or pbs el paso shall be responsible for the views opinions or facts expressed by the panelists on this television program please consult your doctor [Music] we spend one third of our lives asleep if we want to be healthy and enjoy a good life we need to pay attention to the quality and the quantity of sleep and it's when all the activities of our day are archived into our brains and it's also when vital tissues in our body are being repaired how much we sleep and how long we sleep affects several things how long we're going to live totally not kidding we were talking about shaving off five to ten years of your life if you don't sleep well our metabolism our psychological well-being and our general quality of life it also affects how our bodies respond uh respond to specific illnesses and treatments sleep apnea which we're going to go into quite a bit this evening contributes to obesity high blood pressure diabetes depression and a host of other issues during this next hour we have experts answering your questions about sleep disorders and sleep apnea as you know this is a lie program so give us a call at 881-013 you can also watch this show if you have to leave the tv you can watch a show on youtube.com and just search for el paso physician live and you'll also be able to ask some questions this evening's program is underwritten by southwest ent which is ear nose and throat we also want to thank the texas tech paula foster school of medicine for providing our medical student this evening and today we have with us nicholas martinez and he just checked with me my cell number and nicholas is the one that sends the questions my way via this telephone so if you see me looking at my phone this evening i'm not being rude to the doctors i am getting questions from nicholas so nicholas thank you so much for being here and we also want to say thank you and major kudos to the el paso county medical society who's been doing this show for 25 years good evening i'm katharine berg and you're watching the el paso physician it's interesting cause i'll have some of these doctors on the show and yeah they're doctors but i've known them for 20 years we've been doing this show for 20 years you know he talks about farts and he talks about diarrhea and he talks about all kinds of things that nobody wants to talk about and that's what's great about the show because you get to hear those things on the show and go i'm not the only one it's great see el paso physician [Music] thanks again for joining us we have uh three different specialists on the show this evening that are going to talk about sleep apnea but sleep disorders in general and uh there is a quote that we were talking about just a few moments ago dr diaz was talking about for new year's resolutions a lot of us say oh you know what we're going to exercise more we're going to get into shape but no one ever says hey i'm going to try to sleep more but that's actually super important we're going to talk about that this evening we have with us uh dr edward aussie who specializes in cardiovascular disease and then we have dr gonzalo diaz who specializes in sleep medicine and we are back with us again dr kevin bright who specializes in otolaryngology also an ent guy i just love saying those words um but thank you so much for being here and dr aussie i know that we talk about we're often together with cardiology programs and this evening we're here uh regarding sleep so as a cardiologist how is it that your discipline has to do with what we're talking about tonight it's actually quite huge we have so many patients in fact the way i look at myself with dr gonzalo diaz is that i'm actually a referral for him like a primary care physician would refer to me because the prevalence of obstructive sleep apnea and all the disorders that i take is extremely prevalent 40 to 80 percent of my patients with hypertension atrial arrhythmias pulmonary hypertension stroke heart attack 40 to 80 percent of them have obstructive sleep apnea so our field is extremely intertwined with the pulmonary sleep position so it's extremely important that we collaborate and treat these patients appropriately when you're talking about obstructive this is a physiological something's in the way sleep apnea and the reason i want to say that because i know that we've got central sleep apnea as well but sometimes it's nice to be able to picture that when we talk about that dr diaz you are our sleep disorder guy and so uh the other two doc said if we don't know the answer go to job uh so you're that guy you get everything but you really are the person that studies sleep that this is what you do all day every day if you can explain to the audience at home my gosh i don't even know how to explain it because it goes from i haven't been able to sleep since i was little i'm a horrible sleeper but what do you do with people and patients and what are some of the questions that are asked of you well we need to find out what's the cause of the insomnia and basically we're trying to find out if the patient has depression they have a full cycle sleep they have a sleep pattern that can be one of the castles there can be periodic movements there's a lot of things that can give you insomnia and if you don't address the underlying cause of the insomnia you're never going to control that and if you don't if you just take a sleeping pill is not the way to treat it most of the time we don't recommend a sleeping pill for chronic insomnia we recommend sleeping for acute insomnia but for chronic something we have to find out the cause of it and treat the cause of it and treat the cause of it and that's the magic that is correct that's the magic uh dr bright we had you on so you kind of work your way in endocrinology as well but your ear nose and throat guy so you are the person who looks at structures and what's happening and i know that we've got a toy that we're going to show some information on later on this evening but in this world of sleeping as an ear nose and throat guy what are you going to bring to the table today what is it that you study with sleeping so as a surgeon of the upper airway we take care of children and we take care of adults birth through death like dr ossi i'm a heavy referrer to the sleep lab because constantly we see people and i observe their anatomy and say you have to have sleep apnea so my management of sleep apnea is surgical management and uh it's surgical management of obstructive sleep apnea to be clear central sleep apnea i don't have anything to offer but we're looking at those patients that are not getting a good night's sleep because when they try to breathe the air can't get in right and we have a list of treatments that you've been doing for years and that's going to be really