S02_E15 - The 411 on Sleep Apnea

Speaker 1: 0:04

Welcome to the Healthy Matters podcast with Dr. David Hilden , primary care physician and acute care hospitalist at Hennepin Healthcare in downtown Minneapolis, where we cover the latest in health healthcare and what matters to you. And now here's our host, Dr. David Hilden .

Speaker 2: 0:20

Hey, it's Dr. David Hilden and welcome to episode 15 of the Healthy Matters podcast. Today we are gonna talk about sleep apnea. You've probably heard about it, but we're gonna delve into what causes it and what you can do about it. And to help me out, I have invited a past guest from the program, Dr . Ren Verese . He is a sleep doctor who specializes in all kinds of sleep disorders, including sleep apnea. Dr. Verese , welcome back to the

Speaker 3: 0:46

Show. Thank you Dave . It's a pleasure to be here. It's

Speaker 2: 0:48

Great to have you , Regi , now you do all kinds of sleep, but we're gonna stick to sleep apnea today because it's so common and so many people are living with sleep apnea. So start us off, what is it? What is sleep

Speaker 3: 0:59

Apnea? Yeah, so sleep apnea, as you mentioned, it's very common. It's a condition where the back of the throat, the tongue, the muscles in the back of the throat when we sleep at night, become very relaxed. And at that time the airway might close off because our muscles are relaxed when we fall asleep. And if the airway closes off, the oxygen can't get into your lungs. And this is what we call a sleep apnea event. It's essentially a choking episode when we sleep at night. It sounds

Speaker 2: 1:24

Awful

Speaker 3: 1:25

Terrible.

Speaker 2: 1:25

It is. I mean, when you've described it as a choking episode and not getting oxygen, that sounds pretty bad. What causes it?

Speaker 3: 1:31

So a lot of different things causes sleep apnea, but the number one thing is being a male and obesity. So being overweight can cause a lot of weight around the size of your neck. And so that puts a lot of pressure on those soft tissues in the back of the throat. So anything that might put pressure on the throat like obesity, sleeping on your back because if you sleep on your back, your tongue can sort of roll back and choke that , uh, airway as well. But mostly it's being a male, mostly it's obesity and certain things like alcohol can worsen sleep apnea as well. Does the

Speaker 2: 2:02

Word apnea mean? Is that what it means? Choking? Yeah,

Speaker 3: 2:05

It means stopping breathing essentially. It's the cessation of breath. So you said

Speaker 2: 2:09

It's more common in men , what about in age? Does it, do people get it at young ages or is this a disease of, of aging?

Speaker 3: 2:16

Absolutely. I mean we do definitely see this in adult males. Um , when we look at the pediatric literature, it's these kids that have tonsils,

Speaker 2: 2:25

Very

Speaker 3: 2:25

Large tonsils or adenoids that can snore very loud and have sleep apnea as well. But we're really starting to see not just kiddos having obstructive sleep apnea from tonsils, but there's a big crisis in pediatrics with obesity and these children are coming with sleep apnea that's not involved with tonsils when it comes to women. Women are fairly protected from having sleep apnea until they start hitting perimenopause and menopause and then they start catching up to men.

Speaker 2: 2:52

Why is that? Well ,

Speaker 3: 2:54

Uh , the hormones, progesterone, estrogen are, they help us breathe, they help women breathe. It also helps with keeping the airway open. So

Speaker 2: 2:59

You talked about tonsils and adenoids that now we don't take those out so much in kids anymore, but, and when we did, they were just, cuz they were a little big and people were getting sore throats. Right. I mean tonsillectomies weren't done for sleep apnea back in the day, were they?

Speaker 3: 3:12

They were. And they are now. They are now . Okay . They are now. And, and, and it depends on the severity of the sleep apnea for kiddos. So if their sleep is really disrupted and they're sleepy during the daytime and you can really identify using a sleep study that their sleep is disturbed, we then perform in tonsillectomy. And that's usually curative for these kids.

