Maybe your partner has told you that your snore is deafening, or you've woken up on more than your fair share of mornings feeling less than refreshed.
In these instances, it may be a case that something is disrupting your normal night’s sleep.
Today, pulmonologist, Andrew Stiehm will talk with us about the signs and symptoms of sleep Apnea and how to get back to a better night sleep.
Selected Podcast
Awakening the Signs of Sleep Apnea
Featured Speaker:
Learn more about Dr. Andrew Stiehm
Andrew Stiehm, MD -Pulmonologist
Dr. Andrew Stiehm is a board-certified pulmonologist, specializing in sleep medicine, critical care and internal medicine. I have professional interests in insomnia, lungs and lung nodules, sleep apnea, obstructive sleep apnea, narcolepsy and COPD (chronic obstructive pulmonary disease).Learn more about Dr. Andrew Stiehm
Transcription:
Awakening the Signs of Sleep Apnea
Melanie Cole (Host): Maybe your partner has told you that your snore is deafening or you've woken up on more than your fair share of mornings feeling less than refreshed. In these instances, it may be a case that something is disrupting your normal night’s sleep. My guest today is Dr. Andrew Stiehm. He's board certified pulmonologist specializing in sleep medicine, critical care and internal medicine. Welcome to the show, Dr. Stiehm. Tell us, what is sleep apnea and how do you even know you've got it?
Dr. Andrew Stiehm (Guest): Sleep apnea means paused breathing when you sleep and that is most typically a disease that we call “obstructive sleep apnea.” Obstructive sleep apnea is fundamentally a disease of narrowing of the throat. Throats can be narrow for a variety of reasons. Some people are born with narrow throats and we do see obstructive sleep apnea, for instance, in babies with large tonsils. As we get older, there is also a tendency for our throats to get a little bit, for lack of a better word, mushier, and our throat can narrow because of that mushiness. For those of us who have a couple extra pounds, in addition to getting bigger on the outside, we actually getting narrower on the inside. Our tongues get bigger and our throat can enlarge from some extra fatty tissue and our throat can narrow because of that weight gain. What that narrowing adds up to, particularly when we sleep and our muscles are the most relaxed, is difficulty breathing and that is obstructive sleep apnea. It is most commonly diagnosed by a sleep study which is where we scientifically watch you breathe and sleep at the same time. More colloquially, it's diagnosed by the person you're laying next to who notes the snoring, the choking and the pause in your breathing.
Melanie: Dr. Stiehm, if you do have to go for a sleep study, does anybody actually get a night's sleep at those things? Do you actually fall asleep so that you all can record what's happening?
Dr. Stiehm: That's very typical. The warning I give patients is that it will take them about 10 minutes longer to fall asleep in a sleep lab than it will at home. But they should expect beyond that, a pretty typical night's sleep. Most of our patients will spend more than 80% of their time in bed asleep the night of a sleep study. So, I know that's a very common concern but it just doesn't materialize. For those that are very worried, we will frequently offer them a sleeping pill that they can bring with them on a “just in case” basis.
Melanie: If this disorder goes untreated are there complications?
Dr. Stiehm: It depends on the severity. Across all severities of obstructive sleep apnea, we worry about things like productivity at work and automobile accidents because you're just so sleepy that you're not as sharp as you should be. So, maybe you enter your thumb on a blade at work or you fall asleep on your commute in the morning. The more severe of the sleep apnea, it can then start contributing to cardiovascular diseases like high blood pressure, stroke and heart attack. People with severe sleep apnea do live shorter lives because of some of those cardiovascular consequences when they leave their disease untreated.
Melanie: We're learning more and more about the relationship between insomnia, sleep issues, sleep disorders, and all kinds of diseases. What treatments are out there for obstructive sleep apnea and do the ones like a CPAP, actually, are they being adhered to? Are they difficult to follow?
