July 9, 2023 • 26 mins
07/09/23
The Healthy Matters Podcast
S02_E15 - The 411 on Sleep Apnea
Sleep Apnea. There's a number of us who live with the condition, and when you add up the number of bed partners who, by extension, also live with it, that number gets pretty huge. But what is it exactly? Is it dangerous? How is it different from snoring? And what are the options for treating it?
On Episode 15, we'll take a good look at sleep apnea with Dr. Ranji Varghese from the Minnesota Regional Sleep Disorders Center at Hennepin Healthcare. We'll break down the causes, the risks and the range of available treatments that may just save you from a sleep divorce (it's a thing)! From sleep studies to the latest devices and techniques, and even Dr. Varghese's own impression of a didgeridoo, we'll cover it all on this episode of the podcast. Join us!
Congratulations to the Minnesota Regional Sleep Disorders Center for their recent recognition by the American Academy of Sleep Medicine for their 40 years as an accredited institution. The many patients you've served, and their bed partners, thank you!
Got a question for the doc? Or an idea for a show? Contact us!
Email - healthymatters@hcmed.org
Call - 612-873-TALK (8255)
Twitter - @drdavidhilden
Find out more at www.healthymatters.org
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:04):
Welcome to the Healthy Matters podcast with
Dr. David Hilden , primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health healthcare and
what matters to you. And nowhere's our host, Dr. David
Hilden .
Speaker 2 (00:20):
Hey, it's Dr. David Hilden and welcome to episode
15 of the Healthy Matterspodcast. Today we are gonna
talk about sleep apnea. You'veprobably heard about it, but
we're gonna delve into whatcauses it and what you can do
about it. And to help me out, Ihave invited a past guest from
the program, Dr . Ren Verese .
He is a sleep doctor whospecializes in all kinds of
(00:42):
sleep disorders, includingsleep apnea. Dr. Verese ,
welcome back to the
Speaker 3 (00:46):
Show. Thank you Dave . It's a pleasure to be here.
It's
Speaker 2 (00:48):
Great to have you , Regi , now you do all kinds of
sleep, but we're gonna stick tosleep apnea today because it's
so common and so many peopleare living with sleep apnea. So
start us off, what is it? Whatis sleep
Speaker 3 (00:59):
Apnea? Yeah, so sleep apnea, as you mentioned,
it's very common. It's acondition where the back of the
throat, the tongue, the musclesin the back of the throat when
we sleep at night, become veryrelaxed. And at that time the
airway might close off becauseour muscles are relaxed when we
fall asleep. And if the airwaycloses off, the oxygen can't
get into your lungs. And thisis what we call a sleep apnea
(01:21):
event. It's essentially achoking episode when we sleep
at night. It sounds
Speaker 2 (01:24):
Awful
Speaker 3 (01:25):
Terrible.
Speaker 2 (01:25):
It is. I mean, when you've described it as a
choking episode and not gettingoxygen, that sounds pretty bad.
What causes it?
Speaker 3 (01:31):
So a lot of different things causes sleep
apnea, but the number one thingis being a male and obesity. So
being overweight can cause alot of weight around the size
of your neck. And so that putsa lot of pressure on those soft
tissues in the back of thethroat. So anything that might
put pressure on the throat likeobesity, sleeping on your back
because if you sleep on yourback, your tongue can sort of
(01:52):
roll back and choke that , uh,airway as well. But mostly it's
being a male, mostly it'sobesity and certain things like
alcohol can worsen sleep apneaas well. Does the
Speaker 2 (02:02):
Word apnea mean? Is that what it means? Choking?
Yeah,
Speaker 3 (02:05):
It means stopping breathing essentially. It's the
cessation of breath. So yousaid
Speaker 2 (02:09):
It's more common in men , what about in age? Does
it, do people get it at youngages or is this a disease of,
of aging?
Speaker 3 (02:16):
Absolutely. I mean we do definitely see this in
adult males. Um , when we lookat the pediatric literature,
it's these kids that havetonsils,
Speaker 2 (02:25):
Very
Speaker 3 (02:25):
Large tonsils or adenoids that can snore very
loud and have sleep apnea aswell. But we're really starting
to see not just kiddos havingobstructive sleep apnea from
tonsils, but there's a bigcrisis in pediatrics with
obesity and these children arecoming with sleep apnea that's
not involved with tonsils whenit comes to women. Women are
(02:46):
fairly protected from havingsleep apnea until they start
hitting perimenopause andmenopause and then they start
catching up to men.
Speaker 2 (02:52):
Why is that? Well ,
Speaker 3 (02:54):
Uh , the hormones, progesterone, estrogen are,
they help us breathe, they helpwomen breathe. It also helps
with keeping the airway open.
So
Speaker 2 (02:59):
You talked about tonsils and adenoids that now
we don't take those out so muchin kids anymore, but, and when
we did, they were just, cuzthey were a little big and
people were getting sorethroats. Right. I mean
tonsillectomies weren't donefor sleep apnea back in the
day, were they?
Speaker 3 (03:12):
They were. And they are now. They are now . Okay .
They are now. And, and, and itdepends on the severity of the
sleep apnea for kiddos. So iftheir sleep is really disrupted
and they're sleepy during thedaytime and you can really
identify using a sleep studythat their sleep is disturbed,
we then perform intonsillectomy. And that's
usually curative for thesekids.
Speaker 2 (03:31):
Okay. So how common is sleep apnea in our
population? A
Speaker 3 (03:35):
Study population based study in 2014 looked at
men and women, about 14% of menand about 5% of women have
obstructive sleep apnea. Andwhen we categorize sleep apnea,
we think of mild, moderate, andsevere obstructive sleep apnea.
So these are folks that arestopping breathing or their
oxygen is dipping a minimum offive times per hour. And that's
(03:55):
where those numbers come from.
40% of men, 5% of women, that'sa
Speaker 2 (03:59):
Lot. Mm-hmm.
Speaker 3 (03:59):
it
Speaker 2 (03:59):
Is, is that a global phenomenon or is that more of a
thing in our country,especially with obesity?
Speaker 3 (04:05):
That's the correlation is that we are,
there's two components of that.
I think it's the obesityepidemic, but then there's also
a lot of doctors are nowbecoming very well aware of
sleep apnea. This has happenedin the last 20 years. So we
talk
Speaker 2 (04:18):
About it a lot in clinic. I do in primary care
clinic a lot. Someone says,yeah, I think I have sleep
apnea or my spouse snores and Ithink they have sleep apnea.
Are we, are we diagnosing itmore formally with sleep
studies, like what you do orare are we diagnosing it more
just in the clinic? Uh , sortof speculatively like I think
you have sleep
Speaker 3 (04:36):
Apnea. It's on a lot of the radar of a lot of
doctors. Yeah . So I thinkthey're just gonna ask the
right questions and if theyhave the right suspicion for
sleep apnea, the goal is forthe patient to be tested or at
least seen by a sleep physicianto determine whether testing is
indicated and to figure outwhether they have sleep apnea.
Speaker 2 (04:52):
So I take it cases are on the rise then?
Speaker 3 (04:55):
I think so for a number of different reasons.
The fact that people are aging,that's one reason. Number two,
the fact that people arecontinuing to have , uh, this
obesity epidemic. And three, Ithink doctors, again, just like
you, you're , it's on yourradar. You want to ask about
this because it's important.
Speaker 2 (05:09):
I mentioned snoring, I think you maybe did earlier
in this, in this uh , episodewith, especially with kids.
Tell us about, if you could,Reggie , the , the correlation
between snoring and sleepapnea, they're not one in the
same, but they're, they gotogether, right?
