Listen Well

Does Sleep Have to do with our Weight?

Episode Summary

Ever notice that after a bad night’s sleep, your body seems to yearn for comfort food?

Episode Notes

Ever notice that after a bad night’s sleep, your body seems to yearn for comfort food? In our inaugural episode we’ll pull back the covers on the science of sleep, exploring its effects on our health and how it plays a role in keeping our waistlines and our hearts healthy.

We talk with sleep experts Dr. Natalie Dautovich and Dr. Neil Stanley about the rise of sleep disturbances and disorders, the risks involved in getting too little sleep, and how you can recognize whether or not you may need some help. When we've exhausted our time together, you'll be ready to assess your own sleep habits and begin leading a more slumber sufficient life.

Just remember, no nodding off!

The opinions expressed are the opinions of the individuals recorded and not the opinions of Viatris.

 

National Sleep Foundation (USA): thensf.org

Dr. Stanley’s book: “How To Sleep Well” 

Episode Transcription

Disclaimer: This podcast is provided for educational purposes and is not intended to replace discussions with your healthcare provider. All decisions regarding your care must be made with a healthcare professional, considering the unique characteristics of your personal situation. The opinions expressed are the opinions of the individuals recorded and not the opinions of Viatris. Individuals featured in this podcast may have participated in the past as or may be current members of an advisory group for Viatris.

 

PART I: INTRO  

Dr. Mo: Today on Listen Well, we'll be exploring the science of sleep, pulling back the covers on its effects on our health, particularly for our hearts and our waistlines.  

I'll be talking to Dr. Neil Stanley, sleep specialist and author of How to Sleep Well, about the rise of sleep disturbances and disorders, the risks involved in getting too little sleep, and how to recognize the signs of not sleeping well.  

We’ll also be speaking with Dr. Natalie Dautovich – assistant professor at Virginia Commonwealth University and the National Sleep Foundation’s Environmental Fellow – to learn about cognitive and behavioral approaches to improving sleep.

When we've finally exhausted our time together, you'll be ready to assess your own sleep habits and begin leading a more slumber sufficient life. Just remember, no nodding off. It's time to listen well.  

 

 

 

PART II: BASICS OF SLEEP & Technology  

 

Dr. Mo: NARRATION: We all know that sleep is a vital part of our daily lives, and that with the addition of technology, we’re all probably getting a lot less of it than we should. But I think we need to start at the basics….Why is it that we sleep at all? What happens to our brains when we are sleeping?  

Dr. Mo:   NARRATION: Here’s Dr. Neil Stanley.

Dr. Stanley: Basically if it's got a brain, it sleeps. If it's a mammal, its sleep is close to what we have in humans. Of course our closest cousins, the chimps and the gorillas, sleep almost identically to us, but what it does ... we know that it's important for memory and learning and growth, and we've got the new research that shows that it's important for flushing out neurotoxins that have built up in the brain. So we know the function. We just don't know why we have to sleep for an extended period of time, why most of us need between seven and nine hours. You'd have thought over a million years of evolution, we'd have somehow found a way of doing it in a couple of hours, but for some reason we haven't. So, that shows that it must be important, but we don't know why we sleep in that way of, as I say, of having about eight hours a night, having four or five dreams a night. We don't know those very basic fundamentals.

Dr. Mo: Well you mentioned the seven to nine hours and that brings me to a question that's talked about a lot in the media today in the general public, that there's this epidemic of sleep deficiency all around the world. And I guess my question, is that real? Is there really a problem with sleep in the world today?

Dr. Stanley: There is a problem with sleep in the world, but I think the idea that we're in an epidemic of poor sleep perhaps has been slightly overstated. What has happened is for the first time we've all had the ability to forego our sleep. In the past, it was very easy to get a good night's sleep. You got up, you went to work, you came home, you had your dinner, you went to sleep. You had to put the last log on the fire, the last piece of coal on the fire. It wasn't that long ago that TV went off. The late night shopping didn't exist. So it was easy to get sleep, but very recently we've had the ability for everybody.

