0:04

Welcome to the Healthy Matters podcast with

0:06

Dr. David Hilden , primary care physician

0:08

and acute care hospitalist at Hennepin

0:11

Healthcare in downtown Minneapolis, where we cover

0:13

the latest in health healthcare and

0:15

what matters to you. And now here's

0:17

our host, Dr. David Hilden .

0:20

Hey, it's Dr. David Hilden and welcome to

0:22

episode 15 of the Healthy Matters podcast.

0:25

Today we are gonna talk about sleep

0:28

apnea. You've probably heard about it, but

0:30

we're gonna delve into what causes it and

0:32

what you can do about it. And to help me out,

0:34

I have invited a past guest from

0:36

the program, Dr . Ren Verese

0:39

. He is a sleep doctor who

0:41

specializes in all kinds of sleep disorders,

0:43

including sleep apnea. Dr. Verese , welcome

0:45

back to the

0:46

Show. Thank you Dave . It's a pleasure to be here. It's

0:48

Great to have you , Regi , now you do all kinds of sleep, but

0:50

we're gonna stick to sleep apnea today

0:53

because it's so common and so many people

0:55

are living with sleep apnea. So start

0:57

us off, what is it? What is sleep

0:59

Apnea? Yeah, so sleep apnea, as you mentioned,

1:02

it's very common. It's a condition where

1:04

the back of the throat, the tongue, the muscles

1:06

in the back of the throat when we sleep at night,

1:08

become very relaxed. And at that time the

1:11

airway might close off because our muscles

1:13

are relaxed when we fall asleep. And if

1:15

the airway closes off, the

1:18

oxygen can't get into your lungs. And this

1:20

is what we call a sleep apnea event. It's essentially

1:22

a choking episode when we sleep at night. It

1:24

sounds

1:24

Awful

1:25

Terrible.

1:25

It is. I mean, when you've described it as a choking episode

1:28

and not getting oxygen, that sounds pretty bad.

1:30

What causes it?

1:31

So a lot of different things causes sleep apnea,

1:33

but the number one thing is being a male and

1:36

obesity. So being overweight

1:39

can cause a lot of weight around the size of

1:41

your neck. And so that puts a lot of pressure on those

1:43

soft tissues in the back of the throat. So

1:46

anything that might put pressure on the throat like obesity,

1:48

sleeping on your back because if

1:50

you sleep on your back, your tongue can sort of roll

1:52

back and choke that , uh, airway as well. But

1:55

mostly it's being a male, mostly it's

1:57

obesity and certain things

1:59

like alcohol can worsen sleep apnea

2:02

as well. Does the

2:02

Word apnea mean? Is that what it means? Choking?

2:05

Yeah,

2:05

It means stopping breathing essentially.

2:07

It's the cessation of breath. So you said

2:09

It's more common in men , what about in

2:11

age? Does it, do people get it at young

2:13

ages or is this a disease of, of

2:16

aging?

2:16

Absolutely. I mean we do definitely

2:18

see this in adult males. Um

2:20

, when we look at the pediatric literature, it's

2:22

these kids that have tonsils,

2:25

Very

2:25

Large tonsils or adenoids that can

2:27

snore very loud and have

2:29

sleep apnea as well. But we're

2:31

really starting to see not just kiddos

2:34

having obstructive sleep apnea from tonsils,

2:36

but there's a big crisis in pediatrics

2:38

with obesity and these children

2:40

are coming with sleep apnea that's not involved with

2:43

tonsils when it comes to women.

2:45

Women are fairly protected from having sleep

2:48

apnea until they start hitting perimenopause

2:50

and menopause and then they start catching up to men.

2:52

Why is that? Well ,

2:54

Uh , the hormones, progesterone, estrogen are, they

2:56

help us breathe, they help women breathe. It also helps

2:58

with keeping the airway open. So

2:59

You talked about tonsils and adenoids that now

3:02

we don't take those out so much in kids anymore,

3:04

but, and when we did, they were just, cuz they were

3:06

a little big and people were getting sore throats. Right. I

3:08

mean tonsillectomies weren't done for sleep apnea

3:11

back in the day, were they?

