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About Mark Burhenne, DDS
Mark is a bestselling author and a family and sleep medicine dentist who has been in private practice nearly 30 years, focusing on patient-centered and preventative dental healthcare with patients who come to him from all over the world. He received his degree from the Dugoni School of Dentistry in San Francisco and is a member of the American Academy of Dental Sleep Medicine. The day his wife was diagnosed with sleep apnea was the day he began learning everything he could about sleep breathing conditions. He is a TEDx speaker and his advice regularly appears on media outlets such as CNN, CBS, Yahoo! Health, The Huffington Post, Prevention, Men's Health, and MindBodyGreen. He is the creator of AsktheDentist.com, dedicated to exploring the mouth-body connection for better overall health.
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Books Discussed in this Podcast
The 8-Hour Sleep Paradox: How We Are Sleeping Our Way to Fatigue, Disease and Unhappiness
Interview Show Notes
02:05 Sleep and Oral Health: The oral systemic connection is a complex communication between what happens in the mouth and what happens in the body. It is one of the weak spots in our body. Our environment and lifestyle is not conducive to that weak spot. The mouth is the only place where a non-shedding bone-like surface protrudes outside of the body. When we awaken with dry mouths in the morning, we have altered the flora/microbiome in the mouth. It drops pH levels. The gut has a number of filters before having to deal with things. The mouth is on the frontline. Our current methods of oral maintenance are inadequate for dealing with the many things that go on in our mouths. Mouthwash kills bacteria, altering the ratios, and promotes the growth of pathogenic bacteria.
04:50 What Happens in the Mouth Does Not Stay in the Mouth: When pathogenic bacteria from the mouth enters the bloodstream it can cause heart disease, Alzheimer’s, diabetes and insulin resistance, pancreatic and intestinal issues, and impacts the gut microbiome. The oral microbiome and gut microbiome are linked with a 40 – 50% overlay.
05:58 Oral Microbiome: The bacteria of often unique from one another due to the many external influences. The body tries to achieve homeostasis, but we upset the balance with the caustic chemicals we ingest or the oral products we use. Toothpastes can work to break down cell walls of our teeth. Mouthwash can have a huge kill rate for 20 minutes or so, but it creates dysbiosis that can exacerbate problems. Our goal should be to feed and nourish our oral microbiome.
08:34 Diet for the Oral Microbiome: A paleo or ancestral diet is ideal. Our oral biome and our microbiome evolved to a certain diet. Changes have occurred which trigger gene responses. Eating the right diet and proper oral care is what is needed.
09:34 Damage Caused by Little Plastic Beads Toothpaste contains tiny plastic beads to make it look nice when it comes out of the tube. These microbeads get stuck in the fold between the gum and tooth, causing a foreign body reaction. However, our bodies cannot break these down as they do food particles that get stuck. It can form scar tissue to wall it off. The vascular supply to this is different, causing bleeding and inflammation.
10:46 Optimal Oral Maintenance: Water pics are good devices when used appropriately. Do not add hydrogen peroxide. Baking soda and Himalayan salt stabilize our oral ph. Brushing and flossing are important, however they cause bacteremia, where bacteria from the mouth enter the bloodstream. The bacteria that are in cavities are also in the bloodstream. Our bodies create a biofilm over our teeth. A diet high in carbohydrates and scouring oral care can cause a thickening of the biofilm, preventing remineralization of the tooth. Dr. Burhenne prefers silk to plastic floss. He recommends a clean, unworn toothbrush. Flossing and brushing needs to be done correctly. Dr. Burhenne has videos on his website for instruction.
20:04 Sleep Apneas: What is not caused by sleep apnea is a shorter list than what IS caused by sleep apnea. It has been found to cause obesity, breast cancer, prostate cancer (on the verge of being on the list), Alzheimer’s, insulin resistance, IBS, and impacts upon the gut microbiome. If you don’t have a foundation of quality deep 7-9 hours of sleep, you have not gotten your growth hormone and your cortisol has been on all night.
22:40 Your Airway: The airway is the essence of life. You can gain weight in your airway and your tongue. Your airway is not a rigid tube. It can collapse when the muscles around the tube are flaccid, as they are when we are in deep sleep. Airways could be improperly developed from lack of breastfeeding, not chewing hard foods, eating pureed foods as babies, or having low K2 levels, and low mineral levels. Sippy cups and slurping down our food makes the lower face smaller, which affects the airway.
25:28 GERD and Airway Dysfunction Correlation: If your dentist sees GERD, grinding and lingual erosions on the inside where the tooth meets the gum, this means that your stomach acids creep upward with snoring during sleep. The mechanism is unknown. People who suffer from this are often overweight with big neck sizes. A great many children and young adults suffer from this as well.
