Is This Mushroom Edible with Emerson Kerr

Why AI Feels Threatening

0:00 Michael Mackniak: Welcome back to the Holding It Together Kinda podcast.

0:03 Michael Mackniak: I'm Michael Makniak.

0:05 Michael Mackniak: We often hear that the future of healthcare is digital, data driven, increasingly automated.

0:12 Michael Mackniak: As someone who advocates for a return to the 1950s bedside manner, that usually makes me a little nervous.

0:19 Michael Mackniak: I'm a believer in the power of the human touch, the stuff that AI can't replicate.

0:25 Michael Mackniak: Now, AI is all over the news right now.

0:28 Michael Mackniak: We see it every day.

0:30 Michael Mackniak: It's just it's over the top.

0:32 Michael Mackniak: We're bombarded with it.

0:34 Michael Mackniak: And I think that there's a fear-mongering aspect of it that it just perpetuates itself.

0:42 Michael Mackniak: So let me just get that out there and say that right at the outset.

0:46 Michael Mackniak: I am not opposed to AI, nor am I afraid of AI.

0:50 Michael Mackniak: But I understand, given the again, that the bombardment that we get with it, I understand why people uh who don't know or care enough about it uh are sick of hearing it or are even on some level frightened of what it means.

1:08 Michael Mackniak: But recently I sat on a panel with a with a guy who changed my perspective.

1:13 Michael Mackniak: Uh Emerson Kerr is a C-suite executive at uh at Knox Medical, and he's a really a leading voice in sleep technology.

1:22 Michael Mackniak: He's somebody who deeply understands that while AI is not going anywhere, folks, it doesn't have to replace the human element.

1:31 Michael Mackniak: In fact, it might be the very thing that saves the human element.

1:36 Michael Mackniak: Today we're going to talk about how we bridge that gap and why the most advanced technology in the world might actually be the key to getting a better night's sleep for the people who need it most, the caregivers.

Meet Emerson Kerr In Sleep Tech

1:55 Michael Mackniak: Well, hello everybody, thank you for being here.

1:58 Michael Mackniak: And Emerson Kerr, thank you from join for joining us as well.

2:02 Michael Mackniak: As always, I I want to ask you to please introduce yourself, tell us about what you do, your credentials.

2:10 Michael Mackniak: You can brag about how wonderful you are, but more importantly, I'm really interested in what has you fired up right now and what really gets you going in in your work, your private life, your interests, your hobbies, or whatever.

2:23 Michael Mackniak: So welcome and have at it.

2:26 SPEAKER_02: Hey, Mike, it's good to see you again.

2:28 SPEAKER_02: It was great to get to spend a little time with you in Las Vegas at Health 2.0.

2:32 SPEAKER_02: It was fun to meet a lot of different professionals with, you know, interesting interests in life.

2:37 SPEAKER_02: And, you know, uh I believe that you know we all make these connections for a reason.

2:43 SPEAKER_02: I'm glad we're I'm able to speak to your audience today.

2:47 SPEAKER_02: I have been in healthcare since 1995.

2:50 SPEAKER_02: I started as a respiratory therapist, taking care of patients with breathing problems, and that led me into sleep medicine.

2:58 SPEAKER_02: And, you know, at the time I didn't realize how impactful that would be for me.

3:03 SPEAKER_02: It ended up changing my life.

3:04 SPEAKER_02: I fell in love with a field, and that was in 1998.

3:08 SPEAKER_02: So, you know, 20, almost 28 years ago, I made that change in my life.

3:14 SPEAKER_02: And it led me on a journey that has really shaped what I do now, how I think created a passion in me for the sleep industry, sleep medicine, sleep technology.

3:26 SPEAKER_02: I, you know, it took me on a tour with Phillips.

3:29 SPEAKER_02: I worked for Resperonics and Phillips in the CPAP world.

3:32 SPEAKER_02: And there was a little thing called the CPAP recall a few years ago that, you know, really impacted probably a few of your listeners and many others that had to return their CPAP and, you know, look for alternatives.

3:45 SPEAKER_02: It was a tough time for a lot of people, but it it changed my career and it introduced me to some things I'd never been involved with before.

3:53 SPEAKER_02: I'd been a part of sleep and breathing for, you know, literally 27, 28 years.

4:00 SPEAKER_02: And then suddenly I changed careers and got into oral appliance sleep medicine.

4:05 SPEAKER_02: And dental sleep is fascinating.

4:07 SPEAKER_02: You know, if you had tried to talk to me about it when I was in the CPAP world, I would have just laughed you off and said, you know, there's better solutions than that.

4:15 SPEAKER_02: But I began to learn a lot about that as a solution.

4:18 SPEAKER_02: And it's extraordinary what just destabilizing the jaw, maybe moving it forward a few millimeters, can do for someone's life.

4:27 SPEAKER_02: Because for many people, CPAP is just too much.

4:30 SPEAKER_02: It's a sledgehammer, or you know, for a like a penny nail.

4:35 SPEAKER_02: But for for many people, you know, it's it's it's the right solution.

4:40 SPEAKER_02: And it was fun to learn about that, to really enter into a community of sleep dentists that are passionate about the care of patients with sleep disorders.

4:50 SPEAKER_02: And eventually that led me to where I am now as vice president of market development and strategic partnerships with Knox Medical.

4:58 SPEAKER_02: As, you know, Knox is a sleep diagnostics manufacturer.

5:02 SPEAKER_02: And this has been probably the most exciting part of my journey to really work with professionals that are as passionate as I am across the board about sleep and treating people with sleep disorders.

5:15 SPEAKER_02: So it's been a busy, busy career.

5:18 SPEAKER_02: I have a couple of other irons in the fire.

5:20 SPEAKER_02: I'm currently the president of the American Association of Sleep Technologists, which is the professional organization for sleep techs that do the sleep testing on patients, sleep coaching, and sleep education with physicians and other doctors who work in sleep medicine.

5:37 SPEAKER_02: And then for fun, I am, I like you, I have a podcast.

5:41 SPEAKER_02: I have the sleep tech talk podcast.

5:44 SPEAKER_02: It's been insane, you know, to have the success it has.

5:47 SPEAKER_02: It has about 50,000 subscribers.

5:49 SPEAKER_02: We cover a range of topics from what we're going to talk about today to technology, the newest and latest, latest and greatest sleep tech, to really, you know, we've had some interesting people on, like the sleep doctor, who, you know, is sleepdoctor.com and some others like that that are rather popular, but do give us some really keen insights on sleep and where sleep is going.

6:14 SPEAKER_02: So that's been fun to get to do that with a couple of friends and kind of as a as a hobby too, but it's also been incredible to learn from some amazing uh professionals and uh entrepreneurs that are really thinking about where sleep medicine is going and sleep tech for the future.

6:32 SPEAKER_02: So I've got a lot going on, but it's fun.

6:34 SPEAKER_02: Every square inch of it is is absolutely thrilling to be a part of.

6:38 Michael Mackniak: And I'm just thinking as you you described all these things.

From AI Newbie To Daily User

6:43 Michael Mackniak: You have taken your passion, your interests, made a career of it, and made a hobby of it.

6:51 Michael Mackniak: And you, you know, what do they say?

6:53 Michael Mackniak: You live, breathe, sleep, and breathe it, or whatever that work, sleep, whatever that's saying is.

6:58 Michael Mackniak: And it's it's I mean, and I'm much the same way.

7:01 Michael Mackniak: I mean, I as I was saying before we hit record here, I have been just insanely busy with just creating content and and enjoying every second of it.

7:12 Michael Mackniak: Tired at the end of the day, and my sleep has been pretty good.

7:16 Michael Mackniak: Wow, there's so many things I want to touch on there.

7:18 Michael Mackniak: But let me just say, folks, as Emerson said, he and I met at conference that we were asked to do an expert panel on involving AI and the future of AI in healthcare.

7:33 Michael Mackniak: Now, full disclosure, I've never really used AI until about a month ago, five weeks ago.

7:41 Michael Mackniak: Not because I was afraid of it or I didn't appreciate it, but I'll tell you, since I've been using it, I use it almost every time I call Gemini my girlfriend now because we spend a lot of time together.

7:51 Michael Mackniak: For me, it's a great brainstorming tool for other people.

7:55 Michael Mackniak: You know, others use it in different capacities that we're gonna talk about today.

7:58 Michael Mackniak: So I really want to talk about the intersection because we hear so much about AI and what AI is gonna do and how it's gonna ruin the world, or it's already ruined the world, and you know, and all that stuff.

8:11 Michael Mackniak: And I think it's important for all of us to get an expert like you who's knee deep in it, to explain to us what it is and why it isn't gonna ruin the world.

8:21 Michael Mackniak: I mean, I in a simplistic way, I just say, well, I'll I'll unplug the computer.

8:26 Michael Mackniak: I mean, and I know that's not just the end of it, but I mean, really, that's kind of to me how absurd the argument is.

8:33 Michael Mackniak: But the other side of that is I do want to talk about sleep and caregiving and the the you know, the whole care for the caregiver, take care of yourself, put your mask on first, all the cliches.

8:45 Michael Mackniak: So I do want to get into that, but before we do, I want to touch on a couple of points that you brought up.

