CPAP Use Found to Cause Weight Gain?

[MCS2014]

Just got this blog and this onefrom Dr. Steven Park, a board-certified ENT doc.

"It turns out that overall, CPAP use has been found to increase weight significantly, in proportion to how long you use CPAP. The more hours you use CPAP every night and the more number of years, the higher the amount of cumulative weight gain."

"When you alter the relative energy balance (whether by CPAP or surgery), some people seem to be prone to weight gain."

It caught my attention due to the fact that I had been steady on CPAP starting about 4 years back with many adjustments since.

Cut to:

Current time: 25lbs heavier despite same energy (calorie) intake and same, if not more, energy output.

Could it be from this theory of BMR fluctuation from being in sympathetic mode (more adrenalin from hyponeas during sleep) = burning more calories, and once CPAP fixed that, it slowed to a crawl, thus a reduction of fat-burning?

Here's are some mixed science on it:

Impact of Treatment with Continuous Positive Airway Pressure (CPAP) on Weight in Obstructive Sleep Apnea

The Effects of Long-term CPAP on Weight Change in Patients With Comorbid OSA and Cardiovascular Disease: Data From the SAVE Trial

Effects of CPAP on body weight in patients with obstructive sleep apnoea: a meta-analysis of randomised trials

Anyone experience the similar fat gaining effects in the first 2-3 years on CPAP?

More importantly, did your BMR/RMR adjust back to normal - or did you have to make drastic adjustments to diet (i.e. intermittent fasting, calorie restriction, keto) and/or increase metabolism (i.e. exercise)?

[MagnoliaSolana]

I don’t buy into that at all. I have lost weight since being on bipap, no longer have high blood pressure, no metabolic syndrome markers, better overall health, all while my doctors told me this was impossible. I’m exploring and studying more ways to use food to further improve my health. The calories in/out, move more model is outdated - there are too many factors that alter the rate calorie burn. As you mentioned intermittent fasting, that is what I did (without knowing what it was), and never counted calories as I quickly found it tedious and ineffective. Exercise is for physical health, not for weight loss (it can increase weight gain as it makes you hungrier). I’ve never done keto, as it is so undefined and a lot of people use it to continue to consume highly processed junk food, though I now rarely consume any processed carbs after learning what they do to your body.

Insulin is the driver of fat storage. If your body does not produce insulin it cannot store fat. Control your body’s use of insulin and you can control your weight.

Poor sleep raises insulin, mostly temporarily after a sleepless night. Better breathing at night should help, not directly cause or not cause weight gain. The BMR can change a lot for a variety of reasons, calorie restriction in the form of eating all day without letting your insulin go low will absolutely lower your BMR and eventually cause weight gain.

Let’s say using CPAP does cause a slight change in BMR. It would be so insignificant to other factors that you could easily mitigate the effect. We all eat too often. We all eat too little bio available protein (the RDA is the minimum for sustaining life, not health). A majority of the world’s population is now suffering from hyperinsulinemia. When your body does not get the building blocks of life it causes you to over eat and keep eating as it searches to need nutritional requirements. Processed food disrupts your body’s own mechanisms (I ditched processed oils, and most everything that has an ingredient list). 

I went on a bit much. My point is there is little sense on focusing intensely on CPAP as a cause of weight gain. Many are on it because their health is affected by high leveled of insulin at many different levels. That is something you can control well through ways of eating surprisingly quickly once you have the knowledge of how and why.

[sheepless]

it's certainly counterintuitive, to me at least. if true, both untreated and treated apnea are making us heavier! however, I'd think we'd be better able to lose weight after treatment than before.

untreated apnea tends to cause weight gain. sleep deprivation contributes to being sedentary for one thing. and my experience was that the worse I felt the worse I ate. when I feel well I eat properly. when I feel like crap I eat junk. I've read that it's common among apneacs. and I'm sure there are physiological things like insulin mentioned above that contribute to weight gain prior to treatment.

based on nothing more than 'common' sense, my sense is that post treatment we should be more rested, feel better and have more energy to be more active. I'm sure there are exceptions, but pre or post treatment, most of us still have the power to adjust our habits to maintain a healthy weight if we so choose.

[DaveL]

Fascinating posts.
Thanks I'm glad I read them.

[SarcasticDave94]

I wonder... Maybe this is a case of a patient that's well treated of Apnea and fatigue, and then it gives them extra energy to go to McDonald's and Burger King more.

[cathyf]

I started on CPAP on Oct 10, 2014, and by May 2016 I had lost 130 lbs.

Got off blood pressure medication and cholesterol medication.

A data point along the same lines, though (things that make you go "hmmmmm.....")

The way that I lost the weight was by obsessively and exactly measuring all food (like to 1/10th of a gram. Yes I know that is garbage precision, but it's more about the mental exercise of doing arithmetic in my head, which is more fun with more decimal places LOL)

So when I tell you that I'm gaining or losing weight that I can or cannot account for -- trust me, I know how to count!

Back in the fall of 2019 I started taking a new anti-inflammatory for my psoriatic arthritis. It can have bad side effects, so they make me do regular blood work, which so far has been clear. A worldwide shortage of this drug started in November 2020, and by January is was getting hard to find the delayed-release form and I started taking the immediate release and that's been fine. Then in mid-June it disappeared entirely, and I was off it for seven weeks.

