Sleep apnea and obesity are often seen together, but does sleep apnea cause weight gain or does weight gain cause sleep apnea? It turns out, it’s both.
You’re much more likely to develop sleep apnea if you’re overweight, but the disorder itself can contribute to weight gain, creating a vicious circle. But research shows losing weight is possible with sleep apnea, and it can help to improve the sleep disorder.
Below, we’ll dive into the link between sleep apnea and weight gain and share how you can stop the disorder’s related conditions, like sleep deprivation and circadian misalignment, causing additional weight gain.
Sleep apnea is a sleep disorder that causes you to stop breathing temporarily in your sleep. The muscles at the back of your throat relax, closing your airways, stopping you from breathing for 10 seconds or longer. Your brain eventually detects low oxygen levels and wakes you up, kick-starting your breathing again.
You may notice this as you wake up gasping for air, or you may not even know you’re waking up slightly before falling back to sleep again.
Sleep apnea episodes can happen more than 30 times an hour, leading to some serious sleep deprivation and health consequences.
There are three types of sleep apnea:
Obstructive sleep apnea is the most common, most researched, and what most people mean when they just say sleep apnea. We’ll be referring to obstructive sleep apnea as sleep apnea from here on out.
Sleep apnea symptoms include:
We’ve covered how you can know if you have sleep apnea in more detail here.
Sleep apnea can lead to serious medical conditions such as:
Being overweight is a risk factor for sleep apnea. In fact, the prevalence of sleep apnea in obese or severely obese people is nearly double that of healthy-weight adults.
Having excess body weight has been linked to sleep-disordered breathing, and losing weight can improve the condition, but it’s not a simple bidirectional relationship. The benefits of an amount of weight loss are less than the adverse effects of the same amount of weight gain.
People with mild sleep apnea who gain 10% of their baseline body weight increase the risk of progression of the sleep disorder by six times. But losing 10% could result in a about 20% improvement in sleep apnea severity.
Obesity may be linked to sleep apnea because fat deposits in the upper airways, making them narrower and more likely to collapse. Fat can build up in the thorax, or chest area, reducing how well you can breathe. And fat may also build up in the tongue, making it heavier and more likely to block the airway.
Plus, there may be genetic factors at play that predispose someone to both obesity and sleep apnea.
One cruel thing about sleep apnea is that weight gain makes it worse, but the sleep disorder itself causes weight gain, creating a vicious circle.
Weight gain and sleep apnea are so closely linked that recent weight gain may be a sign of the sleep disorder.
A 2019 study also found that adolescents with sleep apnea put on much more weight each year than adolescents without the sleep disorder. The researchers concluded: “The rate of weight gain over time is an important predictor of severe OSA in obese adolescents.”
Sleep apnea can cause daytime sleepiness, leaving people with less energy and motivation to hit the gym or do much exercise. It can also increase appetite, especially for refined carbohydrates. Experts are still discovering the relationship between the sleep disorder and weight gain, however.
Here are a few things that are at play when it comes to sleep apnea and weight gain.
Not getting enough sleep is linked to weight gain for a few reasons. Firstly, sleep deprivation causes imbalances in our hunger hormones. Your levels of ghrelin, the hormone responsible for making you feel hungry, rise, while leptin, the hormone responsible for making you feel full, falls.
Your self-control takes a hit when sleep deprived, as does the hypothalamus region of your brain, which plays a role in appetite regulation and energy expenditure. Plus, the endocannabinoid system is affected by sleep loss, and this also plays a role in appetite and the reward centers of your brain.
All this is a recipe for overeating, craving junk foods and processed foods, and not having the self-control to stick to a healthy diet.
When it comes to burning calories when sleep deprived, you have less energy to work out, and your resting metabolic rate — the rate your body burnings calories when completely at rest — goes down.
All this happens when you don’t meet your sleep need, which is the genetically determined amount of sleep you need each night. Contrary to popular belief, it’s not simply eight hours for everyone.
One study suggests the average sleep need is 8 hours 40 minutes, plus or minus 10 minutes or so, but 13.5% of the population may need 9 hours or more sleep a night.
To take the guesswork out of it, turn to the RISE app. The app uses your phone use behavior and proprietary sleep-science-based models to work out your sleep need down to the minute.
RISE users on iOS 1.202 and above can click here to view their sleep need.
We dive deeper into the sleep and weight connection here.
So, sleep apnea may cause weight gain through all of these methods because of how much sleep deprivation it causes. Remember, you could be waking up more than 30 times an hour, losing out on much more sleep than someone without sleep apnea would, even if they had poor sleep.
