Trouble falling asleep? Getting a good night’s rest is critical to your health and wellness. Alvaro Garcia, MD from WellMed at East Houston discusses obstructive sleep apnea and how you can get back to sleeping through the night again.
July 31, 2024
Docs in a Pod focuses on health issues affecting adults. Providers and partners discuss stories, topics and tips to help you live healthier with hosts Ron Aaron, Dr. Audrey Baria and Dr. Tamika Perry.
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Show transcript
Podcast transcript
INTRO
Welcome to Docs in a Pod, presented by WellMed. Over the next half-hour, Docs in a Pod will educate you about the health and wellness of adults everywhere. Co-hosts Dr. Audrey Baria and award winning veteran broadcaster Ron Aaron will share information to improve your health and well being. And now, here are Ron Aaron and Dr. Audrey Baria.
GINA GALAVIZ EISENBERG
Welcome to the award winning Docs in a Pod, presented by WellMed. I'm your host, Gina Galaviz Eisenberg, along with Ron Aaron, who is on assignment right now. And we're so pleased to have you with us on Docs in a Pod. It's available on podcasts, wherever you get your podcasts. We're also on the radio in several cities in Texas and Florida. Each week, we talk about a variety of health and wellness-related issues as they impact Medicare-eligible seniors and others. Our co-host today is Dr. Audrey Baria. Hi Dr. Baria.
DR. AUDREY BARIA
Hi, Gina.
GINA GALAVIZ EISENBERG
I haven't seen you in a while. I'm glad to see you now. She is a medical director and part of the WellMed family for several years, and she's currently a provider at the WellMed at 9th Avenue North Clinic in St. Petersburg, Florida. Her interest in medicine began at a very young age, thanks to your uncle, who would take you around on his house calls. So, you decided to become a doctor and here you are welcome.
DR. AUDREY BARIA
That's right. That's the story and I'm sticking to it.
GINA GALAVIZ EISENBERG
I like that story. It's a great story. Do you do house calls, too?
DR. AUDREY BARIA
I do, actually. They've become very interesting. I always think about my uncle when I'm doing a house call.
GINA GALAVIZ EISENBERG
Oh, he would be so proud. Well, we're glad you're here today. Some 39 million Americans, including President Biden, have obstructive sleep apnea and 936 million adults around the world have mild to severe sleep apnea. Snoring is a common symptom of sleep apnea in up to 94 percent of patients. I could have diagnosed my husband, Ron, because he used to snore like he was sawing wood, sawing the house down. That was definitely a symptom. I'd like to introduce our expert today, Dr. Alvaro Garcia, a physician at the WellMed at East Houston in Houston, Texas. He earned his medical degree from the Universidad Autónoma de Nuevo León in Monterrey, Mexico. He completed his residency at the Yale New Haven Hospital at St. Joseph Medical Center in New Haven, Connecticut. Dr. Garcia is board certified in family medicine. Welcome, Dr. Garcia. I know you've had some trying times right now being in Houston with, with Hurricane Beryl so we're glad to see you.
DR. ALVARA GARCIA
Thank you for inviting me.
GINA GALAVIZ EISENBERG
Talk to us about this problem. I mean, my husband snored so badly, he doesn't snore any longer now that we have everything in check. But is that a sign there are issues?
DR. ALVARA GARCIA
Quite possibly could be, yes. Not everybody that snores has sleep apnea and not everybody that is overweight is going to have sleep apnea, either. Sleep apnea is a condition that has been recognized since the turn of the of the 20th century. Back then, of course, there was nothing that could be done about it. People just had to put up with it, and many people died. This is a deadly disease. Many people die of sleep apnea. My own brother died at 47 years of age of sleep apnea.
GINA GALAVIZ EISENBERG
Did he know he had it?
