Sleep More, Stress Less to Achieve Your Weight Loss Goals

Weight Watchers and Jenny Craig should get with the program. Neither of the weight loss leaders integrates sleep education and sleep diaries. And the companies are making a big mistake, new research suggests. Popular approaches used by groups like Weight Watchers use a diary to keep track of food and exercise. Adding an extra column in the diary for hours slept would be a minor change that could make a significant impact.

A new study in the International Journal of Obesity found that adequate sleep increases your chances of success during weight loss efforts. People trying to lose at least 10 pounds more often reached their goal if they had six to eight hours of sleep per night. Stress reduction also helps with weight loss, the study reports.

A group of 500 study participants were instructed to lose 10 pounds over a six month period. All participants attended weekly weigh-in and educational meetings. Instructors at the meetings encouraged the participants to consume 500 fewer calories per day, adopt a healthy low-fat, low-sugar diet and exercise for at least 180 minutes a week. Participants were required to keep record of how long they slept, stress levels and mood. The class instructors encouraged participants to keep a food diary as well.

Nearly three-quarters of the people who slept more than six hours and kept a low-stress lifestyle were successful in losing 10 pounds or more and were twice as likely to meet their goals compared to those who get six or fewer hours of sleep.

Sleep loss tends to lead to weight gain or undermine dietary weight loss because it changes the body’s hormone levels. Lower leptin and higher ghrelin can lead to a slower metabolism but a bigger appetite for junk food.

Whether you are trying to lose weight or stay trim for swimsuit season, prioritizing sleep is always a good idea. The American Academy of Sleep Medicine recommends adults get at least seven hours of sleep. Don’t underestimate the power of diet and exercise. Weight loss programs like Weight Watchers work for many people because they educate people to make the right choices and encourage them to hold themselves accountable for their health.

Inadequate Sleep Undermines Dietary Fat Loss

Dieting sometimes just doesn’t work out as hoped, despite your best intentions. Before you reexamine your exercise routine or diet, consider your sleeping habits.

A small study conducted at the University of Chicago suggests sleep is the third vital element in the battle to shed fat. Exercise and dietary efforts may be less effective without a regular 7-8 hours of shuteye.

Dieters in the study shed the same amount of weight with less sleep, however when they had adequate sleep they burned off more body fat. An abstract is available on the website of the journal Annals of Internal Medicine.

A group of 10 overweight study participants with an average BMI of 27.4 adopted a diet with 90 percent of calories required to maintain weight without exercise. The volunteers dieted in two 14-day intervals. One involved sleep restriction with only 5.5 hours per night compared to 8.5 hours in the control portion of the study.

The subjects lost an average of 6.6 lbs during each 14-day dieting period. Half of the weight lost was body fat with adequate sleep. In the sleep restriction condition, the dieters lost only 1.3 lbs of fat and 5.3 lbs of lean body mass.

They also felt hungrier. The “hunger hormone” Ghrelin increased during sleep loss, causing a spike in appetites. Ghrelin also promotes the retention of fat, the study authors report.

"If your goal is to lose fat, skipping sleep is like poking sticks in your bicycle wheels," said Plamen Penev, MD, PhD, the study’s principal investigator. “One should not ignore the way they sleep when going on a diet.”

The authors intend to further investigate how sleep loss affects diet results. They plan on conducting similar, lengthier studies with larger samples of dieters.

Dr. Oz: One Minute of Sleep Apnea Advice

Dr. Oz recently gave advice for obstructive sleep apnea in a segment called “1 Minute to Better Health.”

First he outlined some of the ways that OSA can have a negative effect on your health and performance. It can cause daytime fatigue, poor mood, memory loss, heart disease, stroke and even death.



Then he described who is most likely to have sleep apnea. It often occurs when extra fatty tissue in the throat keeps air from flowing freely as you sleep.

“People with sleep apnea are usually overweight,” he said.

What can be done about sleep apnea?

He said that becoming a side sleeper may help. But he recommended weight loss as a better option.

