Lost weight but still have sleep apnea?

[AnotherMe]

Hi all,
Why do I still have problems breathing during my sleep even though I have lost weight? Might it be the shape of my jawline?
I really have to stop smoking. I am sure quitting smoking would help alleviate some of the night time, early morning breathing issues.

[palerider]

Hi all,
Why do I still have problems breathing during my sleep even though I have lost weight? Might it be the shape of my jawline?

because more modern thinking has discovered that weight is often the result of apnea, not the cause.

[ChicagoGranny]

smoking

Smoking irritates the airways causing swelling. Swelling may make OSA worse.

Might it be the shape of my jawline?

Have you also checked how your hypoglossal nerve is performing?

[jnk...]

Hi all,
Why do I still have problems breathing during my sleep even though I have lost weight? Might it be the shape of my jawline?
I really have to stop smoking. I am sure quitting smoking would help alleviate some of the night time, early morning breathing issues.

It appears that long-term weight carried around the middle/upper torso can change one's breathing/airway permanently. But the thing is, that isn't the only problem related to weight. So if you lost weight in a healthy manner, it may be that having done so could prevent other problems in the future, even if it doesn't resolve all problems from the past and present. It may be that you will always benefit from PAP therapy, no matter what your weight. But if consistent use of PAP "solves" the problem for you, it may be that getting used to PAP is a better option than looking for a surgical solution--unless, of course, there is a true anatomical abnormality (such as a tumor) for which surgery is a good, safe, cheap, easy, painless option in the way that PAP is all of those things for most (tho not all).

[leptic]

I wonder if alcohol doesn't also play several roles - both irritating the airway, plus acting as a CNS depressant.

[Arlene1963]

It appears that long-term weight carried around the middle/upper torso can change one's breathing/airway permanently.

JNK, that is very interesting.

I'm not sure if I'm understanding this correctly, but would it then be possible that OSA can go into remission (dare I say "cured") with sufficient weight loss in those who haven't carried extra middle upper torso weight for very long, IF, and that's a big IF, weight is the cause of their OSA?

So much emphasis is placed on weight and OSA by the medical community, and yet there is a paucity of evidence here on this forum, and in studies of obese patients who've undergone gastric bypass surgery that weight loss "cures" OSA.

The hypothesis that long term weight causes permanent change resulting in intractable OSA even with substantial weight loss is surely worth consideration ....

[BlackSpinner]

Weight reduction surgery has shown that only 50% of people who lost weight are cured of OSA.

[jnk...]

If weight gain is sudden and is the sole cause of a person's meeting the diagnostic criteria, then healthy decrease in the weight may indeed cause such a person to cross back over the line in the sand that constitutes an official OSA diagnosis. My understanding is that it is rare, but that it has and does happen, when timing is perfect.

My personal position, however, is that the larger issue is not whether or not someone meets a particular (and in this case mostly arbitrary) diagnostic definition but whether any individual person may benefit from PAP therapy. Those are two very different questions, in my often-expressed and not-so-humble opinion.

The research-docs' views on such matters do not line up perfectly with clinicians' whose medical training is often, uh, of a certain vintage, I don't think. And most people in the real world gain their weight gradually. And the OSA is often not discovered until the brain has already rewired itself to either be overly sensitive to airway changes or to mostly ignore them until O2 desats become alarming. So the clinical oddity of the exceptional patient gets over-applied in practice, I believe.

And all of that is independent of the fact that OSA may very well precede weight gain for the majority, or precede the condition that leads to weight gain, anyway. Causation has NOT been sorted out yet, so any doc adamant that a particular patient "will" be cured by simply losing weight is engaging in borderline malpractice to my ears.

[Arlene1963]

JNK, I totally agree with you! Thanks for that explanation.

[chunkyfrog]

The statement, "losing weight will cure apnea" is such a huge lie!
People ought to be shot for repeating it;
Losing excess weight is unquestionably a good thing; but to promise a cure for apnea is beyond cruel.

[jnk...]

JNK, I totally agree with you! Thanks for that explanation.

You are welcome. But remember that my views are often slightly askew from accepted doctrine on such matters.

I do feel strongly that the "box" entitled "A word of explanation about obesity-OSA 'comorbidity,'" part way down the page at the following link, should be required reading for any doc who mentions obesity and OSA in the same breath, though:

http://www.currentpsychiatry.com/the-pu ... 2c784.html

[70sSanO]

I lost quite a bit of weight and the only thing that changed was I was able to lower my pressure. The weight loss came over a period of time along with a good amount of exercise. Initially my AHI numbers were worse, and higher machine pressures only drove the numbers higher.

I'm generally don't spend a lot of time going through scientific abstracts, but I do gave a theory of my own. When a person loses weight the skin loses tone and there can be excess tissue. I don't know if this occurs internally around the air passages or not, but if it does the weight loss could potentially make things worse. Nothing scientific to support this and if people thnk it is pretty stupid, that is fine with me.

John

[BlackSpinner]

I lost quite a bit of weight and the only thing that changed was I was able to lower my pressure. The weight loss came over a period of time along with a good amount of exercise. Initially my AHI numbers were worse, and higher machine pressures only drove the numbers higher.

I'm generally don't spend a lot of time going through scientific abstracts, but I do gave a theory of my own. When a person loses weight the skin loses tone and there can be excess tissue. I don't know if this occurs internally around the air passages or not, but if it does the weight loss could potentially make things worse. Nothing scientific to support this and if people thnk it is pretty stupid, that is fine with me.

John

Several of our members have reported needing MORE pressure after weight loss so there is something in your ideas.

[SewTired]

Hi all,
Why do I still have problems breathing during my sleep even though I have lost weight? Might it be the shape of my jawline?
I really have to stop smoking. I am sure quitting smoking would help alleviate some of the night time, early morning breathing issues.

While a good many people do 'cure' their apnea by losing weight, almost as many do not. Much has to do with your age. If you are under 30, the chances of eliminating cpap by losing weight are much higher, according to my sleep doctor. This came up for discussion because I didn't need a cpap until after I lost 30 pounds. I have more weight to lose, but weight loss isn't going to eliminate a cpap for me ever, although less pressure is likely/possible. Even after I get a pacemaker, the RERAs will still be there. (RERAs are not quite apneas - likened to breathing through a straw rather than stopping breathing).

[palerider]

(RERAs are not quite apneas - likened to breathing through a straw rather than stopping breathing).

uh, no, not at all.

a hypopnea is not quite an apnea, likened to breathing through a straw rather than stopping breathing.

a Respiratory Effort Related Arousal is pretty much what the words say.