How do your sleep patterns influence not just your weight but your overall health as well? Dr. Audrey Wells is an authority on the convergence of sleep and obesity medicine. The founder of Super Sleep MD, she explains how sleep disorders like obstructive sleep apnea lead to excess weight.
She also explains the systemic obstacles within the healthcare domain that hamper the delivery of effective care for sleep troubles.
Have you ever considered that the timing of your meals could be as critical as their nutritional content for your sleep and metabolic health? In our dialogue with Dr. Wells, we explore the significance of the superchiasmatic nucleus—the brain's central clock—in orchestrating our daily rhythms of eating and sleep.
Learn why an alignment with daylight hours can help fend off hormonal imbalances and cognitive decline. Plus, discover a range of treatments for sleep apnea that go beyond the familiar CPAP.
From GLP-1 medications aiding in weight loss to innovative hypoglossal nerve stimulation, we examine how tailored therapies can provide effective solutions to these complex health challenges.
If you're seeking to improve your mood, manage hunger, or safeguard your long-term health against cardiovascular issues and dementia, this conversation is an essential listen.
Connect with Dr. Audrey Wells
Chances are, you wouldn't be listening to this podcast if you didn't need to change your life and get healthier.
So take action right now. Book a call with Dr. Ovadia's team.
One small step in the right direction is all it takes to get started.
How to connect with Stay Off My Operating Table:
Twitter:
Learn more:
Theme Song : Rage Against
Written & Performed by Logan Gritton & Colin Gailey
(c) 2016 Mercury Retro Recordings
How do your sleep patterns influence not just your weight but your overall health as well? Dr. Audrey Wells is an authority on the convergence of sleep and obesity medicine. The founder of Super Sleep MD, she explains how sleep disorders like obstructive sleep apnea lead to excess weight.
She also explains the systemic obstacles within the healthcare domain that hamper the delivery of effective care for sleep troubles.
Have you ever considered that the timing of your meals could be as critical as their nutritional content for your sleep and metabolic health? In our dialogue with Dr. Wells, we explore the significance of the superchiasmatic nucleus—the brain's central clock—in orchestrating our daily rhythms of eating and sleep.
Learn why an alignment with daylight hours can help fend off hormonal imbalances and cognitive decline. Plus, discover a range of treatments for sleep apnea that go beyond the familiar CPAP.
From GLP-1 medications aiding in weight loss to innovative hypoglossal nerve stimulation, we examine how tailored therapies can provide effective solutions to these complex health challenges.
If you're seeking to improve your mood, manage hunger, or safeguard your long-term health against cardiovascular issues and dementia, this conversation is an essential listen.
Connect with Dr. Audrey Wells
Chances are, you wouldn't be listening to this podcast if you didn't need to change your life and get healthier.
So take action right now. Book a call with Dr. Ovadia's team.
One small step in the right direction is all it takes to get started.
How to connect with Stay Off My Operating Table:
Twitter:
Learn more:
Theme Song : Rage Against
Written & Performed by Logan Gritton & Colin Gailey
(c) 2016 Mercury Retro Recordings
Oh, and we're back, phil. It has been way too long. This is the stay off my operating table podcast, dr Philip Ovedia. I'm Jack Heald. Phil and I have not looked at each other for at least three weeks, four weeks. This is our first recording of the new year, even though it's not the first recording you all are hearing. So it's good to be back. Glad you're here. Tell us about our guest.
Dr. Phillip Ovadia:Definitely. Yes, we had some holidays and all of our various travel schedules, but great to be back at it, really excited. Today we're going to have some great conversations around one of the main pillars of health that I talk about, which is sleep, and also, as it relates to obesity, metabolic disease, got a real expert. I was honored to be part of a upcoming summit that she has put together and we're going to talk about that some. But first I want to get our guest introduced to our audience. So, dr Wells, audrey, if you wouldn't mind, why don't you give a little bit of your background to our audience?
Dr. Audrey Wells:Sure, I'd be happy to. So my name is Dr Audrey Wells. I am a sleep and obesity medicine physician. I'm the founder of a company called Super Sleep MD and with that I help people who are diagnosed with sleep apnea get fully treated without sacrificing comfort or sleep, and I'm really happy to be here today and talk about sleep and health and metabolism Awesome.
Dr. Phillip Ovadia:Why don't we start? I guess people may not recognize necessarily that sort of link between sleep and obesity. I'm one of them. Yeah, you've done the sort of extra training to get expertise in both of those areas. That may not seem to go together. So talk a little bit about how your interest in one led to the other.
