One More Reason to Get Checked: Sleep Deprivation Can Cause Weight Gain

It’s no surprise that I use my blog as a forum to educate you on various sleep disorders, and the many reasons to get them diagnosed and treated properly. At the risk of sounding alarmist, not getting a sleep issue checked out—even one you may think is fairly benign—can have dire consequences.

Conditions such as sleep apnea that cause sleep deprivation are linked to poor concentration and memory, increased risk of diabetes, hypertension and high blood pressure, heart attacks and strokes, depression and sexual dysfunction.

As if these reasons aren’t enough to scare you into getting tested, here’s another one that just came out: Lack of sleep is now linked to overeating, and as a result, weight gain. That information was just announced at the American Heart Association’s Epidemiology and Prevention/Nutrition, Physical Activity and Metabolism 2012 conference in San Diego.

To be more specific, according to the study’s abstract, sleep is an important regulator of metabolism and energy expenditure. When acute sleep deprivation occurs, the hormone leptin is reduced, while the hormone ghrelin is increased, promoting caloric intake, but not energy expenditure. The likely result is weight gain.

A quick lesson in endocrinology:

Leptin and ghrelin are appetite hormones. Leptin helps regulate hunger, appetite, and metabolism. When you have low levels of leptin in the body—perhaps due to sleep deprivation—the hormone will tell receptors in the hypothalamus of the brain, “Hey, I’m hungry, feed me.” Normal healthy levels of leptin, on the other hand, will let the brain know that you’ve had enough and are no longer hungry. 

Ghrelin is known as the hunger hormone because its job is to tell the hypothalamus when you are hungry and need to eat. That is why ghrelin levels are elevated in the body when you are hungry, and decrease after you have eaten. Ghrelin also promotes fat storage, and has been linked to the accumulation of abdominal fat.

It stands to reason, then, that if sleep deprivation reduces leptin—causing you to feel hungry—and increases ghrelin—also causing you to feel hungry and eat, then sleep deprivation is likely to lead to overeating and weight gain.

So, how did the researchers come to this conclusion?

Virend Somers, M.D., Ph.D., professor of medicine and cardiovascular disease at the Mayo Clinic, Rochester, Minnesota and his colleagues conducted an eight night sleep test on 17 people—11 men and six women—between the ages of 18 and 40.

Eight of the subjects in the “random group” were made to sleep less than they normally do, while the other nine in the “control group” slept their normal amount of time.

All subjects were able to eat as much as they wanted throughout the testing periods, and their daily caloric intake was measured. In addition, their daily sleep times and energy expenditures were measured, and their blood was collected at the end of the test period.

The results of the test are interesting: The sleep deprived group—who slept one hour and 20 minutes less than the control group per night—ate around 549 more calories per day than the normal sleep group. However, the sleep deprived group who ate more did not expend much more energy than the normal sleep group.

The conclusion again is: Less sleep, plus more calories and no increased activity equals more weight gain. It’s a vicious cycle. So let’s turn this equation around. When you sleep well and get enough rest, you help your body to function properly, including your appetite, metabolism and the hunger hormones mentioned above.

And so I continue my tireless crusade against sleep disorders. If you’re having trouble sleeping, from sleep apnea, snoring or some other disorder, get it checked out and treated by a qualified sleep doctor. Doing so could save you a lot, including a few notches around your belt.

To read the abstract of the study, see Insufficient Sleep Increases Caloric Intake but not Energy Expenditure.

Sleepy on the Job? Tips for a Better Night’s Sleep

There’s no denying that sleep deprivation, and the health issues that result, are becoming more prevalent in our go-go, techno society. But a recent sleep study by the National Sleep Foundation (NSF) grabbed my attention as particular cause for concern.

Every year, the NSF releases a Sleep in America® poll.  For its 2012 survey, the NSF examined the specific sleep habits and work performances of transportation workers—pilots, train operators, truck, bus, taxi and limousine drivers. The transportation workers were asked about the duration and quality of their sleep, specifically on work nights, and how it affects their work performance.

