“Sleep loss is associated with striking alterations in hormone levels that regulate appetite [ghrelin, leptin, insulin, & cortisol] and may be a contributing factor to obesity. Anyone making a commitment to lose weight should probably consider a parallel commitment to getting more sleep”
-Dr. Michael Thorpy
1 – Consistently sleep 7 to 9 hours a night
2 – Have a consistent sleep schedule
3 – Take naps
4 – Follow the suggestions for getting quality sleep
And this is why…
You may be surprised to see a chapter about sleep in a weight loss book. The fact is you shouldn’t be. As you can see from the quote above and will see from the information to come, getting the right amount of sleep is an important factor in the regulation of bodyweight, as well as overall well-being. There have been numerous papers published on this subject as well as a number of articles in lay publications highlighting the fact that proper sleep is very important. For example, a recent story in the LA Times, Rest: It’s Required, highlights the thoughts of many of the sleep researchers. The basic conclusion is that adequate sleep is as crucial to a healthy life as are proper diet and exercise.1 Additionally, a recent review paper in the International Journal of Obesity found that chronic sleep debt is a major factor in the increase in obesity.2 Unfortunately, in our current 24/7 society, sleep is often the first thing that is neglected. We feel this neglectful mindset is due to a general lack of understanding of, or under appreciation for, the importance of proper sleep. We hope to change this.
How Much Do We Need?
There is no optimal amount of sleep for everybody. There is a range of needs that most people will fall within, but there are a small percentage of people who can function well on lower amounts and others that need higher amounts, relative to the “normal” needs. The chart on the next page, from the National Sleep Foundation, gives some good guidelines for sleep needs.
The amount of “average sleep duration has decreased from about 9 h per night in 1910 to about 7.5 h currently ”.4 In 2002, the average sleep time for adults had decreased to 7 hours and one-third of adults typically slept less than 7 hours a night.5 These changes over the last century are largely due to the widespread use of artificial lighting, the re-structuring of working hours, technology (television and internet) and the overall 24/7 mentality.6
Consequences of Sleep Deprivation
A state of chronic sleep deprivation results in a negative impact on the metabolic and hormonal systems. The hormones leptin, ghrelin, cortisol, thyroid and growth hormone seem to be major influencing factors regarding bodyweight and appetite regulation.4,7 Getting insufficient sleep leads to an increase in ghrelin and a decrease in leptin which promotes a stronger appetite and fat production.8 Insufficient sleep also causes a disruption of blood sugar control and insulin resistance independent of obesity.4,7 Additionally, sleep deprivation has been suggested to be an independent risk factor for diabetes and high blood pressure.7 A recent paper by Gottlieb et al came to the conclusion that “A sleep duration of 6 hours or less or 9 hours or more is associated with increased prevalence of DM [diabetes mellitus] and IGT [impaired glucose tolerance]” (p.863).5 Animal and human studies have clearly demonstrated a very strong association and a good causal link between chronic sleep deprivation and an increase in bodyweight. Research has also demonstrated strong links for metabolic syndrome, increased systemic inflammation, and negative alterations in mood, memory, cognition, and immune function.4,7,8,9
It is clear that getting the proper amount of sleep is needed for regaining and maintaining a healthy bodyweight and a high level of wellness. The exact number is currently elusive, but the current evidence seems to support 7 to 9 hours of sleep, for most adults, per night, on a consistent basis. Occasionally getting less will not cause harm and the body can recover relatively quickly from a brief deficit. Many people may need to sleep more (9-10 hours) for a relatively short time, about four to six weeks, in order to repay their sleep debt before they can settle into the recommended sleep allotment.10 If you are not typically sleeping 7 to 9 hours/night on a regular basis then you are probably not getting enough sleep. The following chart (figure 2) highlights some of the signs of getting insufficient sleep and a growing sleep debt.
One strategy you can use to help get the rest you need is to nap. Taking a midday nap is a common occurrence in many cultures and is largely due to biologically driven rhythms. The habit of taking a 15 to 30 minute nap on a regular basis can have many physiological and psychological benefits.10 Two caveats to naps; first, naps should not be longer than 30 minutes and second, if it seems to interfere with falling asleep at bedtime, the timing or duration should be changed. Napping will not make up for very low amounts of nocturnal sleeping, but it can help minimize sleep debt and shake off some of the deleterious cognitive effects resulting from poor sleep.
