Overcoming Pain

Why people experience chronic pain, and the power they have to de-intensify it

Dreaming of Losing Weight: The Nexus of Nod

Do you count sheep or lamb chops?

In these virtual pages, the importance of sleep has been discussed on many an occasion. Fibromyalgia is associated with disturbed sleep, and that sense of being "unrefreshed" upon awakening. Disturbed sleep often results in increases in reported pain levels, and a devastating lack of energy.

As if this were not enough bad news for the sufferer of chronic pain, emerging data suggest that lack of sufficient sleep appears to modify the neuroendocrine response to reduced food intake, adversely affecting the metabolic effects of caloric restriction. In fact, studies have shown that individuals who slept short versus long hours experience increased hunger. The ramifications for the fibromyalgia patient is evident: These patients are often suffering from a lack of exercise, due to concomitant fatigue and their daily pain; this results in higher rates of obesity, in turn impacting further upon exercise regimens.

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The weight loss becomes more problematic for the fibromyalgia patient (or anyone for that matter) if the poor sleep patterns associated with that chronic pain syndrome compromise the efficacy of dietary interventions for weight loss.

In the recent past, the well-known obstacles to maintaining a healthy body weight included physiologic, psychological and social factors. Now we must add sleep duration as another factor influencing weight. Interestingly, sleep duration in this country has decreased as obesity rates have risen.

One large study showed that shorter sleep time was associated with higher circulating ghrelin levels and lower circulating leptin levels, these being hormonal changes generally seen in calorie-deficit states that could contribute to weight gain through alterations in food intake and energy expenditure. Acute partial sleep deprivation leads to increased ghrelin levels, decreased leptin levels, and increased appetite.

A more recent study, published late last year in "Annals of Internal Medicine" found that insufficient sleep leads to hunger, obviously making the restriction of calories difficult. In addition, insufficient sleep results in the preferential loss of muscle to fat, compromising further weight loss and weight loss maintenance. Of course, one cannot ignore the obvious: more wake time means more time to snack; and, as discussed earlier, more fatigue from lack of sleep tends to result in less exercise.

So, what approach should be taken by the foes of fat? Do we extend the sleep duration in obese individuals who only sleep for short periods of time? And can such attempts at sleep manipulation be accomplished without causing addiction, and will the achievement and maintenance of a healthy body weight be long-lived? Fibromyalgia patients are often prescribed anti-depressant medications to assist with sleep hygiene; unfortunately, many of these drugs result in weight gain. Some studies suggest that slow-wave sleep loss is associated with metabolic alterations; other studies suggest a role for rapid eye movement sleep. Should certain stages of sleep be targeted?

The sleep deficiencies affecting society take a toll on the highways and in the classroom; they are associated with chronic pain and chronic fatigue, impacting quality of life and quality of work. Research is demonstrating that society's obesity problem is linked to its sleep problem.

We as a society might benefit from foregoing a little more late-night television and internet searching. Sleep certainly appears to be an important factor in successful weight loss, and should be included as part of any lifestyle package that traditionally has included a focus on diet and exercise. Perhaps we are what we sleep.

 

 

 

 

 

 

Mark Borigini, M.D., is a board-certified rheumatologist who has devoted his career to treating illnesses that cause chronic pain and disability.

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