fitness and weight loss

Is Poor Sleep Making it Difficult to Lose Weight?

Just a while ago, I was invited to be a guest on the One Small Bite Podcast, with David Orozco – How to Snooze to Lose. David is a registered nutritionist who has been working on nutritional and healthy diet changes with clients for over a decade.

David and I met after his presentation at one of the American Academy of Dental Sleep Medicine’s (AADSM) annual meetings. The AADSM  is a highly respected professional  organization dedicated to the practice of dental sleep medicine and the treatment of breathing sleep disorders.

In this podcast, Episode 33: How to Snooze and Lose with Dr. Lydia Sosenko, we explained how individuals who suffer from poor sleep caused by obstructive sleep apnea (OSA), snoring, or upper airway resistance syndrome (UARS) often gain weight and have a difficult time losing weight.

We also emphasized how important oral appliance therapy can be in improving sleep.

The significance of nutritional choices as a primary factor in weight loss was also discussed.

Here are a few of the topics that we covered during the podcast interview……

What exactly is snoring?

Think of your air passageway as a pipe. When you’re sleeping, your jaw rests back.  Your tongue is attached to your lower jaw. With your jaw being shifted back, a bottleneck effect occurs which narrows your air passage.

Due to this narrowing, air pressure increases for the air moving up and down your airway as you breathe. That air pressure results in a vibration of soft tissue in the airway known as snoring.

To summarize, snoring occurs when the air moving through the narrow zone of your airway causes the tissue in your throat to vibrate.

What is obstructive sleep apnea?

During obstructive sleep apnea, the airway starts to become even more narrowed, to the point where it could close and breathing is interrupted.The narrowing of your air passage restricts airflow and causes dips in blood oxygen levels. That is when you reach the sleep apnea zone. 

Apnea is considered either when you pause or stop breathing in ten-second increments at a time. This occurs continuously throughout the night, at times up to 100 times or more an hour.

Lowered blood oxygen levels cause interruptions in your sleep cycle that ultimately lead to sleep deprivation. The lowered blood oxygen levels and sleep deprivation  lead to health-related issues, which can end up having severe consequences, and even be lethal.

Does sleep apnea affect overweight people more?

Obese people do have a higher chance of having apnea since they have a larger amount of tissue in their throats and airway passage. That leads to a narrower air passage and an increased chance of apnea events. However, other factors contribute to having obstructive sleep apnea such as increased age and certain ethnicities.

Also there is a “mechanical” component to OSA.  Individuals with certain ‘jaw types’ can have an increased chance of apnea.

Does obstructive sleep apnea lead to poor health?

OSA results in disturbed sleep, which in turn can get in the way of how the body functions. This gives rise to health issues like weight gain, diabetes, heart attack, stroke incidents, chronic sleepiness and depression.

OSA also has a strong connection with the development of type 2 diabetes in patients. When you are asleep, important hormone fluctuations are occurring in your body. During disrupted sleep as a result of OSA, how these hormones are released is disturbed. Your body thinks you are awake and dumps a load of glucose in your bloodstream. This causes your body to start dumping insulin in the blood as well and reabsorbing that glucose again. Your insulin levels are no longer being regulated, which is a cause for diabetes to occur.

Poor sleep leads to weight gain

In some patients, chronic sleep interruptions lead to immense tiredness in patients.  This in turn can lead to a lack of motivation in improving healthier life habits such as, making better nutritional choices, and increasing exercise levels.

Beneficial habits regarding healthy eating and exercise can seldom be at the forefront of people’s minds who are exhausted from poor sleep.

Additionally, during obstructive events, hormone fluctuations inadvertently occur, which creates problems in metabolism. This in turn can cause people to put on weight., and have difficulty losing weight.  

Ghrelin, the hormone that tells you that you are hungry is released in higher amounts during sleep deprivation including apnea patients. And on the flipside, leptin, the hormone that signals you when you are full is secreted in lesser amounts in apnea individuals. 

These hormone irregularities can lead to overeating and weight gain.

How to treat Snoring, UARS, and OSA

There are different approaches to treating poor sleep caused by snoring, apnea, and UARS. The two most common treatments are CPAP and oral appliances. 

Which is best for you will depend on your diagnosis (mild, moderate, severe) and symptoms Discussing all potential treatment options with a knowledgeable sleep medicine provider is crucial

The current standard of treatment care with oral appliances (dental retainers) include people:

  • who snore without apnea
  • who can’t use CPAP therapy
  • or for those who prefer an alternative to CPAP

What is CPAP?

CPAP is a (bed-side) breathing device. It consists of a mask and hose connected to a unit. The mask is worn over your nose/mouth and delivers pressurized air keeping your airway passage open. This forced pressure keeps the oxygen flowing in your windpipe preventing closures (apneas) and allows you to breathe freely.

CPAP devices are wonderful tools but many individuals find them cumbersome and impractical in some situations (travel destinations, airplane travel or preferred sleeping positions). 

Many apnea people are also CPAP intolerant. For this reason, I emphasize the importance of oral appliances therapy, which are medically approved and a convenient option with minimal side effects.

