Sleep Apnea & Weight Loss: How They’re Connected

Are you living with sleep apnea or increased body size, or both? You may be wondering how the two are connected. Does sleep apnea cause weight gain, or does weight gain cause sleep apnea? This page will give you the answers you need.

What is sleep apnea and how does it affect the body?

Sleep apnea is a common condition in which breathing repeatedly stops or becomes very shallow during sleep. Each of these pauses lasts at least 10 seconds, and often longer

There are two main types of sleep apnea, plus a third that combines features of both:

Obstructive sleep apnea: Your airway becomes blocked or partially obstructed during sleep, which may be triggered by multiple factors and conditions. When most people think of sleep apnea, this is the type of apnea that comes to mind, since it is the most common type.
Central sleep apnea: Your brain doesn’t send the signal to breath, so effort to breathe pauses even though the airway isn’t blocked.
Mixed (complex) sleep apnea: A combination of both.

SIDE NOTE: Exact estimates vary, but many studies suggest that approximately 25-30% of men and 9-17% of women in the US have obstructive sleep apnea.

When left untreated over time, sleep apnea is associated with a higher risk of several problems. Some examples are:

Type 2 diabetes
Cardiovascular disease (including high blood pressure and irregular heart rhythms)
Extreme daytime fatigue and drowsy driving
Memory or concentration issues
Liver disease

The link between sleep apnea and weight gain

Increased weight contributes to obstructive sleep apnea in a few ways. For many people with increased weight, added soft tissue around the neck, throat, tongue, and soft palate can narrow the airway, so that when lying down (especially on their back), it’s easier for those tissues to fall back and block airflow. Extra tissue within the tongue and airway walls also makes the airway more prone to collapse during sleep.

Additional weight in the abdominal area can also make it harder for the lungs to fully expand when lying down, which further promotes airway collapse Sleeping on your back adds to the risks of airway collapse, since your airway is narrower in that position.

But weight isn’t usually the only contributing factor here, because things like size and shape of your jaw, tongue, and airway are largely inherited, which is why some people have sleep apnea without excess weight.

Sleep apnea can also push in the other direction. Fragmented, poor-quality sleep also has the potential to affect hormones that regulate hunger and fullness like raising ghrelin, altering leptin, raising cortisol, and reducing insulin sensitivity. All of which can affect weight.

Combined with daytime fatigue that may limit activity, this can create a self-reinforcing cycle where weight worsens sleep apnea and disrupted sleep makes weight harder to manage.

Can weight loss improve sleep apnea symptoms?

Yes, it often can – though how much varies a lot from person to person, because the reasons behind each person’s sleep apnea (family history, genetics, airway anatomy) differ.

Exact estimates vary between studies, but overall a decrease in body size often leads to a decrease in apnea-hypopnea index (AHI), when weight is a contributing factor to their OSA A meta-analysis showed that a BMI reduction of was shown to reduce apnea-hypopnea index (AHI) numbers by around 57%. For most people, this means substantial improvements in the severity of their OSA.

Beyond the airway itself, weight management can frequently bring benefits that shape day-to-day quality of life, such as:

Better cognition
Reduced daytime fatigue
Improved blood pressure and blood-sugar control
Better sleep quality
Mood improvements

Why is weight management challenging for people with sleep apnea?

Genetic and biological factors strongly influence the size and shape of our bodies, which is because overweight and obesity are chronic medical conditions that frequently require medical treatment.

It’s extremely important to remember that each person’s weight management and metabolic health journeys are going to be unique to them. It’s not simply a matter of willpower. What works well for one person’s health goals may not be helpful for someone else. That’s the complex science of the body, not a personal failing.

The fatigue and disrupted sleep caused by sleep apnea can also affect appetite and energy regulation, creating additional barriers to weight management. One encouraging twist is that some studies point towards regular exercise as reducing sleep apnea severity even when little or no weight is lost – small trials show a 24–34% reduction in severity, and combining aerobic with resistance training appears more effective than aerobic exercise alone.

Is sleep apnea reversible with weight loss?

Sometimes – and it depends heavily on severity. When weight was a contributing factor to their OSA, people with milder OSA, weight loss can sometimes resolve the condition (in one cohort, sleep-disordered breathing resolved in over 50% of mild cases two years after a weight-loss intervention). In moderate-to-severe disease, weight loss reliably improves severity but full remission is less common, so ongoing treatment is often still needed.

It’s also worth clarifying that certain conditions often seen alongside sleep apnea (such as fatty liver disease or acid reflux) are associations, not root causes. Even without complete reversal, weight change is a strong predictor of AHI change over time – losing weight frequently lowers it, and regaining weight tends to raise it.

How to know if sleep apnea is affecting your weight

While losing weight has been shown to reduce AHI, the impact of sleep apnea on weight is indirect, through things like daytime fatigue, changes in appetite hormones, and reduced activity. So, treatment with CPAP alone does not reliably produce weight loss.

While the ability to pinpoint the causes of excess weight and sleep apnea may be challenging, it’s important to involve your healthcare team for assessment, treatment, support and guidance.

When should I talk to my healthcare practitioner about sleep apnea?

If you have concerns about your sleep and want to know if sleep apnea may be affecting you, then it’s time for you to contact a healthcare practitioner. A virtual consultation with a Felix healthcare practitioner is a good starting point.

They can assess your health and sleep concerns in order to determine if a sleep study or sleep apnea treatment is appropriate for you, so that you can start sleeping better and work towards your health goals.

With Felix in your corner, you can find the guidance and support you need to move towards your health and well-being goals, so you can get back to living life on your terms – the way it should be.

FAQs about sleep apnea and weight loss:

Why does sleep apnea cause weight gain?

Strictly speaking, sleep apnea itself isn’t the main cause of weight gain, usually, many factors interact to produce both.

In fact, excess gain is more likely to cause sleep apnea than vice versa. However, sleep apnea can promote weight gain for some people through hormonal changes, increased cortisol, reduced physical activity, and other metabolic effects.

How do I know if sleep apnea is affecting my weight?

If you’ve been gaining weight over recent months and, at the same time, your sleep and daytime fatigue have worsened – or you’re waking more often at night to use the bathroom – it may be worth asking your healthcare practitioner whether sleep apnea could be involved.

This may include a sleep study and, where appropriate, weight-management treatment to help reduce the frequency or severity of apnea episodes.

REMEMBER: Sleep apnea is only diagnosed with a sleep study. So, if you are concerned that you may have sleep apnea and you haven’t been diagnosed, start by discussing your concerns and symptoms with your healthcare practitioner. They can assess if a sleep-study referral is an appropriate next step for you.

Sleep testing can be done in a sleep lab/clinic or by home testing. However, the choice of test depends on many factors including your medical conditions and location.