Dhru Purohit Show - The Top Warning Signs You’re One of the Millions of People Suffering from Undiagnosed Sleep and Upper Airway Disorders with Dr. Oliver Zolman

Episode Date: July 15, 2026

This episode is brought to you by Rythm Health, Puori, Branch Basics, and LMNT. If you're struggling with poor sleep, low energy, or brain fog, the root cause may not be what you think. As today's guest explains, the way you breathe and even the structure of your jaw can profoundly influence your sleep, brain health, and long-term risk of chronic disease. Today on The Dhru Purohit Show, Dhru sits down with longevity researcher Dr. Oliver Zolman for a deep dive into one of the most overlooked drivers of brain aging: sleep-disordered breathing. Dr. Zolman explains how conditions like sleep apnea and upper airway resistance syndrome can quietly impact your energy, cognitive function, and long-term health. He also shares his personal journey overcoming chronic fatigue syndrome, how he discovered an underlying breathing problem, and the research-backed strategies that transformed his health. He also walks through the most effective treatment options, the resources that helped him, and what to look for when choosing the right provider for your own care. Dr. Oliver Zolman, MBBS BSc, is a longevity researcher focused on the science of slowing and reversing biological aging. Trained at King's College London, he chose to forgo traditional clinical practice to pursue independent research into biological age testing, rejuvenation therapies, longevity medicine, and preventive health systems. His work explores how emerging science can extend healthspan and help people stay healthier for longer, with the ambitious goal of reversing age-related decline across the body's major organ systems. In this episode, Dhru and Dr. Zolman dive into:  (00:00) Introduction  (4:51) The Hidden Sleep Disorder Millions Don't Know They Have (7:02) Signs Your Airway Could Be Sabotaging Your Health (9:26) The Surprising Reason You Grind Your Teeth at Night (13:15) What to Do If You Think You Have an Airway Problem (15:49) The 2 Tests That Can Reveal Hidden Sleep Apnea (20:01) How Dr. Zolman Is Addressing His Own Airway (39:40) The Overlooked Problem Affecting Kids and Adults (46:30) Why Modern Humans Have Smaller Jaws (and Why It Matters) (49:26) The Link Between Poor Sleep, Faster Aging, and Chronic Disease (55:54) Which Sleep Apnea Treatments Actually Work?  (1:11:14) How to Find a Provider Who Actually Understands Airway Health (1:25:20) Dr. Zolman's Top Strategies for Better Breathing and Sleep (1:30:03) Where to Learn More from Dr. Zolman Also mentioned in this episode: Sleep Doctor Watch Pat Test  Dr. Stanley Liu Dr. Ilya Lipkin  Sleep Apnea Oral Appliance Article For more on Dr. Zolman, follow him on Instagram, LinkedIn, or visit his Website. This episode is brought to you by Rhythm Health, Puori, Branch Basics, and LMNT. Right now, Rythm is offering my community 15% off your first month, plus free shipping at Rythm Health. Just go to rythm.health/DHRU to get 15% off at checkout. Quality protein matters. Get 32% off Puori Grass-Fed Whey Protein and a free shaker when you start a subscription at puori.com/DHRU and use code DHRU at checkout.  Branch Basics is now available nationwide at Target and Target.com. Shop their lineup of safer cleaning essentials including laundry detergent, surface cleaners, dishwasher tablets, and stain remover during your next Target run or at branchbasics.com Right now, LMNT is offering my listeners a free 8-count sample pack with any purchase. Head over to drinkLMNT.com/dhru today. Sign up for Dhru’s Try This Newsletter Learn more about your ad choices. Visit megaphone.fm/adchoices

Hi everyone, Drew Proud here. Today we're diving deep into a topic that affects millions. And yet almost always goes unnoticed, undiagnosed sleep and breathing disorders. And here's the myth that I want to break right away. If you've heard of breathing disorders, if you've heard of undiagnosed sleep disorders, you immediately think sleep apnea. And if you know anything about sleep apnea, you might be picturing that this is an issue that primarily impacts older people, often men, who are heavy set and is something that seems

very extreme, that's met with extreme snoring, and those are the ones that are suffering from this issue. But that's not the case. Young people, women, and people that are at a perfectly healthy weight are suffering in silence, millions of them from these breathing disorders. And if you're someone who's thinking, okay, does this conversation apply to me or someone that I know or someone that I love? If you're someone or knows someone who snores regularly, who grinds their teeth at night. That's a big one. Who clenches very hard, who has maybe even TMJ at night, or breathes through their mouth very heavily while sleeping. These can all be real warning signs of an underlining airway problem and are worth investigating. Now, this one's personal for me. I've always been

a great sleeper. Sleep is always something that I've done well, and I haven't had to think about too much beyond a lot of the basics. But in my early 40s, and I'm 43 now, in my early 40s is when I noticed that things started to change a little bit. I wasn't sleeping as great, but, you know, it wasn't bad enough to do a deep investigation on it. But it was my dentist. Shout out to my dentist, Dr. Rostian here in Santa Monica. It was the first person to tell me that, hey, I'm noticing you're grinding your teeth a lot. Are you stressed out? And that's one of the first things that people will say if they hear that you're grinding your teeth. Are you stressed? And I've had different moments in my life that I've been more stressed than, you know, my normal baseline. But in general,

I'm probably the least stressed person that I know and many people tell me I'm the one of the least stressed people that they know. So that didn't in itself explain everything. And through meeting different colleagues in people in the space like Dr. Mark Bahena asked the dentist and other individuals that are experts and having James Nest on this podcast, what I uncovered was that part of what I was navigating were upper airway issues and upper airway breathing disorder that was tied to a combination of gaining weight. I was pretty thin growing up in my 20s. in early 30s and started to put on a little bit more weight to be at a more normal weight in my early 40s. And I have my natural jaw genetics that are there, slightly narrow jaw. And having really

bad orthodontic treatments when I was younger, including an orthodontist that pulled teeth out, which actually crowded my jaw even further. And all these things were part of the puzzle that I was putting together of why my sleep was not as great as it could be. You know, and that's why I'm excited about today's episode because we're going to be diving deep into this topic. I'm going to tell you a little bit about our guest today and then why he's the perfect person to talk about it. So we're interviewing Dr. Oliver Zalman. He's one of the world's foremost experts in biological aging, whose work over the years and partnership with Brian Johnson and designing blueprint has led to all sorts of advancements and how we think about biological aging and how people can step into

different organ systems and try to optimize them by really focusing on the basics of exercise, lifestyle, diet, sleep, and a whole bunch of other things as well, too. But what many people don't know about Dr. Oliver Zalman and his story is that this topic is actually extremely personal for him as well. For years, as he'll get into on the podcast today, he's been battling chronic fatigue, trying to get to the root of what exactly has been the primary contributor to it. He's gone down a bunch of different channels and ultimately land on this idea that these upper airway issues that he's been navigating have been a massive contributor to poor quality sleep, which not only leaves him just chronically fatigued, but also, as we talk about here, undiagnosed sleep issues can increase your

risk of dementia, increase your risk of heart disease and cancer and everything else that's there. So if sleep isn't great, we want to get to the root of it. And obviously, airway issues is one part of why sleep might not be great for some people. And it's a part that's not talked about enough. So we're excited to dive into it today with Dr. Oliver Zalman. I'm excited for this podcast. Let's jump in. Dr. Oliver Zalman, it's a pleasure to have you here for people.

who do not know your work. You're a trained physician from the UK and one of the world's foremost experts in measuring and reversing biological age. You spend a lot of your time thinking about what's at the

frontier of what we can do to slow the pace of aging today and also what's coming down the pipeline that's on the next frontier of medicine to help us maybe one day reverse aging in the future. Today's episode is dedicated to all things brain aging. And when we were

chatting, one of the areas that we thought would be fantastic for you to start off with is this hidden epidemic that's quietly accelerating brain and body age. And most people around the world have no idea that it's happening to them. And that's sleep apnea and disordered breathing. Walk us through these conditions and the real toll they're taking. on the brain and the body. Sleep apnea is a type of sleep disorder breathing, the most common cause being obstructive sleep apnea, where it's really your airway is being blocked

from having enough airflow for you to breathe properly at night. It can be in many different forms, you know, different causes in the nose, in the back of the mouth, the neurological sometimes, having too big a tongue or too small a jaw. But it's really something I find that is often missed by general practitioners, family doctors, specialists sometimes as well.

It's a really important thing to catch because it leads to a lot of issues. It can be anything from kidney failure, sometimes, to mental health conditions, to chronic fatigue, and of course the corn ones that people know, such as cardiovascular disease and brain aging and dementia as well. But it really can affect a lot of different things. So it links to ADHD, anxiety, depression, as well on the psychiatric side, which is very interesting.

