Students in my online weight management class have been asking me the same question for over 15 years: Which is more important for weight loss--physical activity, or healthy eating? They’re always surprised to discover my answer is...sleep.
In fairness, most of my students aren’t expecting that we’ll cover anything more than physical activity and healthy eating. After all, American diet culture focuses primarily on either nutrition or physical activity. When was the last time you saw a diet that included getting to bed on time?
In contrast, the focus in my online weight management class is how to develop a healthy lifestyle that supports a healthy weight. We explore a variety of topics that influence good health in addition to healthy eating and physical activity, including sleep, hydration, stress, genetics, aging, how to maintain weight loss, and more.
Still, I believe sleep is the most critical aspect of weight management. Why? For starters, getting enough rest affects both physical activity and healthy eating. When you’re tired, you’re far less likely to feel enthusiastic about following through on your plans for physical activity, or consider heading to the kitchen to cook a healthy meal (or feel excited about cleaning up the kitchen afterward!).
And a lack of sleep affects metabolism. One of the many activities your body engages in while you sleep is managing blood glucose levels. Without enough sleep, your blood glucose levels can remain elevated. With elevated blood glucose levels, your insulin levels remain elevated. Higher levels of insulin in the bloodstream can make it harder to lose weight—and for some people, can encourage weight gain!
On top of that, when you’re tired, your body releases more ghrelin, a hormone that increases appetite. Your body also produces less leptin, a hormone that tells your body you’re satisfied. So, when you’re fatigued, increased ghrelin and decreased leptin levels make you more prone to cravings.
You may be thinking that those are more than enough reasons to focus on getting enough sleep. But as it turns out, there’s far more to sleep than fatigue and hormones, and sleep has far more impact on good health than just its influence on weight.
About ten years ago, I began reading about the glymphatic system. The glymphatic system is a relatively newly discovered system in the human body. It’s similar to your lymphatic system. You may already know that your lymphatic system is an organ system made up of lymph nodes, lymph vessels, and other lymphatic organs. Your lymphatic system works to clear your body’s cells of the cellular debris of metabolism.
Your glymphatic system works much the same way, but focuses on cerebrospinal fluid (the fluid in your brain and spinal cord). It’s a collection of fluid-filled structures made up of what are called astroglial cells. These structures surround blood vessels in the brain. The glymphatic system works to clean the cerebrospinal fluid of the byproducts of metabolism in the brain and central nervous system.
Research into the glymphatic system suggests that while it’s working when you lie down and rest, the glymphatic system works best when you are asleep. This is important, because research suggests that diseases like Alzheimer’s, Parkinson’s, and Huntington’s begin with the accumulation of the byproducts of metabolism in the brain. In other words, the work of the glymphatic system protects your brain from developing Alzheimer, Parkinson’s, and Huntington’s disease.
And as if that weren’t enough, more recently I’ve been reading about the impact of sleep on the gut. While this research is just emerging, it appears that a lack of sleep affects circulation, the immune system, and digestion.
How? Research suggests that without sleep, there’s a buildup of what’s called reactive oxygen species, a type of molecule called a free radical. (Free radicals are unstable molecules that steal electrons from other cells, which then damages the cells.) That buildup of reactive oxygen species appears to harm circulation, digestion, and the immune system.
Clearly, getting enough sleep matters—for your health, and for successful weight maintenance. So, how can you make sure you get enough rest?
One challenge many people face is getting to bed on time. The topic of bedtime procrastination, or deliberately choosing not to go to bed, has become a popular media topic recently.
My take on bedtime procrastination is that it’s a variation on a theme of general procrastination. Many therapists, myself among them, believe procrastination is not a matter of willpower, but a matter of emotion identification and regulation. In other words, if you’re having trouble getting to bed on time, it’s not because you’re weak or lazy. It’s because you’re not identifying and regulating your thoughts and feelings.
If you can’t connect with your thoughts and feelings, and engage in positive self-talk that comforts and sustains you, your procrastination habits may be about your relationship to yourself. Working with a therapist so you can become a good caring parent to yourself may be what you need to help you get to bed and get the rest you need.
If you don’t have a problem with getting to bed on time, but you have difficulty getting a good night’s sleep, I’d first suggest you check in with your health care provider to ensure you don’t have a medical issue related to sleep. Sleep apnea, for instance, is a surprisingly common medical condition that significantly affects your ability to get a good night’s sleep. Physical pain is another common medical condition that can affect sleep.
More commonly, people have trouble falling asleep and staying asleep because they're struggling with mental health concerns, like depression, anxiety, and PTSD. If you’re not getting a good night’s sleep, I encourage you to consider talking to your doctor, or getting a referral to a mental health care provider, so you can get the support you need to heal from your hurts, and enjoy a life of thriving.
Whether or not you have physical or emotional concerns that impact sleep, it’s still important to do what you can with your environment and lifestyle to ensure you get a good night’s sleep. Here are some suggestions (some more controversial than others!) to help you doze off and stay asleep:
Create a soothing bedtime routine
Ensure your bed and bedding are comfortable
Keep your room comfortably cool and dark
Turn off technology for 2 hours before bed
Experiment with reducing light during your bedtime routine
Avoid caffeine for at least 8 hours, and alcohol for at least 2 hours, before bed
Avoid using your bedroom, and particularly your bed, for anything but sleep and sex
If you must work in your bedroom, create clear work vs leisure zones in your bedroom
If you have children, interruptions to your sleep are inevitable. However, you can consider ways to reduce other interruptions to your sleep. Talk with your vet if your pets wake you up. Consider changing up your hydration or urinating routines (yes, you can train your bladder!) so you can avoid fluids shortly before bed if you wake up to go to the bathroom.
In a culture that glorifies overwork and overindulgence, focusing on taking excellent care of your physical and emotional health can be challenging. But given what we know—and we continue to learn more every year—if you want to live a life of health and happiness, it just makes sense to focus on ensuring you get quality rest. If you’re struggling to get enough sleep, I encourage you to seek out a doctor and/or therapist who can help you get the rest your mind and body need and deserve!
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