the 8 -hour sleep paradox – why you probably have … · probably have undiagnosed sleep apnea...

The 8Probably Have Undiagnosed Sleep ApneaSpeaker: The information provided in this presentation is for educational and

informational purposes only. It is not a substitute for

professional medical and/or dental advice to diagnosis or treatment any

condition. Always seek the advice

qualified health care professional for any questions you may have regarding

a medical or dental condition.

Scott: Welcome, everyone! I am Dr.Scott S

Today, it is my privilegewith Dr. Mark Burhenne. Dr. Burhenne is the creator and author of www.askthedentist.comSleep Paradox. He's

regularly on TV, radioand other high profile General Dentistry and

to share his vast experience treating people in his dental practice with sleepdisordered breathing issuesHealth Summit!

Mark: Thanks for having me, Scott. I'm glad to b Scott: Glad to have you here.

to get so interested in studying s

you could also give ourbreathing is,how it's a spectrum and

Mark: That's good question start as a personal storydropping my oldest daughterguess it had been some time that we're all in the same h

write in the beginning chapter of my bookdaughters throwing pillows at me in the morning gfreight train." That was news to me of course

really don't know what's going on

To make the very long story shortsnoring and I was snoring a little bit

per hour that the airway closes

The 8-Hour Sleep Paradox – Why You Probably Have Undiagnosed Sleep ApneaSpeaker: Mark Burhenne, DDS

The information provided in this presentation is for educational and

informational purposes only. It is not a substitute for – nor does it provide


condition. Always seek the advice of your physician, dentist or other


a medical or dental condition.

! I am Dr.Scott Saunders, co-founder ofHealthy

rivilege to be speaking on the Functional Oral Health Summit Dr. Mark Burhenne. Dr. Burhenne is the creator and author of

www.askthedentist.com and the number one bestselling author of . He's a family and sleep medicine dentist, whose advice appears

radio, magazines, including the Huffington Post, profile media outlets. He's a member of the American Academy of

General Dentistry and American Academy of Dental Sleep Medicine

to share his vast experience treating people in his dental practice with sleepdisordered breathing issues. Welcome,Dr. Mark Burhenne to the Functional Oral

Thanks for having me, Scott. I'm glad to be here.

here. Let's start at the beginning. What gave you the impetusget so interested in studying sleep and sleep-disordered breathing

you could also give our audience a basic definition of what sleep-how it's a spectrum and what it might include.

good question becauseit was verynew to me. Again, these start as a personal story, as you can imagine. It started back when dropping my oldest daughter−this is more than 10 years ago− off toguess it had been some time that we're all in the same hotel room

in the beginning chapter of my book, I literally woke up with three of my g pillows at me in the morning going,"Dad, you sounded like a was news to me of course,because when we're asleep we

really don't know what's going on.

o make the very long story short, we discovered that it was my wife that snoring and I was snoring a little bit.She had an HI of 34. That's

the airway closes. You're suffocating and your body is

Why You Probably Have Undiagnosed Sleep Apnea

The information provided in this presentation is for educational and

nor does it provide -


of your physician, dentist or other


ealthy Mouth Media.

ealth Summit Dr. Mark Burhenne. Dr. Burhenne is the creator and author of

of The 8-Hour

se advice appears

CNN, CBS News ber of the American Academy of

edicine.He is going

to share his vast experience treating people in his dental practice with sleep-Functional Oral

beginning. What gave you the impetus breathing? Perhaps,

-disordered

stories usually t started back when we were

off to college. I room together. As I

I literally woke up with three of my , you sounded like a

when we're asleep we

was my wife that was 34 interruptions

body is

©2017 Healthy Mouth Media for the Functional Oral Health Summit

alarmed−"fight or flight" response. I was 12 per hour. So that was our awakening moment, so to speak. From there, we were exposed to a system that

was very dysfunctional−the medical system− on how it treated us. Both my wife and I are very thin, very healthy and very active. We were raising three kids. We're both working. We do mountain bike on weekends. We jog midweek. We have Paleo diets. This is the last thing that would have occurred to us that we

were not sleeping deeply without interruptions. Without that, your body slowly, and I'll explain later, falls apart. The body tries to compensate for that and it's a disaster.It's unmitigated, slow progressing disaster that essentially kills you slowly and ages you prematurely.

So that is my story. It startedthat morning in the town of Davis, California. We're dropping Catharine off at UC, Davis. So it came out of left field. From

there, it was going through the medical system, learning about all the inadequacies of that system and how it treats sleep apnea, circumventing it, going around it and then realizing that being a dentist,I could contribute to this area− sleep-disorderedbreathing. The definition of sleep-disorderedbreathing,

it's a wide catch-all phrasefor anything that can interrupt your sleep. It can be airway and other things as well. It can be neurological in origin. Essentially, most people know it as obstructive sleep apnea and that's a subset of sleep-

disordered breathing. That is where your airway collapses at night and you wake up because you feel like you can't breathe anymore and you're suffocating. So it's a disorder of sleep.

Scott: The dental profession has become increasingly involved in treating sleep-disordered breathing issues over the last decade or so or maybe a little bit more, and has been able to develop an alternative perspective on treating these issues. There has been a dichotomy with medicine and dentistry really, being on

different pages with treating sleep disorders. Is that a fair statement? Mark: That is a fair statement and kind of where we came from. There was that

division as it exists in other areas between medicine and dentistry, unfortunately. A lot of what I try and do is to aid collaboration between the two but what you're referring to is two things I think. One is the oral appliance, and that's been around for a long time. A lot of physicians even today, in my area

here in the Silicon Valley-- I'm not talking about the sleep physician that specializes in sleep disorders like a neurologists. I'm talking about the primary care physician. Most of them think that the oral appliance is something that

causes TMJ, and it's outmoded and old-fashioned, where if you talk to theAADSM (American Academy of Dental Sleep Medicine) and the AASM (the medical component of that) the sleep appliance, oral appliance, mandibular advancement device (MAD), all different names for the same concept is back.

The studies support its efficacy.

So the real division is who catches it the earliest. Who can find and discover or identify this disease based on signs and symptoms? I knowthat the recognition

of this disease, sleep-disordered breathing, occurs decades earlier in the dental realm than does in the medical. That's because we have the unique oral perspective. There are things in the mouth that would lead us to believe that

there could be a problem, where a physician is trained to look for different things and these things occur later like comorbidities of sleep apnea and patientshave to report specifically that they've had an issue and have to score high on the Epworth questionnaire that they give out.I give out that


questionnaire because it is a standard in the industry. I'd find that most of the time, I have to coach my patients. They don't know how to fill it out. So it's very

subjective in many areas where I look at the mouth and even before I look at themouth, there are things that indicate to me that this person may have a sleep-disorderedbreathing issue. This occurs at age 1, 5, 10 andcertainly in the adult years.

