Full Transcript 0:00 The well-slept version of you is the best version you. 0:03 And that's the version that you need to rely on when you're doing behavioral change. 0:09 Behavioral change is hard for everybody. 0:12 So to show up at full capacity means you have to be well slept. 0:16 This is Dr. 0:17 Talks. 0:24 For this doctor talks, I have a lovely guest, Dr. 0:27 Audrey Wells or super sleep MD as we know her and she is a sleep specialist and an obesity medicine specialist. 0:36 And we are going to be talking about the relationship between weight and sleep. 0:41 Dr Wells offers individual and group coaching to help people sleep better without sacrificing comfort. 0:47 Doctor Wells, thank you so much for joining me. 0:50 I'm so happy to be here. 0:51 I love geeking out over sleep, so, happy get started. 0:56 Well, let's start off by talking about the relationship between weight and sleep. 1:00 How are those things related? 1:01 Why is sleep so important when someone is trying to maintain or lose weight? 1:06 You know, I think people have kind of an intuitive understanding that making sure you get enough sleep, healthy sleep is gonna be important for weight management. 1:17 But I what's a little bit more fuzzy is how exactly that happens. 1:22 And I'm really happy to highlight that this is a multi-dimensional process. 1:28 I wanna kind use the example of poor sleep as it affects a weight loss journey. 1:34 So poor sleep is going to affect your hunger drive. 1:38 Your appetite will be higher because your brain sees sleep as a source of energy, similar to the way that food or calories are a sort of an energy as well. 1:50 So appetite goes up, your hungry hormone ghrelin is elevated, and the satiety hormone leptin, is down. 1:58 It's like a double whammy in that regard. 2:00 Your sleep actually affects your food selection, your decision-making around food. 2:06 You tend to gravitate towards snack foods, foods that are not healthy, high-carbohydrate, salty, fatty foods. 2:14 And it's harder to kind of make choices that more in line with your long-term goals. 2:20 So decision making suffers when you're in a sleep debt. 2:25 When you're sleep deprived, your metabolism is affected. 2:29 For example, you glucose efficiency, the management of glucose goes down. 2:34 You have more inflammatory mediators in your system, which is a stressor. 2:40 And you can also have an offset of the circadian rhythm of digestion, Which also makes your Metabolism inefficient. 2:49 So all of these things are going to mean that there's more drive for weight gain instead of weight loss. 2:56 Finally, if you're sleep deprived, your mental health can suffer. 3:01 And when you are someone who's looking at the sort of delayed gratification of a weight loss journey, you need your health at peak capacity so that you 3:13 can show up every day with your best self in order to lose weight. 3:19 Wow, okay, so that was a lot of information. 3:21 And I know we're gonna go back to some of it, but I don't wanna miss this one and I'm afraid I'll forget it which is, can you tell us about this circadian 3:28 rhythm of digestion? 3:30 Definitely, yeah. 3:32 So it's the case that insulin is secreted in response to food intake and it is meant to unlock the cells so they can receive the glucose and use that for energy. 3:46 But your insulin sensitivity is not the same over a 24-hour period. 3:53 So when you have the advice of you shouldn't eat three hours before bedtime, a lot of that is due to the potential for acid reflux. 4:03 If you a food mass or food bolus in your stomach and you lay down flat, it has the potentially to go retroactive and to give you problems with reflux. 4:13 But also, if you consume food close to bedtime or even during the night, your metabolism does not process that food efficiently. 4:25 And so there's a mismatch between intake and metabolism that occurs if your consuming food when it's dark outside. 4:35 Wow, okay, so that sort of advice not to eat too close to bedtime definitely can have some physiologic explanations, like really may be good advice for 4:45 many people. 4:46 Definitely, yeah. 4:47 And I would say we're offering that advice to our patients on our GLP medications even more because food stays in your stomach even longer with those medications. 4:55 So a lot of our patience, we are advising, you know, really pay attention to how close the bed they are eating on those medication. 5:02 Okay, so going back to this relationship between hunger and sleep, I think this is something a lot of us, if we think about probably have noticed for ourselves. 5:14 When you have that night where you get, you know, really bad sleep. 5:17 I can fact to residency training as a doctor when you're on a 24 hour call, like. 5:21 The idea of eating a salad does not cross your mind after working for 24 or 36 hours, right? 5:27 You're like, I want like a donut, a cheeseburger, something salty. 5:31 Can you tell us a little bit more about that relationship between sleep and appetite? 5:36 Yeah, definitely. 