What to do when you drop that weight?

[elader]

So I am thinking ahead. After 4 months on cpap, I am getting my life back. Went from 210 pound couch potato to a 230 pound coach potato to diagnosis of severe OSA to a CPAP zealot. Started exercising last month, now at 5 days a week cardio workout, eating low card, smaller portions. Lost 10 pounds, down to 220 and am jazzed about pushing it harder. I am getting back on my road bike asap (still cold here). I can't wait.

My goal is cardio fitness and 180 pounds. I am intrigued what to do about the OSA at that point. Should I push to get another sleep study? Will the doc let my insurance spend $2000 on that? I have always been a loud snorer and had a sort of restricted flow nose.

[bdp522]

You have an Auto, just keep an eye on the reports and adjust the pressure accordingly!

Brenda

[roster]

So I am thinking ahead. After 4 months on cpap, I am getting my life back. Went from 210 pound couch potato to a 230 pound coach potato to diagnosis of severe OSA to a CPAP zealot. Started exercising last month, now at 5 days a week cardio workout, eating low card, smaller portions. Lost 10 pounds, down to 220 and am jazzed about pushing it harder. I am getting back on my road bike asap (still cold here). I can't wait.

My goal is cardio fitness and 180 pounds. I am intrigued what to do about the OSA at that point. Should I push to get another sleep study? Will the doc let my insurance spend $2000 on that? I have always been a loud snorer and had a sort of restricted flow nose.

Assuming your current AHI is satisfactory, what I would do (and have done) is drop the pressure 0.5 cm for two or three nights and check how the AHI responds. You can continue to do this until the AHI starts to go up. Maybe your pressure "sweet spot" will go down some with weight loss.

From what I have read, it is unlikely that weight loss will cure you. If you ever get the pressure down to say 5 cm and your AHI is near zero, then you might want to consider another sleep study. Assuming your original sleep study showed no comorbidities, I would try to find some lab which would let you do a home study with one of their portable units (the wave of the future).

Great progress on the weight and exercise!

[gasparama]

On another discussion board, there are people who have lost great amounts of weight and have quit CPAP therapy without going through a sleep study. I think that is so unwise. You have great advice here and it would be good to take their advice.

[kteague]

Ditto to what Brenda said. Between my OSA and other health issues, and with the help of inactivity and Prednisone, I had steadily packed on weight. Enough that I took down my photo avatar because it had begun to feel like misrepresentation. With CPAP and going off Prednisone and using Byetta for my sugar, the weight is slowly coming off - almost 50 pounds of it so far. At some point in my continued weight loss maybe I'll drop my pressure a smidgen and watch the data. Can't expect better data at the current pressure than I was already getting - an AHI almost always under 1.

I don't hold out much hope of losing my apnea with the weight, since I've been symptomatic most of my life, but I'm certainly open to the possibility. Last night while Idol was on TV two prior season stars appeared and sang the "Letter" song. Before I even thought about it, I said that I saw the Jefferson Airplane perform that live when I was young, but I slept thru the concert so i didn't remember it. That long buried memory held new meaning in view of my current diagnosis.

Sorry, I digress. Love having a data capable machine.

[old64mb]

Should I push to get another sleep study? Will the doc let my insurance spend $2000 on that? I have always been a loud snorer and had a sort of restricted flow nose.

Although I'm in halfway decent shape - would be better if it weren't for an annoying, persistent case of tendinitis that keeps me from cardio work more than 3-4x a week, since the general rule and my previous experience is you really need to get up to 6x a week to show consistent weight loss rather than maintenance - I'm in roughly the same situation, about 40 lbs left.

The answer I got from my sleep doc on what would happen if I did lose the weight and keep it off consistently was that she'd definitely want me to undergo another study. With the APAP I'd be properly titrated, but she'd want to get it for two reasons. First, because while I might not be 'cured' of apnea with the loss - the consensus among her peers apparently is that you need to get down to your weight in high school to even have a shot at that - my AHI might drop down enough so that I could at least consider having tonsillectomy and/or switching to a dental device. In general, the rule of thumb is that you can take 50% off your AHI with surgery...so if you can get it under 10, you've got a shot.

Second, there's a decent shot I've got comorbid UARS, and they could test for that during a second study since they didn't set up for that during the first. (Since CPAP treats both, right now it'd be a waste to go back in.) If you have a restricted flow nose, probably worth checking that out as well.

See you by the boneless skinless chicken breasts.

[carbonman]

elader, what a great cpap story.
I can't help with what to do after you loose the weight.

