by Alvin Ho, myofunctional therapist, Leeming clinic
There was a period in my late teens when I was suffering badly from primary insomnia. I was sleeping an average of 2-3 hours per night over a two-month period. I had to get a sleep study done in the hospital where they told me there were no explanations for my condition.
During that period, I had also developed a habit of binge eating during the night when I couldn’t sleep. I would raid the fridge for anything I could get my hands on – biscuits, cookies, ice cream. I suspect I am not alone in this, as there is a physiological explanation for what was happening.
I have seen many patients with sleep apnoea who have been told to lose weight to improve their sleep. But what if it’s poor sleep that is keeping the weight on?
The Hunger and Satiety See-Saw
Hunger and satiety (feeling full) are modulated in the body by two opposing hormones: ghrelin (hunger) and leptin (satiety). When ghrelin is produced, the body limits the production of leptin and vice versa.
A single night of sleep deprivation is enough to increase ghrelin levels in the body, leading to feelings of hunger. In anthropological metaphor, we are wired to be incentivised to hunt during times of famine and sleeplessness, whereas times of peace and abundance are associated with satiety.
It works the other way as too. With ghrelin levels increased significantly, leptin levels are restricted. The body then dampens down the desire to stop fulfilling hunger signals.
This was what fuelled my late-night fridge raids.
Metabolism and Glucose Tolerance/Insulin Resistance
Recurrent sleep loss (and likely disturbed and fragmented sleep too) is linked with impaired glucose metabolism. This subsequently affects the body’s insulin sensitivity – with more insulin than normal required to process glucose, leading to excessive load on our pancreatic beta cells (which are responsible for producing insulin). This is why poor sleep is considered an independent risk factor for Type 2 Diabetes Mellitus.
Insulin resistance also negatively affects our energy levels, and is often linked to symptoms of chronic fatigue. Our cells require energy in the form of glucose, and the poor metabolism of glucose ‘slows down’ how our cells receive energy. This can lead to fatigue and, in some people, brain fog and inability to concentrate.
All of this feeds into a vicious cycle where we can stop feeling motivated to perform physical activity, which often leaves us physically and mentally worse off.
Stress hormone, growth hormone, and fat retention
Just one to several nights of restricted sleep (e.g. 4-5 hours) can result in significant decrease in nighttime growth hormone (GH) production. During deep slow wave sleep, GH production is essential for tissue repair, muscle growth, lipolysis (fat breakdown), immune function and memory consolidation.
At the same time, our stress hormone (cortisol) production increases. In extreme conditions, chronically high levels of cortisol (i.e., Cushing’s syndrome) can result in significant weight gain (especially in the facial and stomach regions), muscle weakness, high blood pressure, skin weakness and Type 2 diabetes. Other neurophysiological effects include cognitive decline and mood disorders.
Not coincidentally, the above effects are typically observed in people with a history of obstructive sleep apnoea. When you consider the impact of these things together, it’s easy to see how it creates a poor physiological environment for weight loss.
No wonder many people get frustrated when they don’t see satisfactory results with their chosen methods, like restrictive diets or restrictive eating windows (e.g. intermittent fasting).
How Can You Lose Weight and Keep It Off?
For long-lasting results, lifestyle changes need to be sustainable. You should not feel like you have to cease all other priorities just to focus on your diet and exercise.
As a core part of this, it’s important to address sleep quality. (For further information, I recently published this article here, which can help to determine if you are at risk of experiencing obstructive sleep apnoea).
If sleep quality is resolved, then making small steps to change your lifestyle will compound into bigger changes over time. For instance, substituting sugar-dense beverages, tracking your step count, substituting food-based social activities for physical activities like a walk around the river, etc.
Also keep your goals achievable. A target of one kilogram of bodyweight lost a week is a perfectly acceptable place to begin. Progress requires momentum, and momentum requires consistency.
If you would like more guidance, feel free to schedule a consultation and we can discuss your circumstances, and build a plan to support your health goals.
Please book online or by calling (08) 9313 7433.
