Scanning through my daily schedule of patients, I noticed Mr. Johnson was on the schedule. I have been following him for over 10 years since diagnosing and prescribing CPAP for his severe obstructive sleep apnea. I last saw him 3 years ago. He was faithful in using his CPAP 100% of the time, and his adherence numbers were perfect, with an average AHI of 1, minimal leaks, and being used 8-9 hours every night. As I entered the exam room and greeted him, I was shocked to see how much weight he had gained (30 pounds) over the past few years.
One of the basic tenets of sleep medicine is that poor sleep leads to weight gain. It naturally follows that sleeping better with CPAP will lead to weight loss. It’s not uncommon to see patients losing weight after sleeping better with CPAP, dental appliances or even after surgery. However, I had seen a few studies over the years showing that a small proportion of people using CPAP may gain some weight, but what I discovered over the past few weeks studying basal metabolic rates and weight loss in relation to CPAP was surprising.
It turns out that overall, CPAP use has been found to increase weight significantly, in proportion to how long you use CPAP. The more hours you use CPAP every night and the more number of years, the higher the amount of cumulative weight gain.
- Researchers from Harvard and Stanford Universities found that patients randomized to receive CPAP for 6 months gained 0.77 pounds, whereas people on sham CPAP lost 1.5 pounds. Of note, people who more highly compliant (using more than 4 hours/night, at least 4/7 days/week) had higher degrees of weight gain.
- In another study, overall BMI did not increase in CPAP compliant patients after one year, but women and non-obese subjects did gain significant weight.
- A Finnish study in 2016 found that CPAP compliant, more obese patients had higher levels of weight gain after 5 years.
- However, this one retrospective study did not find and significant weight gain in complaint CPAP users.
- Lastly, a meta-analysis of randomized only studies analyzed over 3181 patients from 25 studies, finding significant weight increase in compliant CPAP users.
A number of explanations are given as to why CPAP can promote weight gain. The one most reasonable proposal that I saw is that when you have obstructive sleep apnea, your basal metabolic rate (BMR) in higher. Due to the extra energy demands of having sleep apnea, you burn up more calories. It’s been shown that using CPAP reduces your BMR. Since dietary intake and your body’s baseline weight thermostat does not change, you’ll end up with positive energy balance, leading to slow weight gain. This concept may also explain weight gain in some children who undergo tonsillectomy for sleep apnea.
Based on this finding, should people with sleep apnea stop using CPAP? Absolutely not. The overall risks of not treating sleep apnea (especially severe cases) far outweigh the potential risk of getting heavier. However, I do think that this potential side effect should to mentioned to all new CPAP users, just like any potential side effects for drugs or surgical procedures.
It’s also important to emphasize the importance of radically changing your dietary habits once you’re able to sleep better with CPAP.
For those of you currently on CPAP, did you gain any weight? If so, about how many pounds?
I’ve also gained weight! About 50+ and more. My BELLY protrudes as well as extra fat(water) deposit. My ankles stay swollen with edema. I can relate to ALL comments. I was also advised about my cholesterol. I want to get off of my machine so badly😭. The pulmonologist had also advised “I feel it’s your machine as well because something isn’t right”. I advised my sleep apnea Dr who said “it may be the settings”. I wake up with a heaviness in my body as it’s full of fluid. Where’s the water going in our body from the machine? I have a Resmed too for women. I can’t lean back when I sit as my body feel full. I can’t sit long as my body feels tight!
Now I’m being told that I have a condition that’s affecting my kidneys. And now my blood pressure? NEVER had this. I’m praying they do more research as I want to begin sleeping in a recliner and ween myself off. I’m depressed. And I’m mentally tired! Someone needs to listen to us.
Emma, so sorry to hear. It sounds like your additional 50 pounds is likely tipping you over the edge with all your new medical problems. Did your sleep doctor take a look at your CPAP data and make any adjustments? Perhaps consider looking at an alternative to CPAP if you keep gaining weight.
No, they keep giving me the run around unfortunately. I’m waking up with a gurgling sound and I’m frustrated as I feel heavy. They suggested “work on losing weight”. However; I am only able to do so much. I’m 5’1, and carrying over 60 extra pounds on me. I wheeze and it’s challenging to even walk on treadmill or climb a stair. I feel like I’m drowning. I’m mentally exhausted.
Emma,
If you gain a lot of weight (regardless of the reason) your CPAP pressure may not be high enough. Then you’ll start to have more apneas, which will lead to acid reflux, which can go into your lungs. You can also look at your CPAP data on your own by using free programs such as SleepHQ. Regardless, bug your sleep doctor, or find a new one. Good luck!
I have used my cpap machine for 8 months. I am a compliant user: 7-8 hrs. per night, 7 days per week. I have gained 15 lbs.. There has not been a real change in diet, and I exercise doing water aerobics 5 days per week..
If your daily excercises consist of cardio whether high intensity or low intensity. Your settings may need adjustment quite often. The doctors get frustrated trying to make a decision what should be the correct settings for your cpap machine. They seem to struggle with which way to go. And PHYSICIANS ASSISANTS Do not have the educational knowledge as a Licensed MD has to make decisions with breathing issues. If the settings are not properly set YES it will cause weight gain, high blood pressure, strokes and cardiovascular complications. Also NOTE if you workout exercising consistently there WILL be issues with your breathing and your endurance level. Because of the oxygen level in the bloodstream is working against your aerobics to prevent you from loosing your weight. This is factual information Because I experienced this. They need much more Studies on treating this disease
I’ve gained 5 pounds in one week since starting to use my CPAP machine. I have not changed my eating patterns or activity, but I’m blowing up! On a positive note, my blood sugar levels (I’m Type2 Diabetic) has dropped by nearly 20 points down to 87 from an average of 117. What’s going on?
