Commitment And Consistency

One of my greatest frustrations is when I reveal to a patient that a major cause of his or her underlying medical issues (such as high blood pressure, dieabetes or weight isues) are from untreated obstructive sleep apnea. Most people are ecstatic about finally finding an answer to many of their medical problems and are excited to find how how to go about treating it. But there are some individuals that give me a blank stare, with a glazed over look in their eyes. Some are even adamant that they know that they don't have obstructive sleep apnea.

At this point, I go over again all the reasons I think they have sleep apnea, but only some are convinced. The rest go on treating their end-stage symptoms such as migraines and chronic throat pain with either pain medications or acid reflux reducers, which may help temporarily, but the problem usually comes back. Many of these same people will come back months or years later after worsening of their problems, admitting that "you were right."

This phenomenon reminded me of a psychology book I read a while ago called Influence: The Psychology of Persuasion, by Dr. Robert Cialdini. One of the principles that he describes is commitment and consistency. He states that humans prefer to think the same way, act the same way, and take comfort in the consistency of their ways. In their minds, they've already committed themselves towards repeating the same steps every time.

For example, if you've been taking high blood pressure medications for 20 years, and you're suddenly told that it was actually obstructive sleep apnea that caused it in the first place, how would you respond? If you've suffered from migraines all your life, how would you respond to being told that not sleeping efficiently due to partially obstructed airways can aggravate migraines? Being told something that completely refutes the daily actions (taking pills) you've taken for 20 years. It also conflicts with what your doctor said about your health.

If you were told something by your doctor that completely went against what you've revolved your life around for years, how would you respond, and how do you think your doctor should handle this situation? I'd like your feedback.

Snoring May Cause Strokes

We’ve always known that that heavy snorers are at increased risk for stroke. But a recent study from Australia showed that carotid artery narrowing in the worst snorers was 10 times higher than those who snore the least. In typical scientific journal fashion, a much larger sample size was said to be needed to establish a casual relationship. You can read a layman’s summary here from the New York Times. The authors proposed that perhaps vibrations themselves can damage the thin inner wall lining, leading to plaque buildup and eventual narrowing.
There are many more published articles that associate snoring with stroke. We know that a significant percentage of people who snore will have obstructive sleep apnea, and sleep apnea is strongly linked to stroke. The frustrating thing is that despite regular reports like this that warn of the the dangers of snoring, people continue to equate snoring as something to be laughed at and doctors continue to treat the end effects of obstructive sleep apnea (such as hypertension, diabetes, depression, anxiety, heart disease, heart attack and stroke). At least once per week, I see a younger snoring patient that tells me that his (or her) father snored heavily and suffered a stroke or a heart attack in their 40s or 50s. The frightening thing is that we know now that you don’t even have to snore to have obstructive sleep apnea.

Do you have a parent that snores heavily, and if so, did they suffer from a stroke or a heart attack at a relatively young age?