Explore Causes of Restless Legs Syndrome

By Brandon Peters, MD

Although many people with restless legs syndrome (RLS) may never be able to identify a cause to their disorder, often it results from other secondary causes. This thus results in two categories of the condition, the former being primary RLS (of unknown cause) and the latter deemed secondary RLS. There are many conditions that may independently lead to symptoms of RLS and these are described here.

1. Iron Deficiency

The relationship between iron deficiency and RLS symptoms has been extensively studied. In several research studies, low iron levels have been found in the blood and spinal fluid of individuals suffering from RLS. The lower the iron levels, the worse the symptoms. Magnetic resonance imaging (MRI) has shown that the iron content in an area of the brain called the substantia nigra is lower in those with RLS compared to normal individuals, which may contribute to the disorder. In addition, pathological studies have confirmed this change within the brain.

It is therefore recommended that you have your serum ferritin level (a marker of iron stores) checked if you have symptoms of RLS. If the ferritin level is low, generally at a value <75, a trial of oral iron replacement should be undertaken. Even if the levels are normal, some individuals respond to iron replacement.

2. End-stage Kidney Disease

RLS is very common among individuals suffering from end-stage kidney disease, especially those who are dependent upon dialysis. The incidence has been reported to range from 6 to 60 percent. It is unclear what may be contributing to RLS in this group. Anemia, iron deficiency, or even low parathyroid hormone levels may have a role based on various studies. In some cases, treating anemia with erythropoietin therapy or iron replacement has been effective.

3. Diabetes

In people with Type 2 or adult-onset diabetes, RLS may develop. If diabetes is left uncontrolled, nerve damage can result. This is thought to occur because of high levels of glucose within the blood. This can lead to damage of small blood vessels that supply the nerves called vaso nervorum. When these become clogged, the nerve itself will become damaged. Often this leads to a peripheral neuropathy, which consists of pain and a pins-and-needles sensation in the feet. This may progress up the legs and even involve the hands. Associated with these sensory changes, some people will also have symptoms of RLS. Therefore, it is thought that diabetes may be an independent risk factor for developing RLS. In people who have undergone pancreas and kidney transplants, their symptoms of RLS have improved.

4. Multiple Sclerosis

There is a growing body of evidence that multiple sclerosis seems to be associated with an increased risk of having RLS. Some of the studies are conflicting, however. In one of the larger studies that included 1500 subjects, the prevalence of RLS was 19 percent in people with MS compared to only 4 percent of those people without it.

5. Parkinson’s Disease

It is thought that RLS and Parkinson’s disease may be caused by a similar problem, namely disruptions in the neurotransmitter called dopamine. This is not fully understood, however. Regardless, RLS may be present in individuals who have Parkinson’s disease, with a prevalence ranging from 0 to 20.8 percent, based on the study. Parkinson’s disease often involves a sense of restlessness (called akathisia) that may also occur in RLS, which may make it difficult to discriminate between the disorders. When both conditions are present, RLS usually occurs after Parkinson’s disease has become apparent.

6. Pregnancy

Not all conditions that may lead to RLS are disorders. In fact, the state of being pregnant seems to increase not only the incidence but also the degree of RLS symptoms. In a study of 626 pregnant women, only 10 percent had symptoms of RLS prior to becoming pregnant but this increased to 27 percent during pregnancy. It seemed to worsen in the third trimester. The good news is that the symptoms rapidly improved after delivery. It is not clear what causes the increased frequency of RLS during pregnancy. It may be due to iron or folate deficiency or even because of hormonal changes associated with being pregnant.

7. Rheumatic Disease

There are many conditions such as rheumatoid arthritis, Sjogren’s syndrome, and fibromyalgia that may have an association with symptoms of RLS. This relationship is unclear. In one study, 25 percent of individuals with rheumatoid arthritis had RLS symptoms compared to only 4 percent of osteoarthritis. In another study, 42 of 135 patients with fibromyalgia had RLS. The exact reason for this association is not fully understood.

8. Varicose Veins

In some instances, poor blood flow in the legs has been associated with RLS. In particular, weak veins that distend and become uncomfortable have been blamed. These so-called varicose veins are often engorged and blue in color and may be a sign of venous insufficiency. In a study of 1397 patients, 312 people complained of symptoms of RLS.