DR. ALVARA GARCIA
He didn't know he had it. The youngest patient I've ever had that passed away of sleep apnea was nine years old. As an overview, sleep apnea causes people to stop breathing while they're sleeping. It is a sleep-related breathing disorder. Many people don't know that they have it. They just think that they snore, and they failed to put two and two together in a sense that many of these people have excessive daytime sleepiness, lack of focus. People come into the clinic complaining of lack of energy, and many of those times, many times it is because of sleep apnea, and they don't even know that they had it. Some of the symptoms of sleep apnea include excessive daytime sleepiness, their sleep partner usually comes in with them and says oh, by the way, doc, I've noticed that sometimes he stops breathing at night. His snoring stops and I'm waiting there waiting for it to start up again until he kind of gasps for air and then starts snoring again. Waking up in the morning with dry mouth, headaches in the morning, fatigue during the day, high blood pressure, decreased interest in any kind of physical activity, even decreased libido are all symptoms of sleep apnea. The time to see the doctor is when you first notice it, or you have any of these symptoms and you can put two and two together and say, maybe I do have sleep apnea, let me talk to my doctor about it. The way it's diagnosed or rather the confirmation of the diagnosis is done by a polysomnogram. Usually is done over 2 nights and you go to a sleep lab, and they'll hook up electrodes on your scalp and they'll put a platysma monitor on your chest and a pulse oximeter on your finger. Sleep apnea is diagnosed by observed apnea or hypopnea associated with a decrease in your oxygen saturation and an increase of your heart rate. Usually on the second night of the polysomnogram, they will do a titration study. They'll put you on a CPAP device, which means continuous positive airway pressure device, and they'll titrate the pressure to be able to control your symptoms of your apnea. Sleep apnea cannot be cured, but it can be very well controlled.
GINA GALAVIZ EISENBERG
Dr. Baria, I'm going to ask you what you're seeing in just a moment, but if you've just joined us, you're listening to the award-winning Docs in a Pod. Our podcast is available wherever you get your podcasts. Our co-host is Dr. Audrey Baria, a WellMed physician and medical director. Our guest is Dr. Alvaro Garcia. We're talking about what everybody needs to know about obstructive sleep apnea. Dr. Baria, what are you seeing with your patients?
DR. AUDREY BARIA
One of the things that used to commonly occur when we had patients that were obese or morbidly obese, we would always think about sleep apnea, especially when their sleep partner would come in and say, my partner snores all the time. There used to be kind of like a sign, if you want to call it that the person's obese, let's test them for sleep apnea. But in the recent past, it's come to light that you don't have to be obese, as Dr. Garcia had mentioned previously. It can happen to anybody, and you want to look for these signs that Dr. Garcia has already mentioned about excessive weight gain. fatigue and sleepiness during the day and that and loss of interest in things that they used to do because they're just tired all the time.
GINA GALAVIZ EISENBERG
During COVID, Ron and we just kept, eating, eating, eating. We gained the COVID 50, right? As we decided to lose weight over the past year and a half, my snoring has decreased. I was never diagnosed with sleep apnea, but I mean, everything got back in check. Then after Ron was diagnosed with it, now he sleeps like Darth Vader at night and it's been a game changer. Are you seeing success once folks are diagnosed?
DR. AUDREY BARIA
Absolutely.
DR. ALVARA GARCIA
My patients tell me that they sleep like babies once they've started using their CPAP. I had one gentleman that came to my office many years ago who said he had been told he had narcolepsy and as he described his symptoms, I thought to myself, no, this isn't narcolepsy. Let's do a sleep study on you. Sure enough, we did and his diagnosis is obstructive sleep apnea. On the second night, when they put the CPAP on him. To titrate him, that is the best sleep he ever had in 40 years.
GINA GALAVIZ EISENBERG
Wow. Its amazing it didn't kill him, though.
DR. ALVARA GARCIA
He had been placed on amphetamines to try to combat his, his daytime sleepiness.
GINA GALAVIZ EISENBERG
So, what actually kills us with sleep apnea? Is because our heart stops, we stopped breathing? What, what is it? Can you describe that?
DR. ALVARA GARCIA
Well, since the airways collapsed, the upper airways collapsed because of the weight of the chest and the relaxing of the hypopharynx and the throat muscles, the airway is obstructed and people that die from sleep apnea, they were not able to awaken enough to be able to start breathing again. So basically, they suffocated to death.