interesting once we get to that point as well dr diaz i'd like to kind of start with you as the sleep guy um frequent insomnia in the general population we're talking about sleep apnea a lot tonight but what are some of the the different types of just in general sleep problems that the population has well the most common sleep problem that we see synchronic insomnia without any question now was it cause of chronic insomnia we mentioned it can be a sleep apnea which is very common that most people are not aware of it when you brain when the brain sends that you stop breathing and your ocean drops wakes you up at the beginning because it doesn't want you to stop breathing doesn't want you to drop the oxygen so it keeps you awake because the brain learns that if you are awake you're not going to stop breathing you do it only when you sleep so it's very common problem then another problem is like uh drugs can affect your sleep obviously excess of caffeine consumption can affect your sleep rather leg wounds when you kick your legs at night most of the common cause of that is when you have iron deficiency a lot of people doesn't and they're not aware of it and by replacing the iron those leg wounds gets better about 70 percent of the cases that's like restless legs and the key just to check the ferritin levels different levels are less than 50 you replace it with iron for about three months with vitamin c and 70 gets better and sleep gets better with nothing else there's no need for a sleeping pill and like that there's a lot of cases and and in sleep medicine that we can correct if we found the cause of it right and that's beautifully said too and when you're talking about the cause of it and dr ossie i feel like this is a nice transition to you sometimes you can look as a cardiologist you're looking at the anatomy of a person or if you're looking at different conditions that they have and there is a point where you must have some kind of sleeping issues some type of sleep apnea when is it that you ask your patients to get tested to see if you have sleep apnea there are definitely certain conditions that we find that if we are treating the patient with medical therapy and we are not seeing an improvement and the biggest one that you can pinpoint would be hypertension so patients who are on a what we call a multi-drug regimen i've treated them with two or three drugs and they continue to have resistant hypertension you have to think about obstructive sleep apnea we not only see that with hypertension but we also see it with different types of arrhythmias with the heart so one of the most common arrhythmias that i deal with is atrial fibrillation which is an abnormal rhythm of the heart that predisposes you to fast heart rates and to stroke and in patients who have obstructive sleep apnea if it's not treated well the therapy that i give patients such as if i shock a patient back into normal rhythm it is clearly associated that you have a very high incidence of having recurrence if you leave sleep apnea untreated okay so on that note and i know we have so many different ways of treating sleep apnea going to dr bright so piggybacking on what dr aussie's talking about he's got some people have chronic conditions they need to get the sleep apnea taken care of so now they come and see upper respiratory ear nose and throat guy what are some of the options that you use to treat people like dr aussie's talking about so i i would first of all see somebody and i will frequently observe in their physical exam perhaps they're not even there to see me for their sleep issues but you're looking at their anatomy going this person has got to have sleep apnea and in in our town the prevalence of diabetes is huge and we have this obesity epidemic going on obesity and diabetes together almost always has sleep apnea so i will see these patients and say if you had a sleep study and frequently the answer is no and then it's time to to get their their sleep evaluated um you know we will emphasize weight loss in addition to cpap therapy because that's a key part of the solution and i see besides children adults where surgery plays an earlier role in people where cpap may not be a good ideal option a lot of people will come to me for surgical intervention as a first-line therapy because cpap is is really not compatible with their lives in particular i i see over-the-road truckers that you know really can't be well treated for their sleep apnea and their rigs we see anyone that carries uh weapons whether it's soldiers or police officers border patrol where if you have sleep apnea and it's not being successfully treated you may not be able to keep your job air traffic controllers these people they don't want to carry a diagnosis of sleep apnea and when we use a cpap we're treating the sleep apnea but if we are able to surgically cure it send them back for a sleep study verify that they no longer have it a lot of those people's lives are much more intact and dr diaz this is a nice way of going into what you're doing now you were talking earlier that we often dismiss sleep as being a part of our major health and dr bright was talking about you may not be able to perform your job and some people may not know it's because they're not sleeping well oh yes um so i'd love you to take that statement as you will and kind of talk about that how does one you know when they're not sleeping well i it's on such an easy question but you know again i'm that person that goes two hours awake two hours down you know mostly studies show that when you sleep seven hours you have a better quality of life you get less illness and you live longer people that doesn't sleep well or the lack of sleep because of social reasons or job or whatever reason the instance of high blood pressure is higher the instance of obesity increase you develop diabetes because you release a lot of hormones when you sleep that help you to stay in your normal way just to mention some of the hormones that you release is melatonin that you release it only when you sleep at night and that protects you from cancer of the breasts in cancer the or the prostate men another hormone is to grow hormone that you needed 80 of the grow hormone is released only during delta sleep and that help you to repair all the muscle damage and also help it to grow in kids if you don't have it in adults or you don't have the right amount to grow hormone you're going to have more fat and less muscle because the growth hormone will help you to build more muscle and also repair all the muscle damage that you create the day before so if you exercise you can have a lot of aches and pains where you don't sleep well that's what i was saying before it's more if you have to choose sleep or exercise choose sleep