121: Dr. Keith Matheny, ENT & Sleep Vigil Creator: Dangers of Sleep-Disordered Breathing – Expert Insights & Innovative Solutions Unveiled

Welcome to the sleep as a skill podcast. My name is Mollie McGlocklin and I own a company that optimizes sleep through technology, accountability and behavioral change. Each week I'll be interviewing world class experts ranging from doctors, innovators and thought leaders to give actionable tips and strategies that you can implement to become a more skillful sleeper.

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Let's jump into your dose of practical sleep training.

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Welcome to the sleep as a skill podcast, where we dissect and analyze things that you can do to optimize your sleep and health. And today's topic is going to be all around the ear, the nose and the throat as it relates to sleep, but particularly emphasizing the nose is what we're going to pay quite a bit of attention to in today's conversation.

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We got so in the weeds on this conversation that we decided we need to absolutely do a part two, because it was just far too much to pick apart on this really important topic because we can be doing all kinds of things to improve our sleep. But if you're not breathing correctly throughout the course of the night, Good luck getting good sleep.

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And what I think is exciting though, is that we're going to be unpacking and understanding. But what is exciting is that there are so many new things that you can do to improve this problem. And thankfully we're going to be led by our guest, Dr. Keith Matheny, and he is a Vanderbilt trained ENT, and he has a practice in North Dallas that emphasizes rhinology and sleep in adults and children.

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He has a real passion. And I think you'll hear that in our conversation is a real passion for the business aspects of this area, as well as new technologies and procedures in ENT. He holds numerous patents as well as local drug delivery implants for use in sinus and ear surgery, founding two device companies around these technologies.

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And he is also the founder, chairman, CEO of US ENT Partners, an ENT focus group purchasing organization bringing savings of 20% or more on the high cost supplies that ENT physicians use in their office daily, as well as a co founder of Sleep Vigil, a company pioneering the concept of remote. Patient monitoring R P M for sleep apnea.

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Don't we need that? He also has numerous journal publications and has given numerous presentations on his clinical research and on various topics related to the business of medicine over the last few decades. As a creative outlet, he makes custom 3D printed jewelry within his company, Tuft Links, T U F F Links.

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He volunteers in his community, providing charity clinics for multiple school districts around his practice, serving on the local YMCA board, and even works with the Dallas Cowboys. So clearly our guest Next is very accomplished, quite a polymath, and I think you're going to really enjoy his out of the box look at this important area of our health and our life.

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Today's guest is actually not too far away from me over in Dallas, Texas. Keith, thank you so much for taking the time to be here. Thank you so much, Mollie. I'm excited. I am really excited. So I, once again, this happens a lot to me, I feel on these podcasts, I get to just have these opportunities to speak with such fascinating human beings.

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I feel so grateful and you are one of them. It became very obvious just in our interactions leading up to this podcast. And then of course today that the challenge will be to get all of our things that we want to address in this podcast in the short period of time. Start the timer. Yeah. Start the timer.

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Exactly. So jumping right in. Beginning at the beginning. I wanted to just get a sense of a little bit of your backstory and how you found yourself such a, you know, passionate person in the space that you're in now. Yeah. So I am an ear, nose and throat physician up here in Dallas and, uh, yeah, so not very far away from, and I love your nose and throat.

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And so when I set out, finished my training at Vanderbilt, gosh, 20, 25 years ago, I set out to do all aspects of it. And ENT is a, is a widely varied specialty. The ear surgery is very different than facial plastic surgery, very different than sinus surgery, different than head and neck cancer. We deal with pediatrics, we deal with all kinds of things.

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sleep, of course. And so, uh, my practice really evolved into one where I took care of more and more nasal and sinus disorders. And then it finally dawned on me several years ago that the nose, literally and figuratively, is central in sleep disordered breathing, sleep apnea and other similar type disorders.

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And so that's where my practice is today is dealing with the nose, picking boogers as people like to excuse me, but also where nasal obstruction and nasal resistance. affects sleep, which is a common, common issue. So let's start there too, because I know even before we hit record, you're talking about some of the numbers of people that could benefit from some possible way.

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There's many ways to help improve our aptitude and our breathing through the nose, but maybe you can help kind of like Sherpa us. through understanding why this is important, how prevalent it is. And I'm throwing you like 900 questions, but, and we're going to have to learn this, understand exactly piece by piece, uh, I'll tackle that.

