Weight Loss Sleep

There may not be any more important part thing that you can do that will contribute more to your health and ability to lose weight than getting adequate sleep.

​When I was in Residency as part of my medical training and routinely working 36 or more hours without sleep I came to understand acutely how important sleep was. Poor sleep is intimately connected with obesity and weight loss. (5) Conditions such as sleep apnea, which are associated with frequent interrupted sleep, also contribute to obesity and weight gain. It takes a lot more effort to lose weight when you are not sleeping which is why people with sleep problems often struggle with losing weight. Poor sleep may also increase hunger in part due to the release of hormones such as cortisol.

My Personal Experience

When I have weighed more than 200 lbs I have noticed a significant worsening of my sleep and I have experienced sleep apnea symptoms. On the other hand, when I cross 200 lbs on my way down my symptoms disappear and my sleep and energy levels dramatically improve. The same may true for you if you have weight associated sleep problems.  

Sleep and Overall Health

Poor sleep is associated with an increased risk of chronic health problems such as cancer, diabetes, and cardiovascular disease (4).

​It is also associated with:

1. Low testosterone
2. Cognitive impairment (1, 2)
3. Chronic inflammation (3, 4)
4. Illness (7, 8)
5. Addiction
6. Depression (6)
7. Insulin resistance
8. Increased estrogen conversion
9. Decreased libido
10. Lethargy

How Much Sleep do you need?

Prior to light bulbs people may have slept as long as 10 hours a night. According to a 1960 survery of over 1 million people found a sleep duration of 8.0-8.9 hours. (1) More recently polls conducted as recently as 2002 by the National Sleep Founds indicated that the average duration of sleep for Americans had fallen to 6.9-7.0 hours. (2) It may be that the typical American gets even less. 

Ideally, we need 7 to 8 hours of sleep per night. There is some indication that increased mortality is associated with people that sleep more than 8 hours and less than 7 hours. The average BMI also tends to be lowest for individuals that sleep about 7 - 8 hours per night especially for women. See the graphs below from an article in the journal JAMA Psychiatry. The left graphic is responses by 636 095 women for the average reported frequency of insomnia, the average number of sleeping pills used per month, and the mean body mass index (BMI) according to reported hours of sleep. The 95% confidence intervals of the BMI are shown. Also shown are the hazard ratios from the 32-covariate Cox models and the percentage of women reporting each sleep duration. The reference duration of 7 hours is represented by the lighter bars. On the right for 480 841 men, data comparable to those shown in the left figure for women. BMI indicates body mass index.

Electronics

One of the contributors to poor sleep is the use of artificial lighting and especially electronics at night. Devices, such as our phones and computers, are programmed to emit high levels of blue light in order to mimic the light wavelengths associated with sunlight. This type of light helps us feel alert and suppresses our natural melatonin production. 

As can be seen from the illustration below melatonin begins to rise when the sun sets which is when orange light predominates and blue light wavelengths dissipate. Simultaneously, our cortisol hormones decrease during sleep and begin to rise when we need to awaken. Melatonin helps us feel drowsy and cortisol helps us feel alert. ​

How does our body respond to blue light?

Interestingly, the Ganglion (nerves) in the back of our eye respond to blue light. When the amount of blue light decreases (dusk) this is transmitted from the nerve to the Pineal gland which secrets melatonin. Melatonin suppresses adrenal function and the release of cortisol which helps decrease alertness. With an decrease in cortisol we also get activation of the immune system.

When we use to many electronics especially TV and our phones near bedtime we may be inadvertently suppressing our natural melatonin production and therefore inhibiting our ability to sleep. Therefore, it is probably wise to cease the use of electronics for a period of time before bed or use blue light blocking glasses. There are also some apps that can remove the blue light emissions from electronics that you use which also may be helpful. 

Obesity, Sleep, and Weight Loss

As mentioned previously it may be difficult to lose weight if you are not sleeping well. The levels of hormones may be altered and it is well documented that people that are sleep deprived eat significantly more. Hormones such leptin (associated with satiety) may decrease and conversely there may be increased levels of ghrelin (associated with hunger). There may also be a propensity to eat high carbohydrate and calorie dense foods. (3) There is also increase in insulin resistance which may be associated with the development of diabetes. (4) The levels of the hormone cortisol may also increase and lead to a propensity to evening hunger. 

The bottom line is that it will be much more difficult to lose weight if you are not sleeping well. You stress hormones will rise and you will be hungrier. Addressing your sleep will help you get the weight off and keep it off. 

So if you are having trouble sleeping how do you improve it?

Here are a list of strategies that may help. This list is by no means exhaustive. 

Develop a routine

I have found that everything that you do successfully in life is based on daily routines. You need a routine for exercise, for eating, weight loss, and everything else. A sleep routine is equally important. You can start by starting to relax about 30 minutes prior to going to sleep. Listening to relaxing music by help you relax. There are a lot of great relaxing music for free on YouTube. You can also do reading or light stretching or meditation. Find what helps and do it every night without fail. Make a hard bedtime. Go to bed and get up at the same time 7 days a week. 