Speaker 2: 3:31

Okay. So how common is sleep apnea in our population? A

Speaker 3: 3:35

Study population based study in 2014 looked at men and women, about 14% of men and about 5% of women have obstructive sleep apnea. And when we categorize sleep apnea, we think of mild, moderate, and severe obstructive sleep apnea. So these are folks that are stopping breathing or their oxygen is dipping a minimum of five times per hour. And that's where those numbers come from. 40% of men, 5% of women, that's a

Speaker 2: 3:59

Lot. Mm-hmm.

Speaker 3: 3:59

<affirmative> it

Speaker 2: 3:59

Is, is that a global phenomenon or is that more of a thing in our country, especially with obesity?

Speaker 3: 4:05

That's the correlation is that we are, there's two components of that. I think it's the obesity epidemic, but then there's also a lot of doctors are now becoming very well aware of sleep apnea. This has happened in the last 20 years. So we talk

Speaker 2: 4:18

About it a lot in clinic. I do in primary care clinic a lot. Someone says, yeah, I think I have sleep apnea or my spouse snores and I think they have sleep apnea. Are we, are we diagnosing it more formally with sleep studies, like what you do or are are we diagnosing it more just in the clinic? Uh , sort of speculatively like I think you have sleep

Speaker 3: 4:36

Apnea. It's on a lot of the radar of a lot of doctors. Yeah . So I think they're just gonna ask the right questions and if they have the right suspicion for sleep apnea, the goal is for the patient to be tested or at least seen by a sleep physician to determine whether testing is indicated and to figure out whether they have sleep apnea.

Speaker 2: 4:52

So I take it cases are on the rise then?

Speaker 3: 4:55

I think so for a number of different reasons. The fact that people are aging, that's one reason. Number two, the fact that people are continuing to have , uh, this obesity epidemic. And three, I think doctors, again, just like you, you're , it's on your radar. You want to ask about this because it's important.

Speaker 2: 5:09

I mentioned snoring, I think you maybe did earlier in this, in this uh , episode with, especially with kids. Tell us about, if you could, Reggie , the , the correlation between snoring and sleep apnea, they're not one in the same, but they're, they go together, right?

Speaker 3: 5:22

Absolutely. So you can have snoring la very loud snoring and not have these episodes where the airway's closing off you and you're choking yourself. But snoring tends to very strongly indicate that someone does have obstructive sleep apnea. So if you have someone that has obstructive sleep apnea, they likely have symptoms of snoring, loud snoring. But you can have snoring alone and not have sleep apnea. So

Speaker 2: 5:46

If you think you might have sleep apnea or you think the person you share a bed with, you know they snore is just really loud. How do you diagnose

Speaker 3: 5:53

It? Yeah. So apart from that snoring question I ask , is the snoring loud enough to be able to be heard through a closed door? I ask the patient or their bed partner, does your partner ever snore themselves awake, like with a snort? Kind of like that. Oh , that was

Speaker 2: 6:07

Good. <laugh> Reggie . That was good.

Speaker 3: 6:08

Well the reason why I do that is because when I do that in the clinic with the patient, they go, yes, that's exactly what I have . That's it . That's it. Yeah. And then, then I, I'm fairly certain that I've got the diagnosis or if a bed partner hears that they're snoring and then all of a sudden there's a silence in the snoring and then the patient has a snort awake getting , that's what we call, that's a witnessed apnea. So apart from that, I ask questions like, do you wake up with a dry mouth in the morning? Do you have a headache when you wake up in the morning? Do you feel like you're sleepy during those days? All that sort of gives us an indication that , uh, there's a high probability that someone has sleep apnea.

Speaker 2: 6:43

You practically have to be a marriage counselor if you can hear it through a closed door. Yeah. Wow. I bet you have a lot of conversations with people. Well

Speaker 3: 6:51

There is something called sleep divorce where people separate from their bedrooms to sleep better because of their partner snoring or other sleep complaints. And and yeah, people do say, I'm sleeping better now because my partner's sleeping better. I think they did a study that looked at how much a bed partner's sleep is disturbed by someone else's snoring and it's about 50% of their sleep can be disturbed by someone's sleep apnea and snoring.

