How Lack of Sleep Wrecks Your Diet

Regular readers will recall the many previous posts on the relationship between lack of sleep and weight gain. Now new evidence shows that lack of adequate sleep may be even more detrimental in anyone trying to lose weight. In a study published in a recent issue of the Annals of Internal Medicine, Arlet Nedeltcheva and colleagues from the University of Chicago, tested the hypothesis that lack of sufficient sleep adversely affects the neuroendocrine response and metabolic effects of caloric restriction. In a complicated randomised, 2-period, 2-condition crossover study, 10 overweight nonsmoking adults (3 women and 7 men) with a mean age of 41 years and a BMI around 27, were subjected to 14 days of moderate caloric restriction with 8.5 or 5.5 hours of nighttime sleep in a sleep laboratory. Despite the same amount of caloric restriction, sleep deprivations resulted in 55% less fat loss and alarmingly increased the loss of fat-free mass (muscle) by almost 60%. Sleep deprivation was also associated with increased hunger and reduced fat oxidation. The authors conclude that adequate sleep is important to prevent the loss of fat-free mass during weight loss. As a corollary to this, we can perhaps also conclude that trying to lose weight during times of sleep deprivation may be counterproductive in that it is more likely to lead to loss of lean tissue than get rid of the unwanted fat. I have often advised my time-pressed patients that if they had to chose between 60 mins of exercise and 60 mins of sleep to go for the sleep. This is particularly true, as we know that exercise further increases the need for sleep thereby, making the degree of sleep deprivation, which many of my patients already face, even worse. I propose that a careful sleep history (if not a formal sleep study) and sleep counseling should be part of every bariatric assessment and weight management plan. AMS Montreal, QC You can now also follow me and post your comments on Facebook Nedeltcheva AV, Kilkus JM, Imperial J, Schoeller DA, & Penev PD (2010). Insufficient sleep undermines dietary efforts to reduce adiposity. Annals of internal medicine, 153 (7), 435-41 PMID: 20921542

Sleepy Women Have Poorer Health?

According to the National Sleep Foundation’s 2007 Sleep in America poll, just published by Eileen Chasens and colleagues from the University of Pittsburgh in this month’s issue of Behavior and Sleep Medicine, almost 20% of community-dwelling women aged 40 to 60 years reported sleepiness that consistently interfered with daily life. Perhaps not surprisingly, the sleepy subsample reported more symptoms of insomnia, restless legs syndrome, obstructive sleep apnea, depression and anxiety, as well as more problems with health-promoting behaviors, drowsy driving, job performance, household duties, and personal relationships. Further analyses revealed that sleepiness along with depressive symptoms, medical comorbidities, obesity, and lower education were associated with poor self-rated health, whereas menopause status (pre-, peri- or post-) was not. These results point to the high prevalence of daytime sleepiness in midlife women and suggest that addressing the underlying causes of poor sleep and sleep disruption may be an important measure to improve health in this population. Obviously, what applies to the midlife women in this study may well also apply to women of other age groups as well as men – and of course our kids. Perhaps we should all use the long weekend to get more sleep. AMS Edmonton, Alberta p.s. You can now also follow me and post your comments on Facebook Chasens ER, Twerski SR, Yang K, & Umlauf MG (2010). Sleepiness and health in midlife women: results of the National Sleep Foundation’s 2007 Sleep in America poll. Behavioral sleep medicine, 8 (3), 157-71 PMID: 20582759

Resistant Depression? Screen for Sleep Apnea

Depression is a common finding in overweight and obese patients trying to lose weight. So is obstructive sleep apnea. Unfortunately, the symptoms of sleep apnea can mirror those of major depressive disorder: tiredness and low energy levels, lack of interest and motivation to pursue your favourite activities, trouble with concentration, memory or decision making, and weight gain. A paper by Mitsunari Habukawa and colleagues from the Kurume University School of Medicine, Fukuoka, Japan, just published online in Sleep Medicine, reminds us to screen overweight patients who do not respond adequately to antidepressant therapy for sleep apnea. The authors describe 17 patients, who, despite pharmacotherapy for depression, continued having signs of major depressive disorder and were diagnosed with sleep apnea. After two months of CPAP treatment for sleep apnea, their depression scores significantly improved. Improvement in depression scores paralleled the reduction in sleepiness. The results illustrate that patients with depression, who despite adequate pharmacotherapy continue having residual symptoms, should be screened for sleep apnea and treated if found positive. An important corollary to this is that overweight and obese patients presenting with sleep apnea, should perhaps also be screened for signs of major depression. Given the close association between excess weight, depression and sleep apnea, it is probably wise to regularly screen all patients presenting for obesity treatments for both conditions. While simply treating depression and/or sleep apnea in people with excess weight is unlikely to result in significant weight loss, when present, both conditions can pose important barriers to successful weight management and must therefore be adequately addressed. AMS Edmonton, Alberta p.s. Join my new Facebook page for more posts and links on obesity prevention and management Habukawa M, Uchimura N, Kakuma T, Yamamoto K, Ogi K, Hiejima H, Tomimatsu K, & Matsuyama S (2010). Effect of CPAP treatment on residual depressive symptoms in patients with major depression and coexisting sleep apnea: Contribution of daytime sleepiness to residual depressive symptoms. Sleep medicine PMID: 20488748