Treatment of varicose veins has proven to be effective in alleviating some of the symptoms of RLS. Sclerotherapy led to initial improvement in 98 percent of people, with relief maintained at two years in 72 percent. Medication treatment, including hyrdoxyethylrutoside, has also been shown to be modestly effective.

9. Other Conditions

Beyond the conditions described above, there are many other disorders that seem to be associated with RLS symptoms. These include:

• Obesity

• Obstructive sleep apnea

• Hypothyroidism

• High blood pressure

• Heart disease

• Peripheral neuropathies

• Vitamin deficiencies

• Excessive caffeine intake

• Low blood sugar

• Lumbosacral radiculopathy

• Spinal stenosis

• Use of mianserin (an antidepressant medication)

Sources:

Earley, CJ et al. “Abnormalities in CSF concentrations of ferritin and transferrin in restless legs syndrome.” Neurology 2000; 54:1698.

Allen, RP et al. “MRI measurement of brain iron in patients with restless legs syndrome.” Neurology 2001; 56:263.

Connor, JR et al. “Neuropathological examination suggests impaired brain iron acquisition in restless legs syndrome.” Neurology 2003; 61:304.

Kavanagh, D et al. “Restless legs syndrome in patients on dialysis.” Am J Kidney Dis 2004; 43:763.

Merlino, G et al. “Association of restless legs syndrome and quality of sleep in type 2 diabetes: a case-control study.” Sleep 2007; 30:866.

Manconi, M et al. “Multicenter case-control study on restless legs syndrome in multiple sclerosis: the REMS study.” Sleep 2008; 31:944.

Lee, JE et al. “Factors contributing to the development of restless legs syndrome in patients with Parkinson disease.” Mov Disord 2009; 24:579.

Manconi, M et al. “Restless legs syndrome and pregnancy.” Neurology 2004; 63:1065.

American Academy of Sleep Medicine. International Classification of Sleep Disorders. 3rd Edition Text Revision. 2024.

Walters, A. “Restless legs syndrome and periodic limb movements of sleep.” Continuum. Neurol 2007;13(3):115-138.

What Is the Best Temperature for Sleep?

By Brandon Peters, MD

It can be a common battleground for couples who sleep together: What is the best temperature for sleep? Whether you are fighting over a thermostat setting, disagree on the best bedding or sleep attire, or are tugging or throwing covers from one side of the bed to the other, the effects of the bedroom temperature may be important. It may even cause insomnia. Learn the optimal room temperature for sleep, what to do if it is too warm or too cold at night, how to sleep better if the temperature is uncomfortable in the summer or winter, and what medical conditions may make it hard to regulate body temperature at night.

The Effects of the Bedroom Environment on Sleep

First, consider what makes for an ideal bedroom environment. Beyond reserving it as a space for sleep and removing electronics, including bright screens, it is also important to consider the roles of noise, light and temperature. As a general, the bedroom should be quiet, dark, and a cool but comfortable temperature. Why might this be?

Consider how you would be sleeping if you did not have a modern home. Imagine as it was 40,000 years ago, living as a Neanderthal. Normal bodily processes, including sleep and temperature regulation, would be closely tied to the natural environment. When it becomes dark and starts to cool off, your body temperature also drops and you would get sleepy and lie down for the night. These same patterns persist in the present day, driven by genetic and environmental factors.

The body temperature reaches its lowest point about 2 hours before your normal wake time. This means if you usually wake up at 6 a.m., your minimum core body temperature will occur at 4 a.m. If you have ever stayed up through the night, you may have noticed how cold you feel at this time. Most of the time we are asleep, however. Towards morning, as the sun approaches the eastern horizon, our body temperature starts to increase, following a consistent circadian (“near day”) pattern.

The pairing of our body temperature to the temperature of the environment helps to minimize heat loss overnight. It may promote normal features of sleep, including the patterns of deep and REM sleep. But what is the best temperature for sleep?

What is the Ideal Bedroom Temperature?

