JANUARY 27 — An elderly gentleman, close to his 70s, came to see me for choking spells at night and difficulty maintaining sleep. He was slightly overweight and had an underlying kidney disorder. What was striking was not only the nature of his symptoms, but the fact that he had never previously consulted a medical professional, despite months of disturbed sleep. Like many people, he had tried to cope quietly. He had also tried a medication for several months—hoping it would improve his sleep quality—without any meaningful relief.
His concerns were sincere and specific: he did not feel rested, he woke frequently, and he sometimes felt as though he was choking. Not surprisingly, he had looked for answers. A quick search online, including the use of an AI-based search engine, led him to a firm conclusion: he believed he had obstructive sleep apnea (OSA). He had also been influenced by smartwatch screening results and online explanations that linked snoring and poor sleep directly to sleep apnea. In the best cases, this leads to earlier diagnosis and better outcomes, but in this case, something else stood out during the consultation.
The gentleman told me he was regularly injecting a weight-loss medication. That detail raised immediate concerns, not because weight management is irrelevant—excess weight can indeed worsen sleep-disordered breathing—but because of how he obtained and used the medication. He explained that he received it from a relative. In other words, it appeared to be shared medication. That can involve dose sharing, and potentially even needle sharing. His injection sites were bruised, suggesting poor technique, lack of guidance, and absence of clinical oversight. There was no evidence of consultation, structured dosing advice, or safety monitoring.
His reasoning was straightforward: he had read online that losing weight would resolve snoring and sleep apnea. If weight was the problem, then weight loss was the solution. He had taken that message and acted decisively. This is precisely where public understanding needs to be clearer. Weight can contribute to sleep apnea, but the relationship is not absolute, and it is rarely the whole story.
More importantly, sleep problems are not automatically sleep apnea. Sleep disorders are broader and more complex than many people realise. Insomnia, parasomnias, narcolepsy, circadian rhythm disorders, and restless legs syndrome or periodic limb movements can all disrupt sleep.
Some disorders overlap with obstructive sleep apnea; others mimic it. A person may have more than one sleep condition at the same time. Treating one presumed diagnosis without evaluation can delay the real diagnosis—or worsen symptoms in unintended ways.
Even within obstructive sleep apnea itself, the causes and contributors vary widely. It is often multifactorial. Body weight is one factor, but not the only one. Lifestyle habits such as smoking, alcohol intake, and poor sleep hygiene can affect airway tone and sleep architecture.
Structural issues in the upper airway may also play a major role: tonsillar enlargement, adenoid enlargement, nasal blockage, or other forms of obstruction can contribute significantly. Skeletal restrictions—such as a smaller jaw structure or anatomical crowding—can influence the severity of airway collapse during sleep. Age-related changes and muscle tone also matter.
Because of this, treatment is rarely “one size fits all”. Some patients do well with positive airway pressure therapy, others benefit from oral appliances, and some need targeted interventions for nasal obstruction or throat-level collapse.
Lifestyle measures and sleep hygiene can be vital components, but the appropriate mix depends on the individual. The aim is not simply to reduce a number or follow a trend, but to improve breathing during sleep, restore quality of rest, and reduce health risks.
This brings us to the heart of the issue: clinical assessment is not a formality. It is the foundation of safe, effective care. In a proper consultation, symptoms are contextualised.
Risk factors are weighed. Examination may reveal structural contributors. Medical history—including conditions such as kidney disease—matters, because it can influence which tests and treatments are safe. Investigations are often needed before any intervention is started.
For sleep-disordered breathing, this may involve formal sleep testing rather than relying solely on a wearable estimate. For medications, it involves confirming whether the drug is indicated, ensuring appropriate dosing, and assessing safety—especially in older patients and those with chronic disease.
Weight-loss medications, for example, are not casual tools. They can be appropriate for selected individuals, but they are still medical therapies with potential side effects and contraindications.
Using them without supervision increases risks. Sharing injectable medications introduces additional hazards: incorrect dosing, contamination, infection, and complications from improper injection technique. These risks are preventable when patients have access to proper evaluation and guidance.
None of this means patients should stop reading, searching, or using digital tools. Health information, including AI-assisted summaries, can help people recognise symptoms and seek help sooner. Wearables can offer useful prompts and trends. But these tools should support clinical care, not replace it. They are best treated as starting points—signals to ask better questions—rather than final answers.
If there is a broader lesson here, it is that modern healthcare is not only about managing disease. It is also about managing information.
Patients are navigating a crowded landscape of advice, marketing, anecdotes, and partial truths. Clinicians have a role in acknowledging what patients have read, respecting their initiative, and then helping them translate that information into safe decisions.
For the public, the message can be simple and non-judgmental: if sleep is poor, if choking spells occur, if snoring is loud and persistent, or if daytime fatigue is affecting daily life, it is worth seeking a proper assessment. And if a medication—especially an injectable one—is being considered, it should be done with medical guidance and appropriate monitoring. These steps are not barriers; they are safeguards.
The daily challenges clinicians face will continue to evolve with technology and trends. The goal is to ensure that progress improves access and understanding without sacrificing safety and accuracy. In sleep medicine, as in many areas, the right diagnosis is the beginning of the right treatment.
A search result may raise suspicion, but it cannot replace a consultation. In the end, better sleep is not achieved by a single shortcut. It is achieved by careful evaluation, individualised care, and decisions grounded in both evidence and safety.
*Dr. Julius Goh Liang Chye is a Consultant Otorhinolaryngologist at the Faculty of Medicine,Universiti Malaya and may be reached at [email protected]
** This is the personal opinion of the writer or publication and does not necessarily represent the views of Malay Mail.
