170: Dr. Soroush Zaghi, Highly Specialized- ENT & Sleep Surgeon, Sleep Problems? Discover the Tongue Tie Connection & Learn the Most Advanced Techniques To Tackle this Common Abnormality!

Welcome to the Sleep as a Skill podcast. My name is Molly Eastman. I am the founder of Sleep as a Skill, a company that optimizes sleep through technology, accountability and behavioral change. As an ex sleep sufferer turned sleep course creator, I am on a mission to transform the way the world looks.

Thinks about sleep. Each week, I'll be interviewing world class experts ranging from researchers, doctors, innovators, and thought leaders to give actionable tips and strategies that you can implement to become a more skillful sleeper. Ultimately, I believe that living a circadian aligned lifestyle is going to be one of the biggest trends in wellness.

And I'm committed to keeping you up to date on all the things that you can do today. to transform your circadian health and by extension, allowing you to sleep and live better than ever before.

Welcome to the sleep is a skill podcast. I am absolutely thrilled to introduce this episode, which delves into the fascinating and important topic of tongue ties. Yes, you heard that right. Tongue ties are crucial for anyone interesting in optimizing their sleep. Now, to guide us through this conversation, we have the master.

of all things, tongue ties, Dr. Zaghi. He is not only an expert in this field, but also happens to be my personal doctor, as I will be documenting my journey of getting my own tongue tie removed. If you're not following me on Instagram quite yet, please do at Molly M O L L I E. Dot Eastman, where you can join me as I fly to LA for a frenectomy, also known as a tongue tie release performed by Dr.

Zaghi. I'll share my experiences, including the preparation, which involves numerous myofunctional training sessions. I'm actually doing this with Renata from MyoMoves, another person to follow on social media. And she's got a great podcast and we will also have Renata on our podcast in the very near future.

So I'm excited to provide an in depth look at this topic with one of the best in the business. So first, let's learn a little bit more about our guests. So Dr. Zaghi graduated from Harvard Medical School, completed residency and ENT at UCLA and sleep surgery fellowship at Stanford University. The focus of his study.

Sub specialty training is on the comprehensive treatment of tongue ties, nasal obstruction, mouth breathing, snoring, and obstructive sleep apnea. He is very active in clinical research relating to sleep disordered breathing with over 80 plus peer reviewed research publications in the fields of neuroscience, head and neck surgery, and sleep disordered breathing.

Dr. Zaghi is particularly interested in studying the impact of tethered oral tissues such as tongue tie and oral myofacial dysfunction, upper airy resistance syndrome, and obstructive sleep apnea. He is an invited lecturer, author, and journal reviewer for topics relating to the diagnosis and management of sleep disordered breathing and tongue tie disorders.

So without further ado, let's jump into the podcast. But first, a few crucial words from our sponsors. Our sponsors really keep this podcast alive. So please do me a favor and check out their websites, their offerings. I only align with sponsors that I truly, truly believe in their offerings. So please, please check them out.

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com forward slash sleep is a skill. And I think you're going to be pleasantly surprised by the results.  And welcome to the sleep is a skill podcast. I am delighted to have the opportunity to have Dr. Zaghi in, in the house, if you will, in the zoom house to discuss a few things. We're going to, you know, likely hit on a few different areas in the world of how we can support sleep and maybe some unexpected ways, particularly honing in on.

Tongue tie something that's near and dear to my heart because I am about to in the very near future be undergoing going under the knife, laser, all the things, uh, to actually deal with my own tongue tie. And so I'm going to be on the ground, you know, kind of sharing that experience in my world and, but certainly want to bring this to people's attention.

We've alluded to it in certain podcasts and we did have like one podcast that went in a little deeply, but this is our. real opportunity to go in with the expert in the field, really pioneering. So thank you so much for taking the time to be here. Thank you so much, Molly, and thank you for inviting me to speak to all your speakers here on this amazing podcast.

Uh, you know, it's so great that you're able to get this information out to the audience and people who need to hear it. And so thank you so much for inviting me to share some of the things that I've learned over the years with your audience.  Thank you. And maybe we can start at the beginning to kind of illustrate what the heck is a tongue tie and how did you find yourself is sort of like, can I say the king of tongue ties or pioneer, however we want to refer, but you are.

Absolutely unequivocally, a leader, a thought leader in the space and so grateful that you're able to share this information with us. How did that come to be? Absolutely. So just for a little bit of a context, I was fortunate to graduate from Harvard Medical School and on the. First day of medical school, the Dean came to us and said, this one slide is going to be the most important lesson you learn in all of medical school.