Speaker 3 (05:22):
Absolutely. So you can have snoring la very loud
snoring and not have theseepisodes where the airway's
closing off you and you'rechoking yourself. But snoring
tends to very strongly indicatethat someone does have
obstructive sleep apnea. So ifyou have someone that has
obstructive sleep apnea, theylikely have symptoms of
snoring, loud snoring. But youcan have snoring alone and not
(05:44):
have sleep apnea. So
Speaker 2 (05:46):
If you think you might have sleep apnea or you
think the person you share abed with, you know they snore
is just really loud. How do youdiagnose
Speaker 3 (05:53):
It? Yeah. So apart from that snoring question I
ask , is the snoring loudenough to be able to be heard
through a closed door? I askthe patient or their bed
partner, does your partner eversnore themselves awake, like
with a snort? Kind of likethat. Oh , that was
Speaker 2 (06:07):
Good. Reggie
. That was good.
Speaker 3 (06:08):
Well the reason why I do that is because when I do
that in the clinic with thepatient, they go, yes, that's
exactly what I have . That's it. That's it. Yeah. And then,
then I, I'm fairly certain thatI've got the diagnosis or if a
bed partner hears that they'resnoring and then all of a
sudden there's a silence in thesnoring and then the patient
has a snort awake getting ,that's what we call, that's a
witnessed apnea. So apart fromthat, I ask questions like, do
(06:31):
you wake up with a dry mouth inthe morning? Do you have a
headache when you wake up inthe morning? Do you feel like
you're sleepy during thosedays? All that sort of gives us
an indication that , uh,there's a high probability that
someone has sleep apnea.
Speaker 2 (06:43):
You practically have to be a marriage counselor if
you can hear it through aclosed door. Yeah. Wow. I bet
you have a lot of conversationswith people. Well
Speaker 3 (06:51):
There is something called sleep divorce where
people separate from theirbedrooms to sleep better
because of their partnersnoring or other sleep
complaints. And and yeah,people do say, I'm sleeping
better now because my partner'ssleeping better. I think they
did a study that looked at howmuch a bed partner's sleep is
disturbed by someone else'ssnoring and it's about 50% of
(07:13):
their sleep can be disturbed bysomeone's sleep apnea and
snoring.
Speaker 2 (07:17):
Right now there are a whole lot of people nodding
as they're listening to you saythat and they're right now, I
can just imagine peoplelistening to this episode and
they're going, ah-huh that's myexperience. I don't sleep well
because dude next to me here issnoring so loud. Absolutely is
, is sleep apnea dangerous?
Speaker 3 (07:33):
Yeah, great question. So as we talked about
it, that you can have differentseverities of sleep apnea,
mild, moderate or severe. Ifit's really mild, we kind of
just talk about lifestylemodifications, losing weight,
maybe reducing alcohol beforebedtime , uh, sleeping on the
side and things like that. Whenit becomes moderate or severe,
if the number of times thatsomeone is holding their breath
(07:54):
and stopping breathing isbetween 15 to 29 times an hour,
we call that moderateobstructive sleep.
Speaker 2 (07:59):
That's like once every minute or two.
Speaker 3 (08:01):
Yep . Yep . Exactly right. And if it's beyond that
and or if they're oxygen reallytanks, you know, below 80%, you
know, even in the mid eightieswe know that that left alone
over time confers a risk ofcardiovascular disease, sudden
cardiac death, heart attacksfrom sleep, difficult to treat
high blood pressure, and it,it's a whole host of things
(08:23):
that can happen. So I don'twant people to worry because
the majority of folks that comeinto our daughters, they've had
sleep apnea for an extendedperiod of time. So there's not
a big risk that something'sgonna happen tonight. My
recommendation would be, if youthink you have it, come and see
us. So
Speaker 2 (08:39):
Let's talk about what the experience of someone
who has sleep apnea is . Whatdoes it feel like and and what
kind of symptoms do they have?
The
Speaker 3 (08:47):
Prototypical example of someone has, you know,
symptomatic sleep apnea, severesleep apnea, they'll come in
tired, they'll come in sleepy,they'll feel really just
sluggish. They'll feel ,they'll , they'll say things
like, not only can I sleep if Ihave the opportunity during the
daytime if give , if you gaveme the opportunity, but I just
feel like I'm walking through afog and they'll say multiple
(09:10):
times throughout the night,I'll wake up feeling like
something is in the back of mythroat, like my tongue or I've
just awakened and my heart isracing and they don't sleep
through the night. Um, sothat's typically what people
describe. Uh ,
Speaker 2 (09:23):
You said there's different severities. Is it all
caused by an obstruction or areyou know, what makes one more
severe than the other? I guesswhat I'm trying to say, y there
Speaker 3 (09:31):
Are different types of sleep apnea. The one that we
normally see typically in , inthe population is obstructive
sleep apnea. That wordobstruction is a key that
something is obstructing theairway like the tongue or the
soft palate and and so forth.
There's something else calledcentral sleep apnea. That's
usually happens when someone'susing a lot of opioid pain
medications and there's ,there's sometimes brain lesions
(09:54):
can cause this or heartfailure. Patients can also have
central sleep apnea. Um , butreally the central sleep apnea
is we are concerned about, butrarely are they really
associated with severedesaturations. And we kind of
just watch that for theobstructive sleep apnea, we
definitely want to get thatfixed and treated because it
can be , uh, dangerous.
Speaker 2 (10:11):
Now if you're not breathing once an hour, I can
just imagine listeners arethinking that's a lot. Yeah, I
mean is that considered asevere case and do they know
that this is happening?
Speaker 3 (10:20):
Some people do and that's why they will come in.
Others are brought in by theirspouse and say you are doing
this at night and the patientsays, I have no clue that I was
doing this. This is news to me.
I don't even believe it to behonest with you. And part of
the reason is, Dave, we'resleeping when this happens.
Right? We're sleeping and thenall of a sudden there's this
abrupt sort of arousal ordisruption in our, in our brain
(10:41):
rhythms when we're sleeping.
But it may not last a longenough. Patients may not wake
up long enough to remember thatthat occurred. So they forget
that event and then they justthink that nothing has
happened. Is
Speaker 2 (10:53):
It all night continuously or because and the
reason I ask that , cause youand I have, I've known you for
years and I've learned moreabout sleep from you than any
other living human being and Iknow that there's different
cycles of sleep overnight.
Does, does the apnea occurcontinuously through all sleep
cycles or does it wex and wane
Speaker 3 (11:08):
Overnight? Yeah , we cycle through two different
stages of sleep. Non REM sleepand REM sleep. In REM sleep
it's very interesting becauseour muscles during REM sleep
are paralyzed except for ourbreathing muscles and our eye
muscles. That's why they callit rapid eye movements or our
eye muscles are moving and wecan breathe, but the rest of
our muscles, including ourtongue is way more relaxed than
(11:29):
in non-rem. So in REM sleep wetend to see sleep apnea
becoming much more severe interms of the frequency and even
the oxygen. Desaturations
Speaker 2 (11:38):
Ren , what would cause a person to wake up? Is
it simply the severity of theobstruction or why don't they
just, you know , pass
Speaker 3 (11:44):
Out? Yeah, that's a great question. So sometimes
the fact that the throat isactually obstructing can be
irritating and someone willwake up. But the brain is
really smart. It says if I'mnot getting oxygen, I need to
do something different. Andthen there's a momentary
awakening, the musclesconstrict and then the patient
is able to
Speaker 2 (12:01):
Breathe. It sounds like it's kind of an
evolutionary necessity that youwake up in , otherwise
we'd all be dead. Mother
Speaker 3 (12:07):
Nature knows.
