PowerLiving with Kimberlee Langford
PowerLiving with Kimberlee Langford
January Nurse's Round table with Dr. Randall Smith, D.M.D: Sleep Apnea - Medical Insights into Treatment and Health Risks
Join the Specialty Care Managment Nursing team and special guest Dr. Randall Smith, D.M.D as we talk about an all- too- silent health destroyer.
From the heartache of his father's health struggles to his own diagnosis of sleep apnea, Dr. Smith unveils the gravity of this condition that, when left untreated, leads to serious health issues like hypertension, kidney disease and congestive heart failure. Our discussion lays bare the importance of quality sleep, not as a luxury, but as a cornerstone of bodily repair; and we confront the startling fact that 80% with sleep apnea are walking through life undiagnosed and untreated.
- "Untreated sleep apnea will take 7-10 years off your life"
- "Untreated moderate-to-severe sleep apnea will cost a patient upwards of $200,000 in other medical bills"
- 'Having untreated sleep apnea is worse than being a pack a day smoker'
- 30 million people in the US have sleep apnea and 80% of those people don't know it
- Risk factors include: Snoring, waking at night to urinate, waking with morning headaches, waking with gasping for air, daytime fatigue, and others....
- if your BMI is over 30 - your risk of sleep apnea is 70%
- Consequences of untreated sleep apnea include: hypertension, cardiomegaly (heart enlargement), CHF (Congestive Heart Failure), cognitive decline, and more...
The dentist's role in the fight against sleep apnea is not to be underestimated, and Dr. Smith spotlights this with expertise and passion. We touch on everything from the cellular restoration that occurs during sleep, to the clues that could indicate you're at risk and that you want to be sure to talk to your doctor about. In our conversation, he also addresses the high-stakes long-term health risks of leaving sleep apnea unchecked.
By bringing to light the barriers to diagnosis and the tools at our disposal, we're not just talking about sleep—we're discussing a potential pivot in the longevity and quality of our lives.
While the gold standard is polysomnography - in a sleep lab, Dr. Smith talks about the ease and the savings of the home sleep test. Your PCP can order your sleep test, or in some states, your dentist may be able facilitate that process of obtaining a prescription for your sleep study as well. He also walks us through the various treatments for sleep apnea including: positional therapy, CPAP, the potential game-changer of oral appliances, and the cutting-edge Inspire implant.
But the take-home message is this: in many cases, weight loss and lifestyle changes can be just as powerful. And early diagnosis and treatment can help you enjoy a health life.
YOU can absolutely do something about this threat. Talking to your health care provider about your risk and getting a sleep study are the first steps to help you take hold of your health and breathe easier—the restful nights you seek may just be on the horizon.
Great Books he shared today:
Matthew Walker: Why We Sleep
James Nestor: Breath
Dr. Bradley Bale and Amy Doneen: Beat the Heart Attack Gene
Hey, hey, we are back for another round table with the SCM nurses and I'm super excited to have my favorite dentist here. Dr Randy Smith is here out of Meridian Idaho, and today we're talking about a super hot topic and in various sectors of health, which is sleep apnea, and I think you know a lot of folks don't really pay much attention to their snoring. I mean, I know I have friends who they just sleep in different bedrooms, that's all it is right, just keeps you up, and I think it's one of those silent things that really creeps up and destroys people's health and they really they really don't understand the damage that caught and it's a huge driver for kidney disease because of how that impacts the heart and leads to congestive heart failure and then fluid overload and whatnot. So, dr Smith, this is your expertise and I just love to have you introduce yourself and, you know, share a little bit about what drew you to this space of helping people first of all find out if they have sleep apnea and why should we give a hoot about it?
Speaker 3:Yeah, so I've been at dinner since 1995 and I got drawn to the field of sleep medicine First off, I guess because I was diagnosed with sleep apnea and as I went down that road to treatment and caring for myself, wanted to help other people and the other things.
