Poor Sleep and the Relationship to Your Blood

Poor Sleep and the Relationship to Your Blood with Dr. Brandt Esplin

‍

Hi everyone. Welcome to the podcast.
I'm Dr. Michael Bennett. I'm here today with Dr. Brandt Esplin. Hello Brandt. Welcome.

Thank you.

Glad you're here with us. He's one of the smartest people I know. And we've had a great conversation before starting the podcast—I'm excited for our audience to hear the important insights we discussed.

For those just tuning in, this podcast is rooted in the idea that the human body can heal itself—if provided with the right conditions. Our mission is to help listeners better understand those conditions, so they can activate their body's natural ability to heal, reduce dependence on chronic medical care, and avoid draining their life savings on treatment.

I'm thrilled to have Dr. Esplin here to share insights from his clinical work and his background. I also want to add: he's one of the best people you'll ever meet. Our teenage son even chimed in when he heard Dr. Esplin would be joining—he said, "I love that guy." So, he's not only brilliant but deeply kind. He and his wife are an incredible team committed to making the world better.

‍

Dr. Brandt Esplin’s Journey into Hematology and Oncology

All right, thanks. It's great to be here, and I think this is a fantastic podcast.

Just a little bit about me: I grew up in Utah County, in Spanish Fork. From an early age—sixth grade, really—I was drawn to science. I remember studying my older brother’s AP Biology textbook and being fascinated, even if I didn’t understand everything at the time. I just knew medicine was in my future.

I went to Utah State University for my undergraduate degree, majoring in chemistry and biochemistry. While I was there, I got heavily involved in laboratory research—specifically studying bacteria, immunology, and the immune system. During that time, I kept coming across research papers authored by a renowned scientist named Dr. Paul Kincade, who worked at the University of Oklahoma. His work focused on how bone marrow and the immune system develop, and I was inspired.

That’s when I learned about MD/PhD dual-degree programs. It sounded perfect: doing research and applying it directly to patient care. I didn’t quite realize how much luck and alignment it would take to actually make that happen, but things worked out. I ended up at the University of Oklahoma and—fortunately—joined Dr. Kincade’s lab. He became my mentor, and my dissertation focused on early bone marrow development, particularly hematopoietic stem cells and lymphocytes.

Naturally, that led me into hematology and oncology, since both fields are closely linked. After finishing my degrees, I went on to complete my residency and fellowship at the Mayo Clinic. I trained first in internal medicine, and then specialized in hematology and oncology.

At one point, the plan was to stay at Mayo and join the bone marrow transplant team while continuing research. But over time, I realized how much I loved seeing a variety of cases. And, the mountains started calling us home. So, my wife and I made the decision—together—to return to Utah.

I’m not doing as much lab research now, but everything I learned still shapes how I approach patient care, especially in hematology. Now, I treat cancer patients here in Utah, and I can genuinely say—I wake up every day excited to go to work. It’s an absolute privilege.

That’s beautiful. And I have to say—it sounds like becoming a researcher as well as a clinician has made you an even better physician. Wouldn’t it be great if more doctors had that same dual background? Of course, that would probably double the length of medical school.

Yes, it would. But the payoff is there.

So, you did your training in Oklahoma? I did too. Which campus?

The Health Sciences Center in Oklahoma City.

Same here! I knew there was something good about you. Well, it’s great to have you back in Utah doing work you love.

‍

The Link Between Sleep Apnea, Hypoxia, and Cancer

One day, Dr. Esplin and I were chatting at a community event, and we started comparing notes from our respective fields. As you know, I’m a dentist by training, but I transitioned my practice to focus exclusively on treating sleep breathing disorders. And what you shared about cancer patients and hypoxia—oxygen deprivation—really stuck with me. Can you explain for our audience what happens when someone with cancer also suffers from hypoxia during sleep?

Sure. If you think about it, we spend about a third of our lives sleeping. If that time is spent in a state of hypoxia—intermittent low oxygen levels—it can impact virtually every organ system.

There are some very large studies, including an 18-year longitudinal Wisconsin study and a NIH-backed analysis of over 19,000 patients, which show that cancer patients with untreated or poorly managed sleep apnea have up to five times the risk of death compared to those without hypoxia. These are all-cause mortality figures, so it includes death from cancer progression, organ failure, and other complications.

