Sleep apnea is when a person cannot sleep and breathe properly at the same time.
Left untreated, sleep apnea can lead to high blood pressure, heart failure, heart attack or stroke.
The victim of sleep apnea is usually unaware of the problem, but the pauses in breathing are very alarming to the bed partner.
A pattern of snoring, interrupted by silence, then gasps are indications that breathing has stopped and then started again. In severe cases, this can occur hundreds of times a night.
Leigh Heithoff, sleep technologist with Bryan Health, is here to explain the symptoms and treatments of sleep apnea.
Selected Podcast
Sleep Apnea: Don't Ignore The Symptoms
Featured Speaker:
Learn more about Bryan Sleep Center
Leigh Heithoff, sleep technologist, Bryan Sleep Center
Leigh Heithoff is a sleep technologist with Bryan Health.Learn more about Bryan Sleep Center
Transcription:
Sleep Apnea: Don't Ignore The Symptoms
Melanie Cole (Host): Do you or someone you know have trouble sleeping at night or stay awake during the day? One in three Americans has a sleep disorder that makes sleeping and waking hours miserable. A good night’s sleep is as essential as exercise and proper nutrition. My guest today is Lee Heithoff. She is a sleep technologist with Bryan Health. Welcome to the show, Lee. Tell us a little bit about sleep disorders and what’s going on. Why are so many people – and we hear ads in the media – why are so many people suffering from sleep problems now?
Lee Heithoff (Guest): If you think about it, in your busy life what is the first thing that you are going to give up or sacrifice? Usually it’s sleep. It should be one of the last things that we give up. Sleep makes everything else in your body work better. When you are not sleeping well at night, it directly affects how you are feeling during the day and how your body functions, how it metabolizes food, how fast you are going to run on your jog this afternoon. It affects all of those. When you don’t sleep well at night, you don’t feel very good during the day. Sometimes, people have a hard time relating those two. They come to us and they say, “I sleep just fine.” But, the sleep they’re getting isn’t very good. Then, they don’t feel well during the day. Eventually, they get to us and when we can get a sleep disorder straightened out, then they start feeling a lot better during the day.
Melanie: How do you do that? If someone comes to you, first of all what are the red flags? We all have bad night’s sleep.
Lee: Sure.
Melanie: We all suffer from a little insomnia, but what would signal, “Oh, you’ve got an issue, go see somebody.”
Lee: If you’re sleeping enough during the night – say you’re getting your seven to nine hours of sleep and you’re still feeling awful during the day. You’re not able to function. You’re noticing how it’s affecting your performance, then it’s maybe time to start talking to your family doctor. I want you to talk to your family doctor first because we want to make sure everything else is accounted for. Sometimes like a low thyroid, sometimes depression, sometimes medications all mimic sleep disorder symptoms. We want to get those ruled out before you get to us. When you get to us, the first thing we look at is sleep apnea. That’s where the airway closes during the night. The chief symptom of sleep apnea is snoring. What happens with snoring is, as the airway starts to close – when you start to relax as you fall asleep the airway closes – eventually, it gets small enough that the air you’re needing to get down into your lungs is more than can fit through that tiny little space. When that gets tiny enough, that air that is trying to get into the lungs? There is resistance against it. Resistance makes those tissues vibrate and that’s what snoring is. Sometimes it just stays at snoring but what happens with sleep apnea, then, is that the airway completely closes. I still see people trying to breathe but there is no air coming in and out of the nose and the mouth because we have an obstruction. We have a blockage. Now, eventually the brain is going to choice to breathe rather than to sleep so we might hear a snort, choke or gasp during the night. They wake up and get that airway flowing again and as they fall asleep, it starts to happen all over again. Sometimes people are aware of it and sometimes they are not.
Melanie: Sometimes, it would be their spouse or the person that they’re with that becomes aware of this, yes?
Lee: Typically, the bed partner is a very good source of information. Oftentimes, after hunting season when people go with their buddies and they share a hotel room and then they tell them, “Bud, you need to get your snoring checked out. I couldn’t sleep all night long.” It is usually somebody else is what is nudging them to get it checked out.
