Sleep disorders are issues for a large segment of the population in the U.S. The importance of getting treated and the process of getting treated, were recent topics on CHI Mercy Health’s Talking Health radio show on News Radio 1240 KQEN.
Dr. Razvan Gosman, a physician who is board certified in sleep medicine, and Debbie Langdon, a registered polysomnographic technologist and the manager of Mercy’s Sleep Center were guests recently on the interview program hosted by Lisa Platt.
This is an edited version of the program.
Lisa: What is the definition of sleep apnea?
Dr. Gosman: Sleep apnea is a condition that occurs when a person falls asleep and the muscle tone in the back of the throat relaxes to the extent that the person stops breathing. The part of the brain that controls breathing while we are asleep tries to fill the lungs with air and when that doesn’t work, the brain wakes them up. This interrupted breathing can happen multiple times, even hundreds of times, during the night.
Lisa: How do we know if we have a true sleep issue or if we’re just tired?
Dr. Gosman: It is hard to answer that question, that’s why we end up doing sleep studies. Just feeling blah during the day, feeling tired and laying down and not falling asleep is not necessarily a sign of sleep deprivation, it could be other health conditions, including depression.
Lisa: Obstructive, central and mixed sleep apnea, are there big differences?
Dr. Gosman: These are all separate conditions. Central sleep apnea is when the brain does not ask the lungs to breathe, mixed sleep apnea is a combination of obstructive and central sleep apnea. With mixed sleep apnea, the obstructive part can be treated with C-Pap or positive airway treatment, however, we also want to treat the cause of the central sleep apnea.
Lisa: Would you talk about the risks of not treating sleep apnea?
Dr. Gosman: Not treating sleep apnea can cause long term health issues, including high blood pressure, strokes and heart attacks. It can also limit a person’s abilities to perform duties at work, operate a car or heavy machinery safely.
Lisa: Debbie, can you tell us about a sleep study, what it is and what it will tell you?
Debbie: Patients watch a short video so they know what to expect and have an opportunity to ask any questions. Then the patient settles into one of the center’s hotel-like rooms.
During the study, we measure their oxygen and monitor their heart rate. Generally, once the patient lies down and realizes that they can sleep on their side if that’s more comfortable, most patients do well.
Lisa: What are some of the concerns that people share with you about doing a sleep study in the sleep center?
Debbie: I think the biggest concern is the unknown, just coming in and thinking that the process is going to be painful, or they are concerned about the leads that we will be putting on them. But patients do want to know if they’re holding their breath, or if their oxygen levels are going down at night.
Lisa: Are patients truly asleep at the sleep center while they’re doing the study?
Debbie: Yes, we are monitoring them so we know when they’re asleep and when they’re in stage one, stage two, or stage three of sleep. We do know when they’re dreaming, but we do not know what they are dreaming about.
Lisa: Can you talk about the different therapies for sleep apnea or sleep disorder?
Debbie: There is continuous positive airway pressure, or CPAP, and that is when a constant flow of air is introduced into the airways to keep them inflated. Another mode is called bi-level positive airway pressure therapy, and it supplies higher pressure when inhaling and reduced pressure when a patient is exhaling.
Lisa: Outside of equipment, are there other types of therapies, like oral or surgical?
Dr. Gosman: There are several other therapies that are offered for obstructive sleep apnea. Unfortunately nothing works as well as CPAP — continuous positive airway pressure.
One type of therapy for sleep apnea is an oral appliance. It looks like a mouth guard, it pushes the lower jaw forward to increase the space behind the tongue. Some patients actually do quite well with them.
In general though, these therapies are indicated for just mild obstructive sleep apnea.
Weight loss and positional therapy, which implies sleeping on one’s side instead of the back, are other options.
Lisa: The most frequent concern I hear about the CPAP machine is the mask. Can you talk about that?
Debbie: There are different styles of masks, and they’re constantly improving and changing. They’ve come a long way in the last five to 10 years.
There are nasal pillows which sit at the base of the nostrils and the air is introduced through the nose only. There are nasal masks that are small and just cup the bulb of the nose. Then there is a full face mask which covers the nose and mouth for people that are mouth breathers.
Lisa: Does insurance cover most treatments associated with sleep disorders?
Debbie: Most insurance covers CPAP depending on your plan, usually 80 to 90 percent but again, it’s your plan and deductible.
Lisa: Are there any new developments in this technology?
Dr. Gosman: An exciting development with new machines on the market allows patients to actually see the data themselves. They are Bluetooth enabled, and the patient can go online and see the data generated by their machine on any particular night. This provides the patient with faster feedback, and if they see something off, they can call their physician or the company if the numbers don’t look right.
Lisa: What last recommendations do you have for people who think they might have a sleep disorder?
Debbie: If you feel like you might have a sleep problem, or you’re not feeling rested, definitely start that conversation with your physician. People are welcome to tour the sleep lab between 9 a.m. and 5 p.m. They can look at the rooms and ask us questions to help reduce any anxiety and fears they might have.