A study by a sleep clinic in Newcastle has shown that the severity of their patients’ sleep apnoea was directly linked to their weight. After examining 20 years of records it became clear that as their patients gained weight and increased their BMI, the frequency of their apnoeas increased.
There has long been a link between sleep apnoea and being overweight, but it is interesting to find a study that shows the link between the two so directly. On average men put on 10kg and women 12kg from when they first visited the clinic, but while no specific reason was named for why they put on the weight, the increase in the severity of their sleep apnoea was a clear consequence.
Weight and Sleep Apnoea are closely linked
“As body weight goes up, Sleep Apnoea gets worse”
Dr Jeffry Pretto, who did the analysis of the clinic’s data, said: “How many times each hour people actually stop breathing, or slow their breathing down significantly - that marker is very much linked to body mass index. As people’s body weight goes up, the severity of their sleep apnoea gets worse. The other interesting finding is the instance of severe obesity - that is if they have a body mass index of over 40. Back in 1987, only 3 per cent of people that were referred to us for sleep studies we’d classify as having morbid obesity. In 2007, that went up to 15 per cent. It’s gone up by a factor of five.”
Without successful treatment for sleep apnoea it can become a vicious cycle. Sleep apnoea makes you tired during the day, giving you less energy to be active and do exercise. This leads to you gaining weight, increasing the severity of your apnoea, making you even more lethargic. The cycle goes on and on. Some people also blame increase carbohydrate cravings on tiredness, which leads to weight increase.
To break the cycle, you first need to get treatment for your sleep apnoea. CPAP therapy, the most successful and widely-adopted treatment for sleep apnoea, will alleviate or greatly reduce the frequency of apnoeas, giving you the energy and enthusiasm during the day to allow you to be more active and to exercise.
From there, the circle repeats itself in the opposite direction, more energy, more exercise, lose weight, fewer apnoeas, more energy, etc. It takes determination, will power and patience, but by losing weight you can reduce the severity of your sleep apnoea and, in some cases, alleviate it completely.
Lifestyle changes are difficult - but not impossible
While easier said then done, if you are suffering from sleep apnoea then it is important to try to at least maintain your current body weight if possible, and ideally look to gradually lose weight. One of the major problems with sleep apnoea is that it usually gets diagnosed very late, on average after around seven years of suffering, by which time most people are over 40 and a change of lifestyle becomes very difficult to implement.
One of our forum members, scourserpaul, has just started using the Atkins Diet to reduce his weight. You can follow his progress in his Sleep Apnea And Dieting thread.
Losing weight when you have sleep apnoea is far from easy, but it gets easier as you go along as the positive cycle mentioned earlier begins to take effect. The health benefits are not only confined to reduced sleep apnoea, so it is certainly worth making a concerted effort towards.
If you are known to snore loudly, then it could be more than simply a source of irritation for your partner - it could actually be a sign that you’re suffering from a serious medical problem. Snoring is one of the most obvious symptoms of sleep apnoea, a condition that causes you to stop breathing in your sleep as your airways become obstructed – and one that an estimated 24% of men suffer from1. Sleep apnoea itself can be fatal, but can also lead to further health issues. For example, a study this week found that people with sleep apnoea were 58% more likely to develop heart disease2. Worryingly, it is thought that 90% of those with sleep apnoea have not been diagnosed. The good news? Once you have been diagnosed, almost every case can be treated through therapy. Two of the main symptoms of sleep apnoea are snoring and tiredness during the day. If either or both of these symptoms sound familiar to you, either through yourself or a partner, it may be worth reading on.
Symptoms
According to the NHS3, the symptoms of Sleep Apnoea include:
feeling very sleepy during the day
waking up with a sore or dry throat
poor memory and concentration
headaches (particularly in the morning)
irritability and a short temper
anxiety
depression
lack of interest in sex
in men, impotence (inability to get or maintain an erection)
Additional symptoms include snoring, non-refreshed sleep, restless sleep, gasping or choking during the night, reduced ability to handle stress, frequent toilet visits during the night and high blood pressure4.