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I'll tackle that. So you got this. As most of your audience knows, up to 25% of the population on this planet has sleep disordered breathing. One out of four, at least adults. So there's billions of people walking around. As a medical specialty, certainly in the western world, we have only diagnosed maybe 10% of those people that even have the diagnosis.

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And then of that 10%, we're maybe treating 10% in some form or fashion more than 90 days. So 1% of these people are getting treatment more than 90 days. That's horrible because this is not just a social disease where your bed partner is inconvenienced because you're snoring. This is a fatal disease. Uh, as an ENT physician, as a head and neck surgeon, this is second only to head and neck cancer, uh, as the most severe disease, the most risky disease that I care for.

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So we've got to do better than that. And that's really, all joking aside, why I've become so passionate about it, the more gray hair I get is we're not doing a good job. We're not doing as good a job as we could, and we have a lot of diagnostic tools and therapeutic tools at our disposal that we need to bring to our patients.

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Now, the larger answer to your question, you know, if you and I had done, I don't even know if there were podcasts years ago, maybe they were just starting, but if we had done a live interview back then, um, And talked about whether or not Keith does sleep in his practice. I said, Oh, absolutely. Um, and what I meant, though, back then, or looking back, what I would have meant is that people with snoring usually are dragged in by their ear by their bed partner to see me and said, put on my doorstep and said, fix this person.

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And so I would. Do a physical exam, often ignoring much of the nose, we'll talk about that momentarily, and then send them for a sleep study. Back then, those were done in a clinic type setting at night. Now, most sleep diagnostics are done at home with take home tests. There are many amazing ones on the market.

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And so, I would go through those results with that patient and then refer them elsewhere. Uh, for a CPAP machine, the dreaded Darth Vader mask that many people are prescribed, even though it is a great treatment in the right patient. Or something surgical, which many of the surgeries, certainly 15 years ago, were very barbaric and even worse, they didn't have durable results.

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They didn't, the effects didn't last very long, the positive effects. And so, many times I would never see the patient again because they didn't want to do a CPAP, they didn't want to do a big surgery, um, or they wouldn't even come back after they went to get their sleep study. They were kind of corralled off by the, that physician.

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So, I would argue that I was not doing sleep then because I wasn't taking the patient all the way to the end to a, a long standing treatment. I was really just triaging them. I was listening to their story about snoring and sending them somewhere else for a sleep study and never seeing them again.

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That's not doing sleep. So the first step in our practice was six or seven years ago. When we decided to start doing some home sleep testing and we made the commitment we bought the equipment to actually start doing The watch pad many listening one will be familiar. That's one of the best If not the best home sleep diagnostic test in my opinion, and it's a simple wristband finger probe It's now all that stuff is disposable and interfaces with a phone app.

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So the patient can be In their own bed, in their own settings, sleeping in whatever position they want. There's not headgear and things, vests that are influencing the data that are affecting the patient's sleep. We're able to see how they really sleep and then get a good snapshot of what's actually going on.

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So that was a big step in our practice to get better at caring for sleep because at least we were then in control of the testing, the diagnostics. So. Rehearsing that, patient would come in as a new patient, I'd order the sleep test, I would be the one reviewing the results with the patient and deciding amongst CPAP or dental appliances or some type of surgical procedure.

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So, the patients really liked staying in one place. But even then, once we got to the treatment, I would send them off to the dentist or I would send them off for a CPAP machine because we don't do those in our office. And then I may never see the patient again. Right. So it still left something to be desired.

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So the next step after that, probably four years ago, is before COVID. We brought a sleep dentist into our practice. This has become, even on social media over the last couple of weeks, a very hot topic. And actually, Mollie, as we're recording this, there's a big sleep meeting going on. Yes, there is. Neither you or I are at, but many of our colleagues are there.

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And so, in our practice, we've chosen to partner with dental professionals to fashion dental appliances in those patients where that's the best treatment for them. And that's beyond the scope of this talk. We have so much else to cover, but... Essentially, those appliances keep the tongue from falling back and collapsing the airway during sleep.

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So it's a very, in my opinion, it's equivalent to the effectiveness of CPAP when I do my job and diagnose the patient correctly. And so that really was the next quantum leap in our practice. So now we, we do the initial appointment, we do the diagnosis, we review the results for that subset of patients that a dental appliance is good for.

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So pretty much most mild and moderate OSA in my clinical opinion. So many, many patients could consider that they're still in my office doing. And those that that know me, there's there's a lot of business reasons to do this to so much of my career has evolved into the business sides of medicine. I do a lot of consulting and have companies for that.