Absolutely.
Speaker 2 (12:08):
Exactly. I've heard that certain foods can make it
worse. You've mentionedalcohol. Anything else? You
know,
Speaker 3 (12:12):
As I was mentioning a little bit earlier, the
airway can be very sensitive touh , collapsibility, but other
things kind of make the airwayor the soft tissue in the back
throat swollen. So if we havethings like GERD or reflux or
spicy foods or anything thatcan irritate the back of the
throat, like even smoking canmake it really congested in the
back of the throat, that'sgonna narrow the airway and
(12:34):
it's gonna make it more easy tocollapse at night.
Speaker 2 (12:36):
So one more reason not to smoke, that's an easy
one, but you're not gonna tellme I can't like have a , a
burrito or something out causeit's spicy or good
Indian food. , you
Speaker 3 (12:44):
Can have whatever you want, especially Indian
food. ,
Speaker 2 (12:47):
You know what, I'm ready for a nap and I'm not
even kidding. I can take a napalmost anytime . . Uh ,
so I'll take a short break hereand when we come back we're
gonna talk about what can bedone about sleep. Aptio stay
with us. We'll be right back.
Speaker 1 (13:02):
You are listening to the Healthy Matters podcast
with Dr. David Hilden . Got aquestion or comment for the
doc, email us at HealthyMatters hc m e d.org or give us
a call at six one two eightseven three talk. That's 6 1 2
8 7 3 8 2 5 5. And now let'sget back to more healthy
conversation.
Speaker 2 (13:25):
And we're back with Dr. Regi Verese talking about
sleep apnea. You talked alittle bit earlier about , uh,
things you ask patients aboutsymptoms they might have, but
when they get to you at theMinnesota Regional Sleep
Disorder Center, how do youdiagnose it officially and say
a little bit more about whereyou work?
Speaker 3 (13:42):
So the first thing that we do is we have the
patient come in. Usually welike to have patients come in
with their spouses or their bedpartners to get some collateral
information. We do acomprehensive physical
examination and a just ahistory of how they're doing.
Ask questions about how they'resleeping and , uh, how they're
doing during the daytime. Andif we think that they may have
some obstructive sleep apnea,we'll do sleep studies. And
(14:04):
nowadays we can do sleepstudies at home. There's a
little device that we wear on,on our wrist and, and we can
get information from apatient's , uh, sleep while
they're at home. And then wealso have a comprehensive sleep
study where patients sleep inour lab, we put electrodes on
their scalp, a couple ofsensors near their mouth, nose
near their eyes, chest andabdomen. And we just have them
sleep through the night andfigure out whether they
Speaker 2 (14:25):
Have it. Can I just tell you that sounds awful ,
. What do you meanthey're gonna sleep through the
night? Yeah, we put a sensoraround your nose in your head.
Now go to sleep. Really? Canpeople do
Speaker 3 (14:34):
It? People do.
People do. And if they can't,if we have some concerns, and I
do ask that question, I I dogive a sedative at night or a
sleeping pill for thosepatients, they say, gosh, I I
really don't think I can do it.
And, and that won't mess up ourdata. Our sleep center's been
around for this year, Dave , 45years. It was founded in 1978.
It was one of the earliestsleep centers in the country.
(14:56):
It was founded by Milton Enger, one of the former chairs of
neurology and, and his protege,Dr. Mark Ma Howell , I mean
it's historical Sleep center .
And um , just last week we werehonored by the American Academy
of Sleep Medicine for being anaccredited site for 40 years.
Um, this centered discoveredREM sleep behavior disorder,
which is considered by many asone of the most important
(15:17):
neurological sleep disorders.
Speaker 2 (15:19):
Congratulations on that. Anterior predecessors, I,
I knew , uh, Dr. Maha well andI even got to meet Dr. Edinger
, uh, uh, a few years back.
Truly, the Minnesota RegionalSleep Disorder Center is a
pioneer in this field andcontinues to this day to not
only care for patients butadvance the science. It's
located right here in downtownMinneapolis at Hennepin
Healthcare . Okay. Ren , a lotof people wear fitness devices
(15:42):
and Apple watches and Fitbitsand the like, and a lot of 'em
will tell you how well youslept. Is that a valid
measurement? Is that somethingthat you think about when
you're, when you're helpingpeople who aren't sleeping?
Well,
Speaker 3 (15:53):
I, I do get this question a lot and people do
bring their devices whether ,uh, it be wrist worn or
otherwise. And these devicesare pretty good, not perfect,
they're not as close to amedical grade device, but they
can give us some parameters.
They can give us an idea ofhow, what time people might
fall asleep and what timepeople might wake up. It's a
good correlation of when peoplemight stay in their REM sleep
(16:15):
because there's virtually nomovement during that time and
there's changes in heart rate.
So these algorithms arefiguring that out, but they're
not as good as picking up onsort of the depth of sleep that
people are in. But thesedevices also have oximeter on
them now and those are gettingto be fairly good. Maybe close
but not nearly close to medicalgrade
Speaker 2 (16:35):
To measure the oxygen in your Absolutely. Yeah
. Which is one of the primaryproblems, right?
Speaker 3 (16:39):
Absolutely. And patients bring that in and I
kind of go, well, this is worthinspecting and we should maybe
do an actual sleep study andfigured this out. So
Speaker 2 (16:46):
You've alluded to what people can do in their
lifestyle to help mild sleepapnea, avoid alcohol and things
like that. Um, you know, maybesleep on your side. What
treatments are available forpeople who need more?
Speaker 3 (16:58):
So again, if you're symptomatic, if you have risk
factors for, you know, heartdisease, strokes, blood
pressure, we really want you toget treated. And the mainstay
Gold standard therapy hasalways been C P A P ,
continuous positive airwayairway pressure, which is just
essentially a box that blowsroom air, that's humidified ,
uh, gentle air that's siftsthrough a mass and keeps that
(17:20):
airway nomadically open. Butthat isn't the only treatment.
We look at the data on about50% of people that start C P A
P after a year of uses , whenyou look back into them , about
50% have stopped. So we know weneed to have different
alternatives and we do. So wenow have, and we have had for a
long period of time, littleretainers for your mouth. We
call them mandibularadvancement devices. And these
(17:41):
things are custom molded bysleep dentists to move the
lower jaw forward. And if, youknow, if you move the lower jaw
forward, you're also moving thetissue, including the tongue
forward. And so if we can putthat in before someone sleeps,
the jaws moved forward, thetongues moved forward, the
airway is a little bit moreopen and the sleep apnea is
corrected.
Speaker 2 (17:59):
How far forward?
Because I'm imagining somebodywith a giant underbite all
night
Speaker 3 (18:03):
Long. . So
it depends on when the snoring
is dissipated. We might havesomeone come back in for
another sleep study with these, this device in place. And we
do have to be careful becausepeople can have joint issues by
their cheeks called thetemporal mandibular joint with
some of these devices. But thedevices are so slick nowadays
this is becoming a little bitmore of the norm than sort of
the exception. But we also haveother treatments as well,
(18:26):
surgical options and uh , somedevices that are out there that
actually move the tongueforward with , uh, a little
vacuum seal. These
Speaker 2 (18:33):
Get advertised a lot.
