Sleep Apnea: Signs, Sleep Testing and Treatment

Liam: It's more than snoring. The National Heart, Lung, and Blood Institute says sleep apnea is a common condition where your breathing stops and starts many times while you sleep. That can keep your body from getting enough oxygen.

Claire: Your breathing stops. And you might not even know it?

Claire: Thanks for joining us. You're listening to Between Visits, sponsored by Hope Health Network, a network of medical practices serving South Carolina. We dig into the medical and mental health topics that matter most to patients and the public.

Claire: I'm Claire, and this is episode 5. I'm going to quickly play our disclaimers, and then we'll get started!

Recorded disclaimer: This show is for entertainment, education and general information only. It's not medical advice, and listening doesn't make you a patient. Our hosts and guests are not real people, medical doctors or healthcare providers. We do our best, but we can be wrong, and our content can have errors and omissions. Talk with a licensed medical provider in your state before you make any decisions about your health or medical care.

Claire: In an emergency, call 911. In a crisis, call or text 988.

Claire: Joining me today is Liam, from our digital entertainment team. Welcome, Liam!

Liam: Good to be here, Claire. How's your week going?

Claire: Busy, but good. I finally cleared my whole to-do list, which never happens.

Liam: Well, don't tell anybody, or they'll hand you a longer one.

Claire: Today we're talking about Sleep Apnea: Signs, Sleep Testing and Treatment. Well, we're excited to get your thoughts on this important topic, Liam. Let's get started.

Claire: Today we're talking about sleep apnea. I think a lot of people hear that and think, oh, that's just snoring. So let's start there. What is it?

Liam: It's more than snoring. The National Heart, Lung, and Blood Institute says sleep apnea is a common condition where your breathing stops and starts many times while you sleep. That can keep your body from getting enough oxygen.

Claire: Your breathing stops. And you might not even know it?

Liam: That's why it's worth paying attention to the signs. Waking up tired no matter how long you sleep is one reason people start asking about it.

Claire: How common is common?

Liam: The institute says about 50 to 70 million Americans have a sleep disorder. And it calls sleep apnea a common one.

Claire: That's a lot of tired people. Is there more than one kind of sleep apnea?

Liam: There are two kinds to know. The most common is obstructive sleep apnea. Your upper airway, the path air takes as you breathe in, gets blocked over and over during sleep. That lowers or stops the flow of air.

Claire: So it's like something is in the way. And the other kind?

Liam: That's central sleep apnea. In that kind, the brain doesn't send the signals needed to breathe.

Claire: Okay. So how would I know? What should I watch for at night?

Liam: Breathing that stops and starts. Loud snoring that happens often. Gasping for air during sleep. And waking up several times a night to urinate.

Claire: Wait, getting up to use the bathroom? I would never have connected that to breathing.

Liam: Many people wouldn't. But it's on the list of nighttime signs from the National Heart, Lung, and Blood Institute.

Claire: And what about during the day?

Liam: You may feel sleepy and drained. You may have a dry mouth or headaches, or less interest in sex.

Claire: Do men and women get the same signs? Because I always picture a man snoring.

Liam: A lot of people do. The institute says ongoing tiredness, headaches and trouble sleeping are more common in women. Frequent loud snoring is more common in men.

Claire: So a woman could have this and never think of it, because she's just tired.

Liam: That's why it's good to talk with a provider about any of these signs.

Claire: Who's more likely to have it?

Liam: The risk of obstructive sleep apnea goes up with age and with extra weight, because fat in the neck can block the upper airway. It's also more common in men.

Claire: So what else can play a part?

Liam: Large tonsils, a large neck or tongue, low thyroid hormone, polycystic ovary syndrome, heart or kidney failure, and your genes. Drinking alcohol and smoking can play a part too.

Claire: That's a long list. What about the other kind, central sleep apnea?

Liam: Long-term use of opioid pain medicines is linked to central sleep apnea. So it's important to tell your provider about every medicine you take.

Claire: So let's say this all sounds familiar and I go in. What happens? Is there a big test right away?

Liam: It starts with a talk. Your provider asks about your symptoms, your family history, the medicines you take and any recent travel to a high altitude.

Claire: High altitude? Why would that come up?

Liam: It's simply one of the things your provider may ask about. You may also be asked to keep a sleep diary.

Claire: A sleep diary. I haven't kept a diary since middle school.

Liam: This one has no secrets in it. It's a log of how long and how well you sleep, and how sleepy you feel during the day.

Claire: Okay, I could do that. And then what?

Liam: The key test is a sleep study. Your provider may refer you to a sleep specialist or a sleep center for one. It shows which type of sleep apnea you have and how severe it is.

Claire: Is that the only test?

Liam: You might also have blood tests, such as thyroid hormone levels. Those can look for conditions that add to sleep apnea.

Claire: So if it turns out I have it, what then? I picture one of those machines with the mask.

