.

3:05

He's also the author of a book called treat the cause treat the airway dr.

Lamberg founded the, pediatric and adult are we network of New York called panty were dentists and Physicians collaborate on treating patients in an effort to prevent of star?

3:24

To sleep apnea in adults.

So without further Ado, here is my conversation with dr. Steve Lemberg.

So hi, dr.

Weinberg thank you so much for joining me.

Hi Emma.

How are you?

Good, good.

3:39

You want to just start for people who are not familiar with you?

Do you want to just start with where you are in the world and just a bit about your background?

Absolutely.

I'm a dentist.

I'm a general.

Dentist have been doing general dentistry for 40 years and about 18 years ago.

3:59

I got stuck.

In this sleep apnea world just suck me in.

I had a position friend of mine.

His name is Alan, no last names and he had a snoring problem and he came to me and his wife begged me to make him an appliance.

4:14

And I wasn't excited about it because I had already made a couple of quote-unquote snoring appliances, and the patient's didn't like them.

They were the clear ways from Great Lakes and they were really big.

So you said this is 18 years ago. 2004.

4:34

Yeah.

And that's a lot different than yes.

So these people came to me, I'm called Great Lakes and they said make this Appliance it's our Cadillac Appliance and I made it.

And, you know, it has a high Rex screw on the pallet.

4:50

So Jaws lock together, open wide with a lot.

No tongue space, it was horrible.

I didn't know anything at the time.

I just knew I was advised to get used an appliance and then two people didn't like it.

I gave them their money back.

I paid my lab bill and I figured that's the really, really bad business model to pay your lab bill.

5:10

Give the patient's their money back, Ryan, and they're not happy and their friends and whatever.

So I moved on and Alan walks in the door.

And he said, I want one of those.

These I said, I don't do those because of the reasons I just explained.

So, for him, he said, he said to me, look, we can know, we're family, friends.

5:30

Let me help you out.

I'll pay all your lab bills.

Okay so I'm not going to pay you anything for this service but I'll pay your lip bill.

So let's just make a bunch of them.

So I made him, six different appliances, he hated them all and then he said invade me something so you know how friends can be a little bit demanding sometimes.

5:49

So I fell for that one and I said okay goodbye it's Sunday you know, goodbye, get out of my office and then that night I was thinking you know I was familiar with all the mechanisms always do.

Current appliances and I got excited.

I thought maybe I could just use the NTI one of those little anterior deprogrammers, and I could turn that into an appliance by hanging something off of it.

6:13

And I started thinking along minimalist approach to advancing the jaw and they did that and for him and he was happy, but I wasn't because it was kind of ugly.

And then I decided to attempt to get a patent for that, and when I was drawing pictures, I realized I didn't want to use it.

6:30

See, I wanted to use a questi program in.

T.i. is an entity.

I is a little piece of plastic that fit over the front teeth, okay.

And what that does is it separates the front.

You can only hit in the front.

Mhm.

And people that clench and grind, they wear that because it reduces the elevator muscle activity.

6:49

And the reason it does that it is a thing called proprioceptive inhibition inhibits the muscles when you're hitting on your front teeth.

It's so your teeth.

Don't wear out.

It's got a role in evolution.

Just Magic pathway.

So, it was taken advantage of many years ago in Europe and then popularized by a couple guys in our country who got patents.

7:08

Anyway, long story short, John kois had one a deprogrammer that you were on the palate like with a holy retainer just like a holy and had a little bar in the front and a little Plateau behind the front teeth and he loved it, and I loved it.

7:25

And it was with a suck down on the lower because there was something hanging down pushing the lower job.

And that's how I developed the Lamberg Appliance.

Then he being a physician in my neighborhood started sending me ten patients a month and I didn't know what I was doing.

7:42

So I went out and I found the American Academy Dental sleep medicine which was really a great thing to find after I found them.

I started learning that was 2004 and it just never stopped.

I'm learning when you were dying the rabbit hole.

7:59

Yeah, I mean I realized it along the way I realized that all of the things that we were doing to fix people's teeth their gums, their health.

It all started to add up to me that this was all a result of chronic inflammation.

