- So what's obstructive sleep apnea? It's intermittent repetitive obstruction or collapse
of the upper airway. It's a mechanical process in most cases, although there's other reasons for
it too other than mechanical, associated with a drop of blood pressure. Because you're not breathing,
you're completely choking. You're not breathing oxygen drops and I tell you some of these a apneas
can last two, two and a half minutes. Very long you sit there - when is this guy gonna breathe? You
know - should I go in and shake him? And that's what happens, the bed partner ends up shaking them awake
because it's bothering them. This guy is not, so he usually is the man, this guy's not
not breathing. And so um because they're trying to breathe against the closed throat, that activity
makes them sweat. They sweat they wet, usually the pillow and and then it wakes them up. And luckily
that's what saves them. Because that by awakening up they snore and choke and gasp and carry on, do
that four or five times, breaths and then they fall back asleep. They do it again, repeat the
whole thing again. Heart rate also goes down as you have the apnea, and and it's it's like
stepping on the brakes and the gas at the same time in a car. Because the heart rate goes down
but the blood pressure starts going up. And when you start breathing again you're no longer are
stepping on the brakes not just the gas and then the heart rate would really shoots up and blood
pressure really goes up, and that's a tremendous amount to stress in the cardiovascular system.
And I actually have a graph here from one of our patients. This is of about ten years ago, here at
UCSD. This person has severe effects sleep apnea. We're just gonna focus on this. By the way this
patient is in REM sleep. REM sleep gets worse when, apnea gets worse when you're in REMS.
Because you're paralyzed, yep totally choked out. And there's two channels for airflow, two channels.
For effort, respiratory effort, and this channel is for for saturation, how much oxygen you have
in your blood. Notice there's lack of air movement at all, here almost a minute in this case. Notice
how the effort is crescendo, and the patient is also paradox, meaning that the chest is going in
the belly is going out. Because there's no air movement in. The belly has to move somehow. The
belly is stronger than the chest when we breathe. And I noticed the saturation from 95, 94 percent
down to 66%, tremendous amount of stress in the cardiovascular system. So this patient has severe
obstructive sleep apnea especially in this case during REM sleep. And you can't see the heart
rate here but it speeds up here and then it slows down again. There are other cases that that is more
prominent than in this one. So how many of us have obstructive sleep apnea? I just highlighted two
here in this graph of the prevalence of specific populations, older veterans. I am the chief of sleep
medicine at the VA hospital. If I walk in the wards or in the hallways, anybody I see, 80% of the time I'm
gonna be correct saying this is sleep apnea. Sleep apnea, sleep apnea. Because they're older, they're
overweight, blood pressure, hypertension, diabetes, a number of other risk factors. And so 80% will have
significant obstructive CPAP that needs to be treated addressed. And the elderly, 50 to 70%. Just in this
the fact that we're getting older we tend to get obstructive sleep apnea. As we get older, things
get bigger. You know the ears get bigger, the nose get bigger, things start sagging okay. The uvula,
the soft palate is floppy and they're also very easy to choke, the tongue gets bigger, and if you're
overweight it's even worse. And so the elderly we tend to also get obstructive sleep apnea. And as
you can see the risk factor is also for women and for men, and I didn't put in the reference here but
it just goes to show that aging has a lot to do with the prevalence of ? sleep apnea. It tends
to level off around the age of 65, 70. And that is probably just a survival affect because people have
died off, and now it's just the strongest survive and they don't change. So who gets obstructive
sleep apnea? It is really a public health problem because in epidemic proportion you saw eighty,
seventy percent of us when we get older we get it. Young people have it. I believe that there's
two types of sleep apnea. One that I call malignant sleep apnea, and that hasn't been picked up in the literature yet.
Those who are 30 to 60, strongly associated with being obese. And that has very prominent or very
important cardiovascular complications. They will get a heart attack or a stroke sometime, the younger.
And then you have the apnea that happens just because we get older, you know the the floppiness
that I described, that's exactly. And and so that one is not as bad, but when somebody is sleepy
we do treat him. But you know people who are like this. This gentleman actually give us permission to
use his picture and it's got short thick neck, truncal obesity, skinny arms, skinny legs, maybe
hypertensive diabetes. But what about her? Do you think she would get sleep apnea? Okay
most of us - ok she's young, she's thin. And but I tell you up to 25 to 30 percent of patients
who have sleep apnea are thin. I had people, patients who look like her, and it is a social
problem. They can't keep a boyfriend. Or the family they go on trips with their girlfriends and they
have to rent a room by themselves because, yeah because they snore too much and they say - you go
out there. And so it can become a social problem. Including this the consequences. You can dress
them up, comb their hair, bathe them but you can't take them out anywhere because they fall asleep.