Many folks have heard of the typical situation of a person, often a male, older, who's dealing with weight issues or is obese, snores a lot, and has sleep apnea. A lot of people are familiar with that sort of classic case. Maybe gets a sleep study or their physician or doctor says, hey, look, it's pretty clear you have sleep apnea. you need to go on a CPAP device and address that. But we're talking about so much more than that. You have people that don't hit that criteria

that still have disordered breathing. So how would somebody today listening know if this is something that's impacting them? Basically, you know, everyone understands, you know, if you're very high BMI or just very high muscle mass in the neck area as well. You know, some guys on TRT is quite common, you know, super physiological TRT.

then you're going to have just that sheer mass, which is going to make it harder to breathe. But, yes, there's a huge incidence from what I've seen personally and other colleagues as well around the world. Of this more subtle, you know, not severe sleep apnea that you're going to get in those cases, but more subtle ones, mild and moderate, and something called Upper Airways Resistance Syndrome, U-A-R-S. in the younger population independent of BMI or neck size or collar size,

as is the simple way of screening high-risk people. So, yeah, it really can occur regardless of BMI. And what it really is to do with in these cases, often lack of space in the mouth

for you to have that airflow from your nose and for your tongue to be in the right, position in your mouth as well. So if you don't have enough space because your jaws aren't developed enough, both anteriorly and laterally, then your tongue is going to be in the way. You're going to have grinding issues often assign a sleep apnea if you're grinding your teeth at night or upper airways resistance syndrome, which is the form before you get to sleep apnea. You get this UARS often. And that's a

different marker that we use to measure that. It really can occur in anyone regardless of am i but especially uh if you're snoring it's very hard to tell if you're snoring often unless you have someone in the bed to you reliably and they're honest to you um but yeah if you're snoring you know you can have something called primary snoring which is you know which is fine maybe a tiny little bit of increased risk in some things but often if you're snoring or you're waking up feeling unrefreshed and you don't know why even if your aura score is like 85 plus if your whoops 100 percent doesn't matter is it's not really reliable for picking up sleep apnea or how you feel often as well.

So the key thing is really, are you snoring and are you waking up, feeling unrefreshed? Grinding could be an indication. And a lot of people don't know. We've had dentists on this podcast, functional dentist, that have come on and said, hey, listen, like, maybe your dentist tells you that grinding is a general stress response. Hey, are you stressed? and, you know, a lot of people have some degree of stress that's going on in their lives. And what's the answer?

Let's give you a retainer because we want to make sure you don't end up cracking your teeth and then need a root canal or something else. But actually, if you go upstream, and this is what I'm hearing you say, is that what is the reason that we're grinding? And grinding could be connected to the fact that you're not getting enough oxygen. Can you just elaborate on that a little bit further? Your body has a lot of, it's one of the stress responses to lack of oxygen or just sleep disorder breathing in general.

The most extreme case being, for example, something like bedwetting as a kid, more common as a kid in that case. But in adults, yeah, grinding is very common and it's often a sign of undiagnosed SDB, sleep disorder breathing. So yeah, it's important to get checked out, but it's the same kind of pattern with kind of a ENT doctors. I should mention actually, so this thing I'm wearing right now, I'm getting surgery for my sleep apnea.

So it's a topic close to home and explains my chronic fatigue of had my whole life actually when undiagnosed for 10 years as well with NHS in UK with me. But yeah, this thing I'm wearing, it's a nasal expander. So in my case, I have a deviated septum, a very, like a very recessed lower jaw and a slightly recessed upper jaw. giving me like tiny tiny, tiny airway. And they were actually, the orthodontists have seen, they were surprised at how I survived so far.

They're like, oh my God, how the . There's something called nasorhinometry as well, where you stick these transducers like up your nose in each nostril one at a time, and you try and breathe through it to see how well you can nasal breathe. And mine is like a little, it should be like, you know, a big, nice curve up here.

And mine is like a little smidgen of like a tiny bit of air coming through at the bottom. And they're like, oh my God, we haven't seen this bad a case in a long time. I have mild sleep apnea technically on the diagnostic criteria. But in terms of upper airwage resistance syndrome, I'm moderate to severe. And this is often a marker. I've seen it missed by quite a few clinicians. They get the sleep apnea report.

They have like no sleep apnea or mild on something called the AHA, the apnea hypopnea index. That's the diagnostic criteria for steep apnea, a few different types of it. but they miss something called the RDI, which is the respiratory distress index. And this is much more common in younger people because our nervous system is more sensitive. You know, people underage 40 generally. This is where you have these micro-awakening's. So RDI counts both the AHA plus micro-awakening's on top.

So it's always a larger number than the AHA. And this is what's used to diagnose upper airways resistance syndrome typically. And mine is very like very moderate to severe on-graynors. that and that explains the chronic fatigue that I've been having as well and why I wake up feeling so unrefreshed even though I have mild sleep apnea because my nervous system is waking me up over 100 times a night pretty much so or 200 times a night even and that's a very important thing to understand that a lot of this how to die even diagnose this especially in younger people who are less likely to be obese or overweight it's this up

Airways Resistance Syndrome, and it's the RDI marker, which can explain a lot of the suffering people have from it. So for somebody who's listening is like, okay, I've suffered with some chronic fatigue or, hey, I've had this severe bout of grinding and, you know, the retainer sure is protecting the teeth, but still I'm waking up throughout the night or I feel like unrefreshed. What are their next steps? Do they need a physician or even a physician? functional dentist or somebody who's aware of this to kind of guide them through the process,

or can they go straight to the idea of a sleep study or a home sleep study? What are the tools that you've recommended people? Because it can be a little bit of a wild, wild west out there. The standard dentist will be like, oh, grinding, protect the teeth, do a retainer. That's good. But they're not finding the underlying cause potentially. The same issue with other medical specialties, again, with sleep apnea. So you see an ENT, ear, nose throat doctor, they'll be like, oh, you've got a deviated septum or a nasal valve collapse on the clottle test when you do this to expand your breathing in your nose.

And then they don't address the rest of the airway. So they're just looking at the nose. They're not looking at the second half of the airway. They don't know about surgical procedures for the nose other than septuoplasty or turbinate reduction, which are very kind of basic procedures and often have no effects on sleep apnea or sleep disorder breathing. So there's this disconnect between E&Ts, family doctors, normal dentists, and then standard orthodontists, all of which don't really follow the guidelines, to be honest. So the ideal person is someone like Stanley Liu, who's a doctor in Florida, one of the world experts in this, and he wrote the Stanford Sleep Apenniocirurgical Pathway Guideline as well.

That's what he's famous for. And he's, but he's, the only reason I think he's that good is because he's dual qualified both as a, as a dentist and a, as an oral surgeon, dentist and as a, uh, E&T doctor. Or yet he has both, you know, he's like a double medical specialty that makes him able to see the whole problem and have that insight. So when you're thinking about who to go to about this, it's really, yeah, like the referral pathway is quite unusually bad. Um, I've found. And I've seen people, uh, yeah, I've seen so. much so even personally as well but in many other people are just endless um incorrect referrals that don't uh ever really get much effective treatment even once if they get a diagnosis in the first place so yeah how to start with all this first of all if you're snoring you know that's a that's a sign

something if you checked you're waking up feeling unrefreshed something if you check don't rely on the aura or the whoop or any of the home you know apple watch garment etc it's not really gonna it's not really going to do much. You need to get a sleep app for your test and there's two ways of doing that really. So one is the watch pat. So that's watch capital P, capital A, capital T. And this is quite a cheap test, especially in US, it's like $120, $130. You can buy it online, often covered by insurance. Many plans will cover it. They'll reimburse it or, you know, it's quite cheap. It's not really big deal anyway for most people. And you get that direct to your house, you get the report, you don't even need a description for it. You can buy it online.

And you wear this device on your hand. So it's a finger sensor, a wrist sensor, and then a little microphone that straps onto your chest here. You do it for one night, and then you get a watchpad report. And this will give you your AHA, your apnea, hypopeneer index, your RDI, which is the more sensitive version of that. So the respiratory distress index with all those micro-awakenings on top of the actual stopping breathing kind of stuff, which is the apnea fully stopping breathing or hypopnea stopping breathing by more than 70% I think. for that one and then you also get your odi which is okay we're going to be technical but yeah whatever it's uh oxygen desaturation index that's how much you drop your oxygen um from the oxygen

finger sensor that you're wearing when you stop breathing so having those three um you know three markers together is really important and you also see whether they're occurring on your left side your front side your right side or your back so that's really nice data set to have and you can repeat it over a couple of nights as well and once you're have that, that can diagnose you, start the diagnostic process for sleep apnea, central sleep apnea, which is where it's neurological or obstructive sleep apnea, where it's physical, which is much more common, or UR's upper airway respiratory distress insin syndrome. So that's the first step, getting that watch prep test on. That's the easiest way to do it. It's not the gold standard. The gold standard

is where you're actually doing the airflow analysis in your nose, so you're having nasal cannulae, where they measure the actual airflow. and you also have EEG ideally as well where you're looking at the brainwaves of during sleep to see when you're getting these micro-awakening's and these app, it's an hypoponics. That's the gold standard, but that often has to be done in the sleep lab, and it's a lot more expensive, and maybe when you're in a sleep lab, you're not in your natural environment as well. So that's why I like the watchpad, because it's, you know, it's very validated, it's very cheap, quick to access it's a good place to start you can always get a sleep test later and insurance

is more likely to cover that if you um have your watch pad results as well so yeah watch pat first line then the tests get more complicated so yeah so you're diagnosed then you can look into things then you want to try and find where in the airway um it's going on like where where in the airway is the problem is it the nose is it the tongue is it the the pharyngeal airway with the lower jaw um etc. Is it the symptoms at the back of the nose and so on? Whereabouts is it? Is it multiple places where as it often is? So for this, this is where people often never get this test. They'll just get CPAP and told to go away. CPAP even if they're lucky as well because when you have,

there's two versions of this AHI that insurance companies will argue over. There's one which is defined on dropping your oxygen percentage by 3%. which is a lot more sensitive. You know, you're going to get a higher number if you're only dropping by 3%. And there's the second version, which we're dropped by 4%. Now, the 3% one is pretty much just as clinically dangerous for quality of life and life expectancy probably as well in the long term as 4% once. And scientifically is not really a big deal.