a lot of people wake up one hour before to go to the gym it is a huge mistake it's much better to sleep that extra hour than to do exercise now i'm a cardiologist here you've got to be careful there i'm not saying exercise is not good if you just don't get up early in the morning but don't sustain your sleep if you have to choose either one studies show that when you exercise when you sleep deprived you don't you use more muscle than fat as an energy and the benefit of the exercise is not there just because you're sleep deprived i'm not saying exercise is not good right no i can't that's right it's exciting so here's my question and maybe i'm i'm complicating it more than i should and i'm going to use myself as an example how does one know if they're getting enough rem sleep if they're getting enough delta sleep if you're just chronically a person that doesn't sleep well and i know i'm just throwing that out like oh they don't sleep well um but but again that that's me i will sleep for two hours i'll wake up at two in the morning and i'm just staring at the ceiling my head's going i don't know if i'm sleeping well or not of course you know i go to bed at a certain time and i wake up at a certain time but in between i was up three or four different times so yeah that's definitely that's where the sleep study comes in yeah that's that's what we have to find out what's the cause of that okay it can be a lot of reasons for it can be for medical reasons can be from psychiatric reasons can be from sleep apnea from prayer leg movements we have to have medicines alcohol a lot of things can affect your sleep and if you don't evaluate that you're never going to get better now how do you know how many hours of sleep do you need the the basic rule is when you're not active during the day and you don't feel sleepy you're doing it well you kind of done so when you're not active and you're sitting and you kind of feel tired it kind of does off a little you're not getting enough at night of the people needs between seven eight hours okay ten percent need less than seven hours ten percent is more than eight hours but eighty percent is between seven and eight so explain to me and i feel like i'm just focusing on you but it's kind of setting it up for dr bright and dr aussie too to me what you all do in a sleep study physiologically do you have you know i feel like everybody's got these little things on their brains and you're looking at the breathing and they're hooked up to stuff i have no idea but what are you looking for during these sleep studies yeah we put electrodes in the head so we can see what kind of sleep you have we check if you have stage one two three and four and remove sleep and then we check your breathing to see if you stop breathing at night that is typical sleep apnea and if you start with it we try to find out you have obstructive apnea or central apnea because it's through a different type of agnes and then we check your legs to see if you kick you like tonight that affects your sleep also we check your oxygen some people drop the oxygen because of pulmonary problems or cardiac problems nothing to do with the sleep apnea that affects your sleep also so there's a lot of parameters that we follow and we video video record the whole night so we know exactly what kind of sleeve they have at night okay and then from there now we're going to go see dr ossie because dr ossie said you need to go get a sleep study and so now dr aussie we know that they have let's say obstructive sleep apnea really quick before i do you because i want to again so there's obstructive which again something's in the way what is central sleep apnea sorry i totally put you on hold i figure if i say that we have to explain really quick what central sleep apnea is what is that versus obstructive sleep apnea obstructive apnea means that you airway closed and the brain sends the signal to breathe but you have an obstruction in the airway so you cannot you make the effort and then you wake up and breathe again central avenue your brain doesn't send the signal to breathe so you just start breathing and your skin drops typical cases is congested heart failure is very common to see central avenues people with previous stroke people who have taken drugs narcotics it's very common to see that so now this is a great way to transition to you and i know we we talked a little bit about this before the program because we don't want to scare people but we want to make sure that this is a big deal so we were talking about sudden cardiac death which can be related to a sleeping problem so again we don't want people to dismiss the fact that they're not sleeping well but with the two things that dr diaz was talking about maybe it's a central sleep apnea maybe it's obstructive but you're talking about sudden cardiac death because you're not sleeping right take it from there and educate people at home why this is important that's extremely important i mean obstructive sleep apnea we we put monitors on people all the time patients come in they're having palpitations we put a monitor on them they may not have any trouble sleeping but at the end of the day we're putting a monitor on them and we're seeing that they're having significant slow rhythms of the heart or sometimes their heart stops or they develop a abnormal rhythm that we call a ventricular arrhythmia as opposed to an atrial arrhythmia the ventricular arrhythmias come from the bottom chambers of the heart they can be very serious and the patients that start developing those types of problems are at risk for sudden cardiac death now we usually the term sudden cardiac death is going to be typically associated with the most severe cases of obstructive sleep apnea so when he tests the patients and they come back showing severe obstructive sleep apnea they're having multiple episodes of apnea throughout the hours of the night those are the patients that potentially could be at highest risk for sudden cardiac death but all these arrhythmias are serious um you know we recently had a patient that was in the hospital that had a passing out spell and while he was on the matter at five in the morning he had a 12 second pause that must been central or was that obstructive no it was obstructive it was obstructive it was physically letting the air right there's but still at the same time i mean a 12-second pause is a significant and there's probably underlying heart related issues conduction electrical issues with the heart because everyone drops their blood pressure and their heart rate at night time 10 to 15 percent drop typically but can be exacerbated significantly if you have untreated obstructive sleep apnea dr bright let's talk about treatments because if we're talking about untreated