The Get Healthy Tampa Bay Podcast

E143: Dr. Maria Guzman on Midlife Sleep, Apnea in Women & New Treatments

• Kerry Reller

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Welcome to the Get Healthy Tampa Bay Podcast with Dr. Kerry Reller! This week, I’m joined by Dr. Maria Paola Guzman, a triple-board-certified physician in Sleep Medicine, Obesity Medicine, and Internal Medicine. We dive into why sleep is a vital sign, how perimenopause and menopause raise the risk of sleep apnea in women, and what most screenings miss (including REM-related events). Dr. Guzman breaks down modern testing options—from comfortable home sleep studies to multi-night data—and treatments beyond CPAP, including GLP-1s approved for OSA and an exciting oral airway-tone therapy in late trials. We also cover allergy management for better CPAP tolerance and two simple changes you can make tonight to sleep better. Tune in for practical, evidence-based strategies to improve your sleep and overall health.

Dr. Guzman is a triple board-certified physician in internal medicine, sleep medicine, and obesity medicine, trained at Mayo Clinic and Emory University. With years of experience and a passion for empowering others, she combines medical expertise with a deep understanding of the challenges busy individuals face. Dr. Guzman inspires and empowers patients to live the healthiest version of themselves through a holistic and evidence-based approach. Her passion is working with patients to unlock their potential and reach their health goals in a way that feels doable and sustainable, so they can enjoy a life that they LOVE living!

00:28 Intro & guest welcome
01:29 Why Sleep + Obesity Medicine (Mayo → Emory)
04:07 Why direct specialty care vs. insurance friction
05:15 Sleep as a vital function & cardiometabolic links
10:26 Obstructive vs. central apnea—clear explanation
13:39 Insomnia, PLMD, and Restless Legs in women
17:18 Treatments: CPAP myths, GLP-1 approval, oral therapy coming
20:18 Testing advances: home studies, rings, multi-night data
27:36 Allergies, masks & humidity—CPAP troubleshooting
30:48 Two habits to improve sleep tonight (alcohol & wake-time)

Connect with Dr. Guzman
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Website: https://dreamlifemedical.com/

Connect with Dr. Reller
Podcast website: https://gethealthytbpodcast.buzzsprou... 
My linktree: linktr.ee/kerryrellermd
LinkedIn: https://www.linkedin.com/in/kerryrellermd/
Facebook: https://www.facebook.com/ClearwaterFamilyMedicine
Instagram: https://www.instagram.com/clearwaterfamilymedicine/
Tiktok: https://www.tiktok.com/@kerryrellermd
Clearwater Family Medicine and Allergy website: https://sites.google.com/view/clearwa...
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Kerry:

All right. Hi everybody. Welcome back to the Get Healthy Tampa Bay podcast. I'm Dr. Kerry Reller, your host, and today we have Dr. Maria Guzman. Welcome to the podcast.

Maria:

Thank you so much, Kerry for having me I'm excited to be here with you.

Kerry:

And do, would you mind sharing how we you like to say your name in Spanish? How you said it was so much prettier than what I said.

Maria:

You're so funny. Yeah. So I'm Columbia, and I was born in Bogota and it's, my full name is Maria Paola Guzman. But you know, in English, we tend to lose the middle name typically here in the US so it's, it's Maria Guzman. But yeah, if, if I'm talking to family, it's always Maria Paola. We don't, we don't just, we don't shortchange the, the middle name.

Kerry:

I love it. It's so much prettier when you say it, so thank you for sharing. So tell us, I know you are a triple board certified, so in sleep medicine, obesity medicine, internal medicine. And you know, you just started a new practice as well. But tell me kind of how you got into, you know, what you do and who, tell us a little about who you are besides the fact that you said you were born in Columbia.

