Pillars of Good Health & Sleep with Dr. Raj

🫁 Welcome back to the Steadfast Care Planning podcast! Today, we’re thrilled to welcome Dr. Raj to the show. Dr. Raj is a quadruple board-certified physician and a renowned expert in internal medicine, pulmonary critical care, and sleep medicine. He is also a clinical researcher, associate professor, media personality, and author. In this episode, Dr. Raj delves deep into the critical topic of obstructive sleep apnea (OSA) and its widespread impact on breathing during sleep, comparing it to the extreme sensation of having a pillow placed over one’s face.

💤✨ Not only does Dr. Raj shed light on the underdiagnosis of OSA in women, but he also discusses the significant health implications of untreated OSA, including its effects on organ function and overall quality of sleep. We explore the contributing factors of OSA, such as weight, and a variety of treatment options ranging from CPAP devices and dental solutions to innovative therapies like the Inspire device.

🛌 Moreover, Dr. Raj emphasizes the need for a personalized approach to treatment, discusses the crucial balance between lifespan and healthspan, and outlines the four fundamental pillars of good health: diet, weight, mental health, and sleep. We’ll also touch on common sleep mistakes influenced by modern lifestyles and how to effectively communicate sleep concerns with healthcare providers.

💡 Don’t miss this episode packed with expert insights, practical advice, and Dr. Raj’s strategies to improve your health and well-being. Plus, learn more about Dr. Raj’s presence on social media and his own podcast, "The Dr. Raj Podcast."

In this episode they covered:

🔹 **Four Pillars of Health:** Discover Dr. Raj's four pillars of good health: diet, finding optimal weight, mental health, and sleep, and how they contribute to a healthier life as we age.

🔹 **Stress Management:** Get tips on maintaining a positive attitude, avoiding isolation, and staying connected to manage stress effectively.

🔹 **Common Sleep Mistakes:** Learn about common mistakes that affect sleep quality, such as late-night technology use, alcohol consumption, snacks, and certain medications.

🔹 Dr. Raj shares valuable insights on *Obstructive Sleep Apnea (OSA)*, a condition that disrupts breathing during sleep and affects millions in the U.S.

🔹 **Underdiagnosis in Women:** Uncover why OSA is often underdiagnosed in women and the symptoms to look out for beyond snoring.

🔹 **Health Impacts:** Explore how OSA affects organ function and can lead to poor quality sleep despite getting enough hours in bed.

🔹 **Contributing Factors:** Dive into the role of weight in OSA and how weight loss can improve symptoms, although it’s not the sole cause.

🔹 **Treatment Options:** Learn about the various treatment options for OSA, including CPAP devices, dental devices, positional therapy, surgery, and the innovative Inspire device.

For more information about Dr. Raj and his 4 Pillars of Health, please visit:

https://www.doctorrajd.com

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For additional information about Kelly, check her out on Linkedin or www.SteadfastAgents.com.

To explore your options for long-term care insurance, click here.

Steadfast Care Planning podcast is made possible by Steadfast Insurance LLC,
Certification in Long Term Care, and AMADA Senior Care Columbus.

Come back next time for more helpful guidance!

Chapters

• 0:03 Introduction
• 1:20 Difference between Lifespan and Healthspan
• 3:40 The 4 Pillars of Health: diet, weight, mental health, and sleep
• 8:50 Explaing common sleep mistakes: environment, diet, drinking, medication, electronic devices, etc.
• 14:38 What is sleep apnea? A brief description of airflow and the causes of resricted airflow.
• 17:54 AMADA Senior Care Commercial
• 18:20 Is sleep apnea preventable? How can we avoid having sleep apnea?
• 19:43 New advancements and treatments to help sleep apnea.
• 21:45 What is the Inspire device? Dr. Raj explains the Inspire device and how it works as a sleep apnea treatment.
• 24:19 Who is a good candidate for the Inspire device and explaining sleep labs that help correctly diagnose certain types of obstructive sleep apnea.
• 25:38 Do CPAP users need to get retested periodically and are there sleep lab options like home testing?
• 26:15 Dr. Raj explains ResMed and Respironics that both made CPAP machines and he explains the Respironics recall.
• 27:15 Justifying a retest for insurance purposes, or not.
• 28:48 Dr. Raj answers what advice he has for people to live healthy and to live well.
• 29:00 Dr. Raj explains that 30% of our lives are spent spleeping so we really should take it seriously and make it count for better well-being and healthy living while we are awake.
• 30:21 How to contact Dr. Raj and where to find his podcast, The Dr. Raj Podcast.