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So this makes sense from the patient standpoint. Stay in one place where I can quarterback it and supervise it, but it also makes good sense from a business standpoint. The latest thing that we've done, uh, which I think is, is the crowning touch is, okay, we get these people into treatment, whether it's CPEP, dental appliance, some kind of surgery, but then.

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How is our treatment working? So I mentioned that we're treating 10% of the 10% that we've diagnosed. But are we treating them adequately? That's really the question. And it's kind of a scary answer. So I haven't even published some of this data yet, but one of my other companies is a... It's called Sleep Vigil, and it monitors patients.

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I see you're wearing your aura ring. I'm wearing my Apple watch. We use consumer wearables like that, garments and Fitbits, and trying to check all the boxes to be inclusive here. Yeah. And we actually look at the patient's vital signs each night. The reason that's important, so how it used to be, let's say I got the patient all the way to a dental appliance.

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So then the follow up would be annual, and often done by my physician assistant, who's excellent, but not even me. And so how that visit would go. Is Mr. Jones, Miss Smith, how are you sleeping? And they'll say, well, my spouse is punching me in the arm less because I'm not snoring as much. So I guess I'm good.

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And then they would ask me about my kids or my golf game or something. And then, okay, we'll see you next year. Well, are they good or not? The third party payers in general will only allow us to do a sleep study, a follow up sleep study about every three years. So once every thousand days, Instead, using ongoing nightly monitoring, remote physiologic monitoring, or RPM through sleep vigil, we're doing a sleep study almost, a poor man's sleep study every night.

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So every day instead of every thousand days. And so it's been mostly good, um, seeing that our patients are, are maintaining good oxygen levels, respiratory rates, other vital sign parameters. But we certainly have identified people that we thought were good. Yes, that were not quite good. And as the whole sleep space moves more towards considering the hypoxic burden.

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Rather than A. H. I. and other things that are falling out of favor to some extent. We realize that people that in that 1% that we're treating sometimes still have way too much hypoxic burden and we've got to make some tweaks in their management. So that's the odyssey. So 15 years ago, I argue, I was barely doing sleep.

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I was triaging, snoring. Now, I feel like with the diagnostics, therapeutics, and the ongoing monitoring, now I'm actually doing sleep the way, um, that we should. Oh, I love that evolution. And I love that introspection and seeing where things had been, the path that you took to get where you are now. And then just based on how you're sharing, I'm sure some excitement around what's coming in the future and what you're building.

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Just the use case, the need for this is so, so evident. I'm sure people listening have either considered that they might have some sort of respiratory disturbance while they're sleeping. They might be diagnosed with sleep apnea and maybe are being treated or maybe not, which we see a lot of those as you kind of also pointed to.

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Yeah, they get like lost in the whole shuffle of things. So to kind of. walk through a bit more of this experience for people, what could be possible, because it sounds like you're kind of laying the groundwork of this whole new paradigm where we can have some guidance for people versus, and not just guessing too, now you're leveraging all these different pieces of tech, the poor man's kind of, you know, at home testing.

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So with that, for those listeners, so even those people that can relate that say, Oh, I am tracking with our, with some sort of piece of tech, because a lot of our listeners are leaning. Tech savvy, you're looking to see how can they start to be in this conversation? Are there particular red flags? Of course, we know it's not diagnostic, any of these wearables per se, but from the sounds of it, you're in the camp that we can learn a lot from that.

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Very good. Yeah, this is in

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one of my other lives. I run two medical device companies. And so we want to be very respectful and careful about the FDA, the Food and Drug Administration. So Other to my knowledge, other than the Apple Watch for monitoring abnormal heart rhythms and actual heart rhythms, EKG, you know, most of these consumer wearables, the fitness trackers are not FDA approved medical devices.

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Okay, so that's the disclaimer in case anyone from the FDA is here. Yes. On the other hand, we don't have anything else to use. So at Sleep Vigil. We like to look at the patient's oxygen, the respiratory rate, those types of things, which all these devices monitor some better than others. There isn't a wireless, continuous pulse oximeter, or there are some, but there's not widely available FDA cleared devices to do this.

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And I feel like this is... Again, not just a social disease, this is not the inconvenience of snoring, this is life and death. If you aren't actually dying in your sleep from a heart attack or a stroke, you might be the next day dying in a car wreck or crashing an airplane. There's an epidemic, we talk, all of our friends, our little sleep buddies that we are, we talk about, you know, just a couple months ago, how drowsy driving is the same as drunk driving.

