Can LOSING weight aggravate apnea?

[sonogo]

Nice to come back to this forum after about 3-4 years' absence and see some familiar names!

I've been muddling along the last few years with mixed success. But the last 2 weeks have been a little alarming. I was getting reasonably rested and energetic again to exercise and also control my appetite better, so I've lost about 15 pounds in a 6 weeks. I'm 46, male, 6 feet tall, went from 210 to 195 pounds. (And historically I've been on the lean side)

That should be good news, but either my 3-year-old machine isn't working like it claims it is (there is a bit of a whiny/grinding sound), or the weight loss has affected me for the worse, or it's something else. Before I was diagnosed with apnea, and before I got the leaks under control, I would wake up drenched with sweat, usually after a dream. And not bad dreams either; they could be about bunnies and rainbows or whatever and didn't provoke panic, as one doctor suspected. A smarted doctor said it was the adrenaline rescuing me from choking in my sleep.

Now the last 2 weeks I'm waking up nightly with sweats and the inability to get back to sleep, just like the bad old days. Night sweats come from other causes like chronic infections too, but I finger apnea as my 1st suspect.

So I've been messing around with my settings, which had been working OK for the last few months. I had been 12/16 auto. I adjusted that up and down, then went to non-auto and have been moving things around. The latest has been 11/15, but still only 3 hours of sleep last night, and at least 2 sweaty wake ups.

My card reader/machine has never reliably reported all my episodes of OA, and still doesn't. It is great for monitoring leaks, which I have under control. I just wonder if the weight loss is doing this. I dread going back to my doctor because it's usually only a 5-minute "Oh, that's interesting. Pay at the front on your way out."

Any advice appreciated! I need to get active in this forum again, though I've never had anything great to contribute, which is why I drifted away. But I remember the advice I used to get from Rested Gal and Wulfman and others.

[rested gal]

Hi sonogo! Good to see you posting here again. Sorry, though, that you're having a problem.

I've never heard that losing weight could aggravate OSA, but I guess stranger things could happen.

Been having any allergy problems?

I don't really have any answer for the changes you're experiencing. There's always the possibility that aging tissues are getting slacker, I suppose. Running a race that age might be winning versus the benefits of weight loss. Maybe.

Of course you might have pinpointed the problem already -- aging machine possibly not putting out the pressure it used to. Perhaps get the pressure checked with a manometer? If I were going to bet, however, I'd bet the machine pressure is still right on target.

I'm out of ideas, but do want to welcome you back!

[jabman]

Hi sonogo,
I am probably not the best person to answer your question and am sure someone with more experience then me will be along soon. I think that loosing weight can affect your apnea but it probably varies from person to person. I have lost better then 30 Lbs since I was DXed 4 months ago and I have not noticed any change in how my treatment ( which is great) is affecting me. Since you have an Auto machine maybe you should experiment a little more with your adjustments allowing a few days in between adjustments to see how they are doing. But if you are not having much success maybe another sleep study would be good.

[Llama]

I have lost 30#, since April 2010, bringing me to 5'9" and ~158#. I've only been on xPAP for a year or so, but my pressures have gone *UP* as I have lost weight. My sleep study titrated me to something very low (for me) like 6, but I typically stuck around 8-9 on my Elite II and S8 Autoset. I got my S9 Autoset early 2010 (just before me weight loss) and have watched my pressure slowly inch up to where my 95% pressure is over 11.

My parents were both heavily overweight, but had bariatric surgery in 2009 (one each bypass and lap band). Both of them have lost significant weight and sleep studies have since removed them from xPAP. It bums me out (not sure why) that I weight 80# less than my dad at the same weight and he doesn't need xPAP and I do, especially since based on their results I expected to be able to come off as well. :-/

[Janknitz]

Why is it that you think your machine doesn't reliably report your episodes of OSA?

I had a bout of waking up in a panic and puddle, even though my numbers looked great. When I looked at the data, I could see that the auto was topping out the pressure at my high setting--enough to keep the airway open, but probably not quite enough to avoid what were probably (without an oximeter it's just a guess) some desats anyway. When I increased the pressure slightly, all was well.

As for losing weight, it MAY change your pressure needs, and I've some seen people on this forum actually need a pressure INCREASE after weight loss--it's not a given that your pressure needs will go down. Secondly, you say your leaks are good, but I'd double check, as the changes in your face from weight loss can make the mask fit differently.

It sounds like you should take your machine into the DME for a "checkup" and if all is well there, contact your sleep specialist and you might need a new sleep study to see what's going on.

