Dear Bethany: Why Do You Promote CPAP Instead of Weight Loss for Sleep Apnea?

In honor of the one-year anniversary of me getting my CPAP machine and life being just awesome, I’m kicking off the first ever installment of “Dear Bethany!”

Content Warning: discussion of weight stigma, the belief in fatness as pathology, intentional weight loss, and medical treatment choices for sleep apnea that are NOT weight neutral.

Dear Bethany:

I read about your experience with getting treatment for sleep apnea and I really admire you for sharing your experience. My father has sleep apnea and the whole family slept much better once he started using a CPAP.

But I gotta say, there’s something I’ve wondered about. I have a friend who lost weight and didn’t need his CPAP machine anymore. So I was just wondering why you aren’t considering weight loss, since you are overweight and have sleep apnea? I think if I were in your position I would at least want to try to lose weight.

Hopefully you won’t take this question the wrong way; I swear I am not trying to concern troll you, I am just trying to understand better.

Sincerely,

Santino Fontana*

*Name changed to protect anonymity of the writer. No, the real Santino Fontana doesn’t actually read my blog nor write me letters of concern, and I have no idea whether he knows anyone with sleep apnea. But I have been binge-watching “Crazy Ex-Girlfriend” and his singing voice is so delicious so I’m gonna pretend he knows who I am and is writing me letters.

Dear Santino,

OMG OMG OMG!!! You read my work? Are you for real? I’m fanning myself. I love you. I mean, I don’t know you. But I love your singing.

So, I totally understand your question. After all, many doctors do advise patients to lose weight if they have sleep apnea, and being fat is listed as a risk factor for sleep apnea. So I think it’s totally natural that you have this question.

I’m happy to answer it, but first of all, I want to throw in the disclaimer that I am neither a doctor nor a respiratory therapist. I’m answering from my own perspective as someone who happens to have sleep apnea and happens to be fat. I speak only for myself. Other people in my situation may have different perspectives. Just want to clear that up.

So, I’m actually not against people choosing to attempt weight loss in order to help with sleep apnea. I respect that there are people who might want to try that for various reasons. The societal pressure to do so is indeed high. And they may indeed believe that weight loss will positively affect their sleep apnea and possibly other medical conditions they may have, too. Despite the fact that intentional weight loss has a very low rate of success over the long term, and despite the fact that people of all genders, ages, and sizes can have sleep apnea, some people may decide that they wish to take a chance and try it anyway. I believe in body autonomy and that they have the right to do that. And if they are happy doing that and have no other contraindications to doing so, I wish them success. Truly!

Here’s the thing though – for some of the people whose sleep apnea might be improved by weight loss, the amount of weight loss required to make enough of a difference for those individuals might take a VERY long time. And CPAP therapy can improve those people’s lives in a much shorter time frame. My life got infinitely better in just a week after using a CPAP.  Whereas I have had sleep apnea symptoms even when I was much lighter than I am now, so I’m not even sure weight loss would help me personally…..and if it did, how long would it take me to lose the amount of weight “required” to see if it would help? Years? And it likely won’t even be permanent? Whereas if I just try a CPAP machine, I could feel better in DAYS?

It seems like an easy decision to me. Whether a person with sleep apnea decides to pursue weight loss or not, in my opinion using a CPAP is just a no-brainer. You can feel better so much faster! And what’s more, the evidence actually supports it, unlike intentional weight loss.

So, I choose to promote the truth. That CPAP works. That people of all sizes, genders, and ages can have sleep apnea (like Amy Poehler!).

And as far as whether weight loss can help with sleep apnea – I have no doubt that it does indeed help some people. Sleep apnea can be caused by multiple factors, including the size of the airway, fat in the neck, size of the tongue, throat, tonsils, adenoids, etc. Obviously when you are dealing with so many organs that can differ in size, and different size combinations can occur in different people, some people might stop having sleep apnea when losing weight, if they happen to lose weight in their neck and if they also happen not to have any other factors that can obstruct the airway (such as a narrow airway or a large tongue). In fact, I personally know someone who has been able to stop using his CPAP machine after losing weight.  For myself though, my sleep specialist took one look at the back of my throat and said that the size of my tongue would probably mean I would have sleep apnea at any size. It’s all pretty individual, much like many other medical conditions affected by physical structure.

Perhaps more importantly, I find dieting bad for my own personal health and happiness because I have a history of hypothyroidism, depression, anxiety, attention deficit, and disordered eating when I diet. So even if intentional weight loss does help some people with their sleep apnea, and even if there was solid evidence that it was sustainable, it is not an option that makes sense for me when you consider my entire medical history (not just this one condition).

That said, if others don’t have similar contraindications to dieting and they feel like they can happily sustain a lifestyle that supports a lower bodyweight for them, and they want to try it, more power to them…..and I still think they should get a CPAP machine, too. CPAP machines are pretty sophisticated these days. Many will adjust the pressure automatically based on how you are breathing during the night. This means that if you do happen to need more or less pressure over time (due to factors such as weight change, seasonal allergies, an upper respiratory infection, or anything else), the machine will adjust and record that data for your sleep specialist to review. So, if a person does happen to lose weight, and that does happen to improve or eliminate their sleep apnea, their doctor will know and be able to tell them if and when they can ditch the CPAP machine.

Again, I’m not a doctor, just a fat patient with sleep apnea who is making an informed decision about my own treatment, in the context of my entire physical and mental well-being. Others may have a different experience, and that is fine.

What is NOT fine is when people shame others for making different choices than they would make for themselves. Sadly, I have experienced that. The only people who have any business judging an individual’s medical decisions are that person, their medical providers, and anyone else they choose to ask for their opinion. Many people are ashamed to treat their sleep apnea because of the stigma, and it is really important to me to share my story to empower others to use a CPAP machine, regardless of whether they personally choose to attempt weight loss.

Hope that helps! And also I love you Mr. Fontana.

Sleep well. And call me,

Bethany

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