Sleep Apnea: Ask Dr. Suzette Mikula

I am Dr. Suzette Mikula,
otolaryngologist at MedStar Georgetown University Hospital. One of the things
that led me to become an otolaryngologist is the relationship
that I can develop with patients through the progression of their condition or
disease. I’m specialized in Otolaryngology. But
since I’m also board certified in Sleep Medicine, I try to use a more holistic
approach in the care of my patients. So when patients come in with complaints
including chronic fatigue that can encompass not only in chronic infection
but can also you know be a cause of their chronic sleep deprivation or
chronic sleep problems. So I also try to look at that. In addition, patients have
environmental allergies and believe it or not this can also impact your sleep
and also impact your sinus problems. When you have chronic sleep deprivation, that
can affect you in all walks of life as well as your health. And it can lead to
medical conditions such as hypertension, cardiac arrhythmias, type 2 diabetes,
gastroesophageal reflux disease, and so on. For a patient who comes in, let’s say, with a
snoring problem, because I am board certified in Sleep Medicine, I can see
that patient and figure out their specific diagnosis, send them for a sleep
study, confirm or not confirm that they have that problem, and then treat them
either medically or surgically or sometimes with a non-invasive treatment
in the office. It feels great when I can treat someone
who has a sleeping problem that is affecting all walks of their life and help them
sleep well. An otolaryngologist is someone who
cares for patients with disorders of the ears, nose, or throat, commonly known as
ENT. However, there’s a lot of overlap with other subspecialties.
For example, there’s overlap in the field of neurotology, in pediatrics, in
laryngology, facial plastics, and head and neck surgery, and allergy, and sleep
medicine, and we continue to expand. The most common disorders I see are
snoring, chronic sinusitis, allergy problems, and nasal disorders. We actually are the sleep surgeons. So
it’s important for us to understand and know about how different sleep disorders
can present. The most common symptoms that
patients complain about are snoring, chronic nasal congestion, and post nasal
drainage is another one. Oftentimes, they’ll complain about cough that’s
related to chronic post nasal drip. Or it could also be related to gastroesophageal reflux disease which is another common thing that we overlap
with gastroenterology. So one of the things that brings
patients to me is when they’re having recurrent sinus infections, and they’re
just not going away with multiple courses of oral antibiotics, or they’ve
been treated with over-the-counter antihistamines, or over-the-counter nasal
steroid sprays and it’s just not working anymore. When patients come to see me, I often use
tests to diagnose their conditions. This can include a home sleep test that we
have available in our department that the patient goes home with and wears at
night and then brings back in the morning. This is something that we set
the patients up with in the office and explain to them how to use it which is
very simple and almost always covered by their insurance. We also do blood
testing for allergies and this doesn’t require that they have to stop
their antihistamines ahead of time. We could just actually send them for the
allergy test on their first visit to figure out if they have that condition
or not. We also can send them for radiologic imaging studies such as CAT
scans to diagnose chronic sinusitis. Some of the common symptoms for
obstructive sleep apnea include waking up feeling tired, not refreshed, having
excessive daytime sleepiness, waking up with a morning headache, feeling like
you’re in a fog, or feeling like you’re dysfunctional at work. The reasons for sleep apnea are
multifactorial. It’s not just weight. It’s not just age. It’s a combination of
things. It also has to do with neuromuscular tone, and it can have to do
with fluid shifts that occur after you lay down. A lot of it is related to
anatomy and definitely weight is definitely associated and sometimes can
make it worse. So not all patients who snore have
obstructive sleep apnea. But most patients with obstructive sleep apnea
will snore. Sometimes people or oftentimes people with
obstructive sleep apnea will also grind their teeth. It’s a way of naturally
stenting the airway open. So that’s always a worrisome finding in patients
who snore. And then we look at their oral cavity and see that there’s evidence of
grinding, or maybe their their bed partner hears them grinding as well as
snoring. When patients come to see me for
problems with snoring and I feel that they have risk factors for obstructive
sleep apnea, I will usually set them up for a sleep study which could be off in
a home sleep study or an overnight sleep study. Once I get the results of the
sleep study, I usually have them come back to the office and we discuss the
treatment options. Usually, the first thing that we try them on is the CPAP
machine, the continuous positive airway pressure, using either one of three different types of masks: the nasal mask, the nasal
pillows, or the full face mask. They try this for a period of time usually about
four to six weeks. If they can tolerate this treatment and they feel relief
that’s pretty much all they have to do. But we do monitor them, and we obtain
data reports after a few weeks to ensure that it’s eliminating the obstructive
sleep apnea effectively. If they don’t tolerate this, then we discuss
alternative treatments such as surgical options with them. With the home sleep study, this is a unit
that we have in our department that’s a very simple thing to do. It’s not very
complicated like when you go for an overnight sleep study. Nowadays, insurance
is not covering overnight sleep studies as often, and it’s not always appropriate
to send someone for an overnight sleep study when it’s pretty clear that they
have a condition known as obstructive sleep apnea. A home sleep study can just
help confirm that or not. CPAP is continuous positive airway
pressure delivered through a mask that is used to treat patients with
obstructive sleep apnea. This is usually the gold standard for treatment of
obstructive sleep apnea. However if patients do not tolerate CPAP
and cannot use it, surgical treatments can be used to effectively treat
obstructive sleep apnea. When you use a CPAP, there are three
different masks that you can try and these are really three main categories
of masks. And this includes nasal pillows, which is a almost like a nasal canula
underneath the nose, then there’s a mask that goes over the nose only, then
there’s a mask that goes over the nose and the mouth. You need to use the CPAP
every night in order to prevent the symptoms that include, you know, morning
headaches, excessive daytime sleepiness, feeling like you’re in a fog. There are surgical treatments, and there
is actually a new surgical treatment called the hypoglossal nerve stimulator
which is something that we are doing within the MedStar system. If it’s mild
obstructive sleep apnea, there are some non-invasive office procedures such as
radiofrequency coblation of the soft palate which can also really help with
snoring. There are also some implants that can be
used to also help with snoring and some very mild obstructive sleep apnea. So after they have this type of
surgery, they usually have to heal from the surgical incisions you know which
cause some swelling. And so, it will take a period of time before they actually
start to feel the benefit but there are some people who have significant airway
obstruction where they can almost feel immediate results. One of the things that can occur
with obstructive sleep apnea is falling asleep at the wheel, and there are people
every year that fall asleep at the wheel and either cause death to other people
or injury to themselves or death to themselves. So that is a real risk. Other
risks involve development of hypertension, development of heart
arrhythmias, problems with diabetes type 2. All of these things can be a risk. It
can be a result of not getting treated. Also in addition, if you don’t treat your
obstructive sleep apnea and it’s moderate to severe, studies have shown
that it definitely takes several years off your life. Dieting can actually help reduce the
severity of the sleep apnea, but it often does not eliminate the obstructive sleep
apnea. And if we only rely on diet, this could take a very long time
that the patient would be without effective treatment of their obstructive
sleep apnea while they’re trying to lose weight which we all know can sometimes
be challenging. When patients come to see
me at MedStar Georgetown University Hospital, I can use a more of a holistic approach in
my care for them. So if they’re snoring, you know I can figure out if it’s
related to a sleep disorder such as obstructive sleep apnea, or if it’s related
to a sinus problem such as nasal polyps, or if it’s related to a nasal
obstruction type of problem such as a septal deviation, or a nasal valve
problem, and then arrive at a diagnosis and treat them all in one stop.

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