I am Dr. Suzette Mikula, otolaryngologist at MedStar Georgetown
University Hospital. One of the things that led me to become an
otolaryngologist is the relationship that I can develop with patients through
the progression of their condition or disease.
I'm specialized in Otolaryngology. But since I'm also board certified in Sleep
Medicine, I try to use a more holistic approach in the care of my patients. So
when patients come in with complaints including chronic fatigue that can
encompass not only in chronic infection but can also you know be a cause of
their chronic sleep deprivation or chronic sleep problems. So I also try to
look at that. In addition, patients have environmental allergies and believe it
or not this can also impact your sleep and also impact your sinus problems. When
you have chronic sleep deprivation, that can affect you in all walks of life as
well as your health. And it can lead to medical conditions such as hypertension,
cardiac arrhythmias, type 2 diabetes, gastroesophageal reflux disease, and so
on. For a patient who comes in, let's say, with a snoring problem, because I am board
certified in Sleep Medicine, I can see that patient and figure out their
specific diagnosis, send them for a sleep study, confirm or not confirm that they
have that problem, and then treat them either medically or surgically or
sometimes with a non-invasive treatment in the office.
It feels great when I can treat someone who has a sleeping problem that is affecting
all walks of their life and help them sleep well.
An otolaryngologist is someone who cares for patients with disorders of the
ears, nose, or throat, commonly known as ENT. However, there's a lot of overlap
with other subspecialties. For example, there's overlap in the
field of neurotology, in pediatrics, in laryngology, facial plastics, and head and
neck surgery, and allergy, and sleep medicine, and we continue to expand.
The most common disorders I see are snoring, chronic sinusitis, allergy
problems, and nasal disorders.
We actually are the sleep surgeons. So it's important for us to understand and
know about how different sleep disorders can present.
The most common symptoms that patients complain about are snoring,
chronic nasal congestion, and post nasal drainage is another one. Oftentimes,
they'll complain about cough that's related to chronic post nasal drip. Or it
could also be related to gastroesophageal reflux disease which is
another common thing that we overlap with gastroenterology.
So one of the things that brings patients to me is when they're having
recurrent sinus infections, and they're just not going away with multiple
courses of oral antibiotics, or they've been treated with over-the-counter
antihistamines, or over-the-counter nasal steroid sprays and it's just not working
anymore.
When patients come to see me, I often use tests to diagnose their conditions. This
can include a home sleep test that we have available in our department that
the patient goes home with and wears at night and then brings back in the
morning. This is something that we set the patients up with in the office and
explain to them how to use it which is very simple and almost always covered by
their insurance. We also do blood testing for allergies and this doesn't
require that they have to stop their antihistamines ahead of time. We
could just actually send them for the allergy test on their first visit to
figure out if they have that condition or not. We also can send them for
radiologic imaging studies such as CAT scans to diagnose chronic sinusitis.
Some of the common symptoms for obstructive sleep apnea include waking
up feeling tired, not refreshed, having excessive daytime sleepiness, waking up
with a morning headache, feeling like you're in a fog, or feeling like you're
dysfunctional at work.
The reasons for sleep apnea are multifactorial. It's not just weight. It's
not just age. It's a combination of things. It also has to do with
neuromuscular tone, and it can have to do with fluid shifts that occur after you
lay down. A lot of it is related to anatomy and definitely weight is
definitely associated and sometimes can make it worse.
So not all patients who snore have obstructive sleep apnea. But most
patients with obstructive sleep apnea will snore. Sometimes people or
oftentimes people with obstructive sleep apnea will also grind
their teeth. It's a way of naturally stenting the airway open. So that's
always a worrisome finding in patients who snore. And then we look at their oral
cavity and see that there's evidence of grinding, or maybe their their bed
partner hears them grinding as well as snoring.
When patients come to see me for problems with snoring and I feel that
they have risk factors for obstructive sleep apnea, I will usually set them up
for a sleep study which could be off in a home sleep study or an overnight sleep
study. Once I get the results of the sleep study, I usually have them come
back to the office and we discuss the treatment options. Usually, the first
thing that we try them on is the CPAP machine,
the continuous positive airway pressure, using either one of three different
types of masks: the nasal mask, the nasal pillows, or the full face mask. They try
this for a period of time usually about four to six weeks. If they can tolerate
this treatment and they feel relief that's pretty much all they have to do.
But we do monitor them, and we obtain data reports after a few weeks to ensure
that it's eliminating the obstructive sleep apnea effectively. If they don't
tolerate this, then we discuss alternative treatments such as surgical
options with them.
With the home sleep study, this is a unit that we have in our department that's a
very simple thing to do. It's not very complicated like when you go for an
overnight sleep study. Nowadays, insurance is not covering overnight sleep studies
as often, and it's not always appropriate to send someone for an overnight sleep
study when it's pretty clear that they have a condition known as obstructive
sleep apnea. A home sleep study can just help confirm that or not.
CPAP is continuous positive airway pressure delivered through a mask that
is used to treat patients with obstructive sleep apnea. This is usually
the gold standard for treatment of obstructive sleep apnea.
However if patients do not tolerate CPAP and cannot use it, surgical treatments
can be used to effectively treat obstructive sleep apnea.
When you use a CPAP, there are three different masks that you can try and
these are really three main categories of masks. And this includes nasal pillows,
which is a almost like a nasal canula underneath the nose, then there's a mask
that goes over the nose only, then there's a mask that goes over the nose
and the mouth.
You need to use the CPAP every night in order to prevent the
symptoms that include, you know, morning headaches, excessive daytime sleepiness,
feeling like you're in a fog.
There are surgical treatments, and there is actually a new surgical treatment
called the hypoglossal nerve stimulator which is something that we are doing
within the MedStar system. If it's mild obstructive sleep apnea, there are some
non-invasive office procedures such as radiofrequency coblation of the soft
palate which can also really help with snoring.
There are also some implants that can be used to also help with snoring and some
very mild obstructive sleep apnea.
So after they have this type of surgery, they usually have to heal from
the surgical incisions you know which cause some swelling. And so, it will take
a period of time before they actually start to feel the benefit but there are
some people who have significant airway obstruction where they can almost feel
immediate results.
One of the things that can occur with obstructive sleep apnea is falling
asleep at the wheel, and there are people every year that fall asleep at the wheel
and either cause death to other people or injury to themselves or death to
themselves. So that is a real risk. Other risks involve development of
hypertension, development of heart arrhythmias, problems with diabetes type
2. All of these things can be a risk. It can be a result of not getting treated.
Also in addition, if you don't treat your obstructive sleep apnea and it's
moderate to severe, studies have shown that it definitely takes several years
off your life.
Dieting can actually help reduce the severity of the sleep apnea, but it often
does not eliminate the obstructive sleep apnea. And if we only rely on diet, this
could take a very long time that the patient would be without
effective treatment of their obstructive sleep apnea while they're trying to lose
weight which we all know can sometimes be challenging.
When patients come to see me at MedStar Georgetown University Hospital, I
can use a more of a holistic approach in my care for them. So if they're snoring,
you know I can figure out if it's related to a sleep disorder such as obstructive
sleep apnea, or if it's related to a sinus problem such as nasal polyps,
or if it's related to a nasal obstruction type of problem such as a
septal deviation, or a nasal valve problem, and then arrive at a diagnosis
and treat them all in one stop.