Maria:

Yeah, absolutely. So I'm the first doctor in my family. I went, I've been in Florida most of my life. Went to UF for undergrad, Miami for med school, and found myself in internal medicine Residency at Mayo Clinic in Jacksonville. During residency, I saw like some of the most advanced diseases at Mayo and just, I, a lot of the things that lead to chronic illness are preventable particularly when it comes to weight health, sleep health. So that's where kind of my my interest was peaked in those areas of preventative medicine. I started attending the Obesity Medicine Association conferences during residency and then decided to do a sleep fellowship just to really consolidate that fond of knowledge. I did that at Emory and after that I went into private practice right after training, pretty quickly learned that in private practice, it's the insurance that drives decisions. And I felt like there's a mismatch into what I learned at Mayo Clinic where the needs of the patient come first. But in the real world, we're looking at these binders this big with all the rules that insurance has of like what, when you meet criteria for certain studies or medications to or, or sleep studies to be covered. And so oftentimes I saw patients who have maybe a high deductible plan. Couldn't get the home sleep study that the insurance requires us to do when really I needed them to have an in-lab study to look for idiopathic hypersomnia or narcolepsy, more advanced disorders. But the insurance has these, these rules and that patient would've had a cop a copay of$400 and she was like, I can't do that. I know that these tests may cost$200, so I know that they're being overcharged by the insurance deductible. And then they're not gonna be able to afford the in, in lab study. So things like that kept adding onto me and just became really frustrating and I'm like, there's, there must be a better way. And, and the direct care model of medicine has continued to grow primarily in primary care where doctors. Reestablishing the patient doctor relationship and building that connection back up and taking the insurance and leaving insurance for the catastrophic things where it becomes really important when you need to be in the hospital. But for, for very affordable care in terms of. Of screening tests and things like that. Doing a cash pay model really is where people are moving. So now there's specialists like myself as an obesity and sleep doctor wanting to integrate the specialty model and build the membership or cash pay model into the practice. So that's what I'm currently working on.

Kerry:

Yeah, I mean, I definitely think that it seems to be shifting in that way and mostly'cause of the things like you discussed, like the insurance problem, right? May be getting this giant bill, but if you are a cash pay, you're not gonna be getting that kind of thing. So it's really, I guess, sad with the way that it is run and it definitely needs a big overhaul. So I, one of the ways is that, you know, a lot of doctors like yourself are moving to this direct care like model, whether it's specialty or primary care, and I think we just, we'll see how. See how the world folds out with all the insurance stuff. But so you said you trained internal medicine and so in residency you started realizing, yeah, half this stuff is preventable. So you, you kind of probably felt it a little bit earlier on and I think that's great that you were already involved in like obesity medicine then too. So that's really kudos to you for, you know, already realizing that and, you know, jumping out to these conferences to learn things already. So that's awesome. We were gonna discuss sleep and wellness because that is your expertise. So tell me why is sleep such an important pillar of health? Especially, you know, we were, as we were discussing earlier, during midlife.

Maria:

Yeah, absolutely. So sleep is something we all do, right? It's vi it's one of our vital functions in life if we don't sleep eventually we're gonna develop significant cognitive issues, and there's actually a very rare genetic disease called fatal familial insomnia, where a person genetically does not have the ability to sleep, and it is a mortal disease. So you, you cannot survive that genetic condition. So we need sleep. It is important to improve our emotional regulation, our memory consolidation, our experiences. That's what happens when we're sleeping. Our body gets rid of toxins that have built up over the course of the day, and we know that when we get a good night's sleep, we feel good the next day. The times where we don't get a good night's sleep, it impacts our daily function. Right. So, so it's, it's in terms of overall health and, and, and health, it's, it's. Primary. And we underappreciate it in medicine, right? Like in your medical training and family medicine, you know, how much training did you get in terms of sleep? Right? It's, it's very short, probably. Maybe one of your lectures during the pulmonary rotation or, or training. But really it's primary for every, every vital function, it affects every organ in terms of the cardiovascular system, the, the pulmonary system. Psychiatric conditions affect sleep. So what I love about that field is just how multidisciplinary it is, and I get to learn bits and pieces from all these different fields and how they. Come together and, you know, the nervous system puts it all together and allows us to recover over the course of the night. So that's what impacted me in terms of wanting to, to pursue the sleep fellowship in terms of women's health. Yeah.

Kerry:

I was just saying it's interesting how it affects the cardiovascular system and I'm assuming we'll go more into that, but we don't really think about that. And I would say for me, yeah, my training, I don't even remember a lecture on it. I'm sure we had something on obstructive sleep apnea, but I, I can't really say that it made a big impact on me'cause I don't remember it, but.