[chunkyfrog]

Hi, Sonogo. welcome back.
I would not discount the possibility that the night sweats might be unrelated to your weight loss or your apnea--maybe something else entirely.
Maybe it's time for a visit to your physician.
At least you need to rule out other possible causes--asap.
Just saying.

[jnk]

. . . As for losing weight, it MAY change your pressure needs, and I've some seen people on this forum actually need a pressure INCREASE after weight loss--it's not a given that your pressure needs will go down. . . .

I think that is very well said.

One unproved rule of thumb is that a weight change of 10% in EITHER direction is worth pressure-needs reassessment, since pressure needs MAY increase, either way.

For some, fat deposits in the airway may make the airway smaller, which contributes to apnea. Yet, for some, it appears that a decrease in the fat deposits can make the airway a bit "flabby," which may, in a sense, "contribute" to apnea, if you want to look at it that way. ANY change in overall health may change pressure needs one way or the other.

BUT, eating healthy and being active is always the right choice, regardless of its effects on pressure needs, since eating well and being active is good for overall health for the longterm for everyone, regardless of size.

My opinion is based only on what I've read in forums and a few things I've heard doctors say based mostly on anecdotal observation.

[sonogo]

Thank you all for your speedy replies! To answer a few questions:

1. I have a few vague allergies, but nothing unusual or worse than usual.
2. I can wake up several times at night with the sweats and that choking feeling, but my machine/card will only show maybe one incident of OSA, if at all. I just don't think it's accurate.
3. Weight loss can cause gallstones, which in turn can irritate the gall bladder, which can cause night sweats. (I know this from experience years ago.)
4. BUT! I had multiple drenching night sweats every night for about 2 years, and my doctor checked me for every kind of infection possible, including really obscure things like tiny pancreatic tumors creating too much insulin that can cause blood sugar highs/lows and hence sweats. He really checked me for everything for months. It was only when we rather randomly discussed my "insomnia" and how my bedroom looked like a war zone when I'd wake up in the morning, and he had me tested for "restless leg syndrome," that they found I have apnea. Once I got it treated properly, the sweats all went away. So, to me at least, if they're suddenly back, they're most likely apnea-related. Also, after I have one, I am awake for HOURS as in the old days, the adrenaline making me undesirably alert.
5. Leaks: I think Rested Gal at one point had a photo competition of most-modified mask. I should submit mine sometime. So many straps and other things that you can only see a little bit around my eyes; rest of my head wrapped like a mummy, but it works. My machine is really good at tracking leaks, I'll give it that, and most of the time, they're under control.

Well, I'll keep fiddling with the pressures. If I'm not the only one to lose weight and need more boost, then that seems a reasonable approach. Intriguing idea that losing fat can make tissues more flabby; I can believe it. Tissue can even try to expand into areas where fat has receded.

Sweet dreams, everyone, and thanks again for your help.

[The Guest]

Its difficult to know exactly how weight changes will affect you individually. As one member said in this thread his pressure needed to be increased. However, typically lower weights require lower pressures. It might be that since you've lost weight the pressure is now much more than you need. If pressures are too high, the brain can temporarily stop sending signals to the muscles that control breathing. This is called central sleep apnea. Likely you would do well at a lower pressure.

[kteague]

It was only when we rather randomly discussed my "insomnia" and how my bedroom looked like a war zone when I'd wake up in the morning, and he had me tested for "restless leg syndrome," that they found I have apnea.

Hello and welcome back. Your statement above stood out to me, as that's what I used to say about my bedroom. Just be aware that a person can have sleep apnea and a problem with limb movements and have one or the other just not show up during a study. Is there anybody observing you while sleeping? Or can you video record yourself to try to get an idea what's going on? You are in a situation of ruling out possible contributors to your night sweats, and a limb movement issue is another to add to the already mentioned things to consider.

Oh, and congrats on the weight loss!

Kathy

[Tielman]

Nice to meet you.

Just wondering (didn't see it in your postings) if you take any medicine? I've had several issues with my high blood pressure medicine that have caused issues with sleeping (including dizziness, and fatigue). Also, do you have any issues with GERD/Hearburn? That could be causing some issues as well.

I would rule out any other issues first, and then look at your settings. I was going crazy with issues until I got my blood pressure medicine, and GERD under control. Made for a lousy experience, and lousy AHI numbers. Tried all kinds of settings and never found the issue with my machine, pressure, or leaks, it was of course something else.

Good luck.

