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Not getting enough sleep can make you fat
Having a hard time losing weight? Nutritionist Madelyn Fernstrom, a ‘Today’ contributor, explains why poor sleep habits can pack on the pounds

By Madelyn Fernstrom, Ph.D., CNS “Today” contributor TODAY updated 11:09 a.m. ET, Thurs., Oct. 26, 2006

If you’ve tried to lose weight, you know it’s not easy. But for some of us, it’s even more difficult. Some dieters who are eating less and exercising more still have a hard time dropping those extra pounds. Why? One answer may lie in their sleep habits.

At my weight management clinic at the University of Pittsburgh Medical Center, one of the first questions I ask my patients is if they’re getting enough sleep. The typical response is usually “terrible,” “not enough,” “I’m up all night,” “I have no time,” or “I’m always tired.” So when I work out a weight-loss plan for these patients, I stress that they get enough sleep. Recent scientific studies show a strong relationship between sleep deprivation and weight gain, even though we don’t know exactly why this occurs. Here are some findings:

• People who slept less than six hours a night experienced an increase in their body mass index (height-to-weight ratio) more than those who slept seven to eight hours.
• Women who slept five hours a day, or less, gained more weight than those who slept seven hours a day, according to a 16-year study.
• People who slept less than eight hours a day had larger increases in body fat than those who slept more.

How does sleep affect our bodies?
Our bodies’ major activities, including temperature regulation, hormone secretion, and brain chemistry production, run on a 24-hour cycle. When our bodies aren’t in a regular sleep pattern (think jet lag), hormones that regulate whether we feel full or hungry get out of whack, so all of our normal cues for eating are altered. An undiagnosed medical illness might also cause poor sleep habits. Someone with an underactive thyroid gland, for instance, will feel fatigued and gain weight. And someone who suffers from sleep apnea will wake up repeatedly during the night.

How does sleep affects eating?
When we’re tired, or feeling fatigued, we don’t always make the healthy food choices:

• We’ll snack right before we go to bed to relax.
• We’ll have a quick pick-me-up snack during the day, when we’re feeling sleepy or fatigued.
• We won’t stick with our healthy eating plan.
• When we’re tired and sleep deprived, we tend to make poor food choices, and rely on higher calorie comfort food.

How to catch more zzz’s?
We live in a hectic world with many responsibilities. Trying to juggle work, family, chores, and recreation, it’s no wonder many of us think: “I can’t waste time sleeping.” We also live in stressful times, and often our mental stress prevents sleep, even when we set aside seven to eight hours. This is a real double whammy for weight loss: we eat to relieve stress, but also can’t sleep because we’re too stressed out!

Many people also have physical problems that awaken them from sleep, including sleep apnea and diabetes. (Diabetics often make several trips to the bathroom during the night.) Sleep apnea, often seen in overweight and obese people, is a condition of waking up repeatedly throughout the night. Often the person doesn’t realize that he’s waking during the night, but he’ll feel tired in the morning. Significant snoring usually accompanies this condition. So if you’re tired and gaining weight, it’s important to see your doctor to make sure you don’t medical problems.

While the obvious solution is to sleep eight hours each night, the real-life answer is not so easy. Here some steps you can take to help regain some control and minimize the likelihood that lack of sleep will sabotage your weight-loss efforts:

• Try to set a regular schedule. Eat regularly — at least three to four times each day. Aim for seven hours of sleep. Creating some structure in your life. And make sleep a priority.
• Don’t use food to “wake you up.” Take a power nap between 15 and 20 minutes instead. Always think before you eat and make a healthy choice. Avoid junk food, which may be comforting, but it won’t give you a metabolic pick-me-up. If you feel like you need an energy boost, eat a piece of fresh fruit, a half a sandwich made with lean protein (such as turkey, chicken or tuna), some low-fat cheese or low-fat yogurt, a 100-calorie protein bar, or a 100-calorie pack of crackers.
• Address your stress. Separate mental fatigue (stress) from physical fatigue. Try to reduce your stress levels by taking a 20-minute walk, and increasing your activity of daily living. This can help promote a more restful sleep. Wear a pedometer and monitor your activity. Aim for 10,000 steps daily for optimal weight management. In the beginning, set a more realistic goal of at least 5,000 steps a day.
• See your doctor to rule out any medical illnesses contributing to lack of sleep and weight gain.

