Transcription:
Sleep Apnea, Causes and Remedies

Joey Wahler (Host): Sleep apnea is a disorder that can hurt your lifestyle in various ways. And if untreated can cause serious health problems. So we're discussing what sleep apnea is and how it's addressed. Welcome to UAMS Health Talk, a podcast sponsored by the University of Arkansas for Medical Sciences. Thanks for listening. I'm Joey Wahler. Our guest, Dr. Caris Fitzgerald, a Sleep Medicine Physician for UAMS. Dr. Fitzgerald, thanks for joining us.

Caris Fitzgerald, MD (Guest): Thanks for having me. What are we going to be talking about today?

Host: What we're going to go over the basics of sleep apnea with an expert such as yourself and first for those unfamiliar in a nutshell, what causes sleep apnea and what is it?

Dr. Fitzgerald: Basically, it's just trouble with breathing in the upper airway. And when you have trouble breathing in sleep, you're in danger. So you do what you always do when you're in danger, you put out the flight or fight response, and it's usually those chemicals that end up causing most of the trouble.

Host: So what are the basic symptoms of sleep apnea?

Dr. Fitzgerald: Well, as you can imagine, when you put out that flight or fight response, you're going to have trouble staying asleep. So some people have trouble with insomnia. Some people just feel unrefreshed after their sleep. But it can be much more than that because your sleep is disrupted, you're going to have trouble with daytime fatigue or sleepiness. You could have trouble with blood pressure, blood sugar, blood cholesterol. You can have trouble with reflux and trouble with increased inflammation. So wherever you're having pain, you can have more of it. You can also dysregulate your neurochemicals. And so you can have trouble with depression, anxiety, irritability, and cause nightmares, night sweats, going to the bathroom more at night and moving around in sleep. And in the long run, if it goes untreated, it can result in stroke, heart attack, heart failure, or development of dementia.

Host: All right. So you've obviously hit on a number of different possibilities there. Let's backtrack for a moment. Some people are more prone to sleep apnea, right? So what are some of those factors?

Dr. Fitzgerald: So, you know, everyone starts out with a certain sized airway. Your parents gave you your nose or your color eyes, just like they gave you your sized airway. And that airway may have been so big you were never going to have sleep apnea or so small, you are always going to have sleep apnea. Usually, it's kind of somewhere in between and that airway can get crowded with fat cells or become more floppy, more likely to close on itself due to age, or maybe loss of teeth. A lot of times when people get all of their teeth pulled and their jaws tend to collapse on each other, you can get a lot of sleep apnea that's very hard to treat.

Host: So since snoring is one of the symptoms of sleep apnea, can you talk about the difference between quote unquote, regular snoring and sleep apnea snoring?

Dr. Fitzgerald: Well, you know, snoring is going to be just a sound that's generated from vibration throughout the airway. And so, you know, you could potentially have a snore that's generated in the nose. Now if you have problems with flow with the nose, that's not a big deal because you can just open your mouth and get good air. So usually the problem with sleep apnea has to be at or below the tongue in order for that to be a real medical problem.

Host: Now there are three different types of sleep apnea, known as obstructive, central and complex. What differentiates those three?

Dr. Fitzgerald: So obstructive sleep apnea, it was really descriptive. It is obstruction of the upper airway. Central sleep apnea is really not so descriptive. That just means that even though your airway may be open, your diaphragm is not pulling for air. Your muscles are not pulling for that air on time. And so you are not breathing as you should. And that can generate the flight or fight because you're in danger because you haven't had that breath yet. And we see this with things like opiates, that's the big one, stroke and heart failure. And so, we have to think about those particular things, as well as brain tumors and other things that can involve the brainstem, in regards to central sleep apnea. When it comes to complex sleep apnea, that is when started with obstructive sleep apnea and then a positive airway pressure device was used to try to open the airway. And when you were exposed to that pressure, you started holding your breath. And so it's kind of one of those situations where your obstruction is relieved through pressure, but then that leads to central sleep apnea. So it's a little complicated, a little complex. I think it has a good name, complex sleep apnea.

Host: I was just going to say no pun intended or maybe pun intended. Yeah. Funny, a little sleep apnea levity there. So how is sleep apnea diagnosed? And when is the sleep study recomended?

Dr. Fitzgerald: So sleep apnea is usually diagnosed with an in-lab sleep study. When that's done, especially with good preparation, we can get a fairly accurate idea of the severity of the trouble breathing. If you have an at-home sleep study, unfortunately, those studies often underestimate the trouble breathing with sleep. So a positive is a positive, but a negative is not a negative. If you had a negative sleep home sleep study, you then have to go in and do the in-lab study. And then the in-lab study has to have a certain amount of REM sleep to be adequate as well. So that's how we diagnose. So I went through kind of that list of things that can be kind of symptoms and signs that sleep apnea is going on or medical problems. And so if you're having any of those issues, snoring, trouble going to sleep, staying asleep, daytime fatigue, or sleepiness, nights sweats, nightmares, moving around, a lot of sleep problems with blood pressure, a large neck size, if you have a few of those, you should come in and get seen.

