Dr. Mike T Nelson and wife Jodie talk with Zac about rate limiters on performance like palate issues, teeth movement, and function, as well as how to get a good sleep study (what to look for and what to ask for). We offer advice on what to do if you feel like you need to seek more information.
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Dr Mike T Nelson (00:00:00):
Hey, welcome back to another episode of the flex of diet podcast. And today I've got two special guests. Um, my wife, Jodi joins me on this podcast as a cohost, and we talked to our good friend, uh, Zach couples. And as you know, the flex diet podcast is focused on adding lean body mouse and a better body composition all without destroying your health and a flexible based approach. And today we deviate a little bit from that topic, but it's definitely related. So one of the things I spend a lot of time thinking about and reading research on is what are some of the limiters on your physiology? So for example, even if your goal is to add lean body mass, we've talked about in the past that maybe your cardiovascular system or your robotic capacity may be a limiter. It's not directly worked per se on lifting, but to the replenishment of the ATP, the energy use is all a robotic metabolism based.
Dr Mike T Nelson (00:01:14):
And today we talk with Zach about all things related to, to, uh, upper palate in your mouth, uh, related to teeth movement and function, and a whole host of little bit more esoteric topics, uh, how to get a good sleep study, what to ask your physician for, what are things to look for on a sleep study and why a sleep study will be useful for a vast majority of people. I've had the advantage of knowing Zach for many years, we've hung out together at different conferences, Starbucks and Toronto, and even for many weeks at a time in Costa Rica. Now dr. Ben houses facility there at flow, both of us had been presenters there and just got to hang out and lift together. And I always learn a ton of new stuff from Zach, and I've been able to consult with him on various clients also.
Dr Mike T Nelson (00:02:11):
So I've had more clients recently and myself included, and Jody included here too, that have some upper palate issues. Some breathing issues are looking to get orthodontic work and a lot of that stuff at face value. It doesn't sound like it's related to anything that we normally talk about on the podcast, but today we'll get into the details of how for some people, not everyone, it is very much related and the structure of your mouth and teeth might be a rate limiter. And again, at the end, we tell you if the, you think this is potentially an issue where to go, how to get started, um, because we're discussing the overlap of many fields, and this is a new, that's becoming a lot more popular in the hard part with that is when you have overlaps of different fields. It's unlikely that one person is going to be the person that can kind of do everything under one roof.
Dr Mike T Nelson (00:03:12):
So you're going to have to try to coordinate with different specialists and that can make it tricky. So enjoy this podcast as always sponsored by the flux diet, go to flux diet.com, F L E X, D I E t.com. And you'll be able to get onto the waitlist there to the newsletter, which is free for the next times that it opens with flex and diet certification is eight different interventions related to nutrition and recovery that you can use to enhance your performance, body comp and health. It's ideally designed if you are a trainer to work with yourself and your clients. So it's a complete system of everything from how much protein do you need, how much carbohydrates fat, a neat, which is non-exercise activity, thermogenesis, exercise, sleep, fasting, ketogenic diets. How do you know to use those interventions? And when do you use each particular one? So it's set up in a complete system based on metabolic flexibility and the concept of flexible dieting. So go to flux diet.com, F L E X, D I E t.com and enjoy this wide arranging podcast with my good buddy, Zach couples. Um, we just wanting to get you on here to talk about just some of your experience and just some of the different stuff that's becoming sort of popular now from nasal breathing, mouth reading structure, Jodie is on here too, because she's, as you know, going through all of that stuff right now, I'll have an assessment when I get back.
Jodie (00:05:05):
So, um, I'm calling it narrowly escaping dentures. Doesn't that sound Foxy? So, um, I, I had some interesting dental work that was done when I was in my twenties, um, which was a bridge that should have never been put in place because the, I could have had a wisdom tooth move into that spot where the missing tooth was. However, the dentist just went ahead and threw it in there. Um, I have a missing tooth tooth on the top and last Christmas Eve, that whole bridge that was in my mouth for over 20 years fell out of my mouth. And, um, so as we S we started out the journey of trying to find the, the right, well, luckily his sister said, make sure that, you know what, the oral surgeon don't do this to a regular dentist because they can yank stuff and you won't be able to ever get an implant.
Jodie (00:06:02):
And I'm so glad that she said that. So she knows an oral surgeon, she's a nurse anesthetist, and she has worked with particular ones. She recommended him. He recommended a dentist and orthodontist, which we didn't end up going with. Um, because I was thinking, you know, as long as we're messing around with my mouth, this is going to be for the rest of my life fixed. So this is going to be the thing that I'm going to have going on for the next few decades. So I'm going to really do my homework. I want to know if I have any breathing issues. I want to know what else is going on. And of course, it's not just one answer. I'm finding that, um, some, some trauma, I had a near drowning experience that I never really thought of as impactful to my life, which, um, shut things down in the back of my throat. And, you know, just so, so we've got the breathing issues. I don't just want to start yanking teeth around because if the foundation's not good and I'm still clenching my jaw, and I'm still doing all of these things, then eventually it's not going to change things for the better. So that's why we're kind of on this journey, which I find fascinating because so many different pieces like enter link into this whole thing. So that's why.
Dr Mike T Nelson (00:07:24):
Yeah, well, that's what we wanted to get you on the podcast too, since we're already recording anyway, um, about just your background and your journey and kind of how you got into this. And then Jody can talk more about her experience and I'll have an assessment in December probably once we get back home. So I'm sure I'll probably need some hardware of some form. I talked to Ron years ago, PRI. Um, and I did some of their stuff and he's like, ah, you know, I haven't done a formal assessment or anything he's like, but odds are, you probably need an appliance or something like that going on. So, um, I guess the starting question then is how did you get in to this area, looking at different mouse structures and T structure. And it's kind of becoming more, I don't want to say sexy now, but I mean, I first heard about it from Ron, a PRI probably six or seven years ago. And at the time I was like, what dentist? Like, what are you, what are you talking about? Your physical therapist? What does dentistry have to do with it? It didn't seem like it's that connected, I guess.
Zac Cupples (00:08:32):
Yeah. Yeah. Um, I mean, uh, echo what you said. I think I first got intrigued by that when I was taking a lot of PRI coursework. Um, and it's funny, cause like in, in physical therapy school we learned about, you know, TMJ T M D and doing annual interventions for that, but not once. Did we ever talk about integrating the dentist potentially help with that? Yeah. So I mean, I will give credit to Ron because he at least took it to that next step. Um, although it seemed as though in that case, when, at least when I took the course work several years ago, it was a little bit more bias towards occlusion, which is how the, basically how the teeth contact each other. And then they would do things to improve upon that with a little bit of appreciation for structure of the pallet or the roof of the mouth.
Zac Cupples (00:09:23):
Um, I would say what's really skyrocketed me getting even more in depth to this was going through some of it myself. Um, and let's see, 20, I went and worked with Ron at the prime, um, prime program. I did that, I think 2013. Um, he recommended I get my wisdom teeth pulled out just because they were not, I didn't have room for him basically. Um, and, and they were all weird directions, so I got those pulled out. Um, I couldn't move my jaw side to side. So once I had that done and I could move it side to side, which was intriguing. Interesting. Yeah. And then after that I thought, okay, what else can we do to improve this? A couple of my colleagues were getting the Roto-Rooter done in the nose, so a septoplasty to make more room for that. And so I was initially going to get that done in Arizona.
