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11

Snooze to Lose (Weight, That Is!)

Having trouble catching enough Zzzs? Don’t worry! In this session, we’ll help you incorporate the easiest weight-loss strategy ever—that’s right, sleep.

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SESSION 11

Why We SleepYou know what it’s like when you haven’t

slept enough—you’re tired, you can’t focus

and your energy flags. These are the short-

term effects; the more profound damage to

your body happens after enduring weeks,

months and years of too little sleep.

That’s because during sleep, your body is

busy doing important work, like repairing

cells (including brain cells), producing

protein for muscle and skin, and healing

(the immune system is more active during

sleep). Plus, you give your brain, especially

the areas that control emotions, decision-

making and social interactions, a break.

The result: You wake up feeling refreshed

and able to function at a high level.

If you’re not logging 7 to 8 hours a night,

do you know why? The top three reasons

for skimping on shuteye: you’re not getting

to bed in time, you have insomnia or you

have sleep apnea. We’ll offer slumber

solutions for each one of these issues.

Read ’em and sleep!

Stages of Sleep

There are two basic types of sleep:

Rapid eye movement (REM) and

non-REM. You start out in non-REM,

passing through three phases that

send you into deeper sleep as brain

waves get progressively slower. This is

followed by a period of REM, in which

breathing becomes more rapid and

shallow, eyes jerk around under your

lids and dreaming happens. It takes

about 90 minutes to complete a full

non-REM/REM cycle; about 25 percent

of that time is spent in REM.

Slow-wave, late-stage non-REM sleep

is considered the most restorative

and restful, whereas REM sleep is

important for memory and learning.

Skimping on either type takes a toll

physically and psychologically.

Giving Your Brain a Break

During Sleep Your Body Is...

Producing Proteinfor Muscle + Skin

Repairing Cells

Healing

Most people need 7 to 8

hours of sleep to function

at optimal levels.

Connection Between Sleep and Weight LossDid you know that what you do in the bedroom affects the number on the scale? It’s not what you’re thinking—we’re talking about sleep! Over the past five decades, Americans have cut short their sleep time by 1½ to 2 hours a night. The result: We’re walking around exhausted—35 percent of adults are sleep deprived. We’re also paying the price in pounds: Two out of three adults are overweight or obese. Experts say it’s no coincidence that obesity rates have jumped as we’ve cut back on our sleep. In fact, a lack of sleep is now considered a major cause of weight gain.

Are You Having Sleep Issues?

Quiz

Suss Out Your Sleep Problem

Before we get into why certain sleep

disorders can thwart your weight-loss

efforts and what you can do about

it, you should first figure out if you’re

having any sleep problems. Believe

it or not, it’s not always easy to tell.

Take this quick quiz to see how your

rest rates. (And, of course, this is just

to alert you to possible sleep issues;

only your doc can make an

official diagnosis.)

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SESSION 11

1 Do you: Often feel the need to take a nap? ☐ Yes ☐ No

Often have difficulty staying awake while sitting at the computer, watching TV or reading? ☐ Yes ☐ No

Ever fall asleep during conversations? ☐ Yes ☐ No

Feel drowsy while driving (in the past six months)? ☐ Yes ☐ No

a) If you answered “yes” to any of these questions, continue the quiz.

b) If you answered “no” to all the questions, you probably don’t have a serious sleep issue, but continue the quiz just to be sure.

2 Do you get to bed in time to get 7 to 8 hours of sleep on at least five nights a week?

a) Yes. Congrats! But if you’re still feeling tired or sleepy during the day, then continue the quiz.

b) No. Uh oh, you could be sleep-deprived. The “Sleep Strategies for Everyone” on page 54 will help you rack up those 7 or 8 hours. And just in case there’s another sleep issue, continue the quiz.

