0:00

Sick boy podcast is a health and comedy

0:02

show, but what it's like to be sick.

0:04

Wait, is that right? How can illness be

0:07

funny? You'd be surprised Okay, sick boy is

0:09

hosted by me Brian stever and me Taylor

0:11

me Gilbert and myself Jeremy Saunders every week

0:13

We're bringing you three new podcasts that amazingly

0:15

tie together illness Vulnerability cutting-edge medical science and

0:18

downright silly best friend humor Come on in

0:20

and join us every Monday Wednesday and Friday

0:22

to melt your heart learn something fascinating and

0:24

bust a belly laugh Trust us. You'll be

0:27

glad you did you can find sick boy

0:29

on the CBC Listen app or wherever you get

0:31

your pods This

0:34

is a CBC podcast Hi,

0:41

I'm dr. Brian Goldman welcome to the

0:43

dose if you're a

0:46

regular listener to the dose and our sister podcast

0:48

white coat black art You may have heard me

0:50

talk about my lifelong battle with insomnia My

0:53

sleep issues revolve around a restless mind that

0:55

can't be still but there's

0:58

this other condition that disturbs the sleep

1:00

of Millions of Canadians

1:02

a condition whose origins are

1:05

physical I'm talking about sleep

1:07

apnea and many Canadians don't know

1:09

they have it. So this week We're asking

1:11

what do I need to know about sleep

1:13

apnea? Hi such and welcome to the dose.

1:16

Hi Brian So what

1:18

surprises you most about sleep apnea?

1:21

What surprises me most is how

1:23

many people have somebody with sleep apnea in their

1:25

family and When

1:28

we talk about it how many people you know the

1:30

lights go on? Oh, of course I

1:32

have a family member that has this and Probably

1:35

the related thing is how many people can tell

1:37

me a story of somebody that got way better

1:39

when we've discovered and treated it Well

1:41

now everybody who's gonna listen to this conversation

1:43

knows why we've turned to you for your

1:45

expertise But before we begin, can you give

1:47

us a hi my name is tell us

1:49

what you do and where you do it?

1:51

Just ad lib. Hi. My name is such

1:53

an Penn darker I am a sleep and

1:55

respiratory physician scientist and the medical director of

1:57

the foothills sleep center in Calgary, Alberta I'm

2:00

also an associate professor of medicine and community health

2:02

sciences at the University of Calgary. First of all,

2:04

what do we mean by sleep apnea? What

2:07

it is, is a, as the name

2:09

suggests, a sleep disorder that is

2:11

characterized by recurrent interruptions in breathing.

2:14

To take it a step further, what it

2:16

really comes down to is a problem that's

2:18

primarily in the airway, so in our throats,

2:20

in the back of our neck,

2:23

and what we have is a problem where the

2:25

muscles relax when we go to sleep, and

2:27

what is normally a nice open airway, like

2:29

a pipe, that we can breathe through, starts

2:32

to narrow progressively as those muscles

2:34

relax, and in the case

2:36

of obstructive sleep apnea can collapse completely leading

2:39

to a whole host of other

2:41

consequences. I think a

2:43

lot of people who've heard of obstructive sleep apnea,

2:45

which is what we're going to talk about mostly,

2:48

know that people snore loudly, loud enough

2:50

to wake the dead. That's a description

2:52

that I've certainly heard, but that's not

2:54

the only symptom, is it? No,

2:57

not at all. If we think about sort

2:59

of the mechanism I described earlier, where the

3:01

airway is collapsing, if you have partial collapse,

3:03

that air doesn't flow smoothly, tissues start to

3:06

vibrate, that's what we think of when we

3:08

think of snoring, that's what we're hearing, but

3:10

the more extreme on that spectrum is when

3:13

you start to actually have obstruction, and so

3:15

snoring is often a feature, but usually people

3:17

with obstructive sleep apnea will have other symptoms.

3:19

It sort of carries over into the day.

