20 years ago this little purple box
saved my life it all happened in one
night a night of the most restful sleep
I’d ever known earlier that day I was
talking with my friend and colleague dr.
Thomas Meade a pioneer in dental sleep
medicine
I was belaboring Tom with my two-year
running battle with chronic insomnia
frequent awakenings trips to the
bathroom struggling to get back to sleep
exhausted in the morning and tired and
sleepy throughout the day plus two car
accidents tied to sleep deprivation
Tom’s Cheshire Cat grin told me he’d
heard this story before as he pulled
this magic box out of his oversized
briefcase he pulled it open took out
this piece of plastic plopped it in a
mug of water boiled it in a microwave
and then he handed it to me and said
bite this after clenching my teeth into
the warm plastic mold I handed it back
he smooth the surface handed it back to
me and he said well let’s see if you
breathe any easier tonight which was a
strange thought to someone who is
complaining about insomnia that night
was so memorable I can still picture in
my mind’s eye
waking up turning over and asking my
wife Jessica what happened nothing
happened that night there were no
awakenings no trips to the bathroom I
felt incredibly rested from the best
sleep I’d had in two years really 35
years as the true nature of my sleep
disorder finally dawned on me this exact
moment changed my life dramatically
because that day I experienced an
enormous burst of energy in my mind and
in my body the likes of which I never
dreamed possible for my own health this
moment also revolutionized my thinking
practice and research in the field of
sleep medicine
the irony is dr. Christian gman Oh made
this discovery linking sleep breathing
and insomnia in 1973 nearly 50 years
later we’re here discussing how
something physical could cause insomnia
an idea that has flown so far below the
radar of the general medical profession
and even portions of the sleep medicine
community all because of the failure to
ask this singular question why do you
wake up at night why do you wake up how
common are awakenings in this audience
at minimum probably one third of you
struggle with sleep or make trips to the
bathroom yet because so many of us wake
up we think it’s normal
well here’s newsflash number one if you
wake up suffer from broken sleep trips
to the bathroom you’re tired and sleepy
the next day you suffer from a serious
sleep disorder chronic insomnia a
devastating and costly condition chronic
insomnia damages your brain and your
heart it worsens anxiety and depression
it even inhibits your ability to fight
off infections billions of healthcare
dollars are used up through the ravages
of sleepless nights on your mental and
physical health billions more are lost
economically from sick days workplace
accidents and decreased productivity and
of course billions more are spent in the
desperate search for sleep aids
over-the-counter drugs prescription
sedatives vitamins mineral supplements
herbal remedies yet few find truly
lasting relief mental health patients
suffered the most from insomnia yet more
drugs are prescribed tranquilizers
antidepressants antipsychotics
anti-seizure drugs they may help mental
health but these drugs cause side
effects to worsen your sleep millions
more insomniacs believe or are led to
believe that the only solution to
sleepless nights are drugs
and yet they suffer for years without
finding a cure and often never hearing
of any other options
so if drugs are not the answer to this
very vexing condition that drives some
people so crazy they become suicidal or
make some people feel crazy out of the
embarrassment shame and fear from not
being able to sleep what is the answer
or for these psychological problems
cognitive behavioral therapy for
insomnia cbt-i is a potent tool because
so many insomniacs frustrate themselves
lying awake in bed tossing and turning
checking the clock trying to force sleep
all of which just aggravates their
sleeplessness cbt-i is empowering to you
far beyond drug therapy because it
teaches you to stop losing sleep over
losing sleep yet neither cbt-i
nor drugs answer our question why do you
get up at night
normal sleepers wake up and go right
back to sleep
why because they’re sleepy insomniacs
wake up and go from zero to 60 in about
two seconds not only are they wide-awake
but they may suffer racing thoughts
heart palpitations anxiety stress
worries all because they’ve been jarred
out of their sleep to being fully alert
normally we gradually ascend from
slumber into waking consciousness in the
morning with or without coffee so why
would you suddenly wake up at night
unless something was waking you up this
clue would have explained insomnia but
was ignored for a long time research
does show that insomniacs line up the
usual list of suspects to explain
awakenings anxiety stress worries racing
thoughts but even insomniac snow they
are asleep before they wake up so they
don’t know with certainty why they’re
waking up and they remain perplexed
about being fully alert in the middle of
the night we
he searched insomniacs in the sleep lab
and monitored them before during and
after these awakenings and the results
were breathtaking not only did they wake
up more times than normal sleepers but
they suffered hundreds of mini
awakenings what we call arousal
there were fracturing their sleep and
destroying their sleep quality and if
you’re ready force newsflash number two
90% of their awakenings and arousal ‘z
were caused by please take a deep breath
that’s what they didn’t do their
breathing was compromised and obstructed
because they suffered from obstructive
sleep apnea the same condition that
fueled my insomnia twenty years ago on
this graphic you will see the three main
