Transcription:

Bill Klaproth (Host): Sleep apnea affects many people, making it almost impossible to get a good night’s sleep, which is necessary for optimal health and living a quality life. So we brought in two experts to talk about sleep apnea and how to fix it. Joining us is Steve Swierczek, Director of the Sleep Laboratory, and Dr. Robert Kellman, a physician both from St. Joseph’s Health. Steve and Dr. Kellman, thanks for your time today.

Steve Swierczek (Guest): Thank you Bill.

Dr. Robert Kellman (Guest): Very welcome, thanks Bill.

Host: You bet. Steve, let me start with you. So why is getting a good night’s sleep so important?

Steve: Well Bill I think you said it right in the beginning, obtaining healthy sleep is really important for both physical and mental health. It also improves your overall quality of life and productivity for everyone. Everyone from children to older adults can benefit from practicing good sleep habits and having healthy sleep. So well said, and Dr. Kellman, when it comes to sleep disorders. We hear a lot of about sleep apnea. Is that the most common type of sleep disorder you run across?

Dr. Kellman: Absolutely, certainly in my practice, that’s the kind of referral that I receive. Sleep apnea is a genuine obstruction of the airway, and it occurs in typically the deeper levels of sleep, and something has to be done about it and your oxygenation drops and it puts tremendous stress on the heart and lungs and can lead to strokes and heart attacks.

Host: So there are real physical dangers with sleep apnea. Is that right Dr. Kellman? I’m going to stay with you for a minute.

Dr. Kellman: That’s absolutely correct. It used to be thought to just be an annoyance and left people a little sleepy, but in fact it turns out it puts a tremendous strain on the cardiovascular system, and in addition it is now thought to be an important cause of car accidents.

Steve: I also say regarding drowsy driving, the American Sleep Association reports that annually there’s over 1,500 fatalities and over 40,000 non-fatal injuries that are attributed to drowsy driving and that’s just a remarkable statistic.

Host: That is, so what are some of the other warning signs that we should know about?

Steve: With obstructive sleep apnea, some of the things that are most notably noted is snoring and most of our referrals that come through us, it’s kind of remarkable, it’s patient’s spouse or bed partner usually having the bigger complaint of that, but again, snoring, excessive daytime sleepiness, just cognitive function and productivity throughout the day, all those things and particularly for in the overweight patients and predominantly in males but also in females as well.

Host: And Dr. Kellman, then when is it time to see a doctor, and how do you normally diagnose sleep apnea?

Dr. Kellman: Well the most common way of becoming aware of it is when a patient reports that they’re sleepy in the daytime, and this is something that’s so important that it should be part of the routine questioning of a patient today during their annual physical. People should be asked, do you have daytime sleepiness. Do you fall asleep when driving or when reading a book or watching television? These are important questions and we need to become aware, and then once somebody has a suspicion, that’s when the patient gets referred to Steve and to a sleep laboratory for a sleep study, and of course I think Steve will comment directly on that.

Steve: That’s correct, Dr. Kellman, in fact when we get the referral for the patients we’ll start out with following up on that physical exam, and sometimes do a questionnaire. We sometimes use what we call a STOP-bang questionnaire or there are other different types, but basically they ask you the questions of your symptoms, are you snoring? Tired? Has somebody observed you stop breathing during the night? Do you have high blood pressure? Are you overweight? What’s your age? Those types of questions. And then we bring them right into the lab and they come into our lab to spend the night, and when they come they’re able to spend the night. They bring their pajamas. They bring a favorite pillow, anything like that and we have a hotel like atmosphere, and the patient will come in, we’ll set them up with some wires and we’ll be measuring several different physiologic things. We’ll be looking at brain waves, we’ll be looking at breathing patterns. We’ll be looking at oxygen saturation. We’ll be looking at limb movements. We’ll be looking at your heart rate and your EKG and measuring all these through the night while you’re sleeping, and then in the morning, that entire recording is all scored by one of our certified polysomnographic technologists, and then a physician would review that data and come up with recommendations for patients.

Host: And Steve, let me stay with you. For people then diagnosed with sleep apnea, you were mentioning recommendations, how do you normally treat sleep apnea?