And that was the fact that half of what you will learn in medical school will be shown to be either dead wrong or out of date within five years of your graduation. And so literally that was the theme of my entire, you know, three and a half, four years of medical school. The fact that  Medicine and our understanding is always evolving and they trained us to be the doctors and leaders of the future that would have that open mindset such that we use the research and the books to inform and evolve our practice rather than limiting it.

So it was really that mindset from my training and the investment we made in my clinical research education that allowed me to even discover tongue ties. Wow. Well, that context is so great. Thank you for sharing that with us because I think that allows us a great place to begin and potentially could inform some of the why or the how that you took on sort of this circuitous route or assuming circuitous route and really carving a new path in something that appears to be wildly impactful for many aspects of health.

So allowing you to continue on and what that unfolded to be. Yeah, so the concept of tongue ties far from new, there are biblical references to tongue ties, and there are documents showing how to release tongue ties, dating at least four, five, 600 years.  Meanwhile, with the advent of evidence based medicine over the last 50 years, we've seen a strong push to only offer procedures in which there's hard, evidence.

They want double blinded, randomized, placebo controlled trials. And what we've seen is a big shift away from functional medicine, osteopathy,  lifestyle, naturopathic medicine, and more towards traditional medical treatments that are oftentimes funded by the pharmaceutical industry.  So, in my personal experience, having graduated from UCLA undergrad, Harvard Medical School, UCLA ENT Residency, Stanford Sleep Surgery Fellowship, having published over 97 peer reviewed articles, including numerous meta analyses,  the conclusion I took away is that the traditional medical model is limited.

And the research that we have right now is limited. And really the answer to what we should be doing in the future is to be listening to our patients.  And it's by listening to our patients, identifying their needs, understanding their experiences, and then using clinical research to validate those thoughts and ideas, that we're really going to be able to make a lot of progress.

And I'm so proud to be the medical director of the Breathe Institute where we tackle numerous problems  to help individuals with sleep, breathing, growth, and development, among them tongue tie being one area of our focus. Oh, wow. Well, that was so beautifully stated and really giving us the breadth of this is a huge, huge topic.

And despite the fact that we're kind of. targeting in on tongue ties. For example, in this episode, you're also alluding to them. We could make this like a multi part series in the crucial, crucial aspects of how we breathe, how that impacts, certainly in this conversation, sleep, uh, but many other aspects of health.

So so much for joining us. really, really grateful for all the work that you've been doing and really kind of setting the tone. But also I love how it can almost land as like newfangled or radical to be listening to patients and then kind of helping to support a shift in how we're treating people as a result of taking in that on the ground, that clinical kind of information and then utilizing that really, really listening.

So well said. I'll tell you the story. Totally. Please do. So, you know, I got interested in, uh, sleep apnea, sleep medicine, uh, through my exposure as an ENT resident. I saw that the faculty were really incredible at treating head neck cancer, facial plastic reconstruction, laryngology,  complex ear surgery, but the knowledge basis around sleep was limited.

And so I applied the Stanford sleep surgery fellowship where I got to meet my mentor, Dr. Christian. Give me no. So for those of you who don't know, Dr. Christian, give me, no, was a major pioneer who invented the field of sleep medicine, who Discovered the concept of obstructive sleep apnea, who coined the term upper airway resistance syndrome, who developed the in lab sleep study as we know it today.

And as one of his students, I was exposed to the concept of tongue tie growth and development as a major need for further research. And so I would be in the break room and I got to meet Dr. Gimeno, just pick his brain a little bit. Just to see, like, what are you thinking? What's the research that you're doing?

And I showed a real genuine interest, and he said, tongue tie.  He was so moved by the, by what he had observed about tongue ties and, uh, narrow palates and growth and development. by his exposure to the dental field. So the big problem is that there's a big disconnect between dental,  naturopathic, osteopathic interventions, and traditional medicine.

When you go to an ENT conference, all you hear from is other ENTs. Rather, when you go to conferences that we're a part of. In the conference, we have physical therapists, dental hygienists, lactation consultants, doulas, ENT doctors, oral maxillofacial surgeons, and by having the different perspectives, you're really able to cultivate a new perspective towards these very common problems.

Wow. Well, again, appreciate the scope. I don't know if you've read the book, Mapping the Darkness, just came out recently. Very exciting around really just helping to illustrate how, despite the fact that we all sleep, despite the fact that this has been obviously looked at in a particular way for thousands of years, as you pointed out, the area, the field of sleep medicine being so relatively new as we think of it today, And so kind of in the mapping of that darkness, I appreciate that milestone call out around tongue ties.

