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Proven Weight Loss Strategies for Sleep Apnea Sufferers

My wife just commented to me that just by eating dinner about one hour earlier than usual for the past few weeks, she's automatically lost about 2-3 pounds. We normally eat about 3 hours before bedtime, but by the time we finish dinner and have fruit for dessert, it's about two and a half hours before we go to bed at 10PM. Even our children now seem less tired and more alert during the day. Although we decided to make this change to increase our sleep quality, my wife's weight loss was an unexpected side effect. So how does this apply to sleep apnea sufferers?

The Sleep Apnea Stereotype

At almost every sleep apnea lecture that I've seen in my career, the speaker almost always puts up a picture of Joe the fat boy from Dickens' The Pickwick Papers. If you read any scientific study about obstructive sleep apnea, it almost always starts with, "…typically seen in middle aged or older obese men who snore heavily with large necks."

Although described 30 or so years ago in these stereotypical men, now we know that it can occur even in young, thin women who don't snore. But many overweight people, especially as they get older, will snore or have obstructive sleep apnea. It's estimated that overall, about 24% of men and 9% of women will have it, but by the time you reach your 70 to 80s, the incidence about 55%. Being overweight is still a major risk factor for development of obstructive sleep apnea. If you're overweight and have sleep apnea, then it's much harder to lose weight than if you didn't have sleep apnea. Let me explain why.

How Hormones Affect Your Appetite

It's been proven that poor sleep (quality or quantity) can promote weight gain through various mechanisms. Leptin is one major hormone that provides information about energy status to your brain—essentially, it tells your brain that you have enough energy. Low levels of leptin causes hunger. Normally, leptin increases after you eat, but sleep deprivation lowers this hormone, making you hungry. As leptin drops, your cortisol levels will also increase. As I've mentioned numerous times in my book, Sleep, Interrupted, poor sleep efficiency cause a low-grade physiologic stress reaction that increases your cortisol levels. This hormone also makes you more hungry. Other studies have shown that not only will you be more hungry, you'll tend to crave fattier, sugary, high carb foods.

You can imagine how once this process starts, it's a vicious cycle: Poor sleep makes you more hungry, so you eat more or snack close to bedtime. More frequent obstructions causes your stomach juices to be suctioned up into your throat, causing more inflammation and swelling. These juices can then go into your nose and lungs, causing further inflammation and swelling. Weight gain then narrows your throat further, aggravating sleep apnea, which makes you sleep less efficiently.

First Steps Toward Losing Weight

So what can you do if you have sleep apnea and are overweight? Is it hopeless?

Fortunately, there are steps that you can take that if followed properly, can not only help most people lose pounds, but also sleep better in the process. The first and most important thing is to eat as early as possible before bedtime. I know I keep repeating this, but you'll be surprised by how many people continue to eat late or snack just before bedtime. Three to four hours is the general recommendation to avoid eating before going to bed. The only thing you can have is water within this timeframe. The same goes for any kind of alcohol, since alcohol relaxes your throat muscles, aggravating obstructions and arousals.

The second most important thing to do is to make sure that you can breathe well through your nose. If your nose is stuffy, the challenge is in figuring out what's causing your nasal congestion, since there are a number of different reasons. In many cases, there's more than one reason. This is a huge topic that I cover in my Ask Dr. Park teleseminar called Un-Stuff Your Stuffy Nose. I also have various articles and blogs about this issue on my website at doctorstevenpark.com.

Needless to say, you also have to eat healthy and exercise regularly. I'll leave the specific recommendations for other respective experts in this area. One thing to point out, though, is that if you lift weights or engage in any activity that bulks up your upper chest and neck muscles, remember that your upper airway is unprotected, and that that any degree of neck muscle enlargement and press in on your upper airway. This is why many bodybuilders and weightlifters snore.

