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July 13, 2018

Can sleeping better help you lose weight?

With 2 out of 3 Americans being overweight, a significant portion of the population is seeking a way to shed unnecessary pounds. Traditional weight loss approaches center around diet and exercise, but this overlooks one of the most powerful weight loss tools of all: sleep.  

Many sleep experts believe that optimized sleep care should be integrated into every weight loss program, for its powerful influence over cravings, mood, motivation, insulin regulation, and more. Poor sleep health often leaves you chronically sleep deprived, and an insufficient amount of sleep has two main negative effects on your weight loss efforts.  

First, sleep deprived individuals have consistently been shown to make poor diet choices. This is not due to a lack of willpower, but rather it is a physiological response by the sleep-deprived body. How does all this work? A recent study showed that people who consistently get less than 5 hours a night had significantly different levels of appetite-influencing hormones compared to those who slept an average of 8 hours a night. Those hormones were leptin and ghrelin.

Having low levels of leptin send signals to the body that put it in starvation mode, making you want to consume more calories than you really need. Ghrelin is produced by the stomach and stimulates the appetite. The presence of this hormone, along with leptin, create a two-pronged approach in simulating a feeling of needing to eat. The study reported that those who had a lack of good sleep had 16 percent less leptin and almost 15 percent more ghrelin than those who got a healthy amount of sleep each night.

Second, when you are sleep deprived, you often don’t have the energy to exercise. Being fatigued at the start of the day provides an excuse to not exercise that day, and feeling chronically tired makes it very difficult to consistently exercise.

This combination sets up a vicious cycle when a third variable is introduced: sleep-disordered breathing. Having a breathing issue at night is very common among overweight people, and can range from chronic snoring to sleep apnea, a condition that deprives the body of oxygen and results in a significant sleep deficit. Poor sleep quality can leave you feeling too tired to exercise during the day and prone to poor diet choices.  

Healthier sleep, healthier you

Many sleep experts recommend tackling any sleep issues first to achieve weight loss goals. Getting on a consistent schedule of good quality sleep can cultivate much better habits, because when you’re well rested, you have more energy to work out. You’ll also be better equipped to stick to your diet plans and avoid problem foods.  

Healthy sleep—especially restorative, deep sleep—helps keep us functioning at our best. While we sleep, many important activities take place at the cellular level. Muscles repair and renew themselves. Our brain processes memories of the events of the day. Many other biological actions also occur that keep us healthy, in addition to leaving us feeling refreshed the next morning.

No matter their body type or weight, everyone should be able to enjoy the benefits of restful, restorative sleep. But sometimes, our sleep is interrupted when our breathing patterns change, and many signs point to being overweight as a common cause of these changes in breathing and sleep health.

The importance of healthy breathing

When we repeatedly stop breathing during sleep, it reduces the amount of oxygen available to our bodies for recuperation and repair. And the reason we stop breathing while we sleep could be sleep apnea.  

What is sleep apnea, and why does it happen? When we lie down to sleep, the muscles in our throat, as well as our soft palate and tongue, relax. This, along with the natural pressure of gravity, narrows our respiratory path. This can cause our throat to relax so much that there are momentary lapses in our normal breathing patterns.

These lapses are called “apneas.” They often last between 10-30 seconds, and can occur a few dozen times up to hundreds of times in a single night. Such a high number of apnea events can be detrimental to good health, because the body isn’t receiving the amount of oxygen it needs to function and stay healthy.

Sleep apneas also trigger a brain response of waking the sleeping person up in order to start the flow of oxygen again, which can cause a huge deficit in sleep quality.    

How do you know if sleeping issues like sleep apnea are holding back your weight loss success? Some common symptoms include:

  • Feeling tired all the time, despite getting adequate hours of sleep
  • Snoring at a loud volume
  • Gasping for breath while you sleep
  • Feeling foggy or agitated during the day
  • Falling asleep when you don’t mean to
  • Waking often to urinate
  • Clenching or grinding teeth
  • Morning headaches

Obesity and sleep apnea

There are many biological factors that cause sleep apnea. Not every obese person has sleep apnea, and plenty of people who aren’t obese can still suffer from sleep apnea. However, research strongly indicates that the most consistent predictor of sleep apnea is obesity, in particular central obesity.

Central obesity, also known as abdominal obesity, is when excessive amounts of abdominal fat around the stomach and abdomen are so great that it is likely to have a negative impact on someone’s health.

Neck circumference and sleep health

Generally speaking, a larger neck circumference can also contribute to sleep apnea and poor sleep quality. Research indicates that men with a neck that measures 17 inches or more and women with a neck circumference of 16 inches or more are at increased risk for sleep apnea.

Body composition and weight distribution vary from person to person, but those who are obese tend to have specific fat distributions around their neck. The collapsibility of the throat, as mentioned above, is increased when there is additional pressure put on the neck by these fat deposits.

Weight loss as treatment

The American Academy of Sleep Medicine recommends weight loss as one of their methods for treating sleep apnea. Weight loss is typically achieved through through dietary changes and exercise.

Adjustments in diet

Dietary changes as treatment for sleep apnea can include a reduction in caloric intake along with reduced consumption of carbohydrates. There is strong evidence supporting the effectiveness of lower-carbohydrate diets in promoting weight loss.

The precise reason why lower-carbohydrate diets are so effective for weight loss is debated among the medical community, although one widely agreed-upon theory is that diets very low in carbohydrates appear to have an effect on the hormones that control appetite.

Effects of exercise

A popular theory as to why exercise might reduce sleep apnea severity is that it appears to have a profound effect on the presence of fat deposits around a person’s mid-section. Studies have shown that exercise training—even when no significant overall weight loss occurs—can achieve significant reductions in fat around one’s middle.

During one 6-month long study on older adults with hypertension, exercise training was associated with reductions in total abdominal fat by 12% and abdominal visceral fat—fat stored within the abdominal cavity itself—by 18%. These results were achieved despite an average total body weight loss of just 4.8 lbs for each participant.

Goodbye, CPAP

A CPAP is a special machine that keep the airway open at night, and consists of a mask and hose that delivers pressurized air into the respiratory pathway.

A recent piece of research sought to test the weight loss progress of participants who only used a CPAP, those who only exercised, and those who received a combination of both. Among the patients, those instructed to just focus on weight loss and those assigned to both lose weight and use a CPAP saw reductions in insulin resistance, CRP levels, and serum triglyceride levels. None of these changes were seen in the group who only used the CPAP.

There are also stories of those who are overweight and, with a combination of diet and exercise, wean their way off of using their CPAP over a period of time. It is estimated that a 10 percent body weight loss may reduce the severity of sleep apnea.

Healthier sleep, healthier life

The feeling of waking up well-rested and refreshed is like no other. Making sure your body has a steady flow of oxygen during sleep is crucial to good sleep health. At some point in our lives, many of us have experienced how a lack of sleep from the night before can negatively affect us the next day. It’s not just a question of feeling tired and slow—your body is craving the oxygen it needs.

Keeping airways open so that oxygen may flow more freely through our respiratory system is a crucial task in ensuring good sleep health. With weight loss—and the smaller waistline and trimmer neck circumference that can come with it—you’ll be doing wonders for your nighttime oxygen intake.

Brandon R. Peters, M.D., is board-certified in both neurology and sleep medicine and currently practices at Virginia Mason Medical Center in Seattle. He is also a clinical faculty affiliate at Stanford University's School of Medicine in the Department of Psychiatry and Behavioral Sciences. His latest book, Insomnia Solved, is available on Amazon.

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