Some of the results of the survey are:

• About one-fourth of the train operators and pilots polled said that sleepiness has affected their job performance at least once a week.
• One in five pilots polled—about 20 percent—said they have made a “serious error” as a result of on-the-job sleepiness.
•  One in five pilots and one in six train operators admit to a “near miss” due to on-the-job sleepiness.
• Pilots and train operators are more likely than non-transportation workers to have been involved in a sleep-related car accident while commuting.
• Among all workers surveyed, train operators and pilots report the most work day sleep dissatisfaction.
• Almost two-thirds of train operators and one-half of pilots say they rarely or never get a good night’s sleep on work nights.
• About one-third of bus, taxi, and limo drivers said they rarely or never get a good night’s sleep on work nights.

The results of the poll are some cause for alarm, and reinforce the growing problem of sleep disorders and the potential risks they pose, such as commuter car accidents and errors by public transportation drivers responsible for many people.

Persistent sleep problems left untreated can also lead to myriad health problems, including memory and concentration problems, increased risk of high blood pressure, hypertension, stroke and heart attacks, depression, diabetes and sexual dysfunction. Severe cases of sleep apnea can even be fatal.

Besides these sobering health risks, an untreated sleep disorder can also be the root cause of poor performance at work or school, car accidents and other activities that require focus and concentration.

Common Symptoms of Sleep Disorders

Many people experience some occasional difficulty sleeping and/or daytime fatigue. But how does a person know if he or she has a temporary sleep problem that can be remedied with some simple behavioral changes, or if it is a legitimate disorder such as snoring, sleep apnea, sinusitis or nasal obstruction that should be diagnosed and treated properly?

The first step is to be aware of some common symptoms of sleep disorders. Keep in mind that symptoms vary between disorders, such as snoring, sleep apnea, insomnia, restless leg syndrome, nasal obstruction, narcolepsy, so it pays to do some research based on what you are personally experiencing.

Some common symptoms of sleep disorders include:

• Trouble falling asleep at night
• Waking throughout the night
• Chronic snoring
• Morning headaches
• Poor memory
• Daytime sleepiness/falling asleep during the day/low energy
• Bad moods/ irritability
• Increased depression
• Trouble concentrating/driving/making decisions

The Link Between Lifestyle and Sleep Problems

If you or someone you know is experiencing some of the above common symptoms of sleep disorders, the next step is to examine if lifestyle habits are contributing to the difficulty sleeping, fatigue and irritability during the day and other symptoms.
Some behavioral/lifestyle questions to ask include:

• Am I watching TV or using the computer late at night and too close to bedtime?
• Am I consuming too much caffeine during the day?
• Am I taking a medication that may be affecting my sleep quality and duration?
• Is there something particularly stressful going on in my life that is causing me worry and anxiety?
• Am I exercising enough to help alleviate some of that stress and tension?

See a Specialist—And Be Specific

Many sleep problems can be remedied by making some common sense behavioral changes. However, if you or someone you know is experiencing one or more of the above symptoms on a regular basis, see a qualified ear, nose and throat doctor or otolaryngologist to get diagnosed and treated properly. There are multiple options and minimally invasive techniques available today to treat your sleep disorder.

When you see a specialist, be specific about the symptoms you are experiencing. Many times, sleep apnea and other sleep disorders can be misdiagnosed as chronic fatigue, insomnia, depression, or some other non-specific condition. Some doctors, for example, still associate sleep apnea more with men than women, and are too quick to prescribe a medication, rather than do a full sleep disorder work up.

It may help to keep a sleep log (or, more accurately, lack of sleep log) next to your bed to write down what you are experiencing, when you wake and some symptoms you experience. Again, to try and avoid misdiagnosis, go to a qualified sleep specialist and be specific about your symptoms. Don’t wait — it could save your life.

To read the full report, see “Sleepy Pilots, Train Operators and Drivers”  on the National Sleep Foundation website.

The Relationship between Seasonal Affective Disorder and Sleep Problems

One of the most common questions I get in the office during the winter months has to do with seasonal affective disorder: What is it? Do I have it? And what can I do about it? Seasonal affective disorder is a very real form of depression that may affect six out of every 100 people in the United States, according to the American Academy of Family Physicians.

