ADHD and Sleep Apnea (Podcast)

John Maher: Hi, I am John Maher and I’m here today with Dr. Nammy Patel, founder of Green Dentistry in San Francisco, California, helping patients recognize the vital connection between dental health and whole body health, and author of the bestselling books, Age With Style: Guide to a Youthful Smile and Healthy Living, and Total Wellness: Understanding the Link Between Your Teeth and Your Health. Today, our topic is ADHD and sleep apnea.

Welcome, Dr. Nammy.

Dr. Nammy Patel: Thanks for having me here, John. I’m really excited to talk about this and create more awareness.

How are Sleep Apnea and ADHD Related?

Maher: Absolutely. How are sleep apnea and ADHD related?

Dr. Nammy: ADHD is a condition where we don’t have enough acetylcholine in our bodies, which allows us to focus. When we’re not able to sleep really well, which is what happens in sleep apnea, our body is not able to, or our brains actually, our brains are not able to get the rest that it needs and it doesn’t allow the brain to be able to detoxify.

So, what happens is we wake up, we’re unrefreshed, it’s hard to focus. We’re jittery all day long. Sometimes we have the restless leg syndrome that we see with patients, and there’s just a lot of jitteriness, and that ADHD person can’t focus. They’re just all over the place, is because their brain hasn’t had enough time to rest and replenish that acetylcholine. So that’s the main reason why patients with sleep apnea have ADHD.

Actually, not just with sleep apnea, but actually sometimes there are patients with a sleep-related breathing disorder, so it doesn’t have to be sleep apnea for them to get ADHD, but we find that a lot of patients with sleep apnea have ADHD, but people, even with beginning stages of sleep apnea can get ADHD. Does that make sense?

Can Treating ADHD Help with Sleep Apnea?

Maher: Yeah. So can treating your ADHD symptoms actually improve sleep apnea or is it the other way around that working on your sleep apnea and improving that can actually affect your ADHD symptoms?

Dr. Nammy: Believe it or not, if you do it right, you can have both of them fixed at the same time. And it’s because, like I said, it’s that chemical called acetylcholine. If we fix the pathway in the way it needs to be fixed, which is going to be vitamin D and vitamin Bs and B12, and if we do it in a proper way, we’re going to be able to get people to be sleeping better. Their Bodies are going to be able to rest and they’re going to be able to focus really well. So, we can actually do that in both ways because there’s two pathways for acetylcholine. Acetylcholine is actually really important in making sure in the synapses, what they do is they tell our bodies, it’s a neurotransmitter and it tells our bodies to do certain things. There’s things that keep us excited. There’s also keep things that help us sleep.

And the most important part of sleep when we talk about sleep apnea is the REM sleep. Now, that REM is created and that acetylcholine is basically what tells our body to be in REM sleep. REM sleep is when our bodies are paralyzed, our eyes are moving in rapid movement, our brain is detoxing, our bodies are fighting cancer, heart attack, diabetes, anything that is detrimental. And so when that acetylcholine is present, we’re able to do that properly.

Now, if somebody falls into that REM sleep and they have sleep apnea and they keep waking up, they keep waking up, they’re never going to be able to complete that cycle. So when they’re not able to complete that cycle, it causes them to be irritable the next day, also inability to focus, which is a DH ADHD, right?

And now, it can also be that somebody has beginning stages of sleep apnea, they don’t have sleep apnea, but it’s a breathing disorder. That means that they don’t have as much acetylcholine into the system, stills have the same problem, which is inability to sleep, and then that REM sleep is going to be problematic. So in that person, the first thing we want to do is test your vitamin D levels, really making sure that vitamin D is present because B1 plus B5 is what makes acetylcholine B1 and vitamin D, and then you take that, you add pantothenic acid, which is B5, and then that takes us into acetylcholine. So those vitamins are really important from a neurotransmitter perspective.

Even somebody who has sleep apnea, actually what they do is they’re on a CPAP, and so they’re forced air is going through their body, but what happens is that they’re still never refreshing is because the brain switch is not fixed right. And that’s why they still are irritable. They feel better from what they had before, but they’re not… So if somebody didn’t have a sleep-related breathing [inaudible 00:04:48], they’re super sharp, they’re on it. The comparison is there.

They’re not as fresh as they should be. So they’ll say, “Oh yeah, the CPAP helped me initially, but then it doesn’t help me after,” is because there’s forced air, but the brain switch is not fixed, which is the same thing as an ADHD person. And so we need to get that acetylcholine and large amounts of acetylcholine so that the body can be able to get that REM sleep proper, and we give it the ability to focus is really what we want.

Oral Appliances for Treating ADHD and Sleep Apnea

Maher: Are there any oral appliances or dental treatments that can help with both ADHD and sleep apnea?

Dr. Nammy: Yeah, absolutely. And it is protocol in our practice to be able to treat those because we want to treat things physiologically, but we also want to fix things chemically and to make sure that there’s a chemical balance so that once you’re done, you’re done for a lifetime. You’re not dependent on a device or me or anything else.

There’s devices that help with making sure that there’s a good airway, that’s a good paint airway, so you can breathe through the nose to the back of a throat and down. We definitely have appliances that help us do that. We also have appliances that help expand the 3D nasal volume so that you can get good air and good rest and create more nitric oxide, which helps our body rest even more and go into deeper sleep, also make sure that our microbiomes are balanced really well in our stomach.

So, we really focus on all of those things. And then we look at blood panels. So we look at blood work to see how the vitamin D levels or vitamin B levels are, and we titrate, and that means that we customize everything to each person to make sure that we’re able to help them be focused, stay refreshed, sleep well and on time, and be able to be alert and get things done that they need to do.

Should I Consult A Sleep Specialist?

Maher: Should I consider consulting with a sleep specialist in addition to a dentist like yourself to address my sleep apnea and ADHD issues?

Dr. Nammy: You can. Absolutely. Majority of the sleep doctors are referring to us because when it comes to sleep doctors, they’re allowed to do two things. One is prescribed pills or they’re allowed to give you a CPAP. They’re not experts in how to do this in any other way. So that’s one of the reasons that we come in as dentists or somebody who’s an airway specialist like me comes into place is because what I’m able to do is look at scans and really fix you from a structural perspective.

And we call it it’s like osteopathic work, the bones and everything is in the right place, so physiologically, we’re putting you in the right place, plus with some nutrition, we’re putting your chemical signals in the right place so that you’re able to work well and that way you don’t need that CPAP anymore. And that way you are able to be fresh and you are able to focus, and you don’t have to take an ADHD med.

I’ve successfully taken off people off of ADHD medications over and over and over again. Usually takes me about six months, but I’ve done it on a number of patients, which has been really exciting and really fun.

Maher: All right. Well, that’s really great information, Dr. Nammy. Thanks again for speaking with me today.

Dr. Nammy: My pleasure.

Maher: And for more information, you can visit the Green Dentistry website at sfgreendentist.com or call (415) 433-0119.