Los Angeles, CA | Sleep Apnea with Dr. Avi Ishaaya : MD-VOD | Dr. Avi Ishaaya Centers

Today on MD-VOD, Dr. John Kennedy is joined by board-certified sleep expert, Dr. Avi Ishaaya to discuss sleep disorders, including sleep apnea. Together they examine the cause of sleep apnea, who is at risk, the symptoms, how it's diagnosed and available medications, treatments and therapies. They further discuss the consequences and the realities of living with sleep apnea, including insurance coverage and related costs.


Dr. John Kennedy: Hi everyone. Welcome to MD-VOD, your health live and on demand here on emPOWERme.tv. I'm Dr. John Kennedy, and today we're taking a look at sleep disorders.

Dr. Ishaaya Avi: Over 70 million Americans have trouble with sleep, and of those, 60% have a chronic disorder including sleep apnea, which affects 12 to 18 million people in the United States. When people can't sleep and there's no obvious cause, we call it insomnia, which affects one out of every three people. And difficulty sleeping can be caused by a variety of issues, like teeth grinding, snoring, and even night terrors. To help us better understand insomnia and a common, related problem, known as obstructive sleep apnea, we'll be joined by sleep expert, Dr. Avi Ishaaya. Some of what we'll discuss includes who's at risk, common symptoms, what the causes are, how to make the diagnosis, and treatments available. And finally, we'll take a look at how insurance providers address the costs associated with insomnia and sleep apnea. And it's always helpful to understand the anatomy involved in any disease. So when we come back, we'll take a look at the parts of our body involved with our sleep.

Dr. John Kennedy: Hi everyone. Welcome back to MD-VOD. In order to have a thorough understanding of any disease, it's important to know the anatomy. Today, we're talking about sleep and reasons we're not getting enough of it. Sleep is the body's rest cycle and the time when the body repairs itself. It's when our bodies get a chance to reproduce more bone, muscles, and even nervous tissue. Ideally, we should get eight hours of sleep per night, but because of our frenzied lifestyles, caffeine, lack of exercise, and worry about finances, family and work, most people live on far less.

Dr. John Kennedy: During normal sleep, the muscles of the soft palate and tongue stay open, so that our airway is open. When these muscles relax, it can actually obstruct our airway, and cause snoring and breathing difficulties. When they completely relax, our airway is completely blocked, causing obstruction or obstructive sleep apnea. Stay tuned and learn more about sleep and why we're not getting enough of it. When we're joined by a sleep expert, Dr. Avi Ishaaya.

Dr. John Kennedy: We're back on MD-VOD and we're here with sleep expert, Dr. Avi Ishaaya. Thanks so much for joining us, Dr Ishaaya.

Dr. Ishaaya Avi: Thank you for having me.

Dr. John Kennedy: It's a pleasure. It's great stuff here. Hey, what is sleep apnea and what are some of the problems we have with sleep?

Dr. Ishaaya Avi: Well, sleep apnea is basically a collapse of the airway. So what happens while you sleep is, people think that they don't breathe, but in fact they are breathing against a closed throat, usually the area behind the tongue and behind the palate, which is where the uvula sits. And as a result, what happens is that there's no air exchange, so no oxygen or carbon dioxide is moving through, and as a result we stop breathing. And with it, we do have recurrences in awakenings, if you will, where patients will wake up frequently to open up their throat, and have a very disrupted night of sleep.

Dr. John Kennedy: Wow, that's great. Great answer. And when we don't get enough sleep, what's the biggest risk to us?

Dr Ishaaya: Well, there's been so much literature out there as far as not enough sleep, either sleeping not enough hours or having a disrupted night of sleep, much like sleep apnea is. And as a result, we've seen that the literature suggests that survival is definitely impacted, number one, and we've seen quite a bit of literature about shortened lifespans. Also, the short-term issues related to not enough sleep, either from sleep fragmentation, which is related to sleep apnea, or you awakened throughout the night, or from not enough sleep because of our work or social issues. We find that patients find themselves very sleepy during the day, having difficulty staying awake, being very irritable, having difficulty concentrating and really having problems with memory.

Dr. John Kennedy: So wow, that's great take home-advice. If you're feeling irritable during the day, taking a lot of catnaps, that might be a sign that you have this disorder called sleep apnea. And how common is sleep apnea? How many people really have this disease?

Dr. Ishaaya Avi: Well, at one point we thought that it was somewhere around four to potentially 8% of the population. Today, we actually know that, if you look at the severities, be it mild, moderate or severe, about 20% of the nation's actually affected. And it usually affects patients who are overweight or obese. And that means that, when you look at our population as it stands today, it is approximately 65% of all of us. And that really means that the overwhelming majority of our nation is at risk for sleep apnea and its associated disease states.

Dr. John Kennedy: Wow. So 20% of our nation's population are at risk, or at least at risk for, is that right, for sleep apnea?

Dr. Ishaaya Avi: Correct. Yeah, 20% and when we look at it, we know that the obesity epidemic, which we are now very concerned about, will increase over next 10 to 15 years. And we envisioned that the overweight/obese population will probably rise to somewhere around 75 to 80%, which therefore means that sleep apnea will be even more rampant than it is today.

Dr. John Kennedy: Wow. So even more of a problem in the future, it sounds like. What are some of the ways that you can make the diagnosis of sleep apnea?

