Your Sleep Deprived Patients: How it Affects Your Cases

Welcome to The Dr. Phil Klein Dental Podcast. I'm Dr. Phil Klein. Today we'll be discussing sleep deprivation and how it's impossible to be a poor sleeper and enjoy optimal health and vitality. 60% of people report problems with sleep quality and quantity. The results of this are chronic inflammation, insulin resistance, stubborn fat, poor judgment, weaker immune systems, cognitive decline and memory loss and there's probably a lot of other things that i didn't mention that are associated with sleep deprivation so we can all agree our dental patients don't escape the fallout of sleep deficiency and it's important to us as healthcare providers to understand the dental implications of all this so to sort it out for us here today our guest Dr. Uche Odiatu he's the author of miracle of health a professional member of the American College of Sports Medicine and a practicing dentist in Toronto. He has given 500 plus lectures in various countries and has lectured at the ADA annual session 14 times since 2006. That's impressive. He has recently presented an amazing webinar on Viva Learning titled The Value-Added New Patient Exam, Four Patient Lifestyle Habits That Influence Healing. So I encourage everyone to watch that recorded version. of that webinar. You can find it on vivalearning.com by going to the search field and typing in Dr. Odiatu’s name. It's spelled O-D-I-A-T-U, Odiatu. And if you type that in the search field, you'll find his webinar that I just mentioned, which is really worth watching. Dr. Odiatu, it's a pleasure to have you on Dental Talk. Hey, thank you. I love sharing. If there's an opportunity to share my passion for total health, I am there. So I appreciate the invite. Yeah, and we're getting more and more discussions on the mouth-body connection, and we're really glad to have you on, especially with all the stuff you've done and teaching, you've published. So we're very, very happy to have you on the show. So to begin, what does sleep deprivation do to the body? Well, it's amazing how destructive it is. I think, you know, on January 1st, people make all kinds of health resolutions about losing weight, stopping smoking. exercising but in 25 years of uh being on the road and sharing i've never heard anyone say this year i'm going to sleep more for some reason people think sleep is automatic but sleep is so foundational anytime the body's not sleeping well the body starts breaking down and is unable to repair from the day's awake state the awake state is catabolic the sleep state is reparative and anabolic I can't agree with you more. In fact, the other day I took a walk in my neighborhood and there's an elderly woman who's well into her 80s. And I said, boy, you have a lot of energy. And she goes, you know what? I made sure that throughout my whole life I took naps and I slept well. That's what she told me. So I thought that was very ironic that I just had this discussion with my neighbor or almost my neighbor. And she's certainly one that takes sleep seriously. And I agree with you. Sleep deprivation is something that could really starve the body. of a system that allows us to heal and many, many chemical reactions that occur in our sleep that we're not aware of. So how does this affect the dentist? Like, why is this so important to the dental practitioner? Well, everything we do is a stress to the body, like whether you're scaling and root planing, you're debriding, you're taking away calculus, whether you're putting in an implant, whether you're extracting, whether you're placing retraction cord, whether you're placing a Tafelmeyer band. whether you're polishing a margin below the gum line. Everything we do requires is almost like an insult to the body. Sure, you're doing something good, but it's an insult to the body. And the body has to heal and bounce back. Basically, during the day, the human body is on standby. But the immune system, all sleep scientists agree, it goes into high gear at nighttime. So anytime the body's not sleeping well, the body's not healing well. In order for a patient to be a good healer and respond well to our treatments, it has to heal well. This is why, you know, 70% of patients who aren't sleeping well, they are unable. They're sabotaging the good of their intentions, the good of their clinical provider. So you're a dentist in Toronto, and you see a lot of patients, and you're also obviously really tuned into the miracle of health, your book and so forth, and all the teachings that you do. What do you do in your practice to not only identify sleep deprivation, but how do you... handle that with your patient and how do you address that and how does it affect your treatment? Yeah, great question. I think on the new patient exam, I bring up sleep and people often think it's all about not snoring. And I say it's much more than that. I tell them it's, it's quantity and quality. And I said, I've times on again, I said my patients who are poor sleepers are poor healers. So if you are sleeping less than seven hours a night, or if you're a shift worker, which is about 30% of patients, or one in three, they're not going to respond well to the things we do. So I said, a lot of what we do here, you'll spend maybe two to three hours a year in our office, but you spend, you know, 88,600 hours at home. So I said, a third of that is spent sleeping. So I said, when you're sleeping, you're healing. So that is something new for most patients. On the post-op instructions, I share with them about the only time the patient's going to heal after an extraction is at nighttime. And most patients hear, oh, don't smoke, don't suck through a straw, that kind of thing. But many people don't realize it's the sleep where the body heals and repairs. So it's so foundational. But I think the best coaches in the NFL, the NBA, the NHL focus on the fundamentals. But everyone looks for the esoteric, the fringe things that get people healthy. But sleep is so foundational. But 70%, the research shows that 70% of patients, 70% of North Americans. don't get the 79 hours of quality sleep that they need each night for basic optimal health. Yeah, and I'm sure that that's the case. Now, what about rough patches where you kind of sleep for two hours, you kind of wake up, try to fall back to sleep? Is that dangerous as well? I mean, is that considered deprived sleep as well? That's also an issue. You see people actually, when they have interrupted sleep, the stages have to