Zac Cupples (00:10:21):
I'm so glad I didn't. And this is where, when you're going through this stuff, you really got to make sure you have someone good and get a few different opinions. So the procedure they were going to recommend was potentially shaving down the septum to make it even, but then they're going to take a turbine it out. So the turbine, it basically helps humidify the air as you go in because it was enlarged. Um, the problem is if you do that, you can get a condition called empty nose syndrome, where basically, because the anatomy is changed, you get a lot of the same symptoms you had before, in my case, difficulty breathing through my nose, um, frequent colds, uh, and it, it doesn't fix the problem. So
Dr Mike T Nelson (00:11:04):
We had Jim toaster on the podcast and he talked about that as one of the potential side effects of people having a lot of procedures done right away to try to quote unquote, fix something. So he's like, yeah, there's a potential cost to having stuff removed that may not, may not need to be removed.
Zac Cupples (00:11:21):
Yeah. Yeah. I would echo that a hundred percent. Um, so I ended up getting the surgery in Memphis from, uh, from a doctor who was, cause I was working with the Grizzlies at the time he was connected with them. And so he shaved down the septum very lightly and reduce the turbinate. So just made it a little smaller. Um, and I got profound changes from that, able to breathe through my nose. Like I remember I had plastic in my nose, he took it out and it was just like, I had never been taken that much air in through my nose. And then, um, within two weeks after everything healed out, my resting heart rate dropped 10 beats per minute.
Dr Mike T Nelson (00:11:58):
Yeah. I think I initially met you right after you had the procedure. I think didn't do like you were here in town, I think for when you're with the Grizzlies or something. I can't remember. It was a long time ago, Toronto. That's right. That's right. I remember that. I remember taking the picture with you and it was Starbucks or Starbucks.
Zac Cupples (00:12:23):
Um, yeah, it probably because it was during the all-star break, so it would have been February and it's rhinos cold all the time. So,
Zac Cupples (00:12:34):
Um, but then I would have to, I have to give credit to my friend Joseph's and Nelly, uh, uh, physical therapist. We both studied under bill Hartman and he's been working up in San Francisco for quite a while now. And he, he introduced me to dr. Brian Hall and was really into just a lot of different airway stuff that I, I had never even been exposed to. And so it's like PT school, we looked at the jaw PRI has a little bit more occlusion and then we just kind of kept moving backwards. And that's where the stuff that I'm I'm doing now and I'm exposed to now, I think has been a real big difference. Cause the issue, even with fixing the deviated septum is the septum only accounts for about 20% of the area get through your nose. Hmm. Remaining 80% is impacted by the floor of the nose, which is your roof of the mouth. So yeah. So doing things to affect the oral posture and the oral airway can a lot times have a profound effect on how well you breathe through the nose. And the issue that I found, if someone's trying to go down this route is you really need someone who looks at all the potential pieces. And then from there it's really trial and error of what works and what doesn't, because there's not really like a, a set playbook for any specific case, especially when the dental history gets a bit more extravagant. Like in your case, Jody,
Dr Mike T Nelson (00:14:00):
I liked that you chose a, um, positive word.
Zac Cupples (00:14:09):
Yeah. So that's kind of where I'm where I'm at with it now. And I'm, uh, I'm going through some stuff personally. Um, I'm trying to think of what else I've tried. So I had in 2019 I had a tongue tie release. So I was, I had a slight tongue restriction and uh, so we had dr. [inaudible] Zagi, who's like the guy for this stuff. He's in LA. He, uh, he did my tongue tie release. Joe is doing my myofunctional therapy, which is basically like physical therapy for the tongue. Um, got great range of motion. So, uh, the way they test that as they would have you do opening, and then they would have you tongue tip to the roof of the mouth. And then the whole tongue up to the roof of the mouth basically measure the difference. Hmm. I was about 50% range of motion, which you could potentially get conservatively or with surgery.
Zac Cupples (00:15:05):
Um, the surgery is for the cost pretty low risk high reward. So I got that done. But then the issue that I had now is I had all this range of motion, but I didn't have room for my tongue. And that's because my pallet is narrow side to side and front to back. And that's what got me up with dr. Hochul. We both have a couple of colleagues who work with him. Um, basically, so what we're doing now for me is pushing my teeth out forward and sideways as much as we can, both top and bottom. And the hope is that that gives my tongue more room to sit on the roof, which can potentially affect the dynamics of the floor of the nose to allow me to better nasal breathe. Um, and the reason why we went with that is because I have a good amount of space in my throat for, from an airway perspective, there's a certain amount of range you need to have. And I think the minimum you want is like 200 millimeters squared, something around there. And I think I'm in the upper three hundreds, which is good. Um, because if I had a narrow airway, usually they recommend surgery as the fix where they basically cut the maxilla and mandible and then bring all that forward, rotate it up. Um, so it, but that's expensive. So
Dr Mike T Nelson (00:16:24):
Yeah, I decided very invasive
Zac Cupples (00:16:27):
Very much so. Yeah. It's like a, it's like a year or two year recovery process with like six weeks out of the jaw wired shut. But if you've got sleep apnea,
Dr Mike T Nelson (00:16:36):
It is a hundred percent. Yeah.
Zac Cupples (00:16:39):
Which I don't have, I have upper airway resistance syndrome, which we found to be a sleep study is that's kind of where I'm at. I mean, since I've had the appliance three months now, I've, uh, um, I, my sleep has been dramatically better. I used to get a lot of laws like around noon or mid-afternoon, those are pretty much gone. I think I've had three in the last three months, which was like every day before that. So it's been really cool. And so I'm doing that along with a malfunctional therapist in town, in Vegas who, uh, uh, Melissa McNeil she's really good, um, to basically teach my tongue, to get where it needs to go. Cause that's, I think the one thing I missed with my first bout was we did a bunch of stuff for motion, but my ability to differentiate my tongue from my jaw or even my, my, my facial muscles just wasn't there. And so we're working a little bit on that now. It's been pretty, really challenging. You get tired when you, uh, can get the tongue in the right position.
Dr Mike T Nelson (00:17:39):
So if someone has a tongue tie, that's absolutely not a guarantee that they're going to have issues, correct. It's just a indicator that, that may be limiting the range of motion of their tongue, or are they just kind of have lack of a better word, a dumb tongue that hasn't really ever been trained to do more range of motion.
Zac Cupples (00:17:59):
Yeah. So it, it really depends on if you can get your tongue in, on the roof of your mouth. And so ideally the tongue should kind of sit up and forward and cover the entire roof of the mouth. Now, some people, if they have a large enough restriction, they might not be able to do that. And so in that case, a surgery is indicated. Now other people can get the tongue up there, but they might compensate through the floor of the mouth, which is what I was doing. So basically you would lift the floor musculature up on the roof of the mouth, and then that could be a potential contributing factor to developing, um, bruxism or clenching. Um, if, if you can get development of Torah, which is basically increased bone growth on the, on the floor or on the, on the mandible, which is what I have.
Dr Mike T Nelson (00:18:53):
Yeah. That's the, do you have to duty that? I have that as well.
Zac Cupples (00:18:57):
Yeah. So if the tongue's having to work really hard, uh, either stabilize the jar, get up to the roof of the mouth because the floor is getting lifted, you can get increased bone growth there, and that's, uh, a potential indicator of some type of sleep disturbance. So, um, even if you're not, you don't have a restriction, you could still have a restriction because you're just compensating through that. But there's also some people who can just go through myofunctional therapy, teach their tongue to get up into that position if they're not super restricted and to ensure that, or to practice not using the floor of the mouth to create the lift. And that can lead to some profound benefits. There's, there's good research showing that going through bouts of myofunctional therapy can reduce snoring, improve, sleep quality. And in some individuals, it just depends on the severity of the sleep disorder. Like if you, you have fairly bad sleep apnea, it's probably not going to be the fix, but all of that's assuming you have room. And that's really where I think most people just because of us being a post agricultural revolution society, um, are, are missing.
