Tuesday, March 8, 2016

Sleep and Weight Gain: Natural Ways to Improve Sleep Without Medication

Most of us are familiar with that cranky, foggy feeling which happens when we lose a night of sleep, and most have heard that sleep deprivation can suppress our immune system, and make us more susceptible to infection and illness. But many do not realize that good quality sleep is not only important for mood and immune system health, but is also incredibly important in our quest for a healthy weight.  Insomnia and sleep deprivation can set off a cascade of hormonal and chemical events in our bodies which end up slowing down our metabolism, increasing our cravings for unhealthy food, increasing inflammation and blood sugar problems. Lack of sleep impairs the function of our appetite hormones leptin and ghrelin, worsens insulin resistance, and increases inflammatory blood markers.  Out of desperation, many turn to medications - both over-the-counter and prescription - and sadly these can have a variety of side effects, and ironically can actually cause weight gain, adding fuel to the fire.  Besides weight gain, side effects of these medications may also include next-day “hangover” effects such as foggy thinking and impaired motor control (“Benadryl” or diphenhydramine, the active ingredient in many over-the-counter sleeping pills, is notorious for causing weight gain and “hangover” effects.). Some prescription medications disrupt our REM sleep (dream sleep)  quality, and REM sleep is important for healthy brain function and memory.  Some of these medications are actually associated with dementia with long term use!  Some people turn to alcohol in the hope it will relax them and help with sleep, but alcohol also disrupts REM sleep - so people think they are sleeping, but they are getting poor quality, non-restorative sleep (alcohol also leads to acid reflux, which itself can disrupt sleep.). If this all sounds hopeless, don’t despair.  Let’s look at some common causes of sleep disruption, how lack of sleep can damage our health and cause weight gain, and then discuss some natural strategies to improve sleep quality.

Chronic sleep deprivation -and even short-term sleep disruptions - can set us up for weight gain and illness by triggering a cascade hormone and metabolic problems, including inflammation, insulin resistance, immune system suppression, and can even cause our natural “fullness signals” to malfunction.  When we lose sleep our metabolism slows down, our appetite ramps up, and multiple hormonal and neural changes lead to weight gain.  WebMD interviewed sleep expert Dr.Michael Breus, who explains how sleep deprivation affects our “fullness signals”: “The two hormones that are key in this process are ghrelin and leptin. “Ghrelin is the ‘go’ hormone that tells you when to eat, and when you are sleep-deprived, you have more ghrelin,” Breus says. “Leptin is the hormone that tells you to stop eating, and when you are sleep deprived, you have less leptin.”
Research by the Endocrine Society shows that “Losing as little as 30 minutes of sleep per day on weekdays can have long-term consequences for body weight and metabolism...compared with participants who had no weekday sleep debt, those who had weekday sleep debt were 72% more likely to be obese, and by the 6-month mark, weekday sleep debt was significantly associated with obesity and insulin resistance.”  Research published in the American Journal of Clinical Nutrition shows that after only five days of shorter sleep, people consumed about 300 extra calories per day, and this “was mostly due to an increased consumption of fat, notably saturated fat.”  Ironically, excess saturated fat not only contributes to inflammation and insulin resistance, it may actually worsen sleep itself, since fat consumption can lead to acid reflux (because fat relaxes the “valve” at the top of the stomach, allowing acid to flow upward into the esophagus.).

Lack of sleep can be caused by sleep apnea, sleep disorders of other types, restless leg syndrome, anxiety, depression, work schedules, hobbies or television that that extend too late into the night, difficulty falling asleep (“sleep-onset” insomnia), or waking in the middle of the night and being unable to get back to sleep (“early morning waking”).  It is important to speak with a medical provider to determine the most likely cause of your sleep deprivation. Sleep apnea can have serious health consequences and should not be ignored. Depression can lead to waking up several hours after falling asleep and causing inability to get back to sleep; this may be due to a serotonin issue, and also should be discussed with your medical provider.  However, it can be normal for some people to wake in the middle of the night, then go back to sleep, and they may have no ill effects if their overall quantity and quality of sleep are adequate.  There is an interesting article on this in the New York Times that discusses this "first sleep, second sleep phenomenon”, which may be a normal variant for human sleep.  If you feel rested and alert in the morning, there is likely no reason for concern.  On the other hand, if you wake feeling drowsy, unrefreshed, with a headache or other symptoms (or your partner reports loud snoring or other symptoms of sleep apnea), it is a good idea to check with your medical provider.

An extremely common form of insomnia is difficulty falling asleep. Patients often turn to over-the-counter treatments or to their medical providers to request a prescription medication. While these may be useful in the short-term, they can have significant side effects.  Over-the-counter medications such as Benadryl ( otherwise known as diphenhydramine) can have multiple side effects such as weight gain, next-day sedation known as a "hangover", motor coordination problems, and can have interactions with other medications. This is the most common ingredient in typical over-the-counter sleeping pills such as Unisom, Tylenol PM, etc. those medications may sound unique but in reality they are just Benadryl or Benadryl mixed with Tylenol or ibuprofen.  Benadryl/diphenhydramine is a common and unrecognized cause of weight gain.