So, you know, we've alluded to tongue ties and we've mentioned this thus far. What the heck is this?  Yeah. So a tongue tie is a. physical restriction of tongue mobility due to the presence of a restrictive lingual frenulum. So in essence, a tongue tie is a connection between the tongue and the floor of mouth in such a way that it impairs the tongue's mobility.

That's what a tongue tie is. The tongue is tied to the floor of the mouth.  And in terms of diagnosing A tongue tie, is it a tongue tie, is it not a tongue tie? Traditionally, a tongue tie has been characterized as your ability to be able to stick out your tongue 16 millimeters.  This is the way that we are taught to, uh, assess for tongue ties in medical school.

Yet that is, uh, let me get this here. I'm trying to share the screen. We'll get the visual, which can be really helpful, particularly in this conversation. So, The traditional way of assessing for tongue tie is based on the Kotlow free tongue measurement, which indicates that you should be able to stick out your tongue 16 millimeters  And this measurement is taken from the tongue tip to the insertion of the frenulum.

It's called the colo free tongue measurement. Now, there are also other measurements reported in the, in the literature, such as olis measurement, which says that the frenum length should be about 20 millimeters. And so when a, a traditional medical doctor or pediatrician takes a look, what they're looking for is determining whether or not you're able to stick out your tongue.

Mm. Meanwhile, sticking out your tongue. isn't totally comprehensive in terms of identifying whether or not you have a tongue tie, whether or not this frenulum is restrictive of tongue mobility. And so we have many individuals like this one in which the patient is able to stick out their tongue but they're not able to lift up their tongue.

And so we understand that sticking out your tongue is only one dimension of tongue tie assessment and that you should also be able to lift up the tongue. You should be able to lift up the tip of the tongue and you should be able to lift up the body of the tongue. Yeah. And so what we have done over the years, especially with Dr.

Guillemino's influence is that he introduced us to some paradigms of assessing tongue mobility. Such as the tongue range of motion ratio. And so we literally changed the definition of Ankyloglossia once in 2016, again in 2021. Oh, oh wow. And I'm currently working on a paper that will be published next year that will again redefine.

Wow. We germ all of these concepts in terms of what is a tongue tie, what is an anterior tongue tie? What is a posterior tongue tie? And even the term posterior tongue tie is going to be evolved to better define exactly what it is that we're talking about.  Wow, so important to be able to keep refining and defining this language so that we're all on the same page of what are we actually talking about when we're discussing this, so fantastic.

Okay, and you've got some additional visuals here as well. So the basic concept is that you should be able to lift the tip of the tongue up to the insides of the papilla and you should have the whole body or middle of the tongue be able to get up and sit in the roof of the mouth.  Now we have published once in 2016 17 as well as more recently in 2021  our paradigm of how you can actually measure the tongue mobility to make a hard assessment that yes, this patient definitely has restricted tongue mobility.

And so the first index that we came up with is called the tongue to  incisive papilla measurement. And so what we are asking the patients to do is to open up their mouth and lift their tongue up towards the front two teeth.  You should be able to lift up the tongue up to the front  two teeth like this.

50 or 60 percent of your maximum comfortable mouth opening. So you see how much can you open your mouth  and then you lift up your tongue. be  able to reach 50 or 60%. Now in these bottom examples, you can see that in a grade four or very below average, severe tongue tie, the individual is barely able to lift the tongue up 25%.

And in the moderately severe category, the individuals are not able to lift up the tongue any more than 50%.  Similarly, we make assessments of the body of the tongue in terms of whether or not the body of the tongue is able to lift up around 30 percent of mouth opening. So  in this way, we've developed some classification systems to assess how does this tongue mobility rank compared to the general population.

Okay. And based on these measurements, we can say that you're, you know, significantly above average, significantly below average, right around average, in terms of the mobility of the tip and body of the tongue. And so this becomes extremely valuable for research purposes. And we've been able to use these metrics that have been validated once in over a thousand patients.

And again, in a sample of 600 patients to really be able to identify, uh, the range of normal and abnormal so that we can best identify these issues.  And so moving forward,  Uh, what we have further discovered is that some individuals can lift the tip of their tongue and they can lift the body of the tongue, but they do so with a lot of compensation.

That means that you're trying to reach,  but you're not able to reach. So you stand on your tippy toes or you strain similarly when the tongue itself cannot reach. to touch the front two teeth to make those T L N D sounds or the back body of the tongue to make those R S K G sounds. Or if you're not able to move the tongue to chew and to swallow, you may compensate by recruiting the floor of mouth, the jaw, the neck, And those are much more subtle.