Symptoms of SAD generally manifest in late fall, when the days become shorter and colder, and people enjoy less natural sunlight. Symptoms include, but are not limited to, feelings of sadness, hopelessness and helplessness, lack of energy, loss of sexual interest and usual pleasurable activities, irritability and restlessness, cravings for carbohydrates and overeating (which can lead to weight gain and compound negative and depressive feelings), trouble concentrating, difficulty sleeping and/or insomnia and at the extreme end—thoughts of death or suicide. Symptoms of SAD are usually most intense during the darkest months of the year, so it stands to reason that the farther a person lives from the equator, the higher the incidence of SAD occurs.

These sleep-related symptoms are of particular interest to me, and are usually the catalyst for a person with SAD to come see me for a consultation and treatment. A person with SAD who suffers from sleep problems may go to sleep early and stay in bed for nine or ten hours, but not experience refreshing sleep.  Because of a lack of restful sleep, people with SAD are often drowsy and have trouble concentrating and working during the day.

The relationship between sleep and depression is a bit of a “chicken or the egg” relationship. Which came first? SAD-related depression, or the sleeping problems? It depends. For some, symptoms of SAD occur first—for others, sleep problems appear first. Depression may cause the sleep problems, and sleep problems may cause or worsen the other SAD symptoms.

There is a common link between people with depression and insomnia. Studies have shown that people with insomnia have a ten-fold risk of developing depression compared with people who sleep well. Further, developing depression is highest among those with both sleep onset and sleep maintenance insomnia.

People with depression may also experience insomnia symptoms, including difficulty falling asleep, difficulty staying asleep, experiencing restful sleep and daytime sleepiness. People who suffer from depression are also five times more likely to have a breathing-related sleep disorder than non-depressed people, according to a study at the Stanford University School of Medicine. The 2003 study by Stanford researcher Maurice Ohayon, MD, PhD, found that people with depression were found to be five times more likely to suffer from obstructive sleep apnea (OSA), the most common form of sleep disordered breathing. This was one of the first studies to make the connection between depression and sleep disorders.  More current research has confirmed the connection.

So, if you believe you are experiencing SAD-related depression and/or sleep disorders, please see a psychiatrist or sleep specialist about it. There are treatments such as morning light therapy that can offer some relief, so you don’t have to suffer unnecessarily through the winter blues. Call me—I’m happy to help.

Who’s Suffering More from Lack of Sleep—Men or Women?

This week, I was interviewed by WCBS-TV New York for a news segment called, “Sleep: the Battle of the Sexes.” The topic was one I am very familiar with: People suffering from lack of sleep, and how it can affect daytime mood, mental acuity, job performance and relationship intimacy.

The show drilled down a bit farther and asked: who is more likely to suffer from a sleep disorder, men or women? And of the two genders, which performs better despite a lack of sleep?

What we know is that men and women have different circadian rhythms. According to an article by the Proceedings of the National Academy of Sciences of the United States of America,  “The circadian rhythms of melatonin and body temperature are set to an earlier hour in women than in men, even when the women and men maintain nearly identical and consistent bedtimes and wake times. Moreover, women tend to wake up earlier than men and exhibit a greater preference for morning activities than men.”

In other words, women tend to go to sleep and wake up earlier than men. We also know thanks to a Penn State study that women need 6.8 hours of sleep per night, while men require just 6.2 hours. While scientific studies are interesting, there is a discrepancy between these numbers and what I am seeing in my office at the Manhattan Snoring and Sleep Center.

Based on the facts, one would think women are getting to sleep earlier and sleeping longer than their male counterparts. But are women getting the sleep they need? In my anecdotal opinion, they are not, and they are suffering quietly for it. In our society, men are stressed out, but women are really stressed out. The physical demands of balancing career and family, along with the mental strain of worrying about finances and future is taking its toll on the women in our society. 

Don’t get me wrong, men worry and suffer from sleep disorders too. But they seem more willing to speak up and seek treatment. Women, on the other hand, being the selfless caregivers they are, stay focused on others and what needs to be done and power through their day. Which explains another Penn State study that found sleep deprived women made fewer mistakes compared to men in a series of computer tasks. It seems that, although women need more sleep, they do better without it because, for better or worse, they’re just more used to it.

Whether a man or woman is suffering from a lack of sleep, the fact is that a sleep disorder can lead to negative health issues, including an increased chance of hypertension, heart disease, osteoporosis and inflammatory disease.

