- One in three adults is obese.
- Obesity can increase the chances of developing an obstructive sleep disorder.
- Metabolic Syndrome is a deadly combination of sleep apnea and hypertension.
- Diabetes, obesity, hypertension, high cholesterol, and hypertension.
- Weight management and treatment of sleep apnea are key to success in overcoming metabolic syndrome.
Sleep apnea is a common condition in overweight people. You don’t need to be overweight to experience sleep apnea. However, some people who are obese do not suffer from it. However, the correlation between obesity & sleep apnea can be very strong. Obesity can be a serious medical problem.
Obesity isn’t about reducing weight or changing your clothes size. Obesity and sleep apnea both contribute to a host of medical conditions that can lead to worsening of your health.
Why should you care if your obesity is a problem? The Sinking Spiral
Three reasons why obesity and sleep apnea often go hand-in-hand are: Fat deposits build up in the tissues of the neck and cause obesity. This can cause constriction of your airway, which can lead to sleep apnea and snoring. Obese people are more likely to have excess fat tissue in their abdomen, which can cause abnormal loading and interfere with normal breathing. A sinking spiral develops. Sleep apnea is a sleep disorder that causes sleep to be interrupted. It results in poor quality sleep at night and daytime sleepiness.
Recurrent awakenings can stress the sympathetic nervous system. Hypertension is caused by this and extra weight. As the body loses its ability to handle carbohydrates, it can slip into insulin resistance. This is adult-onset diabetes. Continued weight gain. The levels of cholesterol rise and cardiovascular disease take its toll. Excessive daytime sleepiness (EDS), which is a result of sleep apnea, also increases. A person becomes less active, consumes less energy, and is more likely to have a stroke or heart attack. Breaking the cycle is key. This can be achieved by weight loss, but it’s extremely difficult to lose weight and maintain it in the face of all the other obstacles. If sleep apnea remains untreated, weight loss can be difficult or impossible. The spiral can be stopped by treating sleep apnea. This will allow you to regain your total good health.
How do you know if you’re obese?
Waist circumference is the simplest indicator of central obesity. Central obesity is defined as a waist measurement greater than 40 inches for men and 34 inches for women. Central obesity can lead to serious medical conditions such as heart disease, diabetes, sleep apnea, and hypertension. Extra weight on the hips and thighs is not a concern.
You can also measure your hips and waist by comparing them. You have central obesity if your hips and waist measurements are less than 4 inches. The Body Mass Index (BMI), a more accurate measure of obesity, is shown on page 105. The Body Mass Index is calculated simply by multiplying body weight by the square root of your height. You can find your precise BMI at the following National Institutes of Health website, by typing in your height and weight: www.nhlbisupport.com/bmi/bmicalc.htm.
The Metabolic Syndrome, Sleep Apnea and the Metabolic Syndrome
Metabolic Syndrome is a group of disorders that can often be combined and feed off each other, leading to a downward spiral in health. These conditions include:
- Adult-onset Diabetes (also known as type 2)
- Insulin resistance (the body doesn’t use insulin properly)
- Central Obesity (extra weight is concentrated on the abdomen)
- High blood pressure (higher than 140/90mm Hg)
- High cholesterol.
A person with three or more of these conditions is called the Metabolic Syndrome. The Metabolic Syndrome also includes sleep apnea.
This is because sleep apnea can be treated in people with Metabolic Syndrome to improve insulin use, lower blood pressure, or improve cholesterol. The Metabolic Syndrome, if not treated, can lead to permanent damage to the kidneys, blood circulation, eyes, and brain. . . and premature death. Obese people should find out if they have sleep apnea and get it treated. CPAP removes obstructive apnea. This allows for more restful sleep, better blood oxygen levels, and higher metabolism, which can boost one’s energy level. This can help with weight loss by increasing energy and activity.
The Obesity Hypoventilation Syndrome or the “Pickwickian Syndrome”,
Pickwickian syndrome, which is a combination of severe sleep disorder and obesity, can be accompanied by hypoventilation or heart failure. This syndrome affects approximately 5 percent of patients with sleep apnea. William Wadd (a surgeon to King George III) connected obesity, lethargy, and breathing difficulties in 1816. Three patients were described by Wadd as “suffocated” by fat. A second medical man, A. Morison reported a case in 1889 of an obese and drowsy patient whose drowsiness increased after he lost weight.