Madelyn Fernstrom’s Bottom Line: While we cannot always get a full eight hours of sleep every night, chronic sleep deprivation (for any reason) can be a major sabotage to losing weight and keeping it off. If you are committed to long term weight loss — or just weight stability – examine your sleep patterns. Getting more sleep can make a big difference in your waist line.

Madelyn Fernstrom, Ph.D., CNS, is the founder and director of the University of Pittsburgh Medical Center’s Weight Management Center. An associate professor of psychiatry, epidemiology, and surgery at the University of Pittsburgh School of Medicine. Fernstrom is also a board certified Nutrition Specialist from the American College of Nutrition.

Lack of Sleep Means Pain, Weight Gain
How Lack of Sweet Sleep Can Turn You Sour, Cause Pain and Weight Gain

By STEFAN ASCHAN Jan. 22, 2008

"What happened to you last night? You look like hell."

You may be surprised when a friend greets you in this way on an early Monday morning after a busy weekend.

Then again, considering your routine, it might come as no shock at all. Full Coverage Don't Suffer With Pain: Get Expert Tips

The latest news on the election, worries over stock market — and perhaps even your favorite realty show — might keep you up throughout the night, till midnight, 1 a.m. or even 2 a.m.

Ouch, it's time to go to bed, right? But now you can't fall asleep because you heart is pumping from excitement over the latest news. After a couple of weeks, you notice that you lack energy, and aches and pains are arising that you have not had before.

You start to make appointments with doctors to get to the bottom of the pains. Yet, nobody can find anything wrong. You try physical therapy, pain medication and natural remedies. Still no success. Might sleep be the cause of the issues?

The fact is, staying up late is easy to do when you are young. You used to bounce back. Remember when you could work a full day, head home, change clothes and go out again? It was fun, and you did it three nights in a row. But now you're older, and things have changed.

Sleep is one very important consideration for anyone. We need sleep to restore and repair our systems. Yet, because of the pressures and distractions of modern society, our natural patterns are often interrupted, possibly causing pain and weight gain.

How It Used to Be

Our natural sleep pattern is influenced by light. The cycles of light and dark that occur because of the movement of the sun affect all living creatures.

When health experts speak of our sleeping cycle, you'll often hear it referred to as our "circadian cycle." In times past, it was natural to rise with sunrise and wind down at sundown. Times have changed. You work on the computer, watch TV and read late under electric lights. Hence, there are many opportunities to interrupt our circadian cycle.

F.D.A. Warns of Sleeping Pills’ Strange Effects
Published: March 15, 2007

By STEPHANIE SAUL

The most widely prescribed sleeping pills can cause strange behavior like driving and eating while asleep, the Food and Drug Administration said yesterday, announcing that strong new warnings will be placed on the labels of 13 drugs.

The agency also ordered the makers of the well-known drugs Ambien and Lunesta and the producers of 11 other commonly used sleeping pills to create patient fliers explaining how to use them safely.

The fliers, which the agency says it requires when it sees a significant public health concern, will be handed out at pharmacies when consumers fill their prescriptions.

Although the agency says that problems with the drugs are rare, reports of the unusual side effects have grown as use of sleeping pills has increased.

Sales in the United States of Ambien and Lunesta alone last year exceeded $3 billion. Use of those medications and other similar drugs has soared by more than 60 percent since 2000, fueled by television, print and other advertising. Last year, makers of sleeping pills spent more than $600 million on advertising aimed at consumers.