And these forms of tongue ties can be very impactful for patients and it can affect a host of issues, including headaches, anxiety, as well as sleep disordered breathing. Yes. And so. In  2025, we're going to be publishing our latest series  that is 99 percent sensitive and specific for identifying these posterior tongue ties that we are now calling mid tongue restrictions.

And the way that you assess is by putting a single finger down on the floor of mouth,  And asking the patient to lift up their tongue.  If the individual has a tongue tie, what you will feel and what you will notice is that the tongue will not be able to lift,  the tongue will not be able to lift and you'll feel a tight string underneath the floor of the mouth.

And so this floor of mouth hold maneuver has been, has been found to be extremely helpful, uh, for the assessment of these. you know, posterior or mid tongue restrictions, which I'd love to talk to you more about. So, so helpful. And the visuals really are supportive to share my own personal story. And I'm excited to be meeting with you in person in the future.

But the assessment that I got by a dentist who was trained through some of your teachings, evaluated mine at being a grade three. And so just as a, uh, quick, you know, kind of underscoring of what even you've just shown so far. Some of these kind of unexpected symptoms like that, the last adults with the headaches, the neck pain, those have been some certainly that have shown up in my own life.

And so so one, thank you for illustrating just kind of maybe the unexpected ways that this might show up. Additionally, just a quick aside. I often had shared. I went to an event over at Stanford for a sleep event there, and they were pointing to the beauty aspect of how tongue ties might potentially play a role in our facial development.

I have quite a gummy smile. Is that accurate in some of the ways that I've been saying that that could be connected? Is that what you agree with that?  We have, we have seen that and we have published on that, that, uh, the way that your jaw develops, one is genetic factors. Other component is.  The functional, um, impact of chewing.

And  so if your tongue is up against the roof of the mouth, and when you swallow, you're pushing your tongue up to the roof of the mouth, what tends to happen is that you get a broad palate. Sure. If you have limitations of the way that the body of the tongue is able to get up, the palate can grow narrow.

And so, uh, you know, I'll just share with you this article. Uh, by one moon who, um, is the leader in the, in the, in, uh, in terms of, uh, maxillary skeletal expansion. And so, you know, he used our technique of the floor of mouth hold maneuver and showed that individuals with what we called at the time posterior tongue tie.

This difficulty with the middle or body of the tongue, we're found to have a significantly increased rate of posterior crossbite. The idea being that if you don't have the right swallow and if you are not able to chew on foods in the back teeth, the upper jaw is at risk of underdevelopment.  Tongue tie itself is only one aspect of this problem and the tongue tie only contributes to about 10 percent of the reason why individuals develop narrow palates.

The other very important factor is the function. If you have a tongue tie release, but you don't rehabilitate the tongue, how to lift, how to chew, how to swallow, if  where to be, if you don't have that awareness and you just release the tongue tie, you cannot expect  significant improvements to speech, chewing, swallowing, and facial development.

What's even more important than releasing the tongue tie is educating, bringing awareness to the fact that, hey, the tongue should rest on the roof of your mouth. You should be chewing on both sides. not only chewing on the front teeth, but on the back teeth.  And more over the kind of diet our children are exposed to.

If children are exposed to a soft, mushy, liquid diet, if you're giving them baby food and kids meal, which are universally Soft and mushy. Not only are those tending to be low nutritional value, but in addition, they don't have the chewing efficiency that you need to grow the upper jaw, and so that's why everyone's getting out their wisdom teeth and getting expanders and rounds of rounds of orthodontic care.

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You're investing in your health, wellbeing, and quality of life. So again, go to you block out spelled the letter U block out. And use code SLEEPASASKILL for a discount. Okay, so this is a far reaching topic and, uh, if I'm gathering and hearing you correctly, of course, we're looking to spot this as young as we possibly can and, and correct it as part of our goal.

Corrected then and, but now we're often dealing with, as well, adults that, like myself, who are now finally just getting this, uh, kind of treated today, but you would like to see a future where we're addressing this further. quickly, as quickly as possible. Yes. So, so two things around that. So, one problem with assessment of tongue ties is that it's underdiagnosed and overdiagnosed.

Overtreated. It's undertreated and overtreated.  There are some practices where 70, 80, 90 percent of babies are being diagnosed with tongue tie.  Every kid that comes in, you have a tongue tie, you have a tongue tie, you have a tongue tie, because that's all they're looking for.  So really caution people. from getting an assessment from someone whose only job is to release and identify tongue tie.

Ah, interesting. The individual must be aware of the whole entire big picture. Okay. Things like cranial strains, torticollis,  muscle tension,  narrow palates  can sometimes look like a tongue tie  and present like a tongue tie where the solution is not a surgical release, but rather perhaps. bodywork, physical therapy, occupational therapy, myofunctional therapy.