But insurance companies will often only, you know, cover you if you're 4%, AHA4% based above a certain. certain car off number rather than 3% 1. And then they won't, often won't cover you at all if you're, if you're, if you're high RDI. So even if you've had an RDI, they just won't cover URs, even if you're absolutely wrecked by it. So it's kind of biased towards these more overweight phenotypes

and older phenotypes as well. Yeah, they don't recognize all the nuances that are inside of it that people might be dealing with. And also with URs and even many types of sleep apnoir as well, You often want something more advanced than CPAP. You often want bi-PAP or automated bi-pap, which changes breath-to-breath, or APAP, you know, automated positive railway pressure as well. So there's many different types that go beyond the standard CPAP,

which is often the cheapest machine. There's complexities with how you do all that, and you often, you know, people often have to buy it themselves, learn how to use themselves without physician guidance or, you know, minimal physician guidance because none of it's co-buying their insurance. So they're trying to save money and do it themselves and learning on Reddit and GPD and so on. So it's a kind of a weird situation that people should have to resort to that when it's clearly improving them when they do it and ruining their lives if they don't do it. So that's the kind of diagnostic situation and the first, like the standard of care right now.

What's normally not offered is something called a CBCT or a dice. So a CBCT is a very often using dentistry. looking at the roots for root canals but also used in in a airway dentistry and orthonatic jaw surgery as well so it's a very low dose type of CT scan much both higher resolution for this top part of the body and much much lower radiation dose interestingly than a standard CT scan for this area of the body so it's actually quite a cool invention and it's not not really risky at all I'd say in terms of the radiation exposure I've had one done because like you I've been kind of trying to

to navigate this over the years. I actually didn't know until we chatted this morning that we have this in common. So I'm super paying attention to this podcast. But yeah, they'll call it sometimes like a cone beam scan. It's kind of this thing that scans your head, x-ray, and gives the either dentist or medical doctor a sense of how much space do you have in your airway

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artificial taste that a lot of chocolates have. It blends perfectly into smoothies or shakes up easily when I'm on the go. If you want protein, you can verify, not just trust, go to puri.com and use the code Drew for 32% off your first subscription order. In addition, you'll get a free premium shaker bottle on your first subscription order. All you have to do is go to Puri P-U-O-R-I-com slash D-H-R-U and use the code D-H-R-U at checkout for this limited time. I'm off. Exactly, yeah. You can see the shape of your septum really, like really well as well.

So you can see if there's obstruction going on there. You can see the back of the nose. You can see all the measurements of your jaw sizes, of your, your nasal base sizes. So the anterior and posterior nasal spine transverse widths. Those are important numbers. You can see your, you know, how big your maxilla is. So rather than biting into a piece of toast and then measuring that with a ruler, this is a much more accurate way of doing it.

and there's many other kind of ratios, angles, and distances that the orthodontists or surgeons, if it's jaw surgery, can use to identify deficiencies as well. And yeah, you also get this cool heat map, so a color-coded heat map of, you know, green to red, simply speaking, of green, yeah, your airway size is good in this area, but then all down here is going red, and this is where the blockage is, and it's all really red down here. and then you get something called MCA, a minimal cross-sectional area. And mine was like very, very, very, very small, very, very small. Shockingly small.

And it should be three times bigger even. So it's like, I was pleasantly surprised to discover why this is probably the most like the reason I've been having chronic fatigue my whole life. You got this scan done, this X-ray, this, you know, cone beam scan or what was the other name that you said? CBCT. CBCT. CBCT. Very specialized equipment, but a lot of places have it that, that, you know, do this stuff. And they looked at your, you know, the back of your throat into your sort of airway

that's there. And they saw that it was so narrow. So if it's already narrow standing up, when you're sleeping, you have gravity. And now it's even more narrow. And between the combination of how big your tongue is, how small your jaw is, how narrow way your airway is, all those things together, give them in a sense, and they'll say like, hey, you have, you know, where you should have 100% opening, you really only have like 20% opening or 15% opening. So yours was really bad. And in your perspective, you connect to the dots as, hey, this is one of the reasons why I have this disordered breathing and I don't feel refreshed. And while I've dealt with chronic fatigue, even though I'm the guy that people come to to figure out

how to slow their pace of aging, this was sort of the hidden piece for me, and now I have to decide what I want to do about it. Is that accurate? Yeah, you know, I've been to, you know, doctors for fatigue, you know, loads of times over the years, but no one ever ordered a watchpad or discussed snoring or sleep happening or anything.

And yeah, so I'm getting a lot of the watcher of gains actually already from just wearing this, you know, as much of the day and night as possible. Take it out, there you go. So, like, 10 quid kind of and just goes in like this. So that was based on seeing an E&T and them seeing that you had a deviated symptom. Not everybody who has airway stuff has that, but in your case you have that and the airway issues as well. You have to think about airway top to bottom. So the first part of the airway is the external nasal valves. and you can have nasal valve collapse. So when you, so if you breathe in,

you see my nasal valves collapsed here, and that really reduces my nasal breathing just because of, you know, I'm not really sure what causes that. We don't really know. Oh, it can be like maxillary, there's lots of different reasons, but we're going to do it, it's a bit too technical.

But yeah, the way to test for that is the coughal test. So you pull here either side of the nose, and if your breathing gets much better, then that is a potential positive, nasal valve collapse response. And the treatment for that is, you know, I tried the treatment for that, $3,000 in Miami to tighten my nasal valves using high temperature radio frequency.

But that didn't do anything at all. So the next step after that is, you know, ignore the nasal valves and focus on the base of the nose to expand that. But there is something else you can try. You can get these inserts that you put in. Like they're surgically, a little mini implants that go into this area here to stop it collapsing.

and then they dissolve after two years or so. So kind of little implants to give you that structural support rather than using the radio frequency, which is like a tissue tightening procedure. Rather than using that, this is like the next step on. If you wanted to focus on the nasal valve collapse, it would be those little implants. I can't have the name of them, but Latner or something.

I haven't used them before. It's quite niche. So yeah, you start the nasal valves, do the coddle test. You know, that's a reasonable way of doing it. And that feels so much better actually when I do that. I'm like, oh, that'd be nice. that'd be nice but i can't walk around like that all the time i would uh would um i get some weird looks i still i get enough weird looks wearing this but it's quite fun having people

staring me and be like you see a difference already with that yeah so yeah i do this instead just because of the uh the nasal nasal that that procedure didn't fix my nasal valve collapse too the next step beyond that and then you get to the inferior turbinates which like the little bones coming out that swell for their bone the inside of it of the turbinates the inferior turbinates are the most important the biggest ones for most people so they're the ones right at the bottom or the nose and they have the bone in the middle and they have tissue around that which swells when you have when you lie on one side when you're lying down when you're too hot when you have a cold a virus bacterial infection or allergies as well so there you need to treat

the root cause you know improve your immunity um you can treat your allergies with allergy immunotherapy drops for example or antihistamines and sprays and so on to clear clear out the the allergens physically or you can do a surgical procedure or non-surgical procedure with radio frequency again to reduce the inferior turbinates a turbinate reduction very common procedure did that as well myself i've heard many colleagues um do that on uh on people as well and um and and other people i know have done the procedure never works for anyone uh for more than a few months from what i've seen it's not a very reliable procedure and there's the risk if you do too much you get something called empty nose syndrome, which would be terrifying.

Probably like one of the nightmare scenarios of where you can't recognize that you're breathing. And it just feels your nose can't sense the airflow. And this really fucks up your sense of like, of breathing as well. That's the second step. So it's really like there's so much to it, right? It's not really just like do CPAP as most GPs will do. So that's the inferior inferior turbulence, not very, not a great target. the allergy drops can help a lot.

These can help a lot just as like a physical, you know, overdrive. And then you get a little further back. You get into the sinuses. The sinuses are you going to be careful if you're having like serious sinus surgery. That can mess up your nitrous oxide production and drainage issues. You'll be very careful if you're considering like a sinus procedure, try and keep them minimally invasive and do a lot of reading, go to world experts and so on. But, you know, people have sinus issues and that's another anatomical area where I can go wrong.

