Optimizing Sleep with Dr. Jared Bloxham

March 1, 2024

In this special episode of the Invigor Medical Podcast, hosts Natalie and Derek welcome Dr. Jared Bloxham in-studio to share his expertise in dental sleep medicine and his personal journey into becoming a sleep apnea specialist. Discover the importance of sleep for overall health and well-being.

Time Stamps:
0.00 Sleep apnea and oral facial pain.
1:08 Sleep apnea and its impact on dental practice.
5:18 Sleep quality and quantity
8:43 Sleep apnea and its effects on sleep quality.
14:12 Sleep apnea prevalence and causes.
17:13 Sleep-related breathing issues in children.
20:49 Symptoms and diagnosis.
26:28 Sleep apnea and its impact on overall health.
29:58 Sleep’s impact on physical health and performance.
33:05 Sleep hygiene and circadian rhythms.
35:35 Sleep quality, sleep apnea diagnosis, and treatment options.
41:49 Pillows for proper sleep and neck pain relief.
45:06 Nasal breathing and mouth taping for better sleep.
47:54 Nasal breathing and facial deformities in children.
52:22 Sleep and its impact on health.
55:06 Dreams, REM sleep, and vivid dreaming.
58:03 Sleep hygiene and dreams with a sleep specialist.

Click Here For Sleep Checklist


Natalie 0:00
Hello, and welcome to the Invigor medical Podcast. I’m Natalie Garland here with my lovely co host, Derek Berkey.

Derek 0:05

Natalie 0:05
We are same side today, which is a little bit weird. It’s a little bit odd. We’re used to having most of our guests via the internet. But we’re lucky enough to have our guests in studio today. Very excited to have in the studio, Dr. Jared Bloxham, who is an oral facial pain specialist and dental/sleep medicine expert, and Dr. B accidentally fell into becoming an expert in sleep apnea. Really excited for Dr. B to share his expertise in sleep and sleep well being and achieving optimal sleep and kind of coming at it from a bit of a unique angle. So welcome to the studio Doctor.

Dr. Jared Bloxham 0:43
Yeah! Thanks for having me. I’m glad to be here.

Natalie 0:45
Yeah, we’ve already done as we typically do a few pre conversations before we hit record. And then it’s like I want to keep going. I’m like gonna save it. See record the podcast. So I think if anybody listening is hearing, you know, accidentally became an expert in sleep apnea, like, how does that even happen? So maybe just start with giving us a little bit of the background on, you know, what you got started in? And then kind of how it evolved and got you here?

Dr. Jared Bloxham 1:08
Yeah, so I’ll tell my story real quick.

Natalie 1:10
Yeah, please.

Dr. Jared Bloxham 1:11
I was graduated from dental school, actually, in 2003, and was a general dentist. And so I opened a practice in 2005, here in the Tri Cities. And over the years, I had some neck injuries and some neck problems earlier on in life. And over time, those started to cause some problems for me. And I ended up with some…

Natalie 1:28
I can imagine like, leaning over being a dentist.

Dr. Jared Bloxham 1:29
Yeah, it’s a rough job for the anybody with neck or shoulder injuries. And so I ended up having to have a couple of neck surgeries, I had a disc replacement and a fusion and I couldn’t do the bent over drill and fill anymore. And so I had to retire. And sell my practice and…

Natalie 1:43
Probably not what you were expecting at all.

Dr. Jared Bloxham 1:44
No, not not what I was expecting at all.

Natalie 1:46
Not in the twenty year plan.

Dr. Jared Bloxham 1:47
No, you know, retiring early, it’s nice, but when you’re not ready for it, and when it’s forced upon you, it’s a little bit different than you choose it. And so retirement and I didn’t get along. And so I ended up going back to school for to do a residency, and a master’s degree in oral medicine and orofacial pain with the University of Southern California. And so with that, I was able to do a lot of that online, and then I was down there in person doing some of the clinicals. But one of the things-the issues that I have myself are nerve issues and pain in the head, neck and face. And so when I started kind of doing a little bit of research into that, as I Hey, this is some pretty cool stuff. And it’s I don’t have to do that bent over drill. And Phil, I can really help people that are dealing with some of the same issues that I have. And so I went through that program, and then came back to the Tri Cities and opened up a practice two months before COVID hit.

Natalie 2:37
Oh great. Perfect time.

Dr. Jared Bloxham 2:39
Yeah, you know, you could go back in time and talk to yourself, I’d be like, you know, just take it easy hold on a little bit. But so we got shut down, of course, like anything else for a while. And then as soon as we did, the restrictions were lifted, we were able to get back into practice and the sleep aspect of it many years ago, probably 12 years ago, here in the Tri Cities, I was working with a sleep position as a dentist and we were making oral appliances for patients that couldn’t tolerate a CPAP it’s one of the alternatives to CPAP machine for sleep apnea. And he was like, you know, if you’re gonna be sending patients over here to get these sleep studies done, you should probably get one done yourself. And so I did, I went and I got the sleep study done. So you go and you’re basically sleeping in a hotel room with cameras watching you and people watching you and, and you’re attached to a whole bunch of different monitors. And it’s like, Here, let’s attach you to everything. And now sleep really good. And so I did that. And then the next day, he called me up and he’s like, we need to talk. And so I went into his office, and he’s like, Yeah, you have severe sleep apnea.

Natalie 2:39

Dr. Jared Bloxham 3:34
And I was like, Well, my wife, my kids told me that I snore. And I just thought I was getting older. And I started to recognize some of the things in my health that were associated with poor sleep. And so when I later went back and did my residency and training in orofacial pain and oral medicine, and I didn’t realize how deep into sleep I was gonna have to get. So one of the things that we were working on we are you know, they’re teaching us Dental, sleep medicine and oral appliances, and how to recognize these and, and it kind of took over. I started recognizing some my own issues and then from an orofacial pain standpoint, because that’s kind of my my specialty is orofacial pain. A lot of the individuals that came in that had jaw joint tissues and facial pain from muscle issues. It was related to sleep related breathing disorders.

Natalie 4:17

Derek 4:18

Dr. Jared Bloxham 4:18
And I didn’t realize how deep into that I was going to have to get and so we actually changed the name of our practice to recognize that so now our practice is the Columbia Center for Sleep Apnea and TMJ.

Natalie 4:30

Dr. Jared Bloxham 4:30
And yeah, so, we’ll have some fun stuff to talk about.

Natalie 4:33
Yeah, I think I think the thing that excites me the most is I think anybody who’s on a path of bettering themselves for health and longevity, has some idea of the importance of sleep in the quality of your sleep has some idea and has probably looked up something or heard something about how to optimize sleep, how to get good sleep, how important it is. And I’m excited for this conversation because I think it’s going to open up a whole pathway of Like, holy smokes, I never even thought about that being an issue for sleep, because I think there’s this idea that it’s like, oh, if I fell asleep, you know, by 10. And I don’t remember waking up till seven, I got a good night’s sleep.

Dr. Jared Bloxham 5:13

Natalie 5:13
Fact or fiction.

Dr. Jared Bloxham 5:15

Natalie 5:15

Dr. Jared Bloxham 5:15
So we can get into the talk. And we’ll dig a little bit deeper into this, but the the quality of sleep versus the quantity of sleep. So we sleep in stages, our brain is going through different activities as we’re asleep, and somebody can go to sleep and wake up in the morning, and the alarm clock will say, Hey, good job, you know, you got you got eight hours of sleep. And your body’s telling you, there’s no way you got eight hours of sleep.

Natalie 5:36

Dr. Jared Bloxham 5:37
And so the quality of your sleep versus quantity of sleep can be very different, you can, you can get your eight to 10 hours of sleep, and your body might not get the same regenerative and benefit as getting three hours of quality sleep quality

Derek 5:50
That’s really interesting. So what are some of the main factors that can cause the discrepancy between quality of sleep and quantity of sleep.

Dr. Jared Bloxham 5:57
So a lot of times the quantity of sleep, some of us still sleep is like a nuisance, it’s like, you know, I’m gonna go to bed at 10, I’m going to wake up at six. And, you know, so there’s my eight hours, and we’re gonna call it good. But again, if you if you get that eight hours of sleep, but you’re never getting into deep sleep, so either like stage three, or REM sleep, which is the where your brain is kind of – REM is when your brain is really active stage three, you know, your body is going to be getting that regenerative sleep, and I often explain it as like junk food, sleep versus nutritious sleep. And when the first couple of stages of sleep, they’re just junk food, sleep.

Derek 6:31

Dr. Jared Bloxham 6:31
You know, you’re you’re asleep, you’re tired, but your body’s not going through those same physiological activities that are going to give you a refreshing feeling in the morning where you woke up, he like merited to go through my day. Well,

Natalie 6:42
let’s just sorry, can we just take one moment, because I think we’re gonna be talking about the different phases and cycles of sleep probably alot. So for anybody listening, that doesn’t have a really clear picture of what the cycles of sleep look like, would you take a moment and just kind of explain that so we have like a 10,000 foot view leading into the rest of the conversation?

