Category Archives: Weight Issues

Obesity and Sleep

I was glad to see that obesity is now being called a disease. It should bring much needed attention to a problem that is strongly linked to diabetes, heart disease, and hypertension. However, I was somewhat perturbed by the lack of media attention being given to the link between sleep and obesity. I did not read or hear about it being discussed on any of the network or cable outlets. Yet those of us in the sleep community know it to be true.

We know that the average American is sleeping less now than ever before. The National Sleep Foundation reports that over 30% of Americans are sleeping less than six hours a night. Many of us in the medical community think that this, in part, is responsible for the epidemic of obesity. Only recently have we come to understand the mechanisms behind this.

Lack of sleep leads to the over production of the hormone Ghrelin. This appetite stimulating hormone is produced by the stomach. In fact, when chronically elevated, Ghrelin causes an increased craving for carbohydrates, especially noncomplex carbs, which leads to a rapid rise in glucose followed by surges in insulin. This combination results in increased fat storage and nocturnal eating–right at a time when we are the least likely to be able to burn calories.

At the same time, an appetite suppressing hormone called Leptin is subdued by insufficient sleep. In addition, some studies have shown that a drop in Leptin may also function to decrease our basal metabolic rate.

I believe it is more than coincidental that the rapid rise in obesity over the last two decades has been paralleled by a decrease in the duration of sleep. Therefore, if you are having trouble losing weight, make sure you are getting seven to eight hours of sleep at night. This could be the key to shedding those excess pounds.

REM Sleep and Michael Jackson’s Death

Was it lack of REM sleep, induced by a drug, that killed Michael Jackson?

In the wrongful death case filed by Michael Jackson’s family, it has been hypothesized that death may have occurred due to the medication Propofol, which decreases REM sleep.

REM sleep is also known as paradoxical sleep because, of all the stages of sleep, it most resembles wakefulness. We know that most, but not all, dreaming occurs during REM (rapid eye movement) sleep. Many theories abound as to the purpose of REM sleep. These include consolidation and modification of emotional memories and procedural memories such as how to ride a bike or play an instrument, and restoration of neuron function in the brain itself. However, at this point they are still theories.

There are studies in the death of lab rats after their REM sleep was suppressed for five weeks, although none of these involved Propofol. The hypothesis in the Jackson case is garnering huge media attention.

There are many people on medications such as antidepressants and anti-psychotics that suppress and, in some instances, eliminate REM sleep for months or years. In fact, it is not uncommon in sleep centers such as mine to observe patients who are getting little or no REM sleep during the course of sleep studies. There are also documented cases of people who, as a result of neurosurgery, do not experience REM sleep and have survived for years.

My concern is that people on medications that decrease or possibly eliminate REM sleep will become fearful that they might suffer a fate similar to Jackson’s. Based on the medical literature, there does not appear to be much of a risk. There are few, if any, studies done on the effects of REM suppression in humans that have gone more than a week.

I am not saying that prolonged and improper use of an anesthetic agent such as Propofol as a sleep aide cannot result in serious and possibly fatal consequences. However, I am pointing out that the hypothesis raised in the Jackson case may be incorrect and, worse, could lead to confusion and anxiety among patients taking certain medications. If you have such a concern, I urge you to ask your doctor about it.

What is CPAP?

Sleep Apnea (stopping breathing while sleeping) can be treated in several ways. However, the most common method is called CPAP (Continuous Positive Airway Pressure). CPAP is a small machine that delivers a soft cushion of air to the lungs and air passages. This serves to splint the airway open and in doing so, the airway is prevented from collapsing. The pressure is delivered through a mask that fits over the nose and/or the mouth. When adjusted to the appropriate pressure, CPAP devices are 100% effective in eliminating Sleep Apnea and snoring.

Unfortunately, approximately 40% of patients have difficulty with the treatment when they first use it. Problems vary from the inability to tolerate pressure to discomfort with the mask interface. Most of these issues are corrected easily. Masks for using CPAP are available in all shapes and sizes. In addition, the pressure delivery system can be altered to achieve comfort in most patients. To help patients out with CPAP problems, we utilize a technique called the PAP-NAP. It is a procedure in the lab during the daytime, where our technicians desensitize and acclimate patients to CPAP. We have found it to be very effective. In fact, our overall success rate is well above the national average.