Speaker 3:That drives me is and revs my engine, gets me excited is when people care about their own health and they're willing to do whatever it takes to get healthy. My dad was never tested but as I look back I'm about certain that he had sleep apnea. He had all the signs and all the symptoms and I wonder if that led to his early death. So anyway, that's kind of where I came from. I got excited about sleep apnea, got serious about it just as COVID was getting going, so that kind of worked out good that I was able to get a lot of training and many residencies in during that time when things were a little bit slower at the office. So it's amazing how prevalent sleep apnea is, even just sleep disorders, and we had a pandemic. But we also have an epidemic of sleepy and tired people.
Speaker 1:Yeah, yeah, well, I think a lot of us don't understand how much work is being done at night while we sleep. I tell people that's when the road crews come out, right, we do all the clearing away of the debris and building new cells and it's so important. Interesting that you mentioned about your dad. My dad, my brother, was killed many years ago and my dad put on a lot of weight and I still remember it wasn't until we caught him on video and a family video where I mean he would fall asleep mid sentence and turn blue and almost convulse. It was so hard, so hard, heartbreaking. And because of the delay in treatment he did develop congestive heart failure and once he was started treating for that, I'm sure that's why we had him for as long as he did. But I think a lot of people don't understand that pathway.
Speaker 1:We think of sleep disturbances or, like you mentioned earlier, we were chatting before about how we kind of get accustomed to this slow and steady decline, right, as we get older. We're supposed to get tired. Well, yes, I'm tired, but I work my tail off, right. So, yeah, so. Or well, yeah, I snore, but it's, I love this one only when I'm really tired, right, and we don't understand. So what do you think? Here at specialty care management, we use a stop bang score to help us remember the questions to ask, to make sure that we're screening for sleep apnea at every time we assess a patient. But what are your favorite tools or what would you say would make you advise somebody that they should be tested for sleep apnea?
Speaker 3:Well. So there's a number of things, and some people are probably wondering why are dentists even involved in this space? No-transcript came about. In 2017, the American Dental Association came out with a statement that said that all dentists should screen all their patients for sleep apnea, just in the same way that we screen all of our patients for oral cancer. As dentists, we cannot diagnose sleep apnea, but we can recognize the signs and the symptoms. I've heard physicians say that the reason why they want dentists involved is because they know that we see a lot of patients on a regular basis, whereas many people don't go see their physician or healthcare provider unless there's something wrong. There's too many that don't go in for their regular care.
Speaker 3:A couple of books I think that would be good for anybody to read. One of them is by Matthew Walker and it's titled why we Sleep. It'll break down into the reasons and some problems associated with sleep. It's not just an inactive time but, like you said, that's when the work happens, that's when our memories are consolidated, that's when we heal, that's when we grow, that's when the repair takes place. Sleep is very important. The other book is by James Nester and it's called Breath. I think he's a journalist, and so he just went down this rabbit hole of what happens at nighttime why do we sleep?
Speaker 3:Some of the problems associated with sleep, like sleep apnea, a couple of well, I've got a whole list of things that we look at that cause us to of questions that we ask. But even before I go there, we also need to recognize the impact that sleep apnea has. I don't have any paper that I can cite on this, but I've heard it multiple times that actually I think it came out of the Wisconsin heart study that untreated sleep apnea will take seven to 10 years off of a person's lifespan. I've also heard that untreated moderate to severe sleep apnea will lead to that patient paying upwards of $200,000 in other medical bills. And, anecdotally, I heard one of my mentors say that it'd be healthier for a patient to be a pack-a-day smoker than it would to have untreated sleep apnea. That's how severe it is, and so that's one of the points that we want to get across to our patients.
Speaker 3:The other factor is that it's estimated that there's about 30 million people in the US that have sleep apnea, and the bad thing is that 80% of them are undiagnosed. That's where the dentists get involved. So some of the things that we're going to be looking for are first question is do you snore? Because that's the number one risk factor for sleeping, for the sleep apnea. Other things that we look at, ask them, you know, is if nocturia right, are they waking up during the night? You know, to use the restroom and a lot of people think that's just associated with age.
Speaker 1:But I drink yeah, I'm always drinking, so of course I'm going to get up to pee, yeah.
Speaker 3:Yeah, so the other one you know in the stop bang. One of them is witnessed episodes, right? Has someone else seen you gasping for air? Do you ever wake up gasping for air? Do you wake up with morning headaches?
