Quality sleep is crucial to many areas of health, and one of the most common sleep disorders is obstructive sleep apnea (OSA). This condition shares a complex relationship with obesity, its only truly reversible risk factor. OSA is a potentially life-threatening sleep disorder in which breathing significantly decreases or stops during sleep, usually due to a collapse of the airway. Medically, OSA is defined as having at least 5 or more events called the apnea-hypopnea index (AHI). AHI represents the average number of apneic episodes (breathing stops completely or is reduced to 10% of normal levels for at least 10 seconds) and hypopneic episodes (airways partially collapse by more than 30% for at least 10 seconds) over an hour.
Understanding Sleep Apnea
Sleep apnea is a relatively common disorder in which people experience disrupted breathing while they are sleeping. In obstructive sleep apnea (OSA), the most common type, disruptive breathing occurs because of a narrow or blocked upper airway, similar to breathing through a straw. Sleep apnea is identified by interruptions in breathing or periods of inadequate breathing while asleep. These interruptions may persist for a few seconds to minutes and can repeat several times during the night. Sleep apnea can cause many symptoms, including excessive daytime sleepiness, loud snoring, morning headache, irritability, and difficulty concentrating.
There are different types of sleep apnea:
- Obstructive Sleep Apnea (OSA): This is the most prevalent type, occurring when the throat muscles relax excessively during sleep, leading to airway obstruction.
- Central Sleep Apnea (CSA): Unlike OSA, CSA occurs when the brain fails to send the appropriate signals to the muscles that control breathing.
- Complex Sleep Apnea Syndrome (CompSAS): This condition is characterized by a combination of OSA and CSA.
The Obesity and Sleep Apnea Connection
As the medical community learns more about sleep apnea, several important links to excess body weight are emerging. The prevalence of OSA increases as body mass index (BMI) increases. Neck circumference and waist-to-hip ratio also aid in diagnosis. In a study of almost 700 adults, a 10% increase in weight was associated with a six-fold increase in OSA risk. In another study of more than 1,000 adults, moderate to severe OSA was found in 11% of men and 3% of women of normal weight, 21% of men and 9% of women who were overweight, and 63% of men and 22% of women who were obese. OSA also occurs in nearly 60% of children with obesity. Each condition can exacerbate the other, so it is useful to consider them together.
How Excess Weight Contributes to Sleep Apnea
Excess body weight contributes to sleep apnea by causing increased pressure on the upper airways from fatty deposits. The pressure leads to collapse, decreased neuromuscular control, and decreased lung volume, making it more difficult to breathe.
Read also: Exercise for Sleep Apnea
Several health conditions increase the likelihood of developing sleep apnea, but OSA is most common in people who are overweight or obese. Excess weight creates fat deposits in a person’s neck called pharyngeal fat. Pharyngeal fat can block a person’s upper airway during sleep when the airway is already relaxed. Additionally, increased abdominal girth from excess fat can compress a person’s chest wall, decreasing lung volume, making the upper airway more likely to collapse during sleep.
The Reciprocal Relationship
While excess weight has long been known to be a risk factor for OSA, an increasing amount of evidence suggests the relationship is reciprocal. This is because sleep deprivation is associated with decreased leptin (an appetite-suppressing hormone) and increased ghrelin (an appetite-stimulating hormone), which may increase cravings for calorie-dense foods. It also appears that OSA patients, in particular, may be more susceptible to weight gain than people who have the same BMI and health status but do not suffer from sleep apnea.
Just as weight gain may increase the risk for sleep apnea, untreated sleep apnea may indirectly cause weight gain. Sleep disruption of any kind affects the circadian system. An altered circadian system is associated with changes in eating patterns, which, in turn, may affect weight. It can also lead to hyperglycemia, high blood pressure, dyslipidemia, and an increased risk of heart attack and stroke. OSA, specifically, is associated with glucose intolerance and insulin resistance. Lipid abnormalities associated with OSA include high triglycerides and low HDL. Hormones related to obesity are also altered by OSA. Ghrelin, an appetite stimulant, is higher in patients with OSA. Sleep deprivation tends to lower leptin production, a possible reason that poor sleep may contribute to obesity. Leptin, a hormone produced by adipose tissue, functions in the hypothalamus to signal satiety to the brain. Adiponectin is another adipokine that improves glucose control and lipid metabolism and may reduce inflammation and atherosclerosis. Levels of adiponectin are reduced in both obesity and obstructive sleep apnea.
Another, perhaps shockingly, straightforward way in which OSA affects weight is that it can make someone too tired to exercise. Daytime sleepiness is a common sleep apnea symptom, resulting from fragmented, unrefreshing sleep. Excessive sleepiness may lead sleep apnea sufferers to exert less physical activity during waking hours. This may be particularly problematic for obese people, who frequently experience more shortness of breath and chest discomfort with physical effort, resulting in limited exercise.
Can Weight Loss Improve Sleep Apnea?
Weight loss has been found to reduce the severity of sleep apnea as well as the development of the disorder. Overweight and obesity remain the most important modifiable causes of sleep apnea. By maintaining a healthy weight, one can potentially avoid sleep apnea and other obesity-related disorders.
Read also: Benefits of Sleep Hypnosis for Weight Loss
For individuals with obstructive sleep apnea, losing weight can lead to significant improvements. As body weight decreases, particularly around the neck and abdomen, the pressure on the airway is reduced, minimizing the risk of obstruction during sleep. Even a modest weight loss of 10-15% can substantially reduce sleep apnea symptoms, including mild sleep apnea.
