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Scot: All right. Do you have any questions before we start, Neil? Anything that you want to know? Anything that'll help you feel more comfortable?

Neil: No. I mean, just thanks for having me. I didn't contact you guys for that. I just wanted to know how to treat sleep apnea, but it's great to be a part of the show, so thanks. Yeah.

Scot: Well, that's the danger of reaching out to us, is we might have you on the show. No, we really appreciate you being on the show. This is something we'd like to do more of, but it can be really challenging getting listeners to interact. There's not a lot of interaction. We like that because it's about men talking about health, and we like as many perspectives as we can get.

This is "Who Cares About Men's Health," offering information, inspiration, and a different interpretation of men's health. My name is Scot Singpiel. I bring the BS. As always, the MD to my BS, Dr. Troy Madsen.

Troy: Hey, Scot. Good to be here.

Scot: Mitch Sears, as always, in the mix. We always love having his perspective on the show.

Mitch: I'm happy to be here.

Scot: And we are so excited. Our guest of honor this episode, guys. We have an actual listener joining us.

Troy: Yeah, it's exciting.

Scot: His name is Neil. Neil, welcome to the show.

Neil: Hey, thanks for having me. I'm super excited to be here. Big fan.

Scot: We're super excited. Oh, did you hear that? He's a big fan.

Mitch: I know. What the heck?

Troy: Do we have competition for a number one fan now?

Scot: I don't know. I thought we just had one fan.

Neil: I'm it.

Scot: "Who Cares About Men's Health," changing one Neil's life at a time.

We talk about health turning points on this show, that moment when you knew something wasn't right, and as a result, things needed to change. And listener Neil contacted us about a couple of other questions he had, but as he was doing that, he told us a little bit about his health transformation. We were so intrigued by it, we wanted to find out more.

So this is what Neil had told us in an email. He's 50 years old. He's in better than average shape for a 50-year-old. Works out five to six times a week, runs mud races, takes deliberate walks every day, eats healthy, drinks alcohol only occasionally.

Raised his testosterone from 300 to 450, which puts you right in the zone there, man. That's awesome. And that was done by changing his exercise. He said that he ended workouts that thrashed him, like CrossFit, and instead is doing more lifting. And then started eating healthier based off the show as well.

So we wanted to find out about your story. Before, what was it that molded kind of your opinion or your ideas of health, exercise, nutrition, and sleep that caused you to live the life that was the life before, this kind of extreme life it almost sounds like?

Neil: Yeah, I think that's exactly right, Scot. I was doing way too much. I was doing CrossFit in the morning. It would be nothing for me to get up, do CrossFit 5:00 a.m., 6:00 a.m. in the morning, finish that at 2:00, 3:00, go for a four- or five-mile run, and then maybe even do something at night. That happened as well in preparing for different mud races and things of that nature.

And as I age, which is one of the things I learned from you all, I wasn't losing weight, I wasn't gaining muscle. In fact, I was gaining weight and I was gaining it around my belly, which I knew was bad for my heart. So I kind of knew a change needed to occur.

Troy: So it sounds like your change was really kind of the opposite of a lot of changes we hear about. Your change was definitely not ramping up the exercise, but reassessing the exercise you were doing and just saying, "Maybe I'm doing too much or I'm doing the wrong things."

Neil: Exactly. So what I noticed was, and I think I wrote this to you guys, I felt like I was living the bad commercial that I think all men hate. Your testosterone is low, you're gaining belly fat, you're agitated, and you can't concentrate.

Scot: Don't want to be that guy, do you?

Neil: No. None of us want to be that guy. And as I approached 50, I thought to myself, "I've got to do something different. I'm pushing myself so hard." And so I started doing research, and what I realized is that the stress workouts that I was doing were causing what I believe to be a major increase in cortisol.

And so I learned from one of your previous guests that the only way to naturally raise testosterone was to lift weights. And I had stopped lifting weights because I was taught lifting weights makes you gain weight, and I wanted to lose weight. So I had the completely wrong concepts on what I was trying to accomplish.

Scot: Yeah. You wanted to lose body fat. So what was your diet like? Was your diet kind of the same?

Neil: Yeah. My diet was pretty rigid. It was paleo and I ate a lot of meat, which I don't do anymore. I feel so much healthier eating the way I'm eating.

I want to explore the Mediterranean diet that you guys recommend. But I eat really high quality carbs, split grain bread, quinoa, those types of things, vegetables, and I eat small portions of meat. And I feel way healthier than I used to feel eating paleo, which was high meat, high fat, that type of diet.

Troy: And a couple of things you mentioned I'm curious about. You said you weren't doing any weightlifting. Were you doing any resistance training at all, like push-ups, pull-ups, sit-ups?

Neil: I was doing some push-ups, pull-ups, sit-ups, but not enough. Those were add-ons, if that makes sense.

Troy: Okay. But you were doing quite a bit of CrossFit though, you said, so I imagine you were getting some resistance training there.

Neil: Yes, some there. What I learned from CrossFit is you would do the resistance training and then you would go and do the AMRAP or the EMOM or whatever the next part of it was. And for me, I don't know, maybe I pushed too hard, but I would be completely thrashed by the time it was over. And I would feel awful. I'd crash on the ground.

