Why Not Sleeping Enough Makes Some People Gain Weight

Regular readers of these pages will be well aware of the recent slew of evidence suggesting that not getting enough sleep is an important risk factor for weight gain (as anyone who works shifts probably knows from their own experience). But, as always, not everyone appears to be equally affected. A paper by Jean-Philippe Chaput and colleagues from the University of Ottawa, just published in SLEEP, suggests that sleep deprivation may especially tend to promote weight gain in people who tend to be disinhibited eaters. Based on the examination of 276 adults aged 21 to 64 years and followed for 6 years in the Quebec Family Study, Chaput and colleagues found that individuals having both short sleep duration (loss than 6 hours a night) and high disinhibition eating behaviour (as assessed by the three factor eating questionnaire) were more likely to gain weight and increase their abdominal circumference over time. In contrast, short-duration sleepers with a low disinhibition eating behavior trait had the same weight trajectory as those with average sleep duration. Over the 6-year follow-up period, the incidence of overweight/obesity for short-duration sleepers with a high disinhibition eating behavior trait was 2.5 times more frequent than for short-duration sleepers with a low disinhibition eating behavior trait. This increased risk of high disinhibition in short-duration sleepers was largely explained by higher caloric intake. For those of us still dealing with leftovers from yesterday’s turkey, getting enough sleep may help with any ‘disinhibition’ we may experience when opening the refrigerator. AMS Edmonton, Alberta Chaput JP, Després JP, Bouchard C, & Tremblay A (2011). The Association between Short Sleep Duration and Weight Gain Is Dependent on Disinhibited Eating Behavior in Adults. Sleep, 34 (10), 1291-7 PMID: 21966060

Medical Barriers: Obstructive Sleep Apnea

Today’s post is another excerpt from “Best Weight: A Practical Guide to Office-Based Weight Management“, recently published by the Canadian Obesity Network. This guide is meant for health professionals dealing with obese clients and is NOT a self-management tool or weight-loss program. However, I assume that even general readers may find some of this material of interest. OBSTRUCTIVE SLEEP APNEA Poor sleep and sleep deprivation increase blood cortisol levels and decrease serum leptin levels, leading to metabolic changes that promote weight gain and increase appetite. Obstructive sleep apnea (OSA), an important cause of sleep disruption, is highly prevalent among obese patients as obesity causes anatomic and functional alterations in the pharyngeal airway and central nervous system. A 10% increase in weight is associated with a six-fold increase in the risk of developing moderate to severe OSA. OSA increases a patient’s risk for cardiovascular complications such as hypertension, nocturnal arrhythmias, sudden death, etc. It may predispose to worsening obesity through sleep deprivation, daytime somnolence, and metabolic disruptions that limit a patient’s ability to engage in physical activity and make the dietary changes needed for sustainable weight management. To diagnose OSA, the clinician must be aware of the spectrum of acute and chronic neurocognitive, psychiatric, and nonspecific symptoms it can cause, even when patients are unaware that their sleep is disturbed. The Berlin Questionnaire (widely available, as are other validated checklists and questionnaires) is a useful screening tool, though simple questions can also be used, such as, “If you were on vacation, sleeping seven or more hours per night, would you expect to feel well rested?” Other indicative symptoms are loud snoring, awakenings coupled with gasping for breath, frequent awakening during the night, abnormal daytime sleepiness or fatigue, morning headaches, limited attention and memory loss. Polysomnography is the gold standard in diagnosing OSA and assessing the effects of treatment. Although not curative, nasal continuous positive airway pressure (CPAP) is the treatment of choice for most patients because it is non-invasive and technically efficacious. It is important to note that many patients find falling asleep with high CPAP pressures to be difficult. Those patients may find that using automated positive airway pressure (APAP) devices is more comfortable as they will deliver high pressures on demand rather than continuously. For patients with mild to moderate sleep apnea who are unable to tolerate CPAP, a dental device called the Thornton Adjustable Positioner (TAP) may be… Read More »

Medical Barriers: Sleep Disorders

Today’s post is another excerpt from “Best Weight: A Practical Guide to Office-Based Weight Management“, recently published by the Canadian Obesity Network. This guide is meant for health professionals dealing with obese clients and is NOT a self-management tool or weight-loss program. However, I assume that even general readers may find some of this material of interest. CHAPTER 5: MEDICAL BARRIERS Physical co-morbidities are common in people with obesity and need to be addressed as part of any weight-management plan. Co-morbidities associated with obesity will improve as weight is controlled, but often make it difficult for patients to undertake the effort required for lifestyle-based weight management. In some cases, these physical barriers to weight loss may be insurmountable and the focus of treatment should, from the outset, aim to prevent weight gain rather than achieve weight loss. Strategies for obesity treatment should always be adapted to the patient’s particular situation to make it easier for them to cope with required changes over the long-term. SLEEP DISORDERS Sleep disorders are very prevalent among obese people. Obstructive sleep apnea is the most common disorder, but disturbed sleep may also be due to primary insomnia, or insomnia secondary to medications, medical or psychiatric disorders. Sleep deprivation is linked to obesity. The primary putative connection can be found in the neuroendocrine regulation of appetite and food intake. Neuroendocrine regulation appears to be influenced by sleep duration and sleep restriction, with sleep deprivation favouring obesity as it increases serum cortisol and decreases serum leptin levels. Another reason for the sleep disorder-obesity connection may be simply that the more time a person spends awake, the more time they have in which to eat. Insufficient sleep causes important neurocognitive changes such as excessive daytime sleepiness, fatigue and altered mood. These may, in turn, have a significant impact on the patient’s ability to persist with healthy lifestyle changes such as increasing their level of physical activity or taking the time to cook a healthy meal. © Copyright 2010 by Dr. Arya M. Sharma and Dr. Yoni Freedhoff. All rights reserved. The opinions in this book are those of the authors and do not represent those of the Canadian Obesity Network. Members of the Canadian Obesity Network can download Best Weight for free. Best Weight is also available at Amazon and Barnes & Nobles (part of the proceeds from all sales go to support the Canadian Obesity Network) If… Read More »