Maria:

Yeah, and that's one of the biggest misconceptions is that we, as doctors, we think like, sleep equals, I need to look for sleep apnea. And if it's not there then you know, I, I, I rolled things out and we don't need to worry about sleep. But there's other things that are important in sleep in terms of. Sleep fragmentation. Right? And it changes over the course of life for as we get older, we require shorter and shorter duration of sleep, but the sleep quality gets worse and worse. We end up spending more time awake after falling asleep, and then that starts to really impact a person's ability to function, particularly in when women are on midlife, it tends to be under recognized that. Typically we think of sleep apnea. I think it's probably a man's disorder, right? Like my husband uses a CPA. And we don't tend to associate sleep apnea with women. During the earlier years. It is more common in men but after the perimenopause and postmenopausal transition, women have a two to three time likelihood increase in, in the risk of, of sleep apnea. And that happens because of those hormonal changes that occur in perimenopause, progesterone and estrogen are important in regulating the vent ventilatory control that affects our breathing during sleep. And so as those hormones change, we have a reduced ability to control our ventilatory drive. So that increases the risk of sleep apnea where we have a likelihood of having pauses in breathing, which is what apnea means. It means that you've, you're, you've stopped breathing for at least 10 seconds, and that is often associated either with an arousal from sleep, where you kind of wake up but you're not really aware of it, and you go right back to sleep. Or it's associated with a drop in oxygen and the cardiovascular consequences of that, of, of having multiple times during the night where your oxygen is dropping, that increases the risk of stroke, heart disease, heart attack and it impacts your function. It impacts your cognitive ability because your brain's functioning with less oxygen throughout the night. So estrogen does that. Progesterone is usually a sedating kind of hormone, and so it helps in induce sleep. And as those progesterone levels change over the course of the perimenopause transition we have less of that sleep drive. And so those two together cause women to have significant impact to their sleep quality. They tend to wake up more during the night when they are in that perimenopausal transition. And they have more cognitive dysfunction the next day, right? So during menopause, women may like 30 to 40% of women may have sleep disruption. That's independent of the night sweats and the hot flashes. Often those will be the trigger for poor sleep. But sometimes it's just independent of that. And so that's what we're trying to spread more awareness about is that women are at risk for sleep apnea around that time.

Kerry:

Yeah. So you said they have more likelihood to have apneic events, so are they technically gonna be obstructive or central or, I know that patients might not understand that, so maybe we need to explain the difference, but

Maria:

absolutely. Yeah. So obstructive sleep apnea is more common and that's where the airway closes. When you're in your sleep, your all your muscles relax. And in factoring REM sleep, rapid eye movement, sleep. When we typically dream our body to protect us it paralyzes all of our muscles, and that's completely normal. And when we see a dog, for example, kicking its legs during sleep, that's likely, they're in a period of REM sleep and they are losing that muscle paralysis, so they're actually able to move their legs. That's called REM Sleep without atonia. So that's in, in what? And people, we can see that something called a re sleep behavior disorder, where a person may act out their dreams or jump out of bed and in a dream. But normal physiology is for our muscles to be completely relaxed and almost paralyzed during that timeframe. That means the airway muscles lose their muscle tone and the airway collapses, and if it collapses and causes a pause in breathing for at least 10 seconds, that's an obstructive apnea. A central apnea is based on that ventilatory control that I was mentioning where our, our breathing is, is guided by our oxygen levels and CO2 levels and it's. Automatic, it's controlled by the autonomic nervous system where if our oxygen drops by a certain amount, or CO2 carbon dioxide builds up our, our breath is naturally triggered. So if we sit here and we hold our breath for 20 seconds, 25 seconds, they will come a point where you and I feel the need. To breathe and we will start to feel discomfort and eventually we have to breathe. Right? And so that's that autonomic nervous system saying, Hey, the CO2 is building up. You need a trigger of breath. When we have poor ventilatory control, we lose the threshold at which that breath is triggered. And so during sleep it may cause a person to not respond to the CO2 building up, and then that causes a central apnea, which means the oxygen, the the, there's a pause in breathing for your while your body waits for that CO2 to reach a certain threshold, and then a breath is triggered, hopefully that was a clear enough explaination.

