Understanding Sleep Apnea: A Guide for Patients

Millions of people suffer from sleep apnea, a condition that disrupts sleep and impacts overall health. In this episode, we discuss the types of sleep apnea, how it occurs, the health risks, and various treatment options available to improve sleep quality and overall well-being. Tune in to learn if you, a loved one, or a neighbor may be experiencing sleep apnea and find out how to get help.

Takeaways

• Sleep apnea affects roughly 25% of adults.
• It is a serious medical condition beyond just snoring.
• CPAP is the most common and effective treatment.
• Weight loss can significantly improve symptoms.
• Daytime sleepiness is a key symptom of sleep apnea.
• Sleep studies are essential for accurate diagnosis.
• Obstructive sleep apnea can lead to cardiovascular issues.
• Alcohol and sedatives can worsen sleep apnea.
• There are surgical options for severe cases of sleep apnea.
• Awareness and evaluation are crucial for those at risk.

Keywords

sleep apnea, CPAP, symptoms, diagnosis, treatment, health risks, obstructive sleep apnea, sleep study, healthcare, patient education

Chapters

• 5:00 The Learning

Transcript

Ed Delesky, MD (00:09)
Hi, welcome back to your checkup. We are the Patient Education Podcast, where we bring conversations from the doctor's office to your ears. On this podcast, we try to bring medicine closer to its patients. I'm Ed Delesky Family Medicine resident in the Philadelphia area.

Nicole Aruffo, RN (00:23)
and I'm Nicole Aruffo. I'm a nurse.

Ed Delesky, MD (00:24)
And we are so excited that you were able to join us again here today. I saw God in the chilies today.

Nicole Aruffo, RN (00:31)
Yeah, we went to church. We went to church today while we, we've had a whole day. I'm tired.

Ed Delesky, MD (00:39)
We did have a big day. A wedding venue.

Nicole Aruffo, RN (00:41)
We looked at a wedding venue. Hi, Heather. Hope you're listening.

Ed Delesky, MD (00:45)
Heather's listening. We had a good conversation with her. What a bubbly woman.

Nicole Aruffo, RN (00:50)
And then we went and picked up my brother's girlfriend and we went to church, AKA. We went to the Chili's across the street and got mozzarella sticks.

Ed Delesky, MD (01:01)
Yeah, well, because they this has been like a week long, maybe two journey where you found the mozzarella sticks.

Nicole Aruffo, RN (01:09)
Well, they're like getting served to me on TikTok and that's like the new thing. Everyone's going to Chili's to get these mozzarella sticks. It's really not a stick. It's like a brick, a mozzarella brick. And.

Ed Delesky, MD (01:24)
It's a mozzarella brick.

Nicole Aruffo, RN (01:28)
Yeah. They actually were like really good. Yeah. That was my first time in Chile.

Ed Delesky, MD (01:29)
No, was delicious.

Actually, the whole thing was really good. Really downplayed chili menu. Chaotic. Very colorful. All over the place. Couldn't tell what we were ordering, but got the appetizers, got their bonus wings, which I guess are just chicken nuggets. That was delicious.

Nicole Aruffo, RN (01:54)
Vanessa ordered fries and you ate them all.

Ed Delesky, MD (01:57)
This no, she didn't even notice that the fries were gone by the time that it came to stop eating. So we did that. Then we came all the way back to Philly and here we are doing this. Ready to talk.

Nicole Aruffo, RN (02:08)
We got a tour of my brother's bourbon collection. He didn't want to come to church with us because he was like working on the house or something.

Ed Delesky, MD (02:16)
OK,

Chili's is like not that.

Nicole Aruffo, RN (02:25)
There is a specific group of people who go to Chili's at like noon on a Sunday.

Ed Delesky, MD (02:31)
Yeah,

we're in that group.

Nicole Aruffo, RN (02:33)
part

of that community now. So he didn't want to go, so then we stopped by the house and he showed us all of his bourbon.

Ed Delesky, MD (02:42)
The guy's got like five to $700 of bourbon just laying there. He likes it a lot.