That’s incredible. And you're saying this is especially dangerous for organs already under stress due to cancer or other diseases? What’s actually happening at the blood level in those hypoxic patients?

Right. The technical term is “secondary polycythemia.” In simple terms, the bone marrow is tricked into making too many red blood cells due to the perceived lack of oxygen. The kidneys play a key role here—they're extremely oxygen-sensitive and produce a hormone called erythropoietin (EPO). That EPO signals the bone marrow to ramp up red blood cell production.

Now, you might think more red blood cells equals more oxygen, which would be good. But that’s not what happens. Instead, the blood becomes overly thick—more viscous. It doesn’t flow efficiently through the small capillaries that supply oxygen to your organs. This reduced microcirculation leads to even less oxygen delivery.

So we’ve got more blood, but worse oxygenation. The organs are basically suffocating slowly. That triggers a sympathetic stress response, right?

Exactly. The body enters crisis mode. You see constriction in the pulmonary arteries, leading to pulmonary hypertension. The heart works harder. The brain’s capillaries are affected, leading to mood instability, cognitive decline, and increased stroke risk. Every organ takes a hit.

There’s also early evidence from animal models suggesting that hypoxia can promote tumor angiogenesis—new blood vessel growth inside tumors—which you definitely don’t want. Those studies are ongoing, but it’s a logical concern.

It sounds like this thickened blood—polycythemia—worsens everything. And I assume the treatment starts with correcting the hypoxia?

Yes, that’s always step one. But if the hematocrit—the concentration of red cells in the blood—goes above 55 or 60%, we can’t wait. We have to reduce it quickly. That’s when we use phlebotomy, which is basically medical bloodletting. We remove blood volume to normalize viscosity while we address the root cause.

That’s a throwback to ancient medicine! But clearly still effective. So in your training as a hematologist-oncologist, were you taught to screen patients for sleep apnea as part of their cancer care?

Well, like most specialists, we’re all internists first. Internal medicine includes education about sleep disorders, but once we subspecialize, we often rely on primary care providers to handle that screening. That said, it’s definitely on our radar—especially now as more research connects intermittent hypoxia to cancer progression.

‍

The Expanding Role of Dentists in Identifying Sleep Disorders

It’s fascinating how much overlap exists between our fields. There are about 165,000 dentists in the U.S., and more of them are realizing that snoring and sleep apnea are not just nuisances—they’re medical red flags. Dentists often start out making snore guards, but then discover that around 90% of those patients actually have sleep apnea. That means we’re increasingly involved in treating these issues directly.

That’s fantastic. The airway, after all, starts in the oral cavity—right where dentists work. Sleep apnea is usually managed by pulmonologists further downstream, but early screening can and should start at the dental level.

Exactly. And given that cancer is overtaking heart disease as the leading cause of death in the U.S., this seems like an important opportunity. Most people I know have been personally affected by cancer—either themselves, a family member, or a close friend. So why not enlist dentists in identifying risk factors early?

Absolutely. When dentists identify signs like heavy tooth wear from grinding, cracked molars, or a high Mallampati score (that’s when you can’t see the back of the throat behind the tongue), it’s a sign that the patient may have a restricted airway. Crowded teeth, small jaws, and a tongue with no room to rest are all risk factors for sleep-disordered breathing.

And that’s where the referral comes in. If dentists screen and refer those patients to internists or sleep specialists, we could potentially reduce chronic disease—and maybe even cancer risks—through better oxygenation.

That would be a tremendous help. Internists typically don’t have the oral training to recognize those subtle anatomical indicators, but dentists do. If they flagged those patients and worked in tandem with physicians, it could revolutionize front-line screening.

‍

Challenges in Cancer Treatment and Reasons for Optimism

So, shifting gears a bit—what would you say is the hardest part of treating cancer patients today?

Well, there are many challenges, but the hardest part is knowing that we can’t cure every cancer—especially in younger patients. That’s emotionally tough. But one thing I always tell people is that cancer treatment today is dramatically better than even a decade ago.

