Sleep quality is one of the most under-appreciated variables when it comes to health. I often describe it as the missing link for those who feel like they’re doing everything right, but not seeing results. When my patients tell me “I’ve cut out junk food, I’m eating better, I’m exercising, I’m doing everything right but still not losing weight,” the very next thing I ask is “How are you sleeping?”

While sleep is still a mystery to scientists, it’s known to play a vital role in health. Adults need 7-8 hours of sleep on average and adolescents around 10 hours. Sleep deprivation is linked to obesity and other chronic diseases, and unfortunately millions of people suffer from poor sleep.

What is known about sleep? Well, there are several stages of sleep, and spending enough time in each state of sleep is important. For example, deep sleep is the “restorative” phase of sleep. The brain is stimulated to learn and make memories during REM sleep. Spending the right amount of time in each sleep stage is what’s referred to with sleep quality, which is just as important as sleep quantity.

From “Your Guide to Healthy Sleep” by the National Heart, Lung and Blood Institute

It’s not known why sleep deprivation leads to weight gain and obesity. There are theories. It’s believed varying stress hormones such as cortisol are sensitive to sleep patterns. Poor sleep quality in the short term increases cortisol levels. When cortisol levels are elevated, it’s almost impossible to lose weight, even when eating well and exercising regularly. Metabolism and hunger hormones also appear to be affected by sleep. Poor sleep reduces leptin (the “fullness” hormone) and increases ghrelin (the “hungry” hormone). There is evidence to support that when individuals are sleep deprived, their brain gets more excited about eating unhealthy foods.

There are also data suggesting sleep deprivation may cause expression of genes related to obesity, meaning you have these genes but they’re not “turned on” and causing problems unless sleep deprivation is present.

While the direct cause is unknown, the association between insufficient sleep and poor health is clear. In my opinion, quality sleep is as important as diet and exercise when it comes to health and weight loss. There have been studies that show when diet and exercise are constant, those who sleep less have trouble losing weight. I’ve seen this played out in patients who have started sleeping better and were finally able to reach some of their health and weight loss goals. If you don’t sleep well or always feel tired throughout the day, let’s take a look at some things that may help.

  1. Develop an evening routine. Consider how kids are put to bed. They aren’t active right up until bedtime. Typically they start “winding down” with a bath followed by reading or a relaxing activity before finally going to bed. Adults are the same way, and can’t expect to be wired until the minute they turn in and expect to fall asleep. Start playing around with an evening routine. It should involve “winding down” around the same time every night, and waking up around the same time every morning. This can be difficult because for many busy parents, the few hours late in the evening are the only time they have to themselves and it’s tempting to be hyper-focused on getting things done or staying up just to have some alone time. Try to avoid the temptation of putting tasks off until night time. Also, know good sleep is linked to higher productivity during the day, so you can focus on getting those things done earlier.
  2. Make the bedroom a sanctuary for sleep. There should be no distractions, no TV, minimal lighting, and you shouldn’t be doing other tasks like work or email. Think of walking into a spa to get a massage, how there is an immediate feeling of relaxation after simply stepping into the room. The bedroom should elicit that same feeling of complete relaxation. The brain should immediately go into “sleep mode” when entering the bedroom.
  3. Maximize melatonin. This is the hormone that helps regulate  circadian rhythm, otherwise known as the “biological clock.” Melatonin prepares the body for sleep and causes drowsiness. It’s triggered by external factors, especially fluctuations in daylight. Melatonin peaks in the evening, preparing the body for sleep. Melatonin is very sensitive to light waves, specifically, the short blue light waves emitted from electronic devices. Blue light suppresses melatonin more than other light waves. Watching TV and scrolling on our phones at night is wreaking havoc on the body’s internal clock. Melatonin can be taken in a supplement form, and many people feel it helps. But there really isn’t a lot of evidence supporting that it works the same way as natural melatonin. The best way to avoid counteracting melatonin is to avoid blue light waves in the evening. The best way is to avoid screens altogether, especially in the hour before going to bed. However, turning the “Night Shift” setting on a phone or using an app like Flux limits the blue light emitted from screens. There are also glasses that block blue light. While older versions look a little weird, there are more stylish options now which are not a bad idea, especially for those who spend hours on screens at work.
  4. Get some sun. Exposure to natural sunlight helps regulate sleep patterns. Get out in the sun, preferably without sunglasses, ideally for 15-30 minutes a day early in the morning. A morning break time at work is an opportunity to step outside for a few minutes.
  5. Avoid caffeine after 2 pm. Caffeine block’s adenosine, a hormone that signals the body to sleep. Caffeine doesn’t decrease the need for sleep, it simply causes you to be “wired and tired.” Some people are slower metabolizers of caffeine, so pay attention to how you feel after having caffeine even if it’s in the morning.
  6. Avoid alcohol. Some people feel alcohol helps with falling asleep, but in reality, it causes more time to be spent in the lighter stages of sleep instead of deep sleep and REM. Having a nightcap every night, even if it helps to initially fall asleep, isn’t giving the body the quality sleep it needs.
  7. Avoid exercising late. Exercise during the day helps with sleep while exercising in the evenings can delay sleep onset.
  8. Use caution with napping. Naps can help make up for lost sleep on occasion, but limit naps to no more than 20 minutes and no later than 3 pm to avoid disrupting your sleep pattern.
  9. Do you snore? Snoring can be a symptom of sleep apnea, a condition where the soft tissue of the palate, tongue, and throat relax and cause partial blockage of the airway. This is typically loud snoring with occasional pauses in breathing or shallow breathing. Some people believe snoring is merely a nuisance, however, those with untreated sleep apnea are at higher risk of developing cardiovascular disease and diabetes, and have very poor sleep quality. If you’ve been told your snoring is impressive, consider talking with your healthcare provider about having a sleep study done. Many people are walking around tired throughout the day with undiagnosed sleep apnea.
  10. Do you suffer from anxiety or depression? One common complaint I hear from patients is that they become anxious about not being able to fall asleep, and they’re unable to fall asleep because they’re anxious. It becomes a vicious cycle. Experts recommend for those unable to fall asleep within 20 minutes, to get up and do a relaxing activity such as reading or listening to music until they become tired again. Sleep deprivation is also a common symptom of depression, and one of the many reasons to seek help if you’re concerned about depression. Other symptoms include feeling down, depressed or hopeless, or little interest or pleasure in doing things.

I hope these tips are helpful. There are some good resources available if you want to learn more. One is a free download from the National Heart, Lung and Blood Institute, a division of the National Department of Health and Human Services, which I have referenced throughout this post. Another is the book Sleep Smarter, by Shawn Stevenson. This is a phenomenal, detailed book on how and why to maximize your sleep for optimal health – a good read for someone ready to change how they sleep. And of course, send me any questions you might have to Sources are available upon request.