start over again. So they go one, stage one, two, three, REM, rapid eye movement sleep. one, two, three REM. And it takes about 90 minutes for an adult to go through each stage, one, two, three REM. What happens is if you interrupt it with a nighttime awakening for the bathroom or one of the second most common insomnia is sleep maintenance. People don't have a problem getting to sleep. They have problems staying asleep, just either having a glass of wine before bed or eating a heavy meal before bed or just a higher cortisol. So what happens is these people aren't resting deeply. So anytime that sleep is interrupted, that person will wake up feeling unwell. So even though they might've been in bed eight hours or nine hours, if the sleep efficiency, which is they say after age 60, it's about 70%, they are gonna age poorly. They'll have background levels of chronic inflammation. They'll find themselves not being able to heal or grow after a hard workout. And they'll have troubles with healing after an implant. And all these companies are worried about peri-implantitis. And we talk about strengthening the clinical protocols. But we don't realize that 90% of it is in the patient's court. And a person who's not sleeping well is sabotaging everything we do. And this is where it comes into play. What can we do to support them? What can we do to help boost their realization? Many times for the first time in their lives, how important sleep is to the overall healing procedures. So what can we do as dental practitioners to help them through this process where they may be compromised? poor sleep. Let's take a look at periodontal disease and you're doing scaling root planing and you want to get the soft tissue to heal and you're having some problems getting them to getting the tissue to heal properly what are some of the things we can do well the whole idea about if someone's sleep deprived which is 70 so seven out of ten patients are sleep deprived it's really hard habit to turn that runaway freight train dr phil talks about many people's problems are a runaway freight train so it's really hard to stop a runaway freight train but what they can do though is that night they can get themselves better oral hygiene products. And it sounds so glib, but simply, you know, people love an easy step. Many times, the first step to health is gargantuan, you know, hiring a trainer, going for polysomnography and booking that appointment. But it's about lowering the inflammatory burden. So I talk about, you know, the hygiene appointment, we're lowering the inflammatory burden. I talk about replacing some bulky crowns with better contoured crowns of lowering the inflammatory burden. Because sleep, Poor sleeper is inflammatory. Things like a power brush. You know, think of the Sonicare. Think of the power flosser. You know, these things, the water flosser. This is actually, these are lowering the inflammatory burden. So they can go home on the way home, go into a drugstore, go into a department store, and buy some products that lower the inflammatory burden. And maybe over time they can become better sleepers. But people often want to find, want to have an easy first step to health. And I think when the first step is easy, now... They have early success. Now they feel successful and now they're ready for the next thing. So I really like sharing with people easy first steps because most people's prediction is the first step is huge. And that's why most people don't even get started. Yeah, no, that's a very good point. And that sounds like a coach, which I think you are actually in your sports medicine. part of your life and it does sound like the best way to go because if you try to reach a goal and the first step is like you said is so large it's like oh my god i don't know if i can do that and they never do anything so by taking a smaller step and actually addressing the local inflammation like you said reduces the burden and then you kind of worry about the big issue which is the sleep deprivation next and you can address that but at least you're controlling the local inflammatory burden in the mouth is that the point Yes. And I think many people, and again, you look at you and I, we're discussing something, the science, some of it's new age, some of it's prevention, some of it's complementary. I think many people have a hard time getting their head around it. So many, chair side, you don't have an hour, you don't have six months of coaching. You basically have two or three minutes to share with them how important it is. But a big part of that is looking the part. I think when the clinical provider looks healthy, when you yourself... walking the talk, the communication comes across as a lot more authentic. And I think when it's authentic, it's patients, I call it, they suspend their disbelief for our certainty. And it's our certainty in our products. It's our certainty in our treatments. And it's our belief in lowering the inflammatory burden that gets people like, you know what, this person, this, you know, this hygienist, this dentist is saying things a little differently. I'm going to suspend my disbelief and I'm going to move towards healing. And basically, it's that shift in perception from something that we do to them that they can do themselves. Now they are participants in their own healing. So, you know, they get some products. They have some early success. And that's what I see. I like to see that shift in how they look at me. It's not something I'm doing to them. It's something we're sharing. And ultimately, it's something that they do at home because that's where they spend most of their time. You know, 8,600 hours a year is spent at home. Two to three hours is spent in our office. Yeah, and that's a great way to interact with your patients. And it's a total health approach, which I think is becoming more and more prevalent in a lot of offices, especially in the initial engagement with the patient. So once you get them into the routine of doing things at home, and you mentioned some Philips products, and I'm sure there are others that help them reduce the local inflammatory burden in the gingival sulcus and in their mouth in general, do you recommend something to them about? trying to find a way to sleep better? Well, as much as the fact that, a great question, as much as the fact that they've actually come to me, and I've had my own polysthmography, I've had the sleep study, you'd be surprised how many people are actually a little resistant. It