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Melanie Cole (Host): It’s estimated that up to seventy million Americans suffer from some type of sleep disorder. My guest today is Dr. Ashley Wilk, she’s a family medicine physician at BayCare Health. Dr. Wilk tell us a little bit about the health burden and economic impact of sleep disorders in the country today.

Ashley Wilk, DO (Guest): Sleep disorders have quite a wide spread health burden really in our country. There are multiple components of our health that they affect, not just physical, but mental as well. It can affect things from concentration to comprehension. It affects patients’ reaction time and their mood as well. And that’s not to mention the physical components of patients’ health that it also affects. It can have impacts on blood pressure, increases the risk of heart disease and also increases patients’ risk of obesity and diabetes. All of which are big profound health burdens of our country. Things that a very large proportion of our country is suffering from. So, it is absolutely a wide spread and common ailment that is affecting a lot of patients’ quality of life and overall health.

Melanie: Who notices a sleep disorder whether it’s snoring or sleep apnea? Is it a loved one or are there symptoms that you would notice in yourself?

Dr. Wilk: It really is about half and half in terms of who comes to me as a physician and is the one to bring up the concerns that there might be a sleep disorder coming to fruition, really. Sometimes the patients will end up coming in and they are having complaints of excessive daytime fatigue, sometimes the patient comes in and says that they feel very drowsy. They are nodding off during meetings or they can’t sit through there favorite TV show anymore. Other times, it’s their spouse so it’s the wife that comes in and says my gosh, my husband’s snoring sounds like a freight train coming through our wall. I just can’t handle it anymore. I made him make this appointment. It comes in a variety of different ways is how it presents and sometimes it can be more of a physical presentation of itself. You have somebody come in who you wouldn’t otherwise suspect to have high blood pressure and then low and behold, it’s because they have underlying sleep apnea that is triggering them to have high blood pressure. So, it presents itself in a variety of different ways, not always things that you would expect.

Melanie: Then tell us a little bit about some of these sleep disorders. Let’s start with sleep apnea. What is that?

Dr. Wilk: Certainly. So, obstructive sleep apnea is essentially when our airway is not as patent or open as it should be when we are asleep. Your classic symptoms that you are going to hear are patients who are loud snorers quite often or you have the patients who their significant other is saying you know what, it the middle of the night, they stop, and they gasp for air. These patients often have pretty significant daytime sleepiness. Sometimes they end up being overweight. It can sometimes be caused due to a just kind of a central neurologic disturbance where their body isn’t regulating and keeping their airway as open as it should be. That’s more of a central sleep apnea as we call it, but obstructive sleep apnea is usually when the airway itself does not remain patent and the good news is there’s very efficient and effective ways to diagnose this and we raise our suspicion in the office and we talk and have a conversation, we get the patient tested and get them on proper treatment which is a great, great thing. It can be life changing for these patients.

Melanie: So, before we get into diagnosis and treatment; if somebody snores, does that mean that they have sleep apnea?

Dr. Wilk: No. Just because somebody snores, does not necessarily mean that they have sleep apnea. There are plenty of patients who snore and still get good quality of sleep. It’s more so when you have that very profound loud snoring. I always ask is it snoring that can be heard in a room outside of which the patient is sleeping in and or if they are having that excessive daytime sleepiness and or gasping for air in the middle of the night in addition to the snoring is when my suspicion would be raised and I would want to probe further into possible diagnosis of sleep apnea.

Melanie: Then let’s speak about diagnosis. How is the assessment and evaluation done and while you are talking about things like sleep studies, tell us how people are comfortable at those and what do you tell them when they have an anxiety over a sleep study?

Dr. Wilk: Certainly, so what it starts with is a conversation in the office. Being in primary care it’s usually a conversation that patients really first bring up with me. So, we will delve into the history about their sleep symptoms and then we go through a couple of different assessment tools that we use. There is one called the Epworth Sleepiness Scale where we kind of go through a couple of different daily situations and how likely a patient would be to fall asleep during these situations. It ranges from things like sitting and watching TV, to being in a business meeting to being stopped at a traffic light. We ask the patient how likely would you be to fall asleep in these situations and sometimes it’s a little nerve wracking when you hear they are pretty likely to fall asleep at a red light. You know that they are missing out on some sleep.

And there is another questionnaire. It’s the acronym one, it’s called STOP-Bang so, it kind of goes through different health risk factors so is the patient male, are they obese, are they having excessive daytime sleepiness, are they gasping for air at night. So, we get scores from each of these questionnaires and then we also measure the patient’s neck circumference and we look at their airway to see. Do they have a very small airway? Do they have a large circumference neck? We take these factors into consideration to see if they are at increased risk for sleep apnea.