3:22

They're sleepy during the day, they might have

3:24

difficulty with concentration or alertness. Another

3:26

common one is they have a bed partner that

3:29

says, hey, you stop breathing at night. It's kind

3:31

of scary when it happens, sometimes a little elbow

3:33

or a nudge and you start breathing again. So

3:36

those are sort of common things that might be symptoms.

3:38

The other sort of place where we might see

3:40

it in a physician's office or in a medical

3:42

setting is if somebody has high blood pressure that's

3:44

really poorly controlled, and in people that

3:47

are overweight or obese, where we know that sleep

3:49

apnea is much more common. We

3:51

won't talk a lot about kids. I don't

3:53

think that's not really my area of expertise,

3:55

but I will say that sometimes things like

3:57

poor school performance or even ADHD can be

3:59

a thing. associated with obstructive sleep apnea in children.

4:01

Looks a little different in adults. You

4:04

mentioned off the top that one of

4:06

the surprising things is how many people

4:08

have those symptoms and don't know about

4:10

it. I'm guessing that one of

4:12

the reasons why would be somebody who sleeps

4:14

alone, who doesn't have a partner. Absolutely.

4:17

That's not an uncommon scenario. One of the risk

4:19

factors for sleep apnea, obstructive sleep apnea is actually

4:21

age. So if somebody is older

4:23

and doesn't have a bed partner, they may not

4:26

have anyone to tell them. In those

4:28

scenarios, what you'll have is someone goes away for a

4:30

weekend or has a family member come to visit. They're

4:33

sharing a living space, not necessarily a bedroom

4:36

with somebody and they get told, did you

4:38

know you snore? Did you know you stopped

4:40

breathing? The rest of us in the

4:42

place can't sleep. And then that sort of leads people

4:44

to think about sleep apnea. What

4:46

are some of the most important risk factors

4:48

for sleep apnea? A big one that we

4:50

feed now very commonly in our population is

4:52

when people are overweight or obese. You

4:55

can imagine there's more tissue everywhere, but more

4:57

tissue in the neck that can sort of

4:59

add an additional load on the throat and

5:02

can lead to more weight to

5:04

collapse the airway. There's also probably

5:06

some changes in the airway itself and

5:08

people that are overweight that might contribute

5:10

to that collapse. That's sort

5:13

of one big category and probably the most prominent

5:15

risk factor that we think about. But

5:17

the other one that's probably a little less

5:19

well-recognized is when people have jaw structural abnormalities.

5:21

So if you have a really small jaw

5:23

or a jaw that sits really far back,

5:26

kind of your lower jaw, I mean, it sits really far

5:28

back on your face. Again, back to

5:30

this idea that we're starting with an airway

5:32

that's open like a pipe. If that airway

5:35

is narrowed because of the way the jaw

5:37

sits, then it's more likely to collapse when

5:39

those muscles relax. That's another

5:41

big factor that even in people that aren't overweight,

5:43

for example, we might see pretty severe sleep apnea.

5:46

A couple of other things to think about. I mentioned

5:48

age earlier. We know that sleep apnea is more common

5:51

as people get older. Historically and

5:53

traditionally, we've thought of male sex as

5:55

a risk factor, although we're learning more

5:57

about sex differences in sleep apnea. between

6:00

males and females. So those are

6:02

sort of the main risk factors that we know

6:04

about. Can we still say that the incidence is

6:06

higher in men than in women or is there

6:08

new science about that? I mean, we still are

6:10

working with the information that we've had now for

6:12

many years, that it is more common in men

6:14

than in women. There's some

6:16

science or research that suggests that reproductive

6:19

hormones in earlier life may be protective

6:21

and so post-menopausely then we may see

6:23

more sleep apnea occurring in women when

6:25

some of those protective effects are no

6:28

longer present. But yeah, for the most

6:30

part, we still think of male sex as

6:32

being a risk factor for sleep apnea. What

6:34

is it about the collapse of the airway

6:36

that triggers apnea? Because my first thought is

6:39

that would make people choke and wanna wake

6:41

up and start breathing, but you're saying that

6:43

they develop apnea. What's the connection? As I

6:45

was saying, you start off with you're awake

6:47

with an open airway and as you fall

6:50

asleep and go into deeper sleep, those muscles

6:52

relax progressively. And when we get into the

6:54

deepest stages of sleep, we can

6:56

get more of that relaxation, more of that

6:58

narrowing. For some people who

7:00

snore, it's just a little bit and

7:03

the air can still flow relatively uninterrupted.