Then what I noticed is I was falling into the trend of overeating afterwards. That's when I started realizing I need to make a change.

Troy: And was there one thing specifically? You mentioned you noticed increased belly fat, increased weight rather than losing weight. Was there one specific moment? Was it your testosterone check that really triggered this reassessment, or was it more of a process as you just noticed things were going the wrong direction?

Neil: I think it was more of a process. And actually, I was talking to my doctor, who's my best friend, but I don't go and see him, and we were just BSing at a bar having a beer and dinner together.

Scot: That's my kind of doctor visit. That's good.

Neil: Right? And I said to him, "Man, I'm doing all these events." And I told him what was going on. And he said, "There's a lot of evidence that that can actually do the reverse."

And so I didn't really follow up with him, but I decided to do some research on my own, and that's when the cortisol discovery came up. And I kept reading, "Take Ashwagandha. It fights cortisol." And then I realized cortisol is caused by stress. And so I thought, "Maybe I should stop stressing my body to this extreme." That was the process that I went through.

Troy: And it sounds like realistically you were doing, at least just from what I heard, two to three hours of pretty high intensity exercise every day.

Neil: Yes.

Mitch: Wow.

Troy: Yeah, that's a lot.

Scot: Yeah. It could be super frustrating too, I bet. You're exercising, you're eating what you think is healthy, and you're putting on body fat. That must have been really super frustrating.

Neil: It was super frustrating.

Troy: Were you monitoring your body fat percent during that time, or was it more just you noticed the increased body fat around your waist and on your belly?

Neil: No, I was not. I don't have percentages, but yes, my pants were getting tight. The usual.

Troy: Yeah, that's incredibly frustrating.

Neil: Yeah.

Scot: So where did you get your ideas about fitness? What brought you to be doing three hours of exercise a day and eating paleo? Where did these ideas come from?

Neil: Yeah, that's a good question. I'm not totally sure. I played sports in high school and in college, and I think it just came from media. I just thought that's what you're supposed to do.

And the American way is . . . which I love America, I don't mean to sound negative, but it's "push harder," right? Everything is "push harder, push harder, push harder." So that's what I did.

And I've taken more of a . . . Well, I've adopted your four pillars of health or whatever, four foundations of health. And I meditate now and just do some things quite a bit different.

Troy: But I think it's not at all uncommon. We always think if we're not getting results, you've got to do more of it. It makes sense, I think, for most of us to say, "Well, if I'm not losing weight exercising two hours a day, I should probably exercise three hours a day."

Mitch: And not just that. I mean, I'm really empathetic and resonating with the story, even though I think I come from a very different background. It's just this idea that whenever I was struggling with either my weight or feeling healthy enough or liking how I looked in the mirror or whatever, the thing that I tried to do was work harder, right? I'm not lifting heavy enough or I'm not doing the right program or whatever.

And I'd find something on Reddit and I'd commit to it for a week or two. I'd choke down 12 giant chicken breasts every couple of days or whatever, and I just felt like garbage. I felt tired. I didn't see any real results.

It's so interesting to hear that someone who was very active and who was doing these other things was kind of experiencing the same thing. If you are pushing yourself far too much, it's not going to get . . . I mean, it's not sustainable. It's not good for your body.

Scot: It's counterproductive.

Mitch: Yeah.

Scot: I'd like to share my experience. I wanted to put on some muscle, so at one point, as more of an adult closer to my age now than my age a while ago, I was lifting really, really heavy and doing heavy squats and that sort of stuff.

And I'm sure I was not doing them in good form. I'm sure I was trying to put too much weight on too fast because I had a bit of an ego going and I had this goal that I wanted to lift more weight, so you just put more weight on, right? You don't think about those things.

And then I'd come home and the next day, not from muscle soreness, but just . . . I don't know. It was just muscle fatigue. I could barely squat down and pick something off the floor. And I'm like, "What good is this kind of exercise routine if I can't live my daily life?"

The other thing that would happen is when I would start exercising, even where I wouldn't consider it pushing myself super far . . . it's almost embarrassing the little amount of weight I would do . . . I would notice I would start getting sick every time I started exercising again.

And I think possibly what I was doing is I was just doing too much for what my body could handle at that moment. You've got this built-in recovery system, and if you stress it too much, not great things start to happen. You start to get sick. You start to experience some of the things that Neil experiences.

Neil was going a lot harder than I was, which I'm a little nervous to say. I mean, that's been my observation. So that's really changed my opinion on what is fitness. It's about getting that dosage to be healthy, to have a healthy heart, to have healthy lungs, to have healthy bones and muscles, and to do the things I want, not to take over my life or make it so I can't do the things that I want. So that was a big reframing for me.

Neil, do you have any thoughts on that? Any additional thoughts?

Neil: Yeah, it's been great for me because I actually have more time to do other things that I want to do, like spend time with my family. So that's been great.

And I'll tell you, I probably will do another mud run because I'm curious to see if I can still go as fast as I used to. I have a feeling I can. In fact, I think I can go even faster because I think I'm a lot healthier, and that's what's exciting to me.

So I get up, I lift, I go for at least a one-mile walk every day, and that's about it. And I lift for about a half hour. Then about every fourth day, I do some type of HIIT workout that's about 20 minutes. And then about the 10th day of my routine, I do a big stressor, but I take the next day off. I feel way better. I'm actually excited to give it another shot at that.