GINA GALAVIZ EISENBERG
Oh, geez. Is that why sometimes you hear, well, my mom or my husband died in their sleep?
DR. ALVARA GARCIA
Many times, when you hear about, especially middle-aged persons that died, allegedly died in their sleep of a heart attack. Most of the time, those are from sleep apnea, not heart attacks.
GINA GALAVIZ EISENBERG
Is this something that you, if you don't know if you store, you don't know if you have sleep apnea, when you go in for your physical, do you say, hey, can you test me for this? Or is this something that everybody should be tested for eventually?
DR. ALVARA GARCIA
Well, the D. O. T. has mandated for several years now that anybody with a BMI of 30 or greater undergo polysomnography. Sleep apnea is such a common condition and is so undiagnosed that I think it should be part of our preventive medicine protocols in anybody with a BMI of over 30.
DR. AUDREY BARIA
I agree with Dr. Garcia because I think that this is something that, as Dr. Garcia mentioned, it's not curable, however, there is something that can be done for it so that the patients can lead a productive life.
GINA GALAVIZ EISENBERG
It's frightening just to think that you may have it and you don't know you have it. What are the statistics? Is it like one in five, one in 10 people?
DR. ALVARA GARCIA
It's more on the line of about four out of 10 people have sleep apnea and it's more common in males than in females by two to one.
GINA GALAVIZ EISENBERG
Wow. Well, that is frightening. Dr. Baria, as a prescription or as a treatment, do you suggest that people have to, besides the BMI of 30 or greater? What if you don't have that?
DR. AUDREY BARIA
I usually take the cues from the patient as far as what they're complaining of. If they're complaining about excessive fatigue and excessive sleepiness during the day and there doesn't seem to be any other medical condition that would apply to those symptoms, then I'm definitely recommending sleep studies. Nine out of 10 times, snoring is always present. I don't want to say a hundred percent of the time, but nine out of 10, it is present.
GINA GALAVIZ EISENBERG
I wonder if traffic accidents, the majority of them are caused by this too, cause you just don't know if you've never been diagnosed, you just think, oh, this just happens when I drive, it's dangerous. It can lead to dangerous results. I remember driving to Port Aransas before we started losing all the weight and I couldn't drive for more than like 30 minutes without getting tired. Now I don't have that issue anymore. So, we'll talk more about sleep apnea when we come back, we'll continue our discussion. I'm Gina Galaviz, Eisenberg, along with Ron Aaron, who's our co-host and on assignment and our wonderful, even better co-host. Don't tell Ron, Dr. Audrey Baria. Our guest is Dr. Alvaro Garcia, and you're listening to the award winning Docs in a Pod.
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GINA GALAVIZ EISENBERG
Thank you so much for staying with us on the award winning Docs in a Pod. I'm Gina Galaviz Eisenberg with Ron Aaron, who is on assignment and our co-host, Dr. Audrey Baria. We're going to continue our discussion on sleep apnea with our guest, Dr. Alvaro Garcia. Dr. Garcia. how effective are our new treatments like the Inspire implant that replaces the CPAP machine? Is that something that's giving patients hope?
DR. ALVARA GARCIA
It can give patients some hope but it's not for everybody. What the inspire is an electro-stimulator that is implanted under the skin around your throat muscles in your throat that stimulates your throat muscles to contract and thereby keep the airway open. So, as you can imagine, it's not for everybody. Right now, it's still quite expensive. There are many treatments for sleep apnea. The first line treatment is continuous positive airway pressure and, you know, everybody sleeps with the mask on with oxygen being pushed in, not oxygen, but air being pushed in at a certain pressure to overcome the pressure of the collapsed muscles on the airway. A lot of people can't tolerate it because they can't tolerate breathing against the pressure that is being blown in continuously. For those people, there's BiPAP, where the machine automatically senses your expiration and lowers the pressure so you can exhale. Then there's also autopay, where the machine will measure your inspiration as well as your expiration and automatically adjust the pressures to be able to push air into your lungs. There's other second line treatments, for example, adenoidectomy and tonsillectomy for those people that have very enlarged, hypertrophic tonsils that make the upper airway narrow. People with chronic congestion use topical steroids or even a sinuplasty to open up the airways in the nose as well. Very rarely, theres also a surgery where it's a mobilization of the entire maxilla, the upper airway of the upper jaw, I mean, forward to increase the airway, the volume of air that's going through the nasal pharynx. That's very rare.
