Transcription:
Pregnancy and Sleep Apnea

Carl Maronich (Host): And we are joined by Kathleen Gallagher. Kathleen is the Manager of the Riverside Sleep Disorder Institute. Kathleen, welcome to the podcast.

Kathleen Gallagher (Guest): Thank you. Thanks for having me Carl.

Carl: You are very welcome. And this is sleep month.

Kathleen: It is.

Carl: March is sleep month and so we thought it was a good time to talk to you about I was going to say everybody’s favorite thing. I don’t know if it’s everybody’s favorite thing, it’s one of my top three at least, food is up there too, but sleep. People – it’s fun to sleep, sleep well, but not just fun, it’s important to get good sleep. And those are the things we are going to focus on. Why it’s so important and all those kinds of things, but let’s start with that basic question. Why is sleep so important?

Kathleen: Well the jury is still out as to why we officially sleep, we know we need it. It’s as important as eating, drinking and breathing. There are some studies that show that it has to do with our tissue regeneration, cell regrowth, definitely a lot of human growth hormone in the younger generations, so we worry about them getting adequate sleep and getting enough of that. There are some studies that are showing that we actually can retain some things that are taught to us during certain stages of sleep where we can retain – they say that you can learn while you are sleeping.

Carl: Yeah, so when I fell asleep in class, that wasn’t such a bad thing. I could have been learning while I was sleeping. Good to know. Good to know. So, obviously, for a lot of different reasons, sleep is important to our health. I know one thing that I have heard is that it helps in weight loss if you – if you are not getting good sleep, that can affect your weight which can affect a lot of other things.

Kathleen: Certainly. Definitely. If you are not getting good sleep, certainly it can contribute to weight gain. A lot of that actually gets wrapped up into when we talk about obstructive sleep apnea and children and younger generations, we have issues with their sleep too and waking. A lot of prevalence of diabetes in younger generation and lending itself to weight gain especially with what’s out there for kids to eat these days, parents on the run.

Carl: Yeah, well let’s talk a little about age and how it relates to sleep. And what kind of sleep is required for people of different ages.

Kathleen: Well, you know little babies, they start out with the most amount of sleep because they pretty much just get up to eat and go back to bed.

Carl: Yeah, sounds like a nice life.

Kathleen: It is a nice life. So, up until about a few months of age, they are sleeping about 18 hours a day. We worry about our children age groups especially when they are going to school getting adequate sleep so when we are about 3-5 years, we are looking at 11-13 hours of sleep. We are hoping they are taking naps as well as getting a good night’s sleep. As we get into our adolescent years, especially those teenagers, we really want them to get a good eight and a half to nine and a half hours of sleep. There have studies that show that there is delayed sleep phase in teenagers, so they are trying to push for schools to start later in the morning so that kids can get adequate sleep because they are the hardest o get up in the morning. And then as adults, we’d to get seven to nine hours of sleep and I can tell you there’s probably many people out there who are not fitting that bill at all.

Carl: Yeah, for a lot of different reasons. And we can talk about some of that but back to kids. You mentioned all of the different numbers at kind of the different stages; it seems nowadays, that there are challenges because of the electronics that kids and that it’s not so easy to say just go to bed and kids just to bed. It was never that easy probably, I know when my kids were little it was always a struggle before all the technology even. But trouble has to be compounded I would guess these days and I’m sure you’re seeing that in the institute.

Kathleen: Oh, certainly. Heck, we’ve had kids come for sleep studies with all their electronics and thinking they can stay up on them all night long and you really need the parents to kind of set limits. I remember I used to take my kids’ phone away before they went to bed so they weren’t on them. There is a lot of technology and a lot of kids have their own TVs in their rooms, so games to play, so it doesn’t lend itself for kids to get good sleep at all.

Carl: Yeah, you are not clearing the mind for a good healthy sleep especially with all that going on.

Kathleen: Exactly.

Carl: And so, let’s talk about you mentioned the sleep study. So, kids are candidates for sleep studies?

Kathleen: Sure, they are. We are developing our sleep program for children, so as soon as we get that up and running, we are going to be doing another one of these podcasts Carl, so we can talk a little bit more about that. But, definitely kids are good candidates for it especially when they are younger. Sometimes there are large adenoids or tonsils that play a role in why they are not getting good sleep. Sometimes they come in and it’s really just about limit setting and we will see that clearly, it’s an issue with them not getting adequate sleep because they are up playing games and on their videos.

Carl: Right, so it might not be a physical issue, it’s more of behavioral kind of thing.