Speaker 1 6:57
Yeah. The the general is you have deep sleep and light sleep. Then we actually have four stages of sleep that we recognize. And at stage one, two, and three, and then REM sleep. And stage one and two are light sleep stage one is you’re usually not in it very long at night at all, it’s just you’re, you’re just kind of nodding off and getting into sleep. Stage two is that light sleeper, it’s still pretty easy to arouse you and, and your brain is not going through a lot, your body’s not going through a lot. You’re just light sleep. And then stage three and REM sleep there, the deep slow wave sleep where your brain is – in REM sleep, your brain is really, really active. So but your body is not. And so we can break it down into stage one, two, and three, and then REM sleep, or we can just break it down into deep sleep and light sleep.

Natalie 7:36
Okay. I gotcha. So weird kind of question. But if I feel like I rouse pretty easily but sometimes my my 22 year old sister is living with me right now. And there’s been a couple of times where she had to wake me up for something. And I literally gasp, jerk awake when she’s like, “Why do you always do that?” I’m like, I don’t know, I must be like, in really deep sleep cycle. Because normally I’m just kind of like, can hear someone come in the room.

Derek 7:57

Natalie 7:57
If it’s like in the morning, and I’m already coming out of sleep, but it’s literally, I almost hit her in the face once because like Is that am I in a really deep sleep cycle?

Dr. Jared Bloxham 8:05
Usually in a deep sleep cycle, it’s a little bit tougher to wake you up. So that’s usually that transition between light sleep and deep sleep.

Natalie 8:13

Dr. Jared Bloxham 8:14
So that’s when your brain is just kind of switching gears where your brain becomes a lot more active and your body becomes a lot less active.

Natalie 8:21
That’s funny. Interesting.

Derek 8:22
So I have another question. You mentioned a term regenerator and regenerative sleep.

Dr. Jared Bloxham 8:28

Derek 8:28
Say that 10 times fast. But what about because – so where does that fall in the scale of 1, 2, 3? And what about it specifically makes it like regenerative? Like…

Derek 8:39
Yeah, great question.

Derek 8:40
Is that regenerative for the mind? For the body?

Dr. Jared Bloxham 8:42
All of the above.

Derek 8:43

Dr. Jared Bloxham 8:43
And so when we’re in stage one and two sleep, that’s again, that light sleep, we’re not getting kind of that disk cleanup. So in the stage in REM sleep, we actually have our the chem the fluid on our brain, our cerebral spinal fluid is actively moving, and it is doing like a hard disk cleanup of the day’s activity. So we’re sitting here talking, we’re thinking we’re working, our brain is active, it’s metabolizing fats and, and it is producing proteins that are waste products. Those protein waste products when we’re in REM sleep that cerebrospinal fluid actually does a disk cleanup. And so if that is not happening, then you wake up in the morning, and we see people with that are not getting into REM sleep, they will have memory issues, they’ll have cognition issues, they’ll have somebody that does not get into REM sleep on a regular basis, they have a severely increased risk for dementia and Alzheimer’s.

Natalie 9:38

Dr. Jared Bloxham 9:39
Because those proteins that are generated, they build up and they start to cause some damage and some some basically connective issues in the brain where those nerves can’t quite do the same things that they’re supposed to.

Natalie 9:49

Derek 9:50

Natalie 9:50
So what are some of the things that keep us from getting from that light sleep to that deep sleep because I’m guessing if I had to guess it’s like most people would say they kind of fall into the phase one or two of that light sleep. And the issue is getting into that three and REM sleep cycle.

Dr. Jared Bloxham 10:07
Yeah. And that’s what I deal with mostly is those patients that don’t quite get into that REM sleep, and for the over 40 million Americans have sleep apnea or a form of sleep related breathing disorder. So we hear of sleep apnea. And we’ll just kind of define that.

Natalie 10:23
Yeah, please.

Dr. Jared Bloxham 10:24
What does that mean? What does that mean? So an apnea is a stop in breathing. And so for somebody to have sleep apnea, they have to have a test, they have to have a a stop and breathing or a reduction in breathing, that leads to a drop in the oxygen levels in your blood.

Derek 10:38
That’s really terrifying when you think about it.

Dr. Jared Bloxham 10:40
It is.

Derek 10:40
That’s terrifying.

Dr. Jared Bloxham 10:41
It’s even more terrifying if you take like one of the pulse oximeter, you know, that just measures the oxygenated blood, and you put it on your finger and you hold your breath for as long as you can. And you’ll watch to see what happens. Now for an apnea, you have to have a reduction of at least 3%. And depending on the testing is three or 4%. Yeah. And so I can hold my breath for about a minute, and I can get my oxygen levels to drop about 2% in that minute.

Derek 11:02

Natalie 11:02
Oh my gosh. So you’re stopping breathing enough with sleep apnea that it’s dropping well below what you just holding your breath for a minute.

Derek 11:09
Right. That’s crazy.

Dr. Jared Bloxham 11:10
With the apnea, we, when we’re doing testing for apnea, we’ll look at, we like to use numbers, we’d like to be able to classify things and so we call it an AHI or Apnea Hypopnea Index. And that’s how many times per hour do you stop breathing to the point where your oxygen levels drop. And for mild sleep apnea, it’s anywhere from five to 15 times per hour, that happens for moderate is 15 times to 30 times per hour that happens and for severe sleep apnea that happens over 30 times per hour.

Natalie 11:36
I feel like my I feel my heart rate increasing. By just having this conversation I’m like, stressed about not breathing even though I’m awake right now. Like I just can’t even imagine.

Derek 11:47
So I was noticing something I really like to try and dive deep like you tell me about this stuff. I’m like, oh, man, I’m so interested in like, how does it actually work? Because like you hear, you know, you’re you don’t have oxygen. That’s terrible. But like, Why? Why is that actually terrible. Like in specifically for sleep quality? Obviously, we know that if you if you don’t breathe, you’re going to pass out.

Natalie 12:09
Well and sure, but you start breathing again with sleep apnea, right? So it’s like…

Dr. Jared Bloxham 12:13
As soon as your brain says, Hey, we’re in panic mode now. Yeah, so your brain and your body go through the same responses. If a tiger is chasing you, and you have an apnea event, yeah. And you have that release of adrenaline and norepinephrine, your blood pressure goes up, your heart rate goes up and your body goes through quite an ordeal when you have an apneic event.

Natalie 12:31
I mean that makes sense.

Dr. Jared Bloxham 12:32
The problem that we run into from a sleep quality, if you have one of those apnea events, your brain will never let you get into REM sleep. So in REM sleep,that is when…

Natalie 12:41
Because its like on high alert.

Dr. Jared Bloxham 12:42
…our brain is highly active, but our bodies, we don’t have any muscle tone.

Derek 12:44

Natalie 12:45

Dr. Jared Bloxham 12:45
Paralyzed. Yep. So and so your body won’t let you get into that deep sleep because you’re too relaxed, and your airway will close off. And then that oxygen level will drop in your brain has that panic response. And so it’s a Yeah, from a quality standpoint now from what it does to your body, whenever you have that drop in oxygen. The first areas that are affected by that are going to be the small blood vessels in your heart and the small vessel blood vessels in your brain. Those are the areas that are oxygenated first. And of course. Then that oxygen has to go to your muscles and on all the other parts of your body. But those the small blood vessels in your heart, the small blood vessels in your brain, sleep apnea, or any sleep related breathing disorder increases your risk for heart attack and stroke by over fourfold. So 65% of patients that have a stroke have sleep apnea. And it’s because it damages those little blood vessels around your heart. So you have the lack of oxygen, and it causes that hypoxia or the damage to that blood vessel. And that’s happening all the time. So those blood vessels, they almost get like scar tissue, they harden up and so it’s called atherosclerosis or, and so they harden up and then they start to build up those plaques. So it increases risk for heart attack. And then same thing happens in your brain and increases your risk for stroke. And…

Derek 13:49
Is a – we had another member or a guest on the podcast named Richard Johnson and he talked a lot about amyloid plaques. Is, does that uh…

Dr. Jared Bloxham 13:58
Those are the amyloid plaques. So that amyloid protein and the tau proteins and those amyloid those are the plaques that build up in your brain that when you’re in REM sleep your cerebrospinal fluid does a full clean out.

Derek 14:08
Clear out.

Dr. Jared Bloxham 14:08
It actually flows and removes those byproducts and helps you.

Derek 14:12

Natalie 14:12
But if you’re not in REM sleep, that’s not happening.

Dr. Jared Bloxham 14:14
If you’re not hitting remsleep, that’s not happening.

Natalie 14:15
And if you’re having sleep apnea, you’re never getting REM sleep.

Dr. Jared Bloxham 14:17

Natalie 14:18
All right.

Derek 14:19
So so we have a very dismal picture here.

Natalie 14:21
Yeah! It’s not great.

Derek 14:22
So maybe we can look on the bright side is like how do we how do we, how can people address this?

Natalie 14:27
Well, before we go there, though, I’d like to backtrack a little bit because I think we touched on this. I think it was before we were recording, it’s kind of all overlapping. Because I think that it’s kind of a two fold question. I’m wondering how many people are suffering from sleep apnea at a mild level who are completely unaware? I wonder if you have an idea of percentages, you could give us that if you could. And the other one being why is this becoming more and more prevalent?

Dr. Jared Bloxham 14:51
Great question.

