Sleeping, Breathing and Snoring with Dr Shirazi

"Do you snore?". It's dreaded question, and perhaps an insecurity for some when it comes to sharing a sleep space with someone new. But does it have to be? Dr David Shirazi from the Sleep Therapy Centre in California joins us once again to answer this question in tonight's episode of The Goodnight Show! And the answer - your solution to snoring could be as simple as a sleep study. It's definitely not worth losing sleep over a snore...

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Keen to learn more from Dr Shirazi but haven't had the chance to listen? Read the interview here!

 

Shea: Welcome to The Goodnight Show. I'm Shea Morrison, sleep expert and co-founder of The Goodnight Co. Join me each week for hints and tips on all things sleep. Hello and welcome back to The Goodnight Show. It's estimated that about 45% of the adult population snore. With a statistic this significant, it's pretty safe to assume that we've all shared a room with a snorer at some point, whether it's your partner, your child, your dog, a friend, or maybe you're a snore yourself. Well, today's episode goes out to you. I'm joined once again by Dr David Shirazi from the Sleep Therapy Center in California, and today we're delving deeper into what causes people to snore, the two kinds of snoring, and how doing a sleep study could change, or even save your life. Spoiler alert, it's definitely not worth losing sleep over a snore. Welcome Dr David Shirazi. It's so great to have you back and for any of our listeners that haven't yet listened to our episode on sleep dentistry and acupuncture, please go back and listen to that episode. But I'd love to reintroduce Dr David shirazi. He's joining us all the way from LA, and David, maybe for those who haven't listened. If you could just introduce yourself and talk about what it is that you do.

Dr Shirazi: It's great to be back. I really enjoyed our last session and I hope that this one is great for your listeners as well. Fabulous. So I am a dentist. I'm an acupuncturist, I have a Masters in psychology and for about five years I’ve been a sleep therapist. And I have my own sleep lab and a couple of centers that focus on TMJ disorders and snoring and sleep apnoea.

Shea: Great. So David is very well versed in all things to do with sleep. And it's great to have him on because today, what we wanted to talk about, which we sort of touched on in our last episode, was about snoring. And I know that snoring is a very big issue for lots of people. It doesn't just affect men or old men. It affects all ranges of ages of people and females as well. That's what I would love to pick your brains about. And I guess one of those questions, you know, there's so many things that we can uncover here, but why is it David that some people snore and some don’t?

Dr Shirazi: Snoring, which is very similar to sleep apnoea is strictly connected by and large, what we call our neuro muscular tone deficiency. And, you know, the tissue can get floppy when we're in deep sleep, right? You can also have an obstruction in your nose. You know, your valves, your adenoids and in your throat and your tongue. But in the absence of that it's typically because of the loss of muscular tone. And I wanted to highlight something that you said about, it's not just men and you know, it's women too who did a study. I saw a study on college aged females 18 to 22 with a. B. M. I. Under 20. That means they're thin and 50% of them tested positive for sleep apnoea in their sleep studies. Yeah. So you know we have, I don't know what it's like compared to Australia but we have a pretty sedentary lifestyle out here. Like you know, no one's chasing down their food. You know we're pretty laid back and social media is getting big and people are glued to their phones, you know and they're not really getting out there. They're getting the same stimulation that they would get from the gym from their phones. So you know that's a big part of it. And then of course there's a nasal patton. See being able to breathe through your nose properly right? So there's that in my world I have, I acknowledge two kinds of snoring when someone has any kind of nasal obstruction. They do a tongue rubbing up against the soft palate snore with the mouth open, it’s very common. It's usually the loudest snores and that's why it's usually meant right with nasal snoring. Their lips are still together. Um And they snore through their nose and it sounds like this. Yeah. You understand And I did that with my lips closed. Yeah you can usually it sounds more like a purr when you're snoring but it's still a snore..

Shea: You talked about that study with those female college aged students. Why? What are they saying? Is there something that's changed in society where this is becoming more common or has it always been this way?

