HEALTH MATTERS 1/28: Sleep and Your Weight

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By Lisa Dobruskin, MD, FACS

Craving cookies, pasta, pizza and other carbs throughout the day?

Chances are you probably aren’t sleeping well at night.

Numerous studies have shown that poor quality sleep can sabotage a healthy diet and increase your risk for becoming overweight or obese.

At the same time, being overweight or obese can lead to poor sleep, creating a cycle that can be hard to break.

If you’re concerned about how your sleep is affecting your weight or vice versa, talk to your doctor. There are steps you can take to improve your sleep and your waistline.

The Cortisol Connection

In simplest terms, poor quality sleep can lead to an increase in cortisol, also known as the stress hormone.

Cortisol activates the fight-or-flight response that keeps you safe from danger and signals to your body that you need a quick source of energy — such as carbohydrates — to escape the threat.

This served cavemen well when faced with threatening predators.

Today, even though you no longer have to worry about being devoured by a hungry prehistoric beast, elevated cortisol levels still leave your body wanting a quick source of energy.

Which is why when your cortisol levels are high because of a poor night’s sleep you’re more likely to gravitate toward refined carbohydrates – the kind found in sugary treats like donuts and cookies as well as those made with white flour like pasta and bread.

Unlike whole carbohydrates, which are found in veggies, whole grains, beans, and other minimally processed foods, refined carbs typically lack nutrients and cause spikes in blood sugar levels.

These spikes can ultimately trigger hunger and lead to cravings for more carbs.

Over time, this pattern can contribute to weight gain and impede attempts at weight loss.

Not to mention, when you’re tired it is generally more difficult to make healthy decisions.

The Impact of Sleep Apnea

There are many reasons you might not sleep well at night — from that cup of coffee you had late in the day to excessive screen time too close to bedtime.

However, one of the most common reasons people do not get quality sleep is obstructive sleep apnea, which affects an estimated 22 million Americans, according to the American Sleep Apnea Association.

Obstructive sleep apnea occurs when the upper airway is repeatedly blocked during sleep, reducing or completely blocking airflow. This is often because the muscles in the throat relax and the tongue and the soft palate collapse against the back of the throat, blocking the airway.

When this happens — for some 100 times an hour or more — it awakens the brain and disrupts the sleep cycle.

Signs and symptoms of sleep apnea include:

• Frequent loud snoring
• Gasping for air during sleep
• Episodes when you stop breathing during sleep
• Excessive daytime sleepiness
• Difficulty paying attention when awake
• Dry mouth upon waking
• Morning headaches
• Irritability

While people who are a healthy weight can experience sleep apnea, people who are overweight or obese are more likely to develop the condition, leading to a cycle of poor sleep and further weight gain.

When to See Your Doctor

If you have trouble sleeping or have signs or symptoms of sleep apnea, consult your physician. In many cases, they will recommend an at-home sleep study to confirm a diagnosis.

There are a range of treatments for sleep apnea, including continuous positive pressure airway (CPAP) machines that prevent the airway from collapsing while you sleep.

If you are overweight or obese, your doctor will also likely encourage you to lose weight through diet and exercise.

However, if diet and exercise are not enough, you might be a candidate for bariatric surgery. In fact, studies show that in the vast majority of cases, sleep apnea improves significantly or even completely resolves after bariatric surgery.

At the Center for Bariatric Surgery & Metabolic Medicine at Penn Medicine Princeton Medical Center, a team of weight loss specialists helps patients find a weight-loss strategy that meets their own unique needs, including surgical options such as gastric bypass and sleeve gastrectomy.

Tips for Healthy Sleep

In addition to seeking medical treatment for sleep apnea and other sleep issues, the following tips from the American Academy of Sleep Medicine can help ensure you get enough quality ZZZs.

• Keep a consistent sleep schedule. Get up at the same time every day, even on weekends or during vacations.
• Set a bedtime that is early enough for you to get at least seven to eight hours of sleep.
• Don’t go to bed unless you are sleepy.
• If you don’t fall asleep after 20 minutes, get out of bed. Go do a quiet activity without a lot of light exposure. It is especially important to not get on electronics.
• Establish a relaxing bedtime routine.
• Use your bed only for sleep and sex.
• Make your bedroom quiet and relaxing. Keep the room at a comfortable, cool temperature.
• Limit exposure to bright light in the evenings.
• Turn off electronic devices at least 30 minutes before bedtime.
• Don’t eat a large meal before bedtime. If you are hungry at night, eat a light, healthy snack.
• Exercise regularly and maintain a healthy diet.
• Avoid consuming caffeine in the afternoon or evening.
• Avoid consuming alcohol before bedtime.
• Reduce your fluid intake before bedtime.

Sleep affects almost every aspect of your life, including your weight. Getting enough quality sleep can help keep your cortisol levels in check so you can make healthy food choices and stick to a healthy diet.

To learn more about the Center for Bariatric Surgery & Metabolic Medicine, call 609-785-5870 or visit www.princetonhcs.org/weightloss.

Lisa Dobruskin, MD, FACS, is a board certified surgeon specializing in bariatric surgery, and a fellow of the American College of Surgeons. She is the medical director of the Center for Bariatric Surgery & Metabolic Medicine at Penn Medicine Princeton Medical Center.