Nolan Alexander (Host): This is the Pulse at Tallahassee Memorial Healthcare. I'm Nolan Alexander. And today, I'm joined by Dr. Ruby Williams from Tallahassee Memorial Healthcare. We're diving into the topic of obstructive sleep apnea and other sleep-wake disorders, as well as exploring the comprehensive services available at the Tallahassee Memorial Sleep Center. Dr. Williams, thanks for joining us. How are you today?

Ruby Williams, MD: I am doing good. I am happy to be here and excited to talk more about sleep apnea.

Host: I am excited to learn more. And I'm curious, why is sleep considered a pillar of health And what happens to our bodies when we don't get enough of it?

Ruby Williams, MD: Well, what happens to our bodies if we don't get enough sleep is—I mean, multiple things that can happen. It can include your neurological dysfunction. You know, a lot of things that we do at night when we are sleeping is consolidating our memories from the day, and forming memories and resting our brains. And then, the other thing that can be affected is our mental health, a lot of people don't realize that mood is also part of this; cardiovascular health, endocrinological health. Multiple systems are tied into when you don't get enough sleep, that can be affected dramatically.

Host: So, maybe there is a little truth about waking up on the wrong side of the bed. It's just not getting enough sleep.

Ruby Williams, MD: Yes. There's more than just joking around about not getting enough sleep. As some people have experienced, people who don't get enough sleep can often wake up being a little more grumpier than usual, short-tempered. And I think that happens to tie into your mood. And people's fuses tend to be a little shorter when they don't get enough sleep.

Host: We often talk about our partner snoring and sometimes even joke about it. I know my wife does to me at times. But what are the specific red flag symptoms that suggest someone might have obstructive sleep apnea?

Ruby Williams, MD: Some of the symptoms that can cue you into somebody having sleep apnea, or especially when your partner stops breathing—we call the apnea—and even gasping. Sometimes your partners will wake up with a gasping or choking sensation. And if you notice your partner's waking up several times through the night to use the restroom to have to pee or wake up because of dry mouth, and they're waking up with symptoms of that, that could be a first sign of undiagnosed sleep apnea.

Host: So, how can an untreated sleep disorder affect other parts of our health, like our heart or our blood pressure?

Ruby Williams, MD: Untreated sleep apnea can lead to different organ systems that can be affected. That includes your cardiovascular system. It may increase your risk for heart attack, strokes. It can also increase your risk for developing arrhythmias such as atrial fibrillation and other catastrophic things such as ventricular tachycardia or VFib. So, that is very concerning. It could also affect your risk for developing strokes as we talked about. And neurologically, it can affect your ability to remember, may increase your risk of dementia. And in regards to endocrinological effects, if you have diabetes, it can increase your risk for elevated cortisol, which translates into more difficult glucose control. And we talk about pulmonary effects, it can increase your risk for developing what's called pulmonary hypertension. And that can in turn affect your heart and lead to risk for heart problems and heart failure.

Another area that's not mentioned often with your sleep doctors or primary care doctors is that untreated sleep apnea can affect your ability—for men particularly—for erectile dysfunction. If you have undiagnosed OSA, can affect your ability to perform. And that's something you may want to discuss with a urologist or your primary care doctor and be referred for that. And in regards to mood, I believe that a lot of times, for mental health, people who suffer from anxiety and depression, if you have very difficult-to-control depression, you may find yourself having an undiagnosed sleep apnea, and that can affect your sleep cycle and your your ability to feel well rested at night.

Host: Well, goodness. I can see why this is a pillar of health. You listed just about everything that poor sleep can affect.

Ruby Williams, MD: Yes, absolutely. And a lot of people don't realize that sleep can affect many different systems in your body.

Host: Well, the good news is the TMH Sleep Center is AASM accredited. So, what does that mean for a patient and why is that accreditation important?

Ruby Williams, MD: it's a nationally recognized accreditation across America. It basically means that we hold the same standards across other facilities. And it's quality care. It's something that we bring for our patients. We make sure that it's standardized. We have policies. The facility is kept very clean. We offer modern testing and treatment plans for our patients. And it is something that we're very proud of. We've had this for many years. And every time, we have a site visit, we've always passed. And I think that brings quality care to this region.