The Pickwickian syndrome was first described by anyone in the 1950s. The first person to link obesity and breathing difficulties was a respiratory physiologist. He suggested that obesity causes extra strain on the respiratory system and that this can lead to sleepiness and lethargy. However, he did not connect sleep apnea to the whole picture. Gastaut, in 1965, demonstrated the link between excessive daytime sleepiness and sleep apnea. In 1910, Bramwell published the first medical term Pickwickian. He was reminded by one of his patient’s symptoms of the behavior and description of Joe in Dickens’s The Posthumous Papers of the Pickwick Club (1837). Joe was a “wonderfully obese boy” who would sleep so well that he could stand up. This idea might seem absurd to someone who is not familiar with Pickwickian Syndrome. This may seem strange to someone who has never experienced Pickwickian syndrome.
What is the Pickwickian Syndrome and How Can It Be Treated?
Pickwickian Syndrome results from multiple conditions: obesity, sleep apnea, and abnormal breathing patterns. A few people have a low breathing reflex that allows carbon dioxide (which is a waste gas) to build up in their blood. If the person’s breath is shallow, this tendency can get worse. Obesity can cause shallow breathing because it interferes with the function of the breathing muscles.
When a person lies down, this abnormally shallow breathing pattern can lead to symptoms such as frequent awakenings and sleep apnea. This vicious circle is known as the obesity-hypoventilation syndrome or Pickwickian Syndrome. Pickwickian Syndrome can develop in childhood and may also occur in older adults who were thin.
What are the effects of Pickwickian Syndrome?
Pickwickian Syndrome can cause the same problems as other types of sleep apnea. Pickwickian Syndrome causes fragmented sleep. Deep sleep and rapid eye movements (REM) are often reduced to almost zero. Because the person’s shallow breathing doesn’t take in enough oxygen at night, it can lead to a form of slow asphyxiation. It is not uncommon to experience excessive drowsiness in the daytime. Pickwickian Syndrome sufferers have a remarkable tendency not to fall asleep when there is any relaxation.
Pickwickian Syndrome sufferers often fall asleep while at work, driving, or in a conversation. Roberts recalls how he used to drive to work every day and then fall asleep in the parking lot. He would fall asleep in the parking lot, so his coworkers would find him and take him to his office. One Pickwickian doctor said that he fell asleep while examining a patient. His head was resting on the shoulder of the patient when he awoke. After falling asleep in a weekly game of poker, a Pickwickian business executive sought treatment. He had drawn a full house (kings over aces) and then fell asleep again.
Pickwickian Syndrome is closely linked to serious heart disease. Along with the risk of stroke, hypertension, and coronary heart disease, obesity is closely associated with the Pickwickian Syndrome. There are also risks of heart enlargement and arrhythmias that can be caused by sleep apnea. The rate of sudden death in obese people is high. Pickwickian Syndrome is a serious condition that can be life-threatening.
The Pickwickian Syndrome: How to Treat It
The most conservative treatment is continuous positive airway pressure (CPAP), combined with weight loss, otherwise your doctor might recommend sleep apnea surgery. A temporary tracheostomy may be considered if CPAP fails to eliminate sleep apnea or low blood oxygen levels. There are mixed reports in the medical literature about weight loss’s effectiveness in relieving symptoms of this syndrome. It is possible that the individual’s apnea may improve if they lose more weight. There may be a threshold weight at which Pickwickian Syndrome symptoms can manifest. Weight improvement is possible below this point.
A good example is Mr. Roberts, who has seen a positive outcome with CPAP and weight loss. Pickwickian Syndrome patients who are treated this way may experience a complete “remission”. They can stop using CPAP and appear to be cured of sleep apnea. Gastric bypass, which is weight loss surgery, has been shown to be effective in treating Pickwickian Syndrome. It reduces sleep apnea to a minimum level and restores deep sleep and REM sleep. Gastric bypass surgery should not be considered a routine operation.
Summary
- Obesity is a common complication in patients with obstructive sleep apnea.
- Metabolic syndrome can be described as a combination of obesity, diabetes, and hypertension. It is possible to treat sleep apnea.
- The Pickwickian Syndrome refers to a type of sleep apnea that is caused by obesity and an abnormally shallow breathing mechanism. The Pickwickian Syndrome is characterized by:
- Obesity
- daytime drowsiness
- falling asleep during routine activities
- sleep apnea
- Treatment options include CPAP and weight loss