Tag Archives: weight loss

C-Pap and Apnea

A month of so ago, I went to see a sleep doctor for my snoring. I got a take-home breathing test that gave me the worst night’s sleep in recent memory. A few days later, I got a somber diagnosis: “You are a walking zombie.” Apparently, I hold my breath for ten seconds or more every minute and a half while sleeping. Normal is supposed to be every 4 to 10 minutes. But by this standard, more than half of all middle-aged men are sub-normal (how is this possible?). As a result of my breath-holding, the wrinkled, unsmiling DO claimed I’m brain-dead now and will soon be physically dead unless I change my ways. Without spending 3 minutes with me, the sleep expert told me that I need to lose weight, and that I need a C-Pap (continuous positive airway pressure) device as soon as possible. It’s supposed to help me lose that weight and get back the energy. With that he was gone. The office staff gave me the rest of the dope: I was prescribed  a “ResMed” brand C-Pap, supplied by a distributor right across the hall from the doctor (how convenient).

I picked up the C-Pap three months later. Though I was diagnosed as needing one “as soon as possible,” no one would release the device until they were sure it was covered by my insurance company. The device when I got it, was something of a horror. The first version I tried fit over the whole face and forces air into my mouth and nose simultaneously, supposedly making it easier to inhale, but harder to exhale. I found it more than a bit uncomfortable. The next version was nose only and marginally more comfortable. I found there was a major air-flow restriction when I breath in and a similar pressure penalty when I breathed out. And it’s loud. And, if you open your mouth, there is a wind blowing through. As for what happens if the pump fails or the poor goes out, I notice that there are the tiniest of air-holes to prevent me from suffocating, barely. A far better design would have given me a 0-psi flapper valve for breathing in, and a 1/10 psi flapper for breathing out. That would also reduce the pressure restriction I was feeling every time I took a deep breath. One of my first blog essays was about engineering design aesthetics; you want your designs to improve things under normal conditions and fail safe, not like here. Using this device while awake was anything but pleasant, and I found I still hold my breath, even while awake, about every 5 minutes.

Since I have a lab, and the ability to test these things, I checked the pressure of the delivered air, and found it was 3 cm of water, about 1/20 psi. The prescription was for 5 cm or water (1/14 psi). The machine registers this, but it is wrong. I used a very simple water manometer, a column of water, similar to the one I used to check the pressure drop in furnace air filters. Is 1/20 psi enough?How did he decide on 1/14 psi by the way? I’ve no idea. !/14 psi is about 1/200 atm. Is this enough to do anything? While the C-Pap should get me to breathe more, I guess, about half of all users stop after a few tries, and my guess is that they find it as uncomfortable as I have. There is no research evidence that treatment with it reduces stroke or heart attack, or extends life, or helps with weight loss. The assumption is that, if you force middle-aged men to hold their breath less, they will be healthier, but I’ve no clear logic or evidence to back the assumption. At best, anything you gain on the ease of breathing in, you lose on the difficulty of breathing out. The majority of middle-aged men are prescribed a C-Pap, if they go for a sleep study, and it’s virtually 100% for overweight men with an apple-shaped body.

I’d have asked my doctor about alternatives or for a second opinion but he was out the door too fast. Besides, I was afraid I’d get the same answer that Rodney Dangerfield got: “You want a second opinion? OK. You’re ugly, too.” Mr. Dangerfield was not a skinny comic, by the way, but he was funny, and I assume he’d have been prescribed a C-Pap (maybe he was). He died at 82, considerably older than Jim Fixx, “the running doctor,” Adelle Davis, the “eat right for health” doctor, Euell Gibbons “in search of the wild asparagus,” or Ethan Pritkin, the diet doctor. God seems to prefer fat comedians to diet experts; I expect that most-everyone does.

Benjamin Franklin and his apple-shaped body

Benjamin Franklin and his apple-shaped body; I don’t think of him as a zombie.

What really got my goat, besides my dislike of the C-Pap, is that I object to being called a walking zombie. True, I’m not as energetic as I used to be, but I manage to run a company, and to write research papers, and I get patents (this one was approved just today). And I write these blogs — I trust that any of you who’ve read this far find them amusing. Pretty good for a zombie — and I ran for water commissioner. People who use the C-Pap self-report that they have more energy, but self-reporting is poor evidence. A significant fraction of those people who start with the C-Pap, stop, and those people, presumably were not happy. Besides, a review of the internet suggests that a similarly large fraction of those who buy a “MyPillow.com” claim they have more energy. And I’ve seen the same claims from people who take a daily run, or who pray, or smoke medical marijuana (available for sleep apnea, but not from this fellow), or Mirtazapine (study results here), or  for electro-shock therapy, a device called “Inspire.” With so many different products providing the same self-reported results, I wonder if there isn’t something more fundamental going on. I’d wish the doc had spent a minute or two to speak to this, or to the alternatives.

As for weight loss, statistical analysis of lifespan suggests that there is a health advantage to being medium weight: not obese, but not skinny. I present some of this evidence here, along with evidence that extra weight helps ward off Alzheimer’s. For all I know this protection is caused by holding your breath every few minutes. It helps to do light exercise, but not necessary for mental health. In terms of mental health, the evidence suggests that weight loss is worse than nothing.

