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127 - Dr. Audrey Wells - "Super Sleep MD"

Audrey Wells

Emma Cooksey: [00:00:00] So thank you so much for joining me. 

Audrey Wells: Yeah, it's a pleasure to be here and talk with you today. 

Emma Cooksey: So tell us a little bit for anybody listening that isn't familiar with you. Tell us a little bit about your background and where you grew up and where you trained and all that.

Yeah, I'd be 

Audrey Wells: happy to. I guess where I grew up is a tiny bit unusual. I'm from a very small town in New Mexico called Elephant Butte. And you know, born and raised there. I went to college in New Mexico and then I kind of flew the coop. I've lived all over the United States. I went to medical school at Michigan.

And then I've done Three subspecialty training programs. I did peds pulmonary. I did a sleep medicine fellowship and then obesity medicine. So I have a sort of broad area of expertise, but the majority of my [00:01:00] practice clinically has been in adult sleep medicine. And it's something I'm really passionate about.

But you know, I, Whether I was in a private practice or in kind of a bigger academic setting, I was really frustrated with the limitations of the medical delivery system when it comes to not so much diagnosing sleep apnea, because I think that path is really well laid, but just helping people to actualize on the treatment of sleep apnea.

I mean, we can discuss that. Totally. So, you know, I, I know there's a lot of... Yeah, there's tons of frustration out there on the part of the patients, for sure. And I see that. I think that frustration is kind of mirrored behind the scenes. At least it was for me because, you know, people could come to see me every few months and I would have these little 20 minute slots and my calendar was stacked up [00:02:00] and I just You know, I just never felt good about that.

Because in between I knew they were struggling and then they would drop off. And, you know, these are people's lives we're talking about. And I want to tell you, Emma, this is something that kept me up at night, which is a little bit funny for a sleep medicine doc. Like that's, that's not the position that you want to be in.

So in order to address this problem I ended up leaving my I lost my physician position when my contract expired, and I started an online platform for people with sleep apnea to either get help with the CPAP troubles that they were having, or move on to a different treatment, and that's something that I've always Thanks.

Felt good about is, you know, I'm not married to the idea of CPAP, but people need more information before they know when to quit and Right. Move on to something else. 

Emma Cooksey: Totally. We're on the same page. I [00:03:00] think that the, the biggest thing that keeps me up at night is. And you probably saw this first hand.

It's just all the people who have problems adapting to CPAP and then just abandon it and don't ever go back to their doctor and say, I'm now leaving my sleep apnea untreated. Like, they just don't ever go back. And that's, that's, and the numbers of those people is, is quite high. And that's what really keeps me up at night.

Audrey Wells: It's hard to even think about, right? Like, there's such an investment up front. You invest your time, you invest your energy, you invest your money, because a lot of people have high deductibles nowadays. So there's all this investment, and then to have the ball drop. later on, and to kind of resign yourself to sleeping poorly or dealing with the long term effects of untreated or undertreated sleep apnea.

I just, I'm really passionate about saying that's not acceptable. Right. It's not. 

Emma Cooksey: You're on my team. I love [00:04:00] it. So I don't think we ever really think about it from Doctor point of view, right? We, we all think about it from a patient point of view. We don't get very long with the doctor, but we don't think about the stacked schedule on your, your end.

So thanks for explaining that because that, that really, I think, flips the script for a lot of us. Like, you know, we're just kind of thinking like from the patient perspective, this doesn't feel very good to us. But then it doesn't feel very good probably to most doctors either. 

Audrey Wells: I think that's true. Yes. I think you're, you're spot on.

And I know that it doesn't feel good for patients. I've seen it myself. Sleep apnea happens to run rampant in my family. And one thing I'm always thinking about is what if this was my mom in the appointment, or what if this was my uncle or whatever, you know, It's a person sitting across from you, and I know you can [00:05:00] feel like cattle being pushed through the system, and it's just not right.

Emma Cooksey: So was, was your family, like, when did you discover everybody has sleep apnea in your family? Was it later into your career, or was that part of why you got into sleep in the first place? 

Audrey Wells: It wasn't really why I got into sleep in the first place, but the funny thing is when I was in private practice in New Mexico for nearly 10 years my family would come into my sleep lab to get tested and treated and I would...