Dr. Stiehm: For obstructive sleep apnea, CPAP or Continuous Positive Airway Pressure, CPAP, is the most frequent therapy and what that is, is an air pressure splint. So, you use air pressure to hold your throat open while you sleep. It is the most effective therapy across all severities of obstructive sleep apnea but you hit the nail right on the head. The problem with CPAP therapy is that even in some of the most rigorous studies 20-30% of the people just can't tolerate CPAP therapy. It then becomes a very expensive bedside piece of equipment. For those people or people with milder forms of obstructive sleep apnea, the most typical plan B is an oral applied or what we call a “mandibular advancement device.” What this is, is a special mouth guard that either typically pulls your jaw forward but will occasionally pulling your tongue forward and it opens up your throat by actually moving the tissues mechanically. There are always lifestyle recommendations that we make. As an example, for every 1% change in your weight, we would expect to see about a 3% change in your sleep apnea. So, if you have enough weight to lose, you can cure your sleep apnea with weight loss. Things that will make your muscles flabbier like alcohol or sedative medication, we also tell people to avoid those because those can also result at worsening of your obstructive sleep apnea. Some people are treated with body positioning. When you sleep on your side or on your stomach, gravity will actually pull your jaw forward and we can use gravity to open up your throat. Then, of course, there is surgical therapy that we offer for obstructive sleep apnea. In children or infants, a tonsillectomy is very effective. Remove those big tonsils and big adenoids and the throat becomes a whole lot more open. There is also jaw surgery. The FDA just last year, approved a nerve stimulator that actually moves the tongue out of the way when you sleep by stimulating a nerve. So, there are surgical options for some people as well.
Melanie: Is there anything that you can do at night? You spoke about lifestyle changes, losing some weight and alcohol consumption. Are there any things that you can do at night to help prepare you for a better night's sleep that might reduce your risk of having those kinds of episodes in the night?
Dr. Stiehm: We've already eluded some of them. Body position is one of them. For some people, obstructive sleep apnea has much worse on their back than it is on their side. People have learned that. This is the wife smacking you in the ribs to get you to roll over so that you stop snoring. Some people will choose to sleep in a recliner and try to not sleep on their back in that way. Avoiding alcohol, particularly two hours before you go to bed, can be helpful. Avoiding nicotine and, in particular, smoking it in the hour or two before you go to bed. That smoke also swells the airways and helps keep your throat open. Any pain medications or medicines that might have the tendency to relax you, if you're able to, are things you should also avoid right before you go to bed, specifically for obstructive sleep apnea. Then, there's a list of other recommendations we make for the people that have difficulty falling asleep as well. I wasn't sure if you might want to explore some of those.
Melanie: Sure. Why not? Let's do it.
Dr. Stiehm: So, in general, the rule there is, if it's not broken, don't fix it. So, if you are able to fall asleep pretty quickly, then none of these rules apply to you. But it's about 1/3 of us that, at some point in our lives, are experiencing some degree of insomnia. For those people, there are a couple of simple rules that we recommend. The first is, only sleep and sex in bed. Those are really the only behaviors you should do in bed. You shouldn't read a book in bed; you should not watch TV in bed; you shouldn't engage in long conversation in bed. Again, this is if you have insomnia. If you have no trouble falling asleep, you don't need to abide by those rules. The other rule is, don't spend more than 20 minutes in bed without success. So, if you haven't fallen asleep in 20 minutes, get out of bed, somewhere else to relax. The bed is where you should come to succeed in sleeping not to struggle to sleep. The struggle should be somewhere else. So, those are some of the standard rules that we recommend for good, what we call “sleep hygiene.”
Melanie: That's great advice, Dr. Stiehm, really, for anybody. Sometimes if you suffer from sleep apnea or insomnia, it can cause issues in your relationships and prevent both people from getting a good night's sleep and thereby making everybody more moody the next day. What are some tips you give your patients?
