A little appreciated hidden health risk, observes Dr. Charles Ferzli of the TMJ & Sleep Therapy Centre in Cary, is poor sleep. “Indeed,” he says, “quality sleep is a critically important foundation for health, and poor sleep contributes directly to many serious diseases—including diabetes, heart disease, hypertension, depression, and more. It is during our nightly sleep cycle that our body regenerates and heals. And when that cycle is disrupted, it affects inflammatory processes in the body, contributing to disease and impairing our ability to heal.

“We spend a third of our lives sleeping,” he explains. “And there’s a good reason. Sleep—in all its stages—is essential for every aspect of our health, providing the foundation for healing, growth, and cognitive processing.

“The restorative sleep cycle,” explains Dr. Ferzli, “includes four stages—each with a unique role in maintaining cognitive health and performing physical repair. The first few stages are known as non-rapid eye movement (REM) sleep. Stage one is light sleep, or the transition from wakefulness to sleep. The body slows down still more in stage two, as memory consolidation begins. Stages three and four are deep sleep stages, also known as delta and REM sleep.”

“It’s during deep sleep that the body heals itself, when we secrete hormones, and when children grow.” Dr. Ferzli says. “Deep sleep furthers the process of memory consolidation, but REM sleep—the dream stage—is when the brain basically hashes out the day, flushing out toxins in the brain to make room for new memory and cognitive skills,” says Dr. Ferzli. “REM sleep also supports emotional processing.”

Thus, the consequences of sleep deprivation, says Dr. Ferzli, “are profound. People who lack sufficient, healthy sleep are not just tired, it affects their mood, their patience, their ability to remember and learn new things. They are more likely to be sick, to have more anxiety, and to suffer more from depression.”

The Cascading Consequences of Poor Sleep

“Insufficient or poor-quality sleep has a cumulative, cascading effect on our health,” explains Dr. Ferzli. “Over time, if we don’t sleep well, sleep is less restorative, we have more inflammation, and we feel pain more easily. Increased inflammation, in turn, affects our hormonal and digestive systems. As a result, we experience increased stress—and our nervous system is more prone to being in a heightened state. We’re also more prone to digestive problems, and develop chronic inflammatory processes such as acid reflux, diabetes, and high blood pressure. Poor sleep leads to anxiety and reduces our immune system’s effectiveness in dealing with pain and disease. These problems, in turn, interfere with sleep, creating a vicious cycle of increasing health problems.”

That vicious cycle is a challenge, acknowledges Dr. Ferzli. Just as poor sleep quality can contribute to disease, trauma and disease can interfere with a healthy sleep cycle. “A painful injury, for example, can result in difficulty falling asleep or staying asleep; medications to treat certain illnesses will interfere with the sleep cycle; and severe, persistent stress—such as we experienced during the Covid crisis—can also have long-term impact on sleep patterns. So, our goal,” he says, “is to identify the factors that interfere with a healthy sleep cycle in order to restore quality sleep.”

Obstacles to Quality Sleep

There are many, many obstacles to a good night’s sleep, including allergies, jaw pain, medications, and environmental conditions such as room temperature or too much light. “Two factors, however,” says Dr. Ferzli, “are particularly problematic—diet and breathing issues.

“If you have sleep problems,” says Dr. Ferzli, “is very likely that your diet may be the cause. What we eat and how we eat can have a tremendous impact not only on our sleep patterns, but on our over-all health. In terms of sleep disruption,” he says “the biggest culprit is sugar—refined carbohydrates. Alcohol, which contains a lot of carbohydrates and can contain a lot of sugar, is also significant problem. For example, taking in alcohol past 3:00 PM is likely to affect your sleep cycle.

“Stimulants such as nicotine also interfere with healthy sleep cycles, as do food sensitivities and allergies. Acid reflux brought on by spicy or oily foods can be exacerbated when lying down; and foods that cause inflammation can hinder breathing as the airway swells. Low levels of minerals and vitamins, such as iron and Vitamin D, also cause sleep problems.”

“However, the biggest problem caused by a poor diet is inflammation. Diets high in sugar and processed foods create excessive inflammation in the body. And inflammation plays a powerful role in virtually all disease—whether as a causal factor or an impediment to healing.”

Mouth Breathing and Sleep

“I often begin my conversation with new patients by asking if they snore or wake up with a dry mouth,” says Dr. Ferzli. “Because those are signs that they are mouth breathers. And mouth breathing is a major problem interfering with quality sleep.

“Obstructive sleep apnea and Upper Airway Resistance Syndrome (UARS) are serious, even potentially life-threatening breathing problems; and we will test patients to determine if these conditions exist. However, by far the most common breathing problem affecting sleep,” says Dr. Ferzli, “is mouth breathing. What is not well understood is that how you breathe is fundamental to protecting and maintaining your health. And the right way to breathe—the way that ensures you are getting the oxygen you need—is through your nose. Nasal breathing is essential for proper oxygenation of tissues and is closely linked to sleep quality.

“Although we’re designed to breathe through the nose, many things will cause a person to breathe through the mouth,” he explains, “and it can become a habit. Anatomical problems are one example, chronic nasal congestion is another. Diets high in sugar and processed foods create excessive inflammation in the body. And inflammation leads to nasal congestion, which frequently results in mouth breathing.”

Incorrect breathing creates a ripple of negative impacts notes Dr. Ferzli. “Because they are not getting enough oxygen to the cells. mouth breathers are more prone to developing upper respiratory infections, bronchitis, and asthma. They are also more likely to have TMJ problems because they clench their teeth while sleeping. And they may have more pain overall, because they don’t release oxygen as efficiently to the muscles, causing more inflammation.”

Solving Sleep Problems: It Begins With Education

“In my sleep therapy practice,” says Dr. Ferzli, “healing begins with education. Sleep-related breathing problems are not isolated; they are inextricably connected to other issues, such as jaw pain, stress, allergies, diet, structural and dental problems. Treating these problems begins with a thorough understanding of each patient’s sleep issues—and which factors contribute to their problem.

“Many of these factors relate to lifestyle choices—especially related to diet and sleep habits. So, an important part of any treatment plan—the starting place—is education. Regrettably, most patients share what I would describe as the ‘the Western medicine mindset’—they want a pill. And their first question is likely to be ‘What medicine should I be taking to sleep better?’ instead of, “How do I address the source of my problem?’

 “My response is: ‘You are not suffering from a deficit of sleep medicine; something else is affecting your sleep.’ Then I explain that we don’t believe in using drugs for sleep problems; we want to treat them orthopedically, so that they can live without pain, and without taking medications.

“So, we educate them—explaining how their breathing issues or diet relates to their sleep. And we show them how to adjust their breathing, or to use oral appliances to optimize their airway. For each patient, there’s a plan to address their specific breathing and sleeping problems. If they understand it, and they follow through, they get better.”