As America’s obesity epidemic continues to gain strength, our economy spends billions each year on weight loss techniques and fads. Meanwhile our country is sleeping less and less and its overall deterioration of health as a result of obesity is becoming a major crisis.
Recently the conventional notion that the obese are simply lazy gluttons has been proven as a very simplistic and largely inaccurate viewpoint. Instead we find there are a number of diseases and disorders that can lead to obesity and make weight loss nearly impossible.
The strong and “mutually consequential” relationship between the most prevalent sleeping disorder, Obstructive Sleep Apnea (OSA), and obesity can shed some light on this trend, and should be able to offer some solutions to those looking for help.
In SleepCare.com’s Weight Loss Series we will explore some of the science and solutions around sleep and weight loss, and take a closer look at the cause and effect.
Exercise and an Active Lifestyle
The biggest reward that one can gain from living an active, healthy lifestyle is the gift of long, healthy life. Obesity has become a dangerous epidemic in the United States and has led to a series of diseases and even death for many Americans. Amongst the ailments caused by obesity is Sleep Apnea, which is often linked with hypertension, high blood pressure, diabetes and heart disease. The most effective method for combating Sleep Apnea is weight loss. Along with diet, exercise is a healthy, positive, and life changing habit that can reverse many diseases and improve a person’s overall well being. Several exercise options, programs, and fitness communities can assist in establishing and continuing on a path to wellness.
Traditional exercise can be a simple start to lose weight and enjoy a good night’s sleep. For instance, walking and running, for most, are safe ways to begin a fitness routine. They require no more than a comfortable pair of sneakers and a determination to get in shape. If walking and running don’t sound engaging enough, there are countless aerobic and weight-training programs to fit any interest. Aerobic and cardio workouts, in addition to those mentioned above include swimming, biking, Zumba, step and water aerobics, and really any exercise that increases the heart-rate over an extended period of time. Because of the increased heart rate, aerobic exercise burns calories and, combined with a nutritious diet, is an optimal way to lose weight. A consistent aerobic routine will also increase oxygen consumption while burning fat and cholesterol, control weight, reduce health hazards, lower blood pressure and so much more.
Weight lifting, if done correctly, will burn calories and increase your metabolism. It can also improve your immune system and decrease your chances of developing severe diseases. Types of weight training include squatting, crunches, shrugs, leg curls and presses, arm curls and presses; in fact the list goes on and on. There is a weight training exercise for nearly every muscle in the body. Because conventional weight lifting is generally associated with strength and muscle development it may not always result in drastic weight loss. However, decreasing weight, increasing reps and shortening the time between exercises will help to keep the heart rate elevated, therefore burning more calories.
Sports, Clubs, and Hobbies
For many, working out in a gym can be intimidating, expensive or even unavailable. If this is the case there are countless sports, hobbies and activities, aside from traditional exercise, that can result in weight loss. Swimming, biking, hiking, and rollerblading are fun ways to get fit and enjoy the outdoors. Yoga and dancing are fantastic examples of exercise that can be done in the home and allow for personal expression and stress relief. Joining a sports league, coaching a little league team, or just dusting off the football or basketball for a few minutes in the backyard with family or friends, can be fun ways to lose weight while enjoying the company and community of others. Even non-athletic hobbies such as fishing, building a car, remodeling your home can have a beneficial impact on your health. Don’t just sit on the couch and watch other people do the things you’re interested in, get out and do them yourself.
If weight loss is your goal, open your mind to the many different options and possibilities you have. People have even found ways to turn everyday housework into a beneficial exercise regime. More specifically, putting dishes away can turn into a squatting routine by merely using your entire body. In addition, vacuuming and washing windows can utilize numerous parts of the body, including calves, thighs, shoulders, arms, back and abdomen. Exaggerated motions and a little creativity can turn housework into a clean home, a daily workout and a full nights rest. Video games have also become a fun way to shed a few pounds. These games include the Wii fit, which offers a personalized fitness routine for any individual. Xbox, PlayStation and even Nintendo DS have games available that can help anyone lose weight. Games such as, The Biggest Loser, presents fitness routines geared toward each individual. There are many creative activities that can be enjoyable and improve health at the same time.
Still getting into shape may seem like an overwhelming task, especially when going at it alone. However, there are ways to stay on track while working with others. In particular, SparkPeople.com is an outstanding web community that tracks your progress, offers fitness and diet plans, allows you to contact dieticians and trainers, and links you to people who are also committed to making a change. Becoming part of community, such as this one, can be encouraging and beneficial motivators, especially during the hardships often associated with working out. Getting involved in fitness clubs can also boost your enthusiasm. Most clubs offer an assortment of classes, such as racquetball, kickboxing, cycling, yoga, and personal training. By setting goals and utilizing all of the options that are out there, it can be easier to get into gear and begin a longer and healthier life.
