Second-hand Snoring

- Hey, Dr. Madan Kandula with ADVENT and your host of ADVENTing. Where we talk about everything ENT-related and the world in general around us. I am here with Dr. Ethan Handler our co-host. How are you doing?

- I'm doing well.

- We are here, what is it July 5th?

- July 6th actually.

- July sixth I missed the day, so shortly after our country's birth.

- Did you have to catch Hamilton on Disney Plus?

- I have not, I'll watch it, I haven't seen it. I mean, I've seen it live twice, so I'll, it's on our short-term to do lists to say, did you watch it?

- We, you know, you got to watch segments of it, it's two hours and 40 minutes long, but so the kids know all the music and they like watching the cat of the dancing and that kind of stuff. So with the original cast, which is kind of cool, so yeah.

- You know, it'd be interesting to see what that is like, I enjoyed it the first couple times.

- I'm curious to know how many people watched it. Like how many views they had in streaming, my guess is it's like astronomically high, so we'll see.

- Yeah, I think it's also like, we've talked about this whole quarantine kind of thing and lack of options. I feel like this is... If you've got like a Michael Jordan documentary or Hamilton up your sleeve, and you're a streaming service, like slap that out and just sit back and watch the eyeballs probably come to town,.

- Which is all Disney, all of those things, so--

- Yeah, it's true, yes. You know, they are the mouse, the mouse knows. He's all knowing, he's all powerful.

- He all knowing and powerful.

- He cannot open his, I think he's gonna open his parks.

- Yeah, I don't know what the situation they were.

- I thought it was gonna already, no it's this month. I know that the NBA is going down.

- That's right, they call it the bubble. Did you see something on that? Like the insane, like I mean, I get it, I mean, I guess they wanna, you know, obviously they wanna be safe and get things back up and running, but people coming in there have to quarantine test and like wear bracelets and different colors.

- I think you could lock it down pretty well. I feel like there's like a sabotage angle on this. I think if they actually play the season out of a sense that there are going to be players who get COVID at inopportune times that really impact outcome. Just imagine like going into the finals and say it's the Box and say, Yonis test positive. And so what do you do? Well, you shut down for the entire finals. Like even in your bubble, I'd say that, that's still possible. Just there's a whole, I mean, he could've gotten a flu previously. Like other stuff could have happened, but it's just a whole other level of, whatever.

- Unless all the players are getting phase two, like antibodies in the trial to see if they stay immune.

- I don't know, it's interesting.

- So it is interesting. We'll see. But you, and then July 4th, any special meaning growing up, did you hate this country or love this country?

- No, it was actually very fun. Well, so I grew up, I mean, as you know, in California, but where there are crazy wildfires. And so, we used to grow up and I'd have this. It was, we had lived in the cul-de-sac and so everybody would come out on the street and, you know, you have the board, like, what were the fireworks that spin around on the nail? So for many, many years growing up, everybody would buy fireworks and bring them. And this was pre-California outlawing fireworks, you know I remember one particular year, I mean it was a lot of fun but I remember one particular far off in the distance, you could see a fire raging on the mountain that had been started by a firework, you know? And then all of a sudden California shut down the idea of being able to fly fireworks, because it's been oven flames every summer for 10 years, so.

- They were rolling with it this weekend.

- [Ethan] Were they? Didn't you see it? I guess the governor banned it. I don't think it was... I think it was more assembly versus fire-related but, and I actually didn't see it. I saw a picture of it, but like folks who were like, wow. And so apparently like, it was like fireworks every... So basically, conceptually, the government is banning you from doing fireworks and ban for whatever reasons they have reasons. But then the actual holiday is a celebration of revolt against government intervention. And so, it's sort of an interesting juxtaposition where the government says, don't do this. And on that very day, you see mass displays of the American spirit.

- I mean, we all have always loved the holiday. My family loves it, my kids, my four year and a half year old, couldn't quite make it up for the fireworks. He fell asleep right before they started and then like fell through through them all. But I love it. How about you?

- No same stuff, I mean just as a kid growing up. Yeah, the home, I grew up in Ohio, so it just sort of that we were, I don't know where we got them somewhere. We didn't get them in Ohio, I think. For you like the fireworks, there was a time when they were banned many places, even now, I think you can get them, can you get them in Wisconsin?

- You can buy them here.

- But you can get like good ones. Like there's like some, we would go, I can't remember. We'd go to maybe Indiana and get like the real stuff, 'cause in Ohio you just have the sparklers and you feel like a loser, so you'd have to go outside your zone, get the real stuff and then you just bring--

- Like the M-80s?

