Joey Wahler (Host): It can adversely affect us when sleeping and beyond. So, we're discussing sleep apnea. Our guest is Brittany Gagnon. She's a senior sleep technologist for St. Joseph Hospital. This is Wellness First, a St. Joseph Hospital podcast where we hear and learn directly from the experts on all things health and wellness. Thanks for joining us. I'm Joey Wahler. Hi there, Brittany. Welcome.

Brittany Gagnon, RPSGT: Hi. Thanks for having me.

Host: Great to have you aboard. We appreciate the time. So first, most have heard of it for, but for those unaware, what exactly in a nutshell is sleep apnea and just how common is it among adults?

Brittany Gagnon, RPSGT: Sleep apnea is pretty common. It's estimated to affect about 30 million people, adults in the United States. What happens with sleep apnea is you're having a secession in oxygen while you're sleeping. In the back of your throat, you're having a collapse of that tissue and that's being caused because of relaxation of the muscles in the airway when you go to sleep.

Typically, it's happening 10 seconds or longer each time to be considered a medical issue. And it can happen up to hundreds of times a night for people that have severe sleep apnea.

Host: Wow. Hundreds of times a night. So, how about some of the early warning signs or symptoms that someone may have this?

Brittany Gagnon, RPSGT: Sure. Some of the signs that our patients would have is that they have a bed partner that hears them snoring; if they wake up during the night, gasping or choking; if they're having daytime fatigue and they're getting seven or more hours of sleep on a consistent basis. A lot of times, our patients will mention that they're okay when they're up and moving. But as soon as they sit, say to read a book or watch television, they'll find themselves nodding off even if it's in the middle of the afternoon. Also, waking up with dry mouth on a regular basis or with a headache can be a sign of sleep apnea as well.

Host: Now, with snoring, is there a particular type of snoring that would tend to indicate the presence of sleep apnea?

Brittany Gagnon, RPSGT: So with snoring, two different things could be happening. One, somebody could be what's called the primary snore, and it means that they snore, but they don't have any type of health issue associated with that. The other thing that could be happening is sleep apnea.

So, everybody that has sleep apnea snores, but not everybody that snores has sleep apnea. When that tissue is collapsing in the airway, the airway's becoming smaller and it vibrates. And so, that's what the snoring sound is. So, to know whether you have snoring and no health issue or snoring and sleep apnea, you would want to talk to your doctor about being formally tested for sleep apnea.

Host: And speaking of which, you led me beautifully into my next question, which is what happens during a sleep study at St. Joseph's Sleep Center? What can patients expect in terms of that in order to get a diagnosis?

Brittany Gagnon, RPSGT: We have a couple different kinds of sleep studies that we do here. One is the type of study that I perform, which is a home sleep apnea test. And what happens is the patient would come in, they meet with me for up to half an hour. I'll teach them how to wear the equipment that they'll wear at home that night. And it's very simple. It's just a watch that they wear. And then, there's a piece that goes on their finger and also a piece that goes right here at the sternal notch. So, it's not a ton of equipment, but it's extremely accurate. And it only tests for obstructive sleep apnea.

Now, the next kind of test is our overnight test here in the lab. And when people come in for that, our night tech would spend about 45 minutes setting them up with numerous pieces of equipment. So, that's about 28 wires that the patient is wearing, and they stay overnight for one night and then go home in the morning. And that type of testing would typically be used if somebody has very recently had a stroke or heart attack.

Every once in a while, if somebody's on nocturnal oxygen and needs to be monitored while they're not wearing it during the test, we would do that. Folks who just simply don't feel comfortable with doing the test at home, if their insurance will allow, then it can be ordered for them to do an in-lab test. And that checks for obstructive sleep apnea as well as periodic limb movement disorder.

Host: In layman's terms, Brittany, what exactly is such a test measuring? How do you take that information and use it to determine what's going on?

Brittany Gagnon, RPSGT: Sure. So, the home sleep study test, we're able to see what stages of sleep the patient is in, when they're asleep or awake, when they fall asleep, how often they're waking up. And we're looking at vibration from snoring, position changes. And the most important parts for determining sleep apnea is the finger probe is able to see pulse, blood, oxygen, and what's called peripheral arterial tone. And that's the amount of blood in the vein or artery that we're monitoring. So, those last three factors that I mentioned create a very specific pattern on the data that I look at so that I'm able to count exactly how many apneas are occurring during the night.

Host: Wow, so that sounds very comprehensive. Basically, monitoring and then analyzing every aspect that goes into our sleep pattern, right?

Brittany Gagnon, RPSGT: Yeah, definitely. And then, we collect the data. And then, I go through all of the data, and then it's sent to our sleep physician. And he goes through all the data as well and makes the final determination and diagnosis.

Host: And then, once that diagnosis occurs and treatment is looked into, what are the most common options for sleep apnea and how effective are they?

