No chronic medical condition is as common and commonly unrecognized at obstructive sleep apnea. Somewhere between 10 and 16 % of Americans over 40 stop moving air in and out of their lungs/experience low oxygen/secrete a surge of adrenalin/have sky high blood pressures/ rouse themselves from sleep anywhere from 4 to 60 or more times an hour. That is the physiologic equivalent of being in a combat zone in which mortars are fired from 4 to 60 times an hour every night. In the military, they call it PTSD. At home, they call it OSA.
Sadly, at least 80% of the people who have OSA do not know it. All would benefit from treatment, if they only knew they had the disease. And if they only had health insurance.
And that is the problem with OSA. Since it is commonly not diagnosed in the early stages, many people move on into the advanced stages in which they suffer from depression, chronic pain, uncontrolled high blood pressure, stroke, heart attack, poor concentration, poor memory, weight gain, accidents--all of which combines to make them unfit for work. And without a Job middled aged Americans are likely to be uninsured.
OSA deniers will say "Lose weight! Exercise!" If they only knew. Recent studies have shown that sleep deprivation makes people hungrier and makes them crave high calorie, high fat, sugary foods--the body's way of compensating for poor energy. Sleep deprivation also raises the blood levels of inflammatory factors that make us hurt. And sleep deprivation lowers the effectiveness of pain medicine like codeine. So, telling someone with untreated severe OSA to cure himself by losing weight and exercising is sort of like telling a heart patient "Unclog those coronaries with a brisk aerobic exercise program." Might work if the heart could handle it.
I see a lot of people in my job as a family physician in a "free clinic" for the uninsured. Many of them are middle aged and have lost their jobs. Many of them know about their depression, their chronic back pain, their heart problems, their high blood pressure, the erectile dysfunction that is ruining their marriage. Most do not know about the sleep disorder that is making all of the above worse--and which lead to them being fired from their job for being 1) late 2) forgetful 3) crabby 4) too sick 5) having too many on the job accidents. Without insurance, they are in a Catch22---they can not get a sleep study to prove they have a sleep disorder so that they can get Medicare. Without Medicare, they can not afford effective OSA treatment. So, they are told "Lose weight!" by the health insurance deniers who seem to think that all chronic disease is caused by a moral flaw.
OSA is a hereditary illness. You do not have to be fat to have it--though OSA will make you gain weight. All you have to have is one parent with the disorder (part of the cause is abnormal nerve endings in the airway that do not sense airway closure), bad allergies, a receding chin, radiation therapy to your neck, pregnancy or some other condition that causes your stomach to swell, an orthopedic problem that requires you to sleep on your back, a hiatal hernia, big tonsils, a goiter, an Adams apple or some combination of the above to have OSA. The major symptoms---snoring so badly that you stop breathing--will only happen when you are asleep, so if someone else fails to mention it to you, you will have no idea that you are doing it. You will get sicker and sicker---and fatter and fatter---and poorer and poorer---and will wreck your car because you did not even know you were sleep deprived---and if you survive the car wreck you will have a stroke or heart attack in the middle of the night when you are not doing anything (except experiencing sky high blood pressure and dangerously low oxygen levels)--and eventually die. And they will say "You did it to yourself. You should have lost weight." When they should be saying "If only he had been diagnosed with OSA in time. If only he had health insurance so he could get treated."
So, get insured. Get your sleep disorder treated. I dream about the day when I will come home from the office without having to worry about the ten people I saw who have no hope at all of getting better, because they do not have the insurance to fix what is really wrong with them.