Dr Mike T Nelson (00:20:08):
So would you say most people have a narrow upper palate both potentially with N depth or is it more with, or is it hard to say
Zac Cupples (00:20:21):
It? I would say most people, although there will be differences, have a reduction of side to side and front to back. Um, so if you're someone who's got an underbite, I think that's a very clear example of, so an underbite or under jet would be where the bow or the mandible sits ahead of the maxilla, the top part of your teeth. So in that case, most people have a reduction of ADP dimensions up top entered a post. Yep. Yep. So front and back, if you're someone who's got a, more of an overbite or an overjet where the, the front part of the mouth is a little bit ahead of the back or of the lower, um, some dentists would argue that you're back on both. So the top of your mouth is sitting for their back, but so is the bottom, it's just, the bottom has gone further, further back. Yeah. So, and again, that's likely due to us living in an agricultural revolution, society, less breastfeeding, uh, genetics, because a lot of this is generational. And, um, if you read Western prices books and see how fast the,
Dr Mike T Nelson (00:21:28):
Yeah. It was like two or three generations, I think they saw changes. I believe
Zac Cupples (00:21:33):
They saw, well, they saw changes in tooth structure in first-generation switched. Yeah. So it's a, there's a lot of factors at play. And then it's, you know, once the genetic predisposition is there, then it's, you know, even if you do everything right, you can still have these issues. So most people have underdeveloped faces. Now the question is to what extent, what age do you catch that and intervene? And if you wait to what extent do you have to utilize different strategies to try to increase those dimensions as much as possible. So you have enough room for your tongue to sit up on the pallet and breathe through your nose.
Dr Mike T Nelson (00:22:15):
Interesting. I had one of those other times I was talking to James asked about this too, is my buddy, dr. Kevin Boyd. I met him at the ancestral health symposium years ago. They had a dentistry panel there and listened to him and I was talking to him afterwards and I said, Oh, what do you do? He's like, Oh, I'm kind of a dentist that I treat primarily kids with ADHD. And I'm like, hold on. Well, wait, what you said, you're a dentist. And you're treating kids with ADHD. It's like, yeah, we image their airway. And we find that a lot of kids who present with ADHD, at least the people he sees in his clinic, their airway is like super reduced because everything has just been kind of jammed back in their face. And they present as ADHD because their brain is literally not getting enough oxygen.
Dr Mike T Nelson (00:23:01):
So they become very sympathetic. They become very stressed and ADHD is generally just diagnosed by the symptoms that you have. And he does a more of an oral surgery approach, especially on younger kids. And he said, his success rate is almost like a hundred percent. And I'm like, Oh, you mean they present with ADHD because their brain is literally not getting enough air. And he's like, yeah. I'm like, Whoa, that's, that's so crazy. You know, when you think of all the kids who are on different medication, different things like that, who've never even had their weight image just see, is that potentially an issue or not? Again, it might be, it might not be. Um, so that was probably maybe six or seven years ago. On the same time I was doing some of the peer eyes stuff. And yeah, to me, that was just fascinating. And now, you know, fast forward, it's becoming more and more common at least for people to have airway imaging. And I know when you went in, that's one of the things they did with you was to look to see how much volume you have in your airway also.
Zac Cupples (00:24:04):
Yeah. I think the, well, we already know the wide range of effects of sleep deprivation. Yeah. And while we're doing a lot of things on a environmental or even behavioral aspect to improve upon that, uh, I think we've over the years been missing the importance of, of structure. And that seems to be, uh, something that's very under, under appreciated, I think because it's still in its infancy in terms of how to best address this stuff. But it's so impactful. And I mean, I know for myself as I've gone through this, I haven't been as stringent about the sleep environment, but my sleep quality has been getting dramatically better still. So it does make me wonder to what extent that's really the driver of allow these issues compared to other things and to piggyback off what you said on ADHD. There's a research study that I read a few years ago where they did treatment for people with PTSD post-traumatic stress. And it was just an oral appliance to help him basically improve the airway dimensions while they slept symptoms reduced. And it's the same thing. If you're not getting a lot of oxygen brain perceives that as a threat ADHD or not ADHD, but PTSD symptoms may be increased because of that.
Dr Mike T Nelson (00:25:26):
Yeah. Yeah. And then I even wonder I was doing some research on this, just reading stuff. And there's some preliminary data showing that if you have a traumatic event, what quality of sleep you get after that event may determine, do you get PTSD or do you get potentially post traumatic growth from it? So I've often wondered in that case, if you have someone who already has poor sleep because of facial structure, you know, whatever else they have a traumatic event, they have a history of getting very poor sleep. Now they get poor sleep for the next few nights after that, which messes with the amount of REM, they see the processing of different brain and neural circuits. So potentially is someone who's going to be put into a stressful environment. Them having poor sleep quality going into that does that now become even a risk factor for them having a higher risk of developing PTSD. Once they have it, like you were saying, now they're even more sympathetic at night and they can't get into that more parasympathetic state. So it's just more like a downward spiral at that point then too, in terms of symptoms.
Zac Cupples (00:26:34):
Yeah. I mean, that would, that would make, I mean, obviously I'm biased
Dr Mike T Nelson (00:26:38):
Speculating a lot,
Zac Cupples (00:26:40):
But I think even if there's no link to that with how important sleep is to help perspective, I, if you have the capability to do all in your power to improve that the effects on your health are going to be wide ranging and probably worthwhile. And that doesn't mean that as soon as you get an oral appliance, you can fire your psychiatrist. Yeah. But I'm gonna try this and step. Yeah.
Dr Mike T Nelson (00:27:09):
I sleep my way through it, bro.
Zac Cupples (00:27:14):
That'd be awesome. Uh, but, but I still think it makes a lot of sense to at least do something to improve that, that the issue now though, is there's a large barrier from a cost perspective to get it. That's, that's really the hardest thing. You know, like I would have never been able to do this. I mean, I would have loved to do this when I was running or even as a kid, but, you know, with, with student loans and you know, not growing up rich, I, there's no way that this could happen. And it took me getting rid of my debt to be even able to think about going down this route, just cause it gets costly. And especially if you're someone who maybe needs the surgery for the fix. Yeah.
Dr Mike T Nelson (00:27:59):
The surgery is crazy expensive. Even like in Jodi's case, like the first orthodontist we went to just for the orthodontic, you know, type procedures that's not putting in the implants or anything else, the person we're seeing now, which I think is much better, a much more holistic approach is literally three times the cost, you know, so you're, but I think it's worth it. But again, to your point, it's like, okay, so that's an extra, you know, $9,000 and that's without having, you know, one, two or three implants put in, you know, and this is not having a surgery. This is just doing, you know, more of a full rounded, you know, orthodontic type procedures too. So it gets stupid, expensive, fast.
Jodie (00:28:43):
Well, and the re part of the reason we, we chose who we did was, um, two-fold reasons. So the guy, the orthodontist that we went to originally mouse breather, complete mouth breather. So it's, it's like, okay, so you know how to put the teeth to make them straight, but is there anything else you're doing? And the person that we chose, um, she had to go to extra school and you remember?
Dr Mike T Nelson (00:29:15):
Yeah. So she did orthodontic procedures and then she actually went back and did almost all of the school to be an osteopath on top of that. Uh, it was just super interesting. Cause those, even those two thought patterns are almost like bipolar of each other sort of. So yeah.
Jodie (00:29:32):
Well, and the recommendation came from a friend that Mike knew, um, way back in Z-Health days. And he had, I know, was it, was it from a fight or was it from his structure? Was his chin was totally to the one side of his face. Lots of, um,
Dr Mike T Nelson (00:29:53):
How's a cranio kind of torsion you can see. Yeah.
Jodie (00:29:56):
But he is, he's been working with her for years and sends his kids to see her as well. Um, so she, I was just amazed by what she did, you know, taking pictures of my whole structure, you know, taking a picture of saying, Oh, well you have, the shoulder goes down and your head tilts this way and checking all my cranial sutures, which I'm like, no dentist has ever, ever, ever touched my head checked if my shoulders were tight now I'm like, this is a whole nother level of checking in the body then, Hey, let's just slap some braces on you. So that was very interesting experience too.
