Sleep Apnea and Weight Gain: Understanding the Connection

Sleep apnea and blood sugar regulation

When you have sleep apnea, you experience episodes of hypoxia, which is a dip in the oxygen levels in your body's tissues. “This triggers inflammation in adipose [fat] tissue,” says Rizo. Over time, the inflammation promotes insulin resistance, causes your body to store fat, and may eventually lead to type 2 diabetes, she says. 

Sleep apnea’s effect on energy and activity  levels

Hallmark symptoms of sleep apnea are daytime sleepiness, tiredness, and fatigue, per the National Heart, Lung, and Brain Institute. That affects your desire to move your body and engage in physical activity. “Many people with untreated OSA feel tired during the day, making it harder to stay physically active or exercise regularly,” says Rizo. 

How does weight affect sleep apnea?

Body weight impacts your breathing anatomy, which is why it’s connected to OSA. In fact, older research published in JAMA found that 10% weight gain was associated with a six-fold increase in the risk of developing moderate-to-severe sleep-disordered breathing, including OSA.

“Excess weight — especially around the neck, tongue, and upper airway — can make the breathing passage narrower and more likely to collapse during sleep,” says Jamila Battle, MD, triple board-certified sleep medicine physician with Dreem Health. Then, there’s the relationship between sleep apnea and belly fat. Fat around the abdomen can reduce lung volume, per research in Advances in Respiratory Medicine, which also affects airway opening, she explains. (This is further backed by information presented in research in Sleep Medicine.)

Weight-related risk factors for obstructive sleep apnea

Obesity is one risk factor for OSA. It is not the defining factor. The following are additional risk factors, according to the National Heart, Lung and Brain Institute (NHLBI):

• Age

• Being male

• Anatomy, specifically having large tonsils, neck, or tongue 

• Endocrine (hormone) disorders that may affect your face, mouth, and throat anatomy, such as polyendocrine metabolic ovarian syndrome (PMOS, formerly PCOS)

• Family history

• Medical conditions that cause fluid build-up, such as heart or kidney failure

• Drinking alcohol

• Smoking

What are the health consequences of untreated sleep apnea?

The consequences of sleep apnea are more than a bed partner who’s constantly irritated by snoring. “Repeated airway collapse throughout the night can cause drops in oxygen levels, fragmented sleep, and surges in stress hormones that place strain on the body,” says Battle. Over time, this can affect your entire body in some of these ways:

• Increased risk of cardiovascular disease: OSA affects the nervous system and leads to greater oxidative stress and inflammation, notes a report in the Journal of Clinical Sleep Medicine. 

• Increased risk of hypertension: About half of people with OSA have high blood pressure. (Hypertension is also a risk for heart disease and stroke.) 

• Increased risk of metabolic dysfunction and  type 2 diabetes: The pauses in breathing may lower insulin sensitivity and raise blood sugar levels, according to the World Journal of Diabetes.

• Promotes cognitive decline and dementia: OSA may play a role in neurodegeneration and damage blood vessels that supply the brain, leading to cognitive conditions, according to an article in the journal Sleep.

• Affects mood and may contribute to depression: Quality sleep is essential for mood regulation. One study in Sleep Medicine found that about one in six people with OSA had symptoms of depression.

• Risk of motor vehicle accidents: Many people are surprised to learn that OSA can increase your risk of accidents, says Battle. OSA causes sleepiness at the wheel, explains research in Otolaryngology-Head and Neck Surgery.

It’s important to keep in mind that these risks compound when sleep apnea and metabolic dysfunction both remain unaddressed. If both conditions are present, treating the underlying sleep disorder benefits not just your sleep, but your overall health and future disease risk.

What are the treatment options for sleep apnea?

If you are diagnosed with OSA, there are many options for treatment. And, they make a real difference in how you feel day-to-day, as well as for your long-term health. “The good news is that effective treatment has been shown to improve daytime alertness, quality of life, and blood pressure control,” says Battle. Although the benefits of treatment are still being researched, “there is no question that identifying and treating sleep apnea can have a meaningful impact  on overall health and well-being,” she says.