Sleep experts at the National Sleep Foundation recommend that there is an ideal bedroom temperature range to promote healthy sleep. These ranges may vary somewhat based on age. Consider these recommendations:

• Babies and toddlers: 65 to 70 degrees Fahrenheit (18 to 21 degrees Celsius)

• Children and adults: 60 to 67 degrees Fahrenheit (15 to 19 degrees Celsius)

It may be best to use a smart thermostat to regulate the temperature of your home, turning down the temperature setting overnight. A degree variation from these recommendations, higher or lower, likely has little effect. Though these suggestions may be comfortable for most people, respect your body. If you feel too cool, or too warm, you may have to make some adjustments.

What If It Is Too Cold?

If you sleep in an environment that is too cold at night, your body will have to work to maintain your core body temperature at the desired level. This may provoke shivering, as the muscles of the body contract to produce warming energy. Feeling cold at night may also provoke awakenings. This may be helpful to make changes in the environment, such as pulling up covers or snuggling close to a bed partner. Unfortunately, it may also contribute to poor sleep quality and insomnia.

In extreme scenarios, such as sleeping unprotected in the woods with inadequate clothing, may provoke a serious decrease in the body temperature that can lead to hypothermia and even death due to exposure.

What If It Is Too Warm?

Almost everyone has experienced a night when their bedroom was too warm, making it hard to fall asleep. This may occur in the summer on especially hot days. What occurs when the bedroom is too warm at night?

Not surprisingly, the most common side effect of feeling too warm at night is sweating. The body regulates its temperature by increasing blood flow to the periphery (including to the hands and feet). It also promotes evaporative cooling by causing sweating. Just like during wakefulness, sweating may start in the hair of the head, armpits, and groin. If additional cooling is needed, the torso (chest, abdomen, or back) or extremities (arms and legs) may become slick with sweat.

Beyond feeling sweaty, there may be restless sleep with frequent awakenings and position changes contributing to insomnia. Attempts may be made to flip a pillow over to its cool side, to throw off covers, or to move away from a bed partner. It may be necessary to remove clothing, such as shedding warm pajamas or other sleep attire. It may help to open a window overnight, so the natural cooling of the environment can occur in the bedroom as well. In some cases, major adjustments may be necessary, including changes in the mattress or pillow (such as avoiding memory foam) to improve temperature regulation during sleep.

If the body temperature increases to a dangerous level, the effects of the resulting fever may cause serious consequences, including loss of consciousness, seizures, coma, and even death.

What About Humidity?

Beyond temperature, it is also important to consider the effects of humidity on sleep. When air is cold, or warm, there are changes in the amount of moisture that the air contains. In the winter, colder air may be more dry and this may affect the ability to breathe optimally during sleep. This may lead to nasal dryness or congestion, increasing snoring or sleep apnea, or even may make it more likely to develop upper respiratory illnesses like colds or influenza. Humidifier use, especially in a dry climate, may make it more comfortable to breathe at night and this may improve sleep. 

How to Sleep Better During Cold Weather 

What should you do if you are having difficulty sleeping due to a bedroom that is too cool? This may be more likely during cold weather during the winter months. It may also occur if you share a bedroom with someone who prefers a cooler temperature. Consider these options:

• Wear warmer pajamas (think flannel)

• Use extra blankets or an electric heated blanket

• Put heavier bedding on the bed (such as a heavy comforter or duvet)

• Turn up the thermostat

• Consider a space heater (kept away from flammable materials and with a safety timer feature to automatically turn off)

• Cuddle with a bed partner or pet

• Wear warm socks to bed

• Drink a warm beverage before bedtime (but avoid caffeine)

• Take a hot shower or bath prior to coming to bed

• In some cases, you may need to sleep in a different bedroom from someone who has a starkly different temperature preference at night.

How to Sleep Better During Warm Weather 

What if it is just too hot at night? Fortunately, there may be some helpful interventions to cool off at night when the weather gets too warm. Review these suggestions:

• Choose light, breathable sleep attire (such as cotton) or sleep naked

• Remove heavy blankets and bedding and consider using just a sheet

• Set up a circulating fan near the bed

• Use the air conditioning overnight

• Take a cool shower or bath prior to bedtime

• Leave the windows open at night

• Avoid artificial memory foam mattresses or pillows

• Consider the use of cooling devices (including pillows, sheets, pads, or even headgear)

If the unpleasant weather is due to a summer heat wave, hopefully it breaks quickly and your sleep will promptly return to normal as it does.

Is Poor Temperature Regulation a Medical Condition?