Nicole Aruffo, RN (02:46)
He

has like the official tasting glasses and everything.

Ed Delesky, MD (02:51)
I wasn't so impressed about the glasses, but he had like four different types of the same brand.

Nicole Aruffo, RN (02:56)
the 1972 or something.

Ed Delesky, MD (02:59)
1792. Columbus sailed the ocean. It's actually 1492. Horses.

Nicole Aruffo, RN (03:02)
horses.

on the, what's that, Blanton's or something. It has the horse on top.

Ed Delesky, MD (03:14)
You were there with him and he was explaining the whole eulogy of the whiskey and I didn't get that part. I'm impressed though. mean, like it's all there. I agree, he should display it rather than putting it in a Rubbermaid in the basement. It gives more moonshine if it's in a Rubbermaid in the basement. does valuable liquor that's in his house.

Nicole Aruffo, RN (03:39)
Yeah.

Ed Delesky, MD (03:40)
I did that. then lots of slow cooker recipes. They go on these runs where I just like want to make every meal that I can.

Nicole Aruffo, RN (03:48)
which is really convenient because I think it times perfectly when I don't feel like cooking.

Ed Delesky, MD (03:54)
Yeah, works out well. So I made this honey teriyaki, teriyaki? Yeah, honey teriyaki slow cooked chicken. was some Instagram recipe. I had to watch the reel like 70 times because my squirrel brain couldn't keep up and fathom what it was. Made that. That was delicious. He coupled that up and then made a garlic parm slow cooked chicken yesterday over pasta.

Nicole Aruffo, RN (04:21)
delicious.

Ed Delesky, MD (04:22)
And a milkshake, which is also really good. I like there was something else I wanted to say.

Nicole Aruffo, RN (04:29)
Anything else riveting happened this week our dryer broke this morning That was annoying

Ed Delesky, MD (04:35)
Yeah, that's,

I mean, there are, there are worse things, but I mean, you got creative. You had to like lay everything out to drive.

Nicole Aruffo, RN (04:43)
I think all of our scrubs are washed and dried for the week though, so.

Ed Delesky, MD (04:47)
helpful. That's good. make that happen. And heading tonight this week, which I don't want to think too much about, but that's happening.

Okay. And on that fun, fun note, let's get into it. Let's see for our guests. That was about five minutes. So we'll remember that if anyone wants to skip our chit chat upfront and just go straight to the learning. So what are we going to talk about today, Nick?

Nicole Aruffo, RN (05:16)
We're talking about sleep apnea today, Ed.

Ed Delesky, MD (05:20)
I didn't even do it to you that time. Did you know that roughly 25 % of adults are at risk for some degree of sleep apnea?

Nicole Aruffo, RN (05:29)
I didn't, just at risk.

Ed Delesky, MD (05:31)
Yeah.

at risk. I think it's a tough thing to capture because you don't have that many people who are going to get evaluated actually. But let me tell you, I lead off with a little story here. I was sitting with someone who is really close to me and we were talking about. No, I'm trying to know, no, not your dad. I'm trying to keep it a little keep it a little open ended here, anonymous to know I miss people's health history. So we're sitting there, we're talking and.

Nicole Aruffo, RN (05:50)
My dad.

Ed Delesky, MD (06:04)
the way that his entire life was changed by just getting a CPAP machine to actually treat his sleep apnea. Like he was sleeping better throughout the night. He was more awake during the day. He could think clearer, have more energy. And this thing is so common that, like, how do you not think about it? I just, it baffles me and my hope today is that with this episode, we can actually wrangle some people in who are at risk to just

Go get evaluated. That's my big takeaway. So sleep apnea is actually more than just snoring. It's really a serious medical condition, and it can have a major impact on your overall health and the quality of life that you have if you leave it untreated. But can you take us through what is sleep apnea, actually?

Nicole Aruffo, RN (06:56)
Sleep apnea is a sleep disorder characterized by repeated pauses and breathing or shallow breaths during sleep.

