In this interview Lisa interviews Jez Morris, a clinical sleep physiologist on everything sleep apnoea and also cardiac testing. They do a deep dive into the symptoms and treatments and consequences of not picking up sleep apnoea.
Lisa has a personal interest in this as it pertains to brain function and rehabilitation and it was one of the key factors in saving her mum Isobel's life after a major aneurysm and stroke.
Jez explains the different types of sleep apnoea and co morbidities and risk factors.
You can visit Jez and his team at Fast Paced Solutions
About Fast Pace Solutions
It was a common belief in the need for equitable health care – and improved accessibility for all – that led to three healthcare professionals joining forces to provide primary-based diagnostic services to GPs, specialists and concerned patients themselves.
Fast Pace Solutions offers a range of cardiorespiratory diagnostic tests aimed at early and fast diagnosis of heart, lung and sleep-related complaints. Working closely with a range of health professionals and operating out of their new premises in the Strandon Professionals Centre, Michael Maxim, Jez Morris, and Alan Thomson want to encourage more people who have issues with breathing, dizziness, palpitations or sleep to get themselves checked out.
Visit them at www.fastpacedsolutions.co.nz
Ambulatory Blood Pressure Monitoring
Ambulatory blood pressure monitoring (ABPM) is concerned solely with detecting problems related to high blood pressure – a hugely significant health risk which is currently on the rise.
Blood pressure monitoring involves wearing a cuff linked to a small device which measures your blood pressure every half hour (or hourly during the night) over a 24-hour period, while you go about your day.
Many studies have confirmed this method is superior to clinic blood pressure testing in predicting future cardiovascular events and targeting organ damage. This means your doctor can provide a much more accurate diagnosis and effective management plan
A Holter monitor is a small, lightweight heart rate monitor that measures the rhythm as well as the rate of your heart for a continuous period of 24 or 48 hours.
The monitor has three leads which are attached to your chest via ECG electrodes. The Holter monitor's primary purpose is to correlate symptoms such as heart palpitations, rapid breathing or dizziness with the ECG (see below) and rule in or out any abnormal rhythm activity. The patient is required to document all symptoms in a diary.
24 Hour Holter Monitor
Exercise Tolerance Testing
An exercise tolerance test (or ETT) requires a patient to exercise on a treadmill in the clinic while being monitored by a 12-lead ECG (electrocardiogram) and blood pressure machine and is often used if we don't pick anything up on a Holter heart monitor.
The ETT replicates how your body behaves under stress and can pick up issues such as angina and demonstrate how adequate your heart function is as well as your exercise tolerance. Chest pain and shortness of breath while exercising are common indicators for this test.
Cardiac Event Monitoring
Similar to a Holter monitor, but worn for a full week, cardiac event monitors (or cardiac event recorders) are used to correlate a patient's heart rate and rhythm to their ECG (electrocardiogram) over a period of 7 days.
A cardiac event recorder is preferred when symptoms are less frequent and allows a patient to activate an "Event" button to snapshot a rhythm when they experience any abnormal symptoms. It is often used for younger patients.
7 Day Holter
ECG and Oximetry
An electrocardiogram (ECG) measures the electrical activity of your heart via 12 leads attached to your chest and body. It takes only a few minutes and records your heart's rhythm, checking for abnormal activity which may indicate damage to your heart or blood vessels caused by high blood pressure. An ECG can detect problems long before they become significant issues. In fact, everyone over the age of 45 should have an ECG.
Oximetry measures your oxygen levels while you sleep, or for selected hours of the day.
Getting enough quality sleep at the right times can help protect your mental health, physical health, quality of life, and safety. Snoring is one of the most under-acknowledged symptoms in the management of health. Although often seen as a benign problem, it can cause disharmony in relationships as well as significant disruption to sleep. My favourite running podcast by miles⭐ ⭐ ⭐ ⭐ ⭐ This is the best podcast for long runs. Lisa is just so relatable, honest, funny and inspires me to push my own limits. Awesome guests (I particularly enjoyed the podcast with Kim Morrison) and a wide variety of topics covered. Thanks for keeping me running, Lisa! ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- My favourite podcast ⭐ ⭐ ⭐ ⭐ ⭐ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Two thumbs up ⭐ ⭐ ⭐ ⭐ ⭐ Always great guests, great insights and learnings that can be applied immediately for every level of experience. ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Motivational and Inspirational ⭐ ⭐ ⭐ ⭐ ⭐
Ongoing sleep deficiency can raise your risk for some chronic health problems such as high blood pressure, heart failure, diabetes and many breathing disorders – sleep apnoea is a major cause of cardiac and respiratory issues. We offer an advanced at home sleep study to assess the severity of snoring/sleep apnoea and impact of cardiac and respiratory health.
Level 3 Sleep Study
Level 4a Sleep Study (Oximetry)
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Lisa's third book has just been released. It's titled "Relentless - How A Mother And Daughter Defied The Odds"
Visit: https://relentlessbook.lisatam... for more Information
ABOUT THE BOOK:
When extreme endurance athlete, Lisa Tamati, was confronted with the hardest challenge of her life, she fought with everything she had. Her beloved mother, Isobel, had suffered a huge aneurysm and stroke and was left with massive brain damage; she was like a baby in a woman's body. The prognosis was dire. There was very little hope that she would ever have any quality of life again. But Lisa is a fighter and stubborn.
She absolutely refused to accept the words of the medical fraternity and instead decided that she was going to get her mother back or die trying.
This book tells of the horrors, despair, hope, love, and incredible experiences and insights of that journey. It shares the difficulties of going against a medical system that has major problems and limitations. Amongst the darkest times were moments of great laughter and joy.
