Sleep Debt and Weight Gain--Dr Weil, MD

[Babette]

Hey Goose, I'll take one of those shirts!

I sleep nude at home, but when I'm on the road, I need something to keep the girls covered. I doubt I'll ever get invited to share a hotel room again, but you never know. If I can only convince my elderly parents that they are both suffering from OSA, it could work out really well...

LOL,
B.

[Guest]

As for the apnea (or whatever is causign your sleep debt to increase) causing weight gain, well yeah we can argue that until the cows come home. People are in control of their situations enough to know they have gained 10 lbs and now their snoring has gotten worse. They may be the 5th person, the one who does not have any clinically significant apnea but snores. 10 more lbs and there's a good chance they're going to have full blown apnea.

Where does the apnea cause the weight gain? After you have apnea maybe, before that... no way.

I'm just a dumb lawyer but did manage to copy part of a very interesting article discussing how low blood oxygen levels during the night result in diabetes. I suspect that the insulin dynamic discussed in the article may lend support to the argument that apnea causes weight gain in certain people because it interferes with the normal digestive function. Panic hormones, like cortizol, released during apnea are also linked to wieght gain.

Unfortunately, the original article has since been taken off the Net....

Here's an excerpt:

"Sleep debt strongly affects glucose utilization as well as circadian cycles of thyrotropin, cortisol, growth hormone, and other physiological variables. Sleep debt alone is reported to result in impaired glucose effectiveness similar to that found in non-insulin-dependent diabetics. Severe OSA significantly influences plasma insulin and glycemia and may increase the risk of diabetes independently of obesity."

"Insulin resistance is found in both obese and non-obese OSA patients. Blood pressure and fasting insulin correlate closely with both BMI and the severity of OSA. Thus, both the sleep debt and the sympathetic activation that accompany OSA may speed the deterioration of glucose tolerance. Insulin resistance and hyperinsulinemia lead to further sympathetic activation, thus completing the circle of obesity, diabetes, hypertension, and the related metabolic abnormalities."

"Clearly, it is important to manage all the risk factors for diabetes and hypertension. Patients with diabetes, obesity, and hypertension have about a 70% chance of having significant OSA. Thus,OSA must be included in the differential diagnosis for hypertension. Treatment of OSA in the obese, diabetics, and hypertensives may improve insulin responsiveness (32%), reduce blood pressure, and normalize the abnormal growth hormone cycle – and may possibly improve the impaired lipid metabolism seen in OSA. Patients with hypertension and diabetes should be asked specific questions that can reveal undiagnosed OSA. A positive answer to the following two questions provides a 90% predictability for identifying a sleep disorder:

• Do you snore?
• Have you ever been told that you stop breathing during sleep?

"Physicians who ask these questions can expect an eightfold increase in OSA patients in their office. After treatment of OSA, they can also expect improvement in the management of both hypertension and diabetes."

Recent articles in Chest and Cardio Thoracic Journals state that after the onset of insulin resistance, little can be done to reverse it.

Truth be told, modern medicine knows relatively little about the effects of OSA. I'm just glad for a good doctor who sent me home with an overnight oxymeter several years ago!

I'm familiar with what you're quoting, and completely agree. I believe apnea does cause weight gain, for a myriad of reasons. What I dont agree with is blaming apnea for the initial weight gain which may have caused or significantly increased the severity of any sleep disordered breathing. I think it's a slippery slope situation, where once you have ''apnea'' it's much harder to lose weight because you are constantly cheating your body's ability to metabolize glucose. We'd probably be closeer to the same page if we distinguished sleep debt from apnea also.

[Guest]

again, you can sit there all smug and think your initial weight gain was caused by apnea... but you're fooling yourself. What caused the obstruction in your upper airway which led to the apnea? did you just wake up with it one day? Was it not the product of a sedentary lifestyle (or at least one where you gained weight)?

[JimW]

I've heard of folks who had OSA when they were at or under normal weight. It's certainly not beyond belief that some who started out thin gained weight at a time significantly after the OSA started, and that the OSA may have played a significant role in the weight gain.

Although not tested for it at the time, it's likely that I've had OSA since I was a teenager, when I was 5' 9 1/2" and weighed less than 150 lbs. Poor sleep (especially when accompanied by oxygen desaturations) messes with every part of our bodies.