It is normal to question whether a difficulty regulating the body temperature at night is due to a medical condition. In some cases, such as an acute illness associated with a fever, it clearly is. There may be other chronic medical conditions that affect temperatures at night as well.

The most common conditions that impact the body temperature overnight are related to hormones. Thyroid problems often cause sweats or chills, correlating with hyperthyroidism or hypothyroidism, respectively. In addition, night sweats may be linked to the hormonal changes of menopause.

Sweating may occur due to the side effects of some medications. Sleep disorders such as sleep apnea can lead to frequent sweats due to the associated bursts of cortisol (stress hormone). Obesity, anxiety, and even hypoglycemia may cause sweats at night.

There are rare conditions that can cause elevated temperatures at night, including infectious diseases like tuberculosis and even some cancers. If the temperature regulation problems persist without explanation, especially in the context of other symptoms, it may be worth getting checked out. 

Conclusion

If you have difficulty sleeping comfortably at night, review whether you can make some changes to help yourself to sleep better. If you struggle with chronic insomnia, consider cognitive behavioral therapy for insomnia (CBTI). Fortunately, speaking with a board-certified sleep physician can often provide you the answers you need to sleep normally throughout the year, tolerating the normal variation of nighttime temperatures.

Sources:

Troynikov O, et al. “Sleep environments and sleep physiology: A review.” J Therm Bio. 2018 Dec;78:192-203. doi: 10.1016/j.jtherbio.2018.09.012. Epub 2018 Oct 5.

Szymusiak R. “Body temperature and sleep.” Handb Clin Neurol. 2018;156:341-351. doi: 10.1016/B978-0-444-63912-7.00020-5. 

Roth T, et al. “A novel forehead temperature-regulating device for insomnia: a randomized clinical trial.” Sleep. 2018 May 1:41(5). doi: 10.1093/sleep/zsy045.

Lappharat S, et al. “Effects of Bedroom Environmental Conditions on the Severity of Obstructive Sleep Apnea.” J Clin Sleep Med. 2018 Apr 15;14(4):565-573. doi: 10.5664/jcsm.7046.

Kryger MH, et al. Principles and Practice of Sleep Medicine. ExpertConsult, 6th edition, 2017.

What Are the Symptoms of Sleep Deprivation?

Sleep is a vital biological function that supports every system in the human body. From restoring physical health to maintaining mental balance, adequate sleep is crucial for overall well-being. Yet, in today's fast-paced society, many people sacrifice sleep in favor of work, social commitments, or digital distractions. When the body and brain do not get the sleep they need, a condition known as sleep deprivation can occur. The symptoms of sleep deprivation vary in intensity depending on the duration and severity of the sleep loss, but even short-term deprivation can have noticeable effects. This article explores the physical, mental, emotional, and behavioral symptoms of sleep deprivation, and why recognizing them early is key to preventing more serious health consequences.

What Is Sleep Deprivation?

Sleep deprivation refers to a condition that occurs when an individual consistently gets less sleep than their body requires. Most adults need around 7 to 9 hours of sleep per night, though the ideal amount can vary slightly between individuals. Sleep deprivation may be acute (short-term, often lasting a few days) or chronic (long-term and persistent over weeks or months). In both cases, it disrupts the normal functioning of the brain and body.

Cognitive Symptoms

One of the first areas to show the effects of sleep deprivation is cognitive function. Sleep is critical for memory formation, attention, problem-solving, and learning. When someone is deprived of sleep, they may experience:

1. Reduced Attention and Concentration: Sleep-deprived individuals often find it difficult to stay focused on tasks. Their attention span shortens, and they may become easily distracted or forgetful.

2. Slower Reaction Times: A lack of sleep impairs the brain's ability to process and respond to information quickly. This can be particularly dangerous in situations requiring quick thinking, such as driving or operating machinery.

3. Impaired Judgment and Decision-Making: Sleep-deprived people are more likely to make poor decisions or take risks they normally wouldn't, due to a reduction in prefrontal cortex activity — the brain region responsible for rational thinking.

4. Memory Problems: Both short-term and long-term memory can suffer. Sleep helps consolidate memories, and without it, new information may not be effectively retained.

5. Difficulty Learning: Sleep deprivation can interfere with the brain’s ability to absorb and retain information, making learning new skills or knowledge more difficult.