Steve: Yeah, so sleep apnea – the gold standard still is what we call continuous positive airway pressure, or CPAP and it is basically a blower that is prescribed for the patient, and what it does is it moves air to splint the airway open and keep it open throughout the night so that it’s not collapsing, and it keeps that airway open, the upper airway open as long as there’s pressure there and we make that adjustment to find that pressure that’s most optimal for that patient during the night while measuring all those same physiologic information that we did in the previous study to show the improvement of their breathing and sleep patterns.

Host: And Steve, this can be life changing for many people, is that correct?

Steve: Oh, no question, no question. I can tell you from experience, patients who have successfully been treated will tell you many times that they feel so much better. Their activity increases, their ability to do things and stay awake increases. I remember one patient specifically who told me when he woke up after being on CPAP that he hasn’t dreamt for many, many years, which is a side effect of sleep apnea because you keep waking up and you never get into that deep REM sleep, and he told me he got into this REM sleep and he said he dreamt about his grandfather that he hadn’t seen in a number of years, so it is definitely life changing.

Host: That’s amazing, and we understand how valuable sleep is, Dr. Kellman. Do you think we’re finally turning the corner where people are understanding this and realizing the value of sleep?

Dr. Kellman: Absolutely. I think the awareness of the existence of sleep apnea, is such an important change in medicine and health care. Up to about 20 years ago, it was thought to be an occasional occurrence, and it wasn’t realized just how prevalent it is, and today we realize that a large proportion of the adult population actually suffers from this. It also occurs in children, usually the mechanisms are a bit different, but that’s a different subject for another day; however, what’s really changed in the last couple of decades with the awareness and the ability to start to treat it, and now we have interventions that can really make a difference. We just heard about CPAP. When it works, CPAP is a solution. You could call it a cure. Unfortunately, the data across the country suggests that only about 50% of the population that tries to use CPAP is actually successful with it, and the reasons are multifactorial, but the most common reason is actually an inability to stay compliant involuntarily. In other words, people sometimes think oh yeah, I just don’t like it so I take it off, but in fact when they started to be able to monitor the devices during sleep, so that the patient isn’t even aware that the data is being collected, it’s done automatically, they actually found that a large number of people will just involuntarily remove it during the night and go back into their apnea pattern, which is why we have to come up with other treatments, which is where I come in.

Host: Dr. Kellman, let’s stick with that. So what are those other methods that you’re treating people with? As you mentioned, the involuntary compliance, they don’t know it’s coming off in the middle of the night, so what is the next step then?

Dr. Kellman: Well we do have some surgeries available for patients who are unable to tolerate CPAP. The most innovative and newest, most novel advance is the so called hypoglossal nerve stimulator. This is a very unique technology. It’s only been available within the last one to two years, and this actually allows us to implant a device that will stimulate the nerves to the tongue so that the tongue protrudes during inspiration, and this of course is turned off during the day and it’s only turned on while the patient’s asleep, and I’ve done 8 of these and all 8 thankfully have been complete successes and the patients have described it as life altering. Literally they stop obstructing because the tongue protrudes during inspiration and so they’re able to breathe in and this they can do throughout the night and then turn it off in the morning when they awaken, and these patients have really appreciated the dramatic change in their lives and it’s been very successful, and for patients who aren’t candidates, there are some other surgeries available as well, but I won’t get into all of that for this short discussion.

Host: That is so good to hear, and as you said earlier, with awareness comes treatment, and so exciting to know that new treatment options are being discovered and developed like the hypoglossal nerve stimulator. It sounds like something out of a science fiction novel for goodness sakes. Steve, if you could wrap this up for us, what else should we know about sleep apnea and the importance of sleep?

Steve: Yeah, so I would say you know loud snoring can indicate a potentially serious problem, but not everyone who has sleep apnea snores, so as Dr. Kellman suggested, please talk to your doctor if you have any of the signs and symptoms of sleep apnea, and ask your doctor about any sleep problems that leave you fatigued, sleepy, and irritable.

Host: Sounds good gentleman. Thank you both for your time today, Steve and Dr. Kellman, I appreciate it. For more information, please visit sjhsyr.org, that’s sjhsyr.org. This is St. Joseph’s Health Medcast from St. Joseph’s Health. I’m Bill Klaproth, thanks for listening.