
Effect of Weight Loss on Obstructive Sleep Apnea: The Importance of Tongue Fat - bookofjoe
https://www.atsjournals.org/doi/abs/10.1164/rccm.201903-0692OC
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verisimilitude
I'm a dentist who regularly treats OSA with dental appliances; they work by
posturing the mandible forward with a maxillary and mandibular (two-arch)
device as a way to increase the cross sectional area of the posterior airway,
reducing apneic events -- but it is important to know that the gold standard
remains the positive airway pressure (CPAP) device.

I would also like to point out that I see an incredible amount of fat-shaming
that is rooted in a drumbeat of research that (correctly) shows lower health
risks in many areas when BMI is lowered. In reaction to that, it is important
to understand that for many people weight loss is neither practical nor
maintainable and for that reason it is critical that we continue to advance
our treatment of things like sleep apnea.

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AnIdiotOnTheNet
I'd just like to chime in as someone who has lost and kept off about half his
bodyweight, that yeah, losing significant amounts of weight is a very
demanding undertaking. It requires a significant lifestyle change, large
investments of time, is emotionally and cognitively draining, and to top it
all off does not positively impact your quality of life nearly as much as is
touted. To be successful at it requires a level of obsession that qualifies as
an eating disorder in its own. I track every calorie I eat, and weigh myself
everyday. I have to hate seeing those numbers go up. I have to feel shame at
overeating and not allow myself to make excuses for it, lest I become
complacent. I can't keep food in my house. I avoid social gatherings because
there's almost always food involved. You might think you can just _not_
partake but it doesn't work like that, your brain thinks you're starving and
has all sorts of ways to wear down your will and convince you it is ok to eat.
It's kind of a living hell.

Based on personal experience, I am quite confident that physicians have
absolutely no idea how to give actionable advice in this area, and nutritional
specialists are only slightly better. None of them care about your suffering,
because that isn't something they measure.

I guess what I'm saying is that yeah, it is _possible_ for anyone to lose and
keep off significant amounts of weight, but basically none of you have any
idea what it really takes.

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gfodor
Is the main inhibitor just the sensation of hunger being miscalibrated with
your calorie goals? Instead of using mind over matter, what techniques exist
for eliminating the sense of hunger?

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AnIdiotOnTheNet
As another poster said: stimulants. Ephedrine is one of the easiest to acquire
that has reasonable potency, but I caution that a) there are negative
consequences to stimulant abuse and b) you do become resistant (and eventually
dependent). I have tried it for protracted periods of time but it was
ultimately unsuccessful at lowering the difficulty.

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gfodor
It is a bit fascinating that using coffee or other stimulants seems to be a
'hack'. I guess there's the "diet pills" market, but I am uninformed about how
effective these things are, having never had to try to lose weight. It does
seem like such a drug that actually worked would be transformative though.

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irrational
When I was in my 20s, I weighed around 165 and never snored. By the time I was
in my early 40s, I weighed about 225 and snored like a bandsaw and was
diagnosed with sleep apnea. I improved my diet and started exercising 5 days a
week. By the time I dropped back down to about 175 my snoring and apnea were
both totally gone. At least in my case, the snoring and apnea were definitely
weight related.

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specialp
I'm not surprised by this. When one gains weight, it is distributed pretty
much everywhere. I gained 25 lbs from a sedentary lifestyle that many of us on
this site have from our jobs. I lost it, and snoring/acid reflux went away
completely.

If you go pick up a 25 lb ham hock or something like that you will notice the
volume it takes up. Fat is even less dense so it takes up even more volume.
Sure, it does deposit in some places more than others like the waist line, but
even things like my ski boots fit me different. They were previously too tight
for several seasons so it wasn't just that they broke in. So all that fat is
being deposited all over, and some of that is in your tongue, and I'm sure in
your soft palate.

I notice a lot of talk about fat shaming here and how telling people just to
diet isn't going to solve the problem. This is all true, but is irrelevant
really to the conclusion here. Losing weight is a good way to reverse things
like sleep apnea and acid reflux along with many other problems. So if one can
do it, it is the best way to do it. Not all people with sleep apnea will be
cured by losing weight but it goes a long way for many.

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zelly
Always profile before optimization.

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rafaelvasco
Lived with a friend who is kinda fat, for months before getting my apt. Some
times I thought he was going to die asphyxiated. Thing is serious.

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Nomentatus
The corollary, which I deal with a lot, is that allergies such as MCAS and
other mast cell issues cause tongue edema with the same effect. Antihistamines
(H1 and H2 blockers) can help in the short term but have severe drawbacks,
such as interfering with melanin formation. Ginger and many antidepressants,
such as elavil, are also extremely potent antihistamines.

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RickS
Commenters with sleep apnea, what have you done to resolve it, and how has it
worked?