Speaker 2: 7:17

Right now there are a whole lot of people nodding as they're listening to you say that and they're right now, I can just imagine people listening to this episode and they're going, ah-huh that's my experience. I don't sleep well because dude next to me here is snoring so loud. Absolutely is , is sleep apnea dangerous?

Speaker 3: 7:33

Yeah, great question. So as we talked about it, that you can have different severities of sleep apnea, mild, moderate or severe. If it's really mild, we kind of just talk about lifestyle modifications, losing weight, maybe reducing alcohol before bedtime , uh, sleeping on the side and things like that. When it becomes moderate or severe, if the number of times that someone is holding their breath and stopping breathing is between 15 to 29 times an hour, we call that moderate obstructive sleep.

Speaker 2: 7:59

That's like once every minute or two.

Speaker 3: 8:01

Yep . Yep . Exactly right. And if it's beyond that and or if they're oxygen really tanks, you know, below 80%, you know, even in the mid eighties we know that that left alone over time confers a risk of cardiovascular disease, sudden cardiac death, heart attacks from sleep, difficult to treat high blood pressure, and it, it's a whole host of things that can happen. So I don't want people to worry because the majority of folks that come into our daughters, they've had sleep apnea for an extended period of time. So there's not a big risk that something's gonna happen tonight. My recommendation would be, if you think you have it, come and see us. So

Speaker 2: 8:39

Let's talk about what the experience of someone who has sleep apnea is . What does it feel like and and what kind of symptoms do they have? The

Speaker 3: 8:47

Prototypical example of someone has, you know, symptomatic sleep apnea, severe sleep apnea, they'll come in tired, they'll come in sleepy, they'll feel really just sluggish. They'll feel , they'll , they'll say things like, not only can I sleep if I have the opportunity during the daytime if give , if you gave me the opportunity, but I just feel like I'm walking through a fog and they'll say multiple times throughout the night, I'll wake up feeling like something is in the back of my throat, like my tongue or I've just awakened and my heart is racing and they don't sleep through the night. Um, so that's typically what people describe. Uh ,

Speaker 2: 9:23

You said there's different severities. Is it all caused by an obstruction or are you know, what makes one more severe than the other? I guess what I'm trying to say, y there

Speaker 3: 9:31

Are different types of sleep apnea. The one that we normally see typically in , in the population is obstructive sleep apnea. That word obstruction is a key that something is obstructing the airway like the tongue or the soft palate and and so forth. There's something else called central sleep apnea. That's usually happens when someone's using a lot of opioid pain medications and there's , there's sometimes brain lesions can cause this or heart failure. Patients can also have central sleep apnea. Um , but really the central sleep apnea is we are concerned about, but rarely are they really associated with severe desaturations. And we kind of just watch that for the obstructive sleep apnea, we definitely want to get that fixed and treated because it can be , uh, dangerous.

Speaker 2: 10:11

Now if you're not breathing once an hour, I can just imagine listeners are thinking that's a lot. Yeah, I mean is that considered a severe case and do they know that this is happening?

Speaker 3: 10:20

Some people do and that's why they will come in. Others are brought in by their spouse and say you are doing this at night and the patient says, I have no clue that I was doing this. This is news to me. I don't even believe it to be honest with you. And part of the reason is, Dave, we're sleeping when this happens. Right? We're sleeping and then all of a sudden there's this abrupt sort of arousal or disruption in our, in our brain rhythms when we're sleeping. But it may not last a long enough. Patients may not wake up long enough to remember that that occurred. So they forget that event and then they just think that nothing has happened. Is

Speaker 2: 10:53

It all night continuously or because and the reason I ask that , cause you and I have, I've known you for years and I've learned more about sleep from you than any other living human being and I know that there's different cycles of sleep overnight. Does, does the apnea occur continuously through all sleep cycles or does it wex and wane