Dr. Stanley: …We've fallen out of love with sleep. I don't think it's a major problem. We just need to fall back into love with something that does us good.

 

Dr. Mo: So, do you think technology is partly to blame for us not sleeping well?

Dr. Stanley: Absolutely, you know, the advice used to be, from sleep experts, that you shouldn't have a television in your bedroom. When I started in sleep research 38 years ago, that, for me, was an amazing concept because we had one television in the house and the idea that people were rich enough to have two televisions just seemed crazy. And of course, now we've all got tablets, smart phones, laptops that we can take anywhere and we have 24 hour entertainment, even for children. So, technology is a part of it, and the fear of missing out. Nobody under the age of 40 owns an alarm clock anymore. They use their mobile phone. So the mobile phone is right next to the bed and therefore it's there to ping and ding with messages or you wake up in the middle of the night and you check whether your friends love you enough to have sent you a message or whatever. So, we have this dysfunctional relationship with technology and that is having a big, big part in our having poor sleep. If you think about it, if you've just watched The Exorcist on your laptop, you're probably not going to get a good night's sleep that quickly. That's the problem that we have in this day and age

Dr. Mo: So with these devices, is it just about stimulation or are there other factors?

Dr. Stanley: There are other factors. Again, in the past, we just thought it was stimulation, that if you were watching something scary or involving that would disturb your sleep, but about 15 years ago, a new receptor was found in the retina, which doesn't respond to visual sources. It responds purely to blue light. If you imagine blue light, even on the dullest day, there's a lot of blue light in the sky and the blue light is the thing that tells us it's time to be awake. The problem is electronic devices fluoresce blue, they give off this blue light. So all the time you're looking at a device, it is actually telling your brain it's time to still be awake and it's suppressing the release of melatonin. Now, melatonin is the body's signal to say it's time to prepare and to do the process that settles us into sleep. So all the time you're suppressing that. Once you switch off your screen, it's going to take a finite time before you can then fall asleep.

Dr. Neil Stanle...: A number of companies make night modes, but we found that they actually have no effect. They actually don't do anything because the brightness ... because if you strip the blue light out, the screen becomes muddy, you turn the brightness up, and bright light is just as bad as blue light. Even Paperwhite, your Kindle, your eReader, even those are shown to be disturbing of your sleep because of the light. So it's both the stimulation and the light that are the problem.

Dr. Mo So it's not just the blue spectrum.

Dr. Stanley: There's been research that came out not that long ago, a couple of months ago, that shows that even candle light, even something as dull as a candle, for some people, can be sufficient light to disturb their circadian rhythm. So this is why the advice is, your bedroom needs to be dark and it needs to be dark for a time before you go to sleep.

 

PART III: TEENAGERS  

Dr. Mo:  NARRATION: Dr. Stanley mentioned something called the circadian rhythm, which is just another way to refer to the internal clock that regulates our cycle of sleepiness and alertness. If you’ve ever experienced jet lag, then you know what it feels like to be out of step with your circadian rhythm. That got me thinking. There’s a group of people tied to technology who never seem to get enough sleep: Teenagers.

 

 

Dr. Stanley: Absolutely. The teenagers, they seem wedded to their devices. There was a survey in the UK recently that showed that sort of, I think it was 64% of adults or parents knew that the technology, that phones and that disturbed the teenagers sleep, but they didn't seem to want to do anything. And there was another survey that showed that teenagers and college students were the most aware of the negative effects of poor sleep, but were the least likely to change their behavior. So, nagging your teenager in order to tell them to put their phone down, you're going to meet an awful lot of resistance in doing that. That's the problem because teenagers' sleep is already affected by early school start times and things like that. Technology is just making it worse.

Dr. Mo: So, are there any common telltale signs that someone isn't getting enough sleep or their teen isn't getting enough sleep?