[sharon1965]

wow, talk about smug

i can definitely say, without feeling the need to lie to anyone including myself, or least of all to you, that my weight gain was caused by sleep apnea....i have never been overweight in my life and suddenly 3 years ago i started putting on weight, week after week until i hit around 40-45 lb total gain...at that time i was walking my 90lb dog for an hour every day, rollerblading to and from work, swimming almost every day with my kids and playing baseball...where do you see a sedentary lifestyle there? my husband does all the cooking and we eat a very clean, healthy, organic diet...again, where do you see a problem?

i've had sleep issues all my life, and i have a very large uvula and a small airway...duh, could this be the reason my throat closes while i sleep? i know that at the time i started to gain, my body had had enough, i experienced an adrenal crash, which can be directly attributed to OSA, and my health has been downhill ever since

so you, "guest", can sit there, all smug and think whatever unkind, biased thoughts you want, but i'm in control of my situation enough to know that nothing i did caused me to gain weight...do ya get it?

[Bamalady]

guest wrote:

again, you can sit there all smug and think your initial weight gain was caused by apnea... but you're fooling yourself. What caused the obstruction in your upper airway which led to the apnea? did you just wake up with it one day? Was it not the product of a sedentary lifestyle (or at least one where you gained weight)?

hmmmmm...My BMI was in the Average Range when I was diagnosed with Apnea. I gained about 25 pounds *AFTER* I started treatment. I was very active until I became so fatigued it was a chore just to take a shower or cook a meal.

[Guest]

I've heard of folks who had OSA when they were at or under normal weight. It's certainly not beyond belief that some who started out thin gained weight at a time significantly after the OSA started, and that the OSA may have played a significant role in the weight gain.

Although not tested for it at the time, it's likely that I've had OSA since I was a teenager, when I was 5' 9 1/2" and weighed less than 150 lbs. Poor sleep (especially when accompanied by oxygen desaturations) messes with every part of our bodies.

I'm not arguing this at all, I think you're completely right. I dont know your situation, but assuming it's true... do you think you're closer to the exception or the rule?

[Guest]

guest wrote:

again, you can sit there all smug and think your initial weight gain was caused by apnea... but you're fooling yourself. What caused the obstruction in your upper airway which led to the apnea? did you just wake up with it one day? Was it not the product of a sedentary lifestyle (or at least one where you gained weight)?

hmmmmm...My BMI was in the Average Range when I was diagnosed with Apnea. I gained about 25 pounds *AFTER* I started treatment. I was very active until I became so fatigued it was a chore just to take a shower or cook a meal.

LMAO @ using BMI as much of an indicator of health... so do you think your body just materialized calories out of nowhere?

[Guest]

wow, talk about smug

i can definitely say, without feeling the need to lie to anyone including myself, or least of all to you, that my weight gain was caused by sleep apnea....i have never been overweight in my life and suddenly 3 years ago i started putting on weight, week after week until i hit around 40-45 lb total gain...at that time i was walking my 90lb dog for an hour every day, rollerblading to and from work, swimming almost every day with my kids and playing baseball...where do you see a sedentary lifestyle there? my husband does all the cooking and we eat a very clean, healthy, organic diet...again, where do you see a problem?

i've had sleep issues all my life, and i have a very large uvula and a small airway...duh, could this be the reason my throat closes while i sleep? i know that at the time i started to gain, my body had had enough, i experienced an adrenal crash, which can be directly attributed to OSA, and my health has been downhill ever since

so you, "guest", can sit there, all smug and think whatever unkind, biased thoughts you want, but i'm in control of my situation enough to know that nothing i did caused me to gain weight...do ya get it?

_________________

This is the root of what I dont understand. You said you were active, ate a healthy, clean, organic diet... but gained 45lbs... and claim to be in control of your situation? Were you ''in control'' during the period where you were gaining weight? Were you in control when you knew you had sleep issues and an oversized uvula/small diameter throat?

[Julie]

That's the point - the weight gain doesn't make sense on its own. I too was never o-weight in my life until ~ 10 yrs ago, and then it just started piling on (I was diagnosed 3 yrs ago). There is a very poorly understood connection between OSA and weight gain which we're all trying to figure out, but as yet it hasn't been done defininitively, so keep looking, but don't blame the patients, as there is more to it than will power, bad nutrition, lack of exercise, etc.