Dr Shirazi: Well, okay, so sleep apnoea is a very new profession in the Western world, right. If we look at Chinese medicine, it's at least 2500 years old. More likely closer to 5000, ayurvedic medicine is about 6000 years old. Traditional Western Medicine is about 200 years old. Sleep Apnea, and even the study of sleep is barely 40 years old. So we didn't have studies right. There's very little things to compare it to and I hate to sound condescending, I don't mean it to sound like that. But in medicine they often don't look at functional reasons and functional solutions. They just sort of look at it as a lab value or a number of statistics. So you know like for example, I was at a conference and one of the things we know, I think we talked about the last time that we get all our growth hormone from one stage of sleep, right? The Delta. And let's say either an adult or child who had snoring or sleep apnoea. They have retarded Delta and retarded REM sleep. And when you restrict the airway, whether it's with the CPAP, tonsils and adenoid removal, functional orthodontics. Whatever the methodology there is what's called a rebound, meaning there their Delta. For example, if their Delta was retarded, they get extra delta. Mm. Right? And if you ask the Doctor, why do Children gain on average 8 pounds, which is like 3.5 kg after their tonsils or adenoidectomy. The answer you get is, well, probably because their airway was restricting their diaphragm and the intercostal muscles were working so hard to help them breathe and now they're eating the same amount of food and they're no longer using their muscles. Well that's not why. When you have a rebound of Delta, it's the equivalent of injecting 30 mg of growth hormone into your body. And if you’re growing, knowing muscle weighs eight times more than fat, you're just going to grow and you're going to be heavier because you grow, right? But this is a very typical just sort of like treating the kids as little adults, sort of mentality that we find in our current medical system. But to try to answer the question better - we never looked, you know, we have a joke in my field, the acronym WNL is supposed to stand for within normal limits but it really stands for, we never looked.

Shea: Okay. All right. Well that's a good explanation. But if you were a mother of an eight year old who was a mouth breather and had enlarged tonsils and all sorts of things going on, so the advice was to go and get her adenoids removed but its removed, you know I don't know that it's entirely fixed the problem with the adenoidectomy or a tonsillectomy?

Dr Shirazi: I'm a little bit partial to that because one there's a lot of studies and you can even grow back your tonsils and adenoid sometimes right lymphatic tissue. But we need the mucosa and our tonsils because it's a very specialised tissue. We don't have it anywhere else in the body. So on an eight year old. Yeah that's that's pretty that's pretty shoddy. So if it didn't work. So for example all the different modalities that we have for pediatric sleep apnoea. Whether it's cPAP you know the surgery or what's called functional orthodontics where they expand the palette. The actual one that works the best in Children is the functional orthodontics. It is because it will still work if they have enlarged tonsils and admits it will still work if they have obesity right? Whereas the other two modalities may not work as well. Okay.

Shea: But this is something that really exists isn't it? So there is you know within Children. So it's not as we mentioned earlier, there is a snoring problem within Children, within young adults, and adults. And so maybe it's the most severe in Children.

Dr Shirazi: Yeah Children are the most sensitive to any level of sleep apnoea. But it can be solved. It's not this is not a lifetime sentence. It can be sorted out. But you can literally, and there’s very few times we can say this - you can literally cure sleep apnoea in Children with functional orthodontics. Okay. Right because the tonsillectomy, the cPAP, they don't treat the problem. Okay. And so then if we were moving on from Children, well if we're talking about it as a general issue for society snoring and sleep, what are some of the problems that are encountered through snorers when it comes to sleep? You know this is that well for, well maybe break it down. Is it the same for Children as it is, it's completely different. Okay pediatric neurology is basically the opposite of adult neurology. So whereas in adults with chronic sleep apnoea, fatigue is one of the very first symptoms. Right. In Children they become hyperactive or they become attention deficit whether they just sit around and run around, there's behavioural challenges. Yeah and I was one of them. I had ADHD growing up, I had sleep apnoea. No one knew. My mom was a dentist. My dad knew. Okay in uh in adults, it can cause hypertension it can cause type two diabetes. And therefore if you treat the sleep apnoea, there are lots of studies that verify this. You can resolve your high blood pressure if you also have sleep apnoea and you resolve the sleep. You can resolve or improve your type two diabetes if you also have sleep apnoea and you resolve that right? Um Sleep apnoea is associated directly or indirectly with almost every disease I can think of outside of a genetic one, because it creates so much inflammation and inflammation is behind everything. So in Children they get the opposite they get ADD and hyperactivity, behavioural challenges, academic challenges and growth challenges right? Whereas as an adult they're no longer growing but their repair mechanism goes down and their mental faculties go down. So for example, there was a brilliant study with over 1400 patients that had in-lab testing, aged 30 to 60 that had depression. And the subjects were asked, ‘rate your depression on what's called the zooms depression scale from as little as I have sad thoughts often to consider suicide on a daily basis’. So when they conducted sleep studies on them low and behold they found that the admitted rate of depression was completely 1 to 1 with the rate and severity of sleep apnoea. So the worst of sleep apnoea, the worst of depression and like I said it was a very large study and it was very well conducted. So it was published in a peer reviewed journal, so it was a very strong study. We see that with anxiety if you ever do want to look up the literature, the term is psychosocial psychosocial issues. And so you could look up sleep apnoea with psychosocial issues. Right? And again we also have studies with both CPAP and um or appliance therapy, which is what our centers do in the great improvement of psychosocial conditions with the resolution of this.

