Why Is It Called Empowered Sleep Apnea?
OR: “How A Doorway Made of Language Itself Can Save Our Field”
By David E McCarty MD FAASM (…but you can call me Dave)
8 December 2025
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“It’s better to light a candle than to curse the darkness.”
--Chinese Proverb
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Empowerment Saves!
There’s a story I sometimes tell myself about the early days of “sleep apnea,” back when the term was still a kind of Pickwickian folklore. In those days—our origin myth—an apneic patient was a cartoon proposition: a big, sleepy man, snoring like a beast of burden, pausing, choking, gasping, and then returning to his slumber with the force of a locomotive. These were the days when the term itself felt new and mysterious—something halfway between a medical diagnosis and a Dickensian character sketch.
And like any meme strong enough to become cultural currency, the name stuck. It entered textbooks. Billing codes. Dinner conversations. By the time I arrived in the field, “sleep apnea” was said with the same finality as “pneumonia” or “fracture,” as though the label referred to a single, cohesive pathological creature. A discrete thing. A disease-state with reliable borders.
But it never was. Not really.
Truth be told, “sleep apnea” was always a signpost pointing toward something much larger, much stranger, much more interwoven with human development and physiology than our early language allowed us to see. In the beginning, the only tool we had to define this elusive creature was the Apnea-Hypopnea Index (AHI)—a numerical talisman that seemed to promise objectivity. And so the field built an empire on a number that, in retrospect, was only ever a shadow on the cave wall.
We built our house on the AHI. And then everything—research, treatment, industry, guidelines—took shape around that gravitational center.
But the thing we were trying to describe…you know…the real thing…was never reducible to a respiratory event count. It’s always been bigger than that…a leviathan…a spectrum…a developmental story…a functional story. Turns out, there’s a story about the shape and use of the human airway over time, and how these factors impact sleep, wake, metabolism, cognition, emotion, pain, cardiovascular risk, and human flourishing.
We tried to name all of that with a single term: “sleep apnea.”
And it wasn’t enough.
Behold!-- the launching pad of the Empowered Sleep Apnea project: the recognition that the term “sleep apnea” remains the gateway. The portal. The knock on the door that invites a patient into a deeper conversation about their lived experience, their biology, their story.
The creative question to unravel:
How do we talk about this thing called “sleep apnea” in a way that captures its true nature—without erasing its utility as the doorway everyone recognizes?
Life-Fans, I give you the “Happy E”… I give you Empowered Sleep Apnea.
Empowerment Saves!!
The Name Was the First Technology
People often assume the title of our project is a branding maneuver—something motivational, catchy, designed for the patient market. In truth, the title is a structural device…a linguistic innovation…the earliest tool in a much larger architecture of complexity deconstruction.
The book needed that name because our field needs that name.
Without an empowered version of the term, we’re stuck with the impoverished one: a binary diagnosis, tied to a flawed index, tied to a billing code, tied to a historically narrow view of airway physiology. The standard term is brittle. It excludes more than it includes. It narrows conversations when it should open them.
If I walk into a room and tell a patient, “You have ‘sleep apnea’,” I am invoking the brittle version…the reductive one…the one that pretends the entire universe of dysfunctional breathing during sleep can be summarized in a five-digit ICD code and an AHI greater than 5.
But if I walk into that same room and say, “Let’s talk about Sleep Apnea,” italicizing it, and capitalizing it in my mind, the way we do in the Empowered Sleep Apnea project—something shifts. The capital S becomes an invitation. The italics add a tilt, a subtle cue that says: the thing we’re talking about is not the thing you think we’re talking about.
…sharing a language about Sleep Apnea is not…(wait for it…) … INCONCIEVABLE!
Sleep Apnea signals that the word is a doorway. Not a conclusion.
And thus we see how the title of the book became a planting of the flag…
Let’s empower the word itself, so that the conversation it opens can carry the complexity that reality demands.
See, language is not merely descriptive, it’s generative. It creates the world we get to live in. If we spoke differently about “sleep apnea” from the very beginning, the field itself would be different today.
A Diagnosis That Became Too Easy
Another reason we need an empowered version of the term is that the diagnosis of obstructive sleep apnea…you know?...G47.33?...making that diagnosis has become almost trivially easy to do.