According to Dr. Oz, most people tend to lose weight in their face and neck first. This means that dropping some extra weight could possibly cure sleep apnea.

“So remember, if you want to get rid of that extra sleep apnea problem you’ve got, just lose a little bit of weight,” he said.

If only it were that easy. Studies show that weight loss often reduces the severity of sleep apnea. But it rarely solves the problem.

One recent study found that a very low-energy, liquid diet cured sleep apnea in 17 percent of participants. Another study found that participants still had moderate OSA after a 16-week diet and exercise program.

The AASM recommends dietary weight loss as one treatment strategy for people who are obese and have sleep apnea. But weight loss should be combined with another treatment such as CPAP or an oral appliance.

Why? As Dr. Oz pointed out, sleep apnea can have a severe effect on your health. It requires immediate and effective treatment.

But weight loss takes a long time, and it may not be enough to cure the problem. Weight loss also is difficult to maintain. Excess weight often returns over time.

And it is important to point out that OSA also occurs in people who maintain a healthy weight. A study presented at SLEEP 2009 found a high rate of sleep apnea in non-obese adults.

You should talk to your doctor to develop a healthy weight-loss plan that is right for you. For help with sleep apnea you should contact an AASM-accredited sleep disorders center in your area.

Read more about obstructive sleep apnea and weight loss and OSA.

A Low-Energy Diet & Sleep Apnea

A new study examined the effect of weight loss on obstructive sleep apnea in obese men. The results were published online in the British Medical Journal.

The Swedish study involved 63 obese men with an average weight of 248 pounds. Their average age was 49 years. Sleep apnea was measured using a home sleep test.

All of the men had moderate to severe OSA and were being treated with CPAP therapy. They had an average apnea-hypopnea index of 37 breathing pauses per hour of sleep. An AHI of more than 30 is considered “severe” OSA.

Thirty men were assigned to the treatment group. The other 33 men acted as a control group.

The men in the treatment group were put on the Cambridge Diet for seven weeks. This is a very low-energy, liquid diet. It uses a powder that is mixed with water to replace every meal of the day.

After the seven-week diet normal foods were gradually introduced for two weeks. Treatment also involved group sessions for support and motivation.

Results show that men in the treatment group lost an average of 41 pounds. Twenty-two of the 30 men were no longer obese.

This weight loss produced an improvement in sleep apnea severity. The mean AHI of the treatment group dropped from 37 to 12.

Seventeen percent of the men no longer had sleep apnea. Fifty percent had mild sleep apnea with an AHI of less than 15. Men who initially had severe OSA showed the greatest improvement in AHI.

In a press release the authors noted that a very low-energy diet is not a general solution to weight problems. Typically it is used in the first phase of a long-term treatment program.

They also wrote that the main limitation of the study was its short duration. Weight regain is common after weight loss. Evaluating the long-term effectiveness of weight loss would require at least one year.

The study was funded in part by Cambridge Manufacturing Company Limited, which markets the Cambridge Diet.

The AASM recommends dietary weight loss as one treatment strategy for people who are obese and have sleep apnea. But weight loss should be combined with another treatment such as CPAP or an oral appliance.

In October the Sleep Education Blog reported on another study involving a low-energy diet and OSA. Read more about weight loss and sleep apnea.

Image by Becky Lai

Sleep Apnea in Women: Diet, Exercise & Weight Loss

A new study from Australia tested the effectiveness of a 16-week exercise and diet program for people with obstructive sleep apnea. The results were published today in the Journal of Clinical Sleep Medicine.

The study involved 12 people with an average age of 42 years; nine of the participants were women. They had an average body mass index of 36.1; a BMI of 30 or higher is considered “obese.”

They also had an average apnea-hypopnea index of 24.6 breathing pauses per hour of sleep; an AHI of 15 to 30 is considered “moderate” sleep apnea.

The program used Optifast, a very low-energy diet. Participants also followed a supervised exercise schedule; this included both aerobic and resistance training.

Results show that participants lost an average of about 27 pounds. Some typical OSA symptoms also improved; these included snoring, daytime sleepiness and mood.

