Amanda Wilde (Host): OSA, obstructive sleep apnea
interrupts normal breathing during sleep, and if untreated, OSA can have
serious health implications. But a lot of people with OSA don't even know they
have it. So, we're talking about symptoms, causes, and treatment for OSA or
obstructive sleep apnea with Dr. Tyler Miller, a family medicine doctor with
Cumberland Healthcare.

Host: Welcome to Healthier You from Cumberland
Healthcare. I'm Amanda Wilde. Dr. Miller, wonderful to have you here today.

Tyler Miller, MD: Thank you for having me, Amanda.

Host: What causes OSA?

Tyler Miller, MD: So, OSA is usually caused due to soft
tissue in the back part of your mouth or in your neck that obstructs the airway
while you're sleeping, causing you interruptions in your breathing.

Host: And why does this happen?

Tyler Miller, MD: It can happen for a number of reasons.
The number one cause would be obesity or just having a large amount of soft
tissue, a large neck circumference. While you're sleeping, that soft tissue
becomes relaxed and then kind of collapses in on the airway, which obstructs
your normal breathing. When you're asleep, you're obviously subconsciously
breathing. And so to overcome that obstruction, you have to come out of a deep
stage of sleep or a partial wakening to voluntarily take a breath or overcome
it, and that's why it disrupts your sleep so much.

Host: What are the signs of OSA?

Tyler Miller, MD: So typically, for the patient
themselves that suffers with it, they're going to suffer with daytime
sleepiness, fatigue, oftentimes they may experience headaches in the morning. A
lot of people that are snorers or have obstructive sleep apnea will find that
their throat is sore in the morning. They may have a horse voice. They may
suffer with reflux symptoms in the morning, a bitter taste in their mouth, sore
scratchy throat. More commonly, it is usually the significant other or spouse
that just notices snoring, periods where they stop breathing, periods where
they may even sound like they're choking or gasping for air. And so oftentimes,
the patients will present after they're urged by their significant other to be
evaluated.

Host: Yeah, because a lot of these things occur during
sleep. But you're saying you can wake up with these aftereffects that also may
be a signal that you have a obstructive sleep apnea. When it is diagnosed, how
is OSA treated?

Tyler Miller, MD: There's a couple of different ways to
approach treating it, and it kind of depends on your age, underlying
conditions, and then your body habitus or just your body size. And so to go
about diagnosing it, really what we need to do is a formal sleep study. There's
a couple of different ways to approach that. So years ago, you'd have to go
into a sleep lab for the evening. They'd hook you up to some equipment that
monitors your breathing, your oxygen, your respirations, and they'd evaluate for
how many episodes of this apnea or stopping breathing you have, and then how
that affects your oxygen level.

With technology today, we actually have the advantage of being
able to do this at home in your normal sleep environment. And so, you are given
some equipment, you're educated, you're able to take it home with you, sleep
comfortably in your own bed. The equipment gathers the information we need to
make that diagnosis, and then you just simply drop it off. And so, that's been
a big change in the workup for obstructive sleep apnea that I think that a lot
of people aren't aware of quite yet. And sometimes it's that overnight sleep
study in the hospital that may make people hesitant to getting a formal
diagnosis.

After you're diagnosed, there's a couple different things you
can do. If you're younger, some people that have large tonsils or just extra
soft tissue in the throat, but they're not necessarily somebody who's
overweight, there may be surgical things that can be done by ear, nose and
throat physician that can help alleviate that obstruction. For other people,
weight loss can be a huge improvement in their overall quality of sleep.
Decrease the neck circumference, you have less soft tissue there and you can
resolve your sleep apnea.

The tried and true way to treat it is to do CPAP therapy, which
is essentially a machine that helps you breathe in the night and gives you a
little more pressure, a little more force to your breathing, and make sure that
that airway stays open and you don't have these interruptions in sleep.

Host: And is that still the gold standard?

Tyler Miller, MD: It would be still considered the gold
standard, yes. There is some newer technology kind of on the horizon right now,
that involves an implantable device that stimulates the tissue in the back part
of your throat and opens it up if you are snoring. It's called the Inspire
device. And like I said, it's kind of on the horizon. It's not commonly used
yet, but there are going to be other options in the future. But 100% the gold
standard is to start CPAP therapy.