sounds like something a little scary. Anytime something's a little scary for patients, they have some hesitancy, which means they'll probably postpone doing it. So as little as something like a sleep mask, you know, a huge part of the brain is for visual input. So the minute you have some blackout curtains, the minute you have a really dark room, And if patients have a spouse or a partner that watches CV or reads, I say, you know, a $5, $10, $15 sleep mask, which they get at a travel store or a drugstore, immediately blocks that light. So now we've given them a $5 to $10 to $15 solution. And I'll mention, you know, about having cool the room. Many people want an ambient temperature of, you know, 72, 74 degrees Fahrenheit. But, you know, sleep scientists have shown that 65 degrees. is the sweet spot it's the temperature that the body loves in the ambient room which allows you to get under the covers and that's where you have the deepest sleep where you'll actually sustain deep sleep for the seven to nine hours which means not leaving the bed you know you could have some nighttime awakenings but you're not going to get out of bed because the body is enjoying the stage one two three and the REM sleep so um having easy solutions like a sleep mask um keeping the room cool and it seems so basic but many of the best coaches in you know professional sport It's the basics that they really push into the players and that's where they master. Yeah, that's interesting. What about supplements regarding melatonin or L-tryptophan? What's your thoughts on those? From what I've read and some of the sleep scientists now out of Berkeley and Stanford, they're saying that melatonin works best for the 70 plus year old patient or client or customer, 70 plus. Under 70, many times melatonin is a placebo. And in Canada, what I've heard with a lot of supplements, it's not very regulated. So you might think your tablet or your capsule says this contains melatonin. How much melatonin does it really contain? You know, how much is really inside? So supplements is one way, but I think foundation is sleep mask, you know, keep the room cool. Don't have a big meal before bedtime. You'd be surprised how much energy digestion takes. So one of the biggest users of energy is digestion. So if someone eats within two hours of bedtime, eats a fairly large meal, their body will spend almost majority of the night. digesting food. And after eight hours, they'll wake up feeling unrested. So also not drinking a glass of wine before bed. Many people have a nightcap of a glass of wine or a scotch or some drambui. These help you get to sleep, but they don't help you stay asleep. They encourage hypoglycemia. It also shortens the REM sleep and people dream less, which is a big part of feeling rested because it's during REM sleep that the body processes emotion and processes memory. So a lot goes into it. I think a lot of people want the one one fix-all, but you've got to approach it many different ways. For the patient's expression or the patient's age or the patient's financial means, I will alter it. And you've really got to be flexible and see where the patient looks engaged. And you've got to look right at the patient and saying, okay, this patient's kind of not really engaged. Let's change subjects. So let's approach it differently. So it's really important for the clinical provider to be aware of when you're getting the patient's attention to really see where the most impact is to get them healthy. Yeah, there's a lot of psychology there and you need a lot of experience, which you have to make that judgment to make sure you're going the right direction with your conversation. This has been very helpful, this podcast. I want to wrap it up because I know we have another one on nutrition essentials for the busy dental professional. I'm excited to do that with you. But just to end this one, last question, maybe it sounds silly. What about napping? Does taking a nap during the day make you? less likely to have good sleep at night or does it add the value of some extra sleep that will help you heal and make up for possible sleep deprivation during the night? Yeah, you know, elite performers, elite athletes are big nappers. And, you know, Matthew Walker is a neuroscientist out of Berkeley reports. I've heard Michael Howard, PhD neurophysiologist say that a 20 to 30 minute nap before three o'clock. So after three, you start disturbing your regular nighttime sleep cycle, which is you don't want to do. But before three o'clock, 20 to 30 minutes is equal to an hour of solid slumber. But if an athlete wanted more growth hormone, if someone to integrate, you know, newer, new athletic patterns, you know, napping is one way to do it. So the average patient is thinking, hey, I'm not an athlete. Why would napping help me? Well, you want to integrate new learning. you want to have growth you want to be better at managing blood sugar and all those happen when you're a better sleeper so if 20 to 30 minutes helps the athlete it'll help the busy new mom it'll help the busy student uh it'll help that we're all many people now are working from home so 20 to 30 minutes at home you know you nap before three o'clock it's equal to an hour so that's it's an easy way to get and the science shows you know napping helps support the body rest and and getting that repaired in sleep mode and this woman who takes these walks in my neighborhood in her 80s says that she's lives by taking naps for the last 50 60 years she says she tries to take a nap every day and it's working for her no this makes tremendous sense and i i don't mean to use a single example as a basis for something but with your knowledge and and the literature i i've heard that before and um it's something certainly to consider if If we have the ability to take that time out during the day, and like you said, before this podcast, we talked offline with everybody rushing to achieve things and do things and take care of the family. It's not that easy to block off 30 minutes and get that nap. That's for sure. Dr. Odiato, I appreciate the input that you've had in this podcast, and we look forward to having you on others. And again, please tap into... Dr. Odiatu's webinar, as I mentioned earlier in the introduction, the value-added new patient exam for patient lifestyle habits that influence healing. Something you really should see. It's available on vivalearning.com. Just search Dr. Odiatu's name and you'll find it. Thank you very much. We appreciate it.