Cheryl Martin (Host): Do you have trouble sleeping and it's been a long time since you've gotten a good night's rest? You may be wondering if you have sleep apnea. Dr. Cynthia Crowder Hicks is here to tell us what it is, its symptoms, and more. She's a Pulmonologist and Sleep Medicine Specialist and Medical Director of Mobile Infirmary's Sleep Lab. This is Lifecast, a podcast from Infirmary Health. I'm Cheryl Martin. Dr. Crowder Hicks, delighted to have you on to discuss sleep medicine, and specifically sleep apnea.

Cynthia Crowder Hicks, MD: Hello, and thank you for having me. I'm very happy to be here.

Host: First of all, what is sleep apnea?

Cynthia Crowder Hicks, MD: Obstructive sleep apnea is a very common disease. And it is more common because of obesity. And what happens when we go to sleep is that our muscles tend to relax. And that can cause a collapse of the airway during sleep. In doing so, it minimizes our oxygen flow and that causes the body to have an extra level of stress.

And that can lead to consequences that affect not only just our sleep, but it can affect our brain, our heart, and our overall muscle function.

Host: So, how would a person know that they possibly have sleep apnea? Cover all the symptoms or the majority of the most popular symptoms.

Cynthia Crowder Hicks, MD: And most of the time, patients are unaware that they have sleep apnea. They often present because someone else complained about the symptoms. So typically, if we get complaints, they're of noises. So many times, patients come in because someone complained of them snoring. Someone complained that they have extra movements in sleep or that their sleep is extremely restless.

Patients tend to come in because they feel tired or sleepy during the day. They complain of extra symptoms of fatigue and they don't understand why. Ultimately, they can have a variety of symptoms as well, including morning headaches, awakening frequently during the night to use the restroom, and just overall not feeling rested despite sleeping for long periods of time. And those are the bigger complaints that you see.

Host: So, how is sleep apnea diagnosed?

Cynthia Crowder Hicks, MD: Sleep apnea is typically diagnosed in a sleep lab in which you come and do a sleep study. We have two ways in which we do it. One is in a sleep lab and the other one is with an unmonitored Portable Home Sleep Test. If we do an in-laboratory test, that means that you come to the hospital or to a facility in which you would spend a night.

Most of the time, it looks more like a hotel environment, and you will have a bed, a television, and your own personal space to kind of go around. We put wires and glue in the head, on the face, on the chin, we put belts around the chest and belly and wires on the leg and we monitor those rhythms. In, in-lab tests, we're monitoring your brainwave activity, we monitor your breathing rate, we monitor your chest rise and fall, as well as any limb movements that may occur during the night.

And that will tell us if, in fact, you stop breathing during the night. If we were to do a non-monitored test, you still have some of the same procedures, including oxygen levels, a chest belt so that we can monitor your chest rise and fall, as well as a cannula in the nostrils to determine if your flow is limited.

And with those particular tests, we don't monitor your brainwave activity. So it's a little bit more challenging to determine if you're awake versus asleep.

Host: So, why would one choose one over the other?

Cynthia Crowder Hicks, MD: If you don't have a lot of comorbidities and by that, I mean, if your medical history is pretty straightforward, maybe high blood pressure and obesity, but no other abnormalities that need to be monitored, a home test is a viable. option and it has limited belts and you must be able to follow directions and, be able to apply the equipment.

But what you'll find is that if you have a straightforward history, it can give us a good estimate of the severity of sleep apnea. It does underestimate it by about 20%, but if you have a good index of suspicion with either moderate to severe disease, we tend to get better results. If you have things such as heart failure, abnormal heart rhythms, recent strokes, or strokes with a deficit, we often choose an in-laboratory test because the type of respiratory events may be a little different in addition to the fact that we want to be able to monitor your heart rhythm during the entire test.

Host: And the laboratory test that you mentioned, is that what a sleep study would be like at the sleep lab at Mobile Infirmary?

Cynthia Crowder Hicks, MD: Yes, it is. Our room looks just like a hotel. I tell people you'll come in with a queen size bed, a flat screen TV, a table, a chair, and your own private bathroom, with a very nice setting. We don't feed you. That's the only thing that's a drawback. You put the wires on you and we watch you sleep and it's very comfortable.

It is different though. I tell everyone it is a test and so everybody has a level of discomfort and a little apprehension about a test itself, but we try to make the environment very relaxed so that we can get the best possible results.

Host: And a person is there, what, for 8 or 10 hours?

Cynthia Crowder Hicks, MD: Usually for about 10 hours. And we get you there a little bit early. So you get familiar with your environment and get comfortable with the technicians. It allows us the opportunity to put our wires and our leads in place so that you can also get settled in. We allow you to maintain your normal routine as much as possible in that if you read prior to bed or, you know, watch a little television and then we turn off all devices and then we just go to sleep.