I'll just add in there too that a lot of people are very
hesitant to have a sleep study or to consider using CPAP. I sometimes have to
twist people's arms to get it done. But I can tell you that once they're on
their CPAP therapy, they're the ones twisting my arm to make sure that their
machine's working properly, that they have all their supplies, because the
improvement in their quality of life is so dramatic that they won't go at night
without their sleep machine.

Host: And what do they see that lets them know that the
CPAP is working?

Tyler Miller, MD: Well, usually, it's energy levels,
immediate improvement in energy levels and less daytime sleepiness, 100%. But
people will also find that their blood pressure is much, much more well
controlled, and so they may require less medications. Obviously, their spouse
is happy that they're not snoring so much. And they may even experience a
little bit of weight loss as that improved energy level during the day often
leads to more activity, which can translate to weight loss. And then,
generally, if they do suffer with headaches, sore throat, reflux
symptomatology, those symptoms oftentimes improve as well.

Host: So, you've kind of come around to my next
question, which is, if those good things happen when OSA is treated, what
happens if OSA is untreated?

Tyler Miller, MD: Right. So, what some people don't
understand is those apneic episodes that you're having at night, it's not just
a disruption in your quality of sleep that makes you tired during the day; that
puts a lot of unnecessary stress on your body while you are sleeping. And
considering the amount of time we spend sleeping throughout our life, if you
are constantly have a low oxygen saturation in your body, that's extremely hard
on tissues and organs. It also causes elevated blood pressure, not only in your
body, but specifically in your lungs, which puts added demand on the heart. If
the lungs have high blood pressure within them, the heart has to work harder to
pump blood through the lungs, and that can over time, predispose somebody to
developing heart failure as well.

So if you have underlying chronic conditions, hypertension, any
heart disease, any type of respiratory or pulmonary disease, this is certainly
going to exacerbate those processes. And so, it can have significant effects in
the long term.

Host: Is there a cure or a cure around the corner for
OSA?

Tyler Miller, MD: So an absolute and total cure, no, not
necessarily. Now, there are predisposing factors that can be remedied, like I
said. Weight loss can really improve people's chances of having decreased
apneic episodes or their reliance on CPAP. And so, patients that lose a
significant amount of weight may see that these issues resolve. Like I said,
younger adolescents, adults that have extra tissue within the back of their
throat, surgery can help alleviate that and so, that can technically be a cure.
But there's other individuals that suffer with it regardless of those other
conditions that no, there's really not a cure. There's just a definitive
long-term treatment.

Host: So if you even suspect you have OSA, you should
talk to your physician because it can become a real issue in your daily living,
but also in the long term.

Tyler Miller, MD: Correct. If you have any suspicion
whatsoever, the easiest thing to do is to just have the conversation. There is
a very specific set of screening questions that we do. And then based off of
those screening questions and measurements of the circumference of your neck, you
certainly would qualify for a simple at-home sleep study. And that's just a one
night thing where you can certainly rule it out or rule it in. And then once
you have that information and either have ruled out the diagnosis or ruled it
in, then you can really start to talk about how and if you want to treat it.

Host: Well, you've made getting the diagnosis and
treatment really accessible and that's really important. So, I hope those
numbers of people that are undiagnosed go down and you're starting to see them
go down at this point.

Tyler Miller, MD: Absolutely. People are much more
excited and agreeable to have their sleep study performed when they learn that
it can be done at home. And I can completely understand that. I'd much rather
do it at home if I could in my own bed. I also promote it just because that's
your natural sleep environment. That's where you spend every night of your life
sleeping. So that would be the most appropriate environment to do the testing
in.

In addition to that, I'd also like to add that as technology
changes, the sleep apnea machines themselves have evolved too, so they are much
smaller, they are quieter. They auto-titrate, meaning they change their
settings based on your sleeping in real time at night. They humidify the air,
which makes it much more comfortable, and there's a number of different options
as far as face masks versus just a nose mask versus just little pillows that
sit in your nose to treat it. And so, the technology has progressed in a way
that it's much more comfortable to get CPAP therapy every night for yourself
and for your significant other.

Host: Yeah. Always good to have options and those
options are widening. Thanks so much, Dr. Miller, for a very useful and helpful
conversation about obstructive sleep apnea.

Tyler Miller, MD: Thank you for having me.

Host: That was Dr. Tyler Miller, Family Medicine doctor
with Cumberland Healthcare. For more information, visit
cumberlandhealthcare.com. If you found this podcast helpful, please share on
your social channels and check out our full podcast library for topics of
interest to you. This is Healthier You, a podcast from Cumberland Healthcare.
Thanks for listening and be well.