Kerry:

Well, yeah, it is. I think people might have to listen to it twice to really understand it, but I think that was a great explanation. So it does sound like to me that the estrogen decline would be more creating some central apneas. Right.

Maria:

Potentially, I think there's a lack of research in the area, right? So many of the sleep studies and sleep research is done in primarily men because we tend to think men are more likely to have sleep apnea. So in women it's really underrepresented in terms of research and in menopause sleep connection there's, there's there's limited amount of research. I think, you know, the question's there, but, but the, the physiology would suggest that that's the case.

Kerry:

Okay. Yes. There's obviously lack of research on women, which is one of the things that everybody is trying to improve, so

Maria:

Yeah. Across the

Kerry:

Super important. Yeah. So we kind of, you kind of went over the obstructive or central sleep apnea, but are there any other common sleep problems that you see and kind of who's at risk for that?

Maria:

Yeah, so, so sleep apnea is the most common sleep disorder that we see. Insomnia is the other one kind of probably alongside it, chronic insomnia the diagnosis of that is based on having daytime dysfunction where you feel like you're having difficulty during the day with your typical activities and unsatisfied with your sleep at least three nights out of the week for at least three months. So either you're having trouble falling asleep or trouble staying asleep throughout the night with multiple awakenings in women, we tend to see more of that two or 4:00 AM awakening and I can't go back to sleep. And some of that is explained by the physiology of like our sleep is triggered by our sleep drive, which builds during the course of the day. And in those first few hours after we fall asleep, we take away the sleep drive. And so it's really hard once you wake up in the middle of the night, it's really hard to fall back asleep because you don't have that same. Sleep drive pushing you to sleep. So the other thing that happens later in the night, two to 3:00 AM let's say, is we tend to have more REM sleep. Those REM periods get longer as we, as we go through the cycles of, of sleep a architecture, which is when we have light sleep, deep sleep, rem sleep, and then we go back and have light sleep, deep sleep, REM sleep. So those REM periods get longer as we get into the later parts of the night. For women, for some reason, this is another area where we don't have enough research is women tend to have more of the REM related sleep apnea. So during REM they, they may have pauses in breathing where it's like, you know, maybe 15 times in that hour. But they're not having it during the other sleep periods. And so overall, the study may say they don't have sleep apnea, but if we look at those REM cycles, we do see more sleep apnea. So that's a common complaint when we hear about insomnia as we hear about these nighttime awakenings. But if we have to do a digger, a deeper dive to see is there sleep apnea that's actually causing the insomnia. So a sleep study is indicated when somebody has chronic insomnia. We not only look for sleep apnea, but then we also look for leg movements that may disrupt a person's sleep. Something called periodic limb movement disorder, where during the night your legs just start twitching for whatever reason. And that can disrupt your sleep architecture. It can cause awakening. So your brain is responding to those movements. And if that causes dysfunction during the day where you can't, you know, feel sleepy during the day or feel tired, brain fog fatigued that would be worth treating. And there's medications for those. Another sleep disorder that's pretty common more in premenopausal women because it's related to iron deficiencies. So when you're having your menstrual cycles you tend to lose your iron. That's restless leg syndrome. And so women may have. This urge to move their legs. It happens more commonly in the evening. It's real. That sensation, that urge to move is relieved when you move. So walking around will help. So people may complain, like at night, I just can't get comfortable. Like I keep having to move my legs and I just, it's this discomfort that keeps me from falling asleep. So that's a common sleep disorder as well, that has medications and other tools we can use.

Kerry:

Yeah, that's a really good overview of all of those. I think, you know, I definitely see patients with all of those too. And then you going over the cycle of sleep does remind me that I did have some in med school on this. Yeah. But so what are some exciting new advances Basically in sleep apnea testing and treatments.

