If you have obesity and struggle with sleep issues, you may wonder — are the two related? Could your sleep issues be causing you to gain weight or is your weight gain ruining your shut-eye? It turns out there is a definite link between obesity and sleep problems (and as a result, between sleep and weight loss).
“It’s very common to find obstructive sleep apnea in people who are obese,” says Bestoun Ahmed, MD, an expert in bariatric surgery and obesity medicine at UPMC Magee-Womens Hospital. Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder; it causes the person to stop and restart breathing while they sleep.
This type of apnea occurs when the throat muscles intermittently relax and block the airway during sleep. One noticeable sign of it is snoring. “Obstructive sleep apnea needs treatment because of the long-term consequence of deleterious oxygenation of the heart,” he says.
Treatment for obstructive sleep apnea commonly includes continuous positive air pressure (CPAP) therapy. A CPAP machine uses a hose connected to a mask or nosepiece to deliver constant, steady air pressure to help you breathe while you sleep. Though older models of CPAP machines were often loud or annoying, newer models are quiet and well tolerated by the user and their bed partner.
“CPAP therapy may help decrease snoring and daytime weakness or tiredness,” says Dr. Ahmed. “But we’ve found that significant weight loss, specifically through metabolic/bariatric surgery (MBS), can cure OSA in 80% of patients.”
Bariatric surgery is often very effective in helping people lose large amounts of weight. Dr. Ahmed notes that other forms of weight loss — including medications and dietary plans — typically help people reach a 15% loss of total body weight. MBS averages about a 30% loss of total body weight.
Sleep and Weight Loss
“Sleep problems and obesity have a bidirectional relationship — always,” says Dr. Ahmed. “People who get the recommended seven to nine hours of sleep tend to not be overweight and stay at a normal weight with a normal metabolism. Those people who sleep six hours or less, or even those who sleep too much — they tend to gain weight.”
That’s why people who have sleep issues are often overweight or obese. “The absence of sleep affects the body’s hormone milieu, specifically two hormones — ghrelin, which is an appetite stimulant, and its counterpart leptin, which is an appetite suppressant. Sleep irregularities disturb the balance in favor of ghrelin, the stimulant. People who don’t sleep well — when they are awake, they have stress and eat more food, especially snacks that are high in carbs.”
That’s also why people who have obesity tend to have sleep issues — such as apnea, too much sleep, or slow metabolism — as contributing factors. “But most people with obesity who pursue intentional weight loss — whether through surgery or another method — tend to see sleep cycle improvement. The hormonal milieu improves, leptin has more effect, ghrelin has less effect, so they eat less, and their sleep improves because the melatonin at the brain stem level improves.”
Dr. Ahmed says that people with sleep apnea also tend to have excess tissue in the oropharynx area — the middle part of the throat that includes the soft palate, the side and back walls of the throat, the tonsils, and the back third of the tongue. This tissue causes snoring and can impair oxygenation. “But when they lose the weight, these issues also tend to improve,” he adds.
If you have sleep issues and obesity, Dr. Ahmed noted two key takeaways:
1. Make sure you have a normal sleep cycle
Disturbance of the sleep cycle is one of the leading reasons people gain weight. “We see it in nurses and doctors who work the night shift. They’re awake at different times, which leads to high-carb snacking and weight gain.”
Dr. Ahmed recommends you do your best to get seven hours of continuous sleep with no disruptions, so your body is able to get into the deepest part of the sleep cycle needed for restorative sleep. This is the stage when the body repairs and regrows tissues, builds bone and muscle, and strengthens the immune system.
2. If you’re getting seven hours of sleep but still snoring and unable to lose weight, then obesity is likely causing the sleep problem
“In that case, weight loss by any of the methods would help with the person’s sleep problem, but here again, bariatric surgery has the upper hand in effectiveness,” he adds.
Considering Bariatric Surgery
Currently, most insurance companies cover bariatric surgery for patients who have a body mass index (BMI) of 35 and above. Your BMI calculation depends on your height and weight. According to the Centers for Disease Control and Prevention (CDC) BMI calculator, a BMI of 35 or above indicates severe obesity.
Body Mass Index (BMI)*
| < 18.5 | Underweight |
| 18.5 to 25 | Normal weight |
| 25 to 30 | Overweight |
| 30 to 35 | Moderate or class 1 obesity |
| 35 to 40 | Severe or class 2 obesity |
| > 40 | Morbid or class 3 obesity |
*BMI definitions according to World Health Organization
“When a patient has severe obesity or a BMI of 35 or higher and they have significant chronic medical problems like hypertension, diabetes, OSA, or another chronic problem, they are considered a candidate for MBS,” Dr. Ahmed says. “At a BMI of 40, a patient is qualified for bariatric surgery even without having a chronic disease.”
According to the National Institutes of Health (NIH), 30% of all Americans are overweight; 42.4% have moderate obesity; and 9.2% have severe obesity. And the CDC reports that fully 33.3% of all Pennsylvanians have obesity.
Now, new 2022 guidelines by the American Society for Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) may make weight loss surgery more accessible to a wider range of patients who have obesity.
These guidelines are an update to a 1991 NIH consensus statement, noting that the health complications from even moderate obesity and advances in the safety of minimally invasive weight loss surgery now make the rewards outweigh the risks.
“The new ASMBS/IFSO guidelines drop the BMI threshold for weight loss surgery down from BMI 35 to 30 because obesity causes so many issues and is becoming an epidemic,” says Dr. Ahmed. “Our hope is that insurance companies will follow the recommendations so more patients can benefit from this surgery.”
For more information about metabolic and bariatric surgery, visit the website for the Minimally Invasive Bariatric and General Surgery Program at UPMC Magee-Womens Hospital.
Editor's Note: This article was originally published on , and was last reviewed on .