Sleep apnea may cause weight gain through more than just making you sleep deprived, though.
For example, one study found those with sleep apnea may have higher levels of leptin, which causes their bodies to become resistant to it. This means the hunger-stopping hormone doesn’t work and may lead to you overeating, and therefore gaining weight.
While leptin resistance has been seen in obese patients, meaning sleep apnea may not be acting alone on the hormone, the study found higher leptin levels in those with sleep apnea independent of body fat content.
Sleep apnea has also been linked to metabolic dysfunction, and it may cause it either through sleep deprivation or through the disorder itself. Those with the sleep disorder can have increased insulin resistance and glucose intolerance, which can lead to type 2 diabetes, weight gain, and the body storing more fat, especially belly fat.
Sleep apnea may cause metabolic dysfunction through a few different pathways. Sympathetic activation happens with each sleep apnea episode, which is when your sympathetic nervous system switches on, just like when you’re scared or angry. This activation can increase levels of circulating free fatty acids and promote insulin resistance.
Increased catecholamine levels, hormones released when stressed, are seen in people who are awake longer after they’ve initially gone to sleep. And the broken sleep, repeated low oxygen levels, and triggering of inflammatory cytokines, or proteins, each night may make those with sleep apnea more prone to metabolic syndrome — which includes hypertension (high blood pressure), type 2 diabetes, and obesity.
However, some of these pathways may be caused by the sleep deprivation and circadian misalignment (more on this soon) that sleep apnea causes.
CPAP, or a continuous positive airway pressure machine, is a device people with sleep apnea can wear at night. It continuously pushes air into your airways, keeping them open. It’s often the first-line treatment for sleep apnea.
On the surface, it sounds like it could help patients lose weight. CPAP therapy has been shown to decrease the number of sleep apnea episodes from about 29 an hour to 3.7. It can also help to decrease daytime sleepiness. This would, in theory, give people more energy to work out and they’d be less susceptible to the weight gain that sleep deprivation causes now they’re waking up less often during the night.
An uncontrolled study suggested CPAP can lead to a small short-term weight loss. The researchers said this may be due to increased daytime energy levels leading to increased exercise and wearing the CPAP device could be a sign of commitment to treatment, which could be reflected in other efforts to lose weight.
Another small study found a link between weight loss from dietary intervention and CPAP adherence. This may show that those with personality traits like greater self-efficacy are more likely to stick to both diet changes and the sleep apnea treatment.
However, it’s now accepted that CPAP in and of itself doesn’t cause weight loss and it may even lead to weight gain. One study found sleep apnea patients using CPAP gained weight and those who were most compliant with CPAP gained the greatest amount. More research needs to be done, but one paper stated: “the findings strongly confirm that CPAP therapy for OSA produces a small increase in weight and definitely does not lead to weight loss.”
This may not be the case for everyone, though. One study found the body mass index (BMI) of women increased after a year of using CPAP, while there was no change in the BMI for men and non-obese participants.
It’s not clear why CPAP therapy causes weight gain. It could be due to the treatment causing a decrease in leptin levels, but not a change in leptin resistance, leading to increased hunger. CPAP may also lead to reduced energy expenditure during sleep as breathing becomes easier.
Either way, this research shows that weight loss therapies should be used in conjunction with CPAP when treating sleep apnea in those who are overweight or obese.
Despite the potential for weight gain, CPAP shouldn’t be avoided in most patients as the weight gained may be small. Plus, importantly, CPAP doesn’t make weight loss strategies less effective, so it can be used to manage the sleep disorder while you lose weight through other means.
The short answer is yes, weight loss has been shown to reduce the symptoms and severity of sleep apnea, and may even result in treating it completely.
Weight loss may be recommended as a treatment option alongside other sleep apnea treatments.
One study found one effect of weight loss was an improvement in participants’ sleep apnea. This was achieved through a cognitive-behavioral weight reduction program and a very low-calorie diet.
A paper on the topic stated: “The cornerstone of treatment of overweight patients must be weight reduction by lifestyle changes (healthy eating habits, food behavior therapy if needed and physical activity) and this should be the first-line treatment for all OSA patients. If necessary, bariatric surgery may represent an option in carefully selected patients who are severely obese.”
Bariatric surgery has been shown to significantly reduce how many sleep apnea episodes happen each night by about 38 an hour, but not cure it completely.
We’ve shown weight gain can lead to sleep apnea and make it worse, and sleep apnea can lead to weight gain.
