can also uh cause resistance to air flow so all these things can actually cause um or increase your risk of having sleep apnea okay okay so here's a a side view look of someone who is normal on the uh
So your arousals can come from your own snoring or sleep apnea or they can come from your bed partner's snoring and sleep apnea . It can come from a noisy neighbor's dog, from construction, from a dog or a cat in your bed that's constantly jostling or they themselves are snoring.That can cause the fragmentation.
Common Circadian Disorders-- shift work, I don't imagine anybody here is an actual shift worker. apnea both in adults and also in children who have what you might call a big overbite or what we might call an overjet.
and sleep disorder breathing so with that we're excited to have her here today to talk about sleep apnea thank you for inviting me wow you know I've been to the Facebook um headquarters but this is a differentworld all right um so as you know I'm one of the uh clinicians at the Stanford Sleep Clinic and um I uh many of you
Wisconsin in 1993 showed that 24% of men and 9% of women met criteria for sleep apnea now these numbers underestimate the current prevalence figures that we have now in 2006 the national sleepFoundation indicated that as many as one in four four American adults met criteria for a a high preest probability
of sleep apnea that's that's pretty big um the despite what we know about sleep apnea today we think that about 70 to 80% of people are undiagnosed so far still many people are unaware of thesymptoms of sleep apnea and we need to increase our knowledge um of the risk factors and the symptoms and the
non-specific symptoms and it can be blamed on even just you know stressors in life uh the other the next myth is sleep apnea always causes daytime sleepiness so not everyone with sleep apnea feel sleepy during the day and theseverity of sleep apnea does not correlate with the symptoms in other words you can have mild sleep apnea and have very severe symptoms and you can
circled it it's actually um wider than the person on the right who has sleep apnea can you guys appreciate that okay so looking at the side viewand this is how we know someone is predisposed to or probably has sleep apnea or is at risk for sleep apnea and
be narrow like this this is a very narrow heart pallet which is a big risk factor for sleep apnea okay so this is these are uh huge tonsils and a lot of soft tissue in the in the back of the throat so this personis actually quite severe but uh on the average if you have tonsils that are visible um it's going to take up some
disturb sleep and um cause uh symptoms of sleep apnea okay so um one of the things I want to point out is is allergies ornasal congestion is very common in kids okay and um so PE kids who have abnormal breathing
is one of the problems um that can lead later on in life lead to something like sleep apnea um so the the the Mac the um upper and lower jaw structure are the what wecall the maxilo mandibular bone and for people with mouth chronic mouth breathing their face eventually it they
actually just breathe better period whether it's during the day during the night and if you're using CPAP and tpap apnea okay so some take-home points um so obstructive sleep apnea is a medical
actually just breathe better period whether it's during the day during the night and if you're using CPAP and tpap apnea nasal congestion or obstruction can lead to non-restorative sleep
Okay, so these two These inputs are coming all at the same time and I'm puzzling over these sleep studies. That first gal had sleep apnea . But most of the women that I sent for those studies, they did not have sleep apnea or it come back on the the page it would say no significant apnea . There was a significant score, how many times you stop breathing during the night. And
That make sense? Yeah. sleep apnea , period. The problem with CPAP is that it has a huge failure in patient compliance, like 40% to 60%,
And when she told her doctor about her symptoms during pregnancy, he told her not to do anything because it was too dangerous to treat sleep apnea during pregnancy. So basically, what she did when she slept is--
medicine at Stanford uh her clinical focus is on sleep disorder breathing such as obstructive sleep apnea Central sleep apnea and positive airway pressure devices for sleep apnea treatment so quite a lot there um with a background in critical care and pulmonary medicine Dr cow has a special interest in patients with combined pulmonary disease
have maybe or maybe have you seen me before there if you're a patient there okay so how many of you have heard of sleep apnea in this building good okay all right so let's just start out with with the question what is sleep apnea um it's a medical condition that that's uh basically it's abnormal breathing during
the treatment options for URS patients are the same as for sleep apnea because it's just the degree of of basically sleep apnea and um that what I find in that the ongoing problem I think in the community is that many of these patients remain untreated and they continue to experience symptoms like insomnia fatigue depressed mood you know daytime
here so the Studies have shown that African-Americans and Asian are much High have a much higher prevalence of sleep apnea compared to you know Caucasian people um certain cranial facial morphology or basically certain bone structures in your face can predispose you to sleep apnea um this is also very important is ritis or nasal
this is a big problem because it disturbs sleep and it disturbs um it basically decreases air flow and that that that is one of the definition of sleep apnea looking at the two bottom figures both of these openings are abnormal you can see that you see how the openings are really narrow I mean the person is on the left especially I mean you can barely get air in that nose
crowdedness his Airway is very crowded okay so quickly on uh obesity and and sleep apnea so you consider overweight if your body mass index is 25 or higher um and it it is the strongest risk factor for sleep apnea now 10% of of your weight gain of whatever your weight
it it causes your lower jaw and your upper jaw especially not to grow as well as it should be so that predisposes to sleep apnea remember before I I comment on how important the jaw structure is in sleep apnea and this is one of the problems is that if you have chronic nasal congestion as a child you your jaw bones do not grow appropriately and that
appropriately so then they ended up they end up having you know sleep apnea down later on in life and then they have sleep apnea now so it's the Vicious Cycle because they don't breathe well period so you you want to you know pay attention to these problems um early on so this is a picture of a of a
actually just breathe better period whether it's during the day during the night and if you're using CPAP and tpap sleep apnea so I think weight loss will improve sleep apnea but it will not cure
For women, it's somewhere in the neighborhood of 90 to 95% of women that have clinical sleep apnea will go undiagnosed. Why? If you were to look at me and you would say, if I said, "Stephen, you think I have apnea ?" He said, "No." Right? If I
way, it is also in the same point true. You could have apnea that has nothing to do with body composition. And let's define apnea for a second.