Dr. Audrey Wells:Yeah, one of the bread and butter diagnoses in the field of sleep medicine is obstructive sleep apnea, and this is a condition where the airway muscles relaxed during sleep just like all the other muscles of the body. But for people who have OSA, the muscles sort of relaxed to the point where the airway collapses and that interferes with breathing. So OSA is a breathing disorder and people who are in an overweight or obese category are more susceptible to that condition because there can actually be fatty deposits in the neck, in the back of the airway and then in the belly that pushes up on the diaphragm to make breathing less efficient, especially when you're lying down to sleep. So there's a lot of overlap with weight gain and sleep disruption or sleep deprivation and with obstructive sleep apnea. That tends to kind of occur in the same person. And so I went and got this extra training to help people understand how their weight loss efforts were being impeded by the lack of sleep or inability to get great sleep quality.
Dr. Phillip Ovadia:And I know that you're sort of among the what I'm going to call growing population of doctors who have gotten trained in obesity and weight loss and been sort of disappointed with the traditional approaches and kind of started seeking out, let's say, more effective or different ways of going about weight loss and obesity management. So maybe talk a little bit about your experiences along those lines.
Dr. Audrey Wells:Definitely, we sort of think outside the box, don't we? Yes, so I was really unhappy with the way the medical delivery system is handling sleep and sleep disorders. So I've had a few different jobs in the course of my career and with every one the waiting list to see me was very long, and I would see people sort of for 20, 30 minutes every few months, and this is not the kind of care that's effective for sleep problems. You really need more of a high touch approach, and so that's what Super Sleep MD does. I want to give you a little fun fact about obesity medicine physicians. Are you ready for this?
Dr. Phillip Ovadia:Yep.
Dr. Audrey Wells:So when I certified a couple of years ago, there were 5,500 obesity medicine physicians boarded in the United States. This year, or maybe it's last year the most recent statistics are that 8,500 have now certified and when we look at the trajectory, it's just going up like this. So I think that's really exciting because obesity is such a common condition. When you look at the heat maps that the CDC puts out of obesity prevalence in the United States, this is a problem that's going to be around for a while and I think it needs expert attention to be fully treated and effectively treated.
Jack Heald:Yeah, you said that you were not happy with the way that this branch of medicine was delivered. What you described was short and infrequent visits. Was there anything, any other things, about how it was delivered that bothered you?
Dr. Audrey Wells:Yeah, I mean, one of the things that never sits right with me is when I communicate to somebody about the importance of sleep, I try to do so in a way that sort of shed some light on a short-term picture. Getting healthy sleep helps your mood. It helps your thinking be more clear, it helps to sort of suppress hunger so you can make decisions to go after healthy food instead of highly processed or snack food. Those are kind of the day-to-day benefits of sleep. And then there's the long-term picture. It helps with your cardiovascular health. It helps to have that cleansing of your brain to reduce the chances of getting dementia like Alzheimer's disease or diabetes. So there's short-term and long-term effects.
Dr. Audrey Wells:And when I talk to people about this they get fired up like, okay, let's figure this out. I need a sleep study, and the sleep studies are booking like two, three months away, and then once they have it, they have to wait to come back to get their results or wait to get them over the phone. If they have a problem like sleep apnea, it's another couple of months before they can get treated. So it's just like this massive delay in care, despite my messaging that this is a problem that you would benefit to have corrected in the short term, not after a half a year or two, a year Wow.
Dr. Phillip Ovadia:And what. Go a little bit into why it's such a pressing problem, why it's such an urgent problem, because you know people may be thinking well, you know what's the big deal. I snore a little bit, you know, and maybe it keeps my spouse out, but you know why is it such a problem when it comes to our overall health.
Dr. Audrey Wells:You know, you're exactly right. And some people have the misconception that snoring means that you must be sleeping really deeply or really sleeping really hard. Have you heard that before? Yeah, yeah, so the noise of snoring is an indicator of turbulent air in the airway. That turbulent air comes from the partial collapse of the airway. Okay, so you're getting that air moving through these tissues that have narrowed the space available to breathe and the snoring comes as those tissues sort of vibrate against one another. So snoring is kind of an indicator of that airway narrowing and unfortunately there's no way to know how much the airway has collapsed. You really need to do some testing to shine light on that blind spot. But I'll tell you a little story.
Dr. Audrey Wells:I once had this couple in my office. It was the guy who was my patient and he was referred by his cardiologist because he had had a series of heart attacks that year and the cardiologist was worried that he had sleep apnea very common to see those two coupled. His wife told me proudly that they had been married for 40 years. It was one of those situations and that early on in their marriage he would snore heavily and that happened for a couple of decades and then he seemed to stop and now she was sleeping better, so he couldn't have sleep apnea. Right, he doesn't snore anymore.
