Can the slightly overweight stop apnea with weight loss?

[chunkyfrog]

If you are not using cpap, you have been suffering since 2011, at least;
and are willing to try anything to avoid wearing a mask to bed. (is that correct?)
Believe me, it's not as horrible as you think--you need to give yourself a chance--
give cpap a chance (it IS what works best--by far). When I think of how much better a good night's sleep feels,
it breaks my heart to know someone is voluntarily denying themselves this life-saving treatment.

[ubnoxus]

As Pugsy said, sometimes weight loss can even require increased pressure. I was 6' 225 lbs with 7% body fat at 32 years old when I started CPAP therapy. My doctor was insistent that if I lost 30 lbs I'd no longer need CPAP therapy. I was at a pressure of 12, decided I'd give it a try and dropped my weight down to 190 lbs, I was feeling worse so did another sleep study and found I actually needed a bi-level therapy with a pressure that was 12-16, most nights in the 14-15 range was usual and would hit 18 at times. So my weight loss had a bigger effect on my therapy. A couple years later I was in a car wreck and shattered my nasal cavities and therapy declined from there. I am on a VPAP ASV machine now andsleep amazing.

[jnk]

My understanding is that when sudden weight gain tips the scales (in this case literally) into mild OSA for someone, and that weight gain happens to be the primary factor for that person, losing that weight before the brain gets rewired for OSA can make a person technically no longer have OSA. Those are the "success" stories of weight loss "curing" OSA.

But once a brain has had to deal with a small, unstable airway for a long time, as in the case of a person with moderate to severe OSA who has been overweight a long time and has other anatomical predispositions toward OSA, loss of weight may lessen some aspects of the problem and may not.

Bottom line is that all humans have to work hard to be as active as possible and to make healthy food choices--even those humans with no health problems. So those of us with health problems are no exception to that. Giving up on eating healthy and being active will not help our health, that's for sure. And that is the important point, since the only right way for weight to be affected positively is by being active and eating healthy. That is why the question of "should I lose weight" is nonsensical in some respects. Yes, you should lose weight if you can do it by being reasonably active and eating healthy, but weight loss will be a possible byproduct of the pursuit, not the primary purpose. Any method of losing weight that involves unhealthy eating (such as cutting out entire food groups) or unhealthy levels of activity should not be pursued.

In my opinion.

[70sSanO]

In response to OP's question.

Technically correct response... anything is possible.

Most likely outcome response... probably not.

Long term reality response... no.

John

[JohnBFisher]

I definitely agree. While some people see an improvement, it is pretty rate. In my own case, I had obstructive sleep apnea by my 14th birthday. At the time I was about 20 pounds UNDER weight. Underweight and still had apnea.

[SleepingUgly]

I don't agree, and in my own case, my BMI is ~19.

Very interesting phenomena on this board. Very, very interesting. I'll figure it out someday. Some of it seems to be cognitive dissonance, but what else...?

[chunkyfrog]

Different people, different physique, metabolism, health problems.
We are not alike.

[jnk]

Weight loss alone won’t be enough to help everyone with the condition, [Dr. Harly Greenberg, head of sleep medicine at Long Island Jewish Medical Center in New Hyde Park, N.Y] said. “While a weight-loss program is appropriate for overweight sleep apnea patients, it should not be relied upon as the sole therapy for those with moderate to severe sleep apnea who are at risk for cardiovascular consequences and for patients with any severity of sleep apnea who suffer from daytime sleepiness that adversely affects daytime function,” he said. “Those patients should be treated with therapeutic interventions such as continuous positive airway pressure (CPAP) or oral appliances that can produce more immediate improvement in symptoms and relief of daytime sleepiness while waiting for weight loss to occur,” he said. -- http://news.health.com/2014/02/20/a-lit ... eep-apnea/

If (big if) weight gain "caused" the condition for a particular person (rarely so, but it can happen), then quickly losing the weight may "cure" the condition (though there is no proof that it is a longterm solution or that the links between the two are truly causal in a scientific sense).

What is your cause for surprise in all this, SU?

There are cases where people without OSA, but who have some tendency toward it, have a change of habitus that appears to put them over the edge into OSA territory temporarily, as far as diagnostic criteria. Those people do exist, whether they are on this board or not.

It is sort of how some people suddenly meet the criteria for OSA when they have a cold, or during allergy season. The change in breathing tips them over the edge.

So if someone recently put on a few pounds and suddenly started having sleep-breathing problems, maybe losing a few pounds will help that person. Maybe not. But if walking a few more miles and paying slightly more attention to what they eat happens to work for them, more power to them. That of course has nothing to do with my situation or the situation of many (perhaps most or all) on this board. But things like that can happen now and then for some people, I'm sure.

The problem for me, to my way of thinking, is when that fact gets misapplied to people who have had undiagnosed moderate-to-severe OSA for years. At that point talking about diet as being some sort of a treatment is a waste of precious time if it delays getting CPAP to them. Maybe losing a few pounds would have helped them 20 years ago and 30 AHI ago. But a long-time OSA sufferer doesn't need to have the old blaming-the-victim played with them to try to guilt them into doing drastic things to lose weight that are most likely just going to do more damage to their health.

