B-B-B-B-Bad to the Bone (Chapter Four)

The apple had been made so craftily that only the red part of it had poison. Snow White felt a craving for the beautiful apple, and when she saw that the peasant woman was taking a bite, she could no longer resist. She put her hand out of the window and took the poisoned half. But no sooner had she taken a bite than she fell to the ground dead. The queen stared at her with savage eyes and burst out laughing: ‘White as snow, red as blood, black as ebony! This time the dwarfs won’t be able to bring you back to life!’

At home, she asked the mirror:
’Mirror, mirror, on the wall,
Who’s the fairest of them all?’

And finally it replied:
’O Queen, you are the fairest in the land.’
— Brothers Grimm, Sneewittchen "Little Snow White"

Deep within each of us is a heart crying to be held. Deep within our hearts is an undeniable longing to be beautiful. The eternal search for beauty is a dream that beckons us, a mystery shrouded in a veil of secrecy. Or is it? There are times we must travel a great distance to see what is right before our eyes.

Beyond the vestiges of civilization, far past the end of the road, the sun shines, the air is crisp, and the lush green leaves stand out against a sky of deep ultramarine. You meander on walking paths forged by generations of dear in a world full of birdsong and colorful blooms scenting the air. Trailing chipmunks darting away with your every step and flanked by butterflies flitting above wildflowers and trout splashing about in burbling creeks, it is here, in nature's nest, where you find harmony and rest. It is here you find beauty.

Beauty is not a mystical, abstract quale. Nor is it a certain color of skin or particular height and weight. Beauty is harmony, balance, and peace; it is developing the way nature intended. Did you develop the way nature intended? Are you beautiful?

Your beauty comes from something you cannot see but is in front of you. The upper jaw or maxilla is a bone in the middle of the face. It extends from the upper teeth to the eyes. Proper maxilla development is critical to facial aesthetics and function, as every other bone in your skull is directly or indirectly connected to it.

Growing a maxilla is natural and straightforward. Breathe through your nose, and the maxilla expands like a balloon, growing forward, outward, and upward. By growing forward, a strong jaw projects confidence and strength. By growing outward, the sparkle from a smile stretching from ear to ear fills hearts with love. And by growing upward, a perfectly proportioned nose and supremely high cheekbones herald an aura of the aristocracy. Mona Lisa would blush.

Breathing through your mouth paints a different, darker picture. It's as if the balloon pops and your face deflates. The maxilla retreats backward, inward, and downward as air, in a sense, leaks from the mouth. By growing backward, a diminutive jaw signals weakness and impotence.

By growing inward, a smile as narrow and crooked as a witch's finger touches hearts with dread.

By growing downward, a long face and big nose make you look and feel like a candy-colored clown.

Could there be more to you than just that? Like an onion, is the first paper-thin, unwanted, unpalatable chaff layer only a guise that masks a more desirable core? Is a beautiful swan waiting to break free of an ugly duckling's shell? Can out of the repulsive hide of a beast step a handsome prince?

I'm afraid not. Fairy tales are best left for children in the evening in front of a warm fire. Your descent into the abyss only begins at the surface. You are b-b-b-b-bad to the bone.

All your life, you have strived to be exceptional. To be, in the absence of a more descriptive term, human. But the deviant effects of mouth breathing have morphed you into something altogether unexpected, into a caricature, a satirical, exaggerated, and unflattering version of yourself.

Is a caricature, like a fine work of art, more true to life than life itself? Peel away the veneer and see the lasting truth dwelling beneath the surface. The crack in your smile reveals crooked teeth. In the hollow of your mouth rests a scalloped tongue. Tucked away in your nose is a deviated septum. It's as if all the bits and pieces inside your face are crammed together. The truth is, they are.

Mouth breathing is a disease that maims, mutilates, and mangles. It has the undeniable effect of making the maxilla and the spaces within it smaller. Destined by DNA to grow to their full size, the teeth, tongue, septum, and the other little parts within the face have little choice but to bend, buckle, and bulge. Inflammation from allergies and infections engorges some of those same body parts that have already outgrown their cranial space like an overstuffed suitcase.

Have you ever overstuffed a suitcase? Some overly fill their suitcase with clothes, grooming products, medicines, books, charges, and other knick-knacks. Others stuff their suitcase with emotional heavyweights like unhealthy relationships, bad habits that hinder success, and jobs that hold no promise of a future. Your overstuffed suitcase happens to be your face and all the little things tightly packed inside it.

Having a good head on your shoulders is important. What if, in a literal sense, you don't. What if you have an overstuffed, jam-packed, bursting at the seams head on your shoulder? It's not easy to quickly and adeptly lug an unwieldy load. It hampers you from skillfully maneuvering through life. It complicates your existence and precludes you from living in peace as you strive to fulfill your purpose. It weighs you down and holds you back from the delightful feeling of lightness.