5:37 And just to commiserate, for me, it was biscuits and gravy after a night of call. 5:42 For some reason, that's the way my brain is wired. 5:46 Part of it is this idea that when you're sleep deprived, you've lost out this ability to replenish your energy, so your body starts and your brain starts 5:57 to seek energy from a different source, i.e. 6:00 food. 6:01 It tends to be high density, high caloric foods, reward foods. 6:07 And there's also this idea that you are kind of more reward driven. 6:12 When you think about how we manage the primitive brain, the emotional brain that's seeking pleasure, avoiding pain, making sure we're staying in the cave, 6:22 staying safe, what is known is that the frontal lobe or the newer part of our brain sort of wraps around the limbic system and keeps that managed. 6:33 This is kind of the upper level thinking that we are doing when we making healthy food choices. 6:40 But in a condition of sleep deprivation, our frontal lobes start getting leaky. 6:46 They go offline a little bit and that emotional reward system comes out to play in full force. 6:53 So this is why cravings are so in line with high density caloric snack foods. 7:00 Wow, okay, so that makes sense. 7:03 And let's talk about how much sleep deprivation becomes a problem. 7:07 So I think it's pretty obvious to most people that what you and I may have done in our training of working 24 or 36 hours and really just missing an entire 7:17 night of sleep is not good for any of us, right? 7:19 But it doesn't have to be nearly that dramatic to have an impact on our health. 7:25 How much sleep do people need? 7:27 How do we know if we're getting enough sleep? 7:30 What does that look like? 7:32 This is a really insightful question and first I'm going to answer the question that you didn't ask because I want to highlight that sleep quantity, 7:41 the number of hours you sleep is just one metric under the umbrella of sleep health. 7:48 So when I counsel people about getting healthy sleep, I talk about sleep quality and sleep timing. 7:57 Now, to answer your question, the vast majority of people need between seven and eight hours of sleep. 8:06 When you look at some of the older figures about how much sleep is enough, oftentimes it'll say seven to nine hours. 8:14 But what's known now is that for that group of people that sleeps closer to the 9-hour mark, a significant number have an undiagnosed, 8:24 untreated sleep problem that they're compensating for by getting more sleep time. 8:30 So assuming there's no sleep pathology happening, You want to target some time between 7 hours and 8 hours of sleep time, 8:41 which means you're going to spend between seven and a half to eight and half hours in bed. 8:47 The data coming from big research population studies is very clear that when you are getting less than six hours sleep routinely, 8:57 that's gonna cause you problems, cardiovascular disease, including high blood pressure, metabolic disease weight gain, increased risk for diabetes, 9:05 et cetera. 9:06 And that area between six and seven hours seems to be a little bit of a gray zone. 9:12 So some people are gonna be vulnerable to the health risks that I just mentioned. 9:17 Some people seem to a bit more resilient, but could definitely benefit from boosting up their sleep time more than seven hour. 9:26 So seven is probably a good minimum in terms of amount. 9:32 But tell me more about quantity of sleep, or quality of asleep. 9:36 How do you know if you're getting good quality sleep? 9:39 There's a few ways you can know indirectly, but one of the funny things about sleep is that we are unconscious when we're experiencing it. 9:49 So, you know, if you're waking up a lot in the middle of night, that would kind of suggest to me something's going on that may need to be addressed. 9:58 You can assess your sleep quality at a couple of points during the day, and neither one of these points are when you first wake up in the morning. 10:08 A lot of people have the misconception that when we first woke up, that's the best time to kind of reflect on your night and decide, 10:17 did I sleep well or not? 10:19 But the truth is, when first you wake in in morning, Your cortisol is appropriately surging. 10:25 Your circadian rhythm is only just starting to ramp up, and so is your core body temperature. 10:32 So because those things are only on the upswing, it makes better sense to assess your sleep quality an hour to two hours after you wake up in the morning. 10:43 And that's assuming that your sleeping time is compatible with your biological clock. 10:50 The second time when you can assess your sleep need is in the late morning hours. 10:55 So I'm talking about 11 a.m. 10:58 or so for most people who have a bedtime somewhere in a 10 to 11 p. 11:03 m. 11:03 range and wake up in 6 to 7 a . So assessing whether or not this is your peak alertness time would say, I am probably getting good sleep. 11:15 You need to do this though without over caffeinating yourself. 