3:12

They were. And they are now. They are

3:14

now . Okay . They are now. And, and, and it depends

3:16

on the severity of the sleep apnea for kiddos.

3:18

So if their sleep is really disrupted and

3:21

they're sleepy during the daytime and you

3:23

can really identify using a

3:25

sleep study that their sleep is disturbed, we

3:27

then perform in tonsillectomy. And that's usually

3:30

curative for these kids.

3:31

Okay. So how common is sleep apnea

3:33

in our population? A

3:35

Study population based study in 2014

3:38

looked at men and women, about 14%

3:40

of men and about 5% of women have

3:42

obstructive sleep apnea. And when we categorize

3:45

sleep apnea, we think of mild, moderate, and

3:47

severe obstructive sleep apnea. So these

3:49

are folks that are stopping breathing or their

3:51

oxygen is dipping a minimum of five times

3:54

per hour. And that's where those numbers come

3:56

from. 40% of men, 5% of women, that's

3:58

a

3:59

Lot. Mm-hmm.

3:59

<affirmative> it

3:59

Is, is that a global phenomenon

4:02

or is that more of a thing in our country, especially

4:04

with obesity?

4:05

That's the correlation is that we are,

4:07

there's two components of that. I think it's the obesity

4:10

epidemic, but then there's also a lot of

4:12

doctors are now becoming very well

4:14

aware of sleep apnea. This has happened

4:16

in the last 20 years. So we talk

4:18

About it a lot in clinic. I do in primary care

4:20

clinic a lot. Someone says, yeah, I think I have sleep

4:22

apnea or my spouse snores and I think

4:24

they have sleep apnea. Are we, are

4:27

we diagnosing it more formally with

4:29

sleep studies, like what you do or are

4:31

are we diagnosing it more just in the clinic? Uh

4:33

, sort of speculatively like I think you have

4:35

sleep

4:36

Apnea. It's on a lot of the

4:38

radar of a lot of doctors. Yeah . So I think they're

4:40

just gonna ask the right questions and if they have

4:42

the right suspicion for sleep apnea, the

4:45

goal is for the patient to be tested or at

4:47

least seen by a sleep physician to determine whether testing

4:49

is indicated and to figure out whether they

4:51

have sleep apnea.

4:52

So I take it cases are on the rise

4:54

then?

4:55

I think so for a number of different reasons. The

4:57

fact that people are aging, that's one

4:59

reason. Number two, the fact that people are continuing

5:01

to have , uh, this obesity epidemic.

5:04

And three, I think doctors, again, just like you,

5:06

you're , it's on your radar. You want to ask about this because it's

5:09

important.

5:09

I mentioned snoring, I think you maybe did earlier

5:11

in this, in this uh , episode with,

5:13

especially with kids. Tell us about, if

5:16

you could, Reggie , the , the correlation between

5:18

snoring and sleep apnea, they're not one

5:20

in the same, but they're, they go together, right?

5:22

Absolutely. So you can have snoring

5:25

la very loud snoring and

5:27

not have these episodes where the airway's

5:30

closing off you and you're choking yourself. But

5:32

snoring tends to very strongly

5:35

indicate that someone does have obstructive sleep

5:37

apnea. So if you have someone that has obstructive

5:39

sleep apnea, they likely have symptoms

5:41

of snoring, loud snoring. But you can have

5:43

snoring alone and not have sleep apnea.

5:46

So

5:46

If you think you might have sleep apnea

5:48

or you think the person you share a bed with,

5:50

you know they snore is just really loud. How

5:52

do you diagnose

5:53

It? Yeah. So apart from that snoring

5:55

question I ask , is the snoring loud

5:57

enough to be able to be heard through a closed door? I

6:00

ask the patient or their bed partner, does your partner

6:02

ever snore themselves awake, like with

6:04

a snort? Kind of like that. Oh , that

6:07

was

6:07

Good. <laugh> Reggie . That was good.