Zac Cupples (00:30:36):
That's that's very cool. Well, and I think that's goes to show the power of this stuff when it's done well, but also how you have to look at a lot of, a lot of areas that could potentially be impacted by changing the structure of the mouth. So the fact that your dentist is looking at airway, as well as your movement and, you know, cranial function, that's huge. That's huge.
Dr Mike T Nelson (00:31:04):
Uh, I haven't seen none a few online clients, obviously we've worked together on those. I've consulted with you on that with the Sam and some other ones, um, even on stuff I've worked with, uh, dr. Tommy wood on for just generally just blood work stuff. Like I've noticed more and more. And again, maybe it's just because you're only looking for what you're kind of quote, unquote educated in like lots of weird stuff for like, um, hematic red will be like super high. Like we had a one client just ridiculously high for MADEC red. Her aerobic performance was good, but not amazing. And we looked at it and Tommy agreed also that she probably has some obstructive sleep apnea that she's becoming so hypoxic ignite, right. Her body's going, Oh my gosh, hypoxia, let's, you know, crank up the EPO, we need more blood volume to try to fix this.
Dr Mike T Nelson (00:31:58):
And she just had, you know, some sleep issues and different things like that. So she's in the process of getting a formal sleep study and going through her physician to see what's going on with that. Um, but even then it's like, you know, the general physician she was seen as like, Oh, don't worry about it. You're fine. And I emailed Tommy and I'm like, do it. I don't know exactly what I'm looking at, but this makes no sense to me whatsoever. I'm like, I'm pretty sure there's something going on. And he looked at it and he's like, is she a cyclist? Do an EPO. I'm like new cars are bad at grids, like sky high. Um, so I even see weird stuff like that. Did you notice anything
Zac Cupples (00:32:40):
With, uh, like glucose measures at all?
Dr Mike T Nelson (00:32:43):
They were born. If I remember there were borderline high, they weren't like diabetic and, you know, very active person drawing, very active, you know, very high performer, high level job, you know, but it's, yeah, it was just fascinating how some of those underlying things in terms of stress, you know, HRV is okay. Not amazing. You know, it's always hard to tell cause everyone's a little bit different too. Um, so I'm excited for once you get to a sleep study just to see, you know, what's going on and what can be done with that. Cause I have a feeling the same thing she's reporting and being more tired in the afternoon. Uh, and again, that can be related to a whole host of things too. But yeah. So even again, going back to the whole comprehensive thing of just looking at all the different markers and trying to think holistically of, you know, what could possibly be going on. Okay. If we think it's this, okay. Then obviously talk to your doc about getting a sleep study. If it is then you know what to do. If it's not, then you can rule it out and, you know, kind of go down to the next thing.
Zac Cupples (00:33:45):
Yeah, for sure. Well, in one thing, when you're getting the sleep day, cause I've run into this when I recommend it with some people or if they go through their physician is a lot of times they will only be looking for sleep apnea, right. Only score the, uh, the AHI, which is the apnea hypopnea index, which basically such a bizarre system. But if you have a period of 10 seconds or more where you're not breathing, that's considered one APNIC event. And if you have over five of those per hour, that's when you get a diagnosis of sleep apnea. And then the degree of that is based on severity. But now the issue is, well, what if you have several that are five seconds? Yeah. Or you just de-saturated for a moment your, your brain still thinks I'm not getting enough oxygen. I need to wake up.
Zac Cupples (00:34:37):
And a lot of times that isn't measured on conventional sleep stays. And that's where, uh, the RDI, which is the respiratory distress index is so important because it catches those. And so someone might not have a lot of APNIC events and they might not have sleep apnea, but they could have upper airway resistance syndrome, which is basically a reduction of blood flow or a reduction of oxygen, but not to the degree, the degree of apnea. And if you compare UARS upper airway resistance syndrome to mild sleep apnea, the symptoms are actually worse in that compared to sleep apnea. But you can't catch that. We had this issue with one of my colleagues is his wife. Emma said, one of his wives, he's only got one, but, but she got this one sleep study and you know, her AHI was only three, but she's got horrendous sleep waking up, you know, very frequently throughout the night.
Zac Cupples (00:35:36):
And she's a fit young woman, which is one of the risk factors for having upper airway resistance syndrome. So they did not score the RDI on her. So we had at another one too, to make that a case. And then the other issue too, is you can also have some people who have perfect sleep studies, but there could still be something wrong. Um, and if there's a, there's a cool video on, uh, dr. Ziggy's website, where he had this kid who was just couldn't sleep major issues, sleep studies work totally fine. They ended up doing a dice procedure on him, which basically what that is, is they put you under and they look at your airway to see if there is a physical collapse while you're, while you're sleeping. And this kid, I, gosh, this video is crazy, but he was just like violently moving. His legs were kicking up in the air. So even then if your sleep study is clean, you could still potentially have an issue. Um, and that's where something like a dice procedure can kind of confirm if there is a legitimate airway obstruction. So it's, again, even like a sleep study, isn't exact science in that regard or it doesn't catch everyone.
Dr Mike T Nelson (00:36:56):
Yeah. One thing that, that on a, I guess I'm thinking of the at-home ones where they use kind of an accelerometer monitored thing, would that show up on that? And it's the data may be there that they're just not used to looking at it then, or how does that
Zac Cupples (00:37:09):
Work? That I'm not sure that I'm not sure. I know, I know Zagi uses the watch Pat one, which is the one direct with most people. Um, because that one's going to get your AHI and your RDI, both it does, which is why it's great. Um, whereas I don't know if it would pick up something like that.
Dr Mike T Nelson (00:37:28):
Got it. Yeah. And so for people listening to watch that is something that they can recommend, or they can ask their physician to get a prescription for. And it's done at home because I know one of the restrictions I have with a lot of clients is when they go to their doctor and they ask about it, it's like, well, you know, to get a, you know, a pull full PSG, polysomnography sleep study, it's expensive. You have to go into the hospital, you have to spend an overnight there. Sometimes insurance covers it, sometimes it doesn't. Um, but I think using something like a watch pad where you can do it at home and then have a physician read, it makes it a lot more doable than it has been in the
Zac Cupples (00:38:06):
Absolutely. And the really nice thing is now with the wonders of the internet, you don't even need to go to your doctor to get it done. Someone else read it. Yeah. I mean, I literally, I got, you should have bought stock in them, but there's a company out of Reno called I sleep that I, um, send all of my people to get their sleep study through. And it's only like with the, with the discount code, it's like 225 bucks, but I've even seen the watch Pat on Amazon now
Dr Mike T Nelson (00:38:33):
Too. I was confused. I was what, and it wasn't that expensive if I remember, right? Yeah,
Zac Cupples (00:38:38):
No. I mean, compared to a couple thousand, when you'll get, you're going to be sleeping in your own bed. Yup. And you can get most of the stuff that you would need to make decisions. And I also think too, just like, you know, Mike, you, you do an intervention with someone and maybe you're using or a ring or anything to test retest to see what works. That's a super easy test retest. So you get your watch, Pat, you do some intervention and then you get another one just to see where it's at. Like, to me, I think it's, it's a no brainer for most people just because the barrier is low to at least get a baseline.
Dr Mike T Nelson (00:39:18):
And in your case, did you see difference in HRV or aura or in addition to kind of your symptoms of not being tired in the afternoon? Uh, did you see any change on any of those metrics? I'm more just curious.
Zac Cupples (00:39:32):
So the one thing that's improved since I've gotten this done, because really like my HRV and all that's been fairly good, but I have had an increase in REM sleep. Hm. Not a lot. Cause I mean, I still am 20% or more on both REM and deep. So it's, it's pretty good.