Emotional and Psychological Symptoms

Sleep plays a vital role in emotional regulation and mental stability. When a person is sleep-deprived, their ability to manage stress and respond to emotional challenges is weakened. Common emotional symptoms include:

1. Irritability and Mood Swings: Small annoyances may feel more frustrating or upsetting when someone is sleep-deprived. Mood instability becomes more common.

2. Increased Anxiety and Stress: Lack of sleep can heighten anxiety levels and make everyday stressors feel overwhelming.

3. Depressive Symptoms: Chronic sleep deprivation is closely linked to depression. People may feel hopeless, lack motivation, or have a persistently low mood.

4. Emotional Reactivity: Individuals may overreact to situations or exhibit disproportionate emotional responses due to impaired regulation of the amygdala, the brain’s emotion center.

Physical Symptoms

Sleep is also crucial for maintaining bodily functions and promoting physical health. Physical symptoms of sleep deprivation include:

1. Fatigue and Lethargy: The most obvious symptom, fatigue makes it difficult to stay awake or be productive during the day. People often feel sluggish, drowsy, or physically weak.

2. Weakened Immune Function: Lack of sleep impairs the body’s ability to fight off infections. Sleep-deprived individuals are more prone to catching colds or other illnesses.

3. Headaches and Muscle Aches: Sleep loss can contribute to tension headaches and general discomfort in the muscles and joints.

4. Appetite Changes and Weight Gain: Sleep affects hormones like ghrelin and leptin that regulate hunger. Sleep deprivation increases appetite, particularly for high-calorie, sugary foods, contributing to weight gain.

5. Hormonal Imbalances: Sleep deprivation disrupts the release of growth hormone, insulin, cortisol, and other important regulators, impacting metabolism and stress responses.

Behavioral Symptoms

Sleep deprivation can also change how people behave and interact with others. These behavioral symptoms may include:

1. Clumsiness and Poor Coordination: Without adequate rest, motor skills become impaired, increasing the likelihood of accidents and injuries.

2. Reduced Motivation: Sleep-deprived individuals often lack the drive to complete tasks or engage in activities they normally enjoy.

3. Social Withdrawal: Fatigue and irritability may cause people to avoid social situations or become isolated from friends and family.

4. Increased Risk-Taking Behavior: Due to impaired judgment and decision-making, sleep-deprived individuals may engage in impulsive or risky behaviors.

Long-Term Consequences of Chronic Sleep Deprivation

If left unaddressed, chronic sleep deprivation can contribute to a number of serious health problems over time, including:

• Heart Disease: Persistent sleep loss is linked to high blood pressure, heart attacks, and stroke.

• Diabetes: Poor sleep can affect insulin sensitivity, increasing the risk of type 2 diabetes.

• Obesity: Hormonal changes triggered by sleep loss can lead to overeating and weight gain.

• Immune Dysfunction: This may increase the risk of infection or difficulty returning the body to normal health.

• Cognitive Decline: Chronic deprivation increases the risk of dementia and Alzheimer’s disease.

• Mental Health Disorders: Long-term sleep deprivation can exacerbate or even trigger anxiety disorders, depression, and bipolar disorder.

Recognizing the Warning Signs

Because the symptoms of sleep deprivation can mimic or overlap with those of other conditions, it’s important to monitor sleep habits closely and recognize the early warning signs:

• Falling asleep during daytime activities (such as while reading or watching TV)

• Needing multiple cups of coffee or other caffeine to stay alert

• Struggling to stay awake during meetings, lectures, or driving

• Waking up feeling unrefreshed despite a full night in bed

Conclusion

Sleep deprivation is more than just feeling tired — it’s a serious condition that affects virtually every aspect of life, from physical health to mental clarity and emotional resilience. Recognizing the symptoms early can help individuals take the necessary steps to improve sleep quality and prevent long-term damage. Most adults need 7 to 9 hours of quality sleep to avoid the effects of sleep deprivation, and treatment of underlying sleep disorders like sleep apnea may be important. Whether it’s adjusting lifestyle habits, improving sleep hygiene, or seeking medical support, prioritizing sleep is an investment in health, safety, and well-being.

This article was created using OpenAI’s ChatGPT on May 16, 2025 and it was personally reviewed and edited by Brandon Peters, M.D. to ensure its accuracy. This use of augmented intelligence in this way allows the creation of health information that can be trusted.

