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Episode 86 - Drew Copeland - Home Sleep Apnea Testing Explained

1:06

Hey everyone, it’s Emma Cooksey here and I'm your host.

So, thank you all so much for the people that reach died after last week's episode.

Just to say, you know, they were sorry that my pal extension had been successful and, and everything it really meant a lot to me that you guys were just really kind of, I sit.

1:24

Yeah, so I was glad that I went ahead and shared what my experience had been because I think it can help some other people.

And so last Sunday I had a fun time.

I was over on the project, sleep Facebook page doing a Facebook live.

1:43

So this was really fun because it was Kristen Cassio who I've interviewed on the podcast and she was telling her story, having completed the rising voices speaker, training program.

So you don't know what that is or you're just kind of curious.

1:58

You can go follow the link in the show notes for this episode and you See what that's about.

But basically it's a program that runs during the summer and over by six weeks and you learn to really hone your story to be able to become more active as a patient advocate and telling your story and two different audiences.

2:22

So, Preston had completed that.

So, this was her giving her and presentation, which was really great.

And then I did a little Q&A with her afterwards.

So, again, they'll be a link to that.

That in the show notes and that she'll probably put a link to the rising voices program generally because they're recruiting for that, like they'll start again in the summer.

2:42

So if you're interested in using your voice and using your story of living with a sleep disorder to raise awareness, and make life better for other people with sleep disorders and you can definitely I highly recommend that program and we need all the people we can possibly get to raise awareness.

3:02

Earnest about Sleep disorders and reduce the amount of time, it takes people to get a diagnosis.

So today I'm joined by Drew Copeland, Drew as a national speaker and published researcher with 17 years of experience in clinical sleep medicine.

3:21

He specializes in sleep apnea testing and treatment at sleep.

Batcher NYC.

He is the director of operations and it, and also provides sleep coaching to clients with his background and experience.

Drew's served as a subject matter expert for the be rpt.

3:39

And the a Asm Drew is the executive director for pro sleep sleep.

Testing Solutions company.

I love talking to Draya.

I think this is a great conversation.

So, without further Ado, here's my conversation with Drew Copeland, so, Drew, welcome.

3:56

Hey, Emma.

Thank you.

We should probably say that like, we're already friends in case people think I'm being over familiar.

Do you want to just start off for people that don't know you and tell them where you are in the country a little bit about Our backgrounds.

And how do you know so much about this stuff and a bit about what you're doing that?

4:14

Sure.

Yeah so I'm Drew Copeland.

I'm in New York.

Actually, I'm in Brooklyn, I have been a sleep technologist for 20 years.

Just about 20 years now.

And so that means that I've spent a lot of time watching people sleep.

4:32

I've said for the first kind of decade of my life, I was working in this sleep Labs putting wires on people watching them overnight.

I watched adults children, I spent a good amount of time, running a sleep program for a major health system.

4:48

So all that sort of testing and now I work with home, sleep testing primarily I'm sure we're going to talk a lot about what that is.

But yeah, that's that's my background.

I have a to clinical credentials.

5:04

I'm an RP Sgt some registered polysomnographic technologist and I MACC sh, which means I have my certification and clinical sleep Health.

Okay, awesome.

So that's really good.

And then, do you want to explain a little bit about your work with Teresa and sleep better NYC?

5:22

Just so you know what that is.

Yeah, so the other hat that I wear is IMA sleep coach and I love being asleep coach.

So, I said coaches, were we like to describe ourselves as like, personal trainers for sleep, and with a lot of the so many parallels there.

5:38

So we We want to sit with someone we want to understand their particular lifestyle, their goals, their roadblocks, and then kind of meet them where they are and find like easy wins and and small changes that they could make.

And and you know, a lots of lots of interaction, lots of, you know, are you able to change this?

5:59

Okay, so when I'm going to change it right now, maybe we'll try this smaller step first and just work with them until until he was compounding these good habits and replacing the bad habits.

So we do a lot of coaching.

We do some work with like employee wellness and helping people out with that.

And and now we are starting to really dive into monitoring patients who are on therapy and and helping them, you know, find not just the logistical issues of the Mask or but also helping them find their motivation for it.