Ed Delesky, MD (07:04)
So sleep apnea leads to this disrupted sleep, these pauses called apneas or hypopneas. They disrupt sleep, they lead to poor sleep quality and daytime consequences. I'm gonna kind of deviate off of the outline here a little bit. They create these moments where your body feels like it's in danger. Oxygen drops and your body goes into this fight or flight response, which increases your heart rate.

It increases your blood pressure and it activates what this sympathetic nervous system, which is the type of nervous system in your body that's activated in moments of danger. And just think that that is being activated multiple times a night because whoever has sleep apnea literally stops breathing for one of two reasons that we're going to explain. But that happens repeatedly over and over and over again tonight, which is a lot of stress on the body.

So can you take us through what the two flavors of sleep apnea are?

Nicole Aruffo, RN (08:08)
What are the two flavors of sleep apnea? Eddie?

Ed Delesky, MD (08:11)
So it comes in obstructive sleep apnea, which is the most common type. And this happens when the throat muscles relax and collapse. And then they block the airway during sleep. Now, this is contrasted to central sleep apnea. This is more rare, thankfully, because it's just when the brain fails to send the message to the body that the muscles that control the breathing should be working. So.

We're not going to get into too much about that. But then there also is this land where there's a mixed picture where the muscles relax in the throat and the brain doesn't send the signal the right way. So that's how you get a mixed picture sleep apnea.

Nicole Aruffo, RN (08:54)
So it seems like there are a bunch of causes.

Ed Delesky, MD (08:58)
Yeah, there are. So like I mentioned earlier, muscle relaxation is one of them. So we talked about how those muscles in the throat kind of naturally relaxed during sleep. And then people with OSA, this relaxation is kind of over the top and it can lead to that airway narrowing and the closure. There are other anatomical risk factors as well. And this kind of gets at how different populations of people can have it as well. Obstructive sleep apnea. So.

Nicole Aruffo, RN (08:58)
What are they?

Ed Delesky, MD (09:27)
People can have large tonsils or adenoids and this can oftentimes happen in children and this itself can obstruct the airway.

Nicole Aruffo, RN (09:35)
Or wait, we were just watching Real Housewives of Orange County and what did Terry get? Terry Dubrow. He like got a nose job so he wouldn't have to get a CPAP or something. What did he get done? I think it was his nose.

Ed Delesky, MD (09:54)
think he had deviated septum. Did he? I don't know. He had something and he didn't snore anymore. I think he deviated septum and he had it corrected. And like they called it that but it was a nose job.

Nicole Aruffo, RN (10:06)
He's like I got a nose job so I wouldn't have to get a CPAP.

Ed Delesky, MD (10:11)
So all that to say that you can have large tonsils or adenoids. You can have a small mouth or a small jaw. And so that smaller lower face or smaller mouth proportionally to a large tongue also increases the risk. And there are other situations like we've done several episodes back in August about obesity and having obesity itself, particularly a thicker neck, puts pressure on the airway and makes it more likely

for those airways to collapse.

Nicole Aruffo, RN (10:43)
In the beginning you talked about 25 % of people being at risk for sleep apnea. So what would put someone at risk?

Ed Delesky, MD (10:52)
Great thoughts. So age is something that puts people at risk. Obstructive sleep apnea with increasing age, especially in middle-aged and older adults. Someone's sex. So obstructive sleep apnea is about twice as more common in males than it is females, and especially in middle-aged males. So I will say that this risk levels out after menopause. And there's a couple other things, like cardiovascular risk also levels out after menopause.

Genetics, OSA can run in families. I don't think you're gonna find one specific gene that you turn on and turn off, but I just think you'll see trends in families. Alcohol and sedative use, using alcohol and certain other medications to help you sleep can relax the throat muscles, sometimes a little too much, which can worsen obstructive sleep apnea. Yeah, so and actually using hormone replacement therapy in men actually may increase the risk as well.

Nicole Aruffo, RN (11:48)
Okay. So everyone knows that snoring is a symptom of sleep apnea. Sure. What else is there?

