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Scott Webb: If you snore loudly and feel tired after a full night's sleep, you might have sleep apnea and sleep apnea is a potentially serious disorder in which breathing repeatedly starts and stops. And joining me today to discuss the symptoms, diagnosis, and treatment for sleep apnea including the value of sleep studies are neurologist, Dr. James Bavis, and board-certified sleep medicine specialist. Dr. Ketan Deoras, both of whom are with Summa Health.

This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. Well, thank you both for joining me today. Really appreciate your time. Dr. Deoras, I'm going to start with you. Let's talk about sleep apnea. What is it exactly and what are the signs and symptoms?

What are signs and symptoms of sleep apnea?

Dr. James Bavis: So sleep apnea is a collapse of the upper airway typically accompanied by partial or complete cessation of breathing. And sleep apnea, we'll see this happen numerous times per hour throughout the night, often with the oxygen saturation dipping as well. A lot of times the symptoms we'll see the next day include fatigue and sleepiness. Throughout the night, we'll see this with loud snoring or hear it with loud snoring. Partners can witness that the patient has stopped breathing completely in sleep. And patients can actually wake up throughout the night, feeling like they're choking or gasping. Sometimes they'll wake up with racing heart, palpitations. And typically, they can have a feeling of unrefreshing sleep the next morning and even wake up with headaches as well.

Scott Webb: And Dr. Bavis, what are some of the risk factors for sleep apnea?

What are some risk factors for sleep apnea?

Dr. James Bavis: Many of the risk factors for sleep apnea are uncontrollable. Like just being a man over 50 actually is a risk factor. Weight is a major risk factor. If you're overweight, in particular if you have a bigger belly or if you're a man and you have a neck that's greater than 17 inches, in women, usually it's greater than 16 inches in circumference, that'll make you at greater risk for having sleep apnea.

It's often highly associated with hypertension and heart disease and patients with strokes. So often we’ll find sleep apnea in people with those histories. In younger people, often if there's already some upper airway problems, like enlarged tonsils or enlarged adenoids, that will also make the person more likely to close off their airway while they're sleeping.

Scott Webb: Back to you, Dr. Deoras. What are the treatment options? Because it seems like something that really needs to be treated. So what are the treatment options for sleep apnea?

What are the treatment options for sleep apnea?

Dr. Ketan Deoras: Well, as Dr. Bavis mentioned, weight plays a big role in sleep apnea. So if someone is overweight, we typically start by advising them to work on weight loss, because that will improve the sleep apnea.

For most people, their sleep apnea gets worse when they sleep on their back. So a lot of times we'll also advise sleeping on their side or stomach, what's known as positional therapy. In terms of the modalities of treatment, the most commonly started treatment and what's considered the gold standard first-line one is CPAP, which stands for continuous positive airway pressure. We're basically forcing air down the throat to stent it open so that it can't close up throughout the night. That's usually our first choice, but we also have other options including a dental device that extends the lower jaw forward for milder cases of sleep apnea.

And there've been some newer surgical techniques used for more significant cases of sleep apnea. For example, the Inspire procedure that's almost like a little pacemaker that works to push the tongue out of the way.

Scott Webb: That's really interesting. I'm familiar with the CPAP because my mom has one of those, but I didn't realize there were some other treatment modalities as well.

So that's good to know. And Dr. Bavis, what are some of the other health issues or complications that sleep apnea can cause?

What are some of the other health issues or complications that sleep apnea can cause?

Dr. James Bavis: The big ones are high blood pressure, heart failure, heart arrhythmias, where the heart doesn't beat correctly. The most famous of which is atrial fibrillation and stroke. All these are known to be increased in people with obstructive sleep apnea. There are some other conditions that are highly associated with it such as the weight gain. There may be some association with higher blood sugar levels and there's increase in headaches, particularly chronic daily headaches and migraines.

So there are many other disease conditions that are highly associated with it. But when it comes to direct cause, sleep apnea is directly related to the heart diseases that I mentioned and stroke and high blood pressure.

