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Expert Interview: Dr. Brian Palmer on “The Evolution of Malocclusion & Sleep Apnea”

Dr. Brian Palmer is an internationally recognized expert on dental malocclusion, infant feeding habits, and its’ relation to obstructive sleep apnea.

Topic: The Evolution of Malocclusion & Sleep Apnea

Guest: Dr. Brian Palmer

Length: 2  hours

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How Breast Feeding Improves Children’s Behavior

There are numerous studies on the health benefits of breast feeding, and here’s another one that supports my sleep-breathing paradigm, that your overall state of health is directly proportional to how well formed your jaws are as you age (and subsequently your breathing passageways).

Researchers from Oxford University in the UK found that infants who were breast-fed for at least 4 months had a 33% less chance of having behavioral problems by age 5. They speculate that breast milk has higher amounts of healthy fatty acids, growth factors and hormones that contribute to healthier brain development.

The one thing that all these studies fail to address is that bottle-feeding can cause malocclusion and jaw narrowing. The smaller your jaws, the less room there is for your tongue, which can cause breathing problems when the infant is placed on his back. Add muscle relaxation from deep sleep, and you’re going to deprive infants of quality deep sleep which is vital for proper brain development. With the addition of back sleeping in infants to bottle-feeding, it’s likely that this combination is a major reason for the significant rise in pediatric developmental problems that are so rampant these days.

If you have obstructive sleep apnea, were you breast or bottle-fed as an infant?

Breast-Fed Boys Grow Up To Be Smarter

Here’s a study that showed that boys that were breast-fed as infants for at least 6 months do better in school compared with boys that were bottle-fed. Enhanced nutrients in breast mild and mother-infant bonding were thought to be reasons for this finding. Breast-fed girls also has mild increases in test scores, but the results were not statistically significant.

One major omission from the conclusion of this study is the fact that breast-feeding protects against developing obstructive sleep apnea. Dentists have long said that bottle-feeding promotes malocclusion and dental crowding. The smaller the jaws, the less room there is for the tongue, and the more often you’ll stop breathing at night.

Another important point is that pumped breast milk is not the same as breast-feeding. Unfortunately, our society and modern time don’t make it easy to exclusively breastfeed.

What are your thoughts on this? If you have sleep apnea, do you remember if you were breast or bottle-fed?

Good News For Breast-Feeding Moms

Here’s some good news for new moms: That women who breast-feed sleep the same amount as those who bottle-feed. This is an important issue since bottle-feeding has been shown to cause or aggravate dental crowding and malocclusions. Having smaller jaws (think smaller mouth) crowds the tongue and other soft tissues of the mouth and throat, aggravating or promoting obstructive sleep apnea.

This brings up a very sensitive issue, which implies that infants should be breast fed by using the natural breast, rather than pumping and using a bottle. Most modern women don’t have the luxury, time, or the resources to breast feed exclusively for 6 months or longer. Work schedules, caring for other children, and other demands of modern society makes breast-feeding difficult.

My feeling is that women (with spousal support) should do everything possible to breast feed, but shouldn’t feel guilty for not being able to do so. Everyone has unique circumstances, and ultimately, not everything we want to do is under our control.

What are your thoughts on this issue?

Nutritional Lessons From Africa

 

Traditional cultures in certain parts of the world practice contraception by breast-feeding. Most doctors will tell you that breast-feeding is not a reliable form of birth control. However, the way a woman breast-feeds is vastly different in the developed areas versus underdeveloped parts of Africa. 

 

In the US, most women who breast-feed on demand begin to taper off to intermittent feedings after a few months or at most 1-2 years, either supplementing with solid foods, or pumping and giving the milk through a bottle. I’ve written about how bottle-feeding is thought to aggravate dental crowding and malocclusion. 

 

In certain parts of Africa (such as in Batswana), women breast-feed on demand, with the child strapped in slings to the mother’s chest, feeding on demand until he or she becomes too heavy or becomes more independent. Typically, this lasts about 2-3 years. My patient confirmed that women would typically have 3-4 children evenly spaced over a span of 10-12 years. Repeated, short bursts of breast-feeding promotes prolactin release, which is an effective form of contraception. In developed countries, the interval between feedings lengthen over the first year, increasing the odds that pregnancy may occur.

 

He also noted that for the most part, the natives are very healthy, with few stresses, and they generally eat off the land, without too much processed foods or refined sugars. He even feels stronger and healthier when he lives and eats there. The main health problems that he sees are mainly infectious: malaria and HIV. 

 

Dr. Brian Palmer, a dentist that has spent his entire career researching the link between bottle-feeding and obstructive sleep apnea, has stated that in some areas of the world, people can’t afford infant formula, let alone regular food. The only source of nutrition for infants and toddlers is breast milk. Notice that despite the fact that the children are stick thin, they all have nice smiles and bright teeth.

 

Compare this with pictures of young children (in Dr. Weston Price’s book) who eat lots of sweets and processed foods—you’ll see crooked, stained teeth with lots of cavities, along with narrowed jaws and faces.

 

Take note of a native rural African’s jaw structure, and compare the facial width and jaw structures against multiple generation African-American faces. It’s a pretty stark difference.

Breast-feeding Tax Credits?

Here’s an interesting new tax law: Oregon senator Jeff Merkley sponsored a bill that would create an income tax credit for "50 percent of the qualified breastfeeding promotion and support expenditures of the taxpayer for such taxable year." You can read more about it here.

 

While promoting breast-feeding is a worthwhile cause, I’m not sure Dr. Brian Palmer would agree with the basic principle of this proposed bill. He argues that the physical act of breast feeding is just as important as the breast milk itself. He’s spend his career showing how bottle-feeding can aggravate dental crowding and malocclusion. This is one of the main reasons for the development of obstructive sleep apnea. Listen to his interview here.

