Obstructive Sleep Apnoea and weight loss - A patient's guide
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A patient’s guide
Obstructive
Sleep Apnoea
and weight loss
A patient’s guide
1A patient’s guide
Obstructive Sleep Apnoea As Obstructive Sleep Apnoea
(OSA) is caused by repetitive can improve with weight loss,
narrowing or closure of the air we may be able to lower your
passage in the throat whilst CPAP pressure as your weight
sleeping. These pauses in reduces. This would make your
breathing can cause oxygen treatment more comfortable
levels in the blood to drop and to tolerate. Patients that
brief awakenings from sleep. use higher pressure bilevel
This leads to an unrefreshing ventilators may be able to be
night’s sleep and excessive managed with CPAP which is
daytime sleepiness. It is more smaller and quieter.
common in people that are
overweight especially if the If enough weight is lost, it
excess weight is carried around is also possible to perform a
the neck. sleep study off CPAP treatment
completely. This could be
OSA and daytime sleepiness performed, at your request, to
can improve with weight loss reassess your need for CPAP.
and can even be resolved
if enough weight is lost. By Refer to the charts on page
losing weight, general health two and three which are used
is also usually improved, as a quick tool for working out
lowering risks of heart disease, BMI.
high blood pressure and
diabetes. Untreated OSA can
increase the likelihood of
becoming more obese due
to the sedentary lifestyle
caused by excessive daytime
sleepiness.
This leaflet gives advice and
information on ways of losing
weight.
1A patient’s guide
Are you the right weight for your height?
BMI is worked out by dividing weight in kilograms by the square
of the height in metres.
BMI = weight in kilograms / height in metres2
2A patient’s guide
Classifying overweight & obesity
What is a healthy weight?
There are a couple of ways you can check you are of a healthy
weight and shape:
1) Body Mass Index (BMI) is a way of assessing if you are the
right weight for your height.
2) Measuring your waist circumference is another way of
assessing whether you are storing too much fat around your
abdomen. This type of fat distribution is often referred to as
‘the apple shape’ and is linked with higher risks of diabetes
and cardiovascular disease.
Men Women
Low risk Below 94cm (37 inches) Below 81cm (31½ inches)
High risk 94-102cm (37 to 40 inches) 80-88cm (31½ to 35 inches)
Very high risk Above 102cm (40 inches) Above 88cm (35 inches)
BMI Interpretation
Above are the cut off values
given to indicate the risk of
developing complications
Less than 20 Underweight
based on waist circumference
for men and women.
20-25 Normal range*
See where you fit in; taking
25-30 Overweight both waist circumference and
BMI into consideration, can
Moderate-severe
30-40
obesity
give an even better idea of the
associated health risks. This can
More than 40 Morbid obesity be discussed with your General
Practitioner or Dietitian.
* In some sub-groups of the population such as in the Asian population the
normal range is 18.5-25kg/m2
3A patient’s guide
How can I lose weight? Ask yourself the following
Many people are aware that questions to help you get on
they are overweight and they the right track:
are also aware of the risks of
this to their health. It is often Why do I want to lose weight?
daunting when considering the Assess your level of motivation
extent of weight loss needed to lose weight, possible
to get close to the healthy BMI answers can include:
range or to reduce the waist • I want to improve my OSA
circumference in line with the and therefore get a more
guidelines. restful night sleep and not
feel so tired during the day.
When contemplating weight Or
loss, numerous doubts and
concerns may surface. Negative • I want to reduce my chances
thoughts may appear, such as; of developing heart disease
“How can I possibly achieve and feel better about myself.
these targets?”,”Will I have to What is a realistic weight loss
give up all the things I love?”, goal for me?
“It is just all too much; I don’t • Don’t set yourself up
have enough will power”. for disappointment. We
recommend a steady weight
It cannot be denied that will loss of 1-2lbs (0.5-1kg) per
power will be required and week.
changes to your eating habits
and lifestyle will be necessary • Significant health benefits
to achieve your goals. Small are experienced by reducing
and consistent changes are all just 10% of your body
that it will take however; this weight (for example if you
is dependent on a different lose 9.3kg or 1st 7lbs when
mind set which is essential to you originally weighed 93kg
successful weight loss. or 14st 9lbs).
4A patient’s guide
How will I lose weight? • Eat regularly (three main
It is important to understand meals with snacks in
the basic concept behind why between if necessary)
we gain, lose or stay the same • Always have breakfast
weight.
• Include a carbohydrate
based food at each meal (for
Eat more than you need
example: potatoes or bread)
i
You gain weight • Increase your fruit and
vegetable intake, aim for
Eat the same amount five-a-day
i • Think about reducing your
You stay the same portion sizes
Eat less than you need • Eat slowly and get more
i acquainted with feelings of
You lose weight fullness and hunger
• Be aware of times when
Obviously, to lose weight you you may falter and slip into
must eat less in the way of old habits. Put obstacles in
energy or calories but the key the way such as a note to
to weight loss is to do this in yourself on the biscuit tin.
a sustainable way and one in
which hunger does not get the
better of you.
The idea of dieting should be
put to one side and a long-
term healthy eating approach
adopted. This doesn’t need to
be done overnight but rather
by making slow changes (for
example one change a week)
to incorporate these healthy
eating tips:
5A patient’s guide
Further help and support is Food is listed in traffic light
available to help you to lose colour categories.
weight • Red light foods, which you
Commercially available diets should avoid, if you want to
such as Weight Watchers lose weight.
have a good track record and
many have found the group • Yellow light foods, that you
dynamics helpful. can eat occasionally and
green light foods, which you
www. weightwatchers.co.uk can eat as much as you like.