now we're talking about treatments and i and i'll kind of go through the list we're talking about tonsillectomy that was one of the i mean anything from tonsillectomy to palatoplasty to septoplasty to turbinoplasty base of the tongue surgery um and then you one that you said that is a hundred percent all the time is tracheostomy tracheostomy so now that i just read through them all what the heck are these and let's start with tonsillectomy because we just as kids i feel like everybody had their tonsils out so tonsils there's obstruction there and then we can go into the other ones that we were talking about sure so think tonsillectomy primarily children now we do see adults with monstrously big tonsils and their airways are obstructed we take those out and they breathe better but the typical patient you're talking about is a kid these are kids that wake up with headaches in the morning they're tired all day they're napping during the day they're wetting the bed they have behavioral problems a sleep deprived child looks no different than a child with attention deficit and hyperactivity disorders so i personally feel like it's hard to even make that diagnosis in a child that's not sleeping well so the answer for sleep apnea typically documented with the polysomnogram is to take out tonsils and adenoids in children and it's extremely successful and children aren't compliant typically with uh cpap devices and the other alternative modalities so so that's the tonsil story and it's no different in adults it's just less common right then on that list there over the years we've tried many different things we've shortened the palette we've removed the uvula that's the little thing that hangs down in the back of the throat um people with badly distorted nasal airways frequently can't breathe although i seldom see anybody where i operate on their nose and their sleep apnea goes away oh interesting um i i do see them get their nose fixed and be able to tolerate the cpap device much more easily because the pressures are lower the pain is less and and so forth so uh nasal surgery pallet surgery um tongue surgery is a very up-and-coming thing in this era of robotic surgery and uh so uh some of these people uh their obstructive problem happens at the back of the tongue where another tonsil that we don't usually take out very often lives um and and say that again there's another tonsil at the back of the back of the tongue and we do i don't know about this tonsil okay well okay let's talk about so we have four tonsils okay um we have the adenoid which is the uh the tonsil in the nose we have the palatine tonsils that are the two we see on the side of the throat and then be on the side of the throat and then occasionally gets big especially after the other tonsils have been removed and can be addressed with a lot of these problems when surgery and you were talking about the tracheostomy so a tracheostomy so that that seems more involved because you think trachea not that it's more scary but it just seems more involved really the only thing we have that's a hundred percent successful and it's a hundred percent successful because you completely bypass all the things that obstruct the airway um so a tracheostomy is a hole in the neck right and we we cut through the skin open up the trachea put a put a tube in that that keeps that hole open typically in a sleep apnea patient a different thing than in a cancer patient a small silicone tube with a button on it they close their collar up in the day nobody knows they have it at night they go to sleep and they just open the goodness gracious and there's still a role okay and there's still a role for that interesting um look at the things that i learned on this program i love it um dr diaz i got a question here from the audience we were talking about uh sleep studies and um this is edward who's on the phone so edward thank you for calling in and it said he had a sleep study in the past but with all the wires it was uncomfortable and interfered with his sleep and he wasn't sure if that may have affected his study or not um is there a study at that is there a study that may not have wires and i know that you kind of described earlier what's attached to you um but let's say it's someone that just just has a it has a mental block against having stuff and they're not at home et cetera except when you sleep in the sleep lab you don't sleep as well as you do at home but as long as you sleep it's enough for us to know that you have a sleepover now and most people are able to sleep while in the sleep lab there's a portable sleep studies that can we can be done at home and it's less electrodes than the ones that we do in the sleeper was it disadvantage or the home sleep studies it's not supervised we don't check the brain waves so we don't know if they sleep or not so if it's normal we don't we don't consider normal we can still repeat it if it's mostly normal then we consider a good test okay and that's that's the big thing too because i think everybody needs to figure out what it is that the issue is um dr aussie i would like to talk i know we talked about hypertension and we talked about high blood pressure and the idea that everything kind of goes down you're sleeping anyway but i want to make such a point here because you designed some great questions before getting here and i just want to make sure we address those sure um so hypertension in and of itself is a problem um when we're looking at sleep and we did talk about a couple of treatments and we're going to go into and grace if you don't mind if we can cue up the video we're going to talk about another treatment too but hypertension if it's left untreated and let's say that we do now know with the sleep study that sleep apnea is a major problem of this um as the cardiologist where do you bring the team in so to speak to help this patient out and you can think of a case study or not don't give any names or anything but a time when this may have helped well i mean anyone with resistance like we were saying before resistant hypertension i've already got the patient on two or three medications and they come into my office with a blood pressure of 160 which is unacceptable right and you know at that point the american heart association says that all those patients should be screened for obstructive sleep apnea and not only patients with resistant hypertension but patients who have pulmonary hypertension so remember that every time you go to the doc's office they put a blood pressure cuff on you and they measure your blood pressure right well that's our systemic blood pressure but within the lungs is your there's pressure as well and if the pressure within the lungs raises it rises it can affect the right side of the heart