Preventing Weight Gain in Your Sleep?

Regular readers of these pages will be well aware of the many studies that now show a close association between less sleep and weight gain. In fact, a now often shown slide clearly documents, how steadily decreasing hours of sleep remarkably parallels the steady increase in obesity rates over the past decades. In addition, substantial data from animal experiments clearly documents how sleep deprivation has profound obesogenic effects on appetite and metabolism. So does getting more sleep protect against obesity or even help with weight loss? This question was now addressed by Jean-Phillipe Chaput (CON Bootcamper) and colleagues at the University of Ottawa in a paper just published in the International Journal of Obesity. The researchers analysed data from a 6-year longitudinal, observational study in adults aged 18-64 years. Short-duration sleepers (<6 h per day; n=43) at baseline were divided into two groups: (i) those who increased their sleep duration to a ‘healthy’ length of 7-8 h per day at year 6 (mean increase: 1.52 h per day; n=23); and (ii) those who maintained their short sleep duration habits (mean change: -0.11 h per day; n=20). While both groups had similar baseline characteristics, short-duration sleepers who maintained their short sleep duration experienced a greater increase in body mass index (BMI) (difference: 1.1) and fat mass (difference: 2.4 kg) over the 6-year follow-up period than short-duration sleepers who increased their sleep duration, even after adjustment for relevant covariates. In contrast, there was no significant difference in adiposity measures between short-duration sleepers who increased their sleep duration and a control group of individuals who reported sleeping 7-8 h per day at both baseline and year 6 (n=173). As the authors point out, this is the first longitudinal data suggesting that increasing sleep duration in individuals with short sleep duration is associated with a reduced risk of weight gain. Clearly, it would perhaps now be time for a controlled trial of sleep intervention in short-sleepers with weight problems. While it is unlikely that simply getting more sleep will lead to weight loss – remember, prevention of weight gain is the first sign of success. I wonder if my readers notice any relationship between lack of sleep and their own propensity for weight gain. AMS Edmonton, Alberta Chaput JP, Després JP, Bouchard C, & Tremblay A (2011). Longer sleep duration associates with lower adiposity gain in adult short sleepers. International journal of obesity (2005) PMID: 21654631

How Lack of Sleep Makes You Gain Weight

Regular readers of these pages will recall numerous posts on the profound effect of sleep deprivation on appetite and metabolism – a factor, believed by many, to be a major driver of the obesity epidemic (and not just in kids!). Although epidemiological studies on sleep leave much to be desired both in quality and representativeness, current estimates suggest that we may be sleeping around two hours less than in the 60s. Add to this the increase in night work, extended exposure to artificial light, and a increased eating in the late evening and night hours, and it is not hard to see how these changes would have affected our natural biology. Enough reason for last month’s issue of Best Practices & Research Endocrinology and Metabolism to be entirely dedicated to the topic of Sleep and Metabolism. As pointed out in the preface by Eve van Cauter and David Ehrmann from the University of Chicago, independent observations linking metabolism, sleep and circadian function include the idenfication of the orexin system which links the control of wakefulness with eating behavior, the identification of the circadian ‘Clock’ gene as conferring an increased risk of obesity and diabetes and the “sleep debt study” which showed that short term sleep restriction in healthy young adults results in decreased glucose tolerance (see previous blog entries on all of these landmark studies). The special issue attempts to provide a comprehensive overview of this exciting field with contributions spanning from the molecular circuitry of hypothalamic pathways linking sleep and metabolism to the clinical relevance of sleep for nocturnal hypoglycemia in diabetic patients. Readers may particularly be interested in the following articles in this issue: Role of sleep duration in the regulation of glucose metabolism and appetite (Lisa Morselli et al.) Sleep duration and cardiometabolic risk: A review of the epidemiologic evidence (Kristen L. Knutson) Bariatric surgery and its impact on sleep architecture, sleep-disordered breathing, and metabolism (Silvana Pannain & Babak Mokhlesi) The impact of sleep disturbances on adipocyte function and lipid metabolism (Josiane Broussard & Matthew J. Brady) Sleep loss and inflammation (Janet M. Mullington, et al.) Circadian disruption and metabolic disease: Findings from animal models (Deanna Marie Arble, et al.) Sleep and the response to hypoglycaemia (Kamila Jauch-Chara & Bernd Schultes) Sleep and metabolism: Role of hypothalamic neuronal circuitry (Asya Rolls, et. al.) New evidence for a role of melatonin in glucose regulation (Elmar Peschke & Eckhard… Read More »