When Fixing the Anatomy Didn't Fix the Problem
Years of fatigue, procedures, perfect labs, and things everyone missed.
A Moment with Dr. Stillman
Dr. Andrew Cohen is a dentist and board-certified sleep medicine specialist, someone who spent his career diagnosing and treating sleep disorders in others.
He knew the literature.
He knew the anatomy.
He was, by every professional measure, one of the most qualified people in the country to fix his own sleep problem.
And for nearly two decades, he couldn’t do it.
He is exactly the kind of person I most respect in medicine. He’s conscientious, methodical, deeply invested in doing right by his patients. He’s also someone who quietly organized his entire day around when he could sneak in a nap. He fell asleep at a Cirque du Soleil show. He couldn’t get his eyes to stay open between patients.
This is what under-treated, unresolved sleep disruption actually costs. His story is one of the clearest illustrations I’ve encountered of a principle I write about in my new book, The End of Autoimmunity, releasing at the end of June.
The success of procedures or surgeries hinge upon your daily habits and choices.
In the book, we call these, “Essentials and Hazards.” Essentials are key daily habits for health. Hazards are things that destroy your health one day at a time.
If you’ve been told your labs look fine, told to diet and exercise, tried everything in your professional toolkit, and you’re still running on empty, this story is worth your time.
What I Found When I Looked Closer
Here is what Dr. Cohen’s picture looked like over the years:
Lifelong fatigue, present since high school, hitting snooze nine or ten times, planning the day around naps, never feeling rested.
Worsening weight gain, blood pressure creeping up, reflux, anxiety, all attributed to stress, genetics, or lifestyle.
Sleep study confirmed mild apnea and an oral appliance helped, but didn’t resolve, the fatigue.
Blood work “normal.” Fatigue labeled anxiety and depression.
Over time, apnea progressed from mild to severe despite appliances, laser treatments, and a major jaw expansion procedure; his AHI went from 13 to 37, spending over an hour nightly below 90% oxygen saturation.
The pattern I recognized immediately.
Every intervention so far addressed only the anatomy.
No one looked at the terrain beneath it.
What Nobody Had Looked For
The Mechanism
Dr. Cohen’s insight, arrived at through his own suffering, not a textbook, was this.
The root cause wasn’t anatomical, it was his underlying inflammation.
When he began monitoring his glucose with a continuous glucose monitor, he noticed something his colleagues missed. When his blood sugar spiked and stayed elevated for six to eight hours after eating, his snoring got worse. When it came back into range, the snoring subsided. When he lost access to afternoon sunlight in October, the snoring surged again.
This is what I mean by terrain. The jaw anatomy, the deviated septum, the tongue position, the narrow palate, was real. But the inflammation driving soft tissue into that space was metabolic. Fix the plumbing without fixing what is corroding the pipes, and the problem comes back.
He describes it plainly:
“My body was trying desperately to save me, and in the process of trying to save me was killing me at the same time.”
What reversed it wasn’t a third blood pressure medication.
It wasn’t double jaw surgery, which he was scheduled for and wisely declined.
It was returning to the foundations his body had been starved of.
These are foundations we set with every patient early in our programs:
Morning sunlight to anchor circadian rhythm and restore leptin sensitivity
Blocking artificial blue light after dark
Keeping blood glucose stable through food timing and order, not elimination, just sequencing
Within four weeks of consistent light exposure, he stopped snoring.
Within two months, severe apnea had resolved.
Within a year, he was off both blood pressure medications, off reflux medication, down forty pounds without changing his portion sizes.
His AHI is now 2.9.
His fatigue, once a seven or eight out of ten, is now a one.
The question I always face in the clinic is this: do we keep climbing higher into more aggressive therapeutics, or do we return to the trunk and strengthen what is there? For Dr. Cohen, the answer was obvious in hindsight. The foundations had never been built. Surgery on an inflamed terrain would have fixed nothing that mattered and likely made things worse. In my experience, when patients slow down and address the foundations one piece at a time, it often becomes clear within days to weeks what helps and what overwhelms.
“Little things make big things happen.”
-John Wooden
Three Things To Explore This Week
Notice your light exposures, day and night. Most people living with unexplained fatigue are chronically underexposed to outdoor light during the day and overexposed to artificial light after dark. Pay attention to how often you’re actually outside before noon, and how much screen or overhead light you’re absorbing after sunset. Many patients notice shifts in sleep quality and morning energy within a week or two of making consistent adjustments.
Track what happens to your energy after eating. You don’t need a CGM to start noticing patterns. Pay attention to the two hours after your main meals. Do you feel sharper or more foggy? Does your sleep seem better on nights after lower sugar days? Food order matters. Protein and vegetables before starches can blunt the glucose response for many people. This is an experiment, not a prescription. Just watch what your body tells you.
Look at your sleep quality. If you have chronic fatigue, brain fog, weight that won’t move, or blood pressure that keeps creeping up, and nobody has evaluated your sleep architecture, that conversation is worth having. Unresolved sleep disruption creates repair deficit faster than almost anything else, because the body does its deepest repair work at night.
Where to Go From Here
Dr. Cohen’s story is a reminder that the body has to be treated as a terrain. Sunlight, glucose stability, protected sleep, these are not soft interventions. They are the conditions under which everything else works.
If you want to understand the full framework behind what I’ve described here, terrain, repair deficit, and why foundations come before everything else, it’s all laid out in my new book, The End of Autoimmunity, releasing at the end of June. You can find all the details at stillmanmd.com.
As always, discuss any changes with your own licensed clinician. Read our full disclaimers, disclosures, and our position on health freedom here.
Until next time, be well,
Dr. Stillman
Educational content only. Not medical advice. See full disclaimers.