Sleep deprivation

Lack of sleep leads to weight gain and vicious cycle

 

A cascade of side effects from a lack of sleep can lead to runaway weight gain, which itself can trigger even more unhealthy physiological events.

hcohen@MiamiHerald.com

Lack of sleep can be causing you to gain weight.

At the same time, weight gain and obesity can lead to sleep deprivation or potentially deadly sleep disorders like obstructive sleep apnea, a problem caused when the muscles in the back of the throat fail to keep the airway open and halt breathing repeatedly during sleep and jolts one out of necessary, restful deep REM sleep.

It’s a curious Catch-22 but there are medical reasons for the phenomenon — and remedies.

“There are two big hormones related to weight and sleep,” explains Dr. Timothy Grant, medical director at Baptist Sleep Center at Sunset. “One is ghrelin, a hormone that increases your appetite, tells you what to eat. Then there is leptin, and that is associated with satiety, it tells you when you have had enough to eat.”

When you are sleep-deprived, these hormones throw your metabolism out of whack. Ghrelin is boosted. Imagine hitting the gas pedal. At the same time, leptin is reduced, akin to removing the stop signs on a road. The combination of more ghrelin and less leptin means open-throttle at the junk food buffet — or weight gain. The cycle is frustrating and dangerous and impacts adults, as well as children.

In addition to obesity and hormonal changes, lack of sleep can increase blood pressure and lead to depression, lethargy, confusion, irritability, heart disease, diabetes, strokes and even cancer, Grant said. Sleep apnea can also spike blood pressure in the daytime and, in extreme cases, be a factor in death, as with actors John Candy ( Uncle Buck) and Divine ( Hairspray), Grateful Dead guitarist Jerry Garcia and NFL Hall of Famer Reggie White.

Sleep-deprived people — estimates suggest that more than 40 million Americans are not getting the recommended seven to eight hours of good sleep a night — can be too tired to exercise during the day to help counteract the hormonal changes. These changes physiologically compel them to binge on fatty, salty, “bad” carb foods.

Grant cites the new tag, “social jet lag,” which is related to sleep deprivation and is similar to traveling across time zones that can mess with your internal rhythms.

“What we all do is have one sleep pattern during the week, and it’s different on weekends. That’s classically with teens and college students on weekends who party until 3 a.m. and get up the next day at 2. You can’t really make up for it, it really wreaks havoc on your internal system,” Grant said.

One recent study by the University of Wisconsin looked at hormone levels linked to sleep deprivation in 1,000 volunteers. The participants who had less than the recommended eight to nine hours of sleep at night had lower levels of leptin, so they felt less full, and higher levels of ghrelin, so they gained more weight — results that confirmed what scientists already knew about the detrimental effects of poor sleep.

Grant also cited the school’s 2013 study on how sleep deprivation also compels the brain to signal overeating of exactly the kinds of foods — sweets and fatty — that lead to the most weight gain.

For this study, published in the journal Neuropsychopharmacology, Wisconsin researchers deprived rats of sleep by having them walk on a treadmill when they normally would be asleep, thus disrupting their regular sleep patterns. Researchers compared the rats with rodents who had the same amount of exercise, but during their regular awake periods, and to hungry rats fed a reduced diet.

Only the sleep-deprived rats showed a strong response in the part of the brain that regulates the effects of natural rewards and abusive drugs. This triggered opioids that “tend to magnify the pleasures of eating junk food, including sweet or high-fat foods,” said lead author Dr. Brian Baldo in a University of Wisconsin report. These rats gained 2 1/2 times more weight than the others.

The same results were found among children in a recent study by Massachusetts General Hospital for Children published in Pediatrics in May. Kids who were sleep-deprived were 2.5 times more likely to become obese than those who slept fewer than nine hours for children ages 5 to 7, 10 hours for children ages 3 and 4 and 12 for the first two years. The hormonal changes in ghrelin and leptin were the same as for adults, but fat pockets deposited in children can lead to a lifetime of weight gain and create difficulties in shedding the poundage.

“There’s an association very clearly seen in children, a linear relationship between lack of sleep and obesity,” agreed Dr. Jesse Reeves-Garcia, director of the Division of Gastroenterology and Nutrition at Miami Children’s Hospital, who was not involved in the Massachusetts study.

“The problem is three-fold,” Reeves-Garcia said. “With sleep loss, they get tired and decrease activity. Different hormones increase hunger and they spend energy in an unwise way. And they are more awake and eat a lot, and the type of food they eat is bad. That leads to more obesity, and the worst part is obesity leads to sleep apnea, which leads to more restless sleeping.”

Children are also presenting with fatty liver, which can develop into cirrhosis. “The numbers are scary, where 32 percent of kids in the U.S. in 2011 were overweight, obese [at] 17 percent, and extremely obese was 4 to 8 percent. And this number is increasing,” Reeves-Garcia said.

The results of these studies also suggest that messing with the natural internal clock can lead to weight gain. Eating fatty, heavy meals that take longer to digest will alter sleep patterns.

“The heavier the meal you eat late at night, the worse it is for you to gain weight,” Grant said.

So, what to do?

Surgery is an option to change the shape of the jaw or cut the soft tissues, like the uvula, that get in the way of breathing during sleep. But surgery is generally not particularly effective for most patients who suffer from sleep apnea, said Dr. Belen Esparis, medical director of Mount Sinai Medical Center’s Sleep Disorders Center. “Only 40 percent of those people would get better — doesn’t mean they’d be cured from apnea. Improved, but not cured.”

Instead, patients will often be referred to a sleep center like the ones at Baptist, Mount Sinai and the University of Miami. These outpatient centers offer treatments for sleep apnea, narcolepsy, insomnia, restless leg syndrome, circadian rhythm abnormalities, R.E.M. behavior disorders and other sleep-related issues.

After a referral from a physician, patients check into the sleep center, much like a hotel for an overnight stay. Patients are fitted to computers via wires and pads that test areas like breathing, blood oxygen and limb movement during sleep. Technicians monitor the results, and a treatment plan is formulated.

Often, a CPAP mask, a portable device that delivers measured doses of air into the airway to keep it open, will be recommended. “They have become lighter and smaller every day. They have evolved greatly in the last 10 years,” Esparis said.

Good old-fashioned discipline can go a long way in improving your sleep health. Consider adhering to a proper diet, getting regular exercise, formulating regular bedtime practices like turning off all electronic devices an hour before sleep and limiting TV/video time for the kids.

“For patients who are obese, weight loss is always recommended,” Esparis said. “I’ve had patients lose a significant amount of weight, and that has been curative, so they don’t need to use the [CPAP] machine anymore.

“For some, it’s a treatment for life, like high blood pressure. It tends to be a chronic condition. One way to break that vicious cycle is to normalize the metabolism.”

Where to get help

Sleep centers offer outpatient care. Here are some in South Florida:

Baptist Sleep Centers: Call 786-467-5240 in Miami-Dade or 954-837-1400 in Broward, or visit http://sleep.baptisthealth.net/

Memorial Health Care Systems Sleep Study Program: Call 954-442-8694 or visit http://www.mhs.net/services/sleep-disorder-treatment/

Mount Sinai Center for Sleep Medicine: Call 305-674-2121 or visit http://www.msmc.com/clinical-services/sleep-disorders-center

UHealth Sleep Center at the University of Miami: Call 305-243-9999 or visit http://uhealthsystem.com/sleep-center

Follow @HowardCohen on Twitter.

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