Relentless will not only take the reader on a journey from despair to hope and joy, but it also provides information on the treatments used, expert advice and key principles to overcoming obstacles and winning in all of life's challenges. It will inspire and guide anyone who wants to achieve their goals in life, overcome massive obstacles or limiting beliefs. It's for those who are facing terrible odds, for those who can't see light at the end of the tunnel. It's about courage, self-belief, and mental toughness. And it's also about vulnerability... it's real, raw, and genuine.
This is not just a story about the love and dedication between a mother and a daughter. It is about beating the odds, never giving up hope, doing whatever it takes, and what it means to go 'all in'. Isobel's miraculous recovery is a true tale of what can be accomplished when love is the motivating factor and when being relentless is the only option.
Here's What NY Times Best Selling author and Nobel Prize Winner Author says of The Book:
"There is nothing more powerful than overcoming physical illness when doctors don't have answers and the odds are stacked against you. This is a fiercely inspiring journey of a mother and daughter that never give up. It's a powerful example for all of us."
—Dr. Bill Andrews, Nobel Prize Winner, author of Curing Aging and Telomere Lengthening.
"A hero is someone that refuses to let anything stand in her way, and Lisa Tamati is such an individual. Faced with the insurmountable challenge of bringing her ailing mother back to health, Lisa harnessed a deeper strength to overcome impossible odds. Her story is gritty, genuine and raw, but ultimately uplifting and endearing. If you want to harness the power of hope and conviction to overcome the obstacles in your life, Lisa's inspiring story will show you the path."
—Dean Karnazes, New York Times best selling author and Extreme Endurance Athlete.
Transcript of the Podcast:
Speaker 1: (00:01)
Welcome to pushing the limits, the show that helps you reach your full potential with your host, Lisa Tamati, brought to you by LisaTamati.com.
Speaker 2: (00:12)
Welcome back to the show. This week I have an exciting episode with a clinical sleep physiologist. Jeez Morris, who's been a friend of the family for years and we've actually been in business together. We had a hyperbaric oxygen therapy clinic, but today we're going to be talking about sleep apnea, what it is, what the risks are involved when you have sleep apnea, how to assess it. The symptoms and sinuses are really, really important topic. It's so important that, you know, I don't believe that my mum would be alive if we hadn't picked up that she had sleep apnea. So it's a very interesting episode to learn all about sleep, what it does for your body, and it's a really fantastic interview. So I hope you enjoy the show with, jeez Morris. Um, just a reminder to I have my new book relentless out, which is available on my website.
Speaker 2: (01:03)
Um, it tells a story and part of that story, uh, from bringing her back, uh, from a major aneurism, a part of that rehabilitation journey was, uh, diagnosing her with sleep apnea in dealing with that. So it's really pertinent to today's topic. Um, I am currently working on a brain rehabilitation course that I'm going to be offering to people since the release of my mom's book and the story of her, um, incredible, amazing comeback journey, um, from being not much over a vegetative state to being now fully functioning again, um, fully healthy. Um, I have been inundated with requests for people wanting help with brain rehabilitation, whether it's strokes, dementia, Alzheimer's, uh, TBIs, concussions and so on. So I'm in that, in the throws of making that course because, uh, you know, I just can't deal with so many one-on-one. Um, so look out for that. It's going to be available hopefully within the next couple of months if I can get my energy. Um, and really looking forward to sharing that with the world as well on the back of this book. So right now let's go over to James Morris and learn all about sleep apnea.
Speaker 2: (02:16)
Well, hi everyone. Lisa Tamati here. and pushing the limits. So thank you for being with me again today. I have a friend of mine who is a sleep physiologist, a clinical sleep physiologist. Jeez Morris, how are you doing? Geez. Oh, very, very good now. Um, jeez and I have a bit of a history together. Um, I'm uh, he, when my mum had a stroke and everyone knows that she had an aneurysm and a stroke a few years ago, um, and I was doing better with the hospital because I wanted the sleep apnea test done and I couldn't get one done. Um, saved for going to my friend dues who is asleep physiologists and saying, geez, can you come and help me please? Can we do a test? Um, we did that um, slightly against the roles
Speaker 3: (03:00)
at the hospital at the time, wasn't that, uh, we came back with severe sleep apnea with oxygen and then was at the worst point at around 70% during the night, which is pretty disastrous. So I'm going to talk to you today with uh, jeez about, um, sleep apnea, what it is, what you need to be aware of. And we're also going to go into a new cardiac system that is, that got there. That's going to be really interesting. So jeez, firstly, thank you for helping me back then. My pleasure. I don't know if my mum would be sitting here today. I'm healthy and well, if it wasn't for you coming in and doing a stake assessment, it's that important and this is why the subject is really important to me to get out there and to let people know about this. So just can you just tell me a little bit your background, um, and then you know, what is sleep apnea?
Speaker 3: (03:52)
Okay. My background is actually an anesthetic technology. I used to work as an anesthetic technician here at base. Um, and as the years went by I got approached by a colleague of mine yeah. And T surgeon David Tolbert who was on a real interest in sleep, Mmm. Apnea because of the upper airway and asked me if I could help him with regards to treatment. And that the relationship developed and I got really interested in this area because it's so fascinating that eventually we set up I primary based sleep clinic that then sort of spread a bit and there's quite a few around the country. Um, because sleep is something we all take for granted in some respects, but it actually has a significant role within normal health. Hmm. So that, that's, that's how I started in this field. I'm still doing it 18 years later.