But yeah, like those three are very common, but it's really, it's unlikely to be fully resolved, I think, just by even if you resolve one of those three completely, it's unlikely to be fully resolved your sleep disorder breathing and hence your sleep quality as well. So you can also have a deviated septum, and this can be a common cause, I think, of very bad upper airway resistance syndrome, for example, like in my case. And this is, you know, obvious, it's just like the septum that is deviated. But it's not obvious because my nose looks pretty good, right? It doesn't, you know, it's like very symmetrical. It doesn't have any, no trauma history as well. No nose trauma. I've been punched in the jaw from a TMJ on my birthday, but I haven't been punched in the nose.

We've been punched a lot of places, but not my nose. So no history of trauma, but my septum is a Z shape or a Z shape, as the Americans will say. which is crazy. So on the CBCT scan is absolutely messed up. And when you have the CBCT scan, you can actually do something called CFD computational fluid dynamics, very technical, but it basically tells you about all the pressure and airflow stuff. So then you can use that the x-ray imaging to understand where the airflow is getting restricted the most as well. And I think I'm waiting for the results on that, but I think it's definitely going to show around that Z-shaped septum in particular. So this is where a septuplasty or, you know, nasal cartridge straightening, it's not

cosmetic but they can do the cosmetic stuff at the same time this is where that comes in and it may be you know very helpful in some people but you never start with septuplasty off well that's kind of what everyone has said all the orthodontists are world experts that's what they're saying even though the ENTs will jump ahead with that straight away they'll be like yep 10k general anesthetic septuplasty you're going to be feeling better so they haven't even ordered CBCT so they don't really know what's going on then we have the nasal base and this is just the overall, like the back of the nose, how much airflow you have ability to come out of the back

of the nose. This is basically related to how wide your upper jaw or your maxilla. So you have the maxilla and the mandible, the two jaws, the upper jaw is maxilla. It's related to how wide your maxilla is. And one way of telling whether you're, whether you have transverse maxillary deficiency, TMD, is the diagnostic term, is to, there's a few ways. So one, one way, you can you know get a CBCT scan but there's some simple ways of getting a suggestion of that as well is one is when you smile do you have buckel which means gum corridors black corridors when you smile so I do like you see here yeah I don't think you do I was checking earlier they're quite I think they're smaller they definitely look smaller they're more gummy than black

so if you have those bucle corridors this is a a sign of potential TMD transverse maxillary deficiency. Also, if your tongue is just too big for your mouth and how do you tell that, well, this is another sign. There's this concept called mewing. You may have heard of it by Dr. Mike Neue. Whenever you think about airway, you always have to think about pediatrics and adults. So because the treatment, the body is very different. They're different species. The kids are like aliens compared to adults. So you have to treat them very differently. So when you're a kid, your palate is very, you know, malleable. Lots of things can change it. Even small things like mewing, which is having the tongue on the roof of your mouth.

So the way you do that is like you try and click your tongue and then you store it, you store your tongue or suction your tongue on the top of your mouth. And if you're a kid when you're doing this and you're doing that during your sleep, you're going to create that enough pressure because your bones are still, your skull structure is still forming, your palate is still forming. It's going to help create that jaw width to make sure that your tongue fits inside your mouth. A lot of people out there, including myself, probably you want cleaner products in your homes. And for good reason, when you consider that your homes help regulate everything from your sleep and energy to your mood and metabolism,

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and having a really strong latch and not having a tug tie naturally helps kids sort of have that developed, you know. Exactly. And why do they have tongue tires? We don't really know. One theory is lack of methyl folate. So M-T-H-R, you know, homozygous or double MTFR mutations potentially maybe links to tongue ties as well. Too much folate, not enough methylfolate in the diets typically.

Or just not enough folate at all. You know, very poor deficiency until it started being supplemented quite recently in pregnancy. But tongue ties, you know, this could be one of the root causes, right? So if you have a tongue tie, then you're not going to have enough pressure on the top jaw as a kid to make it wider. And then by the time you're an adult, you're stuck with that. You can't widen it without surgery or complex procedures. And then you're stuck with this anatomical situation.

And the tongue ties, you know, mine was missed. So I have several tongue ties. The anterior one is very easy to visualize. Not myself, my anterior one is pretty normal. But the posterior ones are much harder to see. And often, they're very commonly missed, I'd say. So one thing that I like to recommend for friends having kids right now is like, you know, make sure you get a good tongue tie assessment and then good like jaw assessment, even

once a year like orthodontic jaw assessment, looking at tongue ties, tongue habits, myo-functional, are there the gaps between the teeth so that there is, which is a sign that they're going to have a big enough, wide enough jaw not to have TMD and transverse most cellar deficiency. Lots of different things like that. You know, are you breastfeeding enough? You know, we're very lucky in L.A. There's quite a few trained dentists that are very aware of this, physicians. My own son, I had a, you know, my wife gave birth and we have a baby boy, seven months old.

And, you know, just knowing that my wife has a super strong tongue tie, I have a very narrow jaw. We're like, very much like, dude, we want to make sure he doesn't suffer with the same BS that we've dealt with over the years. But you, what, the thing that I want to highlight is don't just go to a regular orthodontist that does not have a clue about these because they will start taking you down the pathway of all sorts of stuff that can make the problem even worse. You know, extractions, which I had, I had a bunch. I probably had three, four teeth removed as as a young kid because I said I had so much crowding. And that, that can make the problem. problem worse. There's a lot of things that you can do if you find the right person

earlier on. And we can provide some resources, you know, buyer beware, you really got to do your own homework, but we can provide some resources in the show notes of some places that you can start looking at. UK is especially bad. Like I was saying earlier before the cool, like I don't know why. There isn't really a culture of any of this in UK. It's US is a lot more advanced than this, but it's still a very common problem in the US, but it's a bit better than the UK, thankfully. Another sign is that if your tongue is scalloping, so you stick out your tongue,

and if you see little marks in the side of where your tongue is getting hit by your teeth, that's called tongue scalping, again, showing that your upper jaw is too small for your tongue. And another way of seeing that, even if you don't have scalping, is like you can suction to the top of your mouth, and if your tongue is overlapping on any of your teeth, just a little bit, that counts as, again, being too small.

So you should be able to see all of your teeth, when you're suction your tongue through your mouth. That's my primary issue. My tongue is too big for my mouth, when really my mouth is not big enough for my tongue. I got a little bit of scalloping. Apologies to anybody that thinks it's disgusting, but I'll stick out my tongue, you can kind of see.

On the side there, I got a little bit of scalloping that's there. And that seems to be the primary reason that later on in life, I developed more of an issue and started going down the pathway of like, how do I get to the root of this and what are my options on how to fix it? I didn't have chronic fatigue like you did, but I went from being like an incredible sleeper, having great sleep, to all of a sudden now not having great sleep and what was going on or I have to do so many different tricks. And I will say, you know, even though this sounds very complex and it is, right, depending on how bad

this situation is for you for the person that's listening, you know, you tried a lot of things along the way. Some things didn't work at all. Some things maybe worked a little bit. And for everybody who's listening, your severity is going to determine how much of an intervention that you need. And for me, going on even a little bit of like an expansion using an ALF appliance, that made a huge difference. All of a sudden, I went from not being able to, you know, waking up multiple times throughout the night to, oh, many nights when I had my expansion device in, even if it didn't get to the root cause, I could still sleep pretty much from 9.30 to like 4 a.m. I might wake up a little bit, use the bathroom pee, and then go back to sleep and still get a pretty decent score on my

whoop and more importantly feel like refreshed and feel great, right? I'm still grinding in the background, but it's less with the expansion device. So there are ways that are there. It's all personal that you can make a little bit of a difference. And like you mentioned about, you know, the CPAPs. I've had, you know, my dad went on a CPAP and it went from like he would literally fall asleep regularly at night at like 8 p.m. when we have guests and people over, he's so tired to just getting a CPAP, even though it didn't get to the root of everything, now feeling like, oh, I can stay off. I'm not falling asleep randomly. I'm not tired. And I'm waking up in the morning. I'm feeling refreshed. Did it fix everything? No, but it did make enough of a difference that for him it was like, whoa, I feel like I got my, my energy back.

So I only having that in, Oliver, because obviously your situation is, you know, pretty extreme situation. But I also want to make sure that people don't lose all hope that there are some things that could be done potentially depending on how bad your situation. is. Before you get into treatments, can I ask you one more question. You kind of talk to that a little bit. So you said, we don't know why we have tongue ties. Could be potentially one theory about folate, lack of folate, you know, women not getting supplemental folate in their diet and especially methylfolate, which at least there's more attention on this now. There's a lot more better prenatals, people paying attention to the, you know, the diet side. You know, we've had James Nestor on the podcast and that was, you know, many years ago. But just remind our audience, like, why are we dealing with so many, especially in the Western world,

narrowing jaws when it's like, you know, our bodies are designed to be healthy. Like a lot of people in these traditional and sort of modern-day nomadic communities, they're not dealing with this. They have wide jaws, healthy teeth. So what the hell is going on in the Western world that we're dealing with these narrowing of our jaws? Yeah, I'm not an expert on the literature on the latest on this, but my understanding so far is that, you know, tongue ties, that's going to be an issue by itself.

