SPEAKER_02 0:00

Your brain is your body's control center, shaping how you think, feel, and move. When something goes wrong, it can affect everything. Welcome to Your Brain, Your Health, a podcast from St. Luke's Neurosciences. We'll explore conditions that impact the brain, spine, and nervous system and how they connect to your overall well-being so you can stay informed and take charge of your health. Thank you for joining us for today's episode, Understanding Sleep Apnea and the New Wave of Inspired Therapy. We're your hosts. I'm Dr. Eric Eustace, Emergency Medicine Physician at St. Luke's University Health Network.

SPEAKER_01 0:35

And I'm Dr. Daniel Ackerman. I'm section chief for the Department of Neurology and Director of Stroke and Vascular Neurology here at St. Luke's. And we have with us today Gotham Narla, who is a sleep medicine specialist at St. Luke's. Gotham, thank you so much for joining us. Thanks, guys. Happy to be here. Now, some of our listeners and viewers will remember that we talked about the four pillars of brain health before, and sleep is one of them, which is interesting as doctors because we do such a good job of making sure we get adequate rest all the time. You know, before we get into treatments, new technology, um, let's start with the basics about sleep apnea in particular. So when people talk about sleep apnea, what's what's actually happening?

SPEAKER_00 1:12

So sleep apnea is when your airway gets blocked off while you're sleeping. So basically you go to sleep and then your tongue falls backwards and blocks off your airway in your velopharynx. And then basically you stop breathing. Usually it's people's partners that tell them, hey, you're snoring, you stop breathing, and you're like gasping for air. Um and generally when you're not breathing when you're sleeping, that means you're you're not gonna be well rested when you wake up in the morning.

SPEAKER_01 1:38

So your body is trying to breathe, but but the inflow and outflow is kind of blocked off.

SPEAKER_00 1:43

Right. And a lot of people they'll sleep through it, they don't know that they have sleep apnea, but they'll wake up feeling tired, they are dragging all day, that kind of they have brain fog, that kind of thing.

SPEAKER_01 1:52

Yeah. That's actually a really great point. I've had a lot of patients that I've spoken to about sleep apnea tell me, but I I sleep through the night. Right. But when this happens, it it doesn't wake people up enough to be aware of it.

SPEAKER_00 2:02

Sometimes it does. Some people sleep through it. Um but when you're when you have sleep apnea, you're always in a light stage of sleep because your brain will kind of keep you in a light stage so that you don't so you wake up, basically. Aaron Ross Powell, Jr.

SPEAKER_01 2:13

So it's it's not just about quantity, this is really impacting our quality of sleep. Right. All right. Now, if we don't treat sleep apnea, so let's let's start with the scary stuff, right? Yeah if we don't treat sleep apnea, what happens?

SPEAKER_00 2:25

Whenever you have sleep apnea, um you stop breathing, your oxygen levels drop, your heart rate and your blood pressure go up. So imagine every night when you're sleeping, your heart should be resting as well. But instead it's kind of going all going haywire. So that puts a lot of strain on your heart, leads to an early heart attack, stroke, um arrhythmias like aphib, that kind of thing.

unknown 2:46

Okay.

SPEAKER_02 2:46

Those are the that's the stuff I deal with on a daily basis.

SPEAKER_01 2:49

I'm sorry, he said stroke, you know.

SPEAKER_02 2:51

I'm sorry, I'm just I'm stealing your thunder, Dan.

SPEAKER_01 2:53

I'm just saying. No, I although it's really interesting to me how often someone will come in with a stroke or a heart attack or something more simple, high blood pressure, daytime exhaustion, just even an inability to do what they want to be doing from day to day, and we start to have a conversation about sleep apnea, and um it's it's sort of the window through which we realize someone's got this going on. So sometimes it's people are snoring or gasping, other times though it can be some of these more serious medical challenges.

SPEAKER_02 3:20

I was gonna ask, so um why when would we be worried about some of the signs or symptoms? Because I think most people day and age, they have bad nights of sleep, right? They might feel tired in the morning. A lot of people snore. How do I realize and know when to actually go get checked out for sleep apnea?

SPEAKER_00 3:37

So if you're snoring, that's um a good reason to get checked out. Um if you're snoring and you're tired during the day, um, even things like if you're irritable, um, if you're depressed, if you're feel like your memory's off, your concentration's off, um, that's all good signs that you might have sleep apnea. So it's always like anything, it's like a colonoscopy, it's good to get screened for these kind of things. So getting tested is a good idea.