Transcript

Kelly Augspurger [00:00:02]:
Hey everyone, Welcome to Steadfast Care Planning where we plan for care to live well. I'm your guide, Kelly Augspurger. With me today is Dr. Raj, a quadruple board certified physician in internal medicine, pulmonary critical care, and sleep medicine. He's also an active clinical researcher, associate professor of clinical medicine at the University of California, Riverside, and the associate program director of internal medicine residency at Huntington Health. On top of that, he was inducted into the Alpha Omega Alpha Medical Honor Society and is a media personality, author of the best selling case based medical book series, "Beyond the Pearls", which is published by Elsevier, podcast host and spokesperson for the American Academy of Sleep Medicine. Dr. Raj, you are a very busy man.

Kelly Augspurger [00:00:51]:
Thank you for being here.

Dr. Raj [00:00:52]:
Totally, Kelly. This is a treat. Love hanging out with you on your podcast.

Kelly Augspurger [00:00:57]:
Well, we are excited to be talking today. We are going to be focusing on good health. And really what those four pillars of good health are, which I know I'm going to give away one of them right now. We're going to be talking a lot about sleep today. So, Dr. Raj, can we just jump right in?

Dr. Raj [00:01:11]:
Yeah, dude, let's do it. Let's go for it.

Kelly Augspurger [00:01:13]:
Let's do it. Okay, so let's kick off and talk about healthspan and lifespan. Can you let my listeners know what is the difference between healthspan and lifespan?

Dr. Raj [00:01:23]:
You know, one of my passions right now is gonna be talking about as we get older, the elderly. And it's amazing that one of the things that I didn't learn in med school that's not really pounded home is this difference, because I think if you were to say lifespan and healthspan, many people would be like, those are just the same thing. I mean, what's the difference? And I guess, you know, to the "T", when you say the word lifespan, it's gonna be from the minute you're born to, unfortunately, the moment you pass away. But health span is basically, well, how many of those days are you living healthy? And I wish in a perfect world, they're kind of like parallel, but they're really not. There's a gap between those. And in fact, studies have shown there's like a ten year gap. And what makes me kind of surprised and sad at the same time is that when you look at well developed countries, and I assume the United States is part of that, we're not doing that good when it comes to that narrowing of the gap, and that gap is ten years.

Dr. Raj [00:02:20]:
So, you know, I always think about the analogy about, "Hey, I want to find the fountain of youth," you know, and I hope someone finds it one day. But you know what? You may live forever, but you'll get some dementia and you'll get some heart failure and all these other chronic diseases will happen. So what is going to be the goal is to try to close that gap. And how do we close that gap? We do it by putting things in two categories. Things you could modify and things you cannot. So, Kelly, things you can modify, you know what I mean? Are things like your diet, are you doing some exercise? Are you getting enough sleep? Those are things that we're going to work on and talk about, but things that you cannot is going to be your age. I guess you could lie about that, but it doesn't change your age.

Dr. Raj [00:03:09]:
You can't change your genes. You may tell someone you're adopted, but it still doesn't change your genetic makeup. So we are trying to focus now on what I call the pillars of good health. And why am I all motivated about this lifespan and healthspan is because, you know, when I'm wearing a different hat, it's not in the bio. I'm actually the chief medical officer, I just love saying those words, of Aegis Living. I just love them immensely. And they really focus on, as we get older, assisted living, memory care.

Dr. Raj [00:03:41]:
And I just want people to feel that, as you get older, it's not just a time to turn in the towel. It makes me very proud to be part of an organization that wants to make that part of life the best it can be. And it really makes me happy. So I think that's my new thing right now, is about narrowing that gap.

Kelly Augspurger [00:03:58]:
I love that. So what are these four pillars of good health, Dr. Raj?