Shea: And so if you were an adult that was, you know, either yourself suffering, you know that you're a snorer, or your partners told you you're a snorer, what should those people be doing? You know, not just putting up with it.

Dr Shirazi: A sleep study, you have to sometimes be firm and it's okay to do it in an in-home study if an in-lab study is too challenging. Um but do something, go and do it. An in-home study, you know, ask your doctor, say I want to do this and it should be a covered benefit, you know when you have a socialist system like you guys do. And then once you have it and if you're positive then you can do something about it.

Shea: And what would some of them be, because for somebody who's sitting there thinking you know I just know I'm a snorer and I know it bothers my partner or whatever. But this could change their life, couldn't it?

Dr Shirazi: You know this could save their life and just change their life. They could save their life. It is not a joke. The Cleveland clinic did a study. They started out with I believe 1100 patients and they did sleep studies on both the husband and wife at the same time. And on average where one bed partner had sleep apnoea, snoring and sleep apnoea, and the other one didn't they found that the partner that had the apnoea on average, had 27 arousals an hour. Right. The part that causes inflammation and problems is the arousal. Okay well the bed partner with no apnoea, had 21 arousal in an hour. Right? So they started with these 1100 people and they whittled it down to 150 people that could stay with the CPAP. And they didn't do follow up studies on the bed partners. But they asked the bed partners since your partner has been on CPAP, how are you different? And they're like, wow, my headaches are gone, my mood is better. My Children tell me I'm more agreeable. I have more energy throughout the day and et cetera and et cetera. So the bed partner having compromised sleep is not good.

Shea: No it's not negotiable really and people are putting up with it because they put up with it and that's just what society says to do. But if you want to wake up in the morning feeling refreshed and feeling great, able to tackle the world, you don't have off days. As you said, you know, you're more agreeable, your mood is fantastic. Why would you not do it? You know, it makes so much sense.

Dr Shirazi: It's, you know, people just getting used to it, they get used to a certain way of living and you know, especially if you've had it as a kid, it's normal. Yeah. You know, I remember the first night I wore a sleep appliance, it was about almost 20 years ago. I woke up never feeling so good. Like I, I just was, I felt so refreshed, but I had no complaints. Like I didn't know I had snoring or sleep apnoea, I didn't know, but when I wore it and I woke up the next day, wow, what a difference, what a difference.

Shea: But so, so when we're talking about this, not everybody who is a snorer is going to have to wear a sleep apnoea device. Are there some other things that they can do to make change. So, if you were, if you weren't at the extreme of sleep apnoea, what would that look like?

Dr Shirazi: Yeah. And we should say if you do have severe sleep apnoea, wearing a CPAP is usually their best option. Sometimes weight loss is what they need. Sometimes they need to clear up their nose like I recommend a nasal valve dilator to help them breathe through their nose better. That's great for stores. And of course number one is oral appliances there, right? You can have an appliance made by a dentist that specializes in TMJ and sleep disorders. And it opens up your airway and it also helps with your clenching on top of it and the over the counter stuff. You know I need to say okay over the counter but with an asterisk on it. So you know the concept of one is like you know you pick one up over the counter, dip it in hot water and mold it to your teeth. Like a mouth guard. Uh they disintegrate and you throw them away and then you have to get a new one. But the thing is they don't disintegrate on the shelf at the pharmacy. They are at the chemist as you call it. They disintegrate when it's 98.7° in the wet. So you are swallowing the plastic, there's no way around it. You're swallowing the plastic. Okay. So then now you have to deal with the consequences of what that petroleum product is that you've been swallowing. But at the same time let's say you're going to go on a family trip, you're going to go on a hunting trip with your mates or something and you don't want to ruin it for everybody. And obviously you know it might take a while to get a sleep study over the oral appliance. So you could then go to a chemist, get the appliance, have it made, have it molded, and wear it on the trip. And then when you come back, get on with getting your sleep study and get on with having a proper treatment.