The effects of sleep apnoea are wide ranging. As well as the tiredness and increased risk of heart disease, as mentioned above, it also leads to a lack of concentration, higher risk of accidents at work and while driving, anxiety, short temper, as well as leading to problems in your personal life due to depression, irritability and a lack of sex drive.
What can I do about it?
If you think you may have sleep apnoea, there are three main routes to follow – either getting diagnosed and treated by the NHS, privately, or at home. It all depends on how long you are prepared to wait, and on the expense.
You can be diagnosed and treated for sleep apnoea by the NHS. While this is free, the time frame can be quite drawn out. In June this year there were 4,461 people on the NHS waiting list for a Sleep Study, 16% of which had been waiting for over a month already5. Once you actually receive a Sleep Study, you then have to wait for your results, a consultation, and then there is another waiting list to actually get the equipment you need. It is not uncommon for the process to take several months from seeing your doctor initially to being given your CPAP equipment. Please be aware that once you are diagnosed with sleep apnoea, you will not be able to drive until you are shown as being compliant with your therapy. Failing to report a diagnosis to the DVLA can result in a £1,000 fine. Therefore if you drive, the waiting time between getting diagnosed and getting treatment on the NHS can simply be too long, so you may want to consider one of the other, much faster, alternatives.
Alternatively, you can go to a private sleep clinic. There they will assess you, give you a sleep study, and provide you with the appropriate equipment. Prices vary from clinic to clinic, but expect to pay between £1,000 to £2,000 for everything. The difference in waiting time is stark – it is often less than a month from consultation to therapy. The price may put people off, but it is a considerably faster yet more comprehensive solution. For those looking for a similar level of speed but with a much lower cost, then the third option may be the solution.
Your third choice is to simply rent a Sleep Study for use at home. You can rent one for as little as £99, and you get the results within a fortnight, and often within a week. With those results you can then go to the NHS to join the equipment waiting list, or you can order the equipment online and begin your therapy almost immediately. With machines starting at £450 and masks at £54, the whole process costs as little as £600 and you can be getting therapy within three weeks. There is not the same level of consultation or advice as you would get from a Sleep Clinic, but if you’re prepared to do your own research and use your initiative, it can be a much better value alternative.
Stop snoring, start sleeping, start living
Whichever path you choose, you will be well on your way to improved health and wellbeing, it’s just a question of time frame and expense.If you need any further information about sleep apnoea, sleep studies or CPAP, feel free to browse our website, cpap.co.uk for more articles and advice, or browse our forums at forums.cpap.co.uk, where you will be able to ask any questions you want and get advice from those currently undergoing therapy.
Whatever you do, if you have any of the symptoms of sleep apnoea, we strongly recommend that you get tested, as the effects of untreated sleep apnoea can be very serious. The important thing to remember is that diagnosis and treatment can be very quick and incredibly effective, so you could be enjoying a better quality of life within a month.
The key to a good night’s sleep is comfort, and central to that comfort is your sleeping position. I found an interesting news story on the BBC website which, although from a few years ago, provides some interesting information about sleep positions. Although it was mainly concerning personality traits that can be discovered by analysing somebody’s sleeping position, it also showed that 69% of the 1,000 people surveyed slept on their side.
OK, so 1,000 people isn’t the entire population of the UK, but it’s still enough to show that a large amount of people sleep on their side, rather than their back or front. Why is this significant on a CPAP blog? Because one of the main problems with CPAP therapy isn’t particularly side-sleeper friendly. If the majority of a random 1,000 users prefer to sleep on their side, then I’d be willing to suggest that the majority of CPAP users would prefer to do the same as well. Is it possible to side-sleep while using CPAP? What is the best CPAP mask for side-sleepers? How can I improve comfort while side-sleeping with a CPAP mask? In this blog entry we try and find the answers to these common questions.
It isn’t easy though. Sleeping on your side with a CPAP mask means that the interface touches the pillow, often either breaking the seal or pushing it into your face or nose. Either way, it’s uncomfortable and far from ideal. Is there a way to make side-sleeping with CPAP more comfortable though? Yes, and there are several ways around this problem - it’s just finding out with method suits you. If you would have been part of the 69% who naturally side-sleep in that survey, then read on, as there are CPAP masks and bedding available that can make side-sleeping as natural and comfortable for those with sleep apnoea as it is for those without it.
