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Diet, Sleep, and Breath:
Each Important, All Connected

Dr. Charles Ferzli has first-hand experience with many of the issues he sees at the TMJ and Sleep Therapy Center in Cary. And—significantly—he understands how completely issues related to diet, sleep, and breathing are connected.

Dr. Ferzli

The Western diet of highly processed, sugary, and salty foods is certainly a problem, says Dr. Ferzli. “But it goes beyond the nutritional deficiencies. We live in a fast-food environment—high in in sugar, soft and processed food—and you eat it on the run. Which means you don’t digest it properly and you don’t take time to breathe.”

Dr. Ferzli notes that people who don’t breathe properly—through the nose—may face additional nutrition challenges, since they often eat faster, wanting to swallow so they can take a breath. “Less chewing and more gulping hamper proper digestion and absorption of nutrients,” he explains.

TMJD (temporomandibular joint dysfunction) can also have an unhealthy influence on diet. “People with TMJD may struggle to eat hard foods because they can’t open their mouths wide enough to bite into them. So soft and processed food become the easier choice, if not the healthier one.

“And poor diet, in turn, can exacerbate inflammation in the body, resulting in further TMJ pain and impeding nose breathing,” he explains. “That causes further nasal congestion and inflammation, often resulting in clenching of the teeth and sleep issues. These things are all connected.”

Improper breathing also puts the sympathetic system—the fight-or-flight mode—on overdrive. “Learning how to breathe properly at different times of day is huge,” says Dr. Ferzli. “It affects all the metabolic processes in the body and it affects digestion in a big way. So, we teach our patients how to breathe.”

Dr. Ferzli learned this lesson through personal experience. “As a child, I could never breathe through my nose,” he explains. “My mom would ask why are you eating so fast? I didn’t know how to answer her that it was because I had to breathe.”

Health&Healing: So, your own experiences became your first patient example?

DR. FERZLI: Yes. I grew up with a lot of digestive issues. As a child, I was told I had a lot of allergies to different foods and to the environment, but weekly allergy shots never seemed to help. I always had an upset stomach because my body was always in fight-or-flight mode.

When I got a little older, I attributed it to stress—but I just didn’t know how to fix it. I didn’t yet understand the important connections between diet, sleep, and breathing. And I didn’t appreciate the impact sleep has on the body’s ability to rest and recover. If you’re not sleeping well, you wake up with more inflammation, and that inflammation affects the digestive tract. When I put my hand on my stomach, it always felt like it was shaking.

H&H: Did you also experience TMJ issues, like so many of your patients?

DR. FERZLI: I didn’t think I did until I actually started working on my sleep. I realized that as I slept better, my muscles were more relaxed in the morning and I had less tension in my face. And then I connected the dots—realizing that better sleep helped with my headaches. I had chronic headaches but had never associated them with TMJ problems.
Having made that connection for myself, I ask a lot of my patients if they get headaches. Much as I did, they may have had daily headaches and “just learned to live with it.” They often don’t see it as a concern, but it is a symptom of everything else.

We also notice that people with high blood pressure are 80 percent more likely to have sleep apnea if on multiple blood pressure medications. So, when someone comes into the office with two or three blood pressure medications, we know they have sleep problems.

H&H: How do sleep issues related to diet?

DR. FERZLI: When you don’t sleep well, you have more inflammation in the body. That may result in acid reflux, which further influences diet and digestion. Again, I draw on my own experience. When I went to the gastroenterologist to deal with my digestive problems, his approach was typical—treating the symptoms, but not the root problem. He put me on antispasmodic drugs to relax my digestive tract, which would make me very sleepy. And then he added proton pump inhibitors (PPIs) because I was having acid reflux. He even wanted to do surgery on my stomach.

I’m glad I didn’t go with his approach! Because the solution was really to be found by addressing the source problems in my diet and sleep. I learned that I wasn’t digesting my food properly and wasn’t retaining any of the nutrition. I found some really good vitamins that helped me supplement what my body was missing, and my acid reflux went away. And I had to learn how to fix my diet and also how to fix my sleep.

My wife played a big part in fixing my diet. She cooked meals different from the middle Eastern diet I ate growing up. When I started eating more simply, staying away from carbs, and focusing on protein and vegetables, I found that I had more energy and my stomach got better—so eating an anti-inflammatory diet was the way to go.

H&H: What warning signs do you see with younger patients that can be traced back to sleep and diet?

DR. FERZLI: Bed wetting is one. Children are deep sleepers, but if they have airway problems, they may wake up and wet the bed. Attention problems, crowded teeth, mouth breathing, and circles under the eyes can all indicate they’re not sleeping well.

Also, eating an inflammatory diet kicks the immune system into high gear, including the tonsils and the adenoids. For kids who have sleep problems because they have enlarged tonsils and adenoids, there’s a direct link between those problems and the food they eat. They’re congested and cannot breathe from the nose because of the food they eat. So, it all kind of snowballs into a situation like the one I experienced.

We often have patients start with an anti-inflammatory diet as the goal, working with them to gradually make changes towards that. And we supplement with enzymes to help with digestion, as well as work on breathing and sleep.

For some children—and some adults, for that matter—the root problem may be a tongue tie. This is a condition in which a short, tight band of tissue tethers the bottom of the tongue’s tip to the floor of the mouth. And this can interfere significantly with a child’s ability to chew and swallow and that will affect their diet and, in turn, their digestive health, their sleep and their breathing.

The solution to this problem is a relatively simple surgical procedure called a frenectomy. And what’s remarkable about this operation is the wide-ranging impact it can have. In addition to resolving many of the direct problems caused by the tongue-tie, such as sleep and speech difficulties, a frenectomy can release a tremendous amount of tension—and thus relieve pain—in the head, neck, and back.