Host: Now, who is more at risk for sleep apnea?

Cynthia Crowder Hicks, MD: Those who are at risk for sleep apnea are those who are considered obese. And they're considered this because that decreases the size of the airway.

So those with a thicker neck. Males are more at risk than females, but postmenopausal females are also at increased risk. Minorities carry a higher burden of sleep apnea as well, and we see the incidence of sleep apnea increasing mostly due to obesity. Those are the main people who are at risk of sleep apnea.

Host: So, is sleep apnea considered dangerous?

Cynthia Crowder Hicks, MD: Yes, it is. I like to tell everybody that it's never good to stop breathing. Okay, if we deprive our brain of oxygen, we call that a stroke. And if we deprive our heart of oxygen, we call that a heart attack. And it's ultimately an imperative that we have blood flow and oxygen flow 24 hours a day.

If we constantly interrupt our oxygen flow at night, we're slowly damaging these organs. And that's what leads to the long term damage. It is definitely a difficult thing. It's almost like you just constantly peel away layers of protection. We're supposed to get 7 to 8 hours of sleep per day. If we, during that 7 to 8 hours, are not breathing effectively, we're damaging our body over time.

Not only are we sleep deprived because we wake up frequently during the night, but we're also sleep deprived because our brain is not getting the rest that it needs. Our heart is working harder than it should and our body is also more active when it is having periods of stress. Our blood sugars are rising because of the stress and this is all the ingredients that lead to heart disease, heart blockages, and abnormal heart rhythms, and to strokes and dementia. And that's one of the bigger reasons why we want to treat sleep apnea sooner rather than later.

Host: So, once someone has gone through the sleep lab, what therapies, what treatments are available for sleep apnea?

Cynthia Crowder Hicks, MD: And treatment, number one should always include lifestyle changes. And that includes monitoring your diet, increasing your activity, and allowing for weight loss. Because that is the primary reason why we see sleep apnea. Other things that we can do is positional therapy. If, in fact, your sleep apnea is only observed when you're on your back, we can try methods of just sleeping on our side.

 A CPAP, or positive airway pressure, is probably one of the most common and the most reliable therapy. And it is a process by which we put a mask on at night and we push air through the nose or the nose and the mouth and it's designed to keep the airway from collapsing. It's like a pressure stent. If we can keep the airway open, sleep becomes more sound, more refreshing, and less stressful.

And ultimately that is what controls the sleep apnea. It decreases the amount of pressure that we have on the heart and all. For some, with mild sleep apnea, we have used devices such as an oral appliance, which actually keeps the tongue from sliding back at night. And they have new devices out called a hypoglossal stimulator, which is a it's called the Inspire, but it's a stimulator or a pacemaker for your tongue.

If your tongue relaxes and cuts off the airflow, if I can stimulate the tongue during the night, it allows for the airway to remain open as well. And these newer devices are a little bit more invasive, but they have been shown to be very effective for a certain set of people.

Host: That's great. Dr. Crowder Hicks, anything else you'd like to share about sleep apnea or sleep medicine?

Cynthia Crowder Hicks, MD: I always say this, that when you're dealing with your sleep, it encompasses a third of your life. That's where we spend a third of our day. And so we want our sleep to be the most refreshing. And I always tell people that they shouldn't skimp on that. We make it to work on time, we make it to all of our destinations when we should.

So we should try to focus on making it to bed on time, and maintaining a good sleep environment. And in doing so exercising daily, eating appropriately, all of those things not only help to control sleep apnea, but they help to create a better sleep process that will be beneficial down the line.

And those are the things that help to improve our life quality, as well as decreasing the risk of injury and death. So, treating sleep apnea is very important, and I don't want people to ignore the complaints of others. And if they tell you that you snore or that you stop breathing, take it seriously, because we don't want to be getting into trouble down the line with other diseases.

Most people who have been diagnosed with sleep apnea don't present until about 10 years after symptoms start. And so that's 10 years of damage that we can prevent. And those are the things that we want to treat sooner rather than later.

Host: A great final word. Dr. Cynthia Crowder Hicks, thanks for sharing your expertise on sleep apnea, and offering just some practical solutions. Thank you so much.

Cynthia Crowder Hicks, MD: Thank you very much for having me.

Host: As the first choice for health care for the Gulf Coast region, Infirmary Health is here for you. Here for life. Visit us at infirmaryhealth.org to find a physician near you. And if you found this podcast helpful, please share it on your social media. You can also check out the entire podcast library for other topics of interest to you. This is Life Cast, a podcast from Infirmary Health. Thanks for listening.