Sleep Apnea and your Health

Sleep Apnea and your Health

Got Sleep?  The realization that snoring and sleep apnea can be a true health hazard, just as much as diabetes and smoking, had never occurred to me until I went to Dallas, Texas and went to listen to Dr. Kent Smith lecture on sleep apnea.  His presentation, Wasted Days and Sleepness Nights, has provided me with the paradigm shift that will change the way I provide care to my patients from this moment on. 

Did you know snoring is a pathology.  Yes, a medical problem that needs to be addressed.  Snoring is the noise created by the closing of the airway during sleep.  Snoring during sleep can be a problem in spousal relations, but that is not the pathology I am talking about.  Snoring may lead to a lack of oxygen to the body as the airway closes up.  This, in turn, may cause the body to be restless and not get the kind of deep, sound sleep that nourishes the body and mind.  Snoring is very often a symptom of the complex physiological changes that we see from this oxygen deprivation. or apnea.

Do you or your spouse snore?  Are you tired during the day?  Very often patients undergo a sleep study, where they go to sleep in a hospital or ‘hotel-type’ room where they are monitored for airway patency, heart rate, loudness of the snoring, oxygen saturation and position.  You have probably known someone who has undergone a sleep study. Or, perhaps, you have had a sleep study performed.

This can now be performed in your own home, in your own bed.  It is a non-invasive test that can be done with a mobile device, the Itamar PAT-200 watch, which is about the size of an iPhone.  The data is then uploaded to a software program that analyzes your health while sleeping.  A sleep physician can be emailed the raw data and then can read the results, thereby providing input such as a diagnosis.

Getting proper diagnosis and treatment for sleep apnea can be a lifesaver.  A real lifesaver.  No joke.  These patients can develop a myriad of diseases, not the least of which are heart attacks and strokes. It is one thing to be tired and snore.  It is vastly different if you die from this. There is quite a list of signs and symptoms attributable to sleep apnea, including hypertension, depression, irritability, impotence, acid reflux and heartburn, to name a few.

The medical field treats these patients with CPAP machines (an acronym for Continuous Positive Airway Pressure).  The problem is that the CPAP has a low compliance level.  The mask is uncomfortable and claustrophobic.  And, if a patient wakes up in the night for a drink of water or to answer the call of nature, very often the CPAP is not put back on.  Traveling is also difficult to do with the CPAP.

Hence, we can now make an oral appliance that is comfortable for the patient that brings the jaw slightly down and forward so that the airway remains patent (open).  This oral appliance comes in many shapes and sizes, but the latest is an appliance made by a company from Texas called Somnodent.  The long-term commitment by this company and the consistent quality of their appliances is impressive. 

So, if you snore should you just get the appliance?  Absolutely not.  A sleep study is a must,  whether it is done in a hospital/sleep center as a PSG (polysomnogram) or on a mobile device in your home.  Even if a person stops snoring, they can still be a ‘silent apneic,’ not snoring but still having the physiological problems associated with sleep apnea. So sleep studies are a must.

Sleep is a complex series of events that can be broken down to its base elements of REM (rapid eye movement),  non-REM, deep and light stages.  The data from either the polysomnogram  or mobile device delineates and breaks down the timeline so that we can see what is happening during sleep.  Are there any serious drops in oxygen dissolution and when do they occur?  Does the heart rate increase to dangerous levels?  Are there respiratory arousals?

There is no one standard treatment in sleep apnea and each case is unique.  One protocol does not fit all patients.  Just as important as getting the initial data, proper diagnosis and the appropriate device, medication or oral appliance is the followup.  Three to six months post-delivery of a CPAP or oral appliance, it is essential to do a followup sleep study (again, at home or hospital/sleep center)  to see if the treatment is working.  A patient may say that they are feeling better, less sleepy and that he or she is not snoring, but the proof is in the data.   Followup study is essential.

I want to take this last paragraph to thank Dr. Kent Smith.  I will be writing more about this subject over the next few blogs and months.   His love for this subject is highly contagious. He told our group that he was interested in what happens to us in sleep since he was very young.  And, Kent, it shows.  He said that you may be able to create a beautiful smile, and that’s great.  But if you can also save a patient’s life by revealing and treating a serious disease like sleep apnea, now isn’t that something?  Thanks, Dr. Smith.

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