Really? I think many people still picture cancer treatment as harsh chemo and endless side effects.

That’s not wrong, but the picture has changed. While we still use traditional chemotherapy in some cases, we’re increasingly using targeted therapies and even oral medications. Immune therapies like Keytruda and Opdivo are especially exciting. These are monoclonal antibodies, not chemo drugs, that train your immune system to fight cancer.

I’ve seen the ads for those on TV. Sounds promising. Have you seen success stories in your own practice?

Absolutely. In fact, I treated one of the very first patients on Keytruda during my training at Mayo Clinic. She had metastatic melanoma throughout her body. Within six months of treatment, she was completely clean. And that was without chemo.

‍

Cost, Accessibility, and the Role of Pharmaceutical Companies

That's incredible—complete remission from such an advanced case without chemotherapy. But what about the cost? These new therapies sound expensive.

They are. At the time, Keytruda cost anywhere between $30,000 and $50,000 per dose. It’s an infusion, not a pill. But most insurance plans now cover it. And I’ve got to say, Merck, the company that developed Keytruda, has been great to work with. Right now, I have two or three patients who can’t afford the drug—and Merck just gives it to them for free through their compassionate care program.

That’s refreshing to hear. It's good to know these life-saving therapies are becoming more accessible.

Absolutely. These immunotherapies are now a routine part of care. They’ve fundamentally changed the landscape of cancer treatment—and patients are benefiting every day.

‍

Dentists as First Responders for Systemic Risk

Let’s say a dentist sees a patient who has some of those airway risk factors—crowded mouth, scalloped tongue, high Mallampati score—and also learns that there’s a family history of cancer. Would it be professionally helpful if the dentist sent a note or a referral to the patient’s physician saying, “Hey, I noticed these risk factors. Might be worth a sleep study or further screening?”

Absolutely. That kind of communication could be a game changer. Internists don’t always have the training to evaluate the oral cavity for airway risk, but if a dentist flags it and explains their concern, it can set off the right chain of follow-ups. It would absolutely be helpful.

We’re seeing more dentists take on that role, but I think many still don’t realize the power they have to affect systemic health—not just fix teeth.

It’s true. Most physicians would welcome more interdisciplinary communication, especially if it helps catch chronic diseases earlier. The oral cavity is part of the whole system, and it should be treated that way.

‍

Case Study: Crohn’s Disease and Sleep Apnea

Let me share a quick story. One of my patients had Crohn’s disease for over 50 years. He was diagnosed at age 10 and struggled his whole life—frequent scopes, steroids, medications, malnutrition. He told me he just never had energy, even as a teen.

I can imagine. That’s a tough diagnosis.

Well, in his 60s, he finally got tested and treated for obstructive sleep apnea. Within nine months, his GI specialist moved him to a three-year recall for scopes because his symptoms had improved so dramatically.

That’s remarkable. Crohn’s is an autoimmune inflammatory disease, and we know there’s a strong link between chronic inflammation and hypoxia. If treating his sleep apnea improved oxygen flow, it could plausibly reduce inflammation in the GI tract. That’s an amazing example of the body healing once a foundational problem is resolved.

‍

The Body’s Healing Response to Oxygen and Sleep

I see this all the time. Once patients get their sleep apnea treated, they start noticing improvements across their medical history. Better digestion, better energy, lower blood pressure. Some even feel worse on their meds—because their body is healing, and now they’re overdosed.

That makes sense. As homeostasis returns, the same medication dose can become too much. The body is incredibly adaptive.

Exactly. And when people start feeling “toxic” from meds they’ve been on for years, it often means their body is healing and doesn’t need the same pharmaceutical support anymore.

That’s a fascinating observation.

‍

Pediatric Prevention: Addressing Issues Early

Another thing I love is working with lactation consultants and helping infants with oral restrictions. Babies who can’t nurse properly often have tongue or lip ties that hinder normal facial development. That sets them up for airway problems, sleep disorders, and even chronic disease later in life.

It’s not something I deal with directly—pediatric oncology is a separate field—but I can see how foundational development could affect long-term systemic health.

When we release those oral restrictions early, we’re helping shape a healthier airway, better sleep, and better function for the rest of their life. It’s preventative medicine at its best.

