Shelby Stockton spoke with spoke with ENT specialist Dr. Michael Moore discuss common sleep disorders, how to diagnose them, treat them, and what patients can do about snoring and sleep apnea. Dr. Moore explains both surgical and nonsurgical ways to treat sleeping issues and some recent advancements in the field.
Shelby Stockton (00:00):
Welcome to the Texas ENT Audio Blog. I'm Shelby Stockton, and today I spoke with ENT specialist Dr. Michael Moore.
We discussed common sleep disorders, how to diagnose them, treat them, and what patients can do about snoring and sleep apnea. Dr. Moore explains both surgical and nonsurgical ways to treat sleeping issues and some recent advancements in the field.
If you or a bedmate suffer from sleep related issues, take a few minutes to listen to Dr. Moore's advice about what you can do to get a good night's sleep.
Hi Dr. Moore, so good to see you today.
Dr. Michael Moore (00:34):
Hey, how are you?
Shelby Stockton (00:35):
I'm great. Thank you for spending some time with us. I have a few questions for you specifically about some sleep related issues. So my first question for you is, as an ENT specialist can you give us an overview of your experience in treating sleep related issues?
Dr. Michael Moore (00:50):
Sure. As ENT specialist we are trained in both the diagnosis and treatment of multiple sleep issues, mainly snoring and obstructive sleep apnea. So we have the expertise on both the diagnosis side and as well as the treatment side.
So on the diagnosis side, we certainly order sleep studies and one of the advantages we have is we can send a lot of patients home with a quick home sleep study from the office. That way they don't have to go to a sleep lab or make additional stops. It's all done at the point of care, which is a real advantage for a lot of patients. And in addition, we have both the knowledge and the instruments to do a complete assessment and evaluation of the upper airway, and that is where snoring and sleep apnea come from. So I believe that we have both additional funds of knowledge as well as instruments to be able to diagnose and provide information more than a lot of other specialties can.
So on the treatment side, we're able to prescribe CPAP as well as offer additional kind of positional therapies, other things that people can try to do to improve their snoring. But we also offer surgical options, so different types of upper airway surgeries as well as a new implantable obstructive sleep apnea device called Inspire.
Shelby Stockton (02:28):
What are the most common sleep disorders related to ENT issues and how do you diagnose and treat them?
Dr. Michael Moore (02:34):
So really, snoring and sleep apnea are the most common things that we see in our field. Now that can be related to many other issues. A lot of people with bad sleep apnea have bad issues with reflux because of the sleep apnea. So there's a lot of other issues that can tie into that. But mainly it's the snoring and the sleep apnea that we see in our office. In part that's because that is the largest cause of sleep related disorders in people is obstructive sleep apnea.
Shelby Stockton (03:07):
How do you approach your patient's diagnosis and treatment of snoring and sleep apnea?
Dr. Michael Moore (03:12):
So I like to think we take an approach and look at the whole person. So we will do a full diagnosis in the office, including a thorough physical exam as well as a upper airway evaluation, looking at areas in the nose and the sinuses back where the tonsils and adenoids are and down into the throat to get a complete understanding of where the obstruction and where the narrowing is. We're then able to again, interpret and look at studies looking for sleep apnea. And then for most patients able to present four or five different options for the best way to treat them. I like to think that each of those options are very patient tailored depending on the patient's overall health, the patient's age, preferences for trying sleep apnea versus wanting to avoid CPAP, wanting surgical procedures are wanting to avoid surgical procedures. We factor all that into it to create a approach for that particular patient.
Shelby Stockton (04:24):
You touched upon it a little bit before, but what surgical and non-surgical interventions do you typically recommend for sleep apnea?
Dr. Michael Moore (04:31):
Yeah, great. So non non-surgical options, so the most common one being CPAP. And CPAP is great. There's a lot of people who love their CAP machines. But when you look at the data, the long-term compliance is only 40%. So 6 out of 10 patients are not going to be on a CPAP machine within one to two years of being prescribed. So we really need other options for that big population subset.
So other kind of non-surgical options. Some of it is positional therapy. When we break down the data on a sleep study, sometimes we see that maybe if the patient adjusts the bed differently or sleeps on their side, they're able to significantly improve their sleep apnea. We also work closely with dentists who can make what are called mandibular repositioning appliances or more commonly oral appliances that help to pull the lower jaw forward when they sleep so that it relieves the obstruction. And those are kind of the most common non-surgical options that we see, in addition to weight loss. A lot of times we have discussions about weight loss and how that can translate into being successful for obstructive sleep apnea.
In terms of the surgical sleep apnea, a lot of those sleep apnea treatments are going to be based on what we find on the airway assessment and how bad the sleep apnea is. So for some patients we're looking at doing a septoplasty for a deviated nasal septum. Some patients we're looking at removing enlarged tonsils or removing enlarged adenoid tissues. Some patients need sinus surgery because we find nasal polyps or other chronic sinusitis. Some patients we perform what is called a uvulopalatopharyngoplasty, or more commonly a UPPP, where we trim the palate and remove portions of the uvula in the back of the throat, which can open things. And so depending on what the anatomy looks like, it can be a combination of those surgical modalities to get relief for the patient. And then the last thing is, that's a newer surgical technique is the Inspire surgical implant.
Shelby Stockton (07:03):
Which I think is the perfect segue for my next question for you.
Dr. Michael Moore (07:06):
Sure.
Shelby Stockton (07:06):
Are there any recent advancements for sleep related issues that you find to be promising or noteworthy?
Dr. Michael Moore (07:12):
Absolutely. So Inspire is a novel surgical implant and it really gets to the root of the cause of sleep apnea, which is airway collapse. So the Inspire device monitors your breathing while you're sleeping and it stimulates your airways so that you don't have obstruction while you're sleeping. It is a great option for those 60% of patients who are not tolerating CPAP and have failed other types of either surgical modalities or other types of non-surgical attempts of care in the sleep apnea. So mainly it's indicated for people with moderate to severe sleep apnea.
The results are very promising on it. It's greater than 90% of bed partners report no snoring or very soft snoring afterwards. Greater than 90% of patients are pleased with it. And those statistics are a lot better than CPAP and a lot of the other treatments that we have to offer.
Shelby Stockton (08:29):
Amazing. Science is so cool.
Dr. Michael Moore (08:31):
Absolutely. Absolutely.
Shelby Stockton (08:33):
Well, thank you so much for spending time with us today. We really appreciate it.
Dr. Michael Moore (08:40):
You have a great weekend. Thank you.
Shelby Stockton (08:41):
Thank you.