Similarities Between CPAP And Breast-Feeding

 

It’s been three weeks since my wife delivered our third son Brennan, and after doing everything we can to exclusively breast-feed him, we’ve given up. During the first few days, Kathy was doing well, getting into a routine, especially since we had hired someone help us out for for about the first 10 days. Then on day 4, during a visit to the pediatrician’s office, it was discovered that Brennan’s bilirubin was dangerously high. He was admitted to the hospital for UV light therapy. He did fine, and was able to go home in 24 hours, but the whole ordeal wreaked havoc on his breast-feeding regimen. 

 

Because he was under the lights, Kathy was only able to pump and feed the milk via a bottle through the chamber’s holes. Afterwards, he refused to suckle on Kathy. We tried everything, even consulting with a lactation expert, but the stress of not being able to spend the time with Brennan, as well as not having any time to spend with our two other boys was extremely stressful, so we decided to supplement with formula, and breast-feed the the best of her ability. 

 

There’s been a lot of research recently about the benefits of breast milk over formula. There’s even evidence that the act of bottle-feeding (breast milk or formula) has detrimental consequences on jaw development and possibly increasing the risk for developing sleep apnea later in life. The decision to breast-feed has a lot of emotional, practical and financial issues that all new mothers must deal with. Unless one has unlimited time and resources, most new moms are forced to make sacrifices in one area or another. Does she spend 45 minutes breast-feeding every two hours initially, like what the lactation consultant recommended, or does she skip every few feeds (and give the baby formula) to get in more sleep so she can stay sane? Even with help (her spouse or hired help or relatives), things are not always that simple.

 

It seems like in the old days, there was a lot more help available, especially in traditional cultures like with our family. You had multiple resources living with you or close by, including your mother-in-law, aunts, sisters, etc. Today, even in traditional societies, everything’s changed. The lactation consultant that we saw made this interesting comment: New moms have a much harder time breast-feeding and producing milk whenever there is a deadline to go back to work. Imagine having this deadline, whether it’s a few weeks or even a few months, and there’s no one to help out.

 

There were many other circumstances with our situation that prevented the ideal: in addition to the hospital readmission for the elevated bilirubin level, Kathy could not use her left arm at all. During the delivery, the IV was placed in the antebrachial vein (at the bend of her left elbow) which not only caused irritation, but during placement, had bruised the nerve that went to her arm and hand. It’s still very difficult to even handle the baby, let alone breast-feed properly.

 

So what does breast-feeding have to do with CPAP? If you’re diagnosed with obstructive sleep apnea (OSA), the gold standard recommendation is continuous positive airway pressure, or CPAP. This is a device that provides gentle positive air pressure through a mask that fits over your nose or mouth. It works by stenting open your airway, preventing multiple obstructions and arousals. Untreated sleep apnea can lead to high blood pressure, diabetes, depression, anxiety, weight gain, heart disease, heart attack or even stroke. 

 

In the ideal situation, CPAP is the best way of treating OSA. Most people do well, but how many people do well depends on the systems that are in place to support using your CPAP machine. Ideally, the patient should be evaluated and counseled in a sleep center where after the diagnosis of sleep apnea, he or she comes back to have a discussion about the results and get counseled about CPAP. The patient should be able to try on various CPAP masks and models in the office and have a period of slow acclimation to the mask. There should be an intense follow-up and feedback routine for weeks to months, to make sure that the patient is effectively using the CPAP. Compliance data should be analyzed regularly and applied promptly to better optimize CPAP usage. Durable medical equipment (DME) vendors should also provide great support and have constant communication with patients and prescribing physicians. Users should also be involved in a community of CPAP users who can give support, as well as to be able to hold the new CPAP user accountable.

 

In the real world, this almost never happens. With a few exceptions, most people are given a CPAP machine at home, and told good luck. There’s very little follow-up, if any. This is why in our country, overall CPAP compliance is dismal. I’m told in other European countries, the overall compliance rate is much better due to the more centralized aspects of their healthcare. 

 

The problem is that there are 4-5 separate entities involved in your care as a CPAP user, and with our current system, there’s not too much communication or coordination amongst all the health care providers. Granted, there are exceptions to what I’m describing, with some great sleep doctors and DME vendors. But for the most part, the service, support and follow-up is pretty dismal. This is why overall CPAP compliance is so poor, as compared with other countries.

 

As you can imagine, many people fall through the cracks, not using their CPAP at all. It’s not that common, but there are some patients that take full responsibility for coordinating his or her own care and make the effort to follow-up with the sleep center and DME vendors, almost to the point of being aggressive. They have to be a squeaky wheel to make any progress. In many instances, they are willing to pay extra or everything out of pocket to get what they need, rather than relying on the DME vendors or be restricted to the bare-bones equipment that insurance usually covers for. These patients generally do well.

 

Then there are the patients who try everything and are still unable to use their CPAPs. Typically, it either due to irritation, discomfort or claustrophobia from the mask, the excessively high pressures or bloating from swallowing air. They go through all the necessary steps to address all of the above issues, but are still unable to use their machines. Some people are fully compliant with their machines, using it religiously, but find no subjective or objective improvement, or sometimes it just makes things worse.

 

The point of these lengthy comparisons between CPAP and breast-feeding is that there’s a lot more that can be done for people to more fully benefit from CPAP and breast-feeding, but at the other extreme, you have to know when to give up and go on to more realistic and practical methods. Not being able to breast-feed or benefit from CPAP in no way implies a failure on the anyone’s part. These are two important issues that I’m sure will need to be addressed by many new mothers and newly diagnosed sleep apnea sufferers.

 

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