Natalie 14:52
Because I feel like the question is right, like, you know, it used to not it’s kind of there’s other things that are also happening, you know, from a scientific and health standpoint that it’s like, well, we never used to see this, but now we are. So it’s like, is it just more awareness that’s happening or is there actually more cause and effect going on with something like sleep apnea, so kind of a two parter for you there.

Dr. Jared Bloxham 15:11
So there’s, it’s happening more frequently. So we’re better at recognizing that is, it’s also happening more frequently. And so nobody just wakes up one day, they’re like I have sleep apnea, right? It’s something that your body has to go through. Now normally, your body has protective mechanisms that are built in. So for sleep apnea, it’s for 90 plus percent of us that have it, it is a narrowing of the airway. So you get into REM sleep, the muscles of the tongue, relax the throat muscles, relax, the jaw relaxes, and that airway starts to narrow, and the brain will, your body will recognize that and say, Hey, I’m not breathing as good as I can. So it kicks you out of that REM sleep where you don’t have any muscle tone, and it kind of kicks you into a lighter stage sleep where theres loss of muscle tone. So for some individuals, they will clench the jaw, they’ll move the tongue forward. So for a lot of individuals that wake up in the morning, it’s like their jaw is tired, their neck muscles are tight, it’s because their body is trying to hold that airway open. And then when we’re looking at kind of that, cause that can even start as young as infancy. And so we’re starting to recognize this in the last eight to 10 years, we’ve recognized that a lot more. And so even lactation consultants, speech and language pathologists and pediatricians and nurses are starting to recognize that a lot more in kids, and some of these tendencies, but even a child that is breastfed will have a lower chance of developing sleep apnea down the road than somebody who was not breastfed. And that’s because the way our bodies develop, when they are challenged, they develop stronger and bigger. So like a bodybuilder can, if they’re lifting weights hard, their muscles are gonna get bigger, their bones are getting a bit bigger. For an infant that is breastfeeding, they have to work a little bit harder to get their food.

Natalie 16:48

Dr. Jared Bloxham 16:48
So the jaw muscles develop differently, the airway muscles develop differently, the tongue develops differently, the roof of the mouth develops differently, the floor of the sinuses develop differently. So our entire airway develops because the demands are being put on it.

Natalie 17:00

Dr. Jared Bloxham 17:00
So if you have a child that is that has a nipple from a bottle, that’s easy to get that milk, and they don’t have to work as hard.

Natalie 17:08

Dr. Jared Bloxham 16:48
Those muscles don’t develop the same way. The airway doesn’t develop the same way. The jaw doesn’t develop the same way. And eventually, they’re going to be at an increased risk for developing a sleep related breathing issue, like upper airway resistance syndrome, or sleep apnea.

Natalie 17:21
Mm hmm. And I do remember, I mean, my kids are 11, and eight, and I did breastfeed, but I also like, pumped and held bottle, I do remember, though, even that long ago, and hopefully there’s even more of it, seeing there were like a few like bottles and cups that were designed specifically to help encourage proper growth of the soft palate, right. And so that I mean, I always assumed it was really more for just like teeth structure and things like that. It never would have even occurred to me that it plays into, you know, far reaching into their adulthood and the quality of their sleep and ability to breathe. Yeah, so that’s wild.

Dr. Jared Bloxham 17:55
So we recognize that a lot more clearly now. And even things like you know, when when somebody is pregnant, the baby, even gestationally it can develop a little bit differently. So we started adding folic acid to prenatal pills, pills, and vitamins. And that was to prevent and decrease the risk for Spina Bifida, which is an opening at the end of the spinal cord. And it’s because the baby is developing, the two sides of the tissues come together and they form at the midline. And those midline structures have to kind of join up. And so we’re using folic acid to help that physiological…

Natalie 18:31
Which happens too in the development of the soft palate, right, which is when because you wouldn’t know…

Natalie 18:37
Cleft lip and palate.

Natalie 18:37
Thank you. Cleft because that’s where it’s coming together. That makes sense.

Dr. Jared Bloxham 18:40
So just by using folic acid, one of the midline structures is the frenulum. It’s the attachment underneath our tongue. And so the incidence of tongue tie has increased. But that tongue tie, what it does is it keeps the tongue down in the floor of the mouth and up, not up against the roof of the mouth, that makes it so that the airway is more narrow, or the dental arch is more narrow. And then that tongue kind of sits back a little bit further, and the airway doesn’t develop the same. So some of the things that we’re starting to be able to tie together are really kind of cool.

Derek 19:09
That is really cool.

Natalie 19:10

Dr. Jared Bloxham 19:10
We’re starting to catch it. So some of these kids that have these issues, we can correct them and be aware of them so that when they’re adults, we don’t have some of these same issues. Yeah.

Natalie 19:19
Anything else beyond like childhood that’s playing a role in sort of in this and what and sleep apnea?

Dr. Jared Bloxham 19:25
Yeah, and kind of continuing forward into adolescence. And, you know, we could talk a lot about, even with kids, some of the sleep related breathing issues that we weren’t recognizing, ADD ADHD. 70% of the kids that were diagnosed with ADD ADHD, had a sleep related breathing disorder.

Natalie 19:43

Derek 19:43

Natalie 19:43
That’s crazy!

Dr. Jared Bloxham 19:43
We used to wonder, this is really cool. Like, we used to wonder why would we give these kids that have ADD and ADHD, why would we give them Ritalin or Adderall? Those are stimulants. So what these kids that are hyperactive, we’re stimulating them?

Natalie 19:55

Dr. Jared Bloxham 19:56
And what the research was pretty clear about was those same kids that were diagnosed with ADD and ADHD 70% of them were responding favorably to those medications that was helping them with their ADD ADHD. And that’s about the exact percentage that have a sleep related breathing disorder that was not diagnosed. And so anybody that has kids or has been around kids will recognize, hey, when kids are cranky and tired, they are a little bit hyperactive, they’re they’re grouchy, they’re not able to focus, and they act out. And so we were taking these kids that were beyond tired, and we were stimulating them back up to their baseline level with stimulants.

Natalie 20:37

Dr. Jared Bloxham 20:37
And so, yeah, now it’s normal practice. If a child has ADD, ADHD, they should have a sleep study. That needs to be addressed and needs to be investigated.

Natalie 20:49

Derek 20:49
That is very interesting.

Natalie 20:50
Okay, so then back to the first part of that question, because I’m curious, before we go into, like, how can we deal with this is like, I’m curious how many people are suffering from sleep apnea, or something close to it, that are just completely unaware and are just like spinning their wheels trying to figure out how to get better sleep? Or maybe they think they’re doing great? Because, you know, they go to sleep at night and wake up at seven? No issue, they think, but what is the what is that? Like? Do you have a general percentage of how many people?

Dr. Jared Bloxham 21:14
There, about 40 million people, adults in the US are known to have or suspected to have sleep apnea based off of the studies. But even before that, there’s a diagnosis called upper airway resistance syndrome, that’s basically a narrowing of the airway. And so that one is a little bit harder for us, because we have to do some additional testing. And so, but the general consensus is that about one out of every three adults has some form of sleep related breathing disorder, that is affecting their quality of sleep.

Natalie 21:45
That’s wild.

Derek 21:45
So so how can people because obviously, it’s very common one in three, I mean, that’s yeah, there’s three of us here.

Dr. Jared Bloxham 21:52
I’ve already been tested.

Derek 21:53
Okay! Well there ya go.

Natalie 21:54
I haven’t been tested.

Dr. Jared Bloxham 21:54
You guys must be okay, right?.

Derek 21:56
Hopefully. But how can someone find out? Because it’s like, you’re what you’re saying is you might not even know they have this? So what are the telltale signs? Is it just that you wake up in the morning, you feel terrible? And you’re like, Man, I got hit by a truck. And I don’t know why I got eight hours asleep? Or are there other signs you can look for?

Dr. Jared Bloxham 22:13
That’s one of the more common ones. And especially when we’re talking about the upper airway resistance syndrome, that’s basically a narrowed airway. And this is a lot more common, you know, we used to look at sleep apnea- we’re like, it’s just the fat old men that. And then what we recognize is that a lot of the petite females that that don’t have sleep apnea have the upper airway resistance syndrome, that’s a narrowing of the airway. So as soon as you get into REM sleep, that airway narrows down. And so that’s harder to recognize sometimes, because with sleep apnea, you kind of think of, you know, 94% is going to for percentages, people that have sleep apnea, 94% of them will snore, so you can have snoring, but not sleep apnea. But typically, if you have sleep apnea, you probably snore.

Natalie 22:13

Dr. Jared Bloxham 22:13
And so that’ll be one of the big ones. So if your spouse is sleeping in a different room, you probably have sleep apnea. So the noise is a big one, yeah, recognized apneic events where it’s like, Hey, you stopped breathing, I gotta kind of elbow you to get you to start breathing again, those are the ones that are very blatant. Some of the ones that are not as you know, kind of in your face. For like for the upper airway resistance syndrome, a lot of times it’s hard to even tell if they’re breathing, so it can be shallow breathing. The other some of the kind of the telltale red flags that we see for patients. nighttime urination, that’s an interesting one.

Natalie 23:32
Okay, like getting up to have to pee in the night?

Dr. Jared Bloxham 23:33
Getting up to use the restroom.