11:19 And I find that so many people do that. 11:22 So if you're able to pull down your caffeine intake and then say, is this my peak alertness time? 11:28 That's a really good indicator that your sleep quality is where it should be. 11:34 But if you're sort of artificially increasing that alertness with caffeine, then you are just not getting that information. 11:40 Is that the issue? 11:40 Yeah, it's a band-aid. 11:43 You're basically taking a psychostimulant, the most common drug that we have, and using that to kind of prop yourself up. 11:53 I say this a little bit tongue-in-cheek because I love coffee and I really have to watch it. 11:58 Because it's something that you develop a tolerance to, and before you know it, you can be downing more than you really want to. 12:05 So coffee is okay? 12:08 Well, the sleep doctor thinks so. 12:09 Okay, great. 12:12 But obviously, there's a limit. 12:15 There's the limit to anything. 12:17 I would say that's around two cups or so. 12:20 And there is data all over the place about the other benefits of caffeine intake, and those do seem to be accessible with decaf coffee. 12:28 But in terms of helping to support alertness, I think caffeine, when it's used strategically, is a really good tool. 12:38 So we talked about appetite. 12:40 And then we also talked a little bit about metabolism and circadian rhythm as well. 12:46 You mentioned mental health in the beginning and how sleep is intertwined with that. 12:51 Of course, mental is health. 12:54 It affects our whole body. 12:55 Can you explain a bit more about how mental and sleep interact and maybe the implications that has for weight? 13:03 Yeah. 13:04 I think that if a person has had a chronic struggle with their health, with her weight, I mean, their mental health is also taking a hit. 13:16 And I just want to really give a nod to the toll that weight struggles can have on a personal psychologically over time. 13:26 And the problem with getting too little sleep or poor quality sleep, or sleep timing that doesn't fit with your biological need is that everything looks 13:40 darker and it amplifies whatever psychological challenges you're already dealing with. 13:47 You might recall back in residency, as kind of an extreme example, one night of sleep loss and your negativity bias really starts acting up. 13:58 Self-doubt, wondering is it always going to be this way, I'm so alone, blah, you know, all of these things just kind throw a wet blanket on whatever motivation 14:07 you had to pursue a weight loss goal. 14:11 And so I really emphasize to people that Sleep is something that you can look at as low-hanging fruit to amplify your efforts at whatever your weight loss 14:24 journey goals are. 14:26 And the opposite is also true. 14:28 You can amplify the obstacles to your goals by not getting enough of it. 14:34 Yeah, that's one of those foundational things, right? 14:37 It's so basic, it's essential. 14:40 Anyone who has ever helped raise a child knows that we protect the sleep of our kids so much, most of us will schedule our lives around their nap time. 14:51 We know that if kids don't go to bed on time that they get overstimulated and kind of crazy, right? 14:58 And so I think a lot of us recognize that for children and how important that sleep is. 15:04 And we fail to recognize, that oftentimes for ourselves or the other adults around us, it really is so foundational to how we feel to our health and our 15:15 mental health, our decision-making process. 15:17 So I like you saying that. 15:18 This is low-hanging fruit. 15:20 And it may be hard to move forward with some of your health changes, your goals around weight without having that foundation of being well rested. 15:30 And to your point, You still have a toddler brain, and so do I. 15:36 And sleep deprivation only brings that toddler attitude to the surface. 15:42 I like to say the well-slept version of you is the best version. 15:48 That's the version that you need to rely on when you're doing behavioral change. 15:54 Behavioral change is hard for everybody, so to show up at full capacity means you have to be well slept. 16:04 So what are some of the, you know, I think you and I've talked before, even on my podcast, i've been on your, your summit for weight. 16:10 We've about sleep apnea as one of things that is often a health problem that people who have overweight or obesity experience. 16:20 And it in some ways becomes a chicken and an egg situation, right? 16:24 Where sleep, apneia can worsen weight, weight can worse than sleep. 16:27 Apnea give us the spiel about. 16:30 Sleep apnoea and weight? 16:31 Yeah. 16:32 You know, I'm going to address something that I think kind of runs in the undercurrent of the public, which is, if I go get a sleep test, 16:41 i'm gonna get CPAP. 16:43 And I affectionately call this the PAP slap, because people, when they think about bringing a medical machine home to live on their bedside, 16:53 and you know they always say, It's just, you know, it's really hard to get your head around that. 17:00 So I like to highlight to people that a sleep study is just an information-gathering tool. 17:09 I really advocate for people empowering themselves with knowledge, and that may look like CPAP. 17:15 It may like look CPAPP alternatives. 