And so as we get more, uh, experienced in identifying tongue ties, we're also getting experienced at identifying who really needs to have a surgical cut. And who can get by with, uh, physical therapy, non invasive laser modalities that address the fascia, physical therapy, tummy time, occupational therapy, and a whole host of things that we can do to actually improve the tongue mobility without a release.

Wow. Okay. So important. Such an important point. And even as you're speaking of those possibilities, those, uh, kind of multifactorial interventions, that sounds as if that's my understanding with the work that you do, you make sure then even if you are going to be releasing this tongue tie, that you make sure that people are addressing this issue.

behaviorally and that they're doing these exercises, correct? Yes, absolutely. So our requirement, whether you're a baby, child, adult, is that you have a functional assessment  prior to the release. So you got to get all the ducks on the table. What are we what are we working with here? Is the child with oral aversion, tight neck?

Is this an individual with a narrow palate? What are the habits just taking that all in? And making sure the patient understands through a comprehensive consultation that yes, we will be addressing the tongue tie, but tongue tie is only one piece of the puzzle. If your goal is to improve facial development, speech, swallowing, breastfeeding, and a whole host of other issues, there are very, very important and impactful other areas to consider as well.

And that these other areas really constitute 90 percent of the gains that you will achieve.  The tongue tie surgery in and of itself is only one factor in the bigger picture.  Okay. And then for the adults that might be listening and saying, well, do I have a tongue tie? What are some of the best steps that you suggest for them?

Because you shared, right? Like we might be over diagnosing or missing it. What can we do? Yes, absolutely. So, uh, the first thing to do is to determine whether or not you're able to breathe through your nose. Okay. So,  are you able to breathe through your nose? Are you able to keep your mouth up? Where does your tongue rest in your mouth?

Does your tongue rest up on the roof of the mouth, or are you finding that it's held low? Are you finding that your mouth is falling open? Because all of these things will contribute to what we call low tongue posture.  If you have low tongue posture, we can address it by identifying, is it due to tongue tie, or is it due to nasal obstruction, or narrow palate, or low tone tongue?

So just really understanding the why. The other way that these tongue ties can affect individuals is by contributing to tightness and restrictions inside the mouth that cause neck and shoulder tension, jaw clenching, headaches, as a compensation for restricted tongue mobility. So an individual like yourself, Molly.

Yeah. Who has a tongue tie? You speak perfectly, you feed perfectly. Everything is going great for you, but you're trying too hard. Yes,  totally. And the system is under too much stress and tension. So it's not that you maybe aren't able to feed and thrive and live. Sure. It's just that the effort it takes.

The positions you have to go to, to sleep, to hold yourself. You're constantly fighting this tight band that's constricting your tongue, mouth, neck, shoulders, diaphragm, knees, toes, because the tongue is connected to the rest of the body.  system of connective tissue known as fascia. And so if you have tightness in the fashion of the mouse, you're likely to have compensations and other parts of your body  releasing the tongue tight opens a window, a lot of gains very quickly, but to optimize, it's also helpful to do bodywork, physical therapy, fascia therapy, stretches, my a functional therapy.

And it should be said that you could do all the therapy in the world  and, and not get that full result because you do need that key. The tongue tie is often the key to unlocking this door of potential, but you also have to go ahead and walk through that door and take it all in to have all of the gains because you can have the tongue tie release and have some degree of improvement.

But if you want to max out on your potential, the extra therapy and investment that you're making and the habits can be extremely impactful long term. Uh, such an important point. So it requires our participation. It's not just like a one and done you actually. So us as the individual that's going to someone like yourself, we, it behooves us to now we've got to step up.

We've got to set ourselves up powerfully, work with the appropriate providers to get the best results. And it does depend on the individual. There are some people that are just too busy. and they have a really tight tongue tie and their expectations are modest. Okay. Even if I'm a little bit better, I'll take it.

Sure. Okay. That's great. Yes. You will improve by getting the tongue tie released. Okay. Like you, Molly, even if you just came in, did a little bit of therapy, you'll improve. Okay.  But  you know, why settle for something less  where you can have like long term, like meaningful, super impactful if you continue on by incorporating the lifestyle changes.

Okay. So good. Okay, thank you for that. And then, of course, this is the Sleep as a Skill podcast. And so in case people are like, well, I'm not quite clear on how this connects exactly to sleep. Yeah, could you share? So it relates to sleep in a few variety ways. Individuals with tongue tight tend to have more clenching and grinding, which can cause pain and sleep disruption.