Natalie 23:35

Dr. Jared Bloxham 23:35
And that’s because anytime you have one of those apneic events, your heart rate goes up, your body goes through a panic response. So your heart rate goes up, your blood pressure goes up, and your body releases a peptide that tells your kidneys, hey, we’ve got too much fluid onboard. So during the middle of the night, your kidneys are producing more urine than during the day. So we’ll ask questions to patients like that. Heartburn is another one. So gastric reflux. So and that’s kind of think of the the airway as a tube. And for those of us who have sleep apnea, there’s a kink in that tube. And so your chest diaphragm, diaphragm muscles are still moving, the rib muscles are still trying to breathe air in. But instead of bringing air in easily, you create a negative pressure at the top of your stomach. So you’ll actually get the gastric reflux at nighttime. And also you can get what’s called laryngopharyngeal reflux. So that’s the acidic vapor. So waking up in the morning or congested, where it’s like, Man, I wake up in the morning and I’m congested. It feels like I have allergies and then by 10 o’clock or noon…

Derek 23:35
You’re fine.

Dr. Jared Bloxham 23:35
…Everything feels okay. And I’m fine. Yeah, so there are a lot of these things that when when we start asking patients, you know, some of these questions, they’re like, Yeah, I do. I do have that. And we just start like, red flag, red flag, red flag.

Derek 24:41
The big picture starts coming together.

Natalie 24:42

Dr. Jared Bloxham 24:42
Yeah, it starts coming together. It’s like, well, you know what, and and even those active muscles you know, during, during the nighttime from an orofacial pain standpoint, and why it affects the pain so much is during the night if those muscles are activating to help hold the airway open. They can activate with twice as much force at night while we’re asleep then they can during the day because the body doesn’t recognize some of the pressure sensors that tell us how hard we’re biting down. So they wake up in the morning. And it’s like, my face is tired, my neck is tired. It feels like you’re, you’ve been on your heads been on treadmill. And you wake up and you just don’t feel good. You don’t feel refreshed, you wake up just feeling like the alarm clocks a liar. There’s no way I got the sleep that it said that I got.

Dr. Jared Bloxham 24:42
That’s crazy. I did have a question about the nighttime urination.

Dr. Jared Bloxham 24:49

Derek 24:49
How many times is too much? Because and the reason I asked is I know that like as people get older, obviously, like, the kidneys and the prostate function like you people leak a little bit more as, the older you get.

Dr. Jared Bloxham 25:36
Yeah. Yeah.

Derek 25:36
So so how many times is too much? And what can you do to kind of like prevent that from happening.

Dr. Jared Bloxham 25:41
So part of what you have to do to prevent that from happening is just regulating your fluid intake as it gets closer to bed, just to make sure that you don’t have too much fluid on board. And a lot of it is testing, you know, so if you if you start to have those issues, and you start to have some of those red flags, the only real way to know is to get tested.

Derek 25:58

Dr. Jared Bloxham 25:58
And so like, personally, I’ll tell you a bit about myself. I got tested when I was 35. And I was like, Man, I’m getting up to use the restroom a couple of times at night. And I’m like, is this what it’s like to get old? As soon as I had it treated? I don’t do that anymore. And I haven’t for years because I’ve had it treated for years. I don’t do that anymore. I got off my blood pressure medication I got off of the Omeprazole that I was taking, you know to because of the gastric reflux and heartburn. And the nighttime urination went away.

Natalie 26:27

Derek 26:28
That’s incredible.

Natalie 26:28
That’s crazy. I feel like once I got pregnant, I like, now, I just like naturally wake up and I’m like, I might go to the bathroom, I might not. It’s not regularly but like, once I got pregnant and then had babies, it was like, I’m just so used to waking up, you know?

Dr. Jared Bloxham 26:40
Yeah, that’s not gonna be sleep apnea. But if you start, it’s when we start to see a lot of these red flags and conjunction…

Natalie 26:40
Just adding up.

Dr. Jared Bloxham 26:40
…was like, hey, you know, let’s just get tested. Let’s find out what’s going on. Let’s see what your brain and your body is doing while you’re asleep. And let’s just find out.

Natalie 26:56
So let’s talk a little bit about why this is so important.

Derek 26:59

Natalie 27:00
Right? Like, why is it so important that if you’re having issues sleeping, or any one of these things is kind of ringing a bell for you listening? Why is it important for the listener to set up an appointment to get all these things looked into so they can improve their sleep?

Dr. Jared Bloxham 27:15
The health implications that it has, are enormous, just from the increased risk of heart attack, the increased risk and stroke the life, the longevity. So somebody that has sleep apnea, depending on the severity of it, it’s anywhere from six to 18 years reduction in their lifespan expectancy. And so…

Natalie 27:33
That’s not a small number.

Dr. Jared Bloxham 27:34
It’s not, no. And especially the increased risk of heart attack. So my father had his first heart attack in his 40s.

Natalie 27:41

Dr. Jared Bloxham 27:41
And there’s a family history of that.

Natalie 27:42

Dr. Jared Bloxham 27:43
When when I was diagnosed with sleep apnea, and I started recognizing kind of some of those signs. I’m like, I wonder how many of my relatives that have these issues, have sleep apnea that is increasing their risk and increasing kind of that damage? And so sorry, kind of go off on a tangent?

Natalie 28:02
No, no, no! I think I think it’s totally fine. And what I’m, one of the things that I’m thinking about, and I, in general enjoy this kind of topic and I think it’s something we talk about a lot here on bigger medical is, is about you know, how to take care of yourself how to take charge of your own health. And I think I’m loving seeing kind of the shift that’s happening in the medical and scientific field that’s looking at kind of this more holistic and functional medicine approach to things because what I’m hearing here is it’s like, you let’s you know, heart issues, low blood, blood pressure, all these other things that’s happening, and you’re going to a specialist in you’re trying to figure out what this says, and they’re doing this test, and then they’re prescribing this medication, whatever. And what I’m thinking is, if we start with because I’m always thinking first food, like food is medicine, medicine is food.

Derek 28:02
Yep, absolutley.

Natalie 28:02
And that’s always where I’m starting to think you know, and that’s, that’s a tough one too, though. But man thinking about this and sleep, which I’ve always known how important it is. But more and more I’m learning how really important it is-thinking if you’ve got these bigger, you know, issues like coming back, it’s just the basics of like, how’s your sleep? And what do we need to do to get your sleep on track? And then if that’s not improving these other things, now, let’s go from there.

Derek 29:15

Natalie 29:15
You know what I mean?

Dr. Jared Bloxham 29:16
Yeah, absolutely. And too many times, like you said, it’s like, you go and you’re like, hey, I have these symptoms. And I have these signs that’s like, Here, let’s write you a prescription for that

Natalie 29:23

Dr. Jared Bloxham 29:24
And take care of that when, hey, you know, the underlying problem, if we fix that, if we address that, we might get rid of all these problems that are downline from it, or at least help them so one of our goals and any sleep physician or anybody that treats sleep apnea. One of the goals is always hey, let’s reduce the the medication that you’re taking. And it’s it’s amazing how many different medications are related to sleep and sleep problems. So from the heart medications and blood pressure to anxiety and depression to all sorts of different things that are affected by it.

Derek 29:58

Natalie 29:58
Well, I’m thinking about too, like, you know, thinking about the pillars of health and like your, your diet, your exercise your sleep, your connections. But like, if you’re exhausted, mentally and physically, it is so much harder to like, come home and make a healthy dinner, or even to just like, have the like, figure out what your, or make a meal plan or like had like, get up early enough to get to the gym before. You have to get the kids to school and go to work. Like, it’s just making so much sense to me that it’s like, needs more emphasis on the quality of sleep that we’re getting.

Derek 30:30
You know, there’s there’s another podcast that I was listening to in preparation for this, just talking about sleep. And this there’s this guy who’s a sleep physician who’s specifically was trying to focus on athletes. And you know, obviously athletes and a lot of people that listen to our podcasts are like trying to think about how can I optimize my life? How can I get the most gains at the gym? How can I do all these things? And the thing he said is like sleep is the most potent, legal performance enhancing drug that there is.

Natalie 30:55

Derek 30:56
And it’s just like, absolutely incredible. It can you die.

Dr. Jared Bloxham 30:59
Yeah, I can attest to that one personally. So when when I had to retire, I’ve always been very active and very physically fit. And when after I had my my last surgery, I was not active. And I was not fit, I spent almost a year in a recliner recovering.

Natalie 31:17
Wow. That’s a huge hit.

Dr. Jared Bloxham 31:18
And I gained over 40 pounds. And I didn’t realize that my poor sleep was affecting that significantly. So I got the sleep study, and I got the sleep taken care of. And I lost 40 pounds, and I hadn’t changed much. I was…

Natalie 31:35

Dr. Jared Bloxham 31:36
I competed in physique competitions. And I was like, men just waking up and going to the gym, when you’ve not got a good night’s sleep, you cannot perform like you should be able to.