Troy: So you said you're now doing 30 minutes of weights a day, a one-mile walk. How much cardio are you getting? Are you getting a decent amount just with the weightlifting or how's that looking?

Neil: Yeah, the cardio . . . so I get the HIIT. I think I get enough with the walking. My resting heart rate is about 57. So I feel really good about my cardio. My run times have all been . . . I run at 5,000-feet elevation, and my run times have all been sub-9-minute miles, which is good for me. I feel like my cardio is doing great. I mean, if you have another suggestion, Troy, I'd love to hear from you.

Troy: No, I think you just find what works for you. I was curious just how you perceive the cardio and if you feel like it's dropped off too much, because it sounds like before you were doing a lot of cardio. So I'm curious if you feel like you found a good balance there and exactly where things are.

But just the fact that you're getting your heart rate up and you're doing it every day, that sounds like that's what you need and it's working well for you.

Neil: Yeah, I think it is. Thank you.

Mitch: And one of the things that kind of . . . a thought that just kind of entered my head is that's the same approach that a former guest and listener Robb experienced. His approach to fitness and his own health was work out 30 minutes a day, run a couple of times a week, whatever.

But that's not what we hear when we talk about health and fitness, right? We hear, "You've got to push yourself harder. Oh, you've got to do whatever." It's not just a consistent, livable, reasonable kind of approach to your health. That's not what we hear.

Scot: Hey, Neil, it sounded like a lot of your thought of health . . . We do talk about the Core Four, exercise, nutrition, sleep, and emotional health. It sounded like before it kind of really focused around exercise and nutrition more and sleep and emotional health weren't quite at the forefront, and you've kind of brought those to the forefront. Is that accurate?

Neil: Absolutely.

Scot: Yeah. Tell us about that.

Neil: Well, if you remember, Scot, I originally emailed you about sleep apnea. I was diagnosed with moderate sleep apnea. My doctor friend recommended a CPAP. I don't really want to do that, so I'm still working on it. But I do know that I've lost about 16, 18 pounds doing what I'm doing. I have been sleeping way better, and my girlfriend says I do not seem to have the apnea like I did when I was heavier. So that's good.

I meditate every day in the morning, and I do a gratitude/grateful journal every night. And it's funny because I started the grateful journal literally the same week you guys did your show. I was like, "Oh, these guys. I'm their number one fan."

Scot: It didn’t freak you out a little bit, like, "Where's the camera, guys?"

Neil: It did freak me out actually. And actually, some of Mitch's stories freaked me out too because I was like, "Man, yeah, I know what he's talking about there."

Troy: Wow.

Neil: So anyway, that's really helped. I really feel very healthy. I feel better now at 50 than I did at 45 when I was doing all that stuff.

Troy: And it sounds like a lot of . . . The theme of this is just more balance. And it sounds like you're finding a lot more balance. Scot mentioned you were very focused on diet, but it sounds like it was not so much a balanced diet. It was just more of an extreme paleo diet where, again, that theme of balance has come more into your diet approach while also focusing on these other things as well.

Scot: Did the Neil before think the paleo diet was considered eating healthy? And what does the Neil of today think of the paleo diet?

Neil: Yes, to answer your question. Yes, I thought it was healthy and I was . . . When you go to the supermarket, you see all the magazines and everything else, "Eat paleo." So that's what I did.

And yeah, I did think it was healthy. The Neil now says no way. I just feel way too good or way too well to ever eat that way again. I actually like carbs. I have avocado toast every morning and I love it.

Troy: Nice.

Scot: All humans love carbs. That's what has sustained humanity.

Neil: Yeah.

Scot: It's interesting how the media and how popular culture can take things that aren't healthy and make them seem healthy? There was a period of time you believed the paleo diet was a healthy diet. And if somebody is on paleo . . . I might get pushback for this, but I think, Troy, you could speak that that's kind of an extreme diet and probably not the healthiest choice.

Troy: Yeah, it is. I absolutely believe it's an extreme diet. And the big thing I look at are the long-term outcomes. Cardiac outcomes. What's it doing to your cardiac health? What's it doing to your risk of colon cancers and other cancers? If you're eating that much red meat, those risks are all going to increase.

And again, we always come back to the Mediterranean diet. And the big reason I come back to it is because there's great research on it looking at those same outcomes of health in terms of just your . . . You're going to feel better, but just health in terms of your heart health, your cancer risk. All those things have been shown to improve with the Mediterranean diet.

The Mediterranean diet to me is pretty simple. It's just whole grains, nuts, legumes, vegetables, fruits. It's pretty simple, and it's very balanced. Any extreme diet, I think, may show some short-term results. Paleo, obviously, you're not eating carbs.

Scot: Short-term results, and this is interesting, I think, in weight loss. So much of our idea of health revolves around, "What is our weight? What do we physically look like?" We don't even consider "What's this doing inside of me?"

Mitch: "How do you feel?"

Troy: Yeah, exactly. "What is this doing inside of me? What's this doing to my heart health, to future risk 10, 15 years down the road? What's it doing to my cancer risk?" and those kinds of things. So, yeah, we do often focus very much on the short-term. Paleo, I have no doubt people can see some short-term results in terms of weight loss.

