Dr Dingle's Blog / insomnia
Research on 59 participants, those who were confirmed night owls (preferring late to bed and late to rise) had lower integrity of the white matter in various areas of the brain (Rosenberg et al 2014). Lower integrity in these areas has been linked to depression and cognitive instability.
Sleep and weight
Obesity in another disorder linked with insomnia. Research shows that diets that are higher in saturated fats are more susceptible to chronic diseases and disorders which includes insomnia (Novak et al. 1995). This is an alarming fact as 20% of the population of the United States of American are overweight or obese (Patterson et al. 2004).
Many studies, including one spanning twenty years, have tested the hypothesis that sleep and obesity are linked and the majority of results show positive correlations (Gangwisch et al. 2005). Further studies, with over 500,000 total participants via meta‑analysis have supported obesity and insomnia in adults and children (Cappuccio et al. 2008). The trends of increasing BMI and reduced sleep hours appear to go hand in hand, along with sleeping troubles related to Sleep Apnoea often seen in obese patients.
This link between Obesity and the symptoms of its associated diseases demonstrates a common trend towards diminishing an individual’s peak performance. Obesity and many of the health conditions which result from it increase the lower productivity levels associated with lower mental and cognitive functioning.
Obesity is also a serious factor in poor sleep habits. In a number of studies obesity was associated with "reduced sleeping hours " (Ko et al (2007). Obesity, particularly abdominal and upper body obesity, is the most significant risk factor for Obstructive Sleep Apnea (OSA). Patients with sleep apnea often experience daytime sleepiness and difficulty concentrating (Teran-Santos et al, 1999). Studies have also shown a strong association between sleep apnea and the risk of traffic accidents (Terán-Santos et al (1999). In fact, subjects suffering from sleep apnea were at a higher risk than those who had consumed alcohol to be involved in a traffic accident. This has major implications, particularly for overweight and obese workers using any form of equipment of driving vehicles.
This lack in sleep will then leave the employee going to the work already feeling tired, irritable and stressed, therefore making it difficult to concentrate, and highly increasing the chances of being injured or making a mistake which may put fellow workmates in danger (Lynch, 2005) It is situations like this, where the worker comes to work already feeling tired, that the employee is putting his safety and other's safety at risk.
Shift workers are known to be a high-risk group for obesity. In the current study population, rotating-shift workers showed a higher distribution of the highest body mass index compared with daytime workers
In a study of the brains of 24 participants after both a good and a bad night’s sleep. after disturbed sleep, there was increased activity in the depths of the brain, areas which are generally associated with rewards and automatic behaviour. It seems a lack of sleep robs people of their self-control and so their good intentions are quickly forgotten.
What we have discovered is that high-level brain regions required for complex judgments and decisions become blunted by a lack of sleep, while more primal brain structures that control motivation and desire are amplified.”
In other words: lack of sleep robs people of their self-control and so their good intentions are quickly forgotten.
On top of this, the researchers found that after being deprived of sleep, participants displayed greater craving for high-calorie junk food. The more sleep-deprived they were, the greater the cravings. A stufy of 13,284 teenagers found that those who slept poorly also made poor decisions about food. Similarly, a Swedish study found that at a buffet, tired people were more likely to load up their plates.
The link has even been made from poor sleep through to food shopping. A Swedish study found that men who were sleep-deprived bought, on average, 9% more calories than those who’d had a good night’s sleep. These results were likely the result of the poor decision-making. It had been thought that the tendency to eat more after poor sleep was related to the so-called ‘hunger hormone’ ghrelin. But the latest studies suggest that it’s simple self-control that is most important in causing the sleep-deprived to over-indulge.
Many sleep problems but by far the biggest is sleep deprivation and poor sleep. However too much sleep can also be a problem. Over sleeping may also be a problem. In one study sleeping 10 hours or more also increased the mortality rates by one and a half times.
Sleep is as important to the human body as food and water, but most of us don't get enough sleep. Dysoninia (poor sleep) related sleep disorders alone are broken into Intrinsic, Extrinsic and Circadian‑Rhythm sleep disorders including disorders such as but not limited to: "Psychophysiologic Insomnia, Sleep State Misperception Idiopathic Insomnia, Narcolepsy, Recurrent Hypersomnia, Idiopathic Hypersomnia...Restless Legs Syndrome & Intrinsic Sleep Disorder NOS" (MSM, 2001, pp. 27).
Risk factors for sleep related illness are diet, lifestyle, occupation, stress and grief, amongst many others (Helmanis, 2006 pp. 24‑25).