Dentistryis in a very unique position and the politics of it I think is who gets the diagnosis. I've been very happy with just being a screener for a long time but I'm beginning to get to the point now where-- Standard of care is that a dentist

cannot diagnose sleep apnea but we can screen for it. Again, that's fine. I'm beginning to change my tune on that a little bit. We can get into that, if you want. If the physicians were doing their job, and most of them are but in

general, it's still very frustrating because I see a lot of people fall through the cracks.I'm there to pick them up and I'm their dentist. So I walk them through the medical process. I teach and tell them how to get that sleep study, what to do and what's the next step. Of course, this is all in my book. The book is

already two years old and that book essentially was a result of that frustration, the frustration of me and my wife going to the system andnot getting the care that we deserved and needed.

Scott: So that puts dentists in a position of having to reach out to physicians and get in

their world about how they diagnose and treat sleep-disordered breathing. That's the primary care doctors, as well as the sleep medicine specialist doctors.

I would imagine that that could have the potential to create some friction between the dental side and the medical side.

Mark: It does, unfortunately. Even though organizations like the AADSM, which is a

collection of dentists and medical doctors working together, that's not the norm. It doesn't seem to be the norm. I think physicians have their concept of what we do, and we certainly have our concept of what physicians do. Unfortunately, the

collaboration between the two-- It's not just in sleep. It can be with the oral systemic connection or elevated CRP levels. There are so many ways that we can collaborate to help our patients if we did collaborate, but there is a big divide. I think it is improving. Again, the reason for writing the book is that

every time I referred someone out to the primary care physician, they would come back and says,"No. They think I don't need a sleep test." Of course, there's a lot of pushback there because it is a very expensive study.

The physicians, if they're in a large group of physicians like Kaiser and even Sutter Health, they have protocols on who gets a sleep study and who doesn't. There are even incentives on not to prescribe a sleep study. I don’t want to get

into that, but I came across that while I was writing the book and speaking to some physicians ina PPO. Essentially, at the end of the year, they were able to share whatever was left over in the diagnostic pool (the dollar amount) and the person who prescribed the most sleep studiesor other diagnostics as well (it's

not just sleep) could not share in that pool. Also, researching for the book, we came across the Blue Cross datasheet the physicians refer to when they make that diagnosis. It's about 708 pages long and very complicated. There have to

be a lot of comorbidities present. So they have to wait. Physicians,unfortunately, arein a position where they have been told that they have to wait until certain conditions are met. By that time, the patients have sleep apnea for decades.


There are some issues, and I think as a dentist I'm very frustrated. Again, the reason for writing thebook and the reason for my circumventing that system of

referring to a primary care physician. I refer to the specialist directly now. We can talk more about that. I'm not sure if everyone can do that but it seems to work for me. It's great for my patients because they can get a sleep study in three to four days based on, not my diagnosis, but my screening of the patient.

That's really been helpful. Scott: To be fair, there are primary care doctors, notably the one that I see here in

Pennsylvania who are on board with sleep-disordered breathing and doing the

referral for the sleep study or the mandibularadvancement appliance. So the word is spreading slowly but the way I see it, the collaboration is a growing movement. I see the patient himself or herself as being an integral component

of that collaboration between the medical side and the dental side. The more empowered the healthcare consumer is, which is one of the main goals that we're trying to accomplish here on the Functional Oral Health Summit, the more knowledge and the more empowerment the patient has, the more he or she can

be an advocate for himself, herself or a child.

Children, of course have sleep-disordered breathing issues, as well on the

spectrum that you described. This all speaks to greater involvement, knowledge and savvy among the patient population, which is one of the things we're trying to accomplish here. This speaks to, I think what you've referred to in the past in some of our discussions, as the democratization of healthcare and dentistry

settling on what its role is going to be in the whole spectrum of healthcare and working in collaboration with medicine. Do you see this is as gaining traction? Is it slowly gaining traction or does it needs to happen faster? How can the patient help that process?

Mark: Well,I think it does need to happen faster. It is gaining traction. It's definitely on

an upward swing. When it comes to collaboration, it's always the patient that

will bring us all together. Of course, if that's true, then educating the patient makes sense in that the more knowledgeable the patient is, the better collaboration will be and the end result for the patient will be better. So there's definitely a democratization going on. It's the internet. Like in every other area,

patients are very knowledgeable. We can literally reach out to them directly, instead of having them come see us. We are out there on-- For example, like what we're doing right now, writing books and even my website. All those things

are examples of just trying to reach out and give the patient enough information so that they will do the right thing. It's definitely on the upswing. I don't want to sound too negative. It's not more fun to talk about the negative things but it's the negative thingsthat we need to talk about to fix the process; and there's a

lot of positive stuff going on.

On the other hand, andwe were talking about this earlier, patients are overwhelmed. They're getting a lot of information, and then how credible is

information? Where do they go to? So there's a dark side to that democratization. For example,a lot of people are reading in the back of their magazines that they can buy a little oral appliance, kind of a boil and bite,

anywhere for $30 to $75 and they can actually go down the wrong path and think that's not a good solution for them when in fact it is, that it was professionally done. So it's a complicated issue certainly.


Scott: Yes. The healthcare consumer is also being bombarded by ads for the boil and bite, kind of a DIY sleep appliance. You're seeing the advent of DIY, clear-aligner

therapy for do-it-yourself orthodontics, you know straight teeth without having to see the dentist, which just makes me shiver when I see those direct to patient ads in primetime TV and very much the same for sleep appliances. We need to emphasize that if you feel that you may be one of the 90 percent of the

sufferers of sleep-disordered breathing or sleep apnea that are going undiagnosed, that it is essential folks that you see your dentist and collaborate with your primary care physician or sleep physician, if you have one, and all of these members of this healthcare team that is emerging as the concept of the

future of functional medicine.The way I see it, the team approach and the patient at the center of that team is going to be what brings our healthcare system intomore of a positive direction. So maybe, we could talk about that

team approach for a minute. Why is it important, who needs to be on the team and what does thepatient need to know to be contacting members and to assemble that team because it's a formidable task?

Mark: So the team approach is key, as it is in health care and other areas as well. The team is essentially a sleep doctor, I prefer neurologist typically. It can be an EMT, myself (the dentist) but also the staff (the hygienist). So of all those

people, the person the patient sees which the most often? It's the hygienist, and that's usually also an earlier contact. Usually, we see our new patients between age one and two. Of course, the pediatricians have seen them but they may not be looking for sleep-disordered breathing.