There are more sleep apnea treatment options than ever before, says Battle. Here's a  look at some of them: 

CPAP therapy

CPAP treatment is a cornerstone of OSA therapy. CPAP therapy is a machine that delivers constant air pressure through a mask that goes over your mouth and or nose, says the NHLBI. It helps you breathe better as you sleep. The catch is you need to use the machine nightly. Almost half of people don’t stick to their prescribed treatment in the first month, according to StatPearls. 

Oral appliances

Oral appliances for sleep apnea are another option, especially if you’re not a candidate for CPAP treatment, says the NHLBI. These custom devices are mouthpieces that hold the jaw or tongue in place so that your airway stays open and clear. According to StatPearls, people who have mild-to-moderate sleep apnea may be candidates, though there is a risk that these devices may negatively affect your teeth. Your dentist should monitor you while using an oral appliance.

GLP-1 medications

Weight loss is an effective strategy for improving OSA, says Rizo. The obesity medication tirzepatide (a GLP-1/GIP medication with the brand name Zepbound) is an FDA-approved weight loss injection for treating moderate-to-severe OSA in adults with obesity.  “Medications like tirzepatide have shown impressive benefits for OSA,” she says. She points to a specific clinical trial in The New England Journal of Medicine that found that tirzepatide treatment decreased the apnea-hypopnea index (AHI) (the number of breathing interruptions per night) by 59% after one year compared to a 3% decrease in the placebo group.

Surgical and other interventions

In certain situations, your doctor may recommend a surgery or device implant. This may include a nerve stimulation device that keeps airways open, surgery to remove your tonsils or other tissues in your mouth or throat, jaw movement procedures, or weight loss surgery, notes the NHLBI.

Finally, lifestyle changes support better outcomes from these treatments. That includes weight loss, as well as avoiding alcohol, and going over medication use with your doctor, as some can worsen OSA symptoms, per StatPearls. “Sleep apnea is not one disease. It can arise from different combinations of airway narrowing, muscle weakness, body weight, and breathing-control factors,” adds Battle. “The best treatment is the one that effectively treats the condition and [one that you] can realistically use long-term.” 

Getting evaluated for sleep apnea doesn’t require an overnight lab stay or a referral. Sleep apnea testing can be done from the comfort and convenience of your own home. “For many adults with a high likelihood of obstructive sleep apnea, a home sleep apnea test can accurately diagnose the conditions without requiring an overnight lab stay,” Battle says. 

With Dreem Health’s at-home sleep study, you can be tested in your own bed. The test measures breathing patterns, respiratory effort, heart rate, and apneas/hypopnea index when you sleep. Ready to find out if sleep apnea is impacting your health? Book an appointment with Dreem Health today.

Frequently asked questions (FAQs)

Does having sleep apnea make it hard to lose weight?

Yes. OSA affects hunger hormones, insulin sensitivity, and energy levels. Research in Frontiers in Sleep indicates that people with OSA may struggle to lose weight compared to those without the condition. OSA does not make weight loss impossible, though. Tirzepatide, a GLP-1/GIP medication, is FDA-approved to treat moderate-to-severe OSA in adults with obesity and can also support weight loss.

Is sleep apnea reversible with weight loss?

Yes, weight loss is one treatment option that may improve or reverse OSA, says Rizo. Weight loss reduces fat around the airway and decreases pressure on the chest and lungs as you sleep, possibly helping to reduce sleep disruption, improve sleep quality, increase daytime energy, and decrease your risk of other health conditions like hypertension and type 2 diabetes. However, since other factors contribute to OSA, losing weight does not guarantee that OSA will resolve.

Can people without obesity develop sleep apnea?

Yes. Obesity is one risk factor for obstructive sleep apnea. Not everyone with obesity develops sleep apnea. Other factors, such as age, genetics, and airway anatomy are additional factors. A thin person with a small jaw can be diagnosed with sleep apnea, says Battle.