I’m quite certain that people with sleep apnoea for whom weight is a relevant component are quite aware of that. Yours is just a pointless diversion in this context – because what exactly is the your angle here?
Should it be hard for people with sleep apnoea to get treatment? I mean, what are you arguing here for exactly?
All that stuff is true. All that stuff is avoided by losing weight.
Your comment appears to be overly sensitive to a calm, non-judgemental bit of information.
EDIT: Here's the link to the CDC page which lists overweight as a cause of sleep apnea: http://www.cdc.gov/healthyweight/effects/index.html
It's really easy for people, especially men, to hit a BMI of 30 and not realise that they are obese. Especially in obesogenic societies where very many people are obese, morbidly obese or even super obese. This carries a range of health risks, most of which are helped by losing weight.
It's weird the source article doesn't mention weight, since it is caused by lack of sleep (especially in children and young people) and causes lack of sleep (in adults).
http://www.cdc.gov/sleep/about_sleep/chronic_disease.htm
> Laboratory research has found that short sleep duration results in metabolic changes that may be linked to obesity. Epidemiologic studies conducted in the community have also revealed an association between short sleep duration and excess body weight. This association has been reported in all age groups—but has been particularly pronounced in children. It is believed that sleep in childhood and adolescence is particularly important for brain development and that insufficient sleep in youngsters may adversely affect the function of a region of the brain known as the hypothalamus, which regulates appetite and the expenditure of energy
I strongly disagree on the point of time. It is important to realize how slow actual weight loss is. By my naive googling, losing 1kg of fat per week will require quite a lot of calorie restriction, and it is not achievable easily. If you are say 20kg overweight, you will need at least 20 weeks to lose that weight, likely more as nobody is perfect and stress factors here as well.
I am stressing this point as I would like to encourage anyone who suffers from sleep apnea to start both treatment and losing weight. Telling yourself "I don't have to seek treatment, I'll just lose weight" may lead you into several weeks of diminished productivity (as a PhD student with apnea, when not getting enough sleep my scientific productivity is close to zero).
I am not claiming any of the original commenters suggest this, but still: "I'll just suffer until I lose enough weight" is a terrible decision.
That's a good point.
> I am not claiming any of the original commenters suggest this, but still: "I'll just suffer until I lose enough weight" is a terrible decision.
Well, yes, but treatment will change as weight changes. Why go through risky surgery if weight loss might help? Why go through the hassle of sleep studies and waiting for machine fitting if weightloss will help? The alternative to weightloss is not "instant cure", there's still time delays built in.
/working on it
Losing weight is not hard. Change your diet and start walking (just walking) 30-60 minutes a day.
I agree with your other points, but I'd say that getting a CPAP is probably a good idea, but that losing weight could make that unnecessary down the road and there are a myriad of other benefits.
2. The metabolism and appetite changes drastically. Instead of getting a break and waking up in the morning after a good night of sleep not needing food, you are constantly sugar crazy 24/7. You never get a break from the appetite and blood sugar mayhem. This makes it really difficult to change eating behavior.
The best solution is to get as many people as possible a CPAP machine so they can feel well rested and reset their system, and then they will have a much better starting point for losing weight. And yeah, you can be skinny as hell and still have sleep apnea, a bunch of people do.
And for the past several years, I felt the exact same symptoms - falling asleep behind the wheel (or on the subway); craving for food; episodes of sleep paralysis (thankfully not too frequent).
STRONGLY disagree. My doctor says that IN MY CASE, losing weight should be enough. We're talking 10kg (~22 pounds) from the ideal weight.
Is this true for the general population? No idea. There are several other possible causes. And that includes central sleep apnea, or problems in the airways.
We are in agreement that losing weight should be the first thing one should try. But one would think that doctors would point that out too (as they did with me).
> All that stuff is true. All that stuff is avoided by losing weight.
As that is not true in 100% of cases of sleep apnea as you implied, you are being an asshole and misleading, fyi.
http://www.mayoclinic.org/diseases-conditions/sleep-apnea/ba...
> Excess weight. Fat deposits around your upper airway may obstruct your breathing. However, not everyone who has sleep apnea is overweight. Thin people develop this disorder, too.