breathing events of sleep apnea at the
top is normal breathing smooth rounded
curves up and down suggesting breathing
in and out at the bottom is the apnea a
flatline complete suffocation as your
throat collapses obviously anyone would
awaken from that blockage
next are the hypopneas a 50% reduction
and then the flow limitation a 25%
reduction all of these breathing events
can awaken you insomniacs have more of
the moderate type so perhaps you’re
asking would a 25% reduction in your
breathing wake you up well let’s try
this experiment go ahead put your put
your hands out in front of you just take
a moment now bring them up to your
throat and start choking yourself about
25 okay you get the picture breathing is
good not breathing is life-threatening
which explains where all the skepticism
comes about this theory because how
could you possibly wake up all night
long from a breathing problem and not
know about it well consider the case of
severe sleep apnea they suffer hundreds
of Suffocation’s all night long
complete loss of their breathing when do
they seek help at a sleep center only
after someone in their bedroom
freaks out watching and listening to
them not breathe and afterwards do they
seek help a few months later no how
about a few years later no only after
suffering a life-threatening disorder
for about a decade might they seek help
so if the worst case doesn’t get it
how would insomniacs detect the problem
when they only suffer this more moderate
breathing disruption that still wakes
them up this recognition gap caused us
to delay our understanding of the link
between insomnia and sleep breathing
problems now we comprehend that so many
insomniacs suffer two disorders in one
the psychological side is easy to see
you’re awake but the physiological side
is hidden from you because you are
asleep this radical paradigm shift and
knowledge demands a new term to
designate the complexity of this problem
so we call it complex insomnia which
indicates the need for in-depth
physiological testing an overnight sleep
study to identify and diagnose what’s
waking you up for any diehard skeptics
still out there we’ve got one final and
astonishing piece to the puzzle
remember insomniacs make trips to the
bathroom and complain about it
that’s called nocturia snooze flash
number three who would have thought it
sleep apnea causes nocturia sleep apnea
pushes excess blood flow into your heart
all night long the heart responds by
releasing a natural diuretic making the
kidneys work overtime throughout the
night so sleep apnea causes insomnia and
nocturia actually a very nice
two-for-one deal when it comes to
treatment there are three levels of
therapy to treat sleep breathing first
focus on nasal breathing nasal saline
rinses neti
washes prescription nasal sprays will
eradicate chronic congestion last we
strongly recommend nasal strips because
we studied insomniacs with moderate
sleep breathing symptoms and 75% of them
reported a decrease in insomnia just by
using the nasal strip on a nightly basis
next or mandibular advancement devices
or oral appliance therapy like the type
provided to me by dr. Mead these are
becoming first-line therapy they gently
anchor on to your dental arches and
thrust the jaw forward opening the
airway permitting more air through and
eradicating the majority of your
breathing events last is pappi positive
airway pressure the gold standard most
know it is CPAP the C stands for
continuous or constant pressure
breathing in and breathing out and
that’s the problem you probably know
someone who’s failed CPAP because they
couldn’t tolerate breathing out against
that constant pressure mental health
patients and insomnia patients can’t
tolerate CPAP they develop panic attacks
claustrophobia and even traumatizing
experiences so harmful to them they will
drop out of care for a few years just
after a brief exposure to CPAP
unfortunately some insurance carriers
and even some sleep centers do not
recognize these side effects and instead
blame patients for not using CPAP
fortunately technology has found a
better way in 2005 we switched all of
our patients over to by level devices
dual pressure high pressure when you
breathe in and low pressure when you
breathe out this matches your natural
breathing pattern there are even
advanced by level devices that monitor
your breathing and adjust pressures all
night long last sleep technology has
expanded with numerous masks that can
fit into your nose over your nose or as
full face masks
and there are mask liners that enhance
comfort virtually anyone can learn to
use the gold standard breathing
treatment if they are prescribed the
right PAP device accurate pressure
settings and the best mask fit are you
ready to put this to bed I trust you’ve
learned three things insomnia is a
common disorder with serious
consequences to your mental and physical
health but you probably won’t seek
treatment until you realize that
frequent awakenings and broken sleep are
not normal
second insomnia and sleep apnea are
joined at the hip using this term
complex insomnia will encourage you and
your providers to attack the mental and
the physical part of your sleepless
nights for so many of you that suffer as
incredible as it sounds insomnia is not
only in your mind it’s also in your
airway last there are plenty of
treatment options available and all of
them produce good – great results I
would like to close by saying I
sincerely believe sincerely that if you
apply this information with the aid of
your doctors dentists and sleep medicine
professionals you will conquer insomnia
and discover and experience the rest of
your life thank you
saved my life it all happened in one
night a night of the most restful sleep
I’d ever known earlier that day I was
talking with my friend and colleague dr.
