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

[roster]

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.

Don't forget lack of sufficient sleep (caused by SDB)
-causes insulin resistance
-causes underproduction of leptin which leads to overeating which leads to weight gain
-causes underproduction of insulin
-leads to type 2 diabetes.

Or put in fewer words "underdeveloped jaws cause type 2 diabetes".

[kteague]

Since there is no one-size-fits-all when it comes to OSA, we'll never have a consensus on a solitary absolute cause or approach. My only issue with a weight loss approach is when it's presented as an either/or option with CPAP. Weight loss takes time, and it seems only logical to me that CPAP in conjunction with weight loss is a win-win situation. One can always go off the CPAP when enough weight is lost and testing confirms the OSA is resolved. It would take me a year to lose all my excess weight - I don't think I'd survive another year of untreated apnea.

[roster]

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.

Because people with small jaws tend to have SDB and SDB makes it difficult for most people to maintain a normal weight much less lose weight down to a normal level.

SU, Get on board with this "small jaw thing" and I won't spend so much time here being obnoxious.

[roster]

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.

Good doc! Why don't all of them learn that!

[DocWeezy]

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.

Good doc! Why don't all of them learn that!

He is a good doc and I consider myself VERY lucky because I basically stumbled upon him by accident. I was completely ignorant at the time.

Why can't they all learn that? Because I think it one part of the answer is that culturally we still think that if someone is fat, it is because they eat too much and exercise too little, i.e., lazy... a personality defect, not a physical issue. Period. End of subject. If they just TRIED to lose weight, they could; if they just quit eating so much, they'd lose weight, yadda, yadda, yadda. Are some people fat because of simple overeating? Of course! But there are others who are fat but eat quite normally and exercise and who are fighting against subtle metabolic issues caused by chronic sleep deprivation that are just now starting to be studied. Others are fighting incredible cravings for high-energy/calorie dense foods in an unconscious attempt to gain energy. It all comes down to metabolic issues and recent research is showing that chronic sleep deprivation wreaks havoc with that system.

If you read the earlier studies on OSA, they all approached it by looking only at fat people and seeing how many had OSA and came to the conclusion that fat causes OSA. Nothing else was considered. I'll put my soap box away now...

Weezy

[SleepingUgly]

My only issue with a weight loss approach is when it's presented as an either/or option with CPAP. Weight loss takes time, and it seems only logical to me that CPAP in conjunction with weight loss is a win-win situation.

Agreed!

SU, Get on board with this "small jaw thing" and I won't spend so much time here being obnoxious.

I AM on board with the "small jaw thing", I'm just not on board with it as the only cause of SDB!

[DoriC]

... 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!

Thanks, I'm not really a redhead, it's probably the lighting, but you're giving me ideas!

[SleepingUgly]

Being told one more time to lose weight is not going to motivate someone

But might telling someone that their OSA was NOT caused by their weight gain and that losing weight won't impact their OSA possibly de-motivate someone to lose weight? I think so (not to mention that I think it's a gross misrepresentation of the facts).

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.

True, and therefore it is important to convey that, from what we know, weight gain increases OSA risk and having OSA can increase weight.

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.

And there's no reason why a person can't use CPAP first and start to feel better before setting a goal of losing weight.

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.

It is impossible to know for any particular person what the cause of their OSA is. If they are heavy, perhaps weight played a role, perhaps it didn't. If they are thin, then clearly weight didn't play a role, but is it the shape of their jaw, the collapsibility of their airway, their nasal resistance, some combination? No one can know WHY they got OSA.

I don't think it's necessary to bastardize the information in order to avoid people berating themselves. There must be a better way.

[jnk]

People who feel unwell tend to be less than sufficiently active and tend to have cravings for concentrated, high-energy foods, since the body senses something is wrong and causes the cravings for thing it assumes will fix the problem. The solution is to help the patient get well so they can be more active and so the body won't crave all the wrong things.

If sudden extreme weight gain by a particular patient causes that particular patient's apnea, loss of weight MAY cure the apnea. Other than that, there is NO scientific evidence that telling a patient to lose weight is the least bit helpful to that patient. It is blaming the victim. It makes the problem worse. Obesity is rarely the result of a conscious choice on the part of the patient, so telling the patient to change his conscious choices is actually a pretty silly thing to do.

