For those of you who have obstructive apnea---particularly those with hypopneas---do you all know exactly what causes your apnea?  

Since I have been diagnosed I have read a great deal of forums, personal stories and etc. and it seems that there are so many people that have diagnosed with apnea and don't really know why or have been told by their physician that it is due to being overweight. For those of you who have been told that, have they done tests to determine that for sure or did your physician just make that assumption because of your BMI?

I have also read several times that people who have been told to lose weight have done it and still have apnea.  If excess tisue is causing the apnea and weight loss eliminates that, why is there still apnea?  

If muscles are relaxing so much that the throat is collapsing, what research has been done on the reasons for such low muscle tone?

Are there any statistics out there that say what percentage of people with apnea have it because of weight, how many from adenoids, or heredity or whatever other reasons there are?  Or how many are from unknown reasons?  How many sufferers with "unknown" causes?  With all of my reading I have not been able to find out this information.  

Thank you for any help you can give me.

Guest wrote:

For those of you who have obstructive apnea---particularly those with hypopneas---do you all know exactly what causes your apnea?  

Since I have been diagnosed I have read a great deal of forums, personal stories and etc. and it seems that there are so many people that have diagnosed with apnea and don't really know why or have been told by their physician that it is due to being overweight. For those of you who have been told that, have they done tests to determine that for sure or did your physician just make that assumption because of your BMI?

I have also read several times that people who have been told to lose weight have done it and still have apnea.  If excess tisue is causing the apnea and weight loss eliminates that, why is there still apnea?  

If muscles are relaxing so much that the throat is collapsing, what research has been done on the reasons for such low muscle tone?

Are there any statistics out there that say what percentage of people with apnea have it because of weight, how many from adenoids, or heredity or whatever other reasons there are?  Or how many are from unknown reasons?  How many sufferers with "unknown" causes?  With all of my reading I have not been able to find out this information.  

Thank you for any help you can give me.

The most common cause of sleep apnoea is 'hereditary'. This usually relates to the skeletal structure of your head, mainly a receeding jawline. The hereditary aspect can also boil down to the genes you were dealt, maybe other respiratory type dosorders.

Excess weight can be causitive, but usually not on its own........except in cases of very severe obesety, however excess weight particularly around the neck area will exacerbate the condition..........so which comes first apnoea or weight gain ? It's really a 'chicken and egg thing'........untreated apnoea effects metabolism and leaves a sufferer susceptible to weight gain.

Some GPs, who know 'sfa' about apnoea often tell patients to lose weight (never looking to see the cause of weight gain) and even worse often prescribe sleeping tablets. IMHO they should be banned from advising or diagnosing sleep disorders of any type............remember, over 5 years spent qualifying, with a further 2 years as interns they actually spend something like 5/15 minutes (yes minutes) learning about sleep disorders.

There are no peer reviewed studies on the success of weight loss in dealing with apnoea, however it is believed (based on informal reports from some sleep clinics and more importantly some DME suppliers) that approx 2% of sufferers have managed to get off cpap through weight loss. Excess tissue.............depending on where it is located may contribute to sleep apnoea, but all sites of obstruction must be located............this is seldom if ever done as ENTs seem to concentrate on the upper airway only. There is also the question of 'weak' tissue which causes the airway to constrict or collapse. Despite surgery to the upper airway, causing tiisue to scar and stiffen, it eventually reverts to its original condition.......ie weak and subject to constriction.

Causes of apnoea are seldom 'unknown'..........merely medics fail to properly explain.........and in a lot of cases sufferers are unwilling to listen.

Daniel.


_________________
The untreated Sleep Apnoea sufferer died quietly in his sleep.......
Unlike his three passengers who died screaming !!!!!!

(Anon)

Thank you for your reply Daniel.

If the obstruction should be identified, what is the usual procedure?  Are there X-rays?  Muscle testing?  Is it irresponsible for a physician (a sleep specialist in my case) to diagnosis and treat sleep apnea but not pursue the cause?  Just attribute it to weight without even investigating?