Prescription medications for sleep are commonly in the benzodiazepine class, and these may have multiple side effects including blocking important REM sleep, causing sleep eating (a phenomenon in which people eat bizarre, often high calorie foods in a sort of stupor similar to sleep walking while they are asleep), and long-term use of benzodiazepine sleep medications is associated with dementia.

In light of all of these problems it is important to know that there are non-medical ways to enhance sleep and improve symptoms of insomnia. These include methods known as "sleep hygiene". This has nothing to do with cleanliness but rather creating an environment that is conducive to sleep.
The bedroom should be kept cool, very dark with no lights particularly no blue light, and quiet or with a "white noise". White noise can be provided by a fan, gentle music, or a device designed for the purpose which might sound like rain or waves.

It is important that the room be kept free of distractions such as animals jumping on the bed or scratching at the door.  It is also important to avoid stressful situations, tension, or problem-solving, for several hours prior to bed.  Mediation, or progressive muscle relaxation, other the other hand, may be helpful.  Some people find a warm bath or shower before bed maybe soothing and relaxing and help sleep.

It is important to avoid electronic devices such as televisions and smart phones, particularly those which emit blue light, as these may trick your brain into thinking it is daytime, and stimulate an area in the brain called the RAS which can keep you awake.. Some people find it relaxing to read a calming book with a warm, soft light before bed. Be sure to avoid exciting stories, such as mysteries with cliffhangers. If you read, consider a tactic some of my patients use: choose books about favorite hobbies such as music, history, quilting, photography, etc. Some have even browsed healthy cookbooks to help them fall asleep.

Thirty minutes per day of cardiovascular exercise may enhance sleep - but it may be best to do earlier in the day. Some people can hit the gym at night and still sleep well, but others find that evening exercise makes it difficult to fall asleep.  On the other hand, gentle stretching exercises may help you relax and fall asleep more easily.

Stimulants such as caffeine or theobromine or theophylline (which are present in coffee and tea) should be avoided after noon.  Be sure to watch out for hidden caffeine sources such as certain orange soda drinks, cappuccino flavored or coffee flavored items, etc.  Even green, white, and oolong tea have caffeine, unless they specifically say they are decaffeinated.  Avoid any herbal tea which is touts itself as “energizing”; opt for camomile, red rooibus, or other stimulant-free teas.

No alcohol or fatty foods should be consumed before bed since both of these can lead to acid reflux which can interrupt sleep. Alcohol additionally causes an abnormal sleep pattern, and while alcohol may seem to induce sleep,  it actually blocks good quality, "restorative" sleep, particularly REM sleep.  We need REM sleep for good cognitive function and memory consolidation (creating and keeping memories.)


A small snack before bed which contains carbohydrate and a small amount of protein may help some people become sleepy by increasing tryptophan and serotonin levels which may be calming. Again it is important to avoid high fat foods particularly those high in saturated fat before bed.
Herbal supplements such as melatonin and valerian may be helpful. It is important to check with your medical provider to make sure there are no medication interactions or medical problems which would make these dangerous to use. WebMD and the University of Maryland websites are excellent sources to read about herbal supplements, their possible benefits, side effects, and interactions.

Sleep is incredibly important for our physical and mental health, as well as weight management.  The best approach to getting quality sleep is not to try to find a “single magic pill”, but instead employ a “holistic” strategy, creating an optimal environment for our best sleep.  Sweet dreams!

If you would like help fine-tuning your healthy lifestyle plan, including nutrition, exercise, sleep, behavioral strategies, AND would like help with any medical conditions related to weight and health, we can help!  Read more about our program here:  healthyweightcenter.com
Call any time:  (603) 379-6500.

References:
http://www.eurekalert.org/pub_releases/2015-03/tes-l3m030515.php
http://dailyburn.com/life/lifestyle/how-many-hours-of-sleep/
http://www.huffingtonpost.com/2015/04/16/sleep-deprivation-effects-weight-loss_n_7071698.html
http://ajcn.nutrition.org/content/early/2011/06/29/ajcn.111.013904
http://www.journalsleep.org/ViewAbstract.aspx?pid=29022
http://www.webmd.com/sleep-disorders/excessive-sleepiness-10/lack-of-sleep-weight-gain?page=2
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2929498/#!po=1.11111
https://www.psychologytoday.com/blog/the-gravity-weight/201405/down-the-rabbit-hole-when-medication-leads-weight-gain
http://www.health.harvard.edu/blog/benzodiazepine-use-may-raise-risk-alzheimers-disease-201409107397
https://www.psychologytoday.com/blog/dream-catcher/201112/psychopharmacology-rem-sleep-and-dreams
http://flipper.diff.org/app/items/info/5332
Benzodiazepines and REM sleep
http://umm.edu/health/medical/altmed/condition/insomnia
http://www.nytimes.com/2012/09/23/opinion/sunday/rethinking-sleep.html?_r=0
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3548567/
http://www.sciencedaily.com/releases/2008/09/080902075211.htm

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