Derek 31:48

Dr. Jared Bloxham 31:48
And so even from a weight loss aspect and a hormone aspect, when you’re in a deep-when you have one of those apneic events, your body releases adrenaline and norepinephrine and also cortisol. And so cortisol, of course, is the stress hormone. It’s one of the our metabolic regulators. And so when you’re having that cortisol release throughout the night, and that adrenaline release throughout the night, now your body can’t regulate your own metabolism. So just getting that metabolism regulated, you know somebody that has a sleep related breathing issue, and not getting into that deep sleep, they’re gonna have a lot tougher time losing weight and staying healthy than somebody whose body is regulated like its supposed to.

Natalie 32:34
Well and what about muscle repair, like after workouts? If you’re working out regularly and you go into sleep, if you’re not getting your regular sleep, are you even in a repair state often enough to build the muscle like you want to?

Dr. Jared Bloxham 32:42
Not nearly as well as you should.

Natalie 32:44

Dr. Jared Bloxham 32:44

Derek 32:45
That has to do with growth hormone, right?

Dr. Jared Bloxham 32:47

Derek 32:47
It’s like the biggest, the biggest pulse of growth hormone happens while you’re asleep. Is there a specific stage when that happens?

Dr. Jared Bloxham 32:53
I’d have to go back and look at that one, because I probably I don’t want to mess it up. But yeah, your growth hormone and your serotonin levels and your dopamine levels and your norepinephrine levels. They’re all regulated while you’re asleep.

Derek 33:05

Dr. Jared Bloxham 33:05
And so that’s why we see an increase in anxiety and depression and, and other issues too. For somebody that’s not getting good quality sleep getting into that REM sleep.

Derek 33:16
I’ve heard another very important factor for getting really good quality sleep is consistency.

Dr. Jared Bloxham 33:21

Derek 33:21
Can you touch on that and like how important consistency is because it’s like sometimes, you know, it’s like, everyone, I think this is pretty common, like, people are like, Oh, great, the weekends here, I’m gonna sleep in, I’m gonna stay up super late and sleep super late. And then they have to go back to their regular schedule, you know, during the week and kind of oscillate back and forth. Can you talk about like…

Dr. Jared Bloxham 33:38
Yeah. We’re trying to fight 1000s of years of evolution, and body clock circadian rhythms. You know? So our bodies were designed and built for and evolved to the point where, when the sun comes up, the body chemistry says, hey, it’s time to be awake. When the sun goes down the body camera, she says, hey, it’s time to be asleep,

Natalie 33:59
Which is why I struggle this time. My body says, I’m sorry, the sun is not up. What are we doing?

Dr. Jared Bloxham 34:06
Exactly. And that’s because with melatonin, you’ve probably heard of melatonin. Melatonin is one of those things that our body makes that helps us regulate sleep and help regulate our circadian rhythm. But when the melatonin is produced by the pineal gland, so it’s an that pineal gland is attached to your optic nerve. So when light is hitting your retina, then that pineal gland is quiet, it’s not doing anything. As soon as the sun goes down, lights go off that pineal glands like hey, my time we got to make some of this melatonin. So if you are not keeping a regular schedule, meaning like sleep hygiene, we’ll call it-if you’re going to sleep at different times, if you’re staying up and watching TV, if you’re staying up on your phone. If that light is hitting the retina, then your body doesn’t get those same cues that it’s time to go to sleep. And so you’re you’re basically fighting against your own biology by trying to conquer that now it’s really difficult for individuals that that have like rotating shifts So, like a lot of, and that’s difficult for a lot of the people that we depend upon. So yeah, the police force, a lot of them are rotating 12 shifts, the fire department, a lot of them are rotating 12 shifts and nurses, my brother’s an ER doc, and he does a lot of rotating 12 shifts and 12 hour shifts, and that’s really hard for your body to kind of regulate back and forth. So it’s really, really difficult.

Derek 35:23

Natalie 35:23
I had to deal with that. With my, my ex husband was a police officer. And he and they would even as much as like, shift, like, different shifts multiple times within the year, like days to nights, days to nights, and it’s just, it’s brutal, it’s hard. And you my brother in law’s a nurse, and he’ll do the same kind of thing. And even just, he’s even said before, you know, the, you know, the nurses that have been working graveyard for freaking ever just have all of these health issues. Yeah, you know, just and he’s like, there has to be a correlation.

Dr. Jared Bloxham 35:51
There definitely is and the research is pretty clear on that. But if you go to bed and wake up at the same time, whether it’s a weekend or a week day, then you’re gonna have a lot better chance at getting into that those deeper sleep and getting keeping up on that. So we can actually have a sleep deficit, you know, so it’s like, you know, if I just don’t sleep at all during the week, and then I sleep all weekend. Does that make up for it? No. You know, it probably feels nice.

Natalie 36:19
No? It doesn’t?

Dr. Jared Bloxham 36:22
I spent a long time trying to prove that right. And it never really worked out or could prove it that you could, and yeah. No, it doesn’t quite happen.

Derek 36:29
That’s unfortunate.

Dr. Jared Bloxham 36:29
Your body just doesn’t. Yeah, it is unfortunate.

Natalie 36:31
So what about, how can we qualify? Like, what is good sleep? Like, you know, because you hear like, you need a solid eight hours of sleep? Or like, as long as you’re getting six, it’s fine or like, is is it really that cut and dry? Or is it a way that you need to be able to do sort of a self awareness and check in and like, no, no, I’m good with six. Or if I get less than eight, I’m trashed the next day.

Derek 36:54
And to touch on that as well. I kind of want to just tack in at the tail end like sleep tracking devices. Yeah, the rings and the watches, like how how well do those actually track sleep quality,

Dr. Jared Bloxham 37:05
They are getting better and better. And so technology’s amazing. So now a lot of times we’ll do home sleep testing with similar type of technology. So one of the home sleep studies that that we use, the physicians that we work with will use to, it’s kind of called a night owl. And it’s just a sensor that goes on your finger. And it is looking at your heart rate, it’s looking at your pulse oximetry. So it’s looking at the level of oxygen in your blood. And it’s also looking at what we call, or the, the little blood vessels in your finger. And so our involuntary nervous system that fight or flight part versus the rest and digest part, the blood vessels respond differently when different things are going on. So it’s watching the dilation and the contraction of those little blood vessels to kind of help tell what stage of sleep you’re in. So some of those are very helpful as a screening tool. But they don’t give as much information as we need sometimes.

Derek 37:06
Gotcha. And so you don’t have that. Then like, what are the things that you can look for.

Dr. Jared Bloxham 38:02
And that’s how do you feel? A lot of it is like if you wake up in the morning, and you feel like man, I slept great, I’m ready to just go tackle my day, the afternoon comes along, you’re still feeling energetic, and evening comes along and I’m starting to get tired, it’s time to go to sleep, that’s usually a good sign that you’re getting the sleep that you need. The other is that is you-Are you dependent on an alarm clock, meaning if your body is getting enough sleep, you’ll you’ll wake up naturally. And if you’re not waking up naturally, if you’re pushing the snooze button three or four times on the alarm clock, and your body’s not able to take it, you’re probably in a sleep deprivation state. And so just being in tune with your body, a lot of us just start to feel like, you know, this is just my baseline. I’m just this is just how it is. Until we see something different. We just think this is normal for us. Well, when whenever we have patients that get treated, and they’re like this, I’m supposed to feel, which is awesome. It’s like yeah, and I felt the same thing as I’m just getting older. And then when it was treated. I’m like, You mean I can actually wake up and feel like I can accomplish something today and get through my day? Yeah.

Natalie 39:05
Wow. That’s, that’s amazing. So I mean, I think most people have heard sleep apnea, they they know about like CPAP machines, etc. And so like anybody listening, that’s worried that’s like, oh, man, this might be me. I really don’t want to have to do that. Yeah, you mentioned before and this is part of what you do is like there’s other options-can be depending on the severity, I’m guessing

Dr. Jared Bloxham 39:23
Depending on the severity and some other actual factors.

Natalie 39:25
So, kind of walk us through what happens if somebody wants to come in and turns out hey, you know, you’re it’s either mild, moderate, or severe, whatever, we need to do some things, what are their options?

Dr. Jared Bloxham 39:33
So when when we’re looking and let’s say that we’ve first we will test and we always see how severe is this issue? And then what are the issues because sometimes we have obstructive sleep apnea. When we’re talking just apnea. We have obstructive sleep apnea, which is basically just a kink in the airway. Your something is closing that off and an airway is not open. We also have what’s called central sleep apnea. central sleep apnea is where your brain is not sending your body the right signals. And so you have sleep apnea, but it’s because your brain is not telling your body to breathe Really, okay, so the sleep study can be really important in differentiating between that the sleep study, know, the home sleep studies and things like the ring, and even some of the Fitbits and stuff like that, they can usually give you an indication if you have apnea, if your oxygen levels are dropping, but if somebody is like, hey, you know, I did the home sleep study, or my Fitbit says, Hey, you’re doing really good, and they still have those issues, then it’s time to get what’s called a polysomnogram. And that’s where you go in and you’re sleeping in the lab, you’re hooked up to all the different machines, we’re hooked up to an EEG. So we’re we have brain leads on so we know what your body is doing, what your muscles are doing, what your heartbeat is doing, what your your sleep position is, because there’s so many different things that can tie into poor sleep, that sometimes we just need more information so that polysomnogram can be critical sometimes.

Derek 40:47
So you bring up sleep positions.