You don’t need to stop breathing…you don’t need to snore…you don’t need to choke…heck, you don’t even need to be obese…
…all you need is a handful of Respiratory Effort Related Arousals (RERAs) per hour and a complaint of nonrestorative sleep. That’s it. Five non-desaturating obstructive breathing disruptions per hour, paired with some degree of sleep-wake dissatisfaction.
Congratulations: you have OSA!
If the originators of the Pickwickian meme could see what qualifies now, they might laugh—or fall over. Truth is, if pressed, many of the folks you know would qualify. Heck, you prolly would, too!
It’s not hard. That was the point!
See, the AASM’s expanded criteria project was well-intended, meant to capture the blind spots that the Pickwickian meme can’t capture, to broaden the clinical net. When the AASM folded UARS into OSA by redefining the hypopnea, they were trying to unify the terrain—you know, bring the subtle cases into the fold.
They were trying to make the taxonomy more physiologically honest.
But that’s not what happened, out there in the wild blue…
Instead, the definitional boundaries became even more fractured. The clinical vocabulary became more confusing:
Now, an AASM-aligned provider who uses coverage criteria to drive diagnosis assignment will say: “This patient clearly doesn’t have OSA,” because the 4% AHI is less than 5/hr…
…leaving it to an enlightened Airway Focused Dentist to “rescue” the patient with the diagnosis of “upper airway resistance syndrome” (UARS)…a term that’s been officially retired, as if it were a rumor that’s been debunked…leaving it to the unwashed masses to figure out exactly what the hell we are all talking about.
Same patient. Same physiology. Same sleep study.
Different language.
And the patient, caught in the middle, is on their own to determine what universe they’re inhabiting and whether their doctor is disagreeing with the other doctor…or about reality itself.
…it’s a simple question…perhaps the complexity of the answer needs to be better unpacked!
This is what happens when a field tries to stretch a brittle word over a vast behavioral spectrum.
It tears.
Life-Fans, here’s the thing: when language tears, people get lost.
Sometimes for decades.
Sleep Apnea as a Developmental Phenomenon
One of the quiet revolutions of the past two decades has been the expanding recognition that that thing we’ve been calling “sleep apnea” is often the downstream manifestation of developmental issues that began in childhood—or even earlier.
Malocclusion. Oral posture. Mouth breathing. Craniofacial growth patterns. Palatal shape. Tongue space. Nasal resistance. All the functional myofascial relationships that shape airway stability long before adulthood.
If the roof of your mouth becomes the floor of your nose—and that roof is narrow—your nose will suffer. If your tongue cannot find home against the hard palate, the soft palate will compensate, over-function, collapse. If your mandible tracks back during growth, the retroglossal airway will collapse with it. If the headgear pulls in the wrong direction—well, that’s a whole other essay, isn’t it?
The point is this: the vast majority of the airway’s story has nothing to do with whether your AHI is 4.9 or 5.1.
The field keeps trying to refine the number. But the number is a late-stage snapshot. A pixel in a mural.
Empowered Sleep Apnea insists on widening the frame.
The Leviathan in the Room
I keep using the term “leviathan,” and that’s intentional. Because in our field, “sleep apnea” has been treated as though it were a small creature—a manageable housecat that lives in the bedroom and sometimes knocks over your CPAP machine.
But the real Sleep Apnea is a sea creature. A deep-structure phenomenon. A multi-systemic, multigenerational, developmental, biomechanical, neurocognitive, inflammatory, psychosocial tangle of interlocking relationships. You can tug on one thread, but the whole tapestry responds.
…we’re gonna need a bigger fleet!…
So why are we still using a term as though it denotes a single pathology?
Because without a common word, we don’t have a common doorway.
And if we don’t have a doorway, we don’t have shared culture. And without shared culture, we cannot heal fractured systems.
This is where the Rebis Health project shines a lantern into the darkness:
We need a shared language that respects complexity without drowning in it.
We need a term that invites clinicians and patients into the larger landscape.
Sleep Apnea, capitalized and italicized, becomes that term. It signals the leviathan.
But Empowered Sleep Apnea does something more: it gives us a way to work with that leviathan.
Language as a Portal to Healing
In the Empowered Sleep Apnea project, everything begins with questions—not answers. I make the argument that for our fragmented environment to play nicely together, we need to bump foreheads and align as a community on the answers to three fundamental questions:
1. What is Sleep Apnea?
2. Why should we treat it?
3. What else could it be?
These questions are not rhetorical. They are operational. They orient the patient and the provider toward curiosity rather than certainty, toward collaboration rather than authority. They open a dialogue that is iterative and relational, not diagnostic and final.