Dr. Raj [00:04:03]:
So one of the pillars is going to be diet. And that's a hot topic. You know, it's going to be what you eat, how much you eat. And of course, let me just say some words. Antioxidants, you know, let me say some words. Are we doing complex carbohydrates or simple carbohydrates? Let's talk about fats. Are they polyunsaturated? All these things factor in. And of course, everyone wants to know if you are going to eat and you are going to eat healthy, where can you double up and get some anti inflammatory and get a good diet at the same time? And it could be a simple choice as well.

Dr. Raj [00:04:35]:
How much red meat are you eating? Is it okay to go to be a pescatarian like my beautiful wife? Should you be a vegetarian? Should you supplement because you're a vegetarian? So I think diet plays a big role, especially when we talk about gut health, which is a hot topic. And some of my favorite people to kind of hang out with in the hospital are dieticians, nutritionists. They're just amazing because it really, it's the little things. It's not always prescribing medication that really makes a difference. Diet is going to be a huge part of that next is going to be finding the optimal weight and I think I always want to be careful how I say it because every weight is just, what? Beautiful. And I love everyone, but there is an epidemic out there, and there are people who are going to be obese. There are people who are going to be overweight.

Dr. Raj [00:05:20]:
And that's why when you talk about the hottest topic on tv, on media, are these medications for weight loss, which are good and bad whether it's Wegovey or Ozempic or Zepbound. I mean, of course, we definitely need more weapons to help people achieve that. But definitely in the right context, finding that optimal weight and going a little like... side note, have you heard of the body mass index, Kelly, by any chance, the BMI?

Kelly Augspurger [00:05:49]:
Of course. I use that a lot in my industry. Cause our underwriters are looking at the BMI when people apply for long-term care insurance, so. Of course, yeah.

Dr. Raj [00:05:59]:
So one of the things that is a spicy topic is, is BMI the best marker for being healthy? Because the big thing is it's not just looking at your height and weight and dividing the numbers and getting that value, but it's, what is your body composition? Are you mainly muscle? Are you mainly adipose tissue, which is fat and we don't know accurately at the tip of our fingertips, what is your body composition? And sometimes you get the misinformation that, "Oh, you're not healthy because your BMI may be elevated." So that's a spicy topic. Then, my last two are my favorites. You know, your mental health, try to avoid being lonely. In our country, maybe around the world, there's the epidemic of loneliness as we get older. You have chronic disease, you have CoP, you have a mental disorder, you're just getting older. So I really feel happiness is such a big thing. And you came on my podcast, you know I'm always smiley and happy, and that's the way I am, because you just want to bring joy to everyone.

Dr. Raj [00:06:59]:
And being happy in mental health is going to be so, so important. And that's why I think the hardest time when it comes to elderly was during our godforsaken pandemic, which stank in so many levels because we were isolating for the better of health of other people and the safety of our residents and our patients. But, making people when they're older, who live in assisted living, or in a home or whatever eat by themselves and stay in their room, oh, my God, it's just making things worse, I'm telling you. And then the last, I think, is my favorite is going to be sleep. And my take home message is that what happens at night definitely affects what happens during the day. And as we get older, sleep is just as important, but super hard to get. It's hard to get that good quantity and quality sleep. But all those things we could kind of work on a little bit, those are my reversible risk factors, things we can kind of pick at a little bit.

Dr. Raj [00:07:52]:
And that will hopefully close that gap between lifespan and healthspan.

Kelly Augspurger [00:07:57]:
The Steadfast Care Planning podcast is sponsored by AMADA Senior Care. AMADA provides complimentary consultation with a senior care advisor to find the right care, from in home caregiving to community care, as well as long-term care insurance, claim advocacy, and unique support partnerships for financial advisors to address family transitions and generational retention. To learn more, visit www.SteadfastWithAmada.com. Okay, so we have diet, we have weight, we have mental health, and we have sleep. Those are the four pillars of health, right? Did I say those correctly? Okay, cool. So I love to focus on sleep because we know as we age, you know, especially we get 65 plus. A lot of people struggle with getting good quality sleep.

Kelly Augspurger [00:08:50]:
And I know you're no stranger to helping older adults get good quality sleep since you are the chief medical officer at Aegis Living. So let's talk about, Dr. Raj, what are some common mistakes that people make with their sleep?