6:08

Well the reason why I do that is because when I do

6:10

that in the clinic with the patient, they

6:13

go, yes, that's exactly what I have . That's it . That's

6:15

it. Yeah. And then, then I, I'm fairly certain

6:17

that I've got the diagnosis or if a bed

6:19

partner hears that they're snoring and then all of a sudden

6:22

there's a silence in the snoring and

6:24

then the patient has a snort awake getting , that's what

6:26

we call, that's a witnessed apnea.

6:29

So apart from that, I ask questions like, do you wake up

6:31

with a dry mouth in the morning? Do you have a headache

6:34

when you wake up in the morning? Do you feel like

6:36

you're sleepy during those days? All

6:38

that sort of gives us an indication that , uh,

6:40

there's a high probability that someone has sleep apnea.

6:43

You practically have to be a marriage counselor

6:45

if you can hear it through a closed door.

6:48

Yeah. Wow. I bet you have a lot of conversations

6:50

with people. Well

6:51

There is something called sleep divorce where people

6:54

separate from their bedrooms to sleep

6:56

better because of their partner snoring

6:58

or other sleep complaints. And and

7:00

yeah, people do say, I'm sleeping better

7:02

now because my partner's sleeping better. I

7:05

think they did a study that looked at

7:07

how much a bed partner's

7:09

sleep is disturbed by someone else's

7:11

snoring and it's about 50% of

7:13

their sleep can be disturbed by someone's

7:16

sleep apnea and snoring.

7:17

Right now there are a whole lot of people nodding

7:20

as they're listening to you say that and they're

7:22

right now, I can just imagine people listening to this episode

7:24

and they're going, ah-huh that's my experience.

7:26

I don't sleep well because dude next

7:29

to me here is snoring so loud. Absolutely

7:31

is , is sleep apnea dangerous?

7:33

Yeah, great question. So as we talked about it, that

7:35

you can have different severities of sleep apnea, mild,

7:38

moderate or severe. If it's really mild, we

7:40

kind of just talk about lifestyle modifications,

7:43

losing weight, maybe reducing alcohol before

7:45

bedtime , uh, sleeping on the side

7:48

and things like that. When it becomes moderate

7:50

or severe, if the number of times

7:52

that someone is holding their breath and stopping

7:54

breathing is between 15

7:56

to 29 times an hour, we call that moderate

7:59

obstructive sleep.

7:59

That's like once every minute or two.

8:01

Yep . Yep . Exactly right. And if it's

8:03

beyond that and or if

8:05

they're oxygen really tanks, you know,

8:07

below 80%, you know, even in

8:09

the mid eighties we know that

8:11

that left alone over time confers

8:14

a risk of cardiovascular disease, sudden

8:16

cardiac death, heart attacks from sleep,

8:19

difficult to treat high blood pressure, and

8:21

it, it's a whole host of things that can happen.