Maria:

Yeah, absolutely. So typically if somebody may hear sleep apnea, they may immediately think of a CPAP, which is a mask that you wear and while you're sleeping, it pushes air into the airway to keep the airway open to treat that airway collapse that we discussed is the reason for for sleep apnea. Or obstructive events I should say. So when women particularly hear about that, they're like, absolutely not i'm not wearing this mask on my face, like, you know, my husband wears that, that's his thing. Or maybe we think that it's too loud and, and you know, it's gonna disrupt our sleep. So there's misconceptions about CPAP. It is the most effective treatment in terms of it reduces and keeps the airway open. It reduces those episodes of pausing and breathing. Now there are medications that are being studied, which is fantastic. So Zep Bound, which is a GLP one medication that we typically use in weight management. It was just approved for sleep apnea, for moderate or severe sleep apnea because we know that one of the phenotypes, one of the, the causes of sleep apnea can be a large neck, maybe a larger tongue, and that can cause that airway to obstruct. And so obesity and sleep apnea tend to be correlated. A person with excess body weight may have more of a tendency for sleep apnea and vice versa a person with sleep apnea may have weight gain related to those sleep fragmentations that can cause excess cortisol and glucose dysregulation. And more of, independent of BMI, sleep apnea can cause insulin resistance and fatty acid accumulation, and that's pretty exciting research that is done by Dr. Punjabi down at at University of Miami. But, but I digress. Right. So yeah, so, so there's so much physiology that goes beyond just the pauses in breathing. Zepbound can reduce weight and it can reduce sleep apnea severity through that. So that's the first fDA approved medication for sleep apnea. The other ones that's coming out probably next year, and it's currently in those phase three trials to get FDA approval. It's a combination of a noradrenergic medication with an antimuscarinic. And what that means is it's targeting the muscle tone. So we mentioned that in women because of those changes in estrogen and pro, the muscle tone of the airway can go down in response to those hormonal changes. And so this medication is trying to tighten up the muscles of the airway by preventing that relaxation during sleep and that may keep the airway open and that it's exciting data showing that it can reduce the number of episodes of apnea by about 45, 47%. And so that's, that would be the first oral medication that can treat sleep apnea and that we're excited that that may come out in 2026.

Kerry:

Mm-hmm. That's super exciting. Totally different mechanism as well, so that's really neat. So with sleep apnea testing and screening, how can we do better at that? What are we missing at this point?

Maria:

Yeah, sleep apnea testing commonly called a sleep study, right? There are different types of sleep studies. Some people may think of it as something, I go to a lab and I have to sleep with like 50 different wires on me. It's really hard to sleep. So there's misconceptions about maybe that's the only way to look at our sleep. But as technology improves, we can get so much data, not just from FDA approved devices to do sleep testing at home, but also like the the digital health and wellness where we're using our watches, we're using the oura ring and other devices to look at oxygen throughout the night to look at sleep architecture. So there's a lot of data we can gather from those devices. But an FDA approved sleep test device that you can do at home, there's several different types and they're getting more and more comfortable. Some of them are just a watch with a little thing on your finger that can test your oxygen. And through looking at your heart rate and variability and your oxygen levels, it can deduce whether you're having apnea events. So all of that is, is pretty fascinating technology. And there are rings now that can, that have been FDA approved for sleep apnea diagnosis. So there's ways we can do testing at home. You don't have to go to the lab. The lab tests are more for those very complex disorders where we have central sleep apnea or we're looking for other sleep disorders like hypersomnia or narcolepsy. And so there's an indication for those at certain times, but for clear cut screening. There's a lot of home sleep testing that we can do. And the other thing is, typically it's a one and done usually where you have one night at the lab and you either have sleep apnea or not. But we know that not every night of sleep is the same, right? Sometimes we may have caffeine later in the day we don't get to sleep enough, or we are more anxious or, or have more. Racing thoughts during a particular night and we don't get that good quality sleep. So there's so many things that affect us sleep that looking at just one night we're missing a lot of things. And so now there's a push to do multi night sleep testing to get really more data over the course of several nights.

Kerry:

Our insurance is gonna cover that?

Maria:

Yeah, it's just probably not just my thought.