Okay, individuals with tongue tie typically have to sleep on their side or stomach rather than their back Contributing to positional sleep disordered breathing.  They may also have habitual mouth opening during the night Such that their tongue falls down the mouth falls down and their tongue falls back to block their breathing.

So If you are having trouble with sleep, if you're clenching, grinding, tossing, and turning, and only able to sleep in certain positions, or if you have chronic pain due to these issues, addressing that, learning to breathe through your nose, learning to keep your tongue up, getting out of pain, can significantly help improve your sleep quality.

So important. Okay, so good. Now, before we shift over to hearing a bit more about, because clearly you're someone who has trained and thought deeply about many aspects of breathing and sleep. So before we learn more about how you're managing your own sleep, is there anything else that you want to make sure we address when we're talking about tongue ties or beyond and Great.

The main thing I would like to address is the acknowledgement that We don't know enough.  The primary care doctors, the pediatricians don't know enough.  Lactation consultants, pediatric dentists, even tongue tie experts don't know enough.  And so we have to be open to the fact that of everything that I teach, of everything that we publish, 50 percent of it will be shown to be either dead wrong or out of date in another five years.

And so we have to continually be looking for research opportunities, listening to our patients, exploring other avenues, so that we can continue to grow in our knowledge and ability to help patients in a natural, holistic, functional way. I love that growth oriented approach. That is so, so good. I appreciate that.

And real quick, you just made me think of it as far as even just the fact that even people that it might be experts in this field, still, they might be learning and we are learning clearly.  You can consider, you can consider myself. So, uh, I trained with Dr. Guilleminot. I've done, you know, 3, 000, 4, 000 tongue tie surgeries.

Wow. The way that I will continue to learn is through my research, looking at my results, going to different conferences, learning from lactate consultants and doulas, looking at the best practices and analyzing them. That's how you can stay at the forefront of the work that you do. And this could not be more pressing because we are in a day and age where medicines, Are being pushed by the pharmaceutical industry.

You have an ADHD problem. Often the solution is ADHD medicines. If you have a high blood pressure problem, often the solution is high blood pressure medicines. If you have an overweight problem, the answer is becoming, you know, overweight medicines and injections, but rather I'm using my background, my education, my, um, expertise to really promote a functional, natural, holistic approach to health, rather than a disease oriented framework.

Wow, so great. Okay, well, thank you for that work that you're doing. And so we'll stay tuned for the evolving definitions and all that's coming. So I'm gonna aim to make sure we stay abreast of all the work that you're doing and we'll provide ways for people to make sure they follow you at the end as well.

So shifting a little bit of gears to how you're managing your own sleep based on this really, you're clearly thinking critically and thoughtfully around how you're managing these things. So our first question is, right now to date. What would you say is the way that you're managing your nighttime sleep routine right now?

Absolutely. So first of all, I just kind of want to put it out there that I graduated from the best schools. Yeah, I didn't know that I had mouth breathing problems, that I had a deviated septum, that I had a narrow palate. So over the last several years, I've been on my own health journey. I had a septal rhinoplasty.

I just recently completed a maxillary expansion to widen my palate. And since having done those things, I found that my nasal breathing has improved my clenching and grinding, my neck and shoulder retention. And so now I sleep like a champ. My bedtime routine consists of, you know, oral care, washing my face, spraying my nose.

Same, uh, I put on a, um, a, uh, a sleep mask. I have like a, like a drowsy sleep, uh, a silk sleep mask that I put around my eyes and ears. I listen to some sleep music, uh, on Spotify I know fall, uh, fall asleep quickly. I set some intentions.  Recapping what I did in the day as I'm listening to that music. I set some intentions for the next day.

And I get a beautiful sleep until my one year old, uh, cries at 6 o'clock in the morning or my, uh, four year old is climbing into our bed at, you know, seven o'clock sharp, right before my alarm gets on.  Naturally. What a great alarm system. So good, and I appreciate you sharing two of your own personal journey and this opportunity for all of us to continue to up level, optimize, learn, grow, develop on the ground.

So that's so, so helpful. And then our second question is, what does your morning sleep routine look like? And we really stand for that in the possibilities that how we start our day could impact our sleep. Absolutely. Yeah. Uh, so my morning routine is really involved around my, my kids and my family. So I try to, uh, you know, get as much sleep as I can and stay in bed as long as I can.

Uh, but typically it involves, you know, waking up to make a bottle for the baby. Uh, just being there with him for like 10 or 15 minutes. It's really, really enjoyable. Uh, my son Matisse is now nine months old, 10 or 15 minutes. I get to go in his room. Pick him up, change his diaper, uh, give him his bottle and just kind of be there with him.

