Commitment and Consistency: Sleep Apnea In The Medical Community

With all the studies linking untreated obstructive sleep apnea with heart disease, car accidents, high blood pressure, depression, stroke, and various other common medical conditions, it’s surprising to me that not more doctors are looking for or screening for a condition that exists in 24% of all men and 9% of all women. We screen routinely for conditions that occur in 1-2% of the population that are much less deadly, but with sleep apnea, there’s a mental block that keeps physicians from diagnosing 90% of the people who have it. 


Dr. Robert Cialdini, a social physchologist, in his classic book, Influence: The Psychology of Persuasion, describes this phenomenon as commitment and consistency. He states that once you’ve committed to a certain statement, truth, or paradigm, that your subsequent thoughts, words and actions will always be consistent with your original statements or actions. One simple example is an innocent lie that perpetuates more and more lies to cover up the original lie. 


In medicine, we have a number of fundamental beliefs, including the fact that germs can cause illness and disease, and that antimicrobial medications can cure these conditions. Only 200 years ago, bad humors and toxins in your blood was removed with blood-letting. If you proposed back then that an unseen germ can cause illness, you’ll be laughed at or even imprisoned for such a wild and ludicrous statement. Galileo was imprisoned under house arrest for his explanation of our sun-centered solar system. I’m sure that 100 years from now, we’ll look at what we’re doing now in medicine will also seem barbaric and primitive.


Western medicine has a clinical diagnosis for almost every ailment we can imagine. There are a number of overlapping features, but for the most part, conditions such as diabetes, heart disease, depression, cold hands, migraines or diarrhea are treated as independent diseases, with different options for treatment. Eastern medicine, on the other hand, proposes that there are only a small number of basic fundamental imbalances that can lead to a number of common symptoms.


Obstructive sleep apnea today is classified alongside thousands of other common and esoteric medical diagnoses, and so to propose that obstructive sleep apnea may be the root cause of a number other other conditions would be considered heresy. Knowing that most people with heart attacks will have obstructive sleep apnea, suddenly screening and treating for sleep apnea in every patient with heart disease will only confirm that if you treat sleep apnea first, then heart disease won’t happen as much. Not only does it bruise our delicate physician egos, it also affects the bottom line for the entire medical industry, which is based on waiting until things get really bad before treating it. To go this route would be to admit that the way we’re practicing medicine is fundamentally wrong, and that would also open up liability issues as well.


Physicians and the lay public are definitely more aware of obstructive sleep apnea, but to date, we’re still treating it as a separate condition, independent of other medical conditions, rather than looking at it from the big picture. Also, despite numerous studies showing that you don’t have to be overweight or even snore to have obstructive sleep apnea, most doctors still won’t consider obstructive sleep apnea unless you fit the typical profile.


What we need is a major paradigm shift in medicine. Unfortunately, I don’t see that happening anytime soon. Do you think I’m being too pessimistic by not giving the medical profession enough credit? Please enter your reaction to this blog by typing your comments in the box below.

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3 thoughts on “Commitment and Consistency: Sleep Apnea In The Medical Community

  1. I think you’ve hit the nail squarely on the head!

    I’ve experienced this too many times in my own health. Even I’ve been susceptible to it, before my own “paradigm shift”. Despite lots of indications (numerous visits for stubborn, continual ailments or issues), my doctors have missed my hyperglycemia, hypothyroidism, pelvic organ prolapse, possibly apnea, and other conditions) because it’s too easy to dismiss as a side effect of BC pills, common allergies, age (too young or too old), not overweight enough, etc. They religiously check labs, but they don’t compared lab trends over time, or the lab reference range is out of date, etc.

    The main problem is that early detection and effective prevention isn’t really what most of our doctors do (nor is it what most patients want, either). Doctors aren’t trained to do it and they aren’t rewarded to do it, with few exceptions. Treatment is nearly always to simply suppress symptoms with the smallest amount of time and expense for the patient and the insurance company. Further investigation or treatment that actually heals the issue (like physical therapy) is only attempted when repeated attempts at symptom suppression don’t work (or the patient is shuffled off to a specialist with a new bag of symptom suppression tricks).

    I know that sounds so pessimistic, but that is what I have experienced over and over. I am very encouraged to read your blog posts and book because you “get it” and are frustrated too. It’s just time consuming, expensive, and discouraging to seek out doctors who understand the need for that paradigm shift, while avoid the majority that are still fumbling around blindly in the dark ages.

    BTW, love the comment email followup checkbox. Thanks!

  2. Over a period of many years, I mentioned to my doctor(s) that I was very fatigued. Inevitably, the response was “I am tired too.”

    Recently, a friend of mine was experiencing unusual significant fatigue. Several things had been ruled out through testing. She was being very persistent with the doctor on this, and I suggested she take the Epworth Sleepiness Scale so that she would have a way to document her level of sleepiness. Later, she shared with me that when she reported on her fatigue, the doctor said, “I am tired too.” And then he went on to say that recently he had been diagnosed with a sleep disorder and promptly referred her for a sleep study. (By the way, that doctor is thin as a rail and so is my friend).

    Like many “newer”, less understood diagnoses, until a doctor has some personal experience with it, either through a family member, friend, a patient who struggles and finally gets diagnosed and properly treated, or experiences specific education, sleep apnea will likely continue to fall under the radar.

  3. I agree with you completely. I ended up being hospitalized four times in the past year and a half with respiratory failure. I spent one night in Intensive Care and then spent a few weeks at home on oxygen. It wasn’t until my last hospitalization that they sent me to a Pulmonologist, who said he thought I might have Sleep Apnea. They tested me and it was confirmed that I had Severe Sleep Apnea. I now have a CPAP and am doing much, much better. I wish they had discovered this two years ago, it could have saved me four hospitalizations!