6:30

You know, there are a lot of people who say, you know, I want to get more sleep period and that's fine.

But why, what is your reason for getting more?

Is it, do you want your mood to improve?

You know, do you want your energy level to improve?

So that's that's what I do.

6:46

A couple of the other episodes that are going to run in this season of my podcast will point to this really well, but can you maybe talk about?

So I think one of the things that you and Teresa do is help people through the testing process like if they have some symptoms of sleep apnea and I guess a lot of people out there with think, Why would I need a coach for that?

7:11

Do I just go to my doctor and it's really straightforward what we're learning from a lot of the people that I've been interviewing is that does work really well for some people.

But there's a lot of people that traditional system of going to your doctor pushing to get a sleep study.

7:30

Going to the, the Sleep Tech having your, what do you call that?

Do you call it in lab, or?

Yeah.

I call it in absolute terms.

Polysomnography.

Okay.

Yeah, having the polysomnography experience and just how that actually isn't a straightforward to navigate as a lot of people would think so.

7:49

Can you talk about why people might need the help of a sleep coach to go through that process?

Happy to?

Yeah.

So let's start with.

So at the worst case scenario, this is what can happen.

If someone the go to their their PCP, sometimes their PCP, or sometimes, maybe even like their the psychiatrist are called in I'm having sleep issues and the cool, let me write the prescription, but and that's it.

8:13

That's where their sleep Journey ends, which is so as and they're getting medications to help them sleep, put on ambien or, you know, some like that.

And that some people ambient is a good short-term.

I don't.

I'm not a physician.

I'm not going to give medical advice, right?

8:29

And if your physician has prescribed you AMV and you should do that, don't stop taking anything.

Your daughter right?

Don't do anything.

That your doctor hasn't told you to do.

Okay, very good.

You should also know that your health is your responsibility and and you can ask your doctor, the right questions, all right?

8:47

And it's important for you to be informed and be and the sleep.

You get on Ambien is not sleep.

It's like getting hit in the head with a baseball bat.

You know, yes, you're going to get knocked out, but that's not sleep.

It doesn't give you the the restoration.

It doesn't you're not getting into the right sleep stages.

9:03

Your body isn't were repairing itself.

Your, your memory is, we want to talk about the things.

People do on Ambien.

So all that to say if you have any of the signs and symptoms of obstructive sleep apnea and someone is handing you a pill.

9:19

You probably want to seek a second medical opinion, that's okay.

But let's say you are going to your PCP and they do say, oh I think you might have sleep apnea.

Unfortunately, a really typical patient Journey.

There is they go to their PCP is a, I'm tired of snoring.

9:37

Okay, I'm going to send you to a success.

Specialist in many cases that you now.

Wait up to several months to see that sleep specialist, who then looks at you, because there aren't enough sleep specialists in the country.

Right to go around is basically close friends who are hoarsely positions.

9:55

They're already overworked.

There's no way that they're working all the hours but there's just not enough.

Yeah, there's just not enough.

So you wait, you see your physician?

Who says?

Hey, I think you might have sleep apnea.

I'm going to send you to a sleep position sleep positions as I That you have sleep apnea and let me write you an order for a sleep study.

10:12

Now that can go one of two directions, they can go to the in lab polysomnography & Hyuna home, sleep testing.

All right, okay.

And the way that that's determined, there's a number of different ways that I may be determined one unfortunately.

Isn't she Insurance?

Yeah, that happened to me that the last time I had to do a sleep study, when I got a new machine and originally my I kind of talked to my doctor and I said, well, you were And I have talked at length about that.

10:41

I never had a titrating study, so we weren't quite sure that my pressure was where it needed to be.

My doctor was like, yeah, great lets, you know, go ahead and get you a full polysomnography test in the lab and we'll do a titrating part while we're doing it.

10:58

And so my insurance company basically said no to that and they said you can have a home of pretty basic home test just to show you have sleep apnea so that you can get New machine, but they didn't agree that I could do the other thing.

So, insurance is definitely a big part of it would be part of it and okay, I don't want to completely demonize the insurance company.

11:20

What what I will say is some of the, some of the insurance stipulations are valid.

And and there have been times, I mean, way in the past decades, in the past, where patients, who probably didn't need that full in La Plaza fee, many of them were sent there.

