Sleep apnea is the topic of Memorial Medical Center's next Seminar on Thursday evening. Dr. Joshua Levinger, the presenter, talks with KC Counts about the prevalence of sleep apnea, its harms and treatments. Here's a transcript of their conversation:
KC Counts:
So, I have to say, from a personal standpoint, I might be the last person I know who has not gotten a CPAP machine. So, some people have told me they're doing great and sleeping lots better. Others really struggle. So why don't we begin by just telling us a little bit about the foundation?
Dr. Joshua Levinger:
Well, sleep apnea is really, really common. If we look at adults in the 30 to 70-year-old age range, about a third of all men and about 17 to 20% of women have at least mild sleep apnea. It gets worse as we get older, so among adults 50 to 70, in men, that rises from 34 to 43%. And in women, it goes from 17 to 28%.
KC Counts:
So, what are some of the harms that people should be aware of if they let their sleep apnea go untreated?
Dr. Joshua Levinger:
Yeah, so sleep apnea untreated is a two to three times increased risk in heart disease and other metabolic problems. High blood pressure that's really hard to control is definitely a side effect of untreated sleep apnea. Things like irregular heartbeats called atrial fibrillation, heart attack, heart failure. If you have moderate to severe sleep apnea, the risk of stroke is about four times as higher in men with sleep apnea and about two times higher in women.
KC Counts:
Okay, so we know we have it, probably, if we know we snore; is it just snoring, or is there something more we should be looking for?
Dr. Joshua Levinger:
Yeah, so the warning signs are definitely loud snoring every night, but the most telling sign is when a bed partner has seen you wake up gasping or choking or pausing your breathing. If you feel like you're waking up repeatedly, getting up to pee two or more times in the middle of the night, if you wake up ...not feeling refreshed, if you're sleepy during the day and dozing off easily while reading, watching TV; it can also affect memory and concentration. It can cause irritability and depression.
KC Counts:
That's everything. I think you just named everything, right?
Dr. Joshua Levinger:
Yes! And the interesting thing is that the majority of people with sleep apnea are probably not even diagnosed.
KC Counts:
So, we go through that process. I think, you look at what folks have to go through - that sleep study. I mean, you wonder how anyone can actually sleep during the sleep study.
Dr. Joshua Levinger:
Yeah, so we've actually come a long way in terms of equipment to help us diagnose sleep apnea. Most of the time now, we can probably have you do a home sleep study, and really, that's just like a little button that you tape to your finger or a watch that you put on and that's it. You get to sleep in the comfort of your own bed. The machines are really smart. If it thinks you didn't sleep enough, it'll tell you to do another night of testing. And so, the diagnosis has become a lot easier and a lot quicker.
KC Counts:
Have the machines gotten any easier to live with?
Dr. Joshua Levinger:
Yeah, you know, the machines are really quite smart as well. They adjust the pressure based on how it senses you breathing. And so, if it sees that you're having more episodes of sleep apnea, it may turn the pressure up. If it sees that you're having less, then it turns the pressure down and so it auto adjusts or auto titrates to keep your comfort. And then there are a lot of settings that we can do to increase your comfort as well. It definitely takes some getting used to, but if you can learn to tolerate it, really is the gold standard of treatment and nothing is going to be as effective as the CPAP.
KC Counts:
So, tell us what changes when people start using their CPAP. Sure.
Dr. Joshua Levinger:
So the daytime sleepiness gets better. However, about 20% of people don't see improvement in daytime sleepiness. And I tell patients, it's like a deficit. You have a sleep deficit. You went who knows how long with untreated sleep apnea. Well, you have to pay that deficit back before you even start to feel the improvements in the daytime sleepiness and the cognitive functions and things like that. And so, it's a slow process in terms of that. It can, after six months to a year of treatment, you can see reductions in blood pressure, you can see less need for medications, you can come down on your dose. of medications. And so it actually makes it easier to lose weight if you wear your CPAP because it helps reverse some insulin resistance. And so, you definitely see a lot of good benefits from wearing it. And you just feel better, well rested, refreshed, like you actually slept.
KC Counts:
It sounds so nice. Now, you're doing some public education on this topic. Tell us.
Dr. Joshua Levinger:
Yes. Oh, so Memorial Medical Center has a community seminar series. And Thursday, we're going to have a little dinner and lecture series. I'm going to stand up in front of the audience and talk for maybe 1/2 an hour on sleep apnea, but I also want to be there to help answer some questions.
KC Counts:
I mean, this can really be frustrating for people, right? I'm sure you've heard all kinds. How do you help people through that so that they don't give up?
Dr. Joshua Levinger:
Giving up on wearing the CPAP, wearing the treatment. So, we have ways to monitor patients' progress with their therapy. And so, I can see how many hours per night the patient is using their machine. I can see how high the pressure is going. If it's going too high, then maybe something's wrong with the mask and we have to refit that. And so, it's really just about being there for the patient, really being there to sit, to listen to their concerns, to discuss alternatives to treatment, to figure out ways to improve the comfort of the treatment. And so I like to see my patients every six months and more often if they want because we got to check in, we got to see how they're doing, we got to make sure that they're staying compliant with their therapy, that they're getting the benefits from it. So it really is just staying in touch.
KC Counts:
And what about people who are skeptical, maybe even just a little cynical about the whole approach with the kind of the business side, right, of the CPAP machine? What do you tell people who think it's just an effort for folks to make money?
Dr. Joshua Levinger:
You know, I have not even had that happen once in the last 15 years. Yeah, patients definitely are skeptical of the machine. They've heard awful things. They have preconceived ideas about what it's going to be like. And most of the time, that's a little skewed from a family member or a friend who really had a bad experience or didn't have a doctor that was helping support them through all of this.
KC Counts:
I think that support, you mentioned that is what I think a lot of people feel like they're missing along the way. So you really do see us when we're sleeping...
Dr. Joshua Levinger:
I don't watch you when you're sleeping [laughter], but I can get the numbers after you wake up.
KC Counts:
All right. What else is important for people to know about sleep apnea or how they can come and get more information from you?
Dr. Joshua Levinger:
Sure, yeah. So, we are offering home sleep testing through the office as well as the referrals to the overnight labs. Really, it's come a long way and the options for treatment are getting better and better for our patients who don't tolerate the CPAP and have mild sleep apnea. We can consider things like an oral appliance that pulls your lower jaw forward and opens your airway, but that's really only an option for mild sleep apnea. Losing about 10% of your body weight really meaningfully reduces breathing apnea events, weight loss medications, bariatric surgery, these all help. However, it does seem to persist to some degree. And so retesting is definitely something we need to do rather than just assuming a cure. There are surgical options. They can include something as simple as a tonsillectomy or a procedure on the soft palate and throat. We have nerve stimulator implants that are very effective at treating sleep apnea in people who cannot use the CPAP and don't have too high of a body mass index. Things like alcohol and sedating medications near bedtime can also make your night feel worse, especially if you don't wear CPAP. And we want people to stay safe on the roads, not operate heavy machinery, especially if they're feeling drowsy or tired that day. And so, we have lots of great options. Come see me and we'll talk about what options work best for you.
KC Counts:
All right. Well, thank you for all the great information. We really appreciate you taking the time. I'm gonna to come get one of them watches from you!
Dr. Joshua Levinger:
Yes, sounds good.