All these systems in the body were breaking down and there was a reason for it.

8:17

So okay, we're gonna get to that and we put before we get to bed.

And so I really the one of the reasons I wanted to have you on the podcast was to talk a little bit about the article that you wrote about pregnancy.

And To sleep apnea.

So I think it was in Dental sleep practice.

8:34

Am I right, right?

Correct.

And then, yeah, so I heard you talking on the, the neriman group had, you do a webinar recently about pregnancy and obstructive sleep apnea, and I feel like you kind of made me decide about you were a dinner party and you got into an argument with somebody about pregnancy.

8:58

Oh, that's a.

That's a story.

Yeah, that's a that's a very good story.

Yeah, you're finding some of the little emotional touch points of the journey.

That was a fun one actually, because that spurred me long I was at a restaurant in Manhattan, in conjunction with the greater New York, dental meeting and the topic, we were all asleep.

9:20

Docs that were at the table and the topic that came up was pregnancy and I had read a little bit about It and I was very convinced that it changed the fetus significantly and I knew that the mother had a lot of students probably back Nia did.

9:38

Yeah.

Yeah.

Hypoxia that the mother had would change the fetus.

Yeah.

That's at least an hour lecture but the point of it was we had this debate and and they're very intelligent people at the tables.

One woman said Stephen, if there's no positive Health outcomes that we have evidence-based studies on, For insurance companies.

9:59

You know, we can't assume that.

I mean, it might make sense to you, but we can't make an assumption because we need positive Health outcomes by intervention.

And if we can't show that and I said, there has to be some.

10:15

I haven't seen them.

Anyway, long story short, I found them common sense.

You would think like a mother like you, untreated obstructive sleep apnea, having like a baby growing like That can lead to hypoxic environment already.

Yeah with the blood flow to the placenta and the mothers if they have sympathetic activation, think of all the chemicals are going on the cortisol.

10:39

Think about everything the sympathetic activation and the chronic inflammation of the mothers and it's not uncommon in the second or especially the third trimester.

And those are people that didn't have it going into pregnancy and then there's the 15-20 percent that had it before pregnancy.

10:57

It's me.

12:28

So, this is why article interested in this topic because I had one child, when I had untreated obstructive sleep apnea.

So I had one pregnancy with absolutely no treatment, and then I had another pregnancy on CPAP.

12:44

So when I had dr. O'Brien on my podcast, I was just like grilling her for life.

Oh, I mean thankfully for me my children, you know, like didn't have any problems and all that but it does.

It really makes you think it.

13:01

Does it does.

And the rain study just came out and their 1400 people, women, and they looked at the children into childhood and they found that they had propensities to have health issues.

13:19

Fourteen hundred of them, it that glucose dysregulation and the Articles available for free online because it Does have an impact, it's not just for the fetus at that moment, when the fetus is born, not just not just a neonatal environment.

It's also growing up into adolescence.

13:36

There will be an impact on the growth development and health of the children.

And that study has been done.

There are interventions studies showing positive Health outcomes.

But the N is very small 12:13 people, there's several of those studies and I understand that the naysayers they don't like a small and I get that I don't like a smaller.

13:58

Even we want much more research and we want much bigger griefs.

But until we get there I feel like there's a so many women that are pregnant now, you know, and we need the obese to get on board and hopefully the rain study will spur evaluations of positive Health outcomes from Intervention because there's not much intervention right?

14:20

But the ring studies going to turn that around and that came out in April.

Okay?

So it's really I would consider that very Three current piece of magnificent science.

Great, great work.

They follow the kids for about 15 years.

It will it be against?

14:36

It was really an exciting piece.

So I guess first a lot of people listening like, we've done a bunch of episodes on oral Appliance therapy and how dentist can be involved with treating obstructive sleep apnea.

Like, it's just really interesting that you put together that article and you're you're basically calling on any like, dentist.

14:58

Not even just people who specialize in obstructive sleep apnea.

But like dentists across the country to look, For signs and symptoms of Osa input, and their pregnant patients.

So how what kind of role do you see dentist playing in that?

Because I think most people wouldn't expect a dentist to be looking out for things like that.