Appreciation

I have found that it is vital to be appreciative of what you have. I have written on appreciation. As part of your daily routine spend 5 minutes reviewing the things you are thankful for. Instead of focusing on what you lack focus on what you have. What good things happened during that day and what are you thankful for. It could be your beating heart, the birds chirping, the children you have, the taste of a meal. Remember we never get this life back. This experience will never happen again so savor it, every moment! Try to be grateful for the challenges as well. For example, be grateful for the opportunity and challenge of losing and more especially of maintaining weight loss.

Get rid of Resentment

Most resentment is either self-inflicted or arises out of factors that are often beyond your control. Don't resent that you are currently not sleeping well. It only makes you frustrated and elevates your sympathetic nervous system and stress hormones. The more I have examined my own sources of resentment in my life the more that I have found that I am resentful. Don't resent that you are overweight or not sleeping. Resentment is disabling. Love is enabling. Be grateful that you get any sleep at all. Be grateful for being tired in the morning. That doesn't mean that you need to accept poor sleep or poor health. But remember that sleep is not something you can control exactly like you would the number of calories you eat. Sleep is something you can help along but also something that happens to you. Resentment only hurts you. Don't be bitter. Don't be a victim. Be an actor! If you wake up in the middle of the night try to think about all the great things you around you. You are still breathing. Your heart beats.  

Write in a Journal

​One of the best ways to be appreciative is to write down what you are grateful for every day. It takes just a few lines. What insights have you had. Putting your thoughts to paper may help allow you to leave overactive thoughts on the page and not obsessively in your mind. 

Plan

"If you prepare properly, you may be outscored, but you will never lose." John Wooden, Coach and Teacher

A lot of people have overactive thoughts. They are thinking about the next day and all the things that they have to do. A lot of these are things that could be written down. Having a plan and list of things that are important to accomplish will help you to not obsess about remembering all the things you have to do the next day. Much of stress and worry is derived from poor preparation and planning and procrastination. If you think of something that you need to do just write it down and plan to address it later. 

Get up before your alarm clock

Don't let your alarm clock be your enemy. Beat your alarm clock to the punch. If are feeling awake and alert just get up. Cortisol begins to increase early in the morning. You may not need more sleep. I would only use your alarm clock as a backstop. 

Alternate nostril breathing. 

For anybody who has done Yoga you become immediately aware of how important breathing is. Proper breathing can help to decrease stress and help calm you do to help you sleep. It may be worth seeing if it can work for you. So next time you sense anxiety associated with a lack of sleep try a few rounds of alternate nostril breathing. It may help get back moving in the right direction. The following is a good example of how to perform this technique from The Art of Living. (5)     

1. Sit in a comfortable position with the spine long and the hips relaxed. Release any tension from your jaw. Close your eyes.
2. Place your left hand on your left knee with the palm face upward, or in the Chin Mudra by pressing the index finger and thumb together.
3. Place the tip of the index finger and middle finger of the right hand in between the eyebrows with the ring finger and little finger on the left nostril, and the thumb on the right nostril. Use the ring finger and little finger to open and close the left nostril and use the thumb for the right nostril.
4. On an exhalation, close the right nostril with your thumb and breathe out through the left nostril.
5. Breathe in through the left nostril and then close with the ring finger.
6. Release the thumb on the right nostril and breathe out through the right nostril.
7. Inhale through the right nostril, close with the thumb, release the ring finger from the left side and exhale through the left nostril.
8. These two full breaths are called one round of Alternate Nostril Breath.
9. Perform 5 to 9 rounds of this alternating breath between the nostrils.
10. Remember to always inhale through the same nostril you just exhaled through.

​
Meditation

Everyone has heard of meditation. Meditation is a good way to relax for many people and helps get you focused on the moment instead of the past or the future. The practice can help you decrease your stress and prepare for sleep. There are many ways to meditate. Like the alternate breathing technique outlined above breathing is key to meditation. Here are a few things that can be done to help you meditate. 

• Focus on your breathing. Breathe slowly and feel the air move in and out of your lungs. Feel appreciation for each breath and is means you are alive. As you do this let anxiety and stress go out with each breath and calmness enter as air enters. Gradually your level of stress will ease and your heart rate will become more regular. 
• Observe your thoughts. As you focus on your breath observe your thoughts and sensations. Don't suppress or judge. Try to see your thoughts as actors on a stage. They will come and go. Your brain thinks and that is okay. Be at peace as you stand as experience your mind and body and your environment to your fullest capacity. 
• Pay attention to your other senses. Focus on your feet, legs, buttocks, back, shoulders, and jaw. Let go of any tension but also don't judge the tension. Let it be and let it go. You can even progressively tense each muscle group and then relax them starting at your feet or your head. 