7:05

But if that collapse is more pronounced,

7:07

then you get a significant reduction

7:09

in the amount of air that's going in.

7:11

And again, if there's complete collapse, you get

7:14

essentially a complete blockage of air going in.

7:16

And so that's the phenomenon that

7:18

occurs. Now, it gets a little

7:20

more complicated than that in what we've understood about

7:22

sleep apnea more recently, where there are a number

7:24

of other factors. So how well does the

7:27

brain respond to interruptions in breathing?

7:29

How well do the nerves

7:32

and the muscles in the throat respond to

7:34

interruptions in breathing? So there are these feedback

7:36

loops that can sometimes influence

7:38

the response. And of course, how deeply is somebody

7:40

actually sleeping? Or how likely are they to wake

7:42

up when there's an obstruction? And so when

7:45

you pull all these things together, you can sort of

7:47

think about, well, if someone is a pretty deep sleeper,

7:50

they may not wake up when they have obstruction. And so

7:52

it might take a little more of a

7:54

longer event or a more pronounced

7:56

episode of interruption to actually lead

7:59

them to wake up. to relieve that

8:01

obstruction. As you mentioned, there are

8:03

some people who have mild sleep

8:05

apnea and others who have much

8:07

more severe disease. What are

8:09

the factors to account for the difference? Back to those

8:11

risk factors, you know, if you have a higher weight,

8:13

we know that as people gain weight, sleep apnea tends

8:15

to get worse. As people lose weight, it tends to

8:17

become less severe. Again, back to

8:19

the jaw structure, that can certainly play

8:21

a role for people that have more

8:23

pronounced jaw structural issues. Those are

8:26

sort of the main things that determine severity. And

8:28

then again, back, you know, some of these

8:30

other things that I talked about, how much

8:32

the brain responds to some of these interruptions

8:34

and disruptions in normal breathing physiology can

8:37

contribute to severity. I think we're

8:39

learning a lot still. There's still quite

8:41

a bit of variability between one person and the next,

8:43

all of the things being equal. And

8:46

I mean, that's, that's what makes this

8:48

a really kind of exciting area in

8:50

medicine and science more generally. I've certainly

8:52

seen patients with serious heart disease whose

8:54

main risk factor is sleep apnea. What's

8:58

the connection? There's many consequences of obstructive

9:00

sleep apnea when it's untreated. We're

9:02

continuing to learn more about these, but

9:04

the main connection to heart disease really

9:07

is around, at least that what we

9:09

think is around these repeated interruptions in

9:11

breathing through the night. So

9:13

when your airflow through into the lung stops,

9:15

then, you know, along with that, you have

9:18

reduced oxygen getting into the blood. And so

9:20

you can have these intermittent episodes of low

9:22

oxygen. Now, the brain typically will respond and

9:25

either wake you up from deeper sleep to

9:27

lighter sleep or activate the muscles

9:29

in a way that normalizes that breathing. But

9:31

over the course of the night, you're having many,

9:33

many of these episodes. And so

9:35

when that happens, we call that intermittent hypoxia

9:38

that can lead to a whole cascade of

9:40

changes in normal body functions. So a stress

9:42

response in the body, for example, might be

9:44

heightened. Normally when we're sleeping, we

9:47

don't expect that stress response. There's

9:49

inflammation that can be sort of triggered. So lots

9:51

of things that can happen in the body in

9:53

response to these dips in oxygen. And

9:55

when we get, as you can imagine, a stress response

9:57

is one example. Well, blood pressure might

9:59

be a little bit. higher at night, more strain

10:01

on the heart, for example. And so

10:04

those sorts of things, maybe a little more, you know, kind of

10:06

irritability of the heart to maybe pump faster

10:08

or to beat irregularly. So those sorts of

10:10

things, when you pull them all together, can

10:13

contribute to cardiovascular disease. How