Speaker 3: (04:47)
Yep. And you've, so you've had a series of clinics throughout New Zealand at one stage and um, yeah, sleep apnea is what is it defined as specific place? So w w how, you know, people hear this word but they don't often know what the heck it means. Okay. So sleep apnea is a condition that has pretty sure, I realize it basically pauses in breathing during sleep, uh, for a number of reasons. Um, it affects about two to 7% of the population. However, that's with moderate to severe. Um, basically, but what we talk about now is sleep disordered breathing because we know there's a range of respiratory sleep issues affecting the patient. So sleep apnea itself is fundamentally, you can tell, cause if you've got obstructive sleep apnea, which is the main one [inaudible] it's a classic symptom. So all sleep obstructive sleep apnea, but not everybody who shores has obstructive sleep apnea.
Speaker 3: (05:56)
Okay. So that's key. So snoring is, is like, um, a pain in a joint. If we are a runner or sports person, if you get pain in your neck, you don't tend to ignore it. Yeah. You want to know what's happening because it's an abnormal process, right? Shoring is an app, normal process. And as a symptom of something, it could be benign, it may not. So we actually say that up to about 20% of the population will suffer from pathological or issues related to snoring. And that's the key here. So if you snore to start, you really should just get it checked out. We know that snoring gives you a higher chance of developing high blood pressure. Hmm. Um, from there, high blood pressure can lead to other cardiac and physiological issues. Absolutely. Yeah. So that's, that's where we start. Okay. The most common is obstructive sleep apnea.
Speaker 3: (06:57)
Then we move into things like central sleep apnea. That's what mum has. Yeah. Because basically if we see these conditions, there's lots of reasons why we'll see central sweep here. We see it in severe cardiac problems and basically it's a miscommunication where you just physically stopped breathing. So obstructive apnea is the, is the airwaves physically shutting off? Yeah. So you get this jerky movement of patients who have got it until they breathe. Central sleep apnea is a pause, just a stop in breathing. Wow. So they will be breathing quite normally. Then they stop, go silent. There's no effort to breathe nothing. Um, and you can see it for a number of reasons. In your mom's case, it was due to a stroke, uh, that caused her to stop breathing. But we see it in neurological conditions. We see it in change. Stokes breathing is a common cause of central apnea change.
Speaker 3: (07:58)
Stokes is a word that sort of worries me when I heard that. It's what we tend to see in the pre pre mortal issue. So just before people die, they go into this change. However, there's 31 reasons we see more, more that we can see, change, dehydration, heart conditions, all sorts of things because there's not, it's a metabolic condition. It's why we get changed up. So anything that can cause a metabolic issue can cause change steps. Yup. And this is this waxing and waning of, of the respiratory pattern. The center of a nice smooth process. This is what got a particular sound to it.
Speaker 3: (08:48)
It's usually, it's, it's a form of hyperventilation. She'll see the patient sort of get deeper and deeper, deeper, and then weighing off again and then flat. So people refer to it sometimes as like a death rattle. Yep. Okay. Yeah. Yeah. And there's a scary, scary way. And so that's, and so that's happens when you've got a central problem that can happen. Central sleep apnea can be caused by different Cheyne Stokes is one pot, one tile of central apnea. Some people just physiologically stop breathing. Yeah. Because of a stroke or a head injury, a neurological condition. Something in the brain that's been affected by the strokes, our blood supply to a particular gland or a particular part of, uh, of the primary. Primarily. Yeah. Neurological. Yeah. Primarily. Yeah. Okay. Um, all right, so that's two of them. Is there a, is there a third variation? There's a few other ones.
Speaker 3: (09:50)
We've got hyperventilation, which is, um, a reduction of breathing of at least 50% in the, in the volume of breath, but taking with a subsequent, um, reaction. So in other words, you know, your oxygen level starts to drop or you physiologically wake up. Yeah. Uh, hyperventilation in itself, I mean, everyone will stop breathing and the brief assert, so about two, about five times out, we're not going to stress too much about it from a risk perspective, but hyperventilation, we're seeing more and more because like obstructive sleep apnea, one of the main cause of that is weight. Obesity is, is, you know what I mean? Again, within healthcare, I know that people feel that we pushed away question a lot, but obesity with good is a significant health issue that we're not, we don't seem to be successfully addressing. Yep. So you've then got hyperventilation syndromes, you've got obesity hyperventilation syndrome that can be significant, uh, detrimental to long term health.
Speaker 3: (11:01)
Yeah. Okay. And this has seen a bit of a, um, you know, a circle because what's your, what's your obese and then you have this, then you'll get more obese because there's, there's a big, big connection between things like leptin levels and stuff that control appetite, especially in fragmentation. Yeah. So theoretically you mean the worst you sleep the hungry you are. Because at the end of the day, that's how we function as, as a survival mechanism, as a building. Yet, if we're feeling low on energy, we tend to eat to get fuel to feel energetic. Unfortunately, a lot of the foods that we might grate to when we're feeling like that tend to be the highest fat snacky type foods. So in a lot of cases, people who are, who are significantly overweight may not eat big meals, but they eat are very, but a lot of very small, high fat milk, which compounds the issue. Yeah.
Speaker 2: (12:01)
And that's done in Graham on as being a part of that equation. Yeah. So your satiation mechanisms aren't quite as good and of course when you, when you're not sleeping well, I mean there's, there is a whole lot of knock on effects, which I've talked about on a couple of episodes on the podcast. So it all starts to tie into to each other and has huge impacts on your, your mental health, your physical health, your brain, you know, mission, everything.
