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WOMEN’S HEALTH

A newsletter from El Camino Women’s Medical Group

In this issue:

Practice Updates

Online Prenatal Classes

What’s that?: Foreign Bodies in The Nose & Ear

Strong for Life: Protein, Strength Training, and Creatine for Women

Why Do My Legs Get Swollen When I Travel?

Coming Home & Looking for Home

Breaking Down Sleep Apnea

Staying Well This Fall: Your 2026 Vaccine Guide

El Camino Hospital Visitor Policy Updates

Highlights from our Women’s Health Blog

Practice Updates

Practice Updates

A Successful Launch of Our 24/7 AI Lactation Support

We know that breastfeeding questions don’t follow a schedule — and for many of our patients, the middle of the night is exactly when they need help most. We also know many of our families are navigating new parenthood without much nearby family support. That’s why we are introducing our pregnant and postpartum patients to JasmineAI, a voice-first AI lactation assistant available around the clock.

Jasmine is simple to use — just call 1-866-646-6201, speak naturally, and get immediate guidance. No app to download, no typing, no waiting for a callback. Her knowledge base is built on IBCLC clinical standards and has been tested and validated by registered nurses who specialize in lactation. She’s HIPAA-compliant, and your conversations are encrypted and private.

She can help with questions like:

• How can I tell if my baby is getting enough milk?
• What are some tips for a more comfortable latch?
• How do I maintain my supply when I return to work?
• How should I safely store and warm expressed milk?

Pro tip: Save 1-866-646-6201 in your phone as “Jasmine – Lactation Support” now, so it’s ready when you need it.

A few important things to keep in mind: Jasmine is designed to provide evidence-based guidance on common breastfeeding questions — she is not a substitute for a clinical evaluation or diagnosis. During business hours, you can usually reach Nadia, our lactation educator, through the office. For more complex concerns, El Camino Hospital has internationally board-certified lactation consultants (IBCLCs) available for one-on-one support — both in the hospital and via telehealth — through their Breastfeeding and Postpartum Support program (Mountain View: 650-988-8290).   We launched this service because so many of our patients have struggled to get timely, quality advice for breastfeeding issues.  It is meant to complement the resources already available around us, not to replace them.

Wrap-Around Services for Pregnancy and Postpartum

We think of support during pregnancy and the postpartum period as extending well beyond your office visits. Here are the resources we offer or connect our patients with:

Lovu Health — A digital maternal health platform that supports women from pre-conception through two years postpartum, combining real-time health monitoring, personalized care navigation, and a curated marketplace of services — lactation support, mental health resources, prenatal care tools, and more. It helps share actionable data directly with our office and is designed to make care more coordinated and accessible.

Jasmine, 24/7 AI Lactation Support — Call 1-866-646-6201 any time for evidence-based answers to common breastfeeding questions, with Nadia and El Camino’s IBCLCs available for more complex needs. (See above for full details.)

Mariam AlAgha, Nutritionist — Mariam supports patients through pregnancy, postpartum recovery, and breastfeeding nutrition, as well as conditions like gestational diabetes and PCOS. Televisit appointments on Tuesdays, Wednesdays, and Thursdays; in-network with most insurance. To schedule, call, email, or message us through healow.

Mental Health Support — Dr. Rania Awaad and therapist Daniya Ahmed, LMFT, are available for patients experiencing perinatal mood and anxiety disorders, postpartum depression, or other mental health concerns. Screening questionnaires are required; there may be a waitlist. Call, email, or message through healow to get started.

Wrap-Around Services for Women’s Health

Mederva Health — A personal health coaching program, covered by most insurance plans, that pairs you with a dedicated coach to help you reach your health goals between visits — whether that’s weight management, stress, perimenopause, sleep, or building habits that actually stick. All virtual, no extra trips to the office. Register here.

Mental Health Support — Dr. Rania Awaad and Daniya Ahmed, LMFT, see patients for a broad range of mental health conditions, including anxiety, depression, and life transitions. Call, email, or message through healow to get started.

Mariam AlAgha, Nutritionist — Mariam works with women managing prediabetes, high cholesterol, PCOS, perimenopause and menopause, and general weight and nutrition goals. She holds a master’s in Human Nutrition from the University of Aberdeen and has over eight years of clinical experience. Televisit appointments Tuesdays, Wednesdays, and Thursdays; in-network with most insurance.

Online Prenatal and Women’s Health Classes

Prenatal Classes

We offer four virtual prenatal classes each month. These classes cover preparing for childbirth, breastfeeding, and newborn care.   These classes have been very popular, and we plan to have them every month.  They are also available to women who are interested in signing up, though we prioritize our patients.

Virtual Breastfeeding Class

This is a 2-hour class presented by Nadia, RN, our lactation educator.  The class is a virtual, in-depth review of breastfeeding.  Learn how to get the best start, avoid pain, make sure your baby is getting enough, and when to ask for help!

 Virtual Newborn Care & Safety Class

2.5-hour class presented by Nadia, RN

Practical tips for caring for a newborn

• Appearance of newborn
• Normal skin conditions
• bathing & diaper changing
• safe sleeping
• Newborn safety:
  • Car seat safety
  • Choking hazards
  • Poison control
  • Childproofing your home

Childbirth Preparation Part One

2.5-hour class presented by Nadia, RN:

• The last month of pregnancy
• Preparing for the hospital
• Laboring at home, when to call and when to come in
• Admission to the hospital
• Active labor
• Pain management

Childbirth Preparation Part Two

2.5-hour class presented by Nadia, RN:

• The last stage of labor: pushing
• Vaginal delivery
• Cesarean delivery
• Initial recovery in the hospital
• The postpartum period

You can learn more about these classes or register here.