Dr. Raj [00:09:02]:
Oh, my God. I don't even know where to begin, but let's just talk about sleep hygiene. You know, I think that I'll be the first to say that if you suffer from chronic insomnia, the answer is not sleep hygiene. We all could use a little bit of sleep hygiene. And the first layer is the room should be dark and quiet and on the cooler side. But as I kind of layer upon that, what do I think is one of the biggest things for getting hard sleep? It's this device here. It's our cell phone. You know what I mean? It's going to be the broader topic of technology.

Dr. Raj [00:09:33]:
Is it helping us? Is it hurting us? Are you putting it away? Are you checking to see what your grandkid is doing at night? Should you have the tv on? All these things are going to be factoring in. People getting sleep or having trouble sleeping. You know what, "Maybe I'll have that drink of alcohol?" That's a big no no. You know, I think that knowing what you're doing before you go to bed, having that late night snack of carbohydrates and maybe some chocolates, isn't the best thing to do. It can be the fact that you maybe are drinking too much, or taking a medication like your water pill. If you have things like heart failure, that's causing a problem. So it's gonna be simple things that you could just tidy up first. I think when we talk about what is the biggest problem as you get older in anyone for sleep is gonna be you don't tell your doctor and it's no one's fault.

Dr. Raj [00:10:18]:
You know what I mean? Many people in the healthcare profession are overwhelmed when you see them. They're focusing on the problem at hand. But how many people are going to say, you know what, with my limited time with my healthcare provider, let's talk about me not being able to initiate sleep, and I think that's one of the main problems that primary sleep disorders kind of get swept under the table. And those sleep disorders can be obstructive sleep apnea, restless leg syndrome, chronic insomnia, just to name a little bit. And not to mention that I always feel medications have their benefits. You need them, but they also have their side effects. So especially as we get older, this is not a shocker. Polypharmacy medications whose side effects will make you more alert during the nighttime, people who are going to be on antipsychotic, antidepressant, antianxiety.

Dr. Raj [00:11:05]:
So if you take something that makes you sleepy during the day, you're definitely not going to sleep at night. If you take something that makes you a little more alert and you take it right before going to bed, it's not going to help. So I really feel like it's going to be taking a step back, looking at the overall view, making sure you do a little tidying up about your sleep hygiene, being consistent, making sleep a priority, and just kind of opening your mouth when you think there could be a problem. It could be talking to your loved one first, and then maybe talking to someone who knows someone who knows someone who's a doctor. Or just go straight to the healthcare provider itself and say, "Hey, is this normal?"

Kelly Augspurger [00:11:39]:
Right. And if it's not normal, please tell me. And what do we do about it? Right. Let's come up with a game plan in order to fix it so we can get better quality sleep so that the next day you are fully present. Right. And you're able to have the energy and the endurance and everything that you need in order to have, really a productive and successful day. Yeah. I think it's so interesting.

Kelly Augspurger [00:11:57]:
I just, as you're talking here, I just had a vision of babies. Like, when we have our children, sleep is at the top of the list. We want them to get good sleep, not just for them, but we need it, too. Right? Like, if they're not sleeping, that means we're not sleeping.

Dr. Raj [00:12:12]:
Yes. Right.

Kelly Augspurger [00:12:14]:
So it's really. I see sleep as, gosh, this can be such a problem and an issue from birth all the way up to the end of age and in between. And so how do we close that gap? How do we optimize our sleep the best that we can so that we can really be the best people we can be during the day? And so I think those are some great tips that you have there.

Dr. Raj [00:12:36]:
Well, I want to throw some things about women because I think it's going to be important. So, when we talk about who's going to be more sleep deprived and get less sleep, it's women, you know? And I think you brought up so many important things, is that there are things that women do that men just don't, and whether it's going to be, you mentioned about it, birth, you know, that peripregnancy during the pregnancy. It's not easy to get sleep. It's not easy to get at. One, you're about to deliver. And postpartum, you know what I mean? I'm sure there are awesome dudes out there that try to be best husband of the year. But hey, it's mom. Whether it's breastfeeding, or just being the cuddly, awesome mom they're going to be, then women also have that perimenopausal. Men don't have that at all.

