EP 594: Simple Snoring or Serious Sleep Apnea? Rest Easy With Sleep Better Austin

In this episode, Dr. Mistry and Donna Lee are joined by a very special guest and partner of Urology Specialists, Dr. Brandon Hedgecock, DDS of Sleep Better Austin. Dr. Hedgecock is a dentist with advanced training in sleep medicine. Today, the docs discuss sleep apnea and the serious toll it can take on a person's health. If you've been fighting fatigue, blood sugar, stress, or your sleep-deprived partner, listen in to learn why a sleep test could save your life (and your relationship)! 

Voted top Men's Health Podcast, Sex Therapy Podcast, and Prostate Cancer Podcast by FeedSpot

Dr. Mistry is a board-certified urologist and has been treating patients in the Austin and Greater Williamson County area since he started his private practice in 2007.

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Transcript

Speaker 1: 0:07

Welcome to the armor. Men's health hour with Dr. Mystery and Donna Lee.

Speaker 2: 0:13

Hello and welcome to the armor men's health hour. I'm Dr. Mystery, your host here with my certifiable cohost

Speaker 3: 0:20

I board certified co-host

Speaker 2: 0:21

But certified award-winning award

Speaker 3: 0:23

Certifiable,

Speaker 2: 0:24

Co co-host Donnelly.

Speaker 3: 0:25

That's right. Thank you for having me back in all of my awards and accolades.

Speaker 2: 0:29

This is a men's health show. I'm a board certified urologist. And for those of you that are interested in listening to us, uh, off the radio, we also have a podcast. We do

Speaker 3: 0:36

It's everywhere. Uh, iTune, Spotify, buzz, sprout SoundCloud, just like saying those less

Speaker 2: 0:42

Sprout. We, we are terrible at marketing

Speaker 3: 0:45

Properly, but absolutely. And you said, Alexa, they can find us on Alexa at

Speaker 2: 0:48

Home say that's

Speaker 3: 0:48

Right. That's right. Okay. When they're completely

Speaker 2: 0:49

Bored, she's probably listening right now as

Speaker 3: 0:51

A matter

Speaker 2: 0:51

Of fact.<laugh> so, you know, what's an interesting thing about being a doctor, Donna. Mm.

Speaker 3: 0:55

So many things, but do tell<laugh>. So

Speaker 2: 0:58

You go through medical school, you go through this intense training, four years of learning everything about the human body and the moment you pick a specialty, you just forget about all that other stuff.

Speaker 3: 1:07

<laugh> it's not

Speaker 2: 1:07

Interesting anymore. Yeah. Like people just stop caring. Like if you go to an orthopedic surgeon and you ask him about his

Speaker 3: 1:13

Urology

Speaker 2: 1:14

Urology type thing, I was gonna say, but we're on Saturday now. Right? So he, and he'll look at you completely dumbfounded, even though he has he's smart and educated and knows everything. Right. But you just kind of get this tendency. And, and what I recognize, especially over years of practice is that the body's all connected. We, we have an inherent sense that what happens in one part of the body is gonna affect another part. What happens in nutrition and physical fitness affects another part.

Speaker 3: 1:37

I see where this is going.

Speaker 2: 1:38

You see mm-hmm<affirmative> and there's no other disease process that I deal with outside of nutrition, general nutrition. Mm-hmm<affirmative> that is more of a connection that you don't think is natural than urology and obstructive sleep apnea. Right? And so those of you that have listened to the show know that we do a lot of obstructive sleep apnea testing in our practice. Mm-hmm<affirmative> as part of a conjunction for people with low testosterone or a number of other things, especially our pre-surgery patients. And I thought what we would do is have a special guest today, and that is our partner. I'm gonna welcome Brandon Hedgecock DDS today. Thank

Speaker 4: 2:10

You. Thank

Speaker 2: 2:11

You. Welcome. Thanks a lot for joining us today, Brandon. Hey,

Speaker 4: 2:13

Happy to be here.