Speaker 1:Or daytime fatigue. That's a big one.
Speaker 3:Yeah, excessive daytime fatigue. Some of the other comorbidities would be someone that has GERD. In the dental world, we're looking for people that have worn teeth. Bruxism doesn't cause sleep apnea and sleep apnea. It doesn't cause Bruxism like it was once thought, but it's a comorbid condition that is often found paired together People that have night sweats. If you're, there's other risk factors like if you're a male, you're twice the risk of a female up to the age of 50. And then after 50, basically menopause, the risk is equal.
Speaker 1:Great, thanks a lot. Everything falls.
Speaker 3:Yeah, so BMI someone with a BMI over 30, they have a 70% chance of having obstructive sleep apnea. So we also look for someone that has a high, arch, narrow palate, someone that has tori, the bony growths in the jaw bone. Those are some other possible indicators. Something a malampati score, the tongue size if they have a scallop tongue, those are also indicators that a patient might have sleep apnea.
Speaker 1:Yeah, it's interesting. So when we think about this, all that we talked a little bit about you know this the impact of that in terms of our lifespan and I think you know some of those seems so far off. We talked about some of the danger signals, some of the things that we should. You know that we're looking for as far as clinicians, in terms of these screening tools and whatnot. I think, like we were talking about earlier, I think, one of the, I think there's a couple of things that are barriers for most people, and one of those barriers is to your point earlier, as a lot of us, because there's no immediate impact in that.
Speaker 1:I know for me, when I talk to folks, I explain that you know if you're not breathing and sleeping at the same time, your heart has to pick up and do all the work that your lungs aren't doing because you're trying to sleep and the heart as a muscle is going to grow. People get these big hearts and then these big hearts can't do all. They can't do all the work anymore and that they basically you'll develop congestive heart failure and someday not today you're going to drown in your own fluids. That's fairly graphic, but hopefully, to shake them up a little bit, and I think that pathway is we look at, you know what happens? That's a quell of undiagnosed and untreated sleep apnea.
Speaker 1:Where that heads the other thing besides, the fact that people don't feel that immediate impact until, hopefully, somebody shares with them enough to wake them up a little bit to have them be curious enough about that. But then a lot of people and I think Stephanie alluded to that earlier a lot of people. They don't want to wear that jockstrap on their face right, I hear that all the time. I am not going to wear that thing on my face, and so people don't know. They have so many options for treatment and so maybe you can talk a little bit about that. First of all, in terms of if you have some of these symptoms, how do you know for sure if you have sleep apnea, and then you know what can I do about that?
Speaker 3:Yeah, so first, if if you some of these symptoms sound like you, then one talk to your primary care physician. One of the challenges, though, is that primary care physicians are just in undated and swamped and yeah you got about five minutes with them.
Speaker 3:Yeah, so. So the time with them is very short, and so then, the most common way to find out for sure is a sleep test. Right, it used to be. Well, the gold standard is still to do the polysomnogram, which is a sleep study in a lab to where they hook you up to a whole bunch of different leads and and trace your sleep through the night. But that's expensive and it takes a long time to get in for one of those studies because limitation on the number of of labs.
Speaker 3:So what has become more popular in recent years has been the home sleep test. Now, it doesn't give us all the information that a polysomnogram gives, but it gives us enough information to know if a person is positive for sleep apnea, and and some of them give us extra information, that's that's helpful. Also, that will even tell us what stage of sleep they're in. They'll tell us what body position they're having the episodes during, and those can be helpful also because one of the treatments is positional therapy. We see patients that reading and looking at their, their study, it shows that most of their episodes are happening when they're sleeping on their back. So if, if, we can get them on their side or we'll find it, you know, one side is more than the other, so even just positional therapy.
Speaker 1:But so to answer your question though, a home sleep test and not to interrupt it because I have heard that before. But is positional therapy enough? Treatment for somebody with sleep apnea, Really?
Speaker 3:No, by itself, no, okay. But if you know that you have it, you can reduce your, you know your incidents by just even the way you're sleeping. But I do understand there's a lot of people that can't sleep on their side, whether it's because of hip or shoulder pain, and so they're on their back. But when we're on our back, gravity is taken over, and so we're fighting gravity. So another thing too is, as a dentist, I can't diagnose sleep apnea, and so I can't help a patient, other than in some counseling, until I have a prescription from a physician to to help them.