But even regardless of tongue tires, it's the lack of, you know, hard, chewy, tough foods for many, many hours a day as you're growing up, especially in the first, I think, eight to 10 years of life are the key years for jaw development. So that's the second reason, lack of tough, chewy foods. Then it's a lack of breastfeeding because I think bottle feeding, this might be wrong, but bottle feeding may be a lot lower pressure compared to breastfeeding. and then you're not getting, again, that those pressure forces that shape the bones. It's a bunch of things put together.

Oh, I think, like, yeah, like allergies, because there's a lot more allergens now, I'd say. So if you're more allergenic, then you're, you know, all the plastics and so on, in the bedrooms, you know, LED lights even as well, just like even waking up, having poor sleep in another way. It may make you more inflamed, then your nose is not going to be. as clear to breathe through and then you're going to mouth breathe and if you're mouth breathing you're not going to suction with the tongue and then you're not going to get that expansion as you grow up to age eight so allergies on nasal nasal issues you know breastfeeding tough foods

tongue ties and oh yeah that's the one extractions as well like um yeah pre-molar extractions wisdom teeth you know not really an issue it's it's more more the pre-molar extraction for crowding Yeah, your teeth are already crowding. We need to remove teeth and then do orthodontics, which cosmetically, sure, makes things look good, but then now all of a sudden, and I'm a perfect example of this, your jaw narrows even further because there's not the teeth that are all designed to be there to keep it wide in the first place.

Yeah, it's not like the wisdom teeth, which are right at the back, so you can kind of preserve the bone. Often if you do bone preservation strategies when you're extracting them, you're not doing that tool when you're doing these types of extraction supreme ologs. You're trying to decrow it. So, yeah, my understanding is you're making the problem worse for sure. So those seem to be all the causes that I think might be to do with it.

So you were just about to get into treatments. And again, I'm so glad that, you know, this is the beauty of touching base before a podcast because I didn't think this is what we were going to get a chance to talk about. But yeah, I couldn't think of somebody more at the intersection of protecting our brain and not encouraging accelerated aging is so, crucial for health span and then of course as we start to embark on lifespan and what potentially could be there in the future and that's coming down the line and a huge part of that is sleep. If you're not sleeping well, you're already accelerating your brain aging.

So before we get into supplements, before we get into this, before we get into that, like, hey, let's give attention to sleep. And then within sleep, one of the biggest tolls that can be taken on your sleep, you're and really be detrimental is this disordered breathing, this sleep apnea breathing. And because the science and the diagnostics are so emerging, and it takes a lot of advocacy, it takes really you becoming the own,

your CEO of your own health and finding the right people together, because there's not a one-stop shop often that will fix it for you, and a lot of people will take you down the wrong path. I couldn't think of a better person to talk to than you for helping somebody who's like finding themselves either mild sleep out, or mild disorder breathing all the way to full-blown stuff,

which is obviously what you're dealing with. One last point of the testing is it's also an age-rated condition. So AHA, and I haven't seen the data on RDI, but AHA does just increase with age somewhat linearly. And that's, you know, due to loss of elasticity in the tissues, you know, the soft palate, the uvular, tongue tone as well, neurological control probably also. So it's actually an age rate of condition, interestingly.

So you may get this independent of BMI changes, even with age. And that's very bad because you're going to be a lot less resilient, age 70, sleep apnea or age 80 versus age, you know, my age, 30-ish, right? Or 40-ish. It's going to be it's harder to fix at that point. And also the surgery is going to be more risky. You know, there's more side effects. So earlier the better, you want to get this in the bud.

Like doing double double, if you have to do double jaw surgery age 70, you know, that's not a good place to be in. We've talked about CPAP already. That's continuous positive airway pressure. And that is, you know, normally a nasal, nasal little mini nasal nose mask that you wear, which gives you a level of pressure to keep your airways open as you sleep. You can do a full face one as well. It goes over nose and mouse. Yes, there's one that can go over your nose and mouth as well. But ideally you want it going through your nose only to promote nasal breathing.

You humidify the air, so it's not drying on your airways. You sterilize everything, so you're going to get infections from it to clean the device regularly. That's kind of the fundamental treatment for it, other than weight loss. You know, weight loss is very effective. Or even muscle loss in the case of if you're training your neck too much and all that, all that stuff. Just a quick note on that. I mean, people probably seen, we've written about it in our newsletter, a lot of really exciting things down the pipeline for people that have, you know, obesity and where weight is an issue. Just some of the early reporting about GLPs, helping people, you know, with this and resolving some of this disorder breathing that is primarily tied to, you know, being made worse with just a higher BMI.

So, you know, I have some friends that are on, you know, fractional dosing of GLPs, you know, not the full doses and are working with the physician with that. And in some particular instances, a couple of them that were really struggling and already were on a CPAP device, one who, a gentleman who also had a tonsil surgery with some ENTs, uh, ENT doctors do to also sort of get you off of sleep pap, CPAP and try that. He knows a huge difference from just being on the gups, the fractional dosages, and losing some weight. So that is one positive side that's definitely come out from these drugs. Yeah, GOPs can be life-saving in so many situations. Really, really good. If that applies to you, weight loss can be the number one, you know, a number one intervention.

Getting a BMI probably, you know, the normal range is BMI under 25. Under BMI, 23, maybe optimal for various people. sometimes the sleep apnea, sometimes just because of the metabolic benefits, beyond BMI 25 as the traditional cutoff for being overweight. But yeah, typically I see, you know, people, you know, we need around BMI 23 or under, unless you're very dialed in on your, on your gym training and everything, you're a very, you're very health-conscious person. But for the average person who's not super, super dialed in on absolutely everything,

then BMI under 23 is normally what I see to be giving them the best markers for, you know, complete metabolic panel, glucose, cholesterol, sleep disorder breathing, et cetera as well. So that BMI 23 range or less is a good place to aim for. Not medical advice, any of this podcast, of course, but yeah, discuss with your licensed clinicians. The weight loss is curative, actually. You know, if you lose weight and that cure is a sleep apnea, it's technically a cure, right? because that's an anatomical cause that's been gotten rid of. However, if you still have that, like in a lot of cases,

especially when you're younger and you have more upper airways resistance syndrome or the RDI numbers as well, then you're often given CPAP or bi-pap or a similar situation where you're putting air of different types in into the airways to keep them open when you're sleeping, then this isn't really curative because it's not addressing the underlying cause. And so this is where you mentioned earlier, one of these expansion devices. And this is often, I'd say, the first-line therapy

before something like septuplasty where you're straightening the nasal cartilage, even if it looks all from the outside like mine, or the nasal valve collapse interventions, or double jaw surgery. So before all of those, you have this maxillary expansion universe of different therapies. Now there's many, many different types of maxillary expansion.

The most ineffective one for adults is just mewing. A lot of people sort of claim that they cure everything on social media. A lot of people sell courses on it, but these are exercises, tongue exercises. You can do it home to try to expand. You got to be very compliant. And even then, if your situation is bad, you may not actually see too much of a difference. And you have to be a kid as well. Because you're not going to generate enough force to expand the actual

skeletal bone of the upper palate from from doing that unless you're you know underage a very young age right so as a kid it's great like you need that to form it in the first place but once you're you know past that age then it's not really going to work and there's many many many better options off which are covered by insurance anyway so what's the big deal so the gold standard really is a bone born expander and there's many names for this there's different brands as well The overarching philosophy is something basically called M-A-S-P-E. So mini-screw is the M. These are the little screws, so they're going to screw into the roof of your mouth.

Between four and ten screws, depending on if you're a guy or girl, and also how big your palletive is and how much expansion you need in which areas, depending on your anatomy. So mass P, mini-screw assisted slow, palatal expansion. There's also MAPE, which is the same but just rapid or rate varying is the new term for that. So it used to be Marpe and MassP, but now it's kind of just Marpe, but it's less common for people to do Marpe, traditionally where it's rapid expansion, where you're putting the screws in and then turning it in a few weeks to open the suture in a rapid manner.

The rapid version is more side effects traditionally, and this is why the most experienced practitioners in the field. It's only been around for 20 years or so, in my understanding. It's quite a very, very new field of medicine and dentistry. They're doing the slow expansion protocols now. So technically, it's MASPI is this overarching kind of gold standards for non-surgical, because technically it's not surgeries. You're not cutting anything out.

You're not doing permanent implants or cutting out bone or anything like that. It's the gold standard non-surgical procedure for expanding the upper jaw. You can't expand a lower jaw without surgery, not easily, because of there's no suture. So we only have a suture in the maxilla in the upper jaw. And that's why, so when you're doing these screws, say you've got eight screws, they go four on one side of the suture, four on the other side, and then they do a piezoelectric cut, non-surgical cut using high-energy piezoelectricity to open the suture, and then you start turning, and this opens the suture, and then you grow new bone in that gap

over the course of six plus months during this orthodontic procedure. So this is the gold standard, and there's many variants on it. So the silver standard, really, is something where it's connected to the teeth at the same time. And that's called tooth-borne expansion or wings, that has wings, arms or different names for it. But the problem with that is you're often not getting all the expansion with the actual bone. You're getting it from tipping of the teeth. So often when you have small jaws, like in my case, I don't know about yours, but your teeth, you really see this on the CBCT because you get really high res images of your teeth as well.