Speaker 2: 2:14

I heard his commercials. Yeah. KLBJ listeners are gonna know. Uh, and I think, uh, Sam and ed there's

Speaker 3: 2:20

No, Sam it's<laugh> was it gone

Speaker 2: 2:23

Don prior?

Speaker 3: 2:24

Yeah. Had, and Dawn welcome.

Speaker 2: 2:25

1990. Welcome. 1996. Yeah. Uh, so you're not a sponsor of this show. You're a partner of our practice though. And, and, uh, uh, correct. Well, what's the name of your company? So

Speaker 4: 2:33

We've got, uh, sleep better Austin

Speaker 2: 2:35

And that's the one that we use

Speaker 4: 2:37

Mm-hmm<affirmative> and then, yeah. And then Austin sleep solutions as well is the one you guys

Speaker 2: 2:40

Use that's right. A lot of people may not immediately put together why they're gonna get tested for obstructive sleep apnea and urology mm-hmm<affirmative>. And I thought what we would talk about are some of the barriers that patients put forth on getting tested. I also want to talk about how in medicine, we are taught to have a, a solution for a disease process. You have disease, a I have solution B and then a lot of times doctors, they just, their mind just stops right there and insurance companies and the government and quality people are now understanding. It's just as important to make sure people are doing treatment be and following through, not just having an answer for them, because we're not a jeopardy contest. Mm-hmm<affirmative>, we're not here to find out what you have and give you a solution. We need to make sure you're following through. Right? Absolutely.

Speaker 4: 3:28

And I mean, this happens all across medicine. It's not just sleep apnea. I mean, if you give a patient a medication to take for high blood pressure or something like that, what if that medication doesn't work or what if they don't take that

Speaker 2: 3:40

Medication? Because it causes the side effects,

Speaker 4: 3:41

Side effects or something like that. Mm-hmm,<affirmative>, there's gotta be other solutions

Speaker 2: 3:45

In, in medicine. The government is actually gonna be rating us doctors on how well patients are complying with the treatment. And a lot of doctors complain. They say, well, that's not our problem. It's not our fault that patients aren't taking meds. And I would say to those doctors, it is because we have to be able to convince them that it's in their best interest and then follow up appropriately to find a treatment that suits them. And if they're gonna be in uncompliant patients, then that's fine, but you should try your best to try to get people to accommodate their treatments and what sleep apnea. Uh, I think that, uh, where you and I play a big role is helping patients, uh, kind of fulfill. So why don't you tell me, how, how do you describe what sleep apnea is to patients?

Speaker 4: 4:24

You know, the, we, we talk to patients and we simplify it as much as possible. We have a, a hose, a garden hose that goes from our nose and our mouth to our lungs. And the sole purpose of that hose is to get air and oxygen from the environment to our lungs, for gas exchange so that our body gets the oxygen that it needs. And when you have sleep apnea, you essentially have a kink in your hose. Air is not getting through and air is not getting through because typically speaking, the airway is collapsing. The tongue is relaxing. The muscles around the throat are relaxing and collapsing at night when you're in your sleeping. And so it's blocking the passage and it's kinking the hose. And so from a solution standpoint, it's how do we UNK the hose? And that's what we say to patients.

Speaker 2: 5:10

And so going along with that, I try to explain to patients also, your oxygenation drops during these episodes. And it's almost like somebody's kind of partially choking you all throughout the night. Some people enjoy that.<laugh> while awake though. Sorry,

Speaker 5: 5:24

<laugh> sorry.

Speaker 2: 5:26

Saturday. Usually while awake Saturday, Saturday, don't forget.

Speaker 4: 5:29

You enjoy it to a point, right?

