How Weight Affects Sleep Apnea
Here's what you should know about the complex relationship between obesity and nighttime breathing
Apr 18th, 2023 •
Obstructive sleep apnea is a relatively common condition that affects 10% to 30% of people in the United States. While many factors contribute to the development or worsening of sleep apnea, research points to obesity as a major cause of this sleep disorder.
Read on to learn more about sleep apnea, how obesity impacts nighttime breathing, the complex relationship between weight and sleep apnea, and available treatments.
Sleep apnea is a condition in which airway restriction leads to repeated breathing interruptions while asleep. Sleepers briefly wake up to resume breathing, usually without being aware of the event. Pauses in breathing can last up to 10 seconds, and people with severe sleep apnea wake up more than 30 times per hour to catch their breath.
While each brief pause is not terribly harmful on its own, the cumulative effect of these apneic spells can markedly impact a person’s quality of life. Common effects of sleep apnea include:
- Daytime sleepiness
- Low energy levels
- Hormonal changes
- Decreased metabolic rate
Obstructive sleep apnea can also contribute to serious health conditions, which we will explore in more detail later.
Central vs. Obstructive Sleep Apnea
There are two primary forms of sleep apnea: central and obstructive.
Central sleep apnea is less common. It occurs when the brain fails to communicate properly with the respiratory system when asleep. Neurological issues, opioid use, excessive alcohol consumption, and complications from various illnesses can cause central sleep apnea.
Obstructive sleep apnea is much more common. It’s caused by tissues in the mouth and neck relaxing during sleep and obstructing the airway. While it is perfectly natural and healthy for our bodies to relax when we fall asleep, the conditions for sleep apnea arise when there is too much tissue or too little muscle tone.
What is Sleep Apnea?
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The Sleep Apnea Test
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Obstructive sleep apnea can cause or worsen many serious health conditions.
Each time a sleeper stops breathing, their blood oxygen drops and their fight-or-flight response kicks in to wake them up. A spike in blood pressure and heart rate accompanies this response, putting stress on the cardiovascular system and increasing inflammation. In addition, lower oxygen levels and higher carbon dioxide levels in the blood during sleep throw off several other critical bodily processes.
Serious health consequences of obstructive sleep apnea include:
- High blood pressure
- Cardiovascular disease and heart failure
- Insulin resistance and type 2 diabetes
- Metabolic syndrome
- Stroke and transient ischemic attacks
- Atrial fibrillation
Many of these same health problems correlate with obesity, so it is crucial for people with both obesity and obstructive sleep apnea to seek medical treatment in order to avoid potentially severe health outcomes.
Symptoms of Sleep Apnea
Given the many detrimental health impacts of obstructive sleep apnea, you may wonder whether you might be one of the estimated 22 to 25 million individuals in the United States with this disorder.
How do you know if you are suffering from sleep apnea? Look out for the following symptoms:
- Gasping or choking while asleep
- Waking up often from sleep
- Stopping breathing at night
- Daytime tiredness
- Morning headaches
- Difficulty concentrating
- Mood changes throughout the day
If you think you may suffer from obstructive sleep apnea, talk to your doctor. They can schedule a sleep study that measures your blood oxygenation throughout the night, as well as the number of times you stop breathing. This can definitively tell you whether you have sleep apnea.
A strong positive correlation exists between excess weight and obstructive sleep apnea. Around 60-90% of adults with obstructive sleep apnea are overweight, and approximately 40% of people with obesity suffer from obstructive sleep apnea.
While obstructive sleep apnea can develop for various reasons, excess fat around the neck plays a significant role. When your neck muscles relax at night, the tissue above the airway sinks down. In overweight people, excess fat deposits in the neck cause extra tissue volume in this area, increasing the risk of airway obstruction. Additionally, fat deposits around the airway can make it smaller to begin with, and therefore easier for relaxing tissue to create an obstruction.
Abdominal fat impacts things from the other end, as it can press on the diaphragm and chest wall, causing shallow breathing. The combination of these two factors can lead to lower blood oxygenation levels while sleeping.
Illustrating just how significant a role excess weight plays in obstructive sleep apnea risk, research shows that a 10% increase in weight is associated with a sixfold increase in the likelihood of obstructive sleep apnea. So while it may not be the only cause of the disorder, it is a major factor.
