Sleep and Body Weight: A Close Relationship

“If you weigh too much, maybe you should try sleeping more.”

This commentary in the journal Sleep caught my eye. Flip as it sounds to a person who would sleep more if she could, it points to a relationship between sleep and body weight that should be widely publicized.

Sleep can also affect your ability to keep weight off. As for the relationship between insomnia and body weight, the latest news is surprising. Read on for details:

Insomnia with short sleep increases susceptibility to overweight“If you weigh too much, maybe you should try sleeping more.”

This commentary in the journal Sleep caught my eye. Flip as it sounds to a person who would sleep more if she could, it points to a relationship between sleep and body weight that should be widely publicized.

Sleep can also affect your ability to keep weight off. As for the relationship between insomnia and body weight, the latest news is surprising. Read on for details:

Sleep Deprivation and Weight Gain

It’s established now that sleep deprivation increases feelings of hunger (or interferes with feelings of satiation). Sleep deprivation occurs when sleep is arbitrarily restricted—as it might be during a research project in a sleep lab, when participants’ sleep is restricted to 4 hours a night—or when work or family responsibilities keep you from getting the sleep you need. Either way, the tendency is to eat more. And the more you eat, the more weight you gain.

People who are chronically sleep deprived don’t only tend to put on weight. They also risk developing metabolic syndrome, which is linked to serious medical problems like heart disease and diabetes.

So if the bathroom scale is inching upward every time you weigh yourself, consider not just changes to diet and exercise but also allowing more time for sleep if—and this an important caveat—you’re actually able to get more sleep. A mere 30 minutes more sleep a night can help with weight loss and greatly improve your long-term health.

Short Sleep and Body Weight

People who are short sleepers by nature—those who routinely sleep less (sometimes quite a bit less) than 6 hours a night—are also more susceptible to weight gain and obesity than those whose nights are longer. A study conducted over a period of 13 years showed that every extra hour of sleep duration was associated with a 50% reduction in risk of obesity.

Short sleep is also associated with impaired glucose tolerance and insulin resistance. Thus short sleepers are more at risk for developing diabetes as well.

Sleep Duration Is Not the Whole Story

But routinely shortened sleep is not the only sleep issue associated with weight problems. Research is showing now that sleep quality is related to the ability to lose weight and keep it off.

Unlike sleep duration, which can be objectively measured with polysomnography, sleep quality cannot be assessed objectively. So it’s typically measured with questions similar to these:

  • Do you regularly have trouble sleeping?
  • What’s the overall quality of your sleep?
  • How often do you experience a sense of well-being during the day?

One recent study found that better sleep quality and being a “morning person” correlated with successful weight loss maintenance. Compared with current enrollees in a weight loss program, people who’d lost at least 30 pounds and kept the weight off for at least a year reported significantly better sleep quality and were more often early risers.

In another study, investigators compared people who maintained a loss of at least 10% of their body weight to people who regained their lost weight. Men (but not women) who were successful at shedding pounds and keeping them off reported significantly better sleep quality (but not more sleep) than the weight regainers.

Do Insomniacs Typically Have Weight Problems?

Not necessarily, if results of the latest study can be believed. Researchers in Germany compared the body mass index (BMI) of 233 patients with “severe and chronic insomnia . . . showing objectively impaired sleep quality” to the BMI of 233 age- and gender-matched good sleepers. The results were surprising:

  • BMI, insomniacs: 23.8 kg/m2 (The “normal” BMI range is 18.5 to 24.9.)
  • BMI, good sleepers: 27.1 kg/m2

On average, the chronic insomniacs weighed significantly less than the good sleepers. If confirmed by other research, the result should be somewhat reassuring to those of us concerned about the consequences of insomnia. It would also lend support to the idea that insomnia has less to do with insufficient sleep than with excessive arousal (or hyperarousal) that may affect us 24/7.

Do you find yourself eating more after a couple bad nights?

Paradoxical Insomnia: A Second Look at Treatments

Paradoxical insomnia: a diagnosis given to people whose sleep studies show they sleep a normal amount but who perceive they sleep much, much less. When I wrote about it in 2015, the word was that cognitive behavioral therapy (CBT)—the gold standard in treatments for insomnia—might not be an effective treatment for it.

But a brief testimonial that recently appeared in American Family Physician argues otherwise. Here’s an update on this puzzling sleep disorder.

Paradoxical insomnia may respond to treatment with CBT & therapies lowering arousalParadoxical insomnia: a diagnosis given to people whose sleep studies show they sleep a normal amount but who perceive they sleep much, much less. When I wrote about it in 2015, the word was that cognitive behavioral therapy (CBT)—the gold standard in treatments for insomnia—might not be an effective treatment for it.

