Tag: sleep

pillows on a scale

Don’t “Weight” to Focus on a Good Night’s Sleep

I am a poor sleeper. I am not the only one: The CDC reports one third of the U.S. population does not get the recommended amount of sleep. I recently decided to redouble my efforts to get more sleep. I am generally healthy, as I eat well and exercise regularly, so I primarily focused on improving my sleep hygiene (avoiding food/alcohol close to bedtime, consistent sleep times, relaxation techniques and a dark, cool room). For more severe sleep issues, talk to your doctor about other options, including pharmacotherapy, cognitive behavior therapy and non-invasive brain stimulation techniques (6).  

As I began to get more sleep, I noticed I was losing a few pounds. It wasn’t dramatic, but it was those couple extra pounds I had had a difficult time getting rid of. Especially with approximately 42% of the U.S. population now considered obese, I had to explore the relationship between sleep and body weight. 

It is well known that sleep is very important to our physical and mental health (more on the mental health side in next month’s blog). Sleep is not only measured in total sleep time (quantity), but also in quality (number of disturbances/awakenings, minutes awake after sleep onset and percent of time asleep). Ideal sleep amounts for adults are 7-9 hours (higher for children) with less than six awakenings, less than 30 minutes awake after sleep onset and 85% of time asleep (3). Between-day variability also plays a role, with increased variability contributing to lower-quality sleep. Sleep research varies in terms of measurement of sleep, ranging from self-report (e.g., Pittsburg Sleep Quality Index) to actigraphy or wearable device to the gold standard of a polysomnogram. Poor sleep increases the risk of chronic diseases and conditions such as cardiovascular disease, obesity, Type 2 diabetes, some cancers and depression, as well as poor performance in school, work, athletics and while driving. I discovered there is a reciprocal and complex relationship (and which varies by gender, age and race) between sleep quality/quantity and body weight.   

Insufficient sleep negatively impacts metabolism and is associated with increased body mass index (BMI), abdominal body fat and obesity. There are several mechanisms involved, including systemic inflammation, hormonal and metabolic changes and behavioral issues (11). Inflammation increases risk of cardiometabolic disease risk and hypertension, and decreases insulin sensitivity. Changes in the neuroendocrine system include increased ghrelin and orexin-A and decreased leptin, leading to increased appetite and hunger (9). With decreased sleep, there is a tendency towards increased energy intake due to associated behaviors such as increased secondary (not at mealtime) late-night eating and disinhibited (distracted) eating (4,13). These changes in sleep and food intake can also contribute to circadian misalignment, which further disrupts sleep (2). Increased daytime sleepiness may also decrease physical activity. We also see obesity (body weight gain) causing poor sleep due to comorbidities such as hypertension, pain, sleep apnea or exacerbated menopausal symptoms (1,12). 

There is also a positive bidirectional relationship between sleep and body weight change. Body weight loss is associated with improved sleep, and improved sleep is associated with body weight loss (10,14). Body weight loss often coincides with healthy behaviors such as increased physical activity and improved nutrition/eating patterns, which can contribute to improved sleep. Weight loss may also contribute to decreased pain, thus decreasing sleep disturbances. Better sleep health was associated with greater weight and fat loss with a weight-loss intervention (7). Optimizing sleep during a resistance training program provided body composition benefits of higher muscle mass and lower fat mass compared to resistance training alone (5).  

There is still much to learn about the complex connections between sleep and body weight, but this all sounds promising. As I approach the potential for weight gain associated with middle age and menopause, I will continue to include a healthy diet and varied physical activity — and you can bet I will be keeping sleep a priority.  

 

Author: Melissa W. Roti, Ph.D., FACSM

Professor, Director Exercise Science Program

Westfield State University, Westfield, Massachusetts

Twitter: @MelissaRoti 

 