Jodie (00:39:53):
I have a weird question on that. So I'm noticing something strange and I don't know if this is, has to do with any of this at all, but my dreams are more real in the sense that I can read in my dreams. I can feel things in my dreams that I've never felt before. And one of the people that I'm working with, she said, you may be getting more REM sleep, which means you may be dumping your brain is doing a better job of it, dumping things out, but it's a lot more concise, real vivid, very vivid. Did you notice any of that?
Zac Cupples (00:40:35):
It's funny. You mentioned that because yeah, I was someone who rarely dreamed or remembered my dream and I'm not, I'm not consistent yet, but the, I do remember my dreams a lot more and I feel like I'm dreaming more than I was, which is really cool. I remember there was a week where I dreamed or dreamt almost every night and I can't remember. It's probably been over a decade since that's been yes. So yeah, I think it makes sense to me, if, you know, you improve positioning needed to breathe through your nose, um, it would make sense that you would probably have better REM and subsequent dream memory. Um, and that was when you look at my sleep study, that was where I had most of the APNIC events and the respiratory distress was during REM. Hm. So interesting getting that. Uh, yeah, my deep sleep is great, but REM is just not good.
Dr Mike T Nelson (00:41:31):
Yeah. Because I've often wondered about that. Um, I, one client in particular I'm thinking about who would probably watch this and send me an email about it. But, um, and again, it's off of aura and you never know, is it just that person and has a hard time differentiating between REM and non REM, right? Because it's, again, it's a $300 device. It's not a hundred percent sleep stage differentiation based on what they've published, maybe 70%. So it's, it's good. But you also know that if you extrapolate over enough people, you're going to have abnormalities that it's just going to have a harder time dealing with too. So I always kinda look at those as a little bit of grain of salt. And then I try to use it more as a comparison on that person, not take the absolute numbers that say, okay, is this person getting better on REM?
Dr Mike T Nelson (00:42:18):
Are they getting better on deep sleep? Not looking at it going, Oh my God, it says you only get like 40 minutes of REM sleep. Oh, how horrible you, bad human being. You, you know, it's like, if it says 45 and then you consistently are getting an hour and 20 minutes, you know, that's probably a real difference. And then you can look to see, how do you feel? Do you have more vivid dreams? Do you recall stuff better? Or do you feel less tired during the day and try to correlate it that way? Cause I think there is, I've gotten, I don't know how many emails from people who are like, Oh, my HRV is so horrible on an aura. I'm uh, I don't know what's going on and it could be a whole bunch of things. And I've got another client who is isolate.
Dr Mike T Nelson (00:43:00):
HRV is pretty good, but his aura HRV, for whatever reason, it's just super low and everything else is pretty good performances. Good. Everything else is fine. So I'm like, eh, probably don't worry about it that much. I mean, we'll keep, you know, trying and playing around with some other stuff to see if it, it comes up, but who knows? Maybe you're just one of those weird anomalies too, you know? So I don't like people to take data and completely freak out and be convinced that there's something that's wrong with them now, even though they felt fine before, too.
Zac Cupples (00:43:32):
Yeah. Yeah. That's the one. So one issue with measuring all of this stuff is
Dr Mike T Nelson (00:43:37):
Yeah. And as you know, you measure enough stuff, you're going to see something that's out of line, right. You're doing enough blood tests, you did enough tests of anything just by the law of statistics. Something is going to be off. That's just, that's just the way it goes.
Zac Cupples (00:43:52):
Yeah. Well, and that's, I mean, in my realm, in physical therapy, we see that a lot with just imaging of the body. Oh yeah. Definitely. When you measure anything. Yeah. Back imaging. When, you know, depending on what research study you read and what age group you're in 30 to 80% of asymptomatic individuals can have an abnormal finding and that's not even considering there was this really cool study. I forget how many radiologists they had.
Dr Mike T Nelson (00:44:20):
Is that them all the asymptomatic people.
Zac Cupples (00:44:22):
Yeah. And it was like, I think it was like 10 different radiologists. I remember it was a few and it was like 35 different diagnoses for one, one MRI. So with when you're measuring anything, it's not exact science. You have to take that into consideration. But then also like you said, Mike, what are the symptoms or the outputs that this person's feeling. And then you try to meld a story together, putting all these things together and then trying to, you know, use your, your clinical experience and judgment to make whatever seems to be the best decision for that person. Realizing that it's, we call it practice for a reason. And sometimes this stuff, you know, you might think you made the best move and it might not be for that person.
Dr Mike T Nelson (00:45:11):
Yeah. And that's, what's hard too, because like different things will have different outcomes and different people, right? So you can't say, Oh, maybe you have a super narrow palette, but if you have this done, then your HRV and sleep and everything's going to be amazing, man. Maybe, maybe not, you know, like in Jodi's case too, like we did some stuff, uh, some more hands-on work for, you know, the trauma that you had of the surrounding, you know, drowning and that kind of stuff. And that was done at the same time as you're doing a lot of the myofascial stuff too. So it's hard to say which one of those things had an outcome that made it better. But at the end of the day, I don't really care all that much because it's better. You know, like if I was trying to design a perfect study, then of course you want to try to figure out, okay, we've got the one intervention, we've got the placebo control. I mean, doing the sham over here. And your whole goal is to figure out what is the mechanism, but as a, an individual level or even like in your practice. And I would imagine your outcome is more okay, how do I make this person better? Right. I want to understand a little bit about it, of course, but the end result is, are they better or not? Even if that means I'm going to give up knowing exactly why they are better doing it too.
Zac Cupples (00:46:24):
Yeah. Yeah. Your sleep deprivation doesn't care. If the evidence to do this, do this, you want the symptoms to improve. Yeah. And I agree with you a hundred percent on that. Um, it's just, you know, the, the, the issue is you're, you're playing with probabilities that you don't necessarily have the exact percentage success rate for a particular intervention. And so that's, what's tough, but it's also, I think part of dealing with the difference among individuals, Jody, you and I could have the very, very similar sleep studies and similar impairments, but we could need completely different interventions to get to where we want to go. And then where we wanna go is even different. Like your post might be different than mine. That's what makes working with people challenging. Yeah. And it's also challenging even working with trying to diagnose, you know, so when we had all the imaging done for my airway,
Jodie (00:47:30):
They told me I had a voluptuous uvula that was blocking part of my, they didn't say that, but you locked up. Um, I had, I had inflamed turbinates. And what was the other thing? There was one more thing. There's one more thing. Um, but the dental person that I'm working with sent me to see the ear nose and throat specialist that she usually refers people to, to go get checked out. And he's like, ah, nah, you're fine. There's nothing right here. Go get some Flonase and no, you're not bad enough to need surgery. So that's okay. I mean, I don't want something really, truly invasive, but part of it is that I'm not don't have any severe enough symptoms in their eyes or I'm not reporting it as dramatically as a need to, to get the response that I want or that I need, which I don't know if that's what I need.
Jodie (00:48:34):
So that's, that's the interesting part too, even with, when you're getting diagnosed by the people you're trying to trust to do this process, it's very interesting. And that's what makes it also hard. I think for anybody who is the lay person, I would have never been down this road and I decided to just go get my teeth yanked and put back in. So yeah, it's just, it's an amazing, weird trying to decide what's better and best as far as interventions, especially if they're going to be taking something in or out of my throat, that will take a while to get better from. So
Zac Cupples (00:49:14):
Yeah. Did they measure your, your throat dimensions in terms of the airway size there?
Jodie (00:49:20):
I believe we have that on the, um, I don't remember. We've got the scans that show that show it all. And it does show that the, that the airway is a little bit restricted by what's in my throat structurally. So we do have it. I just don't know off the top of my head, what, like the measurements or whatever it was.
