Episode Transcript
[00:00:00] Speaker A: Welcome to Real Medicine, real lives. I'm Dr. Yasser Sambal and together we're showing medical expertise in a human way.
Hello everybody and welcome to Real Medicine, Real Lives. I'm your host, Dr. Yasser Sambal. Today we're going to be talking about a very, very important topic which is sleep. Something we all need and something that we all require on a daily basis. And it's very much more complex than we think.
And we want to reconnect science to real life today about your sleep. So today we're going to talk about this with Christy Plain, the executive vice president of sleep services at Dedicated Sleep. Christy, welcome and thank you for coming on.
[00:00:41] Speaker B: Thank you for having me.
[00:00:42] Speaker A: I think this is a really, really important topic. And as a cardiologist, you know, before the show we were talking about something that I've spent, you know, spend a lot of time dealing with patients and referring to sleep sleep studies because of this, because I think the value of sleep and sleep is underestimated, number one. And sleep apnea is a very underdiagnosed disease and it's not just about regulation, it's really about oxygen and cardiovascular survival, in my opinion.
So you spent over two decades in sleep medicine, so why is sleep one of the most under diagnosed health issues in America?
[00:01:16] Speaker B: I think that most people don't talk to their medicine medical practitioners about sleep. They'll talk to their friends about sleep. It's also the first thing we're willing to give up.
Moms will stay up late to make the cookies for tomorrow when they know they've got to get up early anyway. You know, dads are going to be in there doing their reports at the last minute still because they needed to go to the football game. So we'll give up on our sleep before we'll give up anything else in our health. And we don't think about how important that sleep is throughout the night.
We're just used to saying I'm tired the next day.
[00:01:50] Speaker A: That's true. I mean, I think we all do that. I'm guilty of that myself.
You hold both RP SGT and CCSH credentials for the viewers. What do these credentials represent and certifications represent?
[00:02:06] Speaker B: Sure. So the RPSGT is a registered polysomnographic technologist, which means I'm a good sleep tech.
I have gone in and done the on the job, 1800 hours of training. I've gone and done the course and I have gone in and I have passed the board test.
Then every five years I have to turn in that. I've also Maintained my credentials by doing at least 50 CEUs per year, kept my BLS, my CPR updated so that I stay current on it. Then the CCSH means that I've gone back in, done additional training to be able to train on sleep, to be able to help patients get through, to be an extender to providers again. I set for another board certified test to able to pass those credentials. And I also have to keep up my CEUs for that credential, to keep it current and to keep it going. Which means we attend a lot of courses online in person, and we make sure that we're staying up to date on the newest trends for sleep. What else is new? What else can we learn and how else can we help people?
[00:03:09] Speaker A: Great. That's very, that's very helpful. So, you know, a lot of times, you know, people when they say, I'm really tired today, I just didn't sleep well, right? And they just think they had a poor night's sleep. They were tossing and turning for whatever reason.
But you know, what's actually happening inside the body if people have untreated sleep apnea?
[00:03:29] Speaker B: So when you're laying there nice and relaxed and you're supposed to be letting your body repair and sleep, you're actually making it work harder. It still has the same job. It still has to get oxygen pumped through the body back and forth and nice and neat, right? But if you're not bringing that oxygen in, you're making it work twice as hard to do the same job. So when your heart's supposed to get to repair and relax, it's working harder. When we work too hard, we tend to allow issues to come in, right? So maybe we make mistakes when we're doing too much during the day, the heart's mistakes are arrhythmias, it's hypertension, it's, you know, strokes. When we are having cognitive impairments the next day because we didn't get enough sleep, we didn't get enough cleaning in the brain. The things that we don't think about that are happening every single day are the things that we can fix by just actually letting our body sleep and let it sleep healthy.
[00:04:20] Speaker A: And for people kind of distinguished. So let's just say, I don't mean, I don't know. How do you differentiate between somebody who has sleep apnea, for example, that requires treatment like a CPAP or a bipap or whatever it may be, versus somebody who just tosses and turns and doesn't sleep well at night, you know, for whatever reason, you know, or Just doesn't require a lot of sleep.
[00:04:46] Speaker B: So really and truly the best way to rule it in or rule it out is to get a sleep study. Then you know for sure, right? It's, it's an easy test. It's not very expensive anymore. It's really reasonable to do. But when you do that, then you know what you're working with and how to correct the problem. Some of the major symptoms that people talk about every single day but still ignore. Snoring is a major symptom that people say, well, the snoring's not bothering me. It only bothers that one right in the bed.
My wife hits me all the time for snoring, or my husband complains about my snoring, but it's not bothering me. Well, snoring isn't normal if everybody's not doing it. It's one thing you can quickly say, well, if I'm doing that, maybe I need to look into that. A little more tossing and turning to the point where your bed is completely destroyed by morning. That's probably going to be more sleep apnea than just a little bit of a restless night.
Morning headaches for women. We don't always get up and say, you know, I'm really tired. We'll get up and say, I have a morning. My head's hurting this morning. Those are some things should trigger you to go ahead and get the sleep study versus just waiting it out and seeing. Now if you're waking up tired one day and it's not a consistent, it's not something that's week after week, month after month, maybe you were just having a bad night's sleep that night. But if it's consistent, you're going on and on, go get it checked out.