You know, there's there's kind of this myth out there that sleep apnea is always related to a person's weight. And in my family, that is definitely not true. And it's one of my missions to dispel that myth. So in my family, there are members who are overweight and members who are not, who have sleep apnea.

In fact, I don't. feel shy about telling [00:06:00] you that as I'm trying the new type three home sleep apnea tests and even the type two devices, I am now capturing the beginning of my sleep apnea. So, you know, I knew it was coming and here it is. So, you know, this is it, it's just kind of driving me. It's something that motivates me because like I said, I, I like to put my feet in the shoes of a person who walks this walk.

Emma Cooksey: do we think it's something to do with craniofacial development, or it's just like the structure of the airway in your family, like the way people develop over time, or you just don't know?

You just sort of like paying attention to see what happens. 

Audrey Wells: This is a really good question, and I think this is something that you can kind of only know if you have an extensive evaluation, which is not always indicated. Yeah, it's more of a CBCT 

Emma Cooksey: scan thing. Yeah. Which most people are not getting. 

Audrey Wells: Yeah, and I think [00:07:00] there's limitations to those too.

I like to lay out nine reasons why a person could have sleep apnea. And oftentimes there's a mix of different things contributing. I want to hear your nine. Oh my gosh. Yeah. In fact, I can give you a PDF that you can link in your show notes if you want. Oh yeah, that'd be awesome. So. So in my case and probably my family's case, I would say that there is a component of oral anatomy.

I know that my tongue is large for my mouth. And even though my teeth are straight, they weren't always this way and I didn't have braces. And I feel like I probably should have, because it's, my tongue is too big for the size of my oral cavity. So I've got the scalloping on the sides and I'm sure.

Yeah. Managing my tongue volume. There's probably also a component of the genetic neuro respiratory control [00:08:00] mechanism there. And I say that because for some of my family members, I'm thinking of one uncle in particular, I saw a lot of central apneas at sleep wake transitions, which tells me that there's a sensitivity there to gas.

So I'm sure that's playing a 

Emma Cooksey: role. Yeah, it's such a it's chess, not checkers, right? Because quite often we don't have all of the information, like most people aren't having DICE procedures and that they're not perfect either. And most people don't have like a CBCT scan. So finding out exactly how and why you're, you know, your airways becoming blocked or is collapsing is so tricky.

Audrey Wells: Yeah. And in some respects it's, it's possibly for some people more effective to spend their energy with the treatment that they want to pursue because ultimately the goal, I think there's this overarching goal, goal of healthy sleep, waking up [00:09:00] refreshed and having energy during the day. So. I don't know if for some people it's that helpful to kind of work down to the exact reason or the exact level of obstruction.

Emma Cooksey: Unless you're trying to do a surgery to address that or something. Exactly right. If you're not, then, you know, I totally agree with you. There's been a couple of times in my own journey where, you know, my sleep specialist has said we could, test for, you know, all different other things, and when you, it kind of goes around in a circle, so if you test for idiopathic hypersomnia, I'm like, well, if I got that diagnosis, what would the treatment option be?

And they're like, all we really have is stimulants, which they could prescribe me as somebody with sleep apnea anyway. So it kind of, I think for some patients, like knowing even more, like sometimes doesn't put you any further ahead. 

So are people able to work with you one on one remotely [00:10:00] or, or they, they can do courses? What, what's the main way people can work with 

Audrey Wells: you? Yeah, so I have four online courses currently. Three of them are especially for people who have obstructive sleep apnea. And the one I'm launching right now in in October and November of 2023 is called the Ultimate CPAP Mask Course.

And coupled with that is not only the information that I wanted to tell you in that little 20 minute visit but it, it's also including four weekly sessions with me live in a group coaching setting. So this is really important because I think. What people need is a guide through the mask.

They need somebody to have a high touch approach and I think it's really helpful for them to have community. So seeing other people's questions, other people's struggles. Yes. Yeah. And kind of fleshing out what can I [00:11:00] do? What would be better for me to try. 

so just the titles of my courses kind of say what they do. Another one that I really like. That's how you know 

Emma Cooksey: you have a really awesome title. 

Audrey Wells: Right, right. So another one I have is called 21 Plus CPAP Alternatives. And this is for anybody who's thinking, you know, I don't think this CPAP thing is quite for me.