Dr. Stanley: It's pretty easy, to be honest, to judge whether somebody has had enough sleep. If you've had enough sleep at night, during the day, you'll be awake, focused and alert. If you feel sleepy, you haven't had enough sleep. And what we've got to remember here is the difference between being tired and being sleepy. Tired is just being slightly run down with the day. You know you had an argument with the wife, it's raining, you got wet, and you haven't won the lottery, and life's just not brilliant. That's tired. That doesn't tell you anything about whether you're sleepy or not. Sleepy is a need for sleep. Very simple, if you walk up three flights of stairs, when you get to the top, do you need a sit down or do you need a sleep? If you need to sit down, you're tired, fatigue, exhausted. If you need to sleep, you're sleepy. So if you're sleepy, if you find it difficult to be alert and focused in day, that is a very, very simple pointer that you haven't had sufficient sleep.

 

PART IV: SLEEP & OBESITY

Dr. Mo:  NARRATION: Why is it that when I’m having trouble sleeping, I tend to eat more? Is there a link between our need for food and our sleep?  

Dr. Stanley: Absolutely. There's a strong correlation. One, the people perhaps don't know about, which is interesting, which is not only do we have a light/dark clock, not only are we woken up by sunlight and we go to bed when it gets dark, but we have a food-related clock as well. And so  one of the key things is about eating regularly, but sleep is involved in what you eat and how much you eat. And that's the key link.

Essentially, the more sleepy you are the more you crave sugary and fatty foods. It's about a 33% increase in desire for sugary and fatty food, but also a 24% increased desire for food anyway. So you have an increased appetite and is it down to a hormone called ghrelin in which controls appetite, but also you have a resistance to a hormone called leptin. Leptin is the thing that tells you, you've eaten enough that you're full. You don't need to eat anymore. And we have a resistance to that, so when we're sleepy, we want to eat, we want to eat sugar and fat, we eat sugar and fat, and we don't stop eating sugar and fat. And so research has shown that just one poor night's sleep means the next day we'll eat somewhere between 400 and a thousand calories more simply because we're sleepy. We'll also less vegetables. We'll also season our food more. We'll put more salt on our food, and as I say, we will eat an awful lot of sugar.

 

 

Dr. Mo: NARRATION: This is Natalie Dautovich from Virginia Commonwealth University.  

 

Dr. Dautovich: …when we don't sleep, where we have greater difficulty regulating our emotions, so we're more likely to feel emotional distress, we're more likely to have our negative emotions amplified and we know that when we feel emotionally distressed, we are more likely to consume food, especially those energy dense foods to try to increase our dopamine/serotonin levels. So through either biological, cognitive or emotional pathways, sleep is a powerful predictor of obesity.

Dr. Mo: Is there a clear link between sleep and obesity? Literally weight to the level of a medical problem?

Dr. Stanley: Absolutely. There is a link between sleep and obesity and carrying that on further of course into diabetes because you know, not being simplistic about it, but if you're not sleeping as much, there is more time to eat. And if your body is telling you to eat sugar and fat, let's say that increased consumption. So there was some research from Switzerland that shows that year on year, if you don't sleep the right amount of time for you, you put on about 0.2 of a BMI point. So weight goes up regardless of what else you're doing. Weight naturally goes up if you're not sleeping as well. And I say there is then that link from obesity into diabetes.

 

PART V: SLEEP APNEA & IMPACT ON HEALTH

Dr. Mo: NARRATION: Does that sound familiar? Chances are you know (or sleep close to) someone who sounds like that when they sleep. But a snore may be more than just a noise. It could indicate a deeper, more serious problem: sleep apnea. 5  

Dr. Stanley: Sleep apnea is a problem in society, and it's one that's getting worse. A lot of people who suffer from sleep apnea are people who are overweight, and going back to my early answer about the link between poor sleep and obesity, that's increasing. And also, specifically in women because women are getting proportionately larger than they were in the past, and that's increasing the risk of a sleep apnea in women.

So It's around about 6% of the population have a recognized problem with sleep apnea. Probably it's higher than that. The thing with sleep apnea is a lot of people suffer from sleep apnea, but they don't know it or they don't acknowledge it.  

Dr. Mo: NARRATION: Natalie had some additional statistics for us

Dr. Dautovich: So prevalence rates for men are around 22% and for women are around 17% suggesting that a significant portion of the population might be experiencing these disorders.