The review was prompted, in part, by queries to the agency from The New York Times last year, after some users of the most widely prescribed drug, Ambien, started complaining online and to their doctors about unusual reactions ranging from fairly benign sleepwalking episodes to hallucinations, violent outbursts, nocturnal binge eating and — most troubling of all — driving while asleep.

Night eaters said they woke up to find Tostitos and Snickers wrappers in their beds, missing food, kitchen counters overflowing with flour from baking sprees, and even lighted stoves.

Sleep-drivers reported frightening episodes in which they recalled going to bed, but woke up to find they had been arrested roadside in their underwear or nightclothes. The agency said that it was not aware of any deaths caused by sleep-driving.

The reports gained credence from scientific studies. A forensic toxicologist in Wisconsin, Laura J. Liddicoat, gave a presentation at a national meeting on six instances of Ambien-impaired driving.

And Dr. Carlos H. Schenck and Dr. Mark W. Mahowald of the University of Minnesota said that they had been studying cases of nearly 30 Ambien users who developed unusual nighttime eating disorders.

Last May in Washington, Rep. Patrick Kennedy, Democrat of Rhode Island, blamed Ambien when he crashed his car near the Capitol building.

The agency also received reports of people making phone calls, purchasing items over the Internet, or having sex under the influence of sleep medication.

In each case the consumers had no recollection of the events, which they said had occurred after they took their pills and headed for bed.

An agency official said yesterday that the activities associated with the drugs went beyond mere sleepwalking.

"We do believe that sleepwalking is different from these behaviors," said Dr. Russell Katz, the F.D.A.'s director for neurology products. "Sleepwalking is considered more of a reflex. These behaviors are complex and they're different fundamentally because of the complexity. People get up, they take their car keys and they go drive. As you might imagine, that might be potentially dangerous to the patient and others as well."

Dr. Katz said that it was not entirely clear whether people reporting the problems had been technically asleep or awake. Although Dr. Katz said the side effects were rare, the agency said that the few dozen reports it had received probably did not represent the full extent of the problem.

Drinking alcohol before or after taking the drugs appears to increase the chances of having such a reaction, Dr. Katz said.

A defense lawyer in Atlanta who specializes in impaired-driving cases, William C. Head, said he had received calls from people around the world who had been charged after using such medications.

"Ninety percent of these cases involve alcohol as well," Mr. Head said. Often, though, the people arrested had only a glass of wine or two, then took a sleeping pill, he said.

"You can't even keep your car on the road," Mr. Head said. "I think any warnings that they give, any advertisements should say not a drop of alcohol."

The medication guides that the agency has called for will clearly explain that risk, according to Dr. Katz, who said the drug makers must submit drafts by May. He said the drug makers had been working with the F.D.A. on the wording since the agency notified the companies three months ago that the changes would occur.

Besides warning against alcohol use, the new labels and guides will tell consumers that they should not take the pills with other drugs that suppress the nervous system.

The warnings labels will include some general language required by the agency, along with language that the companies will be required to draft that describes the side effects of their specific drugs.

The drugs affected include newer products as well as older and widely used ones that are sold under brand names and generic names.

Most of the drugs already carry statements warning against alcohol use and of the risk of hallucinations. Advertising for the drugs has also included such warnings. But the labels will make those statements more prominent, and the medication inserts will emphasize the risks when the consumer gets the prescription filled.

The warnings also are to include information about an unrelated and rare risk of life-threatening allergic reactions with sleep medications. Some patients have recently reported such reactions, in which the air passages or face swells up, after using one of the newest drugs in the group, Rozerem, Dr. Katz said.

After reviewing reports, the agency determined that those reactions were also a potential side effect with other drugs in the group, he said.

Although most of the reports of sleep-driving and sleep-eating have involved Ambien, the agency concluded that the behavior can be caused by any of the sleeping pills.

One sleep expert, Dr. Mahowald of Minnesota, said that Ambien had received the most publicity because it was the most widely used. But "there's no question that any of the sedative hypnotics can do this," he said.