If that is the case, then we refer them for something called a sleep study. The great thing about sleep studies these days is they have options where they can actually do them in the patient’s home. For patients who don’t have complex medical issues in addition to their sleep disorder; a lot of times they can pick up a device from the hospital. They take it home for the night. They wear it. They are taught how to use it, how to wear it overnight. They wear a little probe on their finger and it monitors their oxygen saturation throughout the night to see if it drops. Then they return it and a sleep specialist analyzes the data and gives a result to us. And then we are able to get the patient back in the office, review the results and kind of get them a plan together.

And then more classically, or if the patient has complex medical issues that need to be monitored as well; they can go to a sleep center for the study which is not as scary as it sounds by any means. They are usually very serene, very comfortable. They have a nice bed and they have the device that monitors their oxygen on them while somebody is watching them and monitoring different movements of their body, things like that. Patients really should not be anxious in regards to going to the sleep center. The staff are usually very accommodating, very friendly. Many patients say you know what, it was not as bad as I thought it would be. It was just a couple of hours of my night and it was well-worth it because now I’m actually able to get some good quality sleep.

Melanie: And now on to treatment, CPAP, we have heard about it in the media, but some people don’t comply with their prescription for CPAP and there’s a big adherence problem. What do you want to tell us about CPAP and using it properly and by prescription?

Dr. Wilk: Absolutely. So, CPAP is a very effective therapy for treatment of obstructive sleep apnea. What it does is it helps to keep that airway open so that it’s not closing off and stopping the patients from breathing at night. It is certainly like anything else, something that needs to become a habit and something that you might need to adjust a little bit to get used to, but the profound health impact that properly treating sleep apnea can have is well worth making some adjustments in your routine and it really does have to be something that is used on a regular basis, on a nightly basis in order for it to be effective and to allow these patients to get good high quality restful sleep so that they are able to take on their day and perform their activities of daily living.

Melanie: Such important information. People don’t even realize how truly important sleep is. Wrap it up for us Dr. Wilk with some of your best advice regarding sleep apnea, other things in general that people might try to go along with their treatment such as weight loss and such and your best sleep hygiene advice for good sleep habits.

Dr. Wilk: Absolutely. So, my advice would be if you or your loved one are having an excessive amount of daytime sleepiness, if you are finding yourself nodding off or falling asleep during different situations; bring it up to your doctor. Have the conversation. Say, you know I’m quite tired during the day. I don’t know how the quality of my sleep is. And more likely than not it will just start with a simple conversation to see if you have other risk factors that might allow you to benefit from having a sleep study to see if maybe you do have sleep apnea. And as I said, the diagnosis is easier than ever, sometimes can be made in the home with the home sleep study kits that they have available for patients who need to be tested.

And then in terms of sleep hygiene. Sleep hygiene is a big, big topic that I review with a lot of my patients. Mostly because a lot of us are guilty for not following proper sleep hygiene. So, and this advice is true for anyone whether or not they have a sleep disorder, sleep apnea; this is good advice to get good restful sleep and fall asleep quickly and sleep soundly, no matter if you have chronic health conditions or not. So, what my advice would be is go to bed and wake up at the same time every day. This would be weekdays, weekends, work days, non-work days. Keeping the same pattern and schedule for yourself with sleeping allows you to fall asleep at the same time every night and have that good amount of restful sleep. Your body gets used to it and kind of gets in regimen that it is better able to adapt to long-term. I always recommend getting a relaxing pre-bedtime regimen, so it can be something as simple as turning the lights down low, turning off your TV or electronics. My rule for patients is do not have a TV in your bedroom. Don’t take your phone in bed with you. Don’t go surfing on YouTube or Instagram or Facebook in bed. Your bedroom should be just for sleep. You want your body to know that when you are going into your bedroom, it is time to go to sleep. I recommend they keep their bedroom quiet, dark and a little on the cooler side as opposed to warmer because our bodies seem to like to fall asleep in a little bit of a cooler environment. if you are unable to fall asleep within about twenty minutes of trying, get up do something outside of your bedroom, read something very serene, no electronics and then once you start to feel sleep, try to return back to bed and see if you would be successful at that point in time. It’s really, really fascinating how big of a difference this can make and it’s just something as simple as changing your routine or your habits that can make a huge impact on your sleep quality.

Melanie: Great information and such great advice about good sleep habits and sleep hygiene. Thank you so much Dr. Wilk for joining us today. You’re listening to BayCare HealthChat. For more information please visit www.baycare.org, that’s www.baycare.org. This is Melanie Cole. Thanks so much for listening.