The Next Level of Patient Care is Navigating the System Itself

by Dr. David E McCarty

sleep apnea

Look around and you’ll see a lively debate about “the best way to deal with sleep apnea.”

I’ve been thinking a lot lately about the harm that can befall a patient navigating a strange, fractured, and increasingly siloed healthcare environment. I’ve noticed that the term “sleep apnea” means different things to different people.

Let’s tour the different silos to see what we can learn!

If you’re a medical provider in a traditional Sleep Medicine practice, sleep apnea is a floppy airway problem resolved with CPAP.

You sigh lamentably that only half the population tolerates it, so you do your best to encourage people while dutifully informing them of the substantial risks of non-treatment. It burns your biscuits that dentists are pretending to practice medicine because you’ve cared for all the poor souls left behind by profiteering dentists who took cash on the promise of a cure and then turned their backs when the results were unfavourable.

If you’re a successful Dental Sleep Medicine practitioner, sleep apnea is a mechanical problem which can be overcome by simply pulling the jaw forward.

You’ve seen more than a few patients who’ve told you about their harrowing experiences with PAP therapy. As a result, you’re quick to acknowledge that PAP therapy is…um…problematic, and you may even start to agree with your patients that physicians seem to have a one-track mind regarding treatment.

If you’re an Airway Centered Dentistry provider, sleep apnea is a craniofacial developmental problem that begs for reverse engineering.

You’ve acknowledged the harms caused by chronic mouth breathing, and you’ve seen miraculous transformations occur when obligate nasal breathing restores and functional rehabilitation of tongue mobility has occurred. But, on the other hand, you’ve personally cared for individuals left behind by a medical system that consistently overlooks sleep apnea that doesn’t fit the Pickwickian phenotype, and you’ve cared for individuals abandoned by a dental system that always reduces sleep apnea to a simplistic mechanical model.

Here’s the thing: No matter which silos you’re in, it’s easy to conclude that chimps must populate the other silos!

As our healthcare ecosystem continues to fragment, our patients must navigate an increasing array of choices as to who will provide care for sleep apnea, what that care will look like, and how to pay for this care. They must prepare themselves for a journey that has the potential to cross over into different silos while simultaneously advocating for themselves and protecting themselves from flashy marketing campaigns that offer a “one size fits all” solution.

Sleep apnea, as a construct, is evolving, and our understanding of how to guide our patients must also evolve. When we view the problem through the lens of different silos that happen to be tinkering with it, we start to see a much larger leviathan, teeming with the complexity of many moving parts.

Having said all this, I offer the following consideration: the future of sleep apnea management is more extensive than individual silos. The future of sleep apnea management isn’t a specific treatment.

It’s patient empowerment.

Let’s get to work!

About the Author

Dr. David E McCarty is a Sleep Medicine clinician, author, cartoonist, and podcast creator/host. He is the co-author of Empowered Sleep Apnea: A Handbook for Patients and the People Who Care About Them, and the creator and co-host of Empowered Sleep Apnea: THE PODCAST.