Brittany Gagnon, RPSGT: So CPAP, continuous positive airway pressure is the gold standard for treatment for sleep apnea. The beautiful thing about CPAP is if you wear it, it'll work. So as long as you're wearing your CPAP mask at night, it's going to create a splint made out of air that opens that airway and keeps it open and makes your level of apneas occurring into the normal range, that wouldn't be a health concern.

There are some other treatments for sleep apnea. They tend to be very specific to the patient. So, certain patients would do well with them, other patients wouldn't. A few of those examples would be dental devices. There is a mouth guard that can be made that pulls the bottom jaw slightly forward during sleep and creates a little bit more room for air in the airway.

Also, there's something called positional therapy. If a patient only has sleep apnea on their back and doesn't have it in any other position, there are devices that you can purchase that have a physical piece on the back, so say a ball or a foam brick so that when the patient turns on their back, it's uncomfortable and they turn back off of their back.

There's also a surgical option called Inspire that has come out, I believe, within the past few years. That is something that patients can talk to their doctor about as well if they've tried CPAP and it didn't work out for them for whatever reason.

With all three of those non-CPAP options, you're going to want to come back after you start using it and get retested just to make sure that it's working. Where with the CPAP, there's a card inside the device that sends information to the doctor. And so, it's able to be consistently monitored that it's working.

Host: So generally speaking, when having any of those particular treatments, what's the success rate here?

Brittany Gagnon, RPSGT: For CPAP, if you're wearing it, it's successful. With the dental devices, the Inspire and the positional therapy, I don't have a numbers value for that, I apologize. It really is patient dependent.

Host: So, what are some of the health risks of untreated sleep apnea, both short and long term?

Brittany Gagnon, RPSGT: With sleep apnea where you're having a secession of oxygen so many times during the night, if it's left untreated, for short-term options, it can be dangerous to be tired during the day. So if you drive a vehicle, if you're somebody that works with heavy equipment, if you work in, say, as an airline pilot or a truck driver, anything like that, you don't want to be tired during the day at work.

The long-term issues that can occur, if it's left untreated, would be cardiovascular issues, stroke, high blood pressure, diabetes. And it can make the rate of depression go up significantly when somebody is chronically sleep-deprived.

Host: Understood. Couple of other things. How about technology? How has that evolved in diagnosing and managing sleep apnea over the past few years?

Brittany Gagnon, RPSGT: So, the type of study that I do, the home sleep study is newer. It's about the past 10 years that that has been being used. The device I use here just came out a few years ago called WatchPAT. So, being able to wear the watch with the probe and not have to have a cannula in your nose and not have to be wearing belts or any other type of wires is newer technology. And it's really convenient for the patient. It's easy for them to understand. It's easy for them to sleep with it on. So, that's been a great advancement.

Also, CPAP machines used to only be set at one pressure. So, what would happen is you would come into the lab, we would watch you sleep. We'd be watching your brainwaves and your breathing, and we'd have to wait for what's called the worst-case scenario, which is sleeping on your back, so gravity is working against you, put that tissue in the airway. And also, if you're in dream sleep and REM sleep, your muscle tone is low. So, we would have to get the pressure to a point where when you're in REM sleep on your back, you're not having any apneas, and you would be stuck on that high pressure the whole time.

What's come along recently is auto machines. And so, the wonderful thing that they do is it's set at the lowest pressure available and then at the higher pressure, and it reads the breathing of the patient. So, they're always on the lowest pressure unless they start having apneas, and then the machine will go up on its own to the appropriate level they need.

Host: In summary here, Brittany, for someone joining us who may be nervous or even embarrassed about doing a sleep study, you've mentioned having to wear some of these devices that obviously would be something new for people, what assurance would you offer them about having this done?

Brittany Gagnon, RPSGT: Oh, well, you never have to be embarrassed to come to the sleep lab. This is what we see all day, every day. We certainly have no judgment towards wearing a CPAP mask, we think it's wonderful and good for your health. And also, of course, there's HIPAA laws, so we're never going to see you in public and say, "Hey, that person snores." That's illegal. So, we wouldn't do that. Also, wearing a CPAP mask at home, I know people do sometimes get embarrassed, but we remind them that you just put it on right before you go to sleep. You're turning the light off. No one's going to see it anyway. And usually, the bed partner is very happy that they're wearing CPAP. They don't have to listen to snoring. And the bed partners get very nervous if they can hear them stop breathing. Typically, I know it's normal to get embarrassed with anything new like that, but you really don't have to be.

Host: I'm sure those joining us are comforted by hearing that folks we trust you are now more familiar with sleep apnea. Brittany, keep up all your great work. It sounds like having this looked into, if you may be experiencing it, that really only good can come from this testing. And thanks so much again.

Brittany Gagnon, RPSGT: Thank you for having me.

Host: Absolutely. And for more information, please visit stjosephhospital.com. If you found this podcast helpful, please do share it on your social media. And thanks again for being part of Wellness First, a St. Joseph Hospital podcast.