8:50 Michael Mackniak: I have been anybody that knows me well knows that since I was a kid, I was a snorer, and I've been, you know, I have chronic sleep apnea, chronic obstructive sleep apnea, and I've had a CPAP machine for years and years, probably over a decade.

9:07 Michael Mackniak: And I'm as you're talking, I'm turning around and looking at which one mine is, and of course, it's a Philipsonic care.

9:13 Michael Mackniak: Mine never even knew there was a recall, and I'm just however, I will say for the last almost four years, I have been religious with using it.

9:21 Michael Mackniak: I've been very good with it, and it does help in terms of my sleep anyway.

9:25 Michael Mackniak: I can't say necessarily that it translates to more energy for me, but it does help me with that.

9:31 Michael Mackniak: So I'm very familiar with that.

9:33 Michael Mackniak: I'm certainly going to pick your brain offline about the other sleep aids and the dental.

9:38 Michael Mackniak: I did try that as well, and this was way, this is probably 15 years ago, and then it just didn't work.

9:45 Michael Mackniak: It I don't know if it was a technology, but I I am intrigued by the fact that you were a respiratory therapist.

9:51 Michael Mackniak: I know a respiratory therapist very well and saw the importance of a respiratory therapist in their career and their ongoing care and caregiving for the people that they work with, especially during COVID.

10:06 Michael Mackniak: This woman that I know was she she had as a patient, you know, our patient zero in Danbury, Connecticut, who came up from New York City to Danbury, and she was working there and had that patient.

10:20 Michael Mackniak: So she was right at the very beginning and ground zero of the COVID pandemic.

10:26 Michael Mackniak: So a lot of things you you said brought things home, but I really want to jump in with you into first, let's talk about AI, because Emerson's perspective, again, guys, I am not an AI guy other than using it to brainstorm book ideas, podcast ideas, things like this.

10:47 Michael Mackniak: So I I don't know what I don't know.

10:50 Michael Mackniak: And so I'm gonna learn here along with him.

10:53 Michael Mackniak: But the theme of our discussion at at the at the conference was, as I said, to talk about uh AI and the future of healthcare, basically.

11:03 Michael Mackniak: The future of healthcare with uh with all this technology we've got going on.

11:09 Michael Mackniak: As you know, I am still kind of a holistic guy.

11:12 Michael Mackniak: I just I still believe that if we can get back to basics, the basics of client-centered planning and enhanced communication and collaboration among disparate service providers and an enhanced care coordination model that I've been using in my work for 25 years, I really think that that goes a long way in helping healthcare.

11:35 Michael Mackniak: But but I Emerson's perspective on it just blew me away when we were there because he took that my take, and he took the take of a bunch of other panel experts who were really high-tech people and synthesized it into a way that really resonated with me, and I thought it would resonate with a lot of you.

11:56 Michael Mackniak: So I'm gonna shut up here for a second and let let Emerson tell you his perspective from that that panel, that that conference, and how you should think about AI and moving forward.

Precision Medicine Through Pattern Finding

12:10 Michael Mackniak: So, Emerson, the floor is yours, please.

12:12 Michael Mackniak: Yeah, thanks much.

12:13 Michael Mackniak: Get me to stop talking.

12:15 SPEAKER_02: No, no, it's good stuff.

12:16 SPEAKER_02: You know, I think the you know, when we think about AI, it's we're immediately taken, depending on where your age is, you're either thinking about the 2001 space odyssey and how the AI took over the spacecraft and became the enemy of the astronauts, or you think of the Terminator.

12:35 Michael Mackniak: Remember War Games?

12:35 SPEAKER_02: Yeah, War Games, yeah, with Matthew Broderick.

12:37 SPEAKER_02: I thought of that one too.

12:38 SPEAKER_02: And so you've depending on where you are in the spectrum, it's either the space odyssey, war games, or terminator, or even even something more current.

12:48 SPEAKER_02: But, you know, I think the that's science fiction.

12:51 SPEAKER_02: And of course, you know, we begin to think of worst-case scenarios and those kinds of things.

12:55 SPEAKER_02: And there are certainly those doomsday point of view, and some of them are rather accurate.

13:00 SPEAKER_02: And I think that's the healthy part of our free market, is you're always going to have a balance in, you know, those that push back and create boundaries that protect us from any kind of rogue uh developments.

13:14 SPEAKER_02: But I think the thing that I've learned about AI that's really fascinating is, you know, when you begin to look at hundreds of thousands of millions of people, there's no possible way that you, I, or even the very best physician or scientist could synthesize that amount of data and look for a pattern.

13:33 SPEAKER_02: You know, you begin to think about, you know, someone with mental health, and you think of their gender, their age, their nationality, where they grew up, and you start putting these pieces together and they begin to gel into what we call a phenotype.

13:48 SPEAKER_02: There are basic phenotypes like gender or race or something like that that we can kind of bucket people into.

13:55 SPEAKER_02: But I foresee a future where you know we're able to have a conversation with someone and say, listen, there's a solution for you that has worked for 500,000 people just like you.

14:08 SPEAKER_02: And that's what I envision, you know, this turning into is a different level of conversation where it's not so much that the AI replaces the caregiver, but the the caregiver is able to take the AI and have what we call precision medicine.

14:24 SPEAKER_02: And that's really providing the exact solution or near exact solution for the patient that they need.

14:31 SPEAKER_02: Because I think, you know, I've said this so many times in other venues, you know, we've we've done, we've we worked with what we've had and we've done a fairly good job.

14:41 SPEAKER_02: But a lot of the times the practice of medicine is us taking something that's worked and hoping that it works again.

14:49 SPEAKER_02: And, you know, if it worked 50% of the time, you know, it's almost like a great batting average.

14:54 SPEAKER_02: We're like, you know, let's do it again.

14:56 SPEAKER_02: You know, it's a batting average of 500, which is, you know, almost mythical.

15:01 Michael Mackniak: But yeah, well, you know, but let me just stop you there for a because we also do things that didn't work and we repeat them over and over again.

15:09 Michael Mackniak: And I see you see that a lot in the mental health sphere, but go ahead.

15:11 SPEAKER_02: I'm sorry.

15:12 SPEAKER_02: Yeah, no, 100%.

15:13 SPEAKER_02: You know, but that goes back to the 50-50, is that I had a conversation with the doctor one time about a type of ventilation that I wanted him to try.

15:20 SPEAKER_02: And he said, Emerson, let me so tell you where I've not been by staying with what I do and what I'm comfortable with.

15:26 SPEAKER_02: He says, I've not been on the witness stand, I've not had to been taken to court.

15:30 SPEAKER_02: And I think a lot of times our caregivers are gonna lean in the direction of safety for themselves rather than you know, maybe what's best for the patient.

15:39 SPEAKER_02: Probably a bigger topic for another time.

15:41 Michael Mackniak: But comfort, I think that there's we get into we get into trends, and I said this in another episode, or I've written it, you know, I know where my pizza place is, I know where my beer store is, I know where the fishing hole is, and that's where I go.

15:56 SPEAKER_02: Yep, right.

15:56 SPEAKER_02: So absolutely, and that makes sense, right?

15:59 SPEAKER_02: But I think where we're going though is to a whole new place in AI, where we're able to begin to thread patterns together and see what we're we're what we call endotypes.

16:11 SPEAKER_02: So a phenotype is a collection where we're able to kind of put different types of people into these buckets, so to speak.

16:20 SPEAKER_02: I hate to use that term, but I think that makes sense.

16:23 SPEAKER_02: But the endotypes are what make a phenotype, a collection of characteristics about a patient.

16:30 SPEAKER_02: And so what I think AI has a capability of doing is recognizing these patterns, you know, whether it's it's a heart rhythm or a type of uh brain pattern or just patterns in general, where we see repetitive patterns in a person and maybe it's similar to a hundred thousand people just like them.

16:51 SPEAKER_02: Well, that's that's where I think this can take us.

16:54 SPEAKER_02: Because to your point, we don't want to replace the human caregiver.

16:59 SPEAKER_02: Because at the end of the day, there's two roles the caregiver has.

17:03 SPEAKER_02: One is being that empathetic voice to the patient, but they're also that independent arbiter in that they're supposed to be the one that recognizes there's lots of options out there.

17:15 SPEAKER_02: And here's the one that I think is best based on my experience.

17:19 SPEAKER_02: It's not influenced by money or dinner or some perk I get from that organ, you know, that manufacturer or pharmaceutical company, but it's what I believe is best for you based on my experience.

17:30 SPEAKER_02: So I think that's where the human should should stay and can be in that place and not and won't be replaced by technology.

17:39 Michael Mackniak: And in making that, and in making that determination, isn't the human doing what you're saying that the endotype is the AI, the AI is taking all the information that it has gleaned from common common denominators and and phenotypes and offering a solution or it what it thinks would be the best solution.

18:00 Michael Mackniak: And as a caregiver, you who knows the individual, who knows the patient well, you're taking all of your knowledge and you're you're you're synthesizing it down and you're making a decision based upon that, including what worked in the past, what didn't work in the past.

18:17 Michael Mackniak: And and that's really what you're doing, but uh AI can really help.

18:23 Michael Mackniak: And along those lines, then how can AI be used to help the caregiver or the physicians or the entire caregiving team to do this better and quick?

18:36 Michael Mackniak: Obviously, it can be a lot faster.

