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Dr. Shah:
Uh, I’m pleased to be joined by Dr. Steven Park. And he is board certified in both otolaryngology, which stands for ear, nose and throat. Uh, and these are the doctors of the head and neck area, the masters of the head and neck and in sleep medicine. Uh, he received his BA from the Johns Hopkins university and his medical degree from Columbia university. His ENT residency was completed at Montefiore medical center in New York, as well as Albert Einstein. And he’s been in practice and a thriving, private practice for like the last 13 years or so. Uh, he also is at the faculty of Montefiore in the Bronx and is an assistant professor of photo rhino laryngology. Most of us forget about the rhino part, which is just as important as the other, other parts of otolaryngology. Um, he’s also the author of an awesome bestseller, which is called sleep interrupted.
Uh, a physician reveals the number one reason why so many of us are sick and tired. Uh, and if you haven’t listened to his podcast, his podcast is awesome. It’s the breathe, right? Better starting to breathe, better, sleep, better, live better podcast. Um, which I think is amazing because it talks about a lot of things that, um, a lot of doctors either don’t know don’t want to talk about, and it’s really informative for everyone. And I’m a big fan of it. Um, his main mission is to empower anyone with chronic health Ammons, uh, as a result of, for sleep and help us all find resources to help us rejuvenate, restore, and regain optimal health and wellness again. So welcome Dr. Park. It’s awesome having you here. Uh, how are you doing today?
Steven Park:
I’m great. Thanks for inviting me. Cool.
Dr. Shah:
Um, so, um, the first question we’re going to start off with is your background and how you became interested in facial beauty and how that relates to optimal breathing and sleep.
Steven Park:
Yeah. So, you know, when I, I remember taking a plastic surgery classes during residency and I distinctly remember discussing the optimal facial features. That’s, that’s, um, define what defines facial beauty. And I remember you remember all the landmarks they give for women and men. And I do remember saying I’m hearing that the, the, the jaws are very prominent feature. What determines whether it be full face, it looks like. And, but if you look at modern humans these days, it’s really striking that, um, the, our perception of facial beauty has changed dramatically. So for example, if you’re like, if you look at those movie stars in 1940s and fifties, the black and white movies, all the male and female movie stars at these wide square jaws, right? Prominent cheekbones, nice teeth, that was what was considered attractive. But now if you look at all the younger, uh, movie stars and celebrities, they have these triangular faces with recess, jaws, it’s, it’s, it’s pretty striking. Um, and, and there was a study, I forget where it was done, but, um, as I say, looking at people’s perceptions of facial beauty, and now because everyone’s faces are smaller, you think people are preferring people with smaller, more narrow faces.
Dr. Shah:
So you think there’s a selection element going on in as long as we productive.
Steven Park:
Yeah.
Dr. Shah:
But it’s interesting. And I think that, um, yeah, we definitely get a variety. And in our practice alone, talking about patients who want sometimes want that V-shaped look, which is definitely popular, uh, especially in Asia, they kind of coined that term V the line surgery for, uh, creating that narrow road look, um, and, and going from there. Uh, so as we relate to facial beauty, um, do you notice any difference with crooked teeth and facial beauty and how that’s those two terms kind of relate?
Steven Park:
Sure. So when I started out as a general ENT doctor, I cheated all kinds of were all ranges of ENT problems, your problems, sinus infections, throat problems, snoring. And what I realized was that people who had more Cricut teeth and small amounts had more illnesses, more range of problems, and many of these people also snored. And so when I started to look for a sleep apnea in these patients, I got much better outcomes treating the general ENT problems. So your problems, sinus problems were problems got much better when you look for and true the snoring and sleep apnea. And so it kind of makes sense if you have cricket Tia, that means your jaws are too small at the hold with all your teeth. This is one reason. That’s why dentists are saying that upper about a hundred years ago. Most people still had their third, wasn’t it coming in? Now it’s a given that either is going to get impacted or you have to take them out. It just means that the jaws are just too small to hold on your teeth. That also narrows your airway by definition.
Dr. Shah:
Oh, that’s interesting. I never thought of it that way. And, uh, do you think the, not just the result of us kind of having smaller drugs in general, do you think the mouth breathing is contributing to the crooked teeth at all as well, or not necessarily?