GINA GALAVIZ EISENBERG
At what point do you suggest surgery for a patient?
DR. ALVARA GARCIA
During the exam, as part of their workup for obstructive sleep apnea, I always look at their throat. If they have excessive sexually redundant soft palate, or very hypertrophic, very enlarged tonsils, I'll send them over to ENT. They can reduce the size of the palate with laser and have a tonsillectomy, and that alone many times will increase the area of the column of air going through the nasal pharynx.
GINA GALAVIZ EISENBERG
I would imagine that these breathing problems cause so many other issues with your patients as well. I mean, if you can correct that, doesn't everything else start getting better? Heart and pulse and heart rate?
DR. AUDREY BARIA
Just the mere fact that the patient has more energy because think about it, if you're tired all the time, how effective are you at work? So, it's affecting their work. Its affecting their social life. It's affecting their family life. Therefore, it's in essence affecting every single aspect of your life. If you can just get rid of that one symptom of fatigue and excessive sleepiness, you've got your life back.
GINA GALAVIZ EISENBERG
Before I lost all the weight, I was always having nightmares. I always made sure I slept on my side so that way I could breathe easier. I don't have that issue anymore and I don't dream about anything. Is your sleep position also important if you're living with this?
DR. ALVARA GARCIA
Absolutely. Side sleepers typically are side sleepers because of their snoring. They'll snore more when they're on their back. Having sleep apnea, like Dr. Baria was saying, it's a vicious cycle. You're tired all the time. Because you're tired, you don't want to exercise, your concentration is poor. Everything. You gain weight, you slow down. By starting treatment, suddenly you have energy, you're able to move around better, do more exercise, focus better, be more productive at work. Treatment is essential for everything, for all the symptoms.
GINA GALAVIZ EISENBERG
What about diet? How does diet go hand-in-hand with treatment? And how do you get patients to realize that? You want to eat comfort food when you're feeling bad.
DR. AUDREY BARIA
But comfort food is what's not assisting at all in the end result that they're looking for. I think that it's with the relationship that the patients would with their primary care physician is where they're going to be able to build the trust and realize that what the PCP is telling them is for their own good and that they need to work towards this. It's not going to happen overnight, but at least we have a starting point that we can work from.
GINA GALAVIZ EISENBERG
I imagine that's a hard conversation to have with a patient. You're eating yourself to death is really, is really what you're saying.
DR. AUDREY BARIA
It goes for a multitude of other medical conditions, you know, diabetes and if let's say somebody has asthma that's triggered by allergens. I mean, it could be a food allergen. It could be something that's environmental or even seasonal. But again, these are the conversations that people need to have with their PCPs and to realize that diet does play a very important part in their medical conditions.
GINA GALAVIZ EISENBERG
I think we've had this conversation before. A lot of patients don't even want to go in to see their doctor because they know you're going to tell us you've got to lose weight, right?
DR. AUDREY BARIA
Yes.
GINA GALAVIZ EISENBERG
That way you can breathe. It really is a function for everything and add sleep apnea to it.
DR. ALVARA GARCIA
Yes.
DR. AUDREY BARIA
But you know what I found is that once the patient realizes that when they've taken that first baby step and they see an improvement, even if it's just in the amount of energy that they have, they're more apt to continue to do that because now they've seen the positive effect of it.
GINA GALAVIZ EISENBERG
People will say, oh, you lost weight, you look great. I'm like, we're not losing weight to look great.
DR. AUDREY BARIA
It's just an added benefit.
GINA GALAVIZ EISENBERG
Yes, it's an added benefit. Clothes fit better but my goodness, I can breathe.
DR. AUDREY BARIA
Right.