Risk factors for sleep apnea include being overweight or having obesity, alcohol use, smoking can also increase your risk for sleep apnea.

Dr. Mo: NARRATION: Before we go on, let’s quickly explain what we mean by “Sleep Apnea”

 

Dr. Stanley: Very simply, you have the airway from the nose and the mouth that goes down into the lungs. Now, if the soft palate, the bed or the back of the throat closes,  then you will get an obstruction. And so, your body is trying to breathe out, but there's an obstruction that it has to overcome, and it will overcome that. An apnea may last anywhere from 10 seconds to 180 seconds in exchanging. You may be doing this hundreds of times a night. Now, every time you overcome that obstruction, you wake up. You then fall back to sleep, and then the same thing happens again. Your airway is obstructed and therefore you have this pause in breathing and that gets overcome. You wake up, so really sleep is destroyed by sleep apnea because you never get into the deep restorative sleep.

Dr. Mo: So people are waking up and they don't even know it.

Dr. Stanley: They don't even know it. I mean, technically, I have seen patients who have never actually slept because we judge sleep in 30 second epochs. And If you have more of anything, so they're asleep for 14 seconds and awake for 16 seconds, but they're just doing that all the way through the night. So technically, although they've slept, to a degree they haven't actually. It's almost impossible to stay asleep.

The thing with sleep apnea is that some people snore. Some people snore really, really loudly, but they don't obstruct. But many people who do have really loud snoring there is that pause of sometimes some people may pause once an hour, some people may have 60, 70 pauses an hour. If your partner notices you stopping breathing, you have sleep apnea. You just need then to find out how severe it is, and the gadgets like CPAP, continuous positive airway pressure, those machines work, work really well as long as you wear them.

Dr. Mo: The devices actually push air into your airway while you're asleep.

Dr. Stanley.: Essentially, it's a small compressor that pushes air through the airway to keep the airway open.

 

Dr. Mo: NARRATION: Maybe you’ve heard of these bedside air compressors. CPAP, or continuous positive airway pressure, is one type of device used to treat sleep apnea by continually delivering a stream of air through a mask you wear at night. Some devices are also able to vary the air pressure that’s delivered during the night, based on how you are sleeping and how severe your apnea is. People often resist using them, but Dr. Stanley explains how and why they work.

Dr. Stanley: Some people need to wear a full face mask, like you see, you know fighter pilots in top gun wearing. That's the old school. There are now hundreds of different types of masks and some of them just sit over the nose. Some of them are really small. Actually, this is important, you find a mask that is well fitted and works for you.

 

Dr. Mo: NARRATION: People using CPAPs have likely gone through a sleep study … if you or your partner think you may have Sleep Apnew, what’s your next step?  

 

 

Dr. Dautovich: So, you can go to your healthcare provider, and you can also ask if they can refer you to a sleep specialist for further evaluation and testing...

Sleep study is one way that a specialist will assess your sleep to try to get a sense of what might be going on, and a sleep study sounds kind of odd. How in the world are they going to be able to study my sleep? Well, mostly this is done at a sleep center, and you are given a polysomnogram, so you are assessed using polysomnography, which is the medical term. And essentially, you go to a sleep center, you would spend the night there, sometimes you spend up to two nights. You have a nice private room, it's usually clean and comfortable, but you are going to be connected to various equipment that can assess different levels of your functioning while you sleep. Importantly, it's noninvasive, and there's no pain experienced with the procedure as well. But, essentially what the sleep specialist is looking for is how your brain is functioning during sleep.

So, you will have electrodes placed on your scalp. Again, noninvasive, pain-free. Also, measuring movements of your eyes so we can tell when you're entering different stages of sleep. We know that when you're in your rapid eye movement phase or your dream phase, we see a lot of eye movements. Also assessing your muscle tone, heart rhythm, and breathing. So there might be monitors placed on your finger to assess your oxygen levels during sleep. The point of all of this, at the end of it, a printout is produced, and this can tell the sleep specialist what your stages of sleep look like during the night, what your breathing looked like. So, were you having these micro arousals that might be indicative of sleep apnea? Were you moving your legs a lot, which could be an indication of something called restless leg syndrome. So, difficulties with breathing, moving your legs, spending a lot of time awake during the night, or having a lot of frequent awakenings would all be signs of a potential sleep disorder that the specialist would be looking for.

