Kim Vopni (00:01.966)
Hi Dr. Petkus, welcome. Thank you so much for joining me. I found you on Instagram. My phone was listening to me because I was talking a lot about sleep apnea and you popped up in my feed and I've been obsessed with all of the tips that you share. I talk a lot about the correlation between sleep apnea and waking at night to pee, but I don't know the...
know how to dive deeper into sleep apnea. So I really wanted to invite you on so that we could explore this topic in more detail. If we can start out by having you tell us, tell my audience a little bit about who you are, how you became, like you went to medical school, but what brought you down the path of sleep apnea.
Dylan Petkus, MD (00:47.956)
Yeah, yeah, so I'm glad the Instagram algorithm worked. That's great. I've been trying to convince them to also listen for snoring. I would tell them it's way more effective than just looking for sleep apnea, but anyway, they haven't responded to my emails. But how did I get here? yeah, so I think with lot of these things, it's like research is me search, right? Of where like 10, 13 years ago, I forget exactly, but.
Kim Vopni (00:57.166)
You
Dylan Petkus, MD (01:16.176)
I was waking up like every like 60, 90 minutes, just like dragging through the day, starting to have this recurring dream that I was like a sardine trapped in a can and why that's helpful and also funny. When you have sleep apnea, you have like worse and worse dreams. They're scarier. That's another story for another day or perhaps today. And it was just like really spiraling out of hand. And you know, I...
People tell me I look young now. yes, was like, someone may think I'm like 20 right now. Like, whoa, so you were like seven when you had sleep apnea. I was in my twenties. And eventually I dragged myself to the doctor. He's like, well, let's get a sleep study. If you've ever had a sleep study done, you know how painfully ironic they are, right? hey, know, new place, new bed. We're gonna put.
Kim Vopni (02:05.528)
Yeah.
Dylan Petkus, MD (02:10.6)
these electrodes in your head and you gotta breathe into this and you're gonna have this monitor.
sleep normal but when I did it I actually slept way better during the sleep study which is why I was surprising when I came back with moderate sleep apnea which I feel is a term that undermines it still pretty bad because I was just like every day was awful and then next day well not next day that would be a fast turnaround so next time I went to the sleep doctor because it takes I don't know why but it takes like six to eight weeks for someone to look at a sleep lab result he's like oh yeah so you got sleep apnea
Kim Vopni (02:19.886)
you
Dylan Petkus, MD (02:47.38)
and you can do a CPAP or you can get surgery and I'm just thinking like or like no we could do neither of those. I did try the CPAP which was an awful endeavor I'm never sure if you've had the pleasure if you've been Darth Vader for Halloween it's close enough for the impact of just like breathing this thing it's uncomfortable and it only took a couple nights of trying that
I like it made my sleep worse. Some people like have it, they love it, first night, they name it, they like, you know, honeymoon with their CPAP. It's great. That's like 30%, 20 % of people. The rest of us have this more typical experience. So that's when I started to, this was even before medical school. So I started to take a step back and I was like, well, what's like actually going on here? Cause just like, you know, with public floor stuff, it's not just like,
You're you're missing some plastic and your like that's not that it's cord efficiency like there's going on that you should address And so that's why I start to you know dive more into the research understanding. Okay, like what are these mechanisms? Oh, there's a breathing problem. Why did no one mention this? Oh, it actually is literally called sleep disorder breathing Why are we not talking about my breathing? You know that kind of series of questions and That's when I start to learn more of like, okay, it's primarily a breathing disorder
Kim Vopni (03:48.429)
Yeah.
Kim Vopni (04:06.904)
Mm-hmm.
Dylan Petkus, MD (04:14.516)
So crazy thought, I wouldn't say I'm smart for having this thought, why don't I work on my breathing? And working to slow it down, because mechanistically, have sleep apnea, and this will be 10 times less boring than someone may feel right now. Mechanistically, when you have sleep apnea, there's more often than not, there's some sort of narrowing in your airway. Because a lot of people with sleep apnea, they're told, which is probably correct for the most part, depending on the examinations they've had, you have an issue with your nose, maybe it's a deviated septum.
Maybe it is an enlarged tongue. Maybe your jaw is kind of recessed back, or they'll call it a small jaw. Maybe you have enlarged adenoids. Maybe in a past life something happened. I don't know. But for some reason, you have some sort of narrowing. And that's not always the problem, OK? Because just like you can have a risk factor for something, it doesn't mean you're always going to have the thing. So what happens there is when you have a more narrow airway, then you have to struggle to get the same amount of air.
So just like if you're breathing through a straw. So if anyone ever remembers maybe in dare class, which I'm not sure how generational dare class is for everyone, to convince you to not use cigarettes, they had you breathe through a straw and run around the gym. That's what they did. For me at least. And well, I guess it worked. I'm not smoking cigarettes. So thanks, dare class. But the reason is you have a smaller tube. You have to breathe practically the same amount of air.
Kim Vopni (05:31.019)
Wow.
Dylan Petkus, MD (05:43.282)
Now during exercise, that's OK, right? But at nighttime, if you have this faster breathing pattern that dominates, you will actually create this negative pressure, this suction force, like a vacuum. And when someone has slightly more narrowed airways, if they're that much closer, the risk of them collapsing and closing off the airways exponentially higher. But if you slow down the breathing pattern, you can bypass or offset the bad anatomy.
