Heads-up people!! This video is just for information and isn’t medical or dental advice-I’m not a doctor, dentist or licensed healthcare provider of any kind. Always check with a qualified professional for your health questions. Use this info at your own risk-it’s not meant to diagnose, treat, or recommend specific providers, products or procedures.
Great video Ron, one thing I wanna see if you could look into is double Jaw surgery relapse and how common it is 5 years post op. Because every online forum I see, partial relapse is inevitable but how common is complete relapse?
Do you notice all these awakenings (12 were scored) Ron? Pretty crazy your deep/rem sleep was pretty much in the normal range waking up 12 times in a night. You should def try CPAP again and see if it helps could also reduce nocturia of course. I have the same problem with conscious awakenings and CPAP doesn't help I usually get 5-10% rem/deep though according to my sleep monitor I would be curious how Rama would treat these awakenings if interventions aren't helping, like if oxybate is needed.
Dysphagia (difficulty swallowing) can potentially lead to nociplastic changes in the brainstem due to the complex interplay between sensory and motor pathways involved in swallowing and pain processing. Here’s how dysphagia might contribute to such changes: 1. Chronic Sensory Afferent Stimulation • Dysphagia often involves abnormal stimulation of sensory nerves in the pharynx, larynx, and esophagus. Persistent or aberrant sensory input can lead to central sensitization, a phenomenon where the nervous system becomes more responsive to stimuli. • This sensitization can occur in the brainstem, where primary sensory inputs for swallowing and pain converge, especially in the nucleus tractus solitarius (NTS) and the spinal trigeminal nucleus. 2. Neuroinflammation • Dysphagia can be associated with inflammation or irritation in the tissues of the upper digestive and respiratory tracts. Neuroinflammatory responses can amplify nociceptive signaling pathways, leading to plastic changes in brainstem structures. 3. Altered Motor Control and Feedback Loops • The coordination of swallowing involves complex motor feedback loops between the cortex, brainstem, and peripheral structures. In dysphagia, maladaptive changes in these loops may influence the excitability and plasticity of the brainstem nuclei involved in motor control and sensory integration. 4. Stress and Emotional Factors • Chronic dysphagia is often associated with psychological stress, which can amplify nociceptive pathways via the hypothalamic-pituitary-adrenal (HPA) axis. Increased stress responses can contribute to nociplastic changes in the central nervous system, including the brainstem. 5. Cross-Talk Between Pain, Swallowing, and Sleep Pathways • Pain, swallowing, and sleep pathways share overlapping neural circuits in the brainstem and higher centers. Dysfunction in one pathway, such as dysphagia, can lead to maladaptive changes in the others. Here’s how these systems interact: Pain and Swallowing Pathways • The brainstem contains nuclei like the nucleus tractus solitarius (NTS) and the spinal trigeminal nucleus, which are involved in both pain processing and swallowing reflexes. Dysphagia can result in persistent aberrant sensory input, leading to increased excitability of these nuclei, thereby amplifying pain signaling (nociplastic changes). • In chronic conditions, dysregulated swallowing and increased nociception may lead to central sensitization, where normal stimuli such as swallowing become painful (dysphagia-induced pain). Swallowing and Sleep Pathways • Swallowing reflexes are typically suppressed during sleep, especially during deeper stages, to facilitate rest. However, in individuals with dysphagia, disrupted neural circuits may interfere with this natural suppression, leading to micro-arousals or fragmented sleep. This is particularly evident in conditions like obstructive sleep apnea (OSA), where swallowing reflexes and airway patency are compromised during sleep. • Poor sleep quality can impair brainstem plasticity and exacerbate dysphagia by reducing the efficiency of neural repair and coordination. Pain and Sleep Pathways • Chronic pain can disrupt sleep architecture, causing difficulty in achieving restorative sleep stages. In turn, poor sleep exacerbates pain perception by increasing central sensitization and reducing the brain's ability to modulate nociceptive input. • Brainstem centers like the periaqueductal gray (PAG) and the reticular formation, which are involved in pain modulation, also influence sleep-wake cycles. Dysphagia- related nociplastic changes in these areas can simultaneously affect sleep quality and pain thresholds. Three-Way Interaction • Dysphagia can trigger a vicious cycle involving all three pathways: 1. Abnormal swallowing reflexes increase sensory load and nociceptive signaling. 2. Chronic pain contributes to heightened sensitivity and disrupted sleep. 3. Poor sleep further impairs swallowing coordination and pain modulation. • This cycle not only exacerbates dysphagia and pain but also leads to systemic fatigue, heightened stress, and neuroplastic changes in the brainstem that perpetuate the dysfunction. Clinical Implications: • Addressing pain, sleep disorders, and swallowing dysfunction simultaneously is crucial to breaking this cycle. Interventions may include: o Neuromodulation techniques (e.g., transcranial magnetic stimulation) targeting shared pathways. o Multimodal therapy focusing on sleep hygiene, pain management, and swallowing rehabilitation. o Pharmacological approaches to modulate central sensitization and restore sleep quality. Understanding this interconnected system emphasizes the need for an integrated treatment approach to manage the overlapping impacts of dysphagia, pain, and sleep disturbances. 4o Implications of Nociplastic Changes: • Hypersensitivity: Individuals with dysphagia may develop heightened sensitivity to mechanical or chemical stimuli in the throat or esophagus. • Altered Swallow Reflex: Changes in brainstem plasticity could affect the efficiency and coordination of the swallow reflex. • Persistent Pain: Some individuals with dysphagia may experience referred pain (e.g., throat or chest discomfort), potentially linked to nociplastic changes. Conclusion: While the precise mechanisms linking dysphagia to nociplastic changes in the brainstem require further research, it is evident that chronic sensory disturbances, neuroinflammation, and maladaptive neural plasticity could play significant roles. These insights can guide therapeutic interventions aimed at both the mechanical and neurological aspects of dysphagia
The RDI not varying much during supine vs non supine sleep indicating a nasal and not tongue base issue, really isn't conclusive - at what stage of sleep were you in each position? How long were you in each position? Was your head falling straight back or to the side whilst elevated when sleeping supine? With respect, these numbers experts really got me nowhere on my journey to resolve this issue. The only things that have assisted me were those therapies that addressed tongue base collapse or procedures that made my jaws bigger. Only regret is not advancing further the first time.
