How to lose weight. by doing. Absolutely Nothing

by doing

“Absolutely Nothing”

Sleep “is the most

sedentary activity”

yet it protects us

from gaining weight!

Sleep Quality & Obesity

“Sleep is not a luxury – it’s a necessity –

and should be thought of as a

‘vital sign’ of good health

”

www.cdc.gov/sleep

Exercise Nutrition

“Ignorance is the worst Sleep

Disorder of them all”

Dr. William Dement in his book The Promise of Sleep

Dr. Dement was among the first to draw

attention to the fact that

sleep

is as

important ,

if not more so

, than diet and

Sleep Restores

the Brain and the Body

Ø

Brain

Ø

Learning

Ø

Memory consolidation

Ø

Brain development

Ø

Body

Ø

Restoration

Ø

Muscle building

Ø

Cellular repair

Ø

Hormonal secretion control

•

One of the most important functions of sleep is

the re-organization of neural networks in the

brain. A body with a sleep deprived brain starts to

malfunction presenting with

:

•

Problems with heat or cold regulation

•

Decline in immune function

•

An increase in cortisol, catecholamine's, and other stress

hormones.

•

Increased levels of inflammatory hormones such as

interleukin and C-reactive protein

•

Imbalances in appetite and blood sugar regulation

hormones.

6

What happens if you do not get

•

Not getting quality sleep can cause hormonal

imbalance and inflammation as the

Hypothalamic-Pituitary-Adrenal axis need’s

quality sleep to re-balance after wake during the

day.

•

During quality sleep there is an increase in

growth hormone and testosterone, the two crucial

muscle repairing hormones.

–

This is why your body takes longer time to repair and

recovery from physical exercise if you are not getting

quality sleep.

7

What happens if you do not get

Quality Sleep ?

•

Sleep is a

behavioral state

that is a natural part of life,

we should spend about one-third of our life sleeping.

•

Sleep is a

required activity

and is important for a

healthy life. The National Sleep Foundation

recommends 7-9 hours of sleep every 24 hours for

individuals age 24-64 years old.

•

How much sleep is needed depends on:

–

Individual sensitivity to sleep loss

–

Daily activities and exercise

–

Sleep Quality

–

Age

Sleep Loss – Sleep Deprivation

•

Behavioral Sleep Deprivation (BSD)

Ø

Cultural, 24/7 lifestyle

Ø

Circadian rhythm disorders

•

Pathological Sleep Deprivation

Ø

Obstructive Sleep Apnea

Ø

Restless Legs Syndrome

Ø

Insomnia

²

Pain syndromes

Sleep duration Obesity

Ø

Worldwide

obesity

prevalence has

doubled

since 1980

Ø

This is

paralleled

by

reduced sleep

duration

Ø

In 1998

35%

American adults got 8 hours of sleep

Ø

In 2005

26%

American adults got 8 hours of sleep

Ø

In 1998 obesity prevalence in USA was

18%

Ø

Control of sleep/wake cycles and feeding is by:

Ø

Hypothalamic-pituitary-Adrenal axis

Ø

Autonomic nervous system

Ø

Good Quality Sleep

generally

Ø

decreases sympathetic activity

Ø

increases parasympathetic activity

Ø

Poor Quality Sleep

generally

Ø

increases sympathetic activity

Ø

decreases parasympathetic activity

11

Regulation of feeding

Sleep / Wake cycles

Quality Sleep & Endocrine Organs

Ø

Endocrine organs are sensitive to changes in

the autonomic nervous system

Ø

Increased secretion of inflammatory biomarkers

Ø

Changes in hormonal secretion

Sleep deprivation

Inflammatory biomarkers

Ø

Increase in inflammatory biomarkers contributes

to Metabolic Syndrome

Ø

Increases IL-6 during the day, causing

somnolence and fatigue

Ø

Causes shift of IL-6 and TNF from nighttime to

daytime combined with hyper secretion of

cortisol, causing fatigue and difficulty in falling

asleep

Sleep Deprivation

Changes in Hormonal balance

Ø

Insulin

Ø Sleep deprivation leads to changes in circadian rhythm of insulin secretion. Increased sympathetic activity affects insulin secretion and promotes insulin resistance (22,23)

Ø

Cortisol

Ø Sleep deprivation leads to increased levels (cortisol release is inhibited during good sleep) likely to promote

development of insulin resistance (24)

Ø

Growth Hormones

Ø During sleep deprivation tissues are exposed to high levels for an extended period of time and GH anti-insulin effects promote development of insulin resistance (25,26)

Sleep Deprivation

Changes in Hormonal balance

Ø

Leptin

Ø  Hormone released by fat cells dependent on sleep duration and decreased by sleep deprivation, signals release of fat reserves and the thyroid to upregulate thyroid function.