You see that they're actually quite tipped in. So from the top of they're tips in a little bit and the bottom that tipped in as well because the jaw isn't big enough and they're not really standing upright. So that may help with the tongue a little bit. but it's not going to expand the actual base of the nose airway or bring the jaw forward more air at the back in the in the in the in the mouth and and farangile airway as well so the gold the gold standard is one typically it doesn't attach the teeth because then you're going to get the force is going to go to the teeth rather than the bone you want maximum force going into just the bone so

it's a pure bone-borne maxillary expander something like a custom Marpee or an FME, a face Genix maxillary expander, which is a relatively less used, more expensive one which has unclear advantages. It's just marketed more. It's like a marketing technique, a marketing play, so to say. There's not clear evidence that the FME is better than a customized Marpee device. So both of these devices, they're made. in a complex, I think, 3D printed manufacturing process. But the FME, FaceGenx maxillary expander, this one is not customized

other than maybe that you can add in more screws, but you're not going to customize it to the shape of the bone. Whereas a custom MAPE, or custom MAPE, whatever we want to call it, these ones are customized based on the CBCT scan, and the surgeon decides, okay, we want this at this angle, this many screws here, this distance between the screws and so on, to custom manufacture it based on your anatomy. And it's cheaper as well.

So I'm not convinced of the advantage of the FME, only the disadvantages because it's almost twice as expensive. So those are the gold standards, custom MAPE and FME or these similar pure boneborne devices. That's important because we're not getting the tipping of the teeth. You can correct the teeth with braces as you go along, like invisaline or proper tracks as well, but you really want to focus that force on the jaw,

the bone, going to the bone itself. And typically you're going for between 5 and 10 millimeters expansion. So not much. But not just expansion at the front of the jaw, like in one place, you kind of want symmetrical expansion, both in terms of aesthetic looks that's going to cause, and also in terms of bone. bone effects that's going to open up the airways and make it easy to breathe through your nose and for your tongue to sit at the top of your mouth when you sleep and so on so you have the bone-borne expanders are the gold standard as the ones which have the wings on like the elf one you mentioned I think that would be silver standards and less effective you're going for between five and ten millimeters expansion both at the the the front of the nose so the anterior nasal spine and the back of the nose the posterior anasal spine

You don't want to open up just at one area. You ideally want to open up both areas. That's my understanding. That's something important to think about and ask your provider about. You're in that equal expansion across it. So you're not going like a triangle-shaped opening. You're going more square or rectangle. And then this can give remarkable benefits in reducing that AHA.

And it's a permanent structural change. You often look aesthetically a lot better as well. You get rid of those bucle corridors. and it can pop your zygos out so and also you get some you often get a five to one movement laterally to anteriorly as well and when you're bringing as you as you'll see on these cbcc airways you know all the narrowings often at the back as well as in the nose as well but you get a really big narrowing at the back and the only way to fix that um is to bring forward the jaws so interestingly even when you do this transverse expansion which is really helpful by itself you also

at some anterior movement, especially if your providers experienced in doing that. So say you do 5mm expansion laterally, you're going to get 1mm forward often. If you do more like 8 to 10 laterally, you're going to get more like 2mm or even 3 millimeters forward as well. This can give you a bit of an overbite and it's not going to affect the lower jaw unless you do some very experimental dentistry. So this is more for bringing the upper jaw forward. And it's a bit of and freeing up that part of the airway as well. So there's one study to put into perspective, the kind of effect size, this MAPE procedure,

custom MAPE, they're getting 66% reduction in AHA scores long term from this. And this is unlikely to regress because you're growing their new bone, literally, that bone is not going to disappear. So you've opened up there, you've grown your bone, it stays there permanently, you're permanently expanded, and it's a job done for a lot of people. So that's the thing that's start.

with it seems is the is the custom maspi or marpy the slow expansion no matter is it seems to be the safer one doesn't have you many risks with it as well which is pretty cool it's not like double jaw surgery where you're having these permanent implants inside you that can get infected or you get allergic to or like it's a very intense surgical procedure general anesthetic and so on this is actually i'd say a lot lower risk than um than than then some of these very invasive surgeries, what you're going to do after? That's going to know, because one of the recommendations, I went to a place here in LA, and they were saying, you know,

your obstruction in the back is pretty, you know, obstructed because, you know, your tongue is too big for your mouth and the jaw and the narrowing of the jaw. And it's like, you know, you can do all these little things, you can do some expansion other stuff, but this is going to continue to get worse with age. And I have to go back to my notes, but I think the only recommendation they said at the time He said, listen, if you want to get to the root of this, you got to have this jaw surgery. And, you know, it's pretty intense, and we're going to bring it forward.

And on top of that, you can only drink liquids for like six weeks. I think after it's done, you're kind of like, you can't, you can't chew. But to know that there's other options that are there that are worth investigating, you know, everybody's got to look into it and talk to their clinicians, providers. that are cheaper, less downtime. Is there any downtime from this like Mar-P that you were talking about? I mean, yeah, it's a bit, you know, you get the anesthetic and everything when you put it in. I think it's going to be, it's painful for a couple of weeks.

I'm hopefully starting mine next month so I can tell you and tell you all about it. So you have, you decided that this is something that you need to do because of all these other things have made a little bit of a difference, but hadn't made enough of a difference. You're still in a place where you're waking up feeling tired. and still having some version of chronic fatigue. Is that my understanding? Oh, yeah, 100%. But do you feel, like, based on everything you've seen,

you feel pretty confident that what sort of improvement are you expecting? Nobody knows until it happens from undergoing this procedure in the next few weeks. This episode is brought to you by Accenture. When your advertising operations fall out of sync, everything else follows. Spotify and Accenture are. working together to reinvent the rhythm of ad sales, using automation, analytics and smarter workflows to simplify campaign delivery and access better data across the business. The result?

Less time spent on operations, more time connecting brands with the moments and fandoms that matter most. Learn more at Accenture.com slash Spotify. Yeah, so I think, you know, probably the RDI data isn't really, I haven't checked on that specifically but I'm assuming it's going to correlate with the AHA percentage reduction so it'd be nice to get a two-thirds reduction in my in my RDI and AHA. To I think that would be a reasonable expectation to aim for. However yeah in my case my septum is very deviated but so going back to the the order of the treatments so typically all these

orthodontas are speaking to an oral surgeons they're saying you start with a MAPI and then you may not need the septoprality to straighten the septum because it's going to open up the air volume in the nose so much that it wouldn't make a difference you're going to be fixed anyway so that could be you know it could save you the issue there but also you want to do the marpee before you do double jaw surgery so the order is typically marpy first then double jaw surgery and then septuplasty to straighten the septum or other kind of nose adjacent procedures as well. So that's that's the order. If you do it in a different order, it can really mess things up, or it can make you need to redo that same surgery again because things will have changed

after doing one of the previous steps. You don't do it in that order. So that's my plan. Like a lot of my people speaking to are saying any double jaw surgery as well, just because like my lower pharyngeal airway is so wrecked. But yeah, I think I'm going to get good improvement with Marpe. And then maybe that's going to be enough. I mean, we'll see about the double jaw surgery after that. But it's important to know that also, as you do the MAPE, once you've expanded, you leave it in for quite a few months after to regrow the bone

and keep that, I think it's just the typical way of doing it. It's about six to 12 months you keep it in. And you use a crank to turn it. It's pretty cool. I'm going to get some people to crank me just to, and then film it's like, be funny. And then, um, and then, um, Yes, it's important to like release the tongue ties at the right point.

So if you release the tongue tie too early, sometimes that can cause it may make things worse because you're not going to have the room for the tongue to be released. When it's released, it's going to move around more and it may make things worse. Take up more volume, flop around when you sleep and so on. So you want to expand, then you release the tongue ties and you're doing tongue training all the way. Tong and just general kind of a oral facial training with a certified. with a certified person for this throughout the whole expansion procedure as well. Because this is going to help you reform your tongue habits to what they should be ideally and what is natural traditionally, is my understanding.