Speaker 3 (18:35):
Uh , they do this surgical option , um, is uh , a
device that sits in your chest, uh, and has a wire that is
dug underneath your neck and it, it touches one of the nerves
in our tongue. And at night youturn this device on and when
this device figures out thatyou might have a sleep apnea
event , it'll stimulate thenerve, which stimulates the
(18:55):
muscle of the tongue and movesthe tongue forward and you turn
it off in the morning. Reallygood data that it works. You
have to have failed a couple ofdifferent treatments to figure
out whether this is an optionfor you. And it's only good for
people that have not too severesleep apnea and not over a
certain bmi. I have
Speaker 2 (19:12):
To ask the question, it's probably on a lot of
people's mind. Is that safe? Imean, you're putting a wire up,
up onto your tongue. I'm gonnaguess it is safe, but I want
you to comment on the safety.
It
Speaker 3 (19:21):
Is , it is ef it's approved by the fda. So it is
considered safe and efficaciousand it is generally safe. Um ,
we , it works , it , it , itdoes work. And I mean, you
know, nothing is foolproof,nothing has is ever without
some side effects. And the mostcommon side effects that people
notice is that they may feellike their tongue is rubbing
against their teeth. So, butwell tolerated and really a
(19:44):
helpful thing for people. Theycan't tolerate other things. So
Speaker 2 (19:47):
Let's go back to c A P cuz that's what a lot of
people are wearing and I getpatients all the time and
family members, some of 'emswear by it, others is no
biggie. And others say that wasmiserable. You probably deal
with this all the time in yourclinic. Peyton, people who
aren't loving their c A p ,what do you tell them or why is
it that they're hard for somepeople? Yeah ,
Speaker 3 (20:05):
It can be a number of different things. One ,
sometimes people feel like themask itself doesn't fit them
well and that's okay cuz thereare different sizes, different
types of masks that are outthere. So we start with is it
the right mask? If it isn't,sometimes people say it's too
much pressure coming out ofthis tube and I want to , I
want you to lower the pressure.
And sometimes we do that sothat they can get acclimated
(20:26):
over time to be able to use a CP A P . But then other times
that's not gonna work. Andsometimes I bring them back
into the lab and sometimes wetransition them to a device
called a BiPAP . And there'ssome literature that suggests
that BiPAPs can feel morecomfortable compared to A C P A
P .
Speaker 2 (20:43):
Before I go on to sort of the future and some of
the other newer things that areout there, what happens if, if
you simply leave thisuntreated?
Speaker 3 (20:50):
So you're , if you're sleepy because your
sleep apnea is untreated, youhave higher risk for not being
as productive at work. Okay,fine. You are higher risk for
motor vehicle accidents. You'rehigher risk for having an
accident. If you're operating,you know, heavy machinery, your
mood might be disturbed. Youmight not think this clearly,
but then let's start talkingabout all the cardiovascular
(21:11):
outcomes. You, again, arehigher risk for cardiovascular
problems like coronary arterydisease strokes, sudden cardiac
death, congestive heartfailure, resistant
hypertension. It's just wearand tear on the body.
Speaker 2 (21:24):
Lots of good reasons for getting your sleep apnea
treated. Plus you , you maybewon't go through a sleep
divorce too
Speaker 3 (21:30):
for
Speaker 2 (21:31):
Sure. Maybe your bed partner won't kick you out of
the house and put you behindthree double doors. So what,
Speaker 3 (21:36):
What other
Speaker 2 (21:37):
Cool things are out there in the future? Is there
some pill that's gonna make itgo away or are there some other
devices or what are you seeingdown the road
Speaker 3 (21:44):
Again? Yeah, this is interesting. We don't have a
pill, but people are workingwith a combination of molecules
that do keep the airway alittle bit more stiff. That's
really early, early device. Butthe preliminary results are
that it kind of works and it'susually good for people to have
mild obstructive sleep apnea,not severe obstructive sleep
(22:04):
apnea. Uh, there are techniquesthat you can use. Uh , singers,
have you ever heard of singeruse something called circular
breathing? Mm-hmm .
or people thatuse the diri do there are
muscles, no, I don't
Speaker 2 (22:16):
Know that last word you just said .
Speaker 3 (22:17):
The witch the diri do is a , uh, an aboriginal
instrument. It's an indigenousaboriginal instrument. It's a
long tube that has this like
Speaker 2 (22:26):
Me
Speaker 3 (22:27):
Sound to it. And when you start to use your,
Speaker 2 (22:30):
I totally know what you mean by way you've done it
.
Speaker 3 (22:33):
Um, when people use this instrument or use this
circular breathing or just kindof engage in these breathing
exercises, you can strengthenup the muscles of the back of
the airway that you can reducemild sleep apnea. But this
requires daily training, 30minutes or so and even longer.
But as you mentioned, are thereother devices out there? Yes,
there are devices that you canput on your tongue for 30
(22:57):
minutes a day that willstimulate the tongue muscles so
the tongue muscles becomestronger so that it, you know,
reduces the sleep disorderbreathing.
Speaker 2 (23:05):
You're joking. I'm not kidding . There's a thing
you put on your tongue while
Speaker 3 (23:08):
You're awake and you just leave it in your tongue
when it's hanging out. It'sbattery operated and it will
strengthen the muscles of thetongue and keep it a little bit
less prone to collapse. It's
Speaker 2 (23:17):
Battery operating and it strengthens the muscles
of your tongue. I have neverheard of that.
Speaker 3 (23:21):
Absolutely. Do
Speaker 2 (23:22):
People use that?
Speaker 3 (23:23):
Uh, I do not have any of my patients, but the
folks that are at the VA haveseveral patients that have gone
through it and some love it andsome feel like it's not the
right thing for them . Right.
Speaker 2 (23:32):
And I love that thing about the circular
breathing thing. In a littleside note, at one time I , I'll
admit this, I went to a KennyGE concert one time . I
did, I did. He played a notethat was like eight minutes
long and he never took abreath. Yeah . So he was
playing and , and circularbreathing. That's exactly
right. I like your aboriginal ,uh, sound effects better. You
have a career in sound effects.
Appreciate it. Dave. I,what, what would you, leave us
(23:55):
as we close it off here, Ren .
Um, what would you like to tellpeople who are , uh, maybe not
sleeping well, who think theymight have sleep apnea? What,
what would your closing tips beif you're young? Don't wait.
Get it evaluated. Have someonesort of, if you're sleep
sleeping with someone, justhave someone kind of keep an
eye on you. There are appsactually that you can download
that will measure snoringlevels and even sort of
(24:18):
estimate whether you have apneaas well. If, if that's not the
case and you suspect thatyou're sleepy during the
daytime, if you feel likeyou're not getting good quality
sleep, if you're wakingyourself from snoring, tell
your doctor, tell your doctorand they will likely refer them
to a sleep physician and we'llget the ball rolling. I, I
think the answer is, it's socommon. It's so easily
(24:39):
diagnosable and it's sotreatable and the the gains are
so big and the risks are toobig that you might as well get
the gains and not, and , andavoid the risk. That's a great
message to leave us with.
There's so much to be doneabout this. Ren Verese , thank
you for being on the show withme today. I appreciate it Dave,
thank you. We've been talkingto Dr. Ren Verese . He is a
(24:59):
physician and a sleepspecialist at the Minnesota
Regional Sleep Disorder Centerhere in downtown Minneapolis.
And a colleague of mine and afrequent guest of mine.
Whenever I can get some of histime to talk about his
expertise. That's all we havefor today. I hope you'll join
us for our next episode whenwe're gonna tackle the subject
of Alzheimer's Disease. It'sgonna be a great show. I hope
(25:20):
you'll tune in and in themeantime, be healthy and sleep
well.