I didn't have any weight to loose. The road to my diagnosis was:
Dr. "...well, you don't fit the profile, but lets do a sleep study."
I actually have gone in the opposite direction.
I was titrated at 8cm. With help from cpaptalk, I won't try to mention
all the names for fear of leaving someone out, I titrated myself over 3mths.
I live at 12.5-16cm now. .....and as you probably know, I'm getting my life back, too.

am jazzed about pushing it harder. I am getting back on my road bike asap (still cold here). I can't wait.

Don't wait. Just do it.
There is no bad cycling weather, just improper gear.
If you need suggestions for gear, let me know, I can help.
If you're interested, I can also point you to a program you can use at home,
it will push you as hard as you want to push and
it will kick your cycling fitness into high gear.

On that note, way to go! What an inspiration.
Let's plan a ride for this summer. We can meet half way.


.....I'll bring that tube of Lansinoh.

[roster]

..........
The answer I got from my sleep doc on what would happen if I did lose the weight and keep it off consistently was that she'd definitely want me to undergo another study. .........

Ka-ching $$$$

[momadams]

From our experience:
My son started CPAP and then lost 20 pounds. He's using a straight CPAP machine, so I had him get a referral for another titration. His pressure did change slightly. Plus, he knew more about what questions to ask this time, and made sure that they titrated him in assorted sleep positions, since he was having trouble sleeping on his side.
Shari

[sleeplessinaz]

Hi--I lost 22 pounds since starting CPAP and my numbers are still good at the same pressure of "7" that I was titrated with. I don't think losing weight will cure us of sleep apnea---but it does give us the energy to be more healthy by exercising and eating right. I have about 25 more pounds to lose so I will keep on pluggin away!!

Carrie

[DreamStalker]

You may not want a new sleep study right away ... instead you can ask your PCP doc to write you a Rx for a continuous recording oximeter rental to see how you are doing w/o CPAP once you hit your ideal weight. If OSA disappears, then you can have the sleep study to get that OSA diagnosis off your medical records and keep those greedy insurance folks out of your pockets.

As for weight loss itself, 85% is diet and only about 15% is exercise. Exercise is very inefficient at creating the caloric deficit (need to jog 4 or 5 miles just to burn off a Big Mac or jog 30 to 35 miles to burn off 1 lb fat). Nonetheless exercise is very important and crucial to good health for other reasons such as maintaining good hormonal levels that keep your body functioning in a youthful state.

A good exercise program should focus on resistance training (ie weight lifting) and cadio and flexibility exercise should be supplemental or simply for fun ... same goes for women too.

For those who are severely obese or of non-Eurpoean genetics, they are very likely to be insulin resistant and eliminating ALL carbs (at least until an ideal weight is achieved) is essential to make any significant headway towards weight loss.

When I first started PAP treatment I lost about 35 lbs over a 4 month period without any lifestyle changes other than 100% PAP compliance. I then tried exercising (low impact cardio and yoga) and ended up injuring myself. I tore up the connective tissue on the soles of my feet and developed plantar fasciitis ... that set me back for a year and a half of non-activity but I maintained my weight for the entire period.

Anyway, last summer when my feet finally healed I began to gradually exercise again and lost more weight but very very slowly (about 20 lbs over last 5 months of 2008). Back in December I discovered through intensive book and online research that I might be insulin resistant and last month I confirmed it by taking numerous post-prandial glucose measurements with the different foods I was eating (foods I thought were healthy like organic fruits and 100% whole grain products ... I eliminated all refined carbs and “junk foods” back in 2004). So even the so-called healthy foods like a small apple or a small bowl of oatmeal were making me fat and difficult for any exercise to make a dent in my weight loss efforts.

About 3or 4 weeks ago I changed the diet to a paleolithic (meats, veggies, nuts, and berries) or hunter-gatherer diet and have lost about 15 lbs. After further research, I have decided to once again modify the diet into a protein sparing modified fast (similar to OptiFast or MediFast diets except using real food instead of protein shakes) by simply dropping the nuts and berries and just eating lean meats, tons of green veggies, and loads of omega 3 fish oil and a few other supplements to improve my insulin sensitivity (~ 1000 kCal per day diet). After about 6 to 10 weeks my thyroid response will begin to slow the weight loss down and that will be my cue to bring back some good whole carbs for a couple of weeks to restore my thyroid levels so that I can cycle through the PSMF diet for another 6 to 10 weeks and that should get me pretty close to my ideal weight by the end of this summer. I discussed all with my PCP doc last week and he was in agreement with my approach and was impressed that just with the paleolithic diet alone I had dropped my triglyceride levels to my lowest levels ever at about 114 (anything under 150 is good) and my total cholesterol was down to 163 (anything below 200 is good) ... when I was first diagnosed with OSA, my triglycerides were over 350. Exercise will be minimal with one day-a-week high intensity weight training and very low intensity/low impact cardio (walking) and flexibility (yoga) exercise 2 days of each per week.