18:38 Michael Mackniak: So yeah.

18:39 SPEAKER_02: Well, I I talked to a physician once from University of Michigan, and I said, How long do you have with a patient?

18:45 SPEAKER_02: She said, 10 minutes.

18:46 SPEAKER_02: That's all I've got.

18:47 SPEAKER_02: And I mean, this is one of the leading doctors in her, you know, in this in the space of sleep medicine in the world.

18:53 SPEAKER_02: And so it sort of gives you a frame of reference of how little time they have to really synthesize all of that information and have it make a connection with the patient and and the patient feel like they were cared for.

19:08 SPEAKER_02: It's tough.

19:09 SPEAKER_02: So I think that's to your point, what I think technology is giving, you know, professionals the capability of is a little bit more time because if they can get right to the heart of the matter faster, then what we hope happens next is that they can begin to talk about that.

19:28 SPEAKER_02: Because, you know, the one thing that the AI or a computer can't do is have that conversation to weigh, is this patient really ready for this next step?

19:39 SPEAKER_02: Because, like in a mental health situation, maybe it is the best solution, but it isn't time.

19:45 unknown: Yeah.

19:46 SPEAKER_02: Because this person's not ready.

19:48 Michael Mackniak: I have that situation going on right now with a guy I've been working with for years and years, and everybody wants to push him in a direction.

19:54 Michael Mackniak: I'm I'm saying, pump the brakes a little bit, folks.

19:57 Michael Mackniak: We're not there yet.

19:58 Michael Mackniak: And and that's a great way to say it.

20:01 Michael Mackniak: Let me ask you a question.

20:02 Michael Mackniak: We'll get a little off topic here because a cure I'm curious.

20:04 Michael Mackniak: I when I talked to a doctor recently, they told me 13 to 15 minutes per patient.

20:09 Michael Mackniak: So it's obviously your data is getting worse than, you know, and worse, I guess it's your perspective.

20:15 Michael Mackniak: Just curiosity, what do you think the external factors are that are making these doctors say that they only have this 10 minutes, this 15 minutes?

20:23 SPEAKER_02: Well, so many doctors are paid on performance.

20:26 SPEAKER_02: And you know, they are they're paid on the number of patients they see, the amount of revenue they generate, and because they're they're paid in that fashion, you know, they're they're limited, you know, as to what they can do and the amount of time they have.

Why Doctors Have So Little Time

20:41 SPEAKER_02: It's a business it's a business.

20:42 SPEAKER_02: And because it's a business, it's tough.

20:45 Michael Mackniak: And that's frightening.

20:46 SPEAKER_02: Yeah.

20:46 Michael Mackniak: Yeah, it can't be.

20:48 Michael Mackniak: Because along those same lines, I the same doctor told me that she has about two to three minutes to quickly review a chart and figure out what what what what the hell are you doing here?

20:57 Michael Mackniak: What am I seeing you for?

20:58 Michael Mackniak: Yeah.

20:59 Michael Mackniak: And that I don't know which is scarier, but they're pr pr both pretty damn scary.

21:03 SPEAKER_02: Well, that's why I think you know, part of what is risen as a result of that are these advocacy type roles where people can be a an advocate or an educator to to help someone.

21:15 SPEAKER_02: That happened happened in my own family, where a a loved one of mine, I had been talking to them about sleep apnea for a couple of decades.

21:24 SPEAKER_02: And literally, they finally said, Okay, I'll I'll get a test.

21:28 SPEAKER_02: And they get a test and it comes back negative.

21:31 SPEAKER_02: And then it, and the reason was is this person's a female, and and the type of test she used wasn't going to give her the answer she was looking for.

21:40 SPEAKER_02: And so, being having to step in as her advocate, I said, talk to your doctor about having a sleep lab test rather than an at home test based on her situation.

21:51 SPEAKER_02: And so she finally does.

21:53 SPEAKER_02: And then the nurse practitioner calls her and says, You know, you know, you don't have sleep apnea.

22:00 SPEAKER_02: You know, you can talk to your primary care about it.

22:02 SPEAKER_02: I had to step in again and said, Listen, make an appointment with a physician.

22:07 SPEAKER_02: You know, I'm not surprised you got the answer you did.

22:10 SPEAKER_02: Make an appointment with a physician.

22:11 SPEAKER_02: You have what's upper airway resistance syndrome, not classic sleep apnea.

22:16 SPEAKER_02: And so she makes an appointment with the physician.

22:19 SPEAKER_02: The physician who knows me said, Immersion's right.

22:22 SPEAKER_02: You do have this upper airway resistance syndrome, which is classic among women.

22:27 SPEAKER_02: For you and I, we meet all the criteria quickly of having sleep apnea.

22:31 SPEAKER_02: We're white, we're you know middle-aged, nice necks, right?

22:35 SPEAKER_02: We're big, you know, we're we're we win, winner, winner, chicken dinner.

22:38 SPEAKER_02: We get the we get the seep out.

22:40 SPEAKER_02: But the rules, yeah, the rules weren't written for women.

22:45 SPEAKER_02: The rules for for how women have sleep apnea are different than men.

22:50 SPEAKER_02: How, you know, for you and I, we're gonna snore, we're gonna gasp, we're gonna be tired.

22:54 SPEAKER_02: For women, it can be insomnia, it can be a host of other things that actually are the signs of sleep apnea.

23:02 SPEAKER_02: And when they have a sleep test, they may not actually have the classic high apnea popnee index that you and I have.

23:10 SPEAKER_02: And so what happens is a doctor looks at it and says, Oh, you don't have sleep apnea.

23:15 SPEAKER_02: Let's look at other alternatives.

23:17 SPEAKER_02: Well, that's incorrect.

23:19 SPEAKER_02: They do have sleep apnea, it's just a different grade of it, and it's causing the same sleep fragmentation, it's causing the same tiredness and fatigue, it's causing the same mental errors, depression, and all those things we can get into later are still happening.

23:32 Michael Mackniak: No, but and that but doesn't that bring us back to what you were saying before about what you call precision medicine?

23:37 Michael Mackniak: Yeah, yeah.

When Sleep Apnea Looks Different

23:39 Michael Mackniak: Right?

23:39 Michael Mackniak: And and patterns, patterns, patterns, patterns.

23:44 Michael Mackniak: It's becoming I I can tell the story a million times where my my partner at work was doing record reviews for a woman, and she, by doing manual record reviews, discovered that every single year a client of ours was was undergoing massive decompensation mentally because for whatever reason.

24:05 Michael Mackniak: Well, it was Sarah who discovered that oh my goodness, it's the anniversary of her mother's death.

24:10 Michael Mackniak: She goes into this okay, but but uh that's a pattern that's unique, and this is what you're getting at.

24:17 Michael Mackniak: It's unique to that particular individual.

24:20 Michael Mackniak: We cannot treat every cancer the same.

24:23 Michael Mackniak: No, we cannot treat every illness, every every dementia the same, we cannot treat every mental illness, every schizophrenia is not the same.

24:32 Michael Mackniak: And the fear is that AI is going to put people into these boilerplate not diagnosis, what's the word on treatment protocols?

24:43 SPEAKER_02: Yeah, and that's a fair criticism.

24:46 Michael Mackniak: And we want to avoid that.

24:47 Michael Mackniak: So, how do how does AI and how do doctors avoid that?

24:52 Michael Mackniak: Number one, and number two, uh I going back to your other point, I think that's where you have your caregiver who's stepping in and saying that may be true for this 90% of the people, but this guy doesn't fit that exactly.

25:05 Michael Mackniak: And here's what we've done, and here's why.

25:07 SPEAKER_02: Yeah.

25:07 SPEAKER_02: No, 100%.

25:08 SPEAKER_02: I think that that's got to be the thing we continue to fight for is that advocacy.

25:13 SPEAKER_02: It's not just advocacy for the patient, it's advocacy for the system.

25:16 SPEAKER_02: I was talking to a medical director of one of the health plans, and he said that his group of doctors who reviews, you know, cases coming in for reimbursement, you know, were being replaced by an AI.

25:30 SPEAKER_02: And he said the preliminary results were that it was actually costing more because some of the things were getting through that actually shouldn't get through.

25:40 SPEAKER_02: And so you didn't have that human overview of really analyzing the moment.

25:45 SPEAKER_02: Because what he would do is if he really questioned what was being submitted, he would just call the doctor and say, Hey, you and I have both practiced sleep medicine.

25:54 SPEAKER_02: I just need a little bit more information before I can approve this.

25:58 SPEAKER_02: And they might talk it through and think of an alternative.

26:01 SPEAKER_02: Well, that disappears whenever you go to an automated system that's designed to streamline.

26:08 SPEAKER_02: And I and I think what what ultimately we want out of AI is just better tools, not for it to make decisions for us, but to give us, to empower us so that we just make better decisions for the patient and move them past the hurdles that currently exist.

26:26 SPEAKER_02: I mean, say this over and over in different settings.

26:29 SPEAKER_02: We know better, we can do better.

26:31 SPEAKER_02: In the past, we didn't know better.

26:33 SPEAKER_02: We had very little pieces of information that we made decisions from.

26:37 SPEAKER_02: And we just like with you said with cancer, you know, you know, I had uh a mass removed from my thyroid, and the the ENT said, Listen, a few years ago we would have put you into chemotherapy.