In addition to personal health issues, a sleep disorder can wreak havoc on a relationship. The partner of a patient once shared with me how his snoring and sleep apnea had impacted their relationship. It led to weeks without quality REM sleep, and she said it left her feeling groggy with low energy, cranky, unable to concentrate for long and she was more prone to getting sick. His constant snoring caused her to start sleeping on the couch, which led to resentment, lack of intimacy and loss of connection.

I have made it clear in previous blogs that I am not a marriage counselor or relationship expert. But I can tell you unequivocally that, if you or your partner snores or suffers from a lack of sleep on a consistent basis, it will negatively affect your relationship.

In the end, circadian rhythms and who performs better and the sex of the person with the sleep disorder doesn’t matter. What matters is getting it treated and keeping the relationship healthy.

This also bears repeating: Turn off the TV when you go to sleep. Falling asleep with the TV or computer on interrupts deep REM sleep because the light from the screens interfere with the production of melatonin, a hormone that tells our bodies when it’s time to go to sleep. Do yourself a favor and turn off the TV, computer and lights at night. Your brain and body will thank you for it the next day.

To watch “Sleep: The Battle of the Sexes” on CBS2 New York, click here.

Stop Snoring — It Can Be the Secret to Happy Marriage

I am by no means a marriage therapist. However, I hear couples complain all the time in my practice. They come in for a snoring test appointment, and within seconds the husband makes a comment such as “my wife made me come.” Snoring is more common in men than women, but the reverse is also common.

The snoring spouse who feels “dragged” to the doctor’s office is resentful that his or her snoring problem can’t be left alone. The spouse that does the dragging-in is frustrated and tired. Ordinarily affectionate couples can have a strain in their relationship caused by snoring. Sometimes if it wasn’t for their spouse, a snorer wouldn’t even know they had a problem. As one of my patients recently told me, “I was very surprised when my lovely wife first clued me in that I was snoring at night. It was disturbing her sleep, but I didn’t realize that snoring was the cause of my own fatigue.”

The reason for resentment is understandable. Snoring can cause daytime symptoms that can cause serious problems in one’s waking life, and unfortunately, it is not just the snorer that suffers – the snorer’s spouse can suffer just as much. According to the National Sleep Foundation,  39% of American adults get less than seven hours of sleep each weeknight, and more than one in three (37%) are so sleepy during the day that it interferes with daily activities. The sleep loss associated with snoring—whether it’s the snorer or the bed partner who is awakened by the snoring, interrupts important recuperative sleep which can impair a person’s ability to perform cognitive tasks involving memory, learning, reasoning, and mathematical processes. It can impair motor skills and can cause morning headaches, irritability, burnout and depression to mention just a few symptoms.

Symptoms can be even more severe for the snorer if they have sleep apnea, a condition which causes them to stop breathing often many times a night, and wake gasping for air. Sleep apnea is linked to lung and heart disease, diabetes, obesity and stroke.

The disruption of sleep from snoring is causing couples to have a hard time sleeping together. Fifty-three percent of adults say they have relationship problems because of their or their partner's sleep disorder, the National Sleep Foundation found in a recent study. To avoid the symptoms of daytime sleepiness, many couples choose not to sleep together in the same bed.

In the book, "Two in a Bed: The Social System of Couple Bed Sharing," author Paul C. Rosenblatt interviewed 42 couples, and examined how sharing a bed affects the couple’s relationship. Many couples described the intimacy and comfort level of sleeping in the same bed is extremely important to their relationship. As he describes in the book, in their time together before drifting off to sleep, “couples catch up on what's going on with one another, plan, make decisions, deal with disagreements and solve problems.”

With their hectic schedules, many couples often only have this time to catch up. It is no wonder why it’s crucial to their relationship. Unfortunately snoring can force one spouse into another room for the sake of sleep, and this crucial together time is hard to replace in their busy lives otherwise.

If your marriage is suffering because you or your spouse snores, the key to reconciling is to understand that snoring is a symptom of a physical condition, such as sleep apnea, sinusitis, or nasal obstruction and it can be treated. There are many non-surgical, in-office and minimally invasive treatments available to snorers today. Although I would never make the claim that I’ve saved marriages, I’ve heard back many times from patients who tell me that it wasn’t until after their snoring was cured did they realize how much happier they are snuggling next to their spouse again.