Because just like if you have dynamite in your basement, not a big problem if you don't have matches or if your neighbor is not like, what's it, the ATF, they're in charge of explosives. You know, it's not a problem. So with breathing, if you slow down your breathing at night, then whatever anatomical limitation you have, nose, jaw, tongue, et cetera, it's way less of a problem. So first time I did it, and maybe we can do breathing exercise later as we talk through things, I thought it was the dumbest thing ever. Just like.
Well, also being your 20s, you always feel like you're the smartest thing ever and nothing's, but anyway, that's a side. So did some slow breathing exercises and then the next morning, I just remember, I thought it was a dream or someone drugged me. It was gentle sunlight into the window and birds. I'm like.
what happened? Did I just sleep through the night? Is this correct? And I did. it's because I, well, part of it was like, cause after that, like great first night and then kind of came back down, had to work more on breathing, other aspects and other parts of improving breathing and inflammation. But it was just like that quick of a initial bump and gave me a lot of hope and momentum with that. So ever since then, you know, doing the breathing exercise is more, you know, some other
Myofunctional muscle exercises Holistically as well because if you're reducing inflammation all that it will help for better breathing That's the that's the gist of that. That's how I came into that. It was all before medical school Yeah, so just I guess I was delayed going to medical school. Well, I mean, guess I guess nowadays I think you take like 14 gap years before you do something Which I think is average but that's kind of how I came to be here
Kim Vopni (07:45.356)
before medical school.
Kim Vopni (08:02.958)
Very cool. So when you completed medical school, that always your path that you wanted to focus on sleep apnea as part of your practice?
Dylan Petkus, MD (08:11.7)
Definitely sleep, definitely sleep. So in doctoring, or would you say physician, physician sip? I'm not sure the, the gerund of this, but, uh, you're pretty limited, right? 10, 15 minutes and out in the hospital. You're already like five years late on the real problem. Cool. Not really what I set out to do in the medical school essays. So, uh, yeah, very fun. So alongside that,
I was doing like online health education in these sorts of things and then have moved more into that full time. Well, not more into it, completely into that full time to, know, whether it's teaching you the breathing exercises or, you know, holistic lifestyle things. That's what I'm more so focused on fully now.
Kim Vopni (09:01.294)
Got it. Okay. So we have an understanding of what sleep apnea is. What would be, is it, is it, so you said it's disordered breathing. What are some of the reasons why somebody's breathing would become disordered?
Dylan Petkus, MD (09:14.994)
Yeah, yeah. So just as a quick definition, sleep apnea or I guess like, we'll just, go with the American Academy of Sleep Medicine. So when you stop breathing five or more times per hour at night, such that, this is a beautifully long definition, such that your oxygen levels dip by a certain amount. Okay. So it's not just a pause.
It's pause and then there's actually a physiological effect on your body oxygen levels and that's what causes damage and bad things that happen So that can be five times per hour When I got my test I was like, what was I around like 25 or 26 per hour? some of the people that reach out to me they're at like 30 40 50 60 I think 80 is the highest seems some pretty can you imagine every like every minute that's wild So that's what that is so
Kim Vopni (10:07.32)
Yeah.
Dylan Petkus, MD (10:10.748)
you may hear that from someone in your life as I saw you stop breathing last night. It was a little scary or you were snoring because of everybody was sleep apnea. 90 % of people are snores and all snores about 60 % of them have sleep apnea. So there's, I wouldn't say there's really any good healthy snoring and that's what it is. And that's just something that during the daytime, well actually first when you wake up, whether it's dry mouth, headache, brain fog, you feel
like crud, that's how it's gonna be to kind of carry through the day. then if you recognize it, great, and get some help, cool. But if not, it just gets thrown into the category of like sleep problems, you know? Have you tried meditation? Which is helpful, get me wrong, but need a little bit more. So things that can lead to that, many, multi-fold. So kind of the three big things, okay? So it's gonna be the breathing pattern itself.
So how, like what's the rate and the steadiness at which you're breathing. So the bad pattern is fast and irregular. So like, but like not at an even pace. The preferred pattern is slow and steady. All right. Number two is going to be the strength of the different muscles in your airway. Okay. So for instance,
Probably the biggest culprit is a weak tongue. Cause if you're laying on your back, have your tongue, it's weak. It's kind of like down and back. It's going to be more likely to flop and be triggered and pulled by that fast or regular inhale. Right? So that's another bigger contributing factor. And all of these things can be under the umbrella of like driven by anatomy, but there's about like 40 % of people with sleep apnea don't have an anatomical issue. So
It's not like a one-for-one relationship. So second category, I said, myofunctional. And the third one's a bit broader, because it's going to be a lot of things that effectively damage the mitochondria, drive inflammation. So a few things to cover in here. inflammation, any time the tube's going to be more inflamed, that's going to make things more difficult to get through it, whether we're talking about a urethra and the passage of urine.
Kim Vopni (12:26.926)
Mm-hmm.
Dylan Petkus, MD (12:36.1)
Or we're talking about your airway in the passage of air. So if there's inflammation, any small amount of inflammation is going to cause a big problem. Anyone who has had a kidney stone knows what that means because it may feel like a boulder, but it comes out as a pebble. so there's that one aspect of inflammation. But then also, if you have damaged your mitochondria, which is the little thing in your cells that makes energy, that's what also produces CO2.