11:37

There were Physicians who are Owning and running sleep labs and so they turn into a money too, and that's unfortunate come, they're going to bill for all of these tasks plus.

There's also the other side of it where a lot of patience.

I mean I had particular reasons that I thought on in lab study would be helpful.

11:54

But a lot of patients I talk to would much rather do a home study.

So it's kind of a balance between all the different words but you know, I guess the where it's a bit frustrating right now is especially if you're going to see a board.

Slide sleep position.

12:10

They know what the appropriate test is, and the insurance companies should trust their clinical judgment, right?

That's, that's where I have.

No, I'm saying, like, I just hear a lot of things where I'm like, why wouldn't you just trust what the doctor say?

And, unfortunately, some of the denials we for, I mean, it's ridiculous.

12:29

You know, we have, there's a specific type of study where you stay all night at the sleep lab, and then, the following day, you stay for a company called om SLT.

So, multiple master, Okay, so especially if they're trying to relight narcolepsy or idiopathic hypersomnia.

Yeah, and we had an insurance, we have insurance companies, deny, that and say, do a home study instead and, you know, then a board certified physician had to get on the phone with like someone up an injunction would be like, you actually have no idea what you are talking about clinically possible to do this home.

13:02

Sleep testing is is perfectly valid for many, many patients.

It's not like the drop off is Is is massive, you know, right.

They're not saying, you know, instead of getting this medication, you know, you can mix like, like Hogs were and and

14:49

Keep going on.

The patient Journey.

So, you've now created a few months, you got to see a doctor, you Doctor get the soup, so you order.

So if it's a home sleep study, you know, maybe you might have to wait a little bit for your insurance to to get authorized the study, but you're going to have that home sleep study.

If you're gonna go the in lab route again, in most cases, it's going to have to be authorized and in some cases you do have to wait until there's an available slot and that can in some cases, even be months.

15:15

Yeah.

So you've now gone, just pause for a Second, you walked into your PCP.

I'm very, very tired, like, I'm falling asleep at the wheel.

Yes.

Have time to be with my family?

My kids.

I'm not productive at work, and you're now six months later, in some cases and nothing's been done yet.

15:37

So now, you're able to get in, have your sleep study it?

Then depending on the type, it has to be analyzed.

Usually, by someone, that's one of the jobs.

I did you go through and look at 6:00 to 8:00.

Hours of squiggly lines going across the screen.

You have what that is then a physician has to come in and interpret the all of that, all right?

15:57

Then finally, you have a diagnosis of sleep apnea, okay?

So that's that's that's when you can finally get it on therapy.

Once you get that diagnosis, how do you get the information from your doctor, you know, in some cases you don't have to wait a while to get into a doctor's appointment to see them for them to tell you have sleep apnea.

16:15

Unfortunately, in many cases, you know, it's a very very short.

Visit with your doctor who says, you know, here's the the treatment you're going to get use it, it'll be you'll be fine and then they send it to a DME Company which for those who don't use CPAP probably don't even know what it is.

16:32

But there's a third party now durable medical equipment company.

Medical equipment is a third party now that had that has to take that order from The Physician, they have to authorize with the insurance company.

They have to get to the meeting.

All about to say, yeah, it's the, the patient journey is convoluted, it's fragmented, you're getting passed from one to another, you know, from your PCP to your sleep position, to The Sleep Lab, DME back to the same position.

16:59

And so one of the things that we want to do is help guide that, you know, we can't change the American Healthcare System, you know, we would love to but in the meantime, we can help someone navigate it.

Yeah.

And just kind of explain what all those different parts are.

17:15

And so, Talk to me about home sleep test.

So so here's one of the things that I think a lot of people don't really understand, but I know that, you know, all about this.

So, you're the perfect person to explain it.

Can you describe like the different levels of testing and what they can?

17:34

And can't show because I've heard a number of people talking about, well, I had a home sleep test and it was they said it was negative for sleep apnea.

Yeah, so that's that.

But can you talk about this like ruling in and ruling out?

17:50

And again that people, you know, just because they test negative, what does that mean?

Like?

Yeah.

Okay, so let's talk about is saying, first of all, let's talk about what how we measure sleep apnea.