But even if no-one were obese, obstructive sleep apnea would still exist. Anyone who snores could have it. The person may have a deviate septum. They might have swollen tonsils or adenoids. They might have a congenitally narrow airway. Maybe even a particularly long uvula.
And then there are the non-obstructive (worse) sleep apneas, such as those caused by defects in the nervous system, where the brain is unable to tell the diaphragm to move.
Being thin is not a perfect defense against sleep apnea. Nevertheless, it appears that the vast majority of apneas are worsened by obesity, and obesity is worsened by sleep deprivation. That is a vicious cycle.
With my foil hat on, I suspect that safe and effective treatments for reducing body fat in obese individuals are not being researched for public health reasons (esp. as preventative measures against heart disease and diabetes), because an non-curing treatment for fatness would make ten times more money than boner pills, especially in the US. And this is why you get people doing DIY fecal transplants from thin friends in their own kitchens, or buying and injecting barely-tested research peptides (like cyclized CKGGRAKDC-GG-D(KLAKLAK)2 HCl salt) from Chinese synthesis labs. The health care system wants all the money, and the people who need the treatments most just don't have enough of it. When the flow of cash takes priority over patient well-being, people start to do crazy things out of desperation, and a sense that the doctors are acting as drug pushers instead of trying to help them get well.
> All that stuff is true. All that stuff is avoided by losing weight.
No, its not.
For one thing, because if you are overweight and have OSA, "losing weight" can be more difficult if you don't get the OSA treated.
For another thing, healthy weight loss of an amount that is likely will significantly OSA is a longer process than getting treatment for OSA, even with all the problems that can involve.
I slowly gained about 30kg (66lb) in my early twenties (I went from about 75kg to 105kg at peak over about four years). When I started having trouble breathing at night I knew there was a problem (and figured the weight might be the cause), but I didn't hear of sleep apnea until a few years after I had lost the weight (the breathing difficulty disappeared with it).
I know all about this. That is why this condescending behavior is so awful.
(I could also stand to lose several stone.)
- They are both self imposed, chronic problems
- They both induce a myriad of known health issues
- They both are readily solvable using known methods and by building healthy habits over time
It is really imperative that obese people lose weight, in the same way that it's important that smokers stop smoking. You would never say someone is being "smoker shamed" by being told to stop smoking, that they are being "smoker shamed" by being told that their smoking is causing health problems, or that they are being "smoker shamed" by being told that smoking is not that attractive. Why should it be different for obesity?
This difference makes me think that people view obesity as some inherent characteristic of themselves like race or sex. This simply does not have to be the case. I think if people knew how straight forward it was to lose weight by applying validated diet methods over time, there wouldn't be all this nonsense and controversy about "fat shaming".
I was pretty slim until about 23, so my identity was always firmly rooted in a healthy weight range. I never felt defensive over being overweight; sensitive, certainly, but I was also my biggest critic (no pun intended).
Then again, maybe it's something entirely different!
A person who is overweight isn't inherently a "fat person", they're a person that hasn't discovered and applied the methods and systems to be at a normal weight; A person who has no strength isn't inherently a "weak person", they're a person that hasn't discovered and applied the methods to be strong etc.
Once a problem is framed like that, solving it is simply a matter of research and applying known methods. You don't need to change your identity, you just need to change your systems.
I think that goes for you too. If you don't feel that the comment addressed you personally why over-react like this? It was simply a bit of information presented in good faith.
It’s also the typical shitty response overweight people tend to often get – people who are perfectly aware of their weight.
That does not stop it being true!
When a doctor tells someone to lose weight to help some health problem s/he's not dismissing the health problem. S/he's giving very good, useful, achievable, advice. In England the doctor may also give a prescription to 12 weeks free on a weight loss course, such as "Slimming World".
You seem to think this is some kind of /r/fatpeoplehate or /r/fatlogic thing, but it isn't. Your dismissal of this calmly presented, good faith, evidence based bit of advice is odd.
I have no issues with doctors giving someone advice – but that’s really not the point here.
In the UK positive pressure machines are only recommended after lifestyle interventions have been tried.
http://www.nice.org.uk/guidance/ta139/chapter/1-guidance
> 1.1 Continuous positive airway pressure (CPAP) is recommended as a treatment option for adults with moderate or severe symptomatic obstructive sleep apnoea/hypopnoea syndrome (OSAHS).