- Bring Armageddon down. So not that I did that, I would never have done that. Of course not, but I was witness to certain things. So growing up in the 70s and the 80s was good.

- Yeah, it's amazing actually, that probably I didn't lose any fingers or anything else. I mean, that's always like when you're a resident and you're doing trauma call or something else, like July 4th is always one of the busiest holidays as a surgical resident, because you're seeing all sorts of injuries that you wouldn't see otherwise. And so hospital census goes way up just from that.

- Yeah, Oh yeah, it's party, a part of it's. I mean, this is probably why the governor was banning it.

- [Ethan] That was here?

- California. [Ethan] Oh, okay.

- You know, 'cause it's like, it's fireworks, it's basically warm weather, fireworks, alcohol, celebration. The recipe for ERs to be really busy. And so I kind of get it, but yeah, I mean every. I mean, summer in general, in residency, when you're in the ER, is just hoppin' and then July 4th was extra happens. Yeah, speaking of loud sounds, did you like that transition?

- [Ethan] And that was perfect.

- Speaking of loud Saturday. So we heard a term today, which is the first time I've heard it. So we're gonna point it out, which is secondhand snoring. What's secondhand snoring.

- It's bad for your health man.

- What is it? You know, I mean, well, if you're going to run with the analogy of secondhand smoke, it's a person suffering from the effects of snoring who isn't actually sorting themselves. So it's their bed partner, keeping them awake, them having problems, even though they don't necessarily, inherently have that problem.

- Yeah, I think, actually thinking back to the 70s and 80s I remember as a kid, that term secondhand smoke, I was thinking they had smoking secondhand smoke came out. That was a big deal, honestly, because I think pre that it was like I'm, you know, back to the American spirit and the worldwide spirit to some extent is I'm gonna smoke and it may kill me, but I'm gonna smoke. You have no say in the matter, because I wanna smoke. And I think that secondhand smoke kind of thing that came out and being a kid back then, I remember it was sort of, it resonated and they talked about it in school and it was kind of, you know, this smoking thing that is your choice is actually hurting other people and now it's a problem. And now you need to go outside. You know, I could actually almost literally kind of count backwards in time and see how things sort of evolved to now like indoor smoking, unless it's your own house is pretty, pretty rare. Yeah, I remember when those policies, 'cause that was, I mean during my obviously lifetime and enough to remember it, but like that was, there was a lot of pushback against that. There were certain States that kind of started to do it and counties and then all of a sudden, like things started to grow and now think about it now it's like, could you imagine going into a restaurant other than unless you're in Las Vegas or in casino, like if people are avidly smoking like--

- [Madan] No it's crazy Know how weird that would be?

- I tell him, I mean, 'cause we go look like it's with my kids and we'd go. I mean, I remember as a kid on an airplane, and the back rows were smoking section, is this past your-

- [Ethan] Whoa, I predate that, no I don't remember that.

- So they're, you know, the ashtrays were on the armrests and so they would, you know, back of the plane was smoking and they would put the curtains up, the magic curtains that magically kept the smoke away from everybody else. I remember smoking sections in restaurants. And then if you happen to sit in the nonsmoking section, but you were next to the smoking section, same thing magically the smoke, never...

- [Ethan] Isn't that crazy how that never drifted over.

