Effect of Weight Loss on Obstructive Sleep Apnea: The Importance of Tongue Fat

This is spoken like a person who has never struggled with their weight.

The times I have successfully managed my weight were when I was able to control what I brought through the door of my apartment. I would always eat before going to the grocery store to reduce impulse buying. With the exceptions of fruit and veggies I aspired to never bring anything through the door that I could eat without having to cook in some way.

My weight has grown since I got married to a woman with a metabolism that allows her to snack seemingly with impunity and who can be in the same apartment with snack food and not feel drawn to it.

If I am aware of delicious food in the house it can be a constant mental battle to not go eat it. In the morning when I'm full of energy it's easy to resist but late in the day when I'm stressed by work or whatever else my reserve of restraint is much less and I often give in.

I've been following microbiome research with interest. I understand that certain gut bacteria have the ability to stimulate the vagus nerve basically to get the kind of food they like. I am battling an enemy that has a direct line to my lizard brain.

The only solution is to not bring that food in the house.

Just adding another datapoint: With no particular dieting, I tend to hover around 95kg. I was able to get down to 80kg with smart dieting. But I was miserable at that weight.. I couldn't concentrate when programming, my brain kept interrupting me with hunger signals. I put the weight back on; I'd rather not live the rest of my life in hunger-misery. 20 years later and I'm still fine with that decision. I get plenty of exercise and eat lots of vegetables and take other steps to be healthy, but significant sustained weight loss with it's side effects is no longer desirable... until medicine comes up with a pill that removes the hunger itself w/o nasty side effects.

Wow great to see a dentist here! I've had a lot of experience with sleep apnea in the last couple years, and it seems to be under control now after about 5 remedies, the most of important of which is a dental appliance. The other ones were sleep position, weight loss, and breathing habits, as you might imagine.

What do you mean by "gold standard"? Is it because it's more effective for severe sleep apnea?

From my perspective, the dental appliance is easier to use, and is better for traveling. I also tried a CPAP but couldn't get the hang of it.

It's also super creepy that CPAPs all seem to have a cell modem that spies on you. (OK, that info also helps the doctor, but still.)

I know a couple other people who are having problems with CPAP, and the doctor has not even made them aware of the dental appliance. They're surprised when I tell them there's an alternative.

And one of these people is a doctor himself! I feel like sleep apnea is being treated very poorly given how common it is, probably for economic reasons.

I know everyone wants to say this about their pet cause -- but it does seem like an "epidemic". The "epidemic" of weight gain seems to be an obvious reason for this. FWIW my BMI is now normal (less than 25, 166-169 at 5'9"), and I still need the dental appliance and to sleep on my side. Either one alone doesn't cut it.

I've also been meaning to write a article about "Why AHI is wrong", which is basically because outliers determine outcomes and AHI doesn't measure outliers. It's a "count". It has a lot of the fallacies that Nassim Taleb talks about in his books.

The AVERAGE minute of sleep doesn't matter; the WORST minute of sleep matters. The worst minute can ruin your whole night's sleep (or at least a REM's cycle worth of sleep), or it can cause you to have a heart attack and die.

My AHI is 6 or 7, and most doctors have dismissed that as not important. However my sleep quality has improved greatly with all these remedies. Several minor health problems have cleared up all at once.

The thing that motivated me to get treated was that I crushed a tooth in my sleep, which many doctors don't realize is related to sleep apnea (but my dentist did thankfully). But I think of all the people who did NOT happen to crush a tooth and are undiagnosed. I guess it's one of those things that kills you over 20 years and used to be called "getting old". But really it was amazing to me how many problems can have the same fundamental cause.

FWIW I highly recommend this book about the "sleep breathing paradigm". It's written by an ENT who has observed a lot of these things in his practice. A key point is that he actually looks at your airway and sees if your tongue obstructs your airway when lying down. I went to 2 ENTs and neither of them did that. They don't understand the mechanism behind sleep apnea! It's geometry and gravity.

This book is not popular, which is a shame. Don't judge a book by its cover :) It's a bit dense but that will be fine for HN readers.

https://www.amazon.com/Sleep-Interrupted-physician-reveals-r...

> Isn't it akin to telling lifelong smokers, "Just stop smoking."?

It absolutely is. And I say this as someone who, after 25 years smoking, I stopped one day. I wasn't even really wanting or trying to quit. I just... stopped.

I consider myself incredibly fortunate at the complex, unlikely, and non-transferable, set of conditions that made this happen to me. Despite my success, or precisely because of my success, I am the least valid person to help a smoker quit.

Have you tried the alternative dental appliance? Lots of people don't seem to know about it, but I'm using one and it works:

https://news.ycombinator.com/item?id=22014204

I even heard on Joe Rogan that he has to use one. Not sure why more people don't know about it. I guess it depends on whether your doctor or dentist diagnoses it, but that shouldn't be the case. They should exchange more information!