Speaker 2: 5:31

You don't wanna that's right. That's right. You don't wanna be

Speaker 4: 5:33

Choked. Choked. Absolutely. So if you're not getting oxygen in, you're not breathing. If you've got a kink in your hose, you're not getting enough oxygen and your body needs oxygen, your brain needs oxygen. Your heart's job is to get oxygen to the brain and to the body. And so all of your systems kind of start to panic. If you're not getting the oxygen that you need, think about being held underwater, uh, at the bottom of the pool, maybe someone's holding you down underwater or maybe go back to your high school days if you were picked on like I was and got, you know, down in the toilet or something like that.<laugh>,

Speaker 2: 6:06

You know, I think our therapist can

Speaker 4: 6:07

See<laugh>. So, I mean, what happens? You panic. Yeah. You know, your

Speaker 2: 6:12

Body releases, cortisol and adrenaline and all these things that don't let you relax. And so when I'm trying to explain to patients, um, about sleep apnea, the very first thing that the wives often say is he has no trouble sleeping. Mm-hmm<affirmative>. And I try to explain to them that that's right. He probably goes to sleep three seconds after his head hits the pillow right away, because that's exactly what happened with sleep apnea. Mm-hmm<affirmative> and that's something that people sometimes don't recognize and, uh, snoring happens often, but not always mm-hmm<affirmative>. And, um, uh, in terms of urologic symptoms, um, what are some of the things that you see very commonly and then I'll kind of add whatever I heard.

Speaker 4: 6:51

Yeah. You know, really commonly one of the common things we see is patients say they get up six, seven times a night to go pee mm-hmm<affirmative> so nocturia they're waking up frequently cuz they have to pee. Um, we know that as you're struggling for oxygen, it creates intrathoracic pressure, causes the heart to release peptides, all of this acts on the bladder. And so these patients, a lot of times they come in and they're like, well, I think it's my prostate. Uh, but really it's it's the sleep apnea. That's, whatt treated, you put a C P a P on'em, uh, or an appliance and all of a sudden they come back and they're like, you know, I'm not waking up to pee anymore. You know? So that's, that's a very common one that we see. Uh, the other one, uh, there's a lot of men's health issues. There's the low testosterone, um, uh, decrease in, um, you know, erectile dysfunction, decrease in erection strength, things like that, that happened in association with that as well, loss of libido. Um, a lot of those sexual function type things are happening as well

Speaker 2: 7:44

And fatigue

Speaker 4: 7:44

And then fatigue. And you're tired. You're tired,

Speaker 2: 7:46

You know, and you're tired. Mm-hmm<affirmative> and you may not even recognize that. And I think that, um, one of the most dramatic things that I've heard consistently is those with sleep apnea, who appropriately treated often improve their weight loss plans too.

Speaker 4: 7:59

A hundred percent. Yeah. So all the hormones that control appetite, hunger, weight loss, all that, you know, those are active during the nighttime hours as well. And if that's getting disrupted, uh, you don't have the energy, you need to work out. You're not eating properly, everything's thrown off. So once you start getting treated for sleep apnea, uh, you'll see patients that lose weight quicker, faster, maintain their weight better, um, maintain their hormone balance better, whether it's diabetes or testosterone or whatever it is

Speaker 2: 8:27

Mm-hmm<affirmative>. So from our end, from your urologic standpoint, we come at, come at it from the opposite way. So we're not looking for things that are gonna be cured by fixing your obstructive sleep apnea. But, but rather, why are you coming to see me in the first place? So if you're getting up four or five times a night to pee and it's small volume urination, mm-hmm,<affirmative>, uh, it's unlikely that you've, that your prostate is causing that once or twice or three times maybe, but four or five, six times there's gonna be something else. A lot of times guys come to us seeking testosterone therapy for fatigue mm-hmm<affirmative> and they're 280 pounds, five foot, 10 have a neck, the size of a bowling ball. And I immediately know that this guy has sleep apnea and I'll ask him, have you been told you had sleep apnea? And they'll say, oftentimes they'll say I was referred for testing or I was diagnosed or this, but I don't treat it. Mm-hmm<affirmative> and, uh, um, uh, it, it really raises a, a big conundrum for us.

Speaker 4: 9:27

Yeah. Yeah. And, and ignorance is bliss. Right. You know, a lot of times patients are afraid of finding out what they might have because they're afraid of what the treatment might be or whether or not they can do it. Or, um, they they'd rather just, uh, not know, you know, a lot of patients have sleep apnea. They don't know they have it,

Speaker 3: 9:45

You know, mm-hmm and they don't wanna go off site. They think they have to sleep somewhere. They

Speaker 4: 9:48

Think they gotta go a lab. That's right.

