Do you have trouble getting enough sleep each night? If so, you are not alone. We live in a 24/7 society and sleep is often last in a long list of other priorities. In fact, according to the CDC, 35% of Americans get less than 7 hours of sleep per night, the minimum recommended by the American Academy of Sleep Medicine. While nutrition and physical activity are often the main focus of many when it comes to healthy lifestyle changes, sleep also plays an important role in weight and overall health. In fact, inadequate sleep has been linked to several chronic diseases including obesity, diabetes, cardiovascular disease, cancer and depression.

In this article, we will briefly discuss the link between sleep and weight, review how getting more sleep can be beneficial for weight loss, explain common sleep-related disorders which may be impacting health, and provide tips for improving sleep quality.

Can sleeping more help you lose weight?

There are several studies that link shorter sleep duration with an increased intake of calorie-rich foods and reduced physical activity level. One study demonstrated that a sleep time of only 4 hours per night versus a control of 10 hours per night was highly correlated with an increased caloric intake the following day. In fact, those that slept for only 4 hours ate 130% of their daily caloric need the following day versus 100% of daily caloric need in those who slept 10 hours. Most of these extra calories were consumed in the evening, and most were from high fat foods.

Other studies show that the hormones responsible for regulating appetite are affected by sleep, which may be contributing to the increased intake noted above. In fact, one study found that people who only averaged 5 hours versus 8 hours of sleep per night had higher levels of the hunger hormone, ghrelin, and lower levels of one of the hormones that promotes feelings of satiety, leptin. The study also found that, for those sleeping less than 8 hours per night, the fewer hours a person slept the higher their average body mass index (BMI).

Does having a sleep disorder impact your ability to lose weight?

There are several sleep disorders that have been linked to weight gain. Obstructive sleep apnea, insomnia, and shift work sleep disorder are common sleep disorders that can impact metabolic health and weight.

Obstructive sleep apnea (OSA)

OSA is a condition in which the airway is intermittently obstructed during sleep, resulting in a person stopping and starting breathing several times throughout the night. Common symptoms of sleep apnea include loud snoring and excessive daytime sleepiness. Having excess body weight results in changes to the structure and function of the upper airway and can put a person at risk for OSA. In fact 70% of people with OSA also have obesity. This relationship also appears to be bi-directional, as untreated OSA worsens sleep quality which makes it more difficult to control body weight, although the full details of this connection are less well understood.

Continuous Positive Airway Pressure (CPAP) is the most common treatment for OSA. Nightly CPAP usage has been shown to improve blood pressure and quality of life in people with OSA, although a direct effect of CPAP use on weight has not yet been shown consistently in studies. In addition to CPAP use, weight loss can also significantly improve OSA severity. While a 10% weight gain is associated with a six-fold increase in risk of worsening OSA, a 10% weight loss was associated with a 26% improvement in OSA severity.

Insomnia

Insomnia is a disorder in which a person may experience difficulty falling or staying asleep. It can have a number of causes, but is often related to uncontrolled anxiety, depression, or stress. Research indicated that a bi-directional relationship exists between insomnia and obesity: a higher body weight can put a person at increased risk of developing insomnia over time and, as noted above, the shorter sleep duration associated with insomnia can increase the risk of weight gain.

While many seek out medications to help with insomnia, the first-line treatment for insomnia is actually a non-medication treatment option called Cognitive Behavioral Therapy for Insomnia (CBT-I). CBT-I counseling teaches people tools for improving insomnia over time and has been shown to be more effective than medications for long-term insomnia treatment.

Shift work sleep disorder (SWSD) 

SWSD is a condition that can develop in individuals who work shifts other than the typical 9-5 schedule, such as evening, night or rotating shifts. The demands of shift work result in a disturbance in the circadian rhythm of workers, thereby resulting in difficulty sleeping and excessive sleepiness during waking hours. Research shows that shift workers have, on average, a higher body weight and more metabolic disease burden than do daytime workers.

While the most effective treatment for SWSD is a transition to a daytime work schedule, this is not financially or practically realistic for most. Instead, several behavioral interventions are encouraged for shift workers to improve their circadian rhythm such as keeping a consistent sleep-wake cycle (even on days off when feasible), getting blackout curtains and ear plugs to create a restful sleep environment, and bright-light therapy during waking hours. Medications can also be prescribed to help promote wakefulness during working hours

How to improve your sleep

While some sleep disorders require specific treatment plans as noted above, for most people with sub-optimal sleep habits, there are several effective strategies to improve the quality of sleep. These include: 

• Try to keep bedtime and wake-up times stable across days. Our body likes to have a consistent circadian rhythm, and wildly different sleep times each night (or even just on the weekends!) can make it more difficult to get to sleep and stay asleep consistently.

• Try to keep all screens out of the bedroom and instead focus on a restful routine for at least 30 minutes before bedtime. This may include reading, a hot bath, herbal tea, journaling, or a stretching routine. We don't have an "on/off" switch; our bodies and brains need time to wind down before sleep.

• Aim to get physical activity each day, preferably in the morning. Our sleep quality improves when we are exercising regularly, and exercising first thing in the morning can promote a healthy circadian rhythm. Try not to participate in vigorous physical activity right before bedtime as this can make it difficult to fall asleep.

• Aim for bright light exposure first thing in the morning and avoid bright lights and screens in the evening. This improves the strength of your circadian rhythm and allows for more restful sleep at night.

• Aim to stop caffeine intake before noon. Believe it or not, half of that cup of coffee you had at noon is still in your system at midnight and can disrupt your ability to fall asleep easily.

How Form Health can help you with your weight loss journey

At Form Health, patients get matched with a team of specialists including a board-certified obesity medicine doctor and a Registered Dietitian who work with patients to develop a comprehensive weight management treatment plan. In addition to nutrition, physical activity, stress management, and medications (when appropriate), this includes screening for possible sleep disorders and referring for appropriate treatment if needed, as well as developing a treatment plan for improved sleep quality.

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