3 Do you: Take more than 30 minutes to fall asleep two or more times a week? ☐ Yes ☐ No

Often awaken in the middle of the night and have trouble getting back to sleep? ☐ Yes ☐ No

Often have worries or ruminations that interfere with sleep? ☐ Yes ☐ No

Often have an irresistible urge to move your legs, which interferes with falling or staying asleep? ☐ Yes ☐ No

a) If you answered “yes” to any of the above, you may be suffering from insomnia. Read about the causes and treatments later in this session.

b) If you answered “no” to all the above, you probably don’t have insomnia. Continue the quiz to see if you might have another sleep disorder.

4 Do any of the following apply? Have you been told that you snore loudly? ☐ Yes ☐ No

Do you ever wake up gasping for air? ☐ Yes ☐ No

Have you been told that you temporarily stop breathing when you sleep? ☐ Yes ☐ No

a) If you answered “yes” to any of the above questions, you may be suffering from obstructive sleep apnea, a condition in which you stop breathing for short periods throughout the night. Don’t worry—there are good treatments. You’ll find more on this condition later in this session.

b) If you answered “no” to all of these questions, you probably don’t have apnea. Consult with a healthcare provider to get to the root of the problem.

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SESSION 11SESSION 11

• Drives you to the cookie jar or to dial

pizza delivery, or to eat other fatty, carb-

heavy foods. Out-of-whack hormones

somehow trigger cravings, which seem to

intensify at night, for these specific types

of foods.

• Slows calorie burn. You’d think the

longer you’re awake, the more calories

you’d burn because you’re up and

moving around. But when you’re tired,

you’re not moving all that much. Plus,

some studies show that lack of sleep

lowers metabolic rate, the speed at

which you burn calories. It could be that

your body is trying to conserve energy,

like it does when you’re sleeping.

• Can give you a bigger belly. It appears

to direct more fat to be deposited deep

in your abdomen. That’s the riskiest

type of fat because it’s linked to type

2 diabetes and heart disease.

• Makes you too tired to exercise. When

you're zonked, the last thing you feel like

doing is working out.

H ere’s a stat that might convince you

to turn off The Late Show and get

some shuteye: “Short sleepers,” adults

who typically get five or fewer hours per

night, are 60 to 80 percent more likely

to become obese than those who sleep

seven hours or more.

Pulling six-hour nights isn’t much better.

In one study, people who slept six hours a night weighed 88 percent more and had 123 percent more body fat than those who logged seven to eight hours.

What’s the connection between a lack

of sleep and your weight? Not getting

enough Zzzs:

• Makes you hungrier, so you eat

more. It raises levels of hormones that

stimulate appetite while lowering levels

of appetite-suppressing hormones.

After sleeping just four hours for two

consecutive nights, people reported a

23 percent increase in appetite.

The Connection Between Zzzs and Lbs

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Insomnia

I nsomnia—for those lucky enough not

to have experienced it—is a frustrating

inability to fall asleep, or once asleep, to

stay that way.

Ten percent of Americans have “chronic

insomnia,” defined as lasting a month

or more. The number might be closer to

23 percent when you look specifically at

working people, according to a Harvard

University study. (“Acute” insomnia lasts

for days or weeks and is often triggered by

stress or trauma).

Most chronic insomnia can be traced to

one of the following:

• Medications or caffeine

• Substance abuse

• Chronic pain

• Heartburn

• Stress and anxiety, which can keep you

up at night worrying. Sometimes, the fear

of not being able to fall asleep makes

you so anxious that you can’t nod off. In

addition, some people’s brains simply

have a harder time turning off—this could

be genetic—and they remain in a state

that scientists refer to as “hyperarousal.”

• Nighttime hot flashes or night sweats.

About 60 to 80 percent of women get

them during the transition to menopause,

and they typically last four to five years.

• Restless legs syndrome, which starts

with an uncomfortable feeling in the legs

(described as creepy-crawly, burning,

pulling or aching), causing you to move

or jerk your legs around. It can hit when

you’re trying to fall asleep, and can

wake you up at night. Up to 10 percent

of Americans suffer from RLS; it strikes

twice as many women as men.