15:18

They would expect their doctor to be looking for them.

You will their Physicians should be looking out, but they may not have been trained or if they know if they have been trained and they're knowledgeable on this topic.

I don't see why they I wouldn't get involved with intervention, they should they make a lot of money?

15:42

I'm going to put my cynic hat on for a minute.

The, you know, the ents and I mean, many Physicians can make a lot more money sitting in their office just doing exams.

And it takes a little more effort to step out of the box and not be so focused on relative value units, the RV use.

16:01

It's the holy grail for most physicians in most franchises today, medicine.

And medicine.

As you know, Western medicine is pretty much all franchised right now and it's run significantly by the pharmaceutical companies in the hospital groups in America.

16:18

So I'm originally from Scotland, so I'm always just a bit like, you know, we're talking about America but yeah, I understand.

So, you know, so I just think everybody should be involved.

I think Dan should be a dentist are uniquely positioned because as This we see patients frequently and we see them from a very young age and I pregnant patients.

16:41

And it since I'm So Into Airway boy, that was just like it was a no-brainer.

I had to find out about that.

Every time a new patient comes in.

If there's a drug I hadn't heard about where medical condition.

I haven't heard about and there are there are there medical conditions every week or so.

16:59

Yeah, you were watching a TV show and they interrupt with a commercial about a medical condition that, you know, Never even heard of yeah.

So but there's a medication that you can buy, all right, so the point of my story is it never ends, I'm just trying to connect the dots, we do know that non-communicable diseases are a result of chronic inflammation and how do you get chronic inflammation from upregulated sympathetic nervous system that leads to chronic inflammation.

17:27

You put hypoxia in there and you're going to up right up up up regulate your sympathetic nervous system.

So That's really where things are now.

I don't think that's the end of the story.

I think that we have to also start looking at processed foods, processed foods, play a role also.

17:45

Yeah in energy regulation mitochondrial dysfunction.

There's a whole raft of things that I find very exciting right now.

And what's fascinating to me I'm is that the processed foods play a role and all of the targets how they take down the mitochondrial Health in the cells, and You know I'm saying this because one of the biggest problems in our country today is non-alcoholic fatty liver disease and that's a result of dysregulation of the burning or the storing of the fat.

18:20

Should we burn this to carbohydrates to make energy?

Should we store it as fat and a lot of that dysregulation is the result of the processed foods.

Those switches inside the cell which allowed the glucose to come in and then just starting Go through glycolysis and then it can either be burned or can be stored.

18:39

That sounds like your next book.

Am I right?

Is it's it.

I have my table right here.

Right now.

I have about 100 articles and pouring over, and I'm turning the people who aren't familiar.

I got your book and really enjoyed it.

18:55

So you wrote a book about treating getting to the underlying cause treat the cause.

And so, do you want to just tell us a little bit about about like where the idea to write that book came from and what you were seeing in your dental practice all the time, right?

19:12

So seven or eight years ago.

I saw this, I started to see all these things connecting.

So I wrote a questionnaire based on medical histories.

Till someone has a medical condition.

Be it?

Gastroenterology psychology Cardiology Rheumatology pulmonology.

19:35

Anything there's like 20 Specialties so I started every time a patient came in that was asleep.

Patient.

I saw all these medications As in conditions.

So I started writing down and studying, how they were related to hypoxia and fragmented sleep.

19:51

Your questionnaire is extremely comprehensive like it covers every system of the body and I think that that's quite unusual for a dental intake, right?

Like I feel as though often times for dentist, they're just focusing on things that they, you know, they'll be like, are you allergic to these drugs.

20:10

They might use to knock you out and they'll ask things about your oral health.

But Not necessarily about other things.

Yeah, no, that's a great point.

But if the dentist has taken this step in crossed the Rubicon and gotten down the rabbit hole and is now committed to Total Health of their patients instead of your oral health.

20:34

I mean, this is the canvas of the body, you know, frequently, we see things here, which are all the red flags for the rest of the body.

And its, I would call it.

Moral hazard to not see it and once you start to understand it and put it together and then if you don't do anything, it goes from a moral hazard to an immoral Hazard because maybe you gotta learn what to do or make a referral.