Dr. Jared Bloxham 40:49

Derek 40:49
Are there are there are some sleeping positions better than other sleep positions.

Dr. Jared Bloxham 40:56
From from an anatomical standpoint, just kind of thinking of airway and when we’re talking sleep apnea, in particular, if you’re sleeping on your back, then as soon as those muscles relax, that tongue will fall back, the airway will close off. So the majority of people that have sleep apnea, it will be significantly worse when they’re on their back. And so a lot of people with either sleep apnea, or the upper airway resistance syndrome, they can’t sleep on their back. And it’s like, they may try to or they may want to, but they can’t. So they’re always either gonna be on their side or on their stomach. And that’s because your body needs that airway to be open. When you go to sleep, your body’s like, hey, we want to have the heart beating, and we want to have the air moving so that we can wake up alive in the morning. And it’ll do whatever it takes to accomplish those.

Derek 41:37
I get that.

Natalie 41:37
I know my chiropractor would say don’t ever sleep on your stomach, it’d be like me, like, how are you sleeping? And I’m like, what kind of leg then I’m trying to like, show him and he’s like, stop that.

Dr. Jared Bloxham 41:47
But he might have to argue with your cardiologist. I know not breathing appropriately, and it’s causing some damage to heart.

Natalie 41:53
I can do the side. I kind of I kind of fixed myself a little bit to just go on my side instead of like, keep going all the way.

Derek 41:58
What if you get one of those pregnancy pillows?

Natalie 42:00
Oh my god, I love the pregnancy pillows. I like actually still make my pillows do that. But I got rid of the pregnancy pillow because I felit lik it was probably time, but it’s so great.

Derek 42:10
I’ll admit, I’ve borrowed my wife’s pregnancy pillow.

Natalie 42:13
It’s fantastic! It takes up so much space, but even if you’re on your back, like your arms are up and your legs are over it like it’s I don’t know, what’s not to love about that.

Dr. Jared Bloxham 42:22
And some of the times that that can be some of the indications that we look for. It’s like is your and even for kids? Like, you know, do they sleep and awkward positions? Do they sleep in the stinkbug position? Are they kicking? Are they doing a lot of movement. And oftentimes, that can be the body’s way of saying, hey, if like if somebody is really particular with their pillow, they can’t sleep on their back, they’re really particular at their pillow, they’re getting the pillow set, just try to keep that airway open, so your body doesn’t have to. And from an orofacial pain standpoint, neck pain and the facial pain that we see from that I have to talk to patients about pillows all the time. Because of my own neck surgeries. I’m kind of a pillow expert. I’ve tried every pillow.

Natalie 42:55
You’re like an accidental expert in a lot of different things.

Dr. Jared Bloxham 42:58
It’s interesting in treating some of the things that I’ve dealt with myself. And so I can have conversations with my patients, you know, from a little bit different standpoint where it’s like, yeah, I get it. I understand. Here’s what’s worked for me. And here’s what’s worked for a lot of my patients and so…

Natalie 43:10
Yeah. It gives you a really unique perspective.

Dr. Jared Bloxham 43:12
It does.

Derek 43:12
Well let’s have some pillow talk. What pillows are good and what pillows are bad, and what makes it good or bad.

Dr. Jared Bloxham 43:18
So you want a pillow that is firm enough to hold the position, but it’s not going to force it in any position. And so the ones that tend to work the best are those that are like shredded memory foam.

Derek 43:30

Dr. Jared Bloxham 43:30
So, like my pillow is an example of that. You’ll have like the posturepedic and some of those pillows are like, hey, you know, like, here’s a place for your neck to fit. And for some individuals will work. Okay, I’ve had neck surgeries, mine is a lot more temperamental about certain things. The best that I found a Costco to pack for $13. Shredded memory foam pillows, and I spent hundreds of dollars on pillows.

Natalie 43:33
That’s amazing.

Dr. Jared Bloxham 43:45
That $7 pillow works better than…

Natalie 43:54
This is not a paid sponsorship.

Dr. Jared Bloxham 43:56
It is not!

Derek 43:57
But there is a Costco right across the road.

Natalie 43:59
We’re gonna get an affiliate link in the show description.

Dr. Jared Bloxham 44:02
And I couldn’t even tell you the brand because I don’t even know if it like they promote the brand, but it’s just like, go there. And if Costco has one of the totes full or one of the bins full of that there’s one or two of those that go in my cart because I wear through them. They’re the first thing that goes into my luggage when I’m traveling.

Natalie 44:17
Wow. I love it.

Derek 44:17
Is there a life span for pillows?

Dr. Jared Bloxham 44:21

Derek 44:21
When, when? Because I hate throwing away my pillows. I just do but like when when should I say goodbye to a pillow?

Dr. Jared Bloxham 44:27
Now the smart aleck in me says it depends on how bad you drool.

Natalie 44:32
I bet you’re a big drooller. I could see that.

Derek 44:34
Ehhh, no comment.

Natalie 44:37
I’ll ask your wife.

Dr. Jared Bloxham 44:39
When when it starts losing its ability to hold that shape. And so a lot of the memory foam is really good at that because it’ll hold that shape a little bit better and you can manipulate it however you need it. But some of the pillows that are a little bit too small, they’ll-Yeah, it’s going to be dependent on the brand and but as soon as it’s your soften to like I’m going to fold my pillow over twice to get it to where I need to. It’s probably time to get a new pilliow. Or yeah, a new pillow or a different brand.

Derek 45:06

Natalie 45:07
Okay, so I had kind of prior to this pillow talk conversation, thinking this question again maybe kind of a two parter. It seem to love those today.

Derek 45:16
You love those two parters.

Natalie 45:16
I love the two parts. I know. Yeah. Okay, so I’m wondering about mouth breathing when sleeping. And if somebody’s like, even, for example, my daughter, she tends to be a mouth breather when she’s sleeping. And so I’ve heard that that’s a signal. It’s like something’s going on there for sleeping and it can impact sleep. Second part being let’s talk about mouth taping.

Dr. Jared Bloxham 45:38

Natalie 45:39
Okay? Okay, we did pillow talk now we’re doing mouth taping. It’s a weird episode. Yeah.

Natalie 45:44
One of the trends is hostage tape.

Natalie 45:45
Right, yeah, they like tie in together. And I know, some people are like, Why would you tape your mouth shut? And so like, why would you? And also what are your thoughts on that?

Dr. Jared Bloxham 45:53
So we’ll start with the nasal breathing. Yeah, and the importance of that. So when we’re breathing through our nose, our bodies are designed that way. So if we’re breathing through our mouth, it’s because the body is saying, hey, knows you’re not doing your job move out of the way the mouth is going to take over. So one of the first things that we have to do for all of our patients, when we’re starting to get serious about treating it, I always take a CT, and I’m taking a CT of their airway and their cervical spine. And basically we’re looking from the opening of the nose to the opening of the lungs. Is there a restriction in there anywhere?

Natalie 46:20

Dr. Jared Bloxham 46:20
So for a lot of us, and this is this is something that I love doing this with my patients. It’s called the coddles procedure. But so, we have the nostrils and just inside the Nostrils, we have what are called nasal valves. And then beyond that, we have our nasal passages. So I kind of liken it to like, yeah, you come into a house and there’s a screen door, and then there’s a door and then there’s a hallway. So the screen door is the nostrils, the door is the nasal valves, and then the hallway is your nasal passages. And so for most of us, it’s like if somebody has collapsed nostrils, you can see it. If those are narrow, then you’re going to see it. If somebody has collapsed nasal valves, you’re not going to see it. And oftentimes when you’re looking at things like deviated septum, and stuff like that, you’re pushing beyond those nasal vowels and looking beyond it. So you’re looking at the entire sinuses. You’re looking for deviated septum. You’re looking for nasal valve collapse. So we can actually nasal valve collapse, that’s kind of an easy one to check just on yourself. But how we do it is just take it just with lips together, just take a deep breath through your nose. And then breathe out. And then I’ll just close one side and do the same thing. Breathe out.

Natalie 47:24
It’s a little congested there. Don’t breathe out too hard.

Dr. Jared Bloxham 47:26
Yep. Now just do that same thing, but you’re gonna just take

Natalie 47:29
I see Evan our producer on the side during this too. I’m loving it.

Dr. Jared Bloxham 47:33
Yep, but just the side and see if that makes a difference.

Natalie 47:40
Yeah, did a little bit.

Dr. Jared Bloxham 47:41
So for some individuals, I like to watch eyebrows, because some people will do that. And it’s like, whoa. So and so you’ve probably heard of Breathe Right strips, or like nasal dilators. Those are holding the nasal valves. I love those things. Yeah. And so most people that have nasal valve collapse, if they use those, then they can be really helpful. So I have patients that will use those when they’re exercising because they can’t breathe properly through their nose. But for sleep in particular, if you can’t breathe through your nose, your your body is producing some chemicals that actually help you sleep to as you’re breathing through your nose. So the mouth breathing, the dry mouth, you’re gonna have increased dental problems, you’re gonna have a lot of issues from that. But when your mouth is open, too, and if your child that is developing, that tongue is down, the cheeks are kind of pushing the teeth in. And so you’re going to have to visit the orthodontist a lot more than somebody who’s tongue rests against the roof of their mouth, and keeps the dental arch wide, keeps the airway wide. So it’s it’s interesting how sinus problems in kids lead to facial deformities. And you can see that, you know, we used to use derogatory terms like their mouth breather. And it’s because their mouth drops open, their jaw develops differently and their face looks elongated, and the roof of their mouth will be elevated. And it’s because that airway just doesn’t develop appropriately because the muscles are not holding the things where they’re supposed to.