So just like your engine in your car, you put fuel in and then it produces energy to move the wheels round and round. And then it also produces CO2. That CO2 in our bodies, not the CO2 in your tailpipe. I would strongly recommend against getting near that. CO2 in your cells will then signal to your brain, hey, this is how we should be breathing. And people with sleep apnea, obstructive sleep apnea, and also, well, mainly with obstructive sleep apnea, I'll focus the conversation there.
They have this over sensitivity. They're over reactive to CO2. So what that can manifest as is you go to the top of the stairs, you're out of breath. Or sometimes people just add a baseline. feel they just breathe heavier. People notice it a little bit more in the morning as well. There's kind of breathing a little bit faster, especially maybe if they're using a CPAP, they take it off. Their breathing is a little bit accelerated, maybe 30, 60 minutes afterwards.
because your body is in this pattern of overreacting to CO2. So if your mitochondria are sporadically making it, if you think of a cartoon car that's breaking down how it just spurts out CO2, that's basically what it is. And then your body, well, rather your brain, your brain's them. It can't properly be like, OK, there's this much CO2. Let me breathe this much. It can't really comprehend and really pick up a good signal to relay to your diaphragm of the proper rate.
Kim Vopni (14:15.928)
Yeah.
Dylan Petkus, MD (14:32.883)
to breathe. So those are kind of the big three, as I would say.
Kim Vopni (14:38.35)
Okay. What you said obstructive sleep apnea and I think I missed what's the difference between sleep apnea and obstructive sleep apnea.
Dylan Petkus, MD (14:46.804)
Yeah, so sleep apnea is going to be like, we put it in the umbrella. So it's like disorder, nighttime breathing. And then we go a little bit further down on this chart to sleep apnea. And then under that will be obstructive sleep apnea, central sleep apnea. And then between those two would be complex sleep apnea. So obstructive sleep apnea is more the physiology that I discussed previously. You have this collapse of the airway. It is blocked off. Central sleep apnea is your brain.
does not tell your diaphragm to pull on your lungs to breathe. There's no obstruction, but there's no breathing. And then complex is just elements of both.
Kim Vopni (15:31.95)
Okay, so I mentioned something that I talk about in my community is the link between sleep apnea and nocturia or nighttime waking to urinate, to pee. Why does sleep apnea contribute to nocturia?
Dylan Petkus, MD (15:51.848)
Yeah, so there's three big reasons. number one is that I sound much more well-prepared than it does like when you just say like three things. Take notes everyone how to sound very well prepared. number one is when like if you ever seen someone whistle a bad man in bed, not only is it scary like they're not breathing, but then also when they start to breathe again, it's not like a, I'm back.
Kim Vopni (16:01.42)
Yeah.
Dylan Petkus, MD (16:22.012)
It's like, it's like, it's kind of scary. And when that happens, you actually have this big buildup in intra abdominal pressure, which is probably something you think about every single day with pelvic floor strength thing. And that's one of the biggest connections. So the research has shown when someone has obstructive sleep apnea, their odds of having more severe pelvic floor dysfunction urinary and colt.
incontinence is like sixfold if they have moderate to severe sleep apnea. So a lot of that comes from the big increase in pressure and as that happens, especially in a relatively uncontrolled, unconscious environment of being like half asleep, half awake, the pelvic floor over time is going to weaken and weaken and weaken because it's just like not in a very well controlled environment. Then the second one, well, I mean, like two and three are really linked, but
I guess it sounds more substantive if we do three. But number two is one hormone or kind of chemical in your body. It's called ANP. And what that is, it's released by your heart. It helps regulate blood pressure, et cetera. But when you have sleep apnea, this becomes dysregulated. And then that will lead to more bedtime urination or nighttime urination. The bigger one.
would say is number three, which is vasopressin or ADH antidiuretic hormone. And it's the hormone that effectively tells you, we have this liquid, should we keep it? Or like over to the toilet? More so than AMP. AMP more regulates blood pressure. It does have a very similar effect to the kidneys, but antidiuretic hormone is way more impactful.
when you have sleep apnea, antidiuretic hormone is going to tell your body, hey, it's OK. Just go pee. It's fine. Which would be cool if it was the daytime, but it's not. And so at night, that's why people either they have to urinate a lot, or they get up many times to pee, but it's not a very large volume. Because also, overactive bladder syndrome is more common in sleep apnea.
Dylan Petkus, MD (18:45.876)
So then because of that disruption ADH, which is from the constant like being woken up, go to sleep, woken up, go to sleep, then that causes real big problems. So those are the kind of the main three pathways there.
Kim Vopni (19:02.286)
So if somebody was dealing with either of those three in the nighttime, would they always deal with it through the day as well? Could that be part of the overactive bladder condition? Yeah.
Dylan Petkus, MD (19:15.454)
yeah. yeah, for sure. Cause the, like the big double whammy of sleep apnea is that you have taken away your body's ability to repair and reset and then also thrown more damage on top of it. So you've gone from just not taking your car into the shop and like now you're taking your Honda Civic off-roading. So,
and it just becomes this vicious cycle. So that's why lot people have that just permeate through every hour of the day.
Kim Vopni (19:50.606)
Yeah, yeah, and ultimately, you know, the disruption of sleep is it heightens pelvic floor symptoms. just, the overall whole body repair is going to be off. So then you're going to be dealing with more and more inflammation and you you get in that hamster wheel thing. What then, from like, what would shift or what would change if anything as a woman is transitioning into menopause?