References 

  1. Al-Safi ZA, Polotsky AJ. Obesity and menopause. 2015;29(4):548-53. 
  2. Barot N, Barot I. Nutrition and Sleep. In: Encyclopedia of Sleep. 2013. p. 108-13.  
  3. Berger AM et al. Sleep wake disturbances in people with cancer and their caregivers: state of the science Oncol Nurs Forum. 2005;32(6):E98-126. 
  4. Blumfield ML, Bei B, Zimberg IZ, Cain SW. Dietary disinhibition mediates the relationship between poor sleep quality and body weight. Appetite. 2018;120:602-8. 
  5. Jåbekk P, Jensen RM, Sandell MB, Haugen E, Katralen LM, Bjorvatn B. A randomized controlled pilot trial of sleep health education on body composition changes following 10 weeks’ resistance exercise. The Journal of Sports Medicine and Physical Fitness. 2020;60(5):743-8. 
  6. Jackowska M, Koenig J, Vasendova V, Jandackova VK. A two-week course of transcutaneous vagal nerve stimulation improves global sleep: Findings from a randomised trial in community-dwelling adults. Auton. Neurosci. 2022;240:102972. 
  7. Kline CE et al. The association between sleep health and weight change during a 12-month behavioral weight loss intervention. Int J Obes. 2021;45:639-49.  
  8. Leger D, Bayon V, Sanctis A. The role of sleep in the regulation of body weight. Molecular and Cellular Endocrinology. 2015;418(2):101-7. 
  9. Littman AJ et al. Sleep, ghrelin, leptin and changes in body weight during a 1-year moderate intensity physical activity intervention. International J Obesity. 2007;31:466-75. 
  10. O’Brien EM et al. Sleep duration and weight loss among overweight/obese women enrolled in a behavioral weight loss program. Nutrition & Diabetes 2:e43. 
  11. Schmid SM, Hallschmid M, Schultes B. The metabolic burden of sleep loss. The Lancet Diabetes & Endocrinology. 2015;3(1):52-62. 
  12. Shade MY, Berger AM, Dizona PJ, Pozehl BJ, Pullen CH. Sleep and health-related factors in overweight and obese rural women in a randomized controlled trial. J Behav Med. 2016;39:386-97. 
  13. Tajeu GS, Sen B. New pathways from short sleep to obesity? Associations between short sleep and “secondary” eating and drinking behavior. Amer J Health Promotion. 2017;31(3):181-8. 
  14. Thomson CA et al. Relationship between sleep quality and quantity and weight loss in women participating in a weight-loss intervention trial. Obesity. 2012;20:1419-25. 
man sleeping in blue blankets and a pillow

The Importance of Sleep for Health

When we think about the most important actions that we can take to protect our health, we usually consider behaviors such as partaking in regular physical activity or eating a nutritious diet. Yet, an often-overlooked aspect of maintaining a healthy lifestyle is sleep. Sleep has serious implications for your physical and mental health. Adequate sleep will help you recover from exercise, enable your immune system to fight off pathogens and increase cognitive performance. In fact, to highlight its importance to health, the number of hours that people sleep is included as an indicator in the annual ACSM American Fitness Index (Fitness Index).

Despite the proven benefits of sleep on overall health, many of us tend to view it as a luxury and fail to get enough sleep. In fact, the Fitness Index reports that less than 65% of those who live in America’s 100 biggest cities get enough sleep (this number improves only modestly to 70% when we look at the entire U.S. population). Chronic sleep deprivation can have serious consequences on your health. For example, data have shown that lack of sleep can impair your body’s insulin response1—which can potentially contribute to the onset of diabetes. Moreover, chronic sleep deprivation has been associated with an increased risk of obesity and cardiovascular disease2. Lack of sleep can also alter memory retention, cause a negative mood, and inhibit your capacity to operate a motor vehicle. Data show that sleep deprivation impairs your ability to function to a greater extent than if you were intoxicated3.

Considering the negative ramifications of sleep deprivation, it is important to develop good sleep hygiene that contributes to a healthy lifestyle. To accomplish this goal, we must first commit to making sleep a priority. This sounds pretty intuitive but can also be difficult to do if you are juggling several responsibilities. To find balance, try building your daily schedule around your sleep (in much the same way you schedule other important activities like doing regular exercise or eating). Remember, if you make something a priority, you will always find time for it! Another way of developing good sleep hygiene is to go to sleep and wake up at roughly the same time every day, regardless of whether it is a weekend or vacation day. Doing this will help you fall asleep faster and make sleep less stressful.

Another key trait in those who have great sleep hygiene is having a pre-sleep ritual. Developing a routine that you can implement at least thirty minutes before going to bed will help “tell” your body it is time to go to sleep. Adopt activities that will help you relax, such as, taking a hot shower, reading a book or reducing your screen time. The bright light emitted from screens can alter how our bodies release melatonin and adenosine, two key chemicals that initiate our sleep cycles. In turn, it is best to just avoid looking at screens altogether before you go to bed. Lastly, do your best to make your bed your sleep sanctuary. Obviously depending on your circumstances, this may not be possible, but definitely try to use your bed for nothing other than sleep. You can make your space more conducive to promoting sleep by limiting the amount of light that enters your room and setting the room to a cooler temperature. Making these adjustments will contribute to a more restful night of sleep and help you build a sustainable habit.

