Shelby Stockton spoke with otolaryngologist, Dr. Michael Castillo about sleep. They discuss both surgical and non-surgical ways to treat sleep apnea, and explains at-home sleep studies.
Shelby Stockton (00:00):
Welcome to the Texas ENT Audio Blog. I'm your host, Shelby Stockton. Today I spoke with otolaryngologist, Dr. Michael Castillo about sleep. We discussed how allergies, sinus issues, and sleep apnea can interrupt a good night's rest and how they're treated. Dr. Castillo talks about different ways to treat sleep apnea, both surgical and non-surgical, and explains at-home sleep studies. Do you wake up feeling like you didn't get enough rest? If so, take a listen.
Hi, Dr. Castillo. Thank you so much for joining the Audio Blog today.
Dr. Castillo (00:31):
Thanks for having me.
Shelby Stockton (00:33):
I'm excited to talk to you because we get to talk about one of my favorite subjects, which is sleep although we will be talking about what often interrupts sleep. My first question for you is how do allergies, sinus issues, and sleep apnea impact sleep, and how are they different?
Dr. Castillo (00:50):
That's a great question and I honestly don't always think of it in such a tight package because patients come in for different reasons and our conversations lead us in different directions. But allergies definitely impact sleep. People when they go through an allergic event and are having a rough few weeks with allergic congestion, they can feel miserable. And so we think of allergies as being sometimes periodic and there's a periodic nasal congestion and sometimes even all the time nasal congestion. And so when someone tells me they struggle with an allergic issue, it's keeping them from breathing the way they want to, we kind of zone in on the allergic solution to the problem and that could be it. Some people come in with a different story and they're concerned about specifically the fatigue that sleep apnea can cause or they're brought in because their bed partner is specifically concerned that they're not resting well or stopping breathing at night.
And so while we could go down an allergy path as we're discussing it, we do zone in on the idea of sleep apnea specifically. And so we get into the world of doing a sleep study to understand, "Are they stopping breathing at night? Is there a set of pauses that's leading them to not get the oxygen they need at night and not feel the rest they need to feel?" And so these issues intermingle and one does not exclude the other. They do play a role together and there are times we'll evaluate both. And there's times that we zone in on one as being the primary culprit for why they came in to see us today.
Shelby Stockton (02:27):
Can you explain what sleep apnea is and how it's most commonly treated?
Dr. Castillo (02:32):
Yeah. So sleep apnea is basically obstructive events that cause you to not have the amount of oxygen that you need in your body. So those obstructive events can be from different areas of your anatomy. As ENTs, we're most classically tuned into the obstructions in your upper airway. And so most often those obstructive events originate at the area of the tongue base or in the palate. And the amount of times you have those obstructions over the course of a night can lead to the diagnosis of a mild, moderate, or severe sleep apnea. And each of those ticks on that spectrum could have a different idea of what's most appropriate. And that's where really the sleep study helps us understand what your best options are.
Shelby Stockton (03:25):
What role do sleep studies play in diagnosing sleep apnea and when do you recommend them?
Dr. Castillo (03:30):
Yeah, exactly. So one of the most important things for us to understand is what the patient's options are. And so once we start understanding that the reason the patient is in to talk to us, is that concern of fatigue, morning headaches, the bed partner's concern of apneas, a sleep study really helps to paint a picture and I tell people, it gives us an impression of where they are in the world of one end of the spectrum being snoring without apnea, then you have mild apnea, moderate apnea, severe apnea. Each of those ticks have different ideas of what could be the best or most appropriate treatment option. So it's a very helpful thing to do.
Shelby Stockton (04:17):
And some people are really wary of sleep studies because they think that they have to leave their bedroom for them, but these days you don't have to do that, right?
Dr. Castillo (04:26):
Yeah, it's become much easier. In our office, we have devices that we just give to people. They're called a watch pad. So they take it home, they wear it at night, and the data gets sent through the cloud to a sleep physician who reads the study. And very quickly, I'll get the results and communicate with the patient. And so it's not that story that people remember of wires and tubes and a restless night in an odd facility that is very distracting. You're at home in your bed and you have the typical night's sleep that gives us an accurate result of what you're dealing with.
Shelby Stockton (05:04):
You can't get more convenient than that.
Dr. Castillo (05:07):
Right.
Shelby Stockton (05:08):
Can you share a story or a testimonial of a successful sleep apnea patient?
Dr. Castillo (05:13):
Yeah, absolutely. So there's different spectrums of sleep apnea patients, and so we can even take this back to kids. Kids come in and parents have stories where they are worried that kids are stopping breathing. And those patients, we don't even get sleep studies a lot of the times. We do tonsillectomies and adenoidectomies and parents will tell me it's remarkable, they don't hear their child making any noise anymore. They've been cured. Once you get into adulthood, that story is not going to be the classic story. Although I did have a lady in her fifties recently who had a sleep study that was moderate to severe sleep apnea, but she had very unusually large tonsils. And so the decision was made to take out her tonsils and we got a sleep study two to three months later after she was feeling great just to prove that we fixed it.
And her sleep study showed that she had normal sleep with no apneas. That's definitely not the norm. Adults don't necessarily have big tonsils where we're going to cure them, but in certain situations that could be the answer. More often these days we're doing things like the inspire surgery, which is a nerve stimulating surgery. And I can remember my first patient that I did an inspire on, she was a lady in her seventies and she had six or seven foster kids and was just feeling like she was not able to be as helpful as she used to be. We did the inspire and in three months, she had her follow-up sleep study that showed she had no apneas and she was feeling great.
So I think again, getting a before sleep study, the intervention we choose, and getting a follow-up sleep study to make sure it correlates to what they're feeling, we definitely find a lot of successful options out there. And some patients even come in and they haven't really been on a CPAP before and they might be reluctant to use a CPAP. And so what we're doing as ENTs does not always mean you need to have surgery. There's certainly patients that come in and we get a sleep study and we offer a CPAP, we can get it sent to their house. And I've had plenty of patients just say it's been life-changing to get a good night's sleep. They don't mind having a device that helps them keep their airway open. And they've been very happy with non-surgical interventions for this problem.
Shelby Stockton (07:31):
Amazing. Thank you so much. This has been very educational and thanks for your time.
Dr. Castillo (07:37):
Thank you. I appreciate it. Have a great day.
