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CPAP and weight loss surgery
#1
Hi Everyone,

It's been many years since I participated in the board. Back then I received invaluable advice and it inspired me to help many folks I met get started and integrate CPAP into their lives.

I recently went through a gastric bypass and have been dropping weight significantly. After a few weeks, I noticed I was waking up with an extremely dry mouth. Then I started waking up because I was blowing air our my mouth - something I have not done in 16 years of CPAP use.

Back when I started on CPAP I had a hard time getting used to the pressure, so I figured out how to program the pressure settings and started at a lower pressure, adding 1cm H2O every week until I built up to my Rx.

So following that, I wondered if I should start dialing down the pressure (yes, I know, I should get a sleep study and I will, just not now. Have other surgeries in the way).

I was on a ResMed Elite S9 that has 0.2cm H2O resolution, and I started decrementing on 0.4cm steps until I wouldn't have the dry mouth but felt I was getting a decent night's rest.

That's taken me from 12cm down to 9. And now for the question - I'd be interested in hearing from board members about their experience with weight loss surgery and apnea. Does the apnea resolve, if so when, how did you deal with it, etc?

I'm down about 10 pounds from the weight at which I was diagnosed with apnea in 1998. After weight loss surgery, there's "preferrential weight loss" especially around the face and neck/throat area. The surgeon told me that the apnea, if it's obstructive and not central, resolves in about 60-70% of patients at some point.

One ironic thing is after 16 years of CPAP use - and I could not have held my job and enjoyed my life as I have without it - it's become by "comfort blanket" at night to fall asleep. Even a lower pressure setting now feels weird. Hopefully that will also pass.

Thanks in advance for any advice! Lastly, if my apnea does resolve, any pointers on the best way to donate CPAP machines?

Take care everyone
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#2
I've not had weight loss surgery, and am currently 310lbs, but my all time high was 409lbs. CPAP-wise, so far, nothing has changed for me. Perhaps the weight loss has been too slow, or I am old enough (52) that the tissue does not rebound the way it used to?

The way I figure it, I'm on CPAP for life, but as I continue to lose weight, I might get lucky? The only reason I haven't done weight loss surgery is cost. Otherwise I would love to have it done as I am now at a point that losing weight is very hard.
*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
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#3
There is no 100% fix via weight loss, rather, the AHI moves to within an "acceptable range" as far as doctors are concerned, and the CPAP device is then either significantly lowered or removed. Once loosened, the tissue that causes the most common form of obstructive sleep apnoea doesn't really rebound to a great extent, but toning the throat muscles can have a positive on this. I was discussing this effect yesterday with a sleep apnoea specialist at the Unispital here in Zurich, and the criterion for success in terms of this discussion was an AHI of 10 or less. I pointed out that if desatting still happens then it needs to be addressed, but her view was that if the desats are less frequent and there is no cardiovascular impact, then success is considered, and remission is indicated.

This is not to say that weight loss is pointless, because you will never get off the mask - in fact, we see significant reduction of pressure required to maintain an open throat as weight loss occurs, and it can be significant enough to eventually not require a mask any more, or require a very low pressure setting, or even moving off the CPAP to a dental device or other similar methods. Each patient is different in that way.

In short, keep trying to lose weight - the magic measure of 40 cm neck circumference is quite real - below that we start to see a reduction of pressure needed. Well done and good luck on your continued weight loss.
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#4
I just measured my neck at '48' cm. Long ways still to go - although I am not sure it will ever get that small.
*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
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#5
Thanks for the replies. They all make sense. If I needed CPAP for home use, but could do an occasional trip with a dental device or no device and be ok, that would be a boon. My job requires me to travel frequently, so I have 3 CPAP machines - for home, for travel and a spare that can be swapped in in case one of the other 2 breaks.

For long trips I would probably pack a CPAP (hence my purchase of an HDM Z1) but for overnights it's a pain.
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#6
(04-24-2014, 11:31 AM)Peter_C Wrote: I just measured my neck at '48' cm. Long ways still to go - although I am not sure it will ever get that small.

20cm is about 16 inches. I had a 17 inch neck when I was a 17 year old US Airman at 155 pounds and 74 inches tall.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
Up until I was 38, I had a 14 1/2 inch neck, in your measurements. That is 37 cm. Now I am at 42 cm, or 16 3/4 inches. If I got down to 15 /12 inches I would be below the magic 40 cm.... Hope that helps to understand the sizes you are dealing with. 48 cm is a 19 inch neck. For that to be a "normal" fit for a shirt, you would need a 36 1/2 inch sleeve and a 44 1/2 inch chest at least, and be over 6 foot 2 inches tall (I grew up in my dad's clothing shop). Most people aren't a "normal" fit.
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#8
(04-24-2014, 11:24 AM)DocWils Wrote: ...the magic measure of 40 cm neck circumference is quite real - below that we start to see a reduction of pressure needed.

I just measured my neck at 38/39 cm circumference depending on where measured. My 95% pressure has steadily been rising over the last year from the low 19s to the high 19s while my weight remains stable (though I do look thinner as I have toned up a little).

I guess the "magic" only works for believers...
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#9
Hi pperez550,
WELCOME BACK! to the forum.!
Hang in there for more responses to your post and CONGRATULATIONS! on your weight loss.
trish6hundred
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#10
Thanks Trish!

(for others in the thread) My neck had grown to an 18.5" but is now back to a 17.
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