#75 The Healing Power of Sleep and What Happens when Sleep Goes Wrong-Part 2 

In the second installment of our enlightening conversation with Dr. Stephanie Green, we delve deeper into the realm of sleep, a fundamental pillar of health. Dr. Green brings to the fore compelling real-life patient stories, while highlighting key signs and symptoms indicative of sleep disturbances.

Discover the art of good sleep hygiene. Learn how simple routines can counteract the biological disruptions post-breast cancer treatment and during menopause. Small environmental tweaks can pave the way for restful nights, mitigating the stress from sleepless hours.

A standout revelation from Dr. Green is the significant role dentistry plays in sleep health, specifically in assessing airway obstructions. She underscores the necessity for greater interdisciplinary collaboration among medical fields to optimize patient care.

Navigating the world of sleep studies and treatments can be daunting. Dr. Green demystifies the process, from insurance aspects to resource recommendations. She even dispels common myths surrounding sleep apnea and CPAP machines, offering clarity and comfort to those contemplating assessments and treatments.

Tune in for a comprehensive exploration of sleep's profound impact on well-being.

If you haven’t listened to Part 1 click here and do that now, you don’t want to miss out!

In part two you’ll learn:

• The surprising link between dentists and sleep studies.
• An introduction to HST America and their role in sleep health.
• The transformative power of just a bit more restful sleep.

 Resources:

Read Full Transcript Below:

0:01 

This is Laura Lummer, the breast cancer recovery coach. I'm a healthy lifestyle coach, a clinical ayurveda specialist, a personal trainer, and I'm also a breast cancer survivor. In this podcast, we talk about healthy thinking and mindfulness practices, eating well, moving your body for health and longevity. And we'll also hear from other breast cancer survivors who have re engaged with life and have incredible stories to share. This podcast is your go to resource for getting back to life after breast cancer.

0:38 

Well, hello and welcome to another episode of the breast cancer recovery coach Podcast. I am your host Laura Lummer. And today is part two in our two part series on sleep as the pillar of health as a pillar of health. We are talking with Dr. Stephanie green, and if you didn't hear Episode 74 highly recommend Going back and listening to it before you listen to this episode number 75. In 74, Dr. Greene spoke about some common sleep disturbances like sleep apnea and UARs. She explained not only what those are, but how they impact the bigger picture of our health. She shared some amazing patient stories and how many of her patients have had incredible results in other health issues they've been dealing with by treating their sleep. I just found that to be absolutely fascinating. In today's episode, we're going to dig into more stories actually. But in addition to that, Dr. Green is going to talk about what a sleep study is, what to expect, the different types of sleep studies there are. And she's going to give you some resources, information that you can take to your doctor, how you can handle going about getting a sleep study, and even if you don't have insurance, she's got an affordable resource that you can reach out to to get a sleep study. So I'm really excited to dig into this episode because it's just more great stuff. And I could listen to Dr. Green talk about the fascinating area of sleep science forever. It's just absolutely incredible. So without making you wait any longer, let's get back into this. Welcome back Dr. Green to talk a little more about proper sleep hygiene and good sleep. Oh, this is such a fascinating topic. If someone's listening to this and they're like, I don't have sleep apnea. I'm good. If you have what happening with you, maybe you should consider a sleep study.

2:41 

So if you have insomnia, if you have waking up at night to urinate, waking up with a dry mouth, waking up with headaches if you have headaches fairly often, period, but especially waking up with morning headaches, okay, it's from the low oxygen causing it tenses up your neck and all kinds of things. So headache especially morning tossing and turning, sleeping on your stomach. So a lot of people think I'm just more comfortable on my stomach. But you might not realize that your body is making you go to your stomach because your tongue falls forward and you breathe better than being on your back and your tongue falls back. So when someone says I've always been a stomach sleeper, to me, that's a red flag. I'm like, we're gonna eat Yeah, yeah. So people just think I'm comfortable that way. Well, why are you comfortable that way because you're breathing better that way. You realize that, you know, stomach sleeper. And then of course, the medical problems that go along with it. So high blood pressure, anxiety, depression, asthma, acid reflux, grinding your teeth and clenching your teeth. So stress can cause you to grind and clench in your sleep. But if your tongue falls back or your airway collapses, and your airway is closed or partially closed, and your body is going shoot, we need to breathe, we need to breathe. It will tell you to use It will make you clench and grind your teeth because that makes your tongue sort of sit up, hmm. And it opens up your airway and you breathe. So when people clench a lot and grind a lot in their sleep, to me, it's a red flag for sleep apnea. Now, when you grind your teeth, you wear your teeth down, you crack them, wiggling, constantly like that causes the bone to reabsorb. So then there's more cavities, it's a whole thing in the dental field. And so when the dentist see signs on your teeth that you've been grinding, they tend to make a grinding, mouth guard, writing mouth guard is just on one level, usually the top and it's just it's simply a barrier to protect your teeth from the grinding that you're doing. But if you think about it, it's a small airway that causes sleep apnea, which causes you to grind. putting anything at all in your mouth is now taking that small airway that you had and making it even smaller even more so I hear all the time when I'm when I'm asking people for signs and symptoms of sleep apnea. I'm asking them these questions I say to you grind. Yeah, grind a lot, but my dentist made me a grinding mouth guard. So it's okay and I say, Do you sleep better with or without it? And a lot of times I hear them say I actually sleep with it. So I don't I like I don't use it very often, because it's making their apnea worse. Wow have any clue? So dentistry is completely changing to just taking care of your teeth to being more of evaluating your airway. Okay, dental field is completely changing. And my dentist is very involved in sleep medicine, and he goes to dental continuing education. That's about sleep. Wow. And so really, any dentist who's just looking at your teeth and not evaluating your airway, and my mind is causing is doing a disservice, right? whether they know it or not, right, they might not know it, and I and I have to say that this field of medicine is definitely blossoming, and we're learning a lot more about it. And I have a couple of patients that are medical residents, you know, new doctors and training, and I asked him Do you do a lot of training about sleep apnea? Oh, yeah, a lot. Good because my generation, we learned about it, but not much right? We thought it was that heavy pic wikian man, the big neck that had it and that was about it. So I'm happy to hear that. Things times are changing. We need more studies. I think they're starting to be in progress. You know, we need more sleep connects to this. Yeah. So if you have this treat your sleep and just treating this Yeah, yeah, so treating the symptom you know let's look for the cause. I love it. I think it's