Techniques for Quality Sleep
There is little hard evidence for most of these recommendations, but a number of sleep researchers give these suggestions for sleeping well.10-13
- Keep a regular sleeping schedule
- Sleep in a dark room or use an eye mask
- If you get up during the night, avoid using any bright lights
- Make the bedroom a peaceful sanctuary
- Use the bedroom for sleep and sex only
- Minimize noise, but some white noise or nature sounds may be useful
- Best to keep the bedroom temperature between 65 and 72 degrees
- Pleasant smelling. Certain odors can be relaxing, such as lavender, rose, vanilla, and chamomile
- Use some type of de-stressing techniques before bedtime, such as taking a bath, reading, stretching or meditation.
- Reaching orgasm through sexual intercourse or masturbation just before bedtime14
- Avoid alcohol in the evening – it is a sedative and may help you fall asleep, but the quality of sleep will substantially decrease. It can also exacerbate sleep apnea.
- Avoid large meals a couple of hours before bed
- Avoid caffeine late in the day – the exact time will differ from person to person, but typically there should be a 6-8 hour space between caffeine intake and bedtime.
- Avoid cigarettes/nicotine before bed – nicotine is a stimulant
- Avoid very spicy meals in the evening
A recent editorial in the Annals of Internal Medicine (2004) titled; A good night’s sleep: Future antidote to the obesity epidemic?, by Drs. Flier and Elmquist sums up the current sleep-weight situation well; they state:
Although genes play a critical role in weight determination, the increased prevalence in obesity of populations over a period of decades is induced by changes in the environment in which we live rather than changes in our genetic endowment. In thinking about the environmental variables that are probably responsible for the ‘obesity epidemic,’ most of the attention has focused on the status and cost of the food supply, the composition of the food we ingest, and our capacity for or avoidance of physical exertion. Is it possible that we have missed other environmental variables that have the capacity to modify appetite and energy balance? In this issue, Spiegel and colleagues present experimental results suggesting that increasing sleep deficits (or debts), perhaps a result of our hectic lifestyles, bring about physiologic changes in the hormonal signals that promote hunger and, perhaps thereby, obesity. (p.885)15
Hopefully, this information has helped to improve your understanding of, and the need for, getting the proper amount of sleep. If attaining and maintaining a healthy weight is truly a desired goal, then you must make getting the proper amount of sleep a top priority.
 This only applies if you are having troubles sleeping. This does not have anything to do with weight loss per se.
Chapter 6 References:
1 – Brink, S. Rest: It’s required. Retrieved October 28, 2006 fromhttp://www.latimes.com/features/printedition/health/la-he-speep9oct09,1,7071368.story?coll=la-headlines-pe-health
2 – Keith, SW. et al. Putative contributors to the secular increase in obesity: exploring the roads less traveled. Inter J Obesity 2006; 30: 1585-1594.
3 – National Sleep Foundation. Retrieved from http://www.sleepfoundation.org/site/c.huIXKjM0IxF/b.2417141/k.27D9/Home_of_the_Sleep_in_America_Poll.htm
4 – Spiegel, K., Leproult, R. & Cauter, E. Impact of sleep debt on metabolic function and endocrine function. Lancet 1999; 354: 1435-1439.
5 – Gottlieb, D. et al. Association of sleep time with diabetes mellitus and impaired glucose tolerance. Arch Intern Med 2005; 165: 863-868
6 – Foster, R. & Wulff, K. The rhythm of rest and excess. Nature Reviews 2005; 6: 407-414.
7 – Wolk, R. & Somers, V. Sleep and the metabolic syndrome. Exp Physiology 2006; 92.1: 67-78.
8 – Prinz, P. Sleep, appetite, and obesity – What is the link? PloS Medicine 2004; 1(3): e56-e61.
9 – Boonstra, T. et al. Effects of sleep deprivation on neural functioning: an integrative review. Cell Mol Life Sci 2007; 64: 934-946.
10- Mass, J. Power sleep. New York. Quill; 1998.
15 – Flier, J. & Elmquist, J. A good night’s sleep: Future antidote to the obesity epidemic? Annals of Internal Med 2004; 141(11): 885-886.
11 – Breus, M. Good night: The sleep doctor’s 4-week program to better sleep and better health. New York. Dutton; 2006.
12 – National Sleep Foundation. Healthy sleep tips. Retrieved July 7, 2009 from http://www.sleepfoundation.org/article/sleep-topics/healthy-sleep-tips
14 – Komisaruk, B. et al. The science of orgasm. Baltimore. Johns Hopkins University Press; 2006.
13 – Martin, P. Counting sheep: the science and pleasure of sleep and dreaming. New York. Thomas Dunne Books; 2002.