All right, so we use something called the apnea hypopnea index.

18:07

And what that means is we are looking to see how many times throughout the night while you're sleeping, you have some sort of respiratory event, All right, so it means your breathing is going to be off for 10 seconds, and as a result of your breathing, either your throat, completely closing or narrowing, you're going to either wake up at a sleep, or your oxygen is going to drop.

18:27

All right?

So one of those who things happen, so that's when I would analyze these, and when some of them are Auto analyze.

Now, that's what we're looking for, Respiratory event.

And then some sort of thing that affects your body and went in for a diagnosis of sleep.

Apnea, you're looking at the number of those events per our being above five and then yeah.

18:51

So more than five between five and fifteen typically will give you a diagnosis of mild sleep apnea.

Yes between 15 and 30, moderate sleep, apnea and above 30 is severe there.

We have been calling into question recently.

19:06

How important it like the number of times you have one?

How well does that correlate to anything how well does opinions about that dream?

And having talked with this many people for In two years like the number of people I've talked to who, you know, didn't get a diagnosis of sleep apnea because maybe their events were eight seconds long.

19:32

But they're waking up all the time and they're, they're not sleeping well, but their doctor said you don't meet the criteria for sleep apnea, and you can't have any treatment for it, like that happens.

Once he says their doctor said that, but their doctor is parroting the insurance company.

19:50

He's who they know that they cannot say that that patient has sleep apnea because the insurance companies say no they don't it hasn't been well correlated with future out a he have symptoms and how much impact that's having on somebody.

Yeah.

And all of them were almost most importantly, what type of treatment you should get?

20:10

You know, so it's all that to say.

That's how we diagnose you right now.

We look at how many times per hour.

All right so yeah I think of it like you know it's just like Our it's events for our right, right?

And the way that we do that the way that we measure this, I'm going to use the word surrogate right now, and so and we use that all the time so you Thanksgiving is coming up.

20:33

I don't know if I can say like a time-sensitive but so when you walk into in January and people are going to be like okay that's my back in things giving you walk into you.

If you are visiting notice, when you walk into the house you can smell Turkey.

20:51

All right.

Now, you don't know.

You haven't tasted that turkey.

You haven't touched that turkey hadn't seen that turkey but you're using your sensor, so it's a surrogate.

All right, so you know, something is happening based on something else.

All right, that's how we measure.

Checking the actual blood.

21:07

What up?

Doing an a-line and seeing, how much oxygen is here?

But we don't have a camera down your mouth to see like your if your throat, you know, we don't have subdermal electrodes looking to see if you wake up.

So all we're trying to do is we're trying to Other things that will help us know that those those physiological phenomena happen.

21:25

Yes, we do that using sleep testing.

Now, we'll start at the very top will start at polysomnography, all right?

I love polysomnography, I really do.

I mean there's so much the most amount of data, so much data, so much amazing data, unfortunately, over the last few decades, we've taken all that beautiful data.

21:47

And just crunch down to just that.

Hi Which is probably why I love worth in this but so much great deity.

You can really know and trust that the patient is awake or asleep.

You can really trust with the Sleep staging.

It is very subtle seeing if it's there are patients, who just a little bit of like a, like that's all it takes to wake them up.

22:11

Yeah.

And that's if you're doing that right?

And if you're doing that all night long, exhausting who is it exhausting?

Yeah, that's what you can get.

From from PSG, from polysomnography, very very accurate but I just said it's burdensome.

It's expensive for the insurance companies.

22:29

You, you have to go in overnight someone.

Yeah, like me has to put all these wires on you.

It's not in your home.

So I know a lot of people, I talk to, you know, that have you know, I speak to people all the time who are caring for disabled relatives or children or they work like a shift job and they Just take the night off, you know.

22:52

So I think sometimes it doesn't work with people's lives to actually go as well.

Of course, I mean, we used to run sleep studies on children and select their parents would have to, like, come on and say, you have like swapping out halfway through the night.

So it's it's a lot of time and energy and effort but I will I'm just gotta wait.

23:12

Make sure I say it to me.

It's where I love polish Mommy.

I think it's you're going to really find out what's going on right?