TreatmentsTired of the constant tossing and

turning? The following tips (as well as

the “Sleep Strategies for Everyone” at

the end of this session, page 54) will

help you stop counting sheep.

1 Head to bed when you feel sleepy,

not before.

2 Use your bed for sleep and sex

only. Read, talk on the phone,

watch TV and worry in another room.

3 Leave your bedroom if you don’t

fall asleep within 30 minutes.

Come back to bed only when you’re

sleepy. (Repeat if necessary.)

4 See a sleep specialist if these

tips don’t work. He or she can

adjust medications that might be

keeping you awake, help you deal

with restless legs syndrome, and/

or prescribe relaxation techniques or

other treatments. If hot flashes are

the issue, your primary care doc or

gynecologist can offer suggestions.

tipreal fix

Kids

Job

The Other Side Effects of Skimping on SleepA n astounding 711 genes start

malfunctioning within a week of

getting less than six hours of sleep per

night, according to research from the

University of Surrey in the United Kingdom.

These genes gone wild disrupt your

circadian rhythms, natural fluctuations in

body temperature, hormone release, and

other cycles. The results (to name just a

few): inflammation, weakened immunity, an

amplified response to stress and of course,

a spike in appetite.

Aside from weight gain, a chronic lack of

sleep can:

• Make you tired during the day, raising

the risk for driving while drowsy.

• Increase heart disease risk. Women

who reported daytime sleepiness nearly

every day were 58 percent more likely to

develop heart disease over eight years.

• Increase the odds of developing type 2

diabetes by 46 percent.

• Make you anxious and depressed.

About 60 to 80 percent of depressed

people have insomnia or sleep apnea (a

condition that causes lapses in breathing;

see page 48), both of which are linked

with depression and anxiety.

• Make you less alert and less focused,

weaken memory and impair decision-

making and problem-solving.

Mortgage

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SESSION 11

Obstructive Sleep Apnea (OSA)Obstructive sleep apnea occurs when the muscles in the back of the throat fail to keep the airway open, despite efforts to breathe.

Normal breathing during sleep

tipreal fix

Fortunately, there are effective ways to

treat obstructive sleep apnea, such as:

1 Weight loss. What you’re doing on

this Real Appeal program—losing

weight—can make a big difference.

Dropping 10 to 16 percent of your

weight can translate to a 20 to 50

percent reduction in OSA severity.

2 A CPAP machine. A device that

gently blows air into your nose,

helping keep airways open.

Treatments

3 A mouthpiece. This helps open

airways. Trained dentists can make

one to fit your mouth.

4 Surgery. In some cases, surgery

to widen breathing passages

is warranted.

Talk to your healthcare provider about

what steps you can take to conquer

OSA. And even if you’re receiving or

using one of these treatments, it’s also

helpful to adopt the snooze-inducing

tips in “Sleep Strategies for Everyone”

(page 54).

Real Science

Air Flow Open Airway Blocked AirwayAir Flow

Tongue

Soft Palate Soft Palate

Tongue

BMI PERCENT OF WOMEN

WITH OSA

PERCENT OF MEN

WITH OSA

Less than 25 (healthy weight) Up to 8.2% Up to 26%

25 to 29 (overweight) Up to 13% Up to 37%

30 and higher (obese) Up to 46% Up to 77%

In fact, about 58 percent of OSA is caused

by excess weight. Why? Too much fat in the

neck narrows the throat, making it more

prone to closing off. To breathe properly,

muscles in your throat keep airways open

so air can flow through to your lungs.

When you sleep, those muscles relax

a bit, but still keep the throat open just

enough to allow air to flow in. With OSA,

the throat closes off (apnea) or nearly does

(hypopnea), causing you to momentarily

stop breathing.