Kerry:

It is exciting that there's a lot of more availability to do home sleep testing. We do use the watch one at our office, so I think that it is, it's a better one, but it's, it's nice that they can do that at home. I think it at least helps, and honestly, I think it increases the ability to, you know, screen for sleep apnea, which is kind of nice I feel like it was a bit limiting before, and even in area, there's not that many inpatient sleep labs to do the testing in the first place. You mentioned something about not getting people screened press. I think you were mostly pointing to women in midlife, but the lack of screening or thinking about screening. Can you comment on that?

Maria:

Yeah, I think there's two gaps. One of them is that many patients come to their primary care doctor complaining of difficulty falling or staying asleep. And if they don't look, the type of person that we as doctors tend to think of as someone that may have sleep apnea, like a larger body habit is, or you know, they look sleepy in front of you, then we're like, okay, let me look for sleep apnea. But insomnia is an indication to do a little bit more testing and rule out that sleep pathology. So that's where we may miss screening is when we tend to hear somebody has sleep apnea and we're like, okay, here's some Trazodone, here's some medication. Let me know how that goes. And we know that medications for insomnia have often significant side effects. They can have rebound insomnia when they don't take it right. So a lot of use of benzos and Ambien and all of these other sedating medications. We tend to go to that first. We're missing the opportunity to screen for a sleep pathology that could be the root cause of that person's insomnia. The other thing is when we look, when we are thinking of sleep apnea, we're looking to screen for that. We typically do a screening tool called the the stop Bang Score. And one of those it's whether you have, you know, high blood pressure, whether you have a, a large or a high BMI body mass index. Whether you're a man, you get a score for that. So you're more likely to, to have a positive screening questionnaire if you're a man or if you have a large neck, right? So if you have a thin person or someone who doesn't have a large neck or, or as a woman, right, you already lose a couple of points for that. We have to understand that there are different phenotypes of sleep apnea. There's the anatomical, like large neck airway obstruction. There's also the ventilatory control where that person may not have a larger neck or, or a large BMI. There's also disruptions in, those are, those are the two I can think about right this minute, but there are, they're craniofacial abnormalities, for example, of the jaw where, where the jaw may be pushed back a little bit. So that opens the door for another treatment modality, which is the oral appliance. But the point is when we look at the screening tools that are used in primary care, it's targeting that anatomical large neck large BMI and we're missing the opportunity to screen women that are often come into the office with significant sleep complaints. So that's a big gap there.

Kerry:

Do you use the like Epworth scale for that population?

Maria:

Yeah, the epworth scale tells us about the degree of sleepiness that a person may have. Some people with severe sleep apnea may not have the degree of sleepiness, and some people with mild sleep apnea may have significant sleepiness, so the, epworth scale is useful in terms of assessing who is the most symptomatic patient, and does that increase the, the push that we should treat their apnea. So if they have mild sleep apnea and they're severely sleepy, we should treat if they have moderate or severe apnea Even if they are not significantly sleepy, we should treat because there is a higher likelihood of high blood pressure, stroke risk, atrial fibrillation, all the cardiovascular risk factors, even if a person is not sleepy. Right. So there's a lot of education that we do with patients in our clinic where it's like. We have to address not just the symptoms, but also the, the, the potential cardiovascular effects of untreated sleep apnea. So a person may say, I'm not sleeping. Like I don't need that. I don't nap, I sleep great. I'm not bothered by it. I sleep alone. So my wife isn't complaining or my husband's not complaining about snoring. But we have to say, okay, there are other metabolic effects, right? Increased likelihood of diabetes and so on resistance with untreated sleep apnea. That's, that's a lot of the focus of, of our conversations with patients.

Kerry:

Also the reverse, right. Any of those with those conditions that you just mentioned should be screened for sleep apnea,

Maria:

absolutely. Absolutely.

Kerry:

normally use the, a combination of those two screeners depending upon, you know, the, the patient and things like that. So you mentioned obviously CPAP and explained it a little bit and we already busted some myths with that, but since I, we do a lot of allergy in my practice as well. I wanted to get your take on maybe uncontrolled allergies and not tolerating a CPAP or anything like that. Do you have any comments on that?