Anyway, sorry to hijack the thread with my belly transformation experiment but I too have already noticed a difference in my PAP treatment this past week. For almost two years I have been able to maintain a fairly good mouth seal with my nasal pillow mask(s) ... without the use of tape or chinstrap or any other aid. This past week I have been waking with a dry mouth which indicates I have begun mouth leaking all of a sudden. I'm thinking it may be associated with my weight loss but don't know for sure. This weekend it will be time to start analyzing my data again and see what is going on and maybe its time to adjust my pressure settings.

[elader]

I sort of expected these answers - I have been a loud erratic snorer even when I was 160 pounds.

Carbonman, I was quite the roadie a ways back, but it was in Austin Texas where the weather was warmer most of the time. I used to have trouble in really cold air with exercise induced asthma, so I need to wait until its a bit warmer. I have a quite old trek 1500 (16 years) that I am replacing with a really sweet Felt F2C/Dura Ace on Sunday. I promised myself I wouldn't ride the new bike until I could at least do 30 miles on the old one without looking too ridiculous.

This part of Maryland is beautiful green farmland, gentle rolling hills, and no pissed off Texas farm dogs. Really a nice place to ride.

I am afraid all my gear is quite grungy and will need to be replaced. I haven't mentioned this to my wife yet, but she is quite supportive, so I am hoping she won't kill me.

[Jason S.]

Congrats on reclaiming your life! I'm at 195# but would be more comfortable at 180#, as my stomach has grown in the last 6 months. A year ago I was a 34 waist and now I'm pushing very hard on my 36's. I am NOT going to 38, as I just spent hundreds on new 36's and who has the money these days? Its not so much the weight, as you say, but cardio fitness. I need to start walking again and strengthen my legs and then I can start to run.

[old64mb]

Ka-ching $$$$

BUZZ.

While most sleep docs do use their labs as profit centers, one of the many advantages in using major research university-run ones is that the staff docs don't get a cut from referring patients to it. I found this out when I asked why I couldn't just get into the sleep lab with an order from a PCP or specialist; they do initial evaluations partially figure out what you have, but also to stop misdiagnosed referrals from wasting lab time.

The reason they are careful about that is because their facility is usually booked two months out. It's like any other practice in the top-tier med schools: the whole reason the really good MDs go into serious academic medicine even if the pay isn't nearly as good is to get to work on the worst of the worst cases. In sleep medicine, while you'll send someone with simple OSA into the lab to get diagnosed, your real goal is to make sure a spot's available for the asthmatic narcoleptic with COPD who gets presented during grand rounds.

I know I ended up paying more than I would have at fly-by-night (and I have no doubt with what I paid for the lab it nicely offsets the loss the school takes from its ER) but trusting my doctor? Priceless.

Now if I could only find an endo familiar with sleep medicine to help with the weight loss....

[dsm]

So I am thinking ahead. After 4 months on cpap, I am getting my life back. Went from 210 pound couch potato to a 230 pound coach potato to diagnosis of severe OSA to a CPAP zealot. Started exercising last month, now at 5 days a week cardio workout, eating low card, smaller portions. Lost 10 pounds, down to 220 and am jazzed about pushing it harder. I am getting back on my road bike asap (still cold here). I can't wait.

My goal is cardio fitness and 180 pounds. I am intrigued what to do about the OSA at that point. Should I push to get another sleep study? Will the doc let my insurance spend $2000 on that? I have always been a loud snorer and had a sort of restricted flow nose.

I got down to 83 KG (183 lbs) having reached 107 KG (236 lbs) a few years ago. For me the loss in weight was timely as I was recommended for another sleep study - I ended up with a recommended CMs of 12 which was only 1 under my 1st sleep study CMs recommendation.

So any fantasy I had about ridding myself of SA floated out the window like a forgotten dream

Good luck

PS an now at to 89Kg after creeping up to 97 Kg (214lbs) last year after a trip oseas & too much beer & food My target is also about the 180 lbs mark (around 82Kg).