Thomas Meade a pioneer in dental sleep
medicine
I was belaboring Tom with my two-year
running battle with chronic insomnia
frequent awakenings trips to the
bathroom struggling to get back to sleep
exhausted in the morning and tired and
sleepy throughout the day plus two car
accidents tied to sleep deprivation
Tom’s Cheshire Cat grin told me he’d
heard this story before as he pulled
this magic box out of his oversized
briefcase he pulled it open took out
this piece of plastic plopped it in a
mug of water boiled it in a microwave
and then he handed it to me and said
bite this after clenching my teeth into
the warm plastic mold I handed it back
he smooth the surface handed it back to
me and he said well let’s see if you
breathe any easier tonight which was a
strange thought to someone who is
complaining about insomnia that night
was so memorable I can still picture in
my mind’s eye
waking up turning over and asking my
wife Jessica what happened nothing
happened that night there were no
awakenings no trips to the bathroom I
felt incredibly rested from the best
sleep I’d had in two years really 35
years as the true nature of my sleep
disorder finally dawned on me this exact
moment changed my life dramatically
because that day I experienced an
enormous burst of energy in my mind and
in my body the likes of which I never
dreamed possible for my own health this
moment also revolutionized my thinking
practice and research in the field of
sleep medicine
the irony is dr. Christian gman Oh made
this discovery linking sleep breathing
and insomnia in 1973 nearly 50 years
later we’re here discussing how
something physical could cause insomnia
an idea that has flown so far below the
radar of the general medical profession
and even portions of the sleep medicine
community all because of the failure to
ask this singular question why do you
wake up at night why do you wake up how
common are awakenings in this audience
at minimum probably one third of you
struggle with sleep or make trips to the
bathroom yet because so many of us wake
up we think it’s normal
well here’s newsflash number one if you
wake up suffer from broken sleep trips
to the bathroom you’re tired and sleepy
the next day you suffer from a serious
sleep disorder chronic insomnia a
devastating and costly condition chronic
insomnia damages your brain and your
heart it worsens anxiety and depression
it even inhibits your ability to fight
off infections billions of healthcare
dollars are used up through the ravages
of sleepless nights on your mental and
physical health billions more are lost
economically from sick days workplace
accidents and decreased productivity and
of course billions more are spent in the
desperate search for sleep aids
over-the-counter drugs prescription
sedatives vitamins mineral supplements
herbal remedies yet few find truly
lasting relief mental health patients
suffered the most from insomnia yet more
drugs are prescribed tranquilizers
antidepressants antipsychotics
anti-seizure drugs they may help mental
health but these drugs cause side
effects to worsen your sleep millions
more insomniacs believe or are led to
believe that the only solution to
sleepless nights are drugs
and yet they suffer for years without
finding a cure and often never hearing
of any other options
so if drugs are not the answer to this
very vexing condition that drives some
people so crazy they become suicidal or
make some people feel crazy out of the
embarrassment shame and fear from not
being able to sleep what is the answer
or for these psychological problems
cognitive behavioral therapy for
insomnia cbt-i is a potent tool because
so many insomniacs frustrate themselves
lying awake in bed tossing and turning
checking the clock trying to force sleep
all of which just aggravates their
sleeplessness cbt-i is empowering to you
far beyond drug therapy because it
teaches you to stop losing sleep over
losing sleep yet neither cbt-i
nor drugs answer our question why do you
get up at night
normal sleepers wake up and go right
back to sleep
why because they’re sleepy insomniacs
wake up and go from zero to 60 in about
two seconds not only are they wide-awake
but they may suffer racing thoughts
heart palpitations anxiety stress
worries all because they’ve been jarred
out of their sleep to being fully alert
normally we gradually ascend from
slumber into waking consciousness in the
morning with or without coffee so why
would you suddenly wake up at night
unless something was waking you up this
clue would have explained insomnia but
was ignored for a long time research
does show that insomniacs line up the
usual list of suspects to explain
awakenings anxiety stress worries racing
thoughts but even insomniac snow they
are asleep before they wake up so they
don’t know with certainty why they’re
waking up and they remain perplexed
about being fully alert in the middle of
the night we
he searched insomniacs in the sleep lab
and monitored them before during and
after these awakenings and the results
were breathtaking not only did they wake
up more times than normal sleepers but
they suffered hundreds of mini
awakenings what we call arousal
there were fracturing their sleep and
destroying their sleep quality and if
you’re ready force newsflash number two
90% of their awakenings and arousal ‘z
were caused by please take a deep breath
that’s what they didn’t do their
breathing was compromised and obstructed
because they suffered from obstructive
sleep apnea the same condition that
fueled my insomnia twenty years ago on
this graphic you will see the three main
breathing events of sleep apnea at the
top is normal breathing smooth rounded