6:23 

changing and dentistry has to change because that woman that I told you about with a small airway that was getting oxygen in the 60s all night long. If I didn't know about sleep medicine, yeah. And look in her throat and just say I know you have no symptoms, but your airway is so small would you do a sleep study? If I didn't do that she never would have known but a dentist who's in everyone's mouth looking at their airway should say wow, I can barely shoot back here. Yeah, barely work on your molar. right you know you have a tiny airway. You should probably do a sleep study that needs to be the new way of just being more holistic and I know dentistry also I don't want to go off topic to dentistry so much by know they're also looking at dental Health with respect to heart disease, diabetes, all that kind of stuff.

7:03 

So a book that I read is called gasp G-A-S-P gasp and it's written by two dentists, doctors, Michael Gelb and Howard Hindin h i n d i n. And so I read it and it's amazing.

7:16 

Well, I'll post that and the studies that we've been referring to also post the links to that in the show notes for this episode as well. So here's where my head is going. When I listen to this. For most people who have gone through chemotherapy, especially because of that impact it has, and because it puts us into menopause, we get weight gain, we get hot flashes, hot flashes disturb your sleep, and as a doctor, I'm sure you hear women say I wake up with night sweats, right? Hot flashes and night sweats. So you're disturbed all night long. So let's talk about sleeping in the dark and how can we do things to help us sleep better if we have these biological disturbances that wake us up at night?

7:54 

Many years ago, Suzanne Somers put a book out about hormones and sleep and She talked about how important it was to sleep in a dark room. And I remember, I believe it was in her book or else it was something that I read about her online that one of the things she mentioned was a study where somebody slept in a completely dark room. But under the blanket, they held a light onto the patient's leg. And they were testing cortisol levels with and without that light and notice an increased level of cortisol when they had the light on, he couldn't see it at all, but it was just shining on his leg and it's crazy.

8:30 

And cortisol is a stress hormone, which also causes our blood sugar to spike, right, it causes that the the liver to produce more sugar, and that creates a catalyst.

8:42 

Yes. Yeah, it is. So that's fascinating. Yeah. It's supposed to be really dark and quiet where you sleep. And on the cooler side, you know, there's so many different things that affect your sleep. You can say, Well, I don't have sleep apnea. It's just hot. I don't have air conditioning. I can't get it cool enough or I'm menopausal. If I could just have some hormones, I'd sleep better. Yes, all those things contribute. So it's not just sleep apnea. There's all those things and good sleep hygiene is huge. So having a regular sleep wake cycle and a good circadian rhythm having a dark quiet room blackout curtains, everything has lights on it. Yes. And it might be just the little power button with a little green light. But you've got several of them in your room and a clock with LED lights. Yeah, shining the time, right in your face or whatever. And all those things matter. And so how so covering them up, get? What's it called the gorilla tape, the black one, a tiny little square of that tape on that power button light and dark in your room. Get blackout curtains when you can only do what you can. But those are the things to try to do is to try to have a dark quiet room. No heavy eating or drinking near bedtime. We lay down and it all sort of comes back on. Yeah, right. So if you that's another thing that sleep apnea can cause is acid reflux. And then acid reflux can also cause sleep apnea. So you hold your breath You get a higher pressure in your lungs, which then can squeeze acid up and cause acid reflux. So people with sleep apnea have worse acid reflux at the same time, acid flowing up can trigger you to hold your breath, and can cause an apnea response. So it goes both ways. But so that's why no heavy eating or drinking at bedtime. No alcohol within two hours of sleep. Alcohol also affects your sleep pattern, we should go from a shallow sleep to a deep sleep to a REM rapid eye movement sleep which is shorter, and then back up to shallow, deep REM and you just cycle through that all night. Drinking alcohol changes that whole pattern. So you may fall asleep, but you're not going to have good sleep. So it's very common for people with sleep apnea that have insomnia can't fall asleep to want a drink or two in the evening to relax and fall asleep. And now you just worsen it relaxes your muscles in your throat. So you collapse your airway even more. So now you get even worse sleep apnea and you get even worse sleep. Even without apnea, it disturbs your sleep pattern. So you're getting more sleep with that apnea. And whenever I have a patient with sleep complaints that I think might have apnea, and they're also drinking too much, and I mark their sleep, study urgent. And as soon as the sleep lab knows that I have a patient that I'm worried about their alcohol use, they will rush that test through because it's such a common, they're using that as a crutch indeed, because they're so tired you know. So anyway, back to sleep hygiene. So waking up and going to sleep at the same time as much as possible, keeping your room dark and quiet and on the cool side, if possible. The study that I read recommended a 68 degrees. I think that sounds lovely, but what I don't set my AC to go that cold. I do 65 really every night.