Anyway, that collaboration between MD and dentist is critical, which is usually the weak link in the team. The thing I'd like to really emphasize is the hygienist. Training the hygienist to be able to-- They have the patients ear for an hour,

and that's powerful. It doesn't allneed to be about oral hygiene. If they see someone who's got a scalloped tongue, fissured tongue, high Mallampati score [a basic oral assessment of how obstructed your airway is], extreme heavy wear

facets [eroded areas on the teeth caused by grinding or and/or malocclusion],abfractions [flaking off of tooth structure at the gum line], dry mouth, mouth breathing,it's wonderful for them because they have that patient's attention and can educate. Again the definition of doctor is in Latin, the

root word "to teach." That is our role. It's notto heal. I mean according to the definition is to teach first. In the end, we're better healers if the patient is educated. Again, that goes back to the democratization of healthcare.

Though, the team is very important. I've mentioned just now and before in our conversations that I've circumvented that process. I don't refer to a primary care physician anymore because too often, that patient comes back and we have

to work out something else. Typically, when I refer for a sleep study, they come back with an elevated AHI or RDI. They're on the spectrum for sleep apnea. It's 99 percent. Every once in a while, we get someone back with some very erratic sleep results and we can't quite figure it out. They may be tired or maybe

they're not tired, but we're seeing the signs of-- I mean how do you explain sleep bruxism if it's not sleep-disordered breathing. I guess there are possibilities that it could be something else. It could be daytime bruxism that

has not been identified or addressed.

It's a very difficult thing to define. There are so many different ways to look at it, and the signs and symptoms vary tremendously.I have patients coming in


that feel great like myself. They're thin and healthy. They feltgreat. They don't think they have sleep apnea. I have to, over many visits, convince them that

they do. When they get the sleep study then they see it. I think that's where we have to get a different test, and we can talk about that as well.The PSG is wonderful. It's the gold standard. It's one night of being observed, being hooked up, brain wave patterns but I'm hoping for those difficult to convince patients

and physicians that there's something else out there that can make them think, "You know, this could be me."

Scott: There are better at home sleep test technologies available now. The PSG which

stands for polysomnographic study, that's the one where you spend overnight in the sleep center at a hospital usually andthe big high ticket study that no one's insurance company wants to pay for. Consequently, as you alluded to

earlier,physicians generally do not want to order. There are at home sleep studies that the patient can do at home. It measures oxygen levels in the blood, which is one of the main things that you have to keep an eye on. With sleep-disordered breathing, your oxygen saturation in your blood drops, depriving

your bodily tissues of oxygen, in addition to the AHI which is stopping breathing: how often you stop breathing or how often you have compromised breathing. How do you usually handle this? How do you differentiate between what would

be a good way to diagnose sleep-disordered breathing? Say you're running up against the wall and you can't work with the physician together and you have a PSG ordered. Would it be workable to substitute one of these at home sleep test? Can one of these tests be administered in the dental practice, and does the

patient's physician have to sign off on that. Mark: It’s a very good question. Standard of care tells us that we can use those sleep

studies only for one purpose, and that is to calibrate and titrate our oral

appliances. So not used for diagnosis. I would be very careful in that regard. The way I've gotten around it is I found a conduit, a referral to a private sleep lab that has a neurologist and he acts as the primary care physician. He knows my

track record. He knows that when I get a referral-- I'm actually one of his biggest referrers, and that I'm speaking of all the otherMDs and medical associations that he gets referral from. So that referral gets accepted and the PSG is donebased on-- but I have to say and again standard diagnosis. It's just

a screening. He will see the patient and make a diagnosis.

That's unique in my situation. I would encourage any dentist to seek that out, go

around and essentially find someone who's enlightened in that way and thus trust the dentist. The relationship maybe would be a little tenuous in the beginning because as the patient referrals come in, what percentage of them actually does have sleep apnea. Of course, once you do have that diagnosis,

theninsurance is more likely to pay for a CPAP and perhaps, even the oral appliance. I've essentially come up with that method. It wasn't premeditated. It just came to be because I kept bouncing around, and I was frustrated. I'm always the advocate for my patients. WhenI knew that they have sleep apnea

and were being turned away, I fought for them. I found them someone finally to get the PSG.You're hearing a lot of frustration for me. Again, a lot of things do go very well and smoothly. I do refer to a very large medical organization across

the street. I do work with them and then they refer back for the oral appliance. Scott: So a big part of this isrelationship building. The enlightened patient, if you will,

can play a key role in this by understanding the process of what's going on and


you're giving them great information here to empower them to do that. Unfortunately, this is going to involve some homework, folks to empower

yourself, to be an advocate for yourself or for your child. You're going to roll up your sleeves and probably, talk to a number of people before you can get to that comfort zone where you've got a dentist who is doingsome of the things that you're doing, Mark, with collaborating with the medical side to get the sleep

study done and to initiate whatever treatment is going to be best for that patient, which can in itself fall on a pretty good spectrum.

Can we talk a little bit about different therapeutic approaches to dealing with

sleep apnea and sleep-disordered breathing once we've got that diagnosis and once−we hope− you've been able to impress upon the patient that he or she--From what you're saying, mostly "he" because it seems to be men who have

more trouble than women accepting that they may have sleep apnea or sleep-disordered breathing issue. We can talk about that a little bit.Once we got the diagnosis, what are the patients' options? What is the best way for the healthcare consumer to look at what these options are for treating sleep-

disordered breathing? Mark: Scott, as you said a few minutes ago, the whole sleep apnea, first getting to the

point where you think you need the diagnosis, getting the diagnosis and treatment, it is very, very complicated. I experienced this personally. I'm educated in the healthcare field, and I found it confusing. Again, it was for the book. The book actually is being read by dentists as well, which I was very

surprised by.They call me and really liked the book because ithelps them as well. It's a great starting point for anyone who wants to get a handle on this.

So once you get the diagnosis, I let the physician lead treatment, assuming it's

a physician that I thinkhas a good protocol and track record. Typically, they do. So I let them lead the treatment, and if there is mention of an oral appliance, then of course, I'll snip in. So theywill write the letter; they’llprescribe it and

once it's prescribed, then I will move ahead with the oral appliance. Personally, I like what we call "combination" or hybrid therapy. I think the CPAP is still the gold standard or the APAP. Ithasn't been around that long. I think it was invented in the 60s. It's a pretty archaic device if you think about it. We've got

an airway that's collapsing due to lack of muscle tone approaching deep sleep. It's narrow due to weight gain. Age is another factor. You put a lot of air through it.Again, the Bernoulli's principle is that if you put a lot of air through it, airway

that can collapse, it will collapse. So what do we do? We blow it up. We keep a lot of positive pressure inside the body with a machine from the outside. Everytime I say that to myself or to someone else, I think my god! That is just

like the most rudimentary way of dealing with this where anatomically, there are things that are on the wrong position and then I get that oral appliance. Again, the oral appliance doesn't work on everyone but depending on where the obstruction is, it certainly makes sense to prevent the tongue from collapsing

back into that space, keeping the jaw forward and addressing the anatomical reasons why the collapse is occurring.