Melanie: How do you find out if you have sleep apnea? Tell us about sleep studies. What is involved in those?
Lee: Once you get referred into here, you’re going to see a sleep doctor. The sleep doctor is going to do a sleep history and physical. We are really going to look at the fine details of your sleep. Once they do that, they decide what sleep disorder are we looking for and what is the appropriate testing. For the typical sleep apnea case, we’re looking for the snoring. We’re looking witness apnea. We’re looking for do you wake up choking and gasping. Sometimes, insomnia accompanies those issues. When they come in for a sleep study, typically now a lot of the insurances are requiring that we do a home sleep test first. A home sleep test is where you’ll come in during the day for maybe a 20 or 30 minute appointment where we teach you how to put this equipment on. Then, you are going to take it home that night, put it all on, start it, go to bed and then the next day you’re going to bring it back to us and we’re going to download it and see if we’ve got clear and clean-cut apnea. If we don’t, that doesn’t mean you’re off the hook but that means we need to go through further testing. If somebody has some co-morbid conditions, maybe like a neuromuscular disease or central sleep apnea – that’s where the airways open but there’s no drive to breath – then we’ll bring you into the sleep center for a sleep study. We’ve got a great crew. All of the sleep technologists are very good at making people feel comfortable. They understand the anxiety of hooking somebody up, putting all of this equipment on them. It doesn’t hurt. There is no pain. It’s just that everything just rests right on the skin and over the jammies. We monitor during the night. We’re going to monitor a lot more information than that home sleep test did and see if we can figure out what’s going on during the night.
Melanie: Can people actually get a decent night sleep in a sleep study? I’ve always wondered that with the lights and the monitors and knowing somebody is keeping an eye on them.
Lee: We don’t expect you to sleep as well as you normally do. That’s called the “first night effect”. You know when you go spend the night in a hotel you don’t sleep as well as you usually do. That happens here in the sleep center. Now we’re putting equipment on you and you’re kind of being forced to sleep. We make it as relaxing an experience as possible and just reassure people, you are going to sleep. It doesn’t happen very often that somebody doesn’t. It does happen, but not very often. The sleep that you get is going to tell us then what is going on.
Melanie: That is really interesting to note. Then, what do you do if you determine someone has apnea or insomnia – mostly apnea? What are the treatments available? We hear about so many in the media.
Lee: The tried and true treatment for sleep apnea is nasal C-Pap or nasal continuous positive air pressure. It’s going to be a little appliance that is going to fit over your nose or kind of up in your nose. We have a ton of choices now as to the type of appliance that somebody will use. Then, that is connected to a hose that goes to the C-Pap machine that sits beside the bed. That C-Pap machine starts moving air pressure back up through that hose, then it goes through that appliance, then up your nose - kind of up your airway. We are going to kind of splint or blow your airway open with air pressure. It is a very simple solution to a very complicated problem. It’s non-invasive. It doesn’t hurt and its affects are immediate. So, that is the tried and true treatment for sleep apnea.
Melanie: Is there a problem, Lee, with adherence to a C-Pap?
Lee: There is and I tell people, “Everybody has their own time table as to how they are going to adjust to C-Pap”. Some people can wear it from the first night. Some people, it may take them a few nights to get used to it. I tell people, “You just make your own path. I at least want you to put it on every night and slowly work up the time that you’re on it.” Typically, we have pretty good compliance rates. I think we are in probably the 80-85% that people are able to utilize and get used to wearing their C-Pap.
Melanie: Do all of the medications that are on the market – from Ambien to all of these other sleep medications – do they help or hurt apnea?
Lee: Ambien has actually been shown scientifically not to alter your sleep architecture or how your sleep lays out during the night. It doesn’t interfere with sleep stages. So, Ambien is usually very safe and effective. You’ve just got to make sure you have the right dose because Ambien has gotten kind of a bad rap in the last few years where people are sleep eating or sleep driving. Typically, that’s when somebody is taking too much, a higher dose than what they need or they’ve paired it with alcohol and then you get bad results with that. When it’s taken in its proper dose, it is usually very effective and very safe.