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And I, I shudder to think about how exhausted I was during my train sleep deprived making major clinical decisions and learning how to do surgery. Um, it's not okay. So we have to do something. So that sleep visual, we've chosen to use what's available to us now, um, to at least get these, uh, trends back to the clinician in case they need to adjust the patients.

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Um, treatment, whatever it might be, advancing their dental appliance, increasing the pressure on their CPAP machine, considering something else. Absolutely. Are there key markers that you're seeing or you want people to kind of be on the lookout for with their wearables? Great question. So. You know how at least I'm always, I look at my steps and I look at whether I close my rings.

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And so I think so many of, of our audience are similar. So what I'd like people to really pay attention to. Is there oxygen levels? Yeah, some devices. Um, well, let's just take the apple watch. For example, the motherboard. That's an amazing machine. It's much the apple watch is much more complicated than the Apollo lunar landing.

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Okay. So what they learned is on the moon with wild way more simple than what I'm wearing on my wrist. That being said, the motherboard is pulled in a million directions. All the apps and functions and things So it's not necessarily monitoring oxygen continuously, but pretty frequently. In the clinical trials that we did with SleepVigil, we used the Garmin device, the VivoSmart.

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Again, this is not meant to be a commercial, this is really informational. And that actually dedicates more of the motherboard to oxygen monitoring. So we, we actually saw a lot more data points in a given night of sleep and other things that we're bringing on the other fitness tractors fall somewhere on that continuum.

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So I'd like our audience to start paying attention to the oxygenation during sleep general rule of thumb, you know, most of us sitting awake. In breathing, normally we'll have 98 99% saturation of our red blood cells, meaning they're pretty much full of oxygen and we as clinicians get worried when it starts to drop below 92 for sure in the 80% Yeah, so 88 82% that usually indicates you have closed your airway or at least narrowed it.

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And slow down your breathing or possibly stopped it long enough for the oxygen level to drop in your bloodstream. And that's what apnea is, is a stoppage in breathing during sleep. So if, if folks are looking at their, their report card in the morning, and they see several times that they're below 92% for sure, I think that's a reason to go visit your, your primary care physician, ENT, pulmonologist, someone that's familiar with sleep diagnostics to test that further.

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The same thing afterwards, if you are already on a treatment, and this is what I do. I for many years slept with a dental appliance myself. I no longer need it, but I still check my options. One of the first things I do every morning when we talk about my morning routine that I look at that, uh, the, this is an Apple watch six, but, uh, some of the newer ones.

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We'll actually try to look at sleep staging and there are many good apps on that one too. And what we mean by sleep staging is how much deep sleep you're getting, how much REM, rapid eye movement or dreaming sleep you're getting. Those are markers of quality sleep, not just laying in bed and being in light sleep and trying to keep your airway open, but actually enjoying all the beneficial functions that sleep was intended to do.

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So oxygen. Sleep staging, maybe looking at respiratory rate. If your device looks at that, you know, you can see you could pick up times when your rate may really slow down. At the same time, you may see times when you're breathing very rapidly. If your device looks at heart rhythms, you want to make sure there aren't any abnormal heart rhythms that could be indicative of low oxygen as well.

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The, our, our tissues were designed to function with oxygen. So when we have low oxygen, our hearts and our brains and nothing else works right. Great. And the point you made about the sleep staging because that's one of the things that I hear so many people getting stressed or concerned about. Are there particular things that have, when you look at those, the sleep staging breakdown that you say, all right, we definitely got to get you tested.

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Any major call outs there? Yeah, I think a broad sleeping, um, statement would be if, if you're spending most or all of your night in very light sleep. Yeah. And to be a little more specific, you know, stage one, stage two, uh, then you're never cycling through the restorative phases of sleep. And those are the patients that I worry that sleeping for them is work.

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They're working to keep their airway open and they're never allowing, they're not allowed to go into deep sleep because they'll stop breathing. Um, that's, that's the red flag that I definitely would see your healthcare professional about ASAP. And I so appreciate you speaking to that because that's so actual and so many more people are beginning to track in some way, shape or form.

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Are there problems with sleep trackers? Of course, there's some elements and what have you, but I think the breadth of information and the gamification and getting people in this conversation. really helps to open the doors to those red flag elements that might say that, what's wrong with giving you an idea that you should investigate it further.

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I mean, thank you. These devices are claiming to be the end all be all diagnostic test, but if you see trends where your oxygen is in the eighties, most nights and alert. Why is that a bad thing? Of course it's a wonderful thing and it may be life saving. See, this is the type of guidance that is just so exciting to hear from a professional like yourself, where there's been kind of a apprehension from some people in the medical community.