SPEAKER_01 4:00

Usually I think also if you're worried about some of those risk factors, I find it's helpful if you ask their spouse or someone who loves most people don't seem to admit to it on their own, and then someone says, No, come on, look, you you snore and you fall asleep in front of the computer, and remember we were driving last week and you fell asleep at that red light, and it's usually the spouse that forces the patient to come in, and then you know that it's mainly snoring that bothers the partner, and that that's the kind of thing that I see a lot.

SPEAKER_02 4:26

So if somebody comes to you and says, you know, I'm concerned about sleep apnea, what do you do? Like how do you evaluate that?

SPEAKER_00 4:33

First step would be to get a sleep study. Okay. Um there's a home sleep study, and then there's a sleep study in the lab. The main difference is that the home study, um, you basically take the equipment home, wear it at night, and then drop it off in the morning like a library book. Uh the in-lab study is there's gonna be a little bit more equipment. There's gonna be EEG, so we can look at your brain activity, see how much you're sleeping, see what stages of sleep you're getting, how much REM, that kind of thing.

SPEAKER_01 5:00

And so EEG, so we're back in my world again, right? But EEG, so you know when people are sleeping as part of a sleep study with an EEG on, so that's just little stickers on the head, right? Right. And then in the lab, I know there'll be some stickers on the chest and an oxygen monitor and a breathing monitor. At home, it's pretty similar, right? It's um it's an oxygen monitor on the finger, a breathing monitor, and just some loose on your chest that go around to listen to your breathing. Okay. So it's not great. It may not be the absolute greatest night of sleep you ever get, but but most people do sleep enough that we get a sense of it, right?

SPEAKER_00 5:32

Right, right. And all all we really need is two hours to be able to diagnose sleep apnea. Oh, okay.

SPEAKER_01 5:37

Oh, that's fast. That is fast. Not bad. What kinds of people are actually at risk for sleep apnea? I mean, there's uh I mean there are some classic things you hear about in the media, but I see so many different patients that that turn out to have sleep apnea, and some some of the time I'm really surprised.

SPEAKER_00 5:53

There's this uh concept that usually if you're overweight, then you're more at risk for sleep apnea, but that's not the truth. I've a um you can be thin and have sleep apnea. A lot of it's the way your anatomy is, it's partly genetic. Um but yeah, generally when you gain weight, it puts you more at risk for sleep apnea. And then if you're um a male, generally you're higher are at higher risk for sleep apnea if you have high blood pressure, if you're snoring, that's a good indicator. And generally if you're tired during the day.

unknown 6:22

Okay.

SPEAKER_01 6:23

So some of it are risk factors, there's some signs and symptoms we look for, but things that are like pretty common for what we deal with from day to day. Now, you know, I know we're gonna talk about CPAP and we're gonna talk about Inspire and and some of these different therapies, which are super important. Um, but what about lifestyle? What about I change my diet, I lose weight, I I get uh tonsil surgery, I don't know. What like are there are there other things people can do to prevent it or to help treat it if they do have it?

SPEAKER_00 6:52

Um so for kids, actually the treatment for sleep apnea is just taking out their tonsils and their adenoids, and that usually does the trick. Uh for adults, yeah, CPAP is obviously the one that everyone knows. Uh there's also an oral appliance that it pushes your jaw forward so that it opens up the airway. Um there's uh Inspire, which we'll talk about more. Uh lifestyle-wise, uh losing weight generally helps with sleep apnea. Something like 70% of people, if they lose weight, they don't have sleep apnea anymore.

SPEAKER_01 7:21

And what about lifestyle things like um alcohol or sedatives in particular for people who are, you know, they're waking up tired, they might take medicine to try and help them sleep or things like that. Do they do they have an impact one way or another?

SPEAKER_00 7:33

Yeah, so alcohol actually doubles the amount of times that you stop breathing at night if you have sleep apnea. Some of my patients like to have a few drinks, and I always tell them that's the night, even more, even more so. You should use your CPAP or else you're gonna wake up with a vicious hangover. Because it's the sleep apnea and the alcohol that's gonna affect you.

SPEAKER_02 7:50

I've heard a lot about Inspire and is this a meditation app, or what is Inspire? I'm I'm very confused. So it's let's meditate the sleep apnea out of us, right? So no, go I I'm very curious, and I think our listeners are too, kind of what what Inspire is and and how can it can help in patients.

SPEAKER_00 8:10

Yeah, so Inspire, it's a hypoglossal nerve stimulator. So basically it's when you have sleep apnea, your tongue falls backwards into your airway and blocks off the airway. So what Inspire does, it basically stimulates your tongue to move forward while you're sleeping. It's nothing crazy, it's not like your tongue is gonna stick out of your mouth, but it's just just enough to kind of open up the airway.

