Dr. Madan Kandula went on The Morning Blend to answer questions people posted about sleep apnea.
[Molly] To sleep well, you need to breathe well. Welcome back to our continuing series with the ADVENT. About one in every 10 people has sleep apnea, but get this, 80% of them are never diagnosed. So today, what you need to know about this very common problem. Dr. Madan Kandula is a sleep and sinus surgeon. He is board-certified and joins us now. Good morning to you doctor.
[Dr. Kandula] Good morning, good morning.
[Molly] I love that we always get to ask you questions, but in this case, on Facebook, we asked our viewers what questions they have about sleep apnea and I appreciate you answering them for us.
[Dr. Kandula] Yeah, absolutely, absolutely. Yeah, it's good to kind of get the real world, what people want to know.
[Molly] Absolutely, and I think the number one question that we saw most often was people are just wondering what causes it.
[Dr. Kandula] Yeah, that's a good question. I think there are a lot of things in life you hear about and everybody else seems to know what it is and you just sort of nod your head and you go along. I would venture to guess that almost nobody actually knows what sleep apnea is, even folks who have it. So, sleep apnea is blockage in the back of your throat, period. Most people who have sleep apnea, have no idea that that's where the issue is getting caused from. So, 100% of folks who have obstructive sleep apnea, which is what we're talking about here, the issue's in the throat. Almost all of those same folks have issues in the nose as well. So, the nose and the throat, those two areas allow you to breathe and if those areas aren't working properly you can't breathe. So, when somebody lays down to sleep at night and if they have sleep apnea, their throat shuts down and that's what sleep apnea means, stopping breathing when somebody is sleeping at night.
[Molly] This is my question. Is the throat swollen or is it more anatomical? People just have that, that area is just larger?
[Dr. Kandula] Yeah, it's anatomic. So, it could either be just how you're born. So, some folks are born or have the tendency to have big tonsils. That can block up the back of your throat. The most common cause for sleep apnea is actually a tongue that's too big for your mouth. And so, most people don't think about your tongue going all the way to the back of your throat, but part of the use of your tongue is to talk, like I'm doing right now, but another big use for the tongue is to swallow. So, the back part of your tongue is a big bulk of muscle that basically just shoves food and liquids down. And so, if you're upright and you're chewing, great. If you're laying down, that back of the tongue gets in your way. So, it's not swollen. It's not an irritation issue. It's just pure anatomy. It's basically anatomy that's too tight, matched up with gravity. So, you take something when upright that's open and then you lay somebody down and all of a sudden, you collapsed that tube. And again, if you hear snoring, that's the sound of those areas vibrating because things are narrowing down and sleep apnea's the next level up the ladder where instead of just vibrating, they completely shut. And most of the time when that's happening, people have no idea that it's happening, which is very scary. And every day in clinic, when we see folks, I think people are surprised when we go through sleep study results, how frequently they're doing this because they have no idea. If this has been going on for somebody's entire life, they have no idea. And so, it's a very sneaky problem. It sneaks up on you when you're sleeping at night and, literally, if you think about it, it's like if somebody strangled you when you're sleeping at night, that's scary. That's what sleep apnea is doing to you and it's doing it on the inside of your throat and it's doing it in relative silence which is why there's so many people who are suffering without knowing what to do.
[Molly] So, when we introduced you we said that one in 10 people have it. It's very common. That was the other question we got, on Facebook, was how common is it?
[Dr. Kandula] Yeah, it's really common. One in 10 is a conservative estimate. So, some studies will say up to 20% of the American population. And as you said, so 10%, 20%, we're talking about tens of millions of people who have sleep apnea and almost none of those folks are getting treated. So, 80% of folks who have sleep apnea, aren't getting diagnosed. And then, if you're in that lucky 20% way, where you might have a diagnosis, almost none of those people are getting effective treatment either because the one treatment that's out there that most people hear about is a CPAP machine, which is a machine that you can wear when you're sleeping at night that pushes air in the back of your throat. It helps to hold your throat open, but if somebody's nose doesn't work, for instance, a CPAP machine's not gonna work properly. And so, again, there's a lot of people who are frustrated, they've sought treatment and that treatment hasn't worked for them, they're frustrated. And then, you have a whole other crew of folks, the majority of folks, who don't seek out treatment because they don't know that this issue exists. They don't believe that there are options that work for people and they don't know where to go or who to turn to to seek out treatment. So, there's a lot, unfortunately, of misinformation out there and part of my goal is to cut through that and just sort of plain talk, this is what's going on, and there are absolutely things you can do about it.
[Molly] Well, you bring up such a great point with that because another question we had was from someone who said they used a CPAP machine for 15 years now, but they're wondering if there are other options.
[Dr. Kandula] Yeah, I mean, I guess, let me first start by saying congratulations that you're actually in that minority of folks who are getting good treatment. That's awesome. On the flip side, it's almost assuredly there's ways to optimize that machine, if you're finding success there and then, I'd say there are other options. So, again, just to be clear with folks, the sleep apnea issue's coming from somebody's throat, a CPAP machine is one option. That's an option where you're wearing a mask when you sleep at night and just pushing air in the back of your throat and that air pushes your airway open. So, that's one option. Another option is an oral appliance, which is like a retainer that you can wear when you're sleeping at night. That's very low key and it basically helps to pull your lower jaw forward. So, if somebody's a good candidate for a CPAP machine, almost all of those same folks are good candidates for an oral appliance. And so, for this particular individual, I'd say that might be something to consider. And then, the third option for folks who have sleep apnea is surgery in the back of the throat. So, there are some folks who are really good candidates to open up the back of the airway with procedures. And so, again, if somebody has sleep apnea and they're having successful treatment, again, I congratulate them. I'd say, if somebody isn't having success or somebody's looking for other options, there are other options. And I think one of the reasons why sleep apnea treatment tends to not be successful in the typical run-of-the-mill, big-box healthcare system is that it is not a one-size-fits-all situation. So, if you have this issue and the only option that somebody knows about is a CPAP machine and they can't do anything about your nose, it's not gonna work for a lot of folks. And so, I'd say for this particular individual is I would almost say for sure that 15 years ago, nobody really probably evaluated the airway. They probably kind of backed into a sleep study, CPAP machine, "Hey, try this," and the fact that it's working is good, but really a custom-tailored approach to each individual is better than good.
[Molly] Absolutely, and the treatment has such good success rates and is really not as involved as people might think. Doctor, thank you so much for your time today. We appreciate it.
[Dr. Kandula] Thank you, thank you. This was fun.
[Molly] Absolutely, we appreciate you answering the questions of our viewers and go to ADVENTknows.com to schedule online. You can do that in just 60 seconds. Most insurances are accepted and no referral is required. ADVENT has locations in Wauwatosa, Mequon, Oconomowoc, Oak Creek, as well as Pleasant Prairie.