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So I really appreciate you kind of leading the charge and looking to Pioneer to have all this information work in tandem and help support the absolute goal, which is to help people sleep better. So, so appreciate that. We must, we must do a better job. Yes. Yes. It's an epidemic. I mean, you know, we're just, when we're recording this, we're at the end, we hope, of the pandemic, you know, from the COVID virus, but what about sleep?

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I mean, with obesity rising, certainly in the Western world and everything, the numbers, grossly eclipse anything that COVID, you know, had. And we're not paying enough attention to that. And that hasn't gone away. Yes, that pandemic isn't over. It's just getting worse. 100%. Yeah, we must do a better job. Okay, so then one of the things you really identified and certainly well versed in this whole area of ear, nose, and throat, and you also called out specifically this interest around the nose.

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So since we're clear, this is probably going to be our part one of many kind of deep dives with you. But just focusing in on the nose. I wonder if you can help shed some light because I'll talk to certain people and they'll come in and they'll say, Oh, the nose. Yeah, I have a breathe right strip. I'm good.

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Or they'll say, you know, certain things that they're walking around with severe sleep apnea and a breathe right strip. So help us understand the, all the pieces in between that people might be missing. And I'm not meaning to, you know, be little or kind of, you know, They work well in that right situation.

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They really do. Um, so I think the general answer, Mollie, is This is a multi level disease. 100%. They're so backing up. I mean, sleep apnea is really a disease because humans have a flexible airway. The upside of that is we can talk, we can sit here and have a podcast. Most other mammals have a lot more cartilage and even bone in their airway, so it's not prone to collapsing.

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Uh, the, really the only other mammal that has significant sleep apnea are bulldogs and dogs like that. But that's because of their extreme retrognathia, the small chin, how close the chin is to the back of their neck. Uh, most other mammals don't have the collapse of the airway like humans do. And so really any spot of obstruction above the voice box, your Adam's apple, all the way up to the tip of your nose could be causing sleep disordered breathing.

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And that can be a fixed blockage. Like a deviated septum, what the septum is, is the dividing wall between the two nostrils. And when we say the word deviated, we mean it's not straight, it's deviated off the midline, it's curved one way or the other, from both. Uh, large tonsils would be a fixed obstruction in the airway, another example.

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But a lot of sleep apnea is from dynamic obstructions, meaning when we're sitting up awake. Or if someone's sitting in their recliner watching TV, gravity is helped to helping to hold all that soft tissue apart. But when you lie flat on your back. Gravity is helping, and especially as we get into deeper sleep and we lose our muscle tone, all of that just collapses.

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So the tongue, um, again, tonsil tissue, even as we get more mature and we put weight on under our neck, um, even this level of the airway can collapse in deeper stages of sleep, especially flat on your back. So, it's natural in my mind for an ear, nose, and throat physician who deals with this, to lead the charge in dealing with sleep disordered breathing.

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Many of our pulmonology or lung doctor colleagues deal with sleep apnea, and they're very good. But that never really made sense to me because they deal with the airway below the site of obstruction. All the obstruction in sleep apnea is up here. And so it's really important for my colleagues and I to pay attention.

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And I'm saying that because I was guilty of looking past the nostrils. You were joking about breathe right strips, but even the strength or weakness of the cartilage in the nostril can have a significant impact on the airway, but sleep apnea. And so a proper examination of these patients starts literally at the tip of the nose.

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There's a simple maneuver that we do and I think we're getting better as a specialty your nose and throat specialty over the last 5 to 10 years of looking at nasal valve collapse. So the simple thing is if you sniff in hard and your nostrils pension, that's a form of nasal valve collapse and it's dynamic, meaning it's happening during movement.

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You're not walking around like this. It's just when you really inspire deeply, so the right strips, for example, helped out. Those are springs that hold the nostrils open, and there are other technologies we may or may not get into here. We may have to do that in episode two, yeah, that can strengthen the cartilage so that doesn't happen right behind that.

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There deviated septum.

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The third leg of that tripod is how I like to describe nasal obstruction, the nasal valve, the deviated septum, or there are turbinates. So turbinates, if you think if you've ever seen a, you know, we're in Texas, so you see a long horn skull just out in the pasture somewhere. So when you look inside the nose, you see these little hooks on the side.

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Those are the turbinate bones, the same word like a wind turbine, a big windmill for energy. Those are natural structures that filter and humidify the air in the nostrils and direct the airflow back. But they're also the first responders for allergies. So many of us have very large turbinates. They're very engorged and swollen from allergies.

