According to a study in SLEEP about 40% of Americans are sleep deprived, meaning they get less than 5 hours of sleep per night. Maintaining a natural day and sleep cycle is fundamental for brain cells that synchronize the body clock. Skimping on sleep has long been associated with overeating, poor food choices, and weight gain. A recent study in SLEEP shows how this process changes chemical signaling in the blood and encourages eating sweet, salty, high-fat snack foods [21]. The study subjects were sleep-deprived and the endocan- nabinoid levels of the brain rose higher to enhance the desire for food.

Erin Hanlon, PhD, a research associate in endocrinology, diabetes, and metabolism at the University of Chicago points out that “the energy cost of staying awake a few extra hours seem to be modest.” One study has reported that each hour of wakefulness uses about 17 extra calories. That adds up to about 70 cal for the 4 hours of lost sleep. But given the opportunity, the subjects in this study more than made up for it by binging on snacks, taking in more than 300 extra calories. Over time, that can cause significant weight gain [21].

Night shift workers have long been considered candidates for increased weight gain and chronic diseases. An estimated 15 million Americans work the night shift and the adverse health effects are well documented. Jonathan Cedernaes, MD, PhD, a researcher in the Department of Neuroscience at Uppsala University, Sweden indicates that shift workers showed signs of cognitive aging but this was not significantly different from nonshift workers. Dr. Cedernaes showed chronic sleep loss by shift workers can be repaid by choosing better quality sleep—avoiding caffeine, alcohol, and nicotine when catching up their sleep quota at other times [22].

Marie-Pierre St. Onge, PhD, assistant professor of medicine at Columbia University College of Physicians and Surgeons refutes the idea of sleep debt repayment. She asserts that short sleep duration on workdays is ubiquitous in today’s society, so individuals try to catch up on sleep during weekends. Dr. St. Onge describes this behavior as “social jetlag”—the difference in sleep timing between workdays and free days. This behavior attempts to pay back over 2 days the deficit incurred during a 5-day work week, but studies have shown higher levels of obesity and metabolic syndrome due to increased body mass index (BMI) and fat mass, plus elevated C-reactive protein (a marker of inflammation) in the “social jetlag” group. [22].

The risk of diabetes increases with disruptions in a person’s circadian rhythm reports Chandra L. Jackson, PhD, research associate with the Clinical and Translational Science Center at Harvard Catalyst and Harvard T.H. Chan School of Public Health. Type 2 diabetes risk was elevated for each hour of sleep lost among individuals who slept less than 7 hours per day. Dr. Jackson also reported that shift work where a person eats during the night is bad for metabolic health because the body releases hormones throughout the 24-hour period and glucose-insulin dysfunction may result when eating times differ from hormone releases. Weight gain and dysglycemia result [23].

Reduced weight loss in bariatric patients may be related to sleep deprivation because leptin and ghrelin issues are changing appetite and metabolism [24].

Leptin levels contribute to maintaining healthy appetite control but poor sleep contributes to poor leptin management. Ghrelin is the hunger hormone that is suppressed with sufficient sleep but increased during sleep deprivation.

Research over the past 15-20 years has begun to provide answers about why sleep is precious. Studies have explained that sleep provides optimal functioning of the immune system, hormonal balance, emotional, and psychological health, appetite regulation, memory, and learning plus clearance of toxins from the brain [25].

Obstructive sleep apnea (OSA) is a common disorder in obese patients who experience repetitive episodes of nocturnal breathing cessation due to upper airway collapse. Weight loss from bariatric surgery improves symptoms and can produce beneficial sleep [26].

Having good bedtime habits are important. Patients need to be advised to avoid eating late meals—allow at least 3 hours before bed. A light snack 30 minutes before bed is acceptable for those needing protein for blood glucose control. After dinner, mind and body activities need to avoid stimulating and agitative conversations including work stress to ensure better sleep. Small adjustments to the daily routine and sleeping area can go a long way to producing restful sleep and better health. A composite of suggestions include:

  • • Avoid television or computer-related activities at least 1 hour before bed.
  • • Sleep in a dark room.
  • • Use a low wattage yellow, orange, or red light bulb as a night light.
  • • Keep a cool bedroom temperature of 70°F-72°F.
  • • Take a hot bath before bed to increase core temperature and signal the body to sleep.

Sleep disorders often occur due to hormone imbalance or lack of physical activity. Stress and cortisol block the production of melatonin, which is needed to shift the brain from alpha wave sleep to deep delta waves. Supplements are available to help restore quality sleep. Magnesium also plays a role in sleep with low levels preventing the brain from quieting down for sleep. Zhou et al. report that consumption of a high-protein diet may improve sleep in overweight and obese adults [27].

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