In my opinion.

[chunkyfrog]

jnk; I am in complete agreement.
Medicine needs to stop blaming the patient, simply because the medical community
does not wish to admit they don't understand everything.
Think of the centuries that leprosy was believed to be caused by a mortal sin.

[AlOzarky]

FWIW, I was what you would call slightly overweight (about 230 at 6 foot 1) and lost 40 pounds and had maxillomandibular advancement. Still have OSA. Still awaiting post-op sleep study, but in purely subjective terms, I'd guess like 40-50% improvement from those two things.

Ozarky

[OhHelpMe]

If wild animals were fat, https://www.youtube.com/watch?v=_A2f41msFtw

Don't laugh too herd.

[nielloeb]

Thanks for the comments everyone.
Now my comments:
I lost most of the extra weight at one time, had trouble sleeping, did a sleep study, and they added pressure. This was predicted by one of your comments and answers the question of whether I’m on a CPAP. The extra pressure was so much that my mouth wouldn’t stay closed unless I taped it shut (leaving a hole in the middle for emergencies). On my own, I went back to my previous pressure and added doctor-fitted mouthpiece. That worked.
OSA snuck up on me, too.
I have yet to research surgery other than to know that almost anything else, like losing weight, has less risk.
If sleep apnea caused the weight gain, why didn’t the weight disappear once the sleep apnea was successfully treated (with no other changes in lifestyle)?

[BlackSpinner]

If sleep apnea caused the weight gain, why didn’t the weight disappear once the sleep apnea was successfully treated (with no other changes in lifestyle)?

Because you formed bad habits when your OSA kicked in.
You now have to do MORE to get rid of it then your normal activities and eating habits.

[SleepingUgly]

If sleep apnea caused the weight gain, why didn’t the weight disappear once the sleep apnea was successfully treated (with no other changes in lifestyle)?

Some bells can't be un-rung? Maybe you need to lose more weight. Maybe losing more weight won't help. Maybe (likely) it's a combination of factors, and you've only changed one. Maybe aging. So many hypotheses, no answers.

[jnk]

If sleep apnea caused the weight gain, why didn’t the weight disappear once the sleep apnea was successfully treated (with no other changes in lifestyle)?

Because you formed bad habits when your OSA kicked in.
You now have to do MORE to get rid of it then your normal activities and eating habits.

Not just you, as in the conscious you, the you that makes choices. Your body metabolism adapted to the changed circumstances. Part of that adaptation was a change hormonally and in subconscious decision-making.

Let's illustatrate that with how some people's nervous system adapts to sleep-breathing problems.

For some, when sleep-breathing becomes a problem, their nervous system chooses breathing over sleep. It isn't the patients' conscious decision; it is a totally internal adaptation to the sleep-breathing issues. It shows up as highly sensitive sleep in which any change in the airway stability causes arousals. For some, that can become what is sometimes referred to as UARS. It could also be called a hypersensitive airway-control reaction. Their nervous system keeps disturbing sleep in order to keep them breathing. But after a while, for some people, the nervous system realizes that no REM or other deep sleep is happening and so a switch gets mostly flipped the other way. The nervous system then (to oversimplify a bit) chooses sleep over breathing. At that point, the nervous system completely ignores the status of the airway, becomes deadened to it. For those people, they continue to sleep right through a completely closed airway to the point that serious desaturations occur and organs get stressed by too much carbon dioxide in the blood. Only when things get critical will the nervous system panic and send out a load of panic juice to jar the person awake. Now we have a sleep apnea problem in which the airway needs to be kept open mechanically, since modern science knows of no way to flip the switch back. Losing weight will not flip the switch in the nervous system.

The same principles apply to weight gain itself, for some. Once the metabolic switch is flipped into energy storage and energy craving, we have no way to go back in time for those people. Even when weight is lost, the metabolic damage has already been done. Making different conscious decisions does not change the internal decisions of the body and brain. That is why (or at least one of the reasons) simply losing weight does not put things back to the way they were. No amount of willpower resets the nervous system and brain when it comes to apnea or obesity. The trick is to evaluate the patient in the condition he or she is in and use the tools available to be of most help with overall health and quality of life. Spilling more milk and fussing about it doesn't alter the nature of the milk that has already spilled. Evaluate and treat scientifically based on methods that are proved successful rather than making assumptions based on statistical associations between related conditions with scientifically unkown causations. The body's energy system is even more complicated than its breathing system. It just ain't as simple as the models the docs are still using seem to imply.

In my opinion.

The interesting thing is that for SOME people, bariatric surgery actually seems to flip the switch matabolically as far as the obesity/blood-sugar reaction. No one is sure why yet, I don't think. But it does seem to happen sometimes. Unfortunately it does not flip the switch on the obstructive sleep apnea. At least I have never heard of a case in which it has as far as long-term moderate-to-severe OSA. Once the airway-patency controls go dead, no one has found a way to resurrect them. That is why we are so blessed to have something as amazing as CPAP to treat people in that situation.