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Sleep Apnea and Weight Gain: Understanding the Complex Relationship

Written by Andrew Le, MD

UpdatedNovember 28, 2023

Sleep apnea and weight gain have a complex, intertwined relationship. Obstructive Sleep Apnea (OSA) is the most common type of sleep apnea. While excess weight is a significant risk factor for developing OSA, the condition can also lead to weight gain. This bidirectional relationship creates a vicious cycle that can be challenging to break.

Losing weight can help break this vicious cycle, significantly reducing many OSA-related symptoms. Reducing weight decreases daytime sleepiness and irritability, leading to a marked improvement in other neuropsychiatric dysfunctions.

In this article, you will learn the relationship between sleep apnea and weight gain, the health impacts, and effective management strategies to alleviate this dual burden. By understanding how these two conditions perpetuate one another, steps can be taken to halt the cycle and improve health.

🔑 Key Takeaway

  • Sleep apnea disrupts sleep. It leads to hormonal changes, reduced energy expenditure, and metabolic dysfunction, which can all contribute to weight gain.
  • Excess weight, especially fat deposits in the neck and abdomen, is a significant risk factor for sleep apnea by obstructing breathing during sleep.
  • Both sleep apnea and obesity negatively impact cardiovascular health by increasing risks for hypertension, heart disease, stroke, and diabetes.
  • Treating sleep apnea with CPAP can improve sleep quality and symptoms like daytime fatigue but may not directly lead to weight loss.
  • Losing as little as 10% of body weight through dietary changes, exercise, or bariatric surgery can significantly reduce the severity of sleep apnea.
  • A combination of weight loss and sleep apnea treatment is most effective at breaking the vicious cycle between the two conditions.
  • People with obesity should be screened for sleep apnea for early diagnosis and management of both conditions.
Illustration of a healthcare provider asking questions on a smart phone.
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A personalized GLP-1 medication program (eg. Wegovy, Ozempic), delivered to you via our partner Korb Health
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  • Free consultation; program starts at $269/mo
  • Checkmark Inside Circle.Customized online program and wellness coaching
  • Prescription medications and supplies shipped to your door

What is Sleep Apnea?

Sleep apnea is a potentially severe condition marked by episodes of interrupted or shallow breathing during sleep, leading to pauses or disruptions in breathing that result in frequent arousals and fragmented sleep. This condition can result in a range of health issues, including:

It's important to note that severe sleep apnea significantly raises the risk of sudden cardiac death, highlighting the urgency of diagnosis and treatment.

Sleep apnea is categorized into three main types: central sleep apnea, OSA, and complex sleep apnea.

Central sleep apnea is associated with the brain failing to signal the muscles to breathe. It often results from serious illnesses or medication side effects.

OSA, affecting nearly 30 million Americans, is characterized by partial or complete airway blockage during sleep, leading to symptoms like:

  • Snoring
  • Choking
  • Gasping for air

Lastly, complex sleep apnea occurs when central and obstructive sleep apnea are combined.

Risk Factors for Sleep Apnea

Various factors can increase the risk of developing obstructive sleep apnea, including:

  • Gender (with males being more susceptible)
  • Older age
  • A large neck circumference
  • Smoking
  • Alcohol or sedatives

However, excess body weight is one of OSA's most significant risk factors.

📓 Excerpt

“People often think that obstructive sleep apnea is not a big deal and just a nuisance. On the contrary, it can increase your risk of heart attacks, strokes, heart failure, and more.” — Dr. Bina Choi

The Bidirectional Relationship Between Weight Gain and Sleep Apnea

The relationship between sleep apnea and weight is bidirectional, meaning it goes both ways. People with sleep apnea are more likely to gain weight, which can worsen the condition.

Approximately 70% of individuals with sleep apnea are obese, underscoring the close association between the two. As weight increases, the risk of developing sleep apnea rises, and the severity worsens with increasing body weight.

