Is the quality of your sleep making you gain weight?

How many of us would like to lose a few pounds, but look for external ways—outside of our bodies—to lose weight?  Perhaps we should be looking more inward, not only at our personal diet and exercise levels, but the length and level, or phase, of our sleep.

Recently, I read an article in the American Journal of Physiology – Regulatory, Integrative and Comparative Physiology. In it, researchers from St. Luke's-Roosevelt Hospital and Columbia University in New York shed some light on the link between our length and phase of sleep, and hunger and weight gain.

The researchers investigated the effects of “sleep architecture” on hunger to determine whether specific stages of sleep—not just the duration of sleep—affect the appetite and food cravings in healthy adults.

What they found is compelling, and cause for further attention: the length of time of sleep, as well as the percentage of overall sleep in different sleep stages, are associated with decreased metabolic rate, increased hunger, and increased intake of calories, specifically from fat and carbohydrates.

For the study, head researcher Ari Shechter and his colleagues studied a random sample of 27 healthy adults between the ages of 30 and 45. The participants underwent two six-day periods of laboratory observation, during which they were slept different lengths of time.

During a "habitual sleep" phase, they were allowed to sleep for nine hours; in the "short sleep" phase, they were allowed just four hours of sleep. Each of the two sleep phase studies were separated by four weeks to make sure the participants fully recuperated, and the women were observed at the same phase of their menstrual cycle. The amount of time spent in each sleep phase—stage 1, stage 2, slow wave sleep (SWS), and REM sleep—was recorded.

For the first four days in both sleep phases, the participants ate meals to meet their energy requirements for weight maintenance. On day four, they rated their hunger and level of desire for different foods. On day five, their resting metabolic rate (RMR) was measured, and for the final two days of the sleep phase studies, the participants were allowed to select their own foods.

The researchers then compared the participants' sleep architectures in both the short sleep and habitual sleep conditions. They also analyzed the relationships between sleep architecture, resting metabolic rate, food intake and food desire ratings.

Shechter and his colleagues found that sleep duration is important, but sleep composition—the time and percentage of overall sleep spent in each stage—also plays an important role in the link between sleep and obesity.

Head researcher Shechter explained, “Any number of various factors like obstructive sleep apnea, certain drugs/medications, chronic exposure to short sleep duration, shift work, jet lag, and changes in the scheduling of the sleep episode, can affect sleep stage quantity and distribution. Our data may provide an explanation for the greater obesity prevalence observed within some of these conditions."

Read the full article, “Changes in Sleep Architecture Increase Hunger, Eating.”
The results of this study remind me of another study I blogged about not long ago on “social jetlag,” another reason for all of us to get more sleep.

Social jetlag is a modern syndrome caused by the discrepancy between our internal body clock and our social clock. And according to Professor Till Roenneberg, Ph.D. at the University of Munich’s Institute of Medical Psychology in Germany, that gap between how much sleep we need and how much we’re actually getting is contributing to our global weight gain and the growing worldwide obesity epidemic.

Each of us has a physiological clock, and that internal clock — also known as our circadian rhythm — is regulated by daylight and darkness to prompt us to go to sleep or wake up. We also have a social clock of things that make up our daily lives, such as our work schedules and social calendars.

The problem is, in our modern society of too-late work hours and too much time in front of computer screens, we are listening to our social clocks more than our physiological clocks, causing a greater sleep gap known as social jetlag. As a person’s circadian rhythm gets more out of whack, their physiological clock gets set later and later, keeping them awake into the night, and feeling chronically tired during the day.

In their study, Professor Roenneberg and his fellow researchers in Munich discovered that people with different weekday and weekend sleep schedules—i.e., those with more social jetlag — were three times more likely to be overweight. That is a significant increase worth repeating: Three times more likely to be overweight!

Furthermore, the body mass index (BMI) of the overweight participants tended to increase as the gap between their weekday and weekend sleep clocks widened.
I applaud the efforts of Roenneberg and his team for their work in particular, because they are bringing a public awareness of a growing syndrome that is affecting many people worldwide — not just shift workers or those with irregular work schedules.

So, why does social jetlag cause weight gain? One of the theories is that late hours encourage irregular meal times and late-night eating, when the body has more difficulty digesting and metabolizing food. That translates into body fat. Another is that chronically tired people are less likely to exercise and more likely to smoke and drink, further contributing to weight gain.