Liam: That's one option, but there are many. Your provider will help you choose. It depends on the type of sleep apnea and how severe it is.

Claire: Let's start with the simple stuff. What can a person change on their own?

Liam: Regular physical activity, healthy sleep habits and reaching a healthy weight. Also limiting alcohol and caffeine, quitting smoking, and sleeping on your side instead of your back.

Claire: Sleeping on your side. That one sounds simple enough. Okay, now the machine.

Liam: It's called a C PAP machine. Those letters stand for continuous positive airway pressure. It sends steady air pressure through your nose, your mouth or both.

Claire: So it's pushing air in to keep things moving. Are there other machines?

Liam: There are related machines, called B PAP and A PAP. Those change the pressure as you breathe or sleep.

Claire: Any side effects?

Liam: They can include a stuffy or runny nose, a dry mouth or eyes, or nosebleeds.

Claire: Now, here's my pushback. Some people just don't want a machine. Are they out of luck?

Liam: No. There are mouthpieces too. These are custom-fit devices, usually fitted by a dentist or orthodontist. They hold the lower jaw or tongue forward. That's an option if you don't want to use a C PAP, or you can't.

Claire: Good to know. I've also heard there's a medicine now. Is that real?

Liam: It is, for some people. On December 20, 2024, the Food and Drug Administration approved Zepbound, also called tirzepatide. It's an injection, which means a shot.

Claire: Who is it for?

Liam: Adults with obesity who have moderate to severe obstructive sleep apnea. It's used along with a reduced-calorie diet and more physical activity.

Claire: So it's not for everyone, and it's not the shot alone. Anything people should watch out for?

Liam: It can have serious side effects. So tell your provider about any personal or family history of depression, thyroid tumors, kidney disease or diabetic eye disease. The provider who prescribes it and your pharmacist should go over this with you before you start any medicine. So ask them any questions you have.

Claire: And what if none of that works?

Liam: If other treatments don't work, surgery or an implant are options. That could mean removing the tonsils, moving the jaw forward, or weight-loss surgery when obesity is part of the cause.

Claire: An implant? What does that do?

Liam: It's an implanted device that stimulates a nerve to keep the airway open.

Claire: Here's something I bet people do. They're tired all the time, so they just reach for a sleeping pill. Is that a good idea?

Liam: It can seem like the answer. But it makes sense to rule out sleep apnea first. And if you already know you have sleep apnea, tell your provider before you take any medicine that makes you sleepy, or any pain medicine.

Claire: Does that go for surgery too?

Liam: Yes. The National Heart, Lung, and Blood Institute says to tell your provider you have sleep apnea if you need medicine to make you sleep during surgery, or pain medicine after surgery.

Claire: And what about driving? If you're that tired, that seems like a real concern.

Liam: It is. Until you are treated, do not drive if you feel tired or sleepy.

Claire: Let's say someone hears all this and thinks, I'll deal with it later. Why not just live with it?

Liam: The institute links untreated sleep apnea to high blood pressure that is hard to control, heart attack and stroke. It also links it to type 2 diabetes and an irregular heartbeat called atrial fibrillation.

Claire: So it's not just about feeling tired. And once you start treatment, are you done?

Liam: Not quite. Regular checkups help make sure your treatment is working. You may also need a repeat sleep study after a big weight gain or loss.

Claire: If someone wants to bring this up but feels a little silly talking about snoring, what could they ask?

Liam: Here's a simple one. Could sleep apnea explain why I am tired, and should I have a sleep study?

Claire: I like that. You could write that down and take it with you.

Liam: You could. There's nothing silly about asking.

Claire: Okay, before we wrap up. If people only remember a few things from today, what should they be?

Liam: First, loud snoring, gasping for air at night and feeling sleepy all day can be signs of sleep apnea. Talk with a provider.

Claire: Okay. What else?

Liam: Second, a sleep study shows which type you have and how severe it is. And treatment goes well beyond one machine.

Claire: And one more?

Liam: Until you are treated, do not drive if you feel tired or sleepy.

Claire: That's really helpful. Thank you for walking us through this.

Liam: Thanks for having me, Claire. I hope it helps someone.

Claire: This episode is sponsored by Hope Health Network. Its member practices all have providers experienced in managing sleep apnea, or can refer you to a network provider who is. Hope Health Network medical practices provide evidence-based medical care and include Hope Integrative Medicine, Hope Medical Associates, Hope Behavioral Medicine and Hope Addiction Medicine. To learn more, go to Hope Health Network dot com. That website, along with appointment links for all four practices, is in the description of this episode.

Claire: One last reminder. In an emergency, call 911. In a crisis, call or text 988.

Claire: This podcast is a production of Hope Health Network Media.

Claire: You've been listening to episode 5 of Between Visits, Sleep Apnea: Signs, Sleep Testing and Treatment. Thanks for hanging out with us. See you next time!