Host: That's really important. And I'm trying to put myself in a patient's shoes about being nervous about a sleep study, right? I'm already having sleeping issues, and then how am I going to sleep outside of my own bed? So, can you tell us what the experience is actually like at a center?

Ruby Williams, MD: Sure. Absolutely. Often when patients come to visit me, I give them an example of what it's like. You know, it's not going to be in a very sterile environment. It's not going to be in a hospital setting. We like to mimic what seems to be like a person's home or a hotel. It's set in a bedroom. There's even a fan and TV. It has a normal bed. It's not going to be a hospital bed. Like I said earlier, it is very clean, the highest standards we provide for our patients, nice pillows. And the techs are very professional. They'll put you at ease. And what to expect is you'll get some leads that will be on your brain. We look at your brainwaves to identify what stage of sleep our patients are in. And you'll have some other monitors that'll be connected to your chest. So, we can look at your heartbeat when you're having events to make sure you're not having dangerous arrhythmias.

Host: While we're talking, I also wanted to ask you about CPAPs. Is a CPAP machine the only way to treat sleep apnea, or are there other options for patients who might struggle with the mask?

Ruby Williams, MD: That's a great question. If you have sleep apnea, treatment options are wide and variable, and it all depends on our patients. So, the standard of care is we typically start our patients on a CPAP machine, otherwise it's known as positive pressure therapy. And there are different types of machines. And if a patient tolerates the CPAP well, then we continue with a CPAP. However, not all patients can tolerate a CPAP.

So, options may include an oral appliance. And an oral appliance is a special device that is made by a local dentist. We have a few in town that we refer to. And that appliance is used to advance the lower jaw forward so that the airway is opened up so you get more flow, and that decreases the apnea and hypopnea events. It's very convenient to have that as an option for people who like to travel a lot, and they don't want to have to deal with what we call the durable medical equipment companies. And that is an option for this certain severity of sleep apnea. If you have mild or severe sleep apnea, that could be an option.

We also can refer people to get what's called an Inspire device. That is usually reserved for patients who have failed all forms of therapy. And typically, that would be referred to a local, ear, nose, throat physician. The nearest place is Mayo Clinic or University of Florida and Panama City. And they are able to implant this device that is placed underneath the skin. And a wire is tunneled to your diaphragm and up into one of the nerves that stimulate your tongue to move forward. It's activated by the patient prior to going to bed. And that allows the patient again to have a forward tongue movement. Again, same concept as to free up the posterior space so that flow improves and that the apneas are cured. This is usually reserved for patients with moderate to severe sleep apnea.

And another procedure that can be offered is what's called a mandibular advancement surgery. And that is also performed by an oral maxillofacial surgeon. We have two in town that can perform the surgery. We usually don't refer for this specific procedure because it is a very arduous, long, intense healing process and it's really reserved for people who have severe sleep apnea. And they may not be candidates technically for the other device, Inspire device. But there are several options at least. And, you know, patients should know that they're not beholden to one treatment.

Host: Wow. That's really good to know that those other options exist. And starting at the beginning here, right? I want to leave our listeners with this. If someone feels like they aren't sleeping well, what's the first step they should take to get help at TMH?

Ruby Williams, MD: There are many different ways. You can approach a primary care provider. If you think you have some sleep disruption, you should tell them about some of your symptoms and they can refer to Tallahassee Pulmonary Clinic, and we're more than happy to see those patients. Other ways you can do is a self refer. You can go online, and request for an appointment. And we'll have somebody reach out and get the patients a time slot to come and visit us.

Host: Well, Dr. Williams, thank you so much for your insight and your time today. We really appreciate it.

Ruby Williams, MD: Absolutely. Thanks for talking, Nolan. I had a great conversation.

Host: That was Dr. Ruby Williams. For more information, go to tmh.org/sleep. If you enjoyed this podcast, please share it on your social channels and check out the entire podcast library for topics of interest to you, I'm Nolan Alexander. And this is The Pulse at Tallahassee Memorial Healthcare. Thanks for listening.