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So that's blocking Right behind that, you have potential adenoid tissue, which is a big player in the pediatric sleep apnea population. Adenoids are tonsil tissue, just like you have in your throat, but higher up in the throat, in the back of the nose. And then, of course, we talked about the tonsils, we talked about the base of the tongue that can fall back, especially when you're flat on your back, closing the airway there.

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So, we must look at all of those, but all of those are potential sites to intervene, to help these patients. Wow, so knowledgeable in this space. I guess I have concerns too for so many people when they might want to find someone like yourself that is that knowledgeable to this level and really aware of and maybe not practicing like the 15 years ago conversation.

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How can people find someone like yourself or with sleep vigil, how far does that extend so that people can have access to someone that's in this conversation? That's a great question. So I like to think that most of my colleagues, I mean, certainly easily capable of diagnosing. And so where I practice here in North Dallas, um, my patient population is so well educated even before coming in.

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And so I, I think in your hypothetical scenario, a patient could be, you know, amassing their fitness tracker data and looking at how much low oxygen they're experiencing, hypoxia they're experiencing. And I guess thinking about whether their nostrils collapse, whether a breathe right strip helps them, whether sleeping on their side or sleeping up in a recliner helps them.

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So coming in and talking to the physician already armed with that data, knowing that any or all of these levels can be contributory. I think that forms in a symbiotic relationship where the physician can really say, okay, these are the five or six spots in your airway I'm worried about. Let's do the sleep study, see where you stand on that.

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Continuum. And then these are all potential spots I could help you with. That's why CPAP is the gold standard, right? Because most of the time, pressure is either completely or partially delivered nasally. Yeah. So it, it does theoretically hit all those. In actuality, what my colleagues and I often see in ENT though is that nobody looked at the nose.

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and so they slap a mask on this patient and they're putting them on very high pressures simply to overcome a deviated septum or inflammatory polyps from chronic sinus problems. And the pressure is never getting down where it needs to go because the, the front door is blocked. So it's, it's become more and more of a passion of mine to shout that from the mountaintops that we must look at the nose.

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As I said at the outset, the nose is central figuratively and literally in sleep disordered breathing. So it must be examined and addressed. Wow. Okay. So it's becoming very apparent to me that then in our part two, what we can do is kind of walk through what are those things that we could dive into because this is helpful.

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This is setting the stage for us of what to look for, what to be aware of, how to take the steps to start kind of logging some of these things that you are noticing for yourself so that when you do go into your doctor, that you have wide array of information of what seems to flare up certain things, what patterns.

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have arisen so that they can help give you the best, you know, kind of guidance and walk through the process. Great. Absolutely. Okay. Well then in that case, one of the things that we found that people seem to really like a lot out of these episodes is then with someone as knowledgeable like yourself in this area around sleep, they want to know, well, what are they doing with all of these things of managing sleep?

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Because it seems to be an all day affair throughout the day and night. What we do matters in our results with our sleep. So I'm super curious to hear your responses on some of these and what we can learn. So our first question that we ask everyone is what does your nightly sleep routine look like right now?

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And I'm sure it's evolving. You seem very, first of all, I'm a male. So I'm a terrible patient. Secondly, I'm a doctor. So I'm the worst patient of all love it. So I have gotten better. The only patients worse than doctors or nurses, right? I'm saying that in love. Terrible giving advice all day long and not following that advice.

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Okay. Recently, um, I've realized I guess really over the past year or two during our band of friends and all the banter that we have and the exchange of ideas at meetings, sleep is really important, not just preventing sleep apnea, right, but having enough sleep. Thanks. I'm answering your question round about way.

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No, I appreciate that. My nightly routine. This sounds crazy, but you know, in the medical field is definitely always considered a badge of courage. How little sleep you need to and that's reinforced. And, you know, you're, it's almost like you have a purple heart if you don't sleep very much. And I'm a very busy person.

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I still try to practice medicine full time and I run three other companies. Yeah. Full time. So I have four full time jobs and a whole bunch of other sidekicks, but I used to take that as a badge of courage and realize it's actually stupid. If I start looking at the data on dementia, my family history, so many on both sides of my family tree eventually developed Alzheimer's and I saw how horrific that was.

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They, they, most of them lived a long time. Uh, with that dimension or you think about cardiovascular disease, there are things that I can do now. I've been in my early fifties to make my 60s, 70s, 80s so much healthier and probably the main thing I can do shorter, you know, exercise is sleeping. Yes, literally trying to sleep.