Speaker 3: (12:29)
Yeah. Well what we tend to see in people who to be, cause that's what we're really pushing her obstructive sleep apnea. These patients will first of all go to bed. They'll then start to sleep, start to snore. So sleep in itself. It's a very complex process. People always think you're awake, you're asleep. That's it. It's not. We talk, we talk in w we talk about sleep architecture, how your sleep is structured. So for the first seven minutes or so stage one sleep, that's the time you're getting comfortable, your eyes are closed. It's not true sleep. It's that like pre sweet sort of process. Then then we're supposed to drop into stage two, which is what we define as true sleep is when you actually go to sleep physiologically things start to settle down. You're hearing still going so you can still be erased at that stage and we spend 20 to 25 minutes there and then we move into what we call Delta wave sleep stages for him. When the brain goes into that slow wavy pattern, so you've basically got an inactive mind instill a veritable active body so you can still Twitch and stop after about 90 minutes of these processes you then stack and drop into what is REM sleep,
Speaker 2: (13:44)
which is that
Speaker 3: (13:46)
dream fell asleep. Yeah. Which is very, very important within a human, so like, and then we just cycle through that every 90 minutes or so. So you get to have about five, six, seven periods of REM during the night. What we tend to see in people with obstructive sleep apnea is that they'll start to snore at stage one too. Stages three four they'll start to obstruct. Once they stopped breathing, about six seconds later, their oxygen levels start to drop. We then get this sympathetic nerve activation that causes them to physiologically wake up to their heart, beats faster, that blood pressure goes up. Um, and it brings them back to a stage where the obstruction disappears, which may be level one, level two, but that Reiki did deep sleep. And then a lot of cases that these patients don't get true REM periods, pure sleep architecture.
Speaker 3: (14:43)
It's completely fragmented. And we're talking, and we, I've seen people stop breathing, I mean over a hundred times an hour, which means is that our heart rate variability is phenomenal during the night. So in effect, these people are working harder to sleep, to stay awake. So of course, but the body's a learning mechanism, it starts to say, well, I'm burning more energy doing this than I am by just staying awake. So people tend to start to develop this really bad sleep pattern where they can't get to sleep properly or they wake up frequently during the night. So you mean, you mean sleep is really important for things like growth hormone production, cortisol productions, all of these things. Your adrenals have hormones. They have very poor short term memory, their fatigue, blood pressure tends to be high and you mean eventually things are going to shut off.
Speaker 3: (15:40)
Yeah. And, and your health is going to seriously be a farrier, right? Absolutely. Yeah. And this is, this is so it's so important and just not, you know, all the sort of stuff needs to be taught at school. So what happens in the sleep process? Cause we all just fake. We go to bed and we go to sleep. You know, we don't know about deep sleep and REM sleep and in the life stages of sleep and how it, how it actually affects our physiology the next day and how our brain function isn't going to work. And what about the, I read a study recently on the brainwashing. Yeah. Function that happens when we're in asleep and that the brain shrinks. You're talking about, yeah. You're talking about amyloid. Cool. Yeah. Yep. Yep.
Speaker 3: (16:24)
Which is good when we're young because I think, I mean, this is getting into real neurophysiology. So, excuse me. So basically when you're growing or developing synopsis, it sits with that neuro logical function. Mmm. It's a, it's a byproduct of metabolism, of neurophysiological by metabolism and needs to be washed out. Um, which tends to happen during sleep while you were asleep and we beat her is dispersed ready for the next day. So it washes out the break. Yeah. Yep. It's a brainwash. That's what they're calling it. Yeah. They flush it out. Yep. And is it important a protein, but it flushes out all the and the rent. However, what we find sleep apnea patients or insomnia patients and where is that? I don't fully do they, that's why they wake up feeling groggy. Yeah. Yeah. Confused sometimes. Um, we noticed in outside of ms patients that there is a significant higher level within Sam or in place. Yeah. Yeah, yeah. So yeah, that is an important function as well. And we can see that not just in sleep pattern. We can see that in insomniacs and people. Wow. Wow. That is fascinating because if we not washing out those plaques every day and getting rid of them as that cause they build up when we're awake, from what I understand, we're functioning. Yeah. It starts to up over time. And this,
Speaker 2: (17:50)
you know, over a period of 20 years can lead to where they're suggesting it can lead to Alzheimer's. Early onset Alzheimer's. Yeah. Yeah. It's a long side process. So if we can get it early, we can, we can stop that process happening. Um, and this is really, this is the whole point of this conversation is, is to get people to be aware of what are the signs of sleep apnea, what are the things that are going to happen when you're asleep as off. Um, and what we can do about it. Um, uh, you know, we referred, um, just a bit earlier to mum's story. Um, and mum was in the hospital, excuse me, um, for three months and she'd been in Wellington, uh, in the acute phase and the ICU and then in the neurological ward down the air and she'd been on supplemental oxygen.
Speaker 2: (18:36)
Um, when, when she came back through to new Poloma, she was taken off of supplemental oxygen cause she was now stabilized if you like. Um, and I noticed that she was gone from terrible to really, really terrible. Like there was hardly any higher function going on at all. Um, and that's when my brain started to tick over and you know, my history with, you know, um, training at altitude and data races at altitude and I'd seen like things like she had a bacteria in the mouth that was just doing gross, horrible things. Yeah. And that was a really a signal to me like, Hmm. Bacteria, lack of oxygen. Uh, jeez. Sleep apnea basically was the connection that I made there. Um, oxygen in the body, you know, and lack of oxygen causes bacteria to spread and, and proliferate. Um, so it's really, really important that we, we address this. This is not something we should be putting off. So you is inherit in your clinics, you would do the sleep assessment on people, which is an overnight procedure or a test.