Eating earlier helps to reduce inflammation and swelling in your throat, and better nasal breathing lessens the vacuum effect that's created in the throat when you breathe in while sleeping. These two steps alone (along with eating healthy and regular exercise) will help many people, but to various degrees. For some, making these conservative changes alone may be enough, but with others, they will need some form of formal treatment for their obstructive sleep apnea. I won't get into the treatment options for sleep apnea since that's a HUGE topic in itself. For more information about sleep apnea treatment, I have lots of practical information on my website or you can find one comprehensive resource by reading my book, Sleep. Interrupted.

Sleep More, Lose Weight

Lastly, most people in general are sleep deprived. Lack of sleep, in addition to inefficient sleep due to sleep-breathing problems, can also cause similar weight promoting issues. A great example is when Glamour magazine asked women volunteers to try to get consistently 7.5 hours of sleep every night for 10 weeks. Many women lost anywhere from 6 to 15 pounds, all just by sleeping more. Studies have shown that lack of sleep (5 hours or less) per night is a major risk factor for significant weight gain.

So whether or not you are overweight, the recommendations outlined above will help you to breathe better and sleep better. Even if you are thin and don't have obstructive sleep apnea, following these recommendations can the onset of sleep-breathing problems and ultimately lessen the risks that can go along with obstructive sleep apnea. If you are overweight, this is the first step toward losing unwanted pounds.

Is Your Throat Sore Just Before Your Period?

Here's an interesting observation by more than a handful of my female patients: Their throats are sore for a few days just before their monthly periods. It doesn't go on to a cold or other more severe symptoms. Just a transient sore throat. Then it goes away.

If you've been following my blogs, articles, and especially if you read my book, Sleep, Interrupted, there's a simple explanation. During your monthly cycles, progesterone levels increase with ovulation, but drops when there's no egg fertilization. One relatively unknown property of progesterone is that it's an upper airway muscle dilator. It literally tenses your tongue muscles. When in deep sleep, your muscles (as well as your tongue and other throat muscles) tend to relax to various degrees depending on your sleep stage. If you have less progesterone on board, then it's more likely to fall back, obstructing your breathing, leading to a temporary vacuum effect in the throat, suctioning up small amounts of normal stomach juices. All this causes a temporary deep sleep deficiency. If you eat a late meal, more of these juices will come up. But once progesterone levels begin to increase again, the tongue tenses, and sleep quality improves as well.

 

Sometimes, the inflammation in the throat increases to the point of significant deep sleep deprivation, leading to some of the more severe symptoms as pre-menstrual headaches, fatigue, irritability, and weight gain.

 

For you women out there, do you experience sore throats just before your periods? Please enter your responses in the comments box below.

A Link Between Sleep Apnea and Diabetes Confirmed Again

A Link Between Sleep Apnea and Diabetes Confirmed—Again

It’s almost a given that you’ll see headlines regarding sleep apnea every few days, about how it’s linked with heart disease, diabetes, high blood pressure, weight gain, and sudden death. Unfortunately, it’s gotten to the point where you’re likely to yawns at these findings because you’re so inundated with more interesting medical news and other celebrity media stories. Bare minimum, you might glance at the brief article and think, "that’s interesting," and then go on to the next story. 

 

Recently, there’s been news about the National Transportation and Safety Board making recommendations about mandatory screening for all commercial airline pilots, commercial truck drivers, ship pilots, and transit train operators, in light of many recent events including pilots that fall asleep and miss their destinations due to undiagnosed sleep apnea. Yawn.

 

A recent Johns Hopkins study showed that if you have severe sleep apnea, you have a 46% increased risk of dying compared with those that have mild to moderate sleep apnea. Yawn. We already know this information. Sleep apnea patients have a much higher risk of dying from heart attacks or strokes.

 

A study now shows that your risk of developing diabetes is 2-3 times higher if you have severe sleep apnea and you have daytime sleepiness. We already know that sleep apnea is independently linked to diabetes.

 

I guarantee that many more studies will be released repeating these same findings over and over again, linking or associating one variable to sleep apnea, without flat out saying that one causes the other. 

 

I wonder what will it take to significantly elevate sleep apnea awareness in this country? Celebrities with sleep apnea? We already have a few including Rosie and Regis. Politicians with sleep apnea? With the congress being mostly older men, I’m guessing about 1/3 to 1/2 of our leader have at least some degree of sleep apnea.