While we do have some understanding of the primary reasons why obesity leads to obstructive sleep apnea (OSA), the exact mechanisms are not completely comprehended. This connection is primarily attributed to fat accumulation in the neck, which narrows the airway, increasing the likelihood of obstruction during sleep.

On the flip side, sleep apnea itself can contribute to weight gain. Several studies have demonstrated that individuals often experience significant weight gain just before their sleep apnea diagnosis. This can be attributed to sleep disruptions caused by sleep apnea, leading to fatigue, increased appetite, cravings, and hormonal changes that affect body weight.

How Sleep Apnea Contributes to Weight Gain

Sleep apnea can contribute to weight gain in several ways, creating a vicious cycle where increased weight exacerbates the sleep disorder, and the disorder itself leads to additional weight gain. This complex relationship between sleep apnea and weight can be understood through various mechanisms:

1. Sleep Deprivation and Hormonal Imbalance

Sleep apnea interrupts the regular sleep pattern, causing people to frequently awaken during the night, resulting in inadequate sleep. This sleep deprivation has several adverse effects on the body, contributing to weight gain. Here are the key factors contributing to weight gain:

  • Hormonal Imbalance: Sleep deprivation disrupts the balance of two essential hormones - ghrelin and leptin. Ghrelin, which increases appetite, becomes elevated, while leptin, which signals fullness, decreases. This hormonal imbalance makes individuals feel hungrier and less satisfied after eating, increasing their food intake, especially for calorie-dense and processed foods.
  • Impaired Self-Control: Sleep deprivation also impairs self-control, making resisting unhealthy food choices and sticking to a healthy diet more challenging. It affects the hypothalamus, a brain region responsible for appetite regulation and energy expenditure, making it harder to make wise food choices.
  • Reduced Energy Expenditure: Sleep-deprived individuals have less energy for physical activity and exercise. Their basal metabolic rate, which is the pace at which the body consumes calories while at rest, diminishes. This results in fewer calories burned, making it easier to gain weight.

2. Sleep Apnea-Induced Sleep Deprivation

Sleep apnea directly causes sleep deprivation because affected individuals may wake up more than 30 times per hour due to breathing interruptions. This severe disruption leads to significant sleep deficits, contributing to weight gain.

3. Leptin Resistance

Some studies suggest that sleep apnea may lead to higher leptin levels, a hormone that signals fullness. However, individuals with sleep apnea may become resistant to the effects of leptin, rendering this hormone less effective. This resistance can lead to increased hunger, overeating, and weight gain.

4. Metabolic Dysfunction

Sleep apnea has been linked to metabolic dysfunction. It can increase insulin resistance and glucose intolerance, potentially leading to type 2 diabetes, weight gain, and fat accumulation, especially around the abdomen. Several pathways contribute to this metabolic dysfunction:

  • Sympathetic Activation: Each sleep apnea episode triggers sympathetic activation, similar to the "fight or flight" reaction. This activation can increase circulating free fatty acids and promote insulin resistance.
  • Increased Catecholamine Levels: Sleep apnea may lead to higher levels of catecholamines, hormones released during stress. This can further disrupt metabolic processes.
  • Inflammatory Cytokines: Repeated exposure to low oxygen levels and the activation of inflammatory cytokines can render individuals with sleep apnea more vulnerable to metabolic syndrome. This syndrome encompasses conditions such astype 2 diabetes, obesity, and hypertension.
  • Circadian Misalignment: Sleep apnea can disrupt the body's internal clock (circadian rhythm), potentially contributing to metabolic dysfunction.