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So my latest goal is to sleep more than six hours a night and try to get six to seven. I mean, really not laying in bed for six hours, but six to seven. Okay. So that's my first goal. And so I know you'll be happy about that. I'm totally happy about this. And where was it at before? Because it could have been given being in the medical field.

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Yeah. All of these entrepreneurial ventures. Sounds like it can get lower. I didn't used to sleep a lot. So I used to probably honestly sleep less than five hours a night for a long time. Yeah. Probably some of that damage is done, but the human body is resilient. And so I think setting up good habits now, it's never too late.

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Right. I think a lot of the negative effects I had probably from so little sleep, um, can be improved by committing to that. Now, before that, and I know I'm hitting all your bullet points and things. No, I appreciate it. All the time. Yeah. So what does it look like before going to sleep? Okay. So because I work long hours, Oftentimes I would be eating a meal, having a glass of wine or whatever, watching TV in bed and then like, just conking out.

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And there's about 10 sins right there, right? Yes. So, um, trying to clean that up and this kind of answers the next question about what's on the nightstand. Not much on purpose because Love that. Um, I try to read instead of watch tv. I definitely try to, to eat and cut off any alcohol or anything before, well before, you know, at least an hour or two before sleeping.

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The one thing that I just like to read on my iPad, and that's unfortunately a lot of blue light, and so I could probably improve that somehow, but at least I'm not sitting there watching TV. Yes. I try to read. I personally usually have. You know, some challenge without throughout my day or some something I'm working on or some new invention.

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I'm thinking of so I try to focus on one thought right before I drift off and let my subconscious mind work on that all night long. Um, so that's kind of me. I like to, um. I never I really never need an alarm. It annoys my family extremely, extremely, especially on vacation. Um, I always wake up very early, but so I typically naturally wake up about 4 30 or or so my time, which means that I have to really commit to not staying up late to watch overtime of a hockey game or sure.

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You know, whatever, even the news, I, I really need to commit to that 9 30, 10 o'clock hour, at least being getting towards bedtime to be able to get my six hours because I'm going to wake up before my alarm. But the other thing at the other end of the night that you and our friend in New York, Teresa power, as you've been in New York, so Emma, probably because several people have challenged me.

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Those last little minutes before my alarm goes off, what I've tried to do for the last couple months is just doze back off and get some REM snacks, like little snippets of additional REM sleep. And the way I think of it, I don't know if this is medically true, but we do know that sleep is cleansing. Yes, it's really cleansing for the brain.

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So we do know that scientifically. So I like to think that during my six hours, um, my brain sweeping all the dust into little dust piles and those last couple snippets of Ram in the morning before I finally get out of bed, it's like scooping it up in the dust pan and disposing of it. Committing to that because I have a lot of energy and a lot of things on my to do list that roll to the next day, the next day.

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So I'm usually ready to go in the morning, but committing to that. I think it's made a big difference for me. Those 2 things and then nothing that you always preach about, which I really believe. Is I try to see, you know, we live in Texas where there's a lot of sunny days, so some of our friends and other places, it's harder, like, remain, but I try to see the sunrise and the sunset every day, and sometimes it's through a window, I'm still working or whatever, but.

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Or an airplane, or whatever. At least I try to look at it. Most, when at all possible, I like to get out so that ultraviolet light, the sunlight, is actually hitting my retinas. And I think that's also helped me sleep better, too, is committing to that. And that's just good in general to see every sunrise and sunset.

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You never know when's your last one. So those are the, those are the main changes that I've made. A lot of it since we scheduled this and you challenged me to, and I'm here to say, I think it's made a big difference already. I really do. All of that is just music to my ears. you have a future in this. Thank you.

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Maybe you should start a podcast. Maybe I should, yeah. I appreciate that. Oh, my God. You have no idea. I mean, I literally for me, I and I was just on a podcast earlier today sharing about the journey that it's been for me, you know, kind of entering into the sleep space years back and it's one of these areas that I feel like we're clearly very aligned on that you can easily just give your life to fully because people will be like, Oh, aren't you going to get tired of talking about sleep at some point?

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Absolutely not. It is so rewarding. And the difference that is made for all of us, right? And there's always things that all of us can do to up level these things, especially from an entrepreneurial space. Or if you're taking on big things in the world, you know, the more things you're starting to juggle, what tends to go for so many people is that sleep.

