Sleep Problems Can Cause Cravings, Relentless Weight Gain,

and Hormonal Imbalances

by Beverly Yates, ND

Obesity, Cortisol, Cravings and Sleep Problems

For many people, the problems that they experience with sleep, food cravings (especially for sweets), and relentless weight gain are a mystery. Saddled with a belief that their bodies somehow don’t work right, people struggle with obesity and its consequences, feeling trapped and doomed to a lifetime of health problems that stem from the excess weight. This article discusses aspects of these issues from the viewpoint of both patients and doctors. Issues with insulin resistance have been covered well elsewhere and are not the focus of this article.

For a person who experiences relentless weight gain, feelings of overwhelm and being “out of control” are common. It can be frightening to watch weight climb, for reasons unknown, and find that experiences of specific food cravings, especially for sweets, can become more frequent and more intense. Weight gain that is not easily explained by the simple “overeat and no exercise” scenario can really be discouraging for the person whose weight climbs despite paying attention to calorie intake, eating nutrient-dense foods, and doing regular calorie-burning exercise.

Doctors sometimes neglect to ask patients about their sleep at all. This is a mistake. Sleep is where all healing come from in the body. Sleep is a time of major psychological resolution and spiritual renewal. If you have sleep problems, make sure your doctor and any other members of your health and healing team know this, as it can profoundly affect the success of your care.

Questions from the doctor concerning sleep should include addressing the basics of sleep, along with aspects of sleep that may be subtle. Important questions to ask regarding sleep quantity and quality include:

• Is there a regular bedtime, or is bedtime erratic?

• What time does the person go to sleep?

• How easy is it to get to sleep?

• How easy is it to stay asleep?

• How long does the person sleep?

• How many times does the person awaken to use the bathroom during sleep?

• How easy is it to get back to sleep if awakened?

• How does the person feel when awakening to get up for the day?

These questions that address sleep quality and sleep quantity can really help identify where otherwise hidden problems with sleep may lie.

Further questions that really get at deeper, possibly hidden problems with sleep include asking if:

• the person usually awakens with a headache,

• the person wakens and notices the mouth is extra dry,

• the pillow is wet from drool,

• the person has been told that he/she snores loudly,

• others avoid sleeping with or near the person, due to the amount of noise made during sleep.

Awakening regularly with a headache, a dry mouth, and/or in a pool of drool; being told that you snore too loudly, and being told that you stop breathing at times while sleeping are signs of sleep apnea. If the patient does not have a sleep partner, or someone else who sleeps nearby in the household that can serve as a “sleep reporter,” have the patient use a sound recording device so that there is no mystery about whether he snores loudly while sleeping.

Sleep apnea is a serious sleep disorder and warrants further investigation to determine its severity. A sleep study is a good way to assess whether the person has sleep apnea and learn if it is obstructive sleep apnea (much more common) or central sleep apnea.

The presence of sleep apnea frequently disrupts the hormonal system, resulting in imbalances in cortisol, insulin, and other hormones of the endocrine system. A person with sleep apnea may find that the hormones leptin and ghrelin are imbalanced as well, as one of a number of responses to the disturbances brought on by sleep apnea.

With sleep apnea, a person is much more likely to experience steady, relentless weight gain, especially around the belly. The pattern of abdominal weight gain is really problematic, as the fat that grows around the belly packs around the organs of the abdomen and secretes chemicals called cytokines that cause inflammation. This kind of inflammation can lead to heart attacks, strokes, and other serious health problems.

A number of sleep apnea patients over the years have said that they feel achy and deeply exhausted when they wake up. This makes sense, as they’ve been struggling to breathe all night while sleeping, instead of getting deep, restorative sleep that would leave them feeling refreshed when they awaken. This kind of exhaustion is not the same as what people with fibromyalgia and chronic fatigue syndrome experience.

Let’s clear up any mystery as to why poor sleep can cause weight gain.

Leptin is a hormone of starvation, signaling when the body feels it does not have enough energy for its activity level. Ghrelin is a hormone of appetite, and signals when to eat more so the body has the fuel it needs for its activity level.