Host: And if someone does, you just mentioned that for an in-lab sleep study, you need a certain amount of REM sleep. I think if I were coming in, the main thing, I'd wonder is am I going to be able to sleep in a strange environment like that when I know I'm kind of under the microscope. So maybe give people an idea of what the scene is like if you will, when you conduct such a study and what do we actually mean by REM sleep? I think we hear the term often, but maybe not everyone is aware of exactly what that is.

Dr. Fitzgerald: So, I think you bring up a great point. How am I going to sleep with all of these wires hooked to me? Because it is a lot of wires and you're in a foreign environment. And so what I say to patients, is the sleep study is really not a normal amount of sleep. It is a medical procedure and we're going to do things starting two weeks in advance to try new get an optimal, adequate sleep study.

So I actually have my patients undergo things like waking up at 6:00 AM every day for the two weeks prior. Ideally not having anything that opens up the airway like nasal sprays or allergy medicines for two weeks before. We'll stop antidepressants for two days before. And then the night before the test, we don't want any sedatives. We hope you have a worry full night. Like you're worried about the sleep study the next day, because if you don't sleep well the night before that helps push sleep into the night of the sleep study, and then you wake up at six and you have to stay far away from caffeine. Now this is a real big helper right there.

So a lot of our patients are coming in, they're very fatigued or sleepy and they're coping with this through caffeine and then you pull them off one day without, and they can't nap and they can't rest their eyes, and they've got to be more physically active and all that culminates in a good sleep on the night of the study and an appropriate amount of REM sleep because they've been waking up at six every day. So we get pretty good studies using those methods.

Host: And again, REM sleep in a nutshell is what again?

Dr. Fitzgerald: So REM sleep is dream sleep and in dream sleep, you shouldn't act out your dreams, right? That would be a pretty bad idea for you to be able to be acting out your dreams. And so your body does something really cool. It actually suppresses muscle tone. It paralyzes you essentially. And we call that the atonia of REM.

Now, interestingly, upper airway is made out of connective tissue and muscle. And so when your muscles are atonic or paralyzed, they are much more likely to collapse on themselves. And so we see very often that obstructive sleep apnea is usually worse in REM sleep, when the body is paralyzed, makes sense doesn't it?

Host: I think so. I think so. How about treatment ranging from lifestyle changes to sleep aid equipment? When is one or the other typically used?

Dr. Fitzgerald: So there's been several studies to look at efficacy of treatment interventions and the data is that weight loss is absolutely the most healthy thing to do and what we should all be advocating for. But if you talk to a patient about that and you try to encourage them in that way, still less than 50% chance that a significant weight loss is going to happen.

And even if the weight loss does happen, that means the sleep apnea totally goes away. The oral devices and surgery are also in that category of usually 50% effective or less. Now positive airway pressure is actually 90 to 95% effective if you've got the right pressure with a good mask seal. And you're using it, of course. And so because that effectiveness of positive airway pressure, because it's so much more, closer to a hundred percent than all other interventions, that's why we call it the gold standard for treatment.

Host: And so you're talking there about home equipment, obviously, right. And maybe it's not the most attractive or comfortable thing, but it's going to work the best you're saying.

Dr. Fitzgerald: That is what the data says. Yes.

Host: So in closing here, Doctor, that being said, how would you advise or even convince someone if they think they may have a sleep apnea issue, but they're worried, oh, I don't want any equipment at home, I'm not going to be comfortable dealing with all that, but you're the doctor, you know, sometimes it's needed. How do you get that message across?

Dr. Fitzgerald: You know, my stance has always been that education is the key to making appropriate decisions. And so I think that you kind of have to lay out all the risks of, if you leave this untreated, this is kind of what we know will happen. And I have to tell the story of, you know, it wasn't until the eighties that we really started realizing that this was a problem. Before that time, we just knew that men died before women and they usually died a stroke and heart attack and heart failure.

It wasn't until the eighties that somebody started putting together, hey, you know these guys that die, these things, they're big time snorers. We should look into that and see if there's a connection. And there was a connection with all these other things too. And so, you know, now you have a benefit that no one else before you has ever had a way to potentially avoid that stroke, that heart attack, that heart failure or potentially development of dementia by looking into this and trying treatment. It's worth at least to try, you know.

Host: Hey, I'm convinced.

Dr. Fitzgerald: Sleep is your fountain of youth.

Host: I don't know that I have sleep apnea, but certainly if I did, I think that last answer would certainly work on me. Well, folks, we trust you're now more familiar with what sleep apnea is and how it's treated. Dr. Caris Fitzgerald, thanks again so much.

Dr. Fitzgerald: Thank you.

Host: And to make an appointment to be checked for sleep apnea at UAMS please call 501-686-8000. That's 501-686-8000. If you found this podcast helpful, please share it on your social media. And thanks for listening to UAMS Health Talk, a podcast sponsored by University of Arkansas for Medical Sciences. Hoping your health is good health. I'm Joey Wahler.