So the oral appliance is a pretty sophisticated device that can do a lot, compared to a device that's basically blowing you up like a balloon. I do worry about the CPAP. I think we need something better than the CPAP or APAP. There are a lot of companies in the area here that are working on it, even with negative


pressure systems.

What does all that internal pressure do in the body? We know that you're more likely to get pneumonia. You getdried out and have to use a humidifier. What does it do to the oral biome, gut microbiome? What does it do to the lymphatic system, which is a low pressure system? What does all that internal pressure do

over the patient's lifetime? So I do worry about CPAP and APAP. If the physician is willing to entertain this is to do an oral appliance with anAPAP/CPAP therapy.

First of all,CPAP right out of the box is very difficult.I workedwith a lot of

peoples'CPAPs. I have them bring them in to my office. I've learned a lot about it through my patients. They've taught me a lot about CPAPS. I've worn one; my wife certainly wore one for a while. It's a difficult thing to deal with and most

people just give up. So if you have the pressure turned up and you'reblowing past a very occluded airway, well yes that's the extreme and that's where you get all the side effects and the blow by past the mask, dry eyes and dry throat. You're hoarse in the morning and got marks on your face. Why not keepthe

airway open with an oral appliance and let that CPAP work less hard. So I love the two together. In one way or another, if we start off that way or if we get to that point because the CPAP wasn't working, it always seems to work better.

The efficacy and compliance rate is much higher. So I like to go there. It doesn't always work. There are still some physicians that insist it's got to be a CPAP and that no oral appliance really can do the job. It' going to cost TMJ and on from there.

Scott: I can attest personally to how difficult it can be to wear a CPAP. I myself am a

severe obstructive sleep apnea sufferer and had no idea until I met my current partner, Bonnie, about nine years ago now. She observed that, "Hey, you're

ceasing to breathe while sleeping for 20 seconds of the clip." I had no clue. I went the CPAP route. I had state of the art humidifier model with the nasal pillows and the least invasive CPAP device that I could get that was available at

that time. I gave it about three months. A wrinkle that I have myself is that I also suffer from insomnia. So the CPAP device of course just compounded that, a little bit of a claustrophobic dimension to it, but I could not sleep with it. I was just one of the one of the many millions of people who tries CPAP. They give it a

really good shot and try their best but for whatever reason, it becomes a self-defeating proposition. In my case, just that I could not sleep with thedarn thing on.

So that's when I started exploring the mandibular advancement appliance route. The goal of which of course is to wear the appliance to bring your lower jaw and tongue forward,all the while taking pressure off the airway so that you can

breathe better and will have fewer apneic or impaired breathing episodes while you're sleeping. I frankly have had better results with the-- I'm on my second type of oral appliance now and the jury is still out as far as how well that's going to work. I have not tried CPAP in the appliance together, but it'sinteresting that

you voiced the option that using the two together maybe an alternative. So our audience members should really take note of that and write that down as one of the many questions that we advise them to have with them when they go into

the office of whatever practitioner on the healthcare team they happen to be talking with that day.

So CPAP does not have a high compliance rate. For those who can use it, it's


very effective. Is it effective for severe sleep apnea sufferers, those withAHI's like myself? I've had AHIs up in the 70s which is sky high. Is there a threshold

past which CPAP would have a diminished efficacy rate? Mark: Technically, no. That is the standardof care for someone who has severe sleep

apnea. Anything over an AHI of 25 or 30, the oral appliance is not indicated at

that point in time alone. I've had very few successes with AHIs over 35 alone. I've had several. I mean at least 80 to 90 percent efficacy at high AHIs, a little higher than what MDs think would work. Again, it depends on the anatomy of the patient. Are they a nose breather? APAP wearers absolutely have to have

absolute perfection in nasal breathing.A lot of the time, that gets forgotten. The CPAP gets prescribed and the patient can't really breathe through their nose. They may have allergies or a stuffy nose. So you have to have perfect nasal

breathing for CPAP to work well.

I've shared this with you I think the last time we spoke. I have a patient who has an AHI of 75. She was not wearing her CPAP because perhaps, there was a

threshold for her. She had it turned way up, and it was just too much pressure for her. When it's blowing that hard to keep the airway open, there's a lot of stuff that goes on. I mean if it's not a perfect seal of the mask, where does that

air go? It goes into your eyes, lungs and stomach. She just wasn't able to wear it. So I made her a little bit of a deal where I'll make the oral appliance as long as you're willing to try an APAP and with the pressure adjusted−more adjustability but also at a lower pressure. That worked. The oral appliance

brought her down from about I think an AHI of 74 to 19.5. That's a big jump. It still puts her in the middle of moderate sleep apnea. End of the story, of course is she tried the APAP. She went from a CPAP to an APAP, updated the machine and adjusted it so that it would sense what pressure was needed. It was a little

bit of a smarter setting on the APAP. Also, the pressure was way down. Thank goodness, she's now wearing both and has an AHI of less than one.

As far your question goes, is there a threshold for the CPAP? I don't know if there is one technically, but practically speaking there is a threshold. Most people don't like the high pressures. They can't tolerate them. They're blowing your body up all night long for six to eight hours. It's tough. It doesn't always

breathe with you, and it doesn't always have the right pressure. Sometimes you don't need the pressure and it's there; sometimesyou need the pressure and it's not there. It's a very archaic device.

On the other hand, the best we have at this point, it is standard of care and first line of defense. I encourage all of my patients, even for patients that I know an oral appliance will be the end all for them and that will take care of it, to try the

CPAP: (a) to get coverage while the insurance is working and the subject is hot. What if I have to go through an Invisalign trim or let's say, I have to do three or four crowns in two quadrants. That oral appliance would be out of commission for two to three weeks. Even after three days of not sleeping properly and with

interrupted sleep, there's damage to the mammillary bodiesin the base of the brain.

It's that simple. One poor night of sleep can be life-changing. It is cumulative to some point. There are some repair going on but some of it is permanent. So why would you not want to have a backup to your oralappliance? People lose theiroral appliances. Their pets will chew on them. They break. They need to be


adjusted. So I recommend an APAP/CPAP for everyone. From there, we use that as a backup or as an augmentation of treatment. It's a good place to start. Also,

let's face it. Oral appliances aren't that easy to wear.I mean most people love them but people that really love them are the ones that are coming from the CPAP andare desperate, right?

