Sleep Apnea, to treat or not to treat!!!

[roster]

I agree with the idea of feedback loop, preferring to call it a vicious cycle.

There is no doubt in my mind that it is driven by heredity in my family.

John, You don't mention whether you and your stricken family have small jaws.

I believe heredity is only a minor factor across the population.

There are way too many people with small jaws to think it is a hereditary condition. If you become very aware of jaw structure, you can't get away from it. For example, I was recently sitting third row at a concert of 39 musicians in an intimate music chamber. I was very bored with the music and started looking at the jaws of the musicians. (Yes, I am a pervert.) I rated 38 of the 39 musicians as having jaws that made them susceptible to SDB. The 39th's jaw was also not so strong and I would like to have known how many teeth he has.

Some doctors who have studied the situation say most patients have the genes for fully developed jaws but the jaws did not develop well from infancy through adolescence because of their diets.

They point out that the genes were in these people for 32 teeth but 32 teeth won't fit into their small jaws. So they end up with extractions of wisdom teeth, failure of wisdom teeth to develop due to crowding, extractions of other teeth, and crooked teeth or braces with some teeth extracted.

That is not to say that all cases of small jaws are caused by diet/underdevelopment. There certainly are some cases where genetics caused small jaws. But I believe these are in the minority and the great majority of underdeveloped jaws is due to diet.

[roster]

... He is not a young man but his quality of life at his age had improved dramatically because of therepeutic, restful sleep. Education, determination seeking help with an open mind are the keys as you can see by the success stories here.

Don't forget having a fine redhead female partner helps!

[JohnBFisher]

... John, You don't mention whether you and your stricken family have small jaws. ... Some doctors who have studied the situation say most patients have the genes for fully developed jaws but the jaws did not develop well from infancy through adolescence because of their diets. ...

It is possible I would be borderline for small jaw. Diet might have been a factor in all of us except for my daughter. My grandfather, mother and I all experienced lean times during that development stage. But that was not the case for my daughter.

Could it be more related to jaw structure? Possibly. Is it hereditary? I suspect it is in my own case. And yes, that's only one example.

More to my point earlier ... Does weight alone cause OSA? That's an emphatic NO! I know from personal experience the OSA came first. The weight gain was a direct result of poor sleep. (I would eat to try to stay awake. I *KNOW* OSA came first.) Whether the OSA is due to poor jaw structure or not, weight gain can result from and then worsen OSA.

In other words, for many people loosing weight changes nothing about their OSA. It might lessen it a bit, but loosing weight will NOT (for many people, myself included) eliminate OSA.

[SleepingUgly]

Does weight alone cause OSA? That's an emphatic NO!

Yes, it does, in some people, but apparently not you!

weight gain can result from and then worsen OSA.

Yes, it can.

In other words, for many people loosing weight changes nothing about their OSA. It might lessen it a bit, but loosing weight will NOT (for many people, myself included) eliminate OSA.

I haven't seen data to suggest that for "many" people losing weight "changes nothing about their OSA".

For the record, it's faulty logic to say that because losing weight doesn't cure a person of OSA, it means that the OSA wasn't caused by the weight gain (alone or in combination with other risk factors). I'm not saying you were saying that.

P.S. Someone tell me how to set up a function key so it will spit out this message. I intend to post it every time I see someone post something along these lines. No offense, John. The bottom line is that the best way to minimize your chances of developing OSA is to maintain a low/normal body weight. Obviously there are other risk factors that are less under our control, and not all disorders are always reversible.

[DocWeezy]

SU....in some ways, I think we're talking about the same thing but from different sides, and for as often as you will post that, I will try to post this because I think we both believe that it is erroneous to think there is only one cause of OSA. There does need to be recognition that weight is not the only cause of OSA, and that in fact, OSA can be the cause of weight gain. There is no 100% answer on this question because it is BOTH: some people have OSA first and then gain weight; other people gain weight and then have OSA (and the OSA in these people MAY resolve upon losing weight). Yet other people are of completely normal weight and have OSA. Causation is much more complex than was originally thought when only obese people were even considered for OSA testing; sadly, some doctors may still think this way and so normal weight people with OSA may not be getting tested or treated.