Speaker 2: (19:44)
Then if someone comes back with sleep apnea, they get a C-PAP machine? Well, it depends, right? So first of all, the key to anyone as to acknowledge that they have sleep patient. So the reason we can tell people who have sleep issues is people always say, you're mean I have sleep problem, but during the day they still function. Normally people with a true sleep problem don't function so well. So that constantly fatigued. Yeah. Tired, short term memory, it's usually quite poor because they're not dreaming. And part of the process of dreaming is the burn information to a hard drive if you like. So if you're not dreaming, you're not retain that information. So short term memory tends to disappear. There's petite. Quite often they're slightly on the higher. So those are the key things. Now I definitely, yeah, if you're not snoring, it's not obstructive sleep apnea, but it could be upper airways resistance syndrome or something like that. So in other words, you're having difficulty breathing during the night.
Speaker 3: (20:47)
People often wake up for headaches. They often wake up during the night,
Speaker 3: (20:51)
um, maybe once or twice. Um, so these are the common symptoms we see meet. But 70% of most GP consults will involve the word fatigue. Tired, no energy. Yeah. So that should be your key. If you're feeling tired during the day, most people come by their GPS because the GPS are becoming more and more aware of sleep specific. Um, because we spend one third of the day doing it. Yeah. Um, we would then go through a simple questionnaire like you're tired and scale Epworth sleepiness score is that, is that common tired and scale that we use to address how try it or how it affected people. And this involves eight simple questions about the ability to fall asleep doing certain things. And I would have run this through with Uma and basically it's things like if you sat reading a book, what's your chance of falling asleep? Yeah. Not possible. Moderate be high or high or sitting at traffic lights. Um, you mean what's the chances of you falling asleep? And believe it or not, there are people who want to positively, hi. Oh God. Every question. I remember one person telling me in Oxford, he said, I said, yeah, I mean, it's not very good if you're falling asleep at traffic lights. And he said, yeah, we can, we can sit for 20 minutes to traffic lights. So maybe we need to readdress it so that we're sleeping.
Speaker 3: (22:17)
Then we would probably carry out for most people who complain of sleep. The first thing I think to do would be to carry out a very simple respiratory sleep study and there's a couple of types you can do at home. There's all this imagery which surely looks up to gin levels during your sleep and that's a little clip that you wear on your finger, touched with a little monitor, some of wireless, they go on the watches and that's the simplest way and it has a very good correlation to sleep apnea so we can use it as a very simple cheap test. Yeah. As an a level three sleep study, which looks at as a thoracic efforts. So we're looking for specific obstructive central events or under breathing with a nasal cannula, an oxygen saturation monitor, and they can be done at home. Yeah, every simple test I can give us really detailed information, but level two sleep studies is when you're getting into neurophysiology side of sleep.
Speaker 3: (23:16)
Now 96% of sleep disorders. Alright. There were spiritually, mostly the very small percentage are the neurological disorders that we see that REM behavior disorders, the narcolepsy's, all of those more complex disease States that really require much higher levels of Oh, acuity and testing. Right. But the majority, and that's a medicine what we're supposed to address, the majority of patients can be, can be looked at from a respiratory. Yep. Um, once we get a test, we can then identify the severity of any underlying respiratory problem. No. Talk about sleep. Obstructive sleep apnea, which is where we get airway physically closes during the night. Yep. We talk about mild, moderate, severe. Yeah. Mine is any and vent above five to 15 events. Then we talk about moderate, which is 15 to 30 events an hour and anything over 30 we talk about severe. Yeah. This scale is really more focused on funding of therapies.
Speaker 3: (24:27)
Yeah. It's on impact of disease. That's terrible. Well, we know that people with certain tend to have a higher risk morbidity, mortality, but we also know that people with moderate with other pathology, awesome have significant risks. But more and more evidence is saying that if you don't treat the mild, they will become exactly there. Related to it is at the bottom of the cleft problem that we have. It's like fun. It always comes down to funding not how healthy you're going to be, but you'll be basically that's sleep apnea. Yep. Obstructive sleep apnea, obstructive sleep apnea can't be treated. Yeah. That's the good thing. What we talk about is things like conservative measures. Conservative measures are always going weight loss. Yeah. Fitness levels. Yep. Cause obviously the fitter you are just sending you out in the majority of cases. Yes. Um, so those are, those are simple things you can do to help.
Speaker 3: (25:40)
However the research is not green. Yup. Yup. For ag. And then we're moving more into the surgical options. Obviously you've got the weight related surgery, which is very difficult. Very Patrick. Yeah. To get, quite often we look at the upper airway as being part of dish mechanism that's causing the issue finish things like the obvious nasal deviations that we can. But you can see the obvious ones from rugby Plains, but obviously there are also, there's also subtle deviations. Then there's things within the knees or pathway that can cause problems. Their adenoids leaving you. Now tonsils is a controversial area in the area of sleep medicine. Yep. Because tonsils or something that's roughly what disappears. We get, Oh yeah, yeah. Um, however, saying that it would be the conversations I have with GPS about this is quite interesting because being in this, but I look at tonsils and everybody, well look at the back of the throat cause I'm looking at what we call a modern putty index, which is how far back the larynx and the size of the tongue.
Speaker 3: (26:54)
Um, but also I'm looking at tonsils and quite frequently you'll see extremely large asymptomatic in males predominantly. Wow. So if you've got tonsils that are kissing but asymptomatic, which means you don't get tonsillitis as such, then they're going to be causing an issue. Yeah, sometimes. Yep. Yes. Well in children now for sleep disorders. Um, the first line of therapy, children who might snort snoring to all the parents out there in children is not, it's not cute. It's not cute. And noise from a child while they sleep, um, is not cute cause they're supposed to be perfect breathers. Yup. But the first line of therapy, now children, but snoring or anything like that, just taking out there, don't bother with sleep studies. They just take out the tonsils and the admins, which in a significant number of cases can improve it. And there was a study out of the States where they took, uh, patients, children diagnosed with ADHD, trying to remember the study.
