if the neck circumference is 17 inches or higher there's a good chance of obstructive sleep apnea. In females, it's 16 inches or higher.
It has to be tailored to the patient's current health issues, medications and lifestyle. For patients that complain of joint pain and inability to move, I recommend hydrotherapy. Exercising in the water will make it easier for them to be mobile despite their high body mass index, arthritic hips and knees. We also encourage them to join a local weight loss group. It seems people do best when they have a strong support system, a spouse or a buddy that helps them lose weight. When someone goes on their own with unrealistic expectations it doesn't seem to work. You're going to have lapses, but, overall, just keep working the plan. Another important thing to consider is general health and diet education. Many of my patients say, ‘Well I eat very little,' but what they eat is high in calories or empty calories. Being aware of your caloric intake is very important to weight loss.
There was speculation many years ago that sleep deprivation slows your metabolism, which, in dramatic cases, slows to the point where you couldn't lose weight. Science is showing that it's true. There is a tremendous physiological insult to your body including insulin resistance, glucose intolerance, and elevation in blood pressure. I tell my patients, that being treated for obstructive sleep apnea with CPAP (continuous positive airway pressure, the most common treatment for OSA) is not weight loss equipment. But our hope is that if we can control your sleep apnea you will get more consolidated sleep so you won't have these fluctuations in hormone levels. You will rest better, you will be more motivated to proceed with an exercise program, and you will have more energy to proceed with a weight loss program. We hope that [by using CPAP] it starts a chain reaction.