26:49 SPEAKER_02: He said, But what we know now about what we removed, we're just going to observe you every six months.

26:55 SPEAKER_02: And I was like, that's amazing, you know, that I didn't go through that journey, but we he knows better.

27:01 SPEAKER_02: He was able to do better.

27:02 Michael Mackniak: Well, and and and the speed with which this stuff is being learned is just it's Morse Laws.

27:08 Michael Mackniak: I mean, I mean, that was, you know, three years ago they would have given you chemo, and that's putting poison to kill a poison.

27:14 Michael Mackniak: And right.

27:15 Michael Mackniak: So yeah, you dodged a bullet there.

27:17 Michael Mackniak: I mean, I think of the same thing with you know, when I had the uh prostate prostatectomy and the advances there because my father had had it first.

27:26 Michael Mackniak: And anyway, that's that that's totally different story for another day.

27:29 Michael Mackniak: But you you were talking about uh this doctor getting the information in and and being able to process it very quickly.

27:39 Michael Mackniak: And you know, one of the things that that concerns me about all this is getting the information in, right?

27:47 Michael Mackniak: We have to have the information in order to have information to look at.

27:51 Michael Mackniak: And the important thing uh I know a girl who's who's about to graduate college.

27:56 Michael Mackniak: Congratulations, Emma.

27:57 Michael Mackniak: And she was telling me that kids are using AI these days, and it is the end all be all, it's the final answer, and this is the word they're sending in.

28:05 Michael Mackniak: I think that what you're getting at, and what what is important to point out here is that AI is going to give you answers and suggestions.

28:14 Michael Mackniak: It should never ever be the definitive and and what'd you call it?

28:20 Michael Mackniak: You have your prototype, do you have your phenotype?

28:23 Michael Mackniak: Endotype and phenotype, yeah.

28:24 Michael Mackniak: Yeah, yeah.

28:25 Michael Mackniak: AI cannot be the endotype exclusively, correct?

28:29 SPEAKER_02: Right.

28:30 SPEAKER_02: Well, I mean, it that's so that that brings you back to how do you trust the AI?

28:35 SPEAKER_02: And part of the what you know, and a patient's not going to see this, but a caregiver can ask these questions of those that are, you know, providing that technology is how big was the data set that would that taught the AI?

28:49 SPEAKER_02: You know, if it was a few hundred, now you're looking at potential bias.

28:53 SPEAKER_02: Because, I mean, you know, is it Daniel Kahneman that talks about confirmation bias?

28:57 SPEAKER_02: Well, you can have confirmation bias in AI.

29:00 SPEAKER_02: And if your data set isn't big enough, it's got to be in the thousands.

29:04 SPEAKER_02: If it's not in the thousands, now you've got bias, and it's and it could be completely you just you know unintentional, but if your your N isn't big enough, then you're you're going to produce erroneous things because all AI can do is act based on what it's learned.

29:22 SPEAKER_02: That's it.

29:22 SPEAKER_02: It's nothing more.

29:24 SPEAKER_02: Because I you in a note you and I shared, it's kind of garbage in, garbage out.

29:28 SPEAKER_02: If if what it learned is garbage, that's it's sort of like somebody said this the other day.

29:33 SPEAKER_02: It might have been my wife, and and she said, you know, if you look up in AI a certain question, you you know, it can give you an answer that's misleading.

29:43 SPEAKER_02: And and then I found a cartoon that was perfect about it.

29:46 SPEAKER_02: It said, you know, was is this mushroom edible?

29:49 SPEAKER_02: And AI said, Yes.

29:51 SPEAKER_02: It didn't.

29:52 SPEAKER_02: The question wasn't, was this AI safe to eat?

29:55 SPEAKER_02: I mean, this this mushroom safe to eat.

29:58 SPEAKER_02: That's a different question.

29:59 SPEAKER_02: Yeah, you can eat it if you're gonna die.

30:01 Michael Mackniak: Well, and that's one thing that's very frustrating when you start using AI for and I got away from this very quickly because it's so frustrating, you know, with with for generating images and stuff like that.

30:11 Michael Mackniak: It's very frustrating, but because you got to be specific and very the more specific you can ask a question, you're gonna get a better answer.

30:20 Michael Mackniak: To your to your wife's point and to your point, garbage in, garbage out.

30:24 Michael Mackniak: That's an adage from the late 70s when my dad was in computer technology, you know, the the the it mains basically.

30:31 Michael Mackniak: If you put something bad in, the computer's just gonna regurgitate bad.

30:35 Michael Mackniak: Yeah, the other side of that coin now is if you put nothing in, it can't give you anything out, right?

30:42 Michael Mackniak: So, but the other scary thing is I don't know why this sticks in my head, but probably 30 years ago there was a Simpsons episode, and Bart says something along the lines of, you know, if I have learned anything on TV, right?

30:56 Michael Mackniak: It's like that as if that was a definitive uh the go-to about where we were gonna get our you know our information from.

31:05 Michael Mackniak: But I think people have to be very careful in searching the internet and using AI because it's very easy to see where the internet and AI will tell you what you want to hear.

31:17 Michael Mackniak: And caregivers in these situations are desperate very often.

31:22 Michael Mackniak: They're they're experiencing grief and loss, make no doubt about it.

31:25 Michael Mackniak: You know, make no mistake about it.

31:28 Michael Mackniak: Uh and if if if they're looking for a specific answer, it's like finding the witness that will tell you what it is your your case is uh promoting.

31:37 Michael Mackniak: You can't find that answer.

31:38 Michael Mackniak: So you have to be very discerning about the answers that you're looking for.

Garbage In Garbage Out AI

31:44 Michael Mackniak: Physicians, medal, anybody in the medical field has to be very discerning about the information that they're taking in and really look for the outliers because there are outliers everywhere.

31:55 SPEAKER_02: Yeah, absolutely.

31:56 SPEAKER_02: I mean, it's confirmation bias is it's so tempting.

32:00 SPEAKER_02: You know, how can I prove my point?

32:02 SPEAKER_02: I mean, you can you can do it.

32:03 SPEAKER_02: If you have something you believe, you can absolutely find a lot of people that agree with you.

32:09 SPEAKER_02: The challenge is how do you, how do you, how do you create balance?

32:13 SPEAKER_02: Because, you know, the alternative point of view is legitimate.

32:17 SPEAKER_02: Is it correct?

32:18 SPEAKER_02: That remains to be seen, but I think that's sort of the problem is we begin looking for something to agree with what we're thinking and what our bias is rather than seeking real truth.

32:28 SPEAKER_02: And I think that, you know, that's where you know the the idea of what medicine should be is really taking that that look at the patient.

32:38 SPEAKER_02: I think one of the things that's happened in sleep that has really been disconcerting is there's actually 84 sleep disorders.

32:46 SPEAKER_02: And you know, we've already talked about one, and that's sleep apnea, and it becomes the dominant.

32:51 SPEAKER_02: 83 more of them?

32:52 SPEAKER_02: 83 more, yeah.

32:54 SPEAKER_02: I probably have 82 of the 80s.

32:55 SPEAKER_02: All right.

32:56 SPEAKER_02: I hear you.

32:57 SPEAKER_02: But it's but it, you know, when we're looking at one disorder all the time, it kind of plays into that same bias, is that it's got to be that one.

33:07 SPEAKER_02: Some of this is insurance driven, especially in the United States and in Canada, where insurance is going to kind of define what you do next.

33:16 SPEAKER_02: But that's that's the challenge for us is how do we how do we take a look at the whole patient?

33:21 SPEAKER_02: And really, especially if we're talking about behavioral health, there's some amazing, you know, numbers that I I came across as I was preparing for our conversation that where sleep and mental health are so intertwined with each other.

33:35 SPEAKER_02: And you know, the the caregiver, you know, really needs to think about those things as a part of that patient journey in their care.

33:43 SPEAKER_02: And it's it's a it can be a lot to take in.

33:46 Michael Mackniak: No, well, and and I'm gonna ask you a question now that I think is going to lead us into a sleep-related conversation about the caregiver and whatnot, but just to put sort of a bow around this AI conversation.

34:02 Michael Mackniak: How can how do you see AI being able to support the caregiver and what the caregiver does and what they're going through?

34:11 Michael Mackniak: You know, obviously we're going to talk about sleep and the importance of sleep.

34:15 Michael Mackniak: So that's one thing that AI can certainly pin down.

34:18 Michael Mackniak: But how is AI technology going to be able to watch the back of the guy who is caring for a chronic patient?

34:26 SPEAKER_01: Yeah.

Wearables And Early Warning Signals

34:27 Michael Mackniak: And where do you see that going?

34:28 Michael Mackniak: Or is where is it that I don't even know about?

34:31 SPEAKER_02: You know, I think there are a few things that exist right now that may not even be really AI, it's just advancements in technology.

34:38 SPEAKER_02: But that's where I think the wearables help the caregiver really watch themselves, you know, because if they're looking, if they're using the aura ring or their watch, yeah, and they can see some of those those changes in their own behavior.

34:51 SPEAKER_02: Because like I wear an aura ring and it's able actually able to track, I believe it's the anxiety.

34:58 SPEAKER_02: And you know, I I have chronic anxiety, and so we can really map that that journey with it.