Now I had gained 10 lbs during covid. I'd like to say that I can't account for it, but I would be fooling myself. But then during those 7 weeks I lost 5 of those lbs. Ok, I'm not just fooling myself when I say that I can't account for that -- I'm more than willing to believe I'm lying to myself on the upside, but not on the down!

So being my paranoid self (made a little more anxious by the necessity of the blood tests!) I started worrying about kidney function -- that would explain weight gain on the drug and weight loss off of it. But those blood tests are all saying that my kidneys are just fine!

Then I had a very different thought -- maybe the inflammation burns extra calories, and the successful anti-inflammatory drug successfully dialed back my "thermostat" and caused me to burn slightly fewer calories? I mean inflammation is definitely heat causing, so has to burn some calories.

Which would be excellent news that my kidneys are just fine (like the blood tests say) AND the anti-inflammatory drug is doing a really good job at making my quality of life much better. But (because there's always a "but") the inflammation was giving me a couple of extra "free" calories and so I've got to stop eating those now that I've gotten the inflammation back under control!

Ok, this was a long rambling story, but the point is that the human body is really complicated. Being sick consumes all kinds of energy, so, yeah, if you aren't paying attention one of the consequences of not being so sick is that you've got to do some other things to re-balance your metabolism.

[SevereApnea]

Hmm. I had a cursory glance at these references and at the risk of ruffling some feathers, I cannot fail but to be brutally honest and add some comment.

1. Quan


Just an article being published in-order-to-be published, usual academic piffle.

Firstly, there is no mention of lifestyle/dietary patterns in the trial and control group. Therefore you may wish to ask if you would want to believe this or discount this.

Secondly, the weight gain in the CPAP group over 6 months was 0.35 kg with a standard deviation of 5.01 kg. That is hardly significant by any standard!
Too many "mays" "coulds" and "howevers" in the article.

Also it might help us to read the disclaimers and limitations:

"There are several mechanisms related to energy expenditure (EE) that could explain why persons treated with CPAP gain weight. Weight gain occurs when energy intake (EI) exceeds EE."

followed by...

"...Third, because the primary focus of this study was on neurocognitive outcomes, we did not collect data such as direct energy expenditure measurements, which might validate proposed mechanisms underlying the increase in weight observed in CPAP participants"

One might ask, if he didn't, why did he not?

I would expect this to hit the lay press but not be published in mainstream literature.

But then: Dr. Quan is the Editor-in-Chief of the Journal of Clinical Sleep Medicine. 

2. The article by Qiong Ou does not support weight gain with CPAP. Higher sample numbers and at least they provide some P values.

3. Meta-analysis of 25 publications by Drager. More scientific but again not energy expenditure or intake controlled. Only some of the studies gave dietary advice or physical activity counselling. Not good enough.


They conclude there is "significant" increase in weight in CPAP patients, but this is a term of statistical significance.  It is difficult to find out in the article exactly how much weight was gained by these patients.  From what they say the "delta weight for the CPAP groups was 0.417 kg +/- 0.718kg.
One might ask oneself if that is that a real-world weight gain?

Quote from their strengths and limitations: "(2) virtually no studies performed a detailed analysis of participant' dietary patterns and physical activity."

Again, one needs to read these critically and make up your own mind.

Your weight can change by that amount in just one day simply by not eating/pooping, going to the gym/sauna, ask any boxer/jockey trying to hit the weight limit.

Look up Auschwitz, Berg and Belsen or Buchenwald or Ozzie PoWs, Singapore, Japan PoW etc. Then...

I propose that if you want to do a double blind randomized prospective control study for the purposes of real science and not fake news, then at least do the same research in a group of concentration camp victims with the same forced labour workload and the same diet, match the control and trial groups for all demographics, put half of them on CPAP and then let us see who gains weight.

If CPAP causes weight gain, why is no one treating bulimia or anorexia with CPAP?

Sorry, caveat emptor, I cannot buy into these articles.

@MCS2014
In direct and more sympathetic reply to your question in your OP:

Yes, I too have gained weight since Jan 2021 since being on CPAP, 5 kg to be exact.

I take the full ownership and responsibility for that. Sugar, biscuits and carbohydrates. Oh, I forget, chocolates!

I have cut those down in the last 6 weeks and gone from 80 kg to 75.6 kg, all the while being 100% compliant on CPAP. Not that hard to do: I changed my mindset to yes I will fast part of the day, yes I will cut out rubbish food and I will embrace the hunger. It is very good for me!

I do accept however that undertaking CPAP therapy can be emotionally and mentally taxing/draining, and that this diverts the necessary energy away from other areas of one's life.

I also accept that some find it much more challenging to manage weight gain than others, but do not believe there is enough science to lay the blame on PAP therapy for that.

[CorruptAlligator]

These studies are not reliable unless it's well controlled, which is likely not possible. It's 9 O'clock news science at best. Not really scientific.

Anything involving people has many variables and they can easily become biased not accounting for them.

I've been losing weight lately, and it's due to change in diet (this is one variable). Because I know it's best to get off the machine. There's too many negative medical consequences from being overweight. I'd rather take some sacrifices to feel a lot better and live longer.

[LBTRS]

Interesting, I was under the impression that CPAP use helped with losing weight. That's what my doctor told me.

[Melman]

I have been on CPAP for about 10 years. I was slightly overweight when I started and am now down to my ideal weight. I haven't changed my diet significantly and my exercise regimen has been consistently inconsistent. I have significant doubt that nor can see any rationale for CPAP causing weight gain.