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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Presentation Transcript
  • 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


How much sleep did you get last night?

How much sleep do you usually get each night?


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




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



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


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?


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


disposition index
Disposition Index

Marker that predicts the risk for diabetes

DI = AIRg x SI

AIRg= acute insulin response to glucose

SI= insulin sensitivity


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


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


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


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


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


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



Inhibits hunger/food intake

Promotes utilization of fat for energy

Increases energy expenditure

Increases after food is consumed and satiety is reached



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


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


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


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


immune system
Immune System

Increased stress response (high CRP)

Systemic inflammation

Impaired immunological memory

Reduced immune response


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


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


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


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


heart disease
Heart Disease


Increased BP

Inflammation/ CRP

Impaired vasodilation

Decreased anti-oxidant activity

wound healing
Wound Healing


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


prescription medications
Prescription Medications
  • Prescription: sedative hypnotics
    • Barbiturates
    • Benzodizepines
    • Hypnotics
  • Can be dangerous and habit forming


side effects
Side Effects

Changes of appetite

burning/tingling in extremities

Constipation or diarrhea

balance disruptions & dizziness

drowsiness dry mouth,


Heartburn & stomach pains

uncontrollable shaking of body parts

unusual dreams



side effects1
Side Effects
  • Parasomnias
    • Behaviors/actions done in a sleep state
  • Can range from sleep walking to sleep driving
    • Can be very dangerous


natural remedies
Natural Remedies
  • Exercise
  • Warm bath
  • Natural/ineffective
    • Valerian
    • Melatonin
    • Kava


  • 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

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

National sleep foundation

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. May 14, 2012.

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.

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.