Speaker 3: 11:08

Overnight? Yeah , we cycle through two different stages of sleep. Non REM sleep and REM sleep. In REM sleep it's very interesting because our muscles during REM sleep are paralyzed except for our breathing muscles and our eye muscles. That's why they call it rapid eye movements or our eye muscles are moving and we can breathe, but the rest of our muscles, including our tongue is way more relaxed than in non-rem. So in REM sleep we tend to see sleep apnea becoming much more severe in terms of the frequency and even the oxygen. Desaturations

Speaker 2: 11:38

Ren , what would cause a person to wake up? Is it simply the severity of the obstruction or why don't they just, you know , pass

Speaker 3: 11:44

Out? Yeah, that's a great question. So sometimes the fact that the throat is actually obstructing can be irritating and someone will wake up. But the brain is really smart. It says if I'm not getting oxygen, I need to do something different. And then there's a momentary awakening, the muscles constrict and then the patient is able to

Speaker 2: 12:01

Breathe. It sounds like it's kind of an evolutionary necessity that you wake up in <laugh> , otherwise we'd all be dead. Mother

Speaker 3: 12:07

Nature knows. Absolutely.

Speaker 2: 12:08

Exactly. I've heard that certain foods can make it worse. You've mentioned alcohol. Anything else? You know,

Speaker 3: 12:12

As I was mentioning a little bit earlier, the airway can be very sensitive to uh , collapsibility, but other things kind of make the airway or the soft tissue in the back throat swollen. So if we have things like GERD or reflux or spicy foods or anything that can irritate the back of the throat, like even smoking can make it really congested in the back of the throat, that's gonna narrow the airway and it's gonna make it more easy to collapse at night.

Speaker 2: 12:36

So one more reason not to smoke, that's an easy one, but you're not gonna tell me I can't like have a , a burrito or something out cause it's spicy <laugh> or good Indian food. <laugh> , you

Speaker 3: 12:44

Can have whatever you want, especially Indian food. <laugh> ,

Speaker 2: 12:47

You know what, I'm ready for a nap and I'm not even kidding. I can take a nap almost anytime . <laugh> . Uh , so I'll take a short break here and when we come back we're gonna talk about what can be done about sleep. Aptio stay with us. We'll be right back.

Speaker 1: 13:02

You are listening to the Healthy Matters podcast with Dr. David Hilden . Got a question or comment for the doc, email us at Healthy Matters hc m e d.org or give us a call at six one two eight seven three talk. That's 6 1 2 8 7 3 8 2 5 5. And now let's get back to more healthy conversation.

Speaker 2: 13:25

And we're back with Dr. Regi Verese talking about sleep apnea. You talked a little bit earlier about , uh, things you ask patients about symptoms they might have, but when they get to you at the Minnesota Regional Sleep Disorder Center, how do you diagnose it officially and say a little bit more about where you work?

Speaker 3: 13:42

So the first thing that we do is we have the patient come in. Usually we like to have patients come in with their spouses or their bed partners to get some collateral information. We do a comprehensive physical examination and a just a history of how they're doing. Ask questions about how they're sleeping and , uh, how they're doing during the daytime. And if we think that they may have some obstructive sleep apnea, we'll do sleep studies. And nowadays we can do sleep studies at home. There's a little device that we wear on, on our wrist and, and we can get information from a patient's , uh, sleep while they're at home. And then we also have a comprehensive sleep study where patients sleep in our lab, we put electrodes on their scalp, a couple of sensors near their mouth, nose near their eyes, chest and abdomen. And we just have them sleep through the night and figure out whether they

Speaker 2: 14:25

Have it. Can I just tell you that sounds awful , <laugh>. What do you mean they're gonna sleep through the night? Yeah, we put a sensor around your nose in your head. Now go to sleep. Really? Can people do