Dr. Raj [00:13:18]:
Then there's going to be society in general playing that dual role. And studies have shown, this is not my opinion, that women, when they fall asleep, they're so sleep deprived, they go right into this deep stage of sleep just to try to make up for it. So I think that when we talk about sleep and I'm having problems sleeping. It's going to be what gender, what race, what age, and so many things are going to factor into that. And not to mention that when we talk about depression, anxiety, women have it more for a variety of reasons, and those are highly associated with not getting good sleep. So this is my little shout out to women out there. You folks are amazing for still functioning well with all those sleep problems that you have.

Kelly Augspurger [00:14:04]:
Well, I appreciate that. I mean, I think all people, women and men, we all have a lot on our minds and on our plates, and we're all busy, right? We all have a lot on our agenda. But, you add in medications and health complications and young children, or caring for maybe older parents, maybe they're in their home. And so a lot of things can really factor into not getting good sleep. And I know one of those things that can contribute to not getting good sleep, Dr. Raj, which you've already said is sleep apnea. And it seems like it is quite common. And I'd love to hear you talk about this in detail, but talk to us about sleep apnea.

Kelly Augspurger [00:14:40]:
What is it? First of all, what is sleep apnea?

Dr. Raj [00:14:43]:
So I love some epidemiology. Everyone loves numbers, supposedly during an interview. So, 50 million people in the United States have obstructive sleep apnea, based upon the definition. And if you were to ask me, "Hey, what does apnea mean?" That means no flow. Flow of what? Air. Oxygen going in, carbon dioxide going out. And one of my fellows in sleep, that's the people I train, they describe sleep apnea to their patients as kind of like putting a pillow over your head while you're sleeping. That's kind of scary.

Dr. Raj [00:15:14]:
So I'm like, don't use that analogy. But if they come over your face, you're not gonna breathe. And by definition of an apneic event, an apneic event lasts for 10 seconds. So can you imagine someone putting a pillow over your head for 10 seconds? Oh, my God. It just sounds scary. But that literally is what apnea means. So you can't breathe, you're not flowing. Then after 10 seconds, you take the pillow off, you're like...

Dr. Raj [00:15:38]:
And I'm sure we kind of hear...

Kelly Augspurger [00:15:40]:
Gasping for air.

Dr. Raj [00:15:42]:
You nailed it. And you make heroic snoring. Like, wait a minute. Take the rhinoceros out of the room. It's associated with that, and you're just not breathing. You're like, honey, honey, I love you. Wake up. You know, and that could be the man or the woman who can get it and so one of the scary things is that when we talk about, as we get older, we see more obstructive sleep apnea.

Dr. Raj [00:16:02]:
Another scarier fact is sleep apnea is under diagnosed in women. What a surprise, because I think that when you're looking for diseases, screening for diseases, is that if you're asking a woman, are you a heroic snorer? You might be asking the wrong questions. Studies have shown that women present with a fatigue workup, women present with a depression workup because of the OSA. So you need to think a little bit outside the box for that. But OSA definitely is kind of like being sleep deprived. So what is the key word for your listeners?

Kelly Augspurger [00:16:33]:
And what is OSA, Dr. Raj? Sorry, what does OSA mean?

Dr. Raj [00:16:37]:
Obstructive sleep apnea. So obstructive, when you talk about sleep apnea, there's two flavors. One is obstructive sleep apnea, and that's the 50 million people I'm talking about. The other flavor is called central sleep apnea. That's a very small portion, still important, but we're going to focus on Obstructive Sleep Apnea, OSA.

Kelly Augspurger [00:16:58]:
Okay.

Dr. Raj [00:16:59]:
So, after you make the correct diagnosis, that's only going to be just the tip of the iceberg, because it's amazing how OSA is going to be something that can affect every single organ in the body. And the take home message for your listeners is that if you're sleeping the 7 to 8 to 9 hours that you should be sleeping and you still still feel fatigued and tired during the day, you're not getting good quality sleep. And what does that mean? Are you going to deep stages? Are you getting REM sleep? Because with OSA, every time you have these apneas, you prevent yourself from staying in those deeper stages, or going to REM. You keep on waking up, multiple awakenings and arousals throughout the night. So you still sleep the right quantity, but it's poor quality.

