Exploring the Link Between Sleep Apnea and Weight Gain

Dr. Christopher McGowan
November 17, 2020

Imagine suddenly being unable to breathe. Your airway is closed off. You can feel pain start to rise in your lungs. Soon it feels like your whole body is screaming for air. You start to panic and feel your body begin to fight for oxygen. As horrific as this sounds, if you are overweight and have been diagnosed with obstructive sleep apnea, this could be happening to you dozens of times every night. 

Being unable to breathe may be a nightmare scenario, but for millions of Americans, it is also an everyday, or at least every night, reality. Obstructive sleep apnoea or OSA, sometimes just called sleep apnea, is one of the more insidious effects of weight gain. While it may not grab the headlines or attention of diabetes or a heart disease, sleep disorders not only increase your chances of developing cardiovascular problems, but they can also make weight loss harder. 

What is Obstructive Sleep Apnea?

Obesity and OSA go hand in hand. Though there are other risk factors for OSA such as enlarged tonsils or other physical characteristics regarding the structure of your neck and airway, between 60-90% of people who have OSA are overweight. As your body mass index (BMI) rises, so does the likelihood and severity of OSA. 

The link between being overweight and being at risk for high blood pressure or type 2 diabetes may not be as obvious to some, but the connection between excess body weight and sleep disturbances like OSA is very direct. When you gain weight, your body has to store all that fat somewhere, and it can end up being deposited in your upper thorax or in and around your neck. This extra fat in the neck, known as pharyngeal fat, can push on your upper airway, causing it to effectively shrink or even close off while you are sleeping. This obstruction of airflow during sleep can last for as little as 15 seconds or as long as an entire minute. More frighteningly, it can happen many, many times each night.

When your body is starved of oxygen, it will fight to stay alive whether you are asleep at the wheel or not. Low oxygen levels trigger a sudden rise in your heart rate and blood pressure, as well as increases in stress hormones like cortisol. All this is enough to jolt your body awake so you can begin breathing again. The effects of that stress on your body, especially when it occurs night after night, can put you at higher risk of heart disease and many other serious health conditions

Why Does Sleep Apnea Cause Weight Gain?

Sleep apnea causes weight gain in several different ways. Primarily, lowered levels of daytime energy make exercising, or even moving around during your normal daily activities, difficult or impossible. Secondly, sleep apnea can cause the levels of hormones that affect hunger to fluctuate, which can cause you to feel hungry more often than you ordinarily would. 

How is Sleep Apnea Connected to Weight Gain?

It is not difficult to see how extra weight on and around your neck could result in your upper airway being compressed during the night. Obesity is known to be a risk factor in sleep disorders like OSA, but just as excess weight is a risk factor for OSA, some sleep disorders put you at increased risk of weight gain. 

The key to understanding how sleeping poorly could put you at an increased risk of an increasing waistline lies in the vicious cycle of hormone imbalances that sleep disturbances create. Your body works best when the myriad hormones you produce are all in balance. When you sleep poorly, that delicate balance starts to fall apart. Three of the main hormones affected are ghrelin, leptin, and insulin, all of which have an effect on how much you eat and what your body does with the calories you give it. 

Your body manages the sensation of hunger primarily through two different hormones—ghrelin and leptin, though others such as insulin are closely connected to the process as well. The levels of these two primary hormones are responsible for sudden cravings for food, and for the decision to throw in the towel when you have had too much to eat. 

  • Ghrelin
    Ghrelin is responsible for the sensation we call hunger, and is released when your body thinks it is time to chow down. If you have too much of this hormone in your system, you could begin experiencing cravings for food.
  • Leptin
    Leptin has the opposite effect as ghrelin. This hormone is responsible for telling your body you have had enough to eat. Too little of this hormone and you will not feel full until you have eaten more food than you might otherwise. 
  • Insulin
    Insulin is a hormone that helps move glucose through your body. Under some conditions, your body can experience insulin rejection, which makes it harder for your body to process sugars in your food. 

The operations described above seem pretty straightforward. The challenge is that when OSA is introduced into the picture, things fall apart quickly. Sleep apnea has been associated with higher than normal levels of ghrelin, which means you will be hungrier more often. Leptin levels tend to fall when you sleep poorly, which means you will not feel full as quickly. Insulin resistance also increases when you don’t get enough sleep, and higher levels of insulin resistance are also associated with lower leptin levels. 

From this quick description, you can see the dangerous loop of weight gain sleep apnea can produce. When you sleep poorly you are less likely to exercise, and your body is literally giving you all the wrong signals about how much you should be eating. If you spend your days fighting to curb your cravings in an effort to lose weight, it could be that OSA is working against you while you try to sleep.

Exercise and Sleep Apnea

Physical activity is one of the most important parts of any weight loss plan, as well as an important step toward keeping a healthy weight throughout your life. This is one of the sneakier ways OSA causes weight gain. By not being able to get good sleep at night, many people who suffer from OSA find they fall victim to very low energy levels during the day. For some sufferers, the thought of getting through their daily activities may seem like a long shot, let alone trying to add exercise in the mix. 

Of all sleep apnea symptoms, this may be one of the most frustrating for people, particularly if they had been more active in the past before putting on weight. Thankfully, CPAP therapy has been shown to be very effective at helping people recover the energy they need as they overcome sleep problems caused by OSA. This can increase physical activity and help people regain a quality of life that may have been lost. 

Can a CPAP Machine Stop Sleep Apnea?

If you have been diagnosed with weight gain related to obstructive sleep apnea, you can’t cure your condition overnight. As wonderful as it would be to shed pounds instantly, that isn’t really an option. So, what can you do while you are working to bring your body weight down?