SPEAKER_02 8:30

And is it this is a surgical procedure or device or yeah.

SPEAKER_00 8:34

So it looks like a pacemaker essentially. So we implant a device in your chest, okay, and then we put an electrode on the nerve here. And then on the patient's end, they just get a remote where you basically just hit the green button, put it to your chest, and then uh inspire will turn on after you fall asleep.

SPEAKER_02 8:49

Okay.

SPEAKER_00 8:50

So ideally the patient won't know it's happening, but it should turn on when they have fallen asleep, and then it'll turn off before they wake up.

SPEAKER_01 8:58

Is Inspire something that would be an alternative to CPAP or or do people need both? How does it how does it work in the CPEP world?

SPEAKER_00 9:06

Most people do fine with it. Um but if some people they're claustrophobic, they just don't like wearing a mask, you know, for a myriad of reasons. Um if they can't handle CPAP, then I would uh talk to them about Inspire. So basically, if you have tried other things and it doesn't work out, then then we go Inspire because at the end of the day, it's a surgery.

SPEAKER_01 9:24

So I should tell you, I have sleep apnea, which you probably know. But yes, I have sleep apnea. I use a CPAP every night. And um as I'm counseling patients about this, I I talk with them about the fact that I have, you know, plenty of room to roll over. It's not like for whatever reason, I took to it very, very easily. Um but why do some patients, aside from claustrophobia, which of course is pretty common, but but claustrophobia aside, why do some people have trouble with CPAP and are there things we can do to help them with it?

SPEAKER_00 9:55

So I I I could tell you every patient that comes into my office when I show them a CPAP and then the masks, they always make a little face like, uh, I don't I don't know if I want to do that. I always tell them everyone says that, and then when they start using CPAP, they feel so much better that they actually like using it. Some of my older patients, they they can't live without it. Um so I think it's just something you get used to with time. Some people, yeah, claustrophobia is is a big thing. Um honestly just having something on your face, it's it's a lifestyle change. You know, you're used to just feeling free and you know, moving around while you're asleep and resting, but having something additional to do at night, you know, can be challenging.

SPEAKER_02 10:34

I think the alternative is living a life of misery with sleep apnea, right? Like it's like, okay, I think patients don't realize the future potential they have in feeling great when they actually get a restful night of sleep. Right. Because you're not resting with sleep apnea, right? Right. So time only time. I mean, how often, how long do you tell patients to kind of work through that before they start to feel comfortable?

SPEAKER_00 10:58

Um, I would say at least give it a couple of weeks, and usually within a week or two, people feel more comfortable with it. And like you said, it ch it it's like day and night the way they feel. A lot of patients have said, My family likes me a lot better, I'm not a lot less irritable, and I don't, you know, those kind of things. Even like depression, it helps with that. Um sleep apnea causes low testosterone. So usually when you treat your sleep apnea, your testosterone improves over time. So there's so many different ways that sleep apnea affects your body that it's you know good to get it treated. And you'll you'll see the difference pretty quickly. Trevor Burrus, Jr.

SPEAKER_02 11:34

This is one of the episodes where we're talking about sleep, and I think we people don't realize how important it is to get adequate quality sleep, and it affects every aspect of their life. Right.

SPEAKER_01 11:44

Well, and uh and I think with that information about testosterone, every guy listening to this podcast who might have sleep apnea and said, Oh, I don't know if I want to be tested. This you know, the willingness might have just changed. You may have just shifted the paradigm for a whole lot of people.

SPEAKER_00 11:58

Um I always say I'm like I'm kind of like a marriage counselor because there's couples that are sleeping in different rooms and then we get them on CPAP, they're not snoring anymore, and now they're sleeping in the same room again.

SPEAKER_01 12:10

All right. So I I think we've established sleep apnea is important to diagnose, it's important to treat. There's a couple of different treatments, and we'll maybe revisit some of that. But for people who are thinking either after hearing this episode or hearing their significant other, you know, tell them, look, I keep having to smack you to get you to start breathing again in the middle of the night. Um maybe you should be tested. For for all of those people, like what is the first step? How should they go about seeking testing or starting to like you know go down this path?

SPEAKER_00 12:39

Aaron Powell So uh talking to your primary care doctor about getting a sleep study would be the first step. Um having your doctor put in a referral to sleep medicine is always a good second step. And then you know getting a sleep study done, then you know we'll read the study, see if you have sleep apnea, and then you know get the ball rolling.