I don't have a strong tongue tie. I don't have any of the typical sort of symptoms that are associated that, you know, in their questionnaires and their assessments that a lot of these myo facial specialists look at, but I still have narrowing, you know, pretty extreme narrowing of the jaw and that obstructive airway issues that are there. So it's a unique thing. Sure, could I get a little bit better with some of my, you know,

myo facial movements, tongue positioning, other things like that? But in general, I didn't have a lot of those issues. So it'll be interesting for me. I haven't gone down the path of like looking into the MarP enough to see if that's a solution. That could work for me. But I'd be really excited if it was because

I pretty much was like, dude, I'm not going to get permanent implants. And often people do the D.J.S. Double jaw surgery or MMA, maxlow mandibular advancement surgery, and no benefits. That's crazy. I hadn't heard that that was the case. I'm also worried, too, because I've had people on my podcast who have talked about, you know, you implant anything into your body permanently, there's always a risk of some autoimmunity and confusion. That's there. Everybody's body is different. Everybody has a predisposition.

in different ways and, uh, infections. Infections that are there. So it's definitely not something light to, uh, to jump into. So how did you decide, uh, the person that you were going to work with for the Mar-P and, um, you know, uh, is somebody based in the UK, uh, you know, did you, did you find them in a database? Like, how did you connect with the right person and any tips for our audience? if somebody's thinking that, hey, this is an issue,

and I need somebody to kind of walk me down this pathway to see if my chronic fatigue, if my severe grinding, if some of this upper airway stuff that I feel like I have is an issue. How did you find the right person to kind of walk you to stuff? I mean, I haven't had surgery before. So I'm not on the other side. I'm like helping someone find the best surgeon. If we're planning a surgery together,

I'm trying to find the best surgeon. So I use the principles I use for my clients. on myself and that was you really want some like objective evidence on outcomes you know safety and efficacy outcomes so and and also years of experience as well because the larger the sample size the better so there's many people there's many orthodontists that are retraining in this area and they've just started in like the last one year or two years or three years and sure they're getting like maybe they're good at social media and so on but are they really the world experts? Not really. So for a world expert, typically you're looking at

a thousand plus cases over 10 years or even longer. It's quite a new area, so it's hard to find those people. And another way of looking at it is you just speak to other people in the industry, in the airway, in orthodontic industry, and see who they recommend as well. Another way is looking at like going to conferences or asking people that have gone to conferences, who are like the expert speakers that are speaking and who is dealing with all the difficult cases as well, the most complex cases. So those are some like initial criteria. And then once you find those short list of people, then you can ask them, interview them, ask them, have a list of questions. What are your success rates on XYZ? And yeah, I found my guy. I think I'm probably going to go

with Dr. Lipkin in New Jersey. So yeah, America and not UK. UK, there's not really anyone as experienced as him. I don't think. And he seems to be that guy, you know, that's done over a thousand cases, over 10 years experience, even 20 years, I think, in his case. And is the guy that people go to for all the advanced, like complicated stuff, which other orthodontists need advice on. But that's specifically for Marpi. It's not for another type of intervention, which may be like something called ease ease which is a non uh it is a it's like a surgical type of marpy uh where you're taking out bones my understanding and it's not double jaw surgery so there are other surgical options beyond marpe but which aren't double jaw surgery and require implants and so on which can be very evidence

based for improving these these types of sleep disorder breathing so yeah it has to be specific to your exact case So if it's a different type of MAPI, then maybe you want to go to someone else. But if you want the specific type of MAPI, then I think this guy is the one for me. Yeah, and probably for somebody who has not begun on the journey. That's not even the place to start for them. They need to start with, you know, this sleep assessment, like this, you know, this watch device, which we have linked in the show notes that you mentioned. CVCT.

And then maybe, you know, start with somebody locally that can do this comb beam scan, look, see if you actually have this. as an issue because it's easy. There's so many things that can contribute to chronic fatigue, right? Exactly, yeah. There's so many things that, you know, we're all dealing with situations. Right now in my own house, I'm dealing with, you know, mold.

And I found a really great team from San Diego that came highly recommended from multiple sources. And I was so convinced that my bathroom, master bathroom, had a bench in some side of it, you know, it's kind of common in America and a lot of like units, nice bathrooms. They'll put like a bench inside. I don't know why. But I was very convinced because I saw some outer rim of mold that there was some toxic mold. And I had been working with my functional medicine doctor who had noticed that after I started developing a little bit of eczema on my hand

in my 40s, we started going down the rabbit hole like, okay, here, where is this coming from? you know, something toxin the immune system, the gut, this, that. And we did a mycotoxin screening, a urine microtoxin screening. Just to see if I had any elevated levels of mycotoxins and some showed up. And I was convinced, oh, it's this, this is the issue, it's the mold. And I just got back to test results this morning. And he was like, look, there's mold, but it's not any of the ones that are the ones that we know that are the toxic species that are there.

doesn't mean that you still shouldn't be addressing it, but it's not a shut and dry case that, hey, this is the reason that you're having some of these elevated mycotoxins that have been showing up in your urine. I'm just bringing that up to say that I was so ready to drink the Kool-Aid that this was the issue and put the tension there and I wanted to be the issue. But you need to find a good practitioner who can help you and say,

no, you don't have upper airway issues. You probably have this issue. and maybe you should investigate that aspect. Long COVID, whatever. Right? Yeah, yeah, yeah. So there's so many different things that are at play. So getting a sleep assessment, finding somebody locally.

You know, we did an episode on root canals and how some root canals, especially, you know, years ago when people weren't following the best practices, cleaning out the dead tissue properly. We had a doctor who was from Europe, came on the podcast, a dentist, And, you know, so many of my audience was convinced, like, oh, this is why I have this issue, that issue. And it's like, dude, you can get a cone beam scan. You can get this CT scan and see.

And I had multiple people to write in that, hey, I didn't have this issue and I didn't have this infection that was there. So that's not my thing that was causing my issue. So it's good to find the right people that can walk you down the pathway of seeing before you dive. into the deep end and go through all these procedures, which could be completely unnecessary. Yeah, you need a full medical history. And a full medical history is a thousand questions. So when I do an induction questionnaire for someone, it's like a thousand questions, right? It's really, really useful, really useful. Yeah, I mean, you're the exception to the rule. A lot of people are not kind of even like really

great doctors that are out there, but at least you're raising the bar and that, you know, you've got to have somebody that's willing to sit down, ask questions, go through your full history before they're gonna make these assessments that are there. Yeah, it should almost be like a global, just standard. Like, if everyone, another AI is coming around as well, you know, it could make it easier to, for clinicians, to like, you know, auto-analyze stuff and actually make it realistic for clinicians

to do it in a short consult time. But like, yeah, it'd be nice if just everyone had that 1,000 question medical history answers, and that would really help with management. Yeah, I want to ask you a bigger picture question, zooming out, but just first, did you have anything else that you wanted to add about interventions, solutions, treatment options?

Yes, there's the MAPE. It's really good, I think. Then there's the EASE, you can check it out. That's Stanley Lou again. No affiliation to any of these things. Double jaw surgery, that's where you're bringing forward both the maxilla and the mandible. to open up the back of the airway, the pharyngeal airway in particular,

rather than the nose. That's really important. But yeah, you don't, you'll be really careful with that because it can really not do anything a lot of the time. A lot of double jaw surgeons, they're not airway focused. They're more cosmetic because that's often what it's done for or reconstructive. So you want like an airway sleep focused double jaw surgeon or jaw surgeon that's going to really understand you know, drug-induced sleep endoscopy, perhaps,

AHAs, RDIs, Airway, CVCTs, all these things. Not just aesthetic stuff, because you can do, you can get both, but you might have to comprise a bit on the aesthetic stuff to max me improve the airway, which is the most important thing. For the aesthetic stuff, you can always do implants as well after, like, you know, implants or filler. It shouldn't be the priority. It shouldn't be the priority.

So, you know, my big picture question is a multi-part question. You are somebody that people come to. You have an entire consulting company where people from around the world who are highly motivated seek you out to help them age better and get to the root of, you know, pretty complicated things that they're dealing with. And, you know, you put together these, as far as I understand, you know, haven't had a chance to work with you personally or chat with somebody who has, but you put together these very highly personalized protocols

to help people age in the right direction and make sure they're avoiding the things or getting to the root of stuff like disordered and sleep apnea and breathing issues, upper airway issues, that would be accelerating. They're aging. So you do all that. We'll link to your consulting company.

I believe it's called 21 consulting. Oliver.com. Okay, okay. Oliver, okay, got it. We'll link to that in the show notes. So you do that. And you've also been a very honest here on the podcast that you've struggled with this issue, which is why we decided to do a deep dive into it. And you're trying to also get to the root of it earlier instead of later on in your life

because you know it's so important. Because if you have messed up sleep for a long period of time, that's going to be something that's going to accelerate your aging that's there. So the question that I have is a two-part. have you been able to quantify it all, even though you do so many other things right in your life, the toll that disordered sleeping has taken on you? And for anybody that finds himself in a similar situation,

could even be that you're a new parent and you want to have multiple kids and you're a woman that's listening or a husband that's listening. You're like, man, my sleep has been messed up for years. What's the glimmer of hope that you want to add to those people that, hey, it's never too late to start heading in the right direction. Does this make sense at all, you know, kind of what I'm trying to get at? First one, how is it, how I quantified it in myself, like how bad it's been impacted me.