Speaker 1 (25:25):
Thanks for listening to the Healthy Matters podcast
with Dr. David Hilden . To findout more about the Healthy
Matters podcast or browse thearchive, visit healthy
matters.org. Got a question ora comment for the show, email
us at Healthy matters hc m ed.org or call 6 1 2 8 7 3 talk.
There's also a link in the shownotes. And finally, if you
(25:48):
enjoy the show, please leave usa review and share the show
with others. The HealthyMatters Podcast is made
possible by Hennepin Healthcarein Minneapolis, Minnesota, and
engineered and produced by JohnLucas At Highball Executive
producers are Jonathan Comitoand Christine Hill. Please
remember, we can only givegeneral medical advice during
this program, and every case isunique. We urge you to consult
(26:09):
with your physician if you havea more serious or pressing
health concern. Until nexttime, be healthy and be well.
Welcome to the Healthy Matters podcast with
Dr. David Hilden , primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health healthcare and
what matters to you. And nowhere's our host, Dr. David
Hilden .
Speaker 2 (00:20):
Hey, it's Dr. David Hilden and welcome to episode
15 of the Healthy Matterspodcast. Today we are gonna
talk about sleep apnea. You'veprobably heard about it, but
we're gonna delve into whatcauses it and what you can do
about it. And to help me out, Ihave invited a past guest from
the program, Dr . Ren Verese .
He is a sleep doctor whospecializes in all kinds of
(00:42):
sleep disorders, includingsleep apnea. Dr. Verese ,
welcome back to the
Speaker 3 (00:46):
Show. Thank you Dave . It's a pleasure to be here.
It's
Speaker 2 (00:48):
Great to have you , Regi , now you do all kinds of
sleep, but we're gonna stick tosleep apnea today because it's
so common and so many peopleare living with sleep apnea. So
start us off, what is it? Whatis sleep
Speaker 3 (00:59):
Apnea? Yeah, so sleep apnea, as you mentioned,
it's very common. It's acondition where the back of the
throat, the tongue, the musclesin the back of the throat when
we sleep at night, become veryrelaxed. And at that time the
airway might close off becauseour muscles are relaxed when we
fall asleep. And if the airwaycloses off, the oxygen can't
get into your lungs. And thisis what we call a sleep apnea
(01:21):
event. It's essentially achoking episode when we sleep
at night. It sounds
Speaker 2 (01:24):
Awful
Speaker 3 (01:25):
Terrible.
Speaker 2 (01:25):
It is. I mean, when you've described it as a
choking episode and not gettingoxygen, that sounds pretty bad.
What causes it?
Speaker 3 (01:31):
So a lot of different things causes sleep
apnea, but the number one thingis being a male and obesity. So
being overweight can cause alot of weight around the size
of your neck. And so that putsa lot of pressure on those soft
tissues in the back of thethroat. So anything that might
put pressure on the throat likeobesity, sleeping on your back
because if you sleep on yourback, your tongue can sort of
(01:52):
roll back and choke that , uh,airway as well. But mostly it's
being a male, mostly it'sobesity and certain things like
alcohol can worsen sleep apneaas well. Does the
Speaker 2 (02:02):
Word apnea mean? Is that what it means? Choking?
Yeah,
Speaker 3 (02:05):
It means stopping breathing essentially. It's the
cessation of breath. So yousaid
Speaker 2 (02:09):
It's more common in men , what about in age? Does
it, do people get it at youngages or is this a disease of,
of aging?
Speaker 3 (02:16):
Absolutely. I mean we do definitely see this in
adult males. Um , when we lookat the pediatric literature,
it's these kids that havetonsils,
Speaker 2 (02:25):
Very
Speaker 3 (02:25):
Large tonsils or adenoids that can snore very
loud and have sleep apnea aswell. But we're really starting
to see not just kiddos havingobstructive sleep apnea from
tonsils, but there's a bigcrisis in pediatrics with
obesity and these children arecoming with sleep apnea that's
not involved with tonsils whenit comes to women. Women are
(02:46):
fairly protected from havingsleep apnea until they start
hitting perimenopause andmenopause and then they start
catching up to men.
Speaker 2 (02:52):
Why is that? Well ,
Speaker 3 (02:54):
Uh , the hormones, progesterone, estrogen are,
they help us breathe, they helpwomen breathe. It also helps
with keeping the airway open.
So
Speaker 2 (02:59):
You talked about tonsils and adenoids that now
we don't take those out so muchin kids anymore, but, and when
we did, they were just, cuzthey were a little big and
people were getting sorethroats. Right. I mean
tonsillectomies weren't donefor sleep apnea back in the
day, were they?
Speaker 3 (03:12):
They were. And they are now. They are now . Okay .
They are now. And, and, and itdepends on the severity of the
sleep apnea for kiddos. So iftheir sleep is really disrupted
and they're sleepy during thedaytime and you can really
identify using a sleep studythat their sleep is disturbed,
we then perform intonsillectomy. And that's
usually curative for thesekids.
Speaker 2 (03:31):
Okay. So how common is sleep apnea in our
population? A
Speaker 3 (03:35):
Study population based study in 2014 looked at
men and women, about 14% of menand about 5% of women have
obstructive sleep apnea. Andwhen we categorize sleep apnea,
we think of mild, moderate, andsevere obstructive sleep apnea.
So these are folks that arestopping breathing or their
oxygen is dipping a minimum offive times per hour. And that's
(03:55):
where those numbers come from.
40% of men, 5% of women, that'sa
Speaker 2 (03:59):
Lot. Mm-hmm.
Speaker 3 (03:59):
Speaker 2 (03:59):
Is, is that a global phenomenon or is that more of a
thing in our country,especially with obesity?
Speaker 3 (04:05):
That's the correlation is that we are,
there's two components of that.
I think it's the obesityepidemic, but then there's also
a lot of doctors are nowbecoming very well aware of
sleep apnea. This has happenedin the last 20 years. So we
talk
Speaker 2 (04:18):
About it a lot in clinic. I do in primary care
clinic a lot. Someone says,yeah, I think I have sleep
apnea or my spouse snores and Ithink they have sleep apnea.
Are we, are we diagnosing itmore formally with sleep
studies, like what you do orare are we diagnosing it more
just in the clinic? Uh , sortof speculatively like I think
you have sleep
Speaker 3 (04:36):
Apnea. It's on a lot of the radar of a lot of
doctors. Yeah . So I thinkthey're just gonna ask the
right questions and if theyhave the right suspicion for
sleep apnea, the goal is forthe patient to be tested or at
least seen by a sleep physicianto determine whether testing is
indicated and to figure outwhether they have sleep apnea.
Speaker 2 (04:52):
So I take it cases are on the rise then?
Speaker 3 (04:55):
I think so for a number of different reasons.
The fact that people are aging,that's one reason. Number two,
the fact that people arecontinuing to have , uh, this
obesity epidemic. And three, Ithink doctors, again, just like
you, you're , it's on yourradar. You want to ask about
this because it's important.
Speaker 2 (05:09):
I mentioned snoring, I think you maybe did earlier
in this, in this uh , episodewith, especially with kids.
Tell us about, if you could,Reggie , the , the correlation
between snoring and sleepapnea, they're not one in the
same, but they're, they gotogether, right?
Speaker 3 (05:22):
Absolutely. So you can have snoring la very loud
snoring and not have theseepisodes where the airway's
closing off you and you'rechoking yourself. But snoring
tends to very strongly indicatethat someone does have
obstructive sleep apnea. So ifyou have someone that has
obstructive sleep apnea, theylikely have symptoms of
snoring, loud snoring. But youcan have snoring alone and not
(05:44):
have sleep apnea. So
Speaker 2 (05:46):
If you think you might have sleep apnea or you
think the person you share abed with, you know they snore
is just really loud. How do youdiagnose
Speaker 3 (05:53):
It? Yeah. So apart from that snoring question I
ask , is the snoring loudenough to be able to be heard
through a closed door? I askthe patient or their bed
partner, does your partner eversnore themselves awake, like
with a snort? Kind of likethat. Oh , that was
Speaker 2 (06:07):
Good.