Speaker 3:And generally, what in dentistry that we'll do? What you think back to CPR. One of the first things you do is head, head tilt, chin lift, and so the the device. It's a oral device that can be put in. That's essentially what it does, is it opens the airway by advancing the chin, the lower jaw yeah, put you, put you in a forward position there. But as far as being able to get a sleep test, you do need to have a physician order it. There are online services where people can go and have a telemedicine visit with a physician and then they can order a sleep test and it can be sent to them through the mail. The patient can wear it at home in their own bed, and so I think that's one of the advantages of a home sleep test, too, is I hear people that went into the lab to have it and they said they couldn't sleep because they had all those leads attached and then they're in in a hotel bed essentially, and you get a four hour read right.
Speaker 3:Yeah, didn't have their own pillow, and so that's one of the beauties of the home sleep test is it's probably more representative of a typical night.
Speaker 1:Right.
Speaker 3:And another advantage with the home sleep test is that it's easier to do multiple nights. And an interesting thing there is that one night might show that everything is completely normal and the other night is when it shows up and shows that they might have moderate to severe sleep apnea. Yet you know, the first night showed nothing.
Speaker 1:So interesting. Yeah, I think too. I think that one of the barriers is just that the time I've got to take to schedule it and then, you know, I got to figure out who's going to watch the dog so I can go. All those those barriers to that. So, yeah, I know I, you did my, my sleep study, we sent that off. That was so easy to be able to do that at home. And the workout for the one thing I like about the oral appliance is not having to, if I travel, not having to lug a big, heavy you know CPAP, even the smaller CPAP. So because I don't check bags, doggone it.
Speaker 3:Yeah, so we different states have different laws as far as who can even dispense a home sleep test. We can dispense it and but again, like I said, we can't diagnose it. So after the patient has brought it back, it's uploaded and there's a board certified sleep physician that is going to score it and also diagnose off of that, just like we do for x-rays right, you have your x-ray and that gets sent off to a doctor in Australia. Yeah.
Speaker 3:Yeah, yeah and like you were saying about the CPAP. There's a lot of people that, and I think it was Stephanie that mentioned that. There's people that have the diagnosis but then they don't follow through with treatment and a lot of people yeah, they there's different, like Mike and Molly on that sitcom you know, they had a great episode about the CPAP and others will say I'm not going to wear that Darth Vader mask and and others will say that they're claustrophobic. Now I will say that the CPAP still is the gold standard of care and If you have moderate to severe, it should be tried first. But there's, like Stephanie said, there's a lot of people that don't even want to go down that road. And so that's again where the sleep physicians are saying okay, I know you're going to be better off if you're treated with an oral device than not be treated at all. There's a study called the CERA study to where they compared the efficacy of the CPAP versus the oral device, and what it showed was, yes, the CPAP is more efficacious. It does reduce sleep apnea better than the oral device. The problem is the compliance, and so the oral device isn't quite as efficacious, but because of the compliance it's considered as effective as a CPAP, if the CPAP isn't going to be worn all night long.
Speaker 3:Some of the other things that some of the challenges with the CPAP statistically, about 50% of people that were prescribed a CPAP have quit wearing it after the first year. So and the CPAP manufacturers and the physicians know this and that's one of their greatest battles is overcoming the stigma of the CPAP and the challenges associated with the CPAP. The other thing that happens is people go to bed with it on and then when they wake up to go to the bathroom, they take it off and then it doesn't go back on. But then, when you understand the stages of sleep, when we're in REM, that is when we are most at risk for having apnoch episodes, and our REM sleep typically happens later into sleep, you know, the last couple of hours before we wake up. So what's happening is that they don't have the CPAP on when they're most at risk. So again, that's where an oral device most people who have an oral device put it in and leave it until they get up.
Speaker 1:Yeah.