Dr. Stiehm: Sleep apnea is often a disease of two people and you hit the nail on the head there once again. It's not only the person snoring but the person who is lying next to them, who has just as much sleep disruption if not more, from that snoring. You probably wouldn’t be surprised to know that a lot of my patients see me not because they're having concerns but because their loved one and their bed partner is the one with the concern. So, that would always be the first piece of advice I give you, is trust the person who is lying next to you. They actually have a more objective opinion of your sleep and sleep quality than perhaps you do. If they tell you you're a train with your snoring, if they tell you that you're choking and you're pausing breathing, you should trust that opinion. I know a lot of patients come to me and say they sleep just fine and that's actually the typical mentality of some people with sleep apnea. They fall asleep within two minutes. They feel like they sleep all night. They think that their sleep is great and that's actually not always a good thing. You should not fall asleep that quickly. That's a sign of you being too sleepy. So, you should trust the person next to you, that if they’re seeing a problem, you should perhaps consider seeing your doctor and getting evaluated.
Melanie: In just the last minute, Dr. Stiehm, and it really is just great information. Give your best advice on those who they love that might be suffering from sleep apnea and what they can do about it.
Dr. Stiehm: There are two pieces of advice I think that are the best. The first is what we just alluded to: trust the person who’s lying next to you. If they think you have a problem, there's never any harm in getting it checked out. The second piece of advice I would give you is that sleep medicine has come along way from where it was even just a decade ago and there are simpler therapies and there are simpler tests. A lot of people don't want to get their sleep apnea evaluated because they don't want to spend a night away from home. Well, we're doing about half of our sleep studies in your house and so, we can do the sleep study in your bed. That makes it a lot more comfortable and a lot easier for you. A lot of people also don't want to be evaluated because their fear of “the mask.” The CPAP therapy is something that they've already said they don't want to do in their minds and so they don't even want to commit to testing for fear of therapy. For them, I would say the therapy is not as bad as what you think it is but even if it's not for you--and that's common. Twenty to thirty percent of my patients can’t do CPAP. There is plan B, plan C and plan D and so there are things besides CPAP we can do for you. So, I wouldn't be afraid to just come in and have a conversation. I think it's informative as a quick 10 minutes. This can be one-on-one with the patient. I can be more informative.
Melanie: I'm sure you can. You're just very well spoken—an excellent doctor. Thank you so much. You're listening to The WELLcast with Allina Health. For more information, you can go to AllinaHealth.org. That's AllinaHealth.org. This is Melanie Cole. Thanks so much for listening.
Awakening the Signs of Sleep Apnea
Melanie Cole (Host): Maybe your partner has told you that your snore is deafening or you've woken up on more than your fair share of mornings feeling less than refreshed. In these instances, it may be a case that something is disrupting your normal night’s sleep. My guest today is Dr. Andrew Stiehm. He's board certified pulmonologist specializing in sleep medicine, critical care and internal medicine. Welcome to the show, Dr. Stiehm. Tell us, what is sleep apnea and how do you even know you've got it?
Dr. Andrew Stiehm (Guest): Sleep apnea means paused breathing when you sleep and that is most typically a disease that we call “obstructive sleep apnea.” Obstructive sleep apnea is fundamentally a disease of narrowing of the throat. Throats can be narrow for a variety of reasons. Some people are born with narrow throats and we do see obstructive sleep apnea, for instance, in babies with large tonsils. As we get older, there is also a tendency for our throats to get a little bit, for lack of a better word, mushier, and our throat can narrow because of that mushiness. For those of us who have a couple extra pounds, in addition to getting bigger on the outside, we actually getting narrower on the inside. Our tongues get bigger and our throat can enlarge from some extra fatty tissue and our throat can narrow because of that weight gain. What that narrowing adds up to, particularly when we sleep and our muscles are the most relaxed, is difficulty breathing and that is obstructive sleep apnea. It is most commonly diagnosed by a sleep study which is where we scientifically watch you breathe and sleep at the same time. More colloquially, it's diagnosed by the person you're laying next to who notes the snoring, the choking and the pause in your breathing.