Speaker 3 (06:08):
Well the reason why I do that is because when I do
that in the clinic with thepatient, they go, yes, that's
exactly what I have . That's it. That's it. Yeah. And then,
then I, I'm fairly certain thatI've got the diagnosis or if a
bed partner hears that they'resnoring and then all of a
sudden there's a silence in thesnoring and then the patient
has a snort awake getting ,that's what we call, that's a
witnessed apnea. So apart fromthat, I ask questions like, do
(06:31):
you wake up with a dry mouth inthe morning? Do you have a
headache when you wake up inthe morning? Do you feel like
you're sleepy during thosedays? All that sort of gives us
an indication that , uh,there's a high probability that
someone has sleep apnea.
Speaker 2 (06:43):
You practically have to be a marriage counselor if
you can hear it through aclosed door. Yeah. Wow. I bet
you have a lot of conversationswith people. Well
Speaker 3 (06:51):
There is something called sleep divorce where
people separate from theirbedrooms to sleep better
because of their partnersnoring or other sleep
complaints. And and yeah,people do say, I'm sleeping
better now because my partner'ssleeping better. I think they
did a study that looked at howmuch a bed partner's sleep is
disturbed by someone else'ssnoring and it's about 50% of
(07:13):
their sleep can be disturbed bysomeone's sleep apnea and
snoring.
Speaker 2 (07:17):
Right now there are a whole lot of people nodding
as they're listening to you saythat and they're right now, I
can just imagine peoplelistening to this episode and
they're going, ah-huh that's myexperience. I don't sleep well
because dude next to me here issnoring so loud. Absolutely is
, is sleep apnea dangerous?
Speaker 3 (07:33):
Yeah, great question. So as we talked about
it, that you can have differentseverities of sleep apnea,
mild, moderate or severe. Ifit's really mild, we kind of
just talk about lifestylemodifications, losing weight,
maybe reducing alcohol beforebedtime , uh, sleeping on the
side and things like that. Whenit becomes moderate or severe,
if the number of times thatsomeone is holding their breath
(07:54):
and stopping breathing isbetween 15 to 29 times an hour,
we call that moderateobstructive sleep.
Speaker 2 (07:59):
That's like once every minute or two.
Speaker 3 (08:01):
Yep . Yep . Exactly right. And if it's beyond that
and or if they're oxygen reallytanks, you know, below 80%, you
know, even in the mid eightieswe know that that left alone
over time confers a risk ofcardiovascular disease, sudden
cardiac death, heart attacksfrom sleep, difficult to treat
high blood pressure, and it,it's a whole host of things
(08:23):
that can happen. So I don'twant people to worry because
the majority of folks that comeinto our daughters, they've had
sleep apnea for an extendedperiod of time. So there's not
a big risk that something'sgonna happen tonight. My
recommendation would be, if youthink you have it, come and see
us. So
Speaker 2 (08:39):
Let's talk about what the experience of someone
who has sleep apnea is . Whatdoes it feel like and and what
kind of symptoms do they have?
The
Speaker 3 (08:47):
Prototypical example of someone has, you know,
symptomatic sleep apnea, severesleep apnea, they'll come in
tired, they'll come in sleepy,they'll feel really just
sluggish. They'll feel ,they'll , they'll say things
like, not only can I sleep if Ihave the opportunity during the
daytime if give , if you gaveme the opportunity, but I just
feel like I'm walking through afog and they'll say multiple
(09:10):
times throughout the night,I'll wake up feeling like
something is in the back of mythroat, like my tongue or I've
just awakened and my heart isracing and they don't sleep
through the night. Um, sothat's typically what people
describe. Uh ,
Speaker 2 (09:23):
You said there's different severities. Is it all
caused by an obstruction or areyou know, what makes one more
severe than the other? I guesswhat I'm trying to say, y there
Speaker 3 (09:31):
Are different types of sleep apnea. The one that we
normally see typically in , inthe population is obstructive
sleep apnea. That wordobstruction is a key that
something is obstructing theairway like the tongue or the
soft palate and and so forth.
There's something else calledcentral sleep apnea. That's
usually happens when someone'susing a lot of opioid pain
medications and there's ,there's sometimes brain lesions
(09:54):
can cause this or heartfailure. Patients can also have
central sleep apnea. Um , butreally the central sleep apnea
is we are concerned about, butrarely are they really
associated with severedesaturations. And we kind of
just watch that for theobstructive sleep apnea, we
definitely want to get thatfixed and treated because it
can be , uh, dangerous.
Speaker 2 (10:11):
Now if you're not breathing once an hour, I can
just imagine listeners arethinking that's a lot. Yeah, I
mean is that considered asevere case and do they know
that this is happening?
Speaker 3 (10:20):
Some people do and that's why they will come in.
Others are brought in by theirspouse and say you are doing
this at night and the patientsays, I have no clue that I was
doing this. This is news to me.
I don't even believe it to behonest with you. And part of
the reason is, Dave, we'resleeping when this happens.
Right? We're sleeping and thenall of a sudden there's this
abrupt sort of arousal ordisruption in our, in our brain
(10:41):
rhythms when we're sleeping.
But it may not last a longenough. Patients may not wake
up long enough to remember thatthat occurred. So they forget
that event and then they justthink that nothing has
happened. Is
Speaker 2 (10:53):
It all night continuously or because and the
reason I ask that , cause youand I have, I've known you for
years and I've learned moreabout sleep from you than any
other living human being and Iknow that there's different
cycles of sleep overnight.
Does, does the apnea occurcontinuously through all sleep
cycles or does it wex and wane
Speaker 3 (11:08):
Overnight? Yeah , we cycle through two different
stages of sleep. Non REM sleepand REM sleep. In REM sleep
it's very interesting becauseour muscles during REM sleep
are paralyzed except for ourbreathing muscles and our eye
muscles. That's why they callit rapid eye movements or our
eye muscles are moving and wecan breathe, but the rest of
our muscles, including ourtongue is way more relaxed than
(11:29):
in non-rem. So in REM sleep wetend to see sleep apnea
becoming much more severe interms of the frequency and even
the oxygen. Desaturations
Speaker 2 (11:38):
Ren , what would cause a person to wake up? Is
it simply the severity of theobstruction or why don't they
just, you know , pass
Speaker 3 (11:44):
Out? Yeah, that's a great question. So sometimes
the fact that the throat isactually obstructing can be
irritating and someone willwake up. But the brain is
really smart. It says if I'mnot getting oxygen, I need to
do something different. Andthen there's a momentary
awakening, the musclesconstrict and then the patient
is able to
Speaker 2 (12:01):
Breathe. It sounds like it's kind of an
evolutionary necessity that youwake up in
we'd all be dead. Mother
Speaker 3 (12:07):
Nature knows.
Absolutely.
Speaker 2 (12:08):
Exactly. I've heard that certain foods can make it
worse. You've mentionedalcohol. Anything else? You
know,
Speaker 3 (12:12):
As I was mentioning a little bit earlier, the
airway can be very sensitive touh , collapsibility, but other
things kind of make the airwayor the soft tissue in the back
throat swollen. So if we havethings like GERD or reflux or
spicy foods or anything thatcan irritate the back of the
throat, like even smoking canmake it really congested in the
back of the throat, that'sgonna narrow the airway and
(12:34):
it's gonna make it more easy tocollapse at night.