Steven Park:
Well, that’s a big controversy what causes what, but we know that there are monkey studies. There are little Crow experiments where they plug McGee’s noses when they’re first born and they had obvious jaw under development. And so it’s a pretty much a given that if you plug someone’s nose, um, they have mouth breathing. The, the face gets longer, it’s called adenoid faces. I’m sure you’re aware of that. Um, so we see this all the time, kids with large adenoids that know the mouth being the face gets longer and more recessed. Um, and so nasal congestion is a major risk factor, but there are a lot of other, um, common risk factors out there that, that causes malocclusion and especially evidenced in the dental literature. Um,
Dr. Shah:
So do you have any idea why our human faces are shrinking? Like why are, and why our airways are drinking as well and why that’s happening?
Steven Park:
Okay. Well, first I have to kind of look at why humans are susceptible to these sleep breeding problems. Uh, there’s a major landmark paper by this guy named Terrance Davis sent from UC San Diego. Many years ago. He looked at the evolutionary causes of storing a sleep apnea. And what he kind of revealed was that it kind of makes sense that because if we can talk and speak and have complex speech and language was susceptible to sleep, breathing problems, fundamentally our voice boxes are, I have descended. So for example, in chimpanzees and human entrance, the voice box is high up behind the tongue, but then joined development at the sins. So initially the epic lawless and the soft palate overlap like this. So that’s what entrance can breathe and soccer at the same time. But around for the six months, it started to separate away.
Steven Park:
And the te the voicebox, the sounds underneath the tongue and tongue kind of takes up that space. So all when you humans have a true oropharynx, which is that space between the pallet and their voice box. And so because of this descent, the tissues, the soft tissues have to be more pliable and floppy to be able to talk and articulate complex speech language. Right. Um, and so that’s why only humans have all these choking and swallowing problems that animals generally don’t have. Now we did okay for thousands of years, and then we mess everything up by changing our diets. So, number one, modern Western diets are softer. Um, they’re obviously they’re nutritious more processed sugars, refined sugars. Um, actually it does. Uh, another book that really influenced my way of thinking is a book. You may be a premiere with this. Dr. Weston price is a dentist that traveled the world. The 1930s and forties looked at these indigenous cultures at a completely off the land. And they had perfect straight teeth and no cavities, and they were healthy.
Dr. Shah:
Oh, no, I’m not familiar
Steven Park:
With that book. Oh yeah. It’s called nutrition and physical DNA degeneration. Um, there’s actually a really, um, loyal group of people on Augustine called the Western price foundation. They’re into natural eating, uh, very, very prominent, um, in, in the nutrition field. So it’s kind of like
Dr. Shah:
Paleo, uh, the people are looking for people into paleo. They were into this.
Steven Park:
Exactly. Yeah, yeah. It’s the way it is. But what he found was that as he went back every 10, 15 years, when they started out at that restaurant diets, the chosen teeth can be much more crooked, crowded, more cavity is more sickly, more prone to infections diseases. So in one generation that happened. So the other risk factors are, so now these soft diets. So there’s, um, an anthropology anthropology, sorry, uh, medical anthropology, Anthem apologist, um, Dr. [inaudible] found that communities in north America that eat soft foods have more dental, clotting amount of collusion. So soft diets, bottle-feeding, uh, thumb sagging, pacify use nasal congestion. Uh, also, um, new, uh, prematurity is a risk factor for sleep apnea. So, and also many toxins that prevent your jaws from growing properly. So there’s a lot of different factors in modern life that contribute besides your genes too, which is a big factor.
Dr. Shah:
Oh, that’s fascinating. Actually I did not put the sock diet and the, um, you’re kind of the malocclusion and kind of piece of the puzzle together. Um, also talking about this, uh, facial fullness and straight teeth leading to wrinkles to kind of tie this into our beauty, uh, side of things. So, um, how are those kind of correlated? Okay,
Steven Park:
Well, let me give me a little funny story. So I have quite often, maybe once a month, I have middle-aged women coming in with, let’s say, frequent sinus infections, headaches, misery, uh, they get put on multiple antibiotics and it doesn’t work. And maybe for the self-aware for about six weeks, they come to see me and I asked them, do you sleep on your backside or stomach? They say, I sit with my back. I don’t believe her because the mouth is so tiny people with the small mouth generally don’t sleep on their backs. Actually most modern humans can’t sleep on the vaccinating bar or they prefer not to. So then I asked her, well, when you’re a teenager, how did you sleep on my stomach? Well, when do you change? Uh, six, about six or seven weeks ago? Why my dermatologist told me don’t sleep on your stomach because it causes facial wrinkles. So what’s happening is that now she has to go in the back, her tongue falls back more when she’s in deep sleep and she’s waking up. So you’re going to get more banquets if you don’t sleep. But going back to the official structure, the fuller, your face, the more it tightens your muscles of your throat on the inside. So you can breathe better, but also times your facial skin. So as you age, the skin, doesn’t relax as much because the jaws are more full.