Scott: That's for sure. Mark: Yes. That CPAP has many purposes and one is to make the patient more open to

new modalities of therapy and perhaps, not be challenged by what they think

may be potential discomfort. Scott: Right. Good stuff.Good advice andmain differentiation between CPAP and APAP

for our audience members. They may be familiar with CPAP which stands for Continuous Positive Airway Pressure and APAP which is Adjustable Positive Airway Pressure?

Mark: Automatic. Scott: Automatic, sorry.

Mark: No. Scott: Can you give a basic differentiation what makes the APAP different and whyis it

important for people listening to this Summit to have that in the back of their minds to suggest if no one suggested to them?

Mark: So it's a good question. I wish people would ask that more often because CPAP

has become a generic term and they just ask for it when actually they should-- I always encourage my patients. I educate them. After they've gotten their sleep diagnosis, I actually will call or email them or even see them in my office and

talk to them about it. I will go through the sleep study within the PSG.Many times, I'm spending more time with them than their sleep doctor. I'll look at things like, "Are you a side sleeper? Do you have a high AHI but is your desatlevel still pretty high in comparison?"

I'm looking for little clues to what works well to which patient. There are certain things in a PSG that would tell me that they are a good candidate for an oral

appliance. So I'm looking at that.I'malso trying to educate them. Then I will sit down and say, "Listen. Okay, the next step is," and I'm reinforcing what the physician usually says, and that is "it's CPAP time." But ask for anAPAP.

An APAP has a wider range of settings. In other words, it can move up and down on the scale of pressure.So centimeters of water pressure can vary. Well, the CPAP is set by a technician in a sleep lab. So what happens is that it may be the correct pressure or the incorrect pressure set in that one study. It's another

PSG. They come in and adjust it, and then they look for the lowest amount of apneas during a sleep study and that's your new set of pressure.The problem is that what I've foundand I've seen this with oral appliances that once you start

getting therapy for sleep apnea, you start losing weight. The edema in your throat goes away, the airway gets a little bit bigger and you don't need all that pressure. But it's sad and that's when the CPAP becomes uncomfortable to wear because you're putting too much air in for what you need and the airway's


opening sooner than it was before with the set pressure.

The APAP will adjust to that. It will know that pressure is not needed, and it will ramp down or up depending whether you rolled over, kinked your neck and you're sleeping in a weird position on your back. So it's just a smarter, better device. Unfortunately, a lot of patients get CPAPs, and they need to know to ask

for an APAP. Most APAPs have a CPAP setting but you can override it. Don't get the least expensive, basic model of the CPAP. Ask for the best model possible, and that's usually an APAP. Also APAPs are newer so there are other features in it that the older CPAPs don't have that have nothing to do with adjustable

pressure. I think insurance allows youto update your machine every three to five years, depending on which insurance you have. Medicaredoes as well. So anyway, get the best machine you can, man. This is your life.

Scott: Yes, absolutely. An essential question to ask when you're doing your research

and talking to your health care team about what's going to be the best way to treat your sleep-disordered breathing if you find out that is what's going

on.Now, you mentioned insurance coverage. Insurance from what I understand is pretty good at covering CPAP. Is it good at covering APAP as well or is there a difference there?

Mark: That's a good question. I just don't-- Scott: This is medical insurance we're talking about.

Mark: Yes, exactly. To be clear, dental insurance will not cover anything in regards to

CPAP, including the oral appliance. That's also a medical insurance. It's like TMJ. For some reason, dental insurance does not cover TMJ/TMD. So that's

interesting. I think that's always a little bit of a shock to a dentist getting into sleep-disordered breathing in that field. Is there a difference? Well, good news. You've gotten the sleep study, which is great and you've gotten that covered

hopefully. Typically, they will cover CPAP. I think APAP coverage, depending on which plan you have, is a little bit more difficult. Perhaps the co-payment is higherbut I would argue that it is completely worth it.

Scott: Being politely persistent is good advice for the patient. If you're turned down, maybe not for CPAP but you can get an oral appliance covered through your medical insurance if you know how to do it. You have a whole chapter in The 8-

Hour Sleep Paradox that guides people on how to do this. Mark: Right. So there are forms that the medical insurance companies have. It's the

CPAP non-compliance form. Being persistent is important. I think you have to

understand that if the CPAP doesn't work, you have very few options other than the oral appliance. If you have severe sleep apnea, you have very few options at that point other than surgery. So you have to be persistent. The first time you try CPAP/APAP, you wanted to go well. So you want the best device possible.

Being persistent will help. Tell him you're claustrophobic; you may get a better mask if that's the case. You may get a mask for the main air tube attaches to the back of your head, not right in front of your eyes and on your nose.A lot of

people don't like to have their nose torqued by a big heavy tube.

So you really have to sit down with the CPAP person. What's it called? A durable medical device persontechnician and most of the time, they're just dispensed


like a “Pez” out of the Pezdispenser. Here, next. I'm sorry to say that but it's true. I've seen it. Then I will give the patient some interesting things to say

when they go back and all of a sudden, they get an hour of that person and they get a better solution−a different mask. It's interesting dentistry should be making this mask. We have the impression material. We should be making custom silicon mask. I'm not sure why we haven't done that or with 3D printing.

Scan the face; custom mask. Scott: Yes. If we can use intraoral scanning to precisely fit a crown or other intraoral

appliances, why not apply it to something that arguably might not even require

as precise a fit, precise certainly but the same principles of optical scanning and even 3D printing which is a wonderful technology that many of our audience members might be familiar with. It's gaining popularity and again, that's

something to keep in the back of your mind to watch for and maybe just bring up in a conversation to your dentist or yourdoctor.

Let's talk about sleep-disordered breathing in children for a moment. This, from

what I understand, has been a difficult area, especially when dealing with medical profession. Most particularly, it's my perception that the pediatric community is somewhat resistant to diagnosing and treating sleep-disordered

breathing in children. Is this a misconception on my part or is that something that you see as well?

Mark: It is something I see unfortunately. The tragedy is that when you see an

adult,the airway is what it is. That development is done. I mean that's what we're stuck with, that airway. With children, if we catch it early and if we can affect their facial development and facial growth, then we can save them from a lifetime of having sleep-disordered breathing. That's where we need to be very

active as dentists. We need to be screening for this early.