Kelly Augspurger [00:17:47]:
Got it. The Steadfast Care Planning podcast is sponsored by the Certification for Long-Term Care, an in depth training program that gives financial advisors the education and tools they need to discuss extended care planning with their clients. Look for the CLTC designation when choosing an advisor. If you're looking to become a CLTC, enroll in their masterclass and enter "Kelly" in the coupon code field for $200 off. So are there ways to prevent this, Dr. Raj? Can we prevent sleep apnea?

Dr. Raj [00:18:19]:
Yes and no. So, you know...

Kelly Augspurger [00:18:22]:
And is weight a factor?

Dr. Raj [00:18:24]:
Totally. So, of course, I mean, when we talk about weight and obesity, it's not a necessary feature for OSA, because where is the obstruction in OSA? It's here. It's the neck, it's the tongue, my tonsils, my uvula, the obstructions in the upper airways, not here in the gut. So people who have OSA could look like you, Kelly. They could look like me. And that's why it's more than just thinking about what is your weight? But don't get me wrong, that's a key thing. And so that's why all these fancy drugs, Wegovy, Zepbound, Ozempic, Mounjaro, all these people should pay me, by the way. They are proclaiming that if you actually would lose weight, it will treat the OSA, and it will, to an extent, because of the weight loss associated with it.

Dr. Raj [00:19:19]:
But, I think the reason why I'm so scared about all these drugs is that people will just go right to the drug. What happened to the pillars of good health? What happened to diet and weight loss? What happens if you still had some residual sleep apnea? Are you going to wear the mask? Are you going to wear maybe a dental device? So I just don't want to give the wrong message out there. And messaging is always the most important.

Kelly Augspurger [00:19:42]:
Yeah, absolutely. So what are some new advancements that are around to help people with sleep apnea, Dr. Raj?

Dr. Raj [00:19:48]:
Great question. So OSA may not be...besides the drugs, right? Oh, of course. So OSA, once again, cannot be preventable, you know what I mean? Because of the fact that there's strong family history and other things that factor in. But if you have OSA, the next question is, well, "Why?" And based upon your age, it could be kids, it could be things such as the big tonsils as we get over it could be weight, it could be a positional aspect of it, the unfortunate gold standard, you know what I mean? It's not the best thing, because I really feel that choosing the right treatments individualized is this thing called CPAP that stands for Continuous Positive Airway Pressure. That's a device that delivers pressured air through the nose, or mouth, or both, and it opens up the obstruction in the airway. We call that a pneumatic splint. Pneu opening air. Splint means opening.

Dr. Raj [00:20:42]:
So it opens up the obstruction, and then, of course, what is the interface is the mask. And that's the hard part, because sleeping with the mask is not an easy thing for a lot of people. Not every mask has to make you look like Darth Vader, you know what I mean? You can choose a nasal mask, nasal pillows, but it is a mask, and that is what we consider the gold standard for now. It doesn't mean it's the best. It's just what we know has the best efficacy, if I could use that word. But, you know, depending upon your, what we call core morbidities, do you have heart failure? Do you have lung disease? You know that there are other options also based on severity. So you could use a dental device. It's called a mandibular advancement.

Dr. Raj [00:21:24]:
It pulls the jaw forward a little bit. Good for mild to moderate OSA, positional therapy, doing things that will make you sleep on your side, not on your back, because when you're on the back, because of gravity, the tongue falls back and blocks off the airway. Surgery, these otolaryngologists, ENT doctors may offer different things, and I already know one question you're going to ask me, and one of the things they may offer you as an otolaryngologist is something called the Inspire. So. And that's one of the newer things.

Kelly Augspurger [00:21:54]:
Let's talk about that, because that is. That's new, right? I don't know how new it is. I know it's newer to the market, and so there's a lot of buzz around it. So I'd love to get your take on that and tell the people what is Inspire? Right? It's a very inspirational word, but besides that, what does it do, and what are your thoughts on it?

Dr. Raj [00:22:13]:
Sure. Kelly, have you seen the commercials for Inspire by any chance?

Kelly Augspurger [00:22:17]:
Yes.