That’s powerful. And again, it circles back to treating root causes instead of symptoms.

‍

Rethinking Medical Education: A Vision for Holistic Training

If you could design your ideal medical school curriculum from scratch—just dream big—how would you change it based on everything you know now?

That’s a great question, and I’d say there’s definitely room for improvement. The first couple of years of medical school are incredibly intense. You’re studying for 16 hours a day, memorizing endless details. But looking back, not everything we were tested on was necessarily relevant to real-world patient care.

Right. There’s a lot of pressure to pass the boards, which drives what gets taught.

Exactly. And unfortunately, that means foundational topics like sleep medicine are often glossed over. I read a study that said the average medical student receives only two hours of formal education on sleep across all four years. I honestly can’t remember how much we covered—but it wasn’t much.

Even though sleep affects virtually every other system in the body.

Yes. During our clinical rotations, we might interact with pulmonologists or read about sleep disorders, but if we’re not placed with a sleep medicine specialist, we don’t get much depth. That’s a huge gap, considering the impact sleep and breathing have on cardiovascular, immune, and even emotional health.

‍

Building a New Model: Foundational Life Skills for Health

In my imaginary curriculum, I’d want every doctor to graduate with a strong grasp of the basics: sleep and airway, nutrition, movement, and emotional wellness. Those are the pillars of health, right?

I agree. And to make that happen, licensing boards would need to change their priorities so students are incentivized to learn those things. Right now, the curriculum is dictated by what’s tested.

Exactly. But if boards included airway health, sleep function, and the impact of nutrition on systemic inflammation, then medical schools would start to adapt.

It would take a systems-level shift, but I believe it's possible. We’re already seeing more focus on integrative and functional medicine, so change is happening. Slowly.

‍

Dentists and Oncologists: Bridging the Gap

So, what do you think a "mouth doctor" and a "cancer doctor" could do better together? How do we collaborate moving forward?

Communication is key. The more interdisciplinary communication we have, the better our outcomes will be. When we silo healthcare into isolated specialties, that’s when mistakes happen. That’s when details get missed, or critical signs don’t get passed along.

Absolutely. And it seems like the healthcare system trains us to be deep experts in one area but lose the bigger picture.

That’s the trade-off of specialization. We’re incredibly advanced in many areas, but sometimes we miss how it all fits together. Dentists are oral experts. If they see something abnormal, they should absolutely communicate with physicians—especially if they suspect it could have systemic implications.

‍

Restoring the Generalist Mindset in a Specialist’s World

It sounds like we need to bring back the spirit of the old-school family doc—someone who looked at the whole person.

Exactly. Today, your appendix, your heart, and your teeth each get a different doctor. And while that ensures expertise, it also fragments care. So anything we can do to reconnect those dots—like building bridges between dentists and internists—will benefit the patient.

That’s encouraging to hear. So dentists shouldn’t hesitate to reach out to a physician if they’re concerned about airway issues, sleep health, or systemic risk.

Please do. That input is welcome, and it can really help patients avoid long-term complications. It’s all about working as a team.

‍

Final Thoughts: Unleashing the Body’s Healing Power

Well, this has been fantastic. We’ve covered a lot—how hypoxia affects cancer outcomes, how thickened blood from sleep apnea can impair every organ, and how interdisciplinary care could prevent or even reverse chronic disease.

Yes, and the big takeaway for me is that we need to prioritize breathing and sleep just as much as any other intervention. It’s foundational.

And when we get that right, the body can often do the rest—heal itself, balance its chemistry, and restore health naturally.

That’s the goal. Empower the patient, support the system, and treat the root cause—not just the symptoms.

Thank you again, Dr. Brandt Esplin, for joining us and sharing such incredible insights. We’re all better for it.

Thank you. It’s been a privilege to be here.

If you're interested in learning more about airway-focused care or how your oral health might be affecting your systemic health, visit vivoslife.com. You can also contact my clinic, Nuvo Wellness, located in Orem, Utah. We specialize in breathing-related disorders and airway development.

Let’s keep working together—across disciplines—to help people heal, breathe, and thrive.

Until next time, take care of yourselves and your families.

‍