It was pretty obvious. Like, you know, waking up, feeling like you've been punched in the face or beaten up or drunk or, you know, like drinking, been drinking the night before or some heavy drug use. But you haven't, unfortunately. So you're just waking up feeling in absolutely directs and then maybe uh you'll feel good enough in the day to do something maybe you won't it's a bit random um yeah like chronic muscle pain related to that migraines related to that like um exhaustion inability to gain muscle low testosterone as well can really there's one interesting case for a guy that uh he did he did mp tripled his testosterone crazy because if you're you know you don't have oxygen you're not going to be in a

you just nothing is so many things can go wrong another one is like uh you know kidney dialysis a gyosis a gyland dialysis undiagnosed sleep apnea and then that was that was the cause magically transformed his kidney health afterwards so yeah i'll just be in a physically it's very obvious um there's only two things that help really so far uh or three things like the bipap machine helps a little bit. This nasal expander helps a lot. I'd say more than the ViPAP and then this very expensive pillow, which I carry with me wherever I go now. Do you mind mentioning the name and who's that type of pillow for? The perfect pillow is different for everyone. I don't know if it's going to work for someone else,

but it is very good, in my opinion, like technically speaking. It's the Temper, T-T-E-M-P-U-R, cloud-cool, smart pillow, medium, a medium density, not the soft one. I think I have one of those. It's like Tempropeda Company. It's got some cooling effects, but it's got this gel inside as well too, in addition to whatever they put. So you find that it's the right firmness for you?

Is that? It's heavenly. Yeah, really, really helps. I know if you're traveling, you can actually bring it as a carry-on. Like you don't have to get a whole suitcase for it because it's quite big. You just do carry on and that's like a good travel hack as well. Or cut it in half, stitch it up, and then you've got like a mini-ververlion. which you can probably shove in the suitcase if you wanted to.

Yeah, it's definitely a hack. My wife and I, whenever we travel, we always take her own pillows. You don't want to leave it up to the hotel. Very important. You're on vacation and you have like the worst sleep because of a pillow. Just take an extra suitcase, put your pillows inside, check in, pay the extra 30 or 60 bucks. If you're spending a bunch of money on a vacation or travel, you know, what's $60 in a check in a suitcase?

It's nothing. Yeah, you got to do it. You can't do it. Can I ask another question that's there is that what were the things that you were doing? Because biological aging, whole body health is multifactorial. Sleep is definitely one of the top pillars. But now you know, you have this chronic fatigue because you're not sleeping well. Separally for the interventions, which we've gone on a deep dive here, what were the things when it got really bad, which it sounds like it was,

what were the things that you would do to sort of best support? your own body, the things that you would or wouldn't do in other areas, whether it's your diet or lifestyle or other things or working out, that would at least build back up some resilience and not completely destroy you. Any things that you can mention here? I've been completely destroyed several times. The funny thing is, like, and I'm sure a lot of, you know,

patients, you know, with, like, serious conditions, they can relate to this as well. Often you can't do any of those things when you're so ill. You can't exercise. You don't have appetite because you're not exercising. You can't eat healthy. You can't. There's nothing you can do.

You're just helpless and you're trying to find a find a way through it. It's really painful. So what helped me really was just like learning more about medicine. Even as a doctor, right? I'm still, most of what I do is learning every day because there's just so much. So just learning more and, uh, finding better clinicians to work with and learn from. And yeah, I think like having good social, emotional support,

that's the one thing you can kind of, you can't kind of do in any situation. You know, you can't do that. You can't access, like maybe you're, maybe you're a smoker and you just have to, you can't, you're not going to start quitting your smoking when you're completely fucked up from, from your other condition that's going on in an acute flare up situation. So yeah, I think the only thing that could be. is like emotional support and learning more and finding better doctors or clinicians. Man, I never knew.

You know, I've been following your work for a long time. I never knew that this was so bad and this is what you were dealing with. And, you know, my heart goes out to you because that's so tough. And I'm so glad that, you know, you are obviously taking this, you know, unique situation, which unfortunately is impacting a lot more people in the world, right? Not just the upper airway and the disordered breathing, but then that being so bad that it's translating into like chronic fatigue or maybe making another, you know, chronic issue that they're dealing with so much worse. So I'm glad that you're, you know, you're sharing about this and

you're talking about this story because, you know, for people who don't have hope, it kind of feels like your world is just ending and you just don't know which way to go. So I really appreciate you opening up about this. I've been there. I've been there. Any sort of concluding thoughts that you want to add in here as we're winding down on today's episode? AI is really empowering because it's quite hard to access like good doctors. Social media is actually can be empowering as well. If you know how to use it, it's like you can go either way. So it can be, you know, endless scams and anxiety inducing and, you know,

social media addictions and all that stuff. But if you use it in the right way as a tool, you know, in like, you know, you're only looking at, you're looking at top doctors, you're looking at like licensed clinicians, you're looking at like top scientists, etc., whatever your topic it is, you know. If you're looking at the top people and making sure you're filtering out like a lot of the a lot of the stuff that seems too good to be true often as well, then it can be very empowering because, you know, knowledge is power, education is power. That's why I'm in the education space in health as well because I think it's a really a fundamental issue, both the doctors and

individuals are the lack of health education um most doctors don't know about like marpy for example i'd say 90% plus right um but it's but so many other patients have sleep happier and could benefit from that so there's a like issues like that times a thousand that's kind of like what's what it's like to be a doctor um specializing in something it's very it's very very hard to be a doctor and keep up to date of everything it's very very tricky so yeah i think i think i think i'm positive because like the AI situation is good. These AI tools are getting better at educating people and access to healthcare.

It's getting better. And social media can be good as well. And just the drugs and evidence base is getting better for everything. Drugs, procedures, supplements, everything, lifestyle. There's just more and more data coming out. So every year, you know, I like to say, often there's a million new papers

and 50,000 new randomized controlled trials. So it's just a matter of time before we solve every medical condition. Talk about your world. you've got some exciting stuff that you're up to, including some retreats and other things. I'd love to mention to our audience. You know, if they want to, let's start off with, like, you know,

who seeks you out individually, you know, is this something that obviously you're highly specialized? Is it something for people, you know, who are like, got to have like a lot of resources, which no problem with that, right? That's often how we learn. And then, you know, this work ends up translating and impacting, you know, getting involved in other technologies. You have some online courses.

and then the retreats and anything else you want to mention. If you would just give a little overview of your world. Sure, yeah. Well, yeah, so ultimately my goal is, you know, research-based is to prove irrefutably reversal of aging in all 82 organ types in peer-viewed publications. So all my projects are related to that, you know, achieving that goal. So I have a biotech I'm raising funding for right now

for muscle gain to solve sarcopenia. I have longevity school, which is what I like to think is the world's most evidence-based and comprehensive online course for maximizing your health span and lifespan as well. And it's peer-reviewed by other doctors. So it's not like just my opinion. It's also gold standard peer-reviewed methodology. And then, yeah, recently a clinic I'm setting up.

And I think the clinic has always been a kind of project I want to do, but I've never really had the right way of doing it. Because I think it's quite hard to make a difference in a lot of these longevity clinics. they're just glorified excessive screening, which goes against most evidence-based medicine are clinical practice guidelines. You know, it's not very good practice. And they often don't help on the treatment side of things, all the long-term follow-up and behavior change and drug management and device procedures and referrals and everything, the whole package.

That's kind of the issue I find in this, a lot of healthcare, including the longevity space. So the clinic in this case is more about, we're not going for one-day visit, It's minimum seven days, maximum 21 days. So between seven and 21 days are other visits. And in that time, I think you can really make a transformative difference to many, many patients, even in the complex situations where they haven't been able to break through on their conditions previously. So I think that's an important concept, these kind of clinical programs across extended periods of time. We're getting many hours of contact time with doctors,

with different specialists that are personalized and relevant to you, with like exercise trainers, sleep trainers, dietitian trainers, et cetera, covering everything across several weeks. And then separate to that, yep, there's the retreats, which I'm doing my first one, should be very fun. And that's more of an educational experience. So lectures and personalized education during the day

and some fun activities at night. that are longevity related as well. That's awesome. And then first one is coming up in Spain, right? Yep. Beautiful. Amazing. Well, we'll have links to all that.

I think even two, you have like some, you know, you do some individual like one-off consulting for people. People can check it out if it's a right fit, if you really want somebody that's an intersection of all this, but also understands what it's like to deal with a very complicated situation because you're dealing with your own complicated situation is not going to give you, you know, false hope, but is good. going to share the evidence base that's there. That could be a good thing to check out as well. Oliver, this has been fantastic. It's been a pleasure to meet you. And I really appreciate you

opening up about your story and turning that into a very detailed deep dive for our audience that might be thinking, is this something that is impacting my health? And in my particular case, it is. So this was actually very useful for me as well, too. So super appreciate you, brother. Yeah. Brilliant. Thanks. having me. Thanks so much. Hi everyone, Drew here. Two quick things. Number one, thank you so much for listening to this podcast. If you haven't already, subscribe, just hit the subscribe button on your favorite podcast app. And by the way, if you love this episode, it would mean the world to me. And it's the number one

thing that you can do to support this podcast is share it with a friend, share with a friend who would benefit from listening. Number two, before I go, I just had to tell you about something that I've been working on that I'm super excited about. It's my weekly newsletter. And it's called try this. Every Friday, yes, every Friday, 52 weeks a year, I send down an easy-to-digest protocol of simple steps that you or anyone you love can follow to optimize your own health. We cover everything from nutrition to mindset to metabolic health, sleep, community, longevity, and so much more. If you want to get on this email list, which is, by the way, free and get my weekly step-by-step protocols for whole-body health and optimization, click the link in the show notes that's called

try this or just go to drew perot.com that's d hr u p u r o hit dot com and click on the tab that says try this