The Importance of Weight Management/Loss With Successful Apnea Treatment

Long term weight loss can have a significant impact on patients suffering from  obstructive sleep apnea (OSA), a common but serious sleep disorder. Weight maintenance is also of importance when considering long term success of apnea treatment, especially with oral appliance therapy  (sleep mouthguards).

In this article, we will be sharing information on the relationship between weight changes after successful obstructive sleep apnea treatments as well as perspective on the best long term weight maintenance strategies.

The majority of obstructive sleep apnea (OSA) patients are overweight. For these individuals, weight loss can have the following impact:

• Some patients with mild apnea may be cured.
• For individuals heading towards OSA or who have upper airway resistance syndrome (UARS), losing weight can decrease the risk for both conditions. Patients with UARS often exhibit apnea-like symptoms with sleep disruptions but without being classified as having apnea due to mild sleep testing results.
• Patients with moderate to severe OSA can result in a decreased severity of their condition.
• Some apnea patients who have found partial success with oral appliance therapy may get even better results should weight loss continue.
• Patients who have been using CPAP may be in a position to lower pressure settings which can improve CPAP comfort and compliance.

Unfortunately, many patients often continue to gain weight after successful apnea therapy, even though controlling apnea events helps regulate hormones that are involved in weight control and metabolism cycles. For information on hormone effects of untreated apnea affects see 4 Ways Sleep Apnea Affects Weight Loss Efforts.

Our American lifestyle and access to processed foods makes weight loss efforts difficult. Obesity is expected to continue to rise in America, as is apnea.

Unfortunately, increased weight is one of the most significant predisposing factors for obstructive sleep apnea.  And as individuals continue to gain weight across America, more people will have apnea.

If apnea is treated successfully, what effect will FUTURE weight gain have?

For apnea patients, increases in weight may result in the need for higher therapeutic CPAP pressures. This, in return, can lead to mask leaks and lower compliance.

Lower compliance can result in a return of apnea symptoms such as excessive daytime sleepiness, poor sleep quality, and snoring which had been relieved through earlier CPAP use.

Although CPAP therapy is a highly effective treatment choice for OSA, many people prefer to turn to oral appliance therapy, a common treatment alternative for apnea sufferers.

Most successful oral appliance therapy patients use custom dental mouth guards called mandibular advancement devices (MAD). The MADs work by advancing and stabilizing the jaw in a forward position. Muscles and tissues are prevented from collapsing into the airway, preventing the obstructive apnea events from occurring.

For patients who are successful with oral appliance therapy, weight gain may lead to a return of apnea events and associated symptoms and cause the dental sleep mouthguard to be less effective or simply not work.

Should this occur, the dental sleep apnea mouthguard would need to be further advanced. However, a lower jaw (mandible) can be advanced only so far without discomfort. This limiting factor can lead to treatment failure.  These patients may then need to stop oral appliance therapy, turn to CPAP therapy as a primary treatment choice or seek adjunctive therapies.

Maintaining or ideally improving your BMI to a healthier zone is imperative for long term sleep apnea treatment success, and HEALTH!

Body mass index or BMI is a way to help you figure out if you are at a healthy weight for your height. The BMI chart or calculator calculates a number range based on your weight and height. In general, the higher the number, the more body fat a person has. The BMI screening chart is often used to decide if your weight might be putting you at risk for health problems such as heart disease, diabetes, and cancer.

For many health experts, the BMI is not a perfect system for analyzing health for several reasons. BMI does not take into account gender differences nor adjust for athletic composition of muscle-fat ratios.Your calculated BMI index should be used ideally as a screening tool only.

To calculate your BMI and to read more on BMI see: American Cancer Society BMI Info:

It is not uncommon for an individual to have several medical visits to tackle sleep issues. During a patient’s journey through medical appointments, they have often been told to lose weight as part of the treatment recommendation to ‘reverse’ apnea or curb the severity.  But rarely do medical providers give patients specific direction as to the “how” of losing weight Those who struggle with weight know that “Eat healthier food and exercise more”  is not enough to help them on their journey to better health.

Admittedly, this is not an easy task for medical providers. There are many reasons for such little guidance. These may include a lack of nutrition and weight loss training in the medical field, time restraints during medical visits, and lack of a consensus of recommendations. Medical doctors have very little training in nutrition as they focus the majority of their time on disease management.

I personally feel that we as health leaders need to take a more proactive role in helping patients find tools and resources that discourage fad diets and encourage healthy life habits.

Patients with continued weight loss struggles often display ‘obstacle oriented’ thinking:

• “Because of my shoulder, my back, and/or my hip I can’t exercise or move like I used to.”
• “Healthy eating is hard.”
• “Healthy eating costs too much.”
• “I gain weight easily whenever I eat carbs.”
• “Weight issues run in my family’s genetics.”

An eventual painful trigger instigates these individuals to take action.  Often, individuals turn to diet fads thinking the guidance and details will help them and remove the feelings of being overwhelmed. The promises of timed weight loss are even more appealing to our impatient culture. But eventually, a life event or too much stress occurs, and we return to our old habits until the next trigger gets us to seek another weight loss effort.

Many of us who struggle with weight issues have bounced around the yo-yo weight loss cycle. Rarely do we find peace and long term maintenance with dieting.

Where do I begin my new path to health?