Speaker 2 (12:36):
So one more reason not to smoke, that's an easy
one, but you're not gonna tellme I can't like have a , a
burrito or something out causeit's spicy
Indian food.
Speaker 3 (12:44):
Can have whatever you want, especially Indian
food.
Speaker 2 (12:47):
You know what, I'm ready for a nap and I'm not
even kidding. I can take a napalmost anytime .
so I'll take a short break hereand when we come back we're
gonna talk about what can bedone about sleep. Aptio stay
with us. We'll be right back.
Speaker 1 (13:02):
You are listening to the Healthy Matters podcast
with Dr. David Hilden . Got aquestion or comment for the
doc, email us at HealthyMatters hc m e d.org or give us
a call at six one two eightseven three talk. That's 6 1 2
8 7 3 8 2 5 5. And now let'sget back to more healthy
conversation.
Speaker 2 (13:25):
And we're back with Dr. Regi Verese talking about
sleep apnea. You talked alittle bit earlier about , uh,
things you ask patients aboutsymptoms they might have, but
when they get to you at theMinnesota Regional Sleep
Disorder Center, how do youdiagnose it officially and say
a little bit more about whereyou work?
Speaker 3 (13:42):
So the first thing that we do is we have the
patient come in. Usually welike to have patients come in
with their spouses or their bedpartners to get some collateral
information. We do acomprehensive physical
examination and a just ahistory of how they're doing.
Ask questions about how they'resleeping and , uh, how they're
doing during the daytime. Andif we think that they may have
some obstructive sleep apnea,we'll do sleep studies. And
(14:04):
nowadays we can do sleepstudies at home. There's a
little device that we wear on,on our wrist and, and we can
get information from apatient's , uh, sleep while
they're at home. And then wealso have a comprehensive sleep
study where patients sleep inour lab, we put electrodes on
their scalp, a couple ofsensors near their mouth, nose
near their eyes, chest andabdomen. And we just have them
sleep through the night andfigure out whether they
Speaker 2 (14:25):
Have it. Can I just tell you that sounds awful ,
night? Yeah, we put a sensoraround your nose in your head.
Now go to sleep. Really? Canpeople do
Speaker 3 (14:34):
It? People do.
People do. And if they can't,if we have some concerns, and I
do ask that question, I I dogive a sedative at night or a
sleeping pill for thosepatients, they say, gosh, I I
really don't think I can do it.
And, and that won't mess up ourdata. Our sleep center's been
around for this year, Dave , 45years. It was founded in 1978.
It was one of the earliestsleep centers in the country.
(14:56):
It was founded by Milton Enger, one of the former chairs of
neurology and, and his protege,Dr. Mark Ma Howell , I mean
it's historical Sleep center .
And um , just last week we werehonored by the American Academy
of Sleep Medicine for being anaccredited site for 40 years.
Um, this centered discoveredREM sleep behavior disorder,
which is considered by many asone of the most important
(15:17):
neurological sleep disorders.
Speaker 2 (15:19):
Congratulations on that. Anterior predecessors, I,
I knew , uh, Dr. Maha well andI even got to meet Dr. Edinger
, uh, uh, a few years back.
Truly, the Minnesota RegionalSleep Disorder Center is a
pioneer in this field andcontinues to this day to not
only care for patients butadvance the science. It's
located right here in downtownMinneapolis at Hennepin
Healthcare . Okay. Ren , a lotof people wear fitness devices
(15:42):
and Apple watches and Fitbitsand the like, and a lot of 'em
will tell you how well youslept. Is that a valid
measurement? Is that somethingthat you think about when
you're, when you're helpingpeople who aren't sleeping?
Well,
Speaker 3 (15:53):
I, I do get this question a lot and people do
bring their devices whether ,uh, it be wrist worn or
otherwise. And these devicesare pretty good, not perfect,
they're not as close to amedical grade device, but they
can give us some parameters.
They can give us an idea ofhow, what time people might
fall asleep and what timepeople might wake up. It's a
good correlation of when peoplemight stay in their REM sleep
(16:15):
because there's virtually nomovement during that time and
there's changes in heart rate.
So these algorithms arefiguring that out, but they're
not as good as picking up onsort of the depth of sleep that
people are in. But thesedevices also have oximeter on
them now and those are gettingto be fairly good. Maybe close
but not nearly close to medicalgrade
Speaker 2 (16:35):
To measure the oxygen in your Absolutely. Yeah
. Which is one of the primaryproblems, right?
Speaker 3 (16:39):
Absolutely. And patients bring that in and I
kind of go, well, this is worthinspecting and we should maybe
do an actual sleep study andfigured this out. So
Speaker 2 (16:46):
You've alluded to what people can do in their
lifestyle to help mild sleepapnea, avoid alcohol and things
like that. Um, you know, maybesleep on your side. What
treatments are available forpeople who need more?
Speaker 3 (16:58):
So again, if you're symptomatic, if you have risk
factors for, you know, heartdisease, strokes, blood
pressure, we really want you toget treated. And the mainstay
Gold standard therapy hasalways been C P A P ,
continuous positive airwayairway pressure, which is just
essentially a box that blowsroom air, that's humidified ,
uh, gentle air that's siftsthrough a mass and keeps that
(17:20):
airway nomadically open. Butthat isn't the only treatment.
We look at the data on about50% of people that start C P A
P after a year of uses , whenyou look back into them , about
50% have stopped. So we know weneed to have different
alternatives and we do. So wenow have, and we have had for a
long period of time, littleretainers for your mouth. We
call them mandibularadvancement devices. And these
(17:41):
things are custom molded bysleep dentists to move the
lower jaw forward. And if, youknow, if you move the lower jaw
forward, you're also moving thetissue, including the tongue
forward. And so if we can putthat in before someone sleeps,
the jaws moved forward, thetongues moved forward, the
airway is a little bit moreopen and the sleep apnea is
corrected.
Speaker 2 (17:59):
How far forward?
Because I'm imagining somebodywith a giant underbite all
night
Speaker 3 (18:03):
Long.
is dissipated. We might havesomeone come back in for
another sleep study with these, this device in place. And we
do have to be careful becausepeople can have joint issues by
their cheeks called thetemporal mandibular joint with
some of these devices. But thedevices are so slick nowadays
this is becoming a little bitmore of the norm than sort of
the exception. But we also haveother treatments as well,
(18:26):
surgical options and uh , somedevices that are out there that
actually move the tongueforward with , uh, a little
vacuum seal. These
Speaker 2 (18:33):
Get advertised a lot.
Speaker 3 (18:35):
Uh , they do this surgical option , um, is uh , a
device that sits in your chest, uh, and has a wire that is
dug underneath your neck and it, it touches one of the nerves
in our tongue. And at night youturn this device on and when
this device figures out thatyou might have a sleep apnea
event , it'll stimulate thenerve, which stimulates the
(18:55):
muscle of the tongue and movesthe tongue forward and you turn
it off in the morning. Reallygood data that it works. You
have to have failed a couple ofdifferent treatments to figure
out whether this is an optionfor you. And it's only good for
people that have not too severesleep apnea and not over a
certain bmi. I have
Speaker 2 (19:12):
To ask the question, it's probably on a lot of
people's mind. Is that safe? Imean, you're putting a wire up,
up onto your tongue. I'm gonnaguess it is safe, but I want
you to comment on the safety.