Dr. Audrey Wells:Well, here's what actually happened. He was snoring because his airways were narrowing. That got progressively worse and in the past you know, umpteen years before coming into my office what was actually happening is that his airway was collapsing fully. There was no air movement during periods of collapse. He was actually having apneas, which means absence of breathing during sleep, and then he would have a partial awakening to open his throat. So the presence of snoring, followed by the absence of snoring is actually a little bit concerning, because that means there's no air moving through the airway. So his sleep apnea was very severe and definitely a factor in his heart attacks.
Jack Heald:Is there a way for folks who don't have a spouse or a mate sleeping next to them? Are there other signs that, hey, maybe I've got a sleeping problem other than just not sleeping?
Dr. Audrey Wells:This is a really good question because even if there is a bed partner, presumably they're asleep for the majority of the night. They're not sort of up watching you, or if they were, that would be really creepy. But there are actually apps that you can download that will record your sleep, record the audio during the night SnorLab is one of them and you can just kind of get a little bit of an insight as to what's happening with your sleep. A lot of snoring occurs during REM sleep or dream sleep. That's rapid eye movement, the acronym for REM. So the feature of REM sleep is that you get complete muscle atonia, so your muscles are paralyzed, in effect, except for your diaphragm and your eye muscles.
Dr. Audrey Wells:But during REM sleep a lot of people have more trouble breathing, and REM tends to be more common in the second half of the night. So these apps can help you record and see what's going on. Your symptoms are waking up with a fast heart rate, waking up two, three times at night to use the bathroom, waking up feeling like you've got a headache, you're tired, you have some sense that your sleep quality isn't where it should be for the amount of time you are perceiving sleep, and there's a number of daytime symptoms, problems with memory, that annoying word-finding issue that a lot of people have can be a sign that your sleep quality is down. Mood problems, hunger all of these things could point to some issue with sleep.
Jack Heald:So, phil, I'm hearing a lot of overlap with symptoms of metabolic dysfunction.
Dr. Phillip Ovadia:Yeah, definitely so, and that was actually going to be my next question as well. One of the other misconceptions I will say that I think is out there is that sleep apnea is only a problem for obese people, and we know that it does occur in the non-obese and seems to have a correlation with metabolic dysfunction, and so I'd love to hear your perspective on that.
Dr. Audrey Wells:But it is a common misconception that if you are a person struggling with obesity, you have sleep apnea, and then the reverse is also true If you're a person who doesn't have obesity, you cannot have sleep apnea. I actually think this is a form of obesity bias. So people who have obesity definitely are at high risk. In fact, it's the number one modifiable risk factor for obstructive sleep apnea, and I mentioned the fat deposition around the airway and then the belly sort of pressing up on the diaphragm. And when it comes to the metabolic dysfunction and the sleep dysfunction, it's a little bit of a chicken and egg problem.
Dr. Audrey Wells:Yeah, so it's hard to know what comes first, but I can tell you that people who have sleep disruption or sleep deprivation, even if it's not related to obstructive sleep apnea, you tend to have problems with glucose management. Your hunger hormone, ghrelin, is high, your leptin and other satiety hormones are lower and so your appetite is higher. It tends to be later in the evening and it tends to be for high salt, high sugar, high fat foods, otherwise known as snack foods. So there's this metabolic coupling and if you think about it from a perspective that sleep gives you energy and what you eat gives you energy. You can see how those two things might overlap.
Dr. Phillip Ovadia:Yeah, definitely. So I think back to my training days, residency days, when obviously sleep deprivation was a big part of it, and I may very well have had sleep apnea back then, but irregardless of that, I wasn't able to get much sleep anyway. And certainly I just think about now in retrospect, can recognize those same metabolic effects and the poor food choices you'd make the next day and how much hungrier you were the next day, and I think a lot of people have experienced the same. So, with that being said, you would think that improving metabolic disease would lead to improvements in sleep apnea, maybe even not directly related to the weight loss or in people, like we said, who aren't obese to start with and have this. So is that what you see in practice now?
Dr. Audrey Wells:Yeah, it is, and I think that as human beings, we have to eat, we have to sleep and we have to move. So there's a common sense element here you do want to get your nutrition under control, you want to make sure you're moving your body and you want to make sure you're sleeping, and all of these things are interconnected and pull on the other. So it makes total sense. If you're somebody who cares about your health, you need to pay attention to optimizing your sleep just as much as optimizing your diet. Quality, quantity and timing. Those are all important when it comes to nutrition and sleep.
