Weight gain the result of, or cause of OSA?

I believe I have had OSA for over 25 years but was only alerted to the problem in the last year when I woke up gasping for breath several times. My weight has been fairly consistent my whole life (slim build) but I have gained 20 lbs over the last 18 months. I believe this initial weight gain may be the result of genetics and aging, as my father experienced a similar weight gain. However, the extra weight may have aggravated my OSA to the point where it called the problem to my attention, which was a good thing. The aggravation of the OSA resulted in slowing down my metabolism, thus contributing to further weight gain. And so one gets stuck in a vicious cycle, even with unchanged diet and exercise habits; gain weight, aggravate OSA, slow metabolism, gain more weight.

There is a whole bunch of stuff regarding apnea that you are fighting. First, being fat is a major reason for apnea in the first place.

This is not to say OSA will affect everyong this way, but there are a lot of metabolic and chemical things working against you which can make you even fatter. First, if you are tired all the time, you are more likely to reach for a Snicker's bar.. (or Hershy or whatever / something sweet to pep you up). Maybe you are drinking a lot of coffee (with sugar?) or drinking caffiene soda (again with sugar?) of maybe you just fee down all the time and eating makes you feel better psychologically. You are not getting "good" deep sleep and all the body, cell, muscle repair that should happen during deep sleep isn't happening. So in addition to being tired, you may ache or be boarderline sick.

In addition to this, when you don't get enough oxygen to the brain (because of breating stoppage), it makes you heart pump harder and creates stress. This does does a few things. First it disturbs your metabolism and makes it harder to process carbohydrates, leading to fat production. Stress releases a hormone called cortisol which studies link to belly fat. Sress reduces a hormone called leptin which is supposed to suppress appetite. Stress increases a hormone called ghrellin which stimulates your appetite.

I don't think this has anything to do with making you gain weight, but another coincidental thing about this stress is you feel like you have to pee in the night. It is because a hormone is released that mimics a brain signal for a full bladder.

On top of all this, you don't get enough rest so you aren't exactly ready to run a marathon and more likely to be a couch potato.

Have your blood-glucose level checked regularly. There is a risk for type 2 diabetes.

I too believe I've suffered with OSA for many years. Whether OSA came first, or being overweight, I'm not sure. I sure do know that OSA make it more difficult to lose weight or maintain a healthy weight. In the last few years I finally gave up trying to lose weight and got even heavier. The OSA became so severe, I finally had to do something as I was barely able to function on a daily basis. So, the weight gain was a good thing in that it forced me to face my OSA and get treatment. Now I only hope that as I get to feeling better (I'm feeling better already, but still get sleepy during the day), I will be able to lose at least some of the weight I've gained over the years and get in better shape. I have started exercisinng again (which is ESSENTIAL for me to maintain a healthy weight)!

I think the answer to which came first is different for different people.

I think it's cyclical - being overweight tends to induce OSA, OSA tends to reduce not only the metabolism, but the energy available to exercise, which reduces muscle mass which reduces metabolism which tends to induce OSA, which....

Solution? Well - my approach so far as a newbie is to learn to be conscientious with my CPAP therapy, and to introduce more and more exercise into every facet of my life, and log every calorie I eat. If I'm in a cycle that will shorten my life with diabetes and heart disease and risks of blindness and immediate loss of memory and mental function - well, the cycle has to be broken.

What started it barely matters, for now - if the cycle is downward and the symptoms are almost indistinguishable from their causes, and they are, generally speaking, apneas, poor diet, and inactivity, then CPAP, nutrition, and exercise are the solutions.

Plus, I want to go backpacking in the Sierra Nevada, and will need quadriceps for that.....

Wow - you are the spittin' image of Brad Pitt... Here is a strange one for you. I have started to gain weight rapidly in the last two months after several months of consistent CPAP use. Nothing else has changed including my eating habits. I remember reading that snorers burn more calories.

People are different. I always get so irritated with the nutrition field for over-generalizing. When you look at human beings, you see the huge variety in relatively simple things like hair/eye/skin coloration.

The human metabolism is soooo much more complex, so why would "nutritionists and dieticians" assume that everyone is the same?

That being said, I'm almost positive that weight gain is both a "result" and a "cause" of OSA.