8:24

So I don't want people to worry

8:27

because the majority of folks that come into our daughters,

8:29

they've had sleep apnea for an extended period

8:31

of time. So there's not a big risk that

8:33

something's gonna happen tonight. My recommendation

8:36

would be, if you think you have it, come

8:38

and see us. So

8:39

Let's talk about what the experience of

8:41

someone who has sleep apnea is . What does

8:43

it feel like and and what

8:45

kind of symptoms do they have? The

8:47

Prototypical example of someone has,

8:49

you know, symptomatic sleep apnea, severe

8:51

sleep apnea, they'll come in tired, they'll

8:54

come in sleepy, they'll feel really

8:57

just sluggish. They'll feel , they'll , they'll say

8:59

things like, not only can I sleep

9:01

if I have the opportunity during the daytime

9:03

if give , if you gave me the opportunity, but I just

9:06

feel like I'm walking through a fog and

9:09

they'll say multiple times throughout the

9:11

night, I'll wake up feeling like something

9:13

is in the back of my throat, like my tongue

9:15

or I've just awakened and my heart is

9:17

racing and they don't sleep through the

9:20

night. Um, so that's typically what

9:22

people describe. Uh ,

9:23

You said there's different severities. Is

9:25

it all caused by an obstruction or are

9:28

you know, what makes one more severe than the

9:30

other? I guess what I'm trying to say, y there

9:31

Are different types of sleep apnea. The

9:34

one that we normally see typically

9:36

in , in the population is obstructive sleep

9:39

apnea. That word obstruction is a

9:41

key that something is obstructing the airway

9:43

like the tongue or the soft palate and and

9:45

so forth. There's something else called central sleep

9:47

apnea. That's usually happens when someone's

9:49

using a lot of opioid pain

9:51

medications and there's , there's sometimes brain lesions

9:54

can cause this or heart failure. Patients

9:56

can also have central sleep apnea. Um

9:58

, but really the central sleep apnea is we

10:00

are concerned about, but rarely are

10:02

they really associated with severe desaturations.

10:05

And we kind of just watch that for the obstructive sleep

10:07

apnea, we definitely want to get that fixed and

10:09

treated because it can be , uh, dangerous.

10:11

Now if you're not breathing once an hour, I can

10:13

just imagine listeners are thinking that's a lot. Yeah,

10:16

I mean is that considered a severe case and do

10:18

they know that this is happening?

10:20

Some people do and that's why they

10:22

will come in. Others are brought in by

10:24

their spouse and say you are doing this at

10:26

night and the patient says, I have no

10:29

clue that I was doing this. This is news to me. I

10:31

don't even believe it to be honest with you. And

10:33

part of the reason is, Dave, we're sleeping when this happens. Right?

10:35

We're sleeping and then all of a sudden there's

10:37

this abrupt sort of arousal

10:40

or disruption in our, in our brain rhythms

10:42

when we're sleeping. But it may not

10:44

last a long enough. Patients may not wake

10:46

up long enough to remember that that

10:48

occurred. So they forget that event

10:50

and then they just think that nothing has happened. Is

10:53

It all night continuously or because

10:55

and the reason I ask that , cause you and I have, I've known

10:57

you for years and I've learned more about sleep from you than any

10:59

other living human being and I know that there's different

11:01

cycles of sleep overnight. Does, does

11:03

the apnea occur continuously through

11:06

all sleep cycles or does it wex

11:08

and wane

11:08

Overnight? Yeah , we cycle through two different stages

11:10

of sleep. Non REM sleep and REM sleep.

11:13

In REM sleep it's very interesting

11:15

because our muscles during REM sleep are

11:17

paralyzed except for our breathing muscles

11:20

and our eye muscles. That's why they call it rapid eye

11:22

movements or our eye muscles are moving and we

11:24

can breathe, but the rest of our muscles, including

11:26

our tongue is way more

11:28

relaxed than in non-rem. So

11:31

in REM sleep we tend to see sleep apnea

11:33

becoming much more severe in terms of the frequency

11:35

and even the oxygen. Desaturations

11:38

Ren , what would cause a person to wake up?

11:40

Is it simply the severity of the obstruction

11:43

or why don't they just, you know , pass

11:44

Out? Yeah, that's a great question. So sometimes

11:47

the fact that the throat is actually obstructing

11:49

can be irritating and someone will wake up.

11:52

But the brain is really smart. It says if I'm

11:54

not getting oxygen, I need to do something

11:56

different. And then there's a momentary

11:58

awakening, the muscles constrict and

12:00

then the patient is able to

12:01

Breathe. It sounds like it's kind of an evolutionary

12:04

necessity that you wake up in <laugh> , otherwise

12:06

we'd all be dead. Mother

12:07

Nature knows. Absolutely.

12:08

Exactly. I've heard that certain foods can make it worse.

12:10

You've mentioned alcohol. Anything else? You

12:12

know,

12:12

As I was mentioning a little bit earlier, the airway

12:15

can be very sensitive to uh

12:17

, collapsibility, but other

12:19

things kind of make the airway or the soft tissue

12:21

in the back throat swollen. So if we have

12:23

things like GERD or reflux or

12:26

spicy foods or anything that can irritate

12:28

the back of the throat, like even smoking can

12:30

make it really congested in the back of the throat, that's

12:33

gonna narrow the airway and it's gonna make it

12:35

more easy to collapse at night.