Again, Neil, it sounds like that wasn't so much your case. Maybe you did. Maybe initially you did see some results in terms of some weight loss, but I think it eventually catches up with you where your body equilibrates and you're not having that water weight loss that initially you get with all that ketone production from just not taking in carbs.

But yeah, again, long-term outcomes, I think it's that balanced diet. And I think, really, the Mediterranean diet is the one that again and again shows the benefits.

Neil: Yeah, I did have initial weight loss and I thought, "Oh, this is the greatest thing in the world." And that didn't stick.

Troy: Interesting. Yeah. That's my experience in terms of what I've heard from other people and just based on the physiology. Again, Thunder could speak to that a whole lot better than I could. But yeah, it's interesting that was your experience.

Scot: As you started focusing more on your emotional health, how have things in your life changed? How has that aspect of your health changed?

Neil: I definitely have the ability to stay in the moment better. With modern society and phones buzzing every second and computers beeping every other second, the ability to kind of just stay in the moment and concentrate has definitely improved through the meditation. I really enjoy that.

I also feel more at peace. I did share with you guys I'm working on being agitated. My job is somewhat of an agitating job, being a lawyer. But I still feel a little bit better at it. So I'm working on it.

But I do feel definitely more at peace. For me, it's a better connection with my family, because when I'm with them, I'm present, which is nice.

Scot: And then just even from an emotional or mental health standpoint, what would happen at work, Neil, before meditation and gratitude versus now? What might be something that would happen? Did you express anger? Was it frustration? Was it just overwhelm? What was it that's kind of gotten better?

Neil: Frustration. Frustration and allowing things that are out of my control to control me. You guys know this, and I think you guys just were talking about this, but when you meditate, you have the ability to realize what's in and out of your control.

And that's been a big asset, especially in my job, because as lawyers, we constantly or oftentimes have conflict with others. So you can control what you can control. You can't control what the other guy is doing. And so that makes life a lot better, a lot healthier.

Troy: Yeah, I couldn't agree more with you, Neil. I think that's just such a huge, huge thing to be able to meditate on and certainly to approach things with just accepting what we can control and accepting we can control our response, but we cannot control what others do. So, yeah, that's great to hear that's been a big part of this as well.

Neil: I know we're probably going to wrap up here soon. I want to thank you guys because you've really led me down this path. I found you on accident. And the University of Utah, thanks that they keep you guys on. I think it's fantastic what you do.

Men hate talking about this stuff. And when I got asked to do it, I've got to be honest, I was a little nervous. I really appreciate everything you guys have taught me and you guys are super open.

Mitch has shared so many different things, as you, Scot, and Troy have as well, but Mitch I know has led us on quite a path over the last few episodes. And then Troy had his dad episode, and I just listened to it all. I mean, I have two grown kids and I still listened to the episode about being a new dad.

There's always something to learn, and it's entertaining. You're very funny and I get a chuckle out of it, so it's good. Mitch, are you laughing at me?

Mitch: I'm so delighted because this is . . .

Neil: It was like a giggle of delight.

Mitch: Oh my god.

Troy: It was like he's on a merry-go-round.

Mitch: No, it's just that's part of it, is there are times that I think, "I am sharing a lot. I am giving a lot out there." And the hope was that . . . In the same way that just being able to talk to other guys about their health has completely changed my life, if I could just talk about my own health that way, maybe someone out there could hear it and do the same, or have at least even an ounce of the same sort of change I've had.

And so I'm just tickled pink to hear that there's someone else out in the world who is like, "No, we don't have to be super intense, and if guys just start talking to one another, we can help figure this out together."

Scot: You mentioned that you were a little nervous coming on the podcast, right? You listen to the podcast "Who Cares About Men's Health." We talk about guys don't talk about their health. We try to model behavior where you do talk about it because it can make a difference as we're seeing, but yet you were still a little nervous to come on. Where do you think that came from?

Neil: Ego. In a word, just ego. I mean, you can embarrass yourself, right? So I'm sure somebody I know listens and they haven't told me yet and they're going to hear this and they're going to be like, "Dude, I heard you on that show."

Scot: Well, hopefully it goes, "Dude, I heard you on that show and I've struggled with something like that too."

Mitch: Yeah, that's what we need, right?

Neil: Yeah, I hope so. That's why I was willing to do it. If you guys were willing to do it and you need other people to help out, why not?

Scot: So would you have a conversation with any of your men friends, other than this doctor friend that you get your doctor appointments at the bar? I've still got to figure out how to do that, which I think would get guys more interested in health and going and getting their checkups.

Troy: Yeah, sporting events. Let's take this to the arena. I agree.

Scot: Anyway, would you now be more likely to talk to another person in your life, doctor friend aside, about health? Is that something you do, or are you still a little close to the vest? I mean, I'll admit I'm still a little close to the vest.

Neil: I have a core four of friends, let's just say, that I would. And then outside of that, unless I'm asked, I probably wouldn't to be honest.

Scot: Sure. Got it.

Neil: Yeah, I wish I could. It's just not . . .

Troy: Yeah, it's tough. It is. It's tough. I think this podcast definitely gives me more of a forum where I feel like I can be more open about my health. But you're right, I think beyond that. I think it's helped me in a lot of ways to talk to some of my friends about mental health stuff and they've opened up to me, which I think has been really good. But it is. It's still tough stuff that most guys just kind of don't want to talk about, so I get it.

