follow up

Thank you for your response, doctor.

My follow up questions:

1) Why does being overweight put one at greater risk for sleep apnia (apnea)? Does it have to do with the body fat itself? Or does it have to do with, say, the fact that overweight people usually over eat at night, and perhaps the extra food at night being digested over night causes this? In other words, Im wondering, if I do have sleep apnia (apnea) and it is associated with my weight, in your medical opinion, what would start to bring me relief? Would it be right when I start eating well and excersicing (which includes not eating late at night) or would it be not until I lost ALL the weight (I weight 300, I should weigh 190, Im 6 ft tall.) Would it be, perhaps, once I lost a certain amount of it? OR, is it that once one has sleep apnia (apnea) due to their weight, one will have it for life, regardless of their weight? If you cannot give me a definitive answer on this, please just give me your medical opinion.

2) Is an overnight sleep study the only way to diagnose this difinitively? For me money is sort of an issue. What in the heck does an overnight sleep study cost and are they performed just anywhere? Is this something that health insurance typically will cover? (I know it depends on the coverage, but Im asking in general, even though this is not necesarily your area of greatest expertise, Im sure you know more about it than I do.)

3) If a doctor, about three months ago, took a blood test to look for a pre-diabetic condition and it was negative, can I say definitively that diabetes is NOT in play here? Or could diabetes have just sprung up in the last three months since that test?

4) Part of my question in my last post was: Can bad oral hygiene in ITSELF be a cause of dry mouth? If not, why does it seem that my dry mouth is getting much better (not totally gone though) since I've started getting rigorous with my dental hygiene routine? I'd like to think it's just a oral hygiene issue, which would mean I didn't have to think about this other more serious medical stuff. What Im worried, though, unfortunately, from what you've said and what I've seen in the research, is that perhaps good oral hygiene will only relieve dry mouth symptoms to a degree, but that doesn't mean that bad oral hygiene is necesarily the CAUSE of the dry mouth.

4) If you were me, what would you do? Would you go to a doctor now or would you: 1) Start losing weight. 2) Continue with good oral hygiene. 3) Try one of those sprays. 4) Ask your girlfriend to try to pay attention when you're asleep to look for sleep apnia (apnea)? At this point it seems that's all I can do. What can a doctor do right now? It's not like he could diagnose it with an office visit anyway, right?

I would REALLY like you to answer each numbered question to the best of your ability. Feel free to just answer the first two and request of me that I re-submitt the second two. I'm happy to pay the 15 again to get thorough answers. PS: Im on no medications.

[Kevin Pho, MD]

To answer your questions:

1) Many studies correlate obesity with sleep apnea.  There is also data that suggests that the treatment of obesity will help with the symptoms of apnea.  Both medical and surgical studies have demonstrated that as little as 10-percent weight reduction is associated with a more than 50 percent reduction in the severity of sleep apnea.  The preponderance of evidence indicates that the pharynx is abnormal in size and/or collapsibility in patients with OSA - it is hypothesized that obesity leads to a pharyngeal narrowing, thus leading to obesity.

2) An overnight sleep study would be the only way to give a definitive diagnosis.  I do not know how much they cost.  They are typically performed at a sleep study lab in conjunction with a pulmonary specialist.  Insurance will cover it if your physician feels the test is needed.

3) The diagnosis of diabetes takes two samples.  It is unlikely that it can spring up in three months if the previous test was negative.

4) I would always recommend losing weight.  If sleep apnea is a concern, I would visit your physician for consideration of a sleep study.  If apnea is diagnosed, a device known as a CPAP machine would be considered for treatment.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
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