Dr. Raj [00:22:18]:
So it's a bunch of people who, I mean their marketing is outstanding. They pick a bunch of lines. It is individuals sitting in kind of a meeting zone, and they're all wearing their CPAP masks, and they're all complaining about their masks. And then someone's like, "Hey, you know, you should get Inspired." And they don't tell you what it is. So in medical jargon, it's called a hypoglossal nerve stimulator. And all you folks are like, what did he say? It just means it stimulates your tongue to shoot forward because it gives you a little jolt.

Kelly Augspurger [00:22:52]:
Okay?

Dr. Raj [00:22:53]:
And now everyone's like, what the heck did Dr. Raj say? So it's an implantable device. So right here in the right chest, they make an incision. They put in a device about. Oh, no, about yay big, like a pacemaker, you know? And it has two wires. One connects to the chest wall, one they track up right here, and they implant it so it stimulates the hypoglossal nerve. That's the nerve that's innervates your tongue. And I'm oversimplifying it, but basically they give you a remote control, and at nighttime, after we kind of turn on the device, titrate the device, get you used to the device. Every time you sleep, a signal, a voltage, will go to your tongue that is innervated by the nerve, and it shoots it forward so the tongue doesn't block...No way! Way!

Dr. Raj [00:23:44]:
And then I always joke with my patients who got it, you better be nice to your bed partner, because if you're not, when you're sleeping, they're going to crank up the device and make your tongue shoot out. But it's a procedure. It's in you and in broad strokes, I'm always happy when there's other options for OSA because obviously one hat doesn't fit everyone. You know what I mean? I think that it's something that you really have to make sure that it's meant for you. And how does a doctor know that Inspire is for you? Literally, they have to...

Kelly Augspurger [00:24:23]:
I was just going to ask you who's a good candidate?

Dr. Raj [00:24:25]:
Okay. So they, to qualify for it, you have to fail CPAP first. You have to be a certain weight limit. You know what I mean? So if you're really, really overweight or obese, you may not be a candidate for it. And most importantly, they got to do a procedure. When you see the ENT doctor that they make you sleep, how do they do that? They put an IV in you and they inject medications and you fall asleep, and then they take a scope and they go through your nose and they see how does your airway collapse? And in order to get the device, since the tongue has to shoot forward, that if you have a very specific collapse of the airway, then you'd qualify, because if the collapse is lateral, it wouldn't make sense. If the collapse is concentric, it wouldn't make sense. It's a very specific thing.

Dr. Raj [00:25:10]:
So it's a commitment to do it. I think the commercials oversimplify what it really is, but it's still, I had so many, for sure, asking about it. So, yeah, their marketing is ingenious, you know?

Kelly Augspurger [00:25:24]:
It is. I think, yeah. More and more people are hearing about it, especially those that have sleep apnea. And I know I have men in my family that have sleep apnea. And so that has been talked about, like, what is this Inspire? Does it really work? Is it worth considering? If you're not considering Inspire, though, and you do have sleep apnea, or know someone that does, and they have a CPAP machine. Okay. And let's say they've been using the CPAP machine for years, you know, they are compliant with it, using it nightly. Do they need to get retested in the sleep lab after so many years of using it?

Kelly Augspurger [00:25:56]:
Or is it, "No, once you're on the CPAP machine, you're good to go. And we don't need to retest."

Dr. Raj [00:26:01]:
Great question. So I'm going to first give a public service announcement, then I'm going to answer the question. So, for those listening in the United States, there were two main companies that, you know, made CPAP machines. One was called ResMed, and one was called Respironics, made by Philips. So if you're not familiar with Respironics by Philips had a massive recall because their devices were found to have a manufacturer's defect where a little piece of foam that was part of a filter system would get some really tiny micro particles that you would inhale. That sounds horrible. And so now you're not using Philips anymore here in the United States. So I say this because if you know a lot of family members who are using a Philips Respironics, what would I do? I wouldn't just stop using it.