Melanie: Give us a little bit of your best advice about sleep hygiene and what you want people to do to get their best night’s sleep.
Lee: Sleep hygiene is our rules for better sleep. What can we do? What behaviors can we follow to make sure that we get the best night of sleep that we can. The biggest thing is to maintain a consistent wake up time. If you’re not able to fall asleep or you have bits of insomnia during the night, still getting up at that same time helps reset that body clock to know that okay it’s daytime, it’s time to get up. You might struggle a little bit the next day. I want you to be careful while you’re driving and try to avoid napping. That will help you then get to bed your appropriate time the next day. If you’re lying in bed more than 15 or 20 minutes and you’re still wide awake with racing thoughts, I want you to get up and get out of bed. Go do something quiet--non-stimulating. I don’t want you in front of a phone or computer because that light signals to our brain that it is time to be awake. Do that until you fall asleep and then you go back into your bed. We want the bed and the body to associate those two things that this is the place that welcomes sleep, not a place where you struggle to sleep. That’s why I want you to get up and get out of bed. I want you to be careful with your caffeine intake. Usually, typically, we say no caffeine within 8 hours of bedtime. Caffeine is a stimulant. It’s what I call a “sleep robber.” It will affect your sleep even though you may be able to get to sleep, the sleep you get is not going to be a very good sleep. Those are the main rules for better sleep.
Melanie: In just the last few minutes, please tell us about some of the resources Bryan Health offers for people with sleep disorders.
Lee: You can always call into the sleep center and talk to a sleep technologist if you’re having some questions or wanting to know how I get started, what are some things that I’m looking for? The main resource that I want you to use, though, is your family or primary care physician. Let’s make sure that some of those things that might imitate a sleep disorder are taken care of. Then, you get into the sleep center and we’re going to take very good care of you, make sure that we are doing the appropriate testing, doing the right test for the right reason. We have a website through the Bryan main website that you can get in. The National Sleep Foundation is also a good website for some general information on sleep. Every once in a while, we offer talks where we’ll give a talk on sleep and how important sleep is and sometimes on sleep disorders, also.
Melanie: Thank you so much, Lee. It is great information. So beautifully put, besides. For more information about sleep apnea and the Sleep Aware Screening go to BryanHealth.org. That’s BryanHealth.org. You’re listening to Bryan Health Radio. This is Melanie Cole. Thanks so much for listening.
Sleep Apnea: Don't Ignore The Symptoms
Melanie Cole (Host): Do you or someone you know have trouble sleeping at night or stay awake during the day? One in three Americans has a sleep disorder that makes sleeping and waking hours miserable. A good night’s sleep is as essential as exercise and proper nutrition. My guest today is Lee Heithoff. She is a sleep technologist with Bryan Health. Welcome to the show, Lee. Tell us a little bit about sleep disorders and what’s going on. Why are so many people – and we hear ads in the media – why are so many people suffering from sleep problems now?
Lee Heithoff (Guest): If you think about it, in your busy life what is the first thing that you are going to give up or sacrifice? Usually it’s sleep. It should be one of the last things that we give up. Sleep makes everything else in your body work better. When you are not sleeping well at night, it directly affects how you are feeling during the day and how your body functions, how it metabolizes food, how fast you are going to run on your jog this afternoon. It affects all of those. When you don’t sleep well at night, you don’t feel very good during the day. Sometimes, people have a hard time relating those two. They come to us and they say, “I sleep just fine.” But, the sleep they’re getting isn’t very good. Then, they don’t feel well during the day. Eventually, they get to us and when we can get a sleep disorder straightened out, then they start feeling a lot better during the day.
Melanie: How do you do that? If someone comes to you, first of all what are the red flags? We all have bad night’s sleep.
Lee: Sure.
Melanie: We all suffer from a little insomnia, but what would signal, “Oh, you’ve got an issue, go see somebody.”
