073: The Hidden Culprit of Sleep Disorders Nobody Talks About — Couch Talk With Dr. Michael Gelb

In today’s couch talk, we’re going to talk about sleep disorders, sleep problems, and breathing and respiratory issues affecting sleep. We are specifically going to look at how these difficulties with sleep relate to symptoms we often experience in menopause, such as waking up feeling not refreshed, not sleeping through the night very well, fatigue, irritability and so on.

Min 1.46-4.39 How perimenopause and menopause affect sleep

Min 5.02-7.18 TMJ, headaches, and other symptoms

Min 7.28-10.08 Nasal stents, nasal breathing vs. mouth breathing

Min 10.18-11.21 Transitioning to nasal breathing

Min 11.55-14.36 Orthodontics, teeth removal, beautification, apparatus

Min 14.44-17.52 Orthodontics for kids with ADHD / ADD

Min 19.07-21.45 Hormonal changes, sleep fragmentation, nervous system imbalance

Min 21.53-26.57 Home treatments, natural sleep remedies, appliances

Min 27.16-28.30 Effect of dairy, sugar, and gluten on sleep

Min 31.14-35.42 Finding an airway-centric dentist, holistic solutions


Dr. Anna Cabeca:

To identify and address the underlying causes of these issues, we’re taking on a very holistic multi-dimensional approach to enhance the hours we spend sleeping — and hopefully with sweet dreams too — and really make a difference in our lives.

This is often a piece missed by most healthcare practitioners, so today I'm bringing to you Dr. Michael Gelb, a world-renowned temporomandibular joint (TMJ) and sleep specialist with practices in both New York City and White Plains.

He received his medical degree and dentistry from Columbia University College of Dental Medicine, and his M.S. in Masters of Oral Science at Buffalo School of Dental Medicine. He is the author of, “GASP: Airway Health- the Hidden Path to Wellness, and the co-founder of both The Foundation of Airway Health and The American Academy of Physiological Medicine and Dentistry.

He has also earned the prestigious award of Top Doc New York® multiple years in a row and has been featured as an authority in The New York Times, The Chicago Tribune, Fox News, Fox Business News, CBS, CNN, Women’s Day, Elle, The Doctors, Huffington Post, ABC News, Marie Claire, and other national and international newspaper and networks.

The Gelb’s Centre in New York City was founded by his father, Dr. Harold Gelb, a former president of the American Equilibration Society and the American Academy of Orofacial Pain.

Michael you have to tell us about that; your lineage in sleep technologies and how you really become passionate in this area. Welcome, great to have you here.

The Correlation Of Sleep Disorders With Perimenopause & Menopause

Dr. Michael Gelb:

It's great to be here. I started off initially with the TMJ. My dad kind of created the specialty team. And then over time, we developed tools like the home sleep test. So, we could actually visualize the airway, which is the much better view of the joint, and we could actually see a woman's airway and where it might not be as big as we thought the nasal airway was.

With the home sleep test, it really opened us up to be able to diagnose and figure out the symptoms arising from sleep. Not just the oxygen, but also the sleep architecture, how well people were sleeping, or not sleeping, disruptions in sleep, and just the profound effects those will have on a woman's life.

Dr. Anna Cabeca:

So, let’s talk about that. When do changes start to occur with regard to sleep issues for women?

Dr. Michael Gelb:

It’s really around menopause. Up until then, there seems to be some sparing effect. Although there can be very, very thin women that have this thing called upper airway resistance syndrome, which we should talk about.

But really, it's menopausal women who start to have the same airway issues as men have had for 20 years before that. So, they start to have some snoring issues fatigue issues, which they never had before. So, maybe a lot of the overlapping symptoms that you may see in your clients or patients could be due to the fact that they're not sleeping as well as they used to.

Dr. Anna Cabeca:

Yes, that’s absolutely right. Most patients during perimenopause or menopause complain about difficulties with sleeping. So, let’s talk about that from your perspective, which is the airway perspective. 