Shea: Yeah. And I'm somebody who has recently had a mouth guard made for sleeping. I've had mouth guards over the last 20 years but I had a recent one made and it is fabulous and it's completely, I used to wake up was feeling really tight in my jaw but it's completely changed the way that my mouth and my jaw feel in the mornings and I know that I'm not clenching and grinding and causing all of these problems as well.

Dr Shirazi: So if you are snoring, these are some of the things that people could do is go and talk to their doctors about getting a sleep study that they could do at home if they don't want to do one in a clinic. They could see a functional dentist, that would be the preference but going and talking about getting some sort of mouth guard appliance made looking at the nasal applicators which I've also used based on your recommendation which helps open up that airway. Um And dare I say it? But in the interim, if you do have a partner who stores, try sleeping in separate bedrooms because it is having an effect not only on the snorer but on the partner.

Shea: Yeah totally. And it will affect the partner, there's no way around that. And do you think that the moderate snorers, so not quite at the sleep apnoea stage, by doing these things that can really make some differences to their sleep?

Dr Shirazi: It can prevent you from getting to that severe stage, potentially it's possible, Actually there's three studies that I know of. There's probably more now from Australia on the benefits of learning how to use a didgeridoo in reducing snoring and sleep apnoea. About 50%. What we do see in longitudinal studies is on average, whatever your level is whether you started out with just snoring. If we follow up with you 20 years later, you'll have mild to moderate sleep apnoea. if you were younger and you just had a little bit of mild apnoea 20 years later you'll be moderate to severe. So it is a progressive disease if you will think of it that way. So anything you can do to tighten up your muscle tone to lose weight to make sure you have a proper nasal patton. See all these things are going to be factors.

Shea: And one of those things that we talked about, I think last time as well, is that singing can be a good exercise to help with the tone.

Dr Shirazi: It can be. So you know and I think that the other, I did some research after we spoke and kundalini yoga promotes circular breathing. So they do a process as well. So there are things that you can do. And what we're really also talking about is getting people to try to become nose breathers, you know, so breathing through the nose, not mouth breathing. So there is some great need to talk to a specialist about it first or your doctor, your dentist but there is some great tape that you can um you can get these days particularly to wear at night time to encourage the nasal breathing..

Shea: So we can link all those things in the show notes. But I think that really, I think David that covers off what we wanted to talk about and to give some people some steps and advice in what they could look at doing if they feel like they snore or their partners or their Children are snorers um and just go and get that initial advice first from your doctor or your health practitioner um and make some, make some changes.

Dr Shirazi: Yeah. Yeah. I strongly agree with that statement because as you said, it's not only going to change how they feel, but it could, you know, prevent a lot of long term issues. I mean, Parkinson's stroke, heart attack. All of these are associated with sleep back. Even pediatric coronary artery disease is associated with sleep.

Shea: Yeah wow. So the advice is here people go and speak to somebody if you are a snorer, if your partner snores and get it checked out. Don't wait any longer because not only could tomorrow be a better day for you by having better sleep, but it can help with any of those long term things. Thank you, David. It was such a pleasure to have you on again today. I hope that you enjoy the rest of your week in LA and hopefully we get to chat again soon.

Dr Shirazi: I look forward to it. Thank you. Thanks Shea.

Shea: Thank you for listening to the good night show. If you're keen to learn more about our guests or any of the topics we've spoken about today, hop on over to the Goodnight Co closed Facebook Community Group or check us out at thegoodnightco.com.au. And if you're enjoying the show, please subscribe to us on your favorite podcast provider by searching The Goodnight Show. And if you love what you're hearing, don't forget to leave us a glowing review. Thanks everyone.