Kathleen: It is and then we also see kids another thing that’s pretty prevalent are kids that will say that their muscles hurt, my legs hurt, and a lot of parents say it’s okay its growing pains. But really, there are – they come in and they have a sleep study and you can see their legs are moving during the night and sometimes those leg movements cause their brain to have arousals throughout the night and of course it would lend themselves to be sleepy.

Carl: Yeah so, once you are aware of those things, they can be addressed as they need to.

Kathleen: Right.

Carl: So, as we age, we have been talking about kids, but now adults. A lot of reasons again, the technology, a lot of adults probably are guilty of those same kinds of things from back in the day when it was cool to have a TV in your bedroom when that first started to all the different technology that is there now, but the same thing applies even from kids. You have to have a good sleep environment I would guess to get quality sleep.

Kathleen: Definitely good sleep environment to get quality sleep. Ideally, they say you shouldn’t even have a TV in your bedroom. Your bedroom should just be for sleep and sex, honestly, that’s what they say so.

Carl: That could be another podcast, so we will just keep talking about sleep.

Kathleen: We will just stick to nice calm, quiet room, hopefully it is dark because if you are sleeping in a room that has quite a bit of daylight coming through, you are not going to have real good restorative sleep as you would if it was dark. So, you would like a nice cool environment.

Carl: So, you have that, but you still go through the day and you are tired. You are just not, you feel like you are tired, you are not and a lot of that comes from or traced back to a lack of sleep. If somebody is feeling that, is going to their primary care doctor kind of the first thing they should do, is that how they’ll eventually end up getting a sleep study if they need it?

Kathleen: Yes, they need to have a conversation with their physician about how they are sleeping. I would say most of our physicians have been really great about asking patients about their quality of sleep. There is sleepiness scales and questionnaires our there that we can ask our patients to see how they are doing. It’s very rare that people are getting like I said a good eight and a half hours of sleep at night. So, they could be sleepy just because A they are not getting enough sleep or what’s going on with them while they are sleeping.

Carl: Yeah. And one of the big culprits of robbing you of good sleep is sleep apnea. Talk a little bit about exactly what that is.

Kathleen: Sleep apnea is the recurring of your upper airway closing at night. Generally, it is your tongue that falls back and gets in the way of your airflow, so, when I talk to my patients, I’ll ask which sleep position they are sleeping in. If they are sleeping on their back, that is generally the worst place to sleep for that to happen because gravity on the airway will pull your tongue back. You are better off sleeping on your side or your belly for that reason. But what apnea does over time is it causes the heart to work faster because there is decrease in oxygenation throughout your blood. So, when I do tests on patients, one of the things we are watching is how they are breathing and their oxygenation in their blood, their EKG so we can have a good idea what’s going on with them when they are sleeping.

Carl: Yeah, what’s the relation to apnea and snoring?

Kathleen: Well snoring is an upper airway resistance as well so when you look at the airway if your airway was a clear open pass, that’s just your normal open airway. As it starts to get a little narrowing you can have snoring and then as it progresses you can have decreased breathing which we call hypopnea. We always talk about apnea a as general term where we actually stop breathing but there is something called under-breathing which are hypopneas that we see quite frequently as well so we hear patients come in always say my wife says she hears me stop breathing. I say wife, because it is usually the men who get apnea before the women do. And then hypopnea is a little bit harder to detect because it’s just a decrease in flow. But either one hypopneas or apneas will cause usually a decrease in oxygenation that we will see on the pulse oximeter that the patient is wearing at night.

Carl: So, does that then translate to a poor quality of sleep?

Kathleen: Yes.

Carl: And a less restful sleep?

Kathleen: Yes. Because every time you are having usually an apnea or a hypopnea it’s your arousals in your brain activity that we see at the end of that event.

Carl: Okay. So, that’s preventing quality sleep which is going to result in being more tired during the day and all that. Now let me ask, if somebody is a loud snorer, does that directly indicate that they have got either apnea or the other one that you said?

Kathleen: Hypopneas? Not necessarily. You could just be a loud snorer and you might not have apnea at all. However, the loud snorer could be preventing their bed partner if they have one, from getting good sleep as well.

Carl: Yeah. That’s the diplomatic term bed partner.

Kathleen: Yes, exactly. Heck other people in the house too. If your kids can be sleeping down the hall can be complaining about their

Carl: And you mentioned most often in men but not only women snore too and there are those issues with women.

Kathleen: Yes, they do. We always laugh. It’s not ladylike for women to snore. But as women age, definitely when they hit menopause, all bets are off, women are the same playing field as men because those hormones of estrogen and progesterone actually protect the muscle tone of the upper airway. So, once they are gone, lends itself to more snoring and apnea.