21:02

So I think there's a distinction between an immoral and a moral hazard and there's certainly people don't understand all these connections yet and that's fine.

That's fine.

As long as they are committed to their page.

Agents oral health.

So, I came up with the questionnaire because I thought instead of asking to stop banging or the Epworth, or the traditional questions, all of these people that were coming to me.

21:26

We're sick of the airway patients.

They all had five medications.

They all had six or seven different positions.

They were saying it's like this.

Can't be how you probably the different Physicians are not talking to each other about no, they're not toilet individual things.

21:42

Yeah, not only, are they not talking to you?

But but they're treating symptoms.

You have reflux.

You can medication for the acid.

They don't start thinking Airway.

22:08

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22:25

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23:20

That's Viva, s.com patients And it's stupid, it's like making a night guard, okay?

23:39

You're grinding your teeth.

I'll make you a piece of plastic that will put it in your mouth.

Yeah, happens to be that it will push your tongue back into the airway even more and makes it worth.

So what we're going to do is we're going to protect your teeth but allow your system to be in sympathetic activation all night long.

23:57

And that to me?

Yes.

But it could be a moral hazard because of not having the basic knowledge.

Once they understand that and they hear it, it makes sense, right?

So then it becomes, you know, that that's like criminal not to do something.

24:14

When you start to understand and put the art leaves, no enough to refer to other people who are Specialists or experts.

Right.

Like yeah, right.

I tell dentist, and I teach all over and I don't like my course, period.

24:30

You know, if you just put a veneer case in, I understand you don't want And to break anything but hey if they're grinding and that's why you do those mutineers, you deserve them all the pop off because you've ignored the bigger problem, right?

Thank you, General.

There are way it'll just do that for nothing.

24:49

So, you know, we know that there's no, you wrote your book.

I did like the right away, right?

Let the questionnaire Henry years ago, and dr. Kois, I'm very involved with dr. John kois, so if anybody wants to advance their Dentistry and learn about perio and learn about treatment planning and learn about biomechanics and implants.

25:14

You know, it's a great opportunity and function and just learn Aesthetics.

John coila's has put together.

It's basically a graduate program for general dentistry and it's a very, very comprehensive program.

Anyway, I've been going there for 20 years and John and I are very close and he loved the questionnaire and he understood it.

25:34

And he said, he It's to put it in his curriculum but he would like me also to do a favor for him.

He wanted me to write an interpretation key.

Why did I ask each of those questions?

Right questionnaire, so I told them, I would try to write that and I came back and I have 300 articles supporting, all right, of those questions.

25:56

And I'm thinking myself, I can't write.

He wants like, you know, five or six pages to explain why I ask this question, why is this question?

So I thought to myself, Self not gonna happen.

I have to write a book and I'm going to make it short.

I'll make it for general public and I'll make good for whoever wants it and for a lot of waiting rooms, I think.

26:16

Yeah, so it will explain that if the patient has this medical condition and I'll explain it to or three pages by each specialty, what the relationship is.

Yeah, and the statistics are on one page and that is good because for people who are super nerdy like me and you like, put all of the Articles in there.

26:37

So people are specifically interested in one condition, they can go and actually pull out the Articles and read those today.

So I love your hair well done.

Thank you.

Thank you.

Thank you.

Yeah they might have neighbors or friends.

And/or.

26:53

Family members that have a condition and they're taking medication and maybe the medication is helping that symptom but it's a matter of time until another system goes.

Yeah.

So for people Here, I think there's a lot of people listening.

I got lots of dentists and doctors to listen but a lot of the people that listen are just people with obstructive sleep apnea, right?

27:14

So for those people, I think that there's not a lot of understanding and the general public about this kind of like Airway movement, right?

So there's a bunch of you who are like Airway dentists and myofunctional therapist that you work with.

27:32

And I thought maybe you could explain a little bit about setting.

Yup.

Your panty, like your pediatric and adult Airway network of New York?

Great.

Well, did I guess?

I think you did and I'm impressed because it was this was a big undertaking.