12:36

So one more reason not to smoke, that's

12:39

an easy one, but you're not gonna tell me I can't like have a

12:41

, a burrito or something out cause it's spicy <laugh>

12:43

or good Indian food. <laugh> , you

12:44

Can have whatever you want, especially Indian food. <laugh>

12:46

,

12:47

You know what, I'm ready for a nap and

12:50

I'm not even kidding. I can take a nap almost anytime

12:52

. <laugh> . Uh , so I'll take a short

12:54

break here and when we come back we're gonna talk

12:56

about what can be done about sleep. Aptio

12:59

stay with us. We'll be right back.

13:02

You are listening to the Healthy Matters podcast with

13:04

Dr. David Hilden . Got a question or

13:07

comment for the doc, email us at

13:09

Healthy Matters hc m

13:11

e d.org or give us a call

13:13

at six

13:15

one two eight seven three talk. That's 6

13:20

1 2 8 7 3 8 2 5 5. And now let's get back to more

13:22

healthy conversation.

13:25

And we're back with Dr. Regi Verese talking

13:27

about sleep apnea. You talked a little bit earlier

13:29

about , uh, things you ask patients

13:32

about symptoms they might have, but when

13:34

they get to you at the Minnesota Regional

13:36

Sleep Disorder Center, how do you diagnose

13:39

it officially and say a little bit more about

13:41

where you work?

13:42

So the first thing that we do is we have the

13:44

patient come in. Usually we like to have patients

13:46

come in with their spouses or their bed partners to

13:49

get some collateral information. We do a

13:51

comprehensive physical examination and

13:53

a just a history of how they're doing. Ask

13:56

questions about how they're sleeping and , uh, how they're doing

13:58

during the daytime. And if we think that

14:00

they may have some obstructive sleep apnea, we'll do

14:02

sleep studies. And nowadays we can

14:04

do sleep studies at home. There's a little

14:06

device that we wear on, on our wrist

14:08

and, and we can get information from a patient's

14:11

, uh, sleep while they're at home. And

14:13

then we also have a comprehensive sleep study where patients

14:15

sleep in our lab, we put electrodes

14:18

on their scalp, a couple of sensors near their mouth,

14:20

nose near their eyes, chest and abdomen.

14:22

And we just have them sleep through the night and figure out

14:24

whether they

14:25

Have it. Can I just tell you that sounds awful , <laugh>.

14:27

What do you mean they're gonna sleep through the night? Yeah, we

14:29

put a sensor around your nose in

14:31

your head. Now go to sleep. Really?

14:34

Can people do

14:34

It? People do. People do. And if they can't,

14:37

if we have some concerns, and I do ask that question,

14:39

I I do give a sedative at night

14:41

or a sleeping pill for those patients, they say,

14:43

gosh, I I really don't think I can

14:45

do it. And, and that won't mess up our data. Our

14:48

sleep center's been around for this year,

14:50

Dave , 45 years. It was founded

14:52

in 1978. It was one of the earliest

14:55

sleep centers in the country. It was founded

14:57

by Milton Enger , one of the former chairs of neurology

14:59

and, and his protege, Dr. Mark Ma Howell

15:01

, I mean it's historical

15:03

Sleep center . And um , just last

15:06

week we were honored by the American Academy

15:08

of Sleep Medicine for being an accredited

15:10

site for 40 years. Um, this

15:12

centered discovered REM sleep behavior disorder,

15:15

which is considered by many as one of the most

15:17

important neurological sleep disorders.

15:19

Congratulations on that. Anterior predecessors,

15:22

I, I knew , uh, Dr. Maha well and

15:24

I even got to meet Dr. Edinger , uh, uh,

15:26

a few years back. Truly, the Minnesota

15:29

Regional Sleep Disorder Center is a pioneer

15:31

in this field and continues to this day to

15:33

not only care for patients but advance the science. It's

15:36

located right here in downtown Minneapolis at Hennepin

15:39

Healthcare . Okay. Ren , a lot of people wear fitness

15:41

devices and Apple watches and Fitbits

15:44

and the like, and a lot of 'em will tell you how well

15:46

you slept. Is that a

15:48

valid measurement? Is that something that you think

15:50

about when you're, when you're helping people who aren't sleeping?