Whatever the causes, it is in all our personal best interests to become more aware of our own physiological clocks and get more restful sleep. Doing so can help us all maintain a healthy body weight, avoid many health problems, feel better and live happier, more productive lives.

So, now that you have this new knowledge about sleep, weight gain, I suggest you give yourself a wonderful personal gift: get more sleep, especially during the holiday season, when many people are overeating and busier than usual. Also spend more time outdoors and exercise. More and better sleep is one of the best gifts you can give yourself for the holidays.

Read Professor Roenneberg and his team’s full report entitled, “Social Jetlag and Obesity,” published in the May 10 issue of Current Biology.

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.

A Snorer’s Guide to Summer Travel

Summer Vacation

School is out and summer travel plans are getting underway. Whether you’re planning a camping trip, renting a house on the shore for a week, or visiting relatives on the other side of the country, summer is a way for us to relax and reconnect with family.

Unfortunately, if you’re one of the 50 million Americans who snore, sharing close quarters can not only be embarrassing, but put a damper on the entire vacation if you’re a guest in someone’s home or as a housemate in a vacation home. While your spouse may have learned to adjust to the noise of your snoring, it’s important to understand that your snoring can also interfere with the sleep patterns of family and friends in close proximity.

When someone is prevented from receiving their requisite hours of recuperative sleep, it can lead them to be irritable, experience daytime drowsiness, affect their ability to concentrate, and interfere with their response time when they drive.  Absolutely nothing can ruin a vacation faster than cranky, over-tired children, and/or their parents.

However, realizing that your snoring is a problem that can be avoided, and by taking some steps ahead of time, you can prevent the issue altogether and ensure that your vacation will be full of energy and fun.

In-Office Procedures:

There are a few relatively new procedures that cure or drastically eliminate snoring that can be performed in just a few minutes in a snoring specialist’s office:

ThePillar® Procedure can be performed in a doctor’s office in about 20 minutes using only local anesthetic. It is effective to treat snoring that is caused by the fluttering of the soft palate, which occurs when the muscles in the back of the throat relax while asleep. The procedure involves three small polyester implants that are placed into the soft palate and over time, the implants, together with the body’s natural fibrotic response, provide support and stiffen the soft palate. This minimally invasive, simple and safe treatment for snoring and mild to moderate snoring including snoring caused by Obstructive Sleep Apnea, is a relatively painless procedure that is giving hope to snorers everywhere.  

Balloon Sinuplasty™ is another relatively new procedure to treat blocked sinus passages for snoring that is caused by chronic sinusitis. It can also be performed in a doctor’s office on an out-patient basis. It uses a small, flexible, sinus balloon catheter to open up blocked sinus passageways. When the balloon inflates, it widens the walls of the passageway while maintaining the integrity of the sinus lining, and restores normal sinus drainage.

When the sinus balloon is inflated, it gently while maintaining the integrity of the sinus lining.

Over the counter treatments: There are additional treatments a snoring specialist can recommend that can aid you while on your vacation that don’t necessarily include other types of surgery. For example if obstruction in the nose or sinus cavity is the cause of your snoring, many patients get relief from using nasal strips. Antihistamines, decongestants as well as topical and systemic corticosteroids can also be of assistance.

Lifestyle Adjustments: Your snoring specialist may ask you for some lifestyle modifications before any of the above treatments are recommended. That is because there are a variety of influences that could cause you to snore.

•  Lose 5-10 pounds. Excess weight is the most common contributing factor to snoring. If there is time before your vacation, try losing weight,
  because even those that are mildly overweight find that weight loss can significantly reduce their snoring with even a modest weight loss of five to ten pounds.   
• Quit smoking. Since snoring leads to irritation and dryness of mucous membranes, quitting cigars or cigarettes is a lifestyle change that can have a dramatic impact on snoring. 
• Reduce consumption of alcohol and sedatives. Alcohol, sedatives, and sedating antihistamines lower muscle tone in the upper airways, causing an increased airway resistance and snoring. Many people who reduce these substances report improvements in their snoring. 
• Change your sleep position. For some people, an increased amount of obstruction occurs when they sleep on their backs. Described as positional snoring, this type of snoring can have a simple solution. Sew a ball into the pocket of a t-shirt and wear it backwards. This will keep you off your back during sleep.
• Get an extra pillow. Some positional snorers also improve when the head of the bed is elevated.
• Pack some earplugs. If you’re worried that the loudness of your snoring still won’t be under control, do your fellow vacationers a favor, and pack some earplugs for them. They’ll thank you for it.