Ø  Increases energy expenditure and signals satiety to the brain

Ø  Decreases with sleep deprivation lowering the metabolic rate and will likely lead to increased calorie intake(27,28)

Ø

Ghrelin

Ø  Secreted by the stomach, stimulates appetite and is elevated by sleep deprivation causing hunger and increased calorie intake(27,28)

Ø

Thyroid Hormone

Ø  Decreased levels caused by sleep deprivation, lowers the basal metabolic rate (5)

Sleep Deprivation

Chronic Diseases

Ø

Obesity

Ø

Diabetes

Ø

Heart diseases, high blood pressure and stroke

Ø

Alzheimer

Ø

Decreased mental performance and higher risk of

depression

The Sleep Deprived Brain

Ø

The tired brain

craves things to wake it up

Ø

Coffee

Ø

Nicotine

Ø

Drugs

Ø

FOOD

spurs some less-than ideal food

choices, including larger food portions and

craving for junk food

Sleep Deprivation & Obesity

Ø

Obesity is an important risk factor in the

pathogenesis of various diseases

Ø

Obstructive Sleep Apnea

Ø

Diabetes mellitus 2

Sleep Deprivation & Obesity

Ø

Higher BMI is associated with compromised sleep

quality

Ø

Obesity is associated with sleep disturbances that

may predispose to accumulate sleep debt

Ø

This may contribute to

Ø

Increased appetite and more time to eat

Ø

Limit drive for physical activity

Ø

Changes in hormonal secretion influencing

Sleep Duration and Risk of Obesity

Ø

Interpersonal differences exist in the sensitivity

to sleep loss

Ø

U-shaped relationship with BMI, both short

sleepers (<6 hrs) and long sleepers (>9 hrs)

are more likely to be obese

Ø

Stronger correlation between sleep duration and

obesity risk has been found in younger cohorts,

suggesting that age-related factors other than

sleep disturbances may play a more important

role in the development of obesity later in life

Sleep Duration and Risk of Obesity

Ø

Significant association between short sleep

(<6 hrs) and increased obesity risk

Ø

6% increase in the probability of obesity with

less that 7 hours slept

Ø

Study of 1597 individuals showed that every

additional hour of sleep (6<x>9hrs)

Obstructive Sleep Apnea (OSA)

Obesity

Ø

Estimated prevalence of OSA in US adult

population

Ø

Men 24%-58% (severe obesity 93%)

Ø

Women 9%-37% (severe obesity 73%)

Symptomatic OSA present in 4% of middle age men

and 2% of women

Ø

Obesity is a risk factor for OSA

Ø

About 70% of those with OSA are obese

Ø

Losing weight improves OSA

Ø

OSA recurred in 50% after 4 years, regardless of

Obstructive Sleep Apnea (OSA)

Obesity

Ø

OSA itself may cause weight gain

Ø

Frequent micro/macro arousals in OSA lead to

repeated surges in

sympathetic nervous system

activity

and changes in hormonal control

Ø

Patients with OSA have reduced slow wave sleep

(SWS). Shown to lead to increased appetite for

high caloric /carbohydrate dense food

Sleep Deprivation

Slow Wave Sleep (SWS)

Ø

Suppression of SWS led to reduced insulin

sensitivity and higher likelihood of developing

diabetes 2 and obesity

Ø

Subjects with diabetes 2 had shorter SWS

duration and higher arousal indices

Ø

Many patients with diabetes 2 suffer from OSA.

Of interest is the strong link between OSA,

obesity and diabetes 2

Sleep deprivation- Prevention

Child Obesity

Ø

Children with shorter sleep duration are at higher

risk for obesity than children with longer sleep

durations

Ø

This risk is reduced by 9% for each additional

hour of sleep

Obese Children

OSA

Ø

Obese children with OSA, compared with other

obese children

Ø

Eat

2.2x

more fast food and less healthy food

Ø

4.2x

less likely to be involved in organized

sports

Ø

OSA severity is positively correlated with plasma

Example- sleep screening &

treatment

Ø

14 year old boy

Ø

Tired, irritated, issues at school

Ø

Tonsillectomy 5 years ago

Ø

Height 5’5’’ (168cm)

Ø

Weight gain 40 lbs. in one year (20 kg)

Ø

Now 197 lbs. (90 kg)

Test before

therapy Test with use of CPAP Improvement

Stable sleep 2 hrs 5 hrs 10 min 3 hrs 10 min increase Unstable sleep 5 hrs 15 min 1 hrs 45 min 3 hrs 30 min

decrease e-LFCBB 3 hrs 25 min 2 hrs 35 min

decrease e-LFCNB 13 min 0 min 13 min

decrease Sleep Time 8 hours 30 min 8 hours 33 min

30

What we need to better understand

the relationship between Sleep

Deprivation and Obesity

Ø

Reviewing of the medical literature addresses the

limitation of the literature we have today and

highlights the importance of the need to perform:

Ø

Well designed, controlled, large scale studies

Ø

Long follow-up time

Ø

These studies need to assess sleep duration

Let’s be open minded and have the

courage to throw out yesterdays ideas

when they do not appear to be working

and find ways to solve this problem

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