Skip to content 
Welcome
It is important to understand the complicated relationship between sleep and body weight. A lot of people know that diet and exercise are important for keeping your weight in check, but they don’t always realize how important sleep is. Studying the link between body mass index (BMI) and sleep can give you useful information about your health and well-being as a whole.
Sleep is very important for health, but millions of people around the world have sleep problems and don’t even know it. Obstructive Sleep Apnea (OSA) is one of the most common and least diagnosed conditions. A lot of people think it only affects people who are overweight, but that’s not the whole story. Body Mass Index (BMI) is an important part of OSA, but it is not the only one.
In this long article, we look at the strong connections between BMI and sleep apnea, how gaining or losing weight affects this condition, and some surprising facts about skinny people and even famous people who had or died from OSA.
What is BMI and Why Does it Matter for Sleep Apnea?
BMI is a number that comes from a person’s height and weight and is used to group people by body weight:
- Underweight: Less than 18.5
- Normal weight: 18.5 to 24.9
- Too heavy: 25–29.9
- Obese: 30 or more
When the upper airway collapses while you sleep, it causes sleep apnea, which makes you stop breathing over and over again. People with a high BMI have more fat around their neck and upper airway, which makes it harder for air to flow through. Obesity can also make the diaphragm and lungs work less well, which makes the risk even higher. In fact, 90% of people with moderate to severe sleep apnea are overweight or obese.
But BMI doesn’t tell the whole story. Studies show that 20 to 25 percent of people with sleep apnea have a normal BMI. The airway’s anatomy, neuromuscular control, and even genetics all play a part in who gets OSA.
Can Having Sleep Apnea Make You Gain Weight?
There is a two-way connection between sleep apnea and BMI. Obesity can cause OSA, but OSA that isn’t treated can make you gain weight. This is how:
1. Hormonal Changes
Sleep apnea throws off the balance of important hormones:
- Ghrelin goes up (making you hungry)
- Leptin goes down (making you less full)
- Cortisol goes up (making you more stressed and keeping fat)
2. Tiredness During the Day
People with OSA often feel very sleepy during the day. People who are tired are less likely to exercise and more likely to choose high-calorie foods for a quick boost of energy.
3. Not Responding to Insulin
Chronic lack of oxygen from OSA makes insulin resistance worse, which can make the body store fat and slow down metabolism.
This feedback loop—OSA making you tired and weight gain making OSA worse—is very dangerous. That’s why it’s so important to break the cycle with timely treatment.
Can Losing Weight Help with Sleep Apnea?
The short answer is yes, a lot of the time.
Losing weight has been shown to greatly improve or even get rid of sleep apnea, especially in mild to moderate cases. Research shows that:
- Dropping 10% of your body weight can make sleep apnea less severe by up to 36%
- Losing 20% of your body weight can make your apnea less severe by more than half
But the benefits depend on a number of things, such as how the weight loss is achieved and whether the airway anatomy is set up in a way that makes improvement possible. People with serious structural problems may not be able to fully reverse their condition just by losing weight.
How Much Weight Do You Need to Lose?
When it comes to improving apnea, not all weight loss is the same. Studies show that a moderate loss of 5 to 10% leads to a noticeable decrease in snoring and AHI (apnea-hypopnea index).
- Major Loss (15–20%): This often causes mild to moderate OSA cases to go into remission.
New treatments like GLP-1 receptor agonists (Wegovy, Zepbound, and Ozempic) have shown promise.
Clinical trials of tirzepatide (Zepbound) showed that:
- The AHI went down by 63%
- More than 40% of participants went into remission
These drugs also lower inflammation, make you feel full, and keep your blood sugar stable, so they can help with more than just losing weight.
Can People Who Are Thin Have Sleep Apnea?
Yes, and it’s more common than most people think. About a quarter of people with OSA are at a healthy weight or even underweight.
Some of the causes are:
- Narrowing of the Anatomy
Even if they are thin, people with small jaws, high-arched palates, or big tonsils can have trouble breathing. - Lack of Muscle Tone
If your neuromuscular tone is low while you sleep, it can make your throat muscles relax too much, which can block airflow. - Genetic Factors
Some people are more likely to get OSA because they have certain physical traits, like a recessed chin or a long face. - Apnea in a Certain Position
When people sleep on their backs, even a little bit of airway restriction can cause apnea.
So, even though weight is a risk factor, anatomy and genetics can be just as important.
The Bad Cycle: Gaining Weight and Having Sleep Apnea
Let’s look at how sleep apnea makes a cycle that keeps going:
- Sleep fragmentation causes hormonal imbalances.
- Changes in hormones make you want to eat more and crave more.
- Being tired during the day makes you less active
- Being inactive and eating poorly can make you gain weight.
- More fat makes OSA worse.
- The loop goes back to the beginning.
To break this cycle, you need to do a lot of different things, like therapy, changing your lifestyle, and sometimes even getting medical help.
Other Treatments Besides Losing Weight
Losing weight works for some people, but not for everyone. Some other treatments are:
- CPAP (Continuous Positive Airway Pressure):
Still the best way to treat OSA. It keeps the airway open by sending a stream of air that is under pressure. - Appliances for the Mouth:
Tools that move the jaw or tongue to keep the airway open. Works well for mild to moderate OSA. - Therapy for Position:
Teaching patients not to sleep on their backs can help with positional sleep apnea. - Surgery. Some options are:
- Tonsillectomy
- Uvulopalatopharyngoplasty (UPPP)
- Maxillomandibular advancement
- Inspire Hypoglossal Nerve Stimulation
Famous People Who Had Sleep Apnea
Sleep apnea has been linked to a number of famous people:
- Carrie Fisher: Her autopsy said that sleep apnea was a factor in her death.
- Reggie White: An NFL Hall of Famer who died in his sleep; OSA was a major suspect.
- John Candy: A comedian who is said to have had severe sleep apnea.
- Antonin Scalia: A Supreme Court Justice was found dead with a CPAP machine close by.
- Rosie O’Donnell and Shaquille O’Neal have said in public that they use CPAP machines.
These stories show how important it is to be aware and act quickly.
Screening and Diagnosis
If you think you might have sleep apnea, the STOP-BANG questionnaire and other tools can help you figure out how likely you are to have it:
- Snoring
- Feeling tired
- Noticing apneas
- High blood pressure
- BMI over 30
- Age over 50
- Neck size more than 17 inches for men and 16 inches for women
- Male gender
Getting 3 or more points? It’s time to talk to your doctor about a sleep study.
Ways to Stay Healthy and Avoid Problems
- Sleep hygiene: Go to bed and wake up at the same time every day, stay away from blue light, and keep your room cool and dark.
- Exercise: Even light activity, like walking, can help you sleep better and lose weight.
- Cut back on or stop drinking and smoking: Both help relax the muscles in the airways and cause inflammation.
- Diet: Focus on whole foods, lean proteins, and fiber. Eat less sugar and processed foods.
Last Thoughts
BMI and sleep apnea are closely linked, but the link is more complicated than it seems. Sleep apnea can also make you gain weight, even though being overweight increases your risk. Not even thin people are safe.
A personalized approach is needed for treatment to work. There are ways to help, whether it’s losing weight, using a CPAP machine, or taking new drugs like GLP-1 receptor agonists.
More importantly, being aware of OSA, getting an early diagnosis, and getting ongoing support are all important for managing it and improving long-term health.
Also, keep in mind that anyone can have sleep apnea, even famous people, athletes, and even presidents. It’s not shameful to ask for help, but it’s very dangerous to ignore the signs.