15:52

Well,

15:53

I, I do get this question a lot and people do

15:55

bring their devices whether , uh,

15:57

it be wrist worn or otherwise. And these

16:00

devices are pretty good, not perfect, they're

16:02

not as close to a medical grade device, but

16:04

they can give us some parameters. They

16:07

can give us an idea of how, what time

16:09

people might fall asleep and what time people might

16:11

wake up. It's a good correlation of when

16:13

people might stay in their REM sleep because there's

16:16

virtually no movement during that time

16:18

and there's changes in heart rate. So these

16:20

algorithms are figuring that out, but they're

16:22

not as good as picking up on

16:25

sort of the depth of sleep that people are in.

16:27

But these devices also have oximeter on

16:29

them now and those are getting to be fairly

16:32

good. Maybe close but not nearly close

16:34

to medical grade

16:35

To measure the oxygen in your Absolutely. Yeah

16:37

. Which is one of the primary problems, right?

16:39

Absolutely. And patients bring that in and I kind of go,

16:41

well, this is worth inspecting

16:43

and we should maybe do an actual sleep study and

16:45

figured this out. So

16:46

You've alluded to what people can do in their

16:48

lifestyle to help mild sleep apnea,

16:50

avoid alcohol and things like that. Um,

16:53

you know, maybe sleep on your side. What treatments

16:55

are available for people who need more?

16:58

So again, if you're symptomatic, if you have

17:00

risk factors for, you know, heart

17:02

disease, strokes, blood pressure,

17:05

we really want you to get treated. And the

17:07

mainstay Gold standard therapy has always

17:10

been C P A P , continuous positive airway

17:12

airway pressure, which is just essentially a box that

17:14

blows room air, that's humidified

17:16

, uh, gentle air that's sifts

17:19

through a mass and keeps that airway

17:21

nomadically open. But that isn't the only treatment.

17:23

We look at the data on about 50% of people that

17:25

start C P A P after a year of uses , when

17:28

you look back into them , about 50% have stopped.

17:30

So we know we need to have different alternatives and we

17:32

do. So we now have, and we

17:34

have had for a long period of time, little

17:37

retainers for your mouth. We call them mandibular

17:39

advancement devices. And these things are custom

17:42

molded by sleep dentists to

17:44

move the lower jaw forward. And if, you know, if

17:46

you move the lower jaw forward, you're also moving the

17:48

tissue, including the tongue forward.

17:50

And so if we can put that in before someone

17:53

sleeps, the jaws moved forward, the

17:55

tongues moved forward, the airway is a little bit more

17:57

open and the sleep apnea is corrected.

17:59

How far forward? Because I'm imagining somebody

18:02

with a giant underbite all night

18:03

Long. <laugh> . So it depends on when the

18:06

snoring is dissipated. We might have someone

18:08

come back in for another sleep study with these

18:10

, this device in place. And we

18:12

do have to be careful because people can

18:14

have joint issues by their cheeks

18:16

called the temporal mandibular joint with some of these devices.

18:19

But the devices are so slick nowadays

18:21

this is becoming a little bit more of the norm than

18:23

sort of the exception. But we also have

18:25

other treatments as well, surgical options and

18:28

uh , some devices that are out there that actually move

18:30

the tongue forward with , uh, a little vacuum

18:32

seal. These

18:33

Get advertised a lot.

18:35

Uh , they do this surgical option , um,

18:37

is uh , a device that

18:39

sits in your chest , uh, and has a wire

18:41

that is dug underneath your neck and it

18:44

, it touches one of the nerves in our tongue.

18:46

And at night you turn this device

18:48

on and when this device

18:50

figures out that you might have a sleep apnea

18:53

event , it'll stimulate the nerve, which stimulates

18:55

the muscle of the tongue and moves the tongue forward

18:58

and you turn it off in the morning. Really good data

19:00

that it works. You have to have failed

19:02

a couple of different treatments to figure out whether

19:04

this is an option for you. And it's only good

19:06

for people that have not too severe

19:09

sleep apnea and not over a certain bmi.