Speaker 3: (27:56)
Yep. And what they did was, uh, they took this group of patients were all treated, remove tonsils and adenoids. And what they found was that 50% of them, I think it was 50% ended up being taken off that Ritalin medication because it was hype. Children react differently to tiredness than adults. We get, we get authentic, we get children get hyperactive when they're tired. And we've seen that because everyone who knows your kids and then they crash. Yeah, exactly. Cause what they are is tired. Yeah. So when they get tired they send them like they run around.
Speaker 3: (28:33)
So surgery, surgery can help in some cases with obvious deformities. Um, success rate surgery for sleep apnea in the mild to moderate, probably about 63%. Wow. And surgery like anything carries Chris from an aesthetics from the surgery itself. So it's not a guaranteed cure. Then we're moving into things like most guides, uh, mandibular splints that designed the whole, the jewel in a prominent position pulling the, pulling the tunnel way from the back of the throat because as you fall asleep, nobody can physically swallow that up. Yeah. But their tonnes can drop back and include the airway. That's why in recess we pull the jaw forward. If you pull the jaw forward, your pull the tongue away from the back of the truck making that larger space. Monday splints can work very well. Um, there's different types of over the cancer, not so successful, but one is designed by a specialist orthodontist of which there are a number now in the country, um, can have an 80 plus percent success rate.
Speaker 3: (29:39)
That can be very good, but I probably won't be able to do that work very well. Okay. Yeah. Um, for more mild cases and some moderates, there's a thing called microvalve, Serafin therapies, Sarah events. These are the things you stick a little plastic over your nose and what they do is you breathe in normally through lots of holes, but as you breathe through your nose, lots of the valves closed down and one valve remains open. So you get like a, what we call a valve silver effect, like blowing through your nose and that back pressure keeps the airway splinted open. Wow. So it's a physiological form of C-PAP, which is what, yeah. Yeah. What's his, what mom's got like a sticking plaster that you see some athletes or is it on the inside? The strips on the outside. I for anatomical for collapse where the AOS actually collapse.
Speaker 3: (30:45)
So those things pull the nose. I was slightly out. These things stick over the, there's over the holes here. Oh yeah. That there. Interesting to work with. Very interesting feeling. But they can work. Probably don't use that run ongoing costs. You've got to use them every day. If you don't use them, it comes back. Yeah. So they're quite expensive. Right. But as an alternative to seatbelt, there's also this tummy device that don't think we turn the stabilizing device, the TST, very bizarre looking device that basically works upon the fact that if your tongue falls back, you pull your tongue forward. Now in the old days, very old days of anesthesia, we used to have a thing called a tongue clip, but we could collect the tongue, pull it out to open up the airway. Um, we've moved on from there. This is a TSD is like a suction device that you squeeze, stick your tongue in and it sucks your tongue forward.
Speaker 3: (31:47)
Yup. They read it to be cheap. Some people swear by them. I've tried most of these things. I couldn't sleep with it. This is the, it isn't, but it is an option. It is an option to try the only thing guaranteed to reverse sleep apnea. Yeah. Or it is what we call continuous positive airway pressure. Yup. And basically in simple terms is a pneumatic splint, so it blows air into the airway via either a nasal mask or a full face mask. Yup. While you're asleep, um, you can get very little cushions now that you wear like oxygen, things that can also be used for this machine. Um, and that blows air in. So when you breathe, you're breathing out against pressure so that then hold the airway open. Yeah. It's a new magic process. So you breathe in and out again to this flow or like that if you can wear it is guaranteed to reverse obstructive sleep apnea.
Speaker 3: (32:55)
Yeah, it's gold standard for therapy. And interestingly enough, it's only been around since about 1982 so relatively new therapy, but is now widely used worldwide for, that's the one that mum's got. Um, and she has to wear it every night and all night. Um, and you know, it's quite an invasive thing to have on. It's not pleasant for her. Um, having the central, uh, sleep apnea is guaranteed in that case? Like with obstructive or is it a bit, a bit more, it really depends upon that the, the, the reasoning behind the central event. Yeah. Um, in most cases it can improve it to an extent that it's okay. Um, in some cases it doesn't, but we stop an obstructive component. It proves your physiology changed to make the change they him and go away. There are some machines that are specifically designed to treat certain types of breathing, like Cheyne Stokes, the ASB system.
Speaker 3: (34:03)
Yeah. That can only be used. There are certain, a very small group of patients who can't use ASP because there's a higher risk of problems. Right. Like with any therapy, there's always risks. CPR tends to be generally safe if used appropriately in the right patients. And there are then machines that will provide backup. Correct. So if the machine senses that you're not breathing, it doesn't ventilate you, but it reminds you to take a breath. Yep. So we can use things called by levels or bilateral S T's with, with a minimum respiratory REM required. Yeah. So it will, it will. If you stop breathing, it will cook you with air to say take a breath. Is it the machine that mum's got? You know, because it regulates when she's breathing it's, yeah, yeah, yeah. Then when she stops breathing or you hear the machine crank up, yeah, you might, your mom's on auto type ventilate auto sheet. We'll have backup, right? Yeah. Right. And this is similar to what I've been delayed heroes in the hospital and not flight.