Scot: Wrapping up here, what have you learned from this journey that you have gone on this transformation? What have you learned from this experience?

Neil: If I can steal from Troy, I think balance. I was way out of balance. I was over-fit to the . . . Actually, I didn't even share this with you guys, but to the point where I had an EKG that was kind of wonky and they said, "Oh, you've got a runner's heart." It was really . . .

Scot: Wow.

Neil: Yeah, it was really odd circumstance. Anyway, what I've learned is just balance. My eating is better. I have some discipline as part of my eating. I have some discipline as part of my working out. I have some discipline as part of my meditation and my sleep. But I'm not over-the-top disciplined like I was before, where if I ate a piece of pizza and fell off my paleo diet, I needed to go run 10 miles. So I just I feel great. It's all about balance. That's what I learned.

Scot: And enjoying life, right? A piece of pizza has never derailed somebody's health, right?

Mitch: Right.

Scot: It's when that piece of pizza gets together with 18 of its friends every week. Then you've got a problem.

Neil: Right.

Troy: That's right.

Neil: Yes. Well, I've reintroduced pasta into my life and I love it. I just don't do it a lot. That's all.

Scot: Right? And I would contend that's just as much of a mental health thing as anything else. You've got to enjoy life. Why are we doing all these health things to these extremes at the expense of enjoying our lives?

Neil: Absolutely.

Scot: Well, Neil, thank you so much for coming on the show, sharing your story. I'm just so excited that you are finding success in what you're doing. A little of an unusual story, as Troy pointed out. Most of us are coming at it we need to exercise more maybe as opposed to less. But I think it's fascinating to know that you can take things too far, and when you dial that back, good things happen.

I bet you will run that mud race faster, because I've heard stories of runners that end up hurting themselves or getting sick and they take three or four weeks off, and those first runs back, they do better because they were just over-training.

It comes back to what Mitch says. You think, "If I want to get better, I've got to do more," but you've got to remember that recovery and all that other stuff as well.

Troy: And I've got to say this, Scot. I always say I'm not going to talk about running, but since we're doing this, I've got to say one of the big things that really hit me.

Several years ago, I talked to a runner who had broken the three-hour barrier in marathons, which is kind of a big deal when you can get sub-three hours.

And I said, "Well, how did you do it?" And he said, "Well, I just started running slower. I just didn't run as fast on my long runs. I just slowed down on my long runs and I saw the results."

So he went from kind of the same thing where he was just pushing himself way too hard. He said, "I just slowed down on my long runs and my races got faster."

So it's kind of cool to hear that. And it sounds, again, Neil, like you're kind of seeing the same things, where you've taken a step back from the really high intensity stuff. Again, you may see results as you start to do more mud races. It'd be interesting to see what happens.

Scot: And I think if there's another lesson to take away, it's what we believe, what society might have us believe, what the media, what advertisements might have us believe might not necessarily always be the right way, right? The paleo diet or you've got to push yourself if you want to be super healthy.

That's why, Neil, I love that you did some research and you're looking at science and you're looking, "Well, what does that actually say? What is the truth versus what truth are we kind of being fed about health?" So that's one of the lessons I'm going to take away.

Mitch, do you have a lesson?

Mitch: Just talking about it. Willing to be a little bit vulnerable and saying what you are concerned about with your health or whatever, how much it can help one another, right? Talk to your other guy friends. Just talk about health, please.

Scot: Neil, great story. Thank you for being on the podcast, and thank you for caring about men's health.
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Dr. Kirtly Jones: November is National Sleep Comfort Month. This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health Care. And today we're talking in our sleep on The Scope.

Announcer: Medical news and research from University of Utah Physicians and Specialists you can use for a happier and healthier life. You're listening to The Scope.

Dr. Kirtly Jones: The health news has been increasingly focused on the importance of sleep and sleep quality and comfort in many aspects of overall health. But how do we know what we do when we sleep. How do sleep doctors figure that out?
Today in the Scope Radio studio I'll be talking to Dr. Chris Jones who is a neurologist and a sleep medicine specialist who has been the Director of the University of Utah Sleep Wake Center for 25 years. Welcome Dr. Jones.

Dr. Chris Jones: Thank you.

Dr. Kirtly Jones: Before we start, Dr. Jones, do you have any conflicts of interest or disclosures for our listening audience?

Dr. Chris Jones: Yes, I am married to the person who is interrogating, I mean, asking me questions today.

Dr. Kirtly Jones: So given that you are my sleep partner, I'm going to call you Chris.

Dr. Chris Jones: All right.

Dr. Kirtly Jones: Okay. How does talking to the bed partner, your bed partner, let you know about sleep quality and comfort?

Dr. Chris Jones: Even remembering what happened when you're drowsy is extremely difficult, and usually just doesn't even get recorded into long-term memory, much less what happens when you're in unconscious sleep.

Dr. Kirtly Jones: So things can happen when you're sleeping that might actually disrupt your sleep quality, but you don't know about it, right?