you can develop right-sided heart failure swelling of your legs and we can measure those pulmonary pressures through an ultrasound or an echocardiogram which we do in in the office or in the hospitals and you can get an assessment of patients pulmonary pressures and anyone who has pulmonary hypertension should have a screening sleep study so there there's multiple um reasons to jump in and get the team together not only for pulmonary hypertension but patients post stroke bingo that's a good point patients post stroke 80 of patients post stroke have been found to have obstructive sleep apnea interesting that makes perfect sense right so pulling the team in i mean it's almost like there's just like i said at the beginning of the show 40 to 80 percent of my practice when you talk about hypertension pulmonary hypertension arrhythmias and we haven't even touched on coronary artery disease so coronary artery disease obstructive sleep apnea is a risk factor for coronary artery disease just like diabetes is just like hypertension is so patients that have obstructive sleep apnea are at higher risk for developing lack of blood flow to the heart your oxygen levels are dropping the heart isn't happy it's not getting oxygen and at nighttime that are being monitored um on it earlier but what is rem sleep what is happening during rem sleep because we were talking the beginning of the program that sleep helps tissues repair sleep make all these things that dr aussie's treating a little bit better in someone who's not sleeping well losing sleep and they never enter rem or they never enter delta explain what rem and delta is and what happens during those two times during sleep okay when you go to bed it takes about 15 minutes to fall asleep a normal person oh a normal person wouldn't that be grand okay go ahead it takes you more than 30 minutes you have a sleep problem and then you go into stage one and sleep it's a very light type of sleep if you go into the room you're going to wake up and you know what's going on then you go into stage two and then you go into stage three and four that's called delta sleep that's when you release you grow hormone and that usually happens between 30 40 minutes and then you go from delta sleep you may go into stage two or you're going to rem and the first ram usually happens between 70 to 90 minutes after you fall asleep and that's when you're dreaming if i wake you up and ram and i ask why are you dreaming you remember perfectly find your dreams now when you're in ram your whole body is paralyzed except for the diaphragm and the heart so your whole body's paralyzed except for the diaphragm and the heart okay so your brain is very active during breath so you're dreaming that you're running so you the brains and the signals to run and you your brain oxygen consumption is very high during that period of time because it's very active except that it's paralyzed after this level that the whole body is paralyzed so the brain sends the signals to run but you have paralyzed you cannot run right and and that's that's when you have most of the abnormals that usually gets worse because all the muscles are paralyzed so you have a better chance to have significant saturation during and people with copd when people were in sleep apnea that's when you see most of the arrhythmias because of that significant lack of oxygen that happens in rem and that's something you're able to with a sleep study you're able to measure this during rem sleep that is correct and i'm just thinking about dreams i've had where i'm trying to run and i'm paralyzed but that's a dream um so and then you said earlier stage one two three and four are those stages delta stages are there are different stages of delta sleep delta sleep is called stage three and four it's a very deep type of sleep okay if i go into the room and you're in delta sleep you're not going to wake up you can't run the livestream you're not going to wake up that has never happened to me i have never been in sleep and thank god i'm still alive now most people has rem sleep even though they're not aware of it the fact that you wake up in non-rem you're not going to remember your dreams if you wake up in ramp you're going to remember your dreams and that usually happens in people that put the alarm at six o'clock in the morning they may be in rem at that time and they may remember the rams they dream like but you wake up on your own which is the ideal way to do it with the sunrise nothing before the sunrise you're not going to remember your dream because you don't wake up and right most of the time on your own oh i dream all the time and i remember him i need to come see you i want you to be oh my gosh i feel like i'm waiting it's like i remember that dream but if you ask me two or three hours later i won't remember it but i'll wake up from a dream and i'll like i have to get up right now because i'm i'm having i call them stress dreams i just want to get out of my dream get up and walk around and i try to go back to bed and that's part of my problem right let me tell you if you remember a lot of your dreams it's not uncommon to see that obstructive sleep apnea and let me explain you why when you have the abness the worst object happens in breath and when you have an apnea which means that you stop breathing you're going to wake up to breathe again that's the only way to breathe like your brain wakes up and breathe again if you're in rem you're going to remember your dreams interesting i need to come see you and at the beginning of the stages of sleep apnea you don't sleep and eventually you're going to sleep the whole night and the whole day because your brain is going to run this is enough i want to sleep through it i don't care i have to sleep but at the beginning you have chronic insomnia and eventually you're going to sleep through the whole night and then you sleep the whole day or very tiring the whole day how interesting so even if you don't think you've got all the issues and all the background stuff or sleeping issues sometimes you may have that anyway um the patient cannot be aware of it you're not aware of the sleep problems because you have you do it when you sleep and you cannot be aware of it in your sleep right partner you can be aware of it right i know i dream like no one else and i wake up i mean i wake up so easily the light sleeper part of me and i know i'm getting quite a few questions here from the audience too um this is from claudia and i'm just going to throw this out to whoever has woken up at night and is unable to see is it possible detect night blindness that's kind of not what we're talking about right now well i guess question is is it possible to detect night blindness during a sleep study um if it doesn't pertain