Ed Delesky, MD (11:55)
So yeah, that's the most noticeable sign, especially if they're punctuated by pauses or gasps, which can kind of be a disturbing thing to see. But the more subtle signs often present themselves and people aren't able to make that connection. So I'm talking about daytime, excessive daytime sleepiness. And this is the hallmark symptom, aside from snoring and people always feeling tired or drowsy, even after a full night's sleep, I can think of two.

people in our lives who always are like this. And that was a huge thing that I think they both recognize now. Waking up unrefreshed. People with sleep apnea often report that they're feeling unrested, they're groggy when they wake up. And even like when they feel like they've had an adequate sleep, it still isn't quite enough. Morning headaches. I mean, these are common due to the drop in oxygen that happens over and over and over again at night.

So people can have morning headaches. I mean, there's a lot of reasons people can have morning headaches, but.

Nicole Aruffo, RN (13:01)
Sleep apnea.

Ed Delesky, MD (13:03)
I don't know. Difficulty concentrating. Sleep deprivation from the apnea itself can impair cognitive function, making it harder for people to focus and think clearly. I see it all the time. Honestly, I see it in the office. I see it in people I know and love outside. There are other signs. Like sometimes people wake up and they have the choking. They have gasping. They have a dry mouth, a sore throat in the morning. And this one, very interesting, comes up all the time.

and I see this in a lot of my patients is frequent nighttime urination. I didn't have this conversation with a sleep doctor. I had it with a urologist because so many times men would go to their urologist and say, I'm getting up five, six, seven times a night to pee and what's going on? And they get their prostate checked out and their prostate's fine. And it turns out that that fight or flight response that is activated when

those moments of paused breathing happen, increases this hormone, a natriuretic peptide, which makes you pee more. And it only happens at night when the stress of the sleep apnea is happening. And so you get nighttime peeing because this hormone is released at night.

Nicole Aruffo, RN (14:18)
Oh

yeah, this is what you were talking to my dad about at the beach and then he wore a CPAP that night and the next morning he's like, I slept all night. I all night, I didn't Like I told you.

Ed Delesky, MD (14:28)
Yeah. And like I've

people will come in and they're like, I think I need to go see the urologist. And I'm like, no, I think you need to go see the sleep doctor. This was I learned this in med school. I remember the doctor Gore. He he taught me this and it stuck with me because I thought it was so interesting, like just how that works in the body. And that's yeah, I just wanted to take a little time to talk about that. So interesting. Obviously, the other symptom is an unhappy bed partner.

because the snoring itself is really usually disturbing to the person that you're sleeping with. Also disturbing because they're probably witnessing the person that they're sleeping next to. Yeah, I mean, that's so that's not cool. So. Hate when that happens. So those are all the symptoms. Some of the more obvious, some of the more subtle, which can be sneaky.

Nicole Aruffo, RN (15:08)
Stop breathing.

Even that happens.

Okay, so we have all these symptoms of sleep apnea. How does one get diagnosed?

Ed Delesky, MD (15:27)
I wish I could just do it. I really do. It's so simple and I'm not sure that I can order it, but what it is is called a sleep study. So you have to go, you have to be seen by your physician and usually you'll end up being referred to a sleep doctor.

Nicole Aruffo, RN (15:41)
you can't like order.

Ed Delesky, MD (15:42)
Well, I've never done it before. And I don't know if that makes me a wimp or or what, but there are sleep studies. It's called a polysomnogram. And it really is the standard for diagnosing sleep apnea. What it does is it monitors everything during sleep, your breathing effort, airflow, oxygen levels, heart rate, stages of sleep and body movements during sleep. And I mean, what I'll say is that there are home sleep studies. I think a lot of people

probably have this picture in their mind that they have to go somewhere else. They have to arrange a whole night that they're not going to sleep at home. And it may come to that, but there are home sleep studies. And it could be a good option for people who have moderate to severe sleep apnea, who don't have other complicating health conditions. When it's moderate to severe, I'll say it's kind of obvious. So you'll really hit the threshold from a home test. But if.

