Sleep apnea is the repeated interruptions in breathing during sleep. These interruptions, called apneas, can persist for several seconds and occur many times per hour. They cause disruption in the sleep cycle and a reduction in oxygen levels in the blood. The main symptoms of sleep apnea are loud snoring, chronic daytime fatigue, gasping for air during sleep, and morning headaches. If left untreated, it can cause a cascade of health issues, affecting both physical and mental well-being.    

Sleep apnea’s cyclic relationship with weight gain is one of its most concerning aspects. Excessive weight is a potential risk factor for developing sleep apnea, which in turn makes it more challenging to maintain a healthy weight. This cycle represents a difficulty for people trying to treat both conditions.

In this blog, we will discuss the connection between sleep apnea and weight gain and talk about the effective strategies to break it, leading to an improved quality of life.

A. How Sleep Apnea Contributes to Weight Gain    

1. Disrupted sleep and hormone imbalance (e.g., ghrelin and leptin)    

Sleep apnea disrupts the sleep cycle, leading to poor-quality and fragmented sleep. This condition affects hormones that regulate hunger and satiety, such as ghrelin and leptin. Ghrelin, known as the hunger hormone, increases, while leptin, responsible for maintaining a balance between food intake and energy use, decreases. This imbalance causes increased appetite and a tendency to overeat, making weight management challenging.    

2. Decreased energy and motivation for physical activity    

Due to interrupted sleep, people with sleep apnea experience extreme daytime fatigue, leaving them exhausted. The lack of energy decreases the motivation to do any physical activity or exercise (an important step toward weight management). Hence, it sets into motion a cycle that is hard to break.    

 B. How Weight Gain Worsens Sleep Apnea    

1. Increased fat deposits around the neck and throat    

Increased weight, specifically around the neck and body, leads to excessive fat deposits in these areas. These deposits can narrow the airway, making it obstruction-prone while sleeping. This increases the severity of sleep apnea, causing more frequent and prolonged apnea.    

2. Greater risk of other health complications (e.g., diabetes, hypertension)    

Weight gain is also associated with a higher risk of developing comorbid conditions such as hypertension and diabetes, which can worsen sleep apnea. Moreover, diabetes can lead to neuropathy, affecting the nerves that control breathing, whereas hypertension increases the strain on the cardiovascular system. These conditions not only aggravate the symptoms of sleep apnea but also make its management more complex.

A. Types of Sleep Apnea

1. Obstructive Sleep Apnea (OSA)

It occurs when the muscles at the back of the throat relax excessively during sleep, causing a temporary airway blockage. This results in repeated episodes of cessation in breathing (apnea) or shallow breathing (hypopnea) throughout the night. These episodes lead to reduced levels of oxygen in the blood and frequent awakenings, causing a disruption of the sleep cycle.    

2. Central Sleep Apnea (CSA)    

CSA is less common and involves brain failure to send proper signals to breathing muscles, and there is no physical blockage of the airway. Instead, it is the issue of the CNS to regulate breathing. People with CSA experience periods of no breathing or reduced breathing efforts during sleep. CSA is often associated with underlying medical conditions such as stroke, heart failure, and the use of certain medications.    

B. Causes of Sleep Apnea    

1. Physical obstructions (e.g., enlarged tonsils)    

Many physical factors can lead to the development of sleep apnea. Enlarged tonsils or adenoids, particularly in children, can obstruct the airway during sleep. Other anatomical features, such as a thick neck, small jaw, or deviated septum, can also increase the likelihood of airway obstruction.    

2. Neurological factors    

Neurological factors primarily cause CSA. Stroke, neurodegenerative diseases, brain tumors, and other conditions that affect the ability of a brain to control breathing can lead to CSA. Furthermore, some medications that depress the CNS system, like opioids, can also interfere with normal breathing patterns during sleep.    

