Sleeping and eating: Closely linked activities

Because hormones that regulate appetite, food intake, and body weight also play a role in sleep regulation, patients with eating disorders often have associated sleep disorders. For example, obesity is related to obstructive sleep apnea (OSA)—weight gain is a risk factor for OSA, and weight loss often is an effective treatment. Moreover, patients with anorexia nervosa frequently demonstrate sleep initiation and maintenance insomnia.

Conversely, epidemiologic studies have demonstrated that sleep duration is inversely correlated with body mass index. In particular, individuals with shorter sleep times are more likely to be overweight. The nature of this association is unclear; however, hormones that normally regulate appetite are disrupted in patients with sleep deprivation. For instance, leptin is an appetite suppressant that is normally released from adipocytes during sleep, so sleep deprivation may promote hunger by restricting its secretion.

Michael J. Howell, MD
Minnesota Regional Sleep Disorders Center, Hennepin County Medical Center, Assistant professor, department of neurology

Carlos Schenck, MD

Minnesota Regional Sleep Disorders Center, Hennepin County Medical Center, Associate professor, department of psychiatry

Scott J. Crow, MD

Director, Clinical Populations/Assessment Core, Minnesota Obesity Center, Professor, department of psychiatry

University of Minnesota, Minneapolis

References

<sub>1. Flemons WW. Obstructive sleep apnea. N Engl J Med 2002;347:498–504.
2. Levy AB, Dixon KN, Schmidt H. Sleep architecture in anorexia nervosa and bulimia. Biol Psychiatry 1988;23:99–101.
3. Gangwisch JE, Malaspina D, Boden-Albala B, Heymsfield SB. Inadequate sleep as a risk factor for obesity: analyses of the NHANES I. Sleep 2005;28:1289–96.
4. Mullington JM, Chan JL, Van Dongen HP, et al. Sleep loss reduces the diurnal rhythm amplitude of leptin in healthy men. J Neuroendocrinol 2003;15:851–4.
5. International classification of sleep disorders: diagnostic and coding manual, 2nd ed. Westchester, IL: American Academy of Sleep Medicine; 2005.
6. Rogers NL, Dinges DF, Allison KC, et al. Assessment of sleep in women with night eating syndrome. Sleep 2006;29:814–19.
7. Schenck CH, Mahowald MW. Review of nocturnal sleep-related eating disorders. Int J Eat Disord 1994;15:343–56.
8. Winkelman JW. Clinical and polysomnographic features of sleep-related eating disorder. J Clin Psychiatry 1998;59:14–9.</sub>