Dr. Michael Gelb:

Women have this degree of activity in their throat and tongue muscles at night which keeps the airway open. Around perimenopause and menopause, women tend to lose these protective reflexes, muscle reflexes, or neuromuscular reflexes. This causes the airway to relax a little bit more than it should, and the airway can narrow at night.

When the airway narrows, we get problems with our brain. It causes upper airway resistance syndrome. This can manifest as snoring, airway resistance, or full-blown apnea. But they all can produce pretty profound symptoms, just from the slight narrowing of the airway.

Evaluation Of Sleep Apnea And Sleep Quality

Dr. Anna Cabeca:

Well, you’ve talked about a lot of symptoms. Let’s look into the one that we most commonly hear people talk about, which is sleep apnea. Are there other factors causing sleep problems or trouble sleeping other than sleep apnea? Can you kind of go through the different types of sleep issues?

Dr. Michael Gelb:

Sure. So, the first thing we try to do with the patient is to figure out why they’re here. What’s their deep complaint?

For women, it’s often headaches or TMJ, because the TMJ also starts to break down. The jaws tend to recede a little bit, which will lose some muscles, bones, and collagen. Our jaw tends to go back a little bit during perimenopause, and when the jaw goes back, the airway closes.

But it's also the time where you may get neck pain, headaches, and clicking in your jaw. So, I listen for that too. But in the back of my mind, I'm also listening for symptoms like fatigue, unrefreshing sleep, anxiety, insomnia, trouble focusing, and difficulty in concentrating.

So in my evaluation, I do muscle palpation, I listen to the joints, I look down the throat, and I see how big the tongue is. I’ve seen very, very fatigue women who have big tongues, or they may have small noses. And so we anatomically identify where there may be some airway restrictions, and we put together the story with the complaints and with the imaging. The overall result we come up with is really an explanation of why and how they got where they are now.

Now, I want to manage their daytime complaints, which can include things like, “I'm exhausted, I can't focus, I'm depressed, I have anxiety”. And I want to put that together with the daytime solutions and the nighttime solutions.

Usually, it revolves around letting them breathe better. Such as putting something in their nose to help improve their nasal breathing, working with an ear, nose, and throat (ENT) specialist when appropriate, keeping that jaw forward, opening the airway, and improving their quality of sleep.

The Importance Of Nasal Breathing For A Good Night’s Rest

Dr. Anna Cabeca:

So, when we're talking about putting something in the nasal airways to open it, is that a surgical procedure?

Dr. Michael Gelb:

Well, so you’ve probably heard of or read about nasal strips, right? Well, that’s the first one we used years ago. Now there are nasal stents.

Nasal stents go right in the nose, like what the swimmers used to wear. It keeps the airway open all night, even when you're breathing, so it's very effective. If you go into Walgreens or Rite Aid, pretty much pharmacies have nasal stents on their shelves.

Basically, the nasal stent keeps the nose open. That’s the first step, to open up the airway where the air should come in. Next, we teach our patients nasal breathing for increased energy and improved oxygenation. Finally, we tend to move the jaw forward at night, or in other words, we prevent the lower jaw from dropping back.

These things combined give you a more refreshing sleep.

Dr. Anna Cabeca:

So, why is nasal breathing preferred over breathing through the mouth?

Dr. Michael Gelb:

Well, when you breathe through the mouth, your jaw has typically dropped back. This changes your posture. If you want to have a good posture, such as how they teach in yoga meditation, the only way to do that if you’re a mouth breather is by extending your head and bring it forward a little bit. That puts a lot of strain on the neck muscle.

When we breathe through the nose, we get better humidification, better filtering, and heating of the air. Also, nitric oxide, which is produced in the paranasal sinuses, can reach the lungs when you breathe in through the nose rather than the mouth. Nitric oxide increases the ability for the oxygen to get into the bloodstream.