With a little forethought, your snoring doesn’t need to interfere with you or your fellow
vacationer’s sleep. Contact a snoring specialist near you today to get the treatment you need, to relax and enjoy your summer travels.

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David Volpi, M.D., P.C., F.A.C.S. is a board-certified otolaryngology surgeon with Ear, Nose and Throat practices, Otolaryngology Associates, on the Upper West Side and Upper East Side and is a staff member of the best teaching hospitals New York City. Realizing that there is a lack of information on the part of the public about the potential severity of snoring, he founded The Manhattan Snoring and Sleep Center to be a place where snoring patients can go for expert information, diagnosis and treatment. As a recognized authority throughout the country for his work in snoring disorders, he is also the author of the definitive guide book on the diagnosis and treatment of snoring: Wake Up! You’re Snoring…

He is a Fellow of the American Academy of Sleep Medicine (AASM), the American Medical Association (AMA), the American College of Surgeons, the Medical Society of the State of New York, the New York County Medical Society, the American Academy of Otolaryngology—Head and Neck Surgery, the American Academy of Facial Plastic and Reconstructive Surgeons and the American Rhinologic Society.

For more information, contact the Manhattan Snoring and Sleep Center: (866) 835-2361 or visit www.drvolpi.com.

Snoring a Problem? Try Losing Weight…

One of the most common factors that contribute to a person who snores is their weight. Typically, people who are obese have the most problems with respiratory symptoms during sleep. Even what seemingly may seem a small weight issue of 10-15 extra pounds may cause snoring. Although there are other factors that may contribute to snoring, if you’re overweight, weight reduction should be one of your chief goals.

To understand why, you must understand what physically causes snoring. During sleep, the throat relaxes and the tongue falls into the airway in the back of the throat causing a vibration in the soft tissue. Fatty tissue, chin folds and a very large neck, common in those that are overweight, are physical characteristics that can contribute to the snoring sound. Being overweight is linked to difficulties with snoring, regardless of any age. Weight reduction should be one of the chief goals of any overweight person who snores, because typically even the loss of a few pounds can reduce snoring.

However, there is no one solution to weight loss and management. There are vast differences in the human metabolism just as there are differences in anatomy. Weight loss programs are most successful when they combine a lower caloric intake with an exercise program. Since snoring can cause daytime fatigue, it’s often difficult at first for a snorer to get the energy up to start an exercise routine. With consistent effort, however, exercising can actually increase a person’s energy level throughout the day.

It is very important when beginning an exercise program, to start carefully and slowly at first because it is common for people to overdo it at first and become discouraged, or worse injured. It’s also important to get a green light from your physician first — he or she can start you on a program that is right for you.

You may find that you need to experiment with different approaches to dieting to discover what works best for you, since everyone’s metabolism is unique. Whichever approach you choose, commit to the long term for weight normalization, not just loss. The reason that most diets fail is that many dieters try to “force” weight off the body in an unhealthy or unnatural way. In other words, they focus on dropping pounds or losing weight rapidly, as opposed to normalizing their weight in a more natural way over a longer period of time. Sustaining a normal, healthy weight takes patience and a commitment to eating healthy and exercising regularly.

Weight loss reduces snoring in many people, sometimes stopping it completely. It also improves sleep and significantly reduces daytime sleepiness, allowing for a more productive waking day as well. To find out if your weight is a factor in your snoring, schedule an appointment today with the Manhattan Snoring and Sleep Center for an evaluation.

The Stroke Connection: Heavy Snoring and Narrow Arteries

By David Volpi, M.D., P.C., F.A.C.S., The Manhattan Snoring and Sleep Center

In a study completed last year in Australia, researchers calculated that heavy snorers have an elevated risk for carotid artery stenosis, a narrowing of the arteries that supply the brain with blood. When those arteries are blocked, it can lead to stroke.

