Sleep Like a Baby…Really?

| December 1, 2022

Jennifer C. Seger, MD, FOMA, is the Co-clinical Editor of Bariatric Times; Diplomate, American Board of Obesity Medicine; Medical Director, Bariatric Medical Institute of Texas, San Antonio, Texas.

Dear Readers,

If you have kids, you know there is nothing particularly peaceful or predictable about how babies sleep. Where did this saying even come from?

With the recent time change, many of us have experienced issues with sleep quality and duration. This got me thinking about just how critical sleep is to our overall quality of life and wellbeing. 

Sleep is when our bodies do the bulk of their maintenance and repair. It is not unlike taking your car into the shop for a tune-up, except for humans, we need this “tune-up” nightly if we want to keep inflammation in check and decrease the risk of developing diseases, such as cardiovascular disease, diabetes, Alzheimer’s, anxiety, depression and yes, obesity, to name just a few.1–3 As Cappuccio et al4 note, “Cross-sectional studies from around the world show a consistently increased risk of obesity amongst short sleepers in children and adults.”

Mechanisms for how sleep deprivation might contribute to weight gain include decreased leptin and increased ghrelin, which can lead to increased hunger and increased opportunity to eat, both of which can lead to a potential increase in caloric intake, and increased fatigue and disrupted thermoregulation, which can lead to reduced energy expenditure.5

One common mechanism that leads to disrupted sleep in our patients is obstructive sleep apnea (OSA), which occurs in 40 percent of patients with obesity.6 Understandably, patients who undergo bariatric surgery are eager to discontinue their continuous positive airway pressure (CPAP); however, one study found that 50 percent of patients with OSA who discontinued their CPAP after surgery, presuming it had resolved, still had medically significant OSA upon retesting.6 This highlights the importance of doing follow-up studies to confirm resolution prior to discontinuation of CPAP, as there are significant risks of adverse outcomes with untreated OSA. 

With an abundance of science highlighting the critical importance of a good night’s sleep, I am hopeful we are talking regularly to our patients about this aspect of their health. Suggestions for optimizing sleep hygiene include the following: sleeping in a dark, quiet, cool room; removing pets from the bedroom; avoiding electronic screen time for an hour before sleep; and getting regular physical activity. 

While we certainly need to exercise caution with supplements, there is data to suggest potential benefits from several of them, including melatonin, magnesium, and valerian root. For peri- and post-menopausal women, progesterone can be a game changer. Lastly, prescription medications are another option when the aforementioned tactics are ineffective. 

To learn more about sleep, visit the National Sleep Foundation (https://www.thensf.org) or The Society for Behavioral Sleep Medicine (https://www.behavioralsleep.org), which has a search feature to help identify experts in your area.

Here’s hoping we are all prioritizing our sleep during the upcoming holiday season and beyond. 

Sweet dreams!

Jenny Seger, MD, FOMA

References

  1. National Institutes of Health. How disrupted sleep may lead to heart disease. 5 Mar 2019. https://www.nih.gov/news-events/nih-research-matters/how-disrupted-sleep-may-lead-heart-disease. Accessed 28 Nov 2022.
  2. Shaw PJ. Thermoregulatory changes. In: Kushida CA (ed). Sleep Deprivation: Basic Science, Physiology, and Behavior. Marcel Dekker; 2005:319–338.
  3. Grandner MA, Alfonso-Miller P, Fernandez-Mendoza J, et al. Sleep: important considerations for the prevention of cardiovascular disease. Curr Opin Cardiol. 2016;31(5):551–565.
  4. Cappuccio FP, Taggart FM, Kandala NB, et al. Meta-analysis of short sleep duration and obesity in children and adults. Sleep. 2008;31(5):619–626. 
  5. Patel SR, Hu FB. Short sleep duration and weight gain: a systematic review. Obesity (Silver Spring). 2008;16(3):643–653.
  6. Sillo TO, Lloyd-Owen S, White E, et al. The impact of bariatric surgery on the resolution of obstructive sleep apnoea. BMC Res Notes. 2018;11(1):385. 
  7. Wolk R, Shamsuzzaman AS, Somers VK. Obesity, sleep apnea, and hypertension. Hypertension. 2003;42(6):1067–1074. 

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