Melanie: Dr. Stiehm, if you do have to go for a sleep study, does anybody actually get a night's sleep at those things? Do you actually fall asleep so that you all can record what's happening?
Dr. Stiehm: That's very typical. The warning I give patients is that it will take them about 10 minutes longer to fall asleep in a sleep lab than it will at home. But they should expect beyond that, a pretty typical night's sleep. Most of our patients will spend more than 80% of their time in bed asleep the night of a sleep study. So, I know that's a very common concern but it just doesn't materialize. For those that are very worried, we will frequently offer them a sleeping pill that they can bring with them on a “just in case” basis.
Melanie: If this disorder goes untreated are there complications?
Dr. Stiehm: It depends on the severity. Across all severities of obstructive sleep apnea, we worry about things like productivity at work and automobile accidents because you're just so sleepy that you're not as sharp as you should be. So, maybe you enter your thumb on a blade at work or you fall asleep on your commute in the morning. The more severe of the sleep apnea, it can then start contributing to cardiovascular diseases like high blood pressure, stroke and heart attack. People with severe sleep apnea do live shorter lives because of some of those cardiovascular consequences when they leave their disease untreated.
Melanie: We're learning more and more about the relationship between insomnia, sleep issues, sleep disorders, and all kinds of diseases. What treatments are out there for obstructive sleep apnea and do the ones like a CPAP, actually, are they being adhered to? Are they difficult to follow?
Dr. Stiehm: For obstructive sleep apnea, CPAP or Continuous Positive Airway Pressure, CPAP, is the most frequent therapy and what that is, is an air pressure splint. So, you use air pressure to hold your throat open while you sleep. It is the most effective therapy across all severities of obstructive sleep apnea but you hit the nail right on the head. The problem with CPAP therapy is that even in some of the most rigorous studies 20-30% of the people just can't tolerate CPAP therapy. It then becomes a very expensive bedside piece of equipment. For those people or people with milder forms of obstructive sleep apnea, the most typical plan B is an oral applied or what we call a “mandibular advancement device.” What this is, is a special mouth guard that either typically pulls your jaw forward but will occasionally pulling your tongue forward and it opens up your throat by actually moving the tissues mechanically. There are always lifestyle recommendations that we make. As an example, for every 1% change in your weight, we would expect to see about a 3% change in your sleep apnea. So, if you have enough weight to lose, you can cure your sleep apnea with weight loss. Things that will make your muscles flabbier like alcohol or sedative medication, we also tell people to avoid those because those can also result at worsening of your obstructive sleep apnea. Some people are treated with body positioning. When you sleep on your side or on your stomach, gravity will actually pull your jaw forward and we can use gravity to open up your throat. Then, of course, there is surgical therapy that we offer for obstructive sleep apnea. In children or infants, a tonsillectomy is very effective. Remove those big tonsils and big adenoids and the throat becomes a whole lot more open. There is also jaw surgery. The FDA just last year, approved a nerve stimulator that actually moves the tongue out of the way when you sleep by stimulating a nerve. So, there are surgical options for some people as well.
Melanie: Is there anything that you can do at night? You spoke about lifestyle changes, losing some weight and alcohol consumption. Are there any things that you can do at night to help prepare you for a better night's sleep that might reduce your risk of having those kinds of episodes in the night?
Dr. Stiehm: We've already eluded some of them. Body position is one of them. For some people, obstructive sleep apnea has much worse on their back than it is on their side. People have learned that. This is the wife smacking you in the ribs to get you to roll over so that you stop snoring. Some people will choose to sleep in a recliner and try to not sleep on their back in that way. Avoiding alcohol, particularly two hours before you go to bed, can be helpful. Avoiding nicotine and, in particular, smoking it in the hour or two before you go to bed. That smoke also swells the airways and helps keep your throat open. Any pain medications or medicines that might have the tendency to relax you, if you're able to, are things you should also avoid right before you go to bed, specifically for obstructive sleep apnea. Then, there's a list of other recommendations we make for the people that have difficulty falling asleep as well. I wasn't sure if you might want to explore some of those.