But a brief testimonial that recently appeared in American Family Physician argues otherwise. Here’s an update on this puzzling sleep disorder.

A Subjective-Objective Discrepancy

Time and again we hear that people with insomnia tend to underestimate sleep duration. Up to 50 percent of the time, the electroencephalograms (the graphic records of brain waves produced during overnight sleep studies) of insomnia sufferers reporting insufficient sleep look the same as those of normal sleepers, registering 7 or 8 hours of sleep.

But in people with paradoxical insomnia, the discrepancy between their sleep study results and their subjective assessment of their sleep is huge. The woman whose story appeared in American Family Physician perceived that she was routinely “awake all night.” Yet when she finally went in for an overnight sleep study, the record of her brain waves showed she’d slept a total of 7 hours and 18 minutes. She couldn’t believe it.

A Heavy Burden

You might think, since paradoxical insomniacs are getting a normal amount of sleep, that their insomnia symptoms would be less severe than those of “objective” insomniacs, whose sleep studies show they get less (sometimes considerably less) than 7 or 8 hours. Paradoxical insomnia may sound like “insomnia lite.”

Apparently it isn’t. Research has shown that paradoxical insomniacs tend to be more confused, tense, depressed, and angry than normal sleepers. They also have a higher metabolic rate, which suggests an overall higher level of arousal.

In-depth analyses of brain activity at night attest to this heightened arousal. Compared with objective insomniacs, paradoxical insomniacs experience more high-frequency activity, and less low-frequency activity, in the brain at night. Their sleep is light and vigilant.

Yet it’s often hard for people with paradoxical insomnia to convince others that anything is wrong. When the woman writing in American Family Physician complained about not having slept all night, her husband countered with insistence that she’d slept soundly the whole night. Her friends and colleagues were skeptical too, noting that she had a normal amount of energy and competence at work. She felt increasingly tormented—“not only because of the insomnia,” she wrote, “but also because of a loss of trust from my husband and friends. They said they wondered whether I was pretending just to get sympathy.”

What Could Be Wrong? What Can Be Done?

Scientists can’t explain exactly what the problem is. One hypothesis holds that paradoxical insomnia has something to do with sleep quality, and that treatments that train paradoxical insomniacs to perceive sleep when they’re objectively determined to be asleep may help. (See my other post about paradoxical insomnia here.) But adjusting people’s perceptions may not necessarily resolve all their insomnia symptoms or improve their long-term health.

Other researchers have proposed that paradoxical insomnia occurs due to heightened brain activity during sleep, a condition which is accurately perceived by those who experience it but will require more sophisticated measures to assess scientifically. If it’s true that in paradoxical insomnia the main barrier to satisfying sleep is excessive brain activity and vigilance at night, then therapies designed to lower arousal levels—exercise, yoga, meditation—may help.

How About CBT for Insomnia?

Some experts have expressed doubts about whether CBT for insomnia (CBT-I) has the potential to work as well for paradoxical insomnia as it does for the more common psychophysiologic insomnia. The main value of CBT-I is its ability to help people fall asleep more quickly and decrease nighttime wake-ups. At least when their sleep is assessed objectively, paradoxical insomniacs don’t usually have these particular problems.

But CBT-I also helps to dispel negative beliefs and excessive worry about sleep, which can make any type of insomnia worse. It was an effective insomnia treatment for the woman writing in American Family Physician. “After receiving cognitive behavior therapy,” she wrote, “I began to feel much better and now am able to sleep well most of the time.”

So if it feels like you’re hardly sleeping at all, consult a sleep doctor or a sleep therapist for a proper diagnosis and help in improving your sleep. There may be more insomnia treatment options than you think.

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Q&A: Can Poor Sleep Show in the Face?

Can chronic insomnia make you less attractive? speed up the aging of skin? cause irreversible damage to your face?

I heard these concerns as I interviewed insomniacs for my book. But recently I decided to check into them after receiving an email from a woman whose anxiety about her appearance was extreme:

Very worried middle-aged woman

Can chronic insomnia make you less attractive? speed up the aging of skin? cause irreversible damage to your face?

I heard these concerns as I interviewed insomniacs for my book. But recently I decided to check into them after receiving an email from a woman whose anxiety about her appearance was extreme:

 

Ever since it all started eight years ago, my drive has always been an extreme fear of the insomnia’s impact on my physical appearance—especially my face. I just cannot let go of the pain of seeing my face ruined by sleeplessness! . . . Frankly, I look 10 years older than my biological age.

I am so afraid that my face is scarred (it certainly looks that way) and that it cannot recover after all these destructive years!

When we look in the mirror and see drooping eyelids and dark circles under our eyes, do we imagine we look worse than we actually do?