But weight loss did not cure OSA. It did reduce the average AHI by 25 percent; but participants still had moderate sleep apnea with an average AHI of 18.3

“Although there was some improvement in sleep disordered breathing, it was not seen in all patients and was not proportional to the degree of weight loss,” lead author Dr. Maree Barnes told the AASM.

Follow-up at 12 months showed that all but one person who completed the program had regained some weight. But half of the participants were able to maintain weight loss of at least seven percent.

The AASM recommends dietary weight loss as one treatment strategy for people who are obese and have sleep apnea. But weight loss should be combined with another treatment such as CPAP or an oral appliance.

Read more about weight loss and sleep apnea. Learn more about women and sleep apnea risk.

You should talk to your doctor to develop a healthy weight-loss plan that is right for you. For help with sleep apnea you should contact an AASM-accredited sleep disorders center in your area.

Weight Loss, Sleep Apnea & Diabetes

A new study shows that weight loss may reduce the severity of obstructive sleep apnea in some people who also have type 2 diabetes.

The study involved 264 diabetic adults. They had an average age of 61 years; their mean weight was 226 pounds. They had an average body mass index of 36.7; a BMI of 30 or higher is considered “obese.”

They also had an average apnea-hypopnea index of 23.2. This means that they stopped breathing about 23 times per hour of sleep. An AHI of 15 to 30 is considered “moderate” sleep apnea.

Some participants were assigned to a behavioral weight-loss program; it involved portion-controlled diets and 175 minutes of exercise per week.

Other participants were assigned to a control group; they attended three sessions related to diabetes support and education. The two groups were compared after one year.

Results show that members of the weight-loss group lost an average of 24 pounds. Their average AHI decreased, and they were less likely than controls to have severe sleep apnea at the one-year follow-up. The average AHI increased in the control group.

“These results show that doctors as well as patients can expect a significant improvement in their sleep apnea with weight loss,” lead author Gary Foster said in a Temple University statement. “And a reduction in sleep apnea has a number of benefits for overall health and well-being.”

But about 86 percent of people in the weight-loss group still had sleep apnea at follow-up. The average severity of their OSA remained moderate with an AHI of 18.3, reports MedPage Today.

The AASM recommends dietary weight loss as one treatment strategy for people who are obese and have sleep apnea. But weight loss should be combined with another treatment such as CPAP or an oral appliance.

Read more about weight loss and sleep apnea. In May the Sleep Education Blog reported on another study led by Foster; it found that undiagnosed OSA is common in people with type 2 diabetes.

Get help for sleep apnea at an AASM-accredited sleep center near you.

Image by Chris

Biggest Loser: Weight Loss, CPAP & Sleep Apnea

Season eight of the hit TV show “The Biggest Loser” has begun. Once again contestants are being screened and treated for obstructive sleep apnea.

“I have put in place a new policy that all contestants need to undergo a sleep study in future seasons,” the show’s medical expert Dr. Rob Huizenga said in a Philips Respironics statement. “The results have been astonishing after two seasons of testing.”

All 16 contestants were diagnosed with sleep apnea during preparations for the new season. Now they are being treated with CPAP therapy. AASM President Dr. Clete Kushida is working with the contestants to ensure that they receive the maximum benefit from ongoing treatment.

Contestants will continue to receive assistance once their time on the show comes to an end. Philips Respironics will help them find a sleep disorders center in their hometown.

In May the Sleep Education Blog reported that excess body weight is a major risk factor for OSA. Treating sleep apnea with CPAP helps some people bring their weight under control.

But research shows that that CPAP alone is unlikely to produce weight loss; CPAP users still need to take an active role in losing weight.

You should talk to your doctor to develop a healthy weight-loss plan that is right for you. For help with sleep apnea you should contact an AASM-accredited sleep disorders center in your area.

Are you at risk for sleep apnea? STOP and find out. You also can answer these questions on SleepEducation.com to learn more about your risk.

Watch "The Biggest Loser" on NBC, Tuesdays at 8/7c.