Scott Webb: And Dr. Bavis, is this something that we diagnose ourselves or is it usually a partner who alerts us?

Can we diagnose sleep apnea ourselves or is it usually a partner who alerts us?

Dr. James Bavis: Most of the time, the bed partner is the person that gets the person to the doctor. But things that you would notice on your own as Dr. Deoras already mentioned, nonrefreshing sleep, morning headaches. You can look at your sleep schedule and notice that you're sleeping more than eight hours or hours that would have been plenty for you when you were younger and you're just not waking up refreshed, especially if you have all those symptoms and you're starting to have to take blood pressure medicines and then you should definitely be thinking about it, particularly if you're 50 or older. You're at a high risk when you have nonrefreshing sleep and high blood pressure and starting to get weight gain, you're at high risk of having sleep apnea.

So you could diagnose yourself, although the vast majority of people, other people notice that they're stopping breathing, and that's how they end up seeing a sleep specialist.

Scott Webb: So Dr. Deoras, let me come back to you now. Let's talk about sleep studies and how these things are diagnosed and then ultimately treated, what kinds of sleep studies are there?

What kind of sleep studies are there?

Dr. Ketan Deoras: So there's two primary types of sleep studies. One is the home sleep study, which is performed at a patient's home in their own bed. And then the other is when they spend the night in a sleep lab or what's called a polysomnogram. The polysomnogram is still considered, you know, the kind of gold standard most accurate.

The home study initially was really meant to confirm cases in which you suspected sleep apnea and there was a really high suspicion for it and you just basically needed confirmation. Nowadays, sometimes insurance will dictate in part two which study a patient can have performed.

Scott Webb: And Dr. Bavis, what can somebody expect when they do the overnight sleep study in terms of just checking in, getting comfortable? What's that experience like for patients?

What is the experience of a sleep study like for patients?

Dr. James Bavis: Patients who are getting an overnight study in the sleep lab, they go to the sleep lab a couple of hours before they're actually going to go to sleep. Like anytime you go to a doctor's office, there's sometimes some forms to fill out and that usual rigmarole that you get when you go to a medical office. But then, what's done is they put some wires on the head and face.

These are used to determine what state of sleep the person's in. Are they awake? Are they in light sleep? Are they in deep sleep? And then, they have monitors that go in the nose that monitor the breathing and monitor the airflow to see if the airflow is cutting off during sleep, which would indicate they have sleep apnea.

It's not uncomfortable, but there's little straps across the chest and then across the belly. These are to monitor the movements of the chest and belly. When you have an event where you're not breathing well to figure out is this because of an obstructive sleep apnea event where the airway is closed off or is there some other type of event that's causing the airway to no longer have air flow through it.

And then often most of the time, there's little wire on at least one of the legs to monitor for jerking of the limbs during sleep, which often people will have and will be doing at home aren't necessarily aware that's causing them to wake up during sleep.

Now, if the person has a home sleep apnea test, it varies quite a bit between different brands. Usually, there's at least a finger sensor that they put their finger in that monitors the oxygen and some of the devices they even monitor breathing by using that. Most of the devices though have the finger pulse oximeter that's monitoring the oxygen, usually a strap or some other device to monitor the chest wall movements.

And sometimes also they'll have the airflow monitors in the nose as well. Each home device has its own instructions and they are usually pretty easy to follow. And then the next day, you take it off and return it. And you usually, you get very good instructions on how to return it.

Scott Webb: That's pretty cool. I didn't realize you could do sleep studies at home and I've always wanted to ask for the overnight stays in the lab, is somebody there watching people the entire time?

Is there someone watching you the entire time during sleep studies?

Dr. James Bavis: Yes, there's a video. The sleep tech is in another room. She's not in the room with you. That would be very difficult for me to sleep if the tech was in the same room with me.

Scott Webb: That would be awkward, wouldn’t it?

Is it awkward knowing someone is watching you sleep through a video during sleep studies?

Dr. James Bavis: So they're watching you on a remote video. They're not closely examining. It's mainly there in case you are doing unusual things during your sleep, sleepwalking, sleep talking, those kinds of activities. For the most part, we don't go through the whole video unless there's something specific we're looking for.