11:50 

I can't it's got some nice homes. Yeah, and I love cold and I love big heavy blankets on me so it's got to be really cold so I can have my blanket, the big heavy blankets.

11:58 

yeah to kind of fidget less and move less samples heavy blankets for sleep. So like we said no heavy eating or drinking their bedtime. No electronics right before bed. You want to avoid lights in your face and your eyeballs lighting up your brain keeping it active and then turning it off and trying to go to sleep who's going to go to sleep well after that. So what they recommend is an hour of not having lights in your face, you know, maybe reading an old fashioned book with a lamp shining.

12:29 

Those ones that are made out of paper.

12:33 

Going to the bathroom just before you go to bed. So you don't have to get up to urinate in the night. You should be able to sleep all night without getting up to go to the bathroom unless you have a bladder issue. In which case you need to go see a urologist and try to get it fixed. But people just think oh I just I always IP off and I have to get up to pee every night. That's normal for me. It might be your apnea, bringing you awake or nearly awake. And then you feel a halfway point black So you go, Oh, I have to pee and you get up and pee. So a lot of people think, oh, I don't have apnea. And I say, Do you ever get up to go to the bathroom at night? Yeah, a couple times, but that's normal for me. I've always done that. Yeah. And I'm like, well, you're 40. Do you have a bladder problem? No. Yeah. Well, then why are you getting into the bathroom at night? You shouldn't. That's maybe something if you're elderly prostate hypertrophy. Yeah. Like, there, you know, if you don't have a bladder issue, you should not need to. So the thought is, could apnea be pulling you out of a deep sleep? Sometimes it makes you all the way awake. Sometimes it just pulls you into a shallow sleep, and you start your sleep cycle all over again. If it pulls you to a very shallow sleep or all the way awake, are you then feeling your bladder and getting up to go to the bathroom? Not realizing what woke you up?

13:44 

Love that. Yeah, that's that makes so much sense. And we think that because you've done it for so long. Yes. It's just normal. Yeah. Yeah, that's so interesting.

13:54 

Limiting your daytime naps. A lot of people are proud of the fact that they can fall asleep anytime. Anywhere had a little 20 minute cat nap and they're good to go. Yeah, that could be a sign of apnea. We should wake up you should wake up feeling rested and get up and be ready to start your day and not like Oh, here we go again. No time to get up. Let me get some coffee now before I can function coffee should be something that we enjoy. Not something that we quote unquote need right? Just function.

14:25 

Don't let the Starbucks people here that.

14:26 

Is all right.

Speaker  14:29 

So um, you know, we should wake up feeling rested, and we should not need a nap during the day to function and get to the evening. That's not to say that a lovely afternoon nap after lunch isn't a wonderful thing. And not that you're not allowed to do that. Right? But if you can fall asleep anywhere, anytime, that's not a good sign. You shouldn't be living your life like that. You are not fully awake is what it sounds like to me. I would I would question Is there a sleep disorder going on whether you know Not interested. My dad was an OB GYN so he got up at all times a night to deliver babies. So he thought it was very normal to take cat naps all day long. And he just thought I'm an OB GYN I sleep when I can. You know where I can when I can. I could sit in a chair, close my eyes for 10 minutes. Good. guilts go.

15:17 

Yeah, he dies a skill that he developed quickly. Yeah. And it was sleep apnea, severe sleep apnea. And he did not recognize it. And, you know, I hear people say that and I think they're almost saying it like I could sleep anywhere. Yeah, like, it's great for me. Yeah.

15:35 

Yeah, so that's one thing. Okay. Another thing that's important is to ensure adequate exposure to natural light. exposure to sunlight during the day as well as darkness at night helps to maintain your sleep wake cycle. So it's not healthy to wake up go to your car to your office room out at night back home. It's it you know, when my patients I do a lot of gynecology, so when I have patients with an abnormal pap smear because they have the HPV virus and that's another thing. I tell them, we don't have any medications to kill the HPV virus your body needs to fix it. So come back in six months and we'll repeat your pap smear and see if you got rid of it yet. And they always ask me, Well, what can I do to help get rid of it? And I say, you know, what's your immune system that has to fight. So do the things that give you a healthy immune system. Eat healthy, don't smoke, stay away from cigarette smoke everywhere, not just yourself, but secondhand I eat you know, lots of fruits and vegetables, get good sleep, and get sunlight go for a walk out in the sunlight. Even if it's five minutes. If you have a crazy busy day, if you can go out at five minutes and just sit in the park and let the sunshine on your face or just walk around the block and come back. It makes a big difference. And then I tell them laugh and be happy and don't be mad all day long. And they always laugh. And they're like easy to say I go I'm not kidding. Don't be stressed and angry all day long. Yeah, you know, be fine peace and find happiness in your life because it changes your whole chemical makeup and helps you fight.

17:01 

It strengthens your immune system, absolutely, finding joy.