27:50

Yeah, I had friends that understood this that got that got the whole idea of General Health versus just looking at teeth.

Yeah.

And one friend of mine in another state set up Collaborative group, with one oral surgeon and one orthodontist and one, my functional therapy and all the people working together, right?

28:14

And I didn't like I hated that idea.

I didn't want to have one this and one of this and one of this I wanted to make a circle but invite everybody in.

Yeah, I didn't want to just have a we go out to a fancy dinner once a month and showcase and you are the chosen people.

28:31

I didn't like that idea.

I want everybody to know about it.

I want to trumpet This to every specialist everywhere.

So I started this, this is basically one of the ways to look at is in between the silos of medicine Dentistry.

We want to collaborate want to knock down the silos a little bit and share our knowledge.

28:52

And so, we have speakers on all the different Specialties.

Yeah.

And I respect your meeting and met in New York and like, I was really impressed with the fact that you had, you know, like an ENT talking And different doctors different dentists myofunctional therapists like all the different people who really have to work together to solve, some of this wasn't that interesting.

29:15

It's nothing.

You can't unsee that anymore and you need those people, and you need them, you need the support of all of those people.

Not just on your block and you might have patients from far away.

Yeah.

And you need to have a network so we have you can put your profile if you join and you can have your profile.

29:34

Exactly.

Where You are and how to get in touch with you and what you offer.

And this way, if I want to find somebody in the tri-state area, and I think it does make sense to do it in a geographically relevant.

Right?

Low area because that's who were preparing to.

I don't want to refer to Boston and to Philadelphia.

29:52

Yeah.

And a person is going to be looking for all of those different Specialists close enough that they can work with.

Yes that's an always.

It's so high I guess my Question would be like, this is great.

30:08

How do we expand that across the whole country?

So, you know, like you?

Yeah, that's been asked and Noah Siegel who is the ENT?

Yes.

Oh, from Harvard.

And he asked me if we could do Penny up in Boston next year.

30:28

And, or if I could help him organize, put together a panty meeting in Boston.

So, So, you know, might have to be a different an acronym.

I don't know.

You have to change the NY to ma or something.

I'm not egoic.

30:44

So I don't even care, you know.

I just want to help communities maybe it, you know, it could be Penny of Boston, it could be panic because this is the eye of the concept of getting everybody within a 50-mile area on board and then the hospital's next year Penny's going to be very interesting.

31:02

I'm going to get a specialist from everybody on.

It's in one of those classifications on the questionnaire.

If you were asleep doctor, if you are a gastroenterologist, if you are an OB, I'm going to try to find a physician in each category of medicine to get up and talk for 10 or 15 minutes.

31:21

They don't like going to go on board people for an hour, right?

But I want to find a profit in each category and its specialty, and I think that that will open eyes.

And again, once you see this, it was tremendous this year.

We had just about 200 people at the meeting.

31:37

It was such a big success.

Yeah.

Sponsors we're very happy, everybody wants to do it again.

Yeah.

And and so hard.

How do you like when you first started out?

Like how do you get people from all these different Specialties like on boards and you just didn't work with them or you didn't have that at first, the first time I did it, I called suroosh azhagi seen him lecture and I was very impressed with him and Then I called one Moon about MSDS and I had Mary Ann Evans.

32:10

One year.

Absolutely said you want to come and talk and they said yeah I want to come and talk and then I call it to my friends and said, hey maybe you guys want to do a little Ted talk?

So once we got this year, it was really great because we had James Nestor, and James Lester is graduate.

32:26

Charismatic Journey.

Yeah.

Right.

It's got a Charisma and he plays not that drum player either.

Right drums.

So we had some fun.

And yeah, I don't know next next year.

We're gonna definitely have bigger rooms.

Yeah well thank you so much for joining me.

32:41

I really appreciate it.

Yeah, thanks so much for listening.

I love hearing from you.

32:57

If you'd like to be featured in an upcoming episode, please email me at sleep apnea stories at gmail.com.

That's also the place to get in touch with you.

Just want to say hi or ask a question.

Alternatively, you can always reach me on Instagram, my handle there is at sleep apnea stories.

33:17

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