10:15

common is it for people diagnosed with

10:17

advanced heart disease to only then find

10:19

out that they have obstructive sleep apnea

10:21

and that that was a significant risk

10:23

factor? It's always a bit tricky

10:25

to come up with numbers because, first of

10:28

all, you have underdiagnosis, as we talked about

10:30

before, where there's lots more people who probably

10:32

have sleep apnea than have

10:34

a diagnosis. But of course,

10:36

depending on where you live and how it's

10:39

diagnosed and where you present to first, definitely

10:41

those are factors that need to be considered.

10:43

From my clinical experience, I would say

10:46

it's pretty common, and especially when people

10:48

don't have sleepiness associated with the sleep

10:50

apnea. And I didn't mention this earlier,

10:52

but we know that the relationship between

10:54

how severe your sleep apnea is and how sleepy

10:56

you are isn't actually that strong. And

10:58

so you can have a lot of people with pretty

11:00

severe disease that don't have any symptoms and,

11:03

conversely, people with milder disease that have a lot of

11:05

symptoms. But for that severe group that don't have symptoms,

11:08

nobody really knows what's going on. They're

11:10

snoring, you know, maybe they just don't think very much of it

11:12

because they feel okay. And then there's, you

11:15

know, stuff happening in the background. Whether

11:17

you've got a small goal for

11:19

2024 or you want to change your

11:21

life in a more monumental way, head

11:23

over to the LifeKit podcast. We've got

11:25

50 potential New Year's resolutions for you,

11:27

and we will help you pick out

11:29

the right one with our handy resolution

11:31

planner. Take your goals

11:33

off hold by heading over to

11:36

npr.org/LifeKit, or by searching LifeKit wherever

11:38

you get your podcasts. What's

11:42

the connection between obstructive sleep

11:44

apnea and mental health issues?

11:47

Even more broadly with sleep disorders,

11:49

lots of overlap with mental health.

11:51

But with sleep apnea, we think

11:53

that probably those prominent features of

11:55

sleep apnea that contributes to mental

11:57

health is sleepiness. So consequences of

11:59

untreated sleep. sleep apnea. I talked

12:01

about the sort of dips in oxygen,

12:03

but the other big category is sleepiness,

12:05

and that leads to mood issues. It

12:07

can lead to anxiety, poor quality of

12:10

life. You can imagine, you know,

12:12

you think you're getting an adequate amount of sleep, seven,

12:15

eight hours, nine hours, but you wake up feeling

12:17

pretty crummy every day because the quality of that

12:19

sleep is so poor. That can

12:21

certainly lead people to feel pretty lousy,

12:23

irritable, and then again, anxious, depressed, etc.

12:25

So let's move into talking about diagnosis.

12:28

The first thing I wanted to ask

12:30

you is who should be seeing

12:32

somebody who can help them make a diagnosis?

12:34

What are the indications for seeking some

12:37

advice from a healthcare provider? Symptoms are

12:39

a really big piece of this, right? And I

12:41

would say symptoms that you feel during the day

12:43

and I guess things that people are

12:45

telling you about at night. So if you're waking

12:48

up after what seems to be a pretty good

12:50

night of sleep and feeling lousy and oh, you've

12:52

been told you snore, you stop breathing at night,

12:54

I think that's a really good place to start.

12:56

Sleepiness is always a bit tricky because we have

12:58

lots of other things that can make us sleepy,

13:01

including not sleeping enough. But assuming we're trying to

13:03

do all of those things and the quality is

13:05

just very poor, I think that's a

13:07

good indication. If you're waking up a lot at

13:09

night, not staying awake as we might see in

13:11

some with insomnia, but waking up a lot at

13:13

night and having to go back to sleep and

13:15

then sort of having this repeat over and over

13:17

again, I think that'll be another reason to think

13:19

about, well, hey, my sleep is obviously a very

13:21

poor quality, so maybe I should get checked out.