 

Dr. Mo: NARRATION: We’ve heard about the link between sleep and obesity, and the link between obesity and sleep apnea. So, does losing weight help reduce apnea? What else other than CPAP can people do to improve sleep apnea?

Dr. Stanley.: Losing weight helps because some people have a bit too much fat around the  neck, so losing weight helps. Giving up smoking will help massively, and in some people avoiding alcohol. In some people, they only snore or obstruct if they've had alcohol, so giving up alcohol is a very good thing to do. So, but, losing weight and giving up smoking are probably the most important things that you as an individual can do.

But physicians will tell you that you can tell a patient to lose weight until you're blue in the face. They're not going to do it. Unfortunately, and this is why CPAP and its variants are very useful.

Dr. Mo: NARRATION: Beyond sleep apnea, poor quality of sleep is also linked to serious medical issues.  

Dr. Stanley: There is associations between sleep and various serious medical health conditions. Cardiovascular being one of the most obvious. And, there is certainly a link between poor sleep increase in cardiovascular problems, particularly heart disease, and things like that. But, also, it's true that long sleep is also equally dangerous for the heart, and that's something that perhaps people don't realize. But, short sleep is a problem. And sleep apnea, that we've been talking about, can also be a real problem, because you can imagine the strain that your body is under if it's trying to breathe against an obstruction. So, blood pressure goes up really quite significantly, and that, of course, will have negative consequences for cardiac health, and of course then leads to an increased risk of stroke or heart disease

Dr. Mo: NARRATION: Sleep apnea can also complicate another common condition: diabetes  

Dr. Dautovich: If somebody does have for example type two diabetes, it's likely that their condition will worsen if they have obstructive sleep apnea and this remains untreated. So research suggests that if you're able to if you are able to treat breathing difficulties associated with obstructive sleep apnea, you can help patients improve their breathing, which improves their glycemic control, and can help to prevent longer term complications from diabetes.

 

PART VI: SLEEP AND RELATIONSHIPS  

Dr. Stanley: Sleep also plays an important role in emotional wellbeing. We know from studies that show that if you're in a partnership and just one part of that partnership has a poor night's sleep, the next day you have more arguments, you lack empathy for your partner, you have more negative feelings for your partner, and you're less likely to make up those arguments that you had.

What's true of your personal relationship is also true of your work relationship. You have more staff conflicts. If you have a poor night's sleep, you actually trust other people less if you have poor sleep. Interestingly in the workplace, and this seems a bit bizarre, but it's true, if your boss has had a poor night's sleep, you are less motivated to work because we can actually pick up on the signs of sleepiness on nonverbal cues. We can see it in their eyes. We can see the drooping mouth, et cetera. We can pick up on our bosses sleep. So there is a real important part for good physical, mental and emotional health, you need good sleep. It's as simple as that.

 

Dr. Dautovich:  Also, there's interesting research that suggests the importance of our social connections for sleep. If we think about it from an evolutionary perspective, when we're sleeping, we're at our most vulnerable. And so it's thought that our social connections, knowing that we have others in our lives that are important to us that we feel close to, tells our body that it's okay to sleep, that we're going to make it through the night. So, in times of social isolation this can be really challenging, but trying to connect to other people can help prepare you for a good night's sleep by increasing your overall feelings of safety and wellbeing.

 

PART VII: KEY TAKE-AWAYS AND ADVICE

Dr. Mo: So, If I'm going to pull all these threads together, and I want to give someone advice in general about sleeping better, what do I tell them?

Dr. Stanley: First thing to do is to see sleep as important, and hopefully as a result of this podcast, people will now appreciate the importance of sleep. Because once you appreciate sleep is important, then you're going to be willing to make the changes you need to do. One of the most effective changes you can make, is to set a regular wake up time, seven days a week, 365 days a year, because essentially the body starts preparing to wake up about 90 minutes before you do wake up. And so, if you tell the body when it's going to wake up, you become into a habit, and you will wake up naturally, and you'll wake up feeling refreshed. So, that's one of the key things you can do.