DR. ALVARA GARCIA
The main thing that patients always comment on is that they have no energy. How many times, Dr. Baria, have patients come into your office and just tell you that their main complaint is, I just don't have any energy. Can you give me something to give me energy? They don't understand that it's not because they're physically tired. It's because they're physically sleepy. They're still sleepy. They have a sleep debt to their brain.
DR. AUDREY BARIA
It's not something that you can give them a quick fix pill for and sometimes that's the harder battle to fight.
GINA GALAVIZ EISENBERG
So, if someone's not feeling well because they're tired and their better half says you snore or their kids or their grandkids say you snore, what would you suggest they do right now or after they hear this, the first time they can pick up a phone and make an appointment? I mean, what, what do you suggest to them to say when they come and see both of you?
DR. AUDREY BARIA
I would say, you know what, let's get a sleep study on you.
DR. ALVARA GARCIA
I would say exactly the same thing. I would say something like, you know, you have all the symptoms and all the signs of somebody with obstructive sleep apnea, so let's go ahead and get a sleep study on you and either confirm or disprove the diagnosis. I've had a few people that had their sleep study done and did not have sleep apnea.
GINA GALAVIZ EISENBERG
So, it was something totally different?
DR. ALVARA GARCIA
It was something totally different. A lot of times it's depression or other things that can cause their daytime sleepiness as well.
GINA GALAVIZ EISENBERG
936 million adults around the world have this. We're so worried about dying of a heart attack, but it could be our sleep that kills us, right? Well, I guess the main thing is to call Dr. Garcia, call Dr. Baria. Make an appointment, get a physical and ask about that and that's what's going to save your life. Dr. Garcia, does insurance cover these treatments? I know people are always worried about, well, I need to do this, but how do I pay for it?
DR. ALVARA GARCIA
The great majority of insurances do cover it, especially after the diagnosis has been confirmed with a polysomnogram. Of course, some insurances have deductibles and other co-pays that you have to meet. Initially, they will rent the machine, the CPAP device, from the respiratory company. Eventually, they will purchase it if it's going to be for long-term use, which of course it will be. By the way, people should not be reluctant to go ahead and have a polysomnogram because it will save their lives. There are so many treatments available nowadays. Not everyone has to have the big old mask in front of their face and all that pressure. Sometimes they can do a little nasal pillow and the, and the hose will connect. To a little device on the top of their head and it's completely unobtrusive and you really don't even feel it. You can turn while you're sleeping, turn from one side to the other in bed and not even have to bother with the hoses or anything.
GINA GALAVIZ EISENBERG
Can you travel? Do they make them in small traveling packs?
DR. ALVARA GARCIA
They're very compact, about the size of old-fashioned cassette recorders. People put them in their suitcase or the luggage or whatever, and take it with them everywhere they go.
GINA GALAVIZ EISENBERG
That way they're not disrupting their lives at all.
DR. ALVARA GARCIA
Not at all.
GINA GALAVIZ EISENBERG
And they're breathing and they're living.
DR. ALVARA GARCIA
That's the main thing.
GINA GALAVIZ EISENBERG
We're just about out of time so I want to thank you, Dr. Garcia. Thanks to everyone listening for joining us today on the award winning docs in a pod. And thank you to our cohost, Dr. Audrey Baria and our guest again, Dr. Alvaro Garcia. I'm Gina Galaviz Eisenberg and in the words of the late Charles Osgood, I'll see you on the radio and for Pete's sakes, have a nice, good sleep. Bye everybody.
DR. ALVARA GARCIA
Thank you.
GINA GALAVIZ EISENBERG
Thank you.
OUTRO
Executive Producers for Docs in a Pod are Dan Calderon and Lia Medrano. Associate Producers Cherese Pendleton. Thank you for listening to Docs in a Pod presented by WellMed. We welcome your emails with suggestions and comments on this program at radio@wellmed.net.
Be sure to listen next week to Docs in a Pod presented by WellMed.
DISCLAIMER
This transcript is generated using a podcast editing tool; there may be small differences between this transcript and the recorded audio content.
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