Transcription:

Melanie Cole (Host): Of the nearly 70 million Americans who have sleep problems, about half have chronic disorders that keeps them from getting the restorative sleep they need according to the Centers for Disease Control, and many are completely unaware that something's wrong. My guest today is Antonio Cardenas. He's a respiratory therapist, the cardiopulmonary director, and he oversees Doctors Hospital of Laredo's Sleep Center. Welcome to the show, Antonio. What are some of the most common sleep disorders and what's going on in the country today -- why are we not getting that quality sleep?

Antonio Cardenas, RRT (Guest): Well, some of the most common sleep disorders that we have going on is the -- most absolute common one is obstructive sleep apnea and what goes around with -- what happens with sleep apnea, obstructive sleep apnea is our airway tends to get closed while we're sleeping. So, therefore, we're not allowing adequate oxygen to go into our system, so, therefore, when we see -- when we hear -- maybe we're sleeping with someone that they're snoring and all that stuff, that's kind of the airway closing down on them and not allowing that, pretty much that air and oxygen going into the system properly. We tend to see that more with our obese patients or anyone with a neck size greater than 17. They are more prone to have this disorder of OSA. So, that's what I see here at the sleep center when our patients come through and they start going through their diagnostic procedures and whatnot.

Melanie: So, what would signal to someone that they have sleep apnea? Is it a loved one that lets them know? Is there snoring? Would they notice any red flags or symptoms?

Antonio: Actually, some of the more common red flags also -- it doesn't have to be like a loved one or somebody that's sleeping in the room next to you that's complaining. It's actually yourself when you wake up, and you're going throughout your day, are you feeling any type of daytime fatigue? Are you kind of at your office and sitting and kind of dozing off? Or while you're watching TV in the evening are you noticing that within 10 minutes, you see yourself dozing off? Those are kind of classic signs that tell you that you're not getting adequate sleep at night. For some reason, you're not being to be functional for a long period of time during the day, and that's kind of like the first trigger that you should, as an individual, take that -- hey, maybe something is going on. What am I doing differently or what's going on differently?

Melanie: If someone notices that, or a loved one says, “Hey, you snore really a lot,” and so you need to get in -- what's involved in finding out what's going on -- whether it's sleep apnea or something else? What's a sleep study?

Antonio: Okay. So, the first thing you want to do is have that great conversation with your general practitioner. You need to go in and just say -- I've noticed for several months, you know, or several years, some people go on, you know, long time without even discussing it because they think, “Oh, I'm just tired; no, I didn't get good sleep." They tend to blame it on something else that's going on, probably like a late night and so on. But having that great conversation with your general practitioner saying, "Hey, I’m having these issues. I'm noticing that while I'm at work, I tend to fall asleep or if I’m not doing any activity, and I’m sitting there, I tend to doze off." From there, your general practitioner should recommend if anything to kind of rule out is the first night diagnostic sleep study. With a first night's diagnostic sleep study, what goes on is we bring you into our sleep center. We set you up on pretty much on equipment that's from like head to toe. We’re literally monitoring all the waves from your sleep activity in your brain all the way down to how much you breathe per minute, your O2 saturations and so on and so forth.
And from that sleep diagnostic, whenever we receive the results, we start going off of some of the key points like the AHI Index which is an apnea hypopnea index. Kind of lets us know that if there was moments that we stop breathing and then at the same time how long did we stop breathing for? Once we accumulate all that information, there's a certain number that we go off of for that index, and if that index reads really high, then there's a very strong possibility that you're suffering from OSA in which you would come in for a second night, what we call a treatment night, and in that second night, we pretty much bring you in, do the same set up as the first time but this time we start treating you with a -- what we call a CPAP device, or continuous positive airway pressure system -- in which we put on that mask or a nasal mask, and we kind of start seeing if we can give you that adequate pressure to open up your airway and allow for better sleep, better oxygenation, reduces the amount of snoring and then from there we re-evaluate your sleep and how you did with the machine. If we see positive that everything -- all your numbers -- went down, you breathe more adequately, and so on and so forth, then it's a positive thing. It means that you're going to get those good responses from using the device at home.

Melanie: Antonio, do people really get a good night's sleep at a sleep study? What do you want them to know about that? I mean if they're hooked up and maybe a little bit nervous -- is there, I mean, can you get good readings when somebody is there if they are nervous about being watched?