Zac Cupples (00:49:44):
Yeah. Cause I think, you know, the issue with turbine inflammation is that can happen for a variety of reasons. So then, and this is probably goes a little bit out of my scope, but I, my thought would be, you know, if I had to do all of this all over again, especially considering the, the, the relationship of the pallet and the, the oral throw posture, um, in terms of airway dimensions, I might have gone that route first, um, instead of going nose first and then everything else, because if you image right now, I still have turbinate inflammation. And like, I've tried dr. Zagi. I remember when I saw dr. Hochul for the consult, he just texted dr. Zaki and said, Hey, cause I still had like some crap in my sinuses and the turbines were in flame. What do you think of this? Does he need to see, you said that, just give him some drugs.
Zac Cupples (00:50:50):
I mean, but these, it was insane because I, it was a desonide where it basically you put that it's just a corticosteroid, you put that in water and you shoot it up your nose and instantaneous Lee, my nasal breathing was significantly quieter. Like, um, my, my partner at the time, she was like, I don't even hear you. And she would always say, Zach, you're breathing so loud three or sleeping. Um, so it's, yeah, it was crazy how fast that worked. But again, I had the surgery, so why is it that my Terminus were still getting inflamed? And I wonder, well, if, uh, the roof of the mouth has such a, such larger real estate on nasal breathing, if that's not the best area to address first, but then again, if you have a restriction in the throat or the cervical spine, that's limiting the dimensions there, do we need to do something there to improve those dimensions? And then that makes everything easier. And that's where, you know, I don't know, but my suspicion would be, that's probably the first place you'd want to look because what they don't talk about with like septal deviations or things like that is a lot of times these go back and, uh, the, the question is why,
Dr Mike T Nelson (00:52:10):
So there must be some type of local pressure or some type of stress that's then maybe driving it that direction
Zac Cupples (00:52:19):
Could be. Yeah. Uh, you know, there's some research showing septal deviations with people who have scoliosis connects to those two things. Yeah. So are there some movement influences that are potentially driving that? Sure. Well, that there could be moving influences that are driving the, the dynamics of the cranium and the palette. Oh. And that's just where there's a lot of uncertainty, but in my, in my mind, I think addressing the, the oral posture is probably something I would do sooner rather than later. Um, just because of the amount of real estate that it affects from a nasal breathing standpoint. I'd be curious. What did, uh, what did dr. Nester say in that regard, in terms of addressing specific areas, did he have any thoughts? Cause I know he's messed with a few different things in his book.
Dr Mike T Nelson (00:53:16):
Yeah. I mean, the only thing he talked about was what he had done, where he added more actual bone mass to his, and I'm trying to remember what was the device he had. Yes. That's what it was. Yeah. And so he actually had CT scans before and after showing that he actually added, was it three pennies worth, I think of more bone mass than you had before and said his nasal breathing and everything else got significantly better. Um, so that's the only thing I remember, um, from that per se, but yeah, it's super, super interesting. Right? Cause most people looking from the outside would say, you know, if you're older, there's no way you're going to add more bone mass to your, your skull. What are you talking about? That's, that's crazy. But it's just fascinating to me. How, if you apply the right stressors, your body is always going to adapt, right?
Dr Mike T Nelson (00:54:09):
You look at the studies of people who are in their eighties and nineties, they start strength training and they get stronger, right. They get stronger at the same rate as someone who's younger. Granted, they're not going to add as much muscle mass because they may be just, you know, bicep curling a soup camp, right? So they're not lifting as much load, but in terms of percentage of progress, they can still make significant progress over their baseline. So I'm always just fascinated by that your body almost never loses the ability to adapt. And as I worked in medical devices for 12 years, we had devices to treat congestive heart failure. So we'd have these people that were admitted, like these huge, like basketball size hearts, right. Instead of the blood getting pushed out, it's just kind of moving back and forth in this kind of like hula hoop type thing.
Dr Mike T Nelson (00:54:54):
So we put a little wire down on the left side of the ventricle, a little wire down in the right side of the ventricle and then they would time the impulses. So now the heart's actually working better. It's objecting blood injection fraction acutely goes up, you know, 10, 15, 20%. Uh, one of the very early cases, a guy was literally sleeping with like three pillows a night because he had so much fluid backing up in his lungs and three, four or five months later, something like that. And he like rode his bike across the state, you know, and granted he was a very hyper responder to the procedure and all the cardiologists and electrophysiologists were just fascinated because the heart actually remodeled in a lot of cases smaller again. Right. Because now you change the stress completely. You make it more efficient. And the dynamics of that change, and these are people who were really, really like bad off, like probably a couple months from dying in a lot of cases. And even then with the right stimulus, there's a 24 seven stimulus. The body's able to re remodeled back to something that's better. So that to me is always fascinating if you're talking about facial structures, even if you're older having an appliance, having something in there, that's literally applying a small amount of pressure can start to reshape everything again.
Zac Cupples (00:56:13):
Yeah. Yeah. I mean, yeah. The adaptability of the human body is quite amazing, uh, in regards to the bone growth and bone development that even, especially in the mouth is still a bit controversial in the dental field. It's funny because so much of this is political in many respects. Um, yeah, just like in physical therapy, but like you just have all these camps that are selling their particular AMS and you know, to my understanding the, the bone that you can change is most likely alveolar in nature, which is what basically moves when you get braces and things like that. You have to be mindful of people who claim that the, the palatal bone can change with an appliance, um, because that might not necessarily be the case. Hmm. Interesting. And yeah, and not only that, sometimes they'll claim that while I'm moving, you know, the teeth to a very far range, but basically all they're doing is they're pushing the teeth as far as they can out and the alveoli Vilar bone and that then, you know, they potentially have some damage to the roots and then problems in Sioux. So you really have to have, uh, regardless of the mechanisms, you have to have someone who's a skilled practitioner is taking into consideration all of these factors. Um, so it's, yeah, it's just something that is, it's interesting to see how there's similar battles in, in all fields in terms of what mechanisms are going on. And what's also most effective.
Dr Mike T Nelson (00:57:57):
Yeah. And it's like, anything else too, like how much you can change is probably debatable, but if you can change it, then your next question is, well, what direction and how much. Right. So that comes into the, you know, the skill that the clinician or doctor, physician, whoever you're working with to say, okay, in my experience, I think we need to go this direction where someone else could say, no, I think you need to go in that direction. You know? And that's where it gets. I think, especially for someone from the outside, looking in extremely confusing, you know, and now you've got, you're talking about a crossover of realms, of, you know, physical therapy to myofunctional osteopathic dental. You have all these areas that are kind of overlapping each other. And that gets even more confusing because everyone kind of has their own progression and they have stuff that they've seen and things that, that work too. So it gets to be kind of hard,
Jodie (00:58:53):
You know? So it was hard for the person. Um, cause I think self-awareness is such an interesting thing to try to have when we all have stuff that's messed up. Right? Like even just in talking about this, one of the things that I could complain about for much of my life is, um, fear being the overwhelming, uh, like not that I thought I was always a cheerful and hopeful and optimistic person. And yet they're an overriding emotion that constantly came up as fear. Well, why? Well, multiple reasons, including having a trauma. So that's the hard part when as people are sorting through this, you know, which direction do you go first? I don't know. Which is the biggest screaming thing because that's one thing that's interesting is watching as I'm doing different things, getting my gut health back, doing all of this stuff to my teeth and my mouth and the cranial stuff, just watching how much more cheerful I am as a person and watching the level of that emotion that I didn't understand why was there going down or at least needing a little bit. So that's the hard part too, is what is the person going to do? And also how, how is their self-awareness to know, like if you're scared all the time, are you going to make the best decisions? Probably not. So how does that affect? It's just a big ball of trying to figure it out.