What’s that?: Foreign Bodies in The Nose and Ear 

By Katrina Chaung, M.D.
Board-certified Otolaryngology-Head and Neck Surgery
Camino Ear, Nose & Throat
(408) 227-6300

Children are naturally curious, and exploring the world often means exploring what objects can fit into their nose and ears!  

Young children (and occasionally adults) frequently place beads, toy parts, or food into their noses or ears. My least favorites include rocks and crayons.  Parents may not witness it happening. Instead, the first clues may be a child complaining of discomfort, decreased hearing, a foul-smelling discharge from one nostril, or persistent irritation. Occasionally, there are no symptoms at all until the object is discovered during a routine examination.

Foreign objects need to be removed to prevent pain, infection, and trauma.  For the ears and nose, specialized tools and equipment such as a microscope, forceps, and speculums may be necessary.   While most foreign bodies are not an emergency, it is important to note that certain objects need special, and often urgent or even emergent, attention.

Magnets are particularly dangerous because of their powerful attraction forces. If a child places one magnet in each nostril, the magnets can snap together across the nasal septum—the thin wall separating the nostrils. The pressure can cut off blood flow to the tissue within hours, leading to tissue death, infection, and even a hole (perforation) in the septum. These injuries can be permanent and may require reconstructive surgery. Similar problems can occur if multiple magnets are placed in the ear canal.

Parents should also be aware of another serious hazard: button batteries.  These small, coin-shaped batteries are found in many everyday items, including remote controls, key fobs, hearing aids, toys, musical greeting cards, and watches.  If a button battery becomes lodged in the nose or ear, it can generate an electrical current that rapidly damages surrounding tissue. Serious burns can occur in as little as two hours, even if the battery is no longer functioning. Any suspected button battery in the nose or ear should be treated as a medical emergency.  While this is an entirely different subject, it is also an emergency if there is suspicion that a button battery or magnet(s) are swallowed.

If you suspect your child has placed something in the nose or ear, resist the urge to remove it with cotton swabs, tweezers, or other household tools. These attempts often push the object deeper, making removal more difficult and increasing the risk of injury. Likewise, avoid flushing the ear with water unless instructed by a healthcare professional, especially if the object could be a battery.

Prevention is the best strategy. Keep small magnets, button batteries, and tiny toy parts out of the reach of young children. Be especially cautious with magnetic building toys, jewelry, and household items that could contain magnets. Check toys regularly for loose pieces, and supervise young children during play.

Most foreign bodies in the nose and ear can be removed without lasting problems when treated promptly. Knowing the warning signs and acting quickly—especially when magnets or button batteries are involved—can prevent serious complications. A small object may seem harmless, but in the wrong place, it can become a medical emergency.

Board-certified Otolaryngology-Head and Neck Surgery
Camino Ear, Nose & Throat
(408) 227-6300
https://www.caminoent.com

Strong for Life: Protein, Strength Training, and Creatine for Women  

By Mariam AlAgha
Master’s in Human Nutrition 
ElCamino Women’s Medical Group

Protein is not only for bodybuilders. For women, it supports muscle, bone health, recovery, metabolism, and the strength needed for everyday life.

Combine adequate protein with regular strength training—and, optionally, creatine—and you have one of the most effective strategies for staying strong and independent as you age.

How Much Protein Do Women Need?

Protein needs are personal. The right amount depends on your body weight, age, activity level, calorie intake, health, and goals.

The Recommended Dietary Allowance, or RDA, is 0.8 grams of protein per kilogram of body weight per day. This amount is designed to meet basic needs, but it may not be optimal for women who exercise regularly, want to build or preserve muscle, or are losing weight.

The current Dietary Guidelines for Americans provide a general protein target of 1.2–1.6 g/kg per day, adjusted for individual calorie needs. This is a useful range—not a prescription that every woman must follow.

Protein Math Made Simple

For women who perform resistance training, research suggests that benefits for muscle development often begin to level off around 1.6 g/kg per day. This is an average—not a hard ceiling—and individual needs may vary.

Women with kidney disease or other complex medical conditions should receive an individualized recommendation.

Do Not Save All Your Protein for Dinner

Many women eat very little protein at breakfast, a moderate amount at lunch, and most of it at dinner. A more balanced approach is to include protein at each meal.

For many women, 20–35 grams per main meal is a practical starting point. A more individualized target is approximately 0.3–0.4 g/kg per meal.

Try these simple protein anchors:

• Greek yogurt with berries and nuts: approximately 18–25 grams
• Two eggs with ½ cup egg whites: approximately 25 grams
• Three ounces of chicken, turkey, or fish: approximately 20–27 grams
• One cup of cottage cheese: approximately 24–28 grams
• One cup of cooked lentils: approximately 18 grams
• One cup of shelled edamame: approximately 17 grams

Exact amounts vary by brand and preparation, so check the Nutrition Facts label when needed.