[sharon1965]

This is the root of what I dont understand. You said you were active, ate a healthy, clean, organic diet... but gained 45lbs... and claim to be in control of your situation? Were you ''in control'' during the period where you were gaining weight? Were you in control when you knew you had sleep issues and an oversized uvula/small diameter throat?

i guess i can try to explain it in simple terms, so even you can understand, guest

first of all, who said i knew i had a small diameter throat? i know that NOW...many doctors said my uvula was oversized, but no one ever mentioned that it might be a problem related to sleep...i know that NOW

obviously, when i said i was in control of my situation, i was referring back to your earlier use of the phrase, which was clearly meant to imply that lack of control, as in over eating and sedentary lifestyle, was the reason for the weight gain...NOT being in control during the sudden, rapid, UNEXPLAINED weight gain was the reason for seeking yet more medical attention...during the 6 months while i was gaining i was running back and forth to my idiot doctor who patted me on the head and ran rudimentary bloodwork, as she had the same condescending attitude that you do; obviously, the real problem wasn't discovered until i had a sleep study which i had to push for myself, and once it was, the weight gain made sense...maybe not to you, but certainly to my sleep doctor and to me

now do ya get it? or maybe you're a doctor, too, since they rarely listen or take their patients seriously either, and they certainly enjoy patronizing, though maybe not quite as much as you do

[socknitster]

Hey, Guest,

If you know so much about sleep apnea and its causes, why don't you explain to me why my 4 year old son who doesn't have a scrap of extra fat on him was just diagnosed last week?

There is more to apnea than FAT and anyone who thinks otherwise hasn't done his or her homework. My sons tonsils and adenoids are so big that even his ENT doc was shocked.

Like my son, I beieve my apnea started at an early age with huge tonsils and adenoids. I was thin until I turned about 23-24. I have always had sleep issues and always been told I had huge tonsils. But no one knew one caused the other back then. The damn cpap machine wasn't even invented until 1982, for crying out loud. Sleep medicine is IN ITS INFANCY. You don't have any room to make an absolute statements about fat and osa. There isn't any info known on how this might start in many of us as children.

I personally believe, and this is just PURE CONJECTURE, that small abnormalities in the airway, like tonsils and adenoids--and maybe other structures as well, cause some apnea as children. If that goes untreated, then there is a sequelae of events that can occur to contribute to apnea severity in adults--repeated obstructions leading to poor sleep which leads to poorer sleep. In tandem you have inflammation from these tissues from the gasping for breath and potential reflux acid being suctioned up to burn these tissues from the gasping, leading to more long term damage and worsening of symptoms. More and more parts of the airway may be brought into the inflammation response as poor health leads to other problems like allergies or asthma. Which of course only makes the apnea worse and worse and sleep more and more deteriorated.

I read of a study that predicted that taking out t and a in at risk children may in fact prevent a significant number of them from having it as adults.

But I'm having my son's T and A surgery not because of that, but because he is having apnea NOW. His ENT says T and A surgery eliminates apnea in 99% of kids. Apnea in kids is DANGEROUS because they have such small body mass that they desat really fast.

Granted, some apnea may be caused by excess fat. I'm not saying it doesn't. But I don't think anyone has any right to POINT FINGERS and lay BLAME on anyone. No one wants to be fat and no one wants to have apnea. Talking about exceptions to the rule is INSULTING.

In my case, my symptoms go waaaaaaay back to being stick thin and having sleep troubles as a teen and young adult. I remember in college--I wasn't one of those kids who stayed up all night to study. It was lights out by 10pm for me and I'll bet everyone around me thought I was a night owl by how tired I looked and acted. I was 6 feet tall and 165 lb. Well within a normal bmi, if you care to look it up. End of college, early post college years is when the fat came on little by little.

Sorry, this topic is a hot button for me, Guest, and YOU pushed it HARD.

JEN

[Bamalady]

Guest wrote:

LMAO @ using BMI as much of an indicator of health... so do you think your body just materialized calories out of nowhere?

I don't understand your response. The remark I made about BMI was a statement of fact. Nowhere did I say anything about it being an indication of health. As far as the calories, don't understand that response either.

[mindy]

I vote for "enough already"! Since Guest seems to have a basic need to feel superior to the rest of us mortals, he (it sounds like a "he") will never give up.

We know what we're dealing with and throwing stones doesn't chanage things.

Mindy

[geoDoug]

I vote for "enough already"! Since Guest seems to have a basic need to feel superior to the rest of us mortals, he (it sounds like a "he") will never give up.

We know what we're dealing with and throwing stones doesn't chanage things.

I second that vote. You can learn a lot from talking to people who don't always agree with you. That way you don't live in your own little bubble. And I respect how close-to-home this issue is for many of us.

However, eventually online you get to the point of, "please don't feed the trolls." It just encourages people coming on to forums for the sole purpose of causing a flame war. Since I haven't read any good reason otherwise, I'm 99% sure that that's why "guest" is here.

Doug.