Thankfully, one of the most effective treatments for OSA is a readily available machine called a continuous positive airway pressure or CPAP machine. This machine, consisting of a pumping unit, hose, and face mask you wear while you sleep, pushes a flow of extra air into your airway while you sleep. This extra pressure helps keep your upper airway open, preventing the sleep deprivation that happens when your body has to wake you up constantly to get a fresh flow of oxygen. 

Can a CPAP Help You Lose Weight?

It is possible that a CPAP machine, when properly used, can help you get a better night’s sleep if you are suffering from sleep apnea. This, in turn, can help your body rebalance the levels of hormones that regulate hunger, which can help you curb cravings. Getting better sleep will also help you stay more active during the day, which can help you burn more calories. 

CPAP machines are not quite a silver bullet for OSA, but they are very effective for the majority of people who try them. There can be some discomfort associated with wearing a mask while you sleep, particularly during the initial adjustment period when you start using a CPAP. Despite this potential hurdle, many people begin to get better sleep within the first couple of nights after they start using one of these machines. 

If you begin CPAP therapy for your OSA, the effect on hormone levels in your blood will be almost immediate. Within 48 hours of starting to sleep with a CPAP, many sleep apnea patients have been found to experience a return to normal levels of ghrelin, leptin, cortisol, and other hormones that were out of balance due to their disturbed sleep habit. Daytime sleepiness and other side effects also begin to fade, and management of glucose levels in your blood begins to stabilize as well. Soon, energy levels begin to rebound as your body heals from the stress of OSA.

Risks of Sleep Apnea

Heart failure is a genuine risk for individuals suffering from OSA, especially as you get older. The repeated stress on your heart caused by your body having to jump-start you several times a night in your sleep can eventually begin to wear on your cardiovascular system. This negative effect is only increased by hypertension, type 2 diabetes, and other conditions, which are commonly observed in obese patients. 

All of this is only compounded by the fact that your body heals more slowly when you are not getting good sleep. Chronic inflammation, another condition highly correlated to several major diseases, is also more prevalent in people who have OSA. Everything from heart disease to liver troubles have been found to be compounded by inflammation. If you are already in a higher risk category for heart disease thanks to your weight, adding inflammation to the mix will only make things worse. 

Treatment of Obstructive Sleep Apnea

Treatment for OSA begins with getting a proper diagnosis. Simply being overweight and feeling lethargic during the day is not a guarantee that you have OSA. Snoring, especially if it follows a certain pattern associated with OSA, can be an indication your airway is being obstructed. Talking to your doctor, and possibly getting referred to a sleep study clinic, can take the guesswork out of a possible diagnosis. Once you have been diagnosed with OSA, your treatment will almost certainly involve at least testing out a CPAP machine to see if that can alleviate your symptoms while a longer-term solution is put in place.

If it turns out your sleep apnea is related to being overweight, losing pounds will become a high priority. Dropping weight to stop snoring may not sound like a life-or-death endeavor, but it is important to remember the very real risks of cardiovascular disease associated with OSA. Making sure you get an effective, long-term weight loss solution in place is going to be essential to helping ease the symptoms of your OSA.

Follow-up appointments for OSA are sometimes needed, but usually the management of your symptoms is sorted out very quickly once you start using a CPAP machine. From there, the focus is going to turn to what caused your OSA in the first place. In a minority of cases, this could involve addressing structural issues in your neck such as enlarged tonsils. For the vast majority of OSA sufferers, after beginning CPAP therapy, the focus turns to weight loss. 

As important as it is to lose weight, making sure you do it in a safe, planned manner that will help you find the freedom of a lifetime of healthier weight is imperative. For some people, this means simple lifestyle changes. For others, it may mean a medical nutrition therapy program where you can work with a team of professionals to help you come up with and execute a weight loss plan you can stick to. For a smaller number of people, losing weight and keeping it off may even mean a weight loss surgery or minimally invasive procedure. These may sound like drastic measures, but getting a good night’s sleep is about more than just feeling fresh in the morning.

Losing Weight for the Long Term

Weight gain or excessive body weight is one of the strongest predictors of OSA. The good news is this means losing weight is the single best thing you can do to help find relief from your sleep apnea. Getting started on CPAP therapy can help alleviate your symptoms in the short term, but long lasting relief from the dangers of OSA can often only come about by losing weight. 

If you have struggled to lose weight over the course of your life, it may not initially be encouraging to hear that weight loss is the answer for many cases of OSA. Thankfully, even if you have found that diet and exercise alone have not been enough to bring about lasting weight loss, there are still options available. 

At True You Weight Loss, we are dedicated to helping people find the freedom from excess body weight. Often when people think exercise is no longer producing the results they need, it can seem like drastic measures such as gastric bypass surgery might be the only option left. Thankfully, we provide many other options that are lower cost, have fewer dangerous side effects, and in some cases are even reversible. 

Even if you haven’t been diagnosed with OSA, there is no reason to wait to experience the freedom of life at a healthy weight for your body. If you have been diagnosed with OSA or other sleep disturbances, that could mean you are already fighting an uphill battle against your own hormones, and it is time to get all the help you can to get a weight loss plan in place. Whatever your current situation, request a consultation today to find out what True You Weight Loss can do for you.

Dr. Christopher McGowan
Dr. Christopher McGowan

Dr. Christopher McGowan, MD, a leader in endobariatrics, specializes in non-surgical obesity treatments and is triple-board-certified in Internal Medicine, Gastroenterology, and Obesity Medicine. Renowned for pioneering endoscopic sleeve gastroplasty (ESG) with over 2,000 procedures, his global influence and research contributions define him as a top expert.

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