Speaker 3: 9:49

Yeah. That's the biggest component. I think for a lot of

Speaker 2: 9:51

Guys, you know, what's interesting is that this whole idea of how we treat and test for sleep apnea really has gone through a real evolution in the medical profession. There are cardiologists that do obstructive sleep apnea. There are pulmonary doctors that do it. There are primary care doctors that do it, and they all take it from a different angle in terms of what they're really focused on. To me, it seems very natural that a dentist, if this is an oral issue, a dentist would be, and I would be somebody that would be involved with it. Mm-hmm<affirmative>. And especially since a lot of times the conversations that you'll have with a patient in the, in the dentist chair, maybe a little longer. So you might be able to kind of delve into these issues better. Have you found it to be a pretty natural fit?

Speaker 4: 10:32

Yeah. It's a very natural fit for us. In general dentistry. We see patients, you know, every six months at a minimum, we spend an hour with them in the chair. We're looking down the back of their, in their mouth, down the back of their throat. You spend a lot of time looking in people's shorts. We, we<laugh>, we spend more time in the mouth, you know, opposite, opposite ends of the spectrum<laugh> and uh, sometimes they fit together. And so we can see,

Speaker 2: 10:55

Although there are some dentists

Speaker 4: 10:57

<laugh> and so we can see, we can see what's going on in the back of the throat. And we can see when somebody has a small airway and there's also oral side effects. We mentioned a lot of the urology side effects in terms of low tea and erectile dysfunction and nocturia, and those types of things. We see clenching grinding, broken teeth, acid erosion on teeth, all things that are correlated with sleep apnea.

Speaker 2: 11:16

So a lot of people are concerned that they're gonna be tested for in a, in, in some strange room that they have to go sleep outside of their house, being monitored overnight, buying monitor overnight. I don't know,

Speaker 3: 11:26

With some creepy person in their other room. Mm-hmm<affirmative><laugh>

Speaker 2: 11:29

Wait, can I sign up for that

Speaker 3: 11:30

Party? Right.

Speaker 2: 11:31

In our practice we do at home sleep testing. Maybe you can describe what that is, what involves for patients.

Speaker 4: 11:37

Yeah. It's, it's so much more affordable for patients. It's more convenient for patients. You get to do it in your own bed. It's a belt that fits around your chest, a little finger sensor that goes on your finger, push a little button, and then you go to bed and then the next morning you bring it back. Uh, you're able to upload the information, send the data off to a sleep doctor. So no, no longer do you have to go to a lab, spend the night hook up to 27 different wires, have the strange person watching you from the next room. It's just really much more convenient. It's

Speaker 2: 12:04

Covered by insurance. It is covered by insurance, especially if, if we find it to be something that it's indicated.

Speaker 4: 12:09

Yeah. And in in fact, most insurance companies nowadays are mandating a home test prior to doing a lab test or an overnight test because it's more effective and more affordable,

Speaker 2: 12:20

More natural, more affordable. Yeah. Oh, patients are concerned. Number one, they don't properly recognize what might be symptoms of Ossa. We talked about that in the previous segment and if you missed it, catch it on our podcast.<laugh> uh, second we talked about patients are concerned about the testing, but I think the biggest concern is that they're afraid that they're going to be saddled with a C P a P. Maybe you could describe what a C a P is, and maybe why compliance rates are not as high as people would hope they are

Speaker 4: 12:46

C a PS. First of all, are, are an incredible device. And they're very, very, very effective, uh, tool for managing obstructive sleep apnea. Essentially, it's a leaf blower and that's kind of what I tell my patients. It's a, it's a box that sits on your nightstand. They're smaller now, quieter now. And they're hooked up to a hose and a mask and you wear the mask on your face or on your nose. And this machine is going to blow air through the hose, into your mouth and down the back of your airway at a high enough pressure that it keeps it open. You know, going back to our garden hose analogy, you could turn to get past the kink. You could just keep turning up your water pressure until you blow through the kink, uh, with enough water pressure. And that's kind of what it is except it's air