27:35 Neck Circumference: Neck size does not always correlate with airway dysfunction. A study of low BMI pre-menopausal healthy women who did not have sleep apnea showed that half of them with smaller neck sizes had sleep disorder breathing. When women pass menopause, they catch up with men with sleep apnea. The progesterone and estrogen are protective of the airway muscles.
29:03 Treating Sleep Apnea: Early diagnosis garners easier treatment and may not require surgery. Preferred treatments are oral appliance to open the airway and CPAP or APAP machine which blows air into you. Another treatment is surgery to open the airway. Treating sleep apnea will improve the quality of your life. You will live longer and be happier. You’ll have fewer cravings and make better food decisions. Having sleep apnea makes you more likely to be in denial of having it. Dr. Burhenne wrote the book,The 8-Hour Sleep Paradox, to help us navigate the process of getting the appropriate treatment.
35:17 The Sleep Study: Sleep studies are expensive (maybe $1,100) but often it is covered by insurance. Though often insurance companies want us to be sick with overt symptoms or something like high blood pressure before it is covered. A high score on the Epworth sleepiness quiz may prove your case. A PSG attended sleep study is done overnight in a lab and where you sleep in a nice bed with electrodes stuck to your head and body. It is not invasive.
38:50 The Oral Appliance: Dr. Burhenne and his wife both use this for sleep. He says that using it is addicting. Having the jaw pushed forward may be somewhat uncomfortable at the beginning, but the quality refreshing sleep is profound. They are expensive ($2,500 and $4,500). Insurance will often pay for it after your sleep study and with a prescription from an MD specialist. The appliance is for those of us with mild to moderate sleep apnea. The oral appliance can be used effectively with an APAP machine. Dr. Burhenne strongly advises that you have a follow up sleep study to evaluate the efficacy of your treatment.
45:00 Dr. Burhenne’s Favorite Nutrient: Vitamin K2 would help young people develop a better bone structure and, potentially, a better airway. He takes it 3 times a day. Dosages can be found in the book The Calcium Paradox.
46:28 Dr. Burhenne’s Morning Routine: Now that Dr. Bruhenne wears his oral device when sleeping, he does not sleep to the alarm. Now he awakens when his need for sleep is sated. He eats smoked salmon and pastured eggs. He reads the newspaper and listens to music. Then he grabs his service dog and jumps into his electric car and heads to work. When showering, he uses peppermint soap to wake up the brain.
48:25 The Effect of the Oral Appliance upon Dr. Burhenne’s Athletic Performance: It has given him more endurance. Muscle mass is easier to gain. He would like to develop a daytime version of the appliance.
53:44 Dr. Burhenne’s Elevator Pitch: The emancipation of women would help the world.
My 34 year old husband has gained approx. 20-25 lbs. over the past 12 years. Most would not consider him overweight, but he recently bought new dress shirts and his neck circumference went up at least 1/2 inch. He started snoring badly about two years ago and never feels rested or vibrant or ready to get out of bed. He is very active and has a physical job, but isn’t able to take weight off easily despite a clean, nutrient dense diet so the lack of sleep would explain this. I’m wondering how many people get relief from just dropping some weight? Before we explore and invest in expensive health care options, I’d just like to know if for somebody like my husband just losing weight would cure the snoring/apnea?
Snoring is a primary sign of sleep apnea, which has major health implications. One of the consequences of sleep apnea is weight gain and challenges losing it. A very common myth is that losing weight will “cure” sleep apnea. Absolutely not true. There are multiple studies that show weight loss may reduce the level of sleep apnea but is not a cure. Many physicians who do not understand the real issues with sleep apnea will commonly tell a patient to “just lose some weight.”
The human airway during sleep is a complicated structure with multiple neurological controls. It is likely that your husband has a number of underlying sleep issues (more than sleep apnea, which should be viewed as the tip of the sleep berg). A sleep study is indicated to evaluate not only his breathing parameters and blood oxygen levels, but even more importantly the likely sleep interruptions during the night in all sleep stages, along with the amount of REM sleep he actually gets. This is the body’s only time to heal itself and if people are not in REM sufficiently a long list of health issues can develop over time.
New research is showing that the worldwide deficiency of Vitamin D (really a major hormone in the body and not a vitamin) is playing a major role in the simultaneous rise in sleep disorders in all age groups including children.
So, a thorough sleep evaluation is the starting point, along with baseline Vit D level. If sleep apnea is diagnosed, controlling the nighttime breathing stoppages is the starting point, either cpap or an oral appliance. Along with this is eliminating any mouth breathing tendency (see Mike’s video on mouth taping) and optimizing Vit D and possibly Vit B complex levels (see VitaminDcouncil.org on this, along with Dr Stasha Gominak’s presentations on YouTube).
Don’t ignore your husband’s snoring, it is his body crying out for help