13:24

One of the symptoms that's a little less common, but

13:26

I think we see quite a bit,

13:28

less commonly reported, but we see quite a bit and often

13:30

gets better with treatment is having to pee a lot at

13:32

night. An ocular, we call it, which

13:34

has to do with that stress response in the

13:36

body. And again, we want to sort of think

13:38

about why it's occurring, but if they really don't

13:40

have another... The patient's coming to

13:43

see a healthcare provider. Let's talk about

13:45

diagnosis. I've referred patients for sleep studies.

13:47

Explain what happens there and

13:50

how it relates to diagnosing obstructive sleep

13:52

apnea. There's a couple of different types

13:54

of tests that are available. And I think

13:56

you're in Ontario, the main test that is

13:58

sort of the gold standard. test used

14:00

everywhere, but it's the main test that's

14:02

used in Ontario is a polysomnogram. So

14:05

this is an in-laboratory overnight sleep study

14:07

where the patient goes into the lab,

14:10

they're hooked up to a whole bunch

14:12

of different pieces of equipment. So we

14:14

measure rain waves through EEG, we measure

14:16

muscle activity, we measure breathing, oxygen levels.

14:19

We basically use that and then the patient

14:21

sleeps in the lab and we are able

14:23

to monitor their sleep, we're able to monitor

14:26

their breathing and really any other thing that's

14:28

happening during sleep, including muscle activity and leg

14:30

movements and things. So that's sort

14:32

of the main gold standard diagnostic test.