Jack Heald:Okay, talk about quantity. I understand Quality. I have a vague idea of what that might mean, but I'm not a doctor so I don't know. And timing is what do you mean by?
Dr. Audrey Wells:that, yeah, so everything we do is on a sort of 24-hour rhythm. Every cell in our body expresses genes that align with our brain's master clock. It's right in the middle of our head box. It's called the super-chiasmatic nucleus, and it generally. Yeah, you've heard super-chiasmatic nucleus. No, I've never heard that before, but I've heard it. Oh, you haven't heard it.
Jack Heald:I'm going to give that. My next band is going to be named the super-chiasmatic nucleus. That'll be awesome.
Dr. Audrey Wells:Unfortunately it's too many letters for scrabble SCN for short. So it's the brain's clock and it's generally on a 24-hour rhythm, and this clock is set with light. So we are sort of in a relationship with the sun. The sun has a 24-hour rhythm. Human beings have a 24-hour rhythm and because Probably not coincidence.
Dr. Audrey Wells:Yes, that's exactly right. We've kind of evolved over these number of years to operate and optimize things during the day and then other processes at night, and it turns out that eating and vigilance are paired together. So eating and awake, or alertness, are optimally paired together. Sleep and fasting are paired together. So if you disrupt that by changing the timing of your biological system, you have now introduced dysregulation. So digestive hormones, for example, are not optimally released overnight. They're better released during the day and better within a window. This is one reason why I'm a fan of intermittent fasting.
Dr. Audrey Wells:Our cognition is different during the day versus at night, and other processes are also going to follow a day-night pattern. Cortisol is another example. So whatever you do, whether it be eating, sleeping or exercising your body you're going to have some optimal periods during the day when those things occur. So that's the timing piece of sleep. Preferably your sleep period is the same every day, and especially the wake-up time is more important, so that your brain can anticipate the sleep cycling and then the stop and then awake after that. You might imagine if your wake-up time is highly variable, your brain is not going to be able to predict its sleep cycling through non-REM and REM sleep phases, and so your transition to wakefulness is going to be inefficient. And we solve that by taking caffeine. We solve that by sort of propping ourselves up with different things during the day, and then sometimes that leads to trouble sleeping at night again. So all of these systems in our body are functioning sort of like a band, like a musical band. We have instruments. They all need to play at the right time.
Jack Heald:Superchiasmatic, super, what is it again?
Dr. Audrey Wells:I was hoping you would get that.
Jack Heald:The superchiasmatic nucleus is the name of your band Appearing nightly. All right, yes.
Dr. Audrey Wells:And you've got all your instruments playing at the right time, so you're making harmonious music and your bodily processes are working correctly.
Dr. Phillip Ovadia:Now, a lot of people who talk about sleep will focus on things that you should or shouldn't do before you go to sleep in those kind of the nighttime hours, but I don't hear as many people focusing on what you should be doing in the morning, and you just touched on one that's very important trying to have that consistent wake time. Talk about some other things, some other strategies for the start of your day that are going to then set you up to have good sleep at night.
Dr. Audrey Wells:This is a fantastic question because I'm going to give you some really actionable steps that are going to help out a ton. So the morning wake up time should be held consistent and you have a lot of control over that. It's easier to wake up than it is to control what time you fall asleep. So hold your wake up time consistent and the bedtime will follow when you wake up, if you get bright light into your eyes preferably from the sun, but I'll tell you here in Minnesota that's really difficult this time of year, so sometimes an artificial light can do. Wake up at the same time, get that bright light in your eyes and get some exercise. That is the trifecta of perfection for getting alertness mechanisms going. And that bright light in your eyes sets a little timer such that about 16 hours later your brain is going to be very ready for sleep. So what you're doing in the morning is going to help your rhythm at nighttime and give you more of an easier time, a shorter time to get to sleep Light, exercise and consistent wake up time.
Jack Heald:I've heard various fitness bros discuss the pluses and minuses of various light spectrums in the morning, so I'm guessing that any light is better than no light at all. Talk about light that skews toward the blue end of the radius, versus light that skews toward the what did I say? Blue end of the frequency. Red end of the frequency.
Dr. Audrey Wells:You got it yeah.
Jack Heald:The sun, it doesn't matter. That's really what I'm asking.
Dr. Audrey Wells:Yeah, it does matter, it totally matters. So a couple of things. The sun is a full spectrum light, so you're getting red light all the way to blue light. Blue light is short wavelength light. Red light is longer, so ideally in the morning when you're getting that light into your eyes, it would come from the sun, because it's a full spectrum and even on a cloudy day it's very bright. I've actually tested this. There's an app called Light Meter. You can go outside and it'll tell you how many lux you're exposed to Lux. Lux is the measure for light. If you don't have the luxury of having the sun out in the morning, then you can use artificial lights and that's what I do up here in Minnesota during the winter. I have a light box that puts out a short wavelength light and it's got a pretty high intensity. It's between 5,000 and 10,000 lux and when I sit with that box it's about 18 inches from my eyes, which have the light receptors in the back of the retina. That's almost the equivalent of getting that bright light from the sun.