And one of the things Because before will say, you will know if you don't have it, if you don't have sleep apnea, if you go in and have a decent part of talking to, you will know that without a doubt, you are not having any sort of sleep apnea, okay?

23:33

So that's that's what that's what's wonderful about that.

Do we call that level one?

Yes, that's what you call Level 1.

All right, then so then you have level 2.

Alright, level to I'll just say is not use as much in the US.

All right, it's used a lot in in Elia in Asia.

23:52

And what level two is is many of the same sensors that you have in that policy, not to be, but then at home.

So, the way that they do it is they will put all the electrodes on the head.

The put the ones on the chest, they'll put all these on, they'll actually bring you into the lab hook, you up for it and then send you home and your home.

24:09

Yeah.

Okay.

Which before in my path before was asleep Tech I was an EEG Tech and we do we do that a lot in EEG.

Will you put all the sensors on someone they just carry or anyone?

So it's kind of like so that's level 2.

It was kind of like level one except it's not observed by right, a member of Staff watching you sleeping.

24:27

Well and there's a couple other additional measurement tools you have in the sleep lab that you don't have.

And I mean, you can measure someone's as CO2 levels like through their nose or sometimes through their skin tone, you can't do that at home.

You know what you mentioned, if you go into the sleep lab.

24:47

So when someone says having like an in lab sleep study, So, that could be a diagnostic one, but in many cases, it's a CPAP titration.

And so that's where again, someone like me is, like, finally tuning all of the settings and all the pressures to really, make sure you have the right pressure settings again.

25:04

Can't really do that at home though.

There are there, they're working on that remotely like changing the pressures while monitoring live sets a night.

So now that's really helpful and people could do that remotely.

Yeah.

And and so that has a lot of a lot of Of clinical value, it really does.

25:22

But recurring theme, Here, not reimbursed any better than Ur, right?

At the level 3 level 4.

So why would why would people do it?

You know?

Okay, so watch Level 3, okay?

So level 3, you need to have two main sensors here, you need to have an air flow sensor and you have an oxygen sensor.

25:47

All right.

You can also have any was an air flow sensor like a cannula up.

Your nose though.

In some cases, it's a cannula up your nose.

So actually the one of the Physicians and researchers have worked with David Rappaport.

26:03

He it's because of him that we use that nasal Canyon before.

Then we used to use something called the thermistor, or thermocouple and that measured difference in temperature.

So when you go in and out that You blowing across the temperature but the the nasal pressure the nasal transducer their the cannula they put in measures very very subtle changes in pressure and that just gives you a much more accurate again.

26:29

All I'm talking about is that if you have severe sleep apnea you almost don't need a study like, you know, II can the problem is making sure that the people who have the very mild sleep apnea, the people who have them and that wakes them up being able to detect it.

26:46

And so, that's where you Sensor.

So that's you need to have the the nasal pressure car event for it to be a number three are to be number 3 and and this gives you a signal, all right?

And usually, there's a couple other ones.

Yeah, depending and so far a level three tests.

27:05

Can you explain about like reeling in and reeling out?

Like can you use that to realize level you go down in this the less you're able to rule out and in fact this is a very common phrase that they use in clinical, see medicine, you know if you Lo so let's say your physician says, I want you to have it in lab polysomnography and insurances.

27:30

Nope, have to have a home sleep study, but that patient has symptoms of sciatica sentence.

Yeah, if they go, they have a home.

Test and it comes back negative.

That doesn't mean they don't have sleep apnea.

And in many cases, that's then used as justification to say, you know, the patient are presenting clinically like they have sleep apnea home sleep test was was - so we're going to escalate the policy matter fee because they still have all the symptoms.

27:58

Yeah, that's one thing that I think I've heard a number of people were there like well I had a home test and it was negative and they have all the symptoms and I'm like go back and Have them posted doing lab tests right back to my math.

28:14

That's why for my turkey metaphor here.

Like so if you walk into a house and you smell turkey like you can assume that there might be turkey, but you haven't seen you haven't tasted.

So maybe someone has it got spray or maybe they made turkey the day before, or maybe it's coming from in here.

There's us.

That's what these home sleep test.

28:30

Do, is they give you a hint.

And, in many cases, it's strong, but like, you don't know until you've seen it.

You've taste in touch with.