Here's the link to some studies I pulled that have explored OSA from a different angle:

viewtopic.php?f=1&t=60762&p=569938#p569938

If you don't want to read that whole boring post, one interesting thing to note is that the current research and findings on OSA causation came from researchers who started out examining the impact of short sleep/sleep deprivation and discovered the weight gain, metabolic syndrome, etc. etc. etc. and then looked at OSA as one cause of sleep deprivation. Earlier studies only looked at obese people, discovered that many of them had OSA, and concluded that weight caused OSA--that's really a case of researchers finding what they were looking for; whereas the sleep deprivation studies did not start out looking for OSA but counted it as a mechanism for sleep deprivation. I've found more studies along these same lines, but have not had the time to summarize them... and the reality is that we will all believe what we want to believe and no number of current studies will make any different. I'm not trying to change anyone's mind, but to present another side that is currently be studied and that moves beyond the "OSA is caused by obesity" theory that has been in place since the beginnings of OSA treatment and study.

OSA causation is complex, as is the impact of chronic sleep deprivation on multiple body systems.

Weezy

[roster]

It is an excellent practice to maintain a normal body weight.

However I don't believe for one second your statement:

The bottom line is that the best way to minimize your chances of developing OSA is to maintain a low/normal body weight.

Here is what I firmly believe:

Treating Only The Extremes

One of the problems with modern medicine is that we name and treat only the extreme end of a continuum, or only when significant problems result. Having a slightly recessed chin may be thought of a the person’s normal facial feature, and his or her ability to breathe is never even considered.

The entire basis for my sleep-breathing paradigm is that all modern humans have constricted facial structures, not due to a congenital or genetic problem, but due to our eating and lifestyle habits. Genetically, we’re all programmed to have relatively wide jaws, with room for all your wisdom teeth. Now, that rarely ever happens. This is why obstructive sleep apnea can be described as a mild craniofacial condition that can significantly affect your upper breathing passageways.

Small Jaws, Small Airway

It seems that almost everyone these days will need braces to fix crooked teeth or narrow dental arches. Dental crowding by definition means that your upper and lower jaws are underdeveloped. This creates less total volume inside your mouth, leading to overcrowding of your tongue. Your tongue can then fall back easier when on your back, and when in deep sleep, due to muscle relaxation, you’ll stop breathing more often at night.

Even your nose can be affected by this problem. Since your nasal sidewalls follow your upper molars, the side to side distance in your nose will be more narrow, and as the roof of your mouth (nasal floor) gets pushed up, it’ll also cause your septum to buckle.

If you add additional inflammation and swelling in your nose (due to colds, allergies or nonallergic rhinitis), your nose will become stuffier faster, and even worse, your nostrils will cave in easier.

Having underdeveloped upper jaws prevents proper cheekbone fullness, giving your mid-face a sinked-in look. This type of facial appearance is so common these days that it’s almost accepted as normal. I remember reading in the New York Times a few years back where they reported that women’s preferences for male actors has changed from the classic square-faced, angular facial features, to softer, more feminine, rounded faces.

-Dr. Steven Y. Park

http://doctorstevenpark.com/index.php?s=jaw

There is much more good information in that article that points to the same conclusion.

Not only is maintaining a normal body weight not a way to avoid sleep apnea, it is something that very few people with small jaws will be able to achieve.

[SleepingUgly]

I certainly do not believe that there is only one cause of OSA (clearly it's multifactorial), and I'm living proof that people who are thin can have OSA. However, considering weight is one of the few controllable risk factors for OSA (in ourselves, anyway--our young children may be another story), and that it is the biggest risk factor, I think it does people a great disservice not to say to them:

Try not to gain weight in the first place, as it increases your risk of a host of health problems, including OSA.
If you've already gained weight, try to lose it, as it decreases your risk of a host of health problems, including OSA.

People should understand that for some people, weight alone causes OSA, and for some(I don't know what %) of them, losing weight will improve their OSA. But sometimes there's a point of no return, and even if you lose weight that may have caused your OSA, you might not lose your OSA. (I am hypothesizing that this can be due to localized damage, or due to other risk factors that acted in conjunction with the weight to cause the OSA--which in isolation may not have caused the OSA at that point in the person's life, and the development of other risk factors such as aging).

There is NO downside to losing weight to see if it will improve OSA in any given individual. But when repeatedly told that losing weight will not improve OSA, that decreases motivation to engage in a life-improving behavior (whether it reduces/eliminates the OSA or not).

