Snoring: When it’s more than just noise

Podcast transcript

INTRO
Welcome to Docs in a Pod presented by, WellMed. Over the next half hour, Docs in a Pod will educate you about the health and wellness of adults everywhere. Co-hosts Dr. Brooke Mobley and Carmenn Miles will share information to improve your health and well-being. And now here are Carmenn Miles and Dr. Brooke Mobley.

RON AARON
Well hello there and welcome to the award winning Docs in a Pod. I'm Ron Aaron. WeÕre delighted to have you with us. We have a special treat today. Our co-host and special guest, Dr. Brooke Mobley, is with us. Dr. Mobley is a physician with Optum. She's an author, a health care leader, and she's the medical director of post-acute care for Optum and WellMed of Florida. She's a graduate with a bachelor's degree from Xavier University in Louisiana and her medical degree, Master of Business Administration and more from Saint Joseph's School of Business and Doctor of Osteopathic Medicine from the Philadelphia College of Osteopathic Medicine. She was a nephrologist and now is a primary care physician. She also is the author of a bestselling book, I, Too Cry Purple Tears, a story of very personal relationship with domestic violence. October is Domestic violence Prevention Month, and we'll talk about that a little later in this program. I want to begin with first, hello. Dr. Mobley, good to see you.

DR. BROOKE MOBLEY
Good to be here. I always enjoy my 26 minutes with you.

RON AARON
Oh, well thank you. That's cool. So, the topic we have today is one that affects a whole lot of people, and it deals with snoring. When is it a problem? When is it not? And if kids snore, that shouldn't happen. So, let's talk first of all about what makes people snore.

DR. BROOKE MOBLEY
So, a lot of different things can cause snoring. The most important factor is if the snoring is associated with something else, it lets you know if you should go down a diagnosis of something more critical, like sleep apnea. But you can snore because you have a blocked nose. You can snore because you're lying flat. You can snore because you have recently gained weight, and unfortunately, you have excess fat around those organs, and so that can also cause snoring. It can be due to your airway anatomy. Different people may have a large tongue or large tonsils or a long, soft palate or a smaller airway, which means anything could particularly cause for the snoring. So first we have to define what snoring is. Snoring is the sound of tissue vibrating as air squeezes through a narrower passage. Sometimes the reason is as simple as a stuffy nose or sleeping on your back. But if it is paired with stopping breathing when you're sleeping, if it is paired with significant daytime sleepiness, then you should be concerned about other diagnoses such as sleep apnea or obesity hyperventilation syndrome.

RON AARON
Let's talk about sleep apnea because it is turning out to be very common. Former President Biden had it. I have it. A whole lot of folks struggle with it. It can go undiagnosed for a long period of time.

DR. BROOKE MOBLEY
Yeah. Sleep apnea can be very serious. In some instances, it can be fatal. There are numerous causes of sleep apnea, but the most important thing is getting it diagnosed. So, if you've ever been told you snore, or you've ever been told that you stop breathing while you're sleeping, or if you notice that it seems like you slept all night, but you still wake up really, really tired, then that can also be an indication that you have sleep apnea. Now, just having these symptoms doesn't mean you can diagnose yourself. What you do is you take these symptoms and you discuss it with your physician. They will then determine if they feel as though you need to get a diagnosis. That's with a sleep study and you sleep in a facility. They monitor your snoring, if youÕre breathing, and then they get a diagnosis from that standpoint. There are numerous treatment modalities to help.

RON AARON
I have a friend who joked about he was sent to a sleep study clinic. He complained that they kept waking him up. How can I sleep if you keep waking me up?

DR. BROOKE MOBLEY
Well, you're not there to get good sleep. You're there to get a good diagnosis. So, them waking you up is their check in vitals. If you stop breathing during your sleep or your heart rate drops down, they want to wake you up to make sure that your brain is getting proper oxygen. Just know when you're going there for a sleep study, don't go there thinking you're getting good sleep, but look out for a good diagnosis.

RON AARON
Now, when I was diagnosed with sleep apnea, one of the triggers was I had a very high percentage of carbon dioxide in my blood, which is not good.

DR. BROOKE MOBLEY
No. So when we think about how we breathe, carbon dioxide is one of the things that our body breathes out. So, when we take a deep breath in, we're breathing in oxygen, the oxygen goes through all of our blood to all of our organs. And so, when we breathe out, we are releasing carbon dioxide, almost like, I don't want to use the word toxin, but it's one of the things that we need to release because too much of it in our body can be dangerous. No different than your kidneys help you get rid of things that you're not supposed to hold on to through urine. Your bowels get rid of things you're not supposed to hold on to through your stool. We get rid of gases that we're not supposed to hold on to through our breathing. So, if we stop breathing or if we're holding on to too much of that carbon dioxide and not letting it out, it definitely could cause different acidity in your blood and can cause different issues down the line.