Antonio: Just like any exam that you undergo with a doctor or lab work -- it's anxiety -- we all experience it. We're going in, "Oh why do they need this? Why do they need that?” We see it, too, when some of the patients come in. Like, it's overwhelming, the amount of equipment that can be put on, and for them it doesn't seem normal, but for the most part, once we start coaching and talking to the patient and letting them know that this is for the benefit of you, and really, that we're not poking them or anything like that, they tend to calm down a lot better and pretty much we say, "Hey, you're going to get a great night's sleep here -- we're going to figure out what's going on with your sleep, if anything's going on."

Melanie: What about adherence to protocols like the CPAP that you've discussed? Do you see that people don't want to use them or do they have issues using them? What about CPAP?

Antonio: Ok. We see a mix; we see like a good mix of response. Most of it is positive. Most of them after they undergo their second night treatment that we've placed them on the CPAP machine and we've kind of titrated the levels that they need to be. Some will wake up really refreshed and comment right away that, "Wow, I feel really, really awake right now," and most of the time it's because we're meeting that adequate need for the patient. Then, there is the flip: the small percentile that sometimes, no matter what we do or how we do about it, they just cannot get used to it. They feel like it's too much. You know, most of them that experience any type of claustrophobia, of course, we're putting on a mask on their face, and they don't like that feeling. So, we do see some patients that unfortunately, they do not tolerate.

Melanie: What about your best advice for sleep hygiene -- good sleep hygiene -- so that people can get that good quality sleep whether it's electronics or the light in the room because we have – I mean, we're all on our electronics until late at night and keeping them right next to your bed. What do you tell people every day, Antonio, about getting that good, quality night's sleep and the importance of it?

Antonio: I always tell patients, or people in general that I have conversations with, is just that yourself to put your phone and your TV and turn it all off at a certain time. I'm a believer where I don't keep my TV in my personal bedroom; I leave it outside, so therefore, when I leave the living room and go into my room, it's kind of like a lights out, kind of time out zone for me to turn everything off. It's very difficult because we are in a world of technology that everything's at our fingertips, and I've noticed that people tend to, you know, they're going to go to bed, and they'll take their phone or their handheld device and they'll start scrolling saying, "I'll fall asleep right now; I’ll fall asleep right now," but as you know, I mean we get caught up in something or some clip or something that's on there. We just have to be really, really good and let ourselves know that we have to at a certain amount of time, start winding down, start relaxing our brain and start telling it, “Ok, it's time to go to bed” and then go on and so on and so forth, and I always use the weekends personally, to catch up, like if during the week I stayed up a little bit extra because of whatever reason. I always use the weekend to kind of catch up and let myself sleep in and let my body kind of catch up because we tend to -- we tend to overdo it sometimes.

Melanie: We certainly do now. Tell us a little bit about the Sleep Center at Doctors Hospital of Laredo. What other types of conditions do you treat?

Antonio: So, here at Doctors Hospital of Laredo, we have a two bedroom sleep center in which we see pretty much two patients a night and from there we see not only just obstructive sleep apnea, we also see sometimes disorders that are neurological that more are concerned with central sleep apnea whereas it's kind of another issue going on and then as well as we see sometimes every now and then those who suffer -- or think that they're suffering from some type of narcolepsy. We do run MSLT studies on them, too.

Melanie: So now your best advice, Antonio, for recognizing sleep apnea and other sleep disorders and the importance of getting that good quality night's sleep, and why they should come to Doctors Hospital of Laredo for their care?

Antonio: So, best advice is always kind of stepping back and recognizing, “Hey, I've noticed this -- what's going on" or "This is what’s changed in the last few months." Always take that moment to kind of consider it is something different or it is something that's a continuous problem. Once you acknowledge it, it's very important to, like I said, to have that good conversation with your general practitioner to see if a sleep study is the best route to see if you are really truly suffering from something going on.
Now, here at Doctors Hospital, of course, we're going to give you that awesome care here, and we're going to set you up and bring you in some of our greatest rooms. You will have, you know, just, we mimic your own personal bedroom where you walk in and it's not hospital furniture, it's actual furniture and, you know, your own restroom and so on and so forth. And we make you feel like you're at home because we all know sometimes sleeping somewhere else also increases the anxiety of anything.

Melanie: Thank you so much, Antonio for being with us today. You're listening to Doctors Hospital Health News with Doctors Hospital of Laredo. For more information, you can go to ichoosedoctorshospital.com. That's ichoosedoctorshospital.com. Physicians are independent practitioners who are not employees or agents of Doctors Hospital of Laredo. The hospital shall not be liable for actions or treatments provided by physicians. Doctors Hospital of Laredo is directly or indirectly owned by a partnership that includes physician owners including certain members of the hospital medical staff. This is Melanie Cole, thanks so much for listening.