 

I Confess—I Broke My Own Rule

I admit it—I broke my own rule. I had apple pie just before going to bed Sunday night. My 6 year old son and I made apple pie from scratch. We made two pies—one for the family and one for our friends that were coming over that evening. We waited patiently as it cooled after taking it out of the oven. My two boys were salivating and eying it all evening. When it was eventually served, it was a hit. But I literally didn’t have time to taste my own pie, since I was too busy making arrangements for our guests. Later that evening, after our guests had left and we finished cleaning up, I just had to have a slice of my pie. I knew that I was going to turn in to go to sleep within 30 minutes, but I still had to eat it. The next day, I paid the price.

 

One of the most common pieces of advice that I give is that you should try not to eat within 3-4 hours of bedtime. There are lots of explanations for why this can lead to weight gain and poor sleep. One such explanation is that having food in your stomach diverts energy and blood to the stomach, depriving the rest of the body the energy needed to rest and regenerate. Another is that it slows down your metabolism. What most people (and doctors) don’t realize is that the more juices you have in your stomach when you go to sleep, the more likely it’ll come up into your throat, leading to poor sleep. 

 

As mentioned in my sleep-breathing paradigm (in my book, Sleep, Interrupted), all modern humans stop breathing once in a while when sleeping, due to our unique upper airway anatomy and our ability to talk. Muscle relaxation during deep sleep leads to these partial to total obstructions. If these episodes happen very often, for longer periods, then this is what we describe in medicine as obstructive sleep apnea. But obstructive sleep apnea is not something you develop suddenly in your 50s or 60s. All of us have minor variations of it at certain times in our lives (during colds, when we gain weight, or during pregnancy for women). All of us are on a continuum.

 

Once you stop breathing (but before you wake up and turn over), a vacuum effect is created in your throat, which can literally suction up your normal stomach juices into your throat. This not only causes you to wake up from deep to light sleep, but also causes the all-too-common symptoms of post-nasal drip, throat clearing, chronic cough and hoarseness, usually worse in the morning.

 

When I woke up in the morning the night after I ate my apple pie, my throat was a little sore, but what really got my attention was the fact that I felt like I only slept for 5 hours, rather than the 7 that I got that night. I was also more tired than usual all day long.

 

It’s not too surprising that sleep length, sleep efficiency, energy, appetite, and weight loss are all directly or indirectly connected. Yesterday, I saw a child in the office who stated that his sleep quality improved dramatically once he stopped eating ice cream before bedtime.

 

If any of you eat close to bedtime, and don’t sleep well are tired during the day, I challenge you to make it a regular habit to eat earlier for the next 4 weeks. Then let me know on this blog when you feel better. I’m confident that you’ll sleep better and feel better. 

 

By the way, if you want the recipe for my apple pie, just let me know. It’s from a Mrs. Fields recipe book.

Can The Recession Make You Fat?

There’s been a lot of press recently about how the current economic situation is causing people to lose sleep. According to a recent National Sleep Foundation poll, 16% of Americans report losing sleep at least a few days in the past month due to the current financial situation. Another 15% are worried about the economy, and 10% are anxious about losing their jobs.

Lack of sleep for any reason and stress go hand in hand. One aggravates the other. Physiologic stress that develops as a result of inefficient sleep causes hormonal changes that can cause you to gain weight. Any external stresses such as psychological, emotional, or physical stress can also aggravate internal physiological stress.

When cortisol is increased due to stress, your appetite is increased for fatty and sugary foods, or "comfort" foods. This sets off a hormonal chain reaction where as you gain more weight, the fat cells in your throat can narrow slightly, aggravating any underlying breathing problems that I describe in my sleep-breathing paradigm. This perpetuates more sleep disruption and the vicious cycle continues.

Have you gained any weight recently since the recession began?

