Diagnosing obstructive sleep apnea

Michael Albrecht, MD

Oct 24, 2025

Obstructive sleep apnea is a condition where breathing stops while a person sleeps. "Apnea" is a medical term that means "without breathing." The most common reason people develop this condition is due to excess soft tissue in the back of the throat that relaxes during sleep. This tissue can block the airway—basically like putting a lid on the windpipe—so we can't breathe. The blockage is usually temporary, lasting only a few seconds. Our bodies react by waking us up just enough to start breathing again.

Symptoms include loud snoring, other people noticing that your breathing stops during sleep, and daytime sleepiness. That sleepiness is often what prompts a doctor to suspect sleep apnea. It happens because the sleep is non-restorative—your body keeps waking up throughout the night, even if you don’t remember it. Unfortunately, untreated sleep apnea can lead to problems like car accidents, high blood pressure, and heart disease.

The most common reason people develop excess soft tissue in the throat is being overweight. People with large neck circumferences—greater than 17 inches—are at especially high risk. Men are more likely to develop sleep apnea than women. About 25 to 30 percent of men are suspected of having sleep apnea, and most of them haven’t been diagnosed. Around 9 to 17 percent of women are suspected of having it.

Sleep apnea is diagnosed using a sleep study. Most sleep studies are done at home. A home sleep study company will ship the supplies to you and may or may not do a telehealth visit to help you set up the test. Supplies vary, but may include a finger sensor, a nosepiece to monitor breathing, and one or more elastic belts around the chest or abdomen to hold a small monitor in place. After the sleep study, the company sends a report to the healthcare provider who ordered the test. The most important number on the report is called the AHI, which stands for apnea-hypopnea index. This tells us how often your breathing stops or slows per hour of sleep. An AHI of 5 to 14 is considered mild sleep apnea, 15 to 29 is moderate, and 30 or more is severe. An AHI below 5 is considered normal. The more severe the sleep apnea, the more likely someone is to benefit from treatment.

Sleep apnea is usually treated with a CPAP device. CPAP stands for continuous positive airway pressure. These are small machines connected to a mask worn on the face. Some masks go over the mouth and nose, while others just go in the nose (called nasal pillows). The CPAP machine provides a gentle stream of air to keep the airway open while you sleep. Most doctors now prescribe autoCPAP (also called APAP), which adjusts the pressure throughout the night based on your needs. It may take some trial and error to find the right mask, but most people eventually find one that works for them. Weight loss is also recommended. Losing just 10 percent of your body weight can improve or even reverse sleep apnea.

If someone can’t tolerate CPAP, there are other options. One is the Inspire device, which looks like a pacemaker and is implanted under the skin near the collarbone. A wire is placed near the tongue, and the device uses electrical stimulation to move the tongue out of the way while you sleep. Inspire is used for people with moderate to severe sleep apnea who can’t tolerate CPAP. Another option is an oral appliance, usually provided by a dentist. These are typically used for mild to moderate sleep apnea.

If you think you might have sleep apnea, talk to a healthcare professional about getting tested. If you don’t already have a provider, consider BrightMed Clinic in Lansing, KS. We’re a primary care and weight management practice, and we’d be happy to support you on your journey to better health. We accept Medicare, Tricare, and commercial insurance. We offer in-person and telehealth appointments. Visit us at www.brightmedclinic.com to learn more.

The Differences Between Type 1 and Type 2 Diabetes

Michael Albrecht, MD

Apr 09, 2025

Diabetes mellitus (which most people call diabetes for short) is a common condition in the United States. In all forms of diabetes, average blood sugar levels are elevated chronically (long-term). In other words, diabetes doesn’t usually develop overnight and it can last for years or even a lifetime. While there are other forms and causes of diabetes, type 1 and type 2 are the most common types.

Problems develop in our bodies if our blood sugar remains elevated for long periods of time. Without making things too complicated to understand, just know that excessive blood sugar levels can damage our tissues and organs and cause complications over time. The most common complications that uncontrolled diabetes (high blood sugar) levels can cause are nerve damage (leading to numbness/tingling/pain in the feet and hands), kidney damage (which can lead to kidney failure and need for dialysis), and eye damage (which can lead to vision loss and blindness). Having diabetes also greatly increases the risks for heart attacks, strokes, and infections.

Ok, but what’s the difference between type 1 and type 2 diabetes? Many people are confused about which type of diabetes they have. First, about 90% of patients who have diabetes actually have type 2 diabetes. That means only about 10% of people who have diabetes have type 1 diabetes.