If the cause should be identified and your physician is unwilling to test further, should you try to find a physician that will?

I completely agree that the cause should be found but wasn't in my case and many others as I have read.  That is my confusion in all of this. If I had an "obstruction" in any other part of my body, bowels, blood, urinary, etc., it would most likely be investigated.  They wouldn't just give you an catheter and send you on your way.

What advice do you have for people who have not been given an appropriate investigation for the cause of their apnea?

Thank you again.

guest wrote:

Thank you for your reply Daniel.

If the obstruction should be identified, what is the usual procedure?  Are there X-rays?  Muscle testing?  Is it irresponsible for a physician (a sleep specialist in my case) to diagnosis and treat sleep apnea but not pursue the cause?  Just attribute it to weight without even investigating?

If the cause should be identified and your physician is unwilling to test further, should you try to find a physician that will?

I completely agree that the cause should be found but wasn't in my case and many others as I have read.  That is my confusion in all of this. If I had an "obstruction" in any other part of my body, bowels, blood, urinary, etc., it would most likely be investigated.  They wouldn't just give you an catheter and send you on your way.

What advice do you have for people who have not been given an appropriate investigation for the cause of their apnea?

Thank you again.

Individual Obstructions should really only be investigated if you intend undergoing surgery for correction. Usual procedure would involve numerous scans, possibly an MRI and internal examination using a camera. I should point out that you could spend the rest of your life and a load of $ trying to find every conceivable obstruction and reason for constriction. I wouldn't call it irresponsible for a physician (remember the word physician) to look for obstructions as it really isn't their function. A correct diagnosis is sufficient followed by a suitable treatment regimen.........usually cpap. This is a form of mechanical intervention which, when a patient is compliant, treats the condition in 95%+ of all cases. Why would a physician look further ? it's really up to the research and scientific end of medicine to come up with alternatives.

Attributing the condition to 'weight' is really down to the expertise or competence of the physician. We are all different, but most competent sleep physicians can give a fairly accurate reason for the cause of sleep apnoea, in individual cases......they base this on an initial examination, possible detail contained in the GP referral letter, interviewing you and the result of the sleep study and of course years of experience. If you don't want to accept this, then you should look elsewhere...........but don't be surprised if you get the same answer elsewhere. In my earlier post I specifically mentioned GPs as being less than knowledgable and often referring to weight problems, rather than refer you on.............in your case a sleep specialist mentioned it and I assume was based on his findings.

With regard to sleep apnoea in adults, a blockage such as large tonsils, adenoids etc etc can be removed, but is unlikely to 'cure' sleep apnoea..........if tissue is 'weak' then regardless of obstructions it will continue to constrict and cause apnoeas.

Sleep apnoea is not just about blockages............it is about the airway constricting or collapsing and the treatment of choice is an airway splint to keep the airway open..............blockages and growths in the bowel or urinary tract are another story. They block........don't constrict and as such are usually removed. Also they block something coming out......an air splint won't help there.........apnoea events block something coming in.......so the airway must be kept open for that.

In answer to your final question.......people are given a reason for their apnoea.......their airway collapses and to treat it the airway must be kept open. In going to a sleep specialist or clinician it is usually a medical type solution. If you go to an ENT and are willing to pay him sufficiently he will certainly examine your airway and come up with a surgical solution........unfortunately they don't give great results.

I think you should accept the condition, undergo treatment therapy and once its under control have a look around for alternatives.

Daniel.


_________________
The untreated Sleep Apnoea sufferer died quietly in his sleep.......
Unlike his three passengers who died screaming !!!!!!

(Anon)

Thanks again for all of the information.  I understand all of what you are saying.  However, maybe it's denial, maybe doubt or could even be pride, but there is just too much yet for me that doesn't make sense.

For instance, if weight is my reason for apnea than why doesn't my considerably heavier husband and brother have it?  50% of Americans are overweight.  Why don't they all have sleep apnea?  I can understand the morbidly obese, they've got hosts of problems so that would make sense.  But someone like me, I just don't get it.