Speaker 1:So, yeah, I think that's really important. Well, the other thing to I always talk to people. I mean you're gonna be claustrophobic too when you're drowning because of congestive heart failure, so that's gonna happen. But two, I mean the masks are so different. They used to be big and now even the full face masks are so much smaller. Or like my mom uses a CPAP and she uses the nasal pillows and they're pink. So come on, like he doesn't like pink, come on little bitty things. She just loves them because they're comfortable and they just throw it over her mouth or her nose.
Speaker 1:And I think that you know a lot of folks. You know, gosh, try it. The DME company will make money if they get you in a mask that's comfortable. So it behooves you to tell them if you don't like the mask within 30 days right, most of them have like a 30 day try it and bring it back and we'll get you fitted for something different, kind of thing. So I think you know that diligence up front to make sure that you're you know, and the time that it takes to acclimate to a CPAP. So I gotta say coaching, I've done a lot of coaching for people and yet when it was my turn. I'll just say I was surprised at how hard it was to acclimate to a CPAP and so I wasn't ready for that. I had to take my own tablespoon, so my own tablespoon of medicine. So I really appreciate the yeah, the oral appliance. I know Stephanie mentioned what was the implant. Is that inspire or something that they're talking about?
Speaker 2:Yeah, they have one with inspire. But I mean, I say the same thing to my patients If one mask isn't working for you, that's not the only avenue. There's multiple things that can be done and a lot of the times, believe it or not, a lot of them say well, you know, I know I have to wear it because if not, my insurance will cover it too. So there is a big aspect of that, because it's also being recorded for the insurance purposes and you know, they know that in order for they need this and in order for it to be paid which obviously wants to pay no money and throw away money in that way. But a lot of them I have encouraged them to perhaps be to their physicians about the implant, which is a hypoglossal stimulator, and you know how that can impact their lives in other ways.
Speaker 2:I know someone personally that ended up getting it. They had severe sleep apnea, did not tolerate the CPAP, and now, with the stimulator, they say their life is life changing. And they said it was very easy simple procedure in and out. Outpatient Goes right below the scan and they're done.
Speaker 1:I think that's awesome to have options, but my one is always once you cut, you can't uncut, and so what do you think, dr Smith? What are your thoughts on that?
Speaker 3:Well, like what you said, there's no one doing it. You know, once you've cut, you've cut. So it is what we tell patients is, it's what you do when everything else has failed. And so try all the reversible things first, and if the reversible things still aren't working, then you look at the surgical options. Because those surgical options are non-reversible, whether you have the inspire put in or whether you do a maxillary mandibular advancement surgery. So yeah, those work too, but the recovery for that is significant and the cost is significant also, and they're not without complications. So yeah, we tell people, you know, exhaust all your other resources and treatments first before you go to the surgery route. But there are, unfortunately our society, you know, they wanna pill, they want the quick fix and they don't wanna change their lifestyle, they just wanna pill to fix it. So it's-.
Speaker 1:When you find it. You write me a scrap okay.
Speaker 2:Yeah.
Speaker 4:Oh.
Speaker 1:You know. It's interesting that you, you know, because they're really for, like many things, the quick fixes. You know, being healthy, having the vitality and energy that we need to live our best lives, isn't cheap. It takes a certain amount of energy to be healthy and to do the work of self-care, and you know too maybe you can share some insights on that but you know, when you are able to breathe and sleep at the same time, magical things happen, like you do get rest and you, you know you are able to have more energy during the day, which can facilitate weight loss. And I think you and I've talked about that too. I mean the role of, and I think one of the reasons why we're seeing so many younger and younger people with sleep apnea is because we the whole diabetes epidemic are younger and younger people are struggling with this as well. But yeah, oh what?
Speaker 1:about I mean, as if I lose 10 pounds. How?
Speaker 3:Yeah, so they've done studies with that and they've shown that if you can lose some weight some weight that it can, I think it's a 10% weight loss. Is it 10% weight?
Speaker 1:labor BMI.
Speaker 3:Well, yeah, good question. Now, I don't know that you asked that, but whether either or it can lead to a 26% decrease in AHI, whereas just the converse of that a 10% weight gain, leads to a six times the risk of moderate to severe sleep apnea. So, yeah, the weight is a big deal, and so that's probably the number one most modifiable behavior that we have for ourselves.