RON AARON
Let's pick that up in just a moment. I want to let folks know who may have just joined us, you're listening to the award winning Docs in a Pod. I'm Ron Aaron, Carmenn Miles, the regular host on Special Assignment, and I'm delighted to fill in for her today. Our program is available wherever you get your podcasts. We're talking with Dr. Brooke Mobley about what turns out to be a very common problem: Snoring. Now, I see ads for mattresses that say, hey, if you start snoring, our mattress will tilt you up and you'll stop snoring. Nothing to worry about.

DR. BROOKE MOBLEY
I wouldn't say nothing to worry about, but again, companies have to market to the best in their ability. One of the dynamics that can definitely help with sleep apnea, especially if what you're having is an anatomy problem, if one of the issues that you're having is increased body weight. So, what happens is if you elevate your bed about 45 degrees, it opens up the airway more, allows the gases that you inhale and exhale to go in and out without such a narrow opening so that it decreases the snoring and allows for that breathing sensation to happen more smoothly.

RON AARON
The issue of stopping breathing, which is certainly a problem with sleep apnea, do you know you're having it, or does it take a significant other to say, hey, you stop breathing?

DR. BROOKE MOBLEY
Most of the time you're not aware when you stop breathing during your sleep. Most of the time someone else notices it and lets you know. But if you are noting that you felt as though you slept all night long, but you woke up and you were still sleepy, that's an indication that you may be having some symptoms of sleep apnea. One of the most telling symptoms is stop breathing.

RON AARON
You take a look at folks and one example certainly is the president, who has captured sleeping in meetings over and over again. That's not normal.

DR. BROOKE MOBLEY
No, it's not normal. Anytime you find yourself in those situations, yes, sleep apnea should definitely be one of the diagnosis. It could be also that you're not getting a complete sleep cycle in. There are different stages of our sleep cycle, and sometimes we don't get into the deep, restorative part of sleep. If you're somebody who only sleeps for a couple of hours at night, then your body's not actually getting the recharging that it needs. If you're somebody who has anxiety, then maybe your body is not able to really do that restoration because of the mental capacity and the anxiety. So, while being sleepy during the day can be an indication of the sleep apnea, there are other things that may cause it as well. ItÕs important to discuss things like this with your primary care physician.

RON AARON
If it is sleep apnea, talk to me a moment about ways in which it's treated. I know, for example, I have a ventilator, a modified CPAp machine, which I wear, which creates pressure, keeps my airwaves open, and I sleep very well with it. There are commercials that run about people who hate those machines because of the tubing that's connected to it. Are there other ways to treat sleep apnea?

DR. BROOKE MOBLEY
Yeah. First and foremost, lifestyle modifications will always be our first line of treatment. So, if you're someone who has recently gained weight or you have been an obese person, one of those lifestyle modifications is definitely losing weight, increasing your physical activity, making sure that you're sleep hygiene is appropriate. But when we get to the actual treatment modalities, yes, those positive airway pressure machines are definitely helpful. But with modern technologies, those machines have become much smaller and less burdensome. So now they have some machines that have very little tubing. They only have things that they call nasal pillows that go inside your nose rather than a full face mask. Then sometimes some people, based on the severity of their sleep apnea, can also use oral devices. Sometimes it's just a device that you're able to put into your mouth, and based on how the device is developed, it will open up certain areas of your airway so that that passage isn't as narrow. That is more for people who have anatomic reasons as to why that passage is narrow, whether it's a large tongue or large tonsils or a long, soft palate, they have sometimes devices that can help with that while you're sleeping to open up that passage and stop that passage from getting narrow during your sleep.

RON AARON
WeÕll talk more about sleep apnea in a moment. I'm Ron Aaron, and you're listening to the award winning Docs in a Pod. Dr. Brooke Mobley is our special guest today, and we're delighted to have you with us on Docs in a Pod.

AD
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RON AARON
We're so pleased you're sticking with us right here on the award winning Docs in a Pod. Our podcast is available wherever you listen to your podcasts. We're also available on radio in a number of cities in Texas and Florida as well. I'm Ron Aaron, and Dr. Brooke Mobley is our special guest and co-host today. Dr. Mobley is an osteopathic physician, a primary care physician, she was a nephrologist, a kidney doctor, for a period of time. We're delighted to have her with us. We're talking about snoring. We went down the path first of sleep apnea. You said to me off the air that sleep apnea is more common than people think.

