Continuous positive airway pressure

parallels in other diseases and extrapolating to non-obstructive HCM.

And what I mean by that is we take a deep dive and really treat comorbidities that worsen symptoms, whether that's obesity with the GLP-1 agent, whether that's sleep apnea with CPAP, whether that's diabetes, hypertension, we treat all of those things.

And in addition, we sometimes use SGLT2 inhibitors or MRAs in patients that have the more heart failure congestive phenotype of non-obstructive HCM.

And And we work with those combination of therapies to see if we can affect patient symptoms and their functional status.

And sleep studies are really the gold standard for diagnosing sleep disordered breathing.

So if someone's coming in telling me, "We're snoring, gasping, pausing," we're going to proceed with a sleep study to really as- assess the severity of that finding and to know whether or not it needs an intervention like surgery or CPAP, um, versus is it something where we can keep an eye and it's more of a, what we call cosmetic snoring, or you just have the upper airway findings that make turbulent airflow and make you a little bit of a noisy breather.

And so most of the time, if we can find a reasonable place to start, we can actually treat and do interventions without ordering a sleep study.

Oh, that's so cool.

That's a wonderful question.

I think that is probably one of the hardest parts of sleep medicine, is the idea that most changes to sleep architecture and patterns, i.e., how is your body gonna rewire its neurocircuitry, it's in the scale of six to 12 weeks.

Any treatment modality, even if I'm starting someone on s- CPAP for sleep apnea, we're not gonna see improvement in their sleep quality in that six to 12... for at least six to 12 weeks.

Mm.

But then here, let me expose you in an immersive interactive style.

You learn just about, okay, you learn about your CPAP, Mouthpiece, Inspire, GLP-1s on a presentation, great.

We have some interactive time like a Q&A, and then we go into another room and we have an immersive time with our representatives of those industries, of those components.

And these physicians who usually never see what an inspire or oral appliance may look like or, you know, all these details.

I got in as an associate dentist with a dentist.

I was so blessed, lucky that I got in with a doctor who was teaching me dental sleep medicine.

And then my dad was CPAP intolerant.

So right out of the gate, 20 plus years ago, I'm doing this.

So Sermont-OSA included patients that were It had actually two trial populations.

You had one population that was adherent to CPAP and one population that was not.

Patients on average had a class 2 obesity, so VMI between 35 to 40, the 38 range, if I'm recalling correctly.

And so that's around that VMI range.

And these, again, are averages.

So we can get into the weeds on what that means for an individual, but it's a really substantial difference.

That doesn't mean that these patients should not be treated with CPAP, and that CPAP isn't still a mainstay therapy, but it's a good adjunct.

In the past, we would say once someone is on PAP, something like CPAP, there's different kinds of pressure.

You don't necessarily even have to intubate right off the bat.

Sometimes even adding a little bit of CPAP can control your pulmonary blood flow.

But if that fails and your patient continues to deteriorate, That's when we would intubate those patients.

But the concept of introduction of PEEP and increasing your PVR, decreasing your pulmonary blood flow, especially if you think that's the mechanism by which they're failing.

Be mindful of other people's space and don't always be in your cell phone.

You know, if you're a loud snorer, please go get CPAP.

we had what six of us go to sturgis all in an rv six six dudes living in an rv for six days

we all overloaded that circuit with our c-pad machines

He's like the...

Got the CPAP mask.

Yeah, he's

like huffing a few minutes from his...

BMI being one of the reasons that we say no to a lot of procedures.

Other health conditions like a CPAP mask, which tends to come with people in hospital.

in higher BMI brackets and also type 1 diabetic patients for gastric sleeve procedures.

That is probably the number one question I get asked in relation to saying no to patients for medical criteria.

If you are a snorer, you could maybe be getting a...

CPAP machine, which helps you breathe in the night instead of snoring.

There's like so many things that you can try to figure out about sleep and make your sleep better.

And it's possible you need extra support or help with that.