Sleep Apnea and Weight Gain

Researchers now believe that sleep disorders, such as sleep apnea, may contribute more to obesity than they once thought. Sleep apnea is a disorder in which a sleeping person stops breathing because his or her airway is obstructed, or blocked.

Although sleep apnea can affect anyone, it is more common in overweight men. Other risk factors include being more than 40 years old, having a large neck and having a family history of the disorder. While some may think sleep apnea is just a snoring problem, if left untreated, it can lead to heart attack, high blood pressure and stroke.

People who suffer from sleep apnea and other sleep disorders are less likely to enter the deeper, restorative phases of sleep and therefore run the risk of packing on extra pounds as well.

Leptin and Grehlin are hormones that help the body control appetite and weight gain and loss. Leptin suppresses appetite, while Grehlin increases appetite and may prevent a person from losing weight. Studies show that production of both may be influenced by how much or how little we sleep.

Leptin and Ghrelin work in a kind of "checks and balances" system to control feelings of hunger and fullness, Ghrelin, which is produced in the gastrointestinal tract, stimulates appetite, while leptin, produced in fat cells, sends a signal to the brain when you are full.

So what's the connection to sleep? "When you don't get enough sleep, it drives leptin levels down, which means you don't feel as satisfied after you eat. Lack of sleep also causes ghrelin levels to rise, which means your appetite is stimulated, so you want more food," Breus tells WebMD.

Sleep Apnea Impairs Blood Pressure Regulation

People with obstructive sleep apnea (OSA) are likely to have a blood vessel impairment that may cause daytime blood pressure elevation and may lead to heart disease, according to a new Mayo Clinic study published this week in Circulation. An estimated 15 million Americans -- three-fourths of them men -- suffer from sleep apnea, but only about ten percent have been diagnosed and treated.

"We know that high blood pressure, diabetes, congestive heart failure and high cholesterol levels damage the endothelium, and that this endothelial (cells that line the insides of arteries) impairment in turn may lead to blood pressure elevation and further vessel damage," says Virend Somers, M.D., a Mayo Clinic cardiologist and the senior investigator in the study. "This study shows that sleep apnea also is an independent cause of endothelial impairment, even in the absence of other factors. It suggests that sleep apnea in otherwise healthy individuals may set in motion a long-term cycle of endothelial damage, hypertension and heart disease."

Sleep Apnea and Heart Disease

There is a strong association between obstructive sleep apnea (OSA) and hypertension, heart failure, stroke and ischemic (reduced blood flow) heart disease. Research has shown that OSA patients with normal blood pressure run a risk of developing high blood pressure within four years. Hypertension is a major risk factor in the development of heart disease and stroke. Apnea patients have higher levels of sympathetic nervous system (SNS) activity during both wake and sleep than a matched set of control patients without OSA. Involuntary functions such as heart rate and blood vessel constriction are controlled by the sympathetic nervous system. In persons without apnea, there is usually a decrease in SNS activity and blood pressure falls when sleeping. During apnea events, the higher level of SNS activity constricts the blood vessels, while the heart rate also jumps, slamming blood into tight vessels. Blood pressure spikes of up to 250/150 have been seen during apneas.

Summary

As sleep apnea patients stop breathing, their oxygen levels decrease and their carbon dioxide levels correspondingly increase, which activates the sympathetic nervous system. When the apnea patients breathe in, their cardiac output increases and their blood pressure spikes. This disrupts the normal nighttime regulation of blood pressure and the sympathetic nervous system. These factors seem to be implicated in the increased incidence of cardiovascular problems in sleep apnea patients.

Chronic Daily Headache and Snoring (CDH)

Overview

Disrupted sleep regulation may contribute to headache disorders, such as migraine, tension-type, cluster and chronic daily headache. Across studies, headache sufferers exhibit a two- to eight-fold greater risk for sleep disorders than the general population, and the prevalence of sleep disorders tends to increase as headaches become more frequent and severe. Chronic daily or morning headache patterns, regardless of diagnosis, are particularly suggestive of sleep disorders. Most often implicated are obstructive sleep apnea, insomnia, and circadian phase abnormalities. The comorbidity of sleep and headache disorders is believed to have its basis in neuroanatomical connections and neurophysiological mechanisms, involving especially the hypothalamus, serotonin, and melatonin. Treatment literature demonstrates that a significant proportion of sleep apnea-related headaches will improve or resolve with treatment of apnea¹ and preliminary evidence suggests transformed migraine may improve with behavioral insomnia treatment. Clinicians are encouraged to identify and treat sleep disorders that may improve or resolve headache.

Irrespective of diagnosis, chronic daily, morning or “awakening” headache patterns may signal a sleep disorder. Awakening headache occurs in 4% to 6% of the general population, 18% of insomniacs, and 15% to 74% of sleep apneas across studies. The best evidence linking awakening headache with a specific sleep disorder is in the case of obstructive sleep apnea. Sleep apnea headaches may present as awakening headache or as migraine, tension type, cluster or unclassifiable headaches.

Sleep apnea and depression

Sleep apnea can cause symptoms of apparent clinical depression which may respond quickly to treatment of the sleep disorder. A knowledge of the intellectual and emotional impact of sleep apnea may be important in making a correct differential diagnosis. Unfortunately, many physicians, psychiatrists, and psychologists may be unaware of this connection which may lead to apparent symptoms of depression. If there is a possibility that a patient's depression is caused by sleep apnea, they should undergo evaluation and, if necessary, receive treatment for their sleep disorder. In addition, people with sleep apnea may need support in addressing emotional aspects of treatment and recovery. Informed, trained therapists can provide essential therapy and support to the patient and the patient's family in the recovery process.