to what we're talking about we can kind of skip that but i just thought i'd respect that since it came in right now um another question from the audience we're talking about dreaming and art and rem sleep if you rarely dream does that mean that you have sleeping problems since dreams occur and in rem sleep or like you said you'd be dreaming and you have no idea you don't remember your dream doesn't mean anything it just means that you don't wake up okay as long as you feel fine during the day and you sleep throughout the night and you just leave you seven hours and you feel fine during the day your sleep is perfect oh maybe maybe wake up once a night i want to maybe that guy yeah okay dr bright this is kind of a unique type of treatment it's relatively new that i understand so we have a video yes go ahead dr bright yeah let's let's do one thing first because we'll talk about this treatment but this treatment is an alternative to the gold standard which is nasal cpap which we really have i think yeah i think we need to summarize that yeah let's summarize that i think let's make it very simple okay in kids they have a sleep apnea as much as the adults actually in the kids the most common cause is a noise tonsils or other noise and the treatment of choice is surgery not hip-hop okay so always 100 of the kids needs to be evaluated by the ent if they if they haven't lost also they do the surgery if they don't have it which is probably 20 perhaps or less those needs to be treated with the siba okay and adults the first tremendous choice is the cpap okay if they're why why not treatment for adults so i know that there's because if you remove the tonsils and adults right you're not going to take care of the sleep apnea in kids you take care of the sleep apnea in 70 80 percent of the cases and adults if you remove the tonsils the sleep apnea doesn't get better so tell us why nobody knows okay probably because it's too chronic okay the process and the the process is already there there's theories that is coming from the when you're a kid and you have the problem and you live all your life and then it's not going to take care of it so we don't know what's the cause of it but the surgery is not the answer in adult that's why the cpap is the criminal choice now 75 of the people do real well with the cpap 25 percent doesn't tolerance but regardless and those are the cases that needs to be done something else okay and we have three different choices one is their appliance for mild sleep apnea we can use a different type of machine that is more sophisticated and now we have an inspire that that's why we have something that is new but those inspired cases is only for those people who doesn't already hip-hop is the standard or care of the national level so let's explain to those that don't know or haven't had this issue or just new to this idea explain what the cpap machine is doing physiologically as you're sleeping maybe describe the tubes describe the air that's being put so describe what the seat basically when you're trying to uh basically when you fall asleep and you try to breathe the airway closed so you have an airway obstruction there and the air doesn't go in the sea pup is nothing else but positive pressure is air from the room and push air into your back of your mouth and keep the airway open doesn't allow it to close we keep a pressure 10 centimeters of water it can be 5 7 15 20 depends on how much air you need to keep the airway open and that was pretty good in in 100 percent of the cases except that 25 doesn't tolerate that when you say don't tolerate what does that mean they cannot sleep with the machine they feel very uncomfortable they hate the machine the comfort they don't like it they feel uncomfortable sleeping with the partner and with the cpap a lot of reasons that they don't like to use it okay and those are the candidates at 25 that we have an alternative that is inspired that we didn't have it before before we said well we offered you tracheostomy and nobody want that right but that's an excellent alternative yeah like you said that's the one that does work 100 yes we don't recommend that anymore but it's still some cases that we do it okay very difficult cases that they're going to die we don't treat it we we do the trigger and you do that the intolerance is the biggest thing that we we deal with when they come back after i've sent them now we know why you have resistant hypertension or why you're having these arrhythmias but the intolerance to the mask is probably you know the biggest thing that that we see that they have a hard time dealing with it those patients with severe sleep apnea they don't use this hip-hop are the ones that are going to see doctors more often and they end up in the hospital more often that's why the people say well most people doesn't tolerate this hip-hop no it's not the one they don't only they go back to the doctor frequently what they do well they don't see them anymore because they feel better everything improves the cardiac output improves the blood pressure improves the diabetes improve and they even can't lose weight if they follow their diet and exercise exercise and they sleep well right they lose weight they feel better without any question and i love everything about that and again because it's a physiological fix and dr bright so talking about that in case the cpap doesn't work so you were talking about that is a traditional and still golden standard treatment for 75-ish patients and so we're looking at this new treatment i don't know if you can throw a percentage out there yet um how new it is or just maybe talk about this before we show the video maybe you can explain uh what this device does inside the body so for a subset of those patients that don't tolerate the cpap device um and uh we we categorize we're looking for the people who are really going to help with this surgery so the there's criteria for who can have it and those are uh both from the research that went into creating the device and from the fda application and from the you know third-party payers that decide who we're going to pay for this device for um our criteria is number one you have to have sleep apnea and it has to be moderate um so the number of times an hour that we don't breathe the way we're supposed to is 15 to 65. so so that's the group of people we're not looking for the real miles we're not looking for the hopeless we're looking for the ones that this device would help so 15 to 65 times an hour their breathing is disruptive that's a big that's a big variation 15 to 65. okay i agree um and then the the next criteria is weight um some people are so heavy there's no hope that this device is going to help them so there's really no point in putting it in um and