Yeah, there's a lot of those people, right? Yes. Yeah. And I don't think you can get the lay of the land in just one meeting with your sleep medicine doc. So I've sectioned off surgical treatments and non surgical treatments, and there's five in each group that are highlighted. Where I go into detail about outcomes and time and insurance and all that.

And then there's others that kind of spin off from that, that I want people to be aware of so that they can have a better conversation with their sleep medicine doctor, with their dentist, or with their ENT doc. [00:12:00] So that one's been. Received very well. I've got a foundational course called what you need to know about sleep apnea and CPAP.

This is kind of a deeper dive for people who really want to geek out on sleep like me. So it talks about the numbers, what they mean. And then finally the one that's kind of more broad is how to finally sleep better and feel more awake. And it's for anybody who struggles with their sleep and isn't functioning well during the daytime.

Emma Cooksey: I've had some really interesting discussions with people about this gap between well managed or well treated sleep apnea.

in the numbers and restful sleep, right? Because I think that there's this oftentimes you hear people say, you'll get on CPAP, you'll feel better, the end, right? And so, and no doubt, lots of people are in that camp, right? Where they go to their doctor, they get on [00:13:00] CPAP and they feel a lot better even from the first day and they're just like this is great I wish I'd done this years ago and so and that's awesome for those people but those people don't really listen to my podcast so for the rest of us right who You know, either are struggling to use CPAP or are ultra compliant and I think there's a lot of us who, who fall into this category where we're constantly going back to the sleep doctor and saying You know, we're doing all the right things and we're getting a pat on the head and told like, your AHI is great and everything's terrific, carry on.

And we're like, well, but we're not sleeping well. We don't feel well rested and we have like a pretty high Epworth sleepiness scale for People that are treated, right? So how do you start to unpack that? Like, whether there's another sleep disorder going on, whether the person is just, like, really easily aroused from sleep?

Like, what's your take on that? [00:14:00] 

Audrey Wells: I think this is a very clever question and it underscores the fact that sleep and sleep quality Have many, many factors that go into it. So it's, it's a little it's not very satisfying. I think when you have this high expectation that treating your sleep apnea is going to make you wake up out of, out of bed singing in the morning.

And when it does happen, that's what I like to call a slam dunk, but I don't think that's the most common scenario. In the age of home sleep apnea tests, which I think are very good, you know, we should keep doing it, but these type 3 devices are really only for obstructive sleep apnea and interestingly, they don't measure sleep.

Right? So whenever I see someone has had a home sleep apnea test, I just put a pin in that because it tells me there's a blind spot there, you know, there's a blind [00:15:00] spot about their sleep quality. And I just need to keep that in mind since it's not at all uncommon for many people to have more than one sleep disorder.

There's also lifestyle factors that come into it, so I talk a lot about contrast and balance, and what that means is, you know, how you spend your day affects how you spend your night, so things like exercise and light exposure and social engagement and creative outlets, things that help us be sort of the The best human being that we can be translate into more restful sleep, especially when you think of food and exercise and meal meals and social connection.

So getting all of your vectors kind of lined up is really important. And also the timing of everything. I don't think this is. Well [00:16:00] appreciated. So because we as human beings are organic and really responsive to light and the sun and the 24 hour cycle, It emphasizes the need to be regular, regular with our sleep, regular bedtime, wake up time, regular with our meals regular with our exercise, you know, all of these things kind of produce a little, little stimulus that makes it more likely that That we're going to be awake or more likely that we're going to sleep.

So if we want that timing to be predictable and, and be what we want it to be, we have to get entrained to the 24 hour rhythm more than just with our light exposure. And then finally, I'll say that. I think, you know, there's medical conditions that really interfere with daytime alertness. Anything that's chronic, any chronic heart disease, chronic lung disease metabolic disorders, gut problems, [00:17:00] chronic pain is a big one.

I mean, if you're in pain all the time, that just wears you down. It makes you tired. And I think in general, Americans are not terribly good at resting. So. Needing rest and honoring your time to rest also helps you to be more alert and have more energy. Sometimes those things are related. Sometimes they're separate, but all of these factors go into whether a person is awake when they want to and then sleeping well.

Emma Cooksey: Super interesting. I could just like listen to you talk about it all day. is there anything since you started working with patients through your courses that has been surprising to you? 

Audrey Wells: There is, you know, I, I think that when I first started, I was really passionate about getting the 21 plus CPAP alternatives out and I'm agnostic.