Dr. Shah:
That makes sense. Um, now kind of talking about sleep position and all that, um, that’s always that controversial thing. Is there a best position to sleep? Um, some people talk about having their head raised a little bit, you know, putting blocks into the bed, which may or may not work your thoughts on sleep position. Is it the side? Is the, is it the back with blocks? If you can do that, is it, is it kind of slipping on her stomach? Uh, what would be that the one position, or is there one,
Steven Park:
There is no one position. I tell patients whatever you’re most comfortable sleeping in when you’re younger now problems happen when you artificially change that position. So that, for example, the dermatology example, but more often than not, it’s do the surgery. So let’s say you’re a stomach or side sleeper, and now you’ve had surgery, like a knee surgery, hip surgery, abdominal surgery, and now you have to support your back or even breast surgery. And because you can’t breathe on your back, you wake up more often, you have less quality of sleep. Uh, so anything that prevents you from sleeping, your normal position is going to, um, worsen your sleep quality. Now inclining your head. It’s going to help a little bit because you’re taking away the effect of gravity. Right. But it helps to some degree, another thing to think about is the pushy position of your neck. So like it always snore use these contour pillows to extend the neck a little bit. So that opens up the airway a little bit like where the anesthesiologist do to open up your way. So that helps some people sometimes. Um, but if you hit, keep your head down like this, that’s going to narrow the area more. Uh, also if you open your mouth, the tongue goes back. So had people have there’s congestion snore more and stop reading world.
Dr. Shah:
Uh, I, I mistakenly, I I’ve tried to like hack my own sleep. And, um, so one way as I try to lift my bed up and I figured, Hey, guess what if I do it at like, you know, they say 10 to 15 degrees is better than flat. Um, and so if I do it at maybe 30 degrees, that’ll even better, but first of all, I, my wife is furious at me. Like, what are you doing? What’d you do our bed? Uh, the second issue was I, I, I put a little, um, tracker on, uh, I’m not sure if you’re familiar with something called better. It’s like tracks. Your apnea is at night and oxygen levels. And I was having APNIC events that was all freaked out. Um, and I think it was self-induced because I was putting my head down, like you talked about. Um, and oftentimes it’s just probably a little gentle incline is better than massive incline. Um, and the head position is probably a little bit better in that.
Steven Park:
Yeah. So actually got inclined principle is recommended quite often for people with acid reflux. And that’s one of the other, um, connections that I made people who have sleep apnea also have acid reflux by definition. Because every time you stop breathing, your physically forcefully, suction up your normal stomach is into your throat. And so grab the incline, your head up a little bit does help to some degree. But if you have apnea is it’s going to overwhelm the effect of gravity. It just brings everything up to your throat.
Dr. Shah:
Um, just, you know, a lot of people kind of separate like sleep disturbance and sleep apnea and kind of get these all confused. So for someone who’s coming and saying, Hey, guess what? I don’t know, maybe I can black out my windows. Maybe I can put noise, sound, proof, things, whatever, and optimize my temperature. Um, uh, can you kind of like explain for us what, why there’s different types of sleep problems and when they should see a sleep specialist? Um, and what kind of,
Steven Park:
Yeah, that’s a great question because, um, I mean, the first thing you should do before you see a doctor is to work on sleep hygiene techniques. So these are these top 10 lists of things to do. Uh, before you see a doctors they’ll close out all your windows, they completely dark. Don’t read electronic screens before bedtime because the blue lights, lower melatonin, um, use the bed for sleep and sex only does again, there’s a long list of things in the sleep hygiene room. Um, that’s one insomnia around now, the problem is that with modern life, there’s so many distractions like screens, uh, dog barking noises, uh, internet, social media. Um, and then on top of that, more and more people have these sea breathing problems as a result of our narrow jaws. So it’s hard to separate out what’s causing what, but clearly you should start with the conservative options first. And then if that doesn’t work, you go to the doctor, especially B store, because if you store you have a high chance of having sleep apnea, um, and that’s a serious medical condition that goes undiagnosed in most people.