: There's a myriad of sleep advice tips out there. There's thousands of them, but they all just fall into three categories. One, is a bedroom conducive to sleep. Your bedroom needs to be dark, quiet, cool comfortable, and it needs to be reserved for sleep. That's why you're going into your bedroom is to sleep, and if you're not asleep, you shouldn't be in your bedroom. That's number one.

Dr. Neil Stanle...: The second is a relaxed body. You have to have done something during the day to need sleep at night. Exercising, doing something is good, but we all know that we've been physically exhausted, and we still can't sleep.

That brings us to the third thing, which is a quiet mind. You cannot fall asleep unless you have a quiet mind, and it's as simple as that. How do you quite in your mind? Well that individual. That's down to you. I personally read every night before I go to bed, but I'm not recommending you do that. I'm recommending you find what you like to do, whether that's drinking camomile tea, doing meditation, doing yoga, listening to Pink Floyd really loudly. It doesn't matter what you do, you have to do something that you enjoy.

And you need to put the day to bed, the stresses and worries and the strains of the day to bed about 45 minutes before you go to bed. Use those 45 minutes to do lovely, luxurious, nice things that quieten your mind and any other sleep tip that we give people is just a derivation of one of those three things. So it is relatively simple. We have just made it vastly more complex than it actually should be. And that's the problem that we have. We're worried about not getting a good night's sleep, and therefore, we're not going to get a good night's sleep. It's a self-fulfilling prophecy.

 

 

Dr. Stanley: Interestingly, an American physician back in 1916, so 104 years ago said, the biggest cause of insomnia in society is being told you'll go mad or die if you don't get sufficient sleep. So this message has been outdated for 104 years, yet some very respected sleep experts are still trying to somehow terrify people into getting a good night's sleep.

Sleep's not about living longer. Sleeps about living better. It's about getting a good night's sleep today will make you feel better tomorrow. The association of poor sleep to various medical illnesses, is statistic, but is it clinically relevant? The answer, really no, it's not. We really need to say fall back in love with sleep because it is a pleasure. It is a nice thing to do rather than going to bed with the fear that the lack of it is somehow going to kill us. I think that's the important thing. We need to relax more about it. As a particular sports wear brand would say, "Just do it." Don't worry about it.

 

PART VIII: CLOSING

Dr. Mo: NARRATION: Dr. Dautovich, thank you so much for speaking with us today. .. Before you go, can you tell us where our listeners can find out more about sleep health?  

Dr. Dautovich: So a great place to find more information about sleep and how to obtain healthy sleep is the National Sleep Foundation's website. Sleepfoundation.org.

Dr. Mo: So Neil, you literally wrote the book on how to sleep well. Do you sleep well?

Dr. Stanley: I do everything I possibly can to do. After 38 years, you'd expect me to say that. I think, I'm the only sleep expert who actually on their webpage, actually tells you everything about my sleep because, you know,  if I'm going to lecture people about the importance of sleep, I surely have to practice what I preach. But you know, I've got a very comfortable bed. You know, I have thick curtains to block out blinds. I don't drink too much caffeine in the evening. I always read before going to bed, and I know as I say, I feel good after nine and a half hours. So I prioritize getting sleep you know  in terms of time usage. So I've never binged watched something past my bedtime. That's what Tvoe and video recorders are for. So yeah, I sleep well.

 

Dr. Moe Elswedo...: So Neil, thank you so much for joining us today. I hope we didn't keep you up late past your bedtime.

Dr. Neil Stanle...: Thank you.

 

PART IX: OUTRO

Dr. Mo: We spend so much of our lives sleeping, we might as well make sure that its quality time spent. Take a few minutes to think about your sleep quality, and what you can do to change it for the better. I’m Dr. Mo Alsuwaidan. Thanks for listening.  

Dr. Mo:  Brought to you by Viatris, empowering people worldwide to live healthier at every stage of life

 

Powered by Viatris