I love mob flicks. I always have. The Godfather films: love ’em all. Even the third one. I’ve read all the books (including the ones not written by Mario Puzo), memorized the movies. It’s become a tradition in my family to watch the first Godfather movie at least once per year.

Why? Because these “made” guys live lives that are so incredibly different and far-removed from my own. Because I empathize with them, these complex people that are so ruthless on one hand, but on the other protective and loyal to the death, doing the best they can for themselves and the ones they love. And, perhaps, there’s something seductive about the license they have to just simply . . . uh . . . do things–directly and definitively–about the people that wrong them. Whatever the reason, I find these films very cathartic. They never grow old; indeed, they get better with every viewing.

So imagine my happiness when The Sopranos debuted. Now I could follow the exploits of a New Jersey crime family every week! For years! (1999 to 2007, to be more exact.) I still miss it, now that its run is over.

Remember Junior, Tony Soprano’s notorious uncle? Tony and Uncle Junior had, shall we say, a love/hate relationship, one full of turmoil and, at one point, near-murder. Well, here is a scene in which Tony and Uncle Jun are having a brisk discussion in a CPAP clinic. Junior had just been diagnosed with obstructive sleep apnea!

Warning: anybody who has watched an episode of The Sopranos knows about the harsh language. If you’re new to or unfamiliar with the series, consider yourself warned before you watch the clip above.

Anyway, I distinctly remember this scene when it first aired. It was so strange to watch this mob guy get fitted with a nasal CPAP mask. It made Uncle Junior much more human to me, a little vulnerable. Maybe that was the intent of the producer of the show. That passage has remained stuck in my mind since I first saw it. There are some important points to be made from this scene, however:

1. You do not need to be obese to have sleep apnea. There is this misconception that all sleep apnea sufferers are overweight. This is simply not true. I have an army of patients that are as skinny as can be, including 90-pound ladies that snore like freight trains and gasp and choke all night long without treatment. Your throat and mouth anatomy has much to do with this. There are numerous anatomic characteristics that you may simply be born with, and that can predispose to developing sleep apnea, independent of weight: a large or wide tongue; a high-riding tongue base; a low-hanging soft palate; a large uvula (the dangly thing that hangs down from the soft palate); a “highly arched” hard palate; large tonsils; and “retrognathia,” in which the mandible (lower jaw) is set behind the maxilla (upper jaw). So just because you’re skinny doesn’t mean your snoring and witnessed breathing pauses during sleep should be ignored.

2. The prevalence of sleep apnea increases as one ages, particularly in males. The statistics demonstrate that sleep apnea gradually becomes more common the older we get, even independent of weight.

3. There are many different types of CPAP masks available. The one shown in this clip is clunky and old-fashioned, frankly, though similar masks are still out there for potential use. Now there are numerous new masks that are smaller, less leaky, and more comfortable, and with smaller and better-fitting headgear. CPAP (continuous positive airway pressure) is a primary form of therapy for sleep apnea.

4. Sleep therapists are available to help you through the process of initiating CPAP use. If you undergo an in-lab sleep study to diagnose sleep apnea, you will work with a trained sleep technologist who will help you through the testing and answer questions you may have regarding the diagnosis and treatment of sleep apnea. It seems that Uncle Junior was a bit smitten with his. I don’t know if the man fitting his mask was a physician or a therapist. Usually sleep or respiratory therapists conduct the fitting process of masks following sleep study testing. The actual process of mask fitting is (or at least should be, if the CPAP provider service is worth its salt) substantially more detailed and lengthy than what is shown in this clip: the idea is to find a mask that is comfortable and leak-free, and that means trying on multiple masks, of different types, brands, and sizes, to find the right one. What you see in the clip is simplified for the sake of the show; I suspect the viewing public would become bored with a full-scale demonstration of different CPAP masks.

I love Tony’s sarcastic comment to Uncle Jun at the end of his mask fitting: “How many MIG’s did you shoot down last week?”