That's, that's why right?

Right.

Yeah, okay.

So then we got down to three and then you want to talk about it.

So then there's one level of day and from that called, for level 4 is the final one.

28:49

Alright.

And so, that really the big difference in level 3 and level 4 is, it doesn't require the nasal.

Yeah.

You have to have spo2 and another sensor or another signal, you don't know.

So, that would be like a watch Pat device where it's got the thing on your wrist, your finger, and a little thing on your chairs, or Like, I think the West were thing with the, if it has the pulse, ox, on it Westar has a pulse ox.

29:16

There's there's a few different kinds.

So let's see how it's talk a little bit about them.

So talk about the technology behind because that's what's really fascinating to me.

So when you really get down there because you're relying on, so few signals you have to really have good technology to for it to be accurate, right?

29:31

Yeah, so, yeah.

Watch Pat.

Is it uses Peripheral arterial tone door.

Perform tomography.

She is actually the term for it and really what they're looking for is that it's got a little sensor that that looks at your arteries and looks like the volume of blood flow in there.

29:50

Okay.

I won't get too technical into it but they can basically from that they're smelling the turkey when they see that.

And so they know that there is turkey, all right, I'm going to keep going back to this metaphor.

All right?

But that's but it's, but they've got a really good nose.

All right.

Yeah, that's like a really good.

30:06

So that's one done that test and I I was kind of incredible like that they can tell all that from those small sensors course.

So they've they've got that technology.

There's another group out of the Sleep image folks, they use.

Yeah, bring like a pulse ox, the same sort of sense of that you would wear like if you're in the hospital setting a pulse ox and then they do this Advanced signal processing cardiopulmonary coupling where they're looking at like in the ECG wave you know the little thing like your heart.

30:38

Look at how tall.

All each one is and if the, the height goes down, how close they are together and they run it through this whole Advanced algorithm and they can just take that one signal.

Really good nose here and know that there's turkey.

There's definitely turkey baster.

I feel like you and I have probably had the same discussion with the Sleep image ring people.

30:58

And you've been like uh-huh and like laughing all up and I got to like where they were talking about the algorithm and I was just like, I don't really understand how this works but it So, I'm very clever and I've done that one as well, and it's, it's pretty amazing the data they can get from it and I'll make it to really simplify that that signal there.

31:19

You overlay, the ones with the height and like the the distance, and just the combination of the two is what lets?

You know, whether there's an event.

All right?

We'll just say that.

There's another one that I'm actually super excited about coming out in a few is.

So there's a device called a sunrise device, and that measures and tubular, Meant, yes, again, as a surrogate, they know that when you, when you fall in a certain stages of sleep, your muscle tone like, REM sleep, your muscle tone goes completely relaxed.

31:48

So they can use that as a surrogate for knowing your own REM sleep.

Isn't that crazy crazy, every time when I first talked to them about AA, I like I'm not gonna lie to you.

I kind of just felt like how can that possibly work but then they so I'm not sure if I think that they're getting approval for that in the US.

32:09

Right now but it.

So they have available in Europe, they have to what they don't have, is that the SP O2 sensor, which I think is in the works right now, right, the right level for definitely needs the spo2 the, the ponies that got it.

So, but the actual sensor part is this really small flexible thing that sticks on your chin crazy and like it's amazing that they can get data from that.

32:36

Yeah.

You know, and then the other one that I really like that The West part of ice, all right.

Yes.

You know, they use something, they you, they don't have anything about your nose, all right?

But what they have is, so if your Airway is completely open and you were to put your hand on your chest, your hand or something, breathe, like your chest in your abdomen move together, all right?

32:55

But if you put a little bit of resistance there, that changes how you breathe your chest, goes in, your stomach goes out when you're trying to reach and so they can tell the subtle differences in chest, breathing and stomach breathing.

From that that's their nose to know that there's turkey.

33:13

Yeah, so yeah, cuz I've done that one too.

I feel like I've done all this.

You know, I just have a weird job, right?

But what the West more thing of nobody like, people, like their haven't heard of it.

There's two almost like sticky.

How do you describe those patches?

33:29

They'll go like one under your boob and want to over your tummy and it you just kind of like switch them on.

You can't.

They're not uncomfy.

