Ask the Sleep Doctor – Topics: Weight Loss, Antidepressants, and Oral Appliances

Sleep doctor ready to answer questions

Dear Dr. Rosenberg,

Does sleep matter when it comes to weight loss?


Yes, sleep matters. When we do not get enough sleep, we tend to produce excessive amounts of Ghrelin, an appetite-stimulating hormone, and insufficient amounts of Leptin, an appetite-suppressing hormone. In addition, those who do not get enough sleep tend to be fatigued and less active. In fact, their couch potato life style may in part be due to insufficient sleep. There is also more time and opportunity to eat.

Dear Dr. Rosenberg,

Does the amount of sleep you get have anything to do with the effectiveness of antidepressants? My wife was put on fluoxetine (Prozac) three months ago. She sleeps only about five hours a night and seems to be as depressed as ever. I tell her to discuss the lack of sleep with her psychiatrist, but she thinks it doesn’t matter. What do you think?


I think you are a smart man. A recent study done at University of Michigan demonstrated that the amount of sleep the subjects slept did affect their response to antidepressants. In this study, those who slept eight hours responded much better to antidepressants after six weeks than those who slept only six hours. I would encourage your wife to discuss her poor sleep with her psychiatrist.

Dear Dr. Rosenberg,

I had an oral appliance made for my sleep apnea. I could not tolerate a CPAP. I was supposed to be retested to see how effective it was and then we moved. I am wondering what would be considered effective treatment. On my original sleep test, I was told that I stopped breathing 50 times an hour.


That is a great question, yet difficult to answer. The gold standard for oral appliances is at least a 50% reduction in events to less than 10. However, in patients with sleep apnea as severe as yours who cannot tolerate CPAP, I would be happy to see it under 15.

Dear Dr. Rosenberg,

My husband was in a motor vehicle accident last year. He had rather severe whiplash. Since then he has a hard time staying awake. We are retirees but his dozing off has been quite noticeable. He also snores. Could there be any relationship between the accident and his symptoms?


Yes, that is quite likely. In fact, in 2000, sleep researchers discovered that sleep apnea was very common after neck trauma, especially whiplash injuries. I would advise you to discuss this with your health care provider.


Dr. Robert Rosenberg, D.O., FCCP, DABSM

Robert S. Rosenberg, DO, FCCP, is the medical director of the Sleep Disorders Center of Prescott Valley, Arizona and sleep medicine consultant for Mountain Heart Health Services in Flagstaff, Arizona. Dr. Rosenberg is board certified in sleep medicine, pulmonary medicine, and internal medicine. He is a contributing sleep expert blogger and his advice has appeared in Women’s Health, Prevention, Ladies’ Home Journal, Parenting, and O Magazine, among others. Dr Rosenberg is a weekly newspaper columnist addressing sleep Q&As. Dr. Rosenberg appears on TV and radio and lectures throughout the country on Sleep Medicine. His book Sleep Soundly Every Night, Feel Fantastic Every Day  is a best seller. Dr Rosenberg’s latest book is The Doctor’s Guide to Sleep Solutions for Stress & Anxiety. Visit Dr Rosenberg’s website which is a wealth of information on sleep topics.


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2 thoughts on “Ask the Sleep Doctor – Topics: Weight Loss, Antidepressants, and Oral Appliances

  1. Holly Davis Reply

    I am now using my second Tap oral appliance for my OSA. A sleep study showed it to be therapeutically more effective for me (>5 AHI) than AutoPap ever was. That is wonderful but the problem comes about 10 – 12 months into therapy with each device. It seems that the tiny screw that holds the hook mechanism in the proper position becomes stripped. This causes the mechanism to slide backwards and requires significant tightening each night before sleep. By morning, it has moved forward again and my husband says I am now snoring in the early morning hours, I replaced my first Tap device because this was happening and now the second device is performing exactly as the first. Is this a reported problem? My device is quite comfortable tightened to the correct setting so I don’t think I’m putting undue stress on it. Any suggestions as to how I should proceed?

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