Dr. Audrey Wells:You want to preferentially choose blue light to promote alertness and red light to promote drowsiness. If you look at your cell phone at night, it's going to preferentially be blue light. I've done this little thing. I have a shortcut where I turn my phone red. You can do this in the settings. This is an iPhone, I don't know how to do it for an Android, but you can put this red filter on to minimize the effect of blue light. If you wake up in the middle of the night, you check your phone. For the time or at least that's what I do or if you want to look at your phone prior to going to sleep, you can mitigate that effect with that red filter.
Jack Heald:But in the morning the preference is full spectrum. Anything's better than nothing.
Dr. Audrey Wells:The preference is sunshine. Even on a cloudy day, it's going to be probably brighter than the lights in your house. And then second choice would be the artificial light with the blue spectrum.
Jack Heald:Okay, bill, can we talk about the thing that I really don't want to talk about now?
Dr. Phillip Ovadia:I'm always interested in talking about what you don't want to talk about. I can't wait to hear this All right.
Jack Heald:So my dad had a sleep apnea and he had this machine that he wore that made him look and sound like Darth Vader the last 15 years of his life. Let's talk about Darth Vader.
Dr. Audrey Wells:I like to call it a fighter pilot.
Jack Heald:Yeah, that's a little better. You can do that if it works for you.
Dr. Audrey Wells:Scuba, scuba diver maybe. Okay, you've got the CPAP question right.
Dr. Phillip Ovadia:Yeah, yes, so how does it work and who should be using one? I think there's some important things.
Dr. Audrey Wells:Yeah, so I talked about obstructive sleep apnea and I want to emphasize that it's not so much a sleep disorder, although it does only occur during sleep. I like to phrase it as a breathing disorder, and any breathing disorder you have, you want that treated, because it turns out breathing is really important.
Jack Heald:Four out of five doctors recommend breathing for their patients.
Dr. Audrey Wells:I believe that's correct. Yes, so you want to breathe during sleep so your brain doesn't have to wake up to gasp for breath. And when your blood oxygen levels go down it's hard on your brain, it's hard on your heart, it's hard on your organs and it also produces a lot of stress response and inflammation. So inflammatory mediators get released as a result of the oxygen levels going up and down throughout the night. So the gold standard treatment is with a CPAP or auto-PAP. Pap stands for positive airway pressure. If you're talking about CPAP, the C is for continuous, meaning there's a continuous airstream. That sort of acts like a stent to hold your throat open during sleep and it's a gentle pressure. I can give you some parameters if you're interested. Cpap the auto means that the airstream is auto-adjusting according to what the machine detects as obstruction, so it changes the pressure up or down.
Dr. Audrey Wells:Now the air pressure is generated by a very simple compressor. Essentially, the air is filtered, it's warmed, it's humidified to kind of make it more comfortable to breathe, and it goes through tubing into a mask worn on the face. A lot of people have a full face mask, so it goes over the mouth and the nose. Those are good if you really can't breathe through your nose. I'm a big fan of breathing through your nose, so I tend to encourage people to open up their nose so they can use a nasal mask. And a nasal mask comes in three flavors. There's one that goes over the nose, there's one that just comes up to the nostrils, and then a third type makes a little seal inside the nostrils, a little bit similar to an oxygen cannula, but all the mask does is it connects, conducts the air into your airway to hold your throat open while you're sleeping.
Jack Heald:My perception of the CPAP and the auto-PAP is that those are kind of last-ditch treatments that you know if you can't, if nothing else works. This is what we're going to do. Is my perception in the ballpark of reality.
Dr. Audrey Wells:I think it depends on whose perspective you're coming from. So in my experience a lot of people look at CPAP as a last-ditch treatment or effort because they don't want to bring a machine home to live on their bedside. They can't imagine sleeping with a mask on their face and air going down their throat.
Jack Heald:So I think from a oh, they all look sexy with.
