Vital Discourse is a new weekly podcast that provides deep dives into important health-related topics.

On Vital Discourse, two surgeons and friends—Dr. Ben Cilento, M.D. and Dr. Lee Mandel, M.D., J.D., F.A.C.S., F.A.R.S.—help listeners start making sense of their health.

Tune in each week to get the inside scoop on issues concerning health, policy, and law, with advice, interviews, debates, and straight talk you won’t find anywhere else.

With backgrounds in military and law, Dr. Ben and Dr. Lee cut through the noise to bring you the guidance you need. In every episode, they help their audience navigate the healthcare system, find answers to their most pressing questions, and take steps to start feeling great, with lots of laughs along the way.

No appointment necessary—the doctors are in.

The first episode is coming soon.

Snoring and sleep apnea remain among the most misunderstood health problems in modern medicine. They are not harmless habits but airway disorders linked to cardiovascular risk, cognitive decline, and chronic fatigue. In this first episode of Vital Discourse, Dr. Ben Cilento and Dr. Lee Mandel explain how modern medicine approaches snoring, why anatomy matters more than gadgets, and how real treatment plans are built through clinical data and patient-specific design. Listeners will gain clarity on nasal airflow, home sleep testing, CPAP therapy, oral appliances, and hypoglossal nerve stimulation while learning how to protect their own sleep and overall health.

Chapters:

00:00 Intro – Why Vital Discourse Exists

08:14 Dr Lee’s Journey Through Medicine and Law

17:02 The Medical and Legal Disclaimer – Framing the Conversation

20:01 What ENTs Actually Do and Why the Airway Matters

35:21 Why “Quick Fix” Culture Misleads Patients

55:33 Launching Episode 1 – Why Start with Snoring and Sleep Apnea

58:41 Understanding the Three Levels of the Airway

1:01:57 What Sleep Apnea Really Is and Why It Matters

1:03:39 Home Sleep Tests vs Lab Studies – Measuring Real Sleep

1:11:55 From CPAP to Surgery – Matching Treatment to Anatomy

1:18:14 The Power of Nasal Airflow and Why It Shapes Every Outcome

1:24:57 Inspire and Genio Implants – The Future of Sleep-Apnea Therapy

1:39:15 Inside an ENT Evaluation – What Patients Can Expect

1:45:16 The Hidden Costs of Ignoring Sleep Apnea

1:56:19 Final Takeaways – Clear Steps Toward Better Breathing and Sleep

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Obesity and sleep apnea create a loop that reshapes metabolism, hormones, and airway function long before most patients notice the signs. In this episode of Vital Discourse, Dr. Ben Cilento and Dr. Lee Mandel explain how fragmented REM sleep disrupts growth hormone, leptin, and ghrelin, lowers metabolic rate, and drives weight gain that feels impossible to reverse. They break down how fat in the tongue, neck, and belly changes airway physics, how inflammation and insulin resistance add strain, and how GLP-1 medications, testosterone, CPAP, surgery, and weight programs fit into a coordinated plan designed to restore both breathing and metabolic health.

Chapters:

00:00 - Introduction

00:00 - Welcome & Episode Overview

00:36 - Understanding Sleep Apnea

00:36 - What is Sleep Apnea?

01:14 - The Paper Straw Analogy

02:23 - Recognizing Sleep Apnea Symptoms

03:14 - Snoring vs. Obstruction

04:30 - Sleep Study Diagnostics & Severity Levels

05:57 - The Sleep Apnea-Obesity Connection

05:57 - Common Medical Advice About Weight Loss

06:39 - The Truth About Correlation

07:24 - Why Weight Gain Comes First

07:48 - How Sleep Apnea Prevents Weight Loss

07:48 - Sleep Disruption & REM Sleep

08:11 - Understanding REM Sleep & Muscle Relaxation

09:30 - Growth Hormone & Metabolic Changes

10:29 - Leptin & Ghrelin: The Hunger Hormones

11:49 - The Vicious Cycle Explained

12:20 - How Obesity Worsens Sleep Apnea

12:20 - Anatomical & Mechanical Effects

12:43 - Fat Deposits in the Tongue & Throat Muscles

13:32 - Critical Closing Pressure & Airway Physics

14:40 - Impact on Lung Function & Oxygen Saturation

16:27 - Heart Health Complications

16:52 - Neuromuscular & Inflammatory Effects

16:52 - Fat's Impact on Muscle Control

18:04 - Inflammation & Sleep Apnea

19:23 - Why Weight Makes Treatment Harder

19:51 - Treatment Approaches

19:51 - The Multi-Pronged Approach to Weight Loss

21:03 - GLP-1s: Benefits & Risks 22:00 - The Testosterone Trap

24:06 - Comprehensive Treatment Strategy

25:26 - Key Takeaways 25:26 - Vital Point: Weight Doesn't Define Sleep Apnea Risk

26:32 - Importance of Professional Help

27:33 - Closing Thoughts & Call to Action