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And so I love to think of it as this kind of barometer of the workability of our lives. And it's going to be dynamic. And sometimes it's going to, you know, ebb and flow. And sometimes you think, oh, I got this handled. No problem. And then something happens and then suddenly can get thrown. So to be a player in this conversation is amazing.

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And to be curious and, you know, testing and trying different things. So I love that. Did we miss anything at all, uh, that's in your space. I know we touched on the nightstand question. Is there anything else like that you're using? Apps, supplements, anything for your nose? Any callouts at all there? Yeah, I'm, I'm fortunate.

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I don't, uh, have any nasal obstruction. Allergies are less, uh, than a lot of my North Texas, uh, friends and family around here. But, um, No, I, I'm not opposed to some of those at all. I recommend some of my patients, but, but yeah, I, I try to just do it naturally, you know, uh, really take care of my circadian rhythm, disciplined about my schedule and especially my eating habits and things like that, alcohol habits, um, exercise, we didn't even touch on that, but I think that's crucial, um, to have a regular exercise routine to them sleep well.

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Right. First of all, you're just healthier. You may be a little more tired. It's easier to fall asleep. For those of us that struggle with some insomnia, I don't, but I know so many people do. Um, yeah. I mean, there's just so many changes. I think, I think we did great for episode one. There's probably about 10 episodes, but a hundred percent.

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No, absolutely. I'm so excited for more. And then the last question would be, what would you say has made the biggest change to your sleep game or maybe the biggest aha moment in managing your sleep? Thank you. Yeah, I think, you know, kind of the same thing, realizing that I was being an idiot and taking it as a badge of courage that I didn't need as much sleep as the other person.

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I was getting the jump on them. I view it now as, uh, you know, think of an elite athlete, not to lie, but think of an elite athlete and how much they train years. Maybe for a 45 second race in the Olympics, you know, and I feel like sleeping is preparing for whatever this next task, this next mountain you want to climb, you're actually training for it by sleeping and probably a heck of a lot more productive than if you'd stayed up working or doing whatever towards that goal, you're just a, you're a healthier person mentally, for sure.

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And physically too. To do whatever that Ah, so well said. And so for the people that are listening and then you've inspired or kind of sparked some pathways for action for them that they want to explore. Oh, maybe I need to get tested. Maybe there are some things that I hadn't considered that I could do from an anatomical perspective or just get some more data or have some more eyes on me.

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What are the best steps for them to take to kind of have access to some of the information that you're sharing? Yeah, so really I welcome I'm very active on a couple social media platforms, but mostly linkedin seems to work for me um, and I always am happy and and very active on the messaging part of that Uh, so in different parts of the country.

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I have so many like minded healthcare professionals physicians and mid level providers and things that Could walk you through this process. So everyone doesn't have to come to Dallas to do this. There are so many good people around the country and the world really that are passionate about sleep. So, um, I think finding me on LinkedIn, I think you'll probably put that in the show.

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And then I can kind of direct people from there. That would be the best way. Okay. Yeah. Highly suggest following Keith on LinkedIn. I've been really, really enjoying the content that you're putting out. And again, Likewise, likewise. Yeah, yeah. Your, your passion, your interest, your excitement, your just, you know, kind of sharing and bringing people along.

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for this journey versus, you know, just relating to this as a chore or something that people have got to figure out on their own. No, you're absolutely creating and carving a new path of how we can newly think about some of these disruptive pieces to sleep and then actually get to see the other side of it, which is like, you know, the colors are brighter.

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Their world is improved when you actually, this is greener when you actually treat this. Wild thing and to your point and you started this episode with such conviction around because we can we see that it can be almost belittled or snoring. You know, it's going to be jokes and we see it in memes and what have you and that's just kind of the tip of the iceberg of what is lurking underneath that and it goes untreated.

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It's a real, real epidemic. So big deal. So thank you so much for for taking the time to share some of this and setting the stage for our next part two and you today. We spoke before we hit record that I very well might be seeing you in your office in Dallas. My husband's very excited to kind of have your eyes potentially on some of his things that he wants to improve.

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And we'll let him go first. Yeah, we'll let him be the guinea pig. Yeah. Okay. This is going to be very fun. That part too. All right. Well, I appreciate you. And then we will be in touch for, for that next segment. Thank you, Mollie. Appreciate it. You've been listening to the sleep is a skill podcast, the number one podcast for people who want to take their sleep skills to the next level.

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Every Monday I send out something that I call Mollie's Monday obsessions containing everything that I'm obsessing over in the world of sleep. Head on over to sleep as a skill. com to sign up.

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