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Sleep Tight, Slim Down

By Dr. Marisa Weiss on August 13th, 2014 Categories: Uncategorized

Sleep — most of us need much more of it. All the words that describe a bad sleeper apply to me: “light,” “sensitive,” “fitful,” “too much on my mind,” “insomniac.”

My excuses and reasons: hormonal therapy for breast cancer and early onset menopause, plus extended clinical hours, travel for speaking engagements, and my endless list of everyday demands, including taking care of the kids, filling the pantry, doing the laundry, fixing the leaks in the roof, and yes, keeping the husband happy.

Desperate for more sleep, I’ve picked up some bad habits along the way. I am guilty of late night and middle-of-the-night snacks. Sometimes I’m actually hungry, other times agitated or just plain frustrated. Food is soothing. But it turns out that food, insomnia, and weight are related and make a bad combination. Watch out: the extra weight can creep on.

A vicious cycle of sleep and weight problems

Researchers are discovering that sleeping problems can cause weight gain, and being overweight can cause sleeping problems. It’s a vicious cycle. That’s why both getting enough Zs and maintaining a healthy weight are important to your overall health — plus they also help reduce the risk of breast cancer and speed recovery after treatment for the disease.

Those of us with breast cancer, now or in the past, often have sleep troubles. Plus, many of us were already overweight before diagnosis and then gained more weight through and beyond breast cancer treatment. Big surgeries and being under anesthesia for a long time cause pain, disrupt our body’s normal schedule, and decondition our muscle, heart, and lung function. Steroids during and after chemo can make us hungrier and put on more weight. Chemo can change our taste buds and make us crave high-calorie comfort foods. Plus, eating can temporarily soothe the uncomfortable emotions that go along with a breast cancer diagnosis: uncertainty, anxiety, anger, and depression. These are all very mean side effects of an already very upsetting situation.

But we’re not alone: two-thirds of American adult women are considered overweight or obese. This statistic goes hand in hand with the decline in sleep in America. In the last 50 years, the average daily time we sleep has dropped by 1.5 to 2 hours. A recent study found that more than 30% of participants said they got less than 6 hours sleep per night. Sometimes that’s by choice, but usually not. Another large study found that about 1 in 5 people suffer from a sleep disturbance (such as a newborn baby waking them up or constant jet lag). Nearly 1 in 10 had a medical sleep disorder such as insomnia or obstructive sleep apnea.

As with any cycle, you probably wonder which came first: being overweight or sleeping problems? It’s one of those chicken and egg questions. While researchers keep working to figure out the relationship between lack of sleep and being overweight, one thing is clear: Not sleeping enough may stop you from losing weight even if you’re eating right and exercising regularly. This is because our sleep patterns affect our metabolic system, which regulates the production of energy that fuels all of our body functions. Metabolic upset can lead to a host of other health problems.

Breaking the cycle

To lose weight, sleep time may matter more than gym time. Studies have shown that people who get enough sleep tend to have stable weight and stable blood sugar levels. The magic number for sleep seems to be 7 to 8 hours nightly. Still, many of us function even better with more than 8.

Let’s see how sleep and weight issues interact, how they may affect you, and how to break the cycle.

Sleep issues and appetite

Research shows there’s a fairly consistent relationship between sleeping less than 6 or 7 hours per night and the risk of being overweight or obese. A very large study of older people found that men and women who got by on about 5 hours of sleep per night tended to gain more weight than those who got 7 to 8 hours of sleep. People who got less than 4 hours sleep per night had a 40% greater risk of becoming obese compared to the healthy sleepers. A Swedish study found that “short sleepers” were more likely to be obese (and to have many poor health and lifestyle habits) than people who slept 6 to 9 hours per night.

Why does this happen? Eating too much causes weight gain, and lack of sleep turns out to play a role in our eating habits.

If you’re awake longer, you have more chances to eat. But why, when, and how much we eat are partly controlled by hormones that regulate how our bodies use energy, also known as metabolism. Sleep loss affects the hormones that control appetite. One hormone, ghrelin, increases appetite and makes us feel hungry. Another hormone, leptin, decreases our appetite and makes us feel full. The less sleep you get, the less normal these hormone levels are. Your body makes more ghrelin and less leptin. This means you’re more likely to feel hungry and eat more, which could lead to extra pounds.

Also, sleep deprivation creates changes in the brain that lead us to crave high-calorie, high-fat foods — and make us less able to stop ourselves from eating them. Sleep loss also seems to trigger emotional eating in people (especially women) prone to munch during stressful times.

Sleep and metabolism

So we know a lack of sleep upsets metabolism. When your metabolism is upset, it also messes up your circadian rhythms — the body’s internal schedule for when you’re supposed to eat, sleep, and be active.

One of your internal clock’s functions is to regulate insulin (which controls blood sugar levels and how much fat you store), growth and stress hormones, and immune system actions (particularly inflammation). Inflammation is your body’s response to a threat. Signs of inflammation include swelling, warmth, redness, and pain. All these symptoms mean your body is trying to fix anything that’s damaged or trying to get rid of something harmful, such as a virus or bacterium.

Insulin resistance means your body stops responding to insulin the way it should. To learn more about insulin resistance, read one of my earlier Think Pink, Live Green columns, The Ins and Outs of Insulin Resistance.

Not getting enough sleep can also have a bad effect on insulin regulation and increases the risk of diabetes. A study that allowed healthy young adults only 4 hours of sleep per night for just one week found that some of the participants’ insulin and blood sugar levels were similar to the levels of people with diabetes.