17:05 

So I always talk about walking in the sun, you know, getting a little sunlight every day and and trying to get time in nature,

17:11 

yeah, matter so much less and as in terms of breast cancer or any kind of cancer also, but I think specifically breast cancer that also is going to contribute to maintaining a good vitamin D level. Yeah. Which has a correlation with cancer. Yeah, yeah. So

17:26 

that's good advice. And we use sunblock to not get skin cancer, so then that can block you know, the sunlight that causes you to make more vitamin D. But there's so much more to it than that. It's it's you don't have to lay out there and get sunburned. Right. Five minutes, five minutes. 510 minutes. Yeah. on your face, just you know, feeling the glow and the warmth of it. And it gives you such a good energy and it really does matter. The expert sleep experts recommend seven to nine hours of sleep for adults. You know, we all think about our children and making sure they get enough sleep. Yeah, but I can't tell you how many Patients I have that get five to six hours and they say, I function like that. That's just my normal. My own mother in law. She also had no complaints. I see her sleeping. Forgive me for saying this online but with her mouth open and snoring and falling asleep as soon as TV's on and she's relaxed in the couch, she's out, and I'll turn it off and she wakes up and I was watching that. So you know, she can't sit there and movie, every movie that we've seen. She's like, remember if I saw the end of that? Anyway, she doesn't have any complaints. She's got this cute little fit body. She does the online aerobics, she's healthy, she's adorable. And you know, she doesn't have complaints. She's energetic. She wakes up early. I see the way she sleeps though. And I we went to visit them they're back east and we went to visit them for Christmas and I brought my see Pat machine with me, which I got for fun to sort of try because I'm I'm prescribing All these patients that I love to experience what I'm putting out, I've been playing with it as I brought it with me. And I asked her would you just sleep one night with my machine kind of put it on you? She sleeps about five hours a night. She has her whole life. She's completely happy like that. She wakes up energetic by time you wake up, she's already baked an apple pie and done a workout. And she's like morning, well, you know, yeah. So she's one of those people. And she quote unquote, doesn't need more sleep. Very common myth is as you will start a myth because there's some truth but as you get older, you just sleep less. And that's just a normal thing. So I'm normal. This is normal for me, you know? So she sleeps about five hours a night. I put my C pap machine on her and I think this is a little bit unusual because some people take a what most people take a little while to get used to it. She slept nine hours and 45 minutes without waking up. And she woke up in the morning and was like, What time is it

19:59 

she's Like what drug did you put in this thing, you put up my face? Wow, she didn't get up to pee. She didn't wake up at five in the morning to bake an apple pie

20:09 

45 minutes the first night. That is not typical results, right? But I'm just saying, Here's someone who thought she was normal. She thought five hours a night was her normal. And she was fighting and she had energy liquid her body actually needed when it was given oxygen, and given the freedom to sleep as long as it wanted. Yeah, so she uses a C pap now every night and her average sleep is about seven to eight hours. So she didn't stay 10 hours. And she still but that's because she's probably caught up on

20:35 

Yeah, she had a sleep deficit. But still, that adds two to three hours a night of sleep when she's properly oxygenated. Yeah, that's fascinating. And so in my, what I believe is that she's adding years to her life.

20:47 

Well, I was just gonna say that so we you you said a couple of times that we think that's just normal. That's just normal, right? So there's this book that I told you about that I'm listening to called lifespan and and the foundation of this book is That aging is not the normal process that we credited for. We don't have to age the way that we age, we don't have to lose so much function, that there are things we can do in our life. And if we do them properly, and we eat the right foods, and we have the right pillars of health in place, and we follow them, that we don't have to lose so much function, and we can think better and more clearly. So as you're talking about this, and I'm thinking, how many years do we go without the right level of oxygenation without enough sleep in our lives? And how does that contribute to the way that we age that's really interesting, because it affects so many aspects of your body, you know, your hormones and your steroids and all that it all cascades into everything. Yeah.

21:46 

And there's so much going on in our bodies when you're asleep. There's so much detoxification process cell regeneration, yeah, all of that happening, that if we're not doing it to get more buildup of senescence cells, which creates All kinds of havoc in the body.

21:56 

Well, okay, so many more podcasts are coming out I was having this discussion with when we find at me, I tell them, so we all have stressful days, and your sleep is supposed to be the recovery of your day. People with sleep apnea have very stressful nights the daytime becomes their recovery. So, but we have stressful days because we have work, you know, we have relationships with people that are up and all the stress of a normal life. Yeah, you have stressful days. But when you have a stressful night, and that daytime is your recovery, I mean, that's not going to end well. not going to end well. And that leads to anxiety about going to sleep. So some people are like, I'm so tired. I can't wait to go to bed and you get in bed and all of a sudden boiling your mind's racing and you can't fall asleep. Your body has developed an anxiety about going to sleep it because it knows where you're headed. It's like no, don't make me go through another night, please. Why? No, it's Friday. You're fighting sleep because your body is like, oh god, I don't want to go back there. You know, that is I never thought of it like that. It just increases anxiety during the day. I mean, all those stress hormones are not just gone when you wake up and they're still in your system, and so they might go down during your day, but they're still overall an elevated level. So, let's talk a little bit about the natural sleep cycle. So you go through shallow sleep and you go through deep sleep and then you have REM sleep which is rapid eye movement, and shallow and deep sleep. You have mano clonic twitches, which is a twitch of one, one muscle. So Have any of you been falling asleep in your arms just twitches or your leg twitches? Yeah, that's totally normal. Yeah. But when you're in REM sleep, rapid eye movement from basically from your eyes down. You're so relaxed, not paralyzed, obviously, but almost, you know, very, very relaxed. You don't have those mano clonic twitches anymore, but your eyes are going back and forth rapidly and you're basically going through the last day or so that you just experienced and you are In essence, throwing away what's unimportant, because you're forming memories of things you need to remember, memories are formed in REM sleep. So that's really where you get mental clarity during the day is from your REM sleep that you had at night. Okay, so takes about an hour to an hour and a half to have the full sleep cycle. So in an average night, you'll have it maybe five times, you know, if you're lucky, okay, and so each time that you have it, you start out with a really short REM phase, and then back up into shallow sleep and then deep and then REM again, that REM will be a little longer, so the rooms get longer and longer through the night. So it depends how many rooms you have, and how restfully are sleeping. But in a normal cycle, the rooms get longer and longer. And so the longest REM is around three to four in the clock in the morning, okay, when you're in REM sleep, you're so relaxed, that your airway can collapse even more. That makes sense. So apnea is usually worse in REM sleep, and so therefore you get pulled out of REM sleep and and either woken up or Brought back up to a shallow sleep, my apnea and even utrs, the upper airway resistance syndrome. So even if you don't have a full airway blockage, you have enough of a partial blockage to cause what we call a respiratory distress, and it pulls you out of your deep sleep. And when you get pulled out of REM or deep sleep, you don't go back to you don't go back to where you were, and keep going. From there you go all the way back to the top to a shallow sleep, and it takes another hour and a half to get down to rest. The last that REM you can sleep eight hours, quote unquote uninterrupted. You're like I went to bed I woke up eight hours later. But if that whole eight hours was every time you hit REM you got pulled out of it. And so basically more of a shallow sleep the whole night you wake up exhausted, like I understand I just slept eight hours. Why am I still so tired and dragging, going to work entire during the day and I just want you to nap and you know, and you really you think I slept eight hours