Dr. Chris Jones: That's correct. Most of the sleep fragmentation at night does not result in a complete awakening that you could remember. Sleep medicine clinicians routinely invite the bed partner to the patient's clinical visit. We see bed partners who say, "You stop breathing in your sleep, you're gasping for air. And in the daytime you're tired, apathetic and irritable and short with the kids, then you're short with me, and you need to see a sleep medicine doctor."

Dr. Kirtly Jones: So what are the pitfalls in talking to your bed partner about sleep?

Dr. Chris Jones: One of the most common pitfalls we see clinically is the "nagging."

Dr. Kirtly Jones: And just because I'm a woman's health specialist, what gender is that nagger usually?

Dr. Chris Jones: Our rule of thumb clinically is that we get much more information from a female bed partner about her partner's sleep than we do from male bed partners. Often times it is the wife who brings the patient kicking and screaming into the Sleep Clinic.

Dr. Kirtly Jones: Well let's talk about sleep apnea.

Dr. Chris Jones: Sleep breathing problems, especially of the obstructive type, which is associated with snoring, interrupts sleep sometimes as much as once per minute, leaving people not just physically tired, but cognitively tired the next day and emotionally tired. So the most reliable sleep deprivation symptoms we have in human beings are irritability, and apathy.

Dr. Kirtly Jones: Okay, you aren't ready for this, but I know you can do it. You're going to give us an example of what sleep apnea sounds like on the air.

Dr. Chris Jones: It sounds like this...

Dr. Kirtly Jones: Thank you. Okay, so if your partner sounds like that you should talk to him about it.

Dr. Chris Jones: You definitely should talk with him in a supportive... and there is published literature, including some by University Health Care Sleep Researchers, on styles of interacting with your bed partner about stuff that happens when they're in unconscious sleep; and it's the supportive style is usually, not surprisingly, the best.

Dr. Kirtly Jones: So you're sleeping with someone who is twitching and twitching, and you can't go to sleep because they keep twitching. Can you tell us a little bit about restless legs?

Dr. Chris Jones: Restless leg syndrome is very common on the order of 5% to 10% in northern European populations. It is more common in women than in men, and when women get pregnant it is even still more common. Restless legs is known by the patient with it to be present because it happens while they are still awake, before they fall asleep. Usually there is no argument from the restless legs patient whether they have a sleep disorder or not. They are actually actively complaining about it. They don't like it.

Dr. Kirtly Jones: So you don't have to talk with your bed partner, because you know you've got it, and it may affect your bed partner, because they're trying to sleep while you're moving around.

Dr. Chris Jones: It's always difficult to see where you are when you're in the middle of an emotional storm of irritability and apathy every day. And so it's a good idea in terms of the relationship to ask your bed partner, do you think I'm more irritable or apathetic, or short with the kids, because I'm not really sure I've noticed that. And that's just normal for a lot of people, that they don't. So this could be very helpful feedback for them, that boy, they really need to look into this.

Dr. Kirtly Jones: So the conversation could start with, do you think I'm more irritable or apathetic, or cranky with the kids, because I wonder if my sleep is okay.

Dr. Chris Jones: Exactly, yeah.

Dr. Kirtly Jones: Okay. Well let's talk about sleep talking and walking. Do people know if they sleep talk and walk?

Dr. Chris Jones: Some people who completely wake up during the sleep walking or sleep talking, including yours truly, do know that they do it. But the vast majority, again, are not completely awake. They half awake, half asleep during the sleep walking, sleep talking, and so they have no conscious memory of it at all. And they need to be told the next morning, you were talking to me about your bank account, or you were punching me, or you were running in bed, or you got up and wandered around the bedroom a couple of times, and then you went back to sleep. What's going on with you?

Dr. Kirtly Jones: And aside the fact that it's disruptive and kind of threatening, perhaps, sometimes it's just funny to the bed partner. Are there any consequences to the person who is sleep talking or walking? Are there any health consequences to that?

Dr. Chris Jones: Usually if the sleep walker, sleep talker, does not leave the bed and is just talking or moving in the bed, it's not dangerous. But there is always the risk of falls, especially going down stairs and especially as we become, how shall I say, more mature in age.

Dr. Kirtly Jones: Right.

Dr. Chris Jones: And if the sleep walking sleep talking takes a more violent form, then it could be dangerous to the bed partner.

Dr. Kirtly Jones: Yes. Well let's talk a little bit about sleep eating. I'm sure I do that, because that would be the only condition, only situation in which that half of the chocolate chip cookie would go away. But let's talk about sleep eating. Does that really exist?

Dr. Chris Jones: It does, and in fact almost anything you can do awake has been reported asleep, so sleep sex, sleep driving, sleep unlocking doors, sleep walking, sleep talking, you name it. And it's been reasonably well described.

Dr. Kirtly Jones: Let's go to the really hard stuff, which is bed negotiation; so covers, room temperature, ambient light. How do we negotiate that with our bed partner?

Dr. Chris Jones: That's a real sit-down conversation.

Dr. Kirtly Jones: Sleepers might be different in terms of how warm they like to be. Women in mid-life with hot flushes might be struggling with throwing covers off and on. Light sleepers may be bothered by noise, who wants the dog in the bed, who wants the kids in the bed, who wants to eat in bed, and all of those are part of a negotiation.