the measurement we use for height and weight is is called the bmi and the bmi number is something you can calculate and look it up on your phone and put your height and weight in it'll tell you your bmi and the bmi for all comers less than 33 for some comers with different insurances up to 35 at the moment i expect those numbers may creep up slowly over the years as um you know we get more and more comfortable with with the successes and failures and then the last criteria is they have to have a anatomy that's going to be responsive and so anybody that's a candidate for one of these that meets the the didn't tolerate a c path isn't uh too heavy isn't too severe i have to examine them under anesthesia and see if their anatomy is configured in a way that will get better when we treat it with an inspired device okay so what i'd like to do gracie if you can show the video this video does have audio if it comes through it looks like it's a commercial we apologize for that it's not about that but it does explain what this device does and we'll have dr bright go into that a little bit more too but run it whenever you get a chance and dr bright you'll see that coming up we also have some slides this is mike mike has moderate to severe obstructive sleep apnea after years of struggling with cpap and constantly being tired mike felt hopeless then mike found out about inspire inspire is the only fda approved obstructive sleep apnea treatment that treats the root cause of sleep apnea with just the click of a button inspire is a small device that keeps your airway open using a gentle pulse it's implanted in the body with two or three small incisions in a same-day outpatient procedure after the procedure mike works with his doctor to fine-tune his inspire once it's fine-tuned mike simply clicks the remote to turn on inspire and goes down to sleep while mike is asleep inspire monitors his breathing every time he takes a breath a gentle pulse moves the tongue out of the way and keeps mike breathing freely and more importantly sleeping soundly the way he used to this has been a total game changer for mike mike is getting more out of life and back to being his old self again [Music] so that's a happy guy everybody here kind of chuckled a little bit when he grabbed his wife and said hey i'm sleeping goes outside walks a dog so that that's a guy that can sleep which is beautiful um describing even though there was an audience we didn't get to hear audio here in the studio but you all at home i think got to hear it um when again we have gracie there are two graphics that we have there's a slide number one and if we can pull that up and we can have uh dr bright kind of talk over that because it uh shows really in a still shot what that is so here's the device um that they were showing in the video and dr bright can you kind of talk through that as well for example where is that lying right underneath the chin where is it implanted how is it implanted etc so the device works by sensing when you're breathing so directly below the device on the chest wall is a sensor between the ribs that detects breathing that sensor is plugged into the what's essentially a pacemaker and then each time it senses that there's breathing an electrical pulse goes up the electrode that you see extending up across the chest and out under the chin that electrode is hooked to the nerve that moves the tongue that nerve has branches that pull the tongue in and push the tongue out during surgery we find which ones push the tongue out and attach the electrode to that part of the nerve and when the entire device is hooked up and the patient's healed a month after surgery they have a remote control and they turn their device on when it's time to go to bed at night and each time their body tries to take a breath the tongue is moved out of the way to keep the airway open how interesting um so it's like electrical not shocks but electrical signals that are going into your body um how long has this been available how often i know we were talking about intolerance of the mask is about 25 of people who and then you were talking about qualifications earlier is there an approximate percent of the population that is using these right now that you foresee you in using these in the future um i know it's kind of a futuristic thing it's relatively new so it might be a question that's too early to ask but from your side of things all right so to start your question you asked when it's when it became available it hit the market in 2014. didn't really largely in bigger cities largely in academic centers until the numbers were big enough that the company began to move out to you know sort of community-based practices and i think a lot of us dr diaz and myself in in this regard don't tend to jump on every bandwagon that comes out because so many of them flop and you don't want to be the guy that's pushing the thing that flops so i i think we did our due diligence watch what was happening look to see the numbers the numbers look good and about three years ago we were able to to bring the program here to el paso since that time yesterday we did 115th in town and so our program is vibrant and big this is the uh the second largest implant site uh west of the mississippi in the united 000 people in el states this is a a small number right now but i'm thinking that's kind of a big number yeah so what have out of 115 uh what are some of the issues that you may have heard about from the patients that have had these are because again it's new and for those i mean i hadn't seen this until today um what are some of the issues that they have do they love it um and i know we're here it's a medical show i get it but in general it's just it's just interesting well we we have a number of people here in town who have had these implants placed and without being paid they run around and try to sell them to everyone because their lives have been so changed and we didn't talk all that much about it because you don't die from it but one of the things that drives people to a sleep lab is their spouse won't sleep with them ah right and so the this device cpap as well will frequently bring a spouse back into the bedroom and the that's one of the things that people are most excited about is number one there's no snoring in the room so the decibels have gone down um and number two the the spouse or significant other is is willing to be with them um so that that's a big thing the patients appreciate they they clearly like being you know waking up refreshed in the morning they certainly are very happy that they don't have to keep trying to use the mask which many of them don't deal well with and not always is it physiologic you know we live in an army town ptsd is a something that very much