Dylan Petkus, MD (20:19.56)
Just a few things, right? Not a big deal. so with sleep apnea, it's like probably the most missed diagnosis. don't have data on this. This is just, this is my opinion, everyone. But I think it's the most missed diagnosis of sleep problems in a perimenopausal or post-menopausal woman. because like,
Kim Vopni (20:21.774)
Not a big deal.
Dylan Petkus, MD (20:50.947)
Doctors think in these like mental flow charts and algorithms and heuristics. So it's like woman in her 50s comes in, she's not sleeping well. Before you can even count to one, it's like your hormones, let's get you on a hormone replacement therapy, which can be helpful, don't get me wrong. And that's why it's a mental shortcut, because I don't know, probably 60 % of the time you're right and don't need much thought beyond that. But.
Kim Vopni (21:15.107)
Great.
Dylan Petkus, MD (21:17.812)
there's no evaluation of like, was your breathing? So if you look at the sort of, like if we chunk the age of women to like, know, 35 to 44, 45 to 54, 55, 64, like it's the prevalence of sleep apnea, how many people have it is like, you know, not that much, not that much, not that much. And then you hit the, that 45, 54 group and it's like, whoop, just like skyrockets. And
A big part of that is because estrogen is highly involved with your respiratory centers. So we then lose all that instability of, or no, I guess we gain instability or lose stability. Breathing goes to, you know, not good places. So then they fall into that fast irregular pattern and then it gets kind of completely overlooked and not thought of. And a lot of times it goes on for like,
Kim Vopni (22:00.716)
We're just, yeah.
Dylan Petkus, MD (22:13.396)
Geez, like five, 10 years. I have a lot of women that are like in their mid-60s. And they're like, I've been not sleeping for like a decade. And I just got diagnosed three months ago. I'm like, okay, that's unfortunate. Cause it's not just, cause the other mental heuristic around sleep apnea is it's a man's disease. It's a man 40 plus overweight, you know, sort of disease when.
Kim Vopni (22:29.774)
Yeah.
Dylan Petkus, MD (22:43.162)
actuality it's not. Well it is, but there's many other demographics that would fit that there. So when we go through that then it just becomes a compounded breathing issue and then also progesterone specifically is really important for the muscle tone in your airway. So your tongue, the palate, all those different ones. Progesterone goes just way down with everything else then there's going to be a sudden weakness
Kim Vopni (22:49.699)
Right.
Dylan Petkus, MD (23:11.847)
in these muscles here.
Kim Vopni (23:14.51)
Crazy. Okay. And I suspect that we're going to be doing some tongue exercises and some breathing when you're telling us how to get to help overcome this, but we'll get there. You talk about, you've kind of already discussed it, but the way you had written it out to me was compelling that waking at night is a breathing problem, not a bladder problem. And part of what, when I'm explaining to women, again, I talk about the sleep apnea connection, but
Dylan Petkus, MD (23:23.239)
Of course.
Kim Vopni (23:43.992)
There's a lot of other reasons why somebody might be waking to pee and it's also then becomes behavioral and we train the bladder. So as we are waking up for whatever reason it may be and we are responding by going to the washroom, we are now also training the bladder to signal more often. So it can create a bladder problem for some people, but the breathing side of things is compelling and that's a lot of what we talk about in terms of the relationship of the
diaphragm in the pelvic floor as well. So before we get into kind of what we are going to do about it, one other thing I want to talk about, you mentioned that it is historically been thought of as a man's disease or the overweight man. How does sleep apnea influence weight and potentially contribute to weight gain? maybe, if, and is it always if somebody is overweight, is that always a risk factor for sleep apnea?
Dylan Petkus, MD (24:41.172)
So it is a strong risk factor. However, I I literally just did a post on this today. Did you see it? But it's okay if you say no. So it can help.
Kim Vopni (24:48.557)
I didn't.
Dylan Petkus, MD (24:54.868)
But at the same time I posted it, I was like this big lie about sleep apnea. It's like all you gotta do is lose weight. And I feel like posting on Instagram or something like that's always a gamble. I'm like, is anyone gonna like this or watch it? I don't know. And then like lot of comments like, oh my God, I lost 60 pounds, still not sleeping well. I lost 80 pounds, still not sleeping well. Don't get me wrong, healthy weight loss is great. However, the research is very clear that for every 10 to 20 pound,
of weight loss, you will have a 10 % improvement in your symptoms in sleep by opting. So if we want to go from like, you know, a 10 % reduction to like a 60, 80, 100 % reduction, unless you have like 160 pounds to lose, it's not going to be the only main factor. Now it will be important. And perhaps the most important aspect is actually the visceral fat that you can have in your tongue.
Kim Vopni (25:40.472)
Yeah. Yeah.
Dylan Petkus, MD (25:51.646)
So like one study, visceral fat in the tongue. I know, right? Why would it go there? Why would it go there? So there is one study and I think just some scientists were bored or maybe they had this question, I don't know, but they did MRIs. They had person A and person B, put them into the MRI machine. And both these individuals had similar BMIs, similar body fat percentage. One had an AHI, which is like
Kim Vopni (25:53.112)
Bicerol fat in the tongue.
Huh.