Natalie 49:01
So what about mouth taping, and maybe not necessarily go out and put, I’m not saying go put tape on your kid’s mouth while they’re sleeping guys.

Dr. Jared Bloxham 49:08
Mouth taping. First check the coddles and make sure it’s like hey, the nasal passages are open, nasal passages are open, then mouth taping just keeps the and this helps a lot with snoring. So kind of think was snoring it’s this vibration of the soft palate in the back of the throat that is making all that noise. And I’ll use the analogy. It’s like hey, if you’re out watering the garden and you have that hose, all of a sudden you stick your thumb over the end of that hose, you’re reducing the opening. And so that water is coming through a lot faster, it’s a lot more turbulent air through the nose is gonna be the same way. So keeping the nose open is gonna make it so the mouth doesn’t have to. So first we got to make sure that we have a paitent nasal airway so that we can breathe through our nose. Then for some of us, it’s still as soon as the muscles relax, jaw muscle relaxes bottom jaw falls open and now we’re trying to breathe through mouth and nose kind of at the same time. And so mouth taping can be really effective for some individuals.

Derek 50:00
So, sorry, I’m just thinking through this process if your mouth is taped and you have these collapse noses, which I guess that’s what you’re saying is you gotta keep the noses open. Otherwise you’re gonna, you’re gonna get that panic response.

Dr. Jared Bloxham 50:11

Dr. Jared Bloxham 50:11
Yep. And you’re gonna mouth taping will be counterproductive. Yeah. And so you’ll usually find out pretty quickly because if somebody’s like, I tried that mouth taping that hostage shape, I felt like a hostage. I felt like it was trying to kill me. And I’m like, well, let’s check the sinuses and the nasal passages and see if they’re open. And more often than not, yeah, there’s some sinus issues, nasal passage issues that we’ve got to address first,

Derek 50:11
This is a random question, but like, so those nasal things that open up your nose…

Derek 50:34
Like the Breathe Right strips?

Derek 50:38
Like the Breathe Right strips. You know, obviously, those are like disposable. So we’ll go through, are there anything? Is there anything like that that’s like more permanent that people can buy?

Dr. Jared Bloxham 50:46
They’re called nasal dilators. And if you go on Amazon, even you can buy them and just nasal dilators. The my patients favorites are called Hale like inhale, exhale, H A L E. And their little inserts that go into your nostrils. And they hold that open.

Natalie 50:59

Dr. Jared Bloxham 51:00
And so you don’t have to use that. And, and those I’ve been at the gym and seen people where you can see just like a little clear ring. It’s like, Oh, they got their nose piercing. It’s like no, they have the nasal dilators in…

Natalie 51:10
Oh funny.

Dr. Jared Bloxham 51:11
…to pull those nasal valves open.

Derek 51:11
Interesting. Just so that they can breathe through their nose?

Dr. Jared Bloxham 51:13
Just so they can breathe through their nose. And yeah, and it’s a lot better for a lot of distance runners will use those just hey, we’re going to be breathing through my nose. It’s a lot more appropriate and healthier for us to do that.

Derek 51:23
That’s really cool.

Dr. Jared Bloxham 51:24
So yeah, nasal dilators. If you, if you, if somebody’s out there and like, hey, I can really breathe a lot better, like go on Amazon, get the Nasal Dilators.

Natalie 51:24
Well I even felt this kind of like doing the stretching like after that it was clear. It’s like I just needed a little bit of like help to like stretch it open a little bit.

Dr. Jared Bloxham 51:40
Just an interesting story. I had a patient not too long ago, and I was checking that. And as I checking it, he had some facial muscles that would literally pull it. He didn’t have to like use his finger or anything like that. He’s like, I can do that. Yes. First time I’d seen that. But yeah,

Natalie 51:55
I mean, I can flare my nostrils. I can flare my nostrils. But I don’t think that’s the same thing.

Dr. Jared Bloxham 51:59

Derek 51:59
If people aren’t making funny faces, now they’re gonna be. For those listening. You might want to check that out on YouTube.

Natalie 52:05
Can you flare your nostrils?

Dr. Jared Bloxham 52:06
Guaranteed. They’re out there doing the same thing. Everybody’s out there trying to do this.

Natalie 52:09
No, but your eyebrows do a weird thing.

Derek 52:10
I can make my nose like a bunny. I don’t know if that’s-that’s probably not useful.

Natalie 52:14
I can flare my nostrils and wiggle my ears.

Dr. Jared Bloxham 52:17
Yeah, me too.

Natalie 52:17
Yeah, see? Well sorry. You’re not one of the cool kids, Derek. Sorry. Yeah you’re not cool. All right. Do you want to jump into our new section?

Derek 52:25
Yeah, let’s do it.

Natalie 52:25

Derek 52:26
So we have a new section, fact or fiction. So we’re gonna…

Natalie 52:30
Quick draw.

Derek 52:31
You’re gonna do this Quick Draw kind of rapid fire, go through a couple of things. I think that a couple of these things we’ve already touched on.

Natalie 52:36
But let’s do it again.

Derek 52:36
But we’ll go through it and just get your quick take on this.

Natalie 52:39
And then a quick little synopsis after you say Fact or Fiction, okay?

Derek 52:42
So first, fact or fiction? I can catch up on missed sleep.

Dr. Jared Bloxham 52:46
Fiction. So now you can, the damage that gets done sometimes is irrepairable. So that lack of sleep, any of those sleep related breathing issues, any of the oxygen issues, not quite the same. Now, if you have a couple of days where you’re not getting that good sleep, then you can catch up on some of that, but long term-No.

Natalie 52:46
Okay, so damage done, you can’t really like recoup that damage.

Dr. Jared Bloxham 53:09
Short term? Yes. Long term? No.

Natalie 53:10
So like if I have like such a crazy week, and I didn’t get to sleep till like midnight every night, but we’re still getting up at five or six and Friday night hits. I’m like, oh my god, I’m going to sleep until 10.

Dr. Jared Bloxham 53:22
You’re not going to catch up on the rest of the week. So it’s not like, you know, I have 100 hours this week and 30 hours needs to be sleep. So I’m going to do all that in 30 hours. It’s not the same.

Natalie 53:32
Alright, I’m really disappointed with that answer.

Derek 53:34
So that leads to the next one fact or fiction? More sleep is better.

Dr. Jared Bloxham 53:41
That’s a hard one. Fact or fiction? Fiction, I’ll say because it’s the quality of sleep that is more important than the quantity of sleep. And so if you’re getting 10 hours of junk food sleep, so to speak, versus four hours of nutritious sleep, then I take the four hours of nutritious sleep all day, any day.

Derek 53:56
Gotcha. I have some friends who like they say that they sleep 13 hours, 14 hours and they wake up tired. I’m still tired. And so that’s probably just like an underlying issue.

Dr. Jared Bloxham 54:07
There’s something that’s not letting them get into that restorative sleep.

Derek 54:10

Natalie 54:11
Well, I’ve also noticed sometimes even if I’m just like, oh, I can stay in bed so I’m going to stay in bed-actually end up feeling more tired than if I just like gotten up at seven when I woke up on a Saturday. Do you know you mean like this?

Dr. Jared Bloxham 54:22
Yep. And again, you’re fighting your biology?

Natalie 54:23
Yeah. Well dang it.

Derek 54:25
Alright, so here’s the next one. Alcohol helps me sleep.

Dr. Jared Bloxham 54:29
Fiction. Very much so. Now, it might help you get to sleep.

Natalie 54:34
Right? Same with weed too, right? Marijuana if you’re a smoker?

Dr. Jared Bloxham 54:37
Yep. So it might help you get to sleep. But again, it reduces the quality of your sleep significantly. So you’re not gonna get into that deep sleep because it’s a respiratory suppressant, so…

Derek 54:48
And a diuretic as well, right?

Dr. Jared Bloxham 54:50
Yep, yeah. And so yeah, good luck with that. Why do you think people why is a hangover hangover because you wake up and you did not. You could have that That’s that lack of oxygen to your brain from some of those breathing issues that’s causing a lot of that hangover. So.

Derek 55:07
Alright, so the last one, I don’t dream. And I have a story to tell about this, but I want to hear your reaction.

Dr. Jared Bloxham 55:12
Okay. We dream in REM sleep, so and REM sleep is when our muscles are-we have atonia. So we don’t have any muscle tone, and we’re supposed to be paralyzed, we’re not supposed to be moving. And that’s when we dream. And so if you’re not dreaming, then there’s a good chance you’re not getting into REM sleep. Or if you’re having very vivid and almost like night terrors in kids or an adult’s, it’ll be like those panicky dreams, you wake up and it’s like, am I where am I? Okay, I’m in my room, I’m okay. A lot of times, that’s as you’re getting into REM sleep, your body’s not letting you stay in REM sleep. So unfortunately, our eyes will usually see, that’s a very short, highly active moment for your brain where you’re having kind of that very vivid dream.