Almost 90 per cent of Australians suffer from some type sleep disorder at some stage of their lives. Of these, 30 per cent suffer from severe sleep disorders. Very few people regularly enjoy the amount, or quality of sleep that they need. The estimated economic costs to the country from this are between 3 and 7 billion dollars annually. There are also huge, unmeasured physical, psychological, emotional and social costs.
Causative factors for insomnia may be multifaceted but generally include some psycho physiologic hyperarousal or emotional distress. Other precursors may be pain, movement disorders, psychiatric disorders, circadium rhythm dysfunction, medication and substance abuse (Billiard and Bentley, 2004). In some cases, the risk of insomnia is subject to a genetic bias. However, specific physiologic indicators for the familial influence have not been fully identified (Parkes and Lock, 2009).
Insomnia is the difficulty initiating or maintaining sleep or both resulting in inadequate quality or quantity of sleep (Tomoda et al, 2009). Insomnia can manifest itself by many symptoms from not being able to sleep at normal hours and low quality and quantity of sleep to sleeping but not finding it refreshing. Other symptoms may include daytime sleepiness, frequent waking, early morning waking and difficulty retuning to sleep (Cureresearch.com, 2005).
Most adults have experienced insomnia or sleeplessness at one time or another in their lives (Straker, 2008). It is estimated that insomnia effects around 30-50% of the general population with 10% experiencing chronic insomnia (Straker, 2008). It has been estimated that in the US that 70 million people suffer sleep problems, and of these, 30 million suffer chronic insomnia (Stahura and Martin, 2006). Recently a survey showed that 1046 of the 2000 adults surveyed experience at least one night of lost sleep due to insomnia symptoms; the survey also concluded that insomnia is a growing issue of concern (Goolsby, 2006).
Insomnia generally affects women more than men and the incidence rate tends to increase with age (Straker, 2008).
There is a clear correlation of age to insomnia (Curless et a!. 1993). A number of surveys have reported between 28% and 64% of post menopausal women suffer from insomnia (Hachul de Campos et al. 2006).
Insomnia can be classified into three categories transient, short-term and chronic insomnia (Tomoda et al, 2009). Transient insomnia are symptoms lasting less than one week, short term insomnia are symptoms lasting between one-three weeks and chronic insomnia are those symptoms lasting longer than three weeks (Tomoda, 2009).
Narcolepsy is a sleep disorder that causes overwhelming and severe day time sleepiness (Retsas et al, 2000). Pathologic sleepiness is characterised by the fact that it occurs at inappropriate times and places (Retsas et al, 2000). These daytime sleep attacks may occur with or without warning and can occur repeatedly in a single day (Edgar et al, 2006). People who suffer from Narcolepsy often have fragmented night time sleep with frequent brief awakenings (Edgar et al, 2006).
Narcolepsy is typically characterised by the following four symptoms:
Excessive daytime sleepiness (90%)
Cataplexy: A sudden and temporary loss of muscle tone often triggered by emotions such as laughter. (75%)
Hallucinations: Vivid dreamlike experiences that occur while falling asleep or upon wakening. (30%)
Sleep paralysis: Paralysis that occurs most often upon falling asleep or waking up. The person is unable to move for a few minutes. (25%) (Retsas et al, 2000)
Interestingly, regular night time sleep schedule and scheduled naps during the day is required for favourable outcomes (Edgar et al, 2006).
Sleep apnoea affects over 12 million Americans with it being more prevalent in men than women (Sjosten et al, 2009). Sleep apnoea not only deprives sleep from the individual but their partners too (Yip, 2001). Sleep apnoea is defined as frequent and loud snoring and breathing cessation for at least 10 second for five or more episodes per hour followed by awakening abruptly with a loud snort as the blood oxygen level drops (Sjorsten et al, 2009). People with sleep apnoea can experience anywhere between 5 apnoeic episodes per hour to several hundred per night (Sjorsten et al, 2009).
Symptoms of sleep apnoea are:
Excessive daytime sleepiness
Obesity is the major cause of sleep apnoea often losing weight is all that is need to treat this disorder (Yip, 2001).
Part 3 and more coming
I had a friend a long time ago that used to seesaw with her weight many times over the year. Whenever she got depressed or upset she would eat a lot of rich, high calorie foods that gave her some instant pleasure. Her favourites were chocolate, and Milo by the spoonful, straight from the can. Despite her reasons for binge eating, it didn’t bring any happiness and in fact contributed significantly to her problem. We need to deal with the beliefs that underlie the undesirable eating patterns as part of any dietary program.