Dr. Shah:
And so if you kind of look at sleep apnea patients, so somebody comes and says, you know what? I snore, um, you know, I, I just noticed what my partner tells me. I snore I’ve done an app and I snore. They come and see you. What percentage? Like if someone says, um, where is my problem with apnea? Uh, is it going to be, what percentage do you think his nose, tongue jawline, or kind of if it’s obviously different from person to person?
Steven Park:
Yeah, it is all over the place. I mean, I have many young thin people who snore heavily with seniors. EagleView I have young thin women who don’t sweat at all who have severe sleep apnea. Um, I have people who stopped breathing 30 times an hour. We don’t have any apnea says, so it’s not just being overweight that causes apnea or, or is it caused you to snore to have sleep apnea? It’s a physical job structure problem. So most of my patients that I see don’t really have severe apnea, um, what they ha what happens is they stopped reading a lot, but it threshold isn’t long enough to be quite Ave. So they keep waking up. So these people are very tiny mouths, hierarchy, pallets, dental crowding. They’ve had multiple dental work in the past, the tongues that are really high, the Tazo isn’t usually small. Um, so it just, it’s a jaw structure problem, more than a soft tissue problem, but most people have both.
Dr. Shah:
So how do you solve that? They come and see you say, I want to, um, I want to solve this issue, um, because, um, maybe I don’t need, let’s say we talked about you kind of alluded that they, maybe they don’t need to use triple P or tonsil surgery. Maybe they don’t need the tongue base reduction surgery, and maybe they don’t need a nose surgery. So it’s a smaller job, which some of the solutions we can look for.
Steven Park:
Alright. So the number one tip did I get to all my patients and this takes care of Lilly, maybe 10 to 15% of the patient’s symptoms is don’t eat late before bedtime. Oh,
Dr. Shah:
Wow. And that’s going to be obviously the reflux.
Steven Park:
Yes. But what happens is, if you, again, if you stop reading does once in a while, the more reflux you’ve had more inflammation you have, especially if we have, let’s say small tassels, it’s going to get bigger, causing more obstruction. So that they’re actually on top of that, not eating late. Um, the other important thing is improving nasal breathing because the more stuff your nose is, the more of a vacuum effect you create downstream causing more obstructions, causing more reflux. And I’ve actually shown that reflux when you are stopped, when you stop breathing can go into your nose, signs, yours and your lungs causing massive inflammation. So those two things, if you start with that, that takes her about a quarter of all my ENT, sinus, ENT, um, patient’s symptoms in general.
Dr. Shah:
And what are your thoughts? I know that you don’t love medicine, I’ll mention things, and I’m not sure I’m a big fan of medicine myself. So someone comes in and says, well, should I take private sec? Are you profiling sick? [inaudible] um, and what your thoughts?
Steven Park:
Yeah. So my feeling is that acid reflux Americans do absolutely nothing for reflux. What it does is it lowers as a secretion, but the stomach juices still come up, that’s acidic. But what you also find is pepsin, which is the enzyme that degrades pet proteins in sinus and ear among fluid and irritates the throat. And so, yes, it can help, you know, for short-term periods. Um, but it doesn’t really treat true reflux a better way is to, again, that’s why you have to empty your stomach before you go to bed, don’t eat close to bedtime. Um, but in the old days, we used to have these medications called these prom, which the medications like Paul posted that empty the stomach faster for diabetics, but that got taken off the market. Um, so it’s really hard to, um, treat this completely because it’s fundamentally an anatomic problem along with the dietary habits and lifestyle habits.
Dr. Shah:
Okay. So, um, so it kind of a take home point for our listeners is don’t eat too close to bed, time span, three hours. And then are you a fan of a little bit of a bed elevation for that purpose? Or you think it’s, it’s dependent
Steven Park:
The patient? I think that depends more. If you have this on your back, let’s say you have a shoulder injury or something. Um, most people will tell you, I can only sleep on my side of the stomach. That’s it? That’s your position. Um, but any kind of bad, there’s nothing wrong with experimenting. And some people do find that it’s helpful, especially for reflux on this, but again, me flux apnea, all go together. You’re taking away the effect of gravity.
