Unravelling the connection between sleep apnoea and weight

- Nicole Fong, Martin Kueh

Everyone will at least experience the impact of a restless night’s sleep, but what happens when that tiredness becomes a regular occurrence? Feeling constantly fatigue or frequently dozing off during the day could indicate a deeper issue beyond simple sleep deprivation. Sleep disorders can contribute to developing or exacerbating various health conditions, including high blood pressure, heart disease, diabetes, and stroke. In this blog, we’ll delve into the importance of quality sleep for our health and explore the connection between obstructive sleep apnoea, weight gain, and overall well-being. 

What is Sleep apnoea? 

Sleep apnoea is a prevalent disorder characterised by interrupted breathing during sleep. The most common type, obstructive sleep apnoea, occurs when the airway narrows or blocks, leading to breathing disruptions. People with obstructive sleep apnoea experience brief periods of halted breathing, causing them to wake up to take a breath. While seeking professional medical advice for an accurate diagnosis is crucial, the symptoms of obstructive sleep apnoea include snoring, daytime fatigue, excessive sleepiness, mood swings and waking up with a dry mouth or headache. 

Why is this important? 

The risk of developing sleep apnoea is notably higher for those who are overweight or living with obesity, as a buildup of fat deposits further restricts the upper airway. Excess fat can also compress the chest wall, decreasing lung volume and airflow. This increases the likelihood of the airway collapsing during sleep. While sleep apnoea impacts about 3% of normal-weight individuals, the prevalence rises to over 20% for individuals living with obesity. 

 This interplay between sleep apnoea and weight poses a substantial challenge. Sleep apnoea can worsen weight problems due to its adverse effects on daily functioning and hormone levels. Sleep deprivation disrupts our hormonal balance, particularly impacting our appetite through the essential hormones ghrelin and leptin. When we’re tired, our bodies make us crave food for an energy boost. However, hormonal imbalances can cause overeating and weight gain. Poor sleep signals our bodies to produce more ghrelin, increasing our appetite and resulting in overeating. In addition, sleep deprivation impairs insulin sensitivity and raises cortisol levels, leading to greater consumption of fatty and sugary foods. These factors impact how our bodies use insulin and regulate blood sugar. 

 It’s a problematic cycle as sleep apnoea depletes people of the energy required to maintain a healthy body weight. Sleep deprivation from sleep apnoea often leads to more late-night snacking and higher calorie intake. The lack of sufficient sleep makes it difficult to resist indulging in unhealthy food choices due to the over-responsiveness of the amygdala, the part of our brain responsible for emotional responses. Moreover, fragmented and unrefreshing sleep experienced by those with sleep apnoea tends to reduce physical activity levels during waking hours. When combined with unchanged dietary habits, this decrease in activity contributes to further weight gain.

Here are several ways to manage weight in individuals with sleep apnoea:

1. Prioritising obesity treatment for improved sleep apnoea symptoms

As weight increases, so does the risk of breathing interruptions during sleep. That’s why addressing obesity is the first and foremost step in dealing with sleep apnoea. A well-rounded approach to fighting obesity includes adopting a healthier lifestyle with a balanced diet, regular exercise, and, if needed, weight loss medications or surgery.

One such weight loss medication, liraglutide, has shown promising results in managing obesity and sleep apnoea. It mimics a hormone called glucagon-like peptide-1 (GLP-1) which helps to control insulin secretion while curbing appetite and promoting a sense of fullness. Liraglutide has earned the reputation of a “one-stop shop” for sleep apnoea because it not only tackles obesity but also improves related conditions like hypertension, diabetes, and cardiovascular diseases(7).

A notable clinical trial looked at liraglutide’s impact on individuals with obesity and moderate/severe sleep apnoea. The conclusion was that it was well tolerated and significantly improved sleep apnoea severity, body weight and blood pressure(8). However, the real game-changer was the participants’ weight loss rather than the medication alone. This highlights the importance of managing obesity directly influences sleep apnoea and overall health.