[SleepingUgly]

Not only is maintaining a normal body weight not a way to avoid sleep apnea

It is in some people, and I know you disagree.

It is something that very few people with small jaws will be able to achieve.

Why would that be the case? I've never seen anything to suggest that normal body weight is more difficult to achieve in someone with small jaws.

I do believe that jaw size has a role, which is why I am looking very closely at the development of my childrens' jaws and have consulted two orthodontists about whether maxillary expansion would benefit my oldest. But besides intervening in the lives of young children, it's a bit late for the rest of us on that front. Still, I am carefully trying to keep my weight down, as I know that gaining weight puts me at increased risk, small jaw or no small jaw.

[DocWeezy]

I'm with you, Roster!

Whatever the cause of small jaws, etc. (and nutrition makes sense), that's the hereditary "look" of my family back three generations--small chins, receding chins, small noses, VERY crooked teeth, etc. Of course, they were from the slums of Glasgow and even after immigrating to the US the family was very poor--including my parents and my upbringing.

My doctor's comment when he first saw me (after looking at my throat, mouth, and ascertaining that I had had 8 teeth pulled and braces) was that I was an apnea waiting to be diagnosed because there was no way I could have avoided it. He was also the first one to tell me that OSA was most likely the cause of my weight gain and subsequent diagnosis of metabolic syndrome.

Weezy

[Drowsy Dancer]

I haven't seen data to suggest that for "many" people losing weight "changes nothing about their OSA".

I sense I am injecting myself into a repetitive discussion. Nevertheless: see this study: http://www.ncbi.nlm.nih.gov/pubmed/19961023

"A supportive diet and exercise program may be of benefit to obese patients with mild to moderate sleep apnea [DD comments: and doubless to those without apnea as well]. The results of this feasibility study showed significant weight loss and improvement in clinically important neurobehavioral and cardiometabolic outcomes but no significant change in sleep disordered breathing. These promising preliminary results need confirmation with a larger randomized trial." (emphasis added)

It was, however, a very small data sample.

For a contrary example, see this: http://www.ncbi.nlm.nih.gov/pubmed/15852048

"Weight loss provides major improvement or resolution of OSA and CPAP requirements. It also reduces daytime sleepiness, and improves the metabolic syndrome and QOL. LAGB placement should be considered a broadly effective therapy for sleep apnea in the severely obese patient."

This was also a very small data sample. Where are the Framingham people when you need them??

DD

[SleepingUgly]

I think the biggest hindrance to people wanting to accept that weight gain plays a role, any role, in development of OSA is that they assume that means they are therefore to blame for getting OSA. I just can't relate to that way of thinking. My father quit smoking, gained weight, got Diabetes Type II. I don't know for sure that his weight gain led to his diabetes diagnosis, as his father had diabetes at some point also, and I think his father was thin. But it's quite possible. Should I feel guilty for nagging him to quit smoking and indirectly causing his Diabetes?! NOT. I type too much, and I have carpal tunnel. I guess I'm to blame for my carpal tunnel. I don't waste any sleep over that, either! I gained too much weight between pregnancies, and did irreversible damage to my skin. It's my fault. I don't waste time over that either.

My point is, a better question than, "Am I to blame for this?" is "Where is my control here? Is there a place here that I can exert some energy to change the course of things to go in a direction I would like them to go or not?" I think it's wrong to say there definitely is not.

[Drowsy Dancer]

Actually, I would love to believe that there is a correlation, and I'm doing my best to lose a significant amount of weight. My sleep doc's comment based on his view of the research is, "Great idea for your health, but don't go off your CPAP or you'll gain it all back in a heartbeat."

My rate of weight loss (n of 1) accelerated when I started CPAP therapy.

DD

[DocWeezy]

I certainly do not believe that there is only one cause of OSA (clearly it's multifactorial), and I'm living proof that people who are thin can have OSA. However, considering weight is one of the few controllable risk factors for OSA (in ourselves, anyway--our young children may be another story), and that it is the biggest risk factor, I think it does people a great disservice not to say to them:

Try not to gain weight in the first place, as it increases your risk of a host of health problems, including OSA.
If you've already gained weight, try to lose it, as it decreases your risk of a host of health problems, including OSA.