You could have apnea that has nothing to do with body composition. And let's define apnea for a second. You stop breathing at night and that wakes you up.
expected. It says men who are middle-aged have a 24 to 34% prevalence of apnea . Women 9 to 17%. Uh seniors 30 to 60%.
One of my patients said, "These drugs you're giving me haven't worked. I want a sleep study." She had sleep apnea . She was young and thin. She did not look like a fat older male with a fat tongue, which is what we were being sold at that time. The people with sleep apnea have a fat tongue. It
sleep apnea . But most of the women that I sent for those studies, they did not have sleep apnea or it come back on the the page it would say no significant apnea . There was a significant score, how many times you stop breathing during the night. And then the next part is what do they have that's wrong with them? That came about a year and a half
So we definitely see differences in what the patient's hormonal balance is as it relates to storing and sleep apnea . So someone with a high testosterone content is going to be more predicated to having snoring and sleep apnea .
Type 2 diabetes. We have direct, not just correlational, but causal research that shows that the inflammation that's caused from sleep apnea can lead to type 2 diabetes. And we'll actually see these very same patients being treated with either CPAP or oral appliance therapy and their blood sugar is coming down without medication.
That make sense? Yeah. A stands for Apnea , when your airway is closed for 10 seconds or longer.
So that may subside as his facial structure catches up. So any type of apnea that may be going on because he has some type of obstruction can be very scary.
Common Circadian Disorders-- shift work, I don't imagine anybody here is an actual shift worker. It is sleep apnea , and sleep apnea is extraordinarily common.
on the wrong side of three. I had sleep apnea , and I had bad knees. I've been a runner my whole life, my knees never bothered me, and now suddenly they were bothering me.
Dr. Atul Sharma: Yeah. The question is if you're doing all the right things with diet and exercise and you're, you're an optimal BMI, but you still feel stress and you're you have sleep apnea . All those things increase your risk for cardiovascular events. So, sleep's very important. I mean, the thing I, the things you read about sleep is don't bring any electronic
Dr. Atul Sharma: Yeah. The question is if you're doing all the right things with diet and exercise and you're, you're an optimal BMI, but you still feel stress and you're you have sleep apnea . All those things increase your risk for cardiovascular events. So, sleep's very important. I mean, the thing I, the things you read about sleep is don't bring any electronic
Foundation indicated that as many as one in four four American adults met criteria for a a high preest probability of sleep apnea that's that's pretty big um the despite what we know about sleep apnea today we think that about 70 to 80% of people are undiagnosed so far still many people are unaware of the
apnea today we think that about 70 to 80% of people are undiagnosed so far still many people are unaware of thesymptoms of sleep apnea and we need to increase our knowledge um of the risk factors and the symptoms and the Physicians have to also be aware in diagnosing um this disease and getting patients treated so I'm going to go over some
apnea always causes daytime sleepiness so not everyone with sleep apnea feel sleepy during the day and theseverity of sleep apnea does not correlate with the symptoms in other words you can have mild sleep apnea and have very severe symptoms and you can have very severe sleep apnea and not have symptoms at all so even if you have mild sleep apnea it should be taken
severity of sleep apnea does not correlate with the symptoms in other words you can have mild sleep apnea and have very severe symptoms and you can have very severe sleep apnea and not have symptoms at all so even if you have mild sleep apnea it should be taken seriously um it can increase the risk of heart disease and other health problems
can't breathe um so snoring may be the only sign that you have that you know that you have sleep apnea so please see a doctor if you chronically or habitually snore okay so the spectrum of of sleep apnea I just want to um emphasize this because sleep apnea is sleep apnea but then
fibromyalgia or chronic fatigue syndrome okay so who gets sleep apnea anyone can get sleep apnea men women kids any age so who's at risk for it however so if you're a male you're at two or three times higher risk than women so unfortunately that's the case um however
lines up nicely but on the right side you see how the jaw is recessive it's shorter and it's smaller that is a risk factor for sleep apnea okay so I just want to show you the different uh facial face morphologies in different people and looking across the board um you know some of these people have very big necks
a very small chin or small jaw so all of these people here have have are predisposed to sleep apnea okay so this is looking inside the mouth and looking at looking at the the top the roof of the mouth and um it just you can you can just trust me that it's
during awake his mouth is open okay he has braces but once so we we we treated this kid for sleep apnea and allergies and you can see that on the on the right side his nose is much more open now and he's able to close his his mouth now and this is this is actually at the Natural State we ask them just you know to be as
same bone structures as your parents do if your parents know to have sleep apnea most likely you will too okay so how do how do you know if you have sleep apnea okay so these are some of the very common symptoms um you don't have to have all of it you may have just one or two but um let me just go down the list so chronic snoring okay that's the easiest sign to know that you
have just one or two but um let me just go down the list so chronic snoring okay that's the easiest sign to know that you may have sleep apnea if you wake up from sleep with a choking sound or gasping for breath if you have witnessed apneas basically it mean you stop breathing intermittently during sleep a lot of times the the bed partner will kind of