http://news.postbulletin.com/newsmanage ... 0&a=380741Medical Edge: Losing weight best way to treat sleep apnea
1/19/2009 5:45:01 AM
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DEAR MAYO CLINIC: I was recently told by my doctor that I have sleep apnea. He said losing weight was my best bet. What does one have to do with the other? Is there anything else I can do?
Sleep apnea, a condition where people stop breathing during sleep, has two forms -- obstructive sleep apnea and central sleep apnea. For obstructive sleep apnea, which is much more common, losing weight will likely improve symptoms.
Other treatment options are available, but your doctor is correct that weight loss usually is the most effective. Successfully treating sleep apnea is important, because you will sleep better and perhaps reduce your risk of heart problems.
Obstructive sleep apnea occurs when the throat muscles relax and block the airway during sleep. Snoring is the condition's most noticeable sign. Anyone can have obstructive sleep apnea, but older adults, men, and people who are overweight most commonly are affected.
Central sleep apnea occurs when the brain doesn't send proper signals to the muscles that control breathing. Losing weight is unlikely to affect central sleep apnea.
Why weight loss improves obstructive sleep apnea is not clear. People often assume that excess weight results in enlargement of the throat structure, which then blocks the airway when you're relaxed during sleep, and that losing weight will shrink the tissues and solve the problem. That may be part of the connection but it's not the whole story.
Excess weight also affects airway function during sleep. Being overweight seems to change the nerve signals from the brain to the airway, causing muscles in the airway to lose tone and become flaccid, which contributes to the obstruction.
Some researchers have suggested that these nerve signal changes may, in part, result from a hormone called leptin that's produced by fat cells. Too much leptin could affect breathing control, predisposing overweight people to obstructive sleep apnea.
Although we don't know exactly why, the bottom line is that a strong association exists between obesity and obstructive sleep apnea.
A major side effect of sleep apnea is fatigue. Because sleep apnea causes you to wake up frequently in order to breathe, you can't get a good night's sleep. In particular, you don't get restorative dream sleep (rapid eye movement or REM sleep). REM sleep is critical because it helps you retain memories and wake up rested and refreshed.
Less obvious complications of sleep apnea involve high blood pressure and other cardiovascular problems. When breathing stops during sleep, blood oxygen levels can become extremely low (called hypoxia or hypoxemia). As a result, blood vessels constrict, significantly raising blood pressure. In about half the people with sleep apnea, this effect carries over into the daytime. Even when they are awake and breathing normally, blood pressure is still elevated, increasing the risk of heart disease and stroke.
In addition, if a person has underlying heart disease, repeated episodes of low blood oxygen may, in rare cases, lead to sudden death from a cardiac event. The more severe the obstructive sleep apnea, the greater the risk of high blood pressure and other cardiovascular complications.
Although losing weight can effectively reduce or eliminate sleep apnea, the process takes time and may not be an option for everyone. Another treatment often used for sleep apnea is a continuous positive airway pressure (CPAP) machine. Through a mask placed over the nose during sleep, CPAP supplies air at a slightly higher pressure than the air around you. The elevated pressure is just enough to keep upper airway passages open -- preventing apnea and snoring.
For mild sleep apnea, an oral appliance may be helpful. These devices hold the jaw forward during sleep, reducing airway obstruction.
In some cases, surgery may be an option. Nose or throat surgery for sleep apnea removes excess tissue that may be vibrating and causing your snoring or may be blocking upper air passages and causing the sleep apnea. Although surgery can help reduce snoring, the benefits of surgery in treating apnea vary, and the condition may recur over time. -- Virend Somers, M.D., Ph.D., Cardiovascular Diseases, Mayo Clinic, Rochester.
E-mail a question to medicaledge@mayo.edu or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207.
The Mayo clinic said it so I can trust it!
Hmm, my BMI is 23.4, I wonder how low I need to go?