17:17 But the truth is, Having overweight or having obesity is the biggest risk factor for obstructive sleep apnea, which is a serious breathing condition that 17:28 occurs during sleep. 17:31 And it is an modifiable risk-factor, meaning that many people who lose weight and even get to a normal BMI or body composition can cure themselves of obstrative 17:45 sleep Apnea. 17:46 Age is another risk factor. 17:47 That's number two. 17:48 We can't do much about that. 17:50 But it makes so much sense to go get tested, especially if you have obesity, and most especially, if your body mass index is above 40. Because a BMI above 18:04 forty has been well documented to be associated with an OSA, obstructive sleep apnea risk. 18:10 somewhere between 50 and 90. So getting that treated is just another tool in your arsenal to help with weight loss. 18:20 Okay. 18:21 But this, this C-PAP slap, I think is that what you're called it? 18:24 Like, oh, like I don't want to go there. 18:26 I could never do that. 18:27 Which I'm in that camp. 18:28 Like I am the princess in the pee when it comes to sleep. 18:31 You know, the thought of putting something on my face to asleep, but I totally understand why when I mentioned it to patients, 18:38 they're like, whoa. 18:39 Right. 18:40 So can you talk about what some of those strategies are for people who do have sleep apnea? 18:47 And, or, are worried they have it. 18:48 Maybe they haven't wanted to mention it to their doctor because they are worry that that's going to be their only option or they're going feel forced to 18:56 do that. 18:58 Yeah, and quite frankly, this is a source of obesity bias as well because a lot of physicians, a lots of the public will look at someone who's carrying 19:08 more weight and say they're at risk for sleep apnea, but I'm not because my BMI is normal. 19:13 That is bunk. 19:14 20% of people who have obstructive sleep Apnea have a normal Bmi. 19:20 So I want to dispel that myth straight away. 19:23 And also make the point that some people have asked me, well, why don't I just lose weight first and then I'll get tested? 19:32 But because of the reasons that we talked about earlier, it doesn't make sense because your sleep problem, this untreated obstructive sleep apnea, 19:42 is going to compete with your weight loss success, and that is not what you want. 19:48 So in my clinical practice, I became very frustrated with not having enough time to kind of review all of the non-CPAP options for obstructive sleep apnea. 20:01 And they do exist. 20:03 You have surgery, you have oral appliance therapy, and you can have weight loss. 20:08 Those are kind the broad strokes. 20:10 So I'm excited about the GLP-1. 20:13 medications, I think that especially with turzapetide, that has a lot of promise and that's been documented in a recent New England Journal study. 20:23 But when it comes to other alternatives, I think there's surgical options that can be personalized and there are non-surgical options. 20:33 I actually took the time to make a course that lays all of this out and it's meant to get a person to the next best step for them. 20:41 So that's on my website and certainly people can check it out. 20:44 But suffice to say, there is a lot of other options, in fact, my course is called 21 Plus CPAP Alternatives and I counted them all up, 20:53 and there are more than 21. Okay, so that's always encouraging, right? 20:57 Or maybe someone's already tried CPAP and they really struggled with it, or again, just the thought of it. 21:02 They just already know themselves and know that that is something that they may not want to pursue. 21:07 But I also have lots of patients who love their CPAT, they travel with, it they're like, I can't sleep without it has changed their life so much. 21:16 So it certainly is a wonderful treatment option for many people as well. 21:20 Totally. 21:20 And I really relate to what you said about being the princess when it comes to sleep, because I felt the same way. 21:28 Then I'm like, you know what though, I want to walk a mile in my patient's shoes and really figure out you know, how I'm going to counsel people about this. 21:37 And so I've tried all of the masks. 21:40 I have tried CPAP of several different settings. 21:47 What I can say is that usually there's a lot more drama in someone's head than what's actually existing when you try it. 21:56 So it's not that I think CPAP is for everybody, but I also don't try to sell people a bill of goods and say it is just going to turn your life around within 22:05 a few days. 22:06 That's just not the truth. 22:08 You do have to acclimate to it. 22:10 But a lot of times people have a buildup in their head that gets dissipated once they're actually logging some healthy sleep because their sleep apnea 22:20 is treated. 