Maria:

Yeah. Yeah. Some of the anatomical disruptions that can cause sleep apnea or difficulty with sleep at night is, is the, like nasal issues, right? Like septum deviations or chronic allergies that can, can cause that congestion. So sleep medicine works closely with ENT. To address like is, is there any anatomical issues? Are there any chronic inflammatory issues that could be affecting a person's ability to breathe at night? Ideally. We're closing our mouth and breathing through our nose at night. But if anatomically or through allergies, that's difficult, then that can cause either difficulty falling asleep or multiple awakenings throughout the night. So yeah, absolutely. I think in, in people with, with chronic allergies, we wanna treat that as the root cause and see if we get the inflammation down. If we use nasal, you know, corticosteroids can we reduce that congestion and help a person sleep better through that?

Kerry:

Yeah, we definitely you know, get a lot of patient complaints if their allergies aren't controlled, that they aren't tolerating the CPAP and they don't wanna use it and try to counsel, you know, on the repercussions of that can be.

Maria:

Yeah, the, the humidity of the, you know, there's different masks that can be used, right? So working with a tech that can guide you on which mask is best for you, right? For, so if somebody opens their mouth at night with their CPAP, maybe using a mask that covers or sits under the nose. But over the mouth just to get the airway, the, the air in through the mouth instead of the nose. That can be something to troubleshoot. The temperature of the air that comes in the humidity can affect a person's tendency to have allergies. So. The runny nose in the mornings could be, if the air is too dry, it can cause inflammation because the air, the, the, the airway is getting too dry. That causes inflammation. So that can cause the runny nose. So increasing the humidity, even though it's counterintuitive sometimes helps using a tube to, to the CPAP that is wired, that, that has a coil in it. Can be used to heat up and warm up the air as it comes into the nose and that can alleviate some of that discomfort. So, so it's trying a different mask, playing around with the humidity'cause it's different for every person. It depends how cool your room is. And, and there's a happy medium of where you want to have the humidity to avoid having water build up in the tube because that can happen because of the differences between the temperature in the tube and outside in the room. There can be condensation in the tube. So it it, we have to personalize that approach to see what can we troubleshoot in terms of their settings to help them feel more comfortable with it once we've addressed like the Flonase and other things that they could be doing otherwise to help.

Kerry:

Yeah. It's important to know that there are different options and different masks and different ways to make it better, that it's better to not abandon it all, you know, because you don't think it's gonna, you know, toler, you'll tolerate it. So I think that's really important to, to know. So I know we went over a lot and I don't know if there's any other specifics you wanna discuss or we can have you back, but what are kind of one or two simple changes that any, any listeners can do today to make their sleep quality better?

Maria:

Yeah, I think one of the big things that we hear about is wine at night to unwind, right? We live in a society, where're all, we're all chronically stressed. There's multiple things pulling at our attention. If you're a mom and. Middle life, right, that you, you have multiple responsibilities, multiple things you have to take care of. And once the kids go to bed, now it's me time and now to practice self-care. What our society tends to push is like have a glass of wine, relax, take care of yourself. So that wine, while it may help you fall asleep quicker, potentially, because it does have a sedating effect as wine metabolizes, it's gonna cause these metabolizes that are wake promoting. So you may notice you have more of that through two 3:00 AM awakening because of that wine metabolizing. So reducing alcohol is probably the biggest key factor. I can, I can share reducing CBD and and THC, some of those gummies that are often being promoted. For some people it can help in the short term. But when we start relying on that long term, there's more of a likelihood of anxiety and other mental health. Mood disorders that can develop from that, and that can cause more de sleep disruption in the long term. So trying to avoid substances that are often disrupting sleep and then keeping us consistent. Waking, waking time throughout the week, whether it's the weekend, whether it's the weekday trying to be as consistent. So if you wake up at six in the morning to go to work every, every day and in the weekend you sleep in until. 8, 9, 10 am that's gonna cause a disruption in your ability to fall asleep on that Sunday night. Right? And so trying to still keep the same, you know, within an hour of your typical workday wake up time, trying to stay within that on the weekends I think is really important. So, going outside for a walk, doing something that's relaxing, that fills your cup and getting sunlight into your eyes, that's, that's huge in terms of keeping your circadian rhythm and avoiding the, the the changes throughout the week which are socially triggered.