Studies Supporting Weight Loss for Sleep Apnea
Numerous studies show the positive impact of weight loss on sleep apnea. In a study by the Journal of the American Medical Association (JAMA), it was found that weight loss through a low-calorie diet improved obstructive sleep apnea in overweight and obese individuals. Another study published in the American Journal of Respiratory and Critical Care Medicine revealed that weight loss from a comprehensive lifestyle intervention program improved sleep apnea symptoms.
Weight Loss and AHI Reduction
Individuals with overweight or obesity and type 2 diabetes undergoing a lifestyle weight management program have shown significant improvements in AHI. A 10% weight loss predicts a 26% decrease in AHI.
Additional Benefits of Weight Loss
Losing weight offers multiple benefits beyond just improving sleep apnea symptoms. Besides resolving the root cause of sleep apnea in individuals with excess weight, weight loss can facilitate many other positive health outcomes.
Obesity is linked to various health conditions, including hypertension, heart disease, and diabetes, which can exacerbate sleep apnea symptoms. Weight loss is associated with improved sleep patterns.
Read also: Cortisol's Role in Sleep Apnea
Strategies for Weight Loss
Implementing certain lifestyle changes can be highly beneficial for those looking to lose weight and improve their sleep apnea symptoms. Maintaining a healthy body weight requires a comprehensive approach. Reducing weight through a low-calorie, low-fat diet and increased physical activity significantly aids in controlling sleep apnea.
Diet
Implementing small, gradual changes in your diet is the most sustainable way to achieve weight loss. For instance, replace sugary snacks with fruits or opt for whole grains instead of refined grains.
Researchers found that while diets, typically, can cause you to lose 5-10% of your weight in the first six months, this weight tends to return. It’s important to mention that dieting doesn’t mean you have to hate what you’re eating.
Exercise
Regular physical activity plays a crucial role in weight loss and enhancing cardiovascular disease health, especially for those with sleep apnea. Walking for 30 minutes daily can significantly aid weight loss efforts and improve overall fitness. Incorporating aerobic exercises that increase heart rate and overall fitness can be particularly beneficial for managing sleep apnea.
Some of the best exercises are also the most enjoyable kind. In fact, the more enjoyable your activity is, the more likely you are to maintain a regimen. Working out hard in the gym for an hour can be unhealthy and counterproductive. If you like walking, try taking a stroll down a beach or through a mall. Do you play sports? Check out the local organizations and join a team. No matter how you get your exercise, remember that you don’t need to go overboard. Additionally, remember what’s important to you-your health.
Behavioral Changes
Behavioral changes support weight loss and improve sleep quality. Sleep hygiene practices, such as maintaining a consistent sleep schedule and creating a comfortable sleep environment, are crucial for managing sleep apnea. Stress management techniques, including mindfulness, meditation, and relaxation exercises, reduce anxiety and improve sleep quality.
Other Treatment Options for Sleep Apnea
OSA is a chronic condition that requires a long-term treatment strategy. Treating OSA can improve energy levels, concentration, and mood.
A continuous positive airway pressure (CPAP) machine is most commonly the first step in the treatment of sleep apnea. The CPAP machine has a pump that provides a positive flow of air into the nasal passages to keep the airway open. The pump is connected by a hose to a nasal or face mask. Most people who use a CPAP machine feel immediate relief of symptoms and experience increased energy, improved mood and relief from morning headaches.
Other, more conservative measures may help, such as oral appliances or behavior modification to improve the quality of sleep. The person may also benefit from stopping smoking or avoiding alcohol and other sedatives. Surgical treatments also exist.
Oral Appliances
Oral appliances are an excellent alternative to CPAP. These devices are worn in your mouth while you sleep and help keep your airway open. Oral appliances are covered by most medical insurance plans.
Surgical Options
In some cases, surgical options may be necessary to address severe sleep apnea symptoms. For individuals with nasal obstructions contributing to sleep apnea, surgeries to correct structural issues without external incisions may be recommended. In severe cases, combined surgeries might be necessary to address multiple anatomical causes.
Seeking Professional Guidance
Embarking on a weight loss journey to improve sleep apnea symptoms can be challenging. Therefore, seeking guidance from healthcare professionals who can provide tailored advice and an individualized approach to weight loss is essential. A patient may come to a doctor's visit already suspecting sleep apnea. They may be suffering from fatigue, have a partner who reports that they snore, or even have gathered information using a fitness tracker or smartwatch. These devices can measure heart rate and, in some models, oxygen saturation. They also detect movement during sleep, which can point to a diagnosis of sleep apnea. Often, however, a patient will simply complain of tiredness.
Several physical factors may provide clues to a diagnosis of OSA. One is neck circumference. A neck circumference greater than 16 inches for a woman or 17 inches for a man is considered an indicator, as well as certain head and nasal abnormalities. Other high risk medical issues include stroke, heart failure, hypertension, coronary artery disease, and dysrhythmias.
It’s important to help a patient with both obesity and OSA understand that these conditions are related. They cannot expect to treat either in isolation. This may require getting them used to the idea of obesity as a disease and dispelling social stigma. You can then assure them that there are multiple treatment options to try, including but not limited to weight loss. If the patient is struggling with insomnia, particularly if it may be related to a mental health issue, you might encourage them to seek a mental health practitioner to get help.
Potential Challenges in Weight Loss for Sleep Apnea Patients
Losing weight can be challenging for individuals with sleep apnea due to several factors. People with sleep apnea may experience metabolic slowdowns, making weight loss more difficult. This condition can also lead to insulin resistance, complicating weight loss efforts.