I don't I [00:18:00] don't kind of make relationships with companies or, or try to push one treatment over another. I just wanted people to know that there are choices out there. And so it was really a relief to get that out. But I still find that people want the human connection. So I'm very happy to be doing these group, group coaching sessions again.

And I've also opened up a few spots for one on one coaching. Now, this is not me being a person's doctor. And I, you know, want to make that clear because I'm not ordering tests. I'm not ordering any sorts of treatment, but to your point about not feeling awake during the day, that is so valuable to get that solved.

And so for anyone who wants to do a deep dive with me, I have a a select number of spots where I meet with people generally weekly to kind of tease apart what's going on for them [00:19:00] and to start understanding what's holding them back and how we can make that better.

Emma Cooksey: How much do you see people Like, you're talking a little bit about coaching. So how much do you see people who it's really like their mindset versus the treatment? Because I think, like, I, I got into a really big discussion with a sleep tech recently where they were like, people just need to change their mindset in order to do well with CPAP.

And I was like, do they? I think that like there's obviously people who just start out just thinking, I'm not going to use that. I don't want to. So there I can kind of see it, but I talk to people all the time who desperately want to use their CPAP, who are super committed to being healthier, but like, just have insurmountable problems with it.

Audrey Wells: Absolutely. And I think there's more than one phenotype or, or characterization there. Yeah, there's a ton. And you know, this, this is something that [00:20:00] surprised me. Sometimes I think there's a group of people out there for whom mindset is an issue, but they don't quite know it yet. And. It's interesting to uncover that a little bit, and sometimes it's like the person who is lying in bed with their mask on and the pressure is going and they're trying to sleep and they're just hating the CPAP the whole time.

Like, I don't like this experience at all. For others, it's like. The idea that I have to use CPAP, like I'm being pressured to do it, there's no other choice for me, that is burdensome, and it's a joy to kind of let that go with folks, like you don't actually have to do anything you don't want to do. If you reclaim your agency, that's very freeing, and it gives you more empowerment so that you do have more patience and self compassion as [00:21:00] you're trying different masks or whatever.

It kind of takes the edge off of the experience. And then I think there's people that just, like you said, they really are motivated, they want to do it, they understand why it's important for their health, and They struggle with anxiety or claustrophobia, or they have a trouble, a hard time getting a mask fit or dry mouth.

Dry mouth is huge. And one of the drums that I beat is it's better to breathe through your nose. Let's see if we can work on your nose. Let's get it opened up. Let's see if we can make this more comfortable for you. And I love working with those people because they're motivated. They're super energetic about.

Getting to healthy sleep. And sometimes they're just quite not there yet and doing one little thing can help them to increase their comfort. And all of a sudden they're sleeping through the night. 

Emma Cooksey: That's the dream right there. That's the dream. How much do you find [00:22:00] that health equity kind of comes into it?

Like when, when you're looking at alternatives to CPAP and, Which options are covered by insurance and which take out of pocket, you know, people paying for them themselves? Like, in America, like, how much do you see that as an issue? 

I've done episodes where we're talking about options that are not covered by insurance yet, and so those people just feel very excluded from the discussion, you know. 

Audrey Wells: I can totally see how that's an issue. And when I was doing my alternatives course, when I was putting that together the companies that I reached out to, to learn more, to, I trialed a lot of alternatives.

They would most often offer like a cash pay, but then a money back guarantee if there wasn't a result. Now some things aren't really amenable to that. Right. You can't really do that for [00:23:00] a surgery or, or like a oral . You can't give it back. Yeah. You can't take it back. Yeah. And, you know, that's, that's kind of a decision point.

And for the coaching work that I'm doing, that is an out of pocket expense. It's not covered by insurance. I have had some people tell me that they were able to get HSA coverage for it. And in the future, the word on the street is that there's going to be some billing codes for coaching. I've heard that too.

Yeah. I hope that comes up as, as 

Emma Cooksey: true. I hope so too.there's just all sorts of coaches doing really great work that is really vital to people getting, tested and diagnosed. 

Audrey Wells: people have given me the feedback that they were not able to otherwise get to the point where they are to have the success that they have. I mean, there is such a thing as sleep coaches out there. I think there's tons of sleep coaches, but they're not necessarily versed.

in all the [00:24:00] things about CPAP. And it's, it's a little bit of a different experience. You know, you want somebody who can speak to why it's important to use your CPAP throughout the night or, you know, interpreting the numbers that the machine puts out. So it's a little bit of a subspecialty. 

