Aside from being a practicing Internal Medicine Physician, I am also board certified in Sleep Medicine and it comprises around 20-25% of my office based practice.  The importance of sleep is very much lost to America as a whole, and I have said in previous posts that sleeping too much is almost seen as a “sign of weakness.”  On a day-to-day basis I see people who accumulate endless amounts of “sleep debt.”  This is the amount of sleep you should get but don’t, and in the end your body keeps a ledger and knows what it is missing.  The question is, does accumulating sleep debt hurt you?  Is it dangerous to burn the midnight oil?  Let’s do a little research and find out.

What got me thinking about doing this post was a link I saw on Drudge Report this week to this article.  Now the headline claims “BEATING diabetes may be as simple as getting a good night’s sleep…”  Well, I think we all know that is a bit of a simplification, but what was found in this study is important.  Diet and exercise have always been seen as lifestyle modifications vital to treating diabetes (although the American way is certainly give me a pill and pass the cheesecake!), but this study sees sleep as the third piece to the lifestyle puzzle, and “It could be on reason why some other lifestyle interventions are not working.”  The study followed 522 people for a year and found that missing 30 minutes of sleep on a “regular basis” increased one’s risk of obesity 17% and insulin resistance 39%.  If you don’t know, insulin resistance is where you body slowly becomes resistant to its own insulin over time secondary to overconsumption of highly processed carbohydrates.  This in turn is the major pathway to the development of Type II diabetes.  The scientists lastly warn that our “arrogance” in cutting sleep is leading to “serious health problems.”

So, how does losing sleep lead to higher blood sugars?  Well, I can easily see two pathways for this to happen, and they both have to do with CORTISOL.  Cortisol is your body’s major stress hormone and is produced by the adrenal glands.  It’s release is brought about by stress and low blood sugars, and its main function is to increase blood sugar by stimulating gluconeogenesis in the liver.  Although good, cortisol also has harmful effects if in excess such as suppression of the immune system, a decrease in bone mineral density and formation, and the afore-mentioned insulin resistance.

Let’s go back a minute and look at that word stress.  Now none of us live stressful lives right?!  Stress is just part of our culture and basically inevitable.  Eliminating as much stress as possible is vital to long-term health not just for your sanity, but also for your blood sugar!  Chronic stress leads to chronic cortisol elevation…you do the math.

One other interesting tidbit on cortisol.  Viewing yourself as the animal that you are, starvation is a pretty basic form of stress for the human body.  If you are starving cortisol rises to cause a compensatory elevation in blood sugar via gluconeogenesis to provide your power-hungry brain the energy it needs!  So, what happens when you starve yourself on some crazy 1200 calorie a day diet?  Yep!  Your body goes into stress mode, energy conservation mode, elevated cortisol mode.  You starve yourself, stress yourself, and defeat the purpose all together!

Now, back to sleep and blood sugars.  Take a look HERE for a study on how sleep loss elevates cortisol levels.  The authors conclude that “Sleep loss could thus affect the resiliency of the stress response and may accelerate the development of metabolic and cognitive consequences of glucocorticoid excess.”  It’s pretty simple really; chronic sleep debt leads to elevated cortisol levels, and elevated cortisol levels promote insulin resistant and subsequent obesity and diabetes.  It’s like 2 + 2 = 4…

Ok lets give cortisol a break, it can’t be the only hormone causing problems with sleep deprivation can it?  Of course not…let’s discuss leptin.  I tell people leptin is your friend because it triggers the sensation of satiety (being full).  Leptin is produced by fat cells in response to adequate nutrition resulting in the inhibition of hunger; it is essentially an energy regulator.  Take a look HERE to see a study showing short sleep duration is related to reduced leptin levels and increased BMI.  These authors conclude “In Western societies, where chronic sleep restriction is common and food is widely available, changes in appetite regulatory hormones with sleep curtailment may contribute to obesity.”

So think about it!  We live stressed out lives, we starve ourselves to look “good”, we sleep way less than we should…as Dallas Hartwig has said to me we “reek of cortisol”.  So well said!  We do all we can to disrupt your body’s normal way of managing weight and energy by eating the wrong things.  Why did I bold and italic “adequate nutrition” in the prior paragraph?  Well, you cannot fool your body into thinking a bag of Cheetos is good nutrition.  You may fill your stomach with “physical” satiety, but you will not actually satiate your body nutritionally.  So what happens?  You eat food that is poor nutritionally, your body digests it but it fails to elevate leptin levels, and you remain hungry despite having eaten!  Talk about throwing a wrench into God’s design!

So there you have it, a direct link between short sleep, elevated cortisol levels, and rising obesity and diabetes around the world.  By the way, how many times are you out at a movie late, or a restaurant and notice kid after kid with their parents out later than they should be?  Statistically kids are sleeping less and less as the decades pass.  Adults want to continue to live their lives, have their fun, despite having kids so they just drag their poor kids along.  So what does that mean for the cortisol levels in kids these days?  Wow, and obesity and diabetes in kids is on the rise in epic proportions!  Who would have thunk it…

All that from a link I saw on Drudge LOL  This is my life, I see people every day developing diabetes, suffering the consequences of diabetes, and dying from diabetes.  I also see patient after patient with ISS, a technical diagnosis, Insufficient Sleep Syndrome.  Most don’t see the connection, I hope I have helped you clearly see what I see.

Sleep is vital, it is absolutely vital to good health and longevity.  More sleep is almost always the answer, not less.  If you keep your sleep short, you will make your life short.  Every year study after study is published showing us the dangers of not sleeping enough.  There is no end in sight for this flood of research in my opinion.

One last thing, and I’m talking to all you CrossFitters out there!  Those striving to be “elite athletes” through hard work and dedication in what you eat and how you train.  You are being foolhardy to EVER miss sleep to train harder.  Sleep is necessary for adequate recovery, and you will NEVER reach your maximum protection without adequate sleep.  It’s just not physiologically possible.

Many see the Paleo lifestyle as recreating the diet of the first humans to optimize human performance.  I take it even a step farther, quite a few steps actually.  In my humble opinion, in your body, God created the perfect animal.  The tolerances that your body keeps for blood chemistries for example put the efficiency of NASA to shame.  Everything works in perfect harmony until you go and screw it up 🙂  Following a Paleo Lifestyle allows your body to function the way God intended it to!  You fuel it correctly so that it runs correctly.  You also need a certain amount of sleep, and if you don’t get it, you don’t run correctly.

So, are you sleeping enough?  Do you regularly trade in sleep to train more? Work more? Party more?  What is that doing to your health?  Remember, your health is like an investment plan…you sacrifice now so that you win in the end.  Eating right is like depositing into your health, sleeping right is depositing in your health.  If you deposit enough into your health, it will take care of you for a long, long time!

I’m off to BED!

-Ernie