[00:06:09] Speaker A: Okay. And you know, a lot of people have this misconception, I think, about sleep studies, right? You got to go to the sleep lab, you got to spend the night there, et cetera. Can you tell us how things have changed over time and the ease of actually people getting a sleep study now versus how it used to be in the past?
[00:06:28] Speaker B: So I've done both in lab and home sleep testing. Back in the day, in the in lab, we had it counted. You had 28 wires attached to you. You're laying in a wonderful little room with people watching you all night long. It's not your house, right? So that one's the one that has always scared people. They don't want to do it. I can't sleep like that. There's no way.
So now we have all of these brand new different devices out there for home sleep testing. It ranges from anything to being a simple ring you wear on your finger to maybe a belt that wears around your chest with a nasal cannula that you're going to be breathing into.
You wear these at home, in your own rooms, in your own bed, or in the hotels or for my truckers, sometimes in their trucks. It's really easy to get a sleep study anymore. We ship it right to you, or you pick it up right from the facility, you wear it that night, you turn it back in and we're able to get the information we need to see to be able to give you a diagnosis.
I do recommend always get it after speaking to your medical provider first. Don't just fly by the seat of your pants and go out, find one online, talk to a doctor, make sure that you're a candidate for it, then make sure it's a valid, FDA approved, insurance approved sleep study so that when you get those results, you can use those results to move forward with treatment. It's so easy to have a sleep study anymore. You don't even really know that you've got the equipment on.
[00:07:53] Speaker A: Okay, great.
And so, you know, I'm a cardiologist and one of the, one of the things I describe to my patients all the time is I tell them, you know, your heart is like your house, right? It has architecture, it has plumbing and it has electricity. And those are the three things that, you know, drive your heart and make it pump every day. And so how does disrupted breathing at night or sleep apnea, for example, damage your house?
[00:08:16] Speaker B: Well, if you're going to look at it like the plumbing, it'd be the same way as if somebody was to freeze the pipes and then unfreeze the pipe. Freeze the pipes and then unfreeze the pipe. And they do that repeatedly all night long. Something's going to break. Well, if you're giving your heart oxygen and then you don't, and then you give it oxygen and then you don't. So you're taking a breath and then you forget to take a breath, right? So the oxygen is not staying smooth, it's not staying consistent, it's not getting through the body the way it should, something's going to break.
You tend to have more patients that have issues between that last REM cycle of the night. Between 4am and 6am you get a lot more emergency call outs for stroke and heart attacks during those hours because that's the longest REM stage for most patients or for most People, that's when they're going to have the most issues. That's when they're going to have the biggest failures of their pipes or of their heart.
[00:09:07] Speaker A: And what are some of the symptoms patients ignore that should immediately trigger for them to say, I really need a sleep evaluation.
[00:09:15] Speaker B: Sure. One that we see all the time that people ignore. And it wasn't something that I even put together early on in my years was their teeth being really ground down from clenching or grinding their teeth overnight.
That's kind of that person's body's way of making them wake enough to get some air in.
The kicking of the legs, the snoring, as we talked about before, and people saying, you know, you kind of sound weird in your sleep, like you, you're choking or gasping or something. I don't know why you do that. Or patients that have hypertension, that even though they take the medication and they take it like the doctor says, it doesn't seem to be getting better.
Diabetics, that their A1C numbers don't seem to be improving or at least being maintained with the medication and diet. Those are things that I would say immediately go ahead and get that sleep study to see. Is your sleep apnea what's triggering those numbers to be worse?
[00:10:15] Speaker A: Okay, I think that's really great. And what, what recommendation would you make for, you know, primary care physicians, other physicians out there? You know, I think we don't even really think about sleep as much as probably we should. Right. And I think, you know, some people think about it more, whether it's a neurologist or a pulmonologist, because they're always dealing with things as such. But what recommendation would you give, say the primary care physicians, just in general, to decide whether their patients need sleep studies or not?
[00:10:45] Speaker B: I think the first time they look at the patient's chart and realize that, yes, I've given these prescriptions to a patient and the numbers are still not coming better. They should immediately say, oh, maybe we should get a sleep study.
Looking at the patients whose BMI are really kind of above what they should be. And diet's not helping bring it back down. Let's be looking at these other things. Morning headaches, cognitive impairment, Alzheimer's, dementia. All of those patients should have a sleep study to double check.
What else can we do to help a cpap, a mouth device, inspire surgeries? All of those things are going to be things that are easy to accomplish to help increase that patient's health and longevity.
[00:11:28] Speaker A: Gotcha. Well, I think this is really, really Helpful. So, you know, we've uncovered the problem. When we come back, we're going to break down the system and how sleep disorders are diagnosed, treated and managed correctly. So stay with us, everybody. We're going to be back in a couple minutes. Talk more with Christy about sleep medicine.
Stick with us. We'll be right back with more real stories, real breakthroughs and real lives transformed.