Now the home sleep studies of course there's nobody watching you. But for the in-lab studies, it's very helpful if somebody's doing unusual things in their sleep and you're trying to figure out what's going on. It's very helpful to have that video when you capture those events and you can see what state of sleep the person's in and get an idea for why they're doing the unusual behavior, kicking or yelling or whatever they're doing while they're sleeping.

Scott Webb: Yeah. Gotcha. And Dr. Deoras, what kinds of sleep disorders are being evaluated during these studies?

What kind of sleep disorders are being evaluated during sleep studies?

Dr. Ketan Deoras: Usually, the most common thing we're looking for is definitely sleep apnea. And that, like I said, can be diagnosed both by the home study and the in-lab study. One thing we should know when we're doing the home studies, really ideally those should be done in patients without significant cardiac or pulmonary issues because those can be monitored much better in the lab if they're spending the night overnight, where they can monitor their EKG, they have the ability to provide oxygen if they're having significant oxygen desaturations as well.

But aside from sleep apnea, we also look for parasomnias, which are just basically unusual behaviors in sleep. So like Dr. Davis mentioned, they're sleepwalking. People can actually act out their dreams, a condition known as REM sleep behavior disorder, and even seizures. So those kinds of things, it's nice to have the video to capture those events the sleep physician who's reviewing the study needs to go back and look at it, what happened overnight.

One thing I should note that we don't really check or that's not indicated for a sleep study is insomnia. So sometimes, you know, I'll get referrals from doctors just saying this patient can't sleep. And then now we're going to try to have them spend the night overnight, hooked up with all these sensors and we get a report back saying your patient didn't sleep all night and we kind of already knew that if they had insomnia. So if it's just pure insomnia, that's not really an indication to go in for a sleep study.

Scott Webb: Yeah, that sounds good. And Dr. Bavis, as we get close to wrapping up here, first last word to you, anything else you want to tell people about sleep apnea, sleep studies, anything else we need them to know?

What you should know about sleep apnea

Dr. James Bavis: Sleep apnea is very important. It is now closely linked with these bad heart diseases and the strokes. And it's similar to treating high blood pressure and cholesterol in that treating the sleep apnea will in fact prevent strokes and heart disease. The main difference, at least this is what I tell my patients is, you actually will feel better at the end of the process because you'll actually get better sleep and feel more refreshed the next morning, which you can't always say about the cholesterol medicine and the blood pressure medicine. So it's a little bit more of a process than taking a pill, but it's worth it in the end because in the end you feel more refreshed and are sharper mentally the next day once you get treated.

Scott Webb: And Dr. Deoras, last word to you, anything else?

Dr. Ketan Deoras: A lot of the sleep apnea out there has never really been evaluated and people like you'd mentioned earlier, just think, "Oh, I snore," or "I'm just tired for other reasons." And so we're really trying to get the word out that, no, there could actually be a sleep disorder going on here and making you feel that way.

And there are treatments that can make you feel much better. So if you're having any difficulty with sleep or symptoms the next morning or the next day, make sure to see a sleep doctor or have a physician order a sleep study or at least evaluate for that. Because we just know right now, a lot of sleep apnea has gone undiagnosed.

Scott Webb: Yeah. That's a great way to end and a great plan. If this is not, you know, a one-time thing or a temporary or sporadic thing, if this is something that's happening every night and you're waking up every morning and you're just exhausted, even though you've slept plenty, there could be something going on, something serious like sleep apnea. And there is treatment, there are modalities available and we just need people to reach out. So gentlemen, great to have you both on today and you both stay well.

Dr. Ketan Deoras: Thank you so much.

Dr. James Bavis: Thank you. Thank you very much.

Learn more about Summa Health's sleep apnea care

Scott Webb: For more information on sleep apnea, visit SummaHealth.org/sleep. And if you found this podcast helpful and informative, please share it on your social channels and check out the entire podcast library for additional topics of interest.

This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. Stay well, and we'll talk again next time.