Most weight management and health educators would agree that the first place to start on a path to a healthier weight needs to occur in changing our mindsets.

I love this quote from Elizabeth  Benton, a healthy lifestyle influencer and nutritionist,

“Your state of mind either creates success and new opportunities and seeks progress, or  it instructs you to repeat past patterns and remain where you are.”

To listen to Elizabeth Benton discussing more on overcoming limiting beliefs see Primal Podcast Episode 571.

Here are some samples of positive, actionable statements that can replace the negative mindset self-talk:

• What can I do to help me drink more water throughout the day?
• What’s one thing I can focus on this week to help me eat out less this week?
• I can’t wait to try some healthy recipes that have my favorite foods in them.
• I will research affordable, quick and tasty, healthy recipes for this weekend.

Changing your mindset and focusing on small incremental changes in lifestyle choices can help lead to small wins that can be celebrated and built upon. Eventually, long term weight loss results as a byproduct of these habits and weight MAINTENANCE becomes EASIER.

According to Karen R. Koenig, author of The Rules of “Normal Eating,” to reprogram our thoughts and mindset through Behavioral – Cognitive Therapy (CBT) beliefs, emotions and behaviors interact.

“Simply put, your beliefs, whether conscious or unconscious, determine your feelings and behaviors. Change your beliefs, and your feelings and behaviors will be altered.”

Why do healthy lifestyle habits trump dieting?

The focus of an upcoming article is to highlight individual role models who have not only overcome major weight loss but have maintained a healthier weight for years.  In all of these individuals, their success involved a shift in mindset followed by small incremental changes in habits and choices, not fad diets.

All of them did share their long history of successful dieting, but all of their dieting efforts led to a return of their weight, plus added pounds, and years of yo-yo dieting, like most of us stuck in this world.

Most diets aim to restrict or eliminate your favorite foods. This, in turn, leads to feelings of deprivation. Maintaining something long-term is difficult when you are feeling deprived and often completely cutting out some foods you love. Eventually, you reach for “that food”, feel some shame in “falling off the wagon”, and the downward spiral begins.

I’m the first to say; diets didn’t work for me. I have tried many diets over the course of decades including Atkins, Whole 30, Weight Watchers, and even a low carbohydrate physician-assisted program.  Unfortunately, I too shifted my weight up and down.

All of the weight loss maintainers I have studied had some things in common on their journey:

• They chose not to deprive themselves of their favorite foods.  Instead, they learned how to successfully integrate these foods into their lives while NOT feeling deprived.
• They chose NOT rush the process and put deadlines on themselves.
• They not only tolerated the path, but they also found excitement and even enjoyment along the way.
• They made decisions based on “Can I maintain this choice the rest of my life?”
• More on these influencers: Interested in Stopping the Yo-yo Dieting Cycle? Read: The Rules of “Normal” Eating

 

Where is the best place to focus first on healthy habits? Food or exercise? Or Both?

Often, when I bring up weight issues for long term maintenance, the 1st thing that many patients bring up is their obstacles to movement and exercise.

But a resonating factor that also became apparent with studying long term weight loss maintainers and educators: eating habits greatly outweigh exercise efforts, especially early on in creating new habits. We simply cannot exercise enough to compensate for poor eating habits. So let’s stop beating ourselves up and not focus on too many changes at once.

Elizabeth Benton, the author of Chasing Cupcakes, brings up a great analogy when people decide to plunge into a weight loss diet program: people ditch all the foods they are used to having, and buy supplies of “foreign” foods or whatever ingredients may be highlighted in the program. They then hit the gym often overdoing it, they limit their food intake and let’s not forget the purchase of supplements and other products.

Would the average person ever consider learning five languages at once, or would it not be better to learn one solidly, then move on? When individuals try too many radical changes, they eventually become overwhelmed, feel deprived, give up and return to their bad habits.

More to Come:

I have become particularly intrigued not only for myself but how to help patients find their way towards a healthier life and weight. So let’s start changing our mindsets, and make small lifestyle and eating changes. Let’s not forget to celebrate the small wins along the way also. ‘Normal eating’ mindset and patterns can be learned.

Are you interested in what changes several long term maintainers instituted that lost 50 to over 175 pounds and kept it off for years? You may be surprised. Stay tuned to an upcoming article as I turn to the podcast community. Why podcasts? You will have to see them too:-)

Recommended reading: The Rules of “Normal” Eating Karen R. Koenig

Other Helpful Articles:

• 4 Ways Sleep Apnea Affects Weight Loss Efforts
• Stop Dieting and Shift to “Normal” Rules of Eating
• Sleep Apnea 101
• The book review of The Rules of “Normal” Eating

References:

1. Romero-Corral, A., Caples, S. M., Lopez-Jimenez, F., & Somers, V. K. (2010). Interactions between obesity and obstructive sleep apnea: implications for treatment. Chest, 137(3), 711-719.
2. Patel, S. R. (2015). The complex relationship between weight and sleep apnea.
3. Redenius, R., Murphy, C., O’Neill, E., Al-Hamwi, M., & Zallek, S. N. (2008). Does CPAP lead to change in BMI? Journal of Clinical Sleep Medicine, 4(03), 205-209.
4. Hales, C. M., Carroll, M. D., Frayar, C. D. & Ogden, C. L. (2017). Prevalence of Obesity Among Adults and Youth: United States, 2015–2016. CDC Stacks.