limits a lot of people from having things over their faces and so there's many many reasons why people don't want to use a cpap device some of them are even lifestyle things you need to have a place to plug the thing in right you know if you want to go out and camp for a week that that's hard that's a good point and dr diaz i know that we're rounding out to about eight minutes left in the show but we have not talked about psychological issues and i'd like to talk a little bit about that because we've got the sleep studies that i think will be not easy but i would imagine easier to detect during sleep studies but those people that just have issues and can't get outside of their head so to speak when they're sleeping let's talk a little bit about that with sleep disorders kind of take away apnea for a little bit and address that since this is a sleep show well depression is very common in society and one of the symptoms of depression is the lack of sleep they normally wake up early in the morning uh they cannot stay in bed and they just they feel sleepy during the day they some group of depressed patients sleep the whole day but they don't sleep they stay in bed but they don't sleep and they feel sleepy but they don't have that so that's one of them obviously anxiety can affect your sleep it usually affects you to initiate the sleep when you have a lot of anxiety other thing that is very important anybody who has the symptoms of depression it behaves is the same symptoms of obstructive sleep apnea even the whole psychiatric department rotates into sleep lab and the psychiatric residents now they don't treat depression unless they rule out sleep apnea interesting if they have symptoms of a sleep apnea the problem that we used to have before is the same symptoms of the pressure essentially sleep apnea you feel tired you feel sleepy you have headaches you have no energy they think they are depressed but if they had the symptoms of sleep and they asked you snore the you stop breathing they don't treat the depression they treat the sleep apnea and usually after one or two months the depression symptoms improve if these symptoms are related to sleep apnea you know they treat after two months and this is coming from the psychiatric department now okay um what else and from the it can affect your memory these people that have a sleep apnea they started from mris i did 100 of the patients with severe sleep apnea they did an mri they have microblitz now with no previous history of a stroke those microbleeds strongly believe that it's going to give you uh alzheimer's or dementia and you're going to be more susceptible to have a stroke and that's what you were looking but these people had a sleep apnea no previous history stroke they do an mri they have microglia and they're not aware of it ah so if you don't treat it you have more microblitz and eventually you're going to have a stroke micro bleeds that's just freaky to say that out loud um since we we are at four minutes now we have a question on the phone from raymond and he's having difficulty sleeping at night and he does take medications for anxiety and depression could his medications be interfering with his sleep and these are why these are quick fire questions out so absolutely absolutely some medicines can affect your sleep okay uh even some antidepressants can affect your sleep that's when you take it at what time you take it okay is there would you be able to say that quickly on the air is it better to take antipresence at night no it depends on the uh no i don't want to mention it because every patient is different that makes sense uh question here uh from the phone again can sleep apnea cause or increase the risk for dementia you did talk about memory problems dr aussie i know you're cardiologist but let's talk about that really quick and let's talk about uh sleep medications and dementia as well um who wants to take that doctor dr not me i'm the heart guy dr diaz so sleep medications and uh let's talk about some side effects of that and i know it's super fast so uh you were talking about trying to get people off medication it's highly recommended not to take sleeping pills for a long period of time there's a lot of complications from it and a lot of times once you take the sleeping pill for a long period of time you have not improved your sleep what happens is when you stop it if your baseline is say four hours to sleep and you take a sleeping pill you usually probably six hours but eventually you're going to sleep four hours and what do you do you increase your sleeping pills to sleep six hours but if you stop it you sleep two hours instead of the four hours and then eventually you can just leave you four hours baseline and that's why we don't recommend chronic sleeping people some patients we use it i'm not saying we don't use it but we try to avoid as much as we can colony behavioral therapy works in about 75 of the cases when you get rid of the sleeping pills if you follow the standard of treatment like a sleep cleanliness routine okay um only reason i'm stopping you is that we're running out of time dr aussie is there anything you want to get across before we have to close the show and you know how this rapid fire works yeah so go she said she's writing down the number one oh gosh go sleep apnea is not a myth there are so many people that think that oh that's right it is not a myth it has real issues real problems and you need to get evaluated and treated for it absolutely and that's what this program is about and i want to say thank you again uh to nicholas nicholas martinez did an awesome job sending questions my way and thank you to the audience for asking all of those i also want to say thank you very much to the southwest ent ear nose and throat because this is where the magic happens you know we figure out what's going on you do the sleep study with mr dr diaz and then take it from there um i also just want to thank you dr aussie as a cardiologist as a sleep medicine guy and as a dear lord auto laryngology ent guy i really like it when we have doctors of different disciplines on the show because it really shows what the team approach is and if you are watching part of this program and like to watch it again because you missed some of it you can go to pbs excuse me pbselpaso.org you can go to watch and then find this program you can also go to the el paso county medical society website which is epc ms just think of the acronym el pasocountymedicalsociety.com and you can go to youtube.com and look up el paso physician live and i think that you can search for it at that point by the search button anyway i appreciate you watching this is the 25th anniversary of the el paso physician i'm kathryn berg good night [Music] [Music] you