And we're back. I'm Dr. Yasser Sombol. Let's dive right back into today's medical conversation.
Hello, everybody, and welcome back. This is real Medicine, Real lives on NOW Media Television. Watch anytime on the NOW Media Television app, available on ROKO iOS and Android or stream at NowMedia TV.
Christy, welcome back.
[00:12:22] Speaker B: Thank you.
[00:12:23] Speaker A: So let's go a little bit deeper into the clinical side of things. So sleep medicine obviously isn't guesswork. It's physiology, it's data and it's compliance. Right. And so walk us through the diagnostic pathway. What actually happens during a sleep study?
[00:12:39] Speaker B: Sure. So there's two different kinds of sleep studies. You can go in lab for a sleep study.
A lot of times a patient has a lot of comorbidities, really high blood pressure or stroke, patients that have congestive heart failure, things like that, that are really more intense. We're going to recommend that they have an in lab sleep study so that we can watch more parameters if a patient is battling some issues, but maybe not so dramatic yet. We're going to do home sleep test.
The home sleep test is going to be a different variation of units that the patient would wear in their home. And it's still going to be registering certain parameters. It's going to be looking at their oxygen levels throughout the night. It's going to be looking at their heartbeat throughout the night. What is that doing? It's going to be looking at staging of sleep. It's going to assume sleep and then based on the algorithms, give us an assessment of whether we think it's a deep sleep or a non deep sleep.
So it's helping us to be able to look at their oxygen level throughout each of those events. If they have an event, did it last more than 10 seconds? And if it lasted more than 10 seconds, did they lose or have an obstruction of oxygen getting into the body?
Did it go down in oxygen levels? So for instance, a patient's oxygen is running around 94% and now all of a sudden it's dropped to 89 or 80. Right. So we look at those events, whether it's done from an in lab or a home sleep Test. We're looking at the science behind the numbers and we're looking at those numbers in correlation to how many are they having per hour, what would be considered normal and once they reach abnormal, how much abnormal are they? So we know what's going to be a best treatment option for them.
[00:14:30] Speaker A: Great.
And how many hours, for example, does it take to do this study and how many days Is it a one time thing? Is it a couple hours?
[00:14:42] Speaker B: So it can vary. And in labs usually once for getting a diagnostic and they need six hours, minimum would be four hours.
Everybody really looks for trying to get a six hours because you want to try to get that last REM cycle to see how that patient's doing through that time.
Once they've been diagnosed, they may be brought back for a second sleep study to actually do the treatment.
Sometimes there is a third study, if they're a very intense patient, that we have to go further into a more aggressive treatment, a home sleep test. They may do one night or they may do a series of three nights and look at what they're doing over those three nights.
The way I see it is if you're having sleep apnea in qualifying as having OSA in one night, you're most likely going to do it several nights. So I'm going to go ahead and push you forward and try to get that treatment for you. I don't have to have three minutes to say yes, you have apnea.
[00:15:38] Speaker A: Gotcha. And so you've managed sleep labs and you know, DME operations and so you know, where do you find the breakdowns? For example, in patient compliance, I think
[00:15:50] Speaker B: it pass, it's the pass off. So it's not even just on the compliance part, it's the pass off and having to get each step accomplished. So for any of this to be really covered, your insurance requires a recipe to be followed. So you have to talk to a doctor who says, you know what, I've looked at your symptoms, you probably need to go get a sleep study. So I'm going to order that. So that's step one. You have to have it ordered by an md.
Then you have to get to the sleep study. So whether it's done there at the office or they send you out to another lab, so pass off one, you've been sent somewhere else. Now you have to wait for that person or that company to reach out to you and get you situated and get your insurance to approve it and then get you to that device. Now you've got that happening. The results come in, you need to talk to a physician again about those results. So now you've been passed back off again. The physician is back. You have to go over the results. You have to know what's going on. You have to make a decision on how to be treated.
Now you're going to be passed off to the next person, right? The treatment. So you get to the pass off of the treatment. Then they have to follow compliance. They have to make sure that they taught you well enough how to use the equipment and what to do in, you know, the emergency of. I don't know what to do. I can't tolerate this. It's not comfortable. What, what can I do? What's my tips? Right, you have to get back to a person for that or back to some help for that. And then you have to get back to your doctor for showing. Okay, I've compliant. Now I need my new supplies or now I need an adjustment or I need to be fixed a little bit. Every time there is a pass off, there's a chance to lose the patient because they have to go through something more to get there. And if they have to go through more to get there, they'll either give up or they can lose interest in it. Because, you know, it was really important this day when I found out about it. But if it wasn't important enough, two months later, you still have me on treatment. Is it really that important?
It is.
It's unfortunate that some places can take so long in between the pass off.
[00:17:53] Speaker A: Okay, great. And what are some of the myths? You know, people? You, you mentioned something about the mask and, you know, uncomfortable. And that's definitely something I hear from patients all the time.
And so, you know, what are the myths about CPAP that keeps people from seeking treatment?
[00:18:10] Speaker B: So they hear the stories. Oh, it was horrible. It was loud, it was noisy, I hated it.