The first solution is to use a lower-profile mask. The bigger the mask is, then the more likely it is to come into contact with the pillow. Nasal pillow CPAP masks are usually the smallest, with more compact interface than nasal cushion masks as they don’t need to sit around the nose, but rather on the nostrils. This makes side-sleeping while using CPAP much easier. Masks such as the ComfortLite 2 from Philips Respironics, for example, help to minimise contact with the pillow. The eagle-eyed cynics there will instantly notice the flaw in that sentence - “minimise”. Even minimal contact can still lead to the problems I mentioned above. No matter how small the mask is, they’re rigid, so any contact will have an effect of some sort. But there is one mask that could be able to change all that.
The mask I’m referring to is the SleepWeaver Advance CPAP Mask. It’s made of cloth, rather than plastic, and is very low profile. It’s had a great reception in the States so hopefully it will have the same positive impact for UK CPAP users. If you sleep on your side, when the mask does inevitably touch the pillow it doesn’t automatically dislodge and push into your face. As the SleepWeaver is made of soft fabric, it just changes shape as it needs to, so you don’t have the problem of it instantly dislodging - and it certainly won’t dig into your face. Is it the the best CPAP mask for side-sleepers? It depends on the individual of course, but generally speaking, I’d have to say there’s few better. However, while it is a big improvement over any other CPAP mask out there, it’s still not quite the perfect solution. Why? Because if it is pushed hard enough against a pillow, it will inevitably lose its seal (it’s not glued on, after all). The SleepWeaver is great option for nasal users, although it’s almost impossible to recommend a full -face mask for side sleepers (until they release the full-face SleepWeaver that is). They’re simply too big to allow you to naturally sleep on your side. And that’s where our last, but certainly not least, solution comes in.
So now, the moment you’ve been waiting for (drum roll please). The solution that side-sleeping CPAP users have been waiting for is here in the form of…. the Ultra CPAP Pillow! Yes, a pillow! OK so it doesn’t sound that exciting, but it works. Is it possible to side-sleep while using CPAP? It is now, and with ease. It’s a pillow shaped specifically for CPAP users, with cut out sections to allow the mask to sit in unimpeded. You get the comfort of sleeping on your side, with the security of your mask not making any contact with the pillow – no leaks, no digging in, no discomfort. Full-face users will certainly benefit the most from the Ultra CPAP Pillow, as full-face masks otherwise make side-sleeping potentially very difficult, but even those with low profile masks like the ComfortLite 2 and the SleepWeaver will benefit from the unhindered side-sleeping that the pillow brings.
One final suggestion that can make side-sleeping while using CPAP easier is a Hose Lift. Although it won’t solve any specific problems, it can make sleeping feel more natural. It lifts the hose above the bed, out of the way of your chest and arms. Often when side sleeping, the hose can get tangled or pulled on by your arms as you shift position, dislodging the mask. This is particularly common if you have your hands up by your face. With the Hose Lift it’s completely out of the way, giving you the freedom to change position more easily and naturally. It won’t be the make or break as to whether or not you can side-sleep with your CPAP set-up, but it can certainly help when combined with some of the other suggestions.
So whether you’re a foetus, a log, a yearner or even a freefaller, help is at hand. Do not resign yourself to a lifetime of unnatural sleeping positions – if you naturally tend to sleep on your side, do it. CPAP is supposed to give you a better night’s sleep, not simply solve one problem by replacing it with a different one. For side-sleepers, the right CPAP mask, such as the SleepWeaver, and the right bedding, in the form of the Ultra CPAP Pillow can make all the difference. If you’re able to sleep in the position you want to sleep in, then naturally you’ll get better quality sleep and all of the benefits that come with it. Is CPAP really worth losing sleep over?
Thanks for reading, if you have any questions or suggestions for this, or future blog entries please feel free to leave a comment below!
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