DR. BROOKE MOBLEY
1 in 3 adults in the United States, whether diagnosed or not, have sleep apnea. That was from a study done in 2024. Then 15% of the population actually has moderate to severe sleep apnea. Now, again, the scary part of that is these numbers are based on total population, not total population diagnosed. So that goes to show that there are numerous people out there who are still undiagnosed with sleep apnea. Like I stated earlier, there are different severities you have from mild to moderate to severe. In severe cases, if undiagnosed, it can be fatal. Our Hall of Fame football player, Reggie White, unfortunately died in his sleep from obstructive sleep apnea.

RON AARON
Wow. What is it that killed him?

DR. BROOKE MOBLEY
So, you stop breathing throughout the night, that accumulates, your oxygen does not go to your organs, and as we all know, the most critical organ in our body is our brain. And then you don't get proper blood flow to your brain, and it can cause stroke. And if you don't get proper blood flow to your heart, it can cause cardiac events. So, he went into a cardiac event.

RON AARON
And died?

DR. BROOKE MOBLEY
In his sleep.

RON AARON
How do you know if you have sleep apnea? Let's say you're a single person living alone, you're a little tired during the day, but don't think much about it. What are other symptoms you should look for?

DR. BROOKE MOBLEY
Well, first and foremost, if you have a body habitus that is obese, that is something that you should always think about, especially if you're having daytime sleepiness. In the world that we live in today, there are numerous people who sleep alone or who live apart from family members. They have different apps that can record your sleeping and can record snoring. And sometimes if you have the right monitors, Apple Watches, other Fitbits, things of that nature, can also record your heart rate and blood pressure during your sleep. So, if things are taking real big dips down, then that's when you should be concerned about stop breathing. So, you can always utilize these apps to record what's going on from a superficial standpoint. Now, none of these things or these isolated symptoms of snoring are true diagnosis of sleep apnea. You take these things and you present it to your primary care physician, who will then lead you to get appropriate testing. Only from appropriate testing can you truly be diagnosed.

RON AARON
You hear about couples who end up sleeping apart because one of them snores so loudly the other can't deal with it.

DR. BROOKE MOBLEY
The funny part is, is that I remember, my grandparents and my grandmother knew which way to move my grandfather's body while he was sleeping because it would lessen the snoring. People thought, oh, it's just they've been living together for so long. She just knows these things. Well, no, actually it's gravity. So, laying on your back is when you're going to have an the more frequent and louder snores just because of gravity. So, moving someone on their side, elevating the head of their bed, things of that nature with decreased snoring. But again, we want to get to the basis of why you're snoring because if there is a diagnosis associated with it, then you want to get diagnosed so that you can get treated. I want you to understand that just because you snore doesn't mean you have sleep apnea, and just because you have sleep apnea doesn't mean you're going to snore.

RON AARON
Oh, that's interesting. So, is it better to sleep on your back, your side of your stomach?

DR. BROOKE MOBLEY
It's better to sleep on your side, honestly. But again, your body is going to move into a position that is most comfortable for them. So, we can tell somebody, I want you to sleep on your side, but unconsciously, your body is going to roll to what feels comfortable for you. If you're somebody who benefits from an elevated bed, it's best to either have special pillows, put 2 or 3 pillows, or have one of those beds that elevate and incline for you. Unfortunately, our body does what it wants in sleep. So, as much as we may know what position works best for us, we are naturally going to go to what feels good to us from a muscular standpoint.

RON AARON
Now, you and I talked a few weeks ago, and one of the things that came up is how many hours of sleep you need a night. You said about eight hours.

DR. BROOKE MOBLEY
Yeah, and the older you get, the more you need. I have gone through my teens, 20s, 30s, and now I'm in the middle of my 40s, and I definitely can say that in my teens and 20s, I only needed a few hours of sleep to feel restored, rejuvenated, and to be able to go full throttle for the day. But now, at 44, I know if I am not getting an appropriate amount of sleep, my day is not at its best. I feel like my mind is not as refreshed or as sharp as it needs to be. I notice that I drank a little bit. I'm a little tired. I'm not able to move or function, especially when it comes to working out as well as I normally would. So, the older we get, the more sleep we need. We have to remember what sleep is important for. It's basically our body recharging. So, it's important that our body gets effective sleep so that it's able to recharge and then sometimes heal from colds or wounds or different things of that nature. When you sleep is when you get some of your best healing done so that we can be sharp and refreshed and able to function the next day.