But until you try it, it's just like tasting, you know, a new cookie. Until you've tasted it, you don't know if you like that one or if you don't like that one.
I am a person that can wear a cpap. I can wear just about any of them and it doesn't bother me. And what's really funny is I'm very claustrophobic, but the masks don't bother me. But I can also wear the oral devices for sleep apnea, the mouthpieces.
My spouse, he, he doesn't do well with the cpap, but he does well with an oral device. So the thing about it is there's not just one treatment option out there for people anymore. So don't not get tested to find out what's going on because you're afraid of what treatment you'll be given. Go into it with the attitude of, let's see what I have going on, then I'll deal with the next step. When you get to that next step, go into it saying, I can do this. If I say I can do this and then give myself the ability to have a failure role, maybe I didn't wear it all night long, but the next day I put it back on. I get adjusted to it. It's something new. It's setting on my face when I'm going to bed and I'm still kind of awake and I'm noticing there's something there, right? When everything's nice and quiet in the room, keep going back and trying it. Don't just give up after one trial or one night.
Don't listen because your neighbor said it was too noisy.
Nine times out of 10, people turn their ceiling fans on. The ceiling fans are more noisy than the CPAP machines of today.
They're very quiet anymore. We have all types of masks to make it easier. We can change out masks for people. You're not stuck in one option, right? If that one just doesn't work for you, let's come back to the game and try the next type and see, just like the next cookie, let's see what fits you and your body and make it work for you.
[00:19:59] Speaker A: Great. And you know, people struggle obviously with insurance enrollment, especially certain insurances, Medicare, Tricare, things like that. And so why does the operational precision matter in sleep medicine?
[00:20:11] Speaker B: It's like baking.
It's a recipe. And I tell people all the time, insurance company have a recipe that you have to follow. You have to do the steps in the right order and you have to give the results in the right order. If you don't, then the end outcome doesn't work. The end outcome of the cake isn't going to be right. When we are looking at this, every insurance company has what's called a local coverage determination.
It's the recipe book. They tell you what you have to do. And quite frankly, in my books, Medicare and Tricare are probably the easiest.
They set their rules out there, you follow their rules and they pay. It's that simple.
The commercial ones are harder because they change their rules more often.
And that recipe, you have to be able to know what happened two years ago to know what they've changed today. And you need to stay up on those. And for the companies that don't have time for that. It makes it really hard to know, am I doing the right thing today? Is it still correct?
And if you don't have somebody that can guide you with that, you can struggle. People are worried with Medicare and Tricare because it's a government and the word fraud gets thrown out so often. Well, if you follow the recipe and they are so clean on what that recipe is, you're going to be okay. Do the right thing always, and you're going to be fine. If you go into it trying to figure out how to get around it, you will fail.
[00:21:37] Speaker A: Okay. I'd like to spend the last couple minutes, you know, talking about a couple things. One is, you know, obviously CPAP we talked about, and you know, these machines, etc. Obviously there's the Inspire device, right where they implant this thing. And how often do you guys recommend that for patients? And what do you feel about that, for example, being maybe something that makes people more compliant?
Should it be first line therapy, etc. I mean, I asked that because there's a lot of things in cardiology that we do. You know, that I sometimes think I'm not sure why this isn't first line treatment because it may actually make people more compliant and overall may reduce a lot of complications. So I'm curious as to your thoughts about that.
[00:22:17] Speaker B: So I'm old school. Sleep right. CPAP has always been gold standard. You've got to do it. And then I learned about the wonderful oral devices because it's easy and compliant and those seem to be working. And then now we've got Inspire. And for some people, it's a good choice. And for some people, it's just not. It's. I don't know that a surgical solution should always be the first solution, not when you can do things that are a little more holistic. You wear a mask and it's air that's. That's going to be hard to hurt you. You do an oral device that goes in and out of your mouth. If you really hate it or if you're really struggling today, you just take it out or you take it off. You can't do that with Inspire.
So surgical solutions aren't going to be my first choice. But sometimes it is going to be the only choice for a patient who can't tolerate a mouthpiece, who can't tolerate cpap. But Inspire is also not a good choice for all candidates either. You have to meet specific guidelines for that to be okay. And then if you don't like it, you have to have it surgically removed. And that has to be something you're willing to do. But again, when you go into anything, you need to go in saying, this is going to work for me. You have to have the right attitude. If you go in unsure of any one of the treatment options, you're giving yourself a chance, a better chance, for it to not work, for it to be a failure. I think a lot of times treatment has to have the right attitude, too.
[00:23:40] Speaker A: And how much do you guys spend, for example, talking to people about lifestyle modification when it comes to sleep apnea?
[00:23:47] Speaker B: We do a lot of that.
We also work with a lot of drivers, truck drivers, CDLs. And it's really fun because they can reach out to our clinical team by text, by emails, phones.
Any of our patients can, actually. But they tend to be more vocal and they want more help and education.
So it's always fun to have those conversations. You talk about the fact that you're not going to get eight hours of sleep if you're not in bed for at least eight hours. Right. So what time did you go to bed last night? Well, I went to bed about midnight. And what time did you get up? Six. Okay, so how'd you get eight hours?