Dr. Chris Jones: I recommend it be done in all seriousness. I would urge the partner who is missing out on sleep to have the upper hand, because the consequences for driving safety, job performance, and emotional function the next day are actually very serious. This is not a trivial conversation, and you have to be honest with your bed partner about what you need to sleep.

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Interviewer: If you've been diagnosed with sleep apnea there is an alternative to that mask and tank thing. We'll talk about that next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happy and healthier life. You're listening to The Scope.

Interviewer: Sleep apnea can be miserable and for people that have it, they're looking for a way to cure themselves, but sometimes they don't want to wear the mask to bed that's hooked to the air tank, or maybe it just doesn't work for them, but there is an alternative. We're with Dr. Bryce Williams; he's an oral surgeon in the Ear, Nose, and Throat department at University of Utah Health Care. Let's talk about this alternative to what they call a CPAP, which is basically that mask and tank. That's the first thing that people usually are given when diagnosed with sleep apnea.

Dr. Williams: Yes, that's right, and you know, it is a cure for sleep apnea, but unfortunately about 30 to 40 percent of patients that use it, they can't tolerate it for whatever reason, either they don't like wearing the mask, or they can't find a good fit, or their bed partner doesn't like all of the noise that it makes.

Interviewer: Sleeping with Darth Vader.

Dr. Williams: Exactly, yeah.

Interviewer: It's probably not that loud, I probably am being a little silly there.

Dr. Williams: It can be, you know, it can definitely disrupt sleep for sure.

Interviewer: So for a lot of people that's just not really an option; it's not going to work out for them, but what's your alternative that you have?

Dr. Williams: So another alternative that is successful in treating sleep apnea in some patients is a jaw re-positioning device. So it's basically a custom made splint that fits in the mouth that brings the jaw forward, which in turn brings the tongue forward, which in turn opens up the airway just like the CPAP machine does.

Interviewer: Okay, so is this like a mouthpiece type of a thing?

Dr. Williams: Exactly, you have to have dental impressions made, and those are sent to a lab, and you know, a week later you get the device back, and it's kind of adjusted to fit the desired amount or distance to advance your jaw in order to open up your airway.

Interviewer: So is part of the problem that some people might be having sleep apnea is because their jaw is not formed quite right, so they're not getting the air, and this fixes it, or does this? Do you get what I'm trying to ask?

Dr. Williams: Yes, yeah, you're right. Some patients have a small lower jaw, and that in turn doesn't give enough room for the tongue to sit in the mouth, so when they go to sleep the tongue relaxes, and falls back in the airway. With this device it brings the jaw and the tongue forward, opening up the airway, so that you know, you can breathe at night, get a sound sleep.

Interviewer: So this isn't for everybody.

Dr. Williams: It's not for everybody, patients with really large tongues, or very thick necks can get a little better with it, but it doesn't tend to offer them the same cure that CPAP does.

Interviewer: All right, and this is something that somebody like you can help them figure out.

Dr. Williams: Absolutely.

Interviewer: All right, and what kind of success do people have with this device? It sounds almost too simple to work well you know?

Dr. Williams: Exactly, well depending on if the correct patient is chosen you know, success can be up to 90% of a cure rate, and a lot of those patients can get off their CPAP machine. It all takes a meeting with the doctor, and then figuring out if you're the right patient for the appliance.

Interviewer: And what about cost on something like this?

Dr. Williams: Typically medical insurance will cover it, so the cost is usually nominal.

Interviewer: Okay. And tell me the kind of the difference it would make in somebody's life. Do you have any stories from patients?

Dr. Williams: Sure, yeah. I've had patients that snore very loud at night, or end up choking, and then their bed partner can't tolerate it, and they kick them out and make them sleep on the sofa. It's always nice to sleep in your own bed.

Interviewer: So it cures that snoring thing, and then also does sleep apnea, you're waking up numerous times, this will help prevent that as well.

Dr. Williams: Absolutely, yeah that, and you feel more rested during the day, and be able to function like a normal human being I guess.

Interviewer: And a lot of times this works better than the mask and the tank.

Dr. Williams: For sure, for those of you who like Star Wars, and sounding like Darth Vader it's a great thing, but most people don't prefer that I suppose.

Interviewer: All right, any final thoughts on this device?

Dr. Williams: I think it's important to explore different options when it comes to sleep apnea, and not give up. A lot of patients with sleep apnea get tired of looking for different things that can make them feel better, but there's certainly things out there, and this jaw re- positioning device is certainly one of them.

Interviewer: If somebody listening to this has any questions, what would you recommend that they do?

Dr. Williams: They can get on the internet and search out my name, Brice Williams, I'm on the University of Utah website. And you can find some additional information about sleep apnea there, and also my contact information. I'd be happy to answer any questions.

Announcer: We're your daily dose of science, conversation, medicine, this is "The Scope" University of Utah health sciences radio.

Announcer: Medical news and research from University of Utah physician and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: Dr. Bryce Williams is an oral surgeon at the University of Utah Hospital but he's in the Ear, Nose and Throat Department. I don't see teeth in there anywhere so I was curious how exactly do oral surgeons and ENTs, how are they related to each other?