Kerry:

I find the social exhaustion to be the hardest thing and you know, not sleeping in on the weekends. I mean, I don't, can't say I sleep in that much, but I do a little bit like within the hour thing. But it is hard to keep that, and I think that it can trigger a lot of other medical things like migraines and things like that. So

Maria:

yeah. Sleep deprivation is one of the most under-recognized causes of, of the brain fog, the fatigue, headaches, muscle tension. So just making sure that we're getting those seven hours, or at least giving ourselves the seven hours of window to sleep to give our body the best chance to recover of everything that we're facing during the day. But it's hard. It's hard when you have multiple responsibilities. So we have to personalize the care, and that's one of the things that in my practice I wanna offer, right, is these very detailed histories and very personalized treatments to say, okay, for this person, maybe they work a shift, right? They work a third shift, or they work the whole night shift. So how can we optimize their sleep schedule to give them the best chance at recovery, even though they're working? Or circadian rhythm, so there's a lot to cover there as well.

Kerry:

Yeah, well I was gonna ask you more about, you know, your practice and stuff like that and, you know, share the name because I think it's a great name of the practice as well.

Maria:

Dream life, medicine and wellness. Creating the dream practice where patients can get, you know, reach their dream life in terms of their health and wellness goals. Addressing and in a personalized fashion, the root cause of many of the chronic diseases, recognizing that mental health impacts. Our tendency to have sleep issues or metabolic health concerns. Our relationship with food, so helping people with coaching in terms of nutrition and, and behavioral change for improving their health behaviors. I think that's where we can make the most impact. But we have to do it in a. Non rushed way. I wanna take my time with patients. And so that's the unique part of my practice is I do everything. I do the intakes. I check your vitals. I'm doing the consult, I'm ordering the stuff, I'm going over these things with you. It's very personalized and that's what's unique about

Kerry:

I thought it was also a play on words with the word dream. Right? Like dream life and, you know, better dreams maybe. I

Maria:

If we dream better, we live

Kerry:

Yeah.

Maria:

Absolutely. Yeah.

Kerry:

Yeah. Well, is there anything else you'd like to share? I mean, I know I have plenty more questions for you, but maybe we'll have to bring you back on another time.

Maria:

Yeah, we can do another one. There's stuff to talk about with regards to pregnancy and the under recognition of sleep apnea and women who are pregnant. Huge, you know, huge consequences to that and, and very under-recognized. So we can talk about that in the future.

Kerry:

Yeah. Yeah. I mean, we didn't really mention like treating you know, some of these things either other than the CPAP, and the zepbound, but yeah.

Maria:

Yeah, there's other treatment modalities for sure. Depending on the severity of apnea, we're excited about the medication aspect because for the longest time all we've had is CPAP and oral appliance. But in pregnancy we tend to screen for sleep apnea at the beginning of the pregnancy. But what's interesting. Sleep apnea may develop a co along the course of the pregnancy. And so by the third trimester, about 20% of women may have at least mild sleep apnea. And the consequences of that for their, the baby's health is, is worth talking about. But really just the key point is that talk to your doctor if you're snoring later on in pregnancy. Get the screening, test get the treatment started and that can help improve outcomes.

Kerry:

Awesome. Well, where can people find you if they wanna work with you?

Maria:

Yeah, so my, my website is called Dream life medical.com. You can find me on Instagram at Dream Life Medical, so I'm putting some stuff out there. Or if you're in the St. Pete area, I am leading the walk with the doc events at at Crescent Lake Park. So it's the second Saturday of every month. We get people to come out, we do a little health topic to talk about five or 10 minutes about different health topics, and then we go for a couple of loops around Crescent Lake. And so the goal there is to bring the community together and talk about evidence-based, you know, health, education. There's a lot of misinformation out there, so I'm just out here breaking myths and, and getting people to be excited about their health.

Kerry:

Awesome. Yes. I'm glad you mentioned that you're doing the doc with the walk too. I think that's a great program. And busting myths is important, and we need more, you know, people like you doing, doing everything really. So thank you for what you do, and thank you so much for being on the podcast today.

Maria:

Thank you so much for having me.

Kerry:

All right. All right, everybody. Stay tuned next week for next week's episode. Thank you so much Dr. Guzman. We will see you next week.

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Dr. Kerry Reller

Host