And, folks: this is how complexity becomes navigable…through shared language, shared story, shared meaning.
Traditional medical language tends to compress complexity into tiny boxes, labels we call “diagnoses”. Empowered language does the opposite: it expands the box. It gives us a larger cognitive container in which to hold nuance, fluidity, uncertainty, and human agency.
That’s why the term “Empowered” is doing such heavy lifting in the title. It’s not about positive thinking or cheerleading--it’s about restoring ownership and clarity, and reaffirming the patient’s role as the primary narrator of their own physiological story.
When someone can say, “I am learning about my Sleep Apnea” rather than “I have obstructive sleep apnea,” something shifts inside them. They move from being the object of a diagnosis to being the explorer of a phenomenon.
Exploration is healing. Agency is healing. Language is healing.
And this is how a field begins to save itself—not through bigger machines or stricter definitions, but through better stories.
Silos and the Failure of Shared Language
Every field has its silos, but sleep medicine has built entire fortresses around its vocabularies.
Dentists talk about malocclusion and airway volume.
ENTs talk about nasal resistance and collapsibility.
Sleep physicians talk about RERAs, RDI, AHI, REM-supine effects.
Orthodontists talk about arch form and headgear vectors.
Psychologists talk about insomnia and hyperarousal.
Pulmonologists talk about ventilatory control and loop gain.
Each silo uses its own dictionary, believing it to be the one that explains the most. For any given patient, though, all those vocabularies are describing parts of the same beast—while the patient sits in the middle of the room, blinking, wondering why their healthcare team can’t agree on the name of the creature they’re fighting.
The tragedy is not that each silo is wrong…it’s that each silo is right—and incomplete. Each is describing one facet of the same physiological story, using different tools, traditions, and tribal vocabularies.
Empowered Sleep Apnea does not try to replace these siloed languages. It simply offers a common stage on which they can coexist. It gives every member of the care team a shared line of inquiry, a shared mythos, a shared set of tools. It democratizes complexity into a language accessible to the whole team—and to the patient.
This is not simplification. This is unification.
The AHI Was Never the Point
Let’s say this out loud: the AHI is not the gold standard of anything except its own history.
It was useful once. It still has tactical utility. But it cannot hold the weight we have placed on it. It cannot predict who will suffer. It cannot predict who will respond. It cannot tell us what the airway is doing. It cannot tell us how the airway got there. It cannot integrate form, function, or developmental trajectory.
And yet the AHI remains the center of gravity around which insurers, guidelines, and a huge portion of our clinical identity continue to orbit.
This is why we need an empowered version of our term…not to discard the AHI, but to dethrone it, make it a tool rather than a tyrant.
Empowered Sleep Apnea returns the conversation to the broader questions that matter: form, function, symptoms, risk, comorbidities, sleep quality, wake functionality, emotional wellbeing, relational dynamics, lived experience.
The Five Finger Approach and the Five Reasons to Treat—our twin pillars—offer the scaffolding, giving us our shared language, allowing clinicians from different silos to examine the same creature from different angles and still meet in the middle with coherent meaning.
This is the future of the field.
The Gateway That Saves Us
So why call the project Empowered Sleep Apnea?
Because the name is an intervention.
Because the name reframes the diagnosis as a doorway rather than a destination.
…welcome to the adventure…prepare to be EMPOWERED!
Because the name honors the truth that Sleep Apnea is not a disease-state but a landscape—one that includes circadian misalignment, pharmacology, medical comorbidity, psychiatric distress, structural airway issues, ventilatory control instability, inflammatory feedback loops, and developmental history.
Because people still search for “sleep apnea.” That’s the term on their mind when they buy a wearable, when they talk to their spouse, when their primary care doctor sends them for a test. If we want to catch people where they are, we must use the term they already know.
But if we want to heal them—really heal them—we must expand the meaning of that term so that it can hold the truth of their story.
Empowered Sleep Apnea is that expansion.
It is the widening of the doorway so more people can pass through; it is the unification of the vocabularies that once kept us divided; it is the narrative architecture that allows patients and clinicians to explore complexity together.
And if we do this well—if we hold the language with intention, clarity, curiosity, and humility—then the term Sleep Apnea can become not a label but a lantern.
It’s a light we carry together, illuminating the way toward healing.
Kind mojo & happy exploring,
Dave
David E McCarty MD FAASM
Longmont CO
8 December 2025