Sweet, Slender Dreams
A lack of shuteye can lead to daytime sleepiness—and hinder weight loss.
by Lisa James
Tracy Nasca was a mere slip of a girl when she was young. “I got married when I was 19; at that time I was 118 pounds,” she says. Sixteen years later, Nasca weighed 297 pounds—and was tired all the time. “I was so sleepy it was a chore to walk to the end of my driveway so I could get the mail,” she recalls.
It was at that time Nasca learned she has sleep apnea, characterized by stoppages in nighttime breathing often related to abnormalities such as having a large tongue. Nasca also went on and off a number of diets, none of which resulted in permanent weight loss.
Suffering from uncontrolled diabetes, she eventually underwent gastric bypass surgery and dropped more than 120 pounds.
“But my tongue didn’t lose weight,” quips Nasca, now 58 and living in the Minneapolis suburb of Chaska, Minnesota. Her apnea still requires the use of a bi-level machine, a more powerful version of the familiar CPAP (continuous positive airway pressure) device, to keep her airway open at night. She believes the improvement in her sleep has played a role in her ability to avoid weight regain.
The Sleep-Weight Connection
Nasca isn’t the only person who has found a link between how she sleeps and what she weighs. Just as obesity has become an American epidemic, affecting about a third of the US population, so too has sleeplessness. According to the Centers for Disease Control, as many as 70 million adults suffer from chronic sleep difficulties.
The idea that sleep is optional is one reason for sleeplessness. “People are busier now with work and family commitments, and they tend to sacrifice sleep for their other activities,” says Clete Kushida, MD, PhD, of Stanford Sleep Medicine Center (http://sleep.stanford.edu) in Redwood City, California. Hormonal fluctuations are another. While apnea is more common among men, women have more sleep problems in general; menstrual cycles, pregnancy and menopause can all affect sleep.
Sleep apnea is only one of nearly 100 sleep disorders. The most common is insomnia, which Kushida says “is defined as an inability to initiate or maintain sleep, and feeling sleepy or fatigued during the daytime.”
Not all cases of sleeplessness fit the criteria of any one recognized sleep disorder. “Disordered sleep” is the term clinical psychologist Michael Breus, PhD, uses to describe such cases. “For the vast majority of people, disordered sleep is a major problem. Sometimes disordered sleep leads to a sleep disorder,” says Breus, author of The Sleep Doctor’s Diet Plan: Lose Weight Through Better Sleep (Rodale; www.thesleepdoctor.com).
Poor sleep, from any cause, results in sleep deprivation, “which means the number of minutes spent asleep is decreasing and sleep quality is decreasing. Both will lead to increases in weight,” says Breus. In one study, better sleep quality increased the chances that participants would lose weight by 33% (Obesity 3/8/12 online).
The link between sleeping and eating is believed to lie in the appetite-control hormones leptin and ghrelin. Researchers have found that the part of the brain linked to appetite responds more strongly to food images after a night of reduced sleep (The Journal of Clinical Endocrinology and Metabolism 3/12). Stress, known to both promote weight gain and disrupt sleep, is another key factor.
Nasca, founder and senior vice president of Talk About Sleep (www.talkaboutsleep.com), which hosts a message board for people who struggle with sleeplessness, understands the research on a personal level. “When someone is sleep-deprived, the body craves energy any way it can get it, things like caffeine, nicotine and sugar,” she says. “Also, you don’t have the energy to function normally—you’ll take the elevator instead of walking up a flight of steps. So you’re not burning calories.”
Sleep physicians find that patients often aren’t aware of the sleep-weight connection until it’s pointed out to them. “Very, very few people have been able to make the link. They’re usually pretty shocked,” says Breus.
The first step in fighting chronic sleep deprivation is to consult with a trained practitioner. To locate a sleep center near you, visit www.sleepcenters.org.
Some common responses to a restless night in bed can actually make things worse. “A lot of people will just watch TV or sit at the computer, which is the worst thing you can do because it stimulates the brain,” says Nasca. A glass of wine is out, too. “Alcohol might induce sleep but you’ll have frequent night-time awakenings,” Nasca explains, so avoid alcohol for about four to six hours before bedtime. The same time frame holds for nicotine but cut out the caffeine after 1 p.m., especially if you have trouble falling asleep.