I do however agree that if it turns out that a patient chose to be as obese as possible just for fun, telling the patient to stop that would naturally make sense.

Everyone on the planet benefits if they eat well and have a healthy active lifestyle. That isn't the point that is made fairly across all weight classes, as it should be, though. And the point I think SU and most docs miss is that telling a patient to simply lose weight is often heard by the patient as "please adopt a less-than-healthy temporary way of eating that you can't sustain just to get your weight numbers down temporarily." Whether or not that's what the doctor has in mind, that is often what the patient hears. And then that patient eats unhealthy, yo-yos, and ends up more unhealthy, more stressed, heavier, discouraged, depressed, and offended. It should not be "lose weight so you can feel better" but "lets get you feeling better so you can be more active, eat better, and lose weight."

Said another way, if a person with a serious underlying health problem is an unhealthy weight, it is often a silly assumption to blame the weight for the health problem. Help the patient be healthy by solving the underlying health problem so that the patient has the ability to exercise more and not have the constant unignorable cravings that fuel the bad choices at meals and between them.

In other words, a body that is sick and lacks energy will naturally keep sending the message to the brain that more energy is needed, and the brain will cause the person's hand to reach for the highest-energy food as a choice, an unconscious one, every time. That unconscious feedback loop cannot be broken consciously. The underlying health issue must be addressed first. Often, that health issue that must be addressed involves the physical, mental, and emotional stresses that come from bad sleep, and especially, bad breathing during sleep.

Just my 2 cents as your average fat guy on the street.

[SleepingUgly]

Roster, your favorite doctor thinks there is a relation between weight and risk of OSA!

Increased weight increases your chances of sleep apnea.

[SleepingUgly]

The underlying health issue must be addressed first. Often, that health issue that must be addressed involves the physical, mental, and emotional stresses that come from bad sleep, and especially, bad breathing during sleep.

There's nothing to stop a patient from understanding that weight begets OSA and OSA begets weight, so if they'd like to address the OSA first, that's fine, and if they'd like to address both simultaneously, that's fine, too.

In other words, a body that is sick and lacks energy will naturally keep sending the message to the brain that more energy is needed, and the brain will cause the person's hand to reach for the highest-energy food as a choice, an unconscious one, every time.

If it's so unconscious, how did you just delineate it?

That unconscious feedback loop cannot be broken consciously.

I disagree. Many theories of change rely on making conscious the unconscious (whether Freud or CBT--pick your favorite).

[jnk]

Roster, your favorite doctor thinks there is a relation between weight and risk of OSA!

Increased weight increases your chances of sleep apnea.

Yes, a statistical relationship. And that same statistical relationship can be expressed as 'having sleep apnea increases your chances of increased weight.'

The question must be, 'how effective has it been proved to be, statistically speaking, to simply tell an OSA patient to lose weight?' Statistically speaking, it has been proved that it is a waste of breath. Worse, it gives the patient the impression that he chose to have OSA and can simply choose not to have it, independent of present health problems. Statistically speaking, that is a lie in the majority of cases. Yes, it is based on a statistical relation, but the impression given is a lie nonetheless.

Why keep doing something that doesn't work, telling obese OSA patients to simply lose weight to cure themselves? Because it takes all responsibility for helping the patient off the shoulders of the doctor and insurance and makes it a problem the patient is expected to solve on his own without help. That is the worst form of blaming the victim. Choosing to deny a sleep test and treatment on the basis of the patient's being overweight borders on criminally negligent, in my book. And way too many primary docs are doing just that--telling patients "why don't you just lose the weight so you don't have to use one of those stupid machines every night; wouldn't that be better?"

Statistical relations can be used to abuse the sick instead of helping them. I don't like that. It is cruel and uninformed.

[jnk]

The feedback loop I'm referring to is an ingrained metabolic feature, not a malfunction. It is a logical response of the body to sickness. It is not a learned behavior. It is hardwired in. It can't be broken.

Sickness begets sickness. Ignoring the sickness by ignoring the cause of the sickness is the issue I am trying to express.