Type 1 diabetes is an autoimmune disease. What does that mean? It means that–for largely unknown reasons–these patients’ own immune systems attack and destroy their pancreas. The pancreas is where insulin is made. Insulin, in turn, is a hormone that lowers our blood sugar levels by helping to push the blood sugar into our bodies tissues and organs. Since these patients make little to no insulin, their body lacks the hormone that is needed to lower blood sugar. The consequence is that people with type 1 diabetes are treated with insulin because they require this insulin to survive. Many people who have type 1 diabetes use insulin pumps to administer the insulin, although some of them still inject themselves with insulin multiple times per day rather than using an insulin pump. Again, only 10% of people who have diabetes have this form of diabetes.

Type 2 diabetes, the most common type of diabetes, occurs due to insulin resistance. People who have type 2 diabetes make plenty of insulin (in fact, their blood insulin levels are typically very high). However, their body’s tissues and organs don’t lower blood sugars very much in response to insulin. There are several factors that increase insulin resistance, including genetics. However, the biggest risk factor for having insulin resistance is being overweight (obesity). Diet, exercise, weight loss and medications are used to improve the high blood sugar levels associated with insulin resistance and type 2 diabetes. There are numerous medications now on the market that are used to treat type 2 diabetes, including metformin, SGLT2 inhibitors (e.g., Jardiance, Invokanna, Farxiga), GLP-1 medications (e.g., Ozempic, Mounjaro, Trulicity, Rybelsus), and many others. Insulin is sometimes needed in late stages of type 2 diabetes when patients have tried and failed other options.

What are GLP-1 Weight Loss Drugs?

Michael Albrecht, MD

Mar 19, 2025

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By the time patients get to me in weight management practice, they’ve often heard of the “GLP-1 drugs,” such as Ozempic, Mounjaro, Wegovy, Zepbound, and Saxenda. These are powerful medications that can help people lose weight by 15 to 20% or more of their starting weight. However, one of the most common questions I’m asked in weight loss clinic is: “How do these drugs work?”

After being asked that question, I usually go into my spiel of telling them that GLP-1 medications mimic a hormone that our bodies naturally make called GLP-1 (Glucagon-like Peptide 1). I then go on to tell them how GLP-1 works in our bodies:

The GLP-1 hormone is secreted by our small intestine into the bloodstream continuously by our intestines at low levels, but when we eat carbohydrates (“carbs”), our intestines detect this and secrete a “spike” of GLP-1 hormone into the bloodstream.

What does GLP-1 do after it’s in our bloodstream? First, GLP-1 stimulates the pancreas to increase production of insulin and decrease the production of another hormone called glucagon. The overall effect is to decrease our blood sugar levels. Second, GLP-1 tells the stomach to sloooow dooooown. Doctors call this effect “delayed gastric emptying.” In this way, GLP-1 makes the food we eat stay in our stomach longer, and this helps us feel full quicker. Third, GLP-1 has effects on the brain. It communicates to the brain that we’re not hungry, and thus, GLP-1 is a potent appetite suppressant.

GLP-1 drugs mimic the GLP-1 hormone because they bind to the same receptors as GLP-1 hormone in the body. Thus, these medications help us lose weight by increasing satiety (our sensation that we’re full after eating), and by suppressing appetite. Since the drugs also lower blood sugar, the medications also can be used to treat diabetes. We also have strong evidence that these medications reduce the risk for cardiovascular events such as heart attack and stroke.

These medications are very effective for weight loss. Studies have shown that it is common to experience weight loss of 15 - 20% or more of the initial body weight, depending on the medication.

Unfortunately, there’s always a catch. GLP-1 medications are very expensive and sometimes not covered by insurance. They also can cause side effects, such as nausea, vomiting, constipation, diarrhea, burping, heartburn, fatigue, injection site reactions, and hair loss. Caution is needed to use these medications with a prior history of pancreatitis or with any pre-existing gastrointestinal conditions, such as Crohns disease. Because of a theoretical risk of medullary thyroid cancer based on studies in rats, patients should not use these medications if there is a personal or family history of medullary thyroid cancer or a condition known as MEN 2 syndrome.

The bottom line is that the GLP-1 medications are very effective medications for weight loss. They have a number of positive effects in the body, but are not without side effects or expense. Discuss these medications further with your personal physician to help to understand if these medications are right for you.