The effect of sleep on metabolism
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The Effect of Sleep on Metabolism. Kendal Shaffer. Objectives. Discuss the purpose of sleeping Review sleep recommendations Discuss metabolic changes in the body associated with insufficient sleep. Examine methods to improve sleep. Common Beliefs. Restorative powers

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The Effect of Sleep on Metabolism

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The effect of sleep on metabolism

The Effect of Sleep on Metabolism

Kendal Shaffer


Objectives

Objectives

  • Discuss the purpose of sleeping

  • Review sleep recommendations

  • Discuss metabolic changes in the body associated with insufficient sleep.

  • Examine methods to improve sleep


Common beliefs

Common Beliefs

Restorative powers

Recharges our batteries

Important during illness

Important for healing

Improves ability to focus


Sleeping

Sleeping

How much sleep did you get last night?

How much sleep do you usually get each night?


Sleeping1

Sleeping

A necessary part of overall health

Sleep duration and quality are both important

Sleep plays a critical role inmetabolism, emotions, behavior, health, daily performance and learning/ memory filing

A lot has been discovered but there is still so much more to uncover

(1)


Recommendations

Recommendations

(1,2,3)

Above 18: 7-8 hours

10-17 y/o: 8.5-9.25 hours

5-9 y/o: 10-11 hours

3-5 y/o: 11-13 hours

Under 3: 12-15 hours


Reality

Reality

(1,2,3)

72% of adults sleep < 8

30% of adults sleep < 6

70% of teenagers sleep < 8

15 million children in the US do not get enough


Evolution of sleep

Evolution of Sleep

  • Average sleep duration reported by Americans:

    • 1960: 8-8.9 hours

    • 1995: 7 hours

    • 2004: 6 hours or less

    • 25% of Americans take some form of sleep medication

(1,4)


Evolution of sleep1

Evolution of Sleep

Decrease in sleep coincides with the increase in prevalence of obesity, diabetes and other chronic diseases

Coincidence or not?

(1)


Consequences of loss of sleep

Consequences of Loss of Sleep

  • Can lead to metabolic & physical changes:

    • Altered glucose utilization/insulin resistance

    • Type 2 Diabetes

    • Increased appetite

    • Fatigue

    • Obesity

    • Delayed brain responses

    • Decreased memory/learning

    • Impaired immune system

(2,4,6,7,8,9,10)


The effect of sleep on metabolism

http://frequencyapps.com/node/15


Disposition index

Disposition Index

Marker that predicts the risk for diabetes

DI = AIRg x SI

AIRg= acute insulin response to glucose

SI= insulin sensitivity

(4)


Glucose metabolism

Glucose Metabolism

  • Impaired glucose regulation

  • Insulin resistance

  • Lower disposition index

    • A marker for diabetes risk (>2000 ideal)

  • Disrupted secretions of counter regulatory hormones

(2,4,6,7,8)


Response to dietary i ntake

Response to Dietary Intake

  • After eating:

    • Insulin stimulates uptake of glucose by cells

  • Counter regulatory hormones: oppose insulin

    • Glucagon

    • Growth hormone

    • Cortisol

    • Cathecholamines

(4,6,8)


Counter regulatory h ormones

Counter Regulatory Hormones

  • Growth hormone rises in sleep deprivation

    • High GH associated with reduced uptake of glucose

  • Cortisol rises in sleep deprivation

    • High levels in the evening = reduced insulin sensitivity the next day

  • Sleep loss of 2 hrs/night associated with high cytokine levels

(4,7)


Sleep deprivation

Sleep Deprivation

Lowered glucose tolerance – 40%

Glucose effectiveness lowered – 30%

Reduced insulin response – 30%

Lower insulin sensitivity – minimal

Disposition index – fell below 2000

(4)


Diabetes sleep statistics

Diabetes/ Sleep Statistics

  • 57% more likely in those who had trouble falling asleep

  • 84% more likely in those who could not stay asleep all night

  • When compared with 7-8 hours/night, those sleeping 6 or less are:

    • 28% more likely to be diagnosed w/ Diabetes

(11)


Obesity increased appetite

Obesity & Increased Appetite

  • Loss of sleep affects the normal levels of ghrelin and leptin

    • Hormones that regulate appetite

  • More time to eat

  • Increased calories consumed

  • Less physical activity

    • Less energy for cooking and exercise

(4,6,7,10)


Leptin

Leptin

Inhibits hunger/food intake

Promotes utilization of fat for energy

Increases energy expenditure

Increases after food is consumed and satiety is reached

(4,6)


Ghrelin

Ghrelin

Stimulate appetite and hunger

Promotes retention of fat

Reduced energy expenditure

Levels are quickly reduced after a meal is consumed

Levels resurge a few hours later and hunger returns

(4,6)


Normal conditions

Normal Conditions

  • Plasma leptin and ghrelin levels both rise at night

  • Ghrelin spontaneously decreases during the second half of sleeping

  • Hypothesis- when sleep is cut short, ghrelin misses its spontaneous decrease

    • Result: elevated ghrelin upon waking

(4,6,7)


Sleep deprivation1

Sleep Deprivation

Leptin levels decrease as much as 20%

Ghrelin levels increase as much as 28%

Leptin responds more to chronic deprivation

Ghrelin responds quickly to acute deprivation

5 hours of sleep- 220 extra calories on average

4 hours of sleep- 300 extra calories on average

(4)


Sleep duration and bmi

Sleep Duration and BMI

  • Lowest BMI associated with 7-8 hours a night

    • Sleep duration below or above 7-8 is associated with a higher BMI

  • Sleeping

    • <5 hours: 1.14kg increase

    • 6 hours: 0.71kg increase

(4,6,10)