Choose Protein That Brings More to the Plate

The best protein foods provide more than protein. They may also offer iron, calcium, zinc, vitamin B12, choline, omega-3 fats, fiber, folate, and potassium.

Good choices include:

Animal sources: fish, seafood, chicken, turkey, eggs, Greek yogurt, cottage cheese, milk, and lean, minimally processed meats.

Plant sources: lentils, beans, chickpeas, tofu, tempeh, edamame, soy milk, nuts, seeds, and seitan.

Vegetarian and vegan diets can provide enough protein, but very restrictive plant-based diets may require additional planning. When total protein intake is adequate, soy and whey protein appear to support similar strength and lean-mass gains during resistance training.

A Note About Seafood

Adults are generally advised to eat at least 8 ounces of seafood weekly. Women who are pregnant or breastfeeding should aim for 8–12 ounces weekly from lower-mercury choices, such as salmon, sardines, shrimp, pollock, trout, and canned light tuna.

Protein powder can be convenient, but it is not essential. When using one regularly, choose a simple product that has been independently tested by an organization such as NSF Certified for Sport or Informed Choice.

Protein Is Not a Replacement for Eating Enough

Higher protein intake can help preserve muscle during weight loss, particularly when paired with resistance training. However, protein cannot fully compensate for a large or prolonged calorie deficit.

Your body also needs enough total energy, carbohydrates, healthy fats, vitamins, and minerals to train, recover, and maintain muscle.

Why Women Benefit Greatly From Strength Training

Walking and cardiovascular exercise are valuable, but they do not fully replace resistance training.

Federal guidance recommends muscle-strengthening activities involving all major muscle groups on at least two days each week. The ideal program should still be adjusted for fitness level, health, and personal goals.

Strength training can help women:

• Build and preserve muscle
• Support stronger bones
• Improve insulin sensitivity
• Maintain balance and mobility
• Preserve lean tissue during weight loss
• Make daily activities easier
• Protect long-term independence

Women do not need muscle only to “look toned.” Muscle helps us carry groceries, lift children, climb stairs, travel, and remain active as we age.

A beginner can start with two full-body sessions per week using movements such as squats or sit-to-stands, rows, presses, hip hinges, step-ups, and core exercises. Gradually add repetitions or resistance as the exercises become easier.

Strength training supports bone health, but it works alongside adequate calcium and vitamin D. Women generally need 1,000–1,200 mg of calcium daily, depending on age, and 600–800 IU of vitamin D daily, depending on age. These are total-intake goals—not automatic supplement prescriptions.

What About Creatine?

Creatine is a compound produced naturally by the body and found in smaller amounts in meat and seafood. It helps the muscles rapidly produce energy during short, intense activities such as weightlifting, sprinting, and high-intensity intervals.

Creatine is not a steroid, hormone, stimulant, or fat-burning supplement.

By helping you perform an extra repetition or maintain training quality, creatine may support modest improvements in strength and lean mass over time—especially when combined with resistance training.

Women have historically been underrepresented in creatine research. However, available evidence suggests potential benefits for exercise performance and strength in premenopausal women, with promising—but still developing—evidence for muscle and functional benefits after menopause.

How to Take Creatine

For most healthy adult women who choose to use it:

• Choose creatine monohydrate
• Take 3–5 grams daily
• Take it consistently, including on rest days
• Use whichever time of day is easiest to remember

A loading phase is optional and usually unnecessary. More expensive forms have not been shown consistently to work better than creatine monohydrate.

Common Creatine Concerns

“Will it make me gain fat?”
Creatine may cause a small increase in scale weight because it increases water stored inside the muscles. This is not body-fat gain.

“Does it damage the kidneys?”
Recommended doses have not been shown to damage kidney function in healthy adults. Evidence is limited in people with kidney disease, so anyone with impaired kidney function or abnormal kidney tests should use it only with clinical supervision.

“Does it cause hair loss?”
Current evidence has not established that creatine causes hair loss. The concern originated from one small study that measured a hormone related to hair loss but did not measure actual hair loss. Longer-term and female-specific research is still needed.

Creatine is not routinely recommended during pregnancy or breastfeeding because human safety data remain limited. Discuss supplementation with an obstetric or pediatric healthcare professional.

The Bottom Line

For lifelong strength:

1. Choose a protein target that fits your body, activity level, health, and goals.
2. Include protein at each meal instead of saving most of it for dinner.
3. Eat a variety of animal and plant protein foods.
4. Consume enough total energy to support training and recovery.
5. Strength-train all major muscle groups at least twice weekly.
6. Consider creatine monohydrate as an optional addition—not a replacement for food, exercise, sleep, or recovery.

The goal is not perfection. Consistent protein intake and progressive strength training are the foundations for becoming—and staying—strong for life.

Yours in health,
Mariam AlAgha
Master’s in Human Nutrition 
ElCamino Women’s Medical Group

Why Do My Legs Get Swollen When I Travel?

By: Joyce Lu, MD, RPVI, FSVS, FACS
Vascular Surgeon
El Camino Health: Mountain View, Los Gatos, and Morgan Hill.

As the summer vacation season comes to a close, you may have had a great time getting away, but perhaps after coming off your flight overseas or out of their vehicle from a road trip, you noticed your shoes feeling a bit tight or that you looked a bit swollen around the ankles. This is a common concern which sometimes brings patients to my office, particularly if the swelling lasts longer than a few days.  