Speaker 3: 14:34

It? People do. People do. And if they can't, if we have some concerns, and I do ask that question, I I do give a sedative at night or a sleeping pill for those patients, they say, gosh, I I really don't think I can do it. And, and that won't mess up our data. Our sleep center's been around for this year, Dave , 45 years. It was founded in 1978. It was one of the earliest sleep centers in the country. It was founded by Milton Enger , one of the former chairs of neurology and, and his protege, Dr. Mark Ma Howell , I mean it's historical Sleep center . And um , just last week we were honored by the American Academy of Sleep Medicine for being an accredited site for 40 years. Um, this centered discovered REM sleep behavior disorder, which is considered by many as one of the most important neurological sleep disorders.

Speaker 2: 15:19

Congratulations on that. Anterior predecessors, I, I knew , uh, Dr. Maha well and I even got to meet Dr. Edinger , uh, uh, a few years back. Truly, the Minnesota Regional Sleep Disorder Center is a pioneer in this field and continues to this day to not only care for patients but advance the science. It's located right here in downtown Minneapolis at Hennepin Healthcare . Okay. Ren , a lot of people wear fitness devices and Apple watches and Fitbits and the like, and a lot of 'em will tell you how well you slept. Is that a valid measurement? Is that something that you think about when you're, when you're helping people who aren't sleeping? Well,

Speaker 3: 15:53

I, I do get this question a lot and people do bring their devices whether , uh, it be wrist worn or otherwise. And these devices are pretty good, not perfect, they're not as close to a medical grade device, but they can give us some parameters. They can give us an idea of how, what time people might fall asleep and what time people might wake up. It's a good correlation of when people might stay in their REM sleep because there's virtually no movement during that time and there's changes in heart rate. So these algorithms are figuring that out, but they're not as good as picking up on sort of the depth of sleep that people are in. But these devices also have oximeter on them now and those are getting to be fairly good. Maybe close but not nearly close to medical grade

Speaker 2: 16:35

To measure the oxygen in your Absolutely. Yeah . Which is one of the primary problems, right?

Speaker 3: 16:39

Absolutely. And patients bring that in and I kind of go, well, this is worth inspecting and we should maybe do an actual sleep study and figured this out. So

Speaker 2: 16:46

You've alluded to what people can do in their lifestyle to help mild sleep apnea, avoid alcohol and things like that. Um, you know, maybe sleep on your side. What treatments are available for people who need more?

Speaker 3: 16:58

So again, if you're symptomatic, if you have risk factors for, you know, heart disease, strokes, blood pressure, we really want you to get treated. And the mainstay Gold standard therapy has always been C P A P , continuous positive airway airway pressure, which is just essentially a box that blows room air, that's humidified , uh, gentle air that's sifts through a mass and keeps that airway nomadically open. But that isn't the only treatment. We look at the data on about 50% of people that start C P A P after a year of uses , when you look back into them , about 50% have stopped. So we know we need to have different alternatives and we do. So we now have, and we have had for a long period of time, little retainers for your mouth. We call them mandibular advancement devices. And these things are custom molded by sleep dentists to move the lower jaw forward. And if, you know, if you move the lower jaw forward, you're also moving the tissue, including the tongue forward. And so if we can put that in before someone sleeps, the jaws moved forward, the tongues moved forward, the airway is a little bit more open and the sleep apnea is corrected.

Speaker 2: 17:59

How far forward? Because I'm imagining somebody with a giant underbite all night

Speaker 3: 18:03

Long. <laugh> . So it depends on when the snoring is dissipated. We might have someone come back in for another sleep study with these , this device in place. And we do have to be careful because people can have joint issues by their cheeks called the temporal mandibular joint with some of these devices. But the devices are so slick nowadays this is becoming a little bit more of the norm than sort of the exception. But we also have other treatments as well, surgical options and uh , some devices that are out there that actually move the tongue forward with , uh, a little vacuum seal. These

Speaker 2: 18:33

Get advertised a lot.