Sleep Apnea & Bariatric Surgery Risk

Last week the Sleep Education Blog reported that bariatric surgery may reduce the severity of obstructive sleep apnea; but it doesn’t cure the problem.

What about safety? Is weight-loss surgery a risky procedure?

A study published today examined the short-term risks of bariatric surgery. It measured adverse outcomes in the 30 days after surgery.

People in the study had an average age of 44.5 years; 79 percent were women. Their median body mass index (BMI) was 46.5; a BMI of 30 or higher is considered “obese.”

The study analyzed 4,610 surgeries: 3,412 were a Roux-en-Y gastric bypass; 1,198 involved laparoscopic adjustable gastric banding.

Results show a 30-day rate of death of 0.3 percent; 15 of the people died within a month after surgery, CNN reports.

About 4.3 percent of people had at least one major adverse outcome. Complications included blood clots or the need for another surgery.

But obstructive sleep apnea made surgery riskier; people with OSA were more likely to have a major problem in the month after surgery. About half of the people in the study had OSA.

The NIDDK warns that long-term complications also can occur with bariatric surgery. These include malnutrition and hernias.

There also is a 10 percent chance of unsatisfactory weight loss. Some people also regain much of the weight they lose after surgery.

The AASM recommends bariatric surgery as an optional treatment for severe obesity and sleep apnea. But it should only be used along with CPAP therapy, the treatment of choice for OSA.

Contact an AASM–accredited sleep center to discuss all treatment options for OSA.

Does Bariatric Surgery Cure Sleep Apnea?

In February the Sleep Education Blog reported on the use of bariatric surgery to treat obstructive sleep apnea. A small study found that surgery did provide some benefits; but it wasn’t a cure for OSA.

Now a new study takes a broader look at the evidence. The systematic review analyzed 12 studies involving 342 people.

Bariatric surgery did reduce the severity of obesity; the average body mass index (BMI) dropped from 55 kg/m2 to 38 kg/m2. A BMI of 30 or higher is considered “obese.”

Surgery also reduced the severity of sleep apnea; but it didn’t cure the problem.

The average apnea-hypopnea index (AHI) dropped from 55 breathing pauses per hour to 16 per hour. An AHI of 15 to 30 is considered “moderate” sleep apnea; an AHI of more than 30 is considered “severe” OSA.

The AASM recommends bariatric surgery as an optional treatment for severe obesity and sleep apnea. But it should only be used along with a first-line treatment such as CPAP therapy.

Contact an AASM–accredited sleep center to discuss all treatment options for OSA.

Losing Weight with CPAP for Sleep Apnea

Excess body weight is a major risk factor for obstructive sleep apnea. Treating sleep apnea with CPAP helps some people bring their weight under control.

In some cases the change is dramatic. NorthWest Cable News in Seattle reports that CPAP helped one woman lose more than 100 pounds in a little more than a year. She used to weigh more than 300 pounds.

Then she was diagnosed with sleep apnea and started using CPAP. She began to notice that she had more energy. So she started working out regularly and eating better.

CPAP also played a role behind the scenes of the TV show “The Biggest Loser: Couples.” Each contestant was evaluated during an overnight sleep study.

Sixteen of the 22 contestants were diagnosed with sleep apnea. Sponsor Philips Respironics provided treatment for each of them.

But a 2008 study shows that there is no guarantee that CPAP will lead to weight loss. The study was published in the Journal of Clinical Sleep Medicine.

The study involved 228 adults with sleep apnea. They had an average age of 55 years.

Results show that using CPAP for one year did not produce a significant drop in body mass index (BMI). Some participants initially lost weight after starting CPAP. But they gained the weight back during the year.

The authors conclude that CPAP alone is unlikely to produce weight loss; CPAP users still need to take an active role in losing weight.

Using CPAP is likely to increase your daytime alertness and energy level. This can help you lose weight if you become more active and get more exercise.

You should talk to your doctor to develop a healthy weight-loss plan that is right for you.

Learn more about the benefits of CPAP on SleepEducation.com.

Image by Chris

Insomnia and Weight Gain

A new study examined the link between insomnia and weight gain.