Lee: If you’re sleeping enough during the night – say you’re getting your seven to nine hours of sleep and you’re still feeling awful during the day. You’re not able to function. You’re noticing how it’s affecting your performance, then it’s maybe time to start talking to your family doctor. I want you to talk to your family doctor first because we want to make sure everything else is accounted for. Sometimes like a low thyroid, sometimes depression, sometimes medications all mimic sleep disorder symptoms. We want to get those ruled out before you get to us. When you get to us, the first thing we look at is sleep apnea. That’s where the airway closes during the night. The chief symptom of sleep apnea is snoring. What happens with snoring is, as the airway starts to close – when you start to relax as you fall asleep the airway closes – eventually, it gets small enough that the air you’re needing to get down into your lungs is more than can fit through that tiny little space. When that gets tiny enough, that air that is trying to get into the lungs? There is resistance against it. Resistance makes those tissues vibrate and that’s what snoring is. Sometimes it just stays at snoring but what happens with sleep apnea, then, is that the airway completely closes. I still see people trying to breathe but there is no air coming in and out of the nose and the mouth because we have an obstruction. We have a blockage. Now, eventually the brain is going to choice to breathe rather than to sleep so we might hear a snort, choke or gasp during the night. They wake up and get that airway flowing again and as they fall asleep, it starts to happen all over again. Sometimes people are aware of it and sometimes they are not.
Melanie: Sometimes, it would be their spouse or the person that they’re with that becomes aware of this, yes?
Lee: Typically, the bed partner is a very good source of information. Oftentimes, after hunting season when people go with their buddies and they share a hotel room and then they tell them, “Bud, you need to get your snoring checked out. I couldn’t sleep all night long.” It is usually somebody else is what is nudging them to get it checked out.
Melanie: How do you find out if you have sleep apnea? Tell us about sleep studies. What is involved in those?
Lee: Once you get referred into here, you’re going to see a sleep doctor. The sleep doctor is going to do a sleep history and physical. We are really going to look at the fine details of your sleep. Once they do that, they decide what sleep disorder are we looking for and what is the appropriate testing. For the typical sleep apnea case, we’re looking for the snoring. We’re looking witness apnea. We’re looking for do you wake up choking and gasping. Sometimes, insomnia accompanies those issues. When they come in for a sleep study, typically now a lot of the insurances are requiring that we do a home sleep test first. A home sleep test is where you’ll come in during the day for maybe a 20 or 30 minute appointment where we teach you how to put this equipment on. Then, you are going to take it home that night, put it all on, start it, go to bed and then the next day you’re going to bring it back to us and we’re going to download it and see if we’ve got clear and clean-cut apnea. If we don’t, that doesn’t mean you’re off the hook but that means we need to go through further testing. If somebody has some co-morbid conditions, maybe like a neuromuscular disease or central sleep apnea – that’s where the airways open but there’s no drive to breath – then we’ll bring you into the sleep center for a sleep study. We’ve got a great crew. All of the sleep technologists are very good at making people feel comfortable. They understand the anxiety of hooking somebody up, putting all of this equipment on them. It doesn’t hurt. There is no pain. It’s just that everything just rests right on the skin and over the jammies. We monitor during the night. We’re going to monitor a lot more information than that home sleep test did and see if we can figure out what’s going on during the night.
Melanie: Can people actually get a decent night sleep in a sleep study? I’ve always wondered that with the lights and the monitors and knowing somebody is keeping an eye on them.
Lee: We don’t expect you to sleep as well as you normally do. That’s called the “first night effect”. You know when you go spend the night in a hotel you don’t sleep as well as you usually do. That happens here in the sleep center. Now we’re putting equipment on you and you’re kind of being forced to sleep. We make it as relaxing an experience as possible and just reassure people, you are going to sleep. It doesn’t happen very often that somebody doesn’t. It does happen, but not very often. The sleep that you get is going to tell us then what is going on.
Melanie: That is really interesting to note. Then, what do you do if you determine someone has apnea or insomnia – mostly apnea? What are the treatments available? We hear about so many in the media.
