Weight Gain from Therapy?

[apneavolt]

I want to toss this out there to see if there is any evidence of weight gain because of sleep apnea therapy.  In my specific scenario I've been using a RedMed Aircurve 10 ASV for 5 months and in this amount of time I have gained 35 pounds.

This is very odd in my particular situation because I have weighed within a 5 pound range for the past 30 years (on the lower end of normal weight for my height and age but still well within normal ranges).  Nothing has changed in my life in terms of lifestyle, stress, diet, exercise, etc and no major events.  The only change in my life is switching from ResMed AirSense 10 AutoSet in ACPAP mode to the Aircurve 10 ASV about 5 months ago and now my pants are very tight, my shirts are tight, my belly is bulging and my face is thickening.  I've had family and friends comment about it if I haven't seen them for a few months.  Once again, my entire adult life has been in  5 pound range over 35 pounds lower than where I am today.

P.S. I'm not blaming the therapy.  I have more energy from the therapy and not a walking zombie so that is nice but I'm a little concerned that there may be more to it that this is a sign that what I'm doing isn't right for my body.  

[quiescence at last]

there is some evidence to that effect. your body has had such physical stress. since you are probably getting some deeper sleep (and more restorative) it's recovery process is gaining in intensity. Part of that is higher water retention (very important to skin and soft tissue restoration). You can use sparingly some anti-inflammatory meds to moderate it, but not fighting against the body as it mounts an effort to heal. I started out having pitting edema in lower legs and forearms.

Now that you are not eating for stress, you should be able to moderate food intake a little. Don't try to resolve this in a short period, but just reacquaint yourself to your past best eating rules.

Don't try to shave a pound a week, but maybe between that and a pound a month. Just live happy.

QAL

[G. Szabo]

I can recall a YouTube video of a medical doctor who regularly discusses apnea issues, among other things. In the video, he explained his observations of his patients' weight gain as a result of successful CPAP therapy.

[WisNaeMe]

I think these might be the videos that G. Szabo is referencing.  

While they don’t necessarily give you any solutions, they might help explain what’s been going on for you.  They look at the misconceptions round the relationship between being overweight (or gaining weight) and SDB.  Misconceptions seeming widely prevalent in the medical profession too.  

The videos suggest both UARS and shorter sleep times might be contributing factors to the weight gain - so worth checking your OSCAR charts for these.

It might also be useful to have a conversation with your doctors about your weight gain  …maybe point them towards Vic Veer’s findings and observations.

Some folks with SDB have turned to GLP-1 agonists (Wegovy, Ozempic, etc.), to help manage their weight (with some success), so that might be another route to explore with your doctor.

https://www.youtube.com/watch?v=mmgRPFrySFM
https://www.youtube.com/watch?v=rdR8SVCeSJg

[apneavolt]

quiescence at last - Thank you for your comment. I do want to clarify that I don't believe I eat due to stress. I enjoy food but I don't snack very often. I have a fairly good diet and eat around the same times each day. As mentioned in the original post, I have not changed my eating habits at all and a lot of wait in a relatively short amount of time. To be clear I am still technically in healthy weight range even after gaining 35 pounds since utilizing the ASV. No one would look at me and say "he is fat" but people who know me being relatively skinny for my entire adult life have commented "you are thickening" or "your face is more filled out" and such comments.

G. Szabo - Thank you for your comment. Is there any scientific evidence that successful CPAP therapy can mean weight gain? I do feel more alert and more energy since running the ASV even though I do still run into issues every now and again so I don't doubt it has been successful but when does it end? I'm alright if I stick around weight-wise where I am right now but something has to give if I'm going to gain another 35 pounds in the next 5 months for a total of 70 pounds in 10 months. That would be drastic and I doubt can be healthy even if I am getting adequate sleep.

WisNaeMe - I am a big confused about the YouTube videos you linked. Both were topics about the falsehood that only over-weight people need CPAP therapy. Maybe I'm not quite understanding what he means but I feel as though he didn't address that CPAP therapy can cause weight gain but rather the falsehood that overweight causes the need for CPAP therapy (I am a testiment to that falsehood as I am young, healthy and before therapy most people would say "skinny"). Also, I went to the doctor the other week because of this weight gain concern and she said she has never heard of CPAP therapy causing weight gain and after doing a blood panel everything came back totally normal.

Any other comments?

[G. Szabo]

G. Szabo - Thank you for your comment.  Is there any scientific evidence that successful CPAP therapy can mean weight gain?  ...  
I'm alright if I stick around weight-wise where I am right now but something has to give if I'm going to gain another 35 pounds in the next 5 months for a total of 70 pounds in 10 months.  That would be drastic and I doubt can be healthy even if I am getting adequate sleep.

I cannot pinpoint the right video for you, but it was not from the doctor on the above two links. He observed that successful therapy resulted in weight gain, contrary to expectations. It is usually believed that more stressed people eat more and that untreated apnea is a stressor; however, he had the opposite observation. He explained that the stress of untreated apnea is so severe that it wears out the body, and a new equilibrium is established once it is treated. 

Therefore, I conclude that the weight gain during successful therapy (which I am also experiencing) is not going to be continuous. I can confirm the latter based on my personal experience. You are in a new equilibrium and might want to moderate your calory intake accordingly.

[Lady Knitsalot]

When I started CPAP therapy on my own in November 2023 with a second-hand machine, I weighed about 137 pounds at 5'4". This had been steady for about a year. I started sleeping much better and felt much more energetic within a week of starting CPAP. But my weight started going up by about a pound a week for two and a half months. I ended up in the higher 140s. Since then I have had a hard time getting that weight back off again, even though I've increased my activity level via an exercise bike, and walking longer distances.

Originally I thought the weight gain was related to holiday eating because of the timing, but I wasn't gorging by any means. I felt like my eating hadn't changed enough to account for the steady gains.

I've got a good awareness of my intake. In 2021-22, I lost approximately 28-30 pounds over about eight months by restricting sugar and refined carbs, as well as reducing my portion sizes. My top weight had been almost 160 pounds, and my blood sugar had gone up enough that my doctor recommended some weight loss to deal with it. I did not start getting severe sleep apnea symptoms until after this weight loss, or perhaps in its later stages. Before CPAP, my weight had crept up again by about 7 or 8 pounds from early 2022 (when my father died after I had been his caregiver for over five years).

After hearing from others about a possible link between CPAP and weight gain, I looked it up and did find several peer-reviewed studies on the question. No, there don't seem to be any solid answers on how this happens, but it is definitely acknowledged in the medical literature. My own doctor hadn't heard of this, but once she did some research herself, she agreed that this seemed to be what had happened to me. 

The weight gain didn't keep going indefinitely - I just seemed to have established a new "set point" in the higher 140s instead of in the higher 130s. It's been difficult to shift it off again, so I am again practicing portion restrictions and keeping an eye on my activity levels.

[AshSF]

I had experienced weight gain when I got my PAP therapy dialed in. I gained about 10 pounds. But then I went on to 18/6 Intermittent Fasting and returned back to the old weight, and have stayed at that weight for the last 8 years.

YMMV.