Additionally, breathing through the mouth means you get more bacteria and you’ll wake up with a dry mouth. And so, it's just much better for many reasons to breathe through the nose.

How To Transition From Mouth Breathing To Nasal Breathing

Dr. Anna Cabeca:

What’s your advice to transition people from breathing through their mouth at night to nasal breathing?

Dr. Michael Gelb:

Well, we work with these oral appliances that tend to keep the upper and lower jaws together. So it doesn’t let the jaw drop back. So, we keep it together and we’re even taping up the lips. We get some paper tape and we put it over the lips to encourage nasal breathing.

It’s just a little bit to prevent the airway from closing at night and to make it safe to breathe through the nose. To do that, you have to open up the airway behind the tongue. Once you’ve done that, most people can breathe through the nose.

Some others, however, will also need to get their septum repaired, or perhaps get a turbinate reduction or similar procedures like that. And sometimes it starts with an ENT specialist, sometimes it takes a facial plastics specialist who can help with obstructive sleep apnea.

Do Braces Or Orthodontic Procedures Affect Sleep?

Dr. Anna Cabeca:

That's fascinating. I am familiar with the Myobrace as an orthodontic device that some dentists recommend over the typical orthodontic braces and removal of teeth. Would having braces, removing teeth or other adjustments for beautification affect sleep issues? And is it better or not better to do that after menopause and its related sleep issues?

Dr. Michael Gelb:

Right so, you know we have tonnes of cases where we transform the face. What we’re trying to do is restore the height of the lower third of the face for these women to allow better oxygen intake for better sleep. Beautification occurs as a side effect, really. If you give a woman more oxygen and deep sleep, she will look about 10 years younger in three months.

As I work with ENT specialists to restore the height of the face, the ENTs may at times also put in a little filler and give someone back their lips or their chin. And then the eyes open up, and the mouth changes. But I really think it’s the oxygen and the deep sleep that really makes all the difference in the world.

And people just have no idea that they can look 10-15 years younger. On the inside, their inflammations go down, and they really feel 10 -15 years younger too.

Dr. Anna Cabeca:

It's nice to see those results too, in addition to feeling the results which is our priority. So, do having braces early on in our lives affect our sleep?

Dr. Michael Gelb:

Yes. Unfortunately, people that used headgear to bring back the teeth or had four bicuspid extractions, which is having their teeth taken out when they were younger, tend to retract everything and pull the tongue back. This closes off the airwaves because we lose that arch shape.

Now we have other techniques like Invisalign and ClearCorrect where we can do an expansion to reverse the problems caused by procedures done to us when we were kids, with the goal to get back these big broad arches.

I mean, 2,000 or 10,000 years ago, there was no sleep apnea. There was no snoring. There was no cavity. You know, before carbohydrates and probably before the fire, we used to have broad arches and that's what we try to get back to.

What Orthodontics Are Best For Kids Displaying ADHD Symptoms?

Dr. Anna Cabeca:

And so, preventatively we should avoid those orthodontic braces and look at something like Myobrace for our kids.

Dr. Michael Gelb:

Yes. So, you want to start with expansion, with bringing the jaw forward at age three, four, or five. Certainly by age six or seven. We want to try to get the kids mainstream and not show symptoms of ADHD, as well as getting them off those medications.

If you can get kids sleeping through the night by bringing the jaw forward and expanding it alongside myofunctional therapy, then that can work.

Dr. Anna Cabeca:

Wow! That’s huge. So what’s a resource for people to go to? I know there will be a lot of moms listening in who would be interested.

Dr. Michael Gelb:

The Healthy Start website is good. Airwayhealth.org is another resource with a list of practitioners who have pledged to keep an open airway. I also recommend reading the book “Gasp!: Airway Health - The Hidden Path To Wellness”, where you’ll find a lot of evidence-based references and websites. The book details the effects on airway breathing from childhood through to perimenopause and menopause.

