There’s no question that sleep is intricately tied to weight. How big a factor is it? Perpetual sleep deprivation can undermine weight loss efforts as significantly as adding a Big Mac to our regular daily diet.
Research is so strong for the case for sufficient sleep as a weight loss aid that as a nutritionist I look at sleep as the third element in the trifecta of factors that impact our weight, right alongside diet and exercise.
So it should be no surprise that sleep apnea – a condition where people stop breathing during sleep, as often as 30 times or more per hour – can negatively influence a person’s weight.
The stats are striking.
An estimated 25 million Americans – 26 percent of adults – have some degree of sleep apnea, with about 1 in 30 suffering from sleep apnea severe enough to warrant treatment, said Dr. Stuart Busby, Department Chair of Ochsner Sleep Medicine.
Sleep apnea affects an estimated 45 percent of people who are obese.
A whopping 90 percent of male contestants, and 50 percent of female contestants on the NBC series “The Biggest Loser” have been diagnosed with sleep apnea, said Dr. Robert Huizenga, associate professor of medicine at UCLA and physician for “The Biggest Loser.” In season eight, for example, every single one of the male contestants was diagnosed with sleep apnea.
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Here’s why sleep matters
We eat more when we’re sleep deprived – studies show as many as 550 extra calories a day – likely because sleep influences levels of hormones that affect our feelings of hunger and fullness. We crave more carbs when we skimp on sleep, too.
Even when we cut back on calories, sleep deprivation can still make it harder to shed extra pounds. Researchers have found that, among study participants who have the same caloric deficit, those who are sleep deprived lose less body fat, and they actually lose more lean muscle mass.
Barriers to sleep
It can be difficult to get the recommended seven-plus hours of sleep. Our over-extended to-do list, stresses with work or family, technology that keeps us plugged in 24/7, not to mention the stuff swirling through our heads from the day, all work against us in our quest for better sleep.
For those who have sleep apnea, it can seem nearly impossible.
What causes sleep apnea?
Weight often is a factor. Typically, weight gain causes obstructive sleep apnea first, not the other way around, Huizenga said.
Extra weight often means more fat in the area around the throat, which can obstruct breathing. Then the sleep apnea worsens obesity, leaving a person chronically sleep deprived, stacking the odds against weight loss.
Putting on more pounds makes it even worse: One study found that people with a weight gain of 10 percent – say a 200-pound person gaining 20 pounds – are six times more likely to develop sleep apnea. And so the cycle continues.
And weight is just one of many potential complications of sleep apnea. Other issues associated with the disorder include an increased risk for hypertension, cardiovascular problems and diabetes.
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What to do about it?
The good news is that losing extra weight can improve – and even reverse – sleep apnea.
Losing just about 10 percent of excess body weight can lower sleep apnea severity by 30 percent, Busby said, translating to about one-third fewer apnea events throughout the night.
And getting sleep apnea under control may make it easier to shed those extra pounds, plus improve overall health and wellbeing.
Once people are treated for sleep apnea, after even just a few normal nights of sleep, they notice significant improvements in energy and blood pressure, even before they’ve lost any noticeable amount of weight, Huizenga said.
Busby is quick to point out that “using a CPAP machine (which helps to open airways) won’t melt off the pounds” but that it can make it easier to take the steps needed for weight loss. “When someone feels better, with more energy, they’re more likely to do the things needed for weight loss – like exercise – and less likely to mindlessly overeat,” he said.
People who treat sleep apnea report that they have more energy and feel more refreshed. They think more clearly, have better focus, and are more productive. Studies have shown they look younger, and even more attractive. No kidding: Researchers took before and after photos of sleep apnea patients and found that the “pre-treatment” faces looked sadder and less attractive than the “well rested” faces.
How do you know if you have sleep apnea?
You snore. You wake up with dry mouth or a headache. You feel depleted or fatigued during the day in spite of getting what you think is sufficient sleep.
Busby notes, however, that sleep apnea isn’t always as obvious, particularly in women, who may have severe sleep apnea without noticeable symptoms like snoring.
Men are twice as likely as women to develop sleep apnea, especially older men who are overweight, and those who smoke, drink alcohol, or take sedatives. And how we carry extra weight matters: Men with a thicker neck have an increased risk; a collar size of more than 17 inches puts men at very high risk for sleep apnea, Busby said.
Treatment for sleep apnea
Talk with your doctor. He or she may refer you to a sleep clinic, where you may undergo sleep testing to observe your sleep patterns, confirm if you have sleep apnea, and how severe it is.
Treatment typically involves using a CPAP machine (CPAP stands for continuous positive airway pressure), including a mask that’s placed over your nose that delivers just enough air pressure to help keep your upper airway passages open, which in turn helps to improve and possibly alleviate apnea and snoring. CPAP is generally the most effective treatment for restoring normal breathing patterns in patients with sleep apnea, Busby said.
People often are reluctant to use a CPAP machine at first. It can feel uncomfortable and some say they feel panicky wearing a mask. Over time, however, most get used to it. “Nasal congestion or sinus trouble can be part of the culprit for the discomfort, so addressing this issue can make a world of difference when getting acclimated to using CPAP,” Busby said.
A CPAP machine is not the only solution.
Although not as effective as CPAP, other options for treating sleep apnea include oral appliances similar to a retainer, and nasal patches called Provent, both of which can help to open up the space around the airway.
The bottom line: Sleep is such an integral component to our overall health, quite possibly as important as diet and exercise. If we’re consistently not getting the recommended seven hours per night, it’s important to make the effort to alleviate any barriers to a good night’s sleep, whether it’s cutting back on nighttime screen time, limiting our afternoon caffeine intake, or treating an underlying condition like sleep apnea.