What are Oral Appliances?

Oral appliances are small devices that look similar to a sports mouthguard but are custom made for the patient. There are numerous types of oral appliances, but they all work by holding your jaw in a forward position and preventing the collapse of your airway. These devices are (worn only) during sleep. You simply insert them into the mouth when you are about to sleep. Oral appliance therapy uses dental retainers to prevent sleep apnea in patients.

It is important for people who receive dental devices to follow up with their dental and medical providers during and after treatment. The majority of oral appliance patients do get used to their devices fairly quickly, especially compared to CPAP therapy.

Do oral appliances always work?

Oral Appliances are effective appliances that will work approximately 70-80% of the time. In some cases, however, they may not. In these cases often there is just too much tissue around the airway, usually in heavier individuals.  In other cases, there could be apnea blockages lower and higher in the airway than the typical points where these devices tend to work

Another factor contributing to oral appliance success is how much the patient is able to naturally and comfortably move their jaw in a forward position.  Some patients have limitations in their jaw movement, which can affect the outcome. Other patients can move their jaw forward and back quite a bit, which often can positively affect oral appliance therapy outcome. 

Does insurance pay for oral appliance therapy?

Oral Appliances are not covered by dental insurance. Since sleep apnea is a medical condition, these dental devices are covered by medical insurance reimbursements.  Most major medical insurance companies will reimburse for oral appliances. Coverage often ranges from 50 % to 100 %.  Medicare currently also will pay in part for oral appliances, although there are some different parameters they review  for eligibility.

Preventing Weight Gain

We have established that poor sleep leads to weight gain, and then tackled how to prevent poor sleep. However, another issue arises when patients who use oral appliances successfully continue to gain weight and the device stops working. 

Many patients are excited when their sleep apnea dental devices work, but don’t work on changing their lifestyle habits. Unfortunately, they often gain weight over time and the device can become less effective. With weight gain, more tissue builds along the air passage and the tongue size increases. The oral appliance patient may not be able to advance their device comfortably to compensate for the narrower air passage. The device stops working as well.

These patients then may have no option then to go back to CPAP therapy, or make very conscious efforts to establish healthier habits and begin weight loss efforts.

Making Changes to Your Lifestyle

A conclusion that David and I have come to concerning weight loss is that in order to be successful, our clients need to shift the way they think about weight loss. It is important to stick to a mindset of small changes over time, incorporating healthy eating into your lifestyle. Increasing the amount of exercise you do, but having a poor diet, will not solve the weight gain problem.

Through focused research on long term weight loss maintenance, here are a few facts that were discussed. 

One thing in common for individuals who manage to lose substantial weight (and keep it off) involves making small changes to their eating habits and lifestyle. These successful maintainers did not make drastic changes or opt for a 180-degree turn by getting rid of all their favorite foods and starting a huge exercise program. People who stick to a mindset of small changes over time are the most successful. A restrictive approach, where you try to eliminate the food you love, often fails because it leads to feelings of deprivation. These feelings force you to reach out for that very food, urging you to fall into a downward spiral, and feeling like a failure. Instead, take it slowly and don’t be too harsh on yourself. Some days,  it’s okay to have that brownie or slice of pizza, better yet plan for them in advance.

Today’s 3 Takeaways

The dangers of snoring, OSA, and UARS can lead to profound issues in sleeping habits, which can lead to health issues and weight problems. If someone in your family is concerned about sleep or is complaining about snoring, it is important to get a sleep evaluation. Sleep tests may be conducted at a sleep center or in your home, depending on your overall medical health and insurance coverage. A diagnosis can help point you to correct treatment.

Additionally, unexplained constant tiredness or fatigue may be a sign of an underlying sleep disorder. Patients with depression symptoms also may have underlying sleep disorders. You may benefit from a sleep evaluation If you suffer from either of these symptoms.

Lastly, if you are CPAP intolerant, take the time to find a solution that works for you. There are alternative options to CPAP.

To find a dentist who is educated in dental sleep medicine and oral appliances, visit the American Academy of Dental Sleep Medicine website. Finding a sleep treatment solution that works for you can be life-changing. Focusing on healthy lifestyle changes can add to the success of any treatment chosen.  

If you want to know more about what was discussed, visit Episode 33: How to Snooze and Lose with Dr. Lydia Sosenko.

I would love to know what small changes you have made in your lives with regards to losing weight! What is your opinion on the takeaways that David and I discussed on the podcast?

I really appreciated being a guest on the One Small Bite Podcast. Thank you for taking time out of your day to discuss these important issues with me, David! 

You can follow David’s podcast at One Small Bite Podcast – he regularly uploads informative episodes on a diverse range of topics regarding nutrition and a healthy lifestyle. He also conducts one on one Telehealth sessions for people who need a tailored plan to help them adhere to sustainable health and weight choices. In order to learn more about David, you can browse his website at TD Wellness.

This article is general in nature and for educational purposes only. Please consult with your sleep health provider before starting any treatment option for snoring and apnea.