Less than 1 week on KETO Diet - Big Increase in AHI

[walon44]

Firstly I know that all of this is hugely individual and speculative and my question may frustate some people... I will attempt to look at some data from my machine tonight to see if I can see any useful information there...

But I'm just posting now in case anything obvious jumps out that might help me get a good night tonight (I am desperate to get back to my normal sleep as finding it so hard to function today and dreading tomorrow if this keeps going).

For what it's worth I'm treating UARS with CPAP, pressure set at 9 or 9.5 for last year or so.

I started a KETO diet on Saturday, with worsening general sleep quality since monday and my onscreen AHI going from my usual of c. 1 to over 6 last night. This is causing me major, distressing daytime sleepiness and all that goes with that. Have lost a few pounds i think but not enough to cause any significant mask-fit issues. I am supplementing with magnesium and potassium in moderate doses (moderate I think)

I have searched extensively here and saw overwhelmingly positive reports from followers of KETO diet. But perhaps there is something obvious I'm doing wrong that might cause such a precipitous decline in my sleep....

any suggestions welcome

[walon44]

Also if I have posted in wrong forum please advise and I will move

[Cardsfan]

I'd go back to my pre Keto diet and see if that helps.

[Pugsy]

I suspect that the higher AHI just means the machine is flagging awake/semi awake breathing due to the poor sleep you are having.
So the AHI increase is from the poor sleep and not the cause of the poor sleep.
And you feel like crap because you slept like crap.

Probably your body just adjusting to the new changes that happen with the keto diet.

If you want to go looking around at the flow rate up close and try to figure out if awake false positives are being flagged the videos here will explain how to do it and what to look for.
While he mainly talks about centrals...it can actually be any event category that gets flagged. I have it happen often when I have bad quality sleep because of tossing and turning from back pain issues.
http://freecpapadvice.com/sleepyhead-free-software

Once you start sleeping better I imagine the AHI will reduce down to normal.

[walon44]

Thank you cardsfan, I will do that of course if no improvements tonight.

Pugsy that is so so helpful, and is exactly the type of logical thought that I am incapable of when lacking sleep. I will check out those videos and see if that will shed any light on whats happening.

thanks again

[dogsarelife]

I tried keto for sleep, and it did some weird things to my brain and body. Namely, it made my blood sugar way too low, to the point it was disturbing my sleep. My a1c from that period I did keto came back with a 4.2 or something, which meant my average blood sugar was around 65-67 mg/dL or if you're in other parts of the world, 3.6-3.8 mmol/L. I'm not knocking keto for other people who have conditions in which it might be helpful, like type 2 diabetes or epilepsy, but if you retain insulin sensitivity and are keeping your blood sugar on the lower end of things, then maybe it's a wash. At least, I found that such a low a1c was a greater stress to my nervous system overall.

Do you have T2 diabetes or epilepsy, such that that is why you are trying keto or are you just trying it because you read it was good for sleep apnea and UARS? For the latter, I'm not sure that there are papers supporting keto for uars. I found for UARS treatment I needed to do things which supported my overall nervous system health - rest, regular eating patterns, meditation, sleep hygiene list that is passed around here, etc.

There is also some danger from supplementing magnesium and potassium - I forget what those do, but on zonker's thread about his sleep from earlier this year, I posted a link that there was some evidence some supplements, including magnesium and possibly potassium, can drop blood pressure so much that stress hormones have to be raised to increase blood pressure, and I believe zonker said dropping the magnesium supplements he was taking helped his sleep.

If I were you, I might try some experiments - add in more carbs and see if that helps you sleep; try dropping the magnesium and potassium and add in more foods containing those things and see if that helps you sleep. Try taking a break from keto altogether and see how that helps you sleep. etc.

just some thoughts based on personal experience. I understand these things can be difficult and hopefully you can find a customized plan which works for you.

[sleepye]

The first week or so on a low-carb diet (like keto) is typically tough. Search the internet for "Keto Flu" and read about the symptoms. It is not a sickness, per se, but the reaction your body has to changing conditions. One of the common symptoms is difficulty sleeping. These symptoms are short-lived and you will start feeling better than you did before undertaking the keto diet.

[sptrout]

I have been on a Keto Diet now for about 8 weeks and there have not been any changes in my sleep or AHI. If you dived straight into a Keto diet with very low carbs (<30 grams per day) then your body will go through some changes. In my case, I went to 20-30 grams of carbs per day and have not noticed any changes other than weight loss. I do take electrolyte supplements every day plus, some would say, high levels of magnesium (nearly a gram, not including whats in other supplements. I have been taking the magnesium at the level mentioned for years, sure killed off night leg cramps and helps with sleep generally and many other things). Magnesium is correctly taken throughout the day not just at bedtime.

"Keto Flu" is also possible. Called the flu because its symptoms are similar to the real flu only milder. Again, I cannot say that I experienced that fun either. Maybe because I started taking the electrolyte supplements immediately after starting the diet.

Oddly, it was my cardiologist that recommended that I start the Keto diet. I asked him if he got kicked out of Big Pharma's School for all doctors. He just laughed.

[sptrout]

Just thought of one other thing. Make sure that you are drinking a lot of water. One Keto expert that I was reading yesterday recommended one ounce of water per pound of body weight (200-pounds of body weight equals 200 ounces of water). That is a lot of water, more than I am currently able to get down, but I do drink water all day long starting with 16 ounces as soon as I get out of bed. Not unusual for me to be at 30-40 ounces by 9 AM. More salt may also be required.