It's more mild cases. It'll probably be less accurate and you may have to do an in lab study, which isn't the end of the world. It's one night and you make the arrangements if you can. And you might be getting a whole world of benefit just from doing this simple study. So it's the sleep study. Someone may be able to tell you whether you're at risk based on your age, the size of your neck. Someone can look inside your mouth and see like how much stuff.

is in the back, how much tissue, how much at the back of the throat you can see. Those things can tell you about the risk. I can pretty much eye someone up and tell you like a high risk, low risk for sleep apnea, but the sleep study is where you're at.

Nicole Aruffo, RN (17:17)
Okay,

so we get our sleep study. We're diagnosed with one of the flavors of sleep apnea.

What are our treatment options?

Ed Delesky, MD (17:28)
So I'll lead it off because the first and best, most common treatment is the CPAP, Continuous Positive Airway Pressure. CPAP is the most common, most effective treatment for moderate to severe OSA. It's a machine that delivers pressurized air through a mask that's worn over the nose or the nose and the mouth, keeping the airway open during the sleep.

This is a big bugaboo because a lot of people don't like it. We know that it's really effective and that probably about less than half of the people actually use it. So I say this knowing that it can take time to adjust to the CPAP. It can take time to find a comfortable mask, but the benefits are significant. So CPAP is the way to go. There's probably a ton of things out there to say like why people don't use it. I get it. It stinks, but

Once we get to talking about the health risks associated with sleep apnea, you may think twice. I will say there are some lifestyle changes that you can make. Weight loss is one of them. Losing a moderate amount of weight, 5, 10 % of your body weight, will really significantly improve your obstructive sleep apnea symptoms. We mentioned earlier in the episode that alcohol and sedatives can relax the throat muscles, so avoiding those. And something that kind of came up was sleep position.

And if you can actually lay on your side, it can prevent the tongue from falling back and blocking the airway, especially for people with positional sleep apnea. So, which is like basically sleep apnea when people are just laying on their back. So if you're laying on the side, your tongue just falls to the side, you may get some benefit. And exercise, of course exercise helps, but it also facilitates the weight loss as well.

Nicole Aruffo, RN (19:18)
What is someone at risk for if they do nothing to treat their sleep apnea?

Ed Delesky, MD (19:23)
Unfortunately, a lot like with this being so common. This is a really important thing to pick up. So people are at increased risk of cardiovascular disease, especially when left untreated. And so there is a very strong link to high blood pressure or hypertension. This almost like a lot of people have been listening to treat your high blood pressure, treat your hypertension with lifestyle changes. This episode is almost an expansion of that episode because the repeated drops in oxygen

and surges in blood pressure during the apnea episodes contribute to overall hypertension. So treat your sleep apnea, treat your hypertension. That's great. People are also unfortunately at a greater risk of heart attack because of the stress to the cardiovascular system. Obstructive sleep apnea is a risk factor for stroke. It's actually a risk factor for abnormal heart rhythms. One of the most common ones being atrial fibrillation or something called AFib, which...

You could probably do a whole episode on other health problems include a worsening of the insulin resistance related to diabetes. There's some suggestion that sleep apnea can worsen depression. I mean, you put the connections together. If you can't sleep at night, you're tired during the day. You're not feeling good about yourself. You're suffering from major depressive disorder. Boom. It's just all worsening. People who already have deficits with cognitive impairment, worsening the memory.

concentration and overall cognitive function is a recipe for disaster. And because of the daytime sleepiness, people who are doing stuff also are at a higher risk for getting involved in car accidents or workplace injuries. So accidents increase. And there's some evidence that there may be a suggested link to dementia, but there's more studies that need to go out because I think you could find a lot of stuff that's related to dementia as we have an aging population.

So those are the health risks. And I mean, I think it's really important and easy to treat something like this. One thing I didn't mention is that there are some oral appliances to treat. Usually these are fitted by a dentist. They kind of reposition the jaw to help keep the airway open. I'm going to be honest, anytime in training, we've talked about sleep apnea, it's CPAP or the highway. Basically, there are other things. We can mention them briefly here.

usually a conversation for the specialist or the sub specialist.