Dr. Williams: That's a good question. We work together in a lot of different areas. One particular area is sleep apnea. Otolaryngologists offer surgeries that are based mostly on the soft tissues, the tongue, the soft palate. Oral surgeons can offer changes to the upper and lower jaws through surgery, which can help to open to your airway, and so a lot of times it's beneficial for the patient for the ear, nose and throat surgeons and oral surgeons to work together. We also do facial trauma together. Facial trauma's closely tied to the teeth and so getting the teeth in the right spot helps get the bones in the correct position and so ear, nose and throat and the oral surgeons kind of come together on facial traumas as well.

Interviewer: So for sleep apnea, teeth are an important part, it sounds like. What about other breathing like athletics or stuff like that?

Dr. Williams: As far as breathing in patients that play sports or if they're having difficulty breathing while they're playing, the otolaryngologist can offer nasal surgery to those patients to help open up the nose and sometimes in those patients oral surgeons can offer procedure, a simple procedure done to the chin to help kind of pull the tongue forward, if the tongue appears to be an area that's closing off the airway.

Interviewer: Wow. What other ways do the oral surgeons work with ENTs?

Dr. Williams: A lot of times, we're dealing with cancer patients so sometimes oral surgeons will get together and remove teeth prior to radiation therapy for oral cancer. Oftentimes ...

Interviewer: ... you'll have to remove teeth.

Dr. Williams: Yeah, sometimes leaving bad teeth in the area where a jaw is being radiated for cancer, it can cause death of the jawbone if there's some bad teeth in there.

Interviewer: Is this the type of cancer caused by smoking and chewing tobacco products, that sort of thing?

Dr. Williams: Absolutely.

Interviewer: That can really mess up your mouth, can't it?

Dr. Williams: It's no fun.

Interviewer: Yeah. What other ways are you working with ear, nose and throat specialists?

Dr. Williams: Another way we work together is benign tumors of the jaw. Oftentimes ear, nose and throat surgeons will need intra-oral access or incisions inside the mouth rather than going through the skin to get to those lesions and oftentimes I can help out with exposing those lesions through the mouth.

Interviewer: So are there times where in the operating room, you'll go in and do some preliminary work and then somebody else will come in and do the rest of it?
Dr. Williams: Oh, yeah, every week.

Interviewer: Really.

Dr. Williams: Yeah.

Interviewer: So not just one guy doing it all.

Dr. Williams: No, I think collaborating gets different minds together, thinks of different options for the patient. I think it's overall better for the patient. Interviewer: Yeah, so there are options in a lot of these cases and you can bring a perspective that maybe they might not have.

Dr. Williams: Absolutely.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope, University of Utah Health Sciences Radio.

Dr. Kirtly Parker Jones: Love may be blind, but it's not deaf. This is Dr. Kirtly Parker Jones from the Department of Obstetrics and Gynecology at University of Utah Health. Snoring, the health problem woman wish their bed partners would fix, today on The Scope.

Announcer: Covering all aspects of women's health, this is "The Seven Domains of Women's Health" with Dr. Kirtly Jones on The Scope.

Dr. Kirtly Parker Jones: It's called snoring spousal arousal syndrome, and it's not the kind of arousal we want in the marital bed.

According to the National Sleep Foundation survey, twice as many men report that they snore nearly every night, 32 percent, compared to women, 16 percent. Of course the majority of men don't know that they snore, they have to be told by their bed partner, hunting buddies, or kids. All snoring of any magnitude disrupts the sleep of a bed partner, but not all snoring is a health issue. What snoring is a problem for the guy, or the girl, and what to do about it?

Bed partners of snorers get on average one hour less per night of sleep, and they are frustrated and ticked off. It isn't good for their health or their relationship. According to Dr. Chris Jones, former director of the University of Utah Sleep Wake Center, and my wonderfully non-snoring bed partner, it takes an average of a year or two of fighting or negotiating, by the wife, before the husband is willing to seek medical attention.

So, snoring that is accompanied by breath holding, gasping and choking episodes is called sleep apnea. And women who have to listen to this know that it just isn't right and it worries them. Men with sleep apnea have more obesity, diabetes, hypertension, heart disease, and night time bathroom breaks, which also disrupts their sleep and the sleep of their bed partner. Woman complain that their husbands with untreated sleep apnea have excessive daytime sleepiness, falling asleep while waiting for dinner, watching TV, and very scary, while driving.

Woman who come with their bed partners that have sleep apnea will state that their husbands are irritable with the kids and with them, the way anyone that's sleep deprived can be irritable, and men with sleep apnea have decreased libido and lower testosterone. Enough said about that!

So men don't know that they snore or that they are sleep deprived. Often their bed partners have to convince them. I suggest you use the record button on your cell phone and prove it to them.

Woman can have sleep apnea too, but their hormones and where they store body fat, not in their belly or neck, works for them. After menopause more women snore and have sleep apnea. But snoring is not very feminine and it's a touchy topic and your bed partner may not tell you, or he's so unconscious and snoring too, he doesn't even hear you. So get your honey to talk to their primary care provider or see a sleep specialist before he isn't your honey anymore. And you need to go with him. Maybe simple things like weight loss, not drinking alcohol at night, and other approaches will help. But if it's serious, you need to get serious. Check out your local sleep center. This is Dr. Kirtly Parker Jones. Night, night, sleep tight, don't let the bed bugs bite.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: June 13, 2018
originally published: November 26, 2013