I've been trained by several people: ENTs, functional orthodontists and the

AADSM, to look for this and to catch it at age one. Then I will refer to a pediatric ENT, and I have a few here in the Bay Area that I know will respond. I've been told and taught that the protocol is that ifyour child snores, that referral needs to be made that that's standard of care. Typically, they start looking at the

adenoids and tonsils right away. I also refer to functional orthodontists at age six or five. That's an early referral, but if I don't see that facial development is correct which would mean that person has a narrow airway, vaultedarch, that

they're not developing properly and going to have nasal obstructions.If I see a kid who'smouth breathing at age one or earlier, I will say something. These things have to be caught early and the referral has to be made.

Unfortunately, at that age, it's usually surgery. Sometimes the parents are very-- I grew up in a generation where tonsillectomies were like that was not done. Before my generation, it was done often. It was a difficult surgery back then and now it's come back into vogue,but not in all circles. So you have to make sure

your child can breathe, sleep with their mouth closed at night and that they are good sleeper for growth and development. If that's not happening, then it's imperative thatgets caught early. I would reach out to all the dentists watching

this, that is an absolutely must. There should be a check form.Your hygienist should be trained. Everyone should be evaluated for that.Just imagine a world where we catch everyone before they're finished developing their airway, and we can promote or guide them into developing with the proper airway.Think


ofwhat will happen on the backend: less high blood pressure,Alzheimer's, diabetes and insulin resistance. It's huge. The implications are good.

Scott: Less chronic disease burden and that chronic disease burden is one of the things

that is making us the, unfortunately I had to say this but here in the United States, unhealthy society that we've grown into. Again, you mentioned the

unique position that the dental hygienist is in to screen these patients, including children and ask the parent about snoring and any of these red flags that might indicate that child has a sleep-disordered breathing issue. We're reaching, with the Functional Oral HealthSummit, not only the healthcare consumer but also

the midlevel dental and medical practitioners. Probably, the top of that lists is the dental hygienist, because as you pointed out earlier they have got the face time both with the adult and the child patient and can focus on−we would

hope− the medical history in conjunction with just what most people are expecting is going to be done at a dental checkup visit, which is to get their teeth cleaned. The term cleaning is coming out of vogue, and then the more progressively thinking hygienists circles, one of our other speakers, Debbie

Zafiropoulos,gave us a tremendous set of interviews, including clinical demonstrationtalking about all of the things that the dental hygienist is in a position to observe medically, as well as dentally, if she is inclined to do that,

which we would encourage all of our dental healthcare professional team members/audience members to do.

Now, the parent is in a difficult position here because sometimes the parent

might encounter some resistance. The parent sees that the child is snoring, brings this to the attention of the pediatrician/the primary doc, would there ever be resistance to getting a sleep-disordered breathing evaluated? What is the best way for a parent to be the best advocate for a child who may be having

sleep-disordered breathing issue? Mark: So you've hit on a very interesting point and this is resistance. Again, we've

talked about this.I'm a medical advisor for a company. It's is called Knithealth. We're going to launch products in-- I'm not sure. It's coming. It'll be this year hopefully, and I'm very excited. It's something that I talked about in my book along time ago. We need to democratize this sleep study. We need to make it

very simple, easy, available and inexpensive. But the video of this test is that it doesn't touch any part of your body. It's a camera that can witness apneas.

That in itself is great. The reason I bring it up is because it helps motivate a lot of people. So we talked about the middle-aged male who is in complete denial about sleep and has been told and elbowed many times bytheir sleep partnerthat,"This is a problem. Itlooks like you're dyingin bed. But that's not

enough for them. Same thing with parents. Sometimes, they don't get very excited. They think their kidsleeps well.Typically, those parents are in bed, tossing and turning all night having problems of their own, because it runs in families and they're too tired andtoo in denial to even think that their kid could

have a sleep issue. Here's that thing. When that camera shows you an apnea or a hypopnea or a RERA [respirator effort-related arousal],that's certainly an apnea, then that data can be shared with many people including the Pediatric

ENT. It's one thing being told "I witnessed it" or "I think my kid has it" but when they see it, it is undeniable. That I think is very, very powerful.

Scott: Yes, definitely. I agree. Physical evidence, data and that speaks to the principal


of-- That is what the health care consumer is ideally in the role of doing is collecting hard data. That's why we're trying to impart evidence-

basedinformation to our audience members so that they can roll up their sleeves and do the basic science that they need to do to be their own and their child's best health advocate.

Mark: Yes, it's a little blipon a piece of graph paper that's traced out. That's meaningless to even some healthcare practitioners. I had to really sit down and understand what that was. Someone had to tell me what does that mean. What's the top of the curve mean, bottom of the curve, when it's a little shallow

or flattens out, before this bump and this hump? I mean what does that mean? It's difficult to tell a patient that this is an area where you're not breathing, you're suffering from hypoxia and your body is alarmed. When you show them

the picture, it's done. They are convinced .That is very powerful. Scott: Very powerful indeed. Now, here in the US, we do not routinely screen children

for sleep-disordered breathing in contrast to other nations such as Italy and

Iceland who check sometimes beginning from age one. What would it take for us to get to that point?

Mark: That is the million dollar question, because it cost billions of dollars. I forget I mentioned in my book, the cost of not treating sleep-disordered breathing, that's probably an old number, but it's mind-boggling.Again, dentists we're brought up in our academic background as being very preventative orientated.

This is a classic example of prevention. If we can catch this early on, like some other countries are beginning to do, catch it early, think of what we can save in terms of cost. Maybe it could be the tipping point between a terrible medical system that is overrun with high costs and poor coverage, which is kind of what

we've got now, to a system that works and that is more available. It could be that big of a tipping point because of lowering costs down the road.

So yes, I think we need a better test. I think that's we're able to stand to. We need to do it sooner, quicker and cheaper. We need to do it on everyone. Again, as I argue in my book, we need to verify our sleep ability every night, every week or every year at least. We need to have some methodology where the

person at home will know "That was a bad night of sleep. I should be concerned" or"Maybe, it was because the cat jumped on me"or "The last few weeks have been really bad. My AHIs have gone up.My mouth is open all night long. I'm

mouth breathing." That's information we all need to be able to process immediately. We can't wait for PSG. It's too big of a ship to turn that PSG. It really is.

Scott: Once you get to that point, considerable damage may already have occurred. It could be in an adult or a teenwho may be showing signs of impaired craniofacial development. By that time, they're looking at treatment by an orthodontist who may or may not be on board with the whole universe of the high palatal vault

and the dental crowding, He may even, heaven forbid, be suggesting that we take out teeth to make room because we don't have enough bones supporting the teeth to accommodate the teeth that are there, which we're finding more

and more prevalently is a really bad idea. There are of course many orthodontists who still are not on bored with that.