RON AARON
Now, can you sleep eight hours cumulatively? Sleep four, take a few naps, add up to eight hours, or is it consecutive hours?

DR. BROOKE MOBLEY
When you're younger, naps are beautiful. but as we age, taking naps during the day can interrupt our sleep at night. The most effective is going to be that restorative sleep that you get consecutively. Especially for my patients who are elderly or geriatric, I strongly suggest that they do not take mini naps throughout the day. They want to wait, allow their body to get tired so that they're able to sleep consecutively at nighttime.

RON AARON
There's something about a nap that feels so good.

DR. BROOKE MOBLEY
It does. It really, really does. But unfortunately, the older we get, there are consequences to that feeling.

RON AARON
Now, when you graduate from a medical school and began working as an intern. In the old days, interns would work unbelievable hours with very little sleep.

DR. BROOKE MOBLEY
Yes, and studies show that that is not great. Hence why now they have a lot of restrictions on to how many hours residents can work. Because of that, they have developed something called night shift. So instead of a resident being in the hospital for 24 to 36 hours at a time, we now have 12 hour shifts. So, you have somebody who works, say, 7 a.m. to 7 p.m., and then you have the nighttime shift who comes from 7 p.m. to 7 a.m. to allow for that restorative sleep so that as you're taking care of patients, your mind is as sharp as they can be. You're making decisions about people's lives. So, it's important for your mind to be sharp and for your body as well to have been energized appropriately.

RON AARON
So, you're in the hospital, the doctor walks in, can you ask them, so how much sleep did you get last night?

DR. BROOKE MOBLEY
You can ask. I can't promise that they'll answer that question.

RON AARON
Now, as we talk about sleep apnea as an issue, what other problems result from either snoring or interrupted sleep? I'm thinking about people who have insomnia, for example.

DR. BROOKE MOBLEY
So again, it can cause for you to be tired during the day. It can cause for your body to shut down, and whether you're trying to take a nap or not, people fall asleep at the wheel, or they fall asleep at work, or they fall asleep while they are taking care of a newborn baby. Sleep deprivation can be very detrimental to your body mentally and physically. Anything that causes stress can cause anxiety, can cause depression, which can affect every organ system in your body. So, it's important that your mind and body gets restorative sleep so that we're able to recharge, be focused and functional for the next day.

RON AARON
Now, before we let you go, I want to come to the book that you authored, I, Too, Cry Purple Tears. October is Domestic Violence Prevention Month, and you wrote about your own personal experience with domestic violence.

DR. BROOKE MOBLEY
I did. I'm a survivor of domestic violence, and I have a beautiful and thriving 11 year old daughter from that situation. But what I realized is, is that there is a subset of people, professional people who try to keep a certain look upon themselves, and so they don't always share what they have going through. So, it's difficult for them to get help. I wanted to write a book to let people know that it's okay to tell your story, and even more importantly, it's okay to leave.

RON AARON
In that story, you relate how difficult it is to leave.

DR. BROOKE MOBLEY
It is very difficult, and unfortunately for the majority of the population who is impacted by domestic violence, finances tends to be the limiting factor for them being able to leave. Fortunately for myself, that was not my limiting factor, so it made it easier for me to leave. It was the emotional impact that made it hard for me to leave. I also have a nonprofit organization that works on advocacy, education and raising contributions so that we can help and give resources to people, whether it's emotional or financial, to get out of those scary situations.

RON AARON
If people want to get ahold of your book, I, Too, Cry Purple Tears, how do they do that?

DR. BROOKE MOBLEY
It's available on Amazon, and I also have a website called purpletears.net, and it's available through a link on that page as well.

RON AARON
Thank you for talking about it. Lots of folks would say you're pretty brave revealing your own experience.

DR. BROOKE MOBLEY
I had to. I have a little girl who looks up to me, and I don't want her to ever go through what I'm going through or what I went through. She was the reason why I left.

RON AARON
That's cool. I thank you so much, Dr. Mobley. It's great talking with you. Dr. Brooke Mobley is our special co-host and guest today. We've been talking about snoring and a little bit about domestic violence. I thank you for joining us. I'm Ron Aaron. We really appreciate you being here for the award winning Docs in a Pod. Our podcast is available wherever you get your podcast. We hope you join us right here on Docs in a Pod.

OUTRO
Executive producer for Docs in a Pod is Dan Calderon. The producer is Cherese Pendleton. Thank you for listening to Docs in a Pod presented by WellMed. Be sure and listen next week to Docs in a Pod presented by WellMed.

DISCLAIMER
This transcript is generated using a podcast editing tool; there may be small differences between this transcript and the recorded audio content.

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