And if it's slack muscles in the throat than why are they slack?  Muscle weakness can be the result of many things.  Maybe there is a nutritional deficiency or an underlying illness that needs to be investigated.  And why is it only the throat muscles that slack at night?  If my throat muscles are that weak then why aren't others as well, ie bladder, bowel?  I don't have problems wetting the bed or anything so apparently I can control those parts of my body while I am sleeping.  But I need help keeping my airway open?

I completely understand the structural, hereditary reasons for apnea.  I wish I had one of them so I could put this to rest.

I'm sorry if I sound like I am unaccepting of my diagnosis.  That is not the case.  I get that there is something getting in the way of my breathing properly at night and will do whatever it takes to correct it.  But I don't feel like I have all of the facts needed to make the best treatment decision.  Maybe the problem isn't with my particular doctor but with the condition as a whole and the amount of funding and research for it.

I'm glad that cpap works for so many people.  No doubt it has saved many lives.  If that is what I need to use every night for the rest of my life then so be it.  I will start using it just as soon as I am convinced that is the only treatment that will work for me.

You've been very helpful.  Maybe I will never know exactly why something is obstructing my breathing at night.  But I doubt I will ever stop wondering.

Hi guest. I'm just curious. What are your symptoms?

sleepyjean

Mostly daytime sleepiness and occasional choking epiodes during the night.  I also wake up periodically throughout the night for no reason although now I am being told that is part of the apnea.  Often when I wake up, my heart is racing.

throughout this fourum I keep hearing this "only 2% get off CPAP through weight loss", implying that losing weight most likely won't cure your apnea if you are overweight? If this "2%" statistic is true then it is only cause most people FAIL to lose the wieght, not cause weight loss won't cure a much larger percentage of sufferers. I myself did not notice the apnea(and many other problems) until I gained a considerable amount of weight.  There is a link over at Remedyfind.com where people post their results after losing weight and it's effects on their apnea.  Nearly every person improved greatly or eliminated their apnea.  I know not all apnea is caused by being overweight, but if you are then yes indeed their is a great chance that you can eliminate it by losing your excess weight. Here is the link:

http://remedyfind.com/treatments/43/1438/[/i]

scottie wrote:

throughout this fourum I keep hearing this "only 2% get off CPAP through weight loss", implying that losing weight most likely won't cure your apnea if you are overweight? If this "2%" statistic is true then it is only cause most people FAIL to lose the wieght, not cause weight loss won't cure a much larger percentage of sufferers. I myself did not notice the apnea(and many other problems) until I gained a considerable amount of weight.  There is a link over at Remedyfind.com where people post their results after losing weight and it's effects on their apnea.  Nearly every person improved greatly or eliminated their apnea.  I know not all apnea is caused by being overweight, but if you are then yes indeed their is a great chance that you can eliminate it by losing your excess weight. Here is the link:

http://remedyfind.com/treatments/43/1438/[/i]

Scottie,

Excess weight is not the most common cause of sleep apnoea.........fact. The most common cause is hereditary, mainly in the skeletal structure of your head.........the jaw area.

As we seldom become aware of sleep apnoea until such time as symptoms become more pronounced, weight gain (in a lot of cases) has already taken hold, mainly through poor metabolism, sometimes depression and a general feeling of being unable to cope. This can be based on the fact that OSA sufferers probably suffer from the condition in one form or another for quite a few years before diagnosis and treatment.

Quite a lot of posters to the various forums are ill informed, either through ignorance of all the ramifications or an unwillingness to listen to and question their sleep specialists. There is a common misconception that weight loss, in all cases, has a good chance of 'curing' the apnoea.............this is a myth. For weight loss to be truly effective in cases where it may be effective............we are talking serious weight loss........like, say, from (example) 260 lbs to about 170 lbs and having lost that kind of bulk, one must keep it off, which is the really hard thing to do as any weight increase (of significance) will reintroduce apnoea.

Also a significant number of sufferers who lose large quantities of weight and start to feel a little better will declare themselves cured and little is heard of them again............until symptoms start to return after 6/12/18/24 months following weight gain, or even no weight gain. Sleep apnoea is a respiratory sleep disorder which requires mechanical intervention. At its severest it is a potentially life threatening disorder and in the vast majority of cases it is a life sentence.