Examining emotions and habits during a weight loss journey gives an insight as to why people overeat or have a hard time maintaining weight after losing it. The reasons given for overeating and excess weight gain often have similar root causes including boredom, emotional instability, and stress. Some of these I have already covered but the potential list is pretty long.
The major reasons for overeating include and our appetite includes
- Time of day (energy levels)
- low self esteem
- peer/social pressure
- media and advertising
- low price/convenient
- mental stimulation
- too busy
- Feeling Unloved
- Anxious or restless
- Angry or jealous
- Dissapointed or rejected
Or if there are real food cravings, it may require some mineral or nutritional supplementation. For example, some sugar cravings can be significantly reduced with chromium or vanadium supplementation. Sometimes more protein-rich foods need to be eaten.
Lets look at some of the main ones
Busyness and stress are often the underlying factors why we put on weight. One way or another it prevents us from doing what we need and know we should be doing. Too busy to exercise, to busy to eat right or buy the right food, too busy to take the time for ourselves, too busy. Woman are often so busy with looking after the family they constantly justify another little treat and poor eating to get them through another day. While both men and woman often become too busy around their careers. Taking a bit more time for ourselves and focusing on our health and healthy eating can make a big difference to our lives.
Emotional weight gain can be a major problem. Hence why any weight control program needs a lot of emotional support. To much weight on the mind can put on weight in the body. In a study of eating disorders in girls in the 7th to 10th grades, which also applies to us as we age, many of them reported an inability to distinguish between emotional feelings and hunger. Some of these girls were unable to distinguish between scared, angry and hungry and are able to lump all of these conditions together, which leaves them to overeat whenever they have an emotional feeling. This is no wonder if you look at how we use foods as rewards and distracters as we grow up. Often when we are feeling upset or anxious we use food as a substitute.
Energy lows can be a major appetite trigger, either directly or indirectly is the amount of energy you have. If you understand your daily energy cycles you can avoid many food cravings and not confuse your levels of energy with poor eating habits. Remember, they are just habits. Most binge eating for example occurs in the low energy times of late afternoon and late evening when energy levels are low. At this low energy time you are also more likely to feel in a low mood so the food further acts as an energy catalyst to get you out of that mood. Only the solution is only a short-term mood changer and often has a negative energy and emotional rebound effect. In support of this one study of dieters found that the average time at which relapse occurred was late afternoon at 4.34 pm, about 4 hours after their last meal when they were moderately hungry and their energy levels were low. The majority of cases for temptation and relapse were characterised by upset including anger and by depression or tiredness.
On the other side of the coin research is increasingly showing that how we feel is also affected by what we eat. Research shows links between depression and nutritional deficiencies. The research also shows that the deficiencies do not have to be excessive to depress the mood. So it can become a vicious circle of food-mood-food. Dieting and food restriction can also play havoc with our moods. In a review of dieters the research concluded that negative moods particularly depression increased eating amongst the dieters. In another study of people who were at least 30% over-weight and ate only a fasting supplement of 420 calories per day over a 10 week period, they most commonly violated their diets in the second month at a time when they were feeling fatigued. Using brain imaging machine when you fast or deprive yourself of food (as in a diet), your brain sees high calorie foods as being far more pleasurable. The cravings and temptation to eat unhealthily, will be far more intense. This is what they found in the short term, at least. It appears The orbifrontal cortex is responsible for how the brain perceives the “value” of a food—or how pleasurable it will be to eat.
There is no doubt the negative effects of low moods and energy have on weight management. For many people when these two are low up goes the weight. Fortunately, for the majority of people, physical activity is the most effective way to raise energy and reduce tension. It produces rapid and reliable results that can change moods immediately. Overwhelming scientific evidence shows that even moderate physical activity has the ability to increase your energy, unlike the energy drinks which actually make you feel more drained. In an experiment where one group was exercising by walking and a control group sat quietly reading over materials there was a significant change in mood that was significant and unmistakable with the walking group. Research has highlighted that 15 minutes of walking produces slightly more energy than 5 minutes but even 5 minutes of brisk walking has a significant effect. After just a 10 minute brisk walk there were still statistically significant effects 60 minutes later and 120 minutes later a week energy increase was still evident. A brisk walk therefore energises the person for somewhere between 30 to 90 minutes afterward.
In a study on unhealthy snacking researchers identified six distinct motives for snaking including opportunity induced eating, coping with negative emotions, enjoying a special occasion, rewarding oneself, social pressure, and gaining energy. Sound familiar? While Enjoying a special occasion and opportunity induced eating were most important. For all reasons except to enjoy a special occasion, younger people reported a higher score. Women indicated a higher score than men on coping with negative emotions, enjoying a special occasion and gaining energy. People who diet to a stronger extent reported a higher score for snacking because of social pressure, to reward oneself and to cope with negative emotions, with the latter also being related to a higher BMI.