Speaker 2: 13:27

Pressure. And, and, and maybe in a, in a future episode, we might discuss kind of C P a P technology and, and how to maximize it. Needless to say, a lot of my patients have been given C P a PS. They don't use'em mm-hmm<affirmative>, they don't, they're scared of even having the thought of maybe even having to use it. Yeah. And so specifically you specialize in using a dental appliance,

Speaker 4: 13:46

Correct? So we, we use a dental appliance that essentially holds the, the jaw together in a forward position, and doesn't allow that kink to happen in the first place. So it's more of a mechanical option and it fits to the teeth to the jaw, holds it open. And it's an alternative to C P a P for patients that really are not consistently wearing their C P a P the number of patients that wear their C a P every night. If, if you had to guess, do you know the number?

Speaker 2: 14:10

I would guess it's probably less than 20%.

Speaker 4: 14:12

Yeah. It's it's depending on what study you eat, it's in the 30% towel range. Mm-hmm<affirmative> of people that are wearing it every night. And they do really well with it. The rest of the people don't like it for whatever reason, it's a hassle. They get bulky facial irritations. It's bulky, it's harder.

Speaker 2: 14:25

They sleep on their stomach.

Speaker 4: 14:26

They sleep on their stomach. So every time they turn, they get a leak and the air comes out. Uh, it's not really sexy if you're trying to, you know, going back to going back to what we talked about, the beginning of the segment, Hey, babe,

Speaker 2: 14:38

Let me put

Speaker 4: 14:38

A C P P on. I can be with you in a minute. So there's a lot of reasons why people don't like it. It just doesn't work for everybody. And so for those patients, or for patients that maybe are more mild and C P a P is overkill, the dental device is a great option. Works really well. Patients tend to be more compliant with it. The rate of compliance is more like 80% compared to 30%.

Speaker 3: 14:58

I have to do a shout out. My husband went through this process with y'all and he brought home the little sleep thing, and he, um, got a CPA, but it made it, it kind of freaked him out in the middle of the night mm-hmm<affirmative>, but he, um, had the oral appliance and his snoring went down by like 90%. Wow. Yeah. Yeah. And he's sleeping better. He feels better. So,

Speaker 4: 15:13

Yeah. Thank you. Awesome. You're welcome. Thank

Speaker 3: 15:15

You. We can sleep in the same room now. It's awesome.

Speaker 2: 15:17

And he didn't pay at all for that

Speaker 3: 15:18

Insurance covered

Speaker 2: 15:19

It. No Hedgecock couldn't pay it all us at all for that little

Speaker 3: 15:22

<laugh>.

Speaker 2: 15:23

This is the worst show. Oops.<laugh> man. But my husband doesn't snor that much anymore. That's that's awesome. Why would a specially fitted by a dentist appliance? Be better than the one I can buy off Amazon?

Speaker 4: 15:35

Oh yeah. Yeah. That's a great question. First of all, they're more effective. It's fitted. It's a custom fitted device. The ones off Amazon tend to be bulky. Uh, they tend not to be retained very well. They tend to fall out easily and they may or may not be able to position the jaws far forward as it needs to be positioned

Speaker 2: 15:52

Because they don't know what your mouth looks like.

Speaker 4: 15:54

They don't. Exactly. Exactly. So you're buying it. Their one size fits all. It's, it's kind of like you a terrible idea, boil it in the water, and then you hope it works. And it may work for some people, but it may not for others. Um, uh, versus something that's custom fitted, fits it's made to fit your teeth. And then it gives us a little more control. If you need to be a millimeter forward, we can move you a millimeter forward. If you need to be five, we can move you five. If you need to be 2.3 millimeters forward, we can move you 2.3 millimeters forward.