Zepbound: Injection for Sleep Apnea Treatment

By Brandon Peters, M.D.

Zepbound (tirzepatide) is a prescription drug used to treat obesity, diabetes, and obstructive sleep apnea. As it induces weight loss, this may improve crowding of the upper airway that may contribute to snoring and sleep apnea. Research suggests that it may be an effective tool in long-term management. Zepbound may have side effects, however, and careful consideration of the risks and benefits may inform its use.

Use of Zepbound

Zepbound is available via prescription only. One of the glucagon-like peptide-1 (GLP-1) receptor agonist medications, Zepbound is self-administered via a weekly injection. The 2.5 mg dose is started once weekly for 4 weeks. If tolerated, it may be increased by 2.5 mg monthly to a maximum dose of 15 mg via weekly injection. Due to the gradual increase, it will take 5 months to reach the maximum dose.

It may reduce excess body weight in adults who are overweight or obese (the latter defined as a body mass index, or BMI, above 30 kg/m2). It is also approved to treat moderate-to-severe obstructive sleep apnea (OSA)—with an apnea-hypopnea index (AHI) >15 events per hour—in adults with obesity. It is meant to be used in combination with a reduced-calorie diet and increased physical activity.

It is the first medication to be approved for the treatment of sleep apnea. The use of Zepbound to treat sleep apnea was approved by the U.S. Food and Drug Administration (FDA) on December 20, 2024. This approval was based on the results of the SURMOUNT-OSA trial, reported in the New England Journal of Medicine in June 2024. This pivotal trial showed that people on Zepbound for 1 year reduced, on average, their weight by 20% and their sleep apnea severity by 50.7%. This means that a lot of study subjects with moderate to severe sleep apnea were able to normalize their breathing, although sleep apnea persisted to a lesser degree in many.

How It Works

More research is needed to fully understand how these medications work. Generally, Zepbound selectively binds to and activates glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptors. This may help to reduce appetite and caloric intake. As weight loss occurs, fat tissue that is deposited at the base of the tongue and along the upper airway may be reduced and this will gradually increase airflow. It may also reduce pressure on the lungs, increasing lung capacity and allowing more air movement. These changes may resolve snoring and sleep apnea.

Pros

• It may address excessive weight, the most reversible and frequent root cause of sleep apnea in certain people.

• It may reduce the severity of sleep apnea, allowing for other treatment options (i.e., oral appliance, Inspire placement) or the cessation of treatment if the condition resolves.

• It may benefit weight-related medical conditions, including diabetes, hyperlipidemia, hypertension, fatty liver disease, and cardiovascular (i.e., heart attack, heart failure, heart arrhythmia) and cerebrovascular (i.e., stroke, dementia) disease.

Cons

• Weight loss is gradual and benefit may not be derived for months or years into treatment.

• It may reduce sleep apnea severity, but the condition may persist.

• It may not resolve sleep apnea in people who have other anatomy or risk factors contributing to the condition.

• It must be used long-term (lifelong) to maintain the reduced weight. If stopped, the excessive weight may come back.

• It may be expensive and not covered by insurance.

• It may be inaccessible due to demand and production/inventory issues.

Who Should Not Use Zepbound

Zepbound should not be used in people with a personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). The signs of thyroid tumors include a mass in the neck, difficulty swallowing or breathing, and persistent hoarseness.

Anyone with a prior hypersensitivity reaction, such as anaphylaxis or angioedema, to the medication should also abstain from use.

Due to the delay of gastric emptying, Zepbound may reduce the efficacy of oral hormonal contraceptives for 4 weeks after initiating, or changing the dose of the medication, and barrier contraceptive (i.e., condom) use is recommended during this interval. Weight loss is not recommended during pregnancy. There are no data on its use during breastfeeding.

The medication should not be taken with other tirzepatide-containing products or with any glucagon-like peptide-1 (GLP-1) receptor agonists.

