Continuous Positive Airway Pressure (CPAP) machines are a common treatment for sleep-breathing disorders, delivering a gentle, pressurized airflow through a mask to keep airways open during sleep. While CPAP therapy is widely recognized for improving sleep quality, reducing snoring, and alleviating daytime fatigue, its impact on weight can be complex and sometimes contradictory. Some individuals report weight gain after starting CPAP, while others experience weight loss. This article explores the potential link between CPAP therapy and weight changes, examining the theories, research findings, and practical implications for individuals with sleep apnea.
Understanding the Connection Between CPAP and Weight
The relationship between CPAP and weight loss began as a theory, with experts suggesting that improved oxygen flow and reduced daytime sleepiness resulting from CPAP use could lead to increased physical activity. Feeling more energized might encourage individuals to engage in more activities or start a regular fitness routine. In addition to increased activity, experts believed CPAP machine use could cause weight loss through improved appetite control. Research in 2019 suggested that poor sleep contributes to hunger and cravings, meaning better sleep could lead to increased activity and better appetite control, two critical aspects of losing weight.
The Reality: Conflicting Research Findings
Despite the initial theory, research on the impact of CPAP on weight loss has yielded conflicting results. Several small studies have examined the outcomes of CPAP use in weight loss and found inconsistent results or have used very small participant groups.
In 2013, a large-scale prospective, randomized, double-blind sham-controlled clinical trial revealed that weight gain from CPAP is more likely than weight loss. This study is often cited as a landmark in the debate about CPAP machines and weight changes, finding that individuals were more likely to gain weight with CPAP use, and that weight gain increased with longer CPAP usage.
Since then, other large-scale research has produced similar results. A meta-analysis of over 3,000 people in 2015 confirmed a link between CPAP and increased body mass index (BMI) and weight gain. Conversely, a small study of 119 people in 2019 found that more than half of participants experienced weight loss shortly after starting CPAP, with only 6% experiencing weight gain. However, a 2021 meta-analysis on sleep apnea found that CPAP treatment resulted in significant weight gain, echoing the 2013 clinical trial's finding that longer CPAP usage was linked to a higher weight increase.
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Overall, the majority of large-scale, high-quality research indicates that CPAP use is more likely to cause weight gain, but that doesn’t mean you can’t lose weight during CPAP treatment.
Why Might CPAP Contribute to Weight Gain?
Several factors may contribute to weight gain associated with CPAP therapy. A 2016 systemic review suggested that CPAP use doesn’t necessarily result in increased activity. Even with reduced daytime fatigue, individuals may not increase their activity levels. The review also indicated that CPAP use may decrease resting and sleeping metabolic rate. By taking the body out of a state of active stress at night, CPAP may inadvertently decrease resting/sleeping energy expenditure.
Additional factors that may contribute to weight gain after CPAP use include:
- Changes in energy usage: Untreated OSA may cause people to use more energy as they sleep, either due to low oxygen levels or an overactive nervous system. Studies have also found that the basal metabolic rate drops after starting CPAP, which means people burn fewer overall resting calories.
- Having high blood sugar: Weight gain after CPAP use appears to happen more commonly among people who already had existing issues with the regulation of blood sugar, such as those with diabetes.
- Increases in waist sizes with CPAP use: This is not a measure of weight per se, but doctors sometimes use waist size to determine if a person has obesity.
- Time spent using CPAP machine: Weight changes may depend on how much time people spend using CPAP nightly. One analysis found that weight gain only happened in those who used their CPAP machine for less than five hours per night. But, another showed that those who use a CPAP for over four hours per night tend to gain more weight.
Navigating Weight Management During CPAP Therapy
Despite the potential for weight gain, CPAP therapy remains a crucial treatment for obstructive sleep apnea. Putting on weight isn’t a reason to avoid CPAP therapy or to quit using it. Obstructive sleep apnea is associated with major health impacts and can negatively affect your overall cardiac function. CPAP use in sleep apnea is linked to better long-term outcomes and lowered risk for stroke and cardiovascular events. If you feel more alert and energized after CPAP therapy, it can be a great opportunity to increase your activity levels. When paired with a structured diet plan, CPAP may contribute to weight loss. It’s unlikely, however, to make the weight just melt off.