Do the math. It doesn't work.
Our bodies, you know, people don't want to talk about height and weight. They don't want to talk about bmi.
We have to, because sometimes the weight is the issue, sometimes it's not. But it's always something we need to be looking at, making sure that if we have obstructions, we try to remove those out of our way, getting some exercise every day.
One of the companies that we've been partnering with is Project 61. And it's a great company that their whole goal is to help truck. Truck drivers increase their health, increase their longevity, increase their lifespan past 61. And it's by simple things of getting more exercise, getting more sleep, eating healthier, having someone to talk to, working through. You know, there's anxiety and depression. A lot of times sleep, and our diet is going to affect those things. So having someone to talk to through those questions and through those things and having those simple reminders, it's very important to talk to the patient like a person. They are people, not just patients, and not just a number on a chart. You have to get on their level. You have to make it make sense to them and help them find their why. Why are they doing this? Versus are they being told they have to do this?
[00:25:39] Speaker A: Great.
All right, well, so up next, we're going to talk about the human side, the frustration, the fear and the transformation of patients. So stay with us, everybody. We'll be back with Christy to discuss sleep medicine a little bit more.
Stick with us. We'll be right back with more real stories, real breakthroughs, and real lives transformed.
And we're back. I'm Dr. Yasser Sombal. Let's dive right back into today's medical conversation.
Hello, everybody, and welcome back to Real Medicine, Real lives. We're back here with Kristy Plain. We're still going to be talking about our lives and we're going to talk about sleep medicine some more. Okay? So sleep orders don't just affect us at night. They impact marriages, careers and mental health.
So, Christy, welcome back. And please can you share a patient story where treating sleep apnea may have changed their life trajectory?
[00:26:37] Speaker B: Absolutely. The first one that came to mind was we had a 28 year old young man who was a bartender, always exhausted. His mom actually called me up and asked me what we could do to help her son get a sleep study. So we tested the young man and he dropped off the HSC unit, started heading back home. I immediately went upstairs and started scoring the sleep study.
As soon as I opened the sleep study, I couldn't believe my eyes. It was one of the worst ones I had seen before. For a 28 year old, that's not normal and he's not a huge person. He was very healthy, very active. So it wasn't what I was expecting to see. So I finished the study very quickly. I immediately called medical director Close in his area and asked how fast we could get him processed for treatment.
And so before the gentleman could even get back to his side of town, I had him back on the phone, headed over to the medical doctor's office to get set up on cpap. A week later, he came back in to do a follow up. He said, I had no idea what good sleep was. I'd never had good sleep because I didn't know you could actually sleep comfortably throughout the night.
He was no longer having to nap the entire time. Whenever he was going to work. He could go in, enjoy his shift, come home, you know, go to sleep at a regular time and actually feel comfortable and good the next day. Next day, later on down the line, I found out that he had left off some of his medications that he was on because he didn't want to worry his mom was afraid I would tell mom about it. Of course I couldn't. But, you know, he came back and told me that A lot of the medications he was starting to get to kind of wind down a little bit of those because his sleep was better, his oxygen was better, his numbers were coming back down.
28 years old, that's a baby, right? That's young to be having all of those issues. So just imagine had he waited until he was 50 and 60 to start doing something about it, which is when most of us think about our health, you know, as we're kind of hitting that stride and our, our kids are grown, then we start maybe thinking about ourselves a little more. Thank God his mom thought about him sooner and we got him in quickly and got him treated early.
[00:28:43] Speaker A: That's great. And so you know what, what emotional barriers prevent patients from accepting they need, that they need help.
[00:28:51] Speaker B: Most people want to be strong.
It's just like I was saying earlier, women don't get up in the morning, so, you know, I'm really tired today. They don't tell their spouse or the kids, I'm too tired. Let's say, oh, I just have a headache. And they'll keep going about their business, right? So we don't ask for help.
It's not just in sleep apnea, it's in life in general. We forget that there are people that can help us and that it's not weak to say, hey, I need a little bit of help telling your kids, you know what, I'm going to need you to help me pick up today, or telling your spouse, I'm going to need you to help me so I can take a nap today.
Those things are legitimate things that we should be doing. We need to remember our health is important because if we don't take care of ourselves, it's no different than being on the plane. If we don't put our oxygen on first, we're not going to be able to help that person get theirs on. So it's the same in real life. Remember to ask for help and let people be there for you.
[00:29:43] Speaker A: And you know, how does untreated sleep apnea? I mean, I think people just say, well, I mean, I didn't sleep well, it's not a big deal. How does it really affect me? But how does it really affect other parts of your body? You know, like blood pressure, maybe heart palpitations, or just overall long term health.
[00:30:00] Speaker B: So one of the first things that I notice when I have a bad night of sleep is my cognition is impaired. The next day I can be sitting here talking and the word is right on the tip of my tongue and I cannot think of what that stupid word is because my brain is a little foggy. That's what I'll say. I have a foggy brain this morning. Well, it's because I didn't sleep. I didn't get right oxygen last night, right.