35:05 SPEAKER_02: So I think from one standpoint, it's that it's really being self-aware of where they are as a caregiver and not getting so caught up in their own world that they forget their own health.

35:16 SPEAKER_02: And I think that happens a lot, especially among women.

35:19 SPEAKER_02: Women tend to not think of their own health, they think of their spouse or partner, they think of their children, their parents, and then they collapse.

35:30 SPEAKER_02: You know, men, we're we're pretty good about it, you know, of at least complaining about our health.

35:35 SPEAKER_02: We may not go.

35:36 Michael Mackniak: Yeah, I mean, exactly, or we just don't care.

35:40 Michael Mackniak: But it's whatever happens, happens, you know.

35:42 SPEAKER_02: Yeah, right.

35:43 SPEAKER_02: And and so I think that for for them, there's that, there's other things as well, like there's technology now that that can really do some predictive looking at fall risk.

35:55 SPEAKER_02: And and there's even some that that there's discussion about predictive behaviors that can lead to suicide and that can lead to self-harm.

36:05 SPEAKER_02: You know, are we you know, are we really utilizing those tools to begin to to do that?

36:10 SPEAKER_02: You don't want to get to the place where you're like that Tom Cruise movie where you're using psychics to predict behavior, but you want to get to a place where you can at least have a red flag.

36:22 Michael Mackniak: I it but I worry about what we were just talking about, the confirmation bias and the self-fulfilling prophecy with that kind of stuff too.

36:28 Michael Mackniak: Because you know, that's one of the reasons I don't want to ever go to a psychic.

36:32 Michael Mackniak: I don't want to, I don't want to know what's coming because I'll make it happen, right?

36:36 SPEAKER_02: No, 100%.

36:38 SPEAKER_02: But I I do think that if you begin to see a pattern of behavior in a person or a pattern of illness, if it can be a red flag to at least step in and begin asking harder questions and creating accountability and and wrapping around that person, you know, who knows what it could mitigate and help.

37:01 Michael Mackniak: Yeah.

37:01 Michael Mackniak: And and and I think that one of the great things about it is that the old wearables give you data.

37:09 Michael Mackniak: I mean, you could scroll through and it would give you the data that you're looking for.

37:14 Michael Mackniak: But as a lay person, are you translating what that data means and how is it relating to your health?

37:23 Michael Mackniak: For instance, when you're feeling anxious, what were you doing at that minute of that day when you were feeling anxious?

37:29 Michael Mackniak: Were you driving in your car?

37:30 Michael Mackniak: Were you hitting that stupid ball around the course and making trying to get it in that little hole?

37:36 Michael Mackniak: I you know, what were you doing that was making you feel anxious?

37:39 Michael Mackniak: And I think AI could be helpful in that processing.

37:42 Michael Mackniak: And drawing it out.

37:43 Michael Mackniak: Yeah.

37:44 Michael Mackniak: And getting back to your point, if a woman who obviously cares about this stuff more than than I do can take that and look at it and say, huh, I gotta, you know, that could be a really quick way to give you pointers about where your mental, your mental wealth, your mental health is is being compromised.

38:06 Michael Mackniak: And it's an AI can do that.

38:07 Michael Mackniak: AI can be wonderful for that.

38:10 SPEAKER_02: Yep.

38:10 SPEAKER_02: And I think like we're saying, it it has two roles.

38:13 SPEAKER_02: It can be good for them as just a human uh in their own journey.

38:18 SPEAKER_02: But then, you know, does it help with red flags, clues, insights into the person that is giving the caregiver the answer they think they want to hear?

38:28 SPEAKER_02: And, you know, I think it can help in that regard.

38:31 SPEAKER_02: But it's it's definitely, you know, I mentioned it earlier, it's Moore's law.

38:34 SPEAKER_02: I mean, our capability, our insights, our knowledge, everything is doubling so fast on it that, you know, what we really hope is that we keep the guardrails around it in the right way to protect all of us from it running, you know, unchecked, you know, because that's certainly something that I think we all worry about.

Caregiving Mental Load And Organization

38:57 Michael Mackniak: We'll get back to our conversation in just a minute, but I want to take a second to talk about something that many of us in this community deal with every single day, and that's the mental load of caregiving.

39:08 Michael Mackniak: If you're like me, your brain is probably filled with appointment dates, medication schedules, and a never-ending list of questions for doctors.

39:15 Michael Mackniak: It's exhausting trying to keep it all in your head while also trying to show up emotionally for the person you love.

39:22 Michael Mackniak: That's exactly why the team at the Care Coalition created the Care Navigator Journal.

39:28 Michael Mackniak: This is not just another notebook.

39:30 Michael Mackniak: It's a tool specifically designed to help you to stay organized and more importantly, to help you feel a little more in control when things start feeling really chaotic.

39:42 Michael Mackniak: It gives you a dedicated space to track medical updates, manage daily tasks, and even process your own thoughts.

39:50 Michael Mackniak: Imagine such a thing.

39:51 Michael Mackniak: Your well-being matters just as much as the person that you're caring for.

39:57 Michael Mackniak: If you're feeling overwhelmed and looking for a way to stay organized, I highly recommend picking one up.

40:03 Michael Mackniak: You can find it right now at www.carecoalition.org slash holding it together.

40:10 Michael Mackniak: Again, that's carecoalition.org slash holding it together.

40:16 Michael Mackniak: It's a small way to start holding it all together, one page at a time.

40:21 Michael Mackniak: All right, let's get back to the show.

40:28 Michael Mackniak: All right, so now I want to get into some of the stuff that that I'm fascinated with just because of my personal problems.

Sleep Architecture Deep Sleep And REM

40:37 Michael Mackniak: And you you are fascinated with because it's your passion, as you described at the outset today.

40:42 Michael Mackniak: And that is this the science of sleep and what sleep is all about.

40:46 Michael Mackniak: And you know, within the last 15 years or so, I mean, the study of sleep and what what happens to sleep.

40:53 Michael Mackniak: Okay, and and again, this is a in a caregiver context that we're talking about this, because that's who I'm trying to talk to.

41:01 Michael Mackniak: That's who I'm trying to give resources and help to.

41:03 Michael Mackniak: So I want them to understand the importance of sleep.

41:06 Michael Mackniak: And again, I think it's something that we're beat over the head with now because it's our it's really one of the latest and greatest scientific advances, I think, that we've made in terms of overall health.

41:17 Michael Mackniak: It fascinates me how much sleep impacts us.

41:20 Michael Mackniak: And the other side of there's another one that fascinates me too, which is oral health.

41:25 Michael Mackniak: And you you kind of touch both of those things, but I don't I don't want to talk about oral health as much as I want to talk about sleep and the importance of it, because a lot of these caregivers are running around on empty and they're not taking care of themselves, and their sleep is a huge part of that.

41:43 Michael Mackniak: So I'm always astounded when I hear people rattling off such cool, not stats so much, but such cool info and and data.

41:56 Michael Mackniak: So, what are the some of the things that are like mind-blowing about what sleep does for us that we either take for granted didn't know or should know?

42:05 Michael Mackniak: That that I mean, give us a few just nuggets that'll just be like, holy crap, are you kidding me?

42:10 Michael Mackniak: You know, that kind of thing.

42:11 SPEAKER_02: Absolutely.

42:12 SPEAKER_02: Well, I think the first thing is is just recognizing one thing in particular.

42:16 SPEAKER_02: We spend one third of our life asleep, right?

42:19 SPEAKER_02: You know, if you sleep eight hours, it's a third of 24 hours.

42:22 Michael Mackniak: So that's the greatest sales pitch for mattresses ever.

42:25 Michael Mackniak: Yeah, exactly.

42:27 Michael Mackniak: Like, we know we don't.

42:28 Michael Mackniak: We don't spend one third of our life sleeping.

42:30 Michael Mackniak: Yeah.

42:31 Michael Mackniak: But you should.

42:32 Michael Mackniak: You should, at least, right?

42:34 SPEAKER_02: Yeah, yeah.

42:35 SPEAKER_02: And for some, you know, it's gonna be a little more, for others, it's a little less.

42:39 SPEAKER_02: But the reality is is that we need we need that.

42:43 SPEAKER_02: Yes, we start, you know, I've got, like I said, some numbers on mental health, but there are two very specific things that need to happen in sleep.

42:50 SPEAKER_02: One well, three.

42:52 SPEAKER_02: One is time.

42:52 SPEAKER_02: You need enough time in bed, and then it needs to be uninterrupted.

42:56 SPEAKER_02: And what happens is is is we have what's called sleep architecture.

43:01 SPEAKER_02: And sleep architecture is you fell asleep, you you sleep for about 90 minutes and you go into REM, and then you go out of REM and you go through a series of cycles throughout the night.

43:12 SPEAKER_02: That series of cycles is is completely normal of going through the deep sleep to REM and back to light stage of sleep.

43:20 SPEAKER_02: How long does REM last?

43:21 Michael Mackniak: I thought REM was what you wanted to be in.

43:23 Michael Mackniak: You want to deep.

43:24 SPEAKER_02: So you went REM was deep sleep.

43:26 SPEAKER_02: No, no, no, no.

43:27 SPEAKER_02: It's it's it's completely different.