Speaker 3: 18:35

Uh , they do this surgical option , um, is uh , a device that sits in your chest , uh, and has a wire that is dug underneath your neck and it , it touches one of the nerves in our tongue. And at night you turn this device on and when this device figures out that you might have a sleep apnea event , it'll stimulate the nerve, which stimulates the muscle of the tongue and moves the tongue forward and you turn it off in the morning. Really good data that it works. You have to have failed a couple of different treatments to figure out whether this is an option for you. And it's only good for people that have not too severe sleep apnea and not over a certain bmi. I have

Speaker 2: 19:12

To ask the question, it's probably on a lot of people's mind. Is that safe? I mean, you're putting a wire up, up onto your tongue. I'm gonna guess it is safe, but I want you to comment on the safety. It

Speaker 3: 19:21

Is , it is ef it's approved by the fda. So it is considered safe and efficacious and it is generally safe. Um , we , it works , it , it , it does work. And I mean, you know, nothing is foolproof, nothing has is ever without some side effects. And the most common side effects that people notice is that they may feel like their tongue is rubbing against their teeth. So, but well tolerated and really a helpful thing for people. They can't tolerate other things. So

Speaker 2: 19:47

Let's go back to c A P cuz that's what a lot of people are wearing and I get patients all the time and family members, some of 'em swear by it, others is no biggie. And others say that was miserable. You probably deal with this all the time in your clinic. Peyton, people who aren't loving their c A p , what do you tell them or why is it that they're hard for some people? Yeah ,

Speaker 3: 20:05

It can be a number of different things. One , sometimes people feel like the mask itself doesn't fit them well and that's okay cuz there are different sizes, different types of masks that are out there. So we start with is it the right mask? If it isn't, sometimes people say it's too much pressure coming out of this tube and I want to , I want you to lower the pressure. And sometimes we do that so that they can get acclimated over time to be able to use a C P A P . But then other times that's not gonna work. And sometimes I bring them back into the lab and sometimes we transition them to a device called a BiPAP . And there's some literature that suggests that BiPAPs can feel more comfortable compared to A C P A P .

Speaker 2: 20:43

Before I go on to sort of the future and some of the other newer things that are out there, what happens if, if you simply leave this untreated?

Speaker 3: 20:50

So you're , if you're sleepy because your sleep apnea is untreated, you have higher risk for not being as productive at work. Okay, fine. You are higher risk for motor vehicle accidents. You're higher risk for having an accident. If you're operating, you know, heavy machinery, your mood might be disturbed. You might not think this clearly, but then let's start talking about all the cardiovascular outcomes. You, again, are higher risk for cardiovascular problems like coronary artery disease strokes, sudden cardiac death, congestive heart failure, resistant hypertension. It's just wear and tear on the body.

Speaker 2: 21:24

Lots of good reasons for getting your sleep apnea treated. Plus you , you maybe won't go through a sleep divorce too

Speaker 3: 21:30

<laugh> for

Speaker 2: 21:31

Sure. Maybe your bed partner won't kick you out of the house and put you behind three double doors. So what,

Speaker 3: 21:36

What other

Speaker 2: 21:37

Cool things are out there in the future? Is there some pill that's gonna make it go away or are there some other devices or what are you seeing down the road

Speaker 3: 21:44

Again? Yeah, this is interesting. We don't have a pill, but people are working with a combination of molecules that do keep the airway a little bit more stiff. That's really early, early device. But the preliminary results are that it kind of works and it's usually good for people to have mild obstructive sleep apnea, not severe obstructive sleep apnea. Uh, there are techniques that you can use. Uh , singers, have you ever heard of singer use something called circular breathing? Mm-hmm . <affirmative> or people that use the diri do there are muscles, no, I don't

Speaker 2: 22:16

Know that last word you just said .