Other studies have also made a link between emotions and snacking. One study showed movie-goers watching tearjerkers ate between 28% and 55% more popcorn both in the lab and in a mall theatre. Previous studies have shown that humans who play violent video games show clear signs of distress (ie, negative stress), comprising higher blood pressure as well as reports of less fullness and a tendency to prefer sweet food. Studies suggest that watching scenes of an action movie may cause distress, a condition that can increase food intake in the absence of hunger. One study found action and adventure movies also lead television viewers to eat more calories – but only if the foods are within arm’s reach. With action movies, people seem to eat to the pace of the movie. In contrast, watching an engaging comedy clip has been linked with decreasing tiredness, sadness, irritation, anxiety, and restlessness, while increasing relaxation and joy. Thus, watching a comedy clip may cause eustress (ie, positive stress), which, owing to its high rewarding property, may reduce an individual’s concomitant drive to eat. While another study found that female students ate less grams when watching a comedy program compared with food intake when watching a television (TV) documentary.
Our eyes lie
Another major factor in overeating is the supersize me phenomena. Portion size is a key environmental driver of energy intake, and larger-than-appropriate portion sizes increase the risk of weight gain. Unfortunately the size of food packaging and portions has steadily increased over the past 30 years and these super sized food portions play a major role in weight gain. Simply people who sit down with bigger portion sizes of food are more likely to be overweight and obese while those who maintain a small portion size lower their weight. Whether it is from our parents telling us to eat all our food on the plate or our hunter-gatherer starvation mentality once it is on our plate we tend to eat it and as a result over eat. For instance, one study reported that 54% of American adults generally claim that they attempt to eat until they “clean their plates”. Interestingly very early studies showed this when participants who drank soup through a tube drank less when they had visual contact with the soup than when they did not. Literally a person's eyes may influence how much they consume, leading them to be less influenced by physiological cues of satiation. As a result, their estimate of how much they have consumed and how full they are may have to do more with what they believe they saw themselves eat and less with how much they actually ate. In a study of fifty-one men and women were served lunch of different portion sizes subjects consumed 30% more energy (676 kJ) when offered the largest portion than when offered the smallest portion. Larger portions led to greater energy intake regardless of serving method and subject characteristics. In one study after a 3 month intervention subjects who regulated their portion size had a greater weight change from baseline to the end of the 3-month intervention period loosing 3.7 kg compared to 0.1 kg in the control group showing that portion control is effective to reduce body weight in overweight and obese diabetic subjects.
It is time to have a think on why we overeat and puts some steps in place. Simple strategies like keeping a food mood diary can help you identify any common factors in overeating. While serving food on small plates can make a big difference to how much you eat each meal. Time to downsize our meal sizes.
While many factors can contribute to insomnia and poor sleep undoubtedly the most important one in the twenty first century is stress. Increasing research shows that there is an activation of the stress-response system and the degree of sleep disturbance experienced correlates with the level of stress-response activation and that insomniacs and others with poor sleep patterns experience more psychological stress. Including scoring higher in a psychological distress survey and being more sensitive to stressful conditions.
Unfortunately there can be a vicious cycle of stress poor sleep and more stress. If you are not getting enough sleep, you have to rely more and more on your alarm clock, and if you oversleep and wake up already fatigued.
The stress response stimulates production of many chemicals which elevate blood glucose levels, raise heart rate, and alter the secretion of cortisol which makes it hard to relax enough to sleep restfully, and without enough rest, the body will not be able to readjust to a normal circadian rhythm, prolonging the cycle of feeling stressed and restless.
In a study using fifty-three women with insomnia (and seventy-eight controls), insomniacs had higher levels of urinary morning cortisol and also scored significantly higher on a psychological distress questionnaire than did the controls. A similar study found the insomniac group slept for a shorter amount of time under high-stress conditions than under low-stress conditions, while the normal sleeper group showed no variation across conditions.
In another study although all subjects reported equivalent numbers of daily stressful events, people with insomnia found the impacts of these events to be more severe. Insomniacs also experienced major life events more intensely, were much more alert before bedtime, viewed their lives as more stressful, and used emotionally-based coping strategies to deal with stress more often than did the normal sleeper group. The study concluded that the way insomniacs perceive and process stressful events as being beyond their control was perpetuating their insomnia. It appears that although normal sleepers and insomniacs experience similar types of stressful inputs in insomniacs the stress-response is more sensitive to these inputs and its activation leads to lack of sleep.