Many people have more difficulty sleeping when they reach midlife, which is also when they start to see their weight creeping up. Sleep medicine specialist Dr. Jade Wu talks about the relationship between sleep, appetite, weight gain, and midlife changes.
Dr.Jade Wu is the host of the Savvy Psychologist podcast and a behavioral sleep medicine specialist. Jade recently joined me on the Nutrition Diva podcast to talk about sleep, hunger, appetite, and midlife weight gain. I've included some highlights here, but you can also click on the audio player (above) to listen to the entire fascinating conversation.
Monica Reinagel: I’ve written a lot about the connection between sleep and hunger, appetite, and weight management. But I’m looking at this problem as a nutritionist. How do you see the relationship between sleep, appetite, and weight management as a sleep expert?
Jade Wu: When we are sleep deprived, the body compensates for lack of energy by craving more calories and tends to reach out for more saturated fats, carbs, and sweets. We also have less leptin and more ghrelin levels in our blood after a night of not enough sleep, which is how these hormones behave when we’re very hungry.
What’s less talked about is the role that our circadian clocks play in all of this. We all have biological clocks that follow a roughly 24-hour rhythm, and these clocks love to run on time. Having a disrupted circadian rhythm (jet lag, shift work) can slow down our metabolism, make us crave more high-fat foods, and generally increase the stress on our bodies.
Psychologically, this stress from a disrupted body clock (together with the stress of insufficient sleep) makes us less motivated to stick to healthful behaviors… it makes us more cranky so we’re more likely to eat as a way of regulating our emotions… it makes us less energetic and less likely to be active.
So there are both biological and psychological ways that insufficient sleep and a disrupted circadian rhythm can affect weight loss and nutrition.
MR: Most of us the basics of good sleep hygiene (avoiding screens, caffeine, alcohol, keeping a consistent schedule, cool, dark rooms, etc.). But a lot of people still struggle to sleep through the night, despite taking all of those steps. In a recent episode of your podcast, you suggested that sleep hygiene may not be all that. So what is the solution?
JW: Sleep hygiene is a good place to start. It’s like dental hygiene... good as a general baseline, but not enough if you already have a cavity.
If you do have a sleep disorder, like insomnia or sleep apnea, it’s important to get those addressed using evidence-based treatments. Like you mentioned, sleep hygiene is the placebo condition in our clinical trials... not enough to cure insomnia. What is recommended by the American Academy of Sleep Medicine as a first-line treatment is cognitive behavioral therapy for insomnia (CBT-I).
MR: A lot of people develop sleep issues for the first time as they get into midlife--which is also when many of them start to see their weight creeping up. First, Is there something physiological that occurs in midlife that affects sleep rhythms? Or have we just had longer to develop bad habits? Or more to worry about?
JW: There are physical and psychological changes. In terms of physical changes:
- We need less sleep as we age
- Our sleep tends to be more often punctuated by wakefulness, and we tend to have less deep sleep
- Hormonal changes like menopause can certainly disrupt sleep… but this should not permanently make you a bad sleeper
- More aches and pains, less physically and socially active
As for psychological changes, our expectations need to move along with the physical changes.
- We may get more anxious about sleep and health
- We may become increasingly psychologically dependent on sleep aids
- We’ve had longer to learn unhelpful things… like our brains learning that the bed is an awake place
MR: In your opinion, then, how much of an impact does midlife sleep difficulty have on midlife weight gain?
JW: This is hard to tease out because there are so many things that are changing mid-life… perhaps our activity levels, our social lives, our stress levels, our eating habits. I see this time as an opportunity to tune up health in all domains, such as learning to cook more nutritious meals now that the kids have left the house and you have more time. Or doing more self-care, taking up meditation… all good things for sleep and overall health. There’s no reason why sleep has to be bad in midlife or after. It will change, but if you listen to your body and change with it, you can still have great sleep health.