Derek 55:13

Dr. Jared Bloxham 55:13
It means you’re not getting into REM sleep.

Derek 55:43
It sounds like there’s kind of a spectrum. If you’re not having dreams, that’s bad. If you’re having really, really vivid dreams, that’s bad. And so you want to be somewhere in the middle.

Dr. Jared Bloxham 55:58
You want to have those pleasant dreams. Sweet Dreams.

Derek 55:59
And would it be-You could be dreaming and not remembering too, right. So it’s possible, some will be like, I don’t dream, but in reality, it’s happening. There’s just not a memory of it. And I don’t like dream vividly all the time. But I’ve often thought like, I must be just like, just before REM because it is vivid, it is detailed. I’m aware a lot of the time that I’m in a dream. And like sometimes I can even like and shape the story of my dream.

Natalie 56:00
I literally can be like…

Derek 56:04
Wow. That’s impressive.

Natalie 56:05
…Yeah, kind of weird, though, right? And then a lot of times remember the details of the dreams. But as I’m in the dream, I’m like, This can’t be really good sleep, because I’m like, I’m aware of what’s happening in this story. And I’m like, What the hell’s grandpa doing here? You know? Like, this is what’s happening in my. So I’m guessing not REM sleep, if that’s like…

Dr. Jared Bloxham 56:42
Usually not REM sleep. Yeah, that’s your body going through. And usually, when we see those dreams, they may seem like they’re lasting for a long time. But they’re just seconds. And it’s as your body is trying to get into that REM sleep and, and your brain is like well, nope, can’t do that. We’re not gonna be breathing if we’re doing that.

Derek 56:57
Yeah. Time perception is such an interesting thing with sleep. So this is this is my story. Like, when, so I went on a two year mission for my church. Before my mission, I like almost never had dreams, you know, I was pretty much I’d wake up or go to sleep. And then next thing I knew I was waking up and going about my day, I went on my mission to South Africa. And like the, and this is what I tell people just because it sounds so weird. And it’s like, to me, it’s so weird. As soon as I set foot on African soil. And every single night that I was in Africa, I vividly drempt every single night. And it was just like, I don’t know, like, is this something that’s weird going to be? Is there something in the air? There’s something in the water? I don’t know.

Dr. Jared Bloxham 57:37
Sometimes it can be the food. Really? Interestingly, it’s there are some foods that will increase some of that vivid dreaming now. I’m not I haven’t dug into that really deep. But for me, peanut butter m&ms. Whatever they have in that, I don’t know if it’s the dies or whatever it is. But and that’s a that’s one that’s kind of fairly frequent. So some foods will increase that. But for two years in, in South Africa? I don’t know. Good. Good question.

Derek 58:04
Yeah. So so if you’re not dreaming? What like, I don’t know, how can you go from trying to not dream to remembering your dreams? Is that Is that a good goal to have? Or like? How do you go about doing that?

Dr. Jared Bloxham 58:18
Kind of goes back to the testing. And so if you have some of those other little red flags that are kind of there. It’s interesting how many patients will when we start treating their sleep apnea, they come back in they’re like, had some dreams and like I haven’t dreamed in years. And we’re like high fiving. And I Hey, that means you’re getting into REM sleep. And so testing to see why, if there’s a reason why you’re not getting into REM sleep is critical. Just what’s your brain doing? Why is your body not getting into that, that REM sleep. And sleep apnea is not the only reason there are some sleep disorders that are based off of different chemicals in your body like dopamine and norepinephrine and serotonin, that can affect that heavily too. So just kind of ruling out the most common one, which is the sleep related breathing disorders is critical sometimes for that.

Natalie 59:04
You know, as we’re talking about dreaming, and it makes me think about, like, all these things that are happening in the brain that we’re just like, seriously have no idea and are not tapped into and what are dreams and how much of that goes beyond what scientific and like into spiritual or if you believe in that sort of thing. And so like, I’m just like sitting here thinking as much as we know now about how important sleep is, there’s also all of these other spaces that Good sleep can be touching that we’re completely unaware of, that we may never fully recognize or realize, just because of what’s happening in the brain. when we’re sleeping. And there’s just so much of the brain that’s uncharted territory. And so I’m just thinking that as we’re talking about dreams, you know?

Dr. Jared Bloxham 59:41
For something that we do for a third of our life, we know so little about.

Natalie 59:44

Dr. Jared Bloxham 59:44
And it’s like, we do everything we can and we’re like, hey, let’s use this medication or let’s use this route, or let’s use this to try and get better sleep. There’s still so much we don’t know. Yeah, the body is amazing, both when it’s functioning right and when it’s not functioning right. And so, I guess all we can do is just try to find the Those things that-listening to our body, finding out if there are specific things that we know that are wrong with the body, and then not trying to fight biology. It’s like just good sleep hygiene, good habits staying away from caffeine, you know, later in the evening, especially and exercise right before bed. Just doing those things that we know help with sleep, and trying to stay away from the things that we know, help you not sleep.

Natalie 1:00:23
I before we go, if there was like, one little like tip that you give to people that you feel like is seriously underrated that not a lot of people know about, like, I’ve heard like, don’t eat after 7pm-big impact on your sleep. Like if there was one little we’ve talked about a lot of things here, but you’re like, not enough people know this. And it’s like, so simple.

Dr. Jared Bloxham 1:00:39
That is just, I even felt this myself. It’s just if you’re not feeling like you’ve got a good night’s sleep. That’s not right. Something is, something is not right. And whether that’s what you’re doing, whether that’s your sleep hygiene, whether that’s some chemistry in your body that needs to be adjusted or regulated, whether that sleep apnea, whatever it is, if you are waking up after you know, eight hours of sleep, and you don’t feel refreshed, then figure it out.

Natalie 1:01:04

Dr. Jared Bloxham 1:01:04
Go get tested, there’s usually going to be something that can be done to help you.

Natalie 1:01:07
Okay. And what resources outside of going and getting tested. I think everybody should but if everyone if anyone’s like, oh, I want to kind of try this on my own. What are some resources you would recommend for for good sleep hygiene first to kind of do kind of a self check and assessment and like, Okay, nope, I’m not doing that. And I’m not okay, maybe let me try this.

Dr. Jared Bloxham 1:01:24
Yeah. And technology is great. As long as we’re using it effectively, because there are even apps that will help with that you go online and check for that.

Natalie 1:01:31
There’s an app for that!

Dr. Jared Bloxham 1:01:31
Theres a checklist of what to do for sleep hygeine. Because a lot of those, sometimes we’ll get into questions and question after question after question. And finally, somebody’s like, oh, you know what, I do this. So just being aware of those things that can make it so you’re not sleeping well, is gonna be the most critical. So just personal awareness. And people that listen to-that are your audience, they’re going to be usually the ones that are a little bit better at that being self aware, body aware, aware of the things that you put into your body-aware of the things that your body is trying to tell you. That’s kind of the best advice I can get listened your body, be aware of it. And if something’s not right question and figure out why.

Natalie 1:02:10
Yeah, maybe we could even find a good sleep hygiene checklist that we could link in the show notes, kind of run it by you and see if you think it’s a great idea. And then, and then that way, it’s a resource for people to kind of dive into and then beyond that, like, Where can people find you?

Dr. Jared Bloxham 1:02:22
So we’re at columbiaattmjandpain.com. Okay, and then we’re located in Richland, Washington. We’re just off of Columbia park trail. So just down off the river. And so yeah.

Natalie 1:02:29
Okay. Do you have a social media that you like, post about any of this stuff? Or I know, you said earlier that you go and do lecture, so I was like, not sure how much social media content you do.

Dr. Jared Bloxham 1:02:43
We do. And that’s kind of been up and down. So yeah, now I have somebody that’s in charge of like, that’s in charge of that and working a little bit more on that. But yeah, if you go to any of our, either our Facebook or Instagram, and you’ll you’ll find some little videos and stuff. And we’ll link to those. Yeah, we’ll get a link right. Yeah. But the staff, let’s talk about it. So when you call them, they’re gonna be asking some of these same questions. And it’s interesting, a lot of the people that call up, they’re like, I’ve got more information off of the first phone call than I’ve gotten in a while!

Natalie 1:03:15
Ever! Ever. I love that. That’s amazing. Well, thank you so much for taking the time to come in today. It’s been a really interesting conversation. I’m really grateful that you took the time and I’m grateful for the the unexpected, a twist in your journey that kind of brought you here because I think it’s an important conversation. And I’m thankful that our listeners get to hear an interesting perspective on sleep hygiene and good sleep. Think I’m hoping it’s gonna bring a lot of awareness to people and they can have a better, healthier, happier, longer life.

Derek 1:03:17
That’s right.

Natalie 1:03:32
That’s what we all work for. Right?

Natalie 1:03:46
Exactly. So we’re all about.

Natalie 1:03:47
Yeah, thank you.

Derek 1:03:49
All right. Great.

Natalie 1:03:49
That’s it. Well done.

Podcast Guests

Jared Bloxham

Podcast Guests

Natalie Garland
Derek Berkey
5226 Outlet Dr, Paso, WA 99301
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