Jared Gray, author of the Alien movies, was diagnosed with apnea, so he designed his own sleep-mask.

Jared Gray, author of the Alien movies, was diagnosed with apnea, so he designed his own sleep-mask.

Benjamin Franklin was over-weight and apple-shaped, and no zombie, The same is true of John Adams, Otto Von Bismarck, and Alfred Hitchcock. All lived long, productive lives. Hitchcock was sort of morbid, it will be admitted, but I would not want him otherwise. Ed McMahon, Johnny Carson’s side-kick, apologized to America for being overweight and smoking, bu the outlived Johnny Carson by nine years, dying at 89. Henry Kissinger is still alive and writing at 95. He was always fatter than any of the people he served. He almost certainly had sleep apnea, back in the day, and still has more on the ball, in my opinion, than most of the talking-head on TV. The claim that overweight, middle-aged men are all zombies without a breath assisting machine doesn’t make no sense to me. But then, I’m not a sleep doctor. (Do sleep doctors get commissions? Why did he choose, this supplier or this brand device? With so little care about patients, I wonder who runs the doctor’s office.)

I looked up my doctor on this list provided by the American Board of Sleep Medicine. I found my doctor was not certified in sleep medicine. I suppose certified doctors would prescribe something similar  but was disappointed that you don’t need sleep certification to operate as a sleep specialist. In terms of masks, I figure, if you’ve got to wear something, you might as well wear something cool. Author Jared Gray, shown above (not the author of the Alien) was diagnosed with Apnea 6 months ago and made his own C-Pap mask to make it look like the alien was attacking him. Very cool for an ex-zombie, but I’m waiting to see a burst of creative energy.

What do we zombies want? Brains.

When do we want them? Brains.

What do vegetarian zombies want? Grains.

Robert Buxbaum, March 15, 2019. In case real zombies should attack, here’s what to do.  An odd legal/insurance issue: in order to get the device, I had to sign that, if I didn’t use it for 20 days in the first month of 4 hours per night, and thus if the insurance did not pay, I would be stuck with the full fee. I signed. This might cost me $1000 though normally in US law, companies can only charge a reasonable restock fee, but it can’t be unreasonable, like the full  price. I also had to sign that I would go back to the same, quick-take doctor, but again there has to be limits. We’ll see how the machine pans out, but one difference I see already: unlike my pillow.com, there is no money back guarantee with the C-Pap treatment.

Fat people live longer, show less dementia

Life expectancy is hardly affected by weight in the normal - overweight- obese range. BMI 30-34.9 = obese.

Life expectancy is hardly affected by weight in the normal – overweight – obese range. BMI 30-34.9 = obese.

Lets imagine you are a 5’10” man and you weigh 140 lbs. In that case, you have a BMI of 20, and you probably think you’re pretty healthy, or perhaps you think you’re a bit overweight. Our institutes of health will say that you are an “average-wight” or “normal-weight” American, and then claim that the average-weight American is overweight. What they don’t tell you, is that low weight, and so-called average weight people in the US live shorter lives. Other things being equal, the morbidity (chance of death) for a thin American, BMI 18.5 is nearly triple that of someone who’s obese, BMI 32. The morbidity of the normal-weight American is better, but is still nearly double that of the obese fellow whose BMI is 32.

Our NIH has created a crisis of overweight Americans, that is not based on health. They work hard to solve this obesity crisis by telling people to jog to work, and by creating ever-more complicated food pyramids. Those who listen live shorter lives. A prime example is Jim Fixx, author of several running books including “The complete Book of Running.” He was 52 when he died of a heart attack while running. Similar to this is the diet-expert, Adelle Davis, author of “Let’s eat right to keep fit”. She died at 70 of cancer — somewhat younger than the average American woman. She attributed her cancer to having eaten junk food as a youth. I would attribute it to being thin. Not only do thin people live shorter lives, but their chances of recovering from cancer, or living with it, seem to improve if you start with some fat.

The same patter exists where age-related dementia is concerned. If you divide the population into quartiles of weight, the heaviest has the least likelihood of dementia, the second heaviest has the second-least, the third has the third-least, and the lightest Americans have the highest likelihood of dementia. Here are two studies to that effect, “Association between late-life body mass index and dementia”, The Kame Project, Neurology. 2009 May 19; 72(20): 1741–1746. And “BMI and risk of dementia in two million people over two decades: a retrospective cohort study” The Lancet, Volume 3, No. 6, p431–436, June 2015.

Morbidity and weight, uncorrected data, and corrected by removing the demented.

Morbidity and weight, uncorrected data, and corrected by removing the demented. The likelihood of dementia decreases with weight.