Mending Your Relationship When Snoring Rips You Apart

Snoring is a major cause of couple's unhappiness.

Although in this blog I generally discuss the health consequences of snoring, I’d like to bring to light another serious side effect, which is the devastation snoring can wreak on marriage. Often I meet with married couples in my practice who are at their wits end. Both partners are exhausted…the snorer because of the toll snoring takes on their body, and the spouse whose health is impacted dramatically from their partner’s snoring because of the daytime fatigue brought on by their inability to get a healthy full night’s sleep.

According to a new study by the British Lung Foundation (BLF)¹, loud snoring forces more than a third of couples to sleep in separate beds at night. The foundation polled more than 2,500 adults through an online survey in the United Kingdom this past Spring. Even more drastic for these couples is the fact of the 39% who admit they sleep apart, a full third (33%) claim it has become a permanent sleeping arrangement. Certainly sleeping apart from your significant other all the time can’t be healthy for the relationship. In addition to the noise of snoring creating distance between couples, snoring can also be a factor that leads to sexual dysfunction in men, according to a study² that was reported in The Journal of Sexual Medicine.

When couples feel that snoring is ripping their marriages apart, it is often because they are both tired, irritable and tense. If they have been sleeping separately, most likely their relationship has eroded, and their communication has faltered. Certainly the lack of intimacy—not just physically, but the relaxing interactions between companions such as pillow talk—has worn them down.

How intrusive is snoring in a marriage? In 2006, a study from the Rush University Medical Center in Illinois3 determined that couples have a high divorce rate when the husband snores due to sleep apnea. Sleep apnea is the most serious of the many causes of snoring because it causes the snorer to stop breathing multiple times throughout the night, which can lead to heart and lung issues, high blood pressure and stroke. For years many snorers were reluctant to seek treatment because some of the most common treatments involved cumbersome sleep masks or surgery. Thankfully, today there are a number non-invasive in-office techniques that successfully treat the varied types of snoring such as the Pillar® Procedure, Balloon Sinuplasty™, and more based on the individual cause of your snoring.

Although I’m not a marriage counselor or sex therapist, patients who come to the Manhattan Snoring and Sleep Center are taking a positive step to mend their relationship and hopefully will not become one of the statistics of divorce due to snoring. They are not only mending their relationship, but they are taking control of their health, leading to a more fulfilling life.

My marital advice to snorers? Seek treatment and enjoy getting close to your partner again.

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1. The British Lung Foundation, 14 June 2011, Survey of over UK 2,500 adults aged 16 and over through TNS between 28 April – 3 May 2011, completed online through an OnlineBus.
2. Hanak, V., Jacobson, D. J., McGree, M. E., Sauver, J. S., Lieber, M. M., Olson, E. J., Somers, V. K., Gades, N. M. and Jacobsen, S. J. (2008), ORIGINAL RESEARCH—MEN’S SEXUAL HEALTH: Snoring as a Risk Factor for Sexual Dysfunction in Community Men. The Journal of Sexual Medicine, 5: 898–908. doi: 10.1111/j.1743-6109.2007.00706.x
3. The Sleep Disorders Center at Rush University Medical Center, Illinois: The Married Couples Sleep Study, January 2006

Help for Couple’s this Valentine’s Day: Cupid’s Arrow or a Cure for Snoring?

Cure for Snoring?

Cupid could use some help from snoring treatment this Valentine’s Day. Snoring is a major cause of couple’s unhappiness according to the Etap Hotel Group of Europe, which recently conducted a poll of 4,000 couples. Of the three most aggravating factors that drive couples apart, noisiness is the most common complaint, together with hogging the bed covers and restlessness.

Results showed that snoring forces many of couples to sleep in separate rooms. According to the study, nearly a quarter of the couples studied feel resentment towards their partner as a result of lack of sleep, which causes arguments between almost half of couples. Those who do share a bed lose out on an average of 70 minutes sleep a night.

When a partner snores, according to the Etap study, in over a quarter of relationships the couple’s sex drive suffers and one in 20 people would consider leaving their partner because they snore.

When a partner snores, it causes the other person to lose much needed sleep. Even just mild sleep deprivation can cause serious health issues. As a study from the University of Wisconsin-Madison has found, even five consecutive nights of four hours or less of sleep per night has the same negative affects on the brain and body than total sleep deprivation. Someone else’s snoring can take a real toll on your health.

