Feel miserable every time you wake up? Always tired? Partner mention that you sound like a Harley when you sleep or even look like you stop breathing once in a while? Obstructive sleep apnea is something I screen for in every patient that comes to my office. In North America, up to 30% of guys have it and around 15% of females have it. This is a pretty big deal because it can really make your life miserable.
As we gain excess weight, our risk for sleep apnea rises, which is why so many people have it now. What happens in obstructive sleep apnea is that your brain and body just don’t get enough oxygen during sleep. You’re pretty much choking while sleeping. This disrupts and fragments your sleep, leaves you feeling like hell, and puts you at risk for heart disease, stroke, and type 2 diabetes (among others). It is a big deal!
Signs and symptoms to look for:
- Snoring and/or gasping or choking while sleeping. Usually a partner will mention this.
- Wake up unrefreshed and/or with headaches?
- Big neck? (Males bigger than 17 inches and females bigger than 16 inches)
- Always tired during the day? Could you or have you fallen asleep at a stop light or in traffic?
- Have high blood pressure?
Guys tend to be at the most risk, but I see it regularly in women as well. Also for guys, I can’t count how many times I have seen patients diagnosed with “low testosterone” only to find out the underlying cause was their obesity and sleep apnea. Once we fixed those, their testosterone bounced back up to normal.
Sleep apnea may prevent you from losing weight
Losing weight can resolve sleep apnea (not all of the time). However, sleep apnea will cause you to feel like hell, and if you feel like hell, how the heck are you going to follow a good nutrition and exercise plan? It is truly a vicious cycle. Crappy sleep can increase appetite and potentially push us to make poor food choices. How do we break it?
I am a primary care family/obesity medicine physician. I screen for sleep apnea in all of my patients using the same questions above. If I have a suspicion, I send the patient to a sleep medicine clinic where the sleep doctor will likely perform a sleep study (polysomnography). This is generally done in their sleep clinic. You stay overnight where they watch you sleep (it’s not as creepy as it sounds haha). You will be hooked up to monitors to monitor your sleep and oxygen etc.
Sometimes you can do these tests at home, but you will want to discuss this with the sleep doctor to see if you are a candidate for that.
How to treat sleep apnea
If the sleep doctor determines you have sleep apnea, they will bring you back for another night and likely try you with a CPAP machine (Continuous positive airway pressure). Sometimes the sleep doctor will just stop in the middle of your first night in the sleep center and try the CPAP for the second part of the night. Either way, the CPAP machine helps you breathe by forcing air into you. With sleep apnea, your airways are closed off so the machine pushes through that and allows air to get to your lungs.
I have A LOT of patients who say they refuse to ever wear this machine. This is a big mistake. When I finally convince them to use it, their lives improve 100-fold. Their mood improves. They no longer feel like hell everyday. Most importantly, they now have the energy to follow a good diet and exercise program to potentially lose the weight and get off the machine in the future!
Weight Loss, Weight Loss, Weight Loss
The CPAP alone won’t likely lead to weight loss. It will make you feel better, which will allow you to actually follow a good nutrition and exercise plan, which will then lead to weight loss. Losing as little as 5% of your current weight can alleviate your sleep apnea. However, you will likely need to lose more than that to actually get off your CPAP machine. Sometimes folks cannot ever get off their CPAP machine, but this shouldn’t discourage you from trying since weight loss still helps a lot.
Mouth devices, sleep position, and surgery
Depending on your anatomy and severity of your sleep apnea, the sleep doctor may discuss using a mouth device that can help you open your airway while sleeping. Sleeping on your back and even alcohol can worsen your sleep apnea so be aware of that as well. It is also possible your sleep doctor will recommend surgery if you are the right candidate.