Visualize a peaceful time and place

It can be helpful to visualize a peaceful and tranquil place. I personally focus on a particular vacation spot where I used to go as a child. It was at a cabin at a lake, Lake Windermere. I remember that it was often very quiet at night. Occasionally a train would rumble in the distance and reverberate across the lake. The light of the moon with reflect off the undulating waves. There were no worries. There was peace and tranquility. The mountains lay in the background. Their ice caps prominent. The temperature is calm, warm. I am sitting in a canvas rocking chair. It is rocking gently back and forth. The sounds of night abound at a low buzz. The sky is clear. The stars abound. There is an occasional zap as the bug zapper goes off from underneath the deck where I am sitting. There is a slight dull hue from its light. My hair smells like dried lake water. I am wearing my dried bathing suit and a shirt. Hair disheveled but I don't care. Muscles tired but not exhausted. Eyes weary. There is no judgement. A loving family surrounds and talks quietly. On some nights a fire is crackling when we would sit on the lower deck right above the lake. Sparks would fly up into the night sky and fireflies. My grandparents are there. Unconditional love abounds. I don't want the day to end. We all retire peacefully having had a full day. 

If you have such a place in your life try to visualize it. Write it down. Visualize it. Remember the sights, sounds, smells, and feelings that accompanied it. 

Visualize and Count something

Most of us have heard of counting sheep. It may help to relax you and go to sleep if you visualize and count sheep. You can even visualize these sheep going to sleep as you count them. 

Help your body relax

It can help to exercise, take a bath, and to keep your house cool. Just remember not to exercise approximately 3 hours prior to going to sleep or else it will be a long night. A bath can definitely help you relax as well as making sure your house is cool. 

Removing disturbances

As I discussed about electronics and other forms of light can disturb your sleep. Keep your room dark and electronics out of your room. Remove your alarm from view. Use your bedroom only for sex and sleep. Try not to perform any higher cognitive functions in your bed. If you need to think through something or study do so in a chair or in another room. 

Avoid sleep disturbing substances such as caffeine and alcohol close to bedtime. Preferably not any closer than 3 hours before bedtime. ​

​Alternative Medicines:

Steps to perfect sleep

1. Blacken your room
2. Quit using electronics in bed: Remove alarm from view. Set alarm to go to sleep and get up.
3. Make a HARD bed time
4. Get up at the same time everyday
5. Learn 5 ways to reduce stress: Relaxation, Mindfulness
6. Improve your insulin sensitivity with diet
7. Exercise daily: Not after 6 pm
8. Decrease blue light 3 hours before bed: justgetFlux.com app for electronic devices
9. Vitamin D3 supplements
10. If you snore loudly get a sleep study
11. Keep cool: Ideal is 67 degrees
12. Medicines if the above are not successful: Melatonin, phosphatidylserine, 5-HTP, Valerian, chamomile, St. John's wart . Ambien doesn't give stage 3 or sleep.
13. Don't do activities in your bed besides sleep and sex
14. Avoid caffeine/alcohol close to bedtime
15. Need 8 hours of sleep/night

References:

1. Goal N, Roa H, Durmer JS, Dinges DF. Neurocognitive consequences of sleep deprivation. Semin Neurol. 2009 Sep;29(4):320-39. 
2. Killgore WD. Effects of sleep deprivation on cognition. Prog Brain Res. 2010;185:105-29. 
3. Mullington JM, Simpson NS, Meier-Ewert HK, Haack M. Sleep loss and inflammation. Best Pract Res Clin Endocrinol Metab. 2010 Oct;24(5):775-84.
4. Grandner MA, Sands-Lincoln MR, Pak VM, Garland SN. Sleep duration, cardiovascular disease, and proinflammatory biomarkers. Nat Sci Sleep. 2013 Jul 22;5:93-107. 
5. Vargas PA. The Link Between Inadequate Sleep and Obesity in Young Adults. Curr Obes Rep. 2016 Mar;5(1):38-50. 
6. Lee YJ, Cho SJ, Cho IH, Kim SJ. Insufficient Sleep and Suicidality in adolescents. Sleep. 2012 Apr 1;35(4):455-60.
7. Besedovsky L, Lange T, Born J. Sleep and immune function. Pflugers Arch. 2012 Jan;463(1):121-37. 
8. Cohen S, Doyle WJ, Alper CM, Janicki Deverts D, Turner RB. Sleep habits and susceptibility to the common cold. Arch Intern Med. 2009 Jan 12;169(1):62-7. 
9. Kripke D, Simons R, Garfinkel L, et al. Short and long sleep and sleeping pills. Is increased mortality associated? Arch Gen Psychiatry. 1979;36:103-116.
10. National Sleep Foundation. Sleep in America Poll, 2001-2002. Washington, DC: National Sleep Foundation.
11. Brief communication: Sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Spiegel K, Tasali E, Penev P, Van Cauter E
    Ann Intern Med. 2004 Dec 7; 141(11):846-50.
12. Impaired insulin signaling in human adipocytes after experimental sleep restriction: a randomized, crossover study.
    Broussard JL, Ehrmann DA, Van Cauter E, Tasali E, Brady MJ Ann Intern Med. 2012 Oct 16; 157(8):549-57.
13. https://www.artofliving.org/us-en/yoga/breathing-techniques/alternate-nostril-breathing-nadi-shodhan

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Blue light, electonic devices
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