Side Effects

Common

The most common side effects relate to gastrointestinal complaints, and the adverse reactions (listed from most to least common) may include:

• Nausea

• Diarrhea

• Vomiting

• Constipation

• Stomach pain

• Upset stomach

• Injection-site reactions

• Fatigue

• Hypersensitivity

• Belching

• Hair loss

• GERD

• Flatulence (farting)

• Bloating

• Dizziness

• Hypotension (low blood pressure)

Severe

At the highest dose (15 mg), 3.1% of people report severe gastrointestinal issues. Vomiting may contribute to dehydration and volume depletion, potentially triggering acute kidney injury or failure. Gallstones (cholelithiasis or cholecystitis) affected 1.1% of people, compared to 1% of controls. Acute pancreatitis, which may be fatal, has rarely been observed with GLP-1 treatment.

Hypersensitivity to the medication, including anaphylaxis, has been noted in 0.1% of users.

As Zepbound lowers blood glucose levels, this can lead to hypoglycemia, especially when used with other medications to treat diabetes. It may also worsen diabetic retinopathy and caution is advised in this condition.

As it delays gastric emptying, there may be an increased risk of pulmonary aspiration in the context of surgery.

Suicidal thoughts or behaviors have been reported with other weight management products and monitoring for mood changes may be indicated.

When to Check With Your Healthcare Provider

If you are experiencing side effects, especially with the initiation of the medication or an increase in its dose, check in with the prescribing provider. It may be necessary to lower the dose or discontinue the use of Zepbound. Any medication changes should be made in consultation with your medical professional.

Summary

Zepbound may be an effective long-term treatment for moderate to severe obstructive sleep apnea in people with obesity. The side effects are generally tolerable, and the gradual loss of weight may provide other health benefits. Due to the slow effects, people should initiate treatment with continuous positive airway pressure (CPAP) therapy for immediate relief of the condition. The CPAP pressure settings may be gradually reduced and a repeat sleep study may be indicated once weight loss plateaus to evaluate whether the condition has resolved. Insurance coverage may vary, and cost and access issues are common barriers to treatment. If stopped, gradual weight gain is likely to occur. Those who use Zepbound in combination with a reduced-calorie diet, increased physical activity, and ongoing CPAP therapy will derive the greatest benefit from its use.

Can Hypothyroidism Cause Obstructive Sleep Apnea?

Obstructive sleep apnea (OSA) is a common sleep disorder characterized by repeated interruptions in breathing during sleep due to the relaxation of the throat muscles. This condition can lead to various health complications if left untreated, including cardiovascular problems, daytime fatigue, and cognitive impairments. While obesity is a well-known risk factor for OSA, other underlying health issues may also contribute to its development. One such condition is hypothyroidism, a disorder in which the thyroid gland does not produce enough thyroid hormones. This article explores the relationship between hypothyroidism and obstructive sleep apnea, including potential mechanisms and implications for treatment.

Understanding Hypothyroidism

Hypothyroidism occurs when the thyroid gland, located in the front of the neck, does not produce sufficient amounts of thyroid hormones, primarily thyroxine (T4) and triiodothyronine (T3). These hormones play a crucial role in regulating metabolism, energy production, and various bodily functions. Common causes of hypothyroidism include:

Autoimmune Disorders: Hashimoto's thyroiditis is the most common cause of hypothyroidism, where the immune system attacks the thyroid gland.

Thyroid Surgery: Surgical removal of the thyroid can lead to reduced hormone production.

Radiation Therapy: Treatment for thyroid cancer or other head and neck cancers can damage the thyroid gland.

Iodine Deficiency: Iodine is essential for thyroid hormone production, and a deficiency can lead to hypothyroidism.

Symptoms of hypothyroidism can include fatigue, weight gain, cold intolerance, constipation, dry skin, and depression. However, the relationship between hypothyroidism and obstructive sleep apnea is less well understood. If hypothyroidism is severe, stupor and coma may occur.

The Connection Between Hypothyroidism and Obstructive Sleep Apnea

Research suggests that there is a significant association between hypothyroidism and obstructive sleep apnea. Several studies have indicated that individuals with hypothyroidism are at an increased risk of developing OSA. Here are some potential mechanisms that may explain this relationship:

1. Thyroid Hormones and Muscle Tone: Thyroid hormones play a crucial role in maintaining muscle tone and metabolism throughout the body, including the muscles of the upper airway. Hypothyroidism can lead to muscle weakness and reduced muscle tone, making it more likely for the airway to collapse during sleep. This collapse can result in obstructive apneas, where breathing is interrupted due to obstruction in the upper airway as the tongue blocks the throat.