14:34

It gives a lot of information and

14:37

in some parts of Canada and actually

14:39

other parts of

14:41

the world, there are challenges for people to

14:43

actually get access to a lab because there

14:45

just aren't enough lab resources. And so over

14:48

the last 20 or 20 to 30 years,

14:50

there's been this emergence of what we

14:52

call home sleep apnea testing. So this

14:54

is now a limited channel test that's

14:57

really focused on trying to identify breathing

14:59

disorders. So sleep apnea and other breathing problems

15:02

that can occur in sleep. It's only

15:04

used in adults. It's not really a test

15:06

that's available for children, but it's, you

15:08

know, instead of having 20 different things attached

15:11

to you, you have a probe on your finger,

15:13

you have a little sort of

15:15

flow sensor that's in your nose like

15:17

oxygen prongs and a microphone that's on

15:19

your neck. You might have a band around

15:21

your chest and abdomen that sort of

15:23

measure movement of the chest and abdomen, but

15:25

it's a much, much more limited test that

15:27

people can actually take home and use in

15:29

their own bed. What are the

15:32

key things that you're looking for to

15:34

nail the diagnosis? In both cases,

15:36

we're looking for similar information, which is

15:38

if we're measuring airflow, we're

15:40

looking for reductions in airflow, which tells us

15:42

that there's not enough air getting in. We're

15:45

looking for dips in oxygen that might go along

15:47

with those reductions in airflow, again, suggesting that we're

15:49

not getting enough air in and that's having an

15:51

impact on the amount of oxygen that's in the

15:53

blood. And then the microphones tell

15:56

us if they're snoring. And so then

15:58

you put all those things together and you can see. over

16:00

the course of a person's sleep, that there

16:02

are these repeated events that are, you know,

16:04

have these key features. That's the same whether

16:06

you're doing the home test or the in-laboratory

16:08

test. As I say, the in-laboratory test gives

16:10

you other information that you can use

16:13

to sort of figure some other things out, but that's essentially

16:15

what we're looking for. So assume

16:17

that somebody has a diagnosis of

16:19

OSA obstructive sleep apnea. What's

16:22

the best treatment? I would say that this

16:24

is one of the really kind of exciting

16:26

new areas in sleep medicine is sort of

16:28

what is the best treatment and back a

16:30

little bit without getting too nerdy

16:32

about it back to those sort of physiologic

16:34

mechanisms that I said sort of interact

16:36

in any individual patient. The mainstays that we

16:39

know about or that we have at our

16:41

disposal are something called continuous positive airway

16:43

pressure or CPAPs. That's the one that most

16:45

people are going to be familiar with. And

16:47

essentially what that is, is a little

16:49

box that sits on the bedside table connected

16:52

to tubing, connected to a mask that fits either

16:54

over the nose or over the mouth and nose,

16:56

that essentially that box blows pressurized air

16:59

in through the mask and

17:01

essentially blows air into the airway to hold

17:03

it open to prevent it from collapsing. And we

17:06

can adjust the pressure on that box to increase

17:08

the pressure of air that's required to hold the

17:10

airway open to allow air to flow normally in

17:12

and out. That's the first

17:14

line gold standard therapy, especially for more

17:16

severe disease. But there's

17:18

another therapy called mandibular advancement devices or

17:20

dental appliances essentially that are intended to

17:23

pull the lower jaw forward. So back

17:25

to that other mechanism I talked about

17:27

where the jaw might be sitting back.

17:30

Some patients can use one of these

17:32

dental devices to pull the lower jaw forward.

17:34

So instead of now blowing the airway open

17:36

with air, we're pulling it open with a

17:38

device that's sort of connected to the teeth.

17:41

There are many different types of devices,

17:43

but that's the basic concept of those.

17:46

Both of those are actually very good

17:48

treatments for reducing not only the number

17:50

of events, these respiratory events that are

17:52

happening, but also improving sleepiness and quality

17:55

of life. This is a condition for

17:57

which lifestyle changes can make a big

17:59

difference. candidate? Absolutely. We

18:01

often jump to treatments as I

18:04

kind of did there as medical

18:06

treatments but there's a huge component

18:08

of lifestyle changes that can

18:10

help here. So I talked a few times

18:12

already about weight gain and weight loss and

18:15

I would say that for all the benefits that

18:17

might go along with weight loss, reducing the severity

18:19

of sleep apnea and even getting rid of sleep

18:22

apnea altogether is one of them and absolutely people

18:24

are able to do that. It's tremendously helpful and

18:26

valuable and then you don't need to be on

18:28

one of these treatments. Now some

18:30

people are really sleepy and the

18:33

idea of changing any of the

18:35

behaviors in their daily life whether it's exercise,

18:37

diet, etc. can be really hard so there

18:39

are patients for whom will prescribe the therapy

18:41

but we're always talking to them about those

18:44

lifestyle things that will help them to maybe

18:46

get off the therapy one day. That's one

18:48

big category. There are other things so we

18:50

know that alcohol can promote

18:52

relaxation of the muscles in the

18:55

throat. Certain sleeping pills can

18:57

do the same but to talk about

18:59

alcohol if anybody listening has you know

19:01

had a few drinks too many and goes

19:04

to sleep and they get told the next

19:06

day they snore a lot last night or

19:08

if they wake up feeling pretty lousy sometimes

19:10

that could represent sleep apnea that's occurring because

19:13

of the alcohol or worse because of the

19:15

alcohol and the relaxation effect. So we generally

19:17

will recommend that people avoid excessive alcohol or

19:19

at least be prepared to feel pretty lousy

19:22

the next day if they are prone to

19:24

sleep apnea. And then the last

19:26

thing that works for some people if they

19:28

have is they tend to have more snoring

19:30

and especially more interruptions and breathing on their back.