Dr. Audrey Wells:Yeah, yeah, I mean, breathing is sexy and presumably you're not doing a whole lot of sexy time with the mask on your face, but you know, to each his own. So I think from a patient perspective, yeah, like that can even be a barrier to getting tested, because you know you might have the idea that at the end of the test is going to be a CPAP machine, and that's not true. I actually did a whole course called 21 Plus CPAP Alternatives, because there are other things that you can use. From a medical perspective, from a physician's standpoint, cpap is by far the most effective treatment for obstructive sleep apnea. In other words, I can take a patient who has OSA and better than 95% of the time I can correct their breathing with CPAP. The obstacle is wearing it. It only works when you have it on, and so you have to wear it nightly. You have to wear it throughout the sleep period to really get all of the benefit. It is considered the gold standard for sleep apnea care, but I do not believe it's for everyone.
Jack Heald:All right. Well, let me follow up with what's really kind of eaten at me here. One of my deep frustrations with the current Western medical establishment and that's one of the reasons why this is one of the reasons why I was so excited to work with Phil is I think he shares this frustration is it seems to have lost its way in terms of helping people get healthy. Oh my, gosh.
Jack Heald:I'm specialized in creating symptom alleviating solutions that go on forever rather than curing people. So what I really want to know is when we're talking about these sleep problems, can they be cured? What's the chances of curing them? What's the likelihood of curing them, you know? Or is this just something you're stuck with for the rest of your life, like you were born with a short leg and you're going to have to wear a lift in your shoe?
Dr. Audrey Wells:I'm hearing a little subtext here and I want to ask I think there's some resistance to the rather blunt tool that CPAP is. I mean, we have such incredible advancements in medicine, in science and technology, and still for the treatment of obstructive sleep apnea, we've got this machine and a mask. I mean it's kind of primitive and yeah, I mean I get it. I am also frustrated with sick care. I mean, truly it's not health care. If we were doing health care, there would be a preventative element, there would be getting down to the root cause, and don't get me started on the financial motivations of drug companies. I think insomnia treatment is a great example of just masking the problem, and this is one of the things I do with people is to help them get behind the psychological problem that contributes to their insomnia and not just mask it with drugs.
Dr. Audrey Wells:So yes, when it comes to sleep apnea, one of the things I'm excited about is these highly effective GLP-1 injectable medications for obesity. I believe in the next year, maybe the year after, this obstructive sleep apnea will be an indication for these medications, because a significant number of people who lose a significant amount of weight can cure their sleep apnea. It's not as high as you'd think it is, though it's about 40% to 50% of people with obstructive sleep apnea, and obesity will cure their sleep apnea if their weight comes down to the normal range. Okay, it's not like 90% or anything, but it's significant. They're terrible at helping people lose weight and keep it off, and those are two separate problems. There's the weight loss and there's the weight maintenance, and this is another reason that I took the trouble to get educated about obesity medicine, because I wouldn't understand how to counsel people about the single most modifiable risk factor that leads to obstructive sleep apnea.
Dr. Phillip Ovadia:Now, what are? So I guess there's two things I want to ask you about that. So one I think it's important to say that and you touched on this the CPAP only works if you use it and CPAP doesn't solve, Doesn't correct the underlying problem. So people can use CPAP for many years and if they don't address obesity and maybe some other modifiable risk factors, they're not going to get cured of their sleep apnea with the CPAP, it's just going to mitigate the effects of the sleep apnea. And then the second thing I was hoping you can touch on and you mentioned what are some of the things you can do besides CPAP to help mitigate the effects of the sleep apnea?
Dr. Audrey Wells:I want to go back to your first point and just do a little bit of a frame shift here. Cpap treats sleep apnea. You breathe normally with CPAP, but you need CPAP to breathe normally. It's like taking a high blood pressure medication you need to take the medication to get normo-tensive. I think people add to their suffering if they're resistant to that idea. I'm dependent on this machine. This machine is breathing for me. That is adding to the suffering and, frankly, that can interfere with sleep if you're lying there just hating your life because you've got this mask on your face. So I think that one of the most effective things I do when I talk to people is to try to get into a new mindset about their CPAP, to unburden themselves and get to sleep better. If you choose to use CPAP and it is your choice then lean into that and look at the CPAP machine as your ticket to a healthy breathing experience during sleep. It's very simple. There are alternatives. So if you don't want to use CPAP, if you choose something else, then it's incumbent on you to confirm that it's working for you. This is a step people miss a lot of the times. So there's two main alternatives to CPAP treatment.
Dr. Audrey Wells:One is surgical, one is non-surgical. The non-surgical alternative is oral appliance therapy OAT. It's also known as a mandibular advancement device. So what this is is it's a little device made by a dentist. It's specific to the person, so it's personalized. You have a piece of acrylic or dental material that fits on the upper teeth, one on the lower teeth, and the two pieces engage to bring your jaw forward. What that does, or what it's meant to do, is pull your tongue forward so that you're opening up more space in the airway, and in the past, people who had mild sleep apnea or moderate sleep apnea could be referred. There are some people who have severe sleep apnea that respond to an oral appliance. But you never know until you retest with the oral appliance in place. Okay, jack, I see you yawning there, so I'm having a great effect on you.