Dylan Petkus, MD (26:21.556)
how many times per hour at night you stop breathing like we mentioned. Someone had like, I think it was 50 and the other person was nine. Person with 50 had about four times more visceral fat in their tongue than the other person.
So.
Kim Vopni (26:40.814)
Okay, like, do we do tongue it? How do we lose weight? Like, you can't spot train, so how do you lose weight in your tongue?
Dylan Petkus, MD (26:47.732)
Well, I don't know. I don't know. That would be interesting. Well, what was that move? Oh, geez. Is it a Christmas story when the kid licks the pole and he's stuck there? We may want to follow up. might. He might. Nobody do that. Nobody do that. So visceral fat will deposit in the tongue, and it follows visceral fat formation in the body. OK. So it'll correlate. So usually,
Kim Vopni (26:59.47)
That might work.
Maybe.
Dylan Petkus, MD (27:15.752)
Visceral fat will be like someone's in a highly inflammatory state. So when fats like, should I go subcutaneously just underneath the skin or should I go in the visceral department just to completely ruin this person's life even more? It'll make that second decision to go into the visceral department where it's more problematic. doing more things like being very conscious of like eating less inflammatory food, increasing omega-3 in a good way, it's not oxidative.
That will really reduce the visceral fat compartment tremendously and that will help a lot with the sort of the fat in the tongue there and kind of what people will say this is anecdotal haven't ran a study on this because I'm not a research center but people when they switch these like very low inflammatory diets whether it's like intermittent fasting where they're not like eating Reese's cups as part of their
or refeeding thing, or like maybe they go carnivore which is going to be a lot less inflammatory than like the standard American diet there before. Relatively short amount of time, like three, six weeks, they haven't lost much weight. I mean some weight, but like not enough to correlate with like, wow, I'm sleeping so much better. So really induce like inducing a state of low inflammation and also fat burning will help reduce that. There's not like, you know.
these tongue exercises and you'll lose visceral fat although maybe I should make that that would be interesting.
Kim Vopni (28:48.426)
I was going say, there's a market for you.
Dylan Petkus, MD (28:51.764)
Get your tongue ready for this swimsuit season
Kim Vopni (29:00.078)
Cortisol and weight gain, specifically, we can look at it from a midlife perspective, but in general, what's the correlation with sleep apnea and cortisol levels?
Dylan Petkus, MD (29:12.382)
Yes, thank you for bringing me back to the original question. So yes, it's very gonna be hard. We went on this tongue. Anyway, it was great. So when you're not sleeping well, it is almost impossible to lose weight in a way that like makes sense on paper. That's the person who's like, well, I weigh this much. This is my maintenance calories. This is my lose weight calories. I'm doing that. And...
Kim Vopni (29:16.844)
Hahaha
Kim Vopni (29:42.082)
Nothing's happening. Yep.
Dylan Petkus, MD (29:42.1)
No dice. Nothing's happening. And a big part of that is because it's because of these hormones, right? So cortisol. And then I would argue the bigger one, especially with sleep apnea is going to be the leptin function. So sleep apnea is more or less a state of leptin resistance and leptin is the hormone that tells your body, I ate this food and I feel full thumbs up. It's also going to tell your body, Hey, we're doing pretty good here. Let's burn some fat. You know, why not?
And so when that's not working then one you're gonna be more hungry food intake and then two even if you are Like in a caloric deficit, you're not gonna be burning fat. You'll be using other fuel sources as Normally as you would so and then the other thing is like trying to exercise a sleep apnea is this like pyramid scheme of like I don't have energy and the doctor says I need to lose weight to get energy and
Where do start here? It doesn't, I'm not sure that's pyramid scheme, but it's not a sustainable situation there. So that's why like a lot of times when, you know, working with people, they're like, okay, I'm gonna, you know, I really want to lose weight right away. I'm like, yeah, it's kind of, it's kind of cool that on that one. Cause once there's like sleeping a lot better and a lot more like energetic, then those things work a lot better.
because their leptin's working and then also cortisol isn't sky high. Cause whenever you're left in resistance, then also your cortisol resistance, so they're both just going to trend upwards and then just make everything far more difficult than it should be. So until we sort of correct that, yeah, it's very hard to lose weight. So that's why I like just getting those like winds of like focusing on breathing and all that. Cause you know, weight loss is still important.
But just getting those quick wins as opposed to like, all right, well, maybe in six months we'll lose 40 pounds and see how it goes. No, we can make progress way before that on the sleep front. Yeah.
Kim Vopni (31:51.564)
Okay.
Okay, so I want to get into the, you know, what are things that we can do? You mentioned, you know, you were given two options, surgery and CPAP. I, a former business partner of mine, she had a CPAP. So I have experienced sleeping next to the Darth Vader. Maybe you could argue, looks like the Darth Vader, sounds like the Darth Vader. And so I want to, you were like, no, neither of those options. What else can I do? And so you've...
Dylan Petkus, MD (32:09.608)
fun.
Kim Vopni (32:20.162)
design you've talked about on your social media as well that the exercises and so fundamentally we want to reduce inflammation. We want to stay hydrated. We want to eating the right nutrients. We want to be exercise. We want to do all of the lifestyle things first and then now we're going to layer in what can we do specific to help us overcome sleep apnea.