> 1.2 CPAP is only recommended as a treatment option for adults with mild OSAHS if:
> they have symptoms that affect their quality of life and ability to go about their daily activities, and
> lifestyle advice and any other relevant treatment options have been unsuccessful or are considered inappropriate.
http://www.nice.org.uk/guidance/ta139/chapter/2-Clinical-nee...
> 2.4 Major risk factors for developing OSAHS are increasing age, obesity and being male. OSAHS is also associated with certain specific craniofacial characteristics (such as retrognathia), enlarged tonsils and enlarged tongue. Use of alcohol or sedatives can also increase the risk or severity of the condition. OSAHS has been reported to affect up to 4% of middle-aged men and 2% of middle-aged women in the UK. It is estimated that 1% of men in the UK may have severe OSAHS.
> 2.5 Treatments aim to reduce daytime sleepiness by reducing the number of episodes of apnoea/hypopnoea experienced during sleep. The alternatives to CPAP are lifestyle management, dental devices and surgery. Lifestyle management involves helping people to lose weight, stop smoking and/or decrease alcohol consumption. Dental devices are designed to keep the upper airway open during sleep. The efficacy of dental devices has been established in clinical trials, but these devices are traditionally viewed as a treatment option only for mild and moderate OSAHS. Surgery involves resection of the uvula and redundant retrolingual soft tissue. However, there is a lack of evidence of clinical effectiveness, and surgery is not routinely used in clinical practice.
Talking about weight loss in a thread about lack of sleep is not a derailment; it is not condescending. Lack of sleep is one cause of obesity. Obesity plays a major role in lack of sleep.
I also think that this is a much better comment than your first one. I really think one should be very careful when dragging victim terminology into this discussion or, in fact, any discussion about weight. I have been unable to lose weight for years (all the time being extremely aware of how shitty I felt all the time and the negative impact on my health) and now after I did I’m still not sure how I actually did it.
Point is, it’s not as simple as telling people to just lose weight. Because just losing weight is extremely hard and it’s time we acknowledge that. And I’m not talking about the raw mechanics of losing weight here – those are easy and work with mathematical precision (well, ok, I myself may be generalizing too much here, but for me they did: if calories out minus calories in are equal to roughly 7000 I had lost 1kg, maybe ±.3kg, though that’s probably mostly due to the inherent uncertainties of estimating calories).
It’s about psychology and accusing people of playing the victim or trying to insult them to lose weight is just not a workable strategy. It just doesn’t work. Or it may even work for some people, but I don’t think it’s in general a wise strategy because it’s plain dehumanizing.
The medical opinion in the US is that CPAP is the first-line treatment to be done in parallel with any necessary lifestyle adjustments in all cases of OSA.
http://annals.org/article.aspx?articleid=1742606
> Recommendation 1: ACP recommends that all overweight and obese patients diagnosed with OSA should be encouraged to lose weight. (Grade: strong recommendation; low-quality evidence)
> Recommendation 2: ACP recommends continuous positive airway pressure treatment as initial therapy for patients diagnosed with OSA. (Grade: strong recommendation; moderate-quality evidence)
Though not explicitly stated in the paper, the general consensus I have heard from physicians here (and others in this sub-thread have stated) is that lifestyle intervention is much more likely to fail if CPAP is not initiated in parallel.
> 1.2 CPAP is only recommended as a treatment option for adults with mild OSAHS if:
I can't see the definitions of mild and severe, but clearly this is not recommending CPAP only "after lifestyle interventions have been tried" for the entire population.
This is the typical exchange in the US:
MD: Losing 20kg of body fat would reduce your other symptoms tremendously.
Pt: Great. Can you help me do that?
MD: No.
Pt: But I just gave you a $30 co-pay on a $300 office visit.
MD: I can prescribe pills to treat your symptoms for as long as you continue to take
them, and order additional tests. You won't know how much the tests will cost until
after you take them, and your insurance denies the claim to stick you with the entire
bill.
Pt: Could you prescribe exercise? Would that let me use my insurance to get a bench and
barbell or exercise bike or elliptical machine or something?