C. Symptoms and Diagnosis    

1. Common symptoms (e.g., snoring, daytime fatigue)    

The systems of sleep apnea may vary from person to person but commonly include choking or gasping during sleep, loud snoring, and frequent awakenings. Individuals with sleep apnea often experience excessive daytime sleepiness, difficulty in concentration, irritability, and morning headaches. These symptoms arise from repeated interruptions in sleep followed by a reduction in sleep quality.    

2. Diagnostic methods (e.g., sleep studies, Polysomnography)    

Diagnosing typically involves a comprehensive medical history, physical examination, and diagnostic tests. Polysomnography is a test to diagnose sleep apnea (a thorough sleep study conducted in a sleep lab). This test checks for many physiological parameters such as Brain activity, heart rate, blood oxygen levels, eye movements, and breathing patterns. On the other hand, there are home sleep apnea tests that are less detailed but more convenient. These include measuring airflow, blood oxygen levels, and breathing effort while the person sleeps at home.    

Breaking the Cycle: Strategies and Solutions    

 1. Continuous Positive Airway Pressure therapy

CPAP is considered an effective sleep apnea treatment. It is a non-invasive therapy that involves wearing a mask over the nose and/or mouth during sleep. Meanwhile, the CPAP machine delivers a continuous stream of air, keeping the airways open and preventing apnea episodes. Consistent use of CPAP can improve sleep quality and reduce daytime fatigue. Over time, hormone levels will start to produce in proper amounts, leading to weight management as well.    

 2. Surgical options (e.g., Uvulopalatopharyngoplasty or UPPP)

Individuals who cannot go through CPAP therapy or do not experience sufficient improvement can consider surgical options. Uvulopalatopharyngoplasty is a procedure that removes excess tissue from the throat to widen the airway. Other surgical interventions might include enlarged tonsils or adenoid removal.    

B. Lifestyle Changes

1. Weight loss through diet and exercise 

Achieving a healthy weight is essential in breaking the cycle of sleep apnea and weight gain. It can be achieved through a balanced diet rich in fruits, vegetables, lean proteins, and whole grains. Moreover, making physical activities like aerobics and strength training a part of the daily schedule can enhance weight loss efforts. Weight loss reduces fat deposits and leads to a decrease in the severity of sleep apneas, making a positive feedback loop that further facilitates weight management.    

2. Sleep hygiene practices (e.g., consis The connection between sleep apnea and weight gain 

tent sleep schedule, sleep environment)    

Improving sleep hygiene can improve sleep quality and support overall health. Developing a consistent sleep schedule by going to bed and waking up at the same time every day helps to regulate the body’s internal clock. Furthermore, creating a sleep-conducive environment improves sleep quality. Avoiding taking stimulants (caffeine) and using electronics (mobile phones, PCs, and laptops) before bedtime can also help in getting proper sleep.      

C. Behavioral and Supportive Therapies    

1. Cognitive-behavioral therapy (CBT) for sleep issues    

CBT is a highly effective treatment for dealing with sleep issues and promoting better sleep habits. Cognitive-behavioral therapy for insomnia (CBT-I) helps people identify negative thoughts (contribute to sleep problems) and work on them. CBT-I can help mitigate the effects of sleep apnea by improving sleep quality and reducing insomnia.    

2. Support groups and counseling    

Participating in support groups and counseling can offer emotional and practical support for people dealing with sleep apnea and obesity. In support groups, people with similar issues share their experiences and how they have managed to overcome a condition and help lift other’s spirits. On the other hand, counseling on behavior change and stress management helps people develop healthier habits and ultimately achieve better outcomes in both sleep and weight management.    

Conclusion:

All in all, sleep apnea disrupts the sleep cycle, leading to poor-quality and fragmented sleep. Sleep apnea’s cyclic relationship with weight gain is one of its most concerning aspects.  Hormones that regulate hunger and satiety get affected as well, such as ghrelin increases while leptin decreases. For diagnosis, there is a definitive test called Polysomnography, and many home sleep apnea test options are also available.

There are many strategies to treat sleep apnea, such as CPAP therapy, which is one of the most effective sleep apnea treatments. However, individuals who cannot go through CPAP therapy can consider surgical options such as UPPP.