Dylan Petkus, MD (32:40.924)
Mm-hmm. Yeah, so I would do the breathing exercises first. That's usually how I trick people into improving their lives, but I'm sneaky. just do these things. So.
Kim Vopni (32:46.018)
Okay.
Kim Vopni (32:50.776)
Well, it's like you just said, the person who's like, I'm gonna lose weight and do all the things, but you're saying that comes after you've addressed, yeah, okay.
Dylan Petkus, MD (32:57.746)
Yeah, yeah. So with the breathing exercises and the myofunctional aspect, there's a lot of different things. But usually I like to just boil it down to kind of like the, I guess like the starter kit and then also to kind of combine them as opposed to give like, you know, here's three things. So thing number one is you want to get your tongue into this position. Well, I guess everyone just pause. Where is your tongue? When I say where your tongue is, you can't say like in your mouth.
How would you describe it? Would you say it is on the roof of your mouth? Is it just kind of hanging out in the middle? Is it on the bottom? Is tongue position something you've never even thought of until this moment? Think about that, all right? Or how would you say you were? What you say?
Kim Vopni (33:38.296)
Yep, mine is the roof of my mouth and the tip is pressing against the back of my teeth.
Dylan Petkus, MD (33:44.818)
We can't have the right answer right away. So that's the right answer. That's where you want to be. Correct. So most people aren't there because it's not something we think about. then just over time in terms of like how our foods have changed, how like kids are raised, bottles, that stuff, our oral facial development is very different than it has been. So people don't always have their tongue in the right position. So you want to have it.
Kim Vopni (33:46.51)
Oh, sorry. Okay. Okay. Okay. Good. Ding.
Dylan Petkus, MD (34:14.356)
I'm going to turn to the side and try to stay in the camera here. So most people are kind of like this. Okay. Sort of down and back here. then, that almond I ate like three hours ago coming to the fold, but I just got really choked up on these exercises and you want to bring it forward and out. Okay. So how we can do that is imagine
Kim Vopni (34:24.398)
Mm-hmm.
Dylan Petkus, MD (34:43.528)
you have some like peanut butter, almond butter, whatever you want to do, stuck on the middle of the roof of your mouth and you're trying to kind of like push it forward in a way.
Or another way, just try to like create the most suction possible between your tongue and the roof of the mouth. Okay, so it'll look like this. I'll get close to the camera here. Like that. This is very different. This is starkly different than the other way in which a lot of people get this wrong is trying to just simply press it up, which will look like this. That's, it's, that's good. Okay. That is going to help somewhat, but you really want the
Kim Vopni (35:21.965)
Mm-hmm.
Dylan Petkus, MD (35:28.267)
We'll call it the tongue cord You want to see that visible? All right and now I got to put on my podcast checklist to always make sure I brush my teeth. So That's the so that's the thing you want to hold so get into that position All right, cool and then on top of that you want to then add in the breathing exercises so there's a lot of different ones, but I think
gravitating more and more towards this one as the basic starter one because you want to progress your breathing exercises. So for instance, if you were going like, you know, those like, was it like couch the 5k exercise programs?
Day one is not a 5k. It's not. OK. The second to last day of the program is also not like, you know, run 800 meters like it was on day one. So you do need to progress. So I think this one kind of allows you to feel what those progressions may be over time. So we get into the tongue position. Cool. And then you're going to breathe through your nose. Only through your nose. OK, it's the best. OK. And if you can't.
in through your nose and then out through pursed lips. Okay. You're going to go in for four, four, three, two, one, and a continuous breath. I'm just counting. And then out for four, four, three, two, one. And then we're going to go in for four, four, three, two, one, out for six, six, five, four, three, two,
one in for four, four, three, two, one, and then out for eight, eight, seven, six, five, four, three, two, in for four, four, three, two, one, and then out for 10, nine, eight, seven, six, five, four, three, two,
Dylan Petkus, MD (37:37.696)
one and just when you thought we were done in for four three two one and then 12 which i won't you know submit anyone to and then you'll just cycle through that again because
Kim Vopni (37:40.654)
you
Kim Vopni (37:44.14)
Yeah, I got it, got it, yeah.
Kim Vopni (37:49.342)
I have a quick question before you go on. sorry. When you exhale, when I'm exhaling through pursed lips, should my tongue still be in that rooftop position? It's harder. Yeah. It should be. Okay. All right. That's what I was doing, but it was like, she's that right? Okay. Okay. Yep. All right. Sorry. Carry on.
Dylan Petkus, MD (37:58.822)
It's difficult. Yeah, it's difficult, but yes.
Yeah, that's why I breathe through your nose. Yeah.
Yeah, so that's what you'll do and you may find it's harder on certain spectrums. That's good. The idea isn't to push it, but it shouldn't be easy. It should be like slightly challenging and different people like we think of that as like a sliding scale. You can kind of, you know, go about it however you want to do. If you want to stay in the force, that's cool. If you want to do like just cycle through. So it's like easy, easy, medium, medium, hard, hard and then easy. Like you can do that.
Play with it, because everyone always finds their best rhythm with it. But that's kind of the general idea. Because the whole thing is we're slowing down our breathing. Because if we just look at the 4 in, 12 out, and I know that's 16. But I'm going to say 15, just for the sake of math here. Because nobody knows how many times 16 goes into 60. They're still trying to do that math at CERN. 15, let's say you do, that's 15 seconds total.
you're now breathing at four breaths per minute. Now, if you were doing that hospital, people would be very concerned that you're about to die, because that's like a pretty slow respiratory rate. All right. But when you do that, you get the four breaths per minute. Think of like you have the speedometer that's like faster regular breathing, slow breathing. If you bring it to the slow area, then when you go to just breathe of your own accord at night, like kind of unconsciously, it's going to fall more in the middle.