Here are some strategies for managing weight while undergoing CPAP therapy:
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- Consult with your doctor: Discuss any concerns about weight gain with your doctor, who can provide personalized advice and monitor your overall health.
- Adopt a healthy lifestyle: Focus on a balanced diet and regular physical activity to manage your weight effectively. Weight loss programs that incorporate physical activity are the most manageable for reducing body size and addressing high-calorie intake caused by hormone imbalances. However, these can be difficult to maintain when feeling the impacts of daytime fatigue, which is why weight loss solutions services for ongoing support are recommended.
- Monitor your blood sugar: If you have diabetes or insulin resistance, closely monitor your blood sugar levels and work with your doctor to manage them effectively.
- Consider alternative treatments: Explore alternative treatment options for sleep apnea, such as oral devices, which may be more comfortable and less likely to contribute to weight gain.
The Broader Context: Sleep Apnea and Weight
Obstructive sleep apnea has a complex relationship with your weight. Carrying excess weight can make sleep apnea worse by adding pressure to your airways, and sleep apnea can increase the chances you’ll gain weight from hormone fluctuations, decreased activity levels, and increased hunger.
Weight loss may not fix your apnea issue entirely, but it can greatly increase a person’s health prospects. Those with apnea due to anatomical issues, such as an abnormality in the mouth, throat, or other structures in the respiratory system, may not find total symptom relief with weight loss. However, maintaining a healthy weight is always better for any person than struggling with obesity and will greatly reduce the risk of developing other health conditions. Patients who work towards a healthier body size and lifestyle often report improvements in their joints, blood pressure, and general well-being.
Currently, it is recommended that patients see relief of symptoms and apnea episodes by reducing their body weight by only 10-15%. However, this may change as more studies into the condition are released. In the realm of sleep apnea, particularly OSA (Obstructive Sleep Apnea), the role of the neck and airway is crucial, especially during the night when relaxed muscles can lead to a narrowed airway. Reducing neck circumference through weight loss can significantly improve airway patency, thus alleviating symptoms.
Additional Benefits of CPAP Therapy
Treating OSA with CPAP therapy has been found to reduce daytime sleepiness and increase alertness. Some people with OSA might have residual sleepiness even after treatment with CPAP therapy might not reduce sleepiness. Although experts are not certain about the exact effect OSA has on anxiety and depression, some suggest the low oxygen levels associated with OSA may lead to brain changes that affect mood.
There are a few reasons why CPAP use might reduce the risk of stroke in those with OSA. First, OSA can cause fluctuations in blood pressure, low levels of oxygen in the blood, and high levels of carbon dioxide in the blood. Experts suggest that OSA may contribute to build up in the arteries, called atherosclerosis, as well as an irregular heart rhythm called atrial fibrillation, both of which can also contribute to stroke. People with OSA face an increased risk of high blood pressure. Blood pressure improvements may only be seen in those who use a CPAP machine for at least four hours per night. Interestingly, some people may receive greater benefit from CPAP therapy than others. For example, those who have high blood pressure that has persisted despite using medication may benefit more from CPAP use. While CPAP may help reduce blood pressure, it is important for people to continue to follow their doctors’ recommendations for blood pressure management. Research shows that treating sleep apnea with CPAP helps improve the heart dysfunction common in heart failure.
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OSA can cause a person to wake up with a morning headache, but experts are not entirely sure why this is the case. When it comes to headaches, some people may experience greater benefit from CPAP therapy than others. Insulin resistance involves the body becoming less sensitive to insulin, a hormone that helps regulate blood sugar. People who have insulin resistance may develop diabetes or experience the disorder more severely. And, studies show CPAP could improve these complications in people living with diabetes.