Speaker 3: 22:17

The witch the diri do is a , uh, an aboriginal instrument. It's an indigenous aboriginal instrument. It's a long tube that has this like

Speaker 2: 22:26

Me

Speaker 3: 22:27

Sound to it. And when you start to use your,

Speaker 2: 22:30

I totally know what you mean by way you've done it <laugh> .

Speaker 3: 22:33

Um, when people use this instrument or use this circular breathing or just kind of engage in these breathing exercises, you can strengthen up the muscles of the back of the airway that you can reduce mild sleep apnea. But this requires daily training, 30 minutes or so and even longer. But as you mentioned, are there other devices out there? Yes, there are devices that you can put on your tongue for 30 minutes a day that will stimulate the tongue muscles so the tongue muscles become stronger so that it, you know, reduces the sleep disorder breathing.

Speaker 2: 23:05

You're joking. I'm not kidding . There's a thing you put on your tongue while

Speaker 3: 23:08

You're awake and you just leave it in your tongue when it's hanging out. It's battery operated and it will strengthen the muscles of the tongue and keep it a little bit less prone to collapse. It's

Speaker 2: 23:17

Battery operating and it strengthens the muscles of your tongue. I have never heard of that.

Speaker 3: 23:21

Absolutely. Do

Speaker 2: 23:22

People use that?

Speaker 3: 23:23

Uh, I do not have any of my patients, but the folks that are at the VA have several patients that have gone through it and some love it and some feel like it's not the right thing for them . Right.

Speaker 2: 23:32

And I love that thing about the circular breathing thing. In a little side note, at one time I , I'll admit this, I went to a Kenny GE concert one time <laugh> . I did, I did. He played a note that was like eight minutes long and he never took a breath. Yeah . So he was playing and , and circular breathing. That's exactly right. I like your aboriginal , uh, sound effects better. You have a career in sound effects. Appreciate it. Dave. I <laugh>, what, what would you, leave us as we close it off here, Ren . Um, what would you like to tell people who are , uh, maybe not sleeping well, who think they might have sleep apnea? What, what would your closing tips be if you're young? Don't wait. Get it evaluated. Have someone sort of, if you're sleep sleeping with someone, just have someone kind of keep an eye on you. There are apps actually that you can download that will measure snoring levels and even sort of estimate whether you have apnea as well. If, if that's not the case and you suspect that you're sleepy during the daytime, if you feel like you're not getting good quality sleep, if you're waking yourself from snoring, tell your doctor, tell your doctor and they will likely refer them to a sleep physician and we'll get the ball rolling. I, I think the answer is, it's so common. It's so easily diagnosable and it's so treatable and the the gains are so big and the risks are too big that you might as well get the gains and not, and , and avoid the risk. That's a great message to leave us with. There's so much to be done about this. Ren Verese , thank you for being on the show with me today. I appreciate it Dave, thank you. We've been talking to Dr. Ren Verese . He is a physician and a sleep specialist at the Minnesota Regional Sleep Disorder Center here in downtown Minneapolis. And a colleague of mine and a frequent guest of mine. Whenever I can get some of his time to talk about his expertise. That's all we have for today. I hope you'll join us for our next episode when we're gonna tackle the subject of Alzheimer's Disease. It's gonna be a great show. I hope you'll tune in and in the meantime, be healthy and sleep well.

Speaker 1: 25:25

Thanks for listening to the Healthy Matters podcast with Dr. David Hilden . To find out more about the Healthy Matters podcast or browse the archive, visit healthy matters.org. Got a question or a comment for the show, email us at Healthy matters hc m e d.org or call 6 1 2 8 7 3 talk. There's also a link in the show notes. And finally, if you enjoy the show, please leave us a review and share the show with others. The Healthy Matters Podcast is made possible by Hennepin Healthcare in Minneapolis, Minnesota, and engineered and produced by John Lucas At Highball Executive producers are Jonathan Comito and Christine Hill. Please remember, we can only give general medical advice during this program, and every case is unique. We urge you to consult with your physician if you have a more serious or pressing health concern. Until next time, be healthy and be well.