[Joe50]

I have lost way over a hundred pounds and I am now off the cpap machine because of the weightloss and as far as your question I would say that it might be possible to get worse and the probable fix is to keep losing weight. I base my theory on what someone else has already mentioned, "Weightloss might make the tissue slacker". So my suggestion is to just keep losing the weight in hopes that the tissue tightens up. Because of my weightloss I am having a problem with loose skin but it is tightening up so maybe the tissue in your throat just hasn't begun to tighten up. Just my 2cents and no facts to back it up but it does seem possible.

[sonogo]

I think I finally got the pressures right, or nearly so. Last night was the first mostly normal sleep I've had in 2 weeks. I went with 12/16, which seems high compared to what others use, but it works for me, and I've always been on the high end anyway. But yeah, I worry about inducing centrals with high pressures. It actually concerns me quite a bit. But, when lower pressures just don't work (and I backed off to 8/12 at one point, which was disastrous--I choked all night), creeping up by .5 or so a day seems the only answer. I wish I had a better sense of where EPAP and IPAP should be individually, but 3 sleep studies gave 3 different results, so I just have to experiment, it seems.

1. No restless leg syndrome for me: once the apnea was under control, I no longer awoke to a morning war zone.
2. I do have a couple medications, but I've had them for years without change in dosage. I doubt they'd act up now. I may be cursed with apnea, but I'm blessed with an almost-universal "no side effects" reaction to any medication. My blood pressure has always been on the low side. One doctor even encouraged me to increase my salt intake to boost my blood pressure a little. How often to you hear that?!! But it worked: no more dizziness when I stood up and better digestion. Some people just lose salt rather than retain it, and I appear to be one of them. Seems to be related to adrenal function.
3. No heartburn either.

I wish there was a way to "tone" throat muscles. I've been doing neck exercise for years with zero results; probably only affects external muscles. I think I read here once that someone playing a tuba or some similar instrument helped reduce their apnea. I just haven't tried it for various reasons. I did try blowing up balloons everyday, but that just felt silly, so I quit. I guess wearing a hose on my head is silly too.

[Joe50]

I think I finally got the pressures right, or nearly so. Last night was the first mostly normal sleep I've had in 2 weeks. I went with 12/16, which seems high compared to what others use, but it works for me, and I've always been on the high end anyway. But yeah, I worry about inducing centrals with high pressures. It actually concerns me quite a bit. But, when lower pressures just don't work (and I backed off to 8/12 at one point, which was disastrous--I choked all night), creeping up by .5 or so a day seems the only answer. I wish I had a better sense of where EPAP and IPAP should be individually, but 3 sleep studies gave 3 different results, so I just have to experiment, it seems.

1. No restless leg syndrome for me: once the apnea was under control, I no longer awoke to a morning war zone.
2. I do have a couple medications, but I've had them for years without change in dosage. I doubt they'd act up now. I may be cursed with apnea, but I'm blessed with an almost-universal "no side effects" reaction to any medication. My blood pressure has always been on the low side. One doctor even encouraged me to increase my salt intake to boost my blood pressure a little. How often to you hear that?!! But it worked: no more dizziness when I stood up and better digestion. Some people just lose salt rather than retain it, and I appear to be one of them. Seems to be related to adrenal function.
3. No heartburn either.

I wish there was a way to "tone" throat muscles. I've been doing neck exercise for years with zero results; probably only affects external muscles. I think I read here once that someone playing a tuba or some similar instrument helped reduce their apnea. I just haven't tried it for various reasons. I did try blowing up balloons everyday, but that just felt silly, so I quit. I guess wearing a hose on my head is silly too.

Toning a muscle is a myth but shrinking the fat under a tissue can happen and that is why losing more weight might be the answer.

[jnk]

My understanding is that if recent weight gain is the sole cause of recently experienced OSA, losing the weight may well "cure" it. However, if the weight was long-term, and OSA is long-standing, the OSA rarely ever goes away completely with weight loss, as I understand it.

Lessening the weight on the abdomen and around the neck can lessen pressure needs and can improve the condition in some ways. And of course, losing weight would not be a bad thing to happen to anyone if the weight comes off in a healthy way, with healthy eating and good exercise, or in the case of higher weight, responsible surgical techniques. But losing long-term weight for someone with long-standing OSA, although probably a good thing to do that may lessen severity of apnea and lessen pressure needs, is unlikely, in my view, to "cure" the OSA. Once the airway becomes unresponsive to closure during sleep from years of closures, it tends to keep closing without some airway pressure to keep it open. At least, that's how it was explained to me.

It's the didgeridoo that has a reputation for improving tone in the throat, I believe, at least for some.