Stressed and Starving? Three Simple Solutions To Stop Emotional Eating

 

It’s a well known fact that if you have a sleep breathing problem the stress of not sleeping well at night can make you eat more. Equally, if you’re an emotional eater, and use food to cope with stress you’re also more likely to develop sleep breathing problems, like obstructive sleep apnea, since weight gain can aggravate this condition.

Since Valentines is just around the corner, and many of you are just getting started on your New Year’s resolution to lose weight and keep it off this year, I’ve invited Peter Lappin, a holistic nutritional counselor to help you steer clear of your emotional eating problems. Hope it helps!
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You’re happy – you just got a promotion! – so you treat yourself to pizza and Coke.  You’re anxious – Can I handle this new job? – so you grab a candy bar and coffee.  You’re lonely – you come home and there’s no one to celebrate with – so you turn to your two friends in the freezer, Ben & Jerry.  In short, you are eating to manage your feelings, rather than in response to physical hunger.

According to a study done by the National Eating Disorders Organization, 95% percent of Americans eat for pleasure or comfort.  What makes emotional eating so challenging is that, like a criminal returning to the scene of the crime, there’s no escaping food: we generally eat every day.  Unfortunately, we are eating ourselves into compromised health, with skyrocketing rates of diabetes, obesity, and heart disease.

In a typical urban (and even suburban) environment, cheap food is all around us, tempting us.  There are vending machines in every office, coffee carts on every street corner, and shelves of savory snacks by the cash register of every drug store, gas station, and corner bodega.  Television commercials and magazine ads remind us to reward ourselves with General Mills International Coffee or indulge in a Sara Lee dessert.

Eating seems like an effective solution to our emotional turbulence.  When we’re stressed or depressed and use food to take the edge off, we DO feel better, at least temporarily.  It feels good to satisfy our cravings.  But this “medicine” not only has dangerous side effects, it also never gets to the cause of the feelings we’re trying to manage.

What can we do?

We need to stop medicating ourselves with food and start checking in emotionally.  

First, we can look at how we are doing with the other things, beside food, that nourish us.  Do we have work we find meaningful?  Do we have relationships that sustain us?  Do we feel connected to something larger than ourselves, like a spiritual practice or a sense of personal purpose?  Do we have an exercise routine we enjoy that “takes the edge off” when life feels stressful?  We can start to address some of these areas where we may be lacking (one small step at a time. of course – we don’t need to create more stress).

Second, if you think you’re hungry, ask yourself, How hungry am I?  If your hunger feels like a bottomless pit, you’re desperate for a something to put in your mouth and you ate within the last few hours, you may be experiencing emotional hunger.  Breathe.  Take a work break.  Go outside to get some fresh air.  Call a friend.  Find sources of pleasure other than food.

We can’t eat ourselves more love, more friendship, a better job, or more understanding.  But we can feed our hearts with the things we really need to go through life feeling nourished and content.

As always, go gently, and treat yourself like someone you really love – because you are!

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Holistic Health Counselor Peter Lappin works with adults with emotional eating issues in his private practice in Manhattan.  To e-mail Peter, click here.  For more information about Peter, visit his website by clicking here.

Can Snoring Help You Lose Weight?

A recent study published in the Journal Archives of Otolaryngology – Head & Neck Surgery showed that snorers burn more calories while sleeping than nonsnorers. For obvious reasons, the press and the internet is buzzing with this new finding. For those of you who think that you can lose more weight by continuing to snore, the study authors did note, however, that this does not mean that you can continue snoring away without any sort of treatment. 

 

Most people who snore will have some degree of sleep apnea, and this is a serious medical condition. Untreated sleep apnea can lead to high blood pressure, depression, diabetes, heart disease, heart attack or stroke. 

 

If you snore (or have simultaneous apneas) your body is in a stress state, more commonly known as the fight-or-flight response. This increases your metabolism, as well as keeping you from staying in the lowest metabolic state, which is the deeper stages of sleep. We know from numerous studies that inefficient sleep, due to whatever reasons, will promote weight gain.

 

There are even studies that suggest that the vibrational trauma can cause carotid artery plaque formation. 

 

Do you snore, and if so, are you overweight?

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