43:29 SPEAKER_02: Deep sleep is delta sleep.

43:30 SPEAKER_02: That's where you have the slow wave sleep.

43:33 SPEAKER_02: If you've ever been awakened from delta sleep or deep sleep, you don't even know where you are.

43:38 SPEAKER_02: You know, like a phone call at two o'clock in the morning and you wake up and you're like, Where am I?

43:42 SPEAKER_02: And you're on you're in your own bed, and you just don't know it.

43:45 SPEAKER_02: So it's a very different type of sleep.

43:48 SPEAKER_02: And patients that that have alpha delta sleep are going to be patients that likely have some sort of disorder in there that's affecting that.

43:59 SPEAKER_02: And you know, have Working with a boarded sleep physician is usually maybe a psychologist can be really helpful in that because they're going to look at that nuance on that piece of it.

44:09 SPEAKER_02: But then REM sleep is your dream sleep, you know, where you're you're doing that.

44:14 SPEAKER_02: But let me take a step back to Delta first.

44:16 SPEAKER_02: So the the value of delta sleep is it creates the physical recovery.

44:21 SPEAKER_02: You know, you if you look at children, particularly babies, they basically have active and inactive sleep.

44:27 SPEAKER_02: It's just it's messy if you're doing an EG on them for sleep at night.

44:31 SPEAKER_02: It's just nuts.

44:33 SPEAKER_02: But as they age, it it cleans up and you begin to have the distinct patterns again.

44:38 SPEAKER_02: Well, they have a lot of delta sleep and a little bit of REM.

44:42 SPEAKER_02: And as we get older, that flips.

44:45 SPEAKER_02: So that as an older person, we're gonna have less delta and more REM.

44:51 SPEAKER_02: And it's sort of an interesting phenomenon how that switches.

44:54 SPEAKER_02: But the delta is necessary for physical recovery.

44:58 SPEAKER_02: That's where the body's gonna heal and do its things.

45:01 SPEAKER_02: Whereas REM is essential for mental recovery.

45:04 SPEAKER_02: It's going to kind of clean up all the things that happened in our mind.

45:09 SPEAKER_02: I heard a psychiatrist from Harvard talk about this cobbler or shoemaker once that couldn't figure out how to make a pair of shoes and had been working and gave up and went to bed and woke up the next morning and the shoes were perfect.

45:22 SPEAKER_02: And he said, that's the value of dreaming, is that it sort of takes all the information that you have and resorts it into what it should be.

45:31 SPEAKER_02: And when we have healthy sleep, that's exactly how that's supposed to happen, is that deep sleep and REM are supposed to be for healing and recovery.

45:40 SPEAKER_02: The problem is when we have depression and anxiety and medications and a host of other things, sleep apnea, then or you know, that's when those things get out of order.

45:51 SPEAKER_02: And now we're not getting that consolidated sleep.

45:54 SPEAKER_02: We're getting it fragmented.

45:55 SPEAKER_02: Where we you know, you can sleep 10 hours, but if it's all fragmented and messed up, it doesn't matter.

46:01 SPEAKER_02: You're still gonna wake up tired.

46:02 Michael Mackniak: Yeah, yeah.

46:04 Michael Mackniak: I I'm just so REM sleep must be exceedingly important for folks with mental health disorders.

46:13 SPEAKER_02: 1000%.

46:14 SPEAKER_02: I mean, that's that's gonna be and and sadly, because of of nightmares and that's night terrors and that sort of thing, they'll give up that just to not have that experience.

46:27 SPEAKER_02: And that makes one thousand that makes total sense.

46:30 SPEAKER_02: Yeah, to live in that space, but it's sort of good for you.

46:33 SPEAKER_02: No, no, it's not.

46:35 SPEAKER_02: And that's sort of the tragedy, you know, of this is I, you know, was kind of refreshing my memory on this before our call.

Depression PTSD And The Sleep Loop

46:42 SPEAKER_02: For so many people, it's a vicious cycle.

46:44 SPEAKER_02: Yeah, their mental health causes the sleep disorder, and the sleep disorder kind of worsens the mental health.

46:50 SPEAKER_02: So they stay in this loop where they, you know, hopefully, you know, CBTI or medication or something can sort of maybe jolt the loop and reset it and and help the person find their way to healing.

47:05 SPEAKER_02: But that's the tough part.

47:07 Michael Mackniak: You know, that analogy, let me bring that home for the folks who are listening because I see that with folks who are addicted, highly addicted, but also have the mental health.

47:16 Michael Mackniak: We spend so much time focusing on trying to get them recovered and out of this addiction spiral that they're in that we forget about the mental health piece, which leads us right back to the addiction, and they almost they almost strengthen each other in that revolving uh door.

47:33 Michael Mackniak: I can't think of another analogy, but yeah, and and so that that that's what I you know that brings it home to me instantly.

47:40 Michael Mackniak: But yeah, I mean, boy, if we could figure out a way to get the run sleep is almost like your own AI in your brain, it's processing everything you've got, it's clearing it all up, it's throwing out the garbage, hopefully throwing away some of the head trash, and and here you got a clean slate, hopefully the next day, right?

48:01 SPEAKER_02: Yeah.

48:01 SPEAKER_02: Well, I was looking at it, and when you look at depression, 80 to 90 percent of individuals with major depression have sleep difficulties.

48:09 SPEAKER_02: For PTSD, 90% of patients report clinically relevant sleep disorders with 50 to 70 percent suffering from chronic nightmares.

48:18 SPEAKER_02: I mean, your list just goes on and on.

48:20 SPEAKER_02: The numbers are really high with it, and it is that loop.

48:23 SPEAKER_02: They're kind of stuck in that space.

48:25 SPEAKER_02: And I think the strategy has to have all of those pieces together.

48:29 SPEAKER_02: It's you know, how do you break, you know, kind of interrupt the cycle so you can heal these pieces?

48:35 SPEAKER_02: And sleep's got to be a part of that.

48:37 SPEAKER_02: And I think if you aren't familiar with sleep, then it can just be this this other piece to that you're you know, isn't an important part, but it's a critical part of their healing to to to to address that.

48:50 SPEAKER_02: But it's it's tough whenever you've got a really strong medication that's going to you know dampen, you know, what RIM can do and what delta sleep, deep sleep can do.

49:00 Michael Mackniak: Well, and there's your your catch-22, right?

49:03 Michael Mackniak: I mean if I'm in a if I rely upon a heavy sed sedative type of a medication or a medication that has sedative type uh sedation propensities to it, that may interfere with real sleep.

49:18 Michael Mackniak: You know, like they say, when you get drunk and you go pass out, you're not really getting sleep, right?

49:24 Michael Mackniak: So the same kind of thing, though, when you're on these medications that may have high sedation uh propensities, how much is that impacting your sleep and your ability to heal?

49:35 Michael Mackniak: But if you don't have the sedation medication, you are going to be, you know, experiencing decompensations and the other horrible horrible uh manifestations of whatever illness we're talking about.

49:49 Michael Mackniak: So that's a sad, sad place to be.

49:53 Michael Mackniak: And I don't know that there's a good answer for it.

49:55 Michael Mackniak: Or is there?

49:56 Michael Mackniak: Is there a way that we can use AI, getting back to our AI discussion, or use the caregiver's knowledge of the individual to talk to about to the physician and the clinicians and the prescribers about what would might what may be a better way to get them to sleep better, which would lead them to better healing?

50:15 Michael Mackniak: Does that make sense?

50:16 SPEAKER_02: Yeah, absolutely.

Targeted Tweaks Instead Of Sledgehammers

50:17 SPEAKER_02: Well, because there's one particular endotype that we're learning about right now, and it's arousal threshold.

50:23 SPEAKER_02: So if somebody's got a really low arousal threshold, everything wakes them up.

50:28 SPEAKER_02: You know, an oral appliance would wake them up, CPAP would certainly wake them up, a noise in the house.

50:33 SPEAKER_02: So then what if the physician is is understanding that this is a capability, can they use a low dose, and I'll just say hypnotic for like just as an example, just to kind of soften that so that now what you're able to do is is keep that patient asleep so they can they can, they're not waking up with every crack in the house and everything that's going on.

50:59 SPEAKER_02: So I think that's where AI can take us is pulling out these nuances that we can we can now instead of having this big shotgun approach, I'm just gonna put you on volume.

51:11 SPEAKER_02: Yeah, you know, I'm gonna say, okay, I'm gonna use this this drug at this super low dose to fix this little problem over here that's actually having an exponential effect.

51:22 Michael Mackniak: Yeah, it's the sheep, mosquito and the hatchet thing.

51:24 SPEAKER_02: Yeah, exactly.

51:25 SPEAKER_02: Yeah, and that's that's where I, when you really ask me where AI is going, that's how I see it is instead of giving some big, super depressing drug like a Valium, what if I give something really small, very specific, that really speaks to a very specific issue in the patient.

51:44 SPEAKER_02: And now uh and the same thing with breathing, there's a a concept called loop gain.

51:49 SPEAKER_02: And loop gain, if someone has a really high loop gain, their ventilatory control is completely out of sorts.

51:57 SPEAKER_02: Well, that if I if I'm able to give a a medication that now manages their their CO2 level in their body and and stabilizes that, now that ventilatory control changes, right?