The signs that some of these twins and teens are showing also include attention


deficit hyperactivity disorder, which is a consolation in that same universe of a sleep deprivation, which of course is a national epidemic. We have poor sleep

andlack of sleep. That has a really big impact on some of the things that can happen to us such as auto accidents and just general loss of productivity. Can you talk a little bit about the correlation of sleep-disordered breathing issues and the ADHD (Autism Spectrum Disorders) perhaps? How those tie together and

what a problem that causes? Mark: In general, I would include borderline personality disorder, autism (that's a

tough subject), and reduction in sperm rates. I just read that men after age

30,only half of them have viable sperm. It's difficult to say where sleep apnea impedes or has an impact. Certainly, what I've seen in my clinic, and I get--The beauty of being a dentist is that typically you see a patient. I've done exams and

fillings on one and two years old, and I see them now graduating in their ENTs. That kind of span of life and you get to see a lot of that teen angst and their lack of focus. They come in rolled, bandaged upfrom a car accident. You see their personality changes and how they interact with parents.

Think of this, I would just say for whoever who's listening who has a child. Children typically do well; they thrive because that's the human species.

However, if they're not sleeping well as you said earlier, they don't develop properly. Their facial development doesn't happen properly which impacts their airway even more as an adult. It doesn't end there. It impacts the brain. The brain is rebooting at age 10, and it takes till age 27 to reboot. New neurons are

growing after the first setof neurons and that's all dependent on growth and growth hormone. If you're not getting that deep sleep at night whichsleep-disordered breathing will prevent you from getting, then you have to think that kid is having a tough time doing everything that he's supposed to be doing.

Then we throw, on top of that,these demanding schedules and sports after schools, competition ofgetting to college and all these hoops that they have to

jump through, which if you could argue is really not the way our generation grew up or we developed when we were living in tribes, on the planesor in caves. I mean it was a different type of stress. Is that an epigenetic factor that we've introduced into this system? A, we're not developing properly because

we're eating the wrong, crappy food which prevents us from developing properly and we can't sleep well; and then we have this new lifestyle of distraction, stress and short-term goals and long term stress, whereit's this big perfect storm

where in the end at age 30, we can't have a baby because we don't have the sperm count for. I'm just using that as an example.

Scott: Sure.

Mark: Alzheimer's. We're living longer but that's thanks goodness to the miracles of

modern Western medicine. They're great when it comes to saving us during those acute moments, but I don't know. Back to your ADHD question, I would

have to say and want to say this. I always think about it and then I think to myself it's true. When I see ADHD, I see sleep-disordered breathing almost 100 percent of the time, and I can verify that.You see other things too. You see the

teenage angst and the zombie-like behavior. You see a lot of risks taking and recreational drug use. When you're tired, you're looking for answers. I see a lot of waking. A lot of teenagers start eating junk food, big bags of Doritos and cookies because they're looking for an answer. They're deadtired, exhausted and


not able to fix themselves at night−their brains and their bodies−because they're not sleeping well.

There are tons of studies and connections, and it's not just correlation with ADHD and sleep. There are sometheories on how it affects that part of the brain. The brain is cleansed every night we sleep. It actually shrinks a little bit. There's

a glial lymphatic system of drainage. The brain produces a lot of toxins. It's a big energy user; hence, there are a lot of toxins at the end of the day. Long term memory consolidation occurs at night if you're in deep sleep. Sleep repairs the brain. If you're not sleeping well, your brains are wrecked the next day. Next

time you see your teenager, I would feel sorry for him if they're not sleeping well.

Scott: Yes and the cumulative effect of that superimposed on a time in life where there is these multiple stressors, the brain is not properly rested and that does not inure to good decision-making capacity. They're going to make some poor decisions, both in something that requires split-second cognitive decision-

making like driving or even maybe scoring lower than they otherwise would on the SAT or one of the other performance measuring tools that they're up against at that point in their lives.

Let's talk for a minute about The 8-Hour Sleep Paradox. I highly recommend the book to everyone listening here on the Summit. It's very well-written. It's written such that it can be understood and read as you point out more by

dentists. I would hope that thereare some physicians reading it as well. As a dentist myself and as a healthcare consumer wrestling with severe OSA, I found it very informative. It's a manual, if you will for understanding, evaluating in yourself or perhaps in your partner sleep-disordered breathing and strategizing

what to do about it. Going back to your personal story, but I'm sure there are other reasons, what was the main impetus in your writing The 8-Hour Sleep

Paradox?

Mark: It came out of frustration for so many people that I saw suffering. Slowly, as I

came online with being able to recognize sleep apnea or sleep-disordered breathing in my practice, I realized how prevalent it was. Back when I was

getting into this 10 to 12 years ago, they were talking about maybe six percent of the population having sleep apnea. I was looking at my practice, taking notes, checking my computer database and sampling of 5,000 patients. It was 28

percent. Itdepends on how you look at it. Those numbers just didn’t jive. I went back and looked at those patients again and make sure I was looking at this correctly. So I think it was really a little bit of anger too and frustration that there was this disconnect, it wasn't being addressed and some of the patients

suffer. That's not something that I'm really used to, so I felt I had to do something.

I voiced this to my daughter, who also has a little sleep apnea. She's young and

fit as well but it's a family trait certainly. She said,"Dad, let's get that message out there. That's a little bit of what www.askthedentist.com is about." Similar story. Not everyone has access to this information and they may be seeing a

dentist that does not get this information. Unfortunately, it does happen and that will change hopefully. So between her knowledge of the social media, computers and internet and my frustration, and also when she helped me write the book, it was a perfect balance of my frustration having known what I


know,but also, "Well, dad. What's a PSG?" I would just write down, well get this and then she would look at it from the lay person view, "Oh, why should I get

this PSG and what does it mean? Isn't there something else out there that's easier?" So that bounced back and kind of working together with different perspectives.

It just came to be. It took us a year and we worked on it. We would take weeks off the time and go up into the mountains to a cabin and just pack this out. We actually took out a lot of stuff that I wanted in there, like development of the airway, a lot of dental nerdy stuff and medical stuff. Thank goodness! She

looked at it from her point of view and "Dad, that's irrelevant. I want this to read in such a way that everyone can just quickly, in a matter of three or four hours, have an action plan of what to do and cut through all the confusion and

all the noise." Scott: Once again, speaking directly to the healthcare consumer, and it sounds like she

gave you a really good sounding board for that such that in collaboration, you

could produce something that I can tell you as a dentist, it still got some nerdy stuff in it but it's very understandable.I'm a writer in my day job, and I write both for consumer audiences, as well as dental/medical audiences, and The 8-

Hour Sleep Paradox to my observation strikes a very hard to come by balance in that it presents meaningful actionable information that is by no means dumb down but is very understandable to both the clinician audience, as well as the consumer audience; especially, the consumer who is building his or her research

base and is getting empowered and developing a better sense of advocacy, which of course is one of our main goals here on the Functional Oral Health Summit.

