For patients with obstructive sleep apnea, it is hard enough to wake up every morning feeling tired and unrested. The daytime fatigue and fogginess that follow are plenty to deal with, but some sleepers may find the needle on their bathroom scale beginning to creep up as well. There is actually a strong connection between sleep apnea and weight gain, but the news is not all bad. There is also a strong connection between treating sleep apnea and weight loss. Here’s what you need to know.
One of the biggest connections between sleep apnea and weight loss lies within your hormones. Leptin, produced by fat tissues in the body, send signals to the brain when the body has had enough food to eat. When sleep apnea is present, your body may suppress the production of leptin, bringing about the potential for overeating. Leptin also regulates breathing control, and the absence of or decrease in this hormone may be a prime reason why breathing patterns are abnormal in patients with obesity and sleep apnea.
The ghrelin hormone comes into play as well. This hormone stimulates the appetite and increases during the night in obese patients. Leptin and ghrelin are a one-two punch when it comes to potential weight gain. Unfortunately, these hormones that control your rate of weight loss and weight gain can actually be changed by sleep apnea.
There are also different metabolic factors associated with sleep apnea and weight loss. Glucose intolerance and insulin resistance are two metabolic risk factors for the development of diabetes and cardiovascular issues, two conditions that are also present in higher numbers among those with sleep apnea. Systemic inflammation is also an issue that is present in those who experience shorter sleep cycles due to sleep apnea. This inflammation increases and decreases as sleepers get less or more rest.
Increased inflammation and the body’s increased inability to process sugar combined with a fluctuation in important appetite-regulating hormones all contribute to weight loss and gain, even while you sleep.
The short answer? Yes. Sleep apnea and weight gain are linked inextricably. That obesity is a risk factor for sleep apnea is well-studied. Just as the incidence of sleep apnea is double in men to begin with, the risk of overweight men developing sleep apnea is five times that of overweight women.
Patients of any gender who gain 10% or more of their base weight have a six fold-increased risk of already-present mild sleep apnea progressing to more severe forms. One potential reason for this is that fat deposits in the tissues around airways begin to narrow an already-small passage. Fat deposits around the thorax also present challenges for breathing.
But does sleep apnea cause or contribute to obesity? Again, the short answer is yes.
Given what we know about leptin and ghrelin and the importance of a full night’s rest to regulate these hormones, it stands to reason that a poor, interrupted night of sleep contributes to obesity. Leptin levels due to sleep apnea are worse in obese patients than in patients whose sleep apnea has other root causes. Adiponectin is another naturally-occurring substance in the body that improves glucose metabolism but is very low in obese patients and also in patients with sleep apnea.
Weight loss is not the only treatment for sleep apnea. However, it can provide powerful health benefits that include not only improved sleep but also better general overall health.
Remember, there is an increased risk of sleep apnea with a 10% weight gain. But, the same percentage of weight loss can also result in a 20% improvement in sleep apnea symptoms. In one study, extremely obese patients who received bariatric banding saw significant improvement in rapid-eye movement (REM) and slow-wave sleep, two significant indicators of better sleeping patterns.
What is challenging about this result is that patients who tried to lose weight on their own without surgical intervention had about the same chances of success as those without sleep apnea just attempting to lose weight. While many lost nearly 14% of their weight in a 12-month period, weight loss slowed or began to reverse after 24 months. Most subjects saw their sleep apnea symptoms decline with their weight loss but re-emerge with weight gain. Still, at 24 months, even as their weight moved up and down, their sleep apnea symptoms did show some improvement over doing nothing.
The key to this may come down to the hormones leptin and ghrelin. If sleep apnea improves and these two hormones are produced at healthy levels, then they help the sleeper regulate appetite and lose weight. If they continue to fluctuate, with ghrelin building appetite even while patients sleep, weight loss can be even more challenging.
The good news is this: once you begin to lose weight, your sleep apnea will improve and hormone levels will begin to normalize, making it easier to lose weight. This is a win-win cycle. It can help increase your chances of successful treatment of sleep apnea and weight loss at the same time!
The bottom line is this: when it comes to sleep apnea and obesity, there is no one single treatment. The best approach is a whole body one. It looks at all factors contributing to both the sleep apnea and the weight gain. Because an obese person can develop sleep apnea, and a person with sleep apnea may become obese, maintaining a healthy diet and addressing the causes of both conditions is crucial.
Regardless of which came first, a sleep apnea dentist at AZ Sleep can help coordinate your care. Get in touch today to discuss your options for a good night’s sleep!