When we are traveling, we often find ourselves stuck in a seated position.  Walking is not typically an easy option to us because we are cramped up or just trying to get to our destinations as quickly as possible.  When we walk, our calf muscles actually pump the blood in our veins up and out of the legs as part of natural and necessary circulation.  If we are in situations that reduce our opportunities to walk, it can cause the blood to linger longer in our legs.  This shows itself as swelling because the water content of the blood can drift out of the vessels into our tissues nearby and the longer we are in these situations, the more significant the swelling can be.  While we go up in the air for flights, there’s lower air pressure due to the increase in altitude, which further promotes generalized bodily swelling.  

Gravity affects all of us at all times and when our legs are hanging downward in the seated (or even standing) position, all of that fluid will accumulate in the lowest part of our body: the lower legs.  The tight skin of our lower legs can help to resist the swelling, but if the swelling is significant, that additional tension can end up being quite painful, making you want to lie down or put your feet up instead of exploring your travel destination right away.

So what can we do?  Even if people don’t have a vein issue called venous insufficiency (which can make these symptoms even worse), everyone can benefit from wearing compression stockings when they are traveling!  Buying compression stockings “over the counter” from commercial sources can be convenient, but this is the most common pitfall of many well-intentioned people trying to do the right thing.  Commercial-grade compression does not need to abide by any quality criteria, they just need to look enticing enough to get the money out of a consumer’s wallet, unfortunately.  I recommend that anyone looking for compression buy a reputable brand but also ensure that the compression is fit in at least three dimensions (calf, ankle, and length) and it is graduated in design to ensure correct pressure applications.  Shoe size alone has nothing to do with whether the sock will fit correctly.  If you are near the El Camino Mountain View campus, we sell them to patients at a wholesale price and can help you to find the right size at our outpatient pharmacy.  Wearing compression is a method of prevention and control and so don’t wait until swelling has settled in, get them on before you start your travel!

In rare situations, some leg swelling can be caused by blood clots in the leg called deep vein thrombosis or DVT.  Typically, legs will additionally have a redder appearance and also be very painful when walking.  If you suspect this, you should go to an emergency room right away and they will likely perform an ultrasound to check if you do have this condition.  Adequate hydration and trying to go for a 10-15 minute walk every 2 hours will also help to prevent blood clots along with compression stockings.

Hopefully with these tips, your legs will be ready to go exploring as soon you reach your destination!

Joyce Lu, MD, RPVI, FSVS, FACS
Vascular Surgeon
El Camino Health

Accepting new patients in Mountain View, Los Gatos, and Morgan Hill.

 Coming Home & Looking for Home

When I come back home, one of the things I look forward to, is making a small and simple yet sustaining meal in the comfort of my kitchen. Simple flavors, a few spices that are fresh and sharp, and the utter sense of contentment of coming home. Lately, I have been more aware of those who cannot cook themselves a meal anymore, whether it is because of ill health or not having access to a kitchen again.

It is such a loss of independence. Not having the ability to comfort yourself with a meal you can make is a big loss. It could be something as simple as an omelette and soup, or a dal and rice. It is a very basic aspect of self-care.

These two poems that I wrote recently speak to different aspects of food and comfort. They speak of homelands, comforting fragrances and flavors, of longing & belonging.

Spice Cupboard

At the very front

in my spice drawer

are the whole ones–

small bottles of seeds

Mustard Cumin Fenugreek

Urad Dal & Byadgi Chilis

Ajwain & Kalonji

while

pungent Asafoetida shards are

carefully cosseted

In the next row

powerful powders–

Cumin Coriander Chili

Turmeric

Garam Masala Black-salt

Dried Mango & Ginger

Paprika & Piri Piri

Bright Aleppo pepper

Then the blends

Turkish & British Curry

Spanish Tagine

Korean Goxhujang

with

Channa Rajma Chaat & Chai

Tucked further back

On shelves above

Nestle rarely used Oreganos

Thymes, Basil, Lemon Peppers

Within easy reach

And in the circular steel dabba

Grimy with use

are seven little cups

cloves, cardamom, big and small,

flat cinnamon, big bay leaves

nutmeg, and star anise

&

whole black peppercorns from Kerala

To reach up on tiptoe

are the bigger jars

Tamarind, Neem flowers, lemon peels

And, To the right are

my most treasured

and the best spice blends

They have the names of aunties

Prameela’s Saaru

Kalpakam’s Rasam

Lata’s Sambhar

Geetha’s Gojju

I am at home.

~

Coming home sometimes brings back memories of other journeys, times when we brought back different things for the children now grown up and going on travels of their own.

~

Lugging Luggage Home

We filled enormous suitcases

Lugging home colorful toys

Smooth wooden bright ones

Remembered from Channapatna days

Toys from happy memories

Spinning tops with endless cousins

The heavy twine snugly wrapping

Weaving down the top, the knot

Of the twine held just so between fingers

The flick of the wrist unfurling the wood

From the twine

Expert hands

Sending the top into a crazy spin

The sharp nail sometimes splitting

Apart rival’s tops

the victory cry of “appitt”

Recollecting the sadness

Broken wood splintering

Going home without the top

Just the drooping string hanging bereft

We tried to teach them these tricks but without older cousins, they played with other toys

The balance man perching

Precariously his extra long

Arms hanging out from a

Point in a cup on a pillar

The rusty keyed wind-up magic

Merry-go-round with animals

On the stools, the umbrella

Flaring out crinkling as it spun

Slowly Teetering to a halt

The bright-bright soft stuffed

Animals, balls, whose insides

Plop out too soon

The hand-sewn stitches

No match for tug-of-war

The other suitcases filled

Impossibly fragrant spice

Mixes that if mingled with

The toys would elicit

Nose-holding, sneezes

phew phoos from the littles

Now those children shop

In Persian, Indian, Arab

Pakistani Asian stores

Inhaling, feeling, searching

For our ghosts, memories

Fleeting images remembered

Smells, Colors to take home

While hunting ancestral bonds.