Dr. Shah:
Okay. We’re going to dive into the nose now. Cause that’s another part, I think a big part of that. And I think, especially with breathing, okay. So someone comes in, they have a stuffy nose, your thoughts on nasal steroids or antihistamine spray, or a histamine pills. Um, first of all, it’s the first line, whether they have allergies or not in,
Steven Park:
Right. So before we talk about medications, um, if they have allergies, then you have to control the environment. So a lot of people have pets at home, uh, dust issues, um, various and also environmental allergies and seasonal allergies. So you have to control that, uh, from a conservative standpoint, HEPA filter, um, showering before you go to bed, that kind of stuff. Um, but let’s say that you’ve tried all that and that you’re still stuffy. You have allergy symptoms at that point. I, I, I try not to give them medications, but honestly, every medication, almost 90% of all of the medications that we give in our field. I’m sure your feel too has detrimental effects on sleep directly or indirectly. So for example, the high blood pressure medications, because it relaxes your blood vessels, it also relates to your blood pressure and your nose causing more congestion. That’s a major side effect of high blood pressure medications by also lowering your sympathetic tone. It also lowers the pathway of melatonin production in your brain. The melatonin is the pathway goes from your eyes to the HEPA, to the, um, um, the LMS down to the superior. Cervical ganglion in your brain center goes back up to the pineal gland. So if you know, sympathetic tone, you’re lowering melatonin. Um, and I can list all the side effects from all the other medications as well.
Dr. Shah:
And there’s men who take Viagra. Um, if they take it right before they go to bed, they’re going to have a problem. They might have a, uh, some fun that night, but they’re probably going to have difficulty sleeping. They’re going to have a stuffy nose.
Steven Park:
Well, well, you know what? I have a been answered to that. If you look at a urology literature, if you do sleep studies on every man with Erika dysfunction, about 60, 70% will have undiagnosed about Mia, I’m going to treat it half. Those people are cured instantly. Another quarter get much better.
Dr. Shah:
Oh, that’s interesting. And so treated meaning which way treating me with, um, let me see. Okay. Yeah. Okay. I thought you were talking about the erectile dysfunction being treated. So I was like, okay, okay.
Steven Park:
They say they don’t have, they don’t have thousands of questions anymore because they’re on, C-PAP
Dr. Shah:
A great way of, uh, so you’re actually treating it more of kind of the cause of that great point quick point. You mentioned one thing too, that I didn’t want to gloss over it. You mentioned showering before you go to bed with allergies. Uh, as you say that, uh, how come,
Steven Park:
Uh, because if you work quicksand, if it worked out doors, you have Pollins in your hair and then you rubbing your hair into the pillows and you toss you breathing in pollens.
Dr. Shah:
Great, great, great, great tip. Awesome point. Okay. So, um, so we talk about that. Um, and then, so for the allergies, they’ve done all that. Um, they’re still stuffy. They say, Hey, guess what? I wake up and I am miserable. My nose is completely stuffy. Um, I don’t want to use, uh, what are some things they can do? Um, you know, cause we’re not, we’re not taking anti-histamines cause it’s issues potentially with that maybe, uh, sprays, are you okay with sprays or
Steven Park:
I think starting with nasal standing is the best way to go. Uh, the problem with that is it’s a little inconvenient because you have to do it often for it to work. Um, and you can use different ways of getting into your nose as a neti pot or spray bottle is in squeeze bottles and aerosol cans, but any kind of salt water is good to decongestant though, is if it’s a mild decongestant, but you have to do it on a regular basis. Um, so that’s the first way of handling these nasal sinus issues. But if you want to try medical therapy, I prefer the nasal steroids because it doesn’t get absorbed into your bloodstream and it works more as a prophylactic medication and then sauce I’ll give, I’ll start people on the anti-submarine just for short periods and then take them off and maintain the steroids.
Steven Park:
But ultimately that’s not the most ideal way to go either because it’s the sister, right? But the problem is that giving a patient a stair medication is not going to change a deviated septum because most people with smaller jaws have deviated septums. And the reason is that if your height palate doesn’t drop during development as a step in the middle of your nose, as the stepping grows at the floor of your nose, doesn’t drop, it’s going to bulk it to one side. Oh, great point. So these people, all of a sudden nasal when narrow and there’s a cavities HighQ palate, crickets up them, more irritable noses and swelling of the turbinates. And lastly, the one thing that a lot of doctors don’t think about is when the nostril is cave in because the angle of the nostril compared to SEPTA, instead of being like, this is more like this, and you’re more stuff, you’re an instructor, the nationals came in easier. So that’s, those are the three things that I always look for. So clearly I’m not, African-Americans have broader noses and their cartilage is stiffer, but Caucasians tend to have more narrow noses. They’re more susceptible to nostril collapse. So these are the people that benefited from breed match-ups and this guy just did you pronounce with open, but you have to treat the inflammation. You have to treat the structural problems and the nostril collapse medically, and then as a last resort surgery.