Speaker 3: (35:17)
C-PAP is not ventilation. C-PAP. C-PAP is stopping a reverse vacuum cleaner to your nose and away you go. It's, it's, it's helping. It's not breathing for you. It's like a walking stick. It's making your breathing more effective than if you weren't using it. I know ventilator is physically breathing for you. Now there are two types of ventilator says invasive ventilation. Well there's noninvasive ventilation. Noninvasive ventilation is legacy pap, but basically that the pressures are split. So you breathe in at one pressure and you breathe out at another pressure. Yep. And there is a, that can be a backup rate added to that. So that's, that's term. There's noninvasive ventilation. Those are the ones we tend to see used on patients with hyperventilation syndrome or severely large patient who cannot tolerate time levels of C-PAP. Breathing against the pressure of 10 centimeters may not be as bad, but the minute you start to get to 60 18 prep coming sent to me is a pressure that's a hurricane blowing, you know, so then we need to look at how we change. So we have an inspiratory pressure pressure, noninvasive ventilation. So in any form of respiratory failure, which is the end game of some disease States, they work really, really well. And it's becoming more and more used as opposed to inter invasive ventilation in a lot of cases. Now I've just read some reports out covert, they're starting to look at noninvasive ventilation as an alternative, right? Probably with noninvasive ventilation.
Speaker 3: (37:04)
Oh yeah. So you've gotta be really tough and the other ventilator, no, see, perhaps not recommended covert patients anyway, even though it's starting to be used as an alternative, but needs to be used very carefully. And we've got, um, uh, I've been looking at the research. Of course, Jason and I had a hyperbaric oxygen clinic, which we opened up to mum's story. Um, but the hyperbaric and covert, um, it's showing promising results. Uh, I, I saw, I saw that, yeah. The issue with coach, we're in the infancy of a disease state. We don't know what the longterm benefits, risks, outcomes next 10 years, 20 years of research is going to be around the last three. But hell's happened to us. So we keep on sleep apnea.
Speaker 3: (38:07)
Yeah, very true. But yeah, so, so, so treatment for sleep apnea with with C-PAP is very, very common. It's effective. Um, we really started to look at muscle diseases well because what we noticed with patients with mild disease, so they can still suffer all the same as severe disease. They can still be cycling, hypertensive or control. They can still be difficult to control diabetics. They can still suffer extreme daytime tiredness, um, and things like that. So, so C-PAP can be used as a management tool from mold too severe. Yep. So we were one of the first groups that probably made it more available to the mind. Yeah. Cases because in our opinion, the benefits fired out, weighed and the risks associated with treatment and at the end of the day, every therapy of any kind should be the decision that the patient not absolutely.
Speaker 3: (39:10)
Depending on what that treatment is, of course, and something like that. I don't see very low risk with a high reward in medicine. That's what we're looking. Is there any difference between when you were, say I'm now reading a sleep thing study last week is sleeping on your side versus sleeping on your back and can you actually sleep, and this is a question after I read that I was on your back all the time because of the sleep app machine. Is she actually able to sleep on the side? Yeah, of course she is. The machine she has got will automatically adjust for any change impression, so it will go up or down as required. Yeah. That's the benefits of that type of machine that that algorithm look. Positional sleep. Yes. You can talk to any partner who has suffered a partner who snores after a glass of wine or beer or whatever.
Speaker 3: (40:05)
We always poke them to roll them onto their site. Positional treatment for snoring can work and it's one of the conservative methods we recommend you. I mean there are very fancy machines are designed to be worn around the neck. Um, tell it when you were starting to. Sure. And then it plus as you would look for the electric shops to turn you on your side. Wow. The, the, the most practical tool you've got for positional sleep apnea is what your grandmother would have said, which is show up button in the back of your pajamas or get a tennis ball with a loop of elastic. Thread it through. I'm wearing like a backpack and that physiologically keep you on your side. There's no doubt that we can see. So obviously Pat on the back because all this depression is pushing down on their side. All that is moved away from, especially on the left side. Wow. If you turn onto your left, it's easier to breathe. That's why in the recovery position we turn people to their left. Wow.
Speaker 3: (41:09)
Pressure on their, on their venous return helps improve blood pressure, but it also moves and everything away from, from where your track here. So, um, you know, I, I sleep on my side but when I sleep on my left I can always feel my own heartbeat and then I always get worried. I'm putting pressure on my heart on the other side. If anything, if anything, probably be more on the right cause that's why we talk about pregnant women with debt gravid uterus. If you, if you lay on your side, that weight comes on to the vena cave on the right side. So actually restricts blood flow, especially return. Yeah. So your blood pressure theoretically needs to be higher. So in medicine we tend to turn people onto their left side and especially pregnant, when will we say light his left side. Great tap. Positional sleep can work very, very well in those people who are purely shorts.
Speaker 3: (42:09)
Yep. Yeah. It makes slightly improved sleep apnea, but because of all the other factors involved, it's not always there. Okay. But a sleep study, you can tell us that because part of the sleep study told us which side the patient is sleeping on when is happening. Yep. And we can, we can see that so we can recommend position therapy. What about like, um, I know it was several and you probably have a, have a crack at me for talking about him on the phone. Guys. I, he, he sits on his back and he sleeps on the couch. He wants to sit. I sit him up higher with pillows, um, in behind them and then a snoring is a lot less. Yeah, if you laying flat, yeah, it's okay to raise the head of the bedside. If you get a raise, the head of the bed, it's always been to put a pillow under the mattress as opposed to empty your head because the biggest problem is it a head forward and you make this more obstructive. Oh, if you want to put it in the yourself and put it in the shoulders, your headsets slightly flat or sniffing the morning air. This is the position we used to call it an anesthesia. So their head is flushed back, straightens the airway and it's easier to temporary sleeping in a chair. It's not a cool thing because you're not going to, you're not going to sleep, you're not going to sleep as well. Especially in patients who let's say have respiratory problems COPT they've got what we call overlap syndrome, so they've got sleep apnea.