25:55 

I said I'm doing what the doctor told me. Yeah, you know you're getting sleep the week This assumption that if we would know, right, we wake up, we would be aware that we had disturbances, but that's not necessarily true. Absolutely, yeah. So somebody notices they're listening to you. They're like, Oh, gosh, I have headaches or I wake up this way, or I pee all the time. Maybe I need to sleep study. What can they do? What's the next step? How do they go about? Do you have to call your doctor do you call your insurance company?

26:23 

What do you need? So it used to be that we would send patients to the lab for an in lab sleep study, and sometimes we still do for various reasons. It's the most accurate test you have leads on your head. So we can see your brainwaves you have leads on your chest EKG. I mean, we're watching everything videotaping. And one thing that's very interesting is I had a patient that was always tired. That was her only complaint otherwise she's doing everything good sleep, hygiene, love, just always tired. So I said, Okay, this was before the home sleep study. So I sent her for an in lab study. That's what we did back then. She had no apnea, but she had restless leg syndrome and So as soon as she, they could see her wave, her brainwave pattern so they could see the stage of sleep she was in. As soon as she went into a deep sleep, she started kicking her legs, enough to pull her back up into a shallow sleep. So she was one of those people that only got shallow sleep all night. So she slept eight hours, but was still tired, but she had zero apnea. But she had restless legs. And that is something you will not pick up on a home sleep study. Once videotaping, there's no we are, you know, in the lab, they have leaves on your ankles and your arms to look at movements, and you know, muscle twitches and stuff like that. And they're videotaping and watching you. So a home sleep study is not perfect by any means. Okay? But it's kind of like is it good enough? Because if it shows you something, then now you know you can treat and if it doesn't show anything, and you have a lot of symptoms, you might need to go to an in lab one, which nobody wants to do. But yeah, nobody wants to keep that in mind. But take it with a grain of salt it find something great, but if you don't, it might not be so correct and would they let you so it's You got an in home sleep study I didn't show anything but you still had the symptoms would the insurance company let you go to an in lab? They should doctor has

28:08 

to ask for it of course, but yeah, they should. Okay. So it used to be that I would just ask for an in lab sleep study on patients and it would get approved. I started doing home sleep studies on my own not because the insurance told me to but because it's convenient for patients. It's, it's quick, it's easy. You don't have to take work off and you don't have to take work offering in lapsim city but it's just easier if you have children. If you're so many different reasons that you want to stay in your own bed. Some people get in an outside environment, they just won't sleep like in a hotel or something. You know, they're pretty comfortable. They make the rooms really nice. It's kind of like a hotel room. There's usually a flat screen TV, a queen size bed, is talk on the phone, you can bring snacks, so they hook you all up and then they leave the room and you are like like you're in a hotel room with a bunch of wires on your head, you know. So, you know you can wake up in the morning and go to work. You can shower and go to work. It doesn't have to be a day off but still Of course, it's easier to be in your own bed so I started doing more home sleep studies out of convenience and much cheaper you know, for patients. And then now I'm finding that if I order an in lab sleep study, I get something from insurance saying no, we want her to do homework. I was like, oh really starting to balk at the idea of just starting with an in lab. But if I have a patient that I'm I'm thinking she might have restless legs based on the story she's telling me or they're not I want the monitored more Hmm, I asked for an in lab I almost have to fight for it now. Really, now it's becoming like you have to do it at home sleep study before they'll approve it in lab lets you have a real medical reason to be monitored. Okay. So that's what I'm finding now. So I think you know, a lot of family doctors and I'm I'm only in my 40s I'm not like you know, I want to say my generation Yeah, don't be too old school there yet does it doesn't isn't all that trained on the back. Yeah, I became trained because of my father. And that whole story and it got me interested and learning. And so I feel like not the typical family doctor in my age range might not be doing a lot of home study. Right. I think it's like I said, it's I think it's blossoming. I think people are learning a lot more about it. But you might go to your family doctor, and they might simply not know that much about it. And so I don't know how comfortable they are ordering a sleep study on you. They might feel like if I order a home sleep study on you, I'm going to get the report and I don't want to do with it to do it. Yeah. So I don't want to do that. So they might just say, well, you can go see a sleep specialist if you want. But you know, there are sleep specialists are wonderful. But then it's it's also the copay of seeing a specialist and it's taking another day off work to go have another appointment. I don't know how many people actually follow through with that right when that's recommended. Yeah. So I think you just need to say I have been doing some reading Okay, about obstructive sleep apnea. Are you a ers and I you know, Whatever you don't have to explain yourself you just I've learned about this okay? And I feel like I have most of those symptoms. I would like to do a sleep study to evaluate my sleep. Are you comfortable ordering that you know how to order it? How can I get one? So it just to America is the company that I use you they will mail you the apparatus that you were just basically a headband or a chest band. It's pretty easy. And you wear it for two nights. It only has one button so you turn it on when you go to bed. It's simple to use, you know, and then it comes in a pre paid return envelope. So you do it days you put it in there send it back super easy. They will bill your insurance and insurance almost always will cover it because if the doctor that order it if they have any suspicion you have apnea, and they're ordering a sleep study the insurance needs to cover it because Who are they to say No, you don't. Right? Yeah. So they always they usually they usually approve it. But it might all go to your deductible. Right. So the sleep study itself, I think they built 2000 $3,000 something like that for the homeless. study that goes to your insurance. Let's say for example, your insurance approves 1500. Okay, we agree with the test and will pay 1500. But her deductible is 3000. So that whole bill goes to her