Dr. Ishaaya Avi: Well, sleep apnea has to be diagnosed by a sleep study. We most commonly, in the past, have sent patients into the sleep lab to be tested, where you're actually hooked up with wires, both to check brainwave activities, so we can tell what stages of sleep we're in. We do wires to actually see what your heart rhythm is like. We put belts on your abdomen and chest to see if you're breathing against the closed airway, and we even put a leg leads, to see if you have any leg kicks during the night, and then we watch you sleep. But because it's an unusual surrounding, you're sleeping in a different bed, you're wired up, people are watching it, because you do have a technician outside the room. We have now more popularized a home test, where you can take it home with you. It's a little bit bigger than an iPhone, and you sleep in your natural surroundings, and we can still diagnose sleep apnea by that modality.

Dr. John Kennedy: Wow. So you don't have to go to a fancy sleep lab, you can actually go home and make the diagnosis. That's great stuff. You know, I've heard a lot, actually, from my patients. They ask about tonsils, removing the tonsils. Does that help at all in terms of decreasing your risk?

Dr. Ishaaya Avi: Yeah, tonsils is more of an issue with kids, and we see that tonsils and adenoids tend to be the first thing that becomes an issue for kids as far as snoring and sleep apnea. Unfortunately, when we age it tends to be a very small minority of the problem. And it most commonly is related, at least in 75% of the cases, due to being overweight or obese.

Dr. John Kennedy: So, weight loss is important in terms of a therapy for sleep apnea.

Dr. Ishaaya Avi: Absolutely. Weight loss definitely helps reduce the frequency of the apneic events, or the amounts of times you stop breathing. We feel that the reason we have sleep apnea in the overweight/obese population is that, anatomically, there is a fat deposition in that area, constricting the airway, or the area of the throat that collapses during sleep.

Dr. John Kennedy: So on that note, when you treat patients, once you've made the diagnosis, they've gone home with their amazing device, you've made the diagnosis of sleep apnea. How do you treat, what's the most effective way, other than weight loss, that you talked about, effective way to treat people with sleep apnea, to give them a better night's sleep?

Dr. Ishaaya Avi: Well, our gold standard for sleep apnea is what we call CPAP, which is a continuous positive airway pressure. These are machines, or in essence masks that are connected to machines that blow air, and they act much like a straw of air, to keep your throat open. Today with our program, we use only the automatic machines, which will sense the amount of pressure you need, whether you're on your back, on your side, if you're more congested and so on. But for the purposes of sleep apnea, what we call PAP, positive airway pressure is our gold standard. There are certainly alternatives, dental appliances, which help pull the jaw forward, and of course surgeries that help pull the jaw, and essentially detaching and reattaching the jaw at a more forward thrust, so that your airway is now more open.

Dr. John Kennedy: Wow. So it sounds like even the surgical therapies that you might use for someone to, again, pull their jaw forward to keep the airway open. So a lot of these therapists seem like, and the diagnosis, the home diagnostic test you're talking about, sounds like a lot of this could be pretty expensive. How do insurance providers cover some of these costs?

Dr. Ishaaya Avi: Insurance providers, including Medicare, of course, recognize sleep apnea as a disease state, and overwhelmingly 100%, or almost 100% of all insurance companies do cover sleep testing. What we are seeing in the sleep industry, that some insurance companies are in fact interested in doing the test at home first, because it's less expensive but as reliable to be able to get an actual diagnosis of sleep apnea.

Dr. John Kennedy: Wow. So is there anything you recommend, Dr. Ishaaya, that can decrease costs?

Dr. Ishaaya Avi: Absolutely. We do have a national home sleep apnea program, and what we do is, our goal is to be able to deliver a less expensive, very reliable, and very convenient modality of testing for sleep apnea, which is the home test. In fact, what we do is, we send it to the patient's home, so the patient doesn't even have to trouble him or herself as far as going into the lab, picking it up and bringing it back. And the cost is literally a quarter of the price of going into a sleep lab, and yet the results are equivalent.

Dr. John Kennedy: Wow. So that is some great take-home advice. Thank you so much Dr Ishaaya, for joining us and telling us all about how to diagnose and treat one of the big problems for why we're not getting enough sleep.

Dr. John Kennedy: Make sure to join us next on An Apple A Day, when we teach you more ways to get a better night's sleep.

Dr. John Kennedy: We're back, with An Apple A Day, and some common-sense tips to help you get some shut-eye. Most of us need about seven to eight hours of sleep a night. So here are some strategies that will help you keep from tossing and turning.

Dr. John Kennedy: First, create a tranquil space. Keep the lights low for a few hours before bedtime, and stay away from bright lights and computers, or noisy televisions, and make sure your temperature in your house is cool. Try to keep a routine and stick to the same bedtime and wake-up time every day, and make sure you downshift at the end of the day. And if you can, pick up a book, listen to some relaxing music, take a warm bath, meditate, or even write in a journal. These things will allow your body to relax from a hectic day and put you in the mood for sleep. And also, try to work out early in the day, because staying active will help you lower stress and help you get a better night's sleep. And remember to leave work at work. It's a really common mistake to turn your bedroom into your office.

Dr. John Kennedy: So, following these basic strategies and common sense will help you sleep better and have a more productive day. And be sure to stay on top of the latest news about sleep disorders at cdc.gov, because the more you know, the more successful you'll be at getting a better night's sleep.

Dr. John Kennedy: I want to thank you very much for joining us, and I hope you found this information about sleep and sleep apnea helpful. I'm Dr. John Kennedy, and you're watching MD-VOD, your health live and on demand here on emPOWERme.tv. And don't forget to like us on Facebook, follow us on Twitter, and share us with your friends and family. And remember, for any episode you might've missed, they're now available on demand at emPOWERme.tv's website, and the YouTube channel. And be sure to leave us any comments or questions, so that we can better help you cope with your disease. We'll see you next time on MD-VOD.