Kim Vopni (39:12.462)
Mm-hmm. Mm-hmm.
Dylan Petkus, MD (39:36.174)
that makes sense. kind of, mean, through the principles of neuroplasticity, you're just training your unconscious breathing pattern to just be a little bit slower. So we kind of go over like super slow and then end up a little bit higher from that. So that's why the other big thing, do this thing that we just did like 10 minutes, about 30, 60 minutes before bed. Why not just before bed? Because a lot of times people start it and they're like asleep in two minutes. So like you didn't really get the benefits.
Kim Vopni (40:04.557)
Yeah.
Dylan Petkus, MD (40:06.42)
Let's do it like 30, 60 minutes before bed and that'll help not only reset the breathing pattern, but then also because you're holding your tongue the entire time and it will be hard. It will not be comfortable. It will feel weird. You've been warned. It will start to set the posture for that. So then at night, instead of being, you know, floppy McTung, it's more forward there. Okay. And that's almost always a starting point for people.
Kim Vopni (40:35.982)
Cool. the, this cycle where we did, you know, four, six, eight worked up to 12. The intention is for the 10 minutes, would the intention be to ultimately be able to do 10 minutes of 412 or to always do the gradual progression up?
Dylan Petkus, MD (40:51.86)
So that would be like the progression of that would be like kind of the most difficult variant of that. That would be the 5k. Yeah.
Kim Vopni (40:56.611)
The 5K.
Yeah, got it. Okay, okay, cool. can, okay, I do something, I teach something called the core breath. And we inhale and we exhale through pursed lips, but I haven't had the tongue up there now, so now I have an extra little step we can add in just to fool people. What, the younger generation right now does something called mewing. Are you familiar with that?
Dylan Petkus, MD (41:15.454)
keep them on their toes or tongue.
Dylan Petkus, MD (41:25.65)
Yeah, I didn't know that was a trend until someone's like, I posted on TikTok, which is like interesting. I love you guys. The, like, are you mewing bro? I'm like, what? But that's effectively, I mean, I know there's other things that you do or like, I mean, some people will kind of manipulate like sucking in their cheeks, et cetera. But that's the principle of the tongue. I think with mewing, there's going to be a little bit more posterior tongue engagement, which is a
Kim Vopni (41:31.853)
Yep.
Hahaha
Yeah.
Kim Vopni (41:47.12)
It's... Yeah.
Kim Vopni (41:54.798)
Okay.
Dylan Petkus, MD (41:55.358)
difficult concept for people to wrap their head around initially, but the suctioning the tongue to the roof of the mouth is an aspect of that.
Kim Vopni (42:02.508)
Yeah, yeah, okay, okay, cool. I wanna ask you also about mouth taping. This became popular with nasal breathing and looking at the people who are mouth breathers versus nasal breathers. so a lot of, it was trend, I think it still is. It's not quite as hotly talked about maybe, but in the biohacker space, especially mouth tapings, we tape our mouths shut so that we breathe only through our nose.
If somebody had sleep apnea, maybe that they didn't know, could that be dangerous? Could it help improve sleep apnea? So I guess your overall thoughts on mouth taping.
Dylan Petkus, MD (42:42.002)
Yeah, I know the standard CYA, which people can look that up later, but the standard CYA response of doctors would be, my God, absolutely not. You're going to suffocate and die. I can't give a actual calculation or presentation of data on the risk. But what I can say is that I think
I've looked at the last like, I think five years of mortality data. So I don't know who has this job, but someone sits around and just compiles all the reasons people have died in the United States. It's a very cheerful job. And in the suffocation department, Maltape has not been mentioned in last five years. So I don't think anyone's died from it yet. Big part being is that it...
the people who find that mouth tape doesn't work because it falls off a lot of times because they're like, you know, it's it's not like it's duct tape around your entire face. OK, you can breathe through your nose somewhat. It may not be sufficient. And then a lot of times that like gasping that's strong enough to pretty much override most mouth tapes. So when I say it's dangerous, I don't think there's very strong evidence to back up a lot of I see these articles. It's like so and so from Harvard says, you know, mouth tape is going to kill you and, you know, blah, blah,
I don't really see the data behind that. So there's that. people sleep apnea use it? So there's been two research studies done on Maltabe and they've only been done in people with mild sleep apnea. So what's the benefit if you're moderate and above? Nobody knows. I would say anecdotally it's not exceedingly very helpful, but in a more mild range. So just to kind of give a...
context. So five to 15 is mild, 15 to 30, I know I overlap numbers, whatever 15 to 30 is moderate 30 plus severe. So I looked at that five to 15 group. And in these studies, I'll paraphrase the data, I'll combine these two, people were like kind of around 10 on their sleep apnea severity, maltape brought them down to like the five six area. So it can help
Dylan Petkus, MD (45:00.087)
In that regard and a lot of times when I'm working with people it's something I'll educate around if they're at that level it could be a good bridge to get to lower areas but the big thing from this studies is they actually plotted out individual responses, which great and It's it's highly individual. It's like person a went from like all the way up here to way down here person B actually got worse person C no change. It's a very individual response and in a study
Kim Vopni (45:23.939)
Mm.
