Sleep Apnea Pathfinders David Bishop, LCSW, Certified Health Coach (CHC)

In this episode, we discuss who else is podcasting about sleep apnea.  Specifically, what patients are also trying to raise the awareness of sleep apnea.

Are you one of those people who really love podcasts and can't get enough information about sleep apnea (I'm one of those people)?  There are some patients who have great podcasts and we are becoming a community of patients who are working to raise awareness and hopefully helping people take action.

I am someone who learns by listening to something more so than reading things.  So, podcasts are a perfect format for me.  I can slow them down and also play them again and again.  

Since developing this drive to learn all that I can about sleep apnea, I turned to podcasts to find quality information.  What I found was podcasts by sleep physicians as well as dentist who are board certified in dental sleep.  Well that was not satisfying for me and I wanted more of a patient focus.

I found three podcasts that have been fantastic sources of information as well as inspiration.  They are Emma Cooksey's Sleep Apnea Stories, The American Sleep Apnea Associations Awake podcast, and Dr. Steven Park's Breath Better, Sleep Better, Live Better podcast.  

It may be curious that I am talking about other podcasts, but I believe the more information for people to listen to raise awareness the better.  Our focus at Sleep Apnea Pathfinders has a distinct approach that sets it apart from these other fantastic podcasts.

Our first season was structured around discussing the Social, Physical, and Emotional impact of sleep apnea.  This season we are interviewing patients and discussing related medical issues they experienced in addition to their sleep apnea.   We also will dive deeper into issues around diagnosis and treatment.  After all, there are millions of people diagnosed who could not find a treatment that worked for them.  This is a staggering number on top of those who are also undiagnosed as yet.  There are lots of myths out there which cause sleep apnea to be viewed as an overweight mans issue.  

We as patients should feel empowered to advocate for ourselves and ask more questions.  I hope to bring information which can help illuminate more issues which are actionable and useful to patients and their famililies.

I wanted to take a step back and thank all of the listeners of Sleep Apnea Pathfinders.  This seasons episodes have been heard in 7 different countries and 37 cities in the U.S.  It reminds me that sleep apnea is a worldwide issue and many of us are searching for information which is empowering and actionable.  

In this episode, I talk about some of the important issues I covered in the first few episodes.  One issue is the usage of 2 different scoring rules by the American Academy of Sleep Medicine for oxygen desaturation when scoring hypopneas.  Those are partial closures of our throats.  When 4% is used, it is less likely hypopneas will be counted in the Apnea Hypopnea Index.  For some people, it may mean that they will technically be diagnosed with primary snoring and not sleep apnea.  This is especially problematic for women, who research is indicating that hypopneas are more prevalent in women.   I plan to do a more in-depth episode on this issue as it also generally undercounts sleep breathing events for both men and women.

The other episode I'd like to highlight is the episode on Atrial Fibrillation and sleep apnea.  My guest was Melanie True Hills, who is the CEO of STOPAFIB.org.  She shared her sleep apnea and AFIB story and educated us on her mission to help people identify and manage AFIB.  She shared that those who experience a procedure called cardio ablation and cardioversion whose treatment is unsuccessful are likely to have sleep apnea.  

We will delve into cardiovascular conditions more.  The host of conditions which comprise cardiovascular disease have a high rate of occurrence with sleep apnea.  While you may not have any of these conditions, it is important to discuss these issues in hopes that it reaches someone who is experiences these issues.  Ideally, the younger someone who meets the signs and symptoms is diagnosed the better for their long-term health.  

I discuss my interview with John, a sleep apnea patient who has a BMI of 24 which is normal for his height and weight.  He is a thin person and despite signs and symptoms of sleep apnea, it was unlikely his doctor would refer him for a sleep study.  This interview points out that sleep apnea is not about weight for all individuals.  Many people with normal BMI have sleep apnea and they too may believe the myth that its only for overweight people.

We plan to continue to interview various individuals with sleep apnea as well as their partners. 

Are you one of those who only think sleep apnea is something that only people who are overweight can develop?  Well, sleep apnea can be found in people with all body types.  

I interview John Dortch, a thin person with sleep apnea.  His body mass index  is 24, which is normal weight for his height, according the a BMI calculator from the National Heart, Blood, and Lung Institute of the National Institute of Health.