I really cherish that. Mm, and uh, that really sets my framework for the rest of the day in terms of my priorities. And then it's my 4-year-old. Give him him a hug, give him a kiss, spending five minutes dedicated attention to set his intentions for the day. I put them on my knees and I say, you know, we're going to have a discussion.

How are you? What are you excited for? What's going on? So I do that with both kids twice a day, once in the morning, once in the evening, checking in with my spouse. How are you doing? What are your needs? How did you sleep? What's going on? And then, uh, starting my day. So I like to get some physical activity in whether it's going for a walk with the kids to the coffee shop or, uh, you know, personal training or doing some stretches at home.

And, uh, during that process just really helps to kind of, uh, you know, get my energy and my mood in the right place. And then, uh, every day is different. I sometimes have to go to the operating room. We start, you know, 7 30 in the morning. Other days I start clinic around 9 or 9 30 in the morning and just really making sure to take care of myself throughout the day, drinking a lot of water, checking in with myself in terms of how I'm doing, what my needs are.

really have to take care of myself before I can take care of other people. So good. Great. Okay. And then our third question would be, what might we visually see on your nightstand or maybe if you're traveling, proverbial nightstand or extending to your ambient space or your, your space around you. So we have my nightstand and we have my wife's nightstand on my wife's stand.

On my nightstand, I have a little, uh, nighttime light. Uh, it's by, uh, Casper, and it's Oh, sure. It's just like, uh, you turn it on, it's just really light, uh, red light to kind of set the mood. Love it. I have my charger and that's it.  Perfect. That's it. I have, I do have to have my phone next to me because I'm on call at the hospital and patients might be trying to reach me.

Yeah. Uh, ideally if I didn't have that responsibility, my phone would be far away on silent or off. Yeah. Uh, but you know, I do have to have my phone next to me. Okay, so and does that happen often that then those nighttime interruptions that you do need to deal with? And if so, do you have any coping mechanisms for that?

So the best strategy I have for that is as I'm winding down around seven or eight o'clock, I think of potential patients who may call me. Okay. And so I call them preemptively. I say, Hey, how you doing? Okay. Uh, just a few different things. Uh, and, um, you know, I usually don't get disturbed. I do take all the hospital if I get called in the middle of night because someone needs some trauma or something like that.

Uh, you know, it can happen and that's okay. Got it. Okay. So resiliency rolling with that, but then also preemptively if there's anything you can do to support that in advance. Okay, great. And then the last question would be. to date so far, and I'm clear that you've got this mindset around growth and development, so this could change down the road, I'd imagine.

But right now, what would you say has made the biggest change to your sleep game, the management of your sleep, or maybe said another way, biggest aha moment in managing your sleep? Yeah, the most amazing thing is that I graduated from sleep surgery fellowship, and I didn't know that I had a problem. And so really it's, it's, it's that awareness.

Uh, and the understanding that no matter where you are, who you are, what your situation is, there's always gains to be achieved. If you're not breathing well, that's an easy area to go. If you have a tongue tie, that's easy. If you have, uh, you know, um, uh, other opportunities, I think it's wonderful that you have the sleep as a skill podcast because no matter how good your sleep is, uh, you can make incremental gains.

Yes, movies, you know, micro changes and these atomic habits that we're able to see macro changes. Uh, and so, you know, really just being aware of the possibility that in any area of your life, there's always the potential for growth and improvement.  in terms of your physical functioning, in terms of your breathing, in terms of your sleep, and it's up to you to decide, you know, if you're willing to make that investment and what that would be.

So making a commitment that, you know, sleep is important, breathing is important, and what am I doing this month? What am I doing this year to help improve my sleep and breathing quality? Because I understand that those are foundational to my health and well being. Yes. Mic drop. Preach. I love it. And it's so important too.

I love how it almost lands for me is this ability to continually improve and also potentially like make some of those goals around ourselves. and the results and the things that we're after to keep kind of looking and being curious, staying open. So, so good. Hats off to you for having this podcast. One opportunity for your listeners to engage and listen and to explore, uh, new ideas and products and strategies and tools.

Uh, so, you know, thank you so much for investing your time, energy and resources in making this information accessible to so many people. Oh, well, thank you for saying that. And clearly kind of similar shared values of the importance of looking at this area and staying open and never thinking that we're like done and we've, Oh, we figured that area out.

No, no, no. There's so much more to keep going and diving into. And on that note, I wonder if we can just kind of go in about the Institute, the Breathe Institute that you have and just so that people can understand that this is this whole world. What is that about? Yeah. So, you know, I graduated from the top, uh, top schools and programs.