As I wrote up this stack, the oven was bubbling with the warm fragrance of onions, garlic, tomatoes, olive oil, Fresno peppers and home-grown Thyme. One of the younger generation is cooking down a tomato soup. Perhaps this will be another fragrance to remember and recollect someday.

Nostalgia is a strange thing – sharing these kinds of memories can elicit the warmth of shared experiences, or invoke other memories that are unique to each person or family. I looked up the word just now, and am quite delighted, (dare I say Chuffed?) to find out that it is from Greek roots meaning ‘a return home.’

I love circles that come to completion!

These two poems that I wrote recently speak to different aspects of food and comfort. They speak of homelands, comforting fragrances and flavors, of longing & belonging.

Spice Cupboard

At the very front

in my spice drawer

are the whole ones–

small bottles of seeds

Mustard Cumin Fenugreek

Urad Dal & Byadgi Chilis

Ajwain & Kalonji

while

pungent Asafoetida shards are

carefully cosseted

In the next row

powerful powders–

Cumin Coriander Chili

Turmeric

Garam Masala Black-salt

Dried Mango & Ginger

Paprika & Piri Piri

Bright Aleppo pepper

Then the blends

Turkish & British Curry

Spanish Tagine

Korean Goxhujang

with

Channa Rajma Chaat & Chai

Tucked further back

On shelves above

Nestle rarely used Oreganos

Thymes, Basil, Lemon Peppers

Within easy reach

And in the circular steel dabba

Grimy with use

are seven little cups

cloves, cardamom, big and small,

flat cinnamon, big bay leaves

nutmeg, and star anise

&

whole black peppercorns from Kerala

To reach up on tiptoe

are the bigger jars

Tamarind, Neem flowers, lemon peels

And, To the right are

my most treasured

and the best spice blends

They have the names of aunties

Prameela’s Saaru

Kalpakam’s Rasam

Lata’s Sambhar

Geetha’s Gojju

I am at home.

~

Coming home sometimes brings back memories of other journeys, times when we brought back different things for the children now grown up and going on travels of their own.

~

Lugging Luggage Home

We filled enormous suitcases

Lugging home colorful toys

Smooth wooden bright ones

Remembered from Channapatna days

Toys from happy memories

Spinning tops with endless cousins

The heavy twine snugly wrapping

Weaving down the top, the knot

Of the twine held just so between fingers

The flick of the wrist unfurling the wood

From the twine

Expert hands

Sending the top into a crazy spin

The sharp nail sometimes splitting

Apart rival’s tops

the victory cry of “appitt”

Recollecting the sadness

Broken wood splintering

Going home without the top

Just the drooping string hanging bereft

We tried to teach them these tricks but without older cousins, they played with other toys

The balance man perching

Precariously his extra long

Arms hanging out from a

Point in a cup on a pillar

The rusty keyed wind-up magic

Merry-go-round with animals

On the stools, the umbrella

Flaring out crinkling as it spun

Slowly Teetering to a halt

The bright-bright soft stuffed

Animals, balls, whose insides

Plop out too soon

The hand-sewn stitches

No match for tug-of-war

The other suitcases filled

Impossibly fragrant spice

Mixes that if mingled with

The toys would elicit

Nose-holding, sneezes

phew phoos from the littles

Now those children shop

In Persian, Indian, Arab

Pakistani Asian stores

Inhaling, feeling, searching

For our ghosts, memories

Fleeting images remembered

Smells, Colors to take home

While hunting ancestral bonds.

As I wrote up this stack, the oven was bubbling with the warm fragrance of onions, garlic, tomatoes, olive oil, Fresno peppers and home-grown Thyme. One of the younger generation is cooking down a tomato soup. Perhaps this will be another fragrance to remember and recollect someday.

Nostalgia is a strange thing – sharing these kinds of memories can elicit the warmth of shared experiences, or invoke other memories that are unique to each person or family. I looked up the word just now, and am quite delighted, (dare I say Chuffed?) to find out that it is from Greek roots meaning ‘a return home.’

I love circles that come to completion!

Breaking Down Sleep Apnea 

By: Subaila Zia MD, MBA, FCCP, FAASM
Founder & CEO Telemedora
ABIM Board-Certified Sleep, Pulmonary & Critical Care Physician
AASM AI in Sleep Committee Member
AASM Strategic Ambassador for Emerging Technology

What is Obstructive Sleep Apnea?

