Dieting seems to have overtaken baseball as our national pastime. There are many proposed reasons for the current obesity epidemic, including factors such as poor diet, lack of exercise, and simply eating too much. But your ability to sleep well and breathe well can also determine how quickly you can lose or even gain weight. Conversely, your weight can also determine how well you breathe and sleep. This is why that all three of these factors combined can create a vicious cycle of weight gain, loss of sleep and inability to breathe.
Sleep Less, Gain Weight
Recent research studies reveal that lack of sleep (or poor quality sleep) is linked to obesity. The less you sleep, the more your body alters the normal body signaling hormones, like cortisol and leptin that regulate your appetite.
Leptin provides information about energy status to regulatory centers in the brain. Levels increase at night partly due to daytime meal ingestion. In sleep deprived people, however, the level of leptin seems to drop significantly at night. On the other hand, the hormone that stimulates hunger and food intake, or cotisol, was found African Lean Belly to increase in response to experimental sleep deprivation, as well as in insomniacs.
It's a known fact that lower levels of leptin, the hormone that tells the body when it has eaten enough, are associated with higher levels of cortisol (especially at night). Therefore, when the level of leptin decreases, as in the case of those who are sleep deprived, it causes the level of cortisol to increase, thus making you eat more. Furthermore, Ghrelin, another hormone that makes you want to eat, rises as well when you don't sleep well. Thyroid stimulating hormone, or TSH, is also found to be markedly affected by sleep deprivation. Since thyroid levels affect your metabolism, this will affect your weight as well.
Sleep loss has also been found to raise blood sugar levels in your bloodstream. Add to this the elevated level of cortisol which is also known to raise sugar levels. As you can see your loss of sleep can trigger a whole host of hormonal fluctuations that can derail your dieting efforts. But the implications of what I just described is just the tip of the iceberg. If you're also not breathing well while you sleep, you may find losing weight a losing proposition.
Breathe Well, Sleep Well, Lose Weight
When trying to lose weight, you must also be able to breathe well at night while you sleep. Although many of us take this as a given, many patients who are thin and not overweight, can nonetheless find them selves gaining weight rapidly, without any significant increase in caloric intake, if they are already predisposed to a narrow airway and having difficulty breathing during sleep. Many of my patients who have this sleep breathing condition called UARS (upper airway resistance syndrome) compensate therefore by sleeping on their side or stomach and staying active as these are preventative measures.
But over the years, something happens that triggers a slow descend on the sleep-breathing spectrum, which aggravates mild weight gain. Even a few pounds for these patients can make big difference since mild weight gain in the throat narrows the fat cells in your throat, and this, in turn, causes the soft tissues in the throat to grow inwards, encroaching on the airway. This aggravates more palate or tongue collapse which causes more arousals or apneas. This, in turn, causes inefficient sleep, which spins off the entire metabolic response that I described earlier. Also, as you gain more weight you begin to have more apneas which can lead to other health problems like high blood pressure.
Why Can't I Sleep?
In this fast-paced, high-stress society, sleep is the first thing that is sacrificed when we're short on time. It's estimated that compared with 50 years ago, people in America are sleeping about 1 and 1/2 to 2 hours less per night. Although this seems like a small amount, any shortage of sleep can accumulate into something called a "sleep debt" that gets harder and harder to make up over time. Add to this poor dietary habits and the vicious cycle that I described earlier, along with less physical activity, I'm not surprised that well over 50% of adults in this country are considered obese.
Diets: What Have I Got To Lose?
It's understandable then why there are so many diet programs being sold in this country. From diet pills, to exercise regiments, there are a dizzying array of choices all geared toward helping you to lose weight. However, what's interesting to note is that there's not much emphasis on helping you keep the weight off once you lose it (most likely because their products become useless once you lose the weight). There's definitely none that I'm aware of that suggests you must breathe and sleep well to maintain your ideal weight. They just assume that if you were "medically qualified" to undergo their weight loss regiment, that these and other health factors were a given. However, as I stress to patients all the time, weight loss will be difficult to maintain if you have a sleep breathing problem that's not being addressed as well.
As such, my general recommendation for dieting is to avoid anything that stresses too much of one thing, or cuts out too much of another. Instead, eat a variety of whole foods (natural, unprocessed foods with no chemicals, preservatives, or additives, taken as close to the source as possible). It's not how much you eat (or don't eat), but what you eat at what time and how frequently, that's most important.
Consider for instance your typical Sumo wrestler's diet. Sumo wrestlers only eat one big meal a day. They also skip breakfast, which lowers their metabolism, and exercise intensely during the day. After starving themselves all day they consume large quantities of food (typically high in calories) at one sitting right before they go to bed. This, as you can imagine, causes tremendous strain on their bodies which in turn reacts by going into "starvation mode" essentially promoting long-term energy storage and fat production. Definitely not something you want to happen if you're trying to lose weight. However, I know from having heard this over and over again from many patients, that this kind of "diet" is all too common for many of you.
A Dieting Nightmare: Eating Before Bedtime
Eating late just before bedtime is probably the single most common habit that I see that can aggravate the sleep-breathing-weight gain cycle.
Think of it this way. Your airway is like a straw, and the narrower it is, the more prone it is to collapse. If your tongue falls back occasionally and you obstruct (more likely on your back), you will take a few breaths inwards against a closed throat, causing a tremendous vacuum effect that pulls stomach contents into your throat. If there is more stomach acid present because you just ate a meal, then there is more acid to be sucked up into your throat, which can then then go on to irritate your throat and cause more swelling, which aggravates more obstruction which causes you to breathe less efficiently which causes you to sleep less. This vicious cycle continues making it very difficult for you to lose the weight.
Most diet experts recommend that you eat many small meals spread evenly apart (4-5 meals), rich in foods that are low in what is called the glycemic index. The glycemic index is a measure of how quickly the sugar is absorbed into the bloodstream. Foods such as pasta and white rice can be processed and absorbed quickly into the bloodstream, whereas barley and soymilk have a low glycemic indexes, taking more time to be digested and releasing the sugars into the bloodstream. With low glycemic index foods, you won't feel as hungry just after you eat.
So why do so many people who diet and exercise have such a hard time losing weight? I'm willing to bet that if you look closely at their sleep habits, either they don't sleep long enough or something keeps them from achieving deep efficient sleep, such as a sleep-breathing problem. Anecdotally, many patients who have sleep related breathing disorders and are overweight find it easier to lose weight once they are treated for their sleep-breathing condition. So the next time you begin your diet program, make sure you incorporate a good sleep hygiene program. That could make the difference between just losing the weight or losing the weight and keeping it off for good.