Sleep Debt and Weight Gain--Dr Weil, MD

SleepGuy wrote:

Anonymous wrote:As for the apnea (or whatever is causign your sleep debt to increase) causing weight gain, well yeah we can argue that until the cows come home. People are in control of their situations enough to know they have gained 10 lbs and now their snoring has gotten worse. They may be the 5th person, the one who does not have any clinically significant apnea but snores. 10 more lbs and there's a good chance they're going to have full blown apnea.

Where does the apnea cause the weight gain? After you have apnea maybe, before that... no way.

I'm just a dumb lawyer but did manage to copy part of a very interesting article discussing how low blood oxygen levels during the night result in diabetes. I suspect that the insulin dynamic discussed in the article may lend support to the argument that apnea causes weight gain in certain people because it interferes with the normal digestive function. Panic hormones, like cortizol, released during apnea are also linked to wieght gain.

Unfortunately, the original article has since been taken off the Net....

Here's an excerpt:

"Sleep debt strongly affects glucose utilization as well as circadian cycles of thyrotropin, cortisol, growth hormone, and other physiological variables. Sleep debt alone is reported to result in impaired glucose effectiveness similar to that found in non-insulin-dependent diabetics. Severe OSA significantly influences plasma insulin and glycemia and may increase the risk of diabetes independently of obesity."

"Insulin resistance is found in both obese and non-obese OSA patients. Blood pressure and fasting insulin correlate closely with both BMI and the severity of OSA. Thus, both the sleep debt and the sympathetic activation that accompany OSA may speed the deterioration of glucose tolerance. Insulin resistance and hyperinsulinemia lead to further sympathetic activation, thus completing the circle of obesity, diabetes, hypertension, and the related metabolic abnormalities."

"Clearly, it is important to manage all the risk factors for diabetes and hypertension. Patients with diabetes, obesity, and hypertension have about a 70% chance of having significant OSA. Thus,OSA must be included in the differential diagnosis for hypertension. Treatment of OSA in the obese, diabetics, and hypertensives may improve insulin responsiveness (32%), reduce blood pressure, and normalize the abnormal growth hormone cycle – and may possibly improve the impaired lipid metabolism seen in OSA. Patients with hypertension and diabetes should be asked specific questions that can reveal undiagnosed OSA. A positive answer to the following two questions provides a 90% predictability for identifying a sleep disorder:

• Do you snore?
• Have you ever been told that you stop breathing during sleep?

"Physicians who ask these questions can expect an eightfold increase in OSA patients in their office. After treatment of OSA, they can also expect improvement in the management of both hypertension and diabetes."

Recent articles in Chest and Cardio Thoracic Journals state that after the onset of insulin resistance, little can be done to reverse it.

Truth be told, modern medicine knows relatively little about the effects of OSA. I'm just glad for a good doctor who sent me home with an overnight oxymeter several years ago!