And weight gain from poor sleep can come from sleep apnea or sleep loss outside of the sleep disorder. But you can work to break the vicious circle by focusing on sleep debt and circadian alignment. Here’s what to do.
Sleep debt is the measure of how much sleep you owe your body compared to your sleep need. In the RISE app, we calculate it over your last 14 nights. The higher your sleep debt, the more prone to weight gain you’ll be.
By keeping sleep debt low, you’ll have more energy each day to enjoy life and to exercise and stick to a diet to aid weight loss and improve sleep apnea. Plus, you’ll be stopping high sleep debt itself adding to weight gain and improving your overall health.
You can find out more about how sleep debt contributes to weight gain here.
The good news about sleep debt is you can take steps to pay it back and catch up on lost sleep.
You can lower your sleep debt by:
RISE users on iOS 1.202 and above can click here to view their sleep debt.
Your circadian rhythm is your internal body clock. It runs on a roughly 24-hour cycle and dictates things like when you feel awake and sleepy and when your body produces certain hormones.
You might be out of sync with it if:
You can learn how being out of sync with your circadian rhythm leads to weight gain here.
To stay in sync with your circadian rhythm:
The RISE app can tell you the best time to get and avoid light, stop eating, and when your body naturally wants to go to bed and wake up to help you stay in sync with your circadian rhythm.
The app can also predict your natural energy peaks and dips each day. This way, you can schedule workouts to when you’ll have the most energy to do them. Exercise can not only help you lose weight, which is key to improving sleep apnea, but it may help to reduce sleep-disordered breathing even if you don’t lose weight.
RISE users on iOS 1.202 and above can click here to see their circadian rhythm.
Sleep hygiene is the set of healthy sleep habits you can do each day to help you fall asleep faster and wake up less often during the night.
Sleep hygiene is useful because:
The RISE app can help you improve your sleep hygiene by coaching you through 20+ behaviors each day. These range from getting bright light in the morning to avoiding coffee, alcohol, large meals, and light in the evening.
RISE will tell you the ideal time you should be doing these behaviors based on your circadian rhythm each day.
You can learn more about sleep hygiene here.
RISE users on iOS 1.202 and above can click here to set up their 20+ in-app habit notifications.
As we mentioned earlier, CPAP and weight reduction via lifestyle changes are the first-line treatments for sleep apnea. But there are other treatments out there, and you may be prescribed more than one to help you improve or manage your condition.
Sleep apnea treatments include:
You can learn more about how to get rid of sleep apnea here.
The sleep apnea and weight gain connection runs deep. Being overweight increases your odds of sleep apnea, and gaining weight can make the sleep disorder worse.
But sleep apnea can also cause weight gain, either through sleep deprivation or through the condition itself. All this creates a vicious circle of further weight gain and worsening sleep apnea.
As well as seeking treatment for sleep apnea, you can also work to keep your sleep debt low and live in sync with your circadian rhythm — two things that can assist with weight loss and stop you gaining additional weight.
Use the RISE app to find out how much sleep debt you have and what your circadian rhythm looks like each day so you can schedule your sleep, exercise, and meals to match. Plus, the app can guide you through 20+ sleep hygiene habits to help with both keeping sleep debt low and staying in circadian alignment, as well as making sure the sleep you do get with sleep apnea is the best it can be.
Yes, sleep apnea can cause you to gain weight, either through the sleep deprivation it causes, the treatment for the sleep disorder, or the sleep disorder itself. Gaining weight can also make sleep apnea worse, so it creates a vicious circle.
Yes, sleep apnea can make it difficult to lose weight as the disorder itself, the sleep deprivation it causes, and the treatment may cause you to gain weight. However, low-calorie diets and cognitive-behavioral programs have been shown to help those with sleep apnea lose weight and improve the severity of the sleep disorder.
Treating sleep apnea may help you lose weight as the treatment can help you get more sleep overall each night, and sleep deprivation can lead to weight gain. Treating sleep apnea can also increase your daytime energy levels, which can help you exercise more.
Sleep apnea is caused by the muscles in your throat relaxing and your airways collapsing, cutting off your breathing while you sleep. It can be caused by being overweight. You’ll have an increased risk of sleep apnea if you have a large neck, smoke, drink alcohol, or have a health condition like diabetes or heart disease. Age, gender, and genetics also contribute to the risk of developing sleep apnea.
Sleep apnea can be treated through a CPAP machine, oral appliances, losing weight, exercising, surgery, and lifestyle changes like quitting smoking, reducing drinking, and sleeping on your side.
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