Going from one room to the next, and I can't remember what I was going in there for. That's not just age. It happens to some of us when we're younger than we would like to admit because we're not getting that sleep. It's the same, you know, like we talked about with our pipes, our heart. If we're not giving the heart what it needs, it's going to wear out faster if we're wearing out our kidneys, because we're not doing what needs to happen. We're increasing the risk throughout the night. Because every time we have one of these events in our sleep, it gives us a little bit of an arousal, wakes us up just enough that the body's doing something. It's creating more hormones that make us, you know, after needing to go to the bathroom more often during the night or raising our cortisols throughout the night. It's doing so many different things that we don't stop and think about that happen. Because we're assuming we're just sleeping right? It's just the normal. But if we are not doing it right, if we're not giving ourselves the right sleep, the right oxygen so that our body can repair, we are wearing ourselves out internally, faster. Don't ignore the signs and symptoms.
[00:31:23] Speaker A: I agree. And, you know, how do sleep medicine practices, you know, how can they make some collaboration to allow, you know, expanding access to sleep care?
[00:31:34] Speaker B: So our company is completely virtual. We're not the only ones out there. I say we're the best, right? Because I have to. It's just who we are. But virtual, working with your MDs, working with the specialist. How many times have you gone to your dental office now and they're asking you, your dentists are required to look at your pathway, your airway.
That's something that patients don't realize. It's not just them trying to sell something. They're actually challenged to make that part of their care. Look at your airway. You tend to go see your dentist twice a year. You might go see your doctor once a year. So we're increasing the knowledge across different providers even to try to get this handled in a better way. If your dentist asks you about it, it's not, you know, just a whim. It is something they're passionate about. Too. So if your doctor hasn't asked you about sleep apnea and you're seeing signs and symptoms, ask them. You are your best advocate. You know your body. If something feels a little bit off, ask. Worst case scenario is you take a test and you don't have apnea and you know that you're good to go and you move on. Best case, you find out you have apnea and you treat it and you're again good to keep moving on.
[00:32:44] Speaker A: And, and so do you guys for example, provide care like nationwide.
[00:32:50] Speaker B: We are in all states. We are nationwide. We're virtual. You don't have to leave your home to get care.
We did this in original to help our truck drivers who were having to come off the road to get this.
We don't have to do that. We can drop ship equipment to anyone anywhere.
We are licensed in all states. We are covered all the major insurances.
So if it comes to a point where we can't help you, insurance wise, we'll give you options or we'll plug you into someone local to help you get that care. Our goal is to get you treated whether it's us or it's someone else. As long as it is right. We want to do the right thing always.
But virtual care is a very big growing and we were doing it before people went virtual. We've been virtual for the last 13 years.
[00:33:40] Speaker A: Gotcha. Great. So in the last minute and a half or so, I'd like you to first give us one thing about when patients finally feel rested. What's the first thing they notice as a change? And then please let the viewers know how they can find you guys.
[00:33:55] Speaker B: Sure.
Most of the time your family members notice before you notice and they'll notice that you're playing with the kids more or you have more energy or you just seem, you know, to have a pep in your step.
You tend to notice more weeks after getting really good sleep when you start realizing you didn't need so much coffee the next day or you weren't needing, you know that three o', clock, pick me up. That's what you start noticing more, usually around six to eight weeks. But again your, your family may notice it a lot sooner in, in your attitudes. And then for being able to reach us, there's multiple ways. Our website is going to be your fastest. You can go in there and it is going to be dedicated sleep.net on there. You can reach out to us for our sleep apnea care.
You'll also see that we work with patients for TMJ and dental implants. We work with truck drivers. We do CDL and DOT compliance programs. So you can reach us through there. Our phone number is going to be listed there as well. It's 888-342-1827. You'll get a hold of my clinical team that's always happy to help.
You can send the email out to us. If you're seeing this during the evening and you want to just pop an email over to us, please do so. You will get a response back. We're always looking to help out in whatever way we can.
[00:35:19] Speaker A: Great.
Okay, everybody. Well, we've seen what recovery looks like. When we return, we're going to talk about the future of sleep medicine. So stay with us. We're going to talk to Christy a little bit more about all this. We'll be back in a couple minutes.
Stick with us. We'll be right back with more real stories, real breakthroughs and real lives transformed.
And we're back. I'm Dr. Yasser Sombol. Let's dive right back into today's medical conversation.
Welcome back, everybody, to Real Medicine, real lives on Now Media Television.
Love what you're watching. Watch anytime on Now Media Television app available on Roku or iOS and or Android or stream at NowMedia TV.
Now let's return back to our conversation about sleep medicine. Christy, welcome back to the show.
So the future of medicine is obviously proactive, not reactive.
So give us an idea. Where is sleep medicine heading in the next decade? Whether it's diagnostics, technology, etc.
[00:36:24] Speaker B: It's wearables. Everyone is coming out with something that is to make it as easy as possible for a person to find out, do I have sleep apnea or do I not? And then once, you know, am I being compliant? Now I'm on treatment. How's that treatment going?
Patients can look every morning on their CPAPs now and say, did I have a good night? Did I have a leak? Did I have events?