It
Speaker 3 (19:21):
Is , it is ef it's approved by the fda. So it is
considered safe and efficaciousand it is generally safe. Um ,
we , it works , it , it , itdoes work. And I mean, you
know, nothing is foolproof,nothing has is ever without
some side effects. And the mostcommon side effects that people
notice is that they may feellike their tongue is rubbing
against their teeth. So, butwell tolerated and really a
(19:44):
helpful thing for people. Theycan't tolerate other things. So
Speaker 2 (19:47):
Let's go back to c A P cuz that's what a lot of
people are wearing and I getpatients all the time and
family members, some of 'emswear by it, others is no
biggie. And others say that wasmiserable. You probably deal
with this all the time in yourclinic. Peyton, people who
aren't loving their c A p ,what do you tell them or why is
it that they're hard for somepeople? Yeah ,
Speaker 3 (20:05):
It can be a number of different things. One ,
sometimes people feel like themask itself doesn't fit them
well and that's okay cuz thereare different sizes, different
types of masks that are outthere. So we start with is it
the right mask? If it isn't,sometimes people say it's too
much pressure coming out ofthis tube and I want to , I
want you to lower the pressure.
And sometimes we do that sothat they can get acclimated
(20:26):
over time to be able to use a CP A P . But then other times
that's not gonna work. Andsometimes I bring them back
into the lab and sometimes wetransition them to a device
called a BiPAP . And there'ssome literature that suggests
that BiPAPs can feel morecomfortable compared to A C P A
P .
Speaker 2 (20:43):
Before I go on to sort of the future and some of
the other newer things that areout there, what happens if, if
you simply leave thisuntreated?
Speaker 3 (20:50):
So you're , if you're sleepy because your
sleep apnea is untreated, youhave higher risk for not being
as productive at work. Okay,fine. You are higher risk for
motor vehicle accidents. You'rehigher risk for having an
accident. If you're operating,you know, heavy machinery, your
mood might be disturbed. Youmight not think this clearly,
but then let's start talkingabout all the cardiovascular
(21:11):
outcomes. You, again, arehigher risk for cardiovascular
problems like coronary arterydisease strokes, sudden cardiac
death, congestive heartfailure, resistant
hypertension. It's just wearand tear on the body.
Speaker 2 (21:24):
Lots of good reasons for getting your sleep apnea
treated. Plus you , you maybewon't go through a sleep
divorce too
Speaker 3 (21:30):
Speaker 2 (21:31):
Sure. Maybe your bed partner won't kick you out of
the house and put you behindthree double doors. So what,
Speaker 3 (21:36):
What other
Speaker 2 (21:37):
Cool things are out there in the future? Is there
some pill that's gonna make itgo away or are there some other
devices or what are you seeingdown the road
Speaker 3 (21:44):
Again? Yeah, this is interesting. We don't have a
pill, but people are workingwith a combination of molecules
that do keep the airway alittle bit more stiff. That's
really early, early device. Butthe preliminary results are
that it kind of works and it'susually good for people to have
mild obstructive sleep apnea,not severe obstructive sleep
(22:04):
apnea. Uh, there are techniquesthat you can use. Uh , singers,
have you ever heard of singeruse something called circular
breathing? Mm-hmm .
muscles, no, I don't
Speaker 2 (22:16):
Know that last word you just said .
Speaker 3 (22:17):
The witch the diri do is a , uh, an aboriginal
instrument. It's an indigenousaboriginal instrument. It's a
long tube that has this like
Speaker 2 (22:26):
Me
Speaker 3 (22:27):
Sound to it. And when you start to use your,
Speaker 2 (22:30):
I totally know what you mean by way you've done it
Speaker 3 (22:33):
Um, when people use this instrument or use this
circular breathing or just kindof engage in these breathing
exercises, you can strengthenup the muscles of the back of
the airway that you can reducemild sleep apnea. But this
requires daily training, 30minutes or so and even longer.
But as you mentioned, are thereother devices out there? Yes,
there are devices that you canput on your tongue for 30
(22:57):
minutes a day that willstimulate the tongue muscles so
the tongue muscles becomestronger so that it, you know,
reduces the sleep disorderbreathing.
Speaker 2 (23:05):
You're joking. I'm not kidding . There's a thing
you put on your tongue while
Speaker 3 (23:08):
You're awake and you just leave it in your tongue
when it's hanging out. It'sbattery operated and it will
strengthen the muscles of thetongue and keep it a little bit
less prone to collapse. It's
Speaker 2 (23:17):
Battery operating and it strengthens the muscles
of your tongue. I have neverheard of that.
Speaker 3 (23:21):
Absolutely. Do
Speaker 2 (23:22):
People use that?
Speaker 3 (23:23):
Uh, I do not have any of my patients, but the
folks that are at the VA haveseveral patients that have gone
through it and some love it andsome feel like it's not the
right thing for them . Right.
Speaker 2 (23:32):
And I love that thing about the circular
breathing thing. In a littleside note, at one time I , I'll
admit this, I went to a KennyGE concert one time
did, I did. He played a notethat was like eight minutes
long and he never took abreath. Yeah . So he was
playing and , and circularbreathing. That's exactly
right. I like your aboriginal ,uh, sound effects better. You
have a career in sound effects.
Appreciate it. Dave. I
(23:55):
as we close it off here, Ren .
Um, what would you like to tellpeople who are , uh, maybe not
sleeping well, who think theymight have sleep apnea? What,
what would your closing tips beif you're young? Don't wait.
Get it evaluated. Have someonesort of, if you're sleep
sleeping with someone, justhave someone kind of keep an
eye on you. There are appsactually that you can download
that will measure snoringlevels and even sort of
(24:18):
estimate whether you have apneaas well. If, if that's not the
case and you suspect thatyou're sleepy during the
daytime, if you feel likeyou're not getting good quality
sleep, if you're wakingyourself from snoring, tell
your doctor, tell your doctorand they will likely refer them
to a sleep physician and we'llget the ball rolling. I, I
think the answer is, it's socommon. It's so easily
(24:39):
diagnosable and it's sotreatable and the the gains are
so big and the risks are toobig that you might as well get
the gains and not, and , andavoid the risk. That's a great
message to leave us with.
There's so much to be doneabout this. Ren Verese , thank
you for being on the show withme today. I appreciate it Dave,
thank you. We've been talkingto Dr. Ren Verese . He is a
(24:59):
physician and a sleepspecialist at the Minnesota
Regional Sleep Disorder Centerhere in downtown Minneapolis.
And a colleague of mine and afrequent guest of mine.
Whenever I can get some of histime to talk about his
expertise. That's all we havefor today. I hope you'll join
us for our next episode whenwe're gonna tackle the subject
of Alzheimer's Disease. It'sgonna be a great show. I hope
(25:20):
you'll tune in and in themeantime, be healthy and sleep
well.
Speaker 1 (25:25):
Thanks for listening to the Healthy Matters podcast
with Dr. David Hilden . To findout more about the Healthy
Matters podcast or browse thearchive, visit healthy
matters.org. Got a question ora comment for the show, email
us at Healthy matters hc m ed.org or call 6 1 2 8 7 3 talk.
There's also a link in the shownotes. And finally, if you
(25:48):
enjoy the show, please leave usa review and share the show
with others. The HealthyMatters Podcast is made
possible by Hennepin Healthcarein Minneapolis, Minnesota, and
engineered and produced by JohnLucas At Highball Executive
producers are Jonathan Comitoand Christine Hill. Please
remember, we can only givegeneral medical advice during
this program, and every case isunique. We urge you to consult
(26:09):
with your physician if you havea more serious or pressing
health concern. Until nexttime, be healthy and be well.
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