If your spouse’s snoring keeps you up at night, you’re not alone. It is an issue that affects people from all walks of life, including the most famous celebrities. It has been reported that Tom Cruise, Sid Owen and Kevin Jonas sleep separate from their partners because of their snoring. Recently Helena Bonham Carter admitted that Tim Burton, her partner has a deviated septum that causes him to snore loudly. They have two adjacent houses in London, and Carter stated that his snoring is one of the reasons she enjoys having her own house.

If you’re in the New York Tri-State area, schedule an appointment at the Manhattan Snoring & Sleep Center, New York City’s top medical practice for snoring and sleep apnea diagnosis and treatment. The center’s medical/surgical snoring specialists offer the latest techniques to treat snoring and sleep apnea including minimally invasive treatment for deviated deptum, the Pillar Procedure, Balloonplasty™ and even provide the Home Sleep Test for patients for whom an overnight sleep lab is not an option.

Disclaimer:
 This article is intended for general information only is in no way intended to be a substitute for receiving direct medical advice from a medical professional, their diagnosis or treatment. Use and access to this website or any of the links contained within the site do not create a doctor-client relationship. If you have any questions regarding a medical condition, or if you suspect you may have a snoring disorder.

The Stress of Snoring on a Marriage

Can snoring ruin a marriage? In my practice, I hear the complaints all the time. Since it is more common in men than women, wives often make the appointments for their husbands, or the husband will say “my wife made me come in.” Snoring can cause a couple who are normally affectionate and enjoy a healthy home life to become resentful of each other. The non-snoring spouse blames the snorer for causing them to be up all night, the snorer blames the non-snoring spouse for not being understanding.

The reason for resentment is understandable. Snoring can cause daytime symptoms that can wreak havoc on one’s waking life, and unfortunately, it is not just the snorer that suffers – the spouse can suffer just as much. The sleep loss associated with snoring impairs a person’s ability to perform tasks involving memory, learning, reasoning, and mathematical processes. It can cause morning headaches, irritability, burnout and depression to mention just a few symptoms.

It is thought that more than forty million Americans snore every night and that 60% of men snore, and 30% of women. With all that snoring at night, couples are having a hard time sleeping together. According to the National Sleep Foundation, 53 percent of adults say they have relationship problems because of their or their partner's sleep disorder. The housing industry even seems ready to capitalize on this trend, with one survey predicting that by the year 2015, more than 60 percent of custom homes will have dual master bedrooms to be occupied primarily by snoring spouses.

In his book, "Two in a Bed: The Social System of Couple Bed Sharing," Paul C. Rosenblatt explores couples sharing their sleeping space, and it is a groundbreaking book in the field of sleep and relationships. For the book, Rosenblatt interviewed 42 couples, and examines how sharing a bed affects the couple’s relationship.

Many couples described that sleeping in the same bed is extremely important to them, because “it's a time for intimacy, pleasure and feeling comfortable together. During the time before drifting off to sleep, couples catch up on what's going on with one another, plan, make decisions, deal with disagreements and solve problems. For most couples, their time chatting in bed is the most time they have to talk with each other on a daily basis and that talk can be crucially important to their relationship,” Rosenblatt said."If couples don't have this time in bed, then they're in trouble.”

Although many couples know that it’s healthier for their marriage to share that time, sense of security and intimacy, many with snoring spouses are opting to go it alone in separate rooms for the sake of a good night’s sleep and a productive, healthy day.

If your marriage is suffering because you or your spouse snores, the answer to your problem maybe easier to solve than you think. The key is to understand that snoring is a symptom of a physical condition, such as sleep apnea, sinusitis, or nasal obstruction and it can be treated. There are many non-surgical and surgical treatments available to snorers today, dependant on the cause of the disorder. Sometimes snoring can be treated with changes in lifestyle, but when that doesn’t work, medical evaluation is necessary.

Help get your marriage get back on track, and start getting a good night’s sleep. Contact us at the Manhattan Snoring and Sleep Center to schedule your online appointment or call 212-873-6036 today.

-David O. Volpi, M.D., P.C., F.A.C.S.,