Since getting my diagnosis of obstructive sleep apnea and being on CPAP therapy, I have been talking to others who have it (or those who have family members who do). I’ve been reading and learning more about it. And I have some questions.

We may not know the answers to all of these questions yet, but I would love to see them researched.

Weight Stigma and Accurate Diagnosis of Obstructive Sleep Apnea

Before I knew much about obstructive sleep apnea, I had only heard of it as a vague threat of something that could happen to fat people. At the time, the only other person I knew of who had sleep apnea was fat too, so there was nothing to challenge this belief.

Since I started talking about the fact that I have sleep apnea, four people told me that their (thin) husbands also had it, and one thin woman told me that she had it. Of these five people:

• one had his symptoms blown off by doctors. They initially told him that his symptoms were probably related to stress. The fact that he had issues with his airway were not discovered nor tested until it came up while looking for another issue.
• one pushed back against his wife’s insistence that he go get a sleep study to address his snoring and witnessed apneas. Why? He thought it wasn’t possible for him to have sleep apnea because he wasn’t fat.
• after having many medical issues come on fairly quickly, and finding sleep apnea in the process of testing these issues, one had her doctors tell her “you don’t LOOK like you have sleep apnea.”

So, I wonder: If patients and doctors think that sleep apnea has a “look,” how many people go undiagnosed and untreated?

Not all doctors think that sleep apnea has a “look.” My sleep specialist told me that she has patients of all sizes with sleep apnea. Some thin people have very severe cases. But obviously other doctors, as well as the public perception, has some catching up to do.

And insurance companies certainly have catching up to do. My insurance company, United Healthcare, denied my doctor’s request for authorization for an in-lab sleep study, on the basis that I did not have a serious heart or lung condition OR a BMI of over 50. They would only have paid for it if I was fatter or sicker than I already was.

I’m not pretending that there aren’t higher percentages of fat people with sleep apnea than thin people with sleep apnea.  Data says that there are. But that doesn’t mean that thin people with symptoms should be assumed not to have it based on their weight (after all, if thin people are going undiagnosed, that may further skew the data!). And we must also remember that risk factors are not the same thing as causes, and that correlation does not equal causation.

Biological Sex and Accurate Diagnosis of Obstructive Sleep Apnea

According to the Mayo Clinic and almost any other list of sleep apnea risk factors, men are almost twice as likely to develop sleep apnea.

However, almost all other moms I know complain of being tired, and feel that being tired is a normal part of having small children. And they are probably right, however….

I wonder…how many women go undiagnosed and untreated, because they believe their fatigue is normal? If those women were properly diagnosed and treated, would the data still show that men are at higher risk?

Personally, I think my diagnosis was delayed because many of the symptoms I experienced were also common in pregnant and postpartum mothers. It’s just….they didn’t go away.

So, for that matter:

How many people would receive a more timely diagnosis if doctors asked more questions about sleep in their annual physical exams?

Weight Stigma and CPAP Compliance Rates

Though CPAP therapy is considered a highly effective treatment for sleep apnea when used consistently, compliance is extremely low (anywhere from 50-80 percent do not use it at all or frequently enough, depending on which studies you read). Some factors that effect compliance are physical, such as not feeling comfortable with the mask, or even claustrophobia.

But I wonder if some of them are due to stigma around needing a CPAP machine.

If people feel negativity towards their treatment because they subconsciously think it is some kind of punishment for being fat, or because it brings up feelings of fear about their own mortality, are they less likely to try and stick it out and get used to it?

Those are some questions on my mind about how we handle obstructive sleep apnea in our culture.

And one other question on my mind:

My kid was a shitty sleeper and woke up frequently as a baby and toddler. I wonder if my snoring woke him up?

We’ll never find out the answer to that one!

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