Good quality sleep is important for patients with obesity. 

While the amount of sleep we get is important, so is the quality of that sleep. The National Sleep Foundation recommends seven to nine hours of sleep per night, but more importantly, the group highlights the importance of quality sleep for emotional, mental, and physical benefits.¹

According to the National Sleep Foundation, there are four hallmarks of quality sleep: (1) sleep latency, the amount of time it takes to fall asleep; (2) sleep waking, how frequently one wakes up during the night; (3) wakefulness, the number of minutes one spends awake after initially falling asleep; and (4) sleep efficiency, how much time one actually spends in bed asleep. 

When sleep quality is poor, we are at greater risk of associated health issues such as cardiovascular disease, type 2 diabetes, poor cognitive functioning, and weight gain.^2,3 For example, when we experience poorer sleep quality, we are more likely to experience increased hunger, uncontrolled emotional eating, and we are more likely to eat larger portions of food, which is problematic for weight management.⁴  While it is important for everyone to optimize their sleep efficiency, it is especially important for patients with obesity to ensure they are getting good quality sleep.

The Consequences of Poor-Quality Sleep on Weight 

While weight loss maintenance can be challenging, better sleep quality is associated with greater success in maintaining a healthy weight. A recent study⁵ investigated how sleep duration and sleep quality affected weight loss maintenance in 528 participants ranging in age from 18-65. To be eligible, participants had to have purposely lost at least 10 percent of their starting weight and have a maximum BMI ≥ 25 kg/m². Anyone who maintained a minimum of 10 percent weight loss for 12 months was classified as a “maintainer.” 

Sleep quality was a self-reported measure of sleep duration — how long one slept at night plus any daytime naps. Study participants were tasked with recalling the average sleep per night during the previous month and daytime nap frequency and  tasked with self-reporting sleeping difficulties such as falling asleep, waking up at night, and waking up earlier than desired. Results show that the “maintainers” reported more time spent asleep and better sleep quality compared to counterparts. While the results are promising, it should be noted that cause and effect cannot be determined relative to the experimental design. Despite lack of support for a causal relationship, the evidence does suggest that experiencing sleep that lasts for longer periods of time could help with maintaining a healthy weight. 

Maintaining a healthy weight is also important for mitigating the risks of type 2 diabetes, another known risk factor for patients with obesity. Insufficient sleep has been identified as a risk factor for developing insulin resistance, type 2 diabetes, and a high BMI.⁶ There is growing empirical support for the connection between sleep fragmentation and the risk of diabetes. While more research needs to be performed, those who experience fragmented sleep are also at risk for type 2 diabetes. For example, research consistently shown fragmented sleep is associated with increased activity in sympathetic nervous system (SNS). Activity in the SNS is implicated in the secretion of insulin and glucagon, muscle insulin resistance, and adipocyte function.⁶ 

Strategies for Improving Sleep Quality

Certainly, one effective strategy for improving sleep quality is maintaining a healthy weight. In addition to weight loss, effective strategies include developing good “sleep hygiene,” or good sleeping habits.  According to the Centers for Disease Control and Prevention⁷, sleep hygiene includes: 

• Going to bed at a consistent time each night
• Getting up at the same each day
• Optimizing your bedroom to ensure it is dark, quiet, relaxing, and the ambient temperature is comfortable
• Not keeping electronic devices such as smart phones, computers, and TVs in the bedroom
• Not consuming large meals, alcohol, or caffeine before bed
• Including exercise as part of your daily routine

Health care providers working with patients with obesity should consider the role of sleep quality and sleep hygiene in their patients’ lives.  While occasional sleepless nights happen, an ongoing pattern of poor sleep quality can signal trouble, particularly for patients with obesity. Health care providers can help their patients to identify possible causes of poor sleep quality and work with them to problem solve and investigate how their patients’ sleep quality may be negatively affecting their weight loss journey. Lifestyle modifications such as a Low Calorie Diet (LCD) or a Very Low Calorie Diet (VLCD) and exercise should also expand to include strategies for optimizing sleep quality. Getting the recommended seven to nine hours of good quality sleep and optimizing sleep hygiene can help improve one’s overall wellbeing. 

Sources:

1. The National Sleep Foundation
2. Sleep is essential to health: an American Academy of Sleep Medicine position statement
3. The role of sleep duration in the regulation of energy balance: Effects on energy intakes and expenditure
4. Sleep-obesity relation: Underlying mechanisms and consequences for treatment
5. Sleep quality is associated with weight loss maintenance status: The MedWeight Study
6. Sleep influences on obesity, insulin resistance, and risk of type 2 diabetes
7. Centers for Disease Control and Prevention: Tips for better sleep