37:00 Could clenching of muscles be because the body tries to burn off the excess oxygen, to go back to normal CO2 levels. I feel better psychologically when i clench, but my body hurts all over. When i relax, my body feels good, but my head is dizzy/aches. The body must have some kind of reflex/inbuilt mechanism to cope with these elevated levels to protect the brain and organs. Even though it causes major pain in the muscular skeletal system.
Heads-up people!! This video is just for information and isn’t medical or dental advice-I’m not a doctor, dentist or licensed healthcare provider of any kind. Always check with a qualified professional for your health questions. Use this info at your own risk-it’s not meant to diagnose, treat, or recommend specific providers, products or procedures.
Loving this full analysis. To be able to have a doctor explain for a full hour his thoughts and examinations is great
Dr. Rama makes some good points. It’s best to optimize medical treatment before surgery. Looking forward to following your progress, Ron.
Thank you Dr. For giving us alternatives/options of treatment before surgery 🙏🏼 will check them out
Great video Ron, one thing I wanna see if you could look into is double Jaw surgery relapse and how common it is 5 years post op. Because every online forum I see, partial relapse is inevitable but how common is complete relapse?
great interview, thx to both of you for doing this!
Ron, have you tried a tongue retaining device like the AveoTSD? MMA is a serious surgery, brother.. as I’m sure you know.
Do you notice all these awakenings (12 were scored) Ron? Pretty crazy your deep/rem sleep was pretty much in the normal range waking up 12 times in a night. You should def try CPAP again and see if it helps could also reduce nocturia of course. I have the same problem with conscious awakenings and CPAP doesn't help I usually get 5-10% rem/deep though according to my sleep monitor I would be curious how Rama would treat these awakenings if interventions aren't helping, like if oxybate is needed.
Dysphagia (difficulty swallowing) can potentially lead to nociplastic changes in the brainstem
due to the complex interplay between sensory and motor pathways involved in swallowing
and pain processing. Here’s how dysphagia might contribute to such changes:
1. Chronic Sensory Afferent Stimulation
• Dysphagia often involves abnormal stimulation of sensory nerves in the pharynx,
larynx, and esophagus. Persistent or aberrant sensory input can lead to central
sensitization, a phenomenon where the nervous system becomes more responsive to
stimuli.
• This sensitization can occur in the brainstem, where primary sensory inputs for
swallowing and pain converge, especially in the nucleus tractus solitarius (NTS) and
the spinal trigeminal nucleus.
2. Neuroinflammation
• Dysphagia can be associated with inflammation or irritation in the tissues of the
upper digestive and respiratory tracts. Neuroinflammatory responses can amplify
nociceptive signaling pathways, leading to plastic changes in brainstem structures.
3. Altered Motor Control and Feedback Loops
• The coordination of swallowing involves complex motor feedback loops between the
cortex, brainstem, and peripheral structures. In dysphagia, maladaptive changes in
these loops may influence the excitability and plasticity of the brainstem nuclei
involved in motor control and sensory integration.
4. Stress and Emotional Factors
• Chronic dysphagia is often associated with psychological stress, which can amplify
nociceptive pathways via the hypothalamic-pituitary-adrenal (HPA) axis. Increased
stress responses can contribute to nociplastic changes in the central nervous system,
including the brainstem.
5. Cross-Talk Between Pain, Swallowing, and Sleep Pathways
• Pain, swallowing, and sleep pathways share overlapping neural circuits in the
brainstem and higher centers. Dysfunction in one pathway, such as dysphagia, can
lead to maladaptive changes in the others. Here’s how these systems interact:
Pain and Swallowing Pathways
• The brainstem contains nuclei like the nucleus tractus solitarius (NTS) and the spinal
trigeminal nucleus, which are involved in both pain processing and swallowing
reflexes. Dysphagia can result in persistent aberrant sensory input, leading to
increased excitability of these nuclei, thereby amplifying pain signaling (nociplastic
changes).
