Which came first...being fat or having sleep apnea?

[betty303]

There has been a common assumption (in the medical community as well as the wider community) that sleep apnea happens because you are fat. After reading posts here for about two years, it seems clear that many have sleep apnea who are not fat, or did not start gaining weight until the time when they figured they started having sleep apnea symptoms. Others have realized that fat was exacerbating their apnea symptoms, others that losing weight helped (but rarely cured) their apnea.

So is this a chicken and egg question - which came first?

For one possible "side" to the discussion, here is an article that talks about lack of sleep and its relationship to leptin and ghrelin levels. (This link also speaks about lack of sleep and insulin levels. There are other sources that talk about the effect on cortisol levels....) One thing for sure - lack of sleep and its effect on weight has no simple, single-aspect answer.

Here is an excerpt from "How Stuff Works" http://health.howstuffworks.com/sleep-obesity.htm

Leptin and Ghrelin When you don't get enough sleep, your body has too little leptin and too much ghrelin.

The hormone leptin is intricately involved in the regulation of appetite, metabolism and calorie burning. Leptin is the chemical that tells your brain when you're full, when it should start burning up calories and, by extension, when it should create energy for your body to use. It triggers a series of messages and responses that starts in the hypothalamus and ends in the thyroid gland. The thyroid gland controls the way your body stores and uses energy.

During sleep, leptin levels increase, telling your brain you have plenty of energy for the time being and there's no need to trigger the feeling of hunger or the burning of calories. When you don't get enough sleep, you end up with too little leptin in your body, which, through a series of steps, makes your brain think you don't have enough energy for your needs. So your brain tells you you're hungry, even though you don't actually need food at that time, and it takes steps to store the calories you eat as fat so you'll have enough energy the next time you need it. The decrease in leptin brought on by sleep deprivation can result in a constant feeling of hunger and a general slow-down of your metabolism.

The other hormone found to be related to sleep and weight is ghrelin. The purpose of ghrelin is basically the exact opposite of leptin: It tells your brain when you need to eat, when it should stop burning calories and when it should store energy as fat. During sleep, levels of ghrelin decrease, because sleep requires far less energy than being awake does. People who don't sleep enough end up with too much ghrelin in their system, so the body thinks it's hungry and it needs more calories, and it stops burning those calories because it thinks there's a shortage."

[robertmarilyn]

I know for a fact that you don't have to be overweight to have sleep apnea because I was born with obstructive sleep apnea. It took 38 years before doctors diagnosed me with it even though I had been telling them how exhausted I was for two decades. By the time it was diagnosed, they thought I might have a brain tumor because I was having so many problems...so they started a whole array of tests, including a sleep test and it turned out my obstructions were so serious that XPAP wasn't even an option so I had an LPPP.

I recently did two sleep tests and we now realize that I probably should have been on XPAP from the time I had my operation...but 15 years ago, it was such a rare thing for a 38 year old, athletic slender woman to have sleep apnea, that I think the doctors thought that with the operation my sleep apnea was behind me.

I'm still not overweight, I am still athletic, I'm still a woman, and I still have sleep apnea. In my case it had nothing to do with weight. And I am sure there are many other slender folks with sleep apnea.

mar

[dsm]

I believe there are multiple possibilities re this issue of weight and cpap and which comes first.

I believe it is a fact that affluent western societies have shown a marked increase in average weight over the past 50 years. In fact, there are some doctors claiming that diabetes will be the next big scourge of the west due to the growth in the numbers of overweight people. Childhood obesity is becoming a major social concern here in Australia just as much as in USA UK & much of Europe. I have heard it said that we of the boomer generation who keep our weight under control, may outlive the next generation who are considered to not be in control of their weight (fueled by the growing affluence that was well evident in the mid 1960s after the tough yeras during & after WW2).

But, as someone who has been overweight (got up to 107 KG whereas today am 87 KG), my OSA barely varied between when I was overweight & not overweight. But, I have GERD & also suffer from nasal airflow restriction. Some could argue that my current osa was from an extended period of UARS (have hd my nose worked since I was a pre-teen) that was exacerbated by GERD emerging in my mid 40s.

But, I have also noticed (and this is where I believe many others will agree) that when my therapy is working very well (minimal mask leaks) my weight is easy to control & am able to exert the effort to reduce / control it, But, when therapy isn't going so well, will gain weight & not be inclined to control it (too sluggish to be concerned).

I do think there are many lines of argument but I do know that when OSA was becoming an accepted condition in the 1980s & 1990s, many in the profession regarded it as a 'fat man's disease' - however, I am more than sure those same people would now agree that there are more causes to OSA than being overweight, even if overweightness is a sure sign of OSA in some shapes of people, esp people with a thick short neck structure.

DSM

[nobody]

For me the sleep apnea came first. This is the fattest I've ever been in my life and I'm maybe just a few pounds overweight, if at all. I've always been very thin, but my sleep apnea is very severe. So I guess they are not always connected, but I don't doubt that it makes some people really fat.

[MoneyGal]

I think they are related in my case, and I think there is a "chicken and egg" thing, too - like it isn't really possible to untangle which came first.

I am overweight. I now weigh the most I ever have - my BMI puts me firmly in the "obese" category, and I'm closer to a BMI of 40 than 30.

However, I am also *extremely* active - I train in martial arts, which is very, very demanding. But I have very severe OSA, and I was only diagnosed at the end of January 2009.

I suspect I have been overeating for a long time to compensate for my OSA and to allow me to put my body through the kinds of rigourous training that I do.

In my own case, I'm not looking at my weight for another year. I am going to continue training as I have been, and I am also undertaking some new eating practices (limiting carbs unless I've trained beforehand, boosting lean protein and veggie consumption). In one year from now, I'm going to assess where I'm at. I'm looking for my body to *change shape* not to weigh less.

I just had my regular physical this week, and my doc confirms I am very healthy - my blood pressure is normal, lung capacity is good, etc.

[Wulfman]

My "chicken or egg" post a few years ago....

viewtopic/t40770/viewtopic.php?f=1&t=12359


Den