If you have not already, get a Carb Manager App for your smartphone/tablet/ and computer website. The one I use stores my daily intake of many items and has equal data on all the devices I just listed.

[Janknitz]

Walon 44, take a look in the mirror. Dr. William Davis points out that the face changes dramatically in the first 10 days to 2 weeks of a grain free (his diet is essentially keto) diet. All the excess fluid from inflammation seems to leave our faces first. I very definitely noticed problems with my mask fit almost immediately when I got myself on keto. You may see a notable difference in your face.

The other thing you mention is UARS. Could something you are eating more of on Keto be causing more upper airway inflammation? People tend to load up on dairy when they first start Keto, and often that's problematic. Nuts, or eggs can sometimes cause a problem, too.

As Sleepyeye pointed out, the first few weeks on keto are an adaptation phase. Electrolytes can be off, you may feel like dirt, it could interrupt sleep. Taking supplemental electrolytes will help a lot (plenty of water AND salt--salty broth is a good way to do this, magnesium supplements, eating leafy greens and avocado for potassium--some people use Nu-Salt as a potassium supplement but you have to be careful with the dosage). Every system seems to be going through a change. So it may be worth hanging in there a bit, if your goal is to improve your HEALTH through keto. If you are only concerned about losing weight and don't have too much to lose, then fasting or a standard low calorie diet will work in the short term and you don't have to deal with adaptation.

If you are Type 2 and you feel like your blood sugar is going too low on keto, it's often because your body is used to running at a very high blood sugar and may perceive any drop in BG, even into a normal blood sugar range (70 - low 90's) as an emergency situation. If you think you are experiencing a hypo, it's important to check your BG with a meter to see what's really happening. if you really are hypo https://www.bloodsugar101.com/how-to-treat-mild-hypos (does not apply to Type I's). If you over treat, you defeat your efforts to achieve a normal blood sugar. I had a lot of those false hypos in the first few days, but now my blood glucose is steady and even in a normal range. I can't tell you how wonderful it feels to be off the miserable blood sugar roller coaster I rode every day eating carbs.

[Ograx]

Speaking from 2 years experience of being on a keto diet it is unusually hard to actually do a keto diet and not a high-protein with low carb diet. You are essentially eating 60-80 of your calories in fat.

My experience with it was fairly good as far as body aesthetics (I'm a weightlifter) however I did have some fairly nasty hormonal issues (I'm drug free BTW).

My testosterone took a nosedive and it wasnt til I adde carbs back in that it recovered. I also had fairly low energy levels but I can now see looking back this was probably untreated OSA just as much as the Keto diet.

If it works for you great.

[walon44]

thank you all so much for your replies, as always I am pleasantly surprised by the wealth of information members here have and are so willing to share.

dogsarelife - your suggestions about blood sugar rung a bell with me - i have not been diagnosed with anything like that but the feeling I had was actually very familiar from years ago when i might go without food for too long and get shaky/panicky/hot/anxious, not suggesting it is a hypoglycemic moment but certainly mimicked what i have heard about mild hypglycemia. I added some carbs to my dinner and had a slice of melon before bed. Still had to work to calm my breathing and took a long time to get alseep but my quality of sleep was so much better last night and AHi was 2.8 - definitely going in the right direction. I may very well have been underdoing the carbs too severely!

sleepye, thanks for the encouragement im definitely imrpved today so hopefully can hang in here

sptrout & Janjnitz, I just this morning got LoSalt, which is the Irish equivalent of NuSalt and will be mindful of the the water. The thirst is definitely there so its a constant reminder.

Janknitz, its amazing how quickly a mask can feel off, I do struggle with that as my lower face is somehow too small for a lot of the masks, will keep an eye on that. Very true about the new foods - i did already cut down the dairy as that was certainly causing me to feel clogged up and there may be more items to watch for. While I do have about 14lbs to lose, my goal is absolutely to improve my energy levels. CPAP has made a big difference to my life but energy levels still lagging and that is the impetus for cutting carbs, as well as hopefully taking down some imflammation (muscle & joint pain). I hope to continue with strict-ish keto for couple months and then phase up the carbs to something more sustainable. glad to hear you have had success with this way of eating.

Ograx I hear you. It is certainly not for everyone and I will take a wait and see approach with it

[TropicalDiver]

For what it's worth I'm treating UARS with CPAP, pressure set at 9 or 9.5 for last year or so.

any suggestions welcome

One other thought: You are on a fixed pressure of 9ish. What if you went to auto and tracked some data with OSCAR (assuming your machine supports those)?

[Woody]

I know that my apap pressure and AHI both go up when I gain weight.
But it seems the AHI fairy is fighting me as for the last 3 years I have
noticed every time I cut back on carbs my pressure and AHI go up !
But on the other hand if I pig out with carbs right before bed then
I am rewarded with a much lower AHI ! And the last time I started
to do keto my Dreamstation auto maxed out with a 95% pressure
of 19 and a AHI of 12.8 no clear airway events almost all of them
apnias I sure wish I knew why this was happening .

[Mossy]

I have UARS (have the CPAP at home but haven't gotten used to it yet. Telling myself I need more patience). I went on keto and it totally messed up my sleep. Even when I dropped keto I went on this insomnia bender that was so hard to kick. Would not recommend for UARS folks because we have that additional layer of complexity with the ongoing autonomic stress activation, and when you're body is deprived of carbs and has to go into ketosis to get energy, it's a state of stress which probably has a cumulative effect imo.

Also on that note...

How are you doing 1 year into CPAP treatment of UARS? I'm excited to feel the difference but not there yet.