Leptin decreases when a person does not get enough sleep. As a result, she may find that the next day she feels hungrier than normal and not as satisfied after eating as usual. This can leading to eating more food than necessary for sustenance. Also, when a person does not get enough sleep, ghrelin rises, which stimulates the person’s appetite. A increase in appetite can lead to eating more than is needed for sustenance. The combination of these two effects, both a decrease in leptin and an increase in ghrelin, in response to not enough sleep, can lead to creeping weight gain that is challenging to halt and then shift the body into weight-loss mode.

Many people who are overweight or obese and struggle with losing weight do not understand how much their sleep habits affect their weight. It is often the hidden factor, outside the standard calorie intake, food quality, food portion sizes, and eating more frequent, smaller meals during the day. Eating smaller, more frequent meals throughout the day, not allowing oneself to get overly hungry before eating, and taking meals that are gentle on the blood sugar can really help to calm imbalances in the hormones leptin and ghrelin. These daily habits really help keep a person from feeling starved and keep one’s appetite in check, which helps with losing weight and maintaining a healthful weight.

If a person has imbalances in levels of leptin and ghrelin due to poor sleep and also has sleep apnea, this can lead to serious problems with weight management and will likely result in a stubborn kind obesity that is resistant to the standard advice to “eat less and move more.” Just cutting back on calories and increasing exercise frequency and intensity may not result in significant weight loss. This can be discouraging for the person who experiences this set of health problems. The sleep apnea disorder causes a number of disruptions, including abnormal cortisol levels in response to the difficulties with the attempt to sleep.

Cortisol imbalances can lead to persistent cravings for specific kinds of foods, especially sweets. Sugars and other carbohydrates are a quick source of energy for the body. If a person with sleep apnea is struggling to breathe all night, this person is experiencing a direct stress as a result of the sleep apnea. This stress causes a cortisol imbalance that leads to cravings, most commonly for sweets, as a quick source of energy. Awakening feeling tired, with a headache, dry mouth, and as if she “didn’t sleep a wink”, the person is likely to add excessive sugar to her coffee, and reach for sugary snacks, especially in the late afternoon when energy is most likely to sag.

The presence of imbalances in cortisol, leptin, and ghrelin can lead to steady, relentless weight gain despite prudent measures taken to lower calorie intake, increase food quality and to exercise more. The presence of sleep apnea can exacerbate any tendency to easily gain weight, making a weight management problem much more challenging to successfully address.

Making additional changes, if needed, to daily sleep habits may be a necessary part of a successful weight management program. The person with a stubborn weight problem must make it a priority to go to bed at the same time each night, and go to bed early enough each night to get enough sleep. This focus on sleep habits can really help normalize leptin and ghrelin levels, while balancing these two hormones also helps make weight loss possible.

If a person suspects that she has sleep apnea, a visit to an ENT doctor or a sleep specialist is indicated. This specialist will likely order a sleep study, and the results of that assessment determine the need for the use of a CPAP (continuous positive airway pressure) or other breathing-assistance device to promote better sleep quality. In response to sleep apnea, some people have upper airway or palate surgery (back of the mouth) as part of their treatment. There are new implanted devices that assist some people with sleep apnea in keeping the upper airway open while they sleep. Also, there are numerous dental devices that help people with obstructive sleep apnea to breathe better while sleeping; a person with this problem is advised to check out all the options so that he understands what each treatment option offers.

Help is available, and it may take a combination of approaches for success with weight loss, weight management, and hormonal balance to be achieved long term.

Dr. Yates is the author of Heart Health for Black Women: A Natural Approach to Healing and Preventing Heart Disease. She frequently appears on television and radio as a medical expert. Dr. Yates is a graduate of the National College of Naturopathic Medicine and the Massachusetts Institute of Technology (MIT). She serves on several advisory boards and was appointed to the State of California’s Naturopathic Medicine Committee. Dr. Yates maintains a private practice in Corte Madera, California, in the San Francisco Bay Area. She lectures on topics related to obesity, weight management, heart disease, diabetes, PCOS, and women’s health around the country. These talks are either for the general public as a keynote speaker, or as a teacher of Continuing Medical Education (CME) courses for physicians and other health professionals. For free tips on how to lose weight and overcome obesity, visit www.DrBeverlyYates.com/free-weight-loss-tips.

Dr. Yates can be reached at 415-381-4600 (clinic) or Info@DrBeverlyYates.com.