52:10 Michael Mackniak: And so that's just one tweak.

52:13 Michael Mackniak: Yeah, one little sometimes that's what people with with chronic illnesses and mental illnesses need is we call it a tune-up.

52:20 Michael Mackniak: We gotta get everyone, just do a tune-up.

52:21 Michael Mackniak: We need a little tweak here.

52:23 SPEAKER_02: We don't need to to revamp the entire no system, just give us one tweak, and that's where I ultimately how I see AI benefiting all of us is that giving us this super granular solution that hey, you know, let's try this first.

52:41 SPEAKER_02: Instead of using the sledgehammer or the shotgun approach, we're gonna use something very specific, we're gonna touch that one spot, and if that works, awesome.

52:52 Michael Mackniak: And isn't that the essence of the Hippocratic Oath?

52:55 Michael Mackniak: And in most actors are gonna say to you, let's start least invasive and we'll work our way up.

53:02 Michael Mackniak: Yeah, and that's exactly what you're talking about.

53:04 Michael Mackniak: Yeah, and if AI can take us away from highly invasive, i.e.

53:10 Michael Mackniak: all-encompassing fire hose, to the micro less invasive water pick, right?

53:19 Michael Mackniak: That that's a great thing, yeah.

53:21 Michael Mackniak: And that comes from that comes from the AI technology, but it also comes from the caregiver.

53:26 Michael Mackniak: It comes from the caregiver who's in there all the time.

53:29 Michael Mackniak: But here we have a lot of caregivers who are running around feeling like they're too busy, they can't get anything done for the the their loved one, they feel horrible about they don't feel adequate enough, they've got imposter syndrome, like you read about, and they're not supposed they're what the heck am I doing caring for somebody else I can't even care for myself.

53:48 Michael Mackniak: So, one of the things that they're gonna say is I can't worry about my sleep because I'm too damn tired and I'm too damn tired to go get help for it.

53:56 Michael Mackniak: Yeah, one of the things that intrigues me about the work you're doing is to help people who are who use that excuse that I don't have time.

54:05 Michael Mackniak: You help save them time by a lot of home-based technologies now, right?

54:09 Michael Mackniak: Through Nox and and some of the other uh systems that you're working with.

54:12 SPEAKER_02: Yep, yep.

54:13 SPEAKER_02: Yeah, so a couple of things.

Home Sleep Testing And New Options

54:15 SPEAKER_02: One is on like you're saying, on the testing side, we have a home testing technology that is our Nox T3 home testing device.

54:25 SPEAKER_02: So, what that allows is to have the sleep test in the home with a a really high fidelity technology.

54:32 SPEAKER_02: We also have another type that actually gives you all the data you would get in a sleep lab in the home as well.

54:39 SPEAKER_02: And we have some physicians that use that.

54:42 SPEAKER_02: Usually they do it as cash because right now insurance doesn't reimburse for it.

54:47 SPEAKER_02: But what that does allow, though, is having that home experience because you've seen the cartoons or the person's got all the wires all over them and I've been in the sleep labs twice and I've done homes twice.

55:01 SPEAKER_01: Yeah.

55:01 Michael Mackniak: What I you know, for me, and this is a self-serving question.

55:06 Michael Mackniak: I've how is it different now?

55:08 Michael Mackniak: Because I haven't done it in many, many years.

55:10 Michael Mackniak: Yeah, how is it different?

55:12 Michael Mackniak: Because those four tests, two in the sleep stuff in the sleep lab and two at home, one of one of them in the sleep lab, the tech actually woke me up and said, We can't we can't do this anymore.

55:21 Michael Mackniak: You're too you're having way too many aphids.

55:24 Michael Mackniak: It's scaring me.

55:26 Michael Mackniak: Um but anyway, but they've all come back and said, Okay, you got sleep apnea, you need a CPAP machine.

55:31 Michael Mackniak: And this goes back to what we were just talking about.

55:34 Michael Mackniak: I think that hey, maybe now with the Nox T3 testing device and some of the other things that you can offer people in home that would be much more precise, rather than saying, boom, here's your here's your sledgehammer, shotgun approach, sleep CPAP machine.

55:52 Michael Mackniak: Yeah, maybe we could try another.

55:55 Michael Mackniak: Is is are we at that point now?

55:57 SPEAKER_02: We are we're at that point in a lot of ways.

55:59 SPEAKER_02: One is next year, apnimed is going to be launching as a sleep apnea drug.

56:06 SPEAKER_02: That's a drug, a pharmaceutical for sleep apnea.

56:09 SPEAKER_02: So that's gonna be one one to watch for.

56:12 SPEAKER_02: I believe the name of it's going to be Synergy.

56:15 SPEAKER_02: The fantastic group of people out of Harvard who developed it's really two drugs that by themselves do nothing for breathing, but when combined, actually can create tone in the airway.

56:26 SPEAKER_02: And so that's sort of the next level of where we're going.

56:29 SPEAKER_02: And there are other companies that are doing similar work to build that.

56:34 SPEAKER_02: And then you've got, you know, you know, the stimulators that like you see on TV with Inspire that that work on the hypoglossal nerve in the airway to create tone.

56:44 SPEAKER_02: And there's there's newer technology around that that's that's changing every day.

56:49 SPEAKER_02: You do have the oral appliance therapy that does move the jaw forward.

56:54 SPEAKER_02: And one of the silly examples I can give people is if you lean your head all the way back and snore and then push your jaw out and try to snore with your jaw out, you can't.

57:05 SPEAKER_02: And it you it really simulates the impact of mandibular advancement.

57:10 SPEAKER_02: And so I'm a big believer in that after spending some time in that space.

57:15 SPEAKER_02: And so you've got pharmaceutical, you've got mandibular advancement, you've got neuro kind of neuromodulation, you've still got CPAP.

57:23 SPEAKER_02: And then there's newer types of CPAPs coming out that are designed to be more comfortable, you know, for the patient.

57:29 SPEAKER_02: Like there's a KPAP that a friend of mine developed out of out of Tennessee that is is going to deliver the pressure in a different way to be more comfortable for patients.

57:38 SPEAKER_02: So that's that's the worst thing, is the the discomfort of it.

57:42 SPEAKER_02: And that's exactly what he addressed is if he can lower the pressure when you breathe in, then what he's able to do is have that pressure at the right level, you know, at the right time.

57:54 SPEAKER_02: And so instead of having that jetting that makes it so uncomfortable to breathe on it, he's splinting the airway.

58:00 SPEAKER_02: Because we call that a pneumatic splint when the air is holding the, you know, the airway open.

58:06 SPEAKER_02: And so it's you're basically getting the splinting at the right time in the air breathing cycle.

58:11 SPEAKER_02: So a lot of exciting stuff that's out there, but I think most everyone, and GLP1s.

58:17 SPEAKER_02: GLP1s causing weight loss, the zip bound, you know, trazepitide actually has a sleep atomy effect.

58:25 SPEAKER_02: And so not only the weight loss that can come from the GLP1, but because it's a GLP one and a GIP combination, that actually has an effect on breathing.

58:36 Michael Mackniak: Well, one of the things that concerns me about that is okay, so you're taking you're you're using your CPAP machine, you're using your GLP1 or whatever you're using, right?

58:44 Michael Mackniak: This synergy drug that you're talking about in the future.

58:48 Michael Mackniak: Is it a chicken or the egg?

58:49 Michael Mackniak: And how do you figure it out?

58:50 Michael Mackniak: Because in order to figure out, I got to put away my CPAP machine and I got to just, you know, try just using the Synergy or the GLP1 for a period of weeks or whatever.

59:01 SPEAKER_02: Yeah, I don't think anyone is trying to take like, like for me, I've been on a GLP one and I've lost some weight, and I've had conversations with my physician about, you know, what do I do next?

59:11 SPEAKER_02: And so the strategy of the moment is can I wean myself down off the CPAP?

59:17 SPEAKER_02: So with his his assistance, we're looking at that of can I slowly come down from it?

59:23 SPEAKER_02: Could I then transition to an oral appliance?

59:26 SPEAKER_02: To your point, does synergy become the the adjunct to it?

59:31 SPEAKER_02: But I think the future is is probably going to be combination therapy, where maybe it's a medication and an oral appliance.

59:40 SPEAKER_02: Or, you know, or maybe for some people their sleep apnea is so bad that it's the drug and a CPAP.

59:46 Michael Mackniak: You know, a friend of a friend of mine had 200 episodes an hour.

59:50 SPEAKER_02: That's a lot.

59:51 SPEAKER_02: I mean, you're basically not asleep.

59:52 Michael Mackniak: How is that even possible?

59:53 Michael Mackniak: Yeah.

59:54 SPEAKER_02: It's it's awful.

59:55 SPEAKER_02: Yeah, I've seen that.

59:55 SPEAKER_02: It's it's it's not conducive with life.

59:58 SPEAKER_02: And you're you're you know, let me tell you why.

1:00:01 SPEAKER_02: And this is for the listeners out there that just go, oh, it's a nuisance.

1:00:04 SPEAKER_02: I know we're kind of running up on time.

The Real Danger Inside Sleep Apnea

1:00:07 Michael Mackniak: But no, it's it's I mean, for me, it's fascinating to be honest.