Zac Cupples (01:00:28):
Sure. Well, and you know, you're lucky in your case, Jody, because you, you have a clinician, who's looking at a lot of different areas under one, one set of eyes or, or, or, or at least under one model. Whereas think about if you have your dentist and then you have your osteopath and then you have your malfunctional therapist and they're all looking at it from their lenses, but they don't, they don't have anything that unifies them from their approach. I mean, you think about the fear that's going on in that regard, because this person is saying this and this person saying that. And, uh, it really just, like it says, it takes a village to raise a human. I think it, it takes a team to really get people to be optimized. And if the team isn't talking together, then that's, it's hard. It's hard to get that.
Zac Cupples (01:01:19):
And I think that's probably the overarching theme with all of this is hard to find a bunch of people who can work together to help that person get to where they need to go. Um, you know, my, my friend Joe is very lucky in that regard because dr. Hochul teams up with dr. Zaggy, who's the ENT who then they both team up, they have an oral surgeon, dr. [inaudible] had, and then Joe and, and several mile with therapists who all are looking at this from one with one goal in mind. And that's, how can I make this person's airway is as good as possible. It's, it's hard to find that, you know, in one place, let alone every state in the U S yeah.
Dr Mike T Nelson (01:02:00):
Yeah. Because if you're one of the professionals in that group, right. And someone like I come in and go, yeah, I need you to help with this. And I'm gonna work with this cranium person. I'm going to work with this Milo therapy person. And they don't know any of the people I'm working with. They understand them, they get kind of fearful like, Ooh, what are you doing? You're going to muck up my results. And you're now you're doing this and that. And, you know, I think it takes a very special kind of open-minded person to figure out, okay, what exactly are you doing? What's going on? And then they have to be kind of a little bit educated enough to know what you're talking about in that area. And so finding a group that is all coordinated with each other and each know what they're doing and knowing how that's going to help the person in the end, I think is super helpful. Also, unfortunately, very rare.
Zac Cupples (01:02:47):
Yeah. Yeah. Yeah. I mean, and that's the group that I'm referring to one lives in San Francisco, one lives in LA and the other lives in st. Louis. So yeah, it's been in that case, you're still picking people from just across the U S and, you know, unfortunately for most people, that's probably not feasible, uh, to go and fly to all these places, especially when there's a pandemic going on and you want to minimize travel.
Dr Mike T Nelson (01:03:15):
Yeah. So as we wrap up, if someone's listening to this and they're like, cause it, most of the time, this podcast is about different aspects of, you know, performance and body comp and trying to increase your health at the same time. Uh, again, the reason we wanted to have you on is just to not necessarily dictate where people go, but just give them some other ideas when they get kind of, Hey, I've kind of reached a plot to everything else seems to be pretty good. Oh, maybe I should talk to my physician or look at, I sleep to try to get some type of sleep study. Maybe I should, you know, get, uh, these, the evaluation from, you know, a dentist or orthodontist or professional in that regards. Maybe they'll recommend some imaging of the airway, things of that nature. Um, where would you recommend people if they want to go down this sort of path, what, what steps would you recommend? Like where should they start?
Zac Cupples (01:04:09):
I think the first thing is a no brainer and get a sleep study.
Dr Mike T Nelson (01:04:12):
Yeah. That'd be my thought too.
Zac Cupples (01:04:14):
Yeah. Because once you have that data, it allows you to have conversations that you might not otherwise be able to have. And that's really where you got to go. And then once you have that, I think the first place I would go is likely finding someone who can get you some type of airway imaging. Um, if you can find a dentist who is someone who promotes more expansion based stuff. So if you know, you, you talk to your dentist and they say, yeah, I think pulling teeth is okay. I use re retractive orthodontics, which is basically where they pull the teeth back into place to, to, uh, make the smile look good and fit. Um, or, or they, they don't recognize that there's other sleep disorders besides sleep apnea. That's probably not the person you want to go with. You want to find someone who, um, um, appreciates the airway, uses things to, or appreciates oral posture and myofunctional therapy.
Zac Cupples (01:05:17):
That's when their referral sources, uh, uh, you know, uses things to expand the mouth structure collaborates with multiple practitioners. That's the type of person I think he really wants to try to seek out. Um, unfortunately, you know, that's, that's where you got to do a little bit of research on your own to see if you can find that person and, and realize that many times, that's not that you might have to go out of state to make that the case, but we spend a third of our lives sleeping and it's, I think it would be who view, especially if you have the capabilities to do something, to get that taken care of. Even if the best you can do is get a C-PAP or an oral appliance. Um, that's still better than nothing.
Dr Mike T Nelson (01:06:06):
Was the referral. One, one of the ice sleep was that one of them, you said that if people are looking for a referral source
Zac Cupples (01:06:12):
Yes. Um, I, I sleep hst.com.
Dr Mike T Nelson (01:06:16):
I sleep as sc.com,
Zac Cupples (01:06:19):
H a H as in Harold, S as in Steven, T as in Tom, Tom. Okay. Yep. And if, uh, hopefully they're cool with this is that if you type in HST 10, you'll get a 10% discount code. And that's the least expensive that I found for the watch Pat one. And the other thing I would say, if you ended up getting a sleep study through them, make sure you get the watch Pat one, because they have another one on there. Um, one of my colleagues got the other one. Uh, yeah. Cause you have like the, yeah, the watch Pat one disposables, the one you want, uh, the other one does not measure the RDI and that's uh, yeah. So that was the problem that we ran in. So get the watch Pat one, it's a little bit extra, but it's going to give you way more data. So you want to, you want to get that one and they're pretty good, but also too, if you're like, ah, you know, I want to just get it on Amazon. You can get them there as well.
Dr Mike T Nelson (01:07:18):
Cool. And I know you're doing work online now and what kind of work in services do you provide and how do people get ahold of you?
Zac Cupples (01:07:25):
Oh yes. So a place to find me a Zac couples.com, Z a C C U P P L E S. Um, I do a lot of different things remotely. I do movement consultations cause I'm a physical therapist. So doing things to improve your movement capabilities, if you're someone may be, you have some, some neck restrictions and that could potentially impact your airway dynamics, um, or, or you have difficulty getting your tongue into an appropriate posture to breathe through your nose. I can help you with that remotely. Um, I also offer online training as well, where we, where I basically design fitness programs that help you get your fitness goals while also respecting your, your movement capabilities and improving movement simultaneously. Because in my eyes, what I try to do is I try to get people a, the largest movement baseline that they can possibly get.
Zac Cupples (01:08:17):
So then they can go and do whatever they want. So if you have hip restrictions, that's going to limit all the tasks that you can do. I'll try to do everything I can do to improve upon that. And then the other thing that I offer online is a mentoring. So if you're, you know, a coach or a clinician and you want to, uh, do some of the things that I do, whether it's airway or improving someone's movement capabilities, because I think that goes hand in hand with airway. I can help you with that. Um, and also too, if you're someone who, uh, is thinking about going down this pathway and you're unsure where to start, you can always go ahead and reach out and I can help guide you to see if there's someone in your area.
Dr Mike T Nelson (01:08:57):
Yeah. And my advice, if people are listening, even just paying you to do a consult, to help guide them in the direction or to kind of limit, okay, this might be a good idea. That might not be a good idea to start here, if this, then that, to try to help them map it out a little bit, because it's the, the old thing, when you get into new areas, it's like, you don't know what you don't know, you know, and I'm lucky to know you. So with some of this stuff, I was able to reach out to you and I'm like, do what you need to talk to Zach. Cause I, I know enough to be dangerous. And I know there's a whole bunch of that I don't know anything about that he's going to be able to do at least help us or say, yep, this was good. And it looked for this and make sure you get this type of airway imaging, make sure they do this, this and this. Um, but for me it was like super helpful. So thank you for all your help on that.
