Sleep & Obesity: How to Prescribe Better Sleep for Patients

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Approximately 70 million Americans suffer from chronic sleep problems. On average, US adults clock 6 hours and 57 minutes of sleep each night, while about 20% average less than 6 hours of sleep each night. These sleep habits may be a results of today’s time-pressured world that tends to view sleep as an inconvenience or waste, which promotes long work hours, early mornings, and late nights. Those who work night shifts or connect with others in different time zones have further hindered sleep schedules.

For our patients to achieve optimum functional performance, they need at least 7 to 8 hours of sleep each night. Inadequate sleep quality causes an imbalance of essential hormones, including cortisol, insulin, and leptin. An increase in cortisol causes a decrease in insulin sensitivity and lowers daytime leptin levels, causing an increase in hunger of 20%. Increased hunger over time may result in weight gain, overweight, and obesity. Therefore, obesity and poor sleep become a vicious cycle.

It is critical to initiate conversations with our patients about the impact sleep can have on overall health, as well as the correlation between poor sleep and weight gain and obesity. When they get better sleep, our patients are better equipped to reach their health goals.

Impact of poor sleep

Poor sleep can trigger both short-term and long-term health effects. Some of the short-term effects that can lead to long-term complications include:

• Fatigue
• Poor productivity
• Cognitive dysfunction and irritable mood
• Acid reflux
• Seasonal affective disorder

Long-term complications that can develop might include:

• Obstructive sleep apnea (OSA) is a sleep disorder in which the airway partially or fully collapses, causing loud snoring and breathing issues at night. OSA is common in individuals with obesity, and weight gain can increase the risk and severity.
• Depressionand anxiety can develop from constant fatigue and irritability.
• Asthma can be worsened by obesity.
• Hypertension, especially at night, can lower core body temperature by reducing peripheral perfusion, which, in turn, can increase cardiovascular disease mortality.
• Compromised immunity due to an increase in proinflammatory cytokines and histamines can cause persons to become more susceptible to illness.
• Increased cancer-secreting cytokines and a decrease in melatonin.

Prescribing better sleep for patients with obesity

Sleep is one of the strongest pillars of lifestyle medicine, alongside nutrition, physical activity, stress reduction, and strong relationships. It is our responsibility to emphasize this for patients and to develop personalized prescriptions for adequate and optimal sleep.

Explore advice for 5 critical elements of achieving better sleep:

Diet

• Decrease high carbohydrate, high-fat foods closer to bedtime.
• Increase intake of vegetables, fruits, and whole grains to help improve gut health and digestion.
• Limit caffeine and alcoholic beverages.
• Eliminate post-dinner and late-night snacking that often occur with later bedtimes.

Sleep environment

• Turn off or dim lights. Preferably, blue lights should be removed at least 1 hour before bedtime.Allow air temperature to cool to approximately 65°F.
• No television or other screens before bedtime.
• Stop work and stimulating activities before bedtime.
• Use calming, soothing music and meditation apps as needed to aid in relaxation.

OSA management

• Review the proper use of continuous positive airway pressure machines with patients during every visit.
• Monitor blood pressure and blood glucose as OSA may increase risk for hypertension and type 2 diabetes.

Sleep supplements

• Melatonin, vitamin B 6, and magnesium can help improve sleep quality.

Weight management

• The overlap of poor sleep and weight management can present a tricky puzzle. However, discussing with your patients and, if necessary, involving a sleep medicine specialist can help improve sleep and quality of life.
• Discuss weight loss options using apps, calorie counting, physical fitness, and pharmacotherapy to break the sleep-obesity cycle.

Ensuring all patients—and especially those with overweight and obesity—are achieving their best sleep is key to promoting their overall health. Stay up-to-date on the latest obesity treatment news and research by exploring the Obesity Medicine Association (OMA’s) spectrum of resources and tools.

To learn more about obesity treatment or to become an OMA member, visit wwww.obesitymedicine.org/join.