5. CPAP Treatment and Weight Gain

Continuous Positive Airway Pressure (CPAP), a conventional remedy for sleep apnea, entails using a device that provides a constant flow of air through a mask worn over the nose and mouth, to prevent airway obstruction during sleep. Although CPAP therapy enhances the quality of sleep and diminishes daytime drowsiness, its influence on weight can be intricate:

  • Short-Term Weight Loss: Some early studies suggested that CPAP therapy might lead to short-term weight loss, possibly due to improved energy levels and greater adherence to dietary interventions.
  • Potential for Weight Gain: Newer studies suggest that CPAP therapy may not necessarily cause weight reduction and could lead to increased body weight. The reasons behind this are unclear, but it might involve changes in leptin levels and reduced energy expenditure during sleep.

The Benefits of Treating Sleep Apnea

While the impact of sleep apnea on weight gain is clear, treating sleep apnea offers numerous benefits, with improved sleep quality and increased energy being among the most noticeable.

Patients often describe sleep apnea treatment as life-changing and find it hard to imagine sleeping without their CPAP machine.

While the research isn't conclusive on whether treating sleep apnea directly leads to weight loss, some studies have shown that individuals who undergo CPAP therapy often increase their physical activity levels significantly, which could lead to weight reduction.

Additionally, the hormonal changes associated with sleep apnea tend to improve with treatment, enhancing appetite control and facilitating adherence to a reduced-calorie diet.

Can Weight Loss Alleviate Sleep Apnea?

Absolutely! Weight loss is a primary recommended treatment for individuals diagnosed with sleep apnea.

Research has confirmed that even a modest reduction of 10% in body weight can significantly decrease the severity of sleep apnea. In some cases, patients have experienced complete resolution of their sleep apnea following bariatric surgery.

However, it's essential to understand that sleep apnea may still require treatment, such as CPAP therapy, even after weight loss, to prevent serious complications.

The Impact of Excess Weight on Sleep Apnea

Sleep apnea is significantly exacerbated by excessive weight. Fat deposits tend to accumulate in the neck area, forming what is known as pharyngeal fat. This accumulation can obstruct the upper airway, especially during sleep when the muscles are relaxed.

As a result, individuals with sleep apnea often experience snoring, a common symptom caused by air being forced through the narrowed airway.

Furthermore, heightened abdominal fat can put pressure on the chest wall, decreasing the lung volume. The decrease in lung capacity reduces airflow, increasing the susceptibility of the upper airway to collapse during sleep. This risk amplifies with a higher body mass index (BMI). Even a 10% increase in weight is linked to a notable elevation in the risk of OSA.

Excess weight contributes to sleep apnea, leading to increased daytime fatigue from disrupted and unsatisfying sleep.

This fatigue, in turn, can result in reduced physical activity, especially for obese individuals who may exercise less due to their tiredness. This cycle may contribute to further weight gain.

Health Effects of Sleep Apnea and Excess Weight

The health implications of the interplay between sleep apnea and excess weight are extensive, exerting stress on various bodily systems. Individuals with both conditions face heightened cardiovascular, metabolic, and pulmonary risk.

Here's a closer look at some of these effects:

1. Cardiovascular Health

Sleep apnea profoundly impacts the cardiovascular system, triggering a "fight or flight" response each time a breathing lapse occurs. This response leads to blood pressure and heart rate surges, prompting the sleeper to awaken and reopen their airway.

These cycles cause cyclic variations in blood oxygen levels, resulting in inflammation and atherosclerosis—a buildup of plaque in blood vessels associated with heart attacks, strokes, and high blood pressure.

Additionally, sleep apnea elevates carbon dioxide and glucose levels in the blood, disrupts the nervous system's control over heartbeat and blood flow, increases insulin resistance, and alters oxygen and carbon dioxide flow.

Consequently, sleep apnea is linked to hypertension, arrhythmias, heart failure, stroke, coronary heart disease, type 2 diabetes, and metabolic syndrome (a combination of obesity, hypertension, impaired fasting glucose, and dyslipidemia).