Jack Heald:That's the kind of sleep doctor, expertise I'm bringing, I won't have a 250.
Dr. Audrey Wells:I get it. So the oral appliance is the main non-surgical treatment. But again, you have to have that test with the oral appliance in place to make sure it's working, otherwise you're wearing this thing for years and you might still have sleep apnea. The surgical treatment is called hypoglossal nerve stimulation and the brand name is Inspire. Have you guys heard of Inspire?
Jack Heald:I'm just digging all these names.
Dr. Audrey Wells:Yeah, they kind of roll off the tongue, oh geez.
Dr. Audrey Wells:Inspire yeah, I mean, it's cute, right, Because you inspire, you expire. So they chose to focus on the more positive Inspire. So Inspire is a surgical implant. They put this little thing that looks like a pacemaker Feel you're familiar with that right. So they don't touch the left chest, because that's your area, Phil. As they go in the right chest they make a little incision, they put this implant in and one sensor gets fed in between the ribs. That sensor is going to measure when you're breathing. The other sensor gets snicked up into the base of the tongue and the wire is wrapped around the nerve that makes the tongue go forward. Now, when you turn it on with a little remote control at night, you've now become a bionic man or a bionic woman. You turn on the remote and the sensor will coordinate with your breathing to scrunch your tongue forward and out of the airway as you're sleeping. So this is the Inspire device.
Dr. Audrey Wells:It is not as effective as CPAP. There's quite a bit of variability as far as effectiveness goes, but that is the main surgical alternative to CPAP treatment. There's other surgical procedures as well. You can stack them up and combine them any which way, but as far as CPAP alternatives, I would say that beyond that, the other treatments that I review are just going to go down, down, down in efficacy. There's only one surgical treatment that has a 100 percent success rate. I'm going to lay this on you just for the sake of completeness, but it's not very popular. That treatment is a tracheostomy. You put a hole in the neck, bypass all of the structures that are collapsing. I've seen that done a couple of times emergently for sleep apnea. The tracheostomy has a great success rate but again, not a big fan.
Dr. Phillip Ovadia:Not something you want to sign up for electively, I would say for most people. Then, having there been some surgical efforts directed at it, you would think, okay, if you just remove some of this obstructive tissue, and I seem to remember there were at least some trials along those lines.
Dr. Audrey Wells:Yeah, well, you gave me a great chance to really blow Jack's hair back with another name. Are you ready, jack, let's do it. I'm going to talk about the UVLopaladolphingoplasty.
Jack Heald:Okay, that sounds like a character in a Star Wars cantina.
Dr. Audrey Wells:Yeah, or maybe like a Willy Wonka character. The UVLopaladolphingoplasty, also known as a UP3, is a debulking procedure. You know the little punching bag that hangs in the back of your throat, that's the UVLA. The traditional UP3 cuts out the UVLA and also part of the soft palate that it hangs from. That has about somewhere around a 40 percent success rate. The problem was people did this for years for snoring and for sleep apnea. You've got that soft palate that you've just cut down. A lot of people had a tendency to scar in a way. That scar down made that tissue really inflexible and brought the soft palate down so that there was now trouble with swelling up liquid into the nose. Voice changes sometimes and for some people, unfortunately, their sleep apnea got worse because that tissue scarred down. So now they do a modified UP3. There's some palate sclerosing procedures. You can cut a wedge suction out of the tongue to debulk the tongue, like. All of these things are pretty gruesome, right.
Jack Heald:And it starts making— You're making a great case for a CPAP.
Dr. Audrey Wells:You're really awesome, that's what I was just going to say. Like when I really start explaining to people what the alternative is for breathing, then having a mask that you put on at night starts to sound a little bit better. And listen, I've tried all this stuff. I walked a mile in my patient's shoes. I put the mask on. I've acclimated to all of them. I have a couple of favorites, but that's just me. It's a very personal journey and over the past couple of years, I've tried out some home sleep apnea tests and I'm starting to capture the beginning of my own sleep apnea. Ok, so I'm an example of a person who does not have a high BMI. My BMI is in the normal range, but if you look at my family— Sleep apnea, sleep apnea, sleep apnea, sleep apnea— so I knew this was coming. Now I'm capturing it. Now I have to decide what treatment am I going to choose?