Nicole Aruffo, RN (21:53)
Math sub specialist.

Ed Delesky, MD (21:56)
subspecialist.

Nicole Aruffo, RN (22:03)
We mentioned Terry Dubrow's nose job for his sleep apnea. It seems like there are a couple other more specific to sleep apnea surgeries that can happen.

Ed Delesky, MD (22:15)
Yes, there are. We don't talk about them a whole lot. I mean, if you fill your CPAP and you are for sure not going to use it, then maybe you need to consider other options. There is a uvulopaladofuringioplasty. Say that three times fast. That removes the excessive tissue in the throat, including the uvula and the tonsils. Seems like a lot. There is maxillomandibular advancement, where they take the bottom and

upper and lower parts of the jaw and they move them around to enlarge the airway and there is a hypoglossal nerve situa- What? my gosh. Wow.

Nicole Aruffo, RN (22:52)
my god, Turtee's pregnant!

Ed Delesky, MD (23:02)
that's so cute. Aww.

they look so happy.

this is the, that's an ultrasound. It's been out a little while. Aww.

Nicole Aruffo, RN (23:17)
Well, turd.

Ed Delesky, MD (23:18)
Well, we watched another.

Nicole Aruffo, RN (23:20)
god, I gotta go to their Patreon.

Ed Delesky, MD (23:22)
Nikki listens to a podcast. I joined in the toast. We went to one of their live shows. All right, we got to wrap this up so you can, you can go do that. So then there's hypoglossal nerve stimulation, which involves implanting a device that stimulates the nerve that controls tongue movement and prevents the tongue from blocking the airway. And there's a trick. I've never seen it for sleep apnea. I'm sure it exists and in very severe cases. So overall living with sleep apnea is something that

is possible. It can be a little tricky, but it's totally worthwhile. CPAP tips. You should really prioritize mask comfort. You should experiment with different types of masks to find out which one fits well and you shouldn't settle. Talk to your doctor, talk to your sleep doctor about using a mask that actually works for you because here in 2024, there's a lot of options. Make sure you use a humidifier machine with the CPAP to reduce dryness.

and irritation in the nose and throat. Make sure you clean your CPAP machine, which prevents infection and ensures optimal performance. And if you are having a problem with your CPAP machine.

don't hesitate to reach out because that's what people are here for. That's what your sleep doctor is there for. Reach out to them so that you can troubleshoot what's going on. What I really want you to take home is that obstructive sleep apnea is very common. It is treatable. And why don't you go out and see if you think you're one of these people who might be at risk. Why not ask? Why not get the evaluation so that you can see if there's anything going on that can improve your quality of life and all of that.

Thank you for coming back. Please come back and join us for another episode. Please share this with someone. Hopefully today you learned something for yourself, a loved one or...

Nicole Aruffo, RN (25:11)
a neighbor with sleep apnea.

Ed Delesky, MD (25:13)
Check out our website, leave us some fan mail, send us an email, look at our Instagram, and...

Nicole Aruffo, RN (25:19)
The

loyal listener might benefit from this.

Ed Delesky, MD (25:22)
I don't know, maybe our loyal listener would. And most importantly, stay healthy, my friends. I'm Ed Delesky Thank you and goodbye.

Nicole Aruffo, RN (25:29)
I'm Nicole Aruffo

Bye.

Ed Delesky, MD (25:40)
This information may provide a brief overview of diagnosis, treatment, and medications. It's not exhaustive and is a tool to help you understand potential options about your health. It doesn't cover all details about conditions, treatments, or medications for a specific person. This is not medical advice or an attempt to substitute medical advice. You should contact a healthcare provider for personalized guidance based on your unique circumstances. We explicitly disclaim any liability relating to the information given or its use.

This content doesn't endorse any treatments or medications for a specific patient. Always talk to your healthcare provider for a complete information tailored to you. In short, I'm not your doctor. And make sure you go get your own checkup with your own personal doctor.

Nicole Aruffo, RN (26:17)
I am not your nurse.