Here's how my life has gone:

Stage One:
1) High school. I started intentionally sleeping less, drinking alcohol, etc. My quality of sleep went down, my energy levels went down, my weight went up.
2) College. Take the above and double it!
3) Grad school. Take the above and double it again! And now my weight gets high enough that it starts increasing the severity of my OSA. By my late 20's I was an obese wreck, and my life started circling the drain. Dropped out of grad school.

Stage 2:
1) Got a 7-hour/day job with strict start and stop daylight times. Stopped drinking. Stopped partying. Started sleeping regularly. Started losing weight.
2) Two years into this, I realized that everyone in my family suffered from obesity and adult-onset diabetes, so I tried a low-carb diet. Lost 100 lbs, started sleeping even better, started exercising. Was exercising 10 hours/week and was loving life!

Stage 3:
1) Moved and switched careers. Started working a lot of shift work. In an ~4-year period, I switched between days, swing, back to days, graveyard, weekend days, then back to weekday swing. That affected my sleep, which affected my evergy levels, which started the weight gain. Gained 120 lbs. And have just hit rock-bottom again.

For the second time in my life, I think poor sleep hygiene helped me reach a weight where obesity started to impact my sleep, and that vicious circle started to spiral out of control.

Now, looking back through the lens of a probable OSA diagnosis...this all makes much more sense to me. Why could I eat right and exercise at some points in my life, but not in others?

I think it had a LOT to do with sleep quality. I had always based my metric for "adequate sleep" on "several hours unconscious". Now I know how wrong that assumption can be!

The real proof of all this will be if I am able to once again lose weight, once I get an xPAP.

Here's one specific way I am pretty sure OSA is hurting me:
When I wake up tired, headachy, and dehydrated. The thought of eating seems repugnant to me. So I don't eat anything for at least 3-4 hours after I get up. In fact, I often eat only one HUGE meal per day when I get home from work.

When I was fit and trim 9 years ago, I would make myself breakfast as soon as I got up, because I would feel woozy and jittery if I didn't eat before getting ready for work. I ate five times per day to keep my blood sugar and energy levels even. And it felt completely natural and right. In fact, I had a hard time NOT eating right.

But now, when I try to force myself to eat right...it feels wrong. Specially when I try to force myself to eat breakfast.

That contrast is probably the single-most obvious affect on my diet/metabolism that I believe to be directly linked to OSA.

That's similar to my own experience on one key point: major life changes induce negative health habits. For me, when I was thirty I'd recently dropped 45 pounds, had at most ten to go, and was in the best shape of my life, and diet and exercise were a daily habit, and my friends all knew it.

Changing jobs and cities cost me the support group and the habits; I failed to carry the new habits forward. You know the cycle...

2007-243lbs, BP 120/70, get osa, size 38 pants
1979 -223lbs marine corp running my but off body mass index 21
weight gain oh yes after osa now 292lbs Body mass index 35
.... Im 6feet tall and 4 feet round, size 46 pants ......
eating 400 to 850 cals loses weight, over 1250 cals gain weight.
now im not saying thats good for all only say that's all for good for me.

my dream is to be 6x3... 6 feet tall 3 feet around, and 200 lbs before im put 6 feet down in the ground

bipap respitronics 14/18, ffmask mirage q mask

Some thoughts on weight & cpap therapy.

I believ most regulars will say that OSA causes weight gain & weight gain exacerbates OSA. Yup, a vicious cycle. Certainly one I have grappled with in the past 4 years.

What I have observed is that
> when therapy is going well & under control, I have 'the will' to lose weight & inevitably do so
> when therapy slides for what ever reason (weather changes, mask leaks a lot, etc: ) I see my weight go up
> the thing that really seems to be affected is 'the will' to manage the weight

When I do get my weight down (& am just entering into another weight drop phase) I sure as hell feel better, more alert &
more energy. Am also always conscious of the need to keep alert in order to keep my job. I am more motivated by that
aspect than any other that I can think of. I reach the official age for retirement here (in Aust) next year but I sure as hell
don't want to take up the offer & neither do I want my employer to make it

It is an immutable fact that the older we get the harder it is to lose weight & the worse our OSA is likely to get. A few years
back my weight got up to 240lbs then 2 years back I got it as low as 180 lbs - & did a sleep study thinking they would say
I was cured of OSA - nup the diagnosis was within 1 CMs of the 1st sleep study when I was much heavier. Today am around
198 lbs & trying (as I have been for months) to get close to 185 lbs.