32:12 

HST America only bills the patient $249 Wow, that's it maximum and you can make payments without interest. They don't want payment or money to stop people from getting the test. That's awesome. So if your insurance actually paid something, whatever they pay will come off that so I recently had a patient who had to pay $80 over their sleep study because their insurance did pay a portion. But what I see mostly is that they approve it, but it goes your deductible. So you're going to basically pay 249 Hmm, any doctor in the United States can order a home sleep study from HST America easily. Okay, so simple one page. It's got a couple symptoms so they'll check off, you know, difficulty falling asleep, urinates at night, dry mouth in the morning headaches, you know, you check off what symptoms your patient has. You signed the bottom and you fax it Okay, it's that easy. It goes to the patient gets mailed to the patient, patient mails it back, sleep doctor reads it, and then the report is sent to the doctor. Now the report the last page has what to do about it. Oh, it doesn't matter if the doctor is not familiar or comfortable or trained, it doesn't matter, it will tell them what to do. This patient has a sleep disordered breathing. If they don't, they can lose weight, they can see an ear, nose, throat doctor, if that's an issue, they can get the mouth guard, they could use the PAP machine, it tells them exactly step by step into what the choices are. And then it's up to the doctor and the patient, what they choose to do. So a doctor does not need to be trained and sleep, okay, order a sleep study and get those results so they don't need to worry about that.

33:43 

That is really great. That's really great.

33:45 

So I had a patient that I saw recently that it was our last visit because she was moving to Utah. And I said I would order a sleep study on you and she was trying to hit like she wanted to do it but she was moving like the next week. So I called HST America. called my, the person that I speak to there and she said, Oh, no problem. We mail it anyway. So it doesn't matter where they are. And I said, Oh, okay, so we ordered a sleep study on her. Yeah, in a week and a half. I had the result on my desk I go Wait a minute, I thought she was moving. And I called her and she goes yeah, I arranged it right away. It came to my new address and I did it immediately and sent it back. I mean, I was like great blown away so in you touched I already have the results Yeah, couple weeks later, that's Oh, yeah. So anyone anywhere can do it. Okay. And it's easy.

34:27 

And then if somebody does need to C Pap machine or a mouthguard does insurance typically.

34:32 

So that as well, every everyone's different and their plan and what they signed up for so it's like it's impossible to say, but the whole setup the C pap machine, the tube, the mask, it is about 1500 dollars, you can honestly go online and buy yourself a machine today cash, you don't need a prescription. It's just a machine that you're buying, you know, insurance coverage. Typically there's a little copay up front, maybe $100 sometimes 200 Uh huh. And then there's a rental fee. This is what I see typically, of maybe 40 bucks a month for six months. And then after that you own it. It's your machine. Oh, okay. Then you need to get a new mask every three months or so a new tube every six months, just for cleanliness for bacteria shake, you know, so that again, you can go buy on cash on Amazon. You can buy them anywhere, but for insurance to cover it. They typically do my mother in law who now uses it. She said she has a box of six masks, and she hasn't paid a penny. And they sent her so much. She's like, stop, I'm good. So you get on a plane on? Yeah, what your insurance will cover is like regular mask changes, okay, and they just should automatically you should be on an automatic thing, where every three months or every month, whatever they cover, it comes in the mail and you simply snap off the mouthpiece that you have thrown away, put the new one on, and it's nice and soft again, you know? Yeah.

35:54 

And what about the mouth guard is that something that is taking part again is about two to $3,000 The cash price varies my my dentist here in Huntington Beach makes them for $700 cash. You know I always say ask your own personal dentist if they're familiar with sleep medicine if they make sleep apnea mouth guards you can do with your dentist great, you know, the price quote unquote is two to 3000. But typically that's what you Bill insurance. And you know, you don't always get paid that much. And then so there's a there's a big variation but with my patients who qualify for a C pap machine, if I say they're unable to tolerate c Pap, so therefore I'm recommending a mouthguard than insurance usually fully pays for the mouth guard okay. So they will pay for one treatment, whatever you choose mouth guard or C Pap, okay, C pap is the gold standard treatment. Some people cannot tolerate it or they don't want to. And that's fine. That's a personal decision and then the mouth guard is covered. If you have upper airway resistance syndrome. You know, mild Sleep Apnea insurance doesn't think you're bad enough to need treatment. Then you're on your own and all you can do is go pay cash. mouthguard. That's the category that I fell into. So years ago, I did a sleep study. It was so mild that I had it. But what I didn't realize back then is I had lots of episodes without an oxygen drop, but I didn't realize they were still important. I looked at the ones with an oxygen drop. I only have like two, okay, I was like, Okay, I don't know about me. So I didn't do anything about it. I kept suffering. I was always tired. But I have four children. I have a reason to be tired, right? There's always an excuse for things. I woke up with headaches almost every morning, but I'm a headache person. I've had headaches since college. So it's almost normal for me. They're mild. They're gone in about 10 minutes, you know, just part of life. Finally, after a couple years, I was like, I'm just gonna get him out card. I don't care. I'm gonna try it and I paid $700 and I got one. From the very first day I felt better I went headache. I didn't have a headache for about a year and a half. Wow. And then I would get them occasionally with you know, menstrual cycle changes right but rare, right? But for me to live without headaches if you know what life was like without him like wow, this is what life is like when you wake up feeling great without a headache and I was on my own. Yeah, I just went and paid cash just in case I could help was so sick of it into.

