SleepingUgly wrote: He also said straight out that "Apnea CAUSES weight gain, not just the other way around." For him, the proof of that is how many patients have sudden acceleration of weight gain in the six months preceding seeing a doctor. Obviously, to him, the sleep problem causes that phenomenon.
Let's emphasize the word "just" in the quote above. I missed it the first time I read that, and it appears to be the most important word in that sentence.
I might put if fifth or sixth, but hey, that's just me.
SleepingUgly wrote:I don't understand how an acceleration of weight gain in the 6 months prior to seeing a doctor is any more proof that OSA causes weight gain than it is proof that weight gain causes OSA.
The doctor was talking anecdotally, obviously. But I think he was referring to the phenomenon of sudden accelerated weight gain, not gradual weight gain or weight gain in general. Naturally, there could be a third factor or factors causing the sudden accelerated weight gain that then makes the OSA apparent, but that would seem to me to be more of coincidence than the progression of OSA having a role. I may have seriously misunderstood his point, but he is not the first person to say that OSA can cause weight gain.
SleepingUgly wrote: He balked at the statement that "weight loss treats OSA." He emphatically stressed that it does not. "But," he said, "it often DOES 'improve' a person's condition." He repeated again that it is not a "treatment."
How is it not a "treatment" if it "improves" a person's condition? Or do you mean that he said it does not "cure" OSA?
If doctors consider it a treatment, many will say to patients: "Yes, you have severe OSA. But let's take a year or two to let you lose some weight, since losing weight is a valid treatment for OSA." Insurance would love that. But simply telling patients to lose weight to treat apnea does a lot of damage. How can someone lose weight who is not getting effective sleep?
He was clear that losing weight helps. But, yeah, that helps many medical conditions, if done in a healthy way. And telling people to do it has been proved to be ineffective for long-term conditions, since people put the weight right back on eventually, other than a relative few. Imagine doctors telling patients with severe high blood pressure and heart conditions that since weight may have contributed to the problem, 'just go home and try to lose weight.' It is my belief that it is just as silly to tell OSA patients that, especially when a real, proven treatment is available that is as effective as CPAP has been proved to be.
SleepingUgly wrote:His view of the fibromyalgia connection with OSA was fascinating. His way of looking at it is that OSA is worsened when "unperceived" pain is still perceived by the brain during sleep, which causes alpha-intrusion. The chronic pain causes increased tiredness in that way, which, in turn, makes the airway more likely to close. This creates a vicious circle, since fragmented sleep then heightens pain perception.
Having shown recent signs of chronic pain, I'm interested in this part. Why would pain be "unperceived" during wake but be perceived during sleep? Or am I not understanding what he said?
Thanks for passing along all this information.
I put "unperceived" in quotes in an attempt to reflect what I assume his underlying point was when talking to a room that was full of nonmedical people like me. I am no expert in the area, but I assume it is possible for pain that a patient has learned to tune out over the long haul during wake can still do damage to sleep architecture. And I assume pain can be "unperceived" by the conscious brain for other reasons, yet still affect the nervous system in ways that can affect a person during wake too, not just sleep, even though the person would swear there is no pain at all.
Good points, SU. Thanks for making them.