2. Obesity and Metabolism: Hypothyroidism often leads to weight gain due to a slowed metabolism. Increased weight, particularly when fat tissue is deposited at the base of the tongue, can contribute to airway obstruction during sleep. Fat deposits in the neck can also lead to increased pressure on the airway, exacerbating sleep apnea symptoms. The relationship between obesity and OSA is well established, and since hypothyroidism can lead to weight gain, it serves as an indirect contributor to the development of sleep apnea.

3. Fluid Retention and Edema: Hypothyroidism can cause fluid retention, leading to swelling in various parts of the body, including the throat. This swelling can further narrow the upper airway, increasing the likelihood of obstruction during sleep. Edema in the airway tissues can contribute to increased resistance to airflow, making it more challenging to breathe properly during sleep.

4. Decreased Respiratory Drive: The thyroid hormones also play a role in the regulation of the respiratory drive. In hypothyroid patients, decreased levels of thyroid hormones can lead to a reduced response to changes in oxygen and carbon dioxide levels in the blood. This can impair the body’s ability to initiate breathing during apneic episodes, exacerbating the severity of OSA.

5. Neurological Factors: There is evidence to suggest that hypothyroidism can affect the central nervous system, potentially leading to changes in the regulation of breathing patterns during sleep. This dysregulation may contribute to the development or exacerbation of sleep apnea.

Symptoms Overlap

The symptoms of hypothyroidism and obstructive sleep apnea can overlap, making diagnosis challenging. Both conditions can cause excessive daytime sleepiness, fatigue, and cognitive impairments. Individuals with hypothyroidism may already experience fatigue due to hormonal imbalances, which can mask or mimic symptoms of OSA. As a result, it is crucial for healthcare providers to consider the possibility of sleep apnea when evaluating patients with hypothyroidism.

Diagnosis and Treatment Considerations

If you suspect that you have both hypothyroidism and obstructive sleep apnea, it is essential to consult with a healthcare provider. Diagnosis may involve a combination of clinical evaluations, sleep studies (home sleep apnea testing or in-center polysomnography), and thyroid function tests to measure levels of thyroid hormones (T3 and T4) and thyroid-stimulating hormone (TSH).

1. Managing Hypothyroidism: Treatment of hypothyroidism typically involves hormone replacement therapy with levothyroxine, a synthetic form of thyroid hormone. Effective management of hypothyroidism can lead to improved muscle tone and metabolism, which may, in turn, reduce the severity of obstructive sleep apnea.

2. Addressing Obstructive Sleep Apnea: For individuals diagnosed with both conditions, treating sleep apnea is crucial. Treatment options for OSA may include:

-Continuous positive airway pressure (CPAP): This therapy involves wearing a mask connected to a machine that delivers a continuous flow of air, keeping the airway open during sleep.

-Oral appliances: Dental devices can help reposition the jaw and tongue to keep the airway open.

-Lifestyle changes: Weight loss, positional therapy (sleeping on one's side), and avoiding alcohol or sedatives before bedtime can help alleviate symptoms of OSA.

3. Regular Monitoring: Individuals with hypothyroidism and OSA should have regular follow-up appointments to monitor their conditions. Adjustments in thyroid hormone therapy and continuous assessment of sleep apnea treatment efficacy are essential for optimal health outcomes.

Conclusion

Hypothyroidism and obstructive sleep apnea are interconnected conditions that can significantly impact an individual's quality of life. The presence of hypothyroidism may increase the risk of developing OSA through mechanisms such as reduced muscle tone, weight gain, fluid retention, and altered respiratory drive. Given the overlap in symptoms, it is essential for healthcare providers to consider the possibility of sleep apnea in patients with hypothyroidism.

Effective management of both conditions can lead to improved overall health and quality of life. If you suspect you have symptoms of either condition, consult with a healthcare provider for comprehensive evaluation and appropriate treatment options. By addressing hypothyroidism and sleep apnea together, individuals can achieve better sleep quality and overall health.

This article was created using OpenAI’s ChatGPT on August 2, 2024 and it was personally reviewed and edited by Brandon Peters, M.D. to ensure its accuracy. This use of augmented intelligence in this way allows the creation of health information that can be trusted.