SPEAKER_01 12:56

Aaron Powell So a primary care doctor could potentially go ahead and order the sleep study. Yeah. Okay, good. I mean we we do that a lot in our clinic as well, although the neurology clinic and the sleep medicine clinic are are reasonably closely aligned. Right. But um but I think that's really helpful too to have be able to get the study done, especially if it's a home study, figure out if there's anything to write home about, and then if there is, you take the next steps to go ahead and see a sleep medicine physician, get everything organized and it's uh technically any doctor can order a sleep study and then just put in a consult to us.

SPEAKER_00 13:29

So you'd be surprised the range of people that give us consults. So even like urology, if you're urinating a lot at night, that's caused by sleep atom. If you have like prostate issues but you're still urinating a lot, then still put in a consult to us. Uh endocrinology will because it messes with your diabetes and your like we talked about, testosterone, different hormones too.

SPEAKER_02 13:51

And you normally start with a home study then? Is that how it works? Or do you have to because I remember I've had a sleep study done and I had to go spend the night and you know do an overnight study, which was not bad.

SPEAKER_00 14:02

Do most patients start at home or uh So the home study is fine in most cases. Um, but if you have certain conditions like you have underlying lung issues or certain heart issues like arrhythmias like AFib and things like that, um, then you have to get a study in the lab just because there's other types of sleep apnea, just other than the typical obstructive sleep apnea. Um there's something called central sleep apnea where your brain tells your lungs not to breathe.

SPEAKER_02 14:29

Okay.

SPEAKER_00 14:29

So for the when you're at risk for that, then you'd we'd want you to come into the lab.

SPEAKER_02 14:33

Okay.

SPEAKER_01 14:34

And aside from you know claustrophobia or maybe inability to tolerate the mask, um, are there other things that would make someone a a good candidate in particular for inspire or or you know alternative treatments?

SPEAKER_00 14:47

Uh yeah, so inspire is generally a better option if your BMI is less than 35. It works a little bit bit better. Um otherwise CPAP is a better option. The other option is the oral appliance. So you would see a dentist for that where they take a mold of your teeth and um basically they it's pushing your jaw forward while you're sleeping to kind of open up your airway.

SPEAKER_01 15:08

Okay. So I mean there are some there are some options there, but folks who are a little more slender might have a little bit more success with Inspire. Again, folks, of course, who have difficulty tolerating the CPAP mask itself. Um maybe those who see their dentist and their dentist says, no, look, I don't know if this is a great idea for you. Um that's the kind of group that Inspire would really be helpful for. And is it I know you mentioned putting a battery pack in and then running a lead to one of the nerves. And you know, that's the kind of procedure that's been around for a very, very, very long time. It's very, very safe. Um but what's the recovery like from that? Is that is this a big thing that's gonna take someone out of their lives for a while?

SPEAKER_00 15:45

Uh the recovery time is really it's you don't have to do too much. You just can't put too you can't be lifting too much or more than 50 pounds. But otherwise, there's really no restriction in your activity. Aaron Powell And that lifting restriction is short term? Uh yeah, just for about one month until everything heals and gets done. I can go back and be a bodybuilder, is what you're saying.

SPEAKER_01 16:04

I was hoping that would get me out of lugging the luggage back into the I'm usually I'm usually the family pack mule, and it would be great if I didn't have to, you know, hoof all this stuff around.

SPEAKER_02 16:14

So, Gotham, what's one thing for our listeners that you want them to take away about sleep apnea today?

SPEAKER_00 16:21

Um I I think just it's important to get tested because it can affect your life in a lot of different ways. And one of the good things that I like about sleep medicine is it's kind of an instant, instant fix where the next time I see the patient, they're very happy. They they're like, I feel fantastic, I should have done this years ago. So just taking the first steps and getting the ball rolling is important.

SPEAKER_02 16:42

Outstanding. Yeah. Well, thank you so much for being here. We've had a pleasure talking about sleep apnea.

SPEAKER_01 16:46

That's it for today's episode of Your Brain, Your Health. Thank you for spending time with us, and we hope you're walking away today with a deeper understanding of the importance of sleep, sleep apnea, and how early recognition and treatment can have a major impact on your brain health and your overall health.

SPEAKER_02 17:01

Your brain health matters, so keep learning and listening. If today's conversation helped you or might help someone you care about, please share it. And for more resources on your brain health, visit St. Luke's Neurosciences at Sluh N.org. Until next time, take care of your brain and your health.