Speaker 1:Oh, I've gone it Well, you know, it's just a little extra baby weight I'm carrying in Dr Smith.
Speaker 3:What's my excuse?
Speaker 1:Yeah, but just don't let's not mention the fact that she's off in college right now, so that doesn't Don't got it.
Speaker 4:Yeah, yeah.
Speaker 3:But no, you said that the diabetes and the BMI you combine type two diabetes with a BMI over 30. And if you are that patient, statistically you have an 87% chance that you have obstructive sleep apnea. So yeah, you've got two strikes against you right there.
Speaker 1:Well. So in this speaks volumes to the people that we work with, right, our patients are the clients that we coach. These are multi morbid folks and diabetes being the number one driver for kidney disease, which breeds to, leads to hypertension, which of course leads to high cholesterol, and you get in this whole cycle and all of those things like what you mentioned, and then you tack on and treated sleep apnea for a long time. We see a ton of CHF, congestive heart failure because of that pathway. And between you and me, sitting in a dialysis chair is not where I want to spend my retirement years, and so the work that we do upfront to help these members become healthier is really important. Some day we're going to be partakers of our own industry, right, where, if we're old enough to live long enough and do well and eventually say, if it's not us, it's going to be somebody that we care about. So it really booze us to share this message about how simple it is to get screened. First of all, have a discussion.
Speaker 1:You don't know what you don't know. So if you're at risk, even if you don't know your risk, ask and then follow through and find a treatment that's going to work for you. I think that's really important. But knowing that diabetes is one of the comorbid conditions that takes us down this rabbit trail, this path, and we get a little heavier and that, of course, increase our risk. Can I take you down another rabbit trail and talk about just the importance of oral health, dental hygiene, our dental health and just overall health? You know, a lot of times we're talking to folks with diabetes about this and the risk that that plays also on their heart, but maybe you can share a little bit about that too. Why?
Speaker 4:is it so?
Speaker 1:important to see your MSL on regular basis.
Speaker 3:So basically, it's an inflammatory problem, right, and inflammation. I think it was the cover of Time Magazine, I don't know how many years ago, but how. Inflammation is now the silent killer and one of the most common things that we see are patients that have what they think is just a little bit of gingivitis. But if your gums bleed when you floss or brush your teeth, that's a sign that you have an infection. Interestingly, there's a book called Beat the Heart Attack Gene. It's written by Dr Bradley Bale and Amy Donine and in it they talk about the cats lying in the gutter ready to spring out and get you, and one of those is oral conditions that may be asymptomatic, that increase your inflammation.
Speaker 3:So, whether it's periodontal disease or a tooth that has obsessed, unfortunately most of those problems like a tooth that's obsessed until it's really late, most people don't have any idea that they're dealing with an abscess. If I had a dollar for every time a patient has told me, well, it doesn't hurt, I'd be a rich man because I hear it all the time, but it doesn't hurt. So, unfortunately. Fortunately, pain is a great motivator. We just need to find other motivators before we get to the painful part. The Cleveland Heart Clinic has done studies and I don't know how they do it, but people that have had heart attacks they are able to get in and that blockage and take samples and they're finding bacteria that originate in the mouth in these clots. They've also done studies of people that have blockages in their crotted arteries and again they're finding bacteria from the mouth. So what happens in the mouth? The mouth is part of the body.
Speaker 3:And if it's bleeding in the mouth, and the mouth is not sterile. And if you have gingivitis or periodontal disease on top of that, those bacteria are getting into your circulatory system.
Speaker 1:I mean, if you've got high sugars, there's lots of food for them to feast on. Party down at your expense and demo.
Speaker 3:Certainly yeah.
Speaker 2:Yep, yeah.
Speaker 1:Oh, I can't do teeth, my hat's off to you. I can do blood and stool and vomitus and open abdominal cavities, but yeah.
Speaker 3:I hear that a lot.
Speaker 1:Yeah, I'm really glad you do so. Oral health really important to make sure that we're promoting. So if people have questions, as we wrap up here, I want to make sure that nurses have a chance to ask questions. I know I think we've asked some of them already, but if you have them, shout them out and then if you would mind sharing with us about you know how can people contact you if they have questions or want to get to know more.