The study involved 14 men with primary insomnia and 24 healthy controls. It measured their levels of the “hunger hormones” leptin and ghrelin three times during one night of sleep.

Results show that men with insomnia had less total sleep time than controls. Leptin levels were similar between the two groups. Leptin helps to suppress your appetite and increase your metabolism.

But ghrelin levels were about 30 percent lower in men with insomnia. Ghrelin stimulates appetite.

So it would seem that insomnia lowers your risk of weight gain. Less ghrelin means you would be less hungry.

But this may not be the case. Lead author Sarosh Motivala of UCLA thinks that a change may occur during the day to increase appetite. Other studies show that sleep loss decreases leptin and increases ghrelin.

What is clear is that insomnia disrupts how the body regulates appetite.

"The current study shows that insomnia patients have a dysregulation in energy balance that could explain why these patients gain weight over time," Motivala said in a UCLA statement. “"This is an exciting finding because it highlights how diverse behaviors like sleep and eating are connected.”

Most people with insomnia have “secondary” insomnia. It occurs along with another medical problem, mental illness or sleep disorder. It also may result from the use of a medication or substance.

The men in this study had “primary insomnia.” This kind of insomnia is unrelated to another health problem. It is estimated that about 25 percent of people with insomnia have primary insomnia.

A 2008 study in the journal Sleep linked primary insomnia to low levels of a brain chemical. Results show that GABA levels are reduced by 30 percent in adults with chronic primary insomnia.

Learn more about the link between sleep and weight.

Losing Weight: Which Diet is Best?

If you are obese, weight loss is one strategy to reduce the severity of obstructive sleep apnea. It is unlikely to cure sleep apnea, but it can help. And losing weight can produce many other benefits for your health and well-being.

But where do you begin? There are so many types of diets. Each one has its supporters. And it’s easy to be lured in by an advertisement – many of which make false claims.

Should you focus on a high-protein diet? High fat, low carb? High carb, low fat? How do you know?

A new, long-term study provides some helpful insight. It involved 811 adults. They had an average age of 51 and an average body mass index (BMI) of 33.

Each person was assigned to one of four types of diets. The diets allowed differing portions of fat, protein and carbs. All of the diets had the same goals for reducing calories. The diets also were heart healthy: low in saturated fat and cholesterol, high in fiber.

Each diet plan included group counseling sessions two to three times per month. Individual sessions were held every two months. The common goal for activity was to get 90 minutes of moderate exercise per week.

Which diet was the winner? It was a tie. The amount of weight loss after two years was similar for all four diets. On each diet plan, participants lost an average of eight to 10 pounds. They also reduced their waistlines by one to three inches. Most of the weight loss - an average of 13 pounds - occurred in the first six months.

Maintaining the weight loss was harder. The majority of people slowly regained some weight after 12 months. About 23 percent of people continued to lose weight from six months to two years.

Eighty percent of people completed the two-year study. For each diet about 31 to 37 percent of people lost at least 5 percent of their body weight. Fourteen to 15 percent lost at least 10 percent of their body weight.

Dramatic weight loss was rare. Only two to four percent of people in each diet group lost 44 pounds or more.

Attendance at counseling sessions was related to weight loss. People who attended two-thirds of the sessions lost almost 20 pounds over two years.

So which should it be - high protein? High carbs? The results suggest that any type of heart-healthy, low-calorie diet can be effective. For long-term success the authors recommend choosing a diet that fits your personal preferences.

Weight loss is not a quick fix. So it is important to continue CPAP therapy for sleep apnea while on any diet program.

Get tips for setting goals for weight loss and choosing a weight-loss program from the Federal Trade Commission.

Losing Weight: Bariatric Surgery & Sleep Apnea

Is bariatric surgery a good treatment option for an obese person who has obstructive sleep apnea?

A recent study in the Journal of Clinical Sleep Medicine provides caution. The study involved 24 men and women with sleep apnea.

Before surgery they had an average body mass index (BMI) of 51. A BMI of 30 or higher is considered “obese.”