38:06 

And then I had the lecture by the doctor who reads the home sleep studies. And he told me how all the apnea is matter. Even if you're not dropping an oxygen, you're getting that stress response. you're grinding your teeth causing headaches, bloah. And I went back and looked at my study and realized that I was having like 30 or 40. Wow, but only two with the oxygen drop. And he said that he sees that quite often in women versus men. When the makeup of our body we tend to respond to stresses, more, we're more sensitive, so we're more likely to pull out of it before it gets really severe. Whereas a guy will just snore and sleep right through it and get a really low oxygen. Women typically, oxygen starts to drop and we we pull out of it, we pull ourselves into a shallow sleep and we breathe. We're more responsive, and it makes me think almost like when the baby's crying down the hall and you just somehow you wake up and you just know right like Yeah, yeah, it's just more you just said the chemical makeup of one's body just they respond. So you get a lot more ua RS than seniors, they've gotten it. And then it goes untreated because it's not quote unquote bad enough. So insurance doesn't pay for treatment, but it could literally change your life literally change your life changed my life. I will never sleep without my mouth guard. The mouth guard works by bringing your lower jaw forward a little bit, which pulls your tongue away from the back your throat. Wow, if I go away for the weekend and forget it at home, I will stress out I want to sleep up in a chair.

39:24 

Without it, yeah, you know, and how long does a mouthguard last typically?

39:28 

So every five years is when your parents will pay for a new mouth guard. I've had mine for three years and it's brand spanking new. Okay, every time I go for a dental cleaning, I bring it and they clean it in their ultrasound machine. And it's just crystal clear again, it's light as a feather could fit in my pocket. Nice. So even a lot of people that have C Pap machines in their home and use them. They will pay cash for a mouth guard for if they're going away for the weekend. And they don't want to love their machine with them. You know they should do but they don't want to rewrite cliche, right? But you're gonna be sleeping in a hotel room. Some friends and it'd be really nice not to snore and wake them up and also to keep breathing yourself. Yeah, yeah,

40:05 

And are C Pap machines noisy?

40:09 

They are so quiet they're quiet and dark no light. Oh, that's one technology without a light. They're amazing because I always think of it people say oh, I don't want that noisy Darth Vader yeah someone else gonna sleep next to me but no nice so much. I mean, I would say the length of the machine is maybe like your elbow to the tip of your fingers. It's a long skinny kind of a rectangles different machines obviously but and then on the end is a water tank that you literally pull off, put some water in it, shove it back in and that keeps the air slightly humidified, so you don't if you have a nasal mask, you're not going to dry out your nose. Okay, so that's as simple as it is there's an electrical cord coming out the back. There's a skinny tube coming out the front with a mask on your face. There's all different kinds of masks. You can have a full face mask if you sleep with your mouth open. You can have a little nasal Max's like a triangle over your nose. You can have a nasal pillow Which is kind of like a mustache, and it's almost like earplugs, there's little plugs going in your nose okay or not, it can be like a, there's one that's like a mustache that just has slits in the rubber go up against your nostrils, so blows air, but you can't use a nasal mask if you open your mouth because the air will go in your nose and come out your mouth. Every month, you're getting a new mass. So if you want to try a different style, you can say hey, next time I want this Oh, and you get to the one where you love and you're comfortable with, I would say really popular right now is the nasal pillows is what it's called, is very popular and comfortable. And on the report I see like no leaks seems to be the best. So for people that really want to use that kind of mask, but they open their mouth at night, they can get a chin strap, which is $10 it's kind of a little hammock for your chin. It's a little too you know t shirt material and it just goes up on top of your head you Velcro it it's like a band, you know, and I have to tell you that I'm I'm a sensitive sleeper so I like it really dark and quiet and I thought let me see what this see Pat machine is like it's gonna keep me awake. My husband and I both got it because I made him be my guinea pig. And he does snore a little so I made him try it. So we got two machines and we both put them on and we're joking that we're because we're scuba divers so we always say goodbye at the surface of the water before we go down. So as he was putting machine on a second it is like, I'm going down mask on and we were laughing. We both put them on, you know turn arms you kind of rolled over to fall asleep. Well, I like you know the honeymoons over we're both sitting on our seat.

42:33 

So I couldn't hear his and I thought he's not wearing it. You know. I looked over at him. He was on he was sound asleep. I couldn't believe I couldn't hear it. I couldn't tell if he had it on or not.