- Never drifted, so it was like the miracle then, but it gets back to the snorers. It's a, you know, not, well, here's breaking the analogy. I'd say, if you're smoking, you have a choice. Now it could be an addiction, which you know, so for the zone, but at some point you had a choice of starting that or not starting that. Snorers don't have a choice. They're snoring and it's problematic for their sleep significantly. But then the additional ripple effect here and I got to think of, I say this and I pause every single time I say this, but it's a snoring unlike any healthcare issue that I can think of effects, not just the person that it impacts, but those around them. I can't think of anything else that does. There might be others, but if you think about this, if somebody snores their life is negatively impacted, their life will be shortened over time if they don't do something about it likely. And then those around them, especially somebody who's in the bed next to them. Their sleep is disrupted almost just as much as the sleep of the individual who's snoring. So it's like the perfect storm of individual impacted by something that they didn't do, but it's happening within them. And then the person that they probably love, which is a person next to them, they're also impacting that person's day to day life, 'cause that person's probably combination of MAD, frustrated, angry, which is the same as tired. In a haze, all because of you, because of the bozo next to them, that they're like, you know what I mean? You cannot sleep next to a snorer and be kept awake without it creating some degree of friction. You can be the most Zen stoic person in the world. I bet you in monasteries throughout the world, if they have double rooms that, you know, there's the month that's snoring and the month, that's not and the monk is gonna do their Zen. But I challenge you to out Zen a snore because it's like literally you're trying to sleep. You're tired. Obviously you wanna go to sleep. And then the sound comes in and the sound is something that just it's gonna zap you. And so you can't sleep through it. And so, of course you're gonna be frustrated. And of course, you're gonna wanna do something about it. But I don't know that back to the story analogy. Until now, I don't know that society has said, "Hey, secondhand snore, this is not funny, it's not good, this is a problem. If it's snoring is problematic, if because you're just not sleeping properly, snoring, a 100% of folks with obstructive sleep apnea snore and so if you have snoring, you mmmmmh the person who's snoring maybe or well have sleep apnea, which is basically a domino effect, that's gonna shorten your life over time, kind of a thing. And so I think the situation where soar is happening, that partner's annoyed. What are you gonna do about it? It's a challenge. And we've been trying to work through this challenge, you know, at ADVENT, trying to figure things out. We've got some ways that, you know, we think there may be naval ways to try to approach this. But at the end of the day, I think the simple approach is just the indisputable fact that snoring is problematic, taking care of snoring and treating the snore, retreating the snoring is really, really important. And it is a team sport, meaning that it's not just the snore, you know, you guys are on the same team. You know, and it's one of those things where working together, working with the healthcare system, with us for those folks who choose to see us, we can do something to both stamp out the snoring, in a good way, like get rid of it. Somebody snoring it's like their airway is closing down. That's not good, so if somebody is snoring and we can maintain their airway open, when they're sleeping at night, that's good snore, breathing properly, no longer snores, no longer snore, all of a sudden person next to them, instead of, you know, creating an enemy, you're creating somebody who's happy and back in the Zen world.

- Yeah, it's very easy in that world to cast blame. And I think that, you know, we can do as much as, as we can to try and remove it. It's not the blame game. It's not like, "Hey, why can't you fix this or get better?" That person may want to help and it affects the whole household too, on top of that. So, I mean, I find it spans generations, you know, you see patients, they're like, "Oh my dad used to snore like a chainsaw." You know, and that comes up all the time.

- [Madan] Sure, absolutely. So it's like really, I mean, they want people expect that they should because their family did or their dad or their mom did. And there's some genetic predisposition to snore or have this restful sleep. But I mean, that must be etched in their memory if they remember vividly dad or mom snoring that loud.

- Yeah, although that reminds me because when I was a kid, my dad snored, he's actually, well, he's on CPAP now. So he's getting treated, but I don't know exactly. It was past the time I was out of the house that he's on CPAP, but I would say my dad's still alive, and I'm thankful for that. But a lot of times when I'm talking to patients, it's, you know, they come in with their story and they say, yeah, my dad snored. And then it depends on how this individual is, but oftentimes it's, am I, you know, but my dad passed away from a heart attack when he was 50-blanks, 60. And then I don't go there because it's sort of impolite in the moment because we're talking about their issues. But it says the obvious question in that situation is, and the likelihood in that situation is his dad or mom who snored and passed away from a heart attack or stroke in their 50s, 60s, 70s. Those things are likely related.

- No they probably had sleep apnea.

- It's what I'm saying, those things are, it's not two separate things. It's not a one sentence, my dad snored and another sentence, and he died of a heart attack. It's my dad snored and he died of a heart attack because he had untreated sleep apnea is probably the full paragraph there. And most people don't put those things together. It gets back to the situation at hand here. What we're talking about is real significant issues that deserve attention and they don't deserve it tomorrow they deserve it today. And there are real significant things that we can do to help somebody get on the other side of that. Nobody wants to be a snorer. Nobody wants to sleep next to somebody who's snores. Everybody acknowledges it as a problem. I think the reality is the world doesn't know that there are actually solutions for these problems, and so that's the disconnect. The disconnect is that in a world that has no solutions out there, you just sort of accept these problems. And there's no reason to do that, really, at this point, we're not perfect. I mean, medicine is evolving and it will continue to evolve, but I'd say there are enough solutions and options for folks these days that there's no excuse not to seek attention.

- Yeah, I just think that it's such a fractionated kind of process out there that patients oftentimes get lost in the fold and like get half treated and can't follow through, or don't have the bandwidth to understand what they need to do. You know, I mean, they're looking to us and to medical care providers to kind of put them on the right pathway and get them from point A to point B in a process that makes sense to them. And so that's where they get lost really. And so I feel like we do a pretty solid job of at least trying to walk patients through our logic and how we approach things and say, okay, if getting over the goal line means stop snoring, feel better in the morning when you wake up, maybe wanting to lose weight, maybe it's always been a goal, but you sleep like crap and your spouse does too. And like, okay, great. How are we going to get you over that goal line? There's the process that we can take here are the pathways. So it's important because otherwise patients get frustrated and just give up, absolutely.