Effects of Sleep Quality on the Skin

There haven’t been any studies comparing the skin of insomniacs with the skin of good sleepers.

But three years ago I blogged about a study involving 60 women, half reporting good quality sleep with a duration of 7–9 hours and the other half reporting poor quality sleep lasting 5 hours or less. (Symptoms of these poor quality sleepers come close to meeting the criteria for a diagnosis of insomnia disorder.)

First the researchers inspected participants’ skin. Then they tested the skin, exposing it to ultraviolet light and subjecting it to a tape-stripping procedure that caused skin barrier disruption. They then observed how long it took participants’ skin to recover from these challenges.

Study Results

Compared with the good sleepers’ skin, the poor sleepers’ skin:

  • Showed more signs of aging skin (e.g., fine lines, uneven pigmentation, flabbiness, and less elasticity)
  • Took significantly more time to recover from the UV light exposure, with redness remaining higher over a period of 3 days

The good sleepers’ skin recovered 30% more quickly than the poor sleepers’ skin.

The study results suggest that insomnia sufferers’ concerns about the health and appearance of our skin are probably valid.

Effects of Sleep Deprivation on the Skin

In another study researchers took photographs to compare the faces of healthy adults in two different situations: (1) when they were well rested and (2) under conditions of sleep deprivation. (Again, acute sleep deprivation is not the same thing as insomnia—and certainly not the same thing as chronic insomnia—but research suggests that insomniacs may suffer from mild sleep deprivation at least some of the time.)

Twenty-three participants, all healthy adults, were photographed in the afternoon after a normal 8-hour night of sleep and again after sleep deprivation (a 5-hour night of sleep followed by 31 hours of continuous wakefulness). The photos were then viewed in a randomized order and rated by 65 untrained observers.

What the Observers Saw

You can probably guess what the results of the study were. Compared with well-rested faces, sleep-deprived faces were perceived as:

  • Less attractive
  • Less healthy
  • More tired

“Apparent tiredness was strongly related to looking less healthy and less attractive,” the researchers wrote. “The fact that untrained observers detected the effects of sleep loss in others” suggests that our sleep history gives rise to signs that can be noted by other people.

In other words, after several bad nights, the pasty complexion and dark circles we notice in the mirror are not just figments of our imagination. Others see them, too—and may judge us as less healthy and less attractive as a result. (Keep in mind, though, that the participants in this study were quite severely sleep deprived when the second round of photos was taken.)

What Can Be Done

If preserving your skin is important, then taking measures to improve your sleep might be one of the best preservatives. CBT for insomnia (or sleep restriction) is the No. 1 treatment for insomnia recommended by sleep experts. Find information about it by clicking “Blog” at the top of this page and typing CBT or sleep restriction in the site search box.

What about products that might help to preserve the skin? A dermatologist once recommended that I use CeraVe Moisturizing Cream. I like it well enough but have no way of knowing if it’s keeping my skin looking younger than it would otherwise be.

If you’ve found a skin product you like, please share it here

Insomnia: How Do You Score?

You may know you’ve got insomnia. But could you prove it?

Researchers use pencil-and-paper tests to assess different aspects of sleep: sleep quality, insomnia severity, sleep reactivity, and sleep-related beliefs. If you’re unfamiliar with these questionnaires, you may find it interesting to look at them and see how you score.

How do you score on tests given to people with insomniaYou may know you’ve got insomnia. But could you prove it?

There is no lab test for insomnia that would back you up.

An overnight sleep study, then?

Maybe—but probably not. Sleep studies don’t discriminate very well between insomniacs and good sleepers.

Genetic factors?

There may be genetic markers associated with insomnia, but researchers have no definitive understanding of what they are or how they add up to insomnia. The diagnosis of insomnia disorder is still made subjectively, based on questions and answers about sleep.

The list of questions doctors often ask to make the determination is fairly short and sweet.  But researchers use pencil-and-paper tests to assess different aspects of sleep: sleep quality, insomnia severity, sleep reactivity, and sleep-related beliefs. If you’re unfamiliar with these questionnaires, you may find it interesting to look at them and see how you score.

At the Doctor’s Office

If you take your complaints about sleep to the doctor, he or she may attempt to rule out other disorders before asking questions related to insomnia. You’ll get a diagnosis of insomnia disorder if

  • you have trouble falling or staying asleep, or sleep that doesn’t feel restorative, at least 3 times a week,
  • your sleep problem has persisted for at least 3 months, and
  • you experience impairment(s) during the daytime: moodiness, for example, or trouble concentrating or a lack of stamina that interferes with social, occupational, and other types of functioning.