The effect of sleep on metabolism

http://www.bettycjung.net/BG2012/Sleepobesity.gif


Immune system

Immune System

Increased stress response (high CRP)

Systemic inflammation

Impaired immunological memory

Reduced immune response

(4,9


Stress response inflammation

Stress Response/Inflammation

Sleep loss of 2 hrs/night associated with high cytokine levels

Cytokines contributes to inflammation

Effect adaptation in starvation

(4,7,9)


Immunological memory

Immunological Memory

Antibodies- proteins that help fight antigens

When you are exposed to something your body “remembers”

At second exposure, body responds faster and stronger

Same concept used in vaccines

(9)


The effect of sleep on metabolism

http://classes.midlandstech.edu/carterp/Courses/bio225/chap17/lecture5.htm


Immunological memory1

Immunological Memory

  • Sleep after vaccinations strengthens the response

    • Sleeping subjects had 4x the antigen specific antibodies

    • Levels remain higher 1 year later

  • Mice repeatedly exposed to influenza did better with adequate sleep

(4,9)


Immunological cells

Immunological Cells


Reduced immune r esponse

Reduced Immune Response

  • Adequate sleep strengthens the interaction between antigen presenter cells and T cells

  • Inadequate sleep Decreases the production of :

    • T cells

(9)


Heart disease

Heart Disease

(12)

Increased BP

Inflammation/ CRP

Impaired vasodilation

Decreased anti-oxidant activity


Wound healing

Wound Healing

(6)

Common misconception

Wound healing is no faster in mice with adequate sleep compared to sleep deprived mice


Physicians role

Physicians Role

  • 10% of physicians feel their knowledge on sleep and sleep disorders is adequate

  • Of 121 primary care clinics screening questionnaires:

    • 100% inquired about smoking, drugs & alcohol

    • 93% asked about eating habits/behaviors

    • 86% inquired about physical activity level

    • 43% asked about sleeping habits

(1)


Prescription medications

Prescription Medications

  • Prescription: sedative hypnotics

    • Barbiturates

    • Benzodizepines

    • Hypnotics

  • Can be dangerous and habit forming

(13)


Side effects

Side Effects

Changes of appetite

burning/tingling in extremities

Constipation or diarrhea

balance disruptions & dizziness

drowsiness dry mouth,

headache

Heartburn & stomach pains

uncontrollable shaking of body parts

unusual dreams

weakness

(12)


Side effects1

Side Effects

  • Parasomnias

    • Behaviors/actions done in a sleep state

  • Can range from sleep walking to sleep driving

    • Can be very dangerous

(13)


Natural remedies

Natural Remedies

  • Exercise

  • Warm bath

  • Natural/ineffective

    • Valerian

    • Melatonin

    • Kava

(11)


Conclusion

Conclusion

  • Research has shown a consistent association between sleep and chronic disease risk

    • Science still needs more evidence to declare any direct correlations

  • Lack of specific mechanisms and causes for associations

  • Sleeping is an important aspect of patient health

  • Improving sleep habits may improve patient health


Questions

Questions?


References

References

Perry GS, Patil SP, Presley-Cantrell LR . Raising awareness of sleep as a healthy behavior. Preventing Chronic Disease. 2013: 10(1): 133-137

Lindseth G, Lindseth P, Thompson M. Nutritional effects on sleep. Western Journal of Nursing Research. 2011: 35(4): 497-513

National sleep foundation http://www.sleepfoundation.org/article/how-sleep-works/how-much-sleep-do-we-really-need.

Knutson KL, Spiegel K, Penev P, Van Cauter E. The metabolic consequences of sleep deprivation. Sleep Medicine Reviews. 2007 : 11(3): 163-178

Zelevansky N. ten surprising things about how animals sleep. Vetstreet.com. May 14, 2012. http://www.vetstreet.com/our-pet-experts/10-surprising-things-about-how-animals-sleep

Morselli LL, Guyon A, Spiegel K. Sleep and metabolic function. European Journal of Physiology. Jan 2012: 463(1): 139-160

Van Cauter E, Spiegel K, Tasali E, Leproult R. Metabolic consequences of sleep and sleep loss. Sleep Medicine Reviews. Sept 2008: 9(1): 23-28

Nedeltcheva AV, Imperial JG, Penev PD. Effects of sleep restriction on glucose control and insulin secretion during diet influenced weight loss. NIH Public Access Author Manusript. April 2012: 20(7): 1379-1386

Besedovsky L, Lange T, Born J. Sleep and immune function. European Journal of Physiology. 2012: 463(1): 121-137

Peppilyytikainen OR, Lahelma E, Lallukka T. Association of sleep duration with weight and weight gain: a prospective follow up study. Journal of Sleep Research. Jun 2011: 20(2): 298-302

Schardt D. Sleep on it: when counting sheep isn't enough. Nutrition Action Health Newsletter. Center for Science in the Public interest. April 2012. http://0-web.ebscohost.com.maurice.bgsu.edu/ehost/pdfviewer/pdfviewer?sid=c302cd43-ee8f-49e7-9c10-534df7075b3d%40sessionmgr111&vid=2&hid=118

Naughton MT, Geraldo LF. Sleep in Heart Failure. Progress in Cardiovascular Diseases. 2009. 51(4): 339-349.

Mayo Clinic. Prescription sleeping pills. The Mayo Clinic. 2011. http://www.mayoclinic.com/health/sleeping-pills/SL00010


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