Emma Cooksey: What do you think about remote monitoring? I know just from my own experience and from a lot of patients I've interviewed, there's a, there can be a huge discrepancy between the numbers on the CPAP and what's actually happening. with your body, right?

Do you, do you think that's the way it's going? Like, I mean, I think I just I just think that there's a lot of especially cardiovascular consequences that are not really being picked up by a CPAP saying your AHI is four, but then when you actually have someone monitored, you can see that their heart rate is going way up and their oxygen is way down and all of that.

So that's kind of [00:25:00] where I'm hoping it goes in the future, but I don't know what you think on 

Audrey Wells: that. I think anytime there's technology involved, there's like pros and cons always. And in general, the remote patient monitoring. kind of elevates the importance of making, of having that touch point with people.

Anytime you get data, you kind of have to think ahead and say, okay, what are we going to do with this data? And how good is the data? How can we continue to get better? So I, I'm not opposed to it at all, but I think that. With something new coming onto the table, you just have to kind of sit back and say, let's see how it is.

You know, we're going to put this in perspective. The numbers never equate to the person. This is a person behind the numbers. So like we were talking about before, the numbers can look [00:26:00] fantastic. You can look great on paper, but then feel terrible and still slog through your day. So I just. I think that anytime you're looking at numbers, there's always that idea that this is not the whole picture.

It's just one component. Yeah, and 

Emma Cooksey: I can see how a doctor in the position that you were in when you were in private practice, doesn't have the time to really dig it. You know, like if the numbers are saying, this looks great. It's well treated. I understand why they would be like, okay, I don't need to spend as much time on this because she's still a bit tired, but like the numbers look good versus somebody else where the numbers don't look good.

You know, like, I kind of see that, but I also, I just think being able to have more time to try and figure out is way better. 

I think one of the good things maybe about remote monitoring might [00:27:00] be.

That continued relationship with the doctor, you know, like I just think like having, whereas I think a lot of people tend to kind of drop off, and not go for an annual checkup and there's just a lot of limitations like you were saying about the current system for a lot of people. Totally. So do you want to tell us a little bit about your, your organizing a summit next year?

Audrey Wells: Yeah, this is something I'm super excited about because it's entirely free. So nobody has to get their insurance company involved or dip into their wallet. So it's a free summit called sleep deep new approaches in treating sleep apnea and insomnia. And as you know, these conditions can coexist in the same person.

So it's an online summit. I'm interviewing. Experts in the field of sleep medicine cognitive behavioral therapy for insomnia. I'm also interviewing cardiologists, neurologists, [00:28:00] pulmonologists, diabetes specialists, obesity medicine physicians, all of these people who practice evidence based medicine and have a interest in promoting healthy sleep for their patients.

So Summit runs for one week, February 6th through the 12th. You can see I'm really excited about it 

if people are interested in learning more the platform that it's going to run on is called DrTalks, D R T A L K S.

com. And they want to look for the schedule, which has my summit, the Sleep Deep Summit in early February, 2024. 

Emma Cooksey: And we can link to that in the show notes if there's a link for it. Definitely. 

Audrey Wells: Definitely. 

Emma Cooksey: Yeah. Okay. So tell people, is there anything else you want to cover before we wrap it up? 

Audrey Wells: I would like to also say that, you know, for people who feel like they're alone with their sleep apnea or frustrated, I actually host a private Facebook group that I'm in all the [00:29:00] time to give information.

I do Facebook lives. I answer questions and it's. You know, it's a safe space. It's a positive space. And I think that the community there, we're nearly to 2000 members. It's an amazing group. And there are seasoned CPAP users that are there to dispense wisdom. There are people who've been through other journeys with their sleep apnea.

And I'm just really proud. of the community and the reciprocity of the members. So that's a way that I like to connect with people. That's 

Emma Cooksey: great. Well, we can link to that as well. And, and do you have a website that has all of this? Yeah, 

Audrey Wells: I do. So my website is supersleepmd. com. 

Emma Cooksey: Well, thank you so much for joining me.

I really appreciate your time today. 

Audrey Wells: It's been a pleasure to talk to you. 

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