Now you may think that there is a confounding, cause and effect here: that crazy old people don’t live as long. You’d be right there, crazy people don’t live as long. Still, if you correct the BMI-mortality data to remove those with dementia, you still find that in terms of life-span, for men and women, it pays to be overweight or obese but not morbidly so. The study concludes as follows: “Weight loss was related to a higher mortality risk (HR = 1.5; 95% CI: 1.2,1.9) but this association was attenuated when persons with short follow-up or persons with dementia were excluded.” As advice to those who are planning a weight loss program, you might go crazy and reduce your life-span a lot, but if you don’t go crazy, you’re only reducing your life-span a little.

In terms of health food, I’ve noticed that many non-health foods, like alcohol and chocolate are associated with longevity and mental health. And while low-impact exercise helps increase life-span, that exercise is only minimally associated with weight loss. Mostly weight loss involves changing the amount you eat and changing your clothes choices to maximize radiant heat loss.

Dr. Robert E. Buxbaum, October 26, 2017. A joke: Last week I was mugged by a vegan. You may ask how I know it was a vegan. He told be before running off with my wallet.

Most Heat Loss Is Black-Body Radiation

In a previous post I used statistical mechanics to show how you’d calculate the thermal conductivity of any gas and showed why the insulating power of the best normal insulating materials was usually identical to ambient air. That analysis only considered the motion of molecules and not of photons (black-body radiation) and thus under-predicted heat transfer in most circumstances. Though black body radiation is often ignored in chemical engineering calculations, it is often the major heat transfer mechanism, even at modest temperatures.

One can show from quantum mechanics that the radiative heat transfer between two surfaces of temperature T and To is proportional to the difference of the fourth power of the two temperatures in absolute (Kelvin) scale.

Heat transfer rate = P = A ε σ( T^4 – To^4).

Here, A is the area of the surfaces, σ is the Stefan–Boltzmann constantε is the surface emissivity, a number that is 1 for most non-metals and .3 for stainless steel.  For A measured in m2σ = 5.67×10−8 W m−2 K−4.

Infrared picture of a fellow wearing a black plastic bag on his arm. The bag is nearly transparent to heat radiation, while his eyeglasses are opaque. His hair provides some insulation.

Unlike with conduction, heat transfer does not depend on the distances between the surfaces but only on the temperature and the infra-red (IR) reflectivity. This is different from normal reflectivity as seen in the below infra-red photo of a lightly dressed person standing in a normal room. The fellow has a black plastic bag on his arm, but you can hardly see it here, as it hardly affects heat loss. His clothes, don’t do much either, but his hair and eyeglasses are reasonably effective blocks to radiative heat loss.

As an illustrative example, lets calculate the radiative and conductive heat transfer heat transfer rates of the person in the picture, assuming he has  2 m2 of surface area, an emissivity of 1, and a body and clothes temperature of about 86°F; that is, his skin/clothes temperature is 30°C or 303K in absolute. If this person stands in a room at 71.6°F, 295K, the radiative heat loss is calculated from the equation above: 2 *1* 5.67×10−8 * (8.43×109 -7.57×109) = 97.5 W. This is 23.36 cal/second or 84.1 Cal/hr or 2020 Cal/day; this is nearly the expected basal calorie use of a person this size.

The conductive heat loss is typically much smaller. As discussed previously in my analysis of curtains, the rate is inversely proportional to the heat transfer distance and proportional to the temperature difference. For the fellow in the picture, assuming he’s standing in relatively stagnant air, the heat boundary layer thickness will be about 2 cm (0.02m). Multiplying the thermal conductivity of air, 0.024 W/mK, by the surface area and the temperature difference and dividing by the boundary layer thickness, we find a Wattage of heat loss of 2*.024*(30-22)/.02 = 19.2 W. This is 16.56 Cal/hr, or 397 Cal/day: about 20% of the radiative heat loss, suggesting that some 5/6 of a sedentary person’s heat transfer may be from black body radiation.

We can expect that black-body radiation dominates conduction when looking at heat-shedding losses from hot chemical equipment because this equipment is typically much warmer than a human body. We’ve found, with our hydrogen purifiers for example, that it is critically important to choose a thermal insulation that is opaque or reflective to black body radiation. We use an infra-red opaque ceramic wrapped with aluminum foil to provide more insulation to a hot pipe than many inches of ceramic could. Aluminum has a far lower emissivity than the nonreflective surfaces of ceramic, and gold has an even lower emissivity at most temperatures.

Many popular insulation materials are not black-body opaque, and most hot surfaces are not reflectively coated. Because of this, you can find that the heat loss rate goes up as you add too much insulation. After a point, the extra insulation increases the surface area for radiation while barely reducing the surface temperature; it starts to act like a heat fin. While the space-shuttle tiles are fairly mediocre in terms of conduction, they are excellent in terms of black-body radiation.

There are applications where you want to increase heat transfer without having to resort to direct contact with corrosive chemicals or heat-transfer fluids. Often black body radiation can be used. As an example, heat transfers quite well from a cartridge heater or band heater to a piece of equipment even if they do not fit particularly tightly, especially if the outer surfaces are coated with black oxide. Black body radiation works well with stainless steel and most liquids, but most gases are nearly transparent to black body radiation. For heat transfer to most gases, it’s usually necessary to make use of turbulence or better yet, chaos.

Robert Buxbaum