We are all sleep-deprived. The National Sleep Foundation recommends seven to eight hours of sleep. A study published in the Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report found that “more than a third of American adults are not getting enough sleep regularly.” This has major health implications, including the potential for gaining weight. Fighting obesity without the proper amount of sleep is virtually impossible, as “obesity-related cardiovascular risk” can work against treatment plans.
But in our community, numbers are even higher; 45.4% of Black adults reported getting less than seven hours of sleep compared to 33.2.% of non-Hispanic white adults.
How Lack of Sleep Impacts Black Patients in Particular
There is a proven link between poor cardiovascular health, something that can contribute to difficulty reversing obesity, and insomnia. It was first discovered in 2009.
Who the patient is and what their life looks like matters in how they can address this information and what their life looks like. A 2022 review published in Nutrients stated that “Epidemiological and laboratory studies have consistently demonstrated that short sleep duration is a significant risk factor for weight gain and obesity, especially in African Americans.” In 2019, Nature and Science of Sleep published a review stating that “most studies report that Blacks have the highest risk and prevalence of poor sleep patterns across various dimensions of sleep health than any other racial/ethnic group.
“It has been previously shown that ghrelin, a hormone promoting hunger, increases with sleep restriction, whereas leptin, a hormone contributing to satiety perception, decreases,” according to the Journal of Clinical Nutrition.
Dr. Adrian Pristas, who specializes in Sleep Medicine and Pulmonology and serves as the corporate medical director for the Centers for Sleep Medicine at Hackensack Meridian Health, explained the risks associated with not maintaining proper sleep hygiene for all people to Black Health Matters:
“Short sleep for any reason, whether it be intentional or that of an insomnia patient or somebody with sleep apnea, it comes with consequences,” warned Dr. Pristas. He noted that cardiovascular health is one of the major areas impacted by sleep loss. “People who don’t sleep enough hours, including insomniacs, have more heart attacks and strokes and don’t live a normal lifespan,” he said.
How Insomnia Impacts Patient’s Weight
Obesity can be a predictive factor in developing sleep issues as well.
“The reasons for that are things like adrenaline increase in our bodies when we don’t sleep properly. There are also a few hormones involved, so if you’re trying to stay in shape or you’re trying to manage your weight, managing cortisol and thyroid hormones are important, and they have a circadian rhythm,” he continued. “So if you’re not sleeping properly, the circadian rhythm is disrupted, making it difficult to accomplish goals.”
Current Opinion in Endocrinology, Diabetes & Obesity considers sleep disturbances and circadian rhythms novel but potentially deadly risk factors for obesity. In 2017, the journal reported that circadian misalignment “leads to poor dietary choices and reduced energy expenditure, which may contribute to an increased risk for obesity.” It also reported that “insufficient sleep leads to poor dietary choices and altered hormones involved with hunger and appetite, including ghrelin.”
Why Patients Can’t Choose the Gym Over Sleep
Dr. Pristas described the problem with patients choosing to hit the weights over the sheets. “Sacrificing sleep is never a smart approach. It just doesn’t work. Your body won’t respond the way you want,” he said. For people interested in fitness, recovery is part of the plan. You have to allow your body to recover virtually. All recovery happens during sleep. So, you haven’t recovered if you cut your sleep short and then go to the gym.”
This must be explained clearly to patients so they can understand what they are risking when sacrificing sleep for other areas of their lives. Without the knowledge of the risks, it can be difficult for them to understand the gravity of their decisions.
Research confirms his advice. The International Journal of Environmental Research and Public Health reported, “Optimal sleeping time and quality are necessary to benefit the allostatic response after exercise.” In 2022, Nature Reviews Endocrinology reported that “short sleep duration (defined in most of the cited studies as less than 5 or 6 hours per day) is associated with a 38% absolute increase in the incidence of obesity compared with normal sleep duration in a meta-analysis of prospective cohort studies among adults.”
Dr. Pristas previously used furniture to illustrate the limitations of a healthy lifestyle that doesn’t include sleep. “Imagine your health as a stool with three legs: Sleep, nutrition, and exercise,” said the doctor. “Sleep deprivation will shorten the ‘sleep’ leg, and your health will be off-balance.”
It is important to explain that the kind of sleep patients also miss out on matters and that their approach to closing the gap in their sleep hygiene is imperative.
When we chop off a little bit of sleep time, it’s almost always deep sleep that we are chopping off, and that is the kind of sleep we need to feel better. It’s called restorative sleep,” he explained.
“The last two, three hours of our sleep is that deep sleep. And it’s usually REM, So if you don’t sleep enough, you will chop that valuable sleep off your schedule and lose out.”
4 Ways To Help Your Patients Improve Their Sleep Hygiene
Encourage Them To Ask For Help
Dr. Pristas recommends seeking treatment when restlessness arises. One of his go-to treatment plans is recommending cognitive behavioral therapy. Be prepared to recommend this option to ensure the patient has a method for developing how to take and implement the medical advice you are giving.
Explain What Will Happen If They Refuse To Prioritize Sleep
“I always tell people, if you don’t take care of yourself, you’re gonna be a burden to your family at some point. So, it’s important to take care of yourself, said Dr. Pristas. “You do have to be selfish when it comes to sleep. It’s got to be done.”
Have the studies ready to prove to your patients why they should be committed. Be prepared with positive and negative outcomes so that they can absorb the information that best speaks to them.
Consider Integrating Wearables into Their Treatment Plan
Adding an eye mask or earplugs can transform your sleep experience. Dr. Pristas uses this practice in his own life. “I personally wear eyewear because I sleep better,” he revealed. I just tell people to sit in an average-lit room, close your eyes, and then cover each eye with the palm of your hand and realize how much darker it is.”
He explained that many people have no idea that light sensitivity negatively impacts their sleep health. “It’s a very common problem that many folks just don’t realize they have.” Don’t assume that your patients know what their sensitivities are. Ask them detailed questions to understand their experience.
Smart watches can help one monitor their sleep habits by drawing their attention to them. “They’re not always as accurate as I’d like to see, but they make people think about their health,” he said.
Recommend Lowering the Temperature
The thermostat might be the answer to patients tossing and turning. “It’s very difficult to sleep in a hot room,” said Dr. Pristas.
Ask them what their options are for cooling things down, and have a few go-to suggestions to offer.