John is someone whose physician would not think he fit the typical profile of someone who could have sleep apnea.  In this episode, we talk about his path he's traveled to get diagnosed and how he adapted quickly to CPAP.  

John had classic symptoms of sleep apnea-snoring, gasping for breath at night, needing to nap daily, and wanting to go back to sleep after a night of 7 hours .  His wife complained of his snoring for years.  There are millions of people who snore out there, and sometimes it leads to a sleep divorce.  This is where a bed partner goes to sleep in another room.  Well, John talks about his wife doing jus that one night when his snoring got too loud.

In this episode, he also discusses experiencing cluster headaches which occur suddenly and the pain is over one eye and can be debilitating.  After being evaluated by a physician in the office, he was admitted to the hospital due to the concern that it could be a brain tumor.  It would later be diagnosed as cluster headaches.  In trying to soothe his cluster headaches, John found himself taking deep breaths.  This alleviated some of the pain, and he would later conclude after being diagnosed with sleep apnea that lack of oxygen was a major contributing factor causing his cluster headaches.

Another thing John had adapted to over the years was going to the bathroom up to 2 times a night.  He attributed it to aging and much to his surprise, once starting cpap he was sleeping through the night more .  

John was not open to an in lab study and he felt (like many people) that it would be too uncomfortable.  When he heard about how easy a home sleep study would be, he was more open to the idea of a sleep study.  

We discuss his adjustment to cpap being easy and how for some people its not that easy.  Since starting cpap, John has been cluster headache free, he doesn't need naps during the day, and his bathroom trips are all but eliminated.  His sleep doctor explained that he was never able to sleep at night and his body was not able to suppress the function of needing to go the bathroom.

John shared that in thinking back to his father, he snored and had a host of medical issues.   He speculated that his father potentially had sleep apnea and it was untreated.  

This interview with John about his sleep apnea showed that those stereotypes that this sleep disorder is only for someone who is overweight is false. 

If you or someone you know is thin, but they snore and you've witnessed them gasping for air at night, please suggest they see a sleep physician.   

In this episode, David and Yvette discuss the three reasons why sleep apnea can go undiagnosed for years or even decades.  


Fatigue becomes normal to the individual due to their life circumstancesUneducated about sleep disorders and sleep hygieneYou slowly become the person We are faced with managing fatigue within the context of what is happening in and around our lives.  We often (especially when younger) can just adapt to being tired all of the time.  In David and Yvette's lives, the birth of their first child and the effort that went into building their careers, prevented them from sleeping the recommended 8 hours.  We normalize being tired, and even most people in your circle may even talk about how tired they were when they first had children.  The fatigue even can become a shared type of tired when both parents are chronically sleep deprived.  Or maybe the don't have children, but they put everything into building their careers.   There were other instances where fatigue was just a part of daily life.

While in our youth, many people are very social, and the thought of being tired due to a sleep disorder was not top of mind.  In fact, sleep hygiene (soft lights, no digital devices, leave enough time for winding down, etc.) was not a term that was discussed often.  Despite symptoms (headaches, pain in eyes, trouble concentrating, health palpitations, snoring, restless legs) being evident to Yvette, David still felt that they were unconnected.  There was no indication that these symptoms were connected somehow.  Even a trip to the primary care physician after heart palpitations/tightness in chest were not enough for the doctor to refer to a sleep physician. 

Symptoms of sleep apnea which may be described as more classical symptoms (sleepiness all the time, snoring, falling asleep in strange places) develop slowly.  The symptoms rising to the level of a disorder is often missed by the individual.  Symptoms are minimized and when combined with normalizing fatigue, a person can find themselves meeting the criteria for a sleep disorder without even realizing the seriousness of their symptoms.   Those around them can readily see the falling asleep at parties, dinner, and breakfast.   As that process slowly becomes more regular, the debilitating fatigue overtakes many areas of someone's life.  

These three reasons can combine to keep sleep apnea from being a focus for the individual and physician.  While the individuals family can tell that sleep is an issue, it is often very difficult to get a loved one to work with primary care to seek further evaluation through a sleep study.

There are a number of other reasons and contributing factors which keep sleep apnea invisible for millions of people around the world.  