Carl: It could be trouble. I see. If you have apnea, what are the – how do they treat it? How do you treat it? How is it treated?

Kathleen: How is it treated? It’s treated – the gold standard would be with a CPAP machine. CPAP machines have come a long way. They used to be probably a loud and cumbersome back in the day. But now they are these quiet little machines. It works much like a fan, takes room air at a pressure and as you inhale, it helps to distend that airway open. Lots of different masks out there. I know people think of CPAP and they think of some Darth Vader mask they have to wear, but it’s really not like that. Patients pretty much choose what feels most comfortable for them during the night and it could be a little nasal pillow mask and if they are more comfortable wearing a full faced mask, that’s great. And then the pressure gets adjusted throughout the night to eliminate any apneas from happening.

Carl: Oh, so they work with their – and is this their primary care provider that they see about that or is there somebody else that they see?

Kathleen: So, they would actually, when they first complain about their sleep issues, they would go talk to their doctor, get a referral for them to have a sleep study done. Based on what happens the first night of their study, either we can do it all in one night if they are significant enough for having apnea, we can treat it the same night. If not, they come back for a second part which is the treatment part where they would be wearing a CPAP.

Carl: I see. Like get fitted for that and all.

Kathleen: Yes.

Carl: And all the instruction. And once you are wearing a CPAP, does that – will you be wearing that forever? Or is this something that goes away at some point? The apnea?

Kathleen: Good question. If somebody – sometimes it’s driven by weight, sometimes if you lose weight, you can not wear CPAP, sometimes it’s positional, so if you decide you know what, maybe this isn’t for me, and I don’t have this issue on my side, like I do on my back; there are positional devices that you can wear to keep you from getting on your back. I had a patient one time I swear his wife fitted two concrete blocks that he slept between just, so he would not sleep on his back. Heh, whatever works.

Carl: Sounds extreme.

Kathleen: It does. Sometimes it’s the anatomy of your upper airway. It could be maybe you need to have your tonsils removed. Maybe you need to have your adenoids removed to open up that airway some more to help you sleep better.

Carl: Yeah, you mentioned menopause and that affecting. What about pregnancy and women? Is that – is there sleep related issues to pregnancy?

Kathleen: Yes, there are. So, there’s increased blood volume throughout the mom when she’s pregnant. That increased blood volume can actually cause upper airway resistance as there is more swelling and edema in the upper airway, so moms tend to snore a little bit more than they had if they weren’t. some are already snorers to begin with and then pile on extra weight from being pregnant and also possibly lends itself to having apnea on top of that snoring. So, there are studies that are showing that if there is some snoring or apnea during pregnancy, it might be something to take a little closer look at. There are some adverse outcomes that they have noticed if it doesn’t get treated. Possible gestational hypertension, diabetes, low birth weight or C-section, some of that stuff can be averted if some of this is treated during the pregnancy.

Carl: So, if a pregnant woman is not feeling well-rested and probably a lot of pregnant women don’t feel well-rested, but maybe something they want to speak to their doctor about is a sleep study right for them.

Kathleen: Right and that pregnant population is not something that we currently see in the sleep center. We have had over 100 years’ experience among my techs and myself and maybe we have seen just a couple of pregnant people because you are right, when there is higher progesterone within a pregnant mom, she is more sleepy, so they just kind of attribute it to you’re tired, but really you need to be taking a different look at our pregnant population and see if there’s some other way or something that needs to be done to help.

Carl: Yeah. Good advice there. I didn’t start with what I usually do and that’s ask how you got into this kind of work? How did you get into sleep work?

Kathleen: Sleep work? Well I have been I healthcare pretty much all my life and I used to actually work in surgery back in the day and worked in the birth center and for Regional Organ Bank of Illinois which is now Gift of Hope and then stayed home and had my own family and when I wanted to go back in the medical field, somebody had told me I had been out of it too long which I find out is really not the case. But sleep medicine was the next big thing, so I thought, I’m going to learn that and so back in 07, I learned sleep medicine. It’s been great.

Carl: Well, there’s a lot to it obviously as we have learned today. And it has a lot of impact on other aspects of somebody’s health. So, it’s an important thing.

Kathleen: It is very important. It affects all parts of your life.

Carl: And I’m going to think about that tonight when I put my head on the pillow and hopefully get some good quality sleep.

Kathleen: I hope so.

Carl: Kathleen, thank so much for joining us.

Kathleen: Thank you.