Melanie: Sure. Why not? Let's do it.
Dr. Stiehm: So, in general, the rule there is, if it's not broken, don't fix it. So, if you are able to fall asleep pretty quickly, then none of these rules apply to you. But it's about 1/3 of us that, at some point in our lives, are experiencing some degree of insomnia. For those people, there are a couple of simple rules that we recommend. The first is, only sleep and sex in bed. Those are really the only behaviors you should do in bed. You shouldn't read a book in bed; you should not watch TV in bed; you shouldn't engage in long conversation in bed. Again, this is if you have insomnia. If you have no trouble falling asleep, you don't need to abide by those rules. The other rule is, don't spend more than 20 minutes in bed without success. So, if you haven't fallen asleep in 20 minutes, get out of bed, somewhere else to relax. The bed is where you should come to succeed in sleeping not to struggle to sleep. The struggle should be somewhere else. So, those are some of the standard rules that we recommend for good, what we call “sleep hygiene.”
Melanie: That's great advice, Dr. Stiehm, really, for anybody. Sometimes if you suffer from sleep apnea or insomnia, it can cause issues in your relationships and prevent both people from getting a good night's sleep and thereby making everybody more moody the next day. What are some tips you give your patients?
Dr. Stiehm: Sleep apnea is often a disease of two people and you hit the nail on the head there once again. It's not only the person snoring but the person who is lying next to them, who has just as much sleep disruption if not more, from that snoring. You probably wouldn’t be surprised to know that a lot of my patients see me not because they're having concerns but because their loved one and their bed partner is the one with the concern. So, that would always be the first piece of advice I give you, is trust the person who is lying next to you. They actually have a more objective opinion of your sleep and sleep quality than perhaps you do. If they tell you you're a train with your snoring, if they tell you that you're choking and you're pausing breathing, you should trust that opinion. I know a lot of patients come to me and say they sleep just fine and that's actually the typical mentality of some people with sleep apnea. They fall asleep within two minutes. They feel like they sleep all night. They think that their sleep is great and that's actually not always a good thing. You should not fall asleep that quickly. That's a sign of you being too sleepy. So, you should trust the person next to you, that if they’re seeing a problem, you should perhaps consider seeing your doctor and getting evaluated.
Melanie: In just the last minute, Dr. Stiehm, and it really is just great information. Give your best advice on those who they love that might be suffering from sleep apnea and what they can do about it.
Dr. Stiehm: There are two pieces of advice I think that are the best. The first is what we just alluded to: trust the person who’s lying next to you. If they think you have a problem, there's never any harm in getting it checked out. The second piece of advice I would give you is that sleep medicine has come along way from where it was even just a decade ago and there are simpler therapies and there are simpler tests. A lot of people don't want to get their sleep apnea evaluated because they don't want to spend a night away from home. Well, we're doing about half of our sleep studies in your house and so, we can do the sleep study in your bed. That makes it a lot more comfortable and a lot easier for you. A lot of people also don't want to be evaluated because their fear of “the mask.” The CPAP therapy is something that they've already said they don't want to do in their minds and so they don't even want to commit to testing for fear of therapy. For them, I would say the therapy is not as bad as what you think it is but even if it's not for you--and that's common. Twenty to thirty percent of my patients can’t do CPAP. There is plan B, plan C and plan D and so there are things besides CPAP we can do for you. So, I wouldn't be afraid to just come in and have a conversation. I think it's informative as a quick 10 minutes. This can be one-on-one with the patient. I can be more informative.
Melanie: I'm sure you can. You're just very well spoken—an excellent doctor. Thank you so much. You're listening to The WELLcast with Allina Health. For more information, you can go to AllinaHealth.org. That's AllinaHealth.org. This is Melanie Cole. Thanks so much for listening.