Lost 87 lbs, sleep apnea remains, pressures about the same

[Mudrock63]

Just some tips:

3) take a lot of vitamin D...it helps me lose weight. Weeks I'd take 100,000 IU vitamin D, I noticed I'd lose weight easier than when I did not take vitamin D, if you are really obese, personally I dont think you can OD on vitamin D just my personal opinion.

I do think excessive Vitamin D can contribute to kidney stones in some people. So I would check with a doctor before consuming a mega dose.

Exercise is addictive. I try to walk an average of at least two miles/day per month. Some days I do six miles. Feel much better with regular exercise, especially now that my SA is being treated.

[WindCpap]

There is no relationship between pressure and severity of sleep apnea. A person diagnosed with severe SA may only need a pressure of 8 while a person diagnosed with mild SA may need a pressure of 15.

This is not true. Numerous studies have shown that pressure can be predicted in the majority of patients from body measurements, weight measurements, and data obtained through the sleep study. I have referenced a paper that suggests exactly this. More sleep labs should be using these techniques because the end result is a significantly faster titration.

http://journal.publications.chestnet.or ... 2/1061.pdf

[WindCpap]

Just some tips:
Once youve been on a high protein/lower carb for a while (six months or more) and lost a lot of weight, and you try going back to your old eating habits (pizza for dinner, processed food with a lot of carbs and sugars in them, starchy foods like maccaroni and cheese, potatos, etc)...the old foods dont even make you feel like you actually ate a real meal anymore. I swear its true. Only a meal that has a large amount of protein, say 30-40 grams of lean protein and some fat in it feels like a real meal anymore.

And this is exactly why I will be avoiding the high protein diet. I travel for work, and the last thing I want to do is get my body dependent on one particular diet in order for me to feel full. Don't get me wrong, if it works for you, and keeps working for you, that is great. It just doesn't work for me.

[Drowsy Dancer]

There is no relationship between pressure and severity of sleep apnea. A person diagnosed with severe SA may only need a pressure of 8 while a person diagnosed with mild SA may need a pressure of 15.

This is not true. Numerous studies have shown that pressure can be predicted in the majority of patients from body measurements, weight measurements, and data obtained through the sleep study. I have referenced a paper that suggests exactly this. More sleep labs should be using these techniques because the end result is a significantly faster titration.

http://journal.publications.chestnet.or ... 2/1061.pdf

BMI and oxygen saturation appear to be most heavily weighted. Systematic review published in mid-2015. Free PMC article at link.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4534631/

[MrGrumpy]

After my experience recently, I think I have come to the conclusion that this dogma type thinking common with many physicians on the subject of sleep apnea being caused by obesity is...just that...dogma. Its something they themselves have not experienced, personally. Most physicians are hammered by the health insurance industry lobby to "get your patients to lose weight, lose weight, lose weight and if you can get them to lose a bunch of weight, most of this crap will just go away and we will be able to save a bunch of our insurance premium money."

Thats where I think most of this thinking comes from...insurance industry bs claims, to save the health insurance industry money. They will do ANYTHING, to include spreading disinformation, to save their industry $$$$.

Again, I am not saying there is no relationship between obesity, especially morbid obesity...and sleep apnea. I believe there is a relationship and being obese or worse, morbidly obese makes EVERYTHING WORSE. But I dont think obesity is the root cause of many causes of sleep apnea.

My sleep doc told me years ago that the relationship between OSA and obesity is poorly understood, and that it is just as likely that prior OSA causes weight gain as it is that weight gain causes OSA. My own experience with losing a significant amount of weight without any change in pressure needs would appear to bear that out.

[Drowsy Dancer]

After my experience recently, I think I have come to the conclusion that this dogma type thinking common with many physicians on the subject of sleep apnea being caused by obesity is...just that...dogma. Its something they themselves have not experienced, personally. Most physicians are hammered by the health insurance industry lobby to "get your patients to lose weight, lose weight, lose weight and if you can get them to lose a bunch of weight, most of this crap will just go away and we will be able to save a bunch of our insurance premium money."

Thats where I think most of this thinking comes from...insurance industry bs claims, to save the health insurance industry money. They will do ANYTHING, to include spreading disinformation, to save their industry $$$$.

Again, I am not saying there is no relationship between obesity, especially morbid obesity...and sleep apnea. I believe there is a relationship and being obese or worse, morbidly obese makes EVERYTHING WORSE. But I dont think obesity is the root cause of many causes of sleep apnea.

My sleep doc told me years ago that the relationship between OSA and obesity is poorly understood, and that it is just as likely that prior OSA causes weight gain as it is that weight gain causes OSA. My own experience with losing a significant amount of weight without any change in pressure needs would appear to bear that out.

Wait, dogma type thinking? My guy is saying he thinks OSA may cause obesity, not the other way 'round.

[Night Ranger]

Skinny folks have sleep apnea as well as those us with weight issues. Skinny folks have their share of cardio vascular disease.

[MrGrumpy]

I was not referring to your physician. Your physician sounds atypical, sounds like they are locked on. Most of the sleep specialists Ive seen (one exception only), all consider weight loss a part of overall sleep apnea treatment.

A bunch of primary care physicians Ive used over the decades act as if they believe obstructive sleep apnea and the weight issue are inversely connected.