1:00:10 SPEAKER_02: Well, I know we're running up on time, but the the the the real killer and the real problem with sleep apnea is the sympathetic nerve activity.

1:00:19 SPEAKER_02: You know, we all live in a parasympathetic state.

1:00:22 SPEAKER_02: You know, that's our our homeostasis.

1:00:25 SPEAKER_02: Well, when we pause, what do those words mean?

1:00:28 SPEAKER_02: I have no idea what you mean.

1:00:29 SPEAKER_02: Our normal existence.

1:00:31 unknown: Okay.

1:00:31 SPEAKER_02: You know, everything's running on autopilot, right?

1:00:33 SPEAKER_02: That's home, that's your normal homeostasis.

1:00:36 SPEAKER_02: Well, when we have a sympathetic response, it's fight or flight.

1:00:42 SPEAKER_02: That's where your adrenaline kicks in.

1:00:44 SPEAKER_02: And you know, you see people do superhuman feats in those moments.

1:00:49 SPEAKER_02: And it's great if you're running from a grizzly bear or a mugger or something like that.

1:00:53 SPEAKER_01: Yeah.

1:00:54 SPEAKER_02: But when you do it to your to your point 200 times an hour, it's almost like having an IV with a PCA pump, and you're getting, for your caregivers that know this drug, it's getting epinephrine shots every few seconds.

1:01:08 SPEAKER_02: And epinephrine and adrenaline are the same thing.

1:01:10 SPEAKER_02: Adrenaline's, we create epinephrine is the synthetic version.

1:01:14 SPEAKER_02: And it's the very first drug if someone's having a heart attack and a code that you're going to push to save their life.

1:01:20 SPEAKER_02: It's that powerful.

1:01:22 SPEAKER_02: Well, when you're having adrenaline pumped into you every few seconds or every 30 or 60 seconds, yeah, it's not conducive with life.

1:01:31 SPEAKER_02: It's going to cause high blood pressure, it's going to cause diabetes, it's going to cause heart disease, it complicates COPD, it's going to complicate everything.

1:01:40 SPEAKER_02: And so what we're really treating in a patient with sleep apnea is that.

1:01:45 SPEAKER_02: Yeah.

1:01:45 SPEAKER_02: The airway is I never knew that.

1:01:47 SPEAKER_02: Yeah, but it's the insidious piece of it, is what we're really treating.

1:01:52 SPEAKER_02: And that's really where this kind of all comes together is we got to have healthy sleep if we're going to heal from a lot of things, whether it's a physical or mental health issue, healthy sleep is the is really should be the centerpiece of care.

1:02:08 Michael Mackniak: Okay.

1:02:09 Michael Mackniak: So then last question, you just opened it up.

1:02:13 Michael Mackniak: What is the one thing that you do, or what can be the one thing that a caregiver can do tonight or during their nap this afternoon?

1:02:20 Michael Mackniak: Yeah.

1:02:21 Michael Mackniak: What is the one one takeaway?

1:02:23 Michael Mackniak: One thing that they should absolutely non-negotiable do it to today.

Sleep Hygiene You Can Start Tonight

1:02:28 SPEAKER_02: Well, I think you hit on one of them earlier, and one of them is is don't use alcohol to sleep.

1:02:34 SPEAKER_02: That's a dead, it's a dead end.

1:02:36 SPEAKER_01: Yeah.

1:02:37 SPEAKER_02: Combining it with other things like Benadryl and other stuff is absolutely terrible.

1:02:42 SPEAKER_02: We already know Benadryl has its own issues now.

1:02:45 SPEAKER_02: But sleep hygiene is something everyone can do now.

1:02:48 SPEAKER_02: Don't watch TV in your bedroom.

1:02:50 SPEAKER_02: You know, you hear people talk about social media and the phone.

1:02:54 SPEAKER_02: Don't do it an hour or two before bed.

1:02:56 SPEAKER_02: You know, that blue light, the mental activity, everything is going to contribute to poor sleep just from a psychological standpoint.

1:03:04 SPEAKER_02: It's it's just having healthy boundaries, right?

1:03:06 SPEAKER_02: And you create healthy boundaries by deciding, you know, it's sort of like James Clear talks about, you know, everything I do is a vote for the kind of person I want to be.

1:03:17 SPEAKER_02: Well, if you want to have good sleep, what are the things you're going to do that's a vote in that direction?

1:03:23 SPEAKER_02: And that includes making good decisions so that the bedroom is what a bedroom is for.

1:03:28 SPEAKER_02: The in other parts of your home are reserved for the television or for your phone and your activities around your phone.

1:03:36 SPEAKER_02: And so that those are there.

1:03:37 SPEAKER_02: And then not to use, you know, if you're using medication to sleep, make sure it's the right kind, like an ambient or lunesta or something that's been clinically tried that doesn't have the effects.

1:03:51 SPEAKER_02: And lunesta is probably the safest of those two to really help with insomnia.

1:03:56 SPEAKER_02: But it's it's really, you know, at the end of the day, it's it's it's making healthy choices, having a diet that supports it.

1:04:03 SPEAKER_02: You know, Uma Naidu out of Harvard has a lot of great insight on diet and mental health.

1:04:09 SPEAKER_02: And you start putting all those pieces together and you begin to really have a healthier, healthier sleep, healthier life.

1:04:18 SPEAKER_02: But I think it it goes back to what I said before.

1:04:22 SPEAKER_02: Sleep, sleep is a pillar of health.

1:04:24 SPEAKER_02: And it's got to be one of the more essential things that we focus on to get people to be healthy, whether you're the caregiver or the patient, because without it, you're you're you're you're doomed for failure and you're gonna stay in that vicious cycle that you can't.

1:04:40 Michael Mackniak: And I think that people of a certain age, i.e.

1:04:42 Michael Mackniak: you and me, well, me especially, because you have been educated and you loved the the topic and the study, but you know, people that are my age that are old enough to remember when we didn't know anything about sleep and we didn't talk about sleep, and now we're getting beat over the head with sleep.

1:04:58 Michael Mackniak: Yeah, it's almost like, okay, this is when they tried to tell us that eggs were bad for us, and then they were good for us, and now they're bad for us again.

1:05:06 Michael Mackniak: So, folks, I don't think that's I don't think that sleep fits into that same BS category.

1:05:12 Michael Mackniak: I think that what we're talking about with sleep in terms of the pillars of health, I I think is is here to stay.

1:05:19 Michael Mackniak: And I think we should really listen to it.

1:05:21 Michael Mackniak: Emerson, I can't even begin to thank you enough because you took a conversation that could potentially be off-putting to people and really made it interesting and fascinating to me.

1:05:33 Michael Mackniak: And I know two people listening will will really get into it because they they can't keep not listening to it.

1:05:41 Michael Mackniak: So thanks for being here and thanks for for all that you're doing for all of us.

1:05:45 SPEAKER_02: Yeah, no, that's an honor to be here.

1:05:47 SPEAKER_02: Thrilled we got to meet, and uh absolutely honored to be a part of your show and applaud the work you're doing.

1:05:53 SPEAKER_02: And and it's just it's a beautiful thing to see.

1:05:56 Michael Mackniak: Thanks, man.

1:05:57 Michael Mackniak: We'll talk again.

1:05:58 Michael Mackniak: Sounds good.

Using Tech To Protect Human Care

1:06:06 Michael Mackniak: Alright, we spent great time today talking about the bridge between two worlds, the high-tech precision of AI and the old-fashioned heart of personal care.

1:06:16 Michael Mackniak: Emerson Kerr reminded us that technology isn't our enemy.

1:06:22 Michael Mackniak: It's not the enemy of the human touch.

1:06:25 Michael Mackniak: It's the infrastructure that allows the human touch to flourish.

1:06:29 Michael Mackniak: If we use these tools to keep clearing the voices in our head, the head trash and the busy work, we find ourselves with more white space, more time for the F-word, to actually be present for those we love.

1:06:45 Michael Mackniak: Of course, you know by listening to me that the F-word stands for fun, right?

1:06:51 Michael Mackniak: Character's built in the choices we make when no one and no algorithm is watching.

1:06:59 Michael Mackniak: And karma is always watching.

1:07:04 Michael Mackniak: Whether you're utilizing the latest diagnostics or just trying to get five hours of an uninterrupted rest, remember that you are the lead actor in your own life's work.

1:07:13 Michael Mackniak: Don't let the parasites of exhaustion win.

1:07:19 Michael Mackniak: Take care of your sleep so you can keep taking care of your soul.

1:07:24 Michael Mackniak: Embrace AI to the extent that it can help you find time and make your life easy and whatever level that may be.

1:07:33 Michael Mackniak: Or just keep doing what you're doing and adopt new habits to give yourself that white space in your calendar without using AI.

1:07:41 Michael Mackniak: You've made it this far without it.

1:07:42 Michael Mackniak: Why bother why bother now if it's working for you?

1:07:46 Michael Mackniak: So big thanks to Emerson for joining us, and you can find out more about his work at Knox Medical Online, obviously.

1:07:55 Michael Mackniak: Um and of course the AAST is there as well.

1:07:59 Michael Mackniak: You can also check the details of uh the episode here today, and I will put uh his bio and some links in there.

1:08:10 Michael Mackniak: Until next time, keep holding it together, even if it's just kinda screen all the screen.