Speaker 3:Yeah, I'll leave it to the nurses if they have any questions first.
Speaker 1:Jane does. The nurses are asking forわれ. Part three is my breath. Okay, oh, it's the famous saying that you're muted, there you go.
Speaker 4:It was finding the little microphone. A lot of people don't clean their equipment either for C-PAP and don't realize that that is a big risk factor for them too to get upper respiratory or sinus infections or whatnot. I don't know, if anybody's ever seen that happen.
Speaker 1:but Bung infections absolutely.
Speaker 4:That can be. That's another reason people don't want to do equipment like that. But it's got to take some stamina on your part to be able to do the right things for yourself and for your equipment to stay healthy.
Speaker 1:My husband's religious with cleaning his and when I use the C-PAP, I'm religious with cleaning mine, and nowadays they have the ultraviolet light. What do you think of those, dr Smith?
Speaker 3:Well, from what I understand, they're great, but, like you mentioned, you do have to be very diligent about keeping it clean so that you don't end up with these upper respiratory infections. So, yeah, definitely.
Speaker 1:Yeah Well, same thing with your mouthpiece.
Speaker 3:Yes, yes.
Speaker 1:Yeah, yep, I take mine off. Don't tell my dad, because I do take mine off and I do clean it every day.
Speaker 3:So yeah, yeah, and unfortunately, sleep apnea is a chronic, progressive disease. It's not going to go away on its own and so, unfortunately, if you have it, you're kind of stuck with it and you want to do everything in your lifestyle that you can to minimize but the treatment you're going to have to continue with the treatment. So you've got to maintain whether it's the oral device or whether it's the C-PAP. You've got to invest a little bit of time to maintain it so that it stays effective too.
Speaker 1:Or choose to eventually drown in your own fluids.
Speaker 3:Yeah, that doesn't sound very good to me.
Speaker 1:No, I have one more question for you. What about? Because you and I have talked about this before as well, but some folks we count on the losing 10% of our body weight. Maybe we lose some weight and so we don't need that, but what about this primary or central sleep apnea? What do we do in those kinds of cases and where do you see the? I know a lot of folks have a little bit of both, but can you just, as we wrap up, share a little bit about the difference there?
Speaker 3:Yeah, so the central sleep apnea is just where the brain forgets to send the signal to the lungs to breathe and on a sleep test it'll show that there is no effort to breathe at all. People that have had strokes or are more susceptible to this or other brainstem injuries, some heart diseases, lung diseases, can lead to this also.
Speaker 1:I like the OPD the retainers point yeah.
Speaker 3:And so the only treatment that I'm aware of that they say is effective for that is the CPAP. So, but primary, when I see that usually it comes in what they consider mixed apnea, meaning that there's primarily obstructive sleep apnea where there's a collapse of the airway or the tongue falling into the airspace, and so it's mixed, but most of it's obstructive sleep apnea with a few centrals thrown in there. So the concern is when it becomes that the central is the predominant and on that an oral device isn't going to help at all.
Speaker 1:Okay. So, Okay, well again. That's why you need the sleep study.
Speaker 3:Yes, you need to know what you don't. What's the old saying of?
Speaker 1:What you don't know.
Speaker 3:What I don't know can't hurt me. Yeah, it will, sure will.
Speaker 1:I've told people all the time it's like this If I'm driving down the road with my eyes closed, it does not hurt any less. If I close my eyes when I hit the tree, it still hurts. At least with our eyes wide open, we have the information we need to decide do I want to turn right or left, or stop or go? But we can make some decisions, right? So, but without knowing you can't make, you really don't have the information needed to make a decision. Yeah Well, thank you so much for sharing your expertise. Thank you, I'm very motivated now to make sure that we I ask my patients all of them the right questions.
Speaker 3:So yeah, if someone wants to get a hold of me, they can call my office at 208-216-6110.
Speaker 1:Hot dog and his staff is all wonderful. I can vouch for him, so Thank you. Well, thank you very much, dr Smith.
Speaker 3:It's been my pleasure. Thank you, Dr Smith.