MD: No. Your insurance won't cover a preventative treatment that would very
inexpensively reduce your risk for literally dozens of horribly expensive diseases.
The assumption is that you won't exercise, even if you own all the necessary
equipment in your home.
Pt: What about a prescription diet? Could I go on Atkins or some other ketogenic diet?
MD: I can't recommend any diet in particular, because I don't want to get sued, or
censured and persecuted by the AMA. But yes, changes to your diet may or may not
help you achieve a goal of fat loss, depending on what the available research may
indicate.
Pt: What research? Can I read it?
MD: Are you a student or professor?
Pt: No.
MD: Then you probably don't want to pay Elsevier $100 a pop just to read articles with
ambiguous results.
Pt: What about liposuction?
MD: That's a cosmetic procedure. You can't afford it, and your insurance won't pay a
dime.
Pt: Fat loss drugs?
MD: None approved by the FDA that won't make your heart explode.
Pt: Why am I here?
MD: Because you want to help pay for my daughter's orthodontic treatment?You don't need any equipment. All you need to do is walk. Nothing else. Walk for two hours every day or two.
It's also enjoyable and relaxing and mentally stimulating.
It's win, win, win and it costs zero dollars.
They will, however, give you some cash or premium discounts if you enroll in their health nagging/spying program. You self-report a sackfull of valuable risk factor information, and they, in turn, frequently call you and read from a script at you. There is no material support or genuine incentive for positive lifestyle change.
As regular walking has such great, demonstrable health benefits, you would think that a health insurance company might do something like send you a free new pair of walking shoes if you send them your old pair, with the soles worn out from walking.
I can't exactly agree with the part about being enjoyable, relaxing, and mentally stimulating, though. That's largely dependent on your route and companions. Someone walking through a sprawl of suburban McMansions with an unrelenting babbler is not going to keep at it as easily as someone who can enjoy a hiking trail at a scenic park with someone who knows how to just shut up and enjoy nature in companionable silence. (~Any resemblance to actual walking experiences is purely coincidental.~)
The number one reason I have for keeping exercise equipment in my home is because I think you shouldn't have to get in a car and drive somewhere in order to have a positive exercising experience, and walking around my neighborhood is not one.
Of course they don't. It's tautological. Insurance companies by definition do not insure against regular, predictable expenses.
A car insurance company will never insure you for new tires and a health insurance company will never insure you for regular, recurring wellness checkups. Because math.
Yes, sometimes they say they will, and sometimes such a reimbursement actually occurs, but make no mistake - that is never a claim payment and basically amounts to fee for service. You will not receive claim payment for items like this - they are not underwriteable.
Alternatively, you could view the physical exam as a genuine insurance claim because not all insured parties actually take advantage of all the preventative services that they're theoretically entitled to under their policies. I've had years where I didn't get a physical exam or dental exam that my policies would have allowed me to, and so have many other people (but the carriers still got paid the premiums for those years!). If the carrier makes actuarial estimates of the likelihood of people not using those services, it's pretty solidly back in insurance territory!
Well, except for the long list of preventive measures they must pay for, as a result of state and federal regulations [1].
And, except for the fact that some insurers paid for non-mandated preventive services previously (and cover non-mandated preventive measures now), but only to the extent that their experience bore out that those services reduced their downstream expected costs.
[1] e.g., https://www.healthcare.gov/preventive-care-benefits/
However, in this case, it's hugely beneficial that common sense wins the day, most of the time. Most obese people can lose a huge chunk of their fat by cutting out sugar, replacing it with fibre and healthy fats. Throw in a few walks a week and that's the first 100 pounds.
A lifestyle intervention would include exercise (perhaps on prescription - cheaper gym membership) and a few months free access to a slimming club.
Whether the comment is addressed to you or not seems irrelevant to me. Example: somebody says somebody racist, but you're not a member of the discriminated group. Should you be all "i'm not going to say anything, because it doesn't address me personally?" I should hope not.
i'm pretty sure he's arguing for people to treat their own apnea by losing weight instead of dealing with clinics and the treatment "racket"
This is why losing weight is one of the most important steps. The CPAP should make it easier to do so.