People should understand that for some people, weight alone causes OSA, and for some(I don't know what %) of them, losing weight will improve their OSA. But sometimes there's a point of no return, and even if you lose weight that may have caused your OSA, you might not lose your OSA. (I am hypothesizing that this can be due to localized damage, or due to other risk factors that acted in conjunction with the weight to cause the OSA--which in isolation may not have caused the OSA at that point in the person's life, and the development of other risk factors such as aging).

There is NO downside to losing weight to see if it will improve OSA in any given individual. But when repeatedly told that losing weight will not improve OSA, that decreases motivation to engage in a life-improving behavior (whether it reduces/eliminates the OSA or not).

Of course there is no down side to maintaining weight or losing weight--that is a no brainer. But one thing I would like to point out is that just about everyone who is suffering from obesity (at whatever level) already knows this and has most likely tried everything under the sun to maintain good weight or lose weight. Being told one more time to lose weight is not going to motivate someone; being told that OSA probably caused a person's weight gain is also not going to de-motivate anyone who wants to be healthy. I think that understanding the complexity of body systems and the interplay and relationship between sleep deprivation and weight gain can be helpful by taking away some of the "it's your fault" tone that is often implied in anyone telling someone else to lose weight in order to cure something.

One of the issues that is being studied is the impact of sleep deprivation on a person's ability to maintain a normal weight. It is almost impossible to try to maintain a high activity level when one is too exhausted to even think straight, and exhaustion often causes sugar and carb cravings to go through the roof because the body is trying to get energy to survive with. If a person has metabolic syndrome, then losing weight becomes even more problematic until the underlying issues causing the metabolism issues are solved (i.e., no longer being sleep deprived because of OSA). A messed up metabolism means that a person can gain weight even while eating normally and healthily and exercising.

Motivating is one thing, blaming is another, and telling someone to lose weight can be seen as blaming the person for their OSA condition, even when it is not meant that way and is truly meant in kindness. A fat person KNOWS he or she is fat, and knows it every single day in multiple ways. Being told to lose weight because it will [fill in the blank] doesn't help, and if someone does not want to lose weight, then being told to do it in order to help OSA will not motivate at all.

Just my opinion as someone who used to be skinny, fought like hell to stay that way, and gained weight anyway. I've been on both sides, and it ain't easy. But at least now I have some understanding of why I gained weight when I tried so hard not to, and once I am no longer sleep deprived, I am hopeful that the remaining weight will go away through a healed metabolism (I've always eaten decently, which of course no one believed).

Weezy

[idamtnboy]

My rate of weight loss (n of 1) accelerated when I started CPAP therapy.

I can't say for absolute certainty, but it sure seems like in my case CPAP therapy encouraged weight gain after months of stable and/or slightly dropping weight! I'm heavier now than ever, 6 months after starting CPAP. I hypothesize that the increased oxygen in my blood has increased the efficiency of food to energy/fat conversion. I swear my appetite has diminished somewhat, my exercise (or lack of) pattern has not changed much, and yet I'm gaining. Finally got concerned enough to get back on the treadmill where the program I'm using says I burn up 500 calories. Got to help a bunch, I think.

I believe OSA to some extent is the same as I believe about diabetes. Excess weight is not so much the cause of type II diabetes as it, and diabetes, are both the result of some common underlying cause, be it insufficient exercise, chemicals in processed food, lack of fiber intake, inadequate protein to carbohydrate ratio in our food, or some other cause, or more likely some combination of all of them.

[roster]

There is NO downside to losing weight to see if it will improve OSA in any given individual.

There is a huge downside within our population of people who are walking around in a daze trying unsuccessfully to lose weight because they have been told by a doctor or a friend or read many articles in the popular press or posts on the internet that flat out state or imply that losing weight is a good cure for sleep apnea. You won't see those people here because they eschew CPAP, but I do know them several of them personally.

I do believe that jaw size has a role, which is why I am looking very closely at the development of my childrens' jaws and have consulted two orthodontists about whether maxillary expansion would benefit my oldest. But besides intervening in the lives of young children, it's a bit late for the rest of us on that front.

It is not necessarily too late. Doctors who are involved in expansion of the palate by mechanical expanders are now having success with patients in their early sixties. They are finding the body will still generate bone growth. Twenty years ago the idea of this would have been laughed at.

Forum member socknitster, who is age 38, now has braces and is working for jaw expansion. I need to try to rouse her as we have not heard from her since August 2010 on how the "project" is going viewtopic.php?f=1&t=53983&st=0&sk=t&sd=a&start=60 .