Speaker 3: (43:42)
They tend to sleep in chess cause they feel they can breathe each year. The problem is is it's not very good for you from a health perspective and sleeping setup because of venous return, pressure on the kidneys and the heart. Other things probably blood flow to the brain. Yeah. Yeah. So if, if people are sleeping checks because we find it easier to sleep than they really need to be assessed to find out. I've got another fatal on my hands coming up. I can say yes for a number of reasons. Sleep apnea. Interestingly enough, we talked about it being related to obesity and other disease States, but it's also predominantly higher in men than women until about the age of 50. So postmenopausal women trach it to men very fast and it tends to be the effects of, it tends to be than what we see on men.
Speaker 3: (44:33)
Um, is that the weight gain side of what happens is because of the loss of certain hormones in postmenopausal women, especially around respiratory issues, um, we tend to see more in Mali, men especially but also higher percentage. So there is a ethnic link, we're not sure if that's because of body habitus to that. So the shape of the body and the upper airway rather than that, it just isn't working out, whether it's the increased weight, shorter neck, things like that. So yeah, so you mean there is, there should be a definite and I think there is a definite push within modem to check sleep apnea. If you've ever been onto a Mariah, not a pilot in a positive way. So you want me to probably one of the best places to have a sleep person would be on my mind very quickly identify and this is why, you know, sharing this sort of information so that people can directly, because it's with all, you know, all the health stuff that I talk about.
Speaker 3: (45:40)
Um, you know, it's being informed. It's knowing that the stuff is out there. It's being aware that there is a, perhaps a problem that needs to be checked as the first line of getting people in the door. You mean if you want to look statistically around research, you know what I mean? You ask three times more likely to have a stroke. If you have sleep pap, you're three times more likely to die. If you have sleep apnea, you're significantly more likely to develop diabetes. If you have sleep or especially what we call uncontrolled diabetes, you're more likely to develop heart problems, more likely to develop respiratory problems. I mean, we're talking significant percentages. If you look at something like what we call label hypertension, so blood pressure that is difficult to control. 80% of patients with difficult to control blood pressure will have some varying levels of sleep.
Speaker 3: (46:29)
Disordered breathing. Yup. 55% of cardiac patients, especially at S patients will have a compending or causative sleep disordered breathing. Yep. So the numbers start to stack up more and more and more. We're looking at nighttime physiology as a D as a predictor for daytime, especially around things like blood pressure. 24 hour blood pressure now is something that's becoming standard practice because we've historically treated blood pressure on one off. Yeah. Precious. Yeah. When we're noticing that nocturnal hypertension is a better predictor of cardiovascular mortality and morbidity than daytime blood pressure. Wow. So more and more GPS now are moving towards 24 hour blood pressure. You know, you go to your GP and he asked for it.
Speaker 3: (47:23)
Yet there's a few GPS in town who will do 24 hours. Most of the GPS will refer into somewhere like this where we were doing quite a few 24 hour blood pressures and Holter monitoring. Because my area of special interest has always been the impact of sleep on cardiovascular disease or on on cardiac health, which was why I've sort of moved into that sideways, into more cardio-respiratory physiology than I was sleep. So tell us about, a little bit about the clinic that you're in now. Fast based solutions, which is based in your Plymouth. If anybody wants to talk to jazz and come and see you guys. What is it that you do? You showed me a machine before that you can actually wear. Yeah. So basically we moved sideways and I teamed up with two other guys. Mike Maxim is a cardiac physiologist and Alan Thompson, who's a, who's an anesthetic technologist, we looked at what we could provide to primary care as a, as a midway step between primary medical care and secondary medical care.
Speaker 3: (48:26)
So we sort of set out to say, wow, we can bride these tests a lot faster probably because we have less restrictive process. Yep. Um, and so we're doing things like Holter monitoring. Holter monitoring is monitoring the heart over 24, 48, seven day period depending on, on what we're looking for and basically monitors cardiac speak to the variation. So it's great for identifying an arrhythmias. This is ASA Fletcher, all of those conditions. Uh, atrial fibrillation is something we're seeing more and more, um, potentially a significantly life threatening condition if not picked up and manage because of the increased risk of stroke and things. Um, so we brought in more and also we're seeing a higher demand from people wearing wearable technology who have started to notice that happy changing, going faster, slightly out to be, yeah, because they're exerting and it causes concern. And part of medicine is to address concerns and fear.
Speaker 3: (49:38)
So we do, we do Holter monitoring. So we're using small halted co monitors that allow us to monitor patients in a more free fashion. The old ones used to have lots of wires that restrict things. These things you can run cycle. So they're great for people who are active because that's where they notice the problem. So we can monitor the patient in the situation in which they noticed that problem. It's a lot more effective. The older, bigger ones are cumbersome. So you can't run in them cycles when you can with these. Yep. So it allows us to monitor patients or effectively, and we can even do cardiac ones on there so we can get really tiny patches. So we do those, we do exercise tolerance testing to check for narrowing the vessels. So it's a a test that you run on a treadmill and we'd look at your ECG 12 lead ECG. So quite in depth in ECG while you're doing it. Um, would you ambulatory blood pressure, 24 hour monitoring spiral Metairie cause that forms part of the cardiac paradox. You know what I mean? You talk about cardio respiratory disease cause they both obviously work together and they affect each other. Yeah. So that's what we're doing here. We're doing more direct to patient management.
Speaker 2: (
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