In this episode of BackTable ENT, Dr. Gopi Shah talks with Miami-based otolaryngologist Dr. Carlos Torre (Sleep, Snoring & Sinus Clinic of Florida) about his journey to building an adult sleep practice and management of sleep disorders, such as sleep apnea and insomnia.

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SHOW NOTES

First, Dr. Torre shares his personal experience in the field of sleep medicine. He explains his path to becoming board-certified in otolaryngology, sleep study, and sleep medicine, and obesity medicine. During his sleep surgery fellowship, he was fortunate to train with good mentors who showed him a diversity of techniques and procedures to treat sleep disorders. Driven by his entrepreneurial mindset, he eventually transitioned to his own solo private practice in August 2021.

Next, the doctors discuss how to work up an adult patient initially presenting with snoring. Dr. Torre first evaluates the presence and severity of the patient’s symptoms as well as other comorbidities. Next, he orders a home sleep study to confirm the diagnosis of sleep apnea and interprets the sleep studies himself. Many cases of sleep apnea can be resolved nonsurgically through nasal breathing training if the patients are chronic mouth breathers. Nasal breathing training is a type of myofunctional therapy that incorporates exercises such as correct tongue positioning, strengthening of facial muscles, and palatal coupling. Besides nasal breathing training, he recommends CPAP for every patient with obstructive sleep apnea. He prefers to perform surgery conservatively. Thus, he will only consider surgery (tonsil removal, septum deviation surgery) if the patient has failed CPAP therapy for a prolonged period of time and he will use surgery as a tool to optimize CPAP instead of aggressively trying to cure the patient’s sleep apnea. Dr. Torre mentions that nightly dental appliances are also a treatment option.

Finally, Dr. Torre acknowledges that general wellness plays an integral role in sleep hygiene. The most common comorbidity associated with sleep apnea is obesity. He recommends fasting and eating early dinners to patients presenting with obesity-related sleep disorders. He also explains how meditation can help relieve anxiety and depression in patients suffering from insomnia. Dr. Torre ends the episode by emphasizing the benefits of multidisciplinary care for patients with sleep disorders.