42:47 

I think that's good to know. Yes. I think that when it comes to this I know for me personally because you have told me good sleep studies which I'm getting a sleep study. I have a order for a sleep study. But I think our mentality is, that means I'm old. You know, that means I'm not going down that road, you know. So you have that mentality, they don't think it's going to be uncomfortable. And it's going to be loud. And it's going to be cumbersome, all these things. So I think it's really important to say, Gosh, it's not it's like my health is worth more than that so much more than that, and it's not uncomfortable and you will be able to sleep and it is quiet. But I think about Okay, meal prep services are everywhere now, right? Because you don't have time right and you want to eat well, so Okay, they're popping up everywhere because people need them want them? Well, it's kind of like meal prep for sleep right? It's like this C pap is going to get you to sleep and get good sleep. Yeah, you're gonna get good sleep. So you need it. We have to change a shift that perspective to understand that. If I have dietary issues, nutritional issues, I'm going to go to nutritionists, right dietitian and get some professional guidance because I have to eat better. Same thing with sleep.

44:00 

and more than one patient has told me that when they first got their c pap machine, they were thinking, Oh gosh, how is this going to go? And that now they look at it with love

Unknown Speaker  44:11 

me I'm repeating what they said. I said look at my C pap  machine with love because I know that I'm about to put it on and get a great night's sleep that I know cool. One of my patients even took it camping. Really she got a long extension cord plugged in and you can buy batteries. So I found was about $300 it's looks like a small iPad, and it's a battery for the C pap machine. You can't use the cigarette lighter still strong enough. Okay, so it's a battery for the C pap that will blow for two hours. Oh, interesting.

44:40 

It is interesting. And I think about how many breast cancer survivors struggle with chemo brain. And as I just relayed that story to you of how you don't sleep while you're going through chemotherapy, and how it disrupts your sleep pattern for a long time afterwards. And I just like all this Yeah, all This stuff is just going through my head like oh my gosh, could that have something to do with it? like can I go get a C pap over at Home Depot right now?

45:13 

I am going to feel good. I'm gonna look good.

45:16 

I can talk about this is I can talk about this all day long. It's fascinating. But in summary of ours, this one of the critical pillars of good health is good sleep hygiene. Absolutely. Yeah. So if you have sounds like if you have anything that bothers you get the sleep study and see if you can rule out whether or not you are actually sleeping the right way, a healthy way and maybe you can improve your life by just getting a little more good sleep. Absolutely. Thank you so much. This has been awesome and so fun. I'm gonna have you back like every week.

45:50 

I'd love to.

45:52 

Okay, I think that was my favorite episode ever. Well, the both of these episodes in the series actually. I first Love talking with Dr. Greene, she's amazing. I love sleeping. It's amazing. And honestly, I could use better sleep. So I had no idea of that deep impact that having restless sleep, could cause. And so I'm really excited. I think I've mentioned earlier that I did call my doctor have a referral for a sleep study. So I am going to keep you posted on that. And I'm excited also because I've received several emails and direct messages from people who heard the part one of this series. And like me, were shocked to hear this position talking about how important and how significant proper sleep is for you or the one snoring next to you. Right. So for both of you, no matter what if that's the case. So I hope this episode gave you a lot more insights on how to move forward with the sleep study to support your health or the health of a loved one that's keeping you awake at night. Now, as promised, I want to give you an update on revivify. I said on on the show is going to open in January, then I came back and said, it's going to open in February. And let me tell you, there is a lot going on behind the scenes on this new version of revivify. And it is going to open for enrollment in February. I want to give you an exact date, but it's probably going to be towards the end of next week. And I can't give an exact date because some technology is having some not issues, but we're working through it. We're working through it. And I want to make sure that everything is working before I started rolling people in the program. So I've got some great stuff coming up. I have got a wonderful webinar that's coming up. It's a free one hour webinar that's going to talk a lot about the things that we need to do to get our health and our mindset in the right place after breast cancer. So look forward to hearing about that. Thanks to all of you. We're getting on the revivify list. And I want to tell you right now, it is amazing. And I want to thank the dozens of women who have already gone through the defi. And given me their feedback and their comments on what they liked and what they wanted more of. And this version of revivify is just 10 times the version of what it was before. And it's all thanks to these amazing women who I absolutely love and I'm so grateful for it. So look forward to it, go to my website, Laura lummer.com. Get on the rid of the waitlist and make sure you don't miss any of the email notifications about the webinar and when the the enrollment is open and ready for you. And for those of you who are on that revivify waitlist, I am going to have a special surprise for you. As I mentioned last week, I'm not even sure what it is now, but I'm tossing around a couple things. Just because I want to show you how much I appreciate you taking the time to do that and how much I appreciate your patience. I know when you want to start a program You want to start it now. And I've learned a lot in putting a date out there before I understand the background dynamics, bigger course. But trust me, it's going to be worth it. And we're going to have a great time, because I'm going to work through this program together with you all. So, get on the waitlist, Laura Lummer, calm and go on over to my Facebook, find me as Laura Lummer on Facebook, get into the breast cancer recovery group. in that group, you make sure and not miss any updates. You'll get to engage with other breast cancer survivors like minded women, and build a community where we can support each other in a thriving mindset after breast cancer. There's a lot of stuff that we have to go through, and a lot of side effects that happened to us because of what we have to do. We have what we choose to do because we choose to live longer, and having a community to bounce your ideas and concerns off of to hear of other women's experiences, and to support having a healthy mindset as we go through this period of recovery is so critical. You know, one of my favorite quotes is that pain is inevitable. But suffering is optional. And we don't want to continue suffering through breast cancer recovery. We want to understand ways to move past the pain and move into the best version of our lives we can possibly live because we know firsthand and only to well, that life truly is very short. So I will look forward to seeing you are on the waitlist. I look forward to seeing you in the breast cancer recovery group. And I will look forward to making definite date announcements to you next week because I am really, really excited about this. So thank you for listening, and go get some sleep, go get a sleep study and come over to the breast cancer recovery group and let me know how it went as well. Love to hear this. It's so cool. And I'll talk to you again next week.