Obstructive Sleep Apnea (OSA) is a chronic, serious, and most common sleep disorder. It occurs when the throat muscles relax during sleep, causing complete or almost complete airways collapse, cutting off airflow intermittently. Many people think of sleep apnea as just loud snoring; however, sleep apnea when untreated can lead to significant morbidity and mortality. Although all the muscles in the body relax when we sleep, people with naturally narrow throats or large neck size are more prone to sleep apnea. When the airflow gets cut off, oxygen levels go down, and your brain kicks in a survival reflex that momentarily wakes you up so you can breathe again. This reflex is vital for staying alive, but it messes up your sleep, leaving you feeling tired.

Recognizing the Symptoms

People with sleep apnea could suffer from symptoms during the night as well as during the day. These can vary from person to person. Many people don’t realize that they have sleep apnea until a partner, family member, or roommate notices something unusual during their sleep and/or during daytime.

Nighttime Symptoms

•     Loud Snoring: This is the most common symptom, occurring when air pushes through a narrowed airway. However, not everyone who snores has sleep apnea, and not everyone with sleep apnea snores.
•     Breathing Pauses: If you share a bed, your partner might notice you stop breathing temporarily while sleeping. This is scary and concerning for bedpartners. 
•     Gasping or Choking: When your throat closes during sleep apnea, this may cause you to wake up feeling short of breath or as if someone is trying to smother you. You might feel like you need to catch your breath. 
•     Restless Sleep: Sleep apnea often leads to frequent awakenings and difficulty staying asleep, also known as sleep maintenance insomnia.
•     Frequent Urination at Night: Waking up multiple times during the night to urinate is a common symptom that many individuals overlook.

Daytime Symptoms

•     Dry Mouth & Morning Headaches: Many people with sleep apnea wake up with a dry mouth, sore throat, drooling, or even headaches, all because of not sleeping well and not getting enough oxygen at night. They can be mouth-breathers.
•     Non-restorative Sleep: Despite getting adequate amounts of sleep, people with sleep apnea tend to wake up feeling as if they have not slept enough. They feel tired in the morning. 
•     Excessive Daytime Sleepiness: It is also known as hypersomnia. It can be so severe that you may feel sleepy even when you are driving, listening to lectures, watching TV or even talking to someone.
•     Brain Fog and Cognitive Issues: Sleep apnea disrupts the brain’s oxygen supply, and this lack of adequate oxygen can negatively affect attention, concentration, and memory retention.
•     Mood Changes: Not getting enough sleep over time can make people feel cranky, anxious, or even depressed. Some patients with sleep apnea tend to snap easily at others.

Causes and Risk Factors

OSA is caused by a combination of lifestyle, anatomical, biological, genetic, and positional factors.

•     Lifestyle: Certain factors like obesity and alcohol are linked to OSA. Obesity is the most common cause of OSA in adults. Extra fat around the neck increases soft tissue in the throat, which can block the airway. Even a 10% increase in body weight can raise the risk of OSA by sixfold. Also, drinking alcohol six hours before bedtime can relax your throat muscles too much, making it easier for your airway to collapse.
•     Anatomical: Structural features like narrow throat, large tonsils, recessed or small jaw,  a thick neck (over 17 inches for men, 15 inches for women), or a deviated nasal septum increase risk of OSA.
•     Biological: Age and gender play an important role in OSA. It tends to be more common in older adults (50 or above) and is 2-3 times more common in men than women. Notably, the risk of OSA is higher in post-menopausal women.
•     Genetics: A family history of OSA or if someone has genetic conditions (Prader-Willi Syndrome (PWS), acromegaly, etc. have been strongly linked to OSA.
•     Medications: Certain medications cause significant relaxation of airway muscle resulting in airway collapse leading to an increased risk of OSA. These medications include sleeping pills, narcotics, muscle relaxants, and anxiolytics. 
•     Positional: Sleeping on back raises the risk of OSA by allowing the tongue and soft throat tissues to narrow or block the airway.

Consequences of Untreated Obstructive Sleep Apnea

Obstructive Sleep Apnea is not just a sleep problem, it is a whole-body disease that affects multiple organs. If left untreated, the consequences can be life-threatening.

Cardiovascular Health

Sleep apnea places immense stress on the heart. It is a strong, independent risk factor for high blood pressure; about 50% of sleep apnea patients suffer from high blood pressure. The repeated drops in oxygen strain the cardiovascular system, increasing the risk of heart failure, coronary artery disease, and stroke. Furthermore, abnormal heart rhythms, particularly atrial fibrillation, are very common in patients with sleep apnea.

Brain Health

Poor oxygen supply during sleep can damage the brain over time. Sleep apnea has been linked to memory loss, difficulty concentrating, and a short attention span. It has been associated with neurological diseases such as Alzheimer’s dementia and Parkinson’s disease.

Metabolic Health

Sleep apnea has been linked to metabolic syndrome and type 2 diabetes. Sleep apnea negatively affects how the body handles sugar, leading to poor glucose metabolism and insulin resistance.

Mental Health

People with untreated sleep apnea often experience mood swings, irritability, anxiety, and depression. Ongoing poor sleep can also reduce focus, motivation, and overall quality of life.

Surgical Risks

Untreated sleep apnea increases the risk of serious complications during surgeries especially those where general anesthesia is used. These surgical risks include respiratory failure and cardiac arrest.

Cancer Risk

Research suggests a troubling link between sleep apnea and certain cancers. Low oxygen levels during sleep may encourage tumor growth and worsen cancer outcomes.

Motor Vehicle Accidents

Studies have shown that OSA patients tend to get into fatal head-on MVA collisions more while driving. Sleepy drivers tend to have more lane drift.