Jack Heald:Well, we're at the point where I want to be aware of your time. Sorry, I didn't mean to interrupt you, phil, but we're going to have listeners who've listened this far and said, ok, I should probably maybe check, get myself checked out, walk us through the process. What's the next thing for people to do if they think, yeah, maybe I need to check on the quality of my sleep?
Dr. Audrey Wells:I think it's a smart thing to do OK, Because your brain is your most important asset. I don't think anybody would argue Heart may become second. Sorry, Phil.
Dr. Phillip Ovadia:I might argue a little bit, but you know they're both pretty important.
Dr. Audrey Wells:Both are affected by poor sleep. So if you want to preserve your heart, if you want to preserve your brain, you need to have healthy sleep and if you want to make an informed decision about your health, then you need to shine some light on your blind spot, which is a sleep study to figure out if you're sleeping well or not. If you do an in lab sleep study, that's going to be more accurate and it tests for many conditions other than obstructive sleep apnea. If you do a home sleep apnea test, it will only test for sleep apnea and my stance is it's only helpful if it's positive. If it's negative, I would rather call that inconclusive, especially if there are symptoms. Ok, so now you have information and, from my point of view, it's up to the person to decide what they're going to do with that information. If you don't want to get treated, fine, come back and see me if you change your mind. If you do want to try something, great, you don't have to be married to it, you can try it out. If it doesn't work for you, you can move on.
Dr. Audrey Wells:Is there a referral necessary? Some insurances require that, some don't. All of this applies to your deductible. Your health insurances involved All of that kind of applies. I always tell people the busy time for a sleep medicine specialist is in the last quarter of the year because people are trying to get all their sleep care in before their deductible renews. So a word to the wise get your appointment in the second or third quarter and you won't be in that time crunch. But I do think it's worthwhile to get your sleep checked, just so you can be in the know.
Dr. Phillip Ovadia:All right. Yeah, I definitely would echo that and, from the heart standpoint, as you kind of mentioned, not uncommon that I'm seeing people with things like high blood pressure and worsening coronary artery disease, and perhaps they've addressed the metabolic issues that commonly underlie this and they're still having issues. And our discussion oftentimes turns to sleep and getting screened for sleep apnea, afib is another big one right.
Dr. Phillip Ovadia:Yeah, afib, definitely another big one. So tell the people if they want to learn even more how to connect with you, and certainly the summit which should be coming out right about the time that this episode is released, tell people how they can join in on that.
Dr. Audrey Wells:Awesome. Yeah, so the summit is with Dr Tox. The website is drtoxcom backslash sleep-apnea-summit and I'll give you the link to put in the resources. This is a free summit. Anybody can sign up. It's all online. We're going to do a week's worth of expert talks about sleep apnea and insomnia. These are the coke and the Pepsi of my world and we've got just really incredible speakers. That includes You-Fell. It was awesome to get you to talk about nutrition and diet and your approach as a heart surgeon, so I want people to just realize this is an incredible resource. We're going to talk about evidence-based medicine. My program, my website, is supersleepmdcom. I have online courses for people with sleep apnea and insomnia. I also do group coaching to help people in a more high-touch way, and this is my problem-solving. To working behind the doors of my clinic for so long, I was super frustrated, so now I'm helping people get treated in a more meaningful way. Would love to see you in my world.
Jack Heald:That seemed like a really valuable approach for folks like me who wonder I've got a sleeping issue. Yeah, all right. So we will make sure all of that contact information shows up in the show notes so folks can just go there, click on it and off we go the DrTalkscom Sleep Summit. All right, very good, phil, I'm looking forward to this summit as well. Frankly, I'll probably check it out.
Dr. Audrey Wells:You should. I think you'll be pleasantly surprised at the quality of information and it was a pleasure to speak to you guys today. I really had fun. It was good to have you yeah.
Dr. Phillip Ovadia:Thank you so much. Great discussion. I think, as I mentioned at the beginning, this is certainly one of the pillars of health that people need to be paying attention to, and I think people really will have learned a lot from this.
Jack Heald:All right. Well, I guess we're going to say that's a wrap for the day. Thanks for joining us folks. This has been Dr Audrey Wells and the Sleep Summit at DrTalkscom. Check it out. Starts February 6th, runs through February 12th. If it's past February 12th when you're listening to this, is it going to be? Will there be recordings that people will be able to access later?
Dr. Audrey Wells:There will be recordings. Yeah, this will live on the DrTalks website, and so I would certainly encourage people to check it out, even if it's past date.
Jack Heald:Cool. So if you're listening to it past this, you should still at least be able to see the recordings. All right, well, for Philovadia and Dr Audrey Wells, I'm Jack Heald. Thanks for joining us. We will talk to you, people, next time around.