How Lack of Sleep Can Affect Glucose Metabolism

Regular readers of these pages will recall several posts on the importance of adequate restorative sleep for the maintenance of healthy weights. As blogged previously, reduced sleep is not only associated with increased risk for obesity, but sleep deprivation also has profound effects on ingestive behaviour. A new study by Schmid and colleagues from the University of Luebeck, Germany, published in the Journal of Clinical Endocrinology and Metabolism now shows that sleep deprivation can have profound effects on glucagon levels, a key determinant of glucose control. Their study examined the effects of a single night of sleep restriction to 4.5 hours vs. a night of 7 hours of sleep in a crossover study in 10 healthy men. Sleep deprivation not only reduced basal plasma glucagon levels but also glucagon response to a hypoglycemic clamp, but had no effect on circulating concentrations of insulin, C-peptide, epinephrine, norepinephrine, or growth hormone. Basal concentrations of ACTH and cortisol were also reduced after sleep loss during baseline. This finding provides further evidence for the notion that glucose homeostasis is sensitive to subtle changes in sleep duration. Importantly, as glucagon is a key hormone that helps maintain normal glucose levels during fasting by inducing the liver to convert stored glycogen into glucose and release it into the bloodstream, lack of glucagon release resulting from sleep deprivation could promote eating in response to hypoglycemia, thereby promoting weight gain. This may be of particular relevance to diabetic patients on hypoglycemic medications, who are particularly prone to hypoglycemic episodes. This interesting observation clearly supports the notion that ensuring adequate amounts of sleep should be an important cornerstone of weight management. AMS Edmonton, Alberta

Sleeping Giants in Berlin

This weekend, I attended a Cardiovascular Risk Reduction Symposium in Berlin. Co-incidentally, Saturday also happened to be the 20th anniversary of the fall of the Berlin wall. Some of you may know that I was born in Berlin and lived there when the wall went up, for many years raised my kids in the shadow of the wall (a few blocks from our apartment), and was at the wall the night it came down (you probably saw me waving at the cameras on CNN). So being in Berlin again for the 20th anniversary of this event was quite a treat. One of the highlights of the celebration at the Brandenburg gate was the reunion of two giant marionettes (one of them over 7.5 m high, operated by a whole crowd of liveried puppeteers, who used their own weight to move them around), who for several days wandered the streets of former East and West Berlin before finding each other. It so happened, that on my first night in Berlin, I did in fact see the female puppet sound asleep not too far from the gate (click here to watch the meeting of the giants on YouTube). Speaking of sleeping giants, this may be the place to draw attention to the first large randomized trial on the effect of weight loss on sleep apnea (a common problem in overweight and obese patients). In this study, just published in the Archives of Internal Medicine, Foster and colleagues on behalf of the Look AHEAD Research Group, report on the outcomes of a substudy on obstructive sleep apnea in obese patients with type 2 diabetes: the Sleep AHEAD study. The study included 264 participants (average age 61, average BMI 37) with an apnea-hypopnea index (AHI) of 23.2 events per hour were randomly assigned to either a behavioral weight loss program or 3 group sessions on diabetes support and education. The intensive lifestyle intervention participants lost about 11 Kg more than the control group at 1 year resulting in a dramatic reduction of apnoic events to 10 per hour. At 1 year, more than 3 times as many participants in the intervention group had total remission of their sleep apnea. Initial AHI and weight loss were the strongest predictors of changes in AHI at 1 year. This is the first large randomised-controlled trial to actually demonstrate, what patients and clinicians have long suspected, that even… Read More »