Diagnosis of Sleep Apnea

Diagnosing sleep apnea begins with a medical evaluation of your sleep habits, symptoms, and risk factors. If your clinician suspects sleep apnea, they will recommend a sleep test to look for it.

Types of Sleep Studies Used for OSA Diagnosis

Below are some types of sleep studies used to diagnose sleep apnea and observe the activity of your brain, heart, lungs, and body during sleep.

Polysomnography (In-Lab PSG)

This is considered the gold standard and most comprehensive sleep study for diagnosis of sleep apnea. Conducted in a sleep center where patients are video and audio recorded. This study is used to monitor the following during sleep: Brain activity, sleep stages, sleep time, eye movements, heart rate and rhythm, breathing effort, oxygen level, snoring, body position, leg movements and abnormal sleep behavior. It can identify other disorders in addition to sleep apnea like periodic limb movements, insomnia, parasomnias, etc.

Cons: Inconvenient, long wait time and expensive.

Home Sleep Apnea Test (HSAT)

A home sleep apnea test is a simplified version that is designed to only look for sleep apnea, hence, the name, Home Sleep Apnea Test. While convenient, affordable, comfortable and is able to detect most cases of moderate-severe OSA, HSAT is less detailed than in-lab studies and cannot diagnose other disorders. It tends to miss sleep apnea in 10-15% of cases, therefore, when negative, further evaluation with PSG is recommended. There are different types of home sleep apnea tests available in the market. They can be disposable or reusable. They can be single or multiple nights.

Home PSG (Polysomnography)

A home PSG is a newer-type of comprehensive home sleep study. It is comparable to traditional in-lab PSG. It is designed to detect other sleep disorders in addition to sleep apnea. It monitors brain activity, sleep stages, sleep time, eye movements, heart rate and rhythm, breathing effort, oxygen level, snoring, body position and leg movements. For patient’s own privacy, there is no video recording during Home PSG.

Top 6 Reasons to Get a Sleep Study

Getting a good night’s sleep isn’t always easy. Despite going to bed on time, someone might wake up feeling tired or groggy. Sleep studies help doctors understand what’s happening while you sleep and find ways to improve it.

Here are six ways a sleep study can help you:

1.   Find the Problem: Sleep studies track sleep patterns, breathing and oxygen levels during sleep. This helps detect issues like pauses in breathing that may otherwise go unnoticed. Sleep studies can help diagnose sleep disorders like sleep apnea, insomnia, etc.  Knowing the exact issue is the first step toward getting better sleep.
2.   Personalized Treatment: Doctors can use the results to create a customized-treatment plan. This ensures that the solution addresses the patient’s unique sleep challenges.
3.   Feel More Alert During the Day: Treating sleep problems can make a huge difference how people feel during the day. Better sleep improves focus, memory, and overall energy levels.
4.   Protect Your Health: Untreated sleep problems can increase the risk of heart disease, high blood pressure, diabetes, mental health and other health issues. A sleep study can help prevent these long-term risks.
5.   See if Treatment Works: A sleep study can help decide if treatment for sleep apnea is working or not. It may also help to adjust therapy. 
6.   Guide Lifestyle Changes: Doctors can use the results to suggest helpful changes in your habits, diet, or bedroom environment. Even small adjustments can lead to big improvements in sleep quality.

In short, a sleep study is about better understanding your sleep and making sure your body and mind get the rest they need. After all, good sleep is the foundation of a healthy, happy life!

Severity of OSA

The severity of OSA is usually determined by Apnea-Hypopnea Index (AHI) which is a sum of apnea and hypopnea events per hour. An apnea event is when you stop breathing completely for at least 10 seconds due to complete collapse of the airway leading to absence of airflow. While a hypopnea event is caused by partial collapse of airways causing reduced airflow and oxygen drop by 3-4%.

Treatment Options

Treatment of sleep apnea is not one size fits all, it needs to be tailored-based on the severity of sleep apnea and patient preference. Let’s take a look at some of the treatment options for OSA.

Positive Airway Pressure (PAP) Therapy

If diagnosed, the most common and effective treatment is Positive Airway Pressure (PAP) therapy. These devices deliver pressurized air through a hose and mask to keep the upper airway open during sleep. Success with PAP therapy requires good compliance, regularly cleaning the equipment and working with their clinician to resolve issues. Following all these steps optimizes the chances of successful treatment. Some types of these devices include: 

•     CPAP (Continuous Positive Airway Pressure) Therapy: The most well-studied device for the treatment of sleep apnea is CPAP. It provides a steady stream of the same positive airway pressure during inspiration and expiration. It splints open the airway during sleep and prevents it from collapsing. This leads to optimal oxygen supply to the vital organs of the body during sleep, improves sleep quality and minimizes the risk of serious complications of untreated sleep apnea like heart attacks and stroke.
•     APAP (Auto-Adjusting PAP): These machines automatically adjust air pressure based on your breathing patterns and snoring throughout the night.
•     BiPAP (Bilevel PAP): Designed for those who struggle with standard CPAP, BiPAP provides higher pressure when inhaling and lower pressure when exhaling, making it easier to breathe out.