They can look at the rings that they are wearing. So I really believe it's going more virtual and more wearable.
Even in the diagnostic pieces of it. You see more home sleep testing than you do in lab studies nowadays, which is very different from when I first started out.
So wearables, more technology, algorithms, looking at items, things like that is where I see it probably headed.
[00:37:10] Speaker A: Okay, tell us.
You know, obviously we're in this whole AI era, right? And everything is AI and apparently we're all going to lose our jobs and our lives and robots are going to take over and Terminator is going to be real. But how does, how does AI help you guys in this scenario? For example, moving forward, where I'm seeing
[00:37:29] Speaker B: AI right now is in the scoring of the sleep studies. So the algorithms is going in, looking at the heartbeats, looking at the EEGs, the EMGs, the O2, and coming up with an end result at the back end. I'm still old school, even though the computer will do that. We go back in with a human eye, we double check that every step of the way.
But I see that a lot of AI is being looked at that. And then there's programs pulling AI into their software as well, saying, okay, I'm looking through their health chart and I'm collecting all of the data.
And if this patient has these scenarios, what do I think that patient should be looking at next to have accomplished? So they've looked at their health screening, they've looked at their blood pressures and their numbers and their medications and said, okay, well you have this, this and this. I think you should have a sleep study. And it spits back that results to the doctor. So they're not having to think about it, they're just seeing. Patient has all of these symptoms, boom, I need to have these tests.
[00:38:31] Speaker A: Great. And so you know what, what lifestyle modifications do you tell patients or recommend to patients?
Improve sleep quality, medical intervention, maybe reduce the need for a sleep sleep study, a sleep machine or a CPAP machine.
[00:38:49] Speaker B: So some of the biggest thing is to set up a sleep routine. Try to get yourself going to bed at the same time every evening, getting up at the same time every day. Don't vary it by major chunks of change, right? So don't try to change it for hours at a time.
Have a routine of, you know, I go in and get my shower, I get ready for bed, I don't turn the TV on in the bedroom. So setting a good pattern, making sure you're giving yourself those eight hours. Try not to eat anything too sweet or too spicy before going to bed, not exercising right before going to bed. Set the right patterns. Fleets and large employers, compliance shouldn't be complicated. And the next thing you want to look at is also making sure that you look at the other parameters of your lifestyle. You know, the drinking alcohol too late at night is going to cause wake after sleep onset. More making sure that you're not overeating too much so that you're causing indigestion throughout the night. And then looking at your health in general, your weight is going to be an effect.
People that are very, very Healthy, but very, very muscular muscles are still weight. And if it's in the airway area, you can cause sleep apnea for that too. So just because you are in a really good shape doesn't necessarily mean you have an increased risk of sleep apnea. And you would still want to double check that.
[00:40:07] Speaker A: I'm glad you brought that up, you know, because in medical school, right, we're taught, you know, you have sleep apnea, your neck has to be like Jabba the Hutt and, you know, all that kind of stuff. So please, please, just elaborate on that a little bit more. You know, the notion that you don't necessarily have to be obese or overweight or meet a certain physical requirement to actually have sleep apnea. And it could apply to anybody.
[00:40:34] Speaker B: Correct. So sleep apnea can be as simple as you have an obstruction somewhere between the air coming in your nose and getting down into your lungs. Right. So if it's your airway is in your throat, your tonsils are too large, your.
Your tongue is too big for the area it needs to be laying in, your palate is too narrow, or it's too vaulted going up into your nasal cavity, which then decreases your airway from that pathway. All of those things could be on somebody that's a very thin, petite person. It could also be on somebody that's a very large person, the weight around your neck. So usually for men whose neck circumference is more than 16, we start to see issues. And for women more than 14, we start to see issues.
Bodybuilders, weightlifters, basketball, football players, they tend to have a bigger neck from the muscle, you know, lifting that they've done, that's still weight. When you lay down at night, it's still extra weight that's pushing on your airway. And even though you're in really good health, that's still weight muscle or not muscle.
[00:41:40] Speaker A: So people that say, I really only snore when I lay on my back, but if you turn me on my side, I stop snoring.
Is that somebody you would recommend that needs to get a sleep study?
[00:41:52] Speaker B: I would, because just because they've stopped snoring doesn't mean all of the vents have stopped. But there is positional sleep apnea. Only you're worse for. For my spouse, he's worse on his left side than he is in any position. But it's still positional. If I can get him off of that left side, we're golden.
[00:42:14] Speaker A: And do those patients require, for example, positional cpap? Do they require a CPAP machine?
[00:42:22] Speaker B: Not always. So if the positional is only on the one side or only on the back, then there are therapies that we can do to try to minimize them being in that position at night. So, for instance, if they're only bad on their back, let's keep them off their back. There are tools that we can incorporate that help them sleep on their sides and not let them get comfortable sleeping on their back. So now they wear that instead of having to wear a CPAP or an oral device.
If it's positional, but they still have apnea no matter which position, then you're going to want to go to treatment whether it's CPAP or oral device.
[00:42:56] Speaker A: Gotcha. And so if someone says, you know, I feel fine, what are the risks of ignoring that feeling?