It’s important to also look for that right pediatric ENT in your community that's been trained in airway and sleep. What's happening now is many pediatricians not trained in airway and sleep will say, “Don't worry about those tonsils. They will shrink”. But they don’t really shrink. So, you really want to intervene early for your kid to make sure they get the best outcome possible, both neuro-cognitively and neuro-behaviorally.

Dr. Anna Cabeca:

That’s so true to look at the connection between ADD, sleep, and the oral airway. So, for our listeners, the book, GASP, is available on Amazon and at Dr. Michael’s website. It’s really important to do our own homework and research, and not just fall to the peer pressure kids face to get braces. Because we don’t want to treat the symptom without addressing the root cause, as it just won’t serve us in the end.

The Effects Of Hormonal Changes On Sleep

Dr. Anna Cabeca:

So that leads us to menopause, perimenopause and also andropause for men. Can we talk about this transition? What’s the impact of a hormonal change like progesterone and the dropping of DHEA on sleep? How can we correct that?

Dr. Michael Gelb:

Absolutely. The activity of tongue muscles and those protective reflexes actually comes back to normal levels once you restore the hormonal balance and progesterone levels. So, that's really important.

Additionally, fixing alignment and structural issues of the cervical spine, which sits at the back of the airway, can really open someone’s airway. There’s a lot of women who don't have sleep apnea, but their brain never really gets down into deep, restorative sleep. And this may be since they had kids. What they experience is sleep fragmentation that disrupts the sympathetic and the parasympathetic systems to create a stress response.

Some symptoms resulting from this include a tension headache, migraine headache, or irritable bowel syndrome. The whole nervous system gets sensitized. Then it becomes chronic fatigue, which can include symptoms like low blood pressure, cold hands, and cold feet because the body's pumping most of the blood to the brain and the heart. All this is really a generalized stress reaction resulting from an imbalance of our nervous system that could be caused by limited, narrow breathing.

We all know that eating, exercises, and a good attitude can affect our nervous system, but breathing is right up there too. Think about how important the breathing component is in meditation, yoga and the Ayurvedic. There's a long history of the beneficial effects of breathing. And we just have to be aware that even minor changes like a cold or allergies that affect the airways, and certainly perimenopause and menopause, can set off sleep fragmentation or sleep issues.

Dr. Anna Cabeca:

What steps can women start doing at home to address this?

Home Treatments & Natural Sleep Remedies

Dr. Michael Gelb:

You can open up your nose by sleeping on your side, preferably not on your back. You can also sleep on an angle so your airway doesn't close off as much. You can use things like nasal stents of fragrances like lavender to improve your nasal breathing and open up the nasal airway.

You can also consult an ENT, but we usually advise to try non-surgical solutions first. There are also different types of bite plates. You can start with over-the-counter ones, though we recommend custom appliances to give you a better fit. Also, it’s important to work with a dentist trained in the airways. They are known as airway-friendly, airway centers, or airway-centric dentist.

Then there is TMJ headache and clenching. At least 35-50% of people with clenching problems also have sleep-related, airway related problems. Clenching is really a sleep disorder.

So, 50% of the appliances that are worn every night in the United States are actually closing the airway and not helping you. It’s important to get a night guard that is also an airway guard to give you a refreshing sleep. And a deep, restorative sleep will also help you with improving anxiety and mood swings.

Dr. Anna Cabeca:

Can you please explain the difference between night guards and airway guards?

Dr. Michael Gelb:

If you use a flat mouthguard, it allows your jaw just to slide back or just open a little bit. This actually closes the airways. It’s important to bring the jaw slightly forward at night. In post-surgery or in CPR, they pull the jaw forward. Pulling the jaw forward a little bit creates an open airway.

So, that's what we're doing for women and for kids. We’re pulling the jaw forward to restore their airway because through poor diet, epigenetics, pesticides, and preservatives, our jaws have gotten smaller with time. So, basically, we’re just trying to reverse that trend.