When oxygen levels in the body plummet

over and over again each night, for months

or years, it can have serious effects on your

Obstructive Sleep Apnea

I t starts with snoring, then silence and

10 seconds or more of not breathing,

followed by a snort and a gasp for air. The

pattern repeats. This is obstructive sleep

apnea (OSA), and as you can see from

the chart below, the odds of having this

condition rise dramatically when you

get heavier.

weight and health. (See “Why You Really

Should Take Care of Your Apnea,” page 50).

You could get tipped off to your OSA by the

person sleeping next to you, or you might

even wake yourself up gasping for air. Or,

believe it or not, you could suffer from OSA

and have absolutely no idea. Although your

brain goes through many little arousals

throughout the night to restart breathing,

you may never even be aware there’s an

issue. If you suspect you may have this

condition, visit your healthcare provider or

doctor to discuss a professional diagnosis

and possible treatment.

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Sleep’s Gender BiasWomen are 40 percent more apt to develop insomnia than men; men are twice as likely to suffer from obstructive sleep apnea.

Your HealthExcess weight and OSA have a reciprocal

relationship. As you’ve read, being

overweight can increase the risk of

developing OSA, but the reverse is

also true: OSA can also cause you to

put on pounds.

When oxygen levels drop, the body

sounds the alarm to your brain, which

triggers the “fight or flight” response. As

described in Session 8, this response

unleashes a cascade of stress hormones,

like adrenaline and cortisol, as well as

creates harmful substances that cause

inflammation and cell damage. This

encourages fat storage and other

health problems.

Obstructive Sleep Apnea (OSA)It causes daytime sleepiness

and leads to weight gain,

heart disease, stroke, type

2 diabetes, depression,

and anxiety.

Why You Really Should Take Care of Your Apnea

MoodPeople with OSA have 2 to 4

times the rates of depression

as the general population.

And one study found that

middle-aged men with OSA

are about twice as likely

to have anxiety as those

without apnea. Depression

and anxiety can trigger

overeating and weight gain.

Overweight and ObesityExcess weight raises the

risk for OSA (and vice versa;

OSA can lead to weight

gain), type 2 diabetes and

heart disease.

Diabetes, Heart Disease and Stroke

OSA increases the risk for

developing type 2 diabetes.

It also works the other way

around: Both type 2 and

type 1 diabetes raise the risk

of developing OSA. Up to

87 percent of people with

diabetes have obstructive

sleep apnea.

OSA can double the risk of

developing coronary heart

disease or heart failure, and

triple stroke risk.

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Get Your Beauty RestWant to look more attractive? Get some

sleep! In one Swedish study, people

looked at photos of men and women in

a sleep-deprived state or after a night of

good sleep. Well-rested individuals were

rated more attractive in so many ways:

brighter eyes, better skin (even fewer

Adapted from the National Healthy Sleep Awareness Project

Sleep Well Be Well

fine lines) and a happier expression.

Sleep deprivation caused puffy eyes

and mouths that drooped in the corners.

Getting 7 to 8 hours of high-quality rest

will help your skin look more youthful

while leaving you feeling refreshed

and renewed. So, getting your “beauty

sleep” is no myth!

Get 7-9 hours of sleep

Keep a consistent sleep schedule

Avoid before bedtime

Seek help for poor sleep

Calendar

How to Get a Good Night’s SleepDo you have “good sleep hygiene”? That’s the term experts use to describe the behaviors that help set the stage for a good night’s sleep. Make a pact with your coach that you’ll start doing these things right away. In fact, tonight would be ideal.

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SESSION 11

In the Evening Before Bedtime• Ditch the drink. Have your last alcoholic

drink at least two hours before bedtime;

even better, avoid alcohol most evenings.

Even one drink can make it tough to stay

asleep, and can interfere with REM sleep

in particular.

• Eat early. Avoid eating dinner within

three to four hours of bedtime to prevent

sleep-disrupting heartburn. Even

digesting a meal can keep you awake.

• Stop sipping. Avoid liquids two hours

before bedtime (unless you’re really

thirsty) so your bladder doesn’t wake you

during the night.

• Soothe to snooze. Create a relaxing

bedtime ritual. A warm bath, soft music

and dim lights can help you unwind.

