Sleep deprivation is a cruel business. As a former junior doctor, one of those who did the nightmare 100 hours a week that have since been made illegal, and a mother of three, I know a thing or two about surviving without much of the old shuteye, and tend to be very sympathetic to anyone coming to see me who is suffering in this way. But why mention it on a weight loss website? Two reasons really – first, because (as I have mentioned previously) chronic tiredness can cause weight gain when people eat high calorie comfort foods to try and feel more energetic or at least less miserable, and second, because being significantly overweight can cause major sleep disturbance and losing that weight can solve the problem.

Obesity hypoventilation and obstructive sleep apnoea are very similar and closely linked conditions, and most people who have one also have the other. They occur when severely overweight people fail to breathe adequately during sleep, often stopping breathing altogether for up to a minute, and so have insufficient oxygen and excess carbon dioxide in their blood. This is associated with partial or total waking several times a night which is very tiring.

This happens because of a number of factors. Obese people have more fat on their chest which weighs their ribcage down when they are lying down and makes it harder to breathe in. The muscles involved in breathing have to work harder to achieve the same result and become fatigued much more easily. Increased fat in the head and neck obstruct airflow through the neck and throat so it is also more difficult for obese people to breathe out. The lack of oxygen means that the heart tries to compensate by working harder, and occasionally this can result in high blood pressure and heart failure. So there is more to this than just tiredness, it is a medical condition that needs treatment.

People with obesity hypoventilation/sleep apnoea are often brought to the doctor by their partner who is concerned because of either excessive snoring or periods of not breathing, things that they would have not have noticed themselves. Sometimes the individual themselves will ask for help because of other symptoms such as daytime sleepiness or having a headache every morning, difficulty concentrating on simple things or occasionally because of things related to heart failure including leg swelling. If you have any of these symptoms then it is worth a visit to your GP to check things out.

If you do visit your doctor they will probably want to ask you about all the symptoms above and to assess how sleepy you are, this is usually done using the Epworth scale. The higher your score, the sleepier you are and the more likely you are to have obesity hypoventilation/sleep apnoea. The Epworth scale is very simple; you can find yours out now:

Choose the most appropriate number for each situation:

0 = would never doze or sleep.

1 = slight chance of dozing or sleeping

2 = moderate chance of dozing or sleeping

3 = high chance of dozing or sleeping 

SITUATION

Sitting and reading

Watching TV

Sitting inactive in a public place

Being a passenger in a motor vehicle for an hour or more

Lying down in the afternoon

Sitting and talking to someone

Sitting quietly after lunch (no alcohol)

Stopped for a few minutes in traffic 

while driving

Total score (add the scores up)

(This is your Epworth score) ________

If you score 10 or more then you are ‘sleepy’ during the day, if you score 18 or more you are ‘very sleepy’. If you are obese (check elsewhere on this website if you are not sure about this) and score 10 or more then it is very possible that you have obesity hypoventilation/sleep apnoea and you may need referral to a specialist for further assessment. Hospital policy about how high your Epworth score needs to be before you get the tests varies around the UK, your GP will be able to tell you about that.

If your GP does refer you for further assessment then you will have your oxygen and carbon dioxide levels checked by a blood test and you may end up having a sleep study. You would be quite literally studied while you sleep, and oxygen/carbon dioxide levels and periods of not breathing are all noted. If you are obese and your oxygen, carbon dioxide and breathing follow a particular pattern during sleep then obesity hypoventilation or sleep apnoea – or most often both – can be made.

It will come as no surprise to most that the main treatment for obesity hypoventilation/sleep apnoea is to get rid of the obesity, after all the clue is in the name! So weight loss is the key here, and hopefully if you are reading this then you have read a lot of other things on this website and already have a pretty good idea where to start. If your oxygen or carbon dioxide levels are dangerous or your concentration is affected to the extent that you are possibly a danger to yourself or others then your doctor may well want to speed up your weight loss with medication or surgery (gastric band or bypass) – if this is the case then please consider their advice, they will only do this if they are very concerned

An effective but somewhat unpleasant treatment while you are waiting for your weight to return to normal is CPAP (continuous positive airway pressure). You would wear an oxygen mask to bed each night that would exert slight pressure on your lungs in a good way, supplying extra oxygen and making it easier to breathe.

So if you have any of the symptoms I have mentioned, or if anyone has commented on your snoring or breath holding when you are asleep, please don’t worry too much but also please consider looking into it as you can avoid long term health problems later in life and significantly improve your quality of life now by following the advice of your doctor –if any is needed – and continuing to develop your Spirit controlled appetite. Result!