I know I sound negative, but over the last 13 years (since I was diagnosed) and the possible 4/5 years before that when I barely functioned I have received some hard knocks relating to this disorder. I have lost weight (not enough), I am aware of one sufferer who through weight loss managed to get off cpap (it took him 3 years).........He is still off it (5 years), but gets checked out every 18 months now...............to balance that up I am aware of another 15/1600 sufferers who haven't. I think it is wrong to raise hopes on the weight loss 'cure'. It only works for a certain amount of cases.

Daniel.


_________________
The untreated Sleep Apnoea sufferer died quietly in his sleep.......
Unlike his three passengers who died screaming !!!!!!

(Anon)

But you also shouldn't discourage people from losing weight.  That's just like basically telling them "don't bother cause it's not gonna help you", even though you've never bothered to lose all the weight yourself so how could you know?...unless you know with absolute certainty that your apnea is not caused by being overweight.  It just makes sense that if a person's apnea developed as they gained weight, then losing weight should reverse it.

In the link I put up earlier, every single person who lost a lot of weight either greatly improved or more likely eliminated their OSA. I mean obviously if someone is thin and has obstructive sleep apnea then no, weight loss probably won't work for them because they have some other issue that causes their apnea.  BUt for the obese and overweight...and that seems to be a lot of people these days..I think it's worth a good shot.

Here' that link again for anyone interested: http://remedyfind.com/treatments/43/1438/

I'm pretty new to Sleep Apnea but I felt I needed to post my comments on this thread.

About 5 years ago I started snoring to the point where I would wake my husband at night. I tried nasal sprays, those bandaids that you put over your nose, decongestants.... etc. Meanwhile my weight starting going up. I didn't change my eating or exercising habits but I continued to gained weight. My doctor has tested me for everything from diabetes to hyper-thyroid disease. I've been treated twice for depression and still I gained weight.  Meanwhile, according to my husband my snoring got worse. Sleep apnea runs in my family. In retrospect I can see how my symptoms ran in direct parallel with my sleep deprivation.

My weight gain definately made my snoring and apnea worst. My point is that when I was first told I snored I was not overweight, now I am.  

So which came first the chicken or the egg?

This is sort of what I was getting at with my first post.  Is it not possible to determine the cause of apneas?  If there is suspicion that the apnea is from excess weight/tissue than can't that be verified in some way?  Isn't there a scope or something that they could use to see it? Obviously not everone with excess tissue has sleep apnea.  In fact you probably know many, many people with obesity that don't.  Of course it wouldn't hurt anyone at all to keep their weight down, that can only help with overall health.  But I just think it is risky to assume that losing weight is all that is needed when it may have never been the cause in the first place.

scottie wrote:

But you also shouldn't discourage people from losing weight.  That's just like basically telling them "don't bother cause it's not gonna help you", even though you've never bothered to lose all the weight yourself so how could you know?...unless you know with absolute certainty that your apnea is not caused by being overweight.  It just makes sense that if a person's apnea developed as they gained weight, then losing weight should reverse it.

In the link I put up earlier, every single person who lost a lot of weight either greatly improved or more likely eliminated their OSA. I mean obviously if someone is thin and has obstructive sleep apnea then no, weight loss probably won't work for them because they have some other issue that causes their apnea.  BUt for the obese and overweight...and that seems to be a lot of people these days..I think it's worth a good shot.

Here' that link again for anyone interested: http://remedyfind.com/treatments/43/1438/

Scttie,

I don't think that you read my post............or maybe it wasn't clear enough.

Weight loss for general health is good...........and therefore is good if you suffer from sleep apnoea......BUT one should not be raising hopes of sufferers that weight loss is a 'definite' cure.............there is also the question of keeping the weight off, which usually forms a major stumbling block. Quick weight loss very often leads to quick weight gain.