2. Obesity Hypoventilation Syndrome (OHS) and Sleep Apnea

OHS often coexists with sleep apnea, especially in individuals with obesity. Excess weight presses against the chest wall, compressing the lungs and hindering deep, well-paced breathing. Up to 90% of individuals with OHS also have sleep apnea. This dual condition significantly increases the risk of cardiovascular disease, emphasizing the critical need for effective management.

💡 Did You Know?

Prolonged struggles to fall asleep, even when fatigued, are common in adults, often attributed to the fast-paced modern lifestyle. Termed "difficulty falling asleep," is a type of insomnia that, if persistent, significantly impacts quality of life.

Can Losing Weight Cure Sleep Apnea?

Weight loss is a powerful tool in managing sleep apnea. Shedding excess weight reduces fatty deposits in critical areas like the neck and tongue, which can restrict airflow. Moreover, reducing abdominal fat increases lung volume and improves airway traction, making airway collapse during sleep less likely.

Not only does weight loss mitigate the severity of sleep apnea, but it also significantly alleviates associated symptoms such as daytime sleepiness and neuropsychiatric dysfunctions.

It improves cardiovascular health, including insulin resistance, type 2 diabetes, high blood pressure, and quality of life. Even a weight loss of 10-15% can reduce the severity of OSA by half in moderately obese patients.

Choosing the Right Weight Loss Method for Sleep Apnea

Various weight loss methods, including dietary changes, increased physical activity, medications, and surgery, can aid in managing sleep apnea.

Behavioral modifications, such as dietary adjustments and regular exercise, are typically recommended as the first-line treatment for obesity. Exercise alone has shown modest improvements in OSA severity, even without significant weight loss.

It is crucial to select a weight loss approach that corresponds to an individual's situation, overall health, and the extent of their sleep apnea.

📔 Related Articles

For more weight management discussion, check out some of our articles:

The Takeaway

Sleep apnea and weight gain have a cyclical relationship, with each condition worsening the other. Losing even a small amount of weight can significantly improve sleep apnea.

A multi-pronged approach combining weight loss and other sleep apnea treatments is most effective to break this vicious cycle. Given the significant health impacts, screening for sleep apnea is recommended for overweight individuals to allow for early diagnosis and treatment.

Addressing both conditions is critical to halting the feedback loop and reducing associated health risks.

FAQs on Sleep Apnea and Weight Gain

Can severe sleep apnea contribute to weight gain?

Yes, there is a connection between severe sleep apnea and weight gain. Sleep apnea has the potential to disturb the body's hormonal equilibrium, resulting in heightened sensations of hunger and a inclination towards high-calorie foods.

Can mild sleep apnea cause weight gain?

Yes, mild sleep apnea can contribute to weight gain. The condition disrupts normal sleep patterns, affecting hormones that regulate appetite and increasing the likelihood of weight gain.

Additionally, gaining weight, particularly around the neck, can further narrow the airway during sleep, worsening sleep apnea symptoms.

Does sleep apnea make it hard to lose weight?

Yes, sleep apnea can make it challenging to lose weight. It slows down metabolism, and sometimes, weight loss may be hindered. Research supports the idea that sleep apnea can impede weight loss efforts.

Is there a connection between sleep apnea and weight gain?

Yes, there is a notable link between sleep apnea and weight gain. Sleep apnea can disrupt normal sleep patterns, impacting hormones that regulate appetite and making weight gain more likely. Conversely, excess weight, particularly around the neck, can contribute to airway narrowing during sleep, exacerbating sleep apnea symptoms. It's essential to address both factors for a comprehensive approach to managing sleep apnea and promoting overall health.

Illustration of a healthcare provider asking questions on a smart phone.
Virtual weight loss solution
A personalized GLP-1 medication program (eg. Wegovy, Ozempic), delivered to you via our partner Korb Health
Illustration of a healthcare provider asking questions on a smart phone.
  • Free consultation; program starts at $269/mo
  • Checkmark Inside Circle.Customized online program and wellness coaching
  • Prescription medications and supplies shipped to your door