19:32

We know that's a risk factor or like a

19:34

sleep position that tends to predispose people to having

19:36

sleep apnea or make that's where it tends to

19:39

be worse and sometimes sleeping on your

19:41

side can help and so the elbow or the

19:43

nudge that comes from the bed partner sometimes is

19:45

just a sort of a warning to

19:47

turn over onto the side and then people

19:49

snoring and apnea gets a little better. There

19:52

actually are some foam pads and special shirts

19:54

that have been designed and developed to sort

19:56

of facilitate somebody sleeping on their side instead

19:58

of on their back. So those are

20:01

the main things that we generally

20:03

recommend. I've heard that there are

20:05

physical exercises that can strengthen throat

20:07

muscles and in so doing,

20:09

reduce sleep apnea. Can you tell us about

20:11

those? As I mentioned earlier, there's, you know,

20:14

this collapse of the upper airway and the

20:16

tongue muscle is actually the biggest contributor to

20:18

that. There have been some studies

20:20

looking at different types of muscle training of

20:22

the upper airway of the tongue that could

20:24

keep it a little more firm and active

20:26

and less likely to collapse during sleep. One

20:29

really interesting study that is probably 10 or 12

20:31

years old now is related to

20:33

the use of something called a digireedoo, which

20:36

is a long wind instrument that originates in

20:38

Australia. Basically, what this study showed was that

20:40

for people that played the digireedoo on a

20:42

regular basis, they were actually able to reduce

20:45

the severity of their sleep apnea and the

20:47

proposed mechanism was training of the upper airway

20:49

muscles to just keep them a little bit

20:52

more firm during sleep. What's coming down the

20:54

pipeline in terms of research that might lead

20:56

to future ways of treating

20:58

sleep apnea? This is the really exciting thing. I

21:00

talked about CPAP and mandibular devices and you

21:02

talked about sort of the challenges with tolerating

21:04

these treatments, but you know, we're actually, there's

21:06

lots of treatments that are coming that I

21:08

think are going to really change the way

21:10

that we practice going forward. So,

21:13

you know, a few of them just as examples.

21:15

One is something called a nerve stimulator, a hypoglossal

21:17

nerve stimulator. So this is something that's actually been

21:19

around in the US for a while. Some people

21:21

in Canada may have started to see commercials. I

21:24

know we're getting patients asking about it more often.

21:26

It's not widely available in Canada, but essentially what

21:28

it is is a little pacemaker device that's

21:30

implanted under the skin in the chest and

21:32

it works a lot like a cardiac pacemaker,

21:34

except the wires are connected to the base

21:36

of the tongue and provide little

21:39

electrical pulses through the night that activate

21:41

the tongue muscle and keep it open

21:43

even when somebody's asleep. And

21:45

so this is something that's actually been pretty well

21:47

established in the US, but as I say, not

21:50

quite available here yet, but coming. For

21:52

milder disease, it's a treatment that we're going

21:54

to start seeing more and more. But

21:56

the other thing that's really cool is back

21:58

to those mechanisms about... how the brain responds

22:01

to interruptions in breathing, how the tongue muscles

22:03

respond to interruptions in breathing. As we're learning

22:05

about medications that can actually activate

22:07

some of those pathways to allow

22:10

instead of just blowing the airway open, which

22:12

feels a bit like brute force, we're now

22:14

gonna use medications that might say stimulate the

22:17

tongue a little bit or maybe reduce the

22:19

likelihood that someone's gonna wake up from sleep

22:21

too early and allow the normal feedback mechanisms

22:23

in the body to open up that airway

22:26

spontaneously. So this is like really cutting edge.