Calories and Exercise
It is helpful to understand just how many calories are burned by some of the activities mentioned. To begin, just 30 minutes of housework such as vacuuming, doing dishes and washing windows can burn an average of 110 calories. Also, spending nearly 30 minutes skating, roller-blading or cycling can burn about 250 calories. A brisk 30-minute walk can burn approximately 90 calories. An hour of aerobic exercise can expend about 450 calories. Nonetheless, these are merely averages because height, weight and age are all factors that determine the exact number of calories burned. It is important to remember that 1 pound of fat is equal to roughly 3500 calories, which is why the combination of diet and exercise are imperative. For more on calories read the diet feature.
In essence, there are various exercise options and support groups available for anyone that is interested in improving their lifestyle. Getting fit does not have to include spending endless and grueling hours in the gym. All of the activities mentioned above could kick start an enhanced way of life that consists of weight loss and improved sleep. An early day exercise, hobby, or leisure activity is guaranteed to boost your overall health, which can insure an improved quality of sleep at night.
Sleep Apnea is the most common sleeping disorder and its primary cause is obesity. Excess weight leads to the narrowing and collapsing of the airway at night, preventing the intake of oxygen and causing numerous awakenings, which can lead to a variety of other serious health complications. Weight loss is the most effective treatment for sleep apnea, and can improve overall sleep dramatically. Yet finding the most effective weight loss plan is a challenge for many people.
Numerous weight loss methods, pills, and guides can seem overwhelming, intimidating and sometimes have ill effects on overall health. Through the confusion there is one major concept that proves to be the most important and is often over looked; diet. More specifically a proper and balanced diet that provides an appropriate amount of energy and nutrients to support a healthy body is the foundation of weight loss.
Calories are the fundamental element of diet and weight loss, as they represent the measurement of energy stored in the food that we eat and the energy that is burned during exercise. When more calories are burned during exercise than are consumed from food, weight loss occurs. The average adult male requires roughly 1800 calories per day, while women require roughly 1200 calories per day; these estimates vary widely with individual build and lifestyle. When deciding how many calories you should consume a good guide is that 3,500 calories are equal to approximately one pound, meaning if you burn 3,500 more calories than you consume in a week you will have lost one pound.
Counting calories and knowing what foods are high in calories can play a major role in weight loss. Common high calorie choices can easily be replaced to eliminate unnecessary caloric intake. For example, choose skim milk instead of whole milk, water rather than soda, or popcorn instead of potato chips. Being aware of the amount of calories you consume and burn is a vital component in a healthy diet and can easily be tracked to help you lose weight. Numerous calorie-counting tools are easily available to help, such as the LiveStrong Calorie Counter (http://www.livestrong.com/thedailyplate) and even calorie counting apps for smart phones.
A concept related to calorie counting is portion control and is often a tough obstacle to overcome when executing a proper diet. The amount of food that is placed on your plate is considered a portion. Portion sizes in many restaurants and grocery stores have grown enormously and now must be paid close attention. Often people feel that when eating healthy foods more can be consumed through larger portions, which simply is not true. By following a few visual cues, portion distortion in your diet can be eliminated altogether.
Common visual cues can eliminate the need to carry around lists, pictures and measuring cups to every meal when trying to maintain portion control. For example, one small apple or medium orange is close to the size of a tennis ball. This equals one fruit serving. The proper serving size of meat is 3-ounces. That often compares to the size of a deck of cards. Your fist is closely the same as one serving of milk, yogurt, or vegetables. By utilizing these simple visual cues you can easily control proper portions in a quality diet.
Once calorie requirements and portions have been determined, the type and quality of food being consumed is an essential factor in a quality diet. Protein is an essential building block of a healthy diet as it is the fundamental component required by all living cells to build and repair tissue, and create antibodies. Choosing proper proteins not only can boost energy levels for your day-to-day activities, it has the ability to curb your appetite due to its slower digestion rate than other foods. Lean proteins from animals and plants that are low in fat and calories are an important part of any balanced diet. Excellent examples of lean protein from animal sources include skinless chicken breasts, fish, egg whites, and reduced fat milk and yogurt. Quality plant sources include green peas, whole wheat bread, rice and beans, and nuts.