Dr. Raj [00:26:47]:
I would talk to your healthcare provider. You know what I mean? So just a heads up. So right now, it's hard to get a CPAP device, because really, the only one really making it is ResMed. And how are they going to make up for the millions upon millions of people who are using the Respironics? But now, to answer your question is that, well, guidelines, do you need to get retested? So when I answer that question, a lot of it deals with insurance, because you got to justify why you are retesting. And if you are going to retest now, is it going to be as an in lab study where you have to spend the night in a location, or is it going to be at home and is it going to change your management? So I would say that if you have someone, at least I'll talk about personal experience that has OSA and says, "You know what, Dr. Raj? I'm snoring again. I've had notable weight loss, maybe I had a surgical procedure for my obstructive sleep apnea a long time ago, and it initially worked. And where am I now?" Then you got to justify why you're doing it and to get some kind of sleep study. But if you're doing well and you are asymptomatic, then I wouldn't just test the test.

Dr. Raj [00:27:53]:
You know what I mean? I don't think that's going to be the way to do things. But what really has changed OSA is having more home testing because the ongoing joke is that no one sleeps during a sleep study because you're in a lab. It's cold...

Kelly Augspurger [00:28:08]:
I always wondered about that. I always thought that is just the dumbest thing. Who's going to actually sleep well during one of these studies? Yeah, okay. I'm glad you touched on that.

Dr. Raj [00:28:17]:
So now that they're home studies, the take home message for you and your listeners is, hey, there's no excuses. You do a home study, you sleep in your own bed, your own pillow, your own time, and you keep the device for a few days. We average the how many episodes of apnea you have, and we give you a result. And then from there, you talk about what the options are.

Kelly Augspurger [00:28:38]:
Got it? Okay. Good to know. I just learned a lot in a short amount of time, Dr. Raj. But before we say goodbye, can you give us any final advice on how people can plan for good health and care, to live well?

Dr. Raj [00:28:51]:
Oh, wow. So I would say this. My last word about sleep is going to be, 30% of our lives we're asleep. And for most individuals, they would be like, well, what does that mean? You know what I mean? But if you live for a wonderful 90 years, that's almost 30 years of your life, you're sleeping. So don't take it lightly. If there's any question that you have there, that a third of your life you're going to be spent sleeping. We need to focus on that. And in general, the take home message is always going to be, before grabbing a medication, grabbing a surgical evaluation, look at the things that you can do that are simple.

Dr. Raj [00:29:26]:
And simple things to do is just, yes, I say exercise. I'm not telling you to sweat profusely on your treadmill and have heat stroke out in the sun. Just take a couple of extra steps a day. Eat healthy. Maybe when you get your chocolate muffin for your Starbucks in the morning, you know what I mean? Maybe some blueberries. Everyone loves blueberries. And pomegranate instead.

Dr. Raj [00:29:48]:
It's always the little things that matter. And it shouldn't surprise you, Kelly, when I say have a smile on your face. Don't stress about most things. Life is stressful. Don't get me wrong, it's very stressful. But, I think that not isolating, interacting, not being depressed, not being stressed, all these things factor in. And with that being said, I love this conversation, man. I had a great time today.

Kelly Augspurger [00:30:15]:
Fantastic. Thank you, Dr. Raj. Well, where can people find more information about you, Dr. Raj?

Dr. Raj [00:30:20]:
Let me think about that one. So I like to be on social media. So if you do some classic Instagram stuff, you do some like, oh, my God, I'm a little embarrassed, TikTok, or LinkedIn, I'm always on these platforms and check out the podcast that Kelly was on. She is awesome.

Kelly Augspurger [00:30:39]:
Yes. Tell them what your podcast is called.

Dr. Raj [00:30:42]:
It's called The Dr. Raj Podcast, and it's fun. We had some cool people on besides you, Kelly. We had, you know, Bob Saget was on the podcast before he passed away. He was talking about scleroderma. His sister had that, so we had some great people on. My mom was one of my guests on my podcast. She talked about taking care of my dad, who has Alzheimer's. So it's going to be really, really fun.

Dr. Raj [00:31:08]:
So it's The Dr. Raj Podcast. Please check it out.

Kelly Augspurger [00:31:10]:
Fantastic. Well, Dr. Raj, I learned a lot today, and I think my listeners did, too. Thank you so much for your energy and your expertise and your smile. Really appreciate it. Have a great day.

Dr. Raj [00:31:21]:
You, too. Bye, everyone.