It’s been long known that high cholesterol, hypertension, smoking and obesity are linked to carotid artery narrowing. This new risk as discovered after 110 volunteers – a mixture of men and women ages 45-80—were measured for the extent of plaque in the arteries and spent the night in a sleep lab monitoring the timing of their snoring. The study showed that those that were the heaviest snorers (after adjusting for sex, body mass index, hypertension and other factors) had the 10 times the risk of those who snored the least.

Associate Professor of Medicine at the University of Sydney, John R. Wheatley was the lead researcher, and believes that the vibrations of snoring may cause damage to the epithelium, the cells that line the inside of the artery, leading to inflammation and plaque buildup. He acknowledges that the results of this study do not establish a “causal relationship” between artery blockage and snoring. For that a much larger sample must be studied. However it is clear that the study reveals heavy snoring may increase the risk for stroke.

Are you a heavy snorer? Snoring may be caused by a number of factors, and can be treated. Often lifestyle changes such as losing weight, exercise, quitting smoking and stopping alcohol consumption prior to bed are enough to cause snoring to stop. However, sometimes snoring is caused by physical issues such as nasal obstruction or chronic sinus infections. Whatever the cause, there are non-surgical and surgical means that can treat snoring.

If you are a heavy snorer, we recommend you have an examination by an otolaryngologist (ear, nose and throat) physician to assess what is causing your snoring and how it should be treated. For more information on the causes of snoring, visit www.nycsnoringsleepapneacenter.com.

If you’re within the New York tri-state area, contact the Manhattan Snoring and Sleep Center today to schedule an appointment.

Losing Weight Can Reduce – Even Rid Sleep Apnea

By David Volpi, M.D., P.C., F.A.C.S., The Manhattan Snoring and Sleep Center

New research shows that obese sleep apnea patients who lose just 10 percent of their weight can significantly improve their symptoms and potentially rid themselves of the sleep apnea all together.

According to an article in Health News last September, the Center for Obesity Research and Education at Temple University in Philadelphia, and researchers at four other medical centers and universities analyzed data on 264 obese patients with type 2 diabetes and sleep apnea in varying forms. Those in weight loss treatment lost an average 10 percent of their beginning weight, and realized a significant reduction in number of sleep apnea episodes they suffered. Many moved to less severe categories, from moderate to mild, and 14 percent had complete remission of the disorder. Men with severe apnea who lost the most weight saw the greatest benefit.

It is thought that sleep apnea affects more than 18 million Americans. It is a potentially life-threatening disorder that can lead to heart disease, increase blood pressure, cause lung dysfunction and lead to stroke. A sleep apnea patient stops breathing during sleep for usually ten to twenty seconds, sometimes a minute or more, many times throughout the night. Obstructive sleep apnea is the most common type, and also the most dangerous. It is widespread in overweight and obese people because excess weight can cause the soft palate in the back of the mouth to collapse and block airway. However it should be noted that there are anatomical abnormalities such as a narrow throat or large tonsils that can also cause sleep apnea.

Unfortunately, it often goes undiagnosed because sleep apnea episodes occur only during sleep. Recognizing daytime symptoms, which include fatigue and daytime sleepiness (especially when it is thought that the patient should have received enough rest) is key to discovering this potentially life threatening disorder. If you believe you may have sleep apnea, it is important to have a physical examination by an otolaryngologist (ear, nose and throat doctor) to get started on treatment. If your weight is a factor in your sleep apnea, your doctor can lead you to a weight loss program that is right for you.

It’s long been known that overweight and obese people are at risk for numerous health problems. It’s also known that in addition to lowering or ridding sleep apnea, by losing just 10 percent of body weight, overweight patients can improve their heart function, lower blood pressure and levels of blood cholesterol and triglycerides, and decrease the risk of diabetes and cardiovascular disease – all reasons why weight management should be an important goal for a healthy lifestyle.

Those who participated in the weight loss study lost an average of 24 pounds by taking part in group behavior modification, eating a portion-controlled diet with liquid meal replacements, and exercising for 175 minutes per week for one year. “This is one of the first and certainly the largest study ever conducted,” Foster said. “It’s been clear that obesity increases the risk of sleep apnea but less clear that if obese people or people with type 2 diabetes lost weight, it would result in significant improvements in their sleep apnea—and it did.”

The study findings were published in the September 28 issue of the Archives of Internal Medicine. Read more about sleep apnea visit the Manhattan Snoring and Sleep Center.