Carbohydrates are another important element of diet and another primary source of energy. Carbohydrates or “carbs” mainly consist of starches and sugars, are often calorie rich, and come in simple and complex forms. Simple carbs have little nutritional value consisting mostly of processed sugars that give you a short-term energy boost, but in the end leave you feeling sluggish once the sugar has been digested. Simple carbs have also been associated with a high incidence of diabetes. Complex carbohydrates are high-fiber foods, which improve your digestion. They help stabilize the blood sugar, keep your energy at an even level, and help you feel satisfied longer after your meal. These carbs can be found in foods that are closest to their natural forms; fruits, vegetables, whole wheat, oatmeal, rice, potatoes, etc. Avoid processed foods such as table sugar, candy, any baked good with white flour, soda and most packaged cereals. Other obvious foods to avoid are those with high saturated fat and cholesterol content, such as fried foods and fatty meat sources.
Choosing quality foods, actively being aware of portion sizes and calorie counting are all vital characteristics of a proper diet. A quality diet is the basis for not only weight loss but also a healthy mind and body. Developing a healthy daily intake of food will boost energy, your metabolism and self esteem.
Lose Weight by Treating OSA
Wendy has been trying to lose the extra weight she gained following the birth of her second child for about five years now. Despite various diet and exercise programs, she is still about seventy pounds above her ideal body weight. She finds her biggest challenges are having the energy to exercise consistently and a tendency to snack frequently—often on unhealthy foods—throughout her hectic day working as the office manager of a busy dentist’s office. During a recent visit to her family doctor, it was suggested she might have sleep apnea due to her obesity and could benefit from using a CPAP (Continuous Positive Airway Pressure) machine at night to improve her sleep.
Obesity is becoming a significant problem in the United States. According to the National Institute of Health, over two-thirds of adults in the U.S. are overweight or obese. Obesity rates are high among men (72.3%) and women (64.1%), and the costs are steep: obese people pay an average of $1,429 (42%) more in annual health care costs than those who are normal-weight. Defined as having a body mass index (BMI) above 30, obesity can lead to a variety of health problems, including type 2 diabetes, heart disease, high blood pressure, arthritis and stroke.
Sleep apnea is also strongly linked to obesity—in fact, among those considered severely obese (BMI greater than 40), estimates for the prevalence of sleep apnea range from 55% to 90%. The severity of sleep apnea is also affected: the more overweight a person is, the more frequently pauses in their breathing occur during the night, and their oxygen levels are likely to drop further than those with sleep apnea who are not overweight.
Untreated sleep apnea can promote weight gain
For those who have developed sleep apnea as a result of gaining weight, leaving the sleep apnea untreated can cause significant problems to their efforts in losing weight. One study found that subjects who were sleep-deprived had markedly higher appetite and hunger ratings than participants with normal sleep. The sleep-deprived participants were also noted to particularly crave sweets, starch, and salty snacks. Taken together, these results suggest that untreated sleep apnea can leave a person with a larger-than-healthy appetite for foods that are not beneficial to their weight loss efforts.
Sleep apnea also affects the body’s ability to regulate how it uses energy by producing imbalances in the hormone leptin, which controls energy intake and expenditure. Between subjects with similar elevated weights, studies have found those with untreated sleep apnea to have higher leptin levels than those without. Increased leptin levels may lead to increased calorie intake for some individuals.
CPAP and other OSA Treatments Can Improve Weight Loss
Fortunately, animal studies investigating sleep and weight change have found that changes in sleep due to weight gain can be reversed by weight loss—suggesting this could be true for humans as well.
The primary treatment for sleep apnea is CPAP—Continuous Positive Airway Pressure. It involves wearing a mask—usually fitting over the nose—attached to a machine by a hose. Similar to a fan, the machine blows air at a set pressure that works to keep the throat and airway held open when it relaxes after the brain goes to sleep. Since their airway remains open, a person wearing CPAP is able to stay asleep continuously, rather than have their sleep interrupted by the brain as it wakes the body up to reopen the airway.
A 2008 study published in the Journal of Clinical Sleep Medicine found that while CPAP is not sufficient on its own to produce weight loss, it does provide improved daytime alertness and energy levels—which can greatly help with efforts to increase exercise and physical activity. Additionally, improving leptin imbalances can help with maintaining a healthy diet and meal plan—instead of snacking on sweet, salty and starchy foods throughout the day.
Other treatments such as Dental Devices, Surgery, Behavioral Therapy, Medications, if successful at reducing the symptoms of sleep apnea, increasing engery and normalizing metabolic hormones, can also be seen as a means to losing weight. Each treatment has its individual benefits and success rates.