How does a deflated maxilla overfilled with grown and inflamed soft body parts hold us back in life? Once again, it comes down to air and the amount of energy we expend to get it at the expense of all else. In the 1800s, a German engineer named Gotthilf Heinrich Ludwig Hagen and French physicist named Jean Louis Marie Poiseuille formulated an inverse relationship between the flow rate and the tube's radius. The nonlinear algebraic equation is intimidating, but the dynamics of the Hagen-Poiseuille Law can be related to a simple straw. If we reduce the straw's radius in half, the resistance to flow in the straw increases exponentially by a factor of sixteen. In practical terms, you can feel the difference when drinking water through a coffee stirrer versus a regular straw. Worse, wrap your lips around a coffee stirrer straw and breathe through it day and night. It sounds tough, but in some ways, that's precisely how you are breathing now. Your diminutive maxilla is suffocating you.

Despite high nasal resistance, it is healthier to breathe through your nose versus mouth. Yet, you stand steadfast in your defiance, regardless of what ills may come your way. You do it with glee. You ponder if breathing through the nose is hard, why not easily breathe through the mouth? You reason that if some air through the nose is good, more air through the mouth must be better. You believe that while mouth breathing is over-breathing, it trumps nose breathing. So you open your mouth like a public toilet, shrieking like a frantic canary as you flush the air from your bellows. The resonance from your throat transmits through the walls of the neck, silencing the cicadas.

There is a fatal flaw in your logic, one that Danish physiologist Christian Bohr eloquently described in 1904. Hemoglobin carries oxygen to the body from the lungs. The Bohr effect explains the inverse relationship between hemoglobin's oxygen binding capacity and the carbon dioxide concentration. Mouth breathing is over-breathing and reduces the carbon dioxide levels in the blood. Lower carbon dioxide levels, in turn, cause oxygen to bind tighter to hemoglobin. Consequently, hemoglobin releases less oxygen to tissues and organs.

This seemingly absurd paradox bears repeating: Mouth breathing is over-breathing and under-oxygenating. The greater the air taken into your lungs, the less oxygen is delivered to your body. Sometimes, less is more. Breathe less. Breathe through your nose.

The third arithmetic equation that foretold your destiny was written in 1738 by Swiss mathematician Daniel Bernoulli, who described the relationship between speed and pressure. Bernoulli's principle states that when the rate of a fluid increases, the pressure decreases, and vice versa. How does this relate to mouth breathing? Mouth breathing reduces the maxilla in all dimensions: length, width, and height. Sucking air through an undersized maxilla causes the air velocity to increase and the pressure to decrease, collapsing your breathing straw. Fortunately, the opposite is true. Don't just breathe less. Breathe slow. 

Everyone wears a mask. Some to disguise. Some to hide. Some to pretend. The mask you don is one forged by the cruel and untoward effects of mouth breathing. It changed how you look and how you hold your head. It changed your health and how you felt. It changed the course of your life in exchange for the one thing you wanted and needed more than anything else: air.

You did it all for the love of air. You did it to breathe. However, for all you have endured - the suffering, servitude, and struggle - to wear this mask of disfigurement, it betrayed you. While the mask allows you to breathe by day, the same sickly mask smothers you at night. For all the ways your face and body compensated for accepting in earnest a deviant new manner of breathing by day, it was wholly inadequate at night.

In your sleep, you can be a child, dreaming of things past that will never be again. In your dreams, you have comfort, freedom, and love. Perhaps, in another life. Perhaps, in a better life. No one can grasp the labor of your breath, the shallowness of your sleep, and the brokenness of your nights. No one can feel the burden you carry through the night and into the day. No one can know the darkness that lies behind the mask.

But I do.

Chapter Four Conclusion

Anil Rama, MD

Anil Rama, MD serves as Adjunct Clinical Faculty at the Stanford Center for Sleep Sciences and Medicine. He is the former Medical Director of Kaiser Permanente's tertiary sleep medicine laboratory. Dr. Rama is also an editorial board member of the Sleep Science and Practice Journal and has authored several book chapters and seminal peer-reviewed journal articles in sleep medicine. Dr. Rama is a guest lecturer for the Dental Sleep Medicine Mini-Residency at the University of Pacific, Arthur A. Dugoni School of Dentistry. Furthermore, Dr. Rama has been an investigator in clinical trials for drugs or devices designed to improve sleep. Several national newspapers, local news stations, and health newsletters have consulted with him.

https://www.sleepandbrain.com
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Fable of the Crooked Tree (Chapter Three)

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The Checklist (Chapter Five)