Other habits are more helpful. Kushida suggests going to bed at the same time consistently. You can determine your optimal bedtime by noting how much sleep you need to feel alert in the morning, then counting back: If you need eight hours and want to wake at 6:30, count back to 10:30.
Kushida recommends 30 minutes of exposure to bright light within five minutes of arising; if you’re stuck in a low-light situation, get the kind of lightbox used by people with seasonal affective disorder. “For type A people, we recommend a worry diary—write down everything you worry about and mentally address those concerns a few hours before bedtime,” he adds.
Nasca, who also experiences bouts of insomnia, is especially careful about following a sleep routine when the disorder is active. “I might take a hot bath or shower within minutes of getting into bed,” she says. “During the first stage of sleep body temperature normally lowers, so if you raise your body temperature just before bedtime it’s going to naturally start cooling down, which helps initiate sleep. And I don’t exercise before I sleep.”
Exercise earlier in the day, up to four hours before bedtime, can help. “Many of my patients report that they sleep better with regular exercise and that they feel more alert the following day,” says Breus. Many people have found yoga to be particularly helpful; in one study this practice was able to ease insomnia in post-menopausal women (Menopause 2/12).
In addition to fostering weight loss, proper diet can also make getting to sleep easier. Certain foods contain compounds that “will interact with your body’s natural chemistry to help either start the process of sleep and/or help maintain it,” says Breus. Among the calming foods he recommends are almonds, cheddar and Swiss cheeses, whole grains, turkey and pumpkin seeds. A bedtime snack combining protein and carbohydrate, such as nut butter or cheese on a piece of whole wheat bread, can encourage sleepiness.
Certain nutrients promote healthy sleep. These include the vitamin B-complex (Breus says these vitamins may stimulate some people, who should take them earlier in the day), vitamin D, calcium and magnesium. The herbs chamomile and valerian have long been used for their soothing properties. (Some herbs, particularly lavender, encourage sleep when used as aromatherapy.) And three supplements used in tandem—the hormone melatonin, the milk-based protein lactium and the amino acid 5-HTP—provide support for getting to sleep and staying asleep through the night.
There are times when it seems that you’ll never find a good night’s sleep—or lose weight—again. But getting a correct diagnosis and following a sleep-friendly lifestyle can work wonders. Nasca knows. “It took me a couple of years,” she says. “But now I have learned how to break the cycle.”
Insomnia rates tend to be higher among women, but those figures may be deceptive. “Women tend to speak with their physicians more,” says Michael Breus, PhD. “Men have a tendency to be macho, to not want to complain. They will say, ‘I can get by on five hours of sleep and be right as rain,’ but nobody can.”
Researchers do know that men suffer more from sleep apnea, a condition in which the upper airway narrows during sleep and disrupts breathing. Clete Kushida, MD, says 24% of men have this disorder compared with 9% of women (although a woman’s chances of developing apnea increase after menopause). And according to one estimate, 90% of Americans who have sleep apnea are undiagnosed, spending their days in a foggy fatigue without knowing why.
Numerous studies have found that poor sleep decreases men’s testosterone levels. And at least one investigation, published in the journal Sleep, has found a link between chronic sleeplessness in men and an increased risk of dying.
Sleep apnea is often (although not always) linked to excess weight, so shedding pounds may help offset the problem. Sometimes using a bed wedge to raise the level of the head can make breathing easier. Many apnea sufferers are helped by CPAP, which sends air into the nostrils to keep the upper airway open; others use oral appliances to hold the jaw in the proper position.
Chronic sinus inflammation, known as sinusitis, has also been linked to sleep apnea. “Many people who have chronic sinusitis don’t know it,” says Robert Ivker, DO, author of Sinus Survival (Tarcher/Putnam). Sinus troubles can start after a cold or allergic reaction causes swelling of the upper airway, decreasing sinus drainage and increasing the chances of sinus infection. Using an air filter can help keep inflammation-provoking substances out of the airways, and a saline nasal spray can foster proper mucus drainage. In addition to a produce-laden diet, Ivker recommends taking echinacea, garlic and grapefruit seed extract internally, and using eucalyptus and peppermint oils as sinus-friendly aromatherapy agents.