Have you ever experienced heart palpitations and were unsure if it warranted speaking to your doctor? Has your doctor placed you on statins for rising cholesterol based on a family history of heart disease? What does sleep apnea have to do with heart palpitations?  The American Heart Association issued a statement in June 2021 that “between 40% and 80% of people in the U.S. with cardiovascular disease also have obstructive sleep apnea (OSA), yet it is under recognized and undertreated in cardiovascular practice.”1 Sleep Apnea Pathfinders set out to find out more about Atrial Fibrillation (A-fib).  AF is defined as an irregular, often rapid heart rate where the hearts upper chamber (atria) beat out of coordination with the lower chambers (ventricles) and causes poor blood flow.
In this interview with CEO of STOPAFIB.org, Mellanie True Hills, we discuss a wide range of topics from what is Afib to how does it overlap with sleep apnea.  Ms. Hills is an award winning author for her book A Woman’s Guide to Saving Her Own Life: The Heart Program for Health and Longevity.   
40% of individuals don’t have observable symptoms; roughly 6 million people affected by Afib.  "When you have Afib, you have a 500% increase risk of stroke.”   Heart failure is a big issue as is cognitive issues.
She discusses the way to diagnose Afib: Electrocardiogram or loop recorder.
 The risk factors for Afib involve people with high blood pressure, underlying heart disease, diabetes, congestive heart failure, as well as sleep apnea.  For those she encounters who wake up with their heart racing, a common question is have they had a sleep study.  “The two (Afib and Sleep Apnea) go hand in hand”, according to Ms. Hills.
 Crossover issues of women not being referred based on language.  Women tend to be diagnosed with mild sleep apnea.  The research is also showing that women may experience hypopneas, (partial closures of the airway) more than apneas (full closure of airway)2.  David discusses the impact of the American Academy of Sleep Medicine guidelines of defining desaturation with a 3% or 4% measurement (2 & 3).
Triggers are discussed.  The sympathetic nervous system is engaged (for those with sleep apnea, this is nightly).  She posits that Afib runs in families and also added that so does sleep apnea.  
Paroxysmal, Persistent and Long standing.
 They discuss typical treatment.
Intrathoracic pressure of sleep apnea can cause a stretching of the atria of the heart.  Results in remodeling of the heart and also electrical signaling.
 Ms. Hills shared her story of how she experienced Afib and how her surgical procedure helped her get rid of Afib. 
 Ms. Hills was gracious to share her sleep apnea story and how diagnosed with sleep apnea, she had to reframe how treating her condition as a means to keep her Afib managed.  She learned of the connection through research done by Drs. Susan Redline and Virend Somers in 2008 showing the connection between Afib and sleep apnea.
David shared family history with heart conditions and sleep apnea.
Treating Afib early is key.
1.      Newsroom.heart.org Statement published online June 21, 2021 “Sleep Apnea worsens heart disease, yet often untreated”; A scientific statement by the American Heart Association in their associations journal Circulation
2.      Prolonged partial upper airway obstruction during sleep-an underdiagnosed phenotype of sleep disordered breathing; Anttalainen, U; et al
3.      Cardiovascular and somatic comorbidities and sleep measures using three hypopnea criteria in mild obstructive sleep-disordered breathing: sex, age and body mass index differences in a retrospective sleep clinic cohort; Johnson, K; et al

In Part 2 of our interview with Dr. Kubacky, we discuss how fatigue is a hallmark of PCOS and how a host of other health issues are associated such as diabetes, high cholesterol, infertility, and hypothyroidism. 

We discuss how women tend to be diagnosed with mild sleep apnea and how some sleep physicians will recommend weight loss in place of using other interventions such as a CPAP.  The path for women to be diagnosed is often difficult based on how they sometime report fatigue, according to information by the organization Women's Health Research.

This led into how women's health concerns are overlooked because their presenting symptoms don't fit the typical medical perspective taught in medical schools.  For instance, a typical viewpoint is that obese men have sleep apnea.  We know that slim women also have sleep apnea.  The health inequities women face is discussed in this episode as well as those faced by minorities.

Dr. Kubacky provides wonderful resources for people experiencing PCOS.

Her mental health website is: https://drgretchenkubacky.com/
Her PCOS website: https://pcoswellness.com/
Martha McKittrick: https://marthamckittricknutrition.com/nutrition-solutions-pcos/
Society for Women's Health Research https://swhr.org/science/networks/sleep/