It's just It just sticks to your skin and then you add in the SP O2 sensor.

33:45

And actually, the thing that they have that none of the other ones have is, but a temperature sensor as well.

And so there's a whole lot especially if you're, I'll get on my soapbox real kicker.

Now again for a second so we kind of bucket people with sleep apnea as you have sleep apnea.

34:01

But for most people they have sleep apnea, not most, but many people have sleep apnea and insomnia, or sleep apnea.

Yes.

And so knowing where your body temperature is, can, I mean, my ordering has a temperature sensor so I can see like my temperature is about the way it can help, you do know what your optimal sleep schedule is, you know.

34:23

And so what we're saying is for people with this kind of, like, level for thing.

Yeah, if they do that, and it doesn't come back as them having sleep apnea, but they still have all the symptoms, they should then, keep trying to find answers.

Hopefully, A physician will do that work for you and your physician will say, all right we tried this, you still have symptoms but this wasn't even.

34:45

It just means that that tool those tools are very they're wonderful but they're just not sensitive enough to out sleep apnea for many, many people.

Yes, got it.

Thank you for explaining all that.

So well, because I feel like I kind of assumed a lot of knowledge and sometimes people listening or like what some of these, the that can be shipped to your house.

35:05

Some of them are disposable, some of them connect with your phone and the data is pushed What are the next day and it's automatically analyze, you know?

So so I think that's one of the things that we're seeing is just a lot of these companies disrupting, you know, kind of going direct to the consumer to you know, I interviewed somebody who had used a loft ur-text.

35:28

Yeah.

And that's very much.

Like you don't even need to deal with like going to your own doctor and getting a referral and what you talk through to begin with because they have their own dog.

Actors doing Telehealth visits and sending home test run to your house and all that.

35:45

So I think it's changing I think we'll see a lot of change probably which I think from the patient's point of view is probably a good thing.

Yeah and I mean we're highlighting we've probably overwhelmed with the number of different devices we've mentioned but like that's honestly just scratching that there is.

36:00

Yeah there's so many areas, the app kneeling the piers the Sleek profile, there's the Cleveland of all over the place.

How many comes to you and Teresa and they have symptoms of sleep apnea.

What are you going to work with their own doctor and talk them through that?

36:18

Or are there particular tasks that you guys used?

You want to just speak a little bit about that.

If they have a doctor, especially they have a sleep doctor.

We would love to help them and that can go, as far as, you know, letting me know like, you know, this is the person you should reach out to or like this is the script that you can give you no ask these questions and make sure you get these answers before you leave.

36:38

That's it.

It's the sort of things we can help out with.

It's funny because when I interviewed and doctor kashani, he was saying like we were kind of going back and forth because I was like, we need to give people the tools to be able to advocate for themselves.

36:55

In healthcare settings, to get the information they need and to get the testing they need and he was just saying like it shouldn't be that way.

Like it's our job as Physicians to know, you know, all the stuff but I was like but in the meantime Time, right?

We're gonna have to, you know, Empower patients to get the answers.

37:15

They need from the current system and I respect them and great guy, but I will say that I almost don't.

I want Physicians to be Physicians, you know.

I want them making clinical decisions and I don't think that the, I think that all this role.

37:32

This, the Sleep coach sleep Navigators.

He zsh, whatever you want to call it, but I think it has a real place.

And I don't Think it in any way.

Diminishes the role of the physician, I think it's hard to gather what they're doing.

Yes, absolutely.

We can help with educating patients, we can help with coordinating that care.

37:50

We can help monitoring and always always, ultimately going up to the physician for the for the clinical decision.

I don't want to make clinical decisions.

I'm not a physician.

I want the position of the game.

Well I just be a podcast.

The lesson on home sleep testing here and if Is a from where the home sleep testing groups and they're listening this, you know, your mouths for a second.

38:15

But the thing that we're moving toward is that the gap between these consumer wearables and home sleep.

Testing is getting that was going to be my next question.

Okay.

Yeah, there's and maybe by the time this podcast airs, it might even be released but that one consumer device is a I'm hearing is about to get FDA clearance as a home as a A diagnostic tool something, that's where we're going because even the the sophistication of like, you know, even like aura rings and apple watches, which are not diagnostic tools are the amount of data, though, is incredible.