Deny a man sleep. Make him lethargic. He is likely to start gaining weight without even knowing it. The solution is not to tell him to stop it. The solution is to let him get the sleep his body needs.

If CBT solves obesity, let's get the statistics and roll with it. But simply telling a patient to do something he does not have the ability to do on his own has already been proven to be a failed approach scientifically, so why keep using that same tired, failed approach?

That isn't science. It is politics.

[SleepingUgly]

The question must be, 'how effective has it been proved to be, statistically speaking, to simply tell an OSA patient to lose weight?'

How effective is it to tell anyone to do anything? What causes people to change their behavior?

Why keep doing something that doesn't work, telling obese OSA patients to simply lose weight to cure themselves?

Are you talking to me? Because I've never told anyone to lose weight to cure themselves. I've only argued against the propagation of misinformation. As I've said countless times, OSA is likely the result of multiple factors in combination, but to say that "weight gain causes OSA, and not the other way around", is a bastardization of the what is known (the arrows are bidirectional). And I don't approve of the practice of telling people that losing weight likely won't impact their OSA. We have no way of knowing that.

I'm not a fan of lying to people so they won't blame themselves or feel guilty. Don't blame yourself and don't feel guilty for any number of good reasons, including that it's a complete waste of time, but not because someone on cpaptalk lied to you to make you feel better.

My surgeon told me not to gain so much as 15 pounds, lest my OSA take a step backwards post-op, even though that would put me at a BMI of 21, which is hardly overweight. I believe her. I have gained some weight since my surgery. I can blame myself, the carbs, the OSA, my husband, or my dead mother. I can choose to berate myself or I can choose not to berate myself. I can berate myself as I stuff my fat-free pretzels in my mouth (which is making typing hard) or I can not berate myself as I stuff them in my mouth. It's my choice, and I'm not going to blame my doctor, Resmed, or Obama for whichever choice I make.

Because it takes all responsibility for helping the patient off the shoulders of the doctor and insurance and makes it a problem the patient is expected to solve on his own without help.

Then don't let the doctor do that to you!

Choosing to deny a sleep test and treatment on the basis of the patient's being overweight borders on criminally negligent, in my book. And way too many primary docs are doing just that--telling patients "why don't you just lose the weight so you don't have to use one of those stupid machines every night; wouldn't that be better?"

I agree, and I would verbally eviscerate someone who tried to do that to me.

Statistical relations can be used to abuse the sick instead of helping them. I don't like that. It is cruel and uninformed.

So you think data should be bastardized to suit the needs of the sick, and I think bastardization of data that hurts people is bad.

On that note, lest I be sleep deprived tomorrow, I'll bid you all goodnight. I think my work on behalf of the overweight population, misunderstood as my "work" may be, is done for now.

[Mr Bill]

Back near the end of the summer of 2009 before my 2010 sleep study, I had a sudden weight gain, blood pressure increase, and became utterly sleepless. I had just adopted two kittens, I have mild asthma, I let the little monsters sleep with me at the foot of my bed, sometimes they wakened me throughout the night, maybe that contributed. I installed a door and banned them from the room but the sleeplessness abated very slowly. Finally, I went back to the doctor with numbness of face arms and hands. Not true total numbness but a feeling that my skin was generally numb. It felt like my skin was just hanging off me, not connected. I said "I've never been this tired or depressed in my whole life, do something". He changed my blood pressure meds and sent me to a neurologist. So, I paid $500 for a neurologist consultation and he pricked me all over and pronounced "its not multiple schlorosis", you need to exercise and loose weight do you understand? Well, now I know that was probably my sleep apnea beginning to get bad. I was exhausted and loosing strength I thought I was getting old. I still managed the 7 mile hike along Crags Crest at 11,000 feet but it was really harder than in previous years. If things had not suddenly gotten critical in July of 2010, I would never have realized this was sleep apnea and I would have slowly declined and never known the cause. I'm not sure if I would have responded positively to the idea of breathing through a tube without having had the total lack of sleep for two months that made me buy my first pulse oximeter.

So, I feel for people who are borderline and wondering if its worth the trouble. All I can say, now that its been 4 months of therapy, is I cannot recall when it was in the past that I felt so alert, so present, so alive.