Sleep apnea was first described in obese men, so the general trend since then, has been to blame the patient. We are taught that obesity is a disorder of “self-control”. Being fat is an “undesirable personality trait” and if you’d just “try harder” you’d lose weight. All of you who have struggled with being overweight know deep down inside that this is not really true, but how can a normal weight individual know what it’s like to be you? Although it is true that self-control helps us to lose a few pounds this is not the whole story for people who are truly obese. Hunger, like sleep, is involuntary. If the bacteria that live inside us can affect our appetite and the amount of fat we put on, then the person eating the doughnut is not really completely in control. Since we doctors know so little about how hunger is controlled it’s much easier just to blame the patient. Many of my patients have struggled for years to lose weight. They tell me that they eat less than other family members and still don’t lose. We don’t want to believe them because then we would have to open our minds to other possibilities. Could sleeping badly tell the body that it needs to store fat? Could a low vitamin D level or some other hormone that we don’t really understand yet be running this poor obese person’s life? Could their poop be wrong? I mean really, who would ever even think of that?
The “fat neck” explanation of sleep apnea has reigned for 20 years. The bad results: we have attached “shame”, to something that is actually a brain cell malfunction AND we missed apnea in normal weight individuals. My headache patients didn’t look anything like what I had been trained to look for, so the idea that they might have sleep apnea would never have occurred to me. It is now quite clear that apnea is not because the neck is fat. So shouldn’t we at least wonder: “Could there be another cause?” “Could there be a different treatment that would help my sleep and help me lose weight?” Once we become brainwashed by the idea of CPAP masks we stop wondering if insomnia shares anything with apnea. They are both about sleep, could they be related?