Mike,
Sorry to hear about your weight gain, but good news about your glucose level! I recommend you wait and watch for a few more weeks to see what happens. If your weight continues in the wrong direction, talk to your sleep doctor about other ways of treating your obstructive sleep apnea. If you gain too much weight, then your current CPAP pressure won’t be high enough to address your apneas. Clearly, for some people, CPAP is a double-edged sword.
16 lbs gained in two months after using CPAP, but the worst part was being told that it “was clearly my imagination” and “I didn’t know my dietary intake.” This, despite being a daily weigher for >5 years – tracked on my phone via Bluetooth – and a WW member, so I do know my own body. Frustrating to be 10 lbs from my healthy weight range – and 20 lbs from goal – only to gain the weight. It was only after talking with another sleep doctor that I learned: yeah, it’s a thing for some people, for reasons that aren’t completely understood.
Sadly, I’ve stopped using my CPAP until I can find a solution that doesn’t mean my clothes don’t fit, but I appreciate that you’re talking about this so others don’t feel alone. It was so frustrating- and I’m still trying to lose the weight. Again.
This is disturbing as I was diagnosed with extreme sleep apnea and I have been using it regularly after finally getting used to it. I have gained 40 lbs in 6 months and the use of the CPAP has been basically the only constant. I’m miserable and still trying to confirm this prognosis and I have A-Fib as well and have been going in and out of rhythm now since my CPAP usage. I’m a
62 year old white male
I gained 7 lbs in 3 month right after beginning my c-pap treatment. and my weight has been consistent for years. :-(
Bob, sorry to hear. Maybe talk with your sleep doctor about alternatives to CPAP. Good luck!
I have mild sleep apnea and afib. The doc suggested I start cpap due to afib. Well I started it and it seemed fine the first 5 days, then it all went haywire. I was waking up every few hours with feelings of suffocating and lots of air in my mouth. They sent a new nasal mask, but nothing changed. I used it for one month and gained 5 pounds which I certainly don’t need. I decided to stop using it. Too much anxiety and not enough sleep. Goodbye cpap..
After using the cpap machine for a month I gained 6 lbs. This outweighs the sleep apnea disorder I have so it’s okay. Now I have to work on not to get more pounds.
Noreil,
Great to hear that you’re doing better on CPAP. If you look at the studies, the vast majority don’t gain weight on CPAP. My blog article’s main point is that weight gain can happen much more commonly than you think. It’s a balancing game. If you’re sleeping much better despite gaining a few pounds, then it’s worth it. But if you keep putting on weight continuously, then you have to consider other options. Did you ever consider going on a low-carb/high-fat, or even a Keto diet?
Gaining weight since cpap
Concerned
Have no changed my eating habits
I have gained 14 lbs in 8 weeks and I feel horrible. I hope it’s possible to lose this weight or I might quit the machine.
Sorry to hear. Please see your sleep doctor about it. Perhaps consider going on a very low-carb diet.
Michele, please see my response to Ann.
yes, weight gain after about 8 years on cpap, about 25 lbs. it never occured to me that it was related to cpap use
I have been keto/ low carb since 2017, I initially lost some weight in the beginning. A year later I was put on cpap therapy, I am still low carb, and I have gained 20 lbs! I am compliant and use my cpap EVERY night. My doctor thinks I’m nuts for suggesting cpap therapy is causing it. I am a female over 55 so theres that, but I have NEVER felt rested or refreshed from cpap therapy, I still struggle with low energy and daytime sleepiness. But my machine says I am not having any episodes? Its just very frustrating because I feel I’m getting worse not better.
Julie, it sounds like CPAP, while preventing the more severe episodes, is likely causing many more subtle micro-arousals, like what I describe in the article. You can present your sleep doctor with the studies that I cite, especially the meta-analysis. Perhaps it’s time to consider alternatives to CPAP. We’re you ever offered a mandibular advancement device?
Also, if you gain weight, the pre-set CPAP pressure won’t be strong enough to work effectively. Plus the weight gain adds to more cardiovascular and metabolic problems. If you have an APAP device, this is not an issue.
Ive been using my cpap for approximately one month. During this time, I have gone back and forth with a 3-4 lb. weight gain. I am extremely active, working out most every day and have rarely had trouble with gaining weight. When I put on these extra pounds, it takes me several days to peel them off and that is with a daily workout and eating almost nothing. I know it sounds ridiculous to complain about such a small gain but I really don’t want to starve myself to maintain my weight. Not a fun way to live!
i have been a compliant cpap user for 14 months and have gained 20 pounds. Very depressing:( I try to focus on a healthy diet, and exercise for an hour a day, 5 days per week.
Yes. I am so disappointed. All of my specialists told me that now I should have an easier time loosing weight. My energy is going up. I’m exercising and active for much longer periods of the day. However, even eating really healthy and adding to my exercise routine can’t seem to stop the pounds packing on. I’ve had my machine 6 months and gained 10lbs. I think back to my dad, and although his machine helped battle his fatigue, he became a grossly obese man who could put on his own shoes. It’s terrifying.
I’ve only started using my machine (nasal mask) a month and I’ve gained 11 pounds not feeling much better or should I say not feeling more refreshed when I wake up in the mornings. I’m frustrated!