Tired all the time? Struggling to lose weight?
You could have sleep apnoea. Dietitian Melissa Meier helps you sleep tight.
We’ve all experienced a bad night’s sleep (or three!). You wake up feeling tired, struggle to concentrate at work and find yourself reaching for a sugar hit come 3pm. If you feel like you eat more when you’re tired, you’re not imagining it.
When you’re sleep deprived, your hunger and satiety (fullness) hormones are thrown out of balance, which drives you to eat more food. If this happens once in a blue moon, it’s no big deal, but if you’re constantly tired it could be a reason behind unwanted weight gain.
More often, you’ll know what caused your restless slumber. Perhaps you were mentally compiling tomorrow’s to-do list, nursing a crying baby, or being distracted by technology. But what if you can’t put your finger on it? Enter, sleep apnoea.
What is obstructive sleep apnoea?
Obstructive sleep apnoea (OSA) is a condition where your airways relax and close over while you’re asleep. This stops you from breathing and you don’t even realise it. These episodes can last a matter of seconds or for more than one minute and can occur hundreds of times a night. They don’t always wake you up, but you do stir, and they can have some serious knock-on effects.
For a start, you are unable to breathe, causing your oxygen levels to fall, which then creates a stress response in the body. Your heart rate and blood pressure rise, and you release the hormone adrenaline. Essentially, your body thinks that it is being suffocated.
If this happens many times a night, it can lead to tiredness, morning headaches, difficulty concentrating, memory issues and grumpiness, but that’s not all sleep apnoea does.
People with OSA are up to seven times more likely to develop heart disease, and they are two-and-a-half times more likely to have a car accident. OSA is also a risk factor for insulin resistance, potentially leading to further health conditions such as prediabetes and type 2 diabetes.
Conservative estimates from studies late last century put the incidence of sleep apnoea at around two per cent of women and four per cent of men. Nowadays, our increasing weights and an ageing population are thought to be driving increased rates of sleep apnoea.
One study in the US found 13 per cent of men and six per cent of women aged 30-70 years had moderate to severe OSA.
How do you know if you have OSA?
The signs and symptoms of OSA can be subtle, especially in women.
A typical sleep apnoea patient is described as an overweight middle-aged man who snores loudly and gets tired during the day.
Women often experience an unexplained fatigue and tiredness, headaches and lowered mood, as well as waking frequently overnight. Research also reveals that menopause greatly increases the risk of sleep apnoea.
One of the main causes of OSA is obesity, especially excess fat carried around the neck. Others include alcohol consumption, some medical conditions and certain medications. Sometimes it’s bone or muscle structure that’s the root of the problem.
Signs & symptoms
- Loud snoring
- Gasping for air when asleep
- Waking up thirsty or with a dry throat
- Morning headache
- Excessive daytime sleepiness
- High blood pressure
What’s the treatment?
The first port of call to treat OSA is usually lifestyle intervention.
Weight loss is a top priority, along with cutting back on alcohol. That’s particularly important in the evening, as alcohol relaxes the muscles around the throat, which can contribute to apnoea. Quitting smoking is also beneficial, as smoking leads to fluid retention in the airways, which narrows them.
Sleeping on your side is recommended too, as the effect of gravity can cause your tongue to block your airway when sleeping on your back.
Other interventions for OSA include a Continuous Positive Airway Pressure (CPAP) machine, or perhaps a specifically designed mouthguard. In extreme cases, surgery may be required. If you suspect you have sleep apnoea, or if you have any related symptoms (even if you aren’t sure that you snore) speak to your GP for a referral to a sleep specialist for further investigation.
Calculate Your Risk
- Do you snore loudly?
- Do you regularly feel tired during the day?
- Has anyone ever noticed that you stop breathing or gasp while you’re asleep?
- Do you have high blood pressure?
- Is your Body Mass Index (BMI) over 25?
- Are you 50 or older?
- Are you male?
- If you’re male, is your neck circumference greater than 43cm?
- If you’re female, is your neck circumference greater than 41cm?
- If you answered yes to two questions or less, your risk of OSA is low. If you answered yes to five or more, you’re at high risk.
Case study: sleep apnoea
“Like many people with sleep apnoea, I didn’t know I had it. ”
DAN, 53, lost 19kg
Although sleep apnoea can stop you breathing, it doesn’t actually wake you up at night. I was at my GP for an annual check-up, when, perhaps because of my weight and age, he suggested this was one of the tests I should take — even though I didn’t display the usual sleep apnoea symptom of drowsiness during the day.
The doctor referred me to a local sleep apnoea centre for a sleep study test. I had the choice either of staying overnight in hospital or hooking up the eight or so ‘bells and whistles’ myself to my face and upper body at home one night. I chose the cheaper DIY option. A few weeks later the clinic rang me with the results. Five or less apnoea ‘events’ (which includes breathing cessation and airway narrowing) an hour is normal. Over 30 events are considered severe. I had 37. I asked if weight loss would fight sleep apnoea and, while they said it could, the machine was clearly their preferred solution. I was sitting around 95kg, so I decided to lose weight and trial the machine.