Zac Cupples (01:09:46):
Of course. Yeah. And well, and that's the thing too, is a lot of times you might work with a practitioner and they're not going to get all the things necessary to make good decisions. Like I've, I mean, I've had some people where they've gone to the dentist and they just did like the teeth imaging and didn't do a sleep study. Well, it's like, how do we know if what we're doing is going to be effective or not? So you really I've made some of the mistakes myself or I've had colleagues who've made the mistakes. So I would definitely try to help you get that as streamlined as possible so you can hopefully get the best outcome.
Dr Mike T Nelson (01:10:22):
Yeah. And I would say, if you do find your needs, some of these procedures, as we've talked about there, they're really not cheap, you know, and paying your fee to do a consult in the end is probably going to save you a ton of money anyway, much less the peace of mind, a little bit better direction to go to. So yeah, yeah,
Zac Cupples (01:10:41):
Yeah. For sure. Yeah. I mean, if you don't have to spend $60,000 on a surgery, uh, that's always good.
Dr Mike T Nelson (01:10:48):
Yeah. Yeah. That's my new thing now. Cause I've got a couple of people that have come to me that I think are a little bit too excited about having the surgery. And I asked them like, do you really know what happens with that? They're like, ah, not so much. I'm like, eh, so yeah. I usually send them over to you or try to talk them out of it or just get them to chill out a little bit before they start having everything rearranged in their face overnight. Yeah.
Zac Cupples (01:11:18):
Yeah, absolutely. I mean, I, the surgery is always going to be definitive, but even the ones that, that we look into, which might be like a one where they advanced the maxilla and mandible forward and MMA, well that only accounts for front to back dimensions. And then, you know, what, if you're someone who needs a lot more side to side, well, maybe that's an appliance. Maybe that's a surgical procedure for that. But you know, if, if I can help you kind of guide you down that path and hopefully get you in the hands of a skilled practitioner, um, then you you're, you're going to have better success of finding what's best for you. And I think this is one of those cases where the process is still too muddy to do appropriate me-search to find out what that is.
Dr Mike T Nelson (01:12:05):
Yeah, yeah. Yeah. I always do surgery as kind of the, the last resort it's like, yep. We may get there. It it's definitely an option. I'm not an expert in that area, but I also know it's expensive. It's time-consuming and it's really, really hard to reverse. Right? Some of the worst cases I've seen in people just working with other physical therapists and people like yourself is people who've had various surgeries of we'll say questionable quality when you feel, you feel bad for them. And that's not an expertise in my area, but yeah. So, and then I always have him go back, ask your surgeon, if you wait two months, are you going to make anything worse than that process where you're going to make it really, really hard to fix if you do opt to have surgery, but that's a knee hip face, you know, whatever. And if they're like, no, you just may have some pain. You're not gonna make it any worse. Cool. Okay. Now, you know, you have a set period of time to try some other stuff and see what affects it. You may end up needing the surgery. That may be the only fixed and then great. Then that that's the fix. But yeah, I just get nervous if that's the first and only option. Yeah. It makes me a little, it makes me a little nervous personally. So
Zac Cupples (01:13:23):
Unless it's Catherine plants and you always got to go with
Dr Mike T Nelson (01:13:25):
That and that bumps right up to the top of the list, you definitely don't pass it. Go on that. I've always wanted smaller kids. You suck. Wow. We call that a unicorn
Zac Cupples (01:13:40):
Where I come from, get the big cabs. Yeah.
Dr Mike T Nelson (01:13:44):
Awesome. Well, thank you so much. Is that couples.com? I also recommend people get on your newsletter. Great stuff. Always some good hip hop recommendations in there too, which I always appreciate finding good new music, which is awesome.
Zac Cupples (01:13:57):
Yeah. And I'm definitely like backed up on my research in that regard. I made a reminder to take a day off of work just to catch up on hip hop. But uh, yeah. Well, I, yeah, I'm glad that you are. I always, I always enjoy the, uh, the occasional response is sending me some, some metal that I haven't been good exchange there. Yeah. And the hip hop you sent me the other day was, uh, yeah. RTJ is very good. So
Dr Mike T Nelson (01:14:21):
Yeah, I've been getting into run the jewels lately. I don't know why, like everyone else has been in them forever. And just like one of those bands where it's like, I liked them before and then I forgot like how good their stuff actually is. I was like, Oh, and then lately I've been kiteboarding a lot. So I've been listening to Aesop rock a lot every time before I go kiteboarding, I listened to him. So it's my, my neuro anchoring when I don't feel like I'm in a good mood, I listen to that and it makes me feel good again.
Zac Cupples (01:14:48):
Yeah. And anything in 2020 to make yourself feel good. Good. Yeah. If there's one thing that has been good in 2020, it's been the music and the memes.
Dr Mike T Nelson (01:14:57):
No, that is true. That is, that is a, a plus, especially with, uh, all the artists you can, to me, it's a, a stress test of even artists. Right. You can see who is like a legit artist and found a way to produce music or do something creative versus a lot of the other artists who just disappeared, you know, and I get that, you know, money is tight and it's a really hard time for a lot of artists, but you can see the people who as part of their DNA, they just did have to put something out regardless of record companies or money or anything else. And so for me, that's been super fascinating to watch in a kind of weird way.
Zac Cupples (01:15:34):
Yeah.
Dr Mike T Nelson (01:15:36):
Awesome. Well, thank you so much, really appreciate you coming on the podcast today. Thanks again.
Zac Cupples (01:15:41):
Thank you for having me. It's been fun.
Dr Mike T Nelson (01:15:43):
Thank you so much for listening to the podcast today with my buddy, Zach, a big thanks to my wife, Jody, for being on and sharing some of her experience that she's going through right now. Uh, again, I would highly recommend if you have questions in that particular area, uh, please reach out to Zach, tell him I said, hi, he does a great work. It's been an honor for me to do consult with him with different clients. If you are a trainer, having people in your referral network for areas that are outside of your expertise is extremely helpful. Uh, one, because you don't have to be an expert in all areas, which you're never going to be. The biggest key is knowing who to send them to, to get good and accurate information and land of physical therapy. And especially this area, Zack is definitely at the top of my list and he's got great stuff, his newsletter too, which I would recommend that you check out.
Dr Mike T Nelson (01:16:44):
So thanks again for listening to this show, thanks again to Zach for all of his time and sharing so freely of his knowledge, thanks to my wife, Jody, for sharing her experience also, and be sure to sign up to the flux diet certification. The next round will be probably, it looks like around January right now, 2021, depending on when you're listening to this, go to flux diet.com F L E X, D I E t.com. You can get onto the newsletter there. That is the main newsletter, depending upon when you are listening to this, if you're listening to it right, as it comes out, you will notice via the newsletter. I have another certification coming out on the physiologic flexibility. So how do you incorporate all these kind of new and potentially sexy recovery metrics and methods such as breathing methods, cold water, immersion, heat, uh, interval training, cardiovascular work, uh, glucose in terms of, should you avoid large influxes of glucose carbohydrates, or how does your body, uh, handle them?
Dr Mike T Nelson (01:17:59):
Uh, what about differences between nasal and mouth breathing? I cover all of that and again, a complete physiologic system to make you a more robust human being, be able to handle more stressors and recover faster. So for now you can just get on the newsletter. That'll have all the information for both go to flux, diet.com. You'll see a little button there that says, join the wait list that will put you onto the newsletter and you will get all of the updates for free. So thanks again, greatly. Appreciate it. Any comments at all, please let me know. And you can just send an email to questions@flexdiet.com or as always leave information in the reviews and iTunes or whatever your favorite podcast player is. We greatly appreciate it. It does help drive the show and I want to deliver things that are useful to you. Thank you very much. Talk to you again soon.