19:12

I have

19:12

To ask the question, it's probably on a lot of people's mind. Is

19:14

that safe? I mean, you're putting a wire up,

19:16

up onto your tongue. I'm gonna guess

19:18

it is safe, but I want you to comment on the safety.

19:21

It

19:21

Is , it is ef it's approved by the fda.

19:23

So it is considered safe and efficacious

19:26

and it is generally safe. Um , we , it works

19:28

, it , it , it does work. And

19:30

I mean, you know, nothing is foolproof, nothing

19:33

has is ever without some side effects.

19:35

And the most common side effects that people notice is

19:38

that they may feel like their tongue is rubbing

19:40

against their teeth. So, but

19:42

well tolerated and really a helpful thing for

19:44

people. They can't tolerate other things.

19:47

So

19:47

Let's go back to c A P cuz that's what a lot of

19:49

people are wearing and I get patients all the

19:51

time and family members, some of 'em swear

19:53

by it, others is no biggie. And others say that

19:55

was miserable. You probably deal with this

19:58

all the time in your clinic. Peyton,

20:00

people who aren't loving their c A p , what

20:02

do you tell them or why is it that they're hard

20:04

for some people? Yeah ,

20:05

It can be a number of different things. One , sometimes

20:08

people feel like the mask itself doesn't

20:10

fit them well and that's okay cuz there are

20:12

different sizes, different types of masks

20:15

that are out there. So we start with is it

20:17

the right mask? If it isn't, sometimes people say

20:19

it's too much pressure coming out of this tube and I want

20:22

to , I want you to lower the pressure. And sometimes

20:24

we do that so that they can get acclimated

20:26

over time to be able to use a C

20:28

P A P . But then other times that's not gonna work.

20:31

And sometimes I bring them back into the lab and

20:33

sometimes we transition them to a device

20:36

called a BiPAP . And there's some literature

20:38

that suggests that BiPAPs can feel

20:40

more comfortable compared to A C P

20:42

A P .

20:43

Before I go on to sort of the future

20:45

and some of the other newer things that are out there, what

20:47

happens if, if you simply leave this untreated?

20:50

So you're , if you're sleepy because

20:52

your sleep apnea is untreated, you have higher

20:54

risk for not being as productive at work. Okay,

20:56

fine. You are higher risk for motor

20:59

vehicle accidents. You're higher risk for

21:01

having an accident. If you're operating, you

21:03

know, heavy machinery, your mood might

21:05

be disturbed. You might not think this clearly, but

21:08

then let's start talking about all the cardiovascular

21:11

outcomes. You, again, are higher

21:13

risk for cardiovascular problems like

21:15

coronary artery disease strokes, sudden

21:17

cardiac death, congestive heart failure, resistant

21:20

hypertension. It's just wear and

21:22

tear on the body.

21:24

Lots of good reasons for getting your

21:26

sleep apnea treated. Plus you , you maybe won't

21:28

go through a sleep divorce too

21:30

<laugh> for

21:31

Sure. Maybe your bed partner won't kick you out

21:33

of the house and put you behind three double doors.

21:36

So what,

21:36

What other

21:37

Cool things are out there in the future? Is there some

21:39

pill that's gonna make it go away or are there some other devices

21:42

or what are you seeing down the road

21:44

Again? Yeah, this is interesting. We

21:46

don't have a pill, but people

21:48

are working with a combination of

21:51

molecules that do keep the airway

21:53

a little bit more stiff. That's

21:56

really early, early device. But the preliminary

21:58

results are that it kind of works and it's

22:00

usually good for people to have mild obstructive

22:02

sleep apnea, not severe obstructive sleep apnea.

22:06

Uh, there are techniques that you

22:08

can use. Uh , singers, have you ever

22:10

heard of singer use something called circular breathing?

22:13

Mm-hmm . <affirmative> or people that use the diri do there

22:15

are muscles, no, I don't

22:16

Know that last word you just said .

22:17

The witch the diri do is

22:19

a , uh, an aboriginal instrument.

