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When you come to the intersection of sleep apnea and obesity

Obstructive sleep apnea (OSA) can be caused by the bodily conditions that obesity can bring (although being overweight is not the only cause).

Meanwhile, perfectly thin people can also suffer from sleep apnea as well. It might be because they have a neurological condition that leads to central sleep apnea.

Or, they might have problems with the structure of the upper airway (such as a deviated septum) which could make it more likely for them to develop a sleep breathing disorder.

In any event, lost sleep by whatever cause can also lead to unwanted weight gain. Meanwhile, American is getting heavier with each passing year.

Understanding obesity

Being overweight or obese is one of the the US’s biggest public health concerns.

Obesity in America: The statistics

From the Centers for Disease Control and Prevention:

  • More than one-third of U.S. adults are obese

  • In 2015, studies showed that the medical costs for people who are obese were more than$1,400 higher than those for people of normal weight

  • The prevalence of obesity in the state of Washington as of 2015: between 25 and 30 percent

  • The Midwest has the highest prevalence of obesity, narrowly edging out the South, while theWest has the lowest prevalence

  • The most recent research available shows that 17 percent of children ages 2 to 19 are obese; this is problematic, as other research also shows an increased incidence of sleep apnea in children

Obesity, by definition

What does it mean to be obese? The Centers for Disease Control and Prevention offer these definitions:

  • Generally speaking, “Weight that is higher than what is considered as a healthy weight for a given height is described as overweight or obese.”

  • Weight is correlated to health risks; this had led to the adoption of the Body Mass Index to identify scales of weight.

    • A BMI of less than 18.5 = underweight

    • A BMI of 18.5 to less than 25 = normal weight

    • A BMI of 25 to less than 30 = overweight

    • A BMI of 30 or higher = obese

      • A BMI of 30 to less than 35 = Class 1 obesity

      • A BMI of 35 to less than 40 = Class 2 obesity

      • A BMI of 40 or higher= Class 3 obesity (severe, extreme, morbid)

What is BMI?

Body Mass Index (BMI) is a formula that calculates an estimate of body fat based on a ratio of body weight to height. It’s been found to be a reliable predictor of risk factors for diseases related to metabolism.

The higher the BMI score, the higher the risk for chronic illnesses that include, among others, heart disease, hypertension, type 2 diabetes, and sleep apnea. To calculateBMI, visit the BMI calculator tool offered by the National Heart, Lung, and Blood Institute.

The relationship between obesity and sleep apnea

Bidirectional may be the best way to describe the relationship between obesity and sleep apnea. Obesity contributes to the development of sleep apnea, and vice versa.

How obesity contributes to sleep apnea

The Mayo Clinic reports that people who are obese are 4 times more likely to develop sleep apnea.

When we gain weight (especially in our midsection and neck areas),this added fatty tissue joins with gravity to compromise the body’s ability to breathe adequately and with ease during sleep.

Heaviness around the girth makes it harder for the diaphragm to do the work of breathing.A large neck (17 inches or more for men, and 16 inches or more for women) has been shown to lead to partially or completed blocked airways during sleep. This is due to excessive tissue here, as well as less overall tone in the muscles. Also, fat deposits hold more fluid than lean muscle, so water retention may contribute to the problem.

How sleep apnea contributes to obesity

To make matters worse, sleep apnea results in daytime sleepiness, which can sap any motivation a person has to lose weight. In addition, sleep deprivation has been shown to lead to eating behaviors which are driven by the imbalance of chemistry in the brain following periods of lost sleep.

This explains why tired people crave snack foods: the brain’s chemical imbalance of leptin and ghrelin fuels a physiological need for carbohydrates to jumpstart one’s energy levels.

You can see how it becomes a vicious cycle for so many Americans. Not enough sleep = overeating, but the results of overeating also compromise sleep.

An article in Hypertension in 2003 goes as far as to suggest that sleep apnea should be highly suspected in those who are obese, who also have the following:

  • resistant hypertension

  • absence of a nightly reduction in blood pressure

  • unexplained weight gain or difficulty losing weight

  • classic symptoms of sleep apnea, such as witnessed pauses in breathing during sleep, snoring, daytime sleepiness and poor overall sleep quality

“If I could just lose 10 pounds…”

… it would be a great start!

Losing weight while simultaneously treating sleep apnea can reduce daytime sleepiness and return energy and motivation to those who need to exercise and practice better vigilance with their diets.

Even the smallest loss of weight can show significant clinical improvement in the severity of one’s sleep apnea. Keep in mind, however, that one’s BMI is not the only risk factor for sleep apnea. There are many thin people who, due to other physiological reasons, also have sleep apnea.

At Sound Sleep Health, we work in concert with Sound Medical Weight Loss to help those struggling with the sleep-weight connection.

If you are challenged to lose those unwanted pounds, you may wish to consider working with a knowledgeable, trained physician who can help you lose weight and reclaim your health in a safe, healthy way.


American Thoracic Society
Centers for Disease Control and Prevention

Mayo Clinic
National Heart, Lung, and Blood Institute
National Sleep Foundation

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