Lee: The tried and true treatment for sleep apnea is nasal C-Pap or nasal continuous positive air pressure. It’s going to be a little appliance that is going to fit over your nose or kind of up in your nose. We have a ton of choices now as to the type of appliance that somebody will use. Then, that is connected to a hose that goes to the C-Pap machine that sits beside the bed. That C-Pap machine starts moving air pressure back up through that hose, then it goes through that appliance, then up your nose - kind of up your airway. We are going to kind of splint or blow your airway open with air pressure. It is a very simple solution to a very complicated problem. It’s non-invasive. It doesn’t hurt and its affects are immediate. So, that is the tried and true treatment for sleep apnea.
Melanie: Is there a problem, Lee, with adherence to a C-Pap?
Lee: There is and I tell people, “Everybody has their own time table as to how they are going to adjust to C-Pap”. Some people can wear it from the first night. Some people, it may take them a few nights to get used to it. I tell people, “You just make your own path. I at least want you to put it on every night and slowly work up the time that you’re on it.” Typically, we have pretty good compliance rates. I think we are in probably the 80-85% that people are able to utilize and get used to wearing their C-Pap.
Melanie: Do all of the medications that are on the market – from Ambien to all of these other sleep medications – do they help or hurt apnea?
Lee: Ambien has actually been shown scientifically not to alter your sleep architecture or how your sleep lays out during the night. It doesn’t interfere with sleep stages. So, Ambien is usually very safe and effective. You’ve just got to make sure you have the right dose because Ambien has gotten kind of a bad rap in the last few years where people are sleep eating or sleep driving. Typically, that’s when somebody is taking too much, a higher dose than what they need or they’ve paired it with alcohol and then you get bad results with that. When it’s taken in its proper dose, it is usually very effective and very safe.
Melanie: Give us a little bit of your best advice about sleep hygiene and what you want people to do to get their best night’s sleep.
Lee: Sleep hygiene is our rules for better sleep. What can we do? What behaviors can we follow to make sure that we get the best night of sleep that we can. The biggest thing is to maintain a consistent wake up time. If you’re not able to fall asleep or you have bits of insomnia during the night, still getting up at that same time helps reset that body clock to know that okay it’s daytime, it’s time to get up. You might struggle a little bit the next day. I want you to be careful while you’re driving and try to avoid napping. That will help you then get to bed your appropriate time the next day. If you’re lying in bed more than 15 or 20 minutes and you’re still wide awake with racing thoughts, I want you to get up and get out of bed. Go do something quiet--non-stimulating. I don’t want you in front of a phone or computer because that light signals to our brain that it is time to be awake. Do that until you fall asleep and then you go back into your bed. We want the bed and the body to associate those two things that this is the place that welcomes sleep, not a place where you struggle to sleep. That’s why I want you to get up and get out of bed. I want you to be careful with your caffeine intake. Usually, typically, we say no caffeine within 8 hours of bedtime. Caffeine is a stimulant. It’s what I call a “sleep robber.” It will affect your sleep even though you may be able to get to sleep, the sleep you get is not going to be a very good sleep. Those are the main rules for better sleep.
Melanie: In just the last few minutes, please tell us about some of the resources Bryan Health offers for people with sleep disorders.
Lee: You can always call into the sleep center and talk to a sleep technologist if you’re having some questions or wanting to know how I get started, what are some things that I’m looking for? The main resource that I want you to use, though, is your family or primary care physician. Let’s make sure that some of those things that might imitate a sleep disorder are taken care of. Then, you get into the sleep center and we’re going to take very good care of you, make sure that we are doing the appropriate testing, doing the right test for the right reason. We have a website through the Bryan main website that you can get in. The National Sleep Foundation is also a good website for some general information on sleep. Every once in a while, we offer talks where we’ll give a talk on sleep and how important sleep is and sometimes on sleep disorders, also.
Melanie: Thank you so much, Lee. It is great information. So beautifully put, besides. For more information about sleep apnea and the Sleep Aware Screening go to BryanHealth.org. That’s BryanHealth.org. You’re listening to Bryan Health Radio. This is Melanie Cole. Thanks so much for listening.