And my, my goal, my vision was to be a professor, be a faculty member at UCLA, for example. And so, you know, they sent me to Stanford with accolades and appreciation. And it's a lot of support. And when I came back, I shared with them my vision of moving away from traditional medicine towards incorporating natural holistic modalities and engaging the community And I was met with resistance because the existing medical model, insurance model, and the way the hospitals are set up are not supportive of that.

And so the best thing that they did is give me privileges and appointment, but told me that I shouldn't work in the department and that I should go and make my own private practice Institute. That was the advice to me from the chairman. He said, Hey, I'll give you privileges. You can have hospital access.

You could be, you could be on our roster, but in terms of your idea to get this going, uh, that's, we're going to rub too many shoulders. People aren't going to be happy with us and, you know, kind of on your own. And so that moment was extremely heartbreaking for me.  I felt. Uh, you know, like all over the place,  but with my resilience, I picked up and I put myself out there.

I went to different meetings, conferences, and I gave my business card out. And one individual who reached out with me was my partner, uh, Lely Noroos and Sanda Pinkerton. And uh, we met and they were working in the dental office. And they talked about how my functional therapy was so instrumental to their practice  and how we need to get more on tongue ties.

And so we worked together for a few months and we just felt the chemistry and the fire. So with my partners, Lely, Sanda, and Chad Newtson, we developed the Breathe Institute seven years ago. As a center where we would provide clinical care, but also heavily invest in, uh, clinical research and provider education.

And so we all come from different backgrounds, different thoughts, different perspectives, different ways that our minds work. And so we developed the Breathe Institute. Uh, with that in mind, a horizontal hierarchy where everyone's ideas are valued, and currently we have around 50 affiliate centers throughout the country and around the world.

And I have over 2, 500 ambassadors. Who have, uh, have studied with me and trained with me to replicate of a lot of our protocols. And, uh, we're constantly evolving, constantly adapting. We have courses and seminars for other providers who are interested in learning and shadowing, how to implement these ideas in their practice.

Wow. So important. Okay. So, and that's at the breathe institute. com and maybe we can then share additional, all the ways that people can be a part of that and be a part of your world, the research, the whole, all the day. What can they do? So, so they can follow me on Instagram at Soroush Zaghi MD. I'm making an effort to be more involved on, on social media  there.

So we see what the audience wants. And, uh, that's where we will direct our attention and energy. So again, there are two approaches to innovation. One is to see what I want to do. I have an idea and push it forward. And the other is to see what the people at stake need and to develop research and validation products and innovations to suit their needs.

So I would encourage people. Uh, to, uh, come on board, to comment, to engage, to ask questions. And, uh, it's through the questions that, that people on the ground will offer us that will, uh, clue us into the, the different areas that we need to expand the focus of our Institute on. Oh, amazing. Well, that's exciting of all the things that are in the works and developing and coming.

Maybe we can do some sort of IG live or something down the road to answer what I anticipate to be a lot of interesting questions on, or people are going to want to know more about all that you're up to. So let's do this. So, so when this goes live on whatever medium, let's get some feedback from the viewers.

And let's see different, uh, topics that they want covered based on listening to this. And maybe we'll rank them and you'll pull your, your, uh, your audience to see, Hey, what would you like him to talk about next? And we'll pick that topic. And I really had a great time with you, Molly. So I'd love to come back if you'll have me.

Oh, that would be amazing. Okay, you heard it here first, folks. So if you're listening to this, be thinking of your questions, share these questions with us, whether in the comments, reach out, DMs, et cetera, because we have this amazing opportunity to have a kind of a part two to get your further, more detailed questions answered.

So,  Huge, huge thank you. I'm blown away by the work you're doing. I was already just wildly impressed. And now after this conversation and the things that are coming and in the works, it's just incredible and so life changing. And I'm excited to be a part of your sphere and the work that you're doing on my own personal level, but then also to be able to get this information out to the masses really means a lot.

Amazing. Amazing. Well, thank you so much, Molly. And thank you so much to all of your listeners and viewers and audience for creating this platform, uh, so that providers like myself and other experts can come and share their ideas. And we definitely want to hear the feedback, uh, because it's really your feedback that's going to guide us and inform us, uh, towards the future.

So great. Thank you so much. My pleasure. My pleasure. Thank you so much. And I can't wait to see you again.  You've been listening to the sleep as a skill podcast, the top podcast for people who want to take their sleep skills to the next level. Every Monday, I send out the sleep obsessions newsletter, which aims to be one of the most obsessive newsletters on the planet.

Fun fact, I've never missed a Monday for over five years and counting. And it contains everything that you need to know in the fascinating world of sleep. Head on over to sleepisaskill. com forward slash newsletter to sign up.

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