Dr. Shah:
Um, so for that surgery part, um, are you okay with patients? Do you like using breathe right strips? It’s sort of like a diagnosis of valve issues and say, Hey, guess what? It’d be better with the breather. Right. Strip. I’m going to jump into a surgical solution then, are you okay with that as sort of a test?
Steven Park:
Sure, sure. Well, it doesn’t whenever a meme, maybe for this call a coddle, whenever we left the nostrils app, I also use Q-tips to kind of let them nurse on the inside. Um, but they get this wild sensation when you do that. And in the meantime, went to a surgery, they can use dried chips along with it and use a steroid sprays. Um, but, um, I guess the most common surgery I do and there’s a strategy to help them breathe through the nose. Now, one caveat about near the surgery is that it’s been documented that in general, it doesn’t help you sleep apnea, which is a little bit counter intuitive. Uh, but the evidence is out there. It doesn’t really treat sleep apnea. However, patients feel better subjectively, which, which makes sense. Okay.
Dr. Shah:
And when you’re doing nasal surgery for, um, I guess, generalized believing, um, do you dive into all the components? Do you accept a plasti TriNet’s Val and then, um, what are your, some of your solutions for valve, uh, repair, if you dive into that?
Steven Park:
So there’s stuff to play. You’ve got to pretty standard technique, uh, terminates a little bit of controversy about what the belt technique is, but everyone has a favorite technique. Uh, but the valve that’s a little bit tricky because it’s external. It kind of goes into the cosmetic realm too sometimes. Um, and so, I mean the, the standard way is the other band graph. I’m sure you’re familiar with that is usually an open-minded place, but you can do a closed also. So I still do that once in a while. You know, you can take college from the step then with the air. Um, another technique that I do now, I don’t do rhinoplasty for cosmetic reasons. I don’t do classic cosmetic surgery, but I do nasal functional surgery, but it’s does a big overlap between the two. Absolutely. Um, and what I do, I’m also looking out for cosmetic issues, but not formerly as a kind of as surgeon.
Steven Park:
Um, so I kind of take into consideration how the nose is going to look. So, you know, when you did is there’s a band graphs, it does make those a little bit fuller to do some degree. Um, and then there’s another technique idea. Sometimes resist suspension technique where I put a little making a decision here under the eyelid Peppa, Tonya screw into the bone and throw the suture under skin, grab a nostril and lift up and suspend an Asheville. Um, so that’s that’s, I did that once or twice a year for second third line options. Um, more recently, what I’ve been doing is, um, I modified a technique that was put out by a Medtronic. Are you familiar with the ALR technique? ALR stent? Uh, one of my, yeah, one of my colleagues at my medical score, he worked with Medtronic to develop the stent, to help to overlap the, the two parts of the, um, the nostril, the upper and lower level cartilage. So what they do is actually you can back this up when you, when we’re done, there’s a video, they got a law, a L a R Medtronic stent, you sit in animation, how it’s done.
Dr. Shah:
I’ve seen it. I haven’t used it personally. So I’ve seen it temporarily. Is that right? And you take it out in a week in a scars, in a different position, is that
Steven Park:
Yeah, Nick, you make a cut inside the nose between two cartilages and you peel the skin off the cartilage on the upper cartilage and you overlap about two or three millimeters and the heal. So it’s different to nostril, but the stent helps you to do it much more effectively. Now I started doing this guy, got good results, but then the hospital wouldn’t stop the stent for me anymore. So I started doing it without the stent. I got just as good results. It’s a very simple conservative operation. Obviously there’s certain people, there are more candidates. For example, you’ve had very flaring nostrils. You don’t want to lift the nachos up too much. So some people are not, they’re not good candidates for that. So that’s my go-to operation for most people, but not everyone. And it doesn’t again, because it’s so conservative, it doesn’t work a hundred percent, maybe 60, 70%, but when you do it along with the septum and the turbine energy overall, you get pretty good results.