curves up and down suggesting breathing
in and out at the bottom is the apnea a
flatline complete suffocation as your
throat collapses obviously anyone would
awaken from that blockage
next are the hypopneas a 50% reduction
and then the flow limitation a 25%
reduction all of these breathing events
can awaken you insomniacs have more of
the moderate type so perhaps you’re
asking would a 25% reduction in your
breathing wake you up well let’s try
this experiment go ahead put your put
your hands out in front of you just take
a moment now bring them up to your
throat and start choking yourself about
25 okay you get the picture breathing is
good not breathing is life-threatening
which explains where all the skepticism
comes about this theory because how
could you possibly wake up all night
long from a breathing problem and not
know about it well consider the case of
severe sleep apnea they suffer hundreds
of Suffocation’s all night long
complete loss of their breathing when do
they seek help at a sleep center only
after someone in their bedroom
freaks out watching and listening to
them not breathe and afterwards do they
seek help a few months later no how
about a few years later no only after
suffering a life-threatening disorder
for about a decade might they seek help
so if the worst case doesn’t get it
how would insomniacs detect the problem
when they only suffer this more moderate
breathing disruption that still wakes
them up this recognition gap caused us
to delay our understanding of the link
between insomnia and sleep breathing
problems now we comprehend that so many
insomniacs suffer two disorders in one
the psychological side is easy to see
you’re awake but the physiological side
is hidden from you because you are
asleep this radical paradigm shift and
knowledge demands a new term to
designate the complexity of this problem
so we call it complex insomnia which
indicates the need for in-depth
physiological testing an overnight sleep
study to identify and diagnose what’s
waking you up for any diehard skeptics
still out there we’ve got one final and
astonishing piece to the puzzle
remember insomniacs make trips to the
bathroom and complain about it
that’s called nocturia snooze flash
number three who would have thought it
sleep apnea causes nocturia sleep apnea
pushes excess blood flow into your heart
all night long the heart responds by
releasing a natural diuretic making the
kidneys work overtime throughout the
night so sleep apnea causes insomnia and
nocturia actually a very nice
two-for-one deal when it comes to
treatment there are three levels of
therapy to treat sleep breathing first
focus on nasal breathing nasal saline
rinses neti
washes prescription nasal sprays will
eradicate chronic congestion last we
strongly recommend nasal strips because
we studied insomniacs with moderate
sleep breathing symptoms and 75% of them
reported a decrease in insomnia just by
using the nasal strip on a nightly basis
next or mandibular advancement devices
or oral appliance therapy like the type
provided to me by dr. Mead these are
becoming first-line therapy they gently
anchor on to your dental arches and
thrust the jaw forward opening the
airway permitting more air through and
eradicating the majority of your
breathing events last is pappi positive
airway pressure the gold standard most
know it is CPAP the C stands for
continuous or constant pressure
breathing in and breathing out and
that’s the problem you probably know
someone who’s failed CPAP because they
couldn’t tolerate breathing out against
that constant pressure mental health
patients and insomnia patients can’t
tolerate CPAP they develop panic attacks
claustrophobia and even traumatizing
experiences so harmful to them they will
drop out of care for a few years just
after a brief exposure to CPAP
unfortunately some insurance carriers
and even some sleep centers do not
recognize these side effects and instead
blame patients for not using CPAP
fortunately technology has found a
better way in 2005 we switched all of
our patients over to by level devices
dual pressure high pressure when you
breathe in and low pressure when you
breathe out this matches your natural
breathing pattern there are even
advanced by level devices that monitor
your breathing and adjust pressures all
night long last sleep technology has
expanded with numerous masks that can
fit into your nose over your nose or as
full face masks
and there are mask liners that enhance
comfort virtually anyone can learn to
use the gold standard breathing
treatment if they are prescribed the
right PAP device accurate pressure
settings and the best mask fit are you
ready to put this to bed I trust you’ve
learned three things insomnia is a
common disorder with serious
consequences to your mental and physical
health but you probably won’t seek
treatment until you realize that
frequent awakenings and broken sleep are
not normal
second insomnia and sleep apnea are
joined at the hip using this term
complex insomnia will encourage you and
your providers to attack the mental and
the physical part of your sleepless
nights for so many of you that suffer as
incredible as it sounds insomnia is not
only in your mind it’s also in your
airway last there are plenty of
treatment options available and all of
them produce good – great results I
would like to close by saying I
sincerely believe sincerely that if you
apply this information with the aid of
your doctors dentists and sleep medicine
professionals you will conquer insomnia
and discover and experience the rest of
your life thank you
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