Managing weight loss & training with sleep apnea

Medical Q&A [Moderated]
1

For someone who is struggling with sleep apnea, how should they go about introducing training into their lifestyle when they’re struggling with severe fatigue? (Or, should they even introduce training from the beginning?)

The person in question is a South Asian male in his mid-40s with an approximate BMI of 27.5 who has recently been diagnosed with obstructive sleep apnea (though it has probably been an issue for years, which has come with 30 - 40 lbs of weight gain). He is doing his best to address the sleep apnea with a CPAP, but it remains only partially resolved due to treatment emergent central sleep apnea.

He has also started tirzepatide but this is a very recent development and still in the stages of titrating up to a meaningful dose.

He recognizes that it would be beneficial to incorporate more exercise but, as mentioned up top, fatigue has been a major obstacle. He also has a partially physically demanding job (as in, sedentary 3 days of the week and active 2 days of the week) for which he is careful (and very good reason) to try to be as well rested as possible for the active work days.

There is some wariness around adding resistance training to his lifestyle until his sleep apnea is fully addressed due to previous experience of compounded fatigue from training while his sleep apnea went undiagnosed, which makes sense since his recovery was and would be hampered by poor sleep. He is also concerned that training would raise cortisol levels in an already stressed body.

I know there’s an aspect of vicious feedback loop between extra adiposity and obstructive sleep apnea to contend with here. Apologies for the rambling (and if I miscategorized this under medical rather than training) but what advice might you have for this situation?

2

Hi,

Definitely a challenging situation. There isn’t a single answer here, as so much of it depends on his beliefs, expectations, and most importantly, what he is willing to do.

As his CPAP and tirzepatide treatments take effect he should experience progressive improvements (assuming no other unaddressed causes for fatigue are present), and this will gradually open the door to more activity, as he tolerates & is willing to do. It doesn’t have to be “all at once” – for example, starting with a few moderately challenging sets of strength exercises on one of his sedentary days, or a moderate bout of low-intensity conditioning modality that he enjoys and is not enough to cause substantial fatigue.

Assuming the activity is dosed appropriately for his level of fitness, this may actually start a “positive feedback” loop where the activity improves how he feels, improves his sleep quality, and allows for more activity over time.

Lastly, I noted your comment about training “raising cortisol levels in an already stressed body” – I would not be explicitly dismissive of this concern when talking with him, but training-related changes in cortisol are not a concern whatsoever here. If he’s simply using the word “cortisol” as a substitute for “stress”, then the idea of adding stress on an already stressed body is understandable, but this is really a matter of exercise dosing. By managing intensity and volume we can almost always find a reasonable entry point for folks here.

These can be complex, challenging conversations – and sometimes a consultation with our team can be helpful for further individualized guidance.