I am still trying to work out what aspects of cpap therapy most impact the change between weight going down & weight going up.
It obviously isn't just cpap related but I am confident cpap plays a dominant role in managing weight.

#2 (in the below para Co2 retention is different from SpO2 levels - PCo2 is carbon dioxide retention vs SpO2 = blood-oxygen sat)

I am experimenting with swapping between 2 machine brands & am noticing differences to a number of factors including
will to exercise, that seem to occur between these models. I hope I am on to something but need to learn a lot more - esp about
CO2 levels & how they are affected by particular mask/machine combos & if CO2 levels can affect the 'will to' exercise.

With cpap therapy there is so much to absorb & the nuances of issues such as respiratory rate & CO2 retention & mask deadspace
& co2 levels impacting centrals & does one machine do a better job of managing co2 that the other, which all make it very complex.

The great thing about this forum is the opportunity to catch glimpses of answers as the various topics get debated & discussed.

Good luck

DSM

#2 More thoughts
One other aspect of weight gain & indirectly OSA is that when we feel depressed (which OSA` can trigger) we tend to put on weight
and that also feeds the depression. Which in turn affects our mood. When we feel in a good mood, it does become easier to
deal with the weight & depression. Here at cpaptalk we can often see people go through a change in mood and confidence as
they get control of their therapy. I would go as far as saying that good therapy & good mood are often obvious with people who
participate here.

D

Jason S. wrote:However, the extra weight may have aggravated my OSA to the point where it called the problem to my attention, which was a good thing. The aggravation of the OSA resulted in slowing down my metabolism, thus contributing to further weight gain. And so one gets stuck in a vicious cycle, even with unchanged diet and exercise habits; gain weight, aggravate OSA, slow metabolism, gain more weight.

You've just described Pickwickian syndrome to the tee, save for the fact you're not obese, which is why I hope they eventually redefine it to include the vicious cycle that sleep disordered breathing can create at any weight.

There's been a whole bunch of interesting research done on metabolism and OSA, but the sad part is it's been almost all outside of the US (not a problem for those lucky enough to be in Australia, Germany, or Israel, just that if it comes out of a major US research hospital the publicity is 10-fold), published in journals that most endocrinologists don't read, and since the average med school student spends a grand total of 24 minutes during 4 years learning about SDB it so often doesn't get caught until it's progressed to severe OSA with massive, disabling comorbid illnesses.

The chicken and the egg part of your question I've seen answered by some good specialists, and while it's not a complete answer, like many diseases (where you need a particular gene or gene mutation to be at risk) it's genetics that predisposes us to it in the first place - facial structure in particular, since if your tongue just happens to be potentially positioned to collapse and block your airway...well....

This latter is why I've also seen it explained as to why OSA runs in families.

Goodness, weight is such an odd defining factor for OSA, because everyone is different and it doesn't appear that there's one true answer to the link between weight and OSA. I am sure I had OSA for ages, maybe decades, but when I lost 40 lbs it got so bad that I finally had to see the doctor to figure out what was going on. And now that I'm on CPAP therapy I'm rested, exercising better and more, have more energy to diet and fix healthy foods, yet I am gaining weight at the drop of a hat. I have gained 10 of that 40 lost back and it's driving me mad. (Probably metabolism changes, but who knows.)

I'm not trying to provide an answer, just add another data point to the discussion.

Yes ... it is very likely tied to metabolism and the dozens of hormonal balances that maintain the human biochemical machine tuned into to a healthy organism. Weight (over or under) is but one symptomatic expression of hormonal imbalances. The symptomatic expressions can and often do provide a feedback loop driving the momentum of the hormonal imbalances leading to further degradation of the organism's condition of health.

Insulin (and its yin/yang cousin glucagon) is the master hormone when it comes to metabolism followed closely by thyroxine, then there is leptin, ephedrine, cortisol, adrenaline, HGH, seratonin, melatonin, etc, etc. Once insulin gets out of whack, all the others follow trying to keep up with the biochemical symphony. Do as Rooster suggests and get your glucose/insulin levels checked out and see if you can rule out pre-diabetes/insulin resistance/metabolic syndrome.