Wendy was diagnosed with sleep apnea following a sleep study and prescribed a CPAP machine, which she uses each night at home. “It’s nice to wake up feeling like I’m rested enough to meet the day head on,” she says. “Of course, it’s still up to me to exercise and eat healthy—but I find that easier to do now that my sleep apnea is in the past.”
Lose Weight Sleep Better
After years of being told by his family that he snored heavily and would stop breathing during his sleep, James met with a sleep specialist and underwent a sleep study. When the results came back positive for severe sleep apnea, he returned to the sleep lab for a Continuous Positive Airway Pressure (CPAP) titration. While he found he could tolerate the mask and air pressure, he was interested in exploring other treatment options. Noting that he was about seventy-five pounds over an ideal weight for his height, the sleep specialist recommended that he lose some weight and see if that improved his sleep apnea symptoms.
A Universal Problem
Current estimates claim that more than 55% of American adults are either overweight or obese. The prevalence of obesity is roughly the same between genders: in 2007-2008, it was 32.2% among men and 35.5% among women. Race can also play a factor: according to statistics on obesity from the American Heart Association’s website, higher percentages of Hispanics and African-Americans of both genders are overweight or obese than Caucasian Americans.
For many, the cause of obesity is simple: too many calories are taken in (through food) and not enough energy is expended (through exercise or other physical activity). However, there are a variety of other factors that can play a role as well, such as genes and metabolism. Behaviors and environments shaped by cultural, social, and economic forces can also have an impact as well.
Obesity and Sleep Apnea: A Significant Relationship
It is fairly common for an obese individual to also have sleep apnea. Studies indicate that an obese male, for example, is anywhere from 5-18 times more likely to have sleep apnea than a normal weight male. About 50% of obese males are estimated to have sleep apnea.
There are several ways a person’s obesity can affect their likelihood for sleep apnea, and they usually center around where their weight is distributed on the body. Excess weight around the neck, for example, makes the airway more likely to collapse once an individual is asleep and the airway muscles start to relax. High concentrations of adipose (fat) tissue in the throat make the airway smaller in diameter, which makes it easier to completely close during sleep. If the extra weight is concentrated around the stomach and waist, it can be more difficult to inhale deeply because of the increased effort needed to take a complete breath.
Strategies for Losing Weight
Men and women generally tend to store excess weight in different areas on their bodies. Despite this, studies have found that the effects of weight loss on reducing sleep apnea, snoring, and daytime sleepiness is similar for both genders.
Time-tested methods for weight-loss, such as eating a balanced diet, increasing the amount of physical activity and exercise during the week, still work effectively for most people. Group weight-loss and exercise programs can be effective because of the support members can provide to each other. A recent study of obese adults with diabetes found that the group which participated in a weight-loss and diet program was three times more likely to see resolution of their sleep apnea symptoms than a control group that only participated in a diabetes management program.
In addition to choosing healthier foods, portion control is another component of dieting that is important to consider. While this can be a challenge in today’s fast-paced, fast food-oriented society, there are some practical steps to take. For example, when dining out, ask for a take-home box or container and put half of the meal in it for later before starting to eat. Try to eat slowly to give the body time to realize how full it is getting—otherwise, it is easy to overeat. Drinking some extra water before eating can also help reduce hunger and curtail the tendency to eat too much too quickly.
Increasing exercise or physical activity is also an important aspect of weight-loss. According to the American College of Sports Medicine, adding a minimum of 2.5 hours per week of moderate intensity exercise (such as brisk walking or jogging) produces significant results. For long-term maintenance of weight loss, however, the recommendation is 3.3 to 5 hours per week. This can be easily broken down to just 30-40 minutes each day of activity.
Although weight-loss supplements and drugs are popular, the American College of Sports Medicine suggests they are most effective when used in combination with dieting and exercise, as opposed to being used without any other changes.
For some individuals, bariatric surgery can be an option when repeated attempts at diet and exercise have failed to produce any weight loss. Common baratric procedures include the Roux-en-Y gastic bypass and a gastric lap band procedure. While there are usually several steps to go through before the surgery can be done, bariatic surgery can produce significant weight loss results when effective.
Regardless of the approach taken, a physician consultation is always recommended to make sure the individual is healthy enough for whatever changes are planned.
James joined a gym and signed-up for some of their exercise programs, in addition to making changes to his diet. After six months, he’d lost about fifty pounds and found he was sleeping much better. A repeat sleep study showed a significant reduction in his sleep apnea, although he still had a tendency to snore. “I have some pounds left to lose,” he admits, “but it’s encouraging to know that my efforts have really improved my sleep apnea.”