Mark: Very high praise coming from you, Scott. Thanks for noting that. It was important to us to make it readable and not painful because the whole process is painful. That's thelast thing we did not want to add to that burden.

Scott: Yes. The writing process itself, I can attest,is very difficult. Making it clear and

understandable, that is no easy task. I highly recommendThe 8-Hour Sleep

Paradox to everyone on the Summit in our audience membership. Now Mark,

you are a medical advisor on two products that are forming part of a wave of future testing for sleep-disordered breathing. Without getting too technical and without divulging too much information, you have a home sleep study that

you're an advisor on called "The Every Man Sleep study." Is that right? Mark: Well, that's what I call it. That's what I've been calling it for the last eight to

nine years. We need that every person's sleep study. I referred to it earlier in

the show. We need something where we can verify and diagnose our sleep, if it's sleep-disordered breathing or not, and then as we age and get older, as women approach and get menopause. I mean sleep apnea can appear any time. So we do need something other than a PSG.

So when I met the founders of Knithealth, I was very excited. They're actually was so different and so disruptive in a way that I didn't get it at first. I looked at

and so that's interesting. It actually started as a baby monitor. The camera, it's a very sophisticated camera that's very easy to build. It's got great software and an algorithm. It's easily mounted in any hotel room, baby's room or your room. You can move it around. It's as simple as just witnessing poor sleep. Having


worked with the other medical advisers, neurologists and seeing how they respond to it, it's really something. As we talked earlier, it's very convincing.

Forpeople that don't think it's a problem, when they see themselves suffering at night, choking, striving to thrive and gasping, that's pretty dramatic. But it's a wonderful and inexpensive. Everyone can get this. This product will be launched very soon in a few months. I will put out a big press notice on my

websitewww.askthedentist.comtalking about it. It's going to be exciting. It's something I've been wishing for a long time for my patients and for everyone, not in this form of course, because I didn't know about it.It is more information, cheaper to get and more readily usable. You can use it every night. You don't

have to sign up for a sleep study and ask whether insurance is going to pay for it or not. It's wonderful.

Scott: Onceagain, placing that healthcare consumer in the position of empowerment, advocacy and simplicity to put them in the position of gathering hard scientific data that can be presented to the medical community and insurance community to justify and to prove exactly what is happening, and to prove to the patient or

the partner himself or herself that there is an issue, because footage like that is hard to argue with. Where can our audiencemembers check this out? Is there a website?

Mark: At www.knithealth.com currently. Scott: Very good. So audience members--

Mark: Go to my website. I'll announce it when it's live and talk about it but yes, I'm

very excited. I'm very pleased that it's come along so quickly and it's more effective than we even thought it could be. I mean it's wonderful and nothing

gets glued to your face or to your chest. Scott: Imagine that.

Mark: I know. It's amazing. Scott: People who are used to taking PSGs aren't going to have to deal with that.

Mark: Right, exactly. There are a lot of patients that won't do a PSG because they

won't sleep somewhere else, without being able to lock the door. You can't do

that in a sleep study. There will be a lot of people that now have access to sleep study just because of that one fact alone. I can go on with other reasons why people won't get a sleep study. So it democratize diagnostic device.

Scott: That is a major thing of what we've been talking about here today. Definitely,keep your eyes open for that folks, making things easier and putting more power into the hands of the healthcare consumer. Education and empowerment, that's what we're all about here. Dr. Mark Burhenne, do you

have any concluding remarks? Is there anything else that you would like to say to our Functional Oral Health Summit audience?

Mark: Absolutely. There's always something to say. It's just a matter of how to sum it all up. I just want to say that dentistry as a whole, I mean we've been putting charge of--I don't think we even realize how important and how serious it is. We've been putting charge of the only non-shedding surface that erupts out of


the body−the teeth. If you think about that and the analogy to that, it's not a great analogy. It would be like a compound fracture. It's like the bone sticking

out of your leg.If that was the case and you would see that and the potential for infection and death, you will get very excited about it. Unfortunately, I think we could be doing a better job of describing the importance of what goes on in the mouth and how complicated it is to control these teeth that have erupted out

through into the oral environment.

So I just want to say that in general,find a dentist that is talking about sleep development of the airway, the oral microbiome, not using mouthwash because

it's killing everything in the mouth. I would just say find someone that is writing a book like this on sleep, someone who's enlightened and is looking at the mouth as a major contributor to overall health. That's the oral systemic

connection. There's a study back in I thinkit's in the 80s that gum disease is a greater predictor of total morbidity than heart disease is. That's how important oral health is, and sleep and development of the airway is part of that.A good place to start would be reading my book. There are certainly many other

avenues of getting information on that on the web, but make sure you're seeing a dentist that is thinking the way of what I just described. It could save your life.

Scott: Not coincidentally, the information that is coming to light now about the

causation relationship between periodontal disease and coronary disease, and we are fortunate enough to have Dr. Amy Doneen here on the Functional Oral

Health Summit who will be speaking to that and the seminal paper that she, Dr. BradlyBale and theirother coauthor published in the British Medical journal. I think that is a perfect way to tie it together and to give people one more clue in this great puzzlethat healthcare and the medicine and dentistry working

together and solving that.

Folks, we've been talking with Dr. Mark Burhenne. He is a family and sleep

dentist from Sunnyvale, California, creator and author of www.askthedentist.com and number one bestselling author of The 8-Hour Sleep

Paradox. He has appeared in Tedx, multiple TV and radio venues including the Huffington Post, CNN and CBS News. He's a member of the Academy of General

Dentistry and the American Academy of Dental Sleep Medicine. He has given us some tremendous problem solving skills that you ourFunctional Oral HealthSummit audience members can put into your bag of tricks and be your

own and your child's best advocate inassessing out this huge undiagnosed problem that we have with sleep-disordered breathing and sleep apnea, and the critical role that your educated dentist and you, the educated dental healthcare consumer, all the avenues that you can pursue to collaborate to make sure that

you are healthier. Dr. Mark Burhenne, thanks so much for being with us here on the Functional Oral Health Summit.It's been a great privilege and as always, a pleasure speaking with you.

Mark: I'm glad to be part of the discussion. Thanks for including me, Scott. Thanks.

the 8 -hour sleep paradox – why you probably have … · probably have undiagnosed sleep apnea...

Documents