Sorry if I offended you, I was talking generally, not about your specific doctor. There are a few exceptions, but Ive not run into many and reading this and similar forums, it sounds as if many others have the same attitudes from there sleep specialists

My sleep doc told me years ago that the relationship between OSA and obesity is poorly understood, and that it is just as likely that prior OSA causes weight gain as it is that weight gain causes OSA. My own experience with losing a significant amount of weight without any change in pressure needs would appear to bear that out.

Wait, dogma type thinking? My guy is saying he thinks OSA may cause obesity, not the other way 'round.

[Drowsy Dancer]

Sorry if I offended you, I was talking generally, not about your specific doctor. There are a few exceptions, but Ive not run into many and reading this and similar forums, it sounds as if many others have the same attitudes from there sleep specialists

Don't worry, I'm not that easily offended.

[SewTired]

That's really interesting. Saw a sleep specialist this last week after a sleep study in Sept 2015 showed I had moderate sleep apnea, which the sleep specialist now says is borderline mild/moderate based on the fact that my O2 levels were good despite the hypopneas (no obstructive events registered).

Sleep specialist suggests that I lose 10% of my body weight before doing the titration split night lab sleep study in May.

I have to lose about 13 pounds.

She is of the school of thought that a 10% weight loss is beneficial for borderline mild/moderate sleep apnea.

I am going to follow her advice but strongly suspect that it won't make any difference to the end result.

Interestingly, all the patients at her office the day I was there were obese or significantly overweight. I think this indicates a bias to test overweight/obese individuals for OSA.

I would never have been given a sleep study had it not been for an episode of SVT (I now consider that episode of tachycardia a blessing because it got me diagnosed with OSA!)

The sleep specialist told me I am not her "typical" patient. I have a tiny neck.

Worrying to think that this stereotype by many medical professionals probably results in an under diagnosis of OSA in normal weight and slightly overweight patients.

There will always be bias. It's no different with type 2 diabetes or high blood pressure before the age of 60. The majority of folks who have it will be obese or of a certain race. Therefore they LOOK for it in the obese and not so much in those who are not obese. My BIL had diabetes for probably a decade because he was never tested. I mean, he's an athlete, normal weight, etc. By the time he was diagnosed, the damage was already enormous (he's blind now). His daughter was diagnosed when she was 30 (she's a triathalete).

On the other hand, your doctor isn't necessarily wrong. A fair chunk of people no longer have OSA after losing substantial weight. There are also a fair number of folks who simply lie to their doc and say they have no more problems because they aren't going to continue therapy. They only agreed to use equipment in order to get bariatric surgery. They may still have OSA afterwards, but don't care (I learned this from the many folks selling barely used cpap machines on Craigslist).

The problem I have with the 'lose some weight first' mentality is that you are going untreated. You've likely been untreated for years. Do they tell diabetics to lose some weight first and then we will give you meds or insulin? Or people with high blood pressure - get some exercise and if it's still that way in 3 months, we'll give you pills?

[WindCpap]

Do they tell diabetics to lose some weight first and then we will give you meds or insulin? Or people with high blood pressure - get some exercise and if it's still that way in 3 months, we'll give you pills?

This is exactly the point. Whenever you have a treatable condition that is causing irreparable damage, the first step is to treat it. Then if the patient wants to make lifestyle changes to help he/she can go ahead and do that, but at least the condition is brought under control in the first place.

[49er]

""The problem I have with the 'lose some weight first' mentality is that you are going untreated. You've likely been untreated for years. Do they tell diabetics to lose some weight first and then we will give you meds or insulin? Or people with high blood pressure - get some exercise and if it's still that way in 3 months, we'll give you pills?""

Excellent points. However, in this situation, it would be nice if doctors provided non med advice besides just giving pills. In some cases (not all), people might be able to resolve their problem without meds.

And by the way, your example shows how messed up medicine can be. Doctors (not all) many times want to throw meds at a problem too quickly before first trying non med alternatives. Yet, regarding cpap, which has minimal side effects, they want patients to lose weight first, before prescribing a machine.

And just so folks know, I am not attacking doctors as I realize many of them have good intentions and do a lot of great things. But I did wanted to mention what I felt was an irony of medicine.

[jonny515]

Funny you should mention this. I went in and did a short (30 min) desensitization session. The RT said that due to my size and weight (I"m a VERY short guy and normal or near normal weight), I would probably not require too much pressure. He guessed about 8. I did the titration sleep study. I did not go into REM so they prescribed 6-10 cwp, because 6 worked for most of the study. It seems he was very close to being correct. A little tweaking of an APAP would have gotten me the correct range without the damned titration study.

This is not true. Numerous studies have shown that pressure can be predicted in the majority of patients from body measurements, weight measurements, and data obtained through the sleep study. I have referenced a paper that suggests exactly this. More sleep labs should be using these techniques because the end result is a significantly faster titration.

http://journal.publications.chestnet.or ... 2/1061.pdf

[Thatgirl]

I used to think that OSA was an obese person's disease, and felt a lot of guilt around letting myself get this way. Then I had a patient on my unit who was extremely underweight. And had the worst sleep apnea I ever saw. I would watch him have two minute apneic spells and drop his O2 sats into the 60's. And then my very physically fit friend got diagnosed with worse apnea than I had. So yeah, anyone is definitely susceptible.

[tan]

Just some tips:
...
Starches and simple sugars turn right into insulin ...

wut??

...
4) exercise as much as you can...

sounds like a sure way to kill oneself