- Yeah, and I mean we're rolling this out right now, and so we'll see how it continues to go. But one of the initiatives that we've been putting out in the world is actually allowing the person who the secondhand snore or the person who's next to person who snores to take action on their own, 'cause usually the action all until now, until we've kind of put this program together, the only option that for the secondhand snore, to take action was to try to convince these snore, to go do something, and the snorer is asleep. They might not even know that they're snoring and denial is very, very common in that situation. So with what we're trying to do. And we're, again, we're gonna see how this works is really literally if somebody is next to a snore that person, so this is not the snorer, but the person next to them, can actually set up an appointment for us to talk about the issues to basically try to get some Intel on it. I mean, obviously it's a problem. Is this a problem that is likely, you know, is it sleep apnea, not sleep apnea? What's our gut instinct on this and how likely are we going to be able to help them. Because I think nobody wants to waste their time. Nobody wants to waste their effort and taking action. And so I think depending on the situation, there may be very well be situations where it's like, yeah, either it's mild or you're or intermittent, and maybe it's you maybe holding and keep an eye on, it's fine, more often than not. It's likely, "Hey, you know, "this is something we can help you with." And these are the likely options based on what you're describing. These are the likely options that we might consider when we get you in and take a look at you. And so we'll kind of see how that goes to help those folks out. So we'll see, so we just, like I said, that one just launching, and so we'll kind of see how that takes off. I mean, again, back to, we've got a few different initiatives that we're trying to move forward. And at the end of the day, it's really trying to increase awareness on the issues that we treat and these issues they need awareness. We can impact them, we can help them but you need to know that it's a problem. You need to know that there are solutions and you need to a viable door to walk through to get those solutions.

- Yeah, I mean, it's removing again the feeling of blame or resentment and trying to educate people, spouses and again 'cause we have seen plenty of those kinds of arguments between spouses that happen in real time, sometimes in the office, in front of your own eyes. And you wanna try to remove that as much as you can. Say, "Hey, look, you know, someone has a problem." This is how we're gonna address it. But getting a secondhand snore to kind of, I'm sure that they would have for years told husband or wife, you snore and they go like, I don't snore, you snore, you know, kind of thing. And then as kind of the end of the conversation and nothing ever changes. And so it's giving another avenue to try to have independent set of eyes and ears, you know, kind of listen and educate.

- So after we help and treat somebody snoring, they probably feel resilient. Is that your word of the day? I snuck that back, that was my backwards. I used to shout out and snuck it in, in a segway.

- Yes, yes, the shout out. My word of the day is resiliency because I think that, whether it's talking about our conditions or the current state of the world or the United States or anything else that like, you know, as an individual, as a community, as a society, like that's an important word right now, is that we will bounce back in any way, shape and form, and it applies to, "Hey, if you feel like your life "has been in a fog and you haven't been sleeping well, "you can be resilient." You know, that's the way to do it.

- Yeah, I like that word You can, and you know it to be a fact. Someday, we will no longer be resilient each individually. I'm not challenging the concept. I'm just kind of going in a different direction. I'm saying, I think there's, I've said this before. I think, but there's a concept called Momentum Moray, which is that each of us will die. And starting to flip, it's sort of, you could view that as counter to resiliency, but I view it as the exact same thing. And I think when you think about resiliency, you think about humanity over time and you think about your ancestors and my ancestors and in this country, the greatest country that has ever existed in my opinion, our forefathers and foremothers and what has allowed us to be in the position that we are right now is the reality that we, as individuals are flawed, we as societies, therefore built by individuals are flawed. And so there are peaks and valleys and ups and downs, but I think progress, you know, I know without any question in my mind, you know, this country is stronger than it's ever been, and it's also showing its flaws right now. And I think that's where in my lifetime, I've seen the ups and downs that way, but it's a resiliency is part of, it's certainly part of the American spirit. So yeah, I would say without any question in my mind, given whatever we're saying right now, we will be resilient as a society and people will persevere and we will, you know, sort of--

- So good working Clunky Good work. I'm gonna spell it? No.

- That's for next time.

- Exactly with your phone in front of my--

- He's found my ultimate weakness, with my spelling videos.

- Exactly, so yeah, next time we'll work on--

- I can use it in a sentence though.

- You can, all right, that's good. Nope, yap, we'll be resilient and we'll show up next time. And until next time, that's all we got, take care.

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