 

Sources:

  1. Knutson, K. L., Ryden, A. M., Mander, B. A., & Van Cauter, E. (2006). Role of sleep duration and quality in the risk and severity of type 2 diabetes mellitus. Archives of internal medicine166(16), 1768–1774. https://doi.org/10.1001/archinte.166.16.1768
  2. Pacheco, D. (2021, June 24). Physical health and sleep: How are they connected? Sleep Foundation. https://www.sleepfoundation.org/physical-health.
  3. Williamson, A. M., & Feyer, A. M. (2000). Moderate sleep deprivation produces impairments in cognitive and motor performance equivalent to legally prescribed levels of alcohol intoxication. Occupational and environmental medicine, 57(10), 649–655. https://doi.org/10.1136/oem.57.10.649

 

Authors: Rafael Alamilla, M.S. and NiCole Keith, Ph.D. Ph.D., FACSM, IUPUI, Indiana University, Regenstrief Institute, Inc.

 

Infographic Sources:

  1. Markwald, Rachel R. Ph.D.; Iftikhar, Imran M.D., FACP, FCCP; Youngstedt, Shawn D. Ph.D. BEHAVIORAL STRATEGIES, INCLUDING
    EXERCISE, FOR ADDRESSING INSOMNIA, ACSM’s Health & Fitness Journal: March/April 2018 – Volume 22 – Issue 2 – p 23-29
  2. Bushman, Barbara A. Ph.D., FACSM Exercise and Sleep, ACSM’s Health & Fitness Journal: September/October 2013 – Volume 17 – Issue 5
    – p 5-8
  3. Pujalte, George G.A. MD, FACSM1; Benjamin, Holly J. MD, FACSM2 Sleep and the Athlete, Current Sports Medicine Reports: April 2018 –
    Volume 17 – Issue 4 – p 109-110
  4. American Academy of Sleep Medicine Public Safety Committee. TIP SHEET FOR HEALTH CARE PROVIDERS:
    Prioritizing Sleep & Managing Fatigue, 2021.

Infographic Author: Laura Young, Ph.D.

Good Sleep: An Indicator of Good Health

Regularly getting a good night’s sleep is so important for good health that it was added as an indicator to the American Fitness Index last year. The 2018 American Fitness Index Rankings will also list “percent getting seven or more hours of sleep per day” as one of the personal health indicators that are used to calculate the final rankings.

The source of data for this indicator is the CDC’s Behavior Risk Factor Surveillance System (BRFSS) national telephone survey. As you might imagine, the telephone survey methods used are very rigorous to make sure the results are as accurate as possible. Consequently, many medical and public health researchers rely heavily on the BRFSS for their work. Learn more about the BRFSS national survey on the CDC website.

A question on the national survey asks, “On average, how many hours of sleep do you get in a 24-hour period?” As an answer, responders give a number – like six and a half or eight. Generally, experts believe at least seven hours of sleep per day are needed to stay healthy, so this is the measure used for the indicator.

In calculating the Fitness Index scores, each indicator is given a weight from one to three to match how important each indicator is for fitness. Our national experts agreed that getting a good night’s rest was so important that it should be given the highest level of weight (three).

Why is sleep so important to health? 

Sleep influences processes in the brain that allow it to remember and learn new information. It can also influence brain linkages that increase the ability to concentrate and feel positive emotions. People who get more rest have more energy for tackling difficult tasks. Getting enough sleep also helps to control weight by increasing the body’s ability to burn carbohydrates.

On the other hand, having too little or poor quality sleep turns on hormones that affect appetite and promote carbohydrate storage that leads to weight gain. Sleep can also affect heart health: not getting enough sleep can increase the risk for heart disease by increasing high blood pressure, stress hormones and irregular heartbeats.

What is the solution?

Getting at least seven hours of sleep a day is possible by practicing what sleep experts call good sleep hygiene. These are different practices and habits that promote sleep quality and daytime alertness. Here are a few hints:

  • Limit daytime naps to 30 minutes so you are tired at night.
  • Avoid stimulants such as caffeine and nicotine close to bedtime.
  • Exercise to increase your physical energy and allow your tired muscles to relax for a good night’s rest.
  • Avoid watching TV in the bedroom, as the artificial light can disrupt sleep rhythms.
  • Avoid eating foods that may disrupt your digestive system right before bedtime.

Check out the Fitness Rankings to see how well people in your city are sleeping!

 

Authors

Barbara E. Ainsworth, Ph.D., M.P.H., FACSM, FNAK

Terrell W. Zollinger, Dr.P.H, MSPH