Meetings hotline: 08457
123000 Recommended books
• Living the Gl Diet: To
www.slimmingworld.com Maintain Healthy, Permanent
Group meetings hotline: 0844 Weight Loss by Rick Gallop
897 8000
• The New Glucose Revolution
Books advocating a Low GI diet by Jennie Brand-Miller and
are helpful in adopting good Anthony Leeds
eating habits. GI stands for British Heart Foundation
Glycaemic Index. This measures provides useful educational
the speed at which foods are materials, please go to www.
broken down by the body to bhf.org.uk/publications or call
form glucose, the body’s source 08701 600 6566.
of energy.
Your GP can refer you to
High GI foods break down your local dietetic service for
quickly and leave you looking support and advice and give
for food again sooner. Low GI help with exercise prescriptions
foods break down more slowly, if you are eligible.
leaving you feeling full for
longer.
It is these low GI foods that
form the core of the diet.
6A patient’s guide
Weight loss medication Doctors are given guidelines
Sadly, there is no ‘magic drug’ on when to prescribe this
that will get rid of excess medication.
weight forever. However, there
is a place for drug therapy in a Orlistat (Xenical)
structured and well supported Studies have shown that by
weight loss plan. using Orlistat together with
a healthy diet and exercise,
Drug treatment should only there is increased weight loss.
be considered after dietary, Some people can lose up to
exercise and behavioural 10% of their body weight in six
approaches have been started months but in others, it is less
and tried for at least 3 months. successful.
To lose weight the best chance How does it work?
of success is a healthy diet and Orlistat works by blocking
regular exercise. There is only chemicals (enzymes) in your
a limited role for medication gut that digest fat. Orilstat
for weight loss. Your GP may can block digestion of nearly
consider prescribing medication a third of the fat that you eat.
if you do not succeed in losing The usual dose is one capsule,
weight with exercise and diet, three times a day with each
your BMI is above 30 or you meal. You do not need to take
have a medical condition that one if the meal is fat free.
would benefit from improved
weight loss. Orlistat works with a weight
loss diet, but not by itself. You
There is currently only one still have to eat less as Orlistat
medicine available for GPs to only blocks some of the fat in
prescribe for weight loss. This your diet. If you were to eat
is a medicine called Orlistat more fat and not stick to a
(Xenical) and can only be weight loss diet, the extra fat
considered for patients who will easily cancel out the effect
have not reached their target of Orlistat.
weight loss or have reached a
plateau on a dietary, activity
and behavioural changes alone.
7A patient’s guide
Side effects Rimonabant was linked to
The main side effects of a considerable increase in
Orlistat are caused by the fat psychiatric disorders during
which your body is passing out clinical usage.
in your faeces.
Some people who use Orlistat
You may have an increased to help them lose weight find
urgency to go to the toilet, they put weight back on when
fatty smelly faeces and excess they stop taking medication.
wind. These side effects are Try to anticipate this, stick to a
less likely if you follow a low healthy diet, exercise regularly
fat diet and tend to settle with and weigh yourself once per
time. week.
Side effects will recur if more
fat is introduced to your diet.
Other side effects are rare:
please read the packaging and
patient information leaflet
for a full list of possible side
effects.
Unfortunately, other
medications such as
Sibutramine (Reductil) and
Rimonabant (Acomplia) have
had marketing authorization
suspended due to safety
concerns.
The cardiovascular risks of
Sibutramine outweighed
it’s benefits of clinical use
following a review by the
European Medicines Agency.
8A patient’s guide
Keeping weight off Moderate intensity means
Increasing activity levels and working hard enough to make
exercise you breathe more heavily and
Increasing your activity levels raise your body temperature,
whilst following a healthy but not so hard that you are
diet will help you to lose unable to talk and exercise at
weight. Everyone can benefit, the same time.
whatever your size, age and
physical condition. Getting active can simply mean
Most people are fit enough to doing the same things that you
exercise without problems. If would normally do, but more
you have heart disease, high often and in a more energetic
blood pressure, dizziness, way. Work these activities
fainting, or joint problems, you into your daily routine. Take
should consult your GP. Just a bit of extra time, each day,
remember, you are never too for physical activities. This will
unfit to start doing something. quickly build up your fitness
In fact, the greatest health and increase your energy
benefit is felt by inactive levels. For those who have not
people who start to take been active for some time,
regular moderate physical gentle, steady progress is the
activity. Your health risks key. Walking is often the best
improve as soon as you start to way to begin.
do more.
Any increase in activity will
help, but experts agree that
all adults should aim to take at
least 30 minutes of moderate
intensity activity for five days
a week. Build up this exercise
to 60-90 minutes a day for five
days a week if possible.
9A patient’s guide
Taking the first steps
• If you use public transport,
try to get off the bus one
stop early and walk the rest
of the way
• If you drive, try parking the
car further away from where
you want to go and walk the
rest
• Walk or cycle, rather than
drive to the shops
• Walk or cycle to work if
possible
• Take the stairs instead of the
lift
• Walk or cycle to social events
• Get a friend or family
member to join you, exercise
together and support each
other
• Join a Gym or structured
exercise programme
• Try swimming with your
family and friends.
10A patient’s guide Papworth Hospital NHS Foundation Trust Papworth Everard Cambridge CB23 3RE Tel: 01480 830541 Fax: 01480 831315 www.papworthhospital.nhs.uk A member of Cambridge University Health Partners Papworth Hospital is a smoke free site Large print copies and alternative languages can be made available on request. Author ID: Jacqueline Archer Department: RSSC Printed: September 2010 Review date: September 2012 Version: 2 Leaflet number: 21 © Papworth Hospital NHS Foundation Trust 185 10
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