Dr. Shah:
I would agree with that and usually different, lots of different techniques with the nose. And did you find that constellation of techniques that kind of all kind of go together for each person? Um, well, cool. Thanks for sharing that. Um, uh, so some of the things that we’re talking about is you mentioned that some of the patients having sleep issues, uh, stopped breathing 25 times an hour and not really having sleep apnea on a sleep test. Um, so, uh, so these are the people that are kind of like not having enough for an apnea, um, uh, and kind of treating those aspects of it. So it’s really, those are the patients who are kind of a subclinical, um, where you think those are the patients with reflux and, um, other things in an occasionally with surgery, correct?
Steven Park:
Sure. So this is called upper airway resistance syndrome or UARS, and this is described by a Stanford doctor, Dr. Christian [inaudible]. He actually just recently passed away. [inaudible], he’s a luminary in statements and he coined the term sleep apnea. Um, and so he’s a big figure and see medicine, but, um, what he noticed was that this meant in 93, I think he published a paper showing that in young thin men and women who are severely tired and fatigued, but didn’t have sleep apnea officially on the sleep test when he did was he put a salvageable pressure catheter into the chest cavity and did a sleep study and found that with each successive breath, the pressure would get more and more negative. So that breathing against a closed throat and after a couple of breaths to get more and more negative than they would to wake up from deep delights sleep.
Steven Park:
So they would have frequent arousals from state, but not waking up completely. So it’s fragmented sleep. And so essentially another way of looking at this, or another way of describing it is that is how you describe apnea. And the sleep study avenue means ten second pauses for Matra. So for, uh, for adults is 10 seconds for children is to normal miss miss breaths. So let’s say, so the diagnosis of you get, if you have five or more apneas per hour, but let’s say you stopped breathing three times an hour, when nine seconds each or two segments each, then you don’t have apnea on a sleep study. So you don’t have lack of oxygen. You don’t Ashton doesn’t drop, but you have sleep fragmentation. And that leads to chronic fatigue issues, anxiety, depression, headaches, digestive issues, all these conditions that doctors have no idea what to do with, because you look healthy, but your symptoms are just out of proportion to what you’re seeing on the seat test. And these people by definition all have very small mouths. So when they obstruct, they wake up too quickly as opposed to see apnea patients, when they obstruct, they don’t wake up quickly enough.
Dr. Shah:
Do you, do you find, uh, dental, uh, guards or things that kind of help with the job? Um, useful?
Steven Park:
Yeah. So if you is for improper ways now the American academy of medicines to standard recommendations for mild snoring amount, just moderate sleep apnea is either a C-PAP or the mandibular advancement garden. These are these custom-made guards that move the lower jaw forward. And there are these over the counter options that are very low-tech bulky options. And they work, they don’t work that way, but sometimes they work, but anything that moves the jaw forward, we’ll put the tongue for it and time the soft palate. And so there are dentists that do this, that they’re very good at doing this. Um, but not everyone’s a very good candidate because first of all, if your nose is stuffy, you won’t be able to tolerate CPAP or the mouth guard. So they’ve shown in studies that if you optimize the other breathing, you can tolerate dental appliances and seep out much better. So that’s why I’m so adamant about optimizing your breathing to get them prepared for these other options. These non-surgical options that come later. Um, so these over the counter options that you see a lot, they can help. They can be helpful sometimes and some people, so I’m not saying it’s worthless, but it’s not going to get the same degree of efficacy effectiveness as you went through a form device.
Dr. Shah:
Now, you mentioned earlier in the podcast about dermatologists, having people not, uh, lay on their face for wrinkles. Are there any other ways that doctors can worse in your airway?
Steven Park:
Yeah. So this is a huge revelation for me. Um, and I’m, I’m guilty of doing this myself, for example, um, early in my career, a standard way of doing septoplasty and that you probably know is to use nasal packs or splints, right? And so, and then patients would complain they’d be miserable having those packs in. And when I went to literature, I saw that by putting nasal packs in your nose, you create avenues to take healthy college students put in packs for three days, the sleep studies, the avenues went up. So that’s a good reason why they’re miserable. So me early in my career, I stopped using patches sprints completely. So that’s one way you can aggravate the breeding problems by using agile packing. Right. But then for example, um, I mentioned before, if you do any kind of surgery that prevents you from sleeping on your side or stomach, that’s going to support us. Um, not dentists also sometimes what they do is in the process of doing standard orthodontics, they take out four bicuspids. Now some people, you know, they’re sent to the four by cuspids. They have to take the four Wyzant bowlers out before it wasn’t teeth. So now they have a small mouth to begin with. You take out 18, total. Those people are in trouble.