As though obesity contributing to obstructive sleep apnea wasn’t enough, research indicates that it is likely a two-way street. That’s right—obstructive sleep apnea may also contribute to obesity.
This occurs for a number of reasons, most of which make sense when you consider how a night of restless sleep can impact you the following day. These include:
- Lower energy levels: Because getting a good night’s sleep is next to impossible with obstructive sleep apnea, sufferers have less energy to exercise and are more sedentary throughout the day.
- Increased cravings: When you’re tired, your body craves food that will give you a quick kick of energy—often carbohydrate-dense foods. While this is okay during a sleepy day here and there, this is something people with obstructive sleep apnea have to deal with every day, and it can contribute to weight gain.
- Hunger hormone imbalance: Studies show that obstructive sleep apnea can cause changes in your hunger and satiety hormone levels. Namely, leptin, the hormone that lets you know you’re full, decreases; while ghrelin, which signals hunger, increases.
Because obstructive sleep apnea can both cause and be caused by obesity, it can be a vicious cycle for those who suffer from both conditions. Weight gain can worsen sleep apnea, leading to more weight gain, leading to worse sleep apnea, and so on.
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So how can you stop this vicious cycle from snowballing out of control? The good news is that losing weight often corresponds with a dramatic decrease in sleep apnea symptoms. For example, research indicates that losing 10% of your body weight can decrease sleep apnea symptoms by 20%.
The bad news, of course, is that weight loss is neither easy nor straightforward. Particularly when you are contending with obstructive sleep apnea, which itself can cause weight gain, losing weight can be difficult.
Methods for losing weight include dietary changes, exercise, medication, and surgery. Your personal circumstances dictate what method or combination of methods will work best for you and should be discussed with your healthcare provider.
Consider Targeting Sleep Apnea First
One option that works for some patients to kick start their weight loss is actually treating their sleep apnea first. The most common way to treat obstructive sleep apnea is by using a continuous positive airway pressure device known as a CPAP machine. This machine maintains air pressure in your airway and helps keep it from collapsing while you sleep.
A 2008 study suggested that treating sleep apnea in this manner can also help people lose weight. This makes sense, as getting better sleep can help alleviate symptoms such as daytime tiredness and increased cravings for sugary foods. However, keep in mind that a CPAP machine should just be one tool in a more robust weight loss regimen.
Even if you successfully lose weight, you may still have some lingering obstructive sleep apnea symptoms that require treatment.
Outside of using a CPAP machine and losing weight, a few other treatment options exist for obstructive sleep apnea.
- Tonsillectomy and adenoidectomy: Removal of the tonsils and/or adenoids can often help alleviate obstructive sleep apnea in children. It is much less common for large tonsils and adenoids to be the cause of sleep apnea in adults.
- Mouth and facial muscle toning: Because decreased muscle tone contributes to sleep apnea, increasing mouth and facial muscle tone can help alleviate symptoms.
- Changing sleep position: Amazingly, sleeping on your side instead of your back can entirely clear up sleep apnea symptoms for some people. If you are a back sleeper, it might be worth training yourself to sleep on your side to lessen symptoms.
- Custom-made oral appliances: Another option in the fight against obstructive sleep apnea is the use of nighttime oral devices. These can decrease symptoms by repositioning the jaw or holding the tongue forward.
- Other surgical procedures: If your doctor determines that something anatomical contributes to your obstructive sleep apnea symptoms, surgical intervention may be an option for you. Aside from tonsillectomy and adenoidectomy, this may include an implant or jaw surgery.
- Limiting alcohol: Alcohol can worsen the symptoms of obstructive sleep apnea. Reducing or avoiding alcohol may help you feel more rested come morning.
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Weight can significantly contribute to the development and worsening of obstructive sleep apnea. Because this disorder has the potential to cause many serious medical complications, it is crucial that sleep apnea sufferers seek treatment. The most common treatment options for obstructive sleep apnea are weight loss and the use of a CPAP machine.
If you think you or a loved one may have obstructive sleep apnea, please consult with a physician. Early intervention can help you avoid worsening symptoms and potential detrimental health effects.