38:56

And here's my thing on this is I welcome that.

All right, I want us to Accurate testing an accurate diagnosing.

Absolutely.

But we have put such such a bottleneck into that diagnostic process.

39:13

I would love if just as a field we could just get I want.

I want honestly, I would love if there was a blood test, a genetic marker, you know, something for you to just like or again.

You're wearing your order when you wake up in the morning and your phone just says, hey you have sleep apnea, go to your doctor and you know Skype click this button.

39:33

Schedule your appointment for you to talk about your therapy options, you know, I don't think we're that far away from that, to be honest.

And that's where I think a big opportunity is with these devices as they get more and more accurate.

Yeah, we can use them to track patients on therapy.

39:48

Yes, really know that, not just at their their OS, a follow-up.

Like I see that.

You wore your CPAP last night and it didn't go so well and have we tried all these different things and helping people to adjust and that is actually something that's changing out there are these, the insurance goes.

40:09

He's remote patient.

Monitoring codes that decimal search trying out, which allows us to exactly that mrs.

Jones, you, you took off your mask at two am.

Can we?

Can we talk about it?

Is, what particularly was it?

Can we do a video chat?

See how you have it fit on.

I would love to be able to do that with me.

40:25

Yeah, yeah.

So tell people, I could literally talk to you for four hours but I'm gonna have to let you go.

So talk to people about where they can find you, maybe tell them a little bit about you and Teresa have some programs.

People can do little courses.

40:42

Join talked about you, go to sleep.

Better dot NYC not.com, sleep, better dot NYC.

We have all of our information there.

So, you know, as as you said, we have some of these self-paced programs I want.

I want to see a doctor but maybe while you're waiting to see your doctor, you can check out one of these.

41:01

We have programs that can help you kind of a restructure, your sleep, starting with like the environment around you, then maybe with your routines in the morning, your routines at night, maybe the food and beverages that you consume throughout the day and really helping to guide you to improving your sleep on your own.

41:18

Just these are practical tools so that you can control your own sleep.

So we have some information about that or we have another one.

On snoring and sleep apnea.

So let's say you think you want to see a doctor but like you're not quite sure, this can help educate you.

41:35

As to what you're experiencing help, guide you to find.

So we have we have that that on our side as well.

We have another one for people who, who, who have it sleep in mental health and so, a lot of it is educating that when you have bad sleep at, that definitely affects you the next day.

41:54

That's huge.

That's That's like no joke, every person I talk to you like, you know, like I think that when I first started my podcast, I think I thought that I was the only person who's dealing with anxiety and depression.

42:09

And, and, and then one of the things to come out of it was, I think I've interviewed a handful of people who haven't read, who were very young, who got diagnosed really quickly, who haven't had much of a mental health impact, but everybody else like, It's just they go hand in hand.

42:28

If your sleep is not right, they do and yeah, it is right?

Because it's bi-directional and, you know, if you have, you know, if you are, you know, have anxiety, depression, PTSD, anything that's going to impact your sleep, and if you have sleep, this going to exacerbate that, and even if you don't have a diagonal diagnosable, you know a psychiatric disorder mental disorder.

42:56

Just having poor sleep, can mimic a lot of the same anxiety University.

I mean, that's just it's how our brains are wired, you know?

We, yeah, when you, when you won that a poor sleep, your amygdala is like X percent activated and your and your Snapchat with everybody.

43:14

Well and and this is something I heard a podcast recently.

We intuitively know that with children, like anyone who has kids, you know, that that kid has a poor night's sleep or that nap doesn't happen.

Yeah, that's why those are sacred.

So we know that with which order we have better compensatory responses as adults.

43:33

But like do we I think it's more that we just have this like conditioning.

That is not acceptable for adults to just, like have a big meltdown.

But like that's kind of what you like.

That would be me if it were acceptable.

43:52

Well, listen to you.

Thank you so much.

I will put links.

Stu you and Teresa in the show notes and really appreciate your time.

No, thank you, Emma.

And I love, I love you.

Have this podcast.

I love how devoted you are to getting people educated on this.

44:08

This is, I just like having another sleep nerd friend.

So friends are the best.


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