22:28

We're just getting the studies kind of now

22:30

out in literature and I, but I would say they're

22:32

really promising in the next three to five years, I

22:34

would hope that we'd have the ability to prescribe some

22:37

of these. I think they'll really be a game changer

22:39

for CPAP. Finally, are these treatments

22:41

generally not the cutting edge ones,

22:43

but the ones that are currently

22:45

available, are they generally funded by

22:47

the provinces paid for under the publicly

22:49

funded system? The short answer is

22:51

in three provinces in Canada, CPAP

22:53

is funded in some way through

22:55

government programs for everybody. There's

22:59

also the Ontario, Saskatchewan and Manitoba. Everywhere

23:01

else in the country, there

23:03

are programs for people who have very low income, but

23:06

otherwise people are paying out of pocket or

23:08

through private insurance. There's no

23:10

province in the country where mandibular advancement

23:13

devices are funded currently and

23:15

all these other treatments are not funded because

23:17

they're still quite new. There's one other treatment

23:19

that I didn't talk about, which

23:22

is surgical reconstruction of the jaw, so

23:24

upper airway surgery. That's another type

23:26

of treatment that I know is

23:28

pretty big surgery, but can be quite

23:30

effective in appropriately selected patients. That may

23:32

be funded in different provinces. It kind

23:34

of depends on the procedure. Those treatments

23:36

are unfortunately not funded across the board,

23:38

which is too bad because I think

23:40

that really limits access. You have been

23:42

a tremendous fund of information on the

23:45

subject, Dr. Sachin Pindarkar. Thank you so

23:47

much for speaking with us on the

23:49

dose. My pleasure, thanks for the opportunity,

23:51

Brian. Dr. Sachin Pindarkar is a sleep

23:53

and respiratory physician scientist and the medical

23:55

director of the Foothills Sleep Centre in

23:57

Calgary. He's also an associate professor at the

23:59

University of Calgary. Here's Rudos's smart

24:01

advice. Sleep apnea is

24:03

an extremely common condition in which

24:05

breathing stops and restarts many times

24:07

during sleep. There are

24:10

two kinds of sleep apnea. The most

24:12

common by far is obstructive sleep apnea,

24:14

or OSA, which means your upper airway

24:16

becomes periodically blocked while you sleep, which

24:18

affects the flow of air. The

24:20

muscles in the neck may relax to

24:23

an extent greater than in people who

24:25

are unaffected, and that causes the airway

24:27

to close. Lately and

24:29

in large tonsils may also narrow the

24:31

airway. Less common is

24:33

central sleep apnea, in which the brain does

24:36

not send regular signals that tell the body

24:38

to breathe. As many as

24:40

8 out of 10 people living with sleep

24:42

apnea are undiagnosed. The condition affects men more

24:44

than women. Common symptoms

24:46

of sleep apnea include loud snoring and

24:49

episodes of apnea or stopped breathing during

24:51

sleep. Some people awaken

24:53

frequently during the night with gasping or choking.

24:56

Some have a dry mouth, sore throat, or

24:58

morning headaches. Many have

25:00

excessive daytime sleepiness and trouble focusing during

25:02

the day. Consult with

25:05

your healthcare provider if you or a loved one

25:07

notice any of these symptoms. Sleep

25:09

apnea is diagnosed through a sleep study.

25:12

This involves monitoring of your brainwaves as

25:14

well as your breathing and other body

25:16

functions while you sleep. Some

25:19

healthcare providers might recommend sleep testing at home.

25:22

These tests can measure heart rate, blood oxygen

25:25

level, airflow, and breathing patterns. Milder

25:27

cases of sleep apnea can be helped by lifestyle

25:29

changes such as losing weight, quitting

25:31

smoking, and drinking less alcohol. More

25:34

severe symptoms are treated with a mask and

25:36

a device at home that delivers continuous positive

25:39

airway pressure or CPAP to the mouth and

25:41

nose. CPAP is considered

25:43

the most common and most reliable method

25:45

of treating sleep apnea. Most

25:48

people with sleep apnea adapt to CPAP

25:50

but those who don't can try dental

25:52

appliances or mouthpieces that can help keep

25:54

the airway open. Neuromuscular

25:57

electrical stimulation devices send a

26:00

electrical impulses that stimulate and tone

26:02

the tongue and upper airway muscles

26:04

to prevent them from collapsing and blocking the

26:06

airway during sleep. If those

26:09

treatments don't provide relief, surgery may

26:11

be an option. Untreated sleep

26:13

apnea puts people at risk of high

26:15

blood pressure, heart rhythm disturbances and heart

26:17

failure, not to mention accidents

26:20

caused by daytime sleepiness. The

26:22

good news is that most people can be treated

26:24

successfully. If you have topics

26:26

you'd like discussed or questions answered, our email address

26:28

is the dose at cbc.ca. If

26:31

you like this episode, please give us a rating and

26:33

review wherever you listen. This edition

26:35

of the dose was produced by Samir Chhabra,

26:37

our senior producer is Colleen Ross. The

26:40

dose wants you to be better informed about

26:42

your health. If you're looking for medical advice,

26:44

see your health care provider. I'm Dr. Brian

26:46

Goldman. Until your next dose. For

26:55

more CBC podcasts, go to