The CPAP machine, which is about the size of a school bag, sits at the side of your bed and plugs into the wall. A tube connects to a mask that you place over your mouth and/ or nose, and it blasts air down your throat all night to keep your air passage open and prevent apnoea. It’s not for everyone (approximately 50 per cent of those who try the machines give them up) and after three months I decided it wasn’t for me. If anything, the machine was stressing me out which was making it harder to sleep!
I decided to persevere with my weight loss goal. Since I already exercised a fair bit, I concentrated on healthy eating. I start the day with rolled oats and blueberries, and to avoid hunger pangs during the day I snack on mixed nuts, raw carrots, and fruit. Lunch is mainly salads, vegetarian meals, or a small chicken and salad multigrain wrap. For dinner I have salad and salmon, with plain yoghurt and berries for dessert. I hardly ever feel hungry or deprived and I’ve cut right back on bread, beer and weekend takeaways.
The result? I’ve dropped 19kg in six months, which is good for my health on every possible level. Is my sleep apnoea getting better? Every instinct says yes, but I won’t know for sure until I do a second home test in a few months’ time. Regardless of that result, do I feel fitter and healthier? You bet!
5 tips to lose weight and sleep better!
1 Portion perfection
Keeping portions in check is key for successful weight management. Smaller plates, bowls and cups can help reduce portion sizes.
2 Sip smart
Alcohol, soft drink and juice contribute a significant number of kilojoules to your diet, which can lead to weight gain. A glass of wine, for example, could have around 600kJ, and a 600ml bottle of soft drink over 1000kJ. It pays to make the switch to water.
3 Plant power
Rather than sticking with the traditional meat-heavy way of eating, it’s time to shift the focus to veges. That doesn’t mean you have to cut out meat altogether but regularly make plant foods, such as colourful veges, beans and legumes, the main event.
4 Rethink carbs
There’s no need to eliminate carbohydrates to lose weight. Aim to swap refined, processed carbs for sensible portions of high-fibre, slow-burning carbs. That might be half a cup of rolled oats at breakfast, or a slice or two of wholegrain bread as part of your sandwich for lunch. Some carbs, like cake and hot chips, are loaded with energy from added sugar and/or fat , so too much of those can quickly add excess kilos.
5 Get moving
Being physically active helps you burn kilojoules, build muscle and speed up your metabolism. Start small with an activity you enjoy, such as walking or swimming, then build up your fitness.
Improve your sleep routine
Whether you have sleep apnoea or not, try these five tips to help you get a better night’s sleep and boost your energy levels
- Set yourself a regular sleep and wake time.
- Dedicate the bedroom to sleeping and intimacy only. It’s better to do studying, working and watching TV in another room.
- Aim to put away your phone, power down your laptop and turn the TV off at least one hour before bedtime. Take the time to relax and unwind.
- Eat dinner at least two hours before you go to bed, so you don’t go to sleep weighed down with a full stomach.
- If you’re not asleep in 20 minutes, leave your bedroom and spend quiet time in another room. Return to your bed once you feel tired.
What does apnoea mean?
A complete cessation of breathing, often lasting 10 seconds or longer
Article sources and references
- American Thoracic Society. Sleep-Disordered Breathing, thoracic.org Accessed June 2019https://www.thoracic.org/patients/patient-resources/breathing-in-america/resources/chapter-23-sleep-disordered-breathing.pdf
- BPJ. 2011. Obstructive sleep apnoea in adults. BPJ 48https://bpac.org.nz/BPJ/2012/november/apnoea.aspx
- Chai-Coetzer CL. 2014. Guidelines for sleep studies in adults. Prepared for the Australasian Sleep Association, thoracic.org.au Accessed June 2019https://sleep.org.au/common/Uploaded%20files/Public%20Files/Professional%20resources/Sleep%20Documents/Guidelines%20for%20sleep%20studies%20in%20adults%202017_07_04%20(1).pdf
- Harsch IA et al. 2003. Leptin and ghrelin levels in patients with obstructive sleep apnoea: effect of CPAP treatment. European Respiratory Journal 22:251-7https://www.ncbi.nlm.nih.gov/pubmed/12952256
- Paine S-J et al. 2011. Managing obstructive sleep apnoea and achieving equity: implications for health. New Zealand Medical Journal 124:1333https://www.nzma.org.nz/journal/read-the-journal/all-issues/2010-2019/2011/vol-124-no-1334/view-paine
- Sleep Apnoea Association of New Zealand, sleepapnoeanz.org.nz Accessed June 2019http://www.sleepapnoeanz.org.nz/index.php
- Sleepwell clinic. ...all about Sleep Apnoea, sleepwellclinic.co.nz Accessed June 2019https://www.sleepwellclinic.co.nz/sleepapnoea.html
- Snore Australia. 2019. Obstructive sleep apnoea, snoreaustralia.com.au Accessed April 2019http://www.snoreaustralia.com.au/obstructive-sleep-apnoea.php
- Stop Bang.ca. 2012. Screening STOP-Bang Questionnaire, stopbang.ca Accessed June 2019 www.stopbang.ca/osa/screening.phphttp://www.stopbang.ca/patient/screening.php
- Surani SR. 2014. Diabetes, sleep apnea, obesity and cardiovascular disease: Why not address them together? World Journal of Diabetes 5:381-4https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4058742/
- Taheri S et al. 2004. Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Medicine 1:e62https://www.ncbi.nlm.nih.gov/pubmed/15602591