• In chronic conditions, dysregulated swallowing and increased nociception may lead
to central sensitization, where normal stimuli such as swallowing become painful
(dysphagia-induced pain).
Swallowing and Sleep Pathways
• Swallowing reflexes are typically suppressed during sleep, especially during deeper
stages, to facilitate rest. However, in individuals with dysphagia, disrupted neural
circuits may interfere with this natural suppression, leading to micro-arousals or
fragmented sleep. This is particularly evident in conditions like obstructive sleep
apnea (OSA), where swallowing reflexes and airway patency are compromised during
sleep.
• Poor sleep quality can impair brainstem plasticity and exacerbate dysphagia by
reducing the efficiency of neural repair and coordination.
Pain and Sleep Pathways
• Chronic pain can disrupt sleep architecture, causing difficulty in achieving restorative
sleep stages. In turn, poor sleep exacerbates pain perception by increasing central
sensitization and reducing the brain's ability to modulate nociceptive input.
• Brainstem centers like the periaqueductal gray (PAG) and the reticular formation,
which are involved in pain modulation, also influence sleep-wake cycles. Dysphagia-
related nociplastic changes in these areas can simultaneously affect sleep quality and
pain thresholds.
Three-Way Interaction
• Dysphagia can trigger a vicious cycle involving all three pathways:
1. Abnormal swallowing reflexes increase sensory load and nociceptive
signaling.
2. Chronic pain contributes to heightened sensitivity and disrupted sleep.
3. Poor sleep further impairs swallowing coordination and pain modulation.
• This cycle not only exacerbates dysphagia and pain but also leads to systemic fatigue,
heightened stress, and neuroplastic changes in the brainstem that perpetuate the
dysfunction.
Clinical Implications:
• Addressing pain, sleep disorders, and swallowing dysfunction simultaneously is
crucial to breaking this cycle. Interventions may include:
o Neuromodulation techniques (e.g., transcranial magnetic stimulation)
targeting shared pathways.
o Multimodal therapy focusing on sleep hygiene, pain management, and
swallowing rehabilitation.
o Pharmacological approaches to modulate central sensitization and restore
sleep quality.
Understanding this interconnected system emphasizes the need for an integrated
treatment approach to manage the overlapping impacts of dysphagia, pain, and
sleep disturbances.
4o
Implications of Nociplastic Changes:
• Hypersensitivity: Individuals with dysphagia may develop heightened sensitivity to
mechanical or chemical stimuli in the throat or esophagus.
• Altered Swallow Reflex: Changes in brainstem plasticity could affect the efficiency
and coordination of the swallow reflex.
• Persistent Pain: Some individuals with dysphagia may experience referred pain (e.g.,
throat or chest discomfort), potentially linked to nociplastic changes.
Conclusion:
While the precise mechanisms linking dysphagia to nociplastic changes in the brainstem
require further research, it is evident that chronic sensory disturbances, neuroinflammation,
and maladaptive neural plasticity could play significant roles. These insights can guide
therapeutic interventions aimed at both the mechanical and neurological aspects of
dysphagia
Jaw surgery time for Ron! Great interview. Try bipap maybe as well
The RDI not varying much during supine vs non supine sleep indicating a nasal and not tongue base issue, really isn't conclusive - at what stage of sleep were you in each position? How long were you in each position? Was your head falling straight back or to the side whilst elevated when sleeping supine?
With respect, these numbers experts really got me nowhere on my journey to resolve this issue.
The only things that have assisted me were those therapies that addressed tongue base collapse or procedures that made my jaws bigger. Only regret is not advancing further the first time.
37:00 Could clenching of muscles be because the body tries to burn off the excess oxygen, to go back to normal CO2 levels. I feel better psychologically when i clench, but my body hurts all over. When i relax, my body feels good, but my head is dizzy/aches.
The body must have some kind of reflex/inbuilt mechanism to cope with these elevated levels to protect the brain and organs. Even though it causes major pain in the muscular skeletal system.
My advice as an MMA survivor- ASK IF TURBINECTOMY WILL BE DONE AS PART OF MMA. Sometimes they do this and you need to know that.
thank you ron
how much nasal breathing running do you do weekly, Ron?
Tongue toning- Remplenish
I got empty nose syndrome from turbinate reduction.
If you could use a CPAP friend in the meantime before jaw surgery, I might know of someone 👀
Have you been to a Physio for headaches?
So now I'm guessing every person on this planet has some form of mild sleep apnea/UARS ......
Ye since we're all recessed bro
Yes this is a fact, everybody has some degree of sleep apnea and it may worsen as a result of weight issues, upper airway infections etc.
Everyone who is recessed, yes
@ Don’t think Ron is recessed when compared to the general population.
Ron, did you have a DISE done to see if it’s an airway issue?
Bro your tongue is acting like a pink orthotic. Get a neuromuscular orthotic