[00:43:08] Speaker B: I feel fine is something you hear quite often. And it's always a spouse or a significant other that kind of sneaks, you know, snitches you out, said, yeah, you feel fine, but you don't rest at night and you're cranky in the morning and you need coffee here and you need drinks here. And. Right. So we snitch each other out all the time. It's great. Always take your spouse to the doctor's office with you. You'll get the real stories. But I feel fine doesn't mean you're not at a risk, and it doesn't mean you can't be better and you can't be optimal. Again. Some patients don't know what good sleep is until they actually get it. And once you've gotten that good sleep, you don't want to give it up.
[00:43:45] Speaker A: That's true. I think it's really funny that you said that, because usually when my patients show up and they're. They're white, especially the males, if their wife is with them, I say, something must not be right. Huh? Because your wife came with you today, so clearly she's worried you're going to lie to me. So, yeah, I think that's really funny that you mentioned that, but.
And so you know, what is one simple step the viewers can take home tonight to improve their sleep health? I mean, what recommendations do you make to them moving forward?
[00:44:13] Speaker B: I think the first thing you do is set you a sleep pattern and turn the TV off. Give yourself eight hours to try to get good sleep.
See if that improves the way you feel the next day, and do it consistently. Don't do it one night. Say, oh, well, it didn't work.
You're probably right. You have to get adjusted to going to bed at a regular time, getting up at a regular time. But if you are seeing these other signs and symptoms, reach out to a provider and let us go ahead and get it checked. Like I said, it's covered by medical insurance. It's not as intrusive it used to be. It's not as expensive as it used to be. It's a very reasonable, easy thing to accomplish.
Rule it out.
[00:44:53] Speaker A: Can you. Can you elaborate about. Sorry, this is maybe something for me because I love to sleep with the TV on. So, you know, I'm just curious, can you elaborate on. On that? Like, why. Why the TV being on maybe disrupts your sleep?
[00:45:08] Speaker B: It does a couple of things. So first off, you turn the TV on. That light is triggering the brain to stay awake, right? Because you're messing with your circadian. You've got light at a time where it's supposed to not be having light. And then when the noise level changes throughout the evening, rather it's the commercial got higher in the volume or whatever those are looking like those are causing just enough arousal in your sleep to make you start your cycle over. So you go through different sleep cycles. It's not always just deep sleep awake, deep sleep awake. You kind of get there. You go through the slow wave and then you get into the deeper, and then you'll have an arousal and you go back to slow wave and you get into the deeper, and you do that several times throughout the night. The goal is to get four or five good cycles of that and get that really good REM sleep that happens and increases in time each time. Every time one of these arousals happen, it can trigger you out of the stage you're in and you start over. You don't always go right back into that stage. So you may have just cost yourself that whole REM cycle.
[00:46:06] Speaker A: Okay, great.
And so really, the best thing is turn the TV off when you're gonna go to bed. Right? The same thing we tell people. Put your phone down 30 minutes or so before you're gonna go to bed to give your brain a rest. Right.
[00:46:17] Speaker B: Phones are even worse because the light is so much brighter.
[00:46:20] Speaker A: Okay. And you know, do you. What. How do you feel about, for example, people that need sleep agents to go to sleep all the time? Is that. Does that just besides alcohol? So we all know that alcohol really doesn't make people sleep, better, clearly. You know, I mean, even if you have one drink, I don't think that makes people sleep better. I think it actually disturbs your sleep more than it helps it. But Other agents, you know, people always want sleeping pills and whatnot. How does that affect quality sleep?
[00:46:46] Speaker B: So what that is doing is helping you get to sleep. It doesn't mean it's fixing what you're doing while you're asleep.
We used to allow the patients to take their sleep aid when they'd come in for sleep studies because they would get to sleep and then we could see what you're doing while you're asleep. And that's the part that's going to cause your bigger conditions, your bigger problems with your body long time. So sleep aids, I wouldn't want to use them for long term. I'd want to see what is the true cause of why I can't go to sleep. Let's get my, our sleep patterns fixed. Let's get our sleep health fixed and then hopefully you won't need those sleep aids. I can see using them once in a while to try to get you there while you're going through this. But let's not use that as a crutch and that be the only way we can sleep because you're going to have to increase it and then increase it and then increase it. It's just increasing the problem long term.
[00:47:35] Speaker A: Great. Christy, thank you so much for being here today and making us understand that sleep is not a luxury. Quickly, can you remind us, you know, where the viewers can get connected with you?
[00:47:46] Speaker B: Absolutely. Grab us on the website. It's dedicated sleep.net our phone number is listed there. You can call us, you can email us. We do all kinds of different assistance to help you figure out what may or may not be going on. It doesn't cost anything to have a conversation. And let us see if we can be a help to you.
[00:48:06] Speaker A: Great, everybody. This was real medicine, Real lies. We were joined today by Christy Plain. This was really, really interesting topic. Sleep is a very important thing and people should be aware of it.
I'm Dr. Yoster Sombol. This was real medicine in real lives only on NOW Media Television. Until next time, see you next week.
