Sleep Apnea – A Cure?

September 02, 2014

A Cure for Sleep Apnea?

Reference: Science Daily, Sleep Medicine 2014 

 Sleep apnea is increasingly being recognized as a huge risk for men. It keeps climbing up the risk ladder as causes of heart disease.   What is it? It’s the subtle collapse of the upper airway that blocks normal, effortless breathing while asleep. What ensues is a tug-of-war between the effort to break that blockage by increasingly rigorous efforts at breathing, and the need for deep, restful sleep. In its most classical form, the person breaks through their apnea with a sudden snort or loud snore after a variable period of silence. Observing the sleeping person in that silent period will show someone who almost looks like they are gagging, as they make an effort to breathe in, but have it arrested by being unable to force open the collapsed airway. 

The net effect is awakening, every 2-5 minutes, all night long. Guess how well-rested that person feels the next day! If you have an issue of fatigue, and you snore, you likely have some measure of sleep apnea and are not getting restorative, restful sleep. (Mild sleep apnea = 5-15 episodes per hour, moderate is 15-30, severe > 30) It is intuitively obvious that extra weight makes sleep apnea worse. The need for effortless, easy breathing is impaired by extra weight on the chest and abdomen. The diaphragm has more work to do. There is more weight in the neck area. Extra fat provides less room for muscles to move it. 

But it has never been studied as a means to cure.   This is the first study looking at weight loss as the solution. That’s what this study provides. For the first time, obese men and women were taken and carefully instructed to make meaningful lifestyle changes so that real weight could be lost.   They started with 81 subjects and finished with 47.   They all had sleep apnea. They were followed for 5 years while being counseled. Those who achieved 5% weight loss were considered successful (n=20) versus those that didn’t achieve meaningful weight loss. (n=27) 

The risk of progression to more severe sleep apnea was reduced by 80% in the weight loss group compared to the other group.   Some men were cured completely. The dietary intervention was to increase the consumption of lean meats, fish, fruit, and vegetables and to avoid desserts, dairy fats, and saturated fat. (No wonder only 20 men lost weight.)   Exercise was counted when men exercised 30 minutes three times a week. The main finding, that sleep apnea gets better with weight loss, is huge. But this is a very small study, and only a tiny bit more than 50% could finish it. An 80% reduction of progression when you have only 20 participants might be a very small number. What is more interesting to me is that they found 20 folks who could lose 5% weight on a low-fat diet. We now know that these folks will fail in time and regain their weight. The only weight loss that is long-lasting and successful has the consumption of fat as central to its mechanisms. Eating carbs turns on insulin and insulin stores calories: that’s how you gain weight. 

 WWW. What will work for me? I think it’s time to take this knowledge and press the advantage. In my practice, I have dozens of folks in just a few years who have dramatically improved their weight and sleep, and very likely their snoring. We don’t need more studies of low-fat weight loss, we need a high-fat, low carb (>20 grams/day) weight loss study. That will show folks to be cured. 

 Pop Quiz

  1. Sleep apnea can be cured with 5% weight loss? T or F                          Answer:  True
  1. This cure applies to men and women. T or F                            Answer:  True
  1. Snoring is a cardinal symptom of sleep apnea. T or F                       Answer:   True
  1. Sleep apnea will get worse over time if you don’t lose weight. T or F.              Answer:  True
  1. Sleep apnea is a huge risk for heart attack, diabetes, high blood pressure. T or F           Answer: True