• Power off. Set an “electronics shut-down

time”—no TV, no texting, no computer, no

screens of any kind—about an hour before

bedtime. Light emitted from these devices

triggers the brain to stay awake. Also,

these devices can be stimulating—just the

opposite of what you need before bed.

In the Bedroom• Stay serene. Try to do your worrying

elsewhere and think pleasant (or at least

neutral) thoughts while lying in bed.

• Do a “melatonin makeover.” Darken

your room by getting rid of light-emitting

devices, such as clocks (or position the

clock away from you, which also prevents

you from checking the time, another

sleep saboteur). Also, use thick curtains

or shades to block out any light. When it

gets dark, a hormone called melatonin

rises, making you feel drowsy.

• Keep it quiet. Consider springing for sound-

proof windows if you live on a busy street;

or use earplugs, a white noise machine or

the hum of a fan to mask noises. Is a snoring

partner the problem? He or she can try

some of the anti-snore devices mentioned

under “OSA Treatments,” page 49. If that

doesn’t work, you may have to sleep apart;

it’s your health that’s on the line, after all!

• Temper the temperature. Keep your

room at a comfortable temperature

so you don’t wake up from sweating

or shivering. Play around with the

thermostat until you hit the right

temperature for you.

• Create a sleep haven. Invest in a

comfortable mattress and pillow. This

is individual, so take your time at the

mattress store lying (and turning) on

several types before you buy. If you

have allergies or asthma, get the type

that’s free of feathers.It’s time to shut down!

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General• Stick to a schedule. Get to bed at the

same time each night and wake up at

the same time every morning, even on

weekends. If you get to bed late, try to

still wake up at your regular time so you

can get back into your routine.

• Wake up with a little help. Use an alarm

clock if you’re having trouble waking up

at the scheduled time.

During the Day• Move it. If you are physically active, you

are more likely to fall asleep sooner, get

better quality sleep, and maybe even

stop taking sleep aids if you use them. (It

also works the other way around: Getting

enough sleep makes it more likely that

you’ll keep your activity date.)

• Have a caffeine cutoff. Caffeine can stay in

your system for more than 12 hours so it’s

best to have your last caffeine hit early in

the day. You may be able to get away with

a later caffeine fix; try doing a “personal

study” over the course of a day or two to

determine your reaction to the stimulant.

• Do a “quickie.” Naps are a great way

to unplug and recharge your energy.

However, make sure to keep it short (20

to 30 minutes max) and do it before

3 p.m. Any longer and you might disrupt

your sleep later that night. And if you

have insomnia, your sleep doc might

recommend nixing naps.

Sleep Strategies for Everyone

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My signature: ______________________________

Commitment Contract Because getting enough good-quality sleep will help me lose weight and positively impact my health, I’m resolving to improve my sleep habits.

Specifically:

If I’m not getting enough sleep, I will:

Aim to get 7 to 8 hours of sleep each night by going to bed

earlier. My new bedtime will be:

Tip: Start with the time you need to wake up and count backwards 7 to 8 hours.

If I have insomnia, I will:Start adopting the sleep tips and insomnia treatment tips in this

session beginning tonight. If they don’t work, I will talk to my

healthcare provider about seeing a sleep specialist.

Meanwhile, I’ll continue my other healthy habits (weighing in,

tracking, staying within my calorie range, etc.) to the best of

my ability.

If I’m not sure what’s wrong, but suffer excessive daytime

sleepiness, I will: Start adopting the sleep tips on pages 54–55 beginning tonight.

If they don’t work, I will make an appointment with my healthcare

provider within the next days to get help.

If I suspect I have obstructive sleep apnea, I will:

Make an appointment with my healthcare provider within the

next days to discuss treatment options.

To stick to this bedtime, I will:

Examples: turn off the TV at 10 p.m. or shut down electronic devices at 9:30 p.m.

I’ll focus on getting a good night’s sleep