22:22

It's an indigenous aboriginal instrument. It's

22:24

a long tube that has this like

22:26

Me

22:27

Sound to it. And when you

22:29

start to use your,

22:30

I totally know what you mean by way you've done it <laugh>

22:32

.

22:33

Um, when people use this instrument

22:36

or use this circular breathing or just kind of engage

22:38

in these breathing exercises, you can

22:40

strengthen up the muscles of the back of the airway

22:43

that you can reduce mild sleep apnea.

22:45

But this requires daily training, 30

22:47

minutes or so and even longer. But

22:50

as you mentioned, are there other devices out there? Yes,

22:52

there are devices that you can put on

22:55

your tongue for 30

22:57

minutes a day that will stimulate

23:00

the tongue muscles so the tongue muscles

23:02

become stronger so that it, you know, reduces

23:04

the sleep disorder breathing.

23:05

You're joking. I'm not kidding . There's a thing you put on your

23:07

tongue while

23:08

You're awake and you just leave it in your tongue when

23:10

it's hanging out. It's battery operated and

23:12

it will strengthen the muscles of the tongue and

23:15

keep it a little bit less prone to collapse.

23:17

It's

23:17

Battery operating and it strengthens the muscles

23:20

of your tongue. I have never heard of that.

23:21

Absolutely. Do

23:22

People use that?

23:23

Uh, I do not have any of my patients,

23:26

but the folks that are at the VA have several

23:28

patients that have gone through it and some love it and

23:30

some feel like it's not the right thing for them . Right.

23:32

And I love that thing about the circular breathing

23:35

thing. In a little side note, at one time I , I'll

23:37

admit this, I went to a Kenny GE concert

23:39

one time <laugh> . I did, I did. He

23:41

played a note that was like eight minutes long and he

23:44

never took a breath. Yeah . So he was playing and , and

23:46

circular breathing. That's exactly right. I like your

23:48

aboriginal , uh, sound effects better. You have

23:50

a career in sound effects. Appreciate it. Dave.

23:53

I <laugh>, what, what would you, leave

23:55

us as we close it off here, Ren . Um, what

23:57

would you like to tell people who are , uh,

23:59

maybe not sleeping well, who think they might have sleep apnea?

24:01

What, what would your closing tips be if

24:04

you're young? Don't wait. Get

24:06

it evaluated. Have someone sort of,

24:08

if you're sleep sleeping with someone, just have

24:11

someone kind of keep an eye on you. There are

24:13

apps actually that you can download that

24:15

will measure snoring levels and

24:17

even sort of estimate whether you have apnea as

24:19

well. If, if that's not the

24:22

case and you suspect that you're sleepy during

24:24

the daytime, if you feel like you're not getting good quality

24:26

sleep, if you're waking yourself from snoring, tell

24:29

your doctor, tell your doctor and they

24:31

will likely refer them to a

24:33

sleep physician and we'll get the ball rolling. I,

24:35

I think the answer is, it's so common.

24:38

It's so easily diagnosable and

24:40

it's so treatable and the the

24:42

gains are so big and the risks

24:44

are too big that you might as well

24:46

get the gains and not, and , and avoid the risk. That's

24:49

a great message to leave us with. There's so much

24:51

to be done about this. Ren Verese , thank

24:53

you for being on the show with me today. I appreciate

24:56

it Dave, thank you. We've been talking to Dr. Ren Verese

24:58

. He is a physician and a sleep

25:00

specialist at the Minnesota Regional

25:02

Sleep Disorder Center here in downtown

25:05

Minneapolis. And a colleague of mine and a frequent

25:07

guest of mine. Whenever I can get some of his

25:09

time to talk about his expertise.

25:12

That's all we have for today. I hope you'll join us

25:14

for our next episode when we're gonna tackle the

25:16

subject of Alzheimer's Disease.

25:18

It's gonna be a great show. I hope you'll

25:20

tune in and in the meantime, be healthy and

25:23

sleep well.

25:25

Thanks for listening to the Healthy Matters podcast

25:28

with Dr. David Hilden . To find out

25:30

more about the Healthy Matters podcast or browse

25:32

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25:35

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25:44

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26:02

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26:04

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26:06

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26:09

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26:11

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26:13

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