Dylan Petkus, MD (45:29.044)
What that? I think it was October, November of 2024. They looked at, I don't know why they didn't use the word mouth tape. They could have, you know, ruined the trend a little bit, but they didn't. They were investigating if they forced people to close their mouths while breathing. I'm like, just say it. What determines if that's helpful or not? And the number one determinant is what is your baseline ability to breathe through your nose?
Kim Vopni (45:47.502)
Yeah.
Dylan Petkus, MD (45:58.228)
So people who can't breathe through their nose, forcing it does not make it magically better. Some people who already have some capacity, then they just take that from like a B minus to an A plus by doing that there. So improving nasal breathing before doing mouth tape will be a sequence of steps there. Because just going for a right away, I don't really think so. I mean, I do.
educate around it if someone's like at a certain level where what I've shared it would be beneficial at those higher levels there's There's many more fish to fry and then the other big thing is that it's kind like the I always mess this analogy up like the what is the The tail wagging the dog. That's the saying right? I think so. Let's just agree on that. So
Kim Vopni (46:32.206)
Mm-hmm.
Kim Vopni (46:38.318)
Mm-hmm.
Kim Vopni (46:49.506)
Yeah. Yeah.
Dylan Petkus, MD (46:53.608)
We had to ask why is the mouth opening at night? Because nasal breathing for the most part is the preferred way unless you're sprinting or running or whatever. And most people, unless they've had something done to their nose or an injury or an accident or severe allergies, whatever, nasal breathing can be done in a baseline. But at night, again, we come back to that fast or regular breathing pattern. And when that happens, not only does it pull things back,
But when you have that sort of vacuum effect, if we imagine the back of the throat, the physics of the airways have to decide what is the path of least resistance here. Is it through these two narrow holes? Because we got a whole lot of air. We got a lot of air. It has to move. What's the path of least resistance? Is it two narrow passages? One big one.
And the one big one is going to be what happens and sort of prevails and gets popped open. And you can even, mean, because sometimes people are like, that true? Well, here's a little experiment, a little Bill and I for you. Uh, if you do like the, this is something else I saw on Tik Tok. like it's like sort of like fish pucker thing. I sound like I'm like 90 years old now. Uh, it was whippersnappers. So you do that and it's not so much the tensions in the lips.
Kim Vopni (48:07.342)
Yeah.
You
Dylan Petkus, MD (48:18.876)
It's like right behind it. Okay. And then when you're in this position, inhale as quickly as you can through your nose.
Okay, mine usually pop open a lot more. It's like the sniff of sniffs, like the champion of stuff. So mine will pop open there, maybe because I've had weaker lips, but when I do that there, because that negative suction force will just kind of peel things open in that sense. So that's why nasal breathing, slowing down your breathing, would be the actual like fixing the core things as opposed to just
Kim Vopni (48:31.726)
Take a sniff.
Dylan Petkus, MD (48:59.454)
taping it up there.
Kim Vopni (49:00.642)
Yeah. Okay. So one last thing in terms of people who are waking at night to pee, go get evaluated, go get a sleep study done to get tested would be the first step. And if they have sleep apnea doing these exercises and other ones that you share, is there anything else that they should be doing to overcome that waking that nocturia?
Dylan Petkus, MD (49:25.106)
Yeah. the, and this is something to run by your doctor, everybody out there. Okay. You know, pointing there. So the pointing peacefully. So a lot of times what would be very helpful is actually ingesting a little bit of salt before bed. Now, again, if you're on blood pressure, red is all that talk to your doctor and doing this and doing it in a little bit of water. Cause obviously if you drink salt into a lot of it, a water, like what did we accomplish? Not much. And
What this salt will do, and when I say a little bit of salt, I'm talking like 1 1⁄6 of a teaspoon, 1⁄8 of a teaspoon. This is not like you're not diving into the Dead Sea. This will increase ADH. So then your body is like, let's hold on to stuff. Because normally, it's low, so you don't have that signal to hold on to things.
and then things are gonna go out. So it'll raise it, keep things in there. And usually when people do that, like maybe they go from like three or four times a night to like maybe one to two is what I'll typically see happen there. So it'll reduce it, maybe it doesn't make it go all the way away, but helps a lot with that.
Kim Vopni (50:42.958)
Very cool, very cool. Where can people follow along on TikTok or Instagram and what's your website?
Dylan Petkus, MD (50:49.908)
So many ways, so many ways. So yeah, Instagram, TikTok, YouTube. Started posting on X and threads, which has been interesting. So totally up to you. If you guys like text, into you. And then apneareset.com, we're kind of shifting things around with our website, because that's a way easier name to remember. So the website's apneareset.com. Those would be other places. And if you can spell my last name, then you can.
You definitely have the internet search capacity to find me on YouTube. All the places.
Kim Vopni (51:22.284)
all the places and I'll have the links down below as well. So this has been super interesting. I'm gonna change around my core breathing and I'm gonna make sure I've got my, I'm gonna slow down with that cycle. Thank you for sharing that tip. And yeah, I learned a lot. Thank you so much for your wisdom and for all the work that you do.
Dylan Petkus, MD (51:40.116)
Thanks for having me