With regard to the link, the posts are primarily 'subjective' patient reports and appear to refer, in the main, to short term improvement............as there doesn't appear to be follow up reports over a period of 12/36 months. The posts are subjectively rated by the poster and there appears to be no reference to follow up sleep studies, to prove that apnoea has been 'cured'. Feeling better does not indicate that apnoea has gone. The leading banner also mentions a number of reports and studies, but fails to clarify their content. I also notice that the site is effectively 'commercial', with plenty of advertising.............

Yes, I am negative...........not towards weight loss, which in itself is good for ones health and should be encouraged.........but towards the inference that weight loss will cure sleep apnoea (without qualification).

Daniel.


_________________
The untreated Sleep Apnoea sufferer died quietly in his sleep.......
Unlike his three passengers who died screaming !!!!!!

(Anon)

Scottie, thanks for the link. Interesting. I agree weight loss usually doesn't work because people can't/don't do it. It appears to me that the cause of sleep apnea in most cases is simply unknown. My symptoms decreased dramatically with a 15% weight loss although I was not obese initially. When I fiinally had my sleep study my snoring had stopped and my
AHI was relatively low. Although I am not overweight by bmi criteria (24) I still have some symptoms and can't comfortably sleep on my back. I want to reduce my weight a little more to see if it helps. In my case there must be an anatomic component interacting with weight. My father had severe osa but was quite heavy. I suspect that I could go from borderline osa to severe with increasing weight but I don't want to find out for sure.

Weight loss takes time and most folks with significant osa would seem to be best off with cpap in the short run.

Quote:

I'm pretty new to Sleep Apnea but I felt I needed to post my comments on this thread.

About 5 years ago I started snoring to the point where I would wake my husband at night. I tried nasal sprays, those bandaids that you put over your nose, decongestants.... etc. Meanwhile my weight starting going up. I didn't change my eating or exercising habits but I continued to gained weight. My doctor has tested me for everything from diabetes to hyper-thyroid disease. I've been treated twice for depression and still I gained weight.  Meanwhile, according to my husband my snoring got worse. Sleep apnea runs in my family. In retrospect I can see how my symptoms ran in direct parallel with my sleep deprivation.

My weight gain definately made my snoring and apnea worst. My point is that when I was first told I snored I was not overweight, now I am.  

So which came first the chicken or the egg?

hey   i may becompletely wrong, but it seems obvious to me that if you were doing ok and then the snoring began.... then it was the apnea that came first. It would then follow that the apnea caused you to put on weight along with all of your other symptoms- even more weight gain, depression, snoring got worse, being tested for all kinds of problems.
You also say that sleep apnea runs in the family- so you most likely had it all along, it just gets worse with time until eventually it causes all the things your describing- weight gain, snoring, depression etc. and you also said it yourself,

Quote:

My weight gain definately made my snoring and apnea worst

implying that the apnea was always there.

So logically it's your apnea that came first, it was never your fault or the weight that caused it.... the weight (which you put on BECAUSE of the apnea) just made it worse.

So in regards to the rest of the threads here, technically you should lessen the severity of your apnea with weight loss.. BUT you most likely can't loose weight without cpap treatment, because it is the apne itself that is causing you to keep the weight on....as you say,  

Quote:

I didn't change my eating or exercising habits but I continued to gained weight

obviously there are people that are severly obese and they should be able to drop a few pounds without any treatment, simply by lowering their daily intake of food. (easier said than done)

So by using the treatment you should find it easier to loose weight and in turn there should be less strain on your body, but it won't CURE it... just like daniel said. If you go off cpap, it'll most likely just come back because in so many cases people put on weight due to the apnea (in the stages when they may not even feel they have a problem) so they assume that the apnea started due to weight gain.... that may or may not be the case.... but i believe in the majority of cases it was always there (the apnea) and it was only when the weight started creeping in that they realised there was something wrong (as the weight can make it worse)

obviously there are a load of people that never experience weight problems and there are lots of different reasons for each individual case, and so far as weight loss is concerned, everyone should try... purely for their general health. having said that... it's much easier to say it that to do it.

take care everyone

abi