It’s best if you can get it done as a child, but if you’re in your 40’s or 50’s and you didn't get this treatment as a child, it’s never too late to get intervention. We’ve treated 84-year-olds and they've done great. So, we're reversing the trend and we're lowering inflammation in all ages by restoring the balance of the sympathetic and parasympathetic in the brain. For women, in particular, this can lead to a lot of good changes.

Dr. Anna Cabeca:

Well, that makes sense. And this is something everyone listening can self-assess, right? So for example, if you’re sitting slumped in a chair, to open up the airway you would sit up straight, right?

Dr. Michael Gelb:

Yes, and put the jaw slightly forward with the lips together and teeth apart. Then extend the head, as they do in yoga, to open up the airway and the nose.

Dr. Anna Cabeca:

Well, I definitely felt a capacity increase, which is very interesting.

How Dairy & Gluten Affects Airway Issues

Dr. Anna Cabeca:

Do you also find that if you remove dairy from the diet that it can help with airway issues?

Dr. Michael Gelb:

We try to recommend removing dairy and a low-sugar diet. And then also try an elimination diet, which means no gluten.

A lot of women breath as if they’re breathing through a coffee stirrer. We want women to breathe as if they’re breathing through a garden hose. In other words, we want the airway to be really big. When you have a bigger airway, the effects on the brain, heart and the rest of the body are profound.

Dr. Anna Cabeca:

Yes, diet is really a huge missing piece. I can’t say enough about that, because as you know my key program is to get people into a healthy, nutritional ketosis. And the other thing is the apparatus, as you have mentioned. And then there are great blends of breathing essential oils like lavender, peppermint, and eucalyptus. And also the breathing exercises you just showed us.

So, if we’re already doing all of that, what do we do next?

The Importance of An Airway-Centric Dentist

Dr. Michael Gelb:

Your next option could be a Juvabite, which you can wear during the day. It really opens everything back up. It’s an all-natural, non-surgical facelift that restores face height. So instead of having your teeth done, you can use Juvabite.

Another option is seeking a dentist in your area that’s’ been trained in sleep medicine. There's a big push right now in this country. Dentists are now supposed to screen all their patients for snoring and sleep disorder breathing. The American Dental Association just passed that in October. So, look for a dentist that's airway friendly. I hate to say it, but a lot of orthodontists are not airway friendly and many dentists are not yet airway friendly.

So, if you can follow you know an airway friendly organization -- other terms to look out for are airway-centered or airway-centric dentistry -- that's the lead into integrative medicine and the type of medicine you're doing, which is the alkaline and ketogenic stuff that’s fantastic to restore health to the body. Dentistry has to be complementary to what you're doing.

Dr. Anna Cabeca:

Absolutely. It all works together.

Dr. Michael Gelb:

I also came up with an airway-centric guided system, where any dentist in any part of the country can order these airway friendly ACG devices through ProSomnus Sleep Technology labs. So, it's just a way you can ensure your dentist uses an airway-friendly device.

References And Recommendations

Dr. Anna Cabeca:

Where can our listeners find out more about these recommendations you’re talking about?

Dr. Michael Gelb:

My website, drmichaelgelb.com, is probably the best.

Dr. Anna Cabeca:

Wonderful. And if I may also add, you can also follow the GELB Centre on Facebook. Michael, it's been great to talk with you today. I have learned so much. I thank you very much. And for all our listeners, definitely leave your comments and questions below. And also share this important information with the people you know because this information really makes a difference in the quality of our lives. Again, thank you, Dr. Gelb.

Dr. Michael Gelb:

Thank you, Anna. Nice to be here with you all.

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Dr. Anna Cabeca

Dr. Anna Cabeca

Certified OB/GYN, Anti-Aging and Integrative Medicine expert and founder of The Girlfriend Doctor. During Dr. Anna’s health journey, she turned to research to create products to help thousands of women through menopause, hormones, and sexual health. She is the author of best-selling The Hormone Fix, and Keto-Green 16 and MenuPause.

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