Transcription:
There Is Help For Sleep Apnea

Melanie Cole (Host):  Do you wake up feeling as if you’ve not gotten a good night’s sleep? Do people sometimes tell you that you snore loudly? Well, it could be sleep apnea, and there is help. My guest is Dr. Jacalyn Nelson. She’s the director of the Stoughton Hospital Sleep Disorder Center. Welcome to the show, Dr. Nelson. Tell us a little bit about some of the symptoms that would signal somebody has a sleep disorder. 

Dr. Jacalyn Nelson (Guest):  Thank you for that introduction. Probably some of the main symptoms of sleep apnea include loud or frequent snoring. I often get told by patients that bed partners are requesting that they leave the bedroom or the bed partner themselves will leave the bedroom because of the snoring, choking, gasping, arousals while you’re sleeping. Something else you might not think of being associated with sleep apnea are morning headaches, and then also there is often associated daytime sleepiness with sleep apnea. Trouble concentrating is another big issue because obviously we all know what it’s like not to sleep well at night or not to get enough sleep, and you know how difficult it is to focus and concentrate the next day. Those are some of the symptoms that people will complain of. 

Melanie:  Does someone with sleep apnea know that they’re having these issues in the night, or do they wake up with these symptoms and not quite sure why? 

Dr. Nelson:  Both. Sometimes I think people do know. Sometimes they’re in denial or they think it’s attributable to something else. Then there are times when people are totally unaware, and sometimes they get histories that are -- I’m not sure that this person could have sleep apnea and I get the sleep study back and they’ve got severe sleep apnea. They were just unaware that that was going on, especially if they live alone. 

Melanie:  What do you do to determine if somebody has sleep apnea? If they come to you complaining of daytime fatigue or their partner says they snore very loudly or they know that they have these symptoms, how do you diagnose it? And if we’re talking about sleep studies, do people actually get a good night’s sleep with those? 

Dr. Nelson:  Sure. Taking the first question, in order to diagnose sleep apnea, you really do have to do a sleep study. In terms of whether or not you get a good night’s sleep, in reality, it may not be quite like the sleep you have at home. It may take you a little bit longer to fall asleep, for example. But in the end, almost always, we get enough data or enough sleep to make the diagnosis. That’s really what’s important. 

Melanie:  What about home sleep tests? Are those available, too? 

Dr. Nelson:  Home sleep testing is available but not through Stoughton Hospital. I think that you’ve got to be careful with home sleep testing. I know that some insurers these days really are pushing towards that route, and I think it’s very appropriate for the patient who almost certainly has sleep apnea. However, not everybody presents like that. Walking through the door, I know they have sleep apnea. In those cases, when I’m unsure whether or not somebody has sleep apnea or if there are a lot of associated cardiac—in other words, heart-related issues, or lung-related issues—the diagnosis is more complicated. And in those patients in whom I’m not sure they have sleep apnea or if they have a lot of associated medical issues, often, home testing is just not the way to go. 

Melanie:  Before we talk about therapies and help for those with sleep apnea, are there some things that you would like to recommend for behavior modification or even possibly prevention, some complementary things people can do on their own to help control the problems they might have? 

Dr. Nelson:  Are we talking directly about sleep apnea or just about sleep in general? 

Melanie:  About sleep apnea. Does losing weight help? Is there any myth about diet or alcohol at night? 

Dr. Nelson:  Sure. Definitely, weight makes a difference. I see sleep apnea as being an interaction of the throat structure. Some people are more prone to or at risk for sleep apnea than others. It’s also weight-related and it’s also age-related. As we get older, say after 50, we start to lose tissue tone, and a lot of that tissue in the back of the throat becomes floppy. So that also makes you more at risk to close off your airway. Again, those three factors—the anatomy of your throat, weight, and age—are I think probably the three primary factors which interact. Clearly, weight is the one modifiable factor that we have. We have tried modifying the throat structure. And in general, that was not very successful. All those studies were done in the ‘90s and it can be somewhat beneficial, but it’s generally in the long run not going to solve the problem. Weight loss definitely can help. As far as age, there’s not much we can do about that, is there? 

Melanie:  No, not really. Now, therapies. What do you do for someone that you’ve diagnosed, you’ve done a sleep study? You’ve said yes, you have sleep apnea? What’s your first line of defense, and how do you make sure that they adhere to what it is you prescribe? 

Dr. Nelson:  In general, for most people who have sleep apnea, I’m going to be recommending CPAP or continuous positive airway pressure, which is a machine that is going to blow just room air in through a tube in a mask to keep your airway open at night. These days, machines are sophisticated enough that they keep data on whether or not you’re having breathing events with this mask. Is it leaking? How much are you using the machine? So we get a lot of data from machines, and that’s how we track therapy. And it oftentimes can alert to us problems going on that the patient may or may not be aware of. In addition to weight loss, in addition to CPAP therapy, sometimes it’s appropriate for people to use positional therapy if their sleep apnea is only occurring on their back, for instance. Positional therapy is most often done by asking a patient to get a fanny pack, fill it full of tennis balls and turn it around so that the pack is actually between the shoulder blades so that if you roll onto your back, it’s going to be very uncomfortable. 

Melanie:  Well, that’s certainly also the partner’s job. You always see in the movies people pushing over their partner and rolling them over so that they stop snoring. So there’s actually some truth to that. Why don’t you just, in this last minute, if you would please, Dr. Nelson, give the listeners your best advice about sleep apnea, how to determine if they have it, and why they should come to Stoughton Hospital to see you and get help for their sleep disorder. 

Dr. Nelson:  First of all, very clearly, not getting good sleep. And especially if you have sleep apnea, it affects all of your health. You think of sleep apnea as it causes high blood pressure and it’s associated with strokes and heart attacks, sudden death at night, heart failure, a couple of other things as well as some comorbidities like diabetes, depression, cancer, dementia, all these things you won’t even associate with the sleep problem. Those are all associations with sleep apnea. If you think you have a sleep problem, like sleep apnea, or if you’re not sleeping well and you’re not even sure why, there is help. I’m happy to evaluate you and determine whether or not a sleep study is indicated and then go from there to help you with your sleep problems, whether they be sleep apnea or anything else, actually, related to sleep.  

Melanie:  Thank you so much. You sound like an amazing physician. You’re listening to Stoughton Hospital Health Talk. For more information, you can go to stoughtonhospital.com. That’s stoughtonhospital.com. This is Melanie Cole. Thanks so much for listening.