Studies have shown that a 10-15% reduction in body weight can lead to a 50% reduction in sleep apnoea severity(9). So, making sustainable lifestyle changes, adopting better eating habits, and staying active are key to managing sleep apnoea effectively. Here’s how you can make these positive changes in your life. 

2. Mindful eating

1. Portion control: Smaller plates or bowls can be helpful for some individuals.

2. Meal planning 

3. Opt for healthy choices: Prioritise meals high in fibre, complex carbohydrates while low in sugar. Include brown rice, quinoa, whole grains, sweet potatoes, and oatmeal.

4. Refrain from late-night snacking within 3-4 hours of bedtime to avoid heartburn and indigestion. 

5. Avoid alcohol and caffeine close to bedtime 

3. Physical activity and exercise

Increasing your levels of everyday physical activity and exercise has numerous health and weight management benefits. There are countless ways to increase activity levels. Consult your healthcare provider for safe and personalised exercise recommendations. These are some practical ideas to increase your day-to-day activities: 

1. Opt for the stairs instead of the elevator.

2. Engage in outdoor jogging in the morning.

3. Take breaks from prolonged sitting by standing up or walking throughout the day.

4. Good sleep hygiene

Quality sleep is vital for those with sleep apnoea on their weight loss journey. It affects appetite, energy, and well-being. While sleep hygiene applies to everyone, the ideal approach varies from person to person. Trying out different adjustments to find what aids your sleep the most. Here are some tips for doing that. 

1. Create and stick to a sleep schedule. 

2. Sleep on your side with a straight back is generally recommended to reduce disruptions and snoring. However, try sleeping on your back with your head elevated for individuals with chronic joint pain, back pain, or acid reflux.

3. Limit daytime napping to 20 minutes and take them at least 8 hours before bedtime.

4. To create a sleep-friendly environment, consider 

   • Incorporate meditation or mindfulness

   • Avoiding using electronic devices 30-60 minutes before bed

   • Dimming the lights or using blackout curtains

   • Wearing eye masks and blocking out noises with earplugs.

Conclusion

Addressing sleep apnoea and living with obesity requires a comprehensive approach beyond focusing on good sleep hygiene. The two conditions share various underlying mechanisms and consequences. Collaborating with healthcare professionals is crucial to create personalised weight management plans tailored to your needs. Doing so makes it possible to experience a reduction in the severity of sleep apnoea and mitigate the cardiometabolic problems related to both conditions. Let’s take a step towards better sleep and improved well-being! 

References

1. https://www.self.com/story/eating-before-bed-sleep-digestion-weight

2. https://www.sleepfoundation.org/nutrition/alcohol-and-sleep#:~:text=Since%20alcohol%20can%20reduce%20REM,symptoms%20and%20feel%20excessively%20sleepy

3. https://www.sleepfoundation.org/sleep-apnoea

4. https://www.bannerhealth.com/healthcareblog/better-me/sleeping-like-a-baby-when-you-have-obstructive-sleep-apnoea

5. https://www.weatherfordsleep.com/blog/2021/07/19/napping-and-sleep-apnoea-in-weatherford/

6. https://www.sleepfoundation.org/sleep-hygiene

7. Sultana R, Sissoho F, Kaushik VP, Raji MA. The Case for Early Use of Glucagon-like Peptide-1 Receptor Agonists in Obstructive Sleep Apnea Patients with Comorbid Diabetes and Metabolic Syndrome. Life (Basel). 2022;12(8).

8. Blackman A, Foster GD, Zammit G, Rosenberg R, Aronne L, Wadden T, et al. Effect of liraglutide 3.0 mg in individuals with obesity and moderate or severe obstructive sleep apnea: the SCALE Sleep Apnea randomised clinical trial. Int J Obes (Lond). 2016;40(8):1310-9.

9. Nousseir HM. Obesity: the major preventable risk factor of obstructive sleep apnea. J Curr Med Res Pract. 2019;4:1-5. Available from: https://www.jcmrp.eg.net/article.asp?issn=2357-0121;year=2019;volume=4;issue=1;spage=1;epage=5;aulast=Nousseir