Dr. Shah:
Oh, wow.
Steven Park:
Yeah. Or in another, another dental realm, um, Nazi have a mismatch of bite. So let’s say your lower jaw is more protuberant than the upper jaw. And so the ideal way is to pull your upper jaw forward, but in use it, but more, the more standard ways to push your lower jaw back. So anything that retracts your jaws back is going to narrow your airway more cool. Yeah. Um, what else? Oh, and this is another thing that I’m sure you see sometimes, you know, when you do a standard rhinoplasty and let’s say you want to narrow the tip. And we saw this quite often, like in the 1950s, Dr. Goldman in New York city, very aggressive
Dr. Shah:
Rhinos day. Yeah. We know his name,
Steven Park:
Very aggressive, really pointed noses. But in the process, when you narrow the tip, you have to shave off some of the upper that the low lot of cartilage. And that now is a tip. But in the process, you also weakening the valve. That’s why you have to think about these things when you’re doing any kind of nasal surgery is to prevent that collapse that’s going to happen later on. So I think that’s a concept that most students are aware of these days, but we still see patients from 20, 30 years ago. They have these poignant point, you know, is, is to have nasal congestion. Uh,
Dr. Shah:
Yeah. I was in New York for a little bit and they’re all over the place. There’s a lot of these ladies who are in their seventies and eighties have these really, really small noses that I’m not sure they’re, they’re breathing from their nose at all. Um, well, amazing stuff I think, um, is a takeaway point that we can kind of, uh, let everyone know about kind of sleep that you can share us with.
Steven Park:
Sure. But I think you’ll agree with me that good quality sleep is essential for health and beauty. I totally grow on, even though it’s legal body doesn’t heal well, you don’t feel well on not sleeping. Well. Also increase your hunger for unhealthy sugary fatty foods. It’s hard to, hard to lose weight if you don’t see. Well. So it’s this vicious cycle of poor breeding is the poor sleep. We support eating, causing weight gain. Um, it’s just this conglomeration of symptoms that is that stems from poor breathing. So not just during the nighttime, but also daytime to it, because if he knows this, the return, any time you breathe through your mouth, uh, one of the thing I wanted to mention is very important with the reason why it’s so important to breathe your nose is that the nose makers get Mexican gas called nitric oxide, which is a, is a gas that dilates blood vessels. And so if you bypass your nose and breathe your mouth, you’re missing out on nitric side, going into your lungs and having nitric oxide in your lungs increases arches and PR uptake by 10 to 20%. Oh wow. So, so what you do, you’re mad. You’re going to breathe a little bit more, faster, more shallow, and you start to hyperventilate your carbon dioxide goes down and you get more anxious and tired. So that’s why these deep reading techniques through the nose are very rarely,
Dr. Shah:
And it’s interesting in, um, like an ancient Indian medicine, Ayurvedic medicine, they always talk about patients being more anxious who breathe through their mouth versus yoga breathing kind of has that kind of calming effect and works more on that person if they change. So, um, it’s cool to kind of get that scientific backing behind that.
Steven Park:
Exactly. Yeah. And this very medicine, it was well-known Gaza years ago. Um, but now we’re just kind of realizing that there’s a scientific basis behind it.
Dr. Shah:
So, uh, amazing. Well, um, all amazing points I’ve said, I learned a lot from just from just talking to you and, um, great stuff. And so, um, I want everyone to kind of, uh, kind of follow you on your, uh, your podcast, which we talked about. Um, I’m going to put that up as well as your website, which is doctor, uh, spelled out as Dr. D OCT or Steven park.com. And then you written a book on this on Amazon, which is sleep interrupted. So, um, awesome stuff. Uh, I’m going to keep listening to your podcast because, uh, uh, when it comes to sleep, oh my God. Do you know so much more about that? And, uh, so many things just about improving our lifestyle in so many other ways.
Steven Park:
Thank you so much for having me on the
Dr. Shah:
Show. Awesome. Cool. Well, thank you so much. It was a
Steven Park:
Pleasure.