22:21 Okay. 22:22 So some of the, the stress or anxiety around things is heightened because of poor sleep. 22:27 And I think in general, a lot of us don't like new things, right? 22:30 So, you know, I have the same reaction sometimes when I recommend an injectable medication, like, we'll go be or step under any medication. 22:37 Oh, do I really need a medicine? 22:38 I'm like what? 22:39 Oh. 22:39 But it might be something to consider. 22:41 Right? 22:41 And so sometimes if we're not happy with where we are at health-wise, We do need to be open-minded to trying some new thing to change our health. 22:53 Now, what are some of the signs, like in case people are not aware of sleep apnea? 22:57 If someone's like, do I have that? 22:59 Isn't that like you stop breathing? 23:00 Wouldn't I know if I stop reading? 23:03 How does someone know, if they might be at risk or have sleep Apnea. 23:08 Perfect question because I think there has been this surge in awareness for sleep apnea, but still not everybody knows. 23:14 And it's a great question to just really get clear. 23:18 That being said, because of the situation where we're unconscious, a person might not know at all that they have obstructive sleep Apnea. 23:28 But truly for anyone who feels that their sleep quality may not be there, and especially if they are in an obesity category or having other medical conditions 23:41 that sleep apnea can aggravate, I would recommend getting tested because it is so, so common. 23:48 So snoring is a big. 23:51 A big symptom that's common but not always appreciated, even if you have a bed partner, presumably your bedpartner is sleeping during the night as well, 24:00 so they may not perceive snoring. 24:02 If you wake up gasping for breath, that is certainly a sign, but a more subtle situation is when somebody kind of tosses and turns and can't get to sleep. 24:13 That can actually be a side that you're not oxygenating well and it's more settle. 24:18 Daytime sleepiness, also a very common symptom, but not universally present. 24:25 And we don't really understand this yet, But you can have severe sleep apnea and not perceive sleep. 24:33 Sometimes it's a boiled frog effect where you kind of forget what it is like to be awake and you're just functioning. 24:40 But for some people I've actually got them on treatment and they say, yeah, I feel no different. 24:46 And I can show them how deep their blood oxygen levels drop and how severe their apnea is, but there's no real change in their degree of sleepiness. 24:58 That being said, it's still worth it to get treated because it will have effects on your heart, risk for diabetes, risks for weight gain, 25:05 et cetera. 25:05 Well, what haven't we covered, Dr. 25:07 Wells? 25:09 I ask you that as you try to take a sip of water. 25:11 Yeah, I could go on. 25:13 And I think that what I would want somebody to know as they kind of close on this talk is that just have a really low threshold to look at the blind spot 25:26 of sleep when it comes to weight loss, because by the time you're considering a medically supported weight loss journey, 25:34 you want to make sure that you've got your bases covered. 25:38 And sleep is foundational to health. 25:41 Like I said, it affects your appetite. 25:43 It affects you decision-making. 25:46 it will affect how well you do on a weight-loss journey even if it's supported by medications or injections. 25:54 So I would really encourage people just to take a close look on all of the free and easy things they can do to improve their sleep health. 26:04 I love it. 26:05 Thank you so much. 26:05 That's a great way to start thinking. 26:07 We've heard this, I think, different themes throughout the summit of what some of those foundations are. 26:12 And a lot of them are sleep, stress, eating whole foods, right? 26:17 So those are the foundation. 26:19 Then you might layer a supplement or a medication or procedure of some sort on top of that. 26:26 But if the Foundation isn't there, those other things might just be band-aids that are not really changing your health or how you feel. 26:35 Totally, totally agree. 26:37 Dr. 26:37 Wells, if people want more information or wanna connect with you, where can they find you? 26:42 Yeah, I am passionate about this type of work, and my company is called SupersleepMD at supersleepmd.com. 26:52 I have four courses on my website.I do group coaching, individual coaching. 26:58 And I'd love to work with anyone who's interested in up-leveling their sleep. 27:01 Thank you so much.Thank you for tuning in to Doctor Talks. 27:05 We hope today's episode has enlightened and inspired you on your path to optimal health. 27:10 Each day is a new opportunity to make choices that empower your well-being. 27:14 For more insights and strategies, subscribe to our podcast and visit our website, www.doctortalks.com. 27:23 Stay connected, stay healthy, and join us next time on Doctor Talks, Real Talk from Real Doctors, on the issues that matter to you most.
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