Their sleep apnea also was severe. They had an average apnea-hypopnea index (AHI) of 47.9.

This means that they stopped breathing about 48 times per hour of sleep. In general an AHI of more than 30 is considered “severe.”

Bariatric surgery did provide some benefits. But it wasn’t a cure.

One year after surgery the participants were still obese; but they had a much lower average BMI of 32.

Their average AHI also dropped to 24.5. But only one person no longer had sleep apnea.

The majority of the group still had moderate to severe sleep apnea. All but one of them also continued to snore. They still needed to use CPAP therapy to restore normal breathing during sleep.

The AASM recommends bariatric surgery as an optional treatment for severe obesity and sleep apnea. But it should only be used along with a first-line treatment such as CPAP.

The NIDDK warns that complications can occur with bariatric surgery. These include blood clots and hernias.

There also is a 10 percent chance of unsatisfactory weight loss. Some people also regain much of the weight they lose after surgery.

Bariatric surgery also is costly. The NIDDK estimates that the price for surgery is about $20,000 to $25,000.

Medicare only covers bariatric surgery if you are “morbidly obese” with a BMI of at least 35. You also must have a serious health condition related to obesity. Sleep apnea is listed by Medicare as one of the obesity-related problems that is covered.

Contact an AASM –accredited sleep center to discuss all treatment options for sleep apnea.

Can a “Sleep Diet” Really Help You Lose Weight?

Research has linked your risk of obesity to how long you normally sleep. So can you lose weight by getting more sleep?

Seven women decided to take the challenge. Their story is told in Glamour magazine and on the Today show.

They practiced a specially designed “Sleep Diet” for 10 weeks. They were told to refrain from making any other changes to their eating or exercise habits.

The results? Six of the seven women stuck to the sleep plan and lost weight; one woman was unable to follow the plan because of her work schedule. The women lost six to 15 pounds each.

Here’s the sleep plan they followed:

1. Get at least 7.5 hours of sleep each night.
2. Go to sleep and wake up at the same times every day. A one or two-hour change was allowed on weekends, as long as they still slept for at least 7.5 hours.
3. No caffeine after 2:30 p.m. No alcohol within three hours of bedtime.
4. Find your ideal sleep time. You may need more than 7.5 hours of sleep each night if you depend on an alarm to wake up in the morning. Go to bed about 15 minutes earlier each night until you are able to wake on your own, feeling fully rested.

That’s it. The women did face some challenges. For some it was hard to go to bed earlier than they had in the past.

But there were other benefits in addition to the weight loss. Some of the women reported having much more energy than before.

So what do you think? Is the “Sleep Diet” a good way to lose weight and maintain a healthy weight?

Which would be harder for you: giving up some foods to go on a diet or giving up some free time to get more sleep?

Learn more about healthy sleep habits. Read a list of sleep tips for women.

Weight Loss & Sleep Apnea

Obstructive sleep apnea is common in people who are overweight or obese. So is weight loss an effective way to treat sleep apnea?

A new study from Finland shows that people with mild sleep apnea may benefit from weight loss. Participants were put on a very low calorie diet. They also received supervised lifestyle modification.

The treatment led to an average weight loss of 10.7 kg, which is almost 24 pounds. It also led to a significant reduction in sleep apnea severity.

All common sleep apnea symptoms improved. The treatment benefits remained at the one-year follow up.

The AASM recommends dietary weight loss as one treatment strategy for people who are obese and have sleep apnea. But weight loss should be combined with another treatment such as CPAP or an oral appliance.

Why? There are three main reasons. First, weight loss takes time. Sleep apnea is a serious health problem that requires immediate treatment to normalize your breathing during sleep.

Second, weight loss is difficult to maintain. Often there is a trend toward regaining weight over time.

Finally, although it may reduce the severity of sleep apnea, weight loss rarely cures sleep apnea. Breathing pauses during sleep are still likely to occur.

Talk to your doctor before starting a diet or a weight-loss plan. Contact an AASM-accredited sleep center for help with sleep apnea.