Welcome, my name's Dr. Warrick Bishop. I'm a cardiologist, I'm an author and a keynote speaker. I'm CEO of the Healthy Heart Network. I'm all about trying to help people live as well as possible for as long as possible. Heart disease is huge in Australia. Every 20 minutes someone suffers a heart attack. Most of these could probably have been avoided if only we knew what to do. This podcast is all about helping you understand blood pressure, weight, cholesterol for better health. If you enjoy this podcast, I would be honored for a five-star review. You can share it with your family and friends. It may well save someone you love. Hi, my name's Dr. Rick Bishop and welcome to my podcast and videocast station. As always, I really appreciate you tuning in. Look, I thought I'd talk about obstructive sleep. One of the listeners has been in touch and said they would really appreciate a podcast on OSA, obstructive sleep apnea. Well, it's common. About 20 million adults in the United States alone have obstructive sleep apnea. And we're talking tens to hundreds of thousands in Australia if we apply approximately the same apnea. ratio of prevalence. Well, what is obstructive sleep apnea? Essentially, apnea is the word that we use in medicine for not breathing dyspnea. We use for breathing that's labored apnea for breathing that's stopped. So obstructive, as you might guess, is to do with an obstruction in the During the night time while we're asleep, apnea, stopping breathing. It occurs when the muscles in the throat, particularly during sleep, relax and lead to a partial or complete blockage of the airway. Well, who's at risk? Probably one of the most significant risk factors is obesity. And you can imagine that if you've got a thick neck and you're carrying extra weight, there can be intrusion into the airway by fat mass alone. Age tends to be a driver as well, and so does family history. When we look at the sexes, it's more common in men, but the incidence increases in postmenopausal women. So as women become postmenopausal and age, the ratio between men and women So sleep apnea is generally identified by the partner who sleeps with the individual suffering it. My own experience in clinics is that I have the wife or the husband, less commonly, telling me that hubby just stops breathing and they wait, wondering if he's going to start again. Or sometimes nudge them. or sometimes roll them over. Things such as loud snoring, choking, gasping, sometimes even waking up from sleep, startled, could all be symptoms. But one of the most striking ones and one of the really important ones is excessive daytime sleepiness. Well, this is super important in terms of safety within the community and safety for the individual. Imagine if you like, and I don't want to generalise too much, but imagine if you like the archetypal truck driver who might have indulged in unhealthy eating for a number of years, does not have a very active lifestyle, has gained excessive weight and has undiagnosed significant obstructive sleep apnea. This is a high risk situation and one that leads to many. many motor vehicle accidents so it is an important condition. When it comes to that daytime sleepiness I remember a patient I met once who told me that they had obstructive sleep apnea and the reason they were able to find out was not because their partner reported it they were single at the time but this is a big man who was at a party and as he was at this party he saw a corner in the room went over to the corner, leant into the corner, and promptly fell asleep. He was subsequently woken up by one of the other attendees of the party who said, I had a friend who used to fall asleep in corners just like that, and that person had obstructive sleep apnea. Well, what a good trigger to go and get checked. So, how do we pick it? Well, you do what's called a sleep test. That's called a polysomnograph. and it's a way that we measure heart rate, respiratory rate, and saturations overnight. We can also count the number of, if you like, apneic episodes, and we can even generate an apnea hyponeal index, H-A-H-I, which classifies as severity. If you're having these apnea hyponeal episodes 5 to 15 times in a night, that's mild. If it's 15 to 30 times, that's moderate. And if it's greater than 30, then that's severe. So there is a classification. But you need a polysomnograph to give you the best information. In Australia, because there's a real difficulty getting to respiratory physicians and sleep physicians, A good starting point can be to go to your local MCAL pharmacy where they have an arrangement with an organization that have provided take home sleep testing units. And for a few hundred bucks, you can run yourself through one of those tests and it will give you an idea if there's any major problems or not. Why is that useful? Well, if there are significant problems, you may well have a better chance of getting a prioritized referral to a sleep. specialist or a respiratory physician. Well, what are some of the consequences of having obstructive sleep apnea that is untreated? Well, we know it can drive all sorts of responses in the body and can induce high blood pressure and therefore heart disease with an increased risk of stroke. Type 2 diabetes. Interestingly, poor sleep even drives appetite centres and even weakens your will to choose better foods, believe it or not. There's no question, as I've already alluded to, that obstructive sleep apnea is closely linked with increased risk of daytime accidents, particularly and most dangerously driving. We do know that people with untreated obstructive sleep Apnea are five times more likely to die from cardiovascular causes, and that is pretty significant. Well, how do we treat obstructive sleep apnea if we identify it? Well, because obesity is closely linked in many of the cases, then the first port of call is to try and lose weight. This makes perfect sense, but it's not always perfectly easy. Don't want to change. Tired people don't feel like exercising. So there really needs to be a lot of support around that. Sleep position is important. Laying on your back will increase your chance of obstructing, whereas laying on your side can be really a significant change in your airway opening and can make substantial difference. Or also simple things like avoiding alcohol. before bedtime are a pretty important thing to try as well. Having undertaken some simple first-line lifestyle type manoeuvres, then the treatment of choice centres on a device that we call a continuous positive airway pressure machine. And this machine is attached to the nose and face and literally blows air in to make sure that good air entry occurs During the time that the patient's asleep. So this continuous positive airway pressure therapy. Which we shorten down to CPAP. C for continuous P for positive A for airway P for pressure. Therapy when used can reduce daytime sleepiness by as much as 70%. So it is very very important. For those people who live with obstructive sleep apnea, if they've undertaken the lifestyle changes, then their CPAP machine really does become central. And the day-to-day existence with that is really centered around that machine fitting well and being comfortable and the patient being able to deal with it. Obviously, if the machine doesn't fit properly or if it causes distress to the patient, then it's very hard for that individual to use it long term. So getting the right fit. Really, really important. It's also really important to recognize that the machines can have an impact on partners and relationships. Taking a Darth Vader mask equivalent into bed can obviously put strain on relationships and there needs to be a fair bit of understanding around that for both parties in a relationship. Some patients... end up sleeping by themselves however the upshot on balance is that although they sleep by themselves their time and their quality with their partner when they're awake because of their better sleep is enhanced so what do we do with obstructive sleep apnea well my suggestion is if there's a suggestion you may have it get it checked out Very important, particularly if you're at risk. If you're carrying too much weight, if you drink a bit too much before bed, you could cut that out. But if your partner reports that you seem to be stopping breathing through the night, then this is a pretty important signal, particularly if that's associated with things like daytime somnolence and difficulty concentrating. It could be a really good opportunity to go and get checked. You may speak with your GP about it. You may unilaterally seek out one of the services that provides home monitoring, as I mentioned earlier. It is a really important condition. We don't want to see people's oxygen saturations dropping. We don't want to see multiple sleep apnea episodes. And we don't want people on the roads who could be at risk of falling asleep and causing not just harm to themselves. but harm to others. Obstructive sleep apnea, it is common. It can be treated. We do need good diagnosis and there are therapies that can help. I hope you found that interesting. It is something to have a dream about. If you've got any queries or questions, drop us a note. I'm always interested to hear if you have any ideas for any future podcasts, as this one was a suggestion by a listener. For now, though, I am going to wish you the very best. I hope you live as well as possible for as long as possible and sleep without any apnea. Take care and bye for now. Did you know that coronary artery disease kills one in four people? So most of us are likely to carry some risk or know someone who does. If you're interested in finding out more about how to evaluate that risk, check out www.virtualheartcheck.com.au It will give you information about risk and what else can be done to be even more precise.