Ambien and its extended-release formula, Ambien CR, made by Sanofi-Aventis, dominated the market last year, accounting for 27.6 million of the 44 million sleep drug prescriptions in this country, according to data from Verispan.

In second place, with about 7.3 million prescriptions, was the drug temazepam, a generic that is also sold by Tyco Healthcare under the brand name Restoril.

Lunesta, by Sepracor, was next with 5.8 million prescriptions.

Dr. Mahowald directs the Minnesota Regional Sleep Disorders Center, where doctors have been involved in a study of about 30 patients who developed sleep-eating while using Ambien. Some of the patients gained weight before discovering that they were getting up at night to cook and eat.

"Hopefully this will make doctors think twice before blindly giving patients a prescription," said Dr. Mahowald, who advocates a combination of medication and behavioral therapy to treat insomnia.

He also criticized marketing of the products. "I personally think the extent of advertising has just been unconscionable," he said.

Data from the research firm TNS Media Intelligence shows that in 2005 and 2006, Sanofi-Aventis spent a total of nearly $350 million to advertise Ambien and Ambien CR.

Sepracor spent more than $500 million on advertising for Lunesta during that same two-year period. And Takeda, which makes Rozerem, spent about $100 million.

After yesterday's F.D.A. announcement, Sanofi-Aventis immediately posted the text of a "Dear Doctor" letter to its Web site, outlining the new warnings. The agency has ordered all the companies to send such advisories to prescribing doctors.

In a statement last night, Sanofi-Aventis said that information about sleepwalking had always been included on its label. In company clinical studies, it occurred in fewer than 1 in 1,000 patients, the statement said.

The agency also said that it was recommending that the drug makers conduct additional clinical studies involving sleep-driving and other reactions to determine whether any of the sleeping pills do not cause those problems. But those studies will not be required. And so far, none of the companies have announced plans to conduct them, Dr. Katz said.

The agency's move follows a warning last month by authorities in Australia, where Ambien is marketed as Stilnox.

The Australian drug agency said that it had received 16 reports of unusual activities by consumers using the product, including sleep-driving and sleep-eating. In one case, a woman woke up with a paintbrush in her hand, discovering she had painted the front door of her home while asleep.

Lack of sleep sends emotions
off the deep end

By Sharon Jayson, USA TODAY

"What happened to you last night? You look like hell."

You might have guessed it, but now researchers have real proof: Sleep deprivation causes our emotions to go haywire.

That's according to the first neurological probe into the emotional brain without sleep. It was carried out by researchers at the University of California-Berkeley and Harvard Medical School.

"Most people think that when you're sleep-deprived, what happens to the brain is that it becomes sleepy and less active," says Matthew Walker, assistant professor of psychology at Berkeley and a former Harvard sleep researcher. But Walker says the imaging study published in today's issue of Current Biology found that the brain's emotional centers become "60% more reactive."

The study also suggests that lack of sleep elevates activity in the emotional centers of the brain most closely associated with psychiatric disorders such as depression.

Walker's team studied 26 people ages 18 to 30 who were divided into two groups. The sleep-deprived group was awake 35 hours; the other group slept normally.

Using the brain scans, the researchers showed participants a series of images, from neutral to increasingly negative and disturbing. The responses of both groups showed up as hot spots, but the sleep-deprived evoked stronger responses because the prefrontal area of the brain that normally sends out inhibiting signals wasn't able to keep emotions in check.

Though the thinking has been that psychiatric disorders cause poor sleep, Walker says now he's not so sure because those he studied didn't have psychiatric conditions, yet they exhibited emotional brain reactions similar to psychiatric conditions.

Mary Carskadon, a professor of psychiatry and human behavior at Brown University who has studied adolescents and sleep deprivation, says the new study is compatible with her findings. She is particularly concerned about what it means for adolescents, who are often sleep-deprived and who are being diagnosed with depression in increasing numbers.

"What we don't know is whether early sleep deprivation then projects out to things like major depressive disorder or bipolar illness and whether we're really setting up our kids for these major problems as they grow up," she says.