Speaker 2: 16:20

It's it's a great point. You're making, which is that after you get treated, whether it be a C P a P or a dental appliance or weight loss or whatever mechanism you're gonna use, you need to get tested again. Absolutely.

Speaker 4: 16:29

We gotta make sure it's working. You know, we can't just say, you know, patients will say, well, I lost 30 pounds. I don't snore anymore. And, and the question is, well, are the apnea gone?

Speaker 2: 16:37

Right? Right. You did. Did we, did we fix the choking? Mm-hmm<affirmative> mm-hmm<affirmative> what does a fitting look like to a patient, you

Speaker 4: 16:43

Know, in, in our office, we use digital scans these days. So you don't even have to get the gooey impression material. Like if you think back to really your braces. Yeah. So we do digital scans. So a little video camera in the, in the mouth takes pictures of the teeth. We send that off to the lab. Uh, they make it, so it's a two appointment process to get your device. You come in, we, first of all, we gotta check your teeth, make sure everything's stable enough to support a device. Mm-hmm<affirmative>, uh, we send that off. You come back, we're gonna fit it and make sure it's fitting properly, make sure it's adjusted properly. Um, and then we're gonna kind of coach you through how to adjust it, using it. Um, making sure it's working, what to look for signs and, and symptoms. And we're looking for less snoring, more refreshing sleep. Mm-hmm<affirmative>, uh, a lot of times the, the bed partner is not elbowing them anymore, or they're back in the same room. Mm-hmm<affirmative> because, uh, the noise is gone in that cup.

Speaker 2: 17:31

Or when you go on a, on a Cub scouting, uh, camp out, you don't have to bring a 14 pound battery along with your C a

Speaker 4: 17:37

Machine.

Speaker 2: 17:38

For sure. As one of my, uh, tent mates did recently,

Speaker 4: 17:42

The summer I travel a lot and I see people at the airport, they're always taking their C P a out. And I just like, I just slide.'em a business.

Speaker 2: 17:50

That's nice. That's nice. A great idea. So let's talk about, um, insurance coverage. So if somebody does have insurance, somebody doesn't gimme your spiel on this and what does it cost if you don't have insurance?

Speaker 4: 18:01

Yeah, it completely depends on the plan. Uh, if you have insurance, your insurance may cover the whole thing. You may not have to pay anything out of pocket, depending on deductibles and copays. And I know of course, you know, everybody's got high deductibles these days. Um, if you don't have insurance, we've got a discounted cash fee. We can break it up into payments. Um, it's a, it's a 2,500 bucks or so for the device, but that device is warranted for at least five years. Mm-hmm<affirmative>. So you're gonna get minimum five years use out of it. Um, and, and it's, it's gonna last you

Speaker 2: 18:30

Because your teeth change and your mouth changes.

Speaker 4: 18:32

You mean teeth change, mouth changes, but C PS too, you know, C PS have to get replaced and masked and hoses and all that gets expensive over time.

Speaker 2: 18:38

Mm-hmm<affirmative> uh, what about Medicare patients?

Speaker 4: 18:40

Medicare? This is covered by Medicare, for sure.

Speaker 2: 18:43

And I think that would be a dramatic surprise to a lot of patients.

Speaker 4: 18:46

Well, they know it works. Medicare wouldn't cover it if it didn't work. And if it didn't, if treating it didn't save Medicare money, they wouldn't cover it.

Speaker 2: 18:52

Good point. Well, that's amazing. Well, Brandon, I can't thank you enough for joining us today. Can you tell people how to get ahold of you

Speaker 4: 18:58

Sleep better? austin.com can go to our website, find all the information you need there.

Speaker 2: 19:03

Awesome. Awesome. Uh, Donna, you wanna do a quick shoutout to us, even though we're over time.

Speaker 3: 19:07

Um, call us the(512) 238-0762. Send your emails to armor men's health, gmail.com. Thanks. Be in a

Speaker 1: 19:13

Bit. The armor men's health hour is brought to you by urology specialists for questions, or to schedule an appointment, please call 5 1 2 2 3 8 0 7 6 2 or online at arm men's health.com.