Oral Appliance Therapy

These are also known as Mandibular Advancement Devices (MADs). For patients with mild to moderate sleep apnea who cannot tolerate CPAP, oral appliances are a valuable alternative. These are custom-fitted titratable devices which cover the upper and lower jaw and gently pull the lower jaw forward. This in turn creates space in the back of the throat and opens the airway. It is crucial that these devices are custom-fitted by a dentist trained in sleep medicine to ensure effectiveness and monitor for side effects like bite changes.

eXcite OSA

This is a relatively newer technology used during daytime to treat snoring or mild OSA. It works by neuro-muscular electrical stimulation of the tongue muscle. It prevents tongue from rolling back.

Positional Therapy

In some cases where OSA is position-dependent, sleeping on side can significantly reduce apnea events by keeping the airway open. There are several types of positional therapies available over-the-counter in the market.

BongoRx

Bongo Rx is a small, simple medical device used to treat mild obstructive sleep apnea without a CPAP machine. It is non-motorized and consists of small valves inserted into the nostrils. These valves create resistance during exhalation to keep the airway open. It fits just inside the nostrils and uses your own breathing to create EPAP. When you breathe out, tiny valves close and push air back into your airway to help keep it open. It doesn’t need electricity, hoses, or batteries, and it’s portable, reusable, and FDA‑cleared with a prescription.

Medications

Zepbound (Tirzepatide): As of December 2024, this injectable medication is approved for adults with both sleep apnea and obesity. By mimicking a hormone called GLP-1, it induces weight loss leading to significant reduction in the severity of sleep apnea. It has side effects as well.

Inspire Hypoglossal Nerve Stimulator (HNS)

HNS is a treatment for sleep apnea that uses a small implantable device to keep the airway open. It has three parts: a stimulator in the chest, a lead on the hypoglossal nerve to move the tongue, and a sensor that detects breathing. When you inhale, the device sends mild pulses to push the tongue forward, stopping airway collapse. It turns off during exhalation and repeats each breath. Patients can control it with a remote, and it helps reduce apnea and improve sleep.

Lifestyle Changes That Can Help You Manage Sleep Apnea

While medical treatments are often necessary, lifestyle changes are a critical part of managing sleep apnea.

•     Maintain a Healthy Weight: Losing weight can reduce the severity of symptoms by decreasing the fat stored around the neck.
•     Review Medications: Be cautious with opioids, muscle relaxers, and certain anxiety medications, as they can slow breathing and relax airway muscles.
•     Exercise Regularly: 30 minutes of moderate exercise can improve oxygen levels and sleep quality, even independent of weight loss.
•     Adhere to Therapy: Consistency is key; using sleep apnea therapy regularly has been shown to reduce the chances of serious diseases associated with significant sleep apnea.
•     Avoid Alcohol: Alcohol must be avoided because even in moderation, it significantly relaxes the throat muscles, leading to sleep apnea.

By combining medical treatment with healthy lifestyle habits, you can reduce your health risks, regain your energy, and reclaim your quality of life. If you suspect you or a loved one has sleep apnea, do not wait to seek medical advice.

Future Directions

Apnimed’s Daily Pill: Currently in development, this experimental pill targets the throat muscles rather than weight. It works by stimulating the brainstem to keep airway muscles toned during sleep, preventing collapse. Early tests suggest it could reduce apnea severity by nearly 50%, with potential availability by 2027.

Conclusion

At Telemedora, we recognize the profound impact that untreated sleep apnea can have on an individual’s life. We understand the chronic fatigue, the frustration of restless nights, and the serious long-term health risks associated with this condition. It is this understanding that drives our commitment to providing a patient-centered, comprehensive care model. Our approach begins with a commitment to personalized treatment. We move beyond a one-size-fits-all methodology, recognizing that every patient’s sleep apnea is unique, influenced by individual physiology, preference, lifestyle, and severity. We offer home sleep studies (home polysomnogram, single-night and multi-night home sleep apnea testing) and our board-certified sleep specialist creates a treatment plan tailored precisely to your needs.

Furthermore, Telemedora is dedicated to longitudinal care, a philosophy of ongoing support that extends far beyond the initial diagnosis and treatment setup. Sleep apnea management is not a one-time fix; it requires ongoing monitoring and adjustment. The sustained support is crucial for ensuring long-term adherence to treatment, optimizing health outcomes, and ultimately helping you reclaim restful sleep and a better quality of life.

Wondering about your risk for obstructive sleep apnea? If you have any symptoms or risk factors noted above, talk to your doctor or contact Telemedora for an appointment. If you are in one of the states which we serve (CA, FL, GA, IL, IN, OR and PA), call us at 650-687-7368 (M-F 9 AM – 5 PM Pacific) or visit telemedora.com to book an appointment. At Telemedora, we have helped hundreds of patients with sleep apnea in improving their quality of life. We bring expert care directly to the comfort and privacy of your own homes. We help patients get the rest they need so they can wake up refreshed, focused, and ready to crush their goals for the next day.

Disclaimer This is an educational blog and not medical advice. 

© 2026 Telemedora. All rights reserved. This content, including all text, images, and material contained herein, is the exclusive property of Telemedora and may not be reproduced, distributed, or transmitted in any form without prior written permission. 

Subaila Zia MD, MBA, FCCP, FAASM
Founder & CEO Telemedora
ABIM Board-Certified Sleep, Pulmonary & Critical Care Physician
AASM AI in Sleep Committee Member
AASM Strategic Ambassador for Emerging Technology

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