Still, the biggest concern is developing metabolic syndrome, a group of risk factors for heart disease and cancer that includes high blood pressure, blood sugar, and cholesterol levels. Studies have found that people who don’t get enough sleep had a higher risk of developing metabolic syndrome. And guess what? These metabolic problems can disturb your sleep — another vicious circle. Yikes, this stuff is complicated.

Sleep apnea

Even if you always go to bed on time, you may not be able to sleep well due to obstructive sleep apnea. Sleep apnea is a fairly common medical condition. While you’re sleeping, the airway in your throat collapses or becomes blocked. You may even briefly stop breathing, which then wakes you up. Apnea is more common in overweight people, and most extremely obese people suffer from it. Like any sleep disorder, sleep apnea can cause metabolic changes, raising the risk of being overweight even if you’re currently at a healthy weight. This creates another unhealthy feedback loop (less sleep, more hunger; more hunger, more food, and so on). People with sleep apnea, especially if they are also obese, tend to have more metabolic problems, including diabetes.

The breast cancer connection

When it comes to the risk of developing breast cancer, there doesn’t seem to be a link between sleep and the disease. But there is a connection between aging and breast cancer risk: the older you are, the higher the risk. Aging involves all the wear and tear of living, as well as environmental exposures. Sleep is when you repair a lot of these everyday stresses and strains to your system. With or without breast cancer — but especially if you’ve had the disease — sleep quality can play a big role in how well you feel, function, heal, and recover.

Sleeping problems have been found to show up before and after breast cancer surgery, and most chemotherapy patients have temporary sleep issues. Many women who’ve had chemotherapy have ongoing sleep problems, especially if they are very overweight.

If you’re a regular reader of this column, you know that overweight and obese women have a higher risk of developing breast cancer in the first place. They also have a higher risk of the breast cancer coming back (recurrence), especially if they carry extra fat in their midsection. This is partly because the extra fat cells make a lot of extra hormones that can lead to extra breast cell growth. The extra hormones include estrogen, insulin growth factors, prostaglandins, and others. When you have higher levels of these hormones in your blood over time, the risk of cancer is increased. Extra weight also is connected to inflammation, which puts stress and strain on your immune system and breast cells. A lot of new research shows a link between weight-related inflammation and breast cancer risk.

Rest for success

Thankfully, better sleep promotes weight loss and vice-versa. If you’re struggling to get good sleep and stick to a healthy weight, here are some tips to get back on track:

  • Make time in your schedule for 7 to 8 hours of sleep nightly — no excuses!
  • Retrain your body’s internal clock. Start and stick to a regular schedule of eating, exercising, and sleeping.
  • Figure out the cause of your sleep issues. Often changing or shifting a habit, activity, or behavior can make a big difference.
  • Break the caffeine cycle. Drink fewer caffeinated beverages such as coffee, tea, soda, and energy drinks. I’ve had to cut back to only one caffeine beverage per day, which I have to drink before noon. Drinking coffee or soda all day to boost your energy will likely make it harder to fall and stay asleep at night. Plus, if you’re fan of sugary, caffeinated drinks, they can add pounds.
  • Keep your bedroom dark and avoid using electronic devices such as cell phones, tablets, and video games right before your go to bed. Light — especially the blue light given off by computer screens and energy-efficient light bulbs — suppresses an important hormone called melatonin. Melatonin helps regulate sleep. Some researchers think normal melatonin levels also can help maintain normal cell growth and that low levels of melatonin may contribute to the risk of developing cancer. If you work a night shift or must use devices after dark, buy a special blue-light filter.
  • Get treatment for sleep problems with a medical cause:
    • If you have obstructive sleep apnea or severe snoring, talk to your doctor. Experts recommend treating the apnea first, before dealing with any related extra weight. That way, you’ll be rested enough to start exercising. Your doctor may prescribe a CPAP (continuous positive airway pressure) machine to help you breathe at night.
    • If you have breast cancer-treatment-related insomnia or sleep disturbance, try some of the tips in my column Sleep Well: Turn In, Tune Out, and Unplug. Complementary medicine techniques such as meditation, yoga, and acupuncture might also help. Check out the Breastcancer.org section on Complementary and Holistic Medicine for more information.
  • Avoid widely prescribed hypnotic sleeping medicines, especially after a breast cancer diagnosis. This class of medicines includes Ambien (chemical name: zolpidem), Halcion (chemical name: triazolam), Sonata (chemical name: zaleplon), and Lunesta (chemical name: eszopiclone). A very large study published in 2012 found that users of hypnotic sleeping medicines (especially people who took them often) had a much higher risk of death or being diagnosed with cancer than non-users. Also, each of these medicines can have many problematic side effects. For example, Ambien and Halcion have been associated with walking, eating, and even driving while asleep. The U.S. Food and Drug Administration recently halved the recommended dose of Lunesta because that medicine can make it difficult to drive and may affect memory and coordination the day after taking it. All of these medicines may be habit-forming and cause withdrawal symptoms if stopped suddenly.
  • Cognitive behavioral therapy, a special type of counseling that doesn’t use medicine and focuses on changing one’s thoughts, may help with sleep.
  • Try some of the diet and exercise tips in the Breastcancer.org Lower Your Risk section. Besides burning calories, exercise also promotes better sleep. But remember, work out at least 3 hours before bedtime or you’ll be too revved up to sleep.

Have you ever had problems sleeping? What did you do to get more sleep?

Dr. Marisa Weiss

Marisa Weiss, M.D. is the founder, president and guiding force behind Breastcancer.org, the world's most trafficked online resource for medically reviewed breast health and breast cancer information, reaching over 8 million visitors per year. A breast cancer oncologist with over twenty years of active practice in the Philadelphia region, Dr. Weiss is regarded as a visionary advocate for her innovative and steadfast approach to informing, empowering, and treating patients with breast cancer.

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