Researchers, however, use pencil-and-paper assessment tools to evaluate subjects’ sleep and sleep improvements. Following are some of these questionnaires, downloadable as PDF files.

Pittsburgh Sleep Quality Index (PSQI)

In 1989 University of Pittsburgh sleep scientists introduced the PSQI in an attempt to quantify an aspect of sleep acknowledged to be important but difficult to measure.

The scoring of the PSQI questionnaire—with 19 self-rated questions—is a bit involved, but explicit scoring instructions are given at the end of the test. (Five more questions are to be answered by your bed partner or roommate if you have one. But these questions are not scored.) The 19 self-rated questions are divided into 7 “component” scores. The component scores are then added together to get the global score, which can range from 0 to 21. A global score of over 5 is indicative of poor sleep quality.

Sample question: During the past month, how often have you had trouble sleeping because you wake up in the middle of the night or early morning?

Insomnia Severity Index (ISI)

Some people experience insomnia occasionally while others experience it practically every night. The severity of a person’s insomnia may predict how likely he or she is to respond to various treatments. So it’s seen as a key variable to take into account when diagnosing insomnia and recommending a treatment, and when assessing improvements in study participants’ sleep.

Scores on this 7-item ISI questionnaire range from 0 to 28. Trouble sleeping is considered to be severe enough to warrant a diagnosis of insomnia disorder if scores are 8 or higher.

Sample question: How worried/distressed are you about your current sleep problem?

Ford Insomnia Response to Stress Test (FIRST)

The FIRST is the newest of the tests, introduced in 2004. This questionnaire is said to measure people’s overall level of “sleep reactivity,” a trait hypothesized to increase the likelihood of a person’s sleep being disturbed during stressful situations. The claim is that people who score higher on the FIRST are more likely to develop persistent insomnia.

FIRST scores range from 9 to 36. Scores of 20 and above indicate that stressful situations experienced prior to sleep—or the anticipation of stressful situations ahead—may routinely knock your sleep off track and make you vulnerable to chronic insomnia. Access this questionnaire by looking at Table 1 on the third page of this article about stress-related sleep disturbance.

Sample questions: How likely is it for you to have difficulty sleeping (a) after an argument? (b) before having to speak in public?

Dysfunctional Beliefs and Attitudes About Sleep Scale (DBAS)

If you don’t sleep well, you may find yourself having negative thoughts about sleep. Over time, these thoughts may coalesce into ideas, attitudes, and beliefs about sleep that give rise physiological arousal, making it harder TO sleep. In turn, the sensations of increased warmth, muscle tension, and faster heart rate that accompany arousal reinforce the negative thoughts, giving rise to a vicious circle.

The 16-item DBAS identifies misconceptions about sleep and assesses how big a role these and other cognitive factors likely play in perpetuating a person’s insomnia. A high score suggests that dysfunctional beliefs and attitudes may be a significant component of your insomnia, amenable to treatment with cognitive therapies.

Sample item: When I sleep poorly on one night, I know it will disturb my sleep schedule for the whole week.

If you’re curious enough to take any of these tests and end up learning something about your sleep, please take a moment to share it by leaving a comment. Thanks!

Going Off Sleeping Pills

Occasionally I hear from long-term users of sleeping pills who suspect the pills are doing more harm than good. Their sleep is not very satisfying and they don’t feel rested during the day.

Here’s why you might want to explore the idea of discontinuing sleeping pills and what to expect if you decide to do it.

Fear of insomnia can make some long-term users of sleeping pills afraid to stop themOccasionally I hear from long-term users of sleeping pills who suspect the pills are doing more harm than good. Their sleep is not very satisfying and they don’t feel rested during the day. They’re toying with the idea of going off sleeping pills but afraid that if they do, their insomnia will return worse than ever.

If these are your concerns, discuss them with your doctor or a sleep specialist. Stopping sleeping pills is a medical issue requiring assistance from a medical professional.

That said, here’s why you might want to explore the idea of discontinuing sleeping pills and what to expect if you decide to do it.

 

Why Consider Going Off Hypnotics?

Sleeping pills have their place. They can be a godsend on long transmeridian flights, after traumatic events, and for occasional situational insomnia. But there are several reasons to consider discontinuing a hypnotic if you’ve used it nightly for months and years.

The first is the one I’ve mentioned: it doesn’t feel like the pill is doing your sleep—or your energy levels—much good. Used long-term, many hypnotics tend to degrade sleep quality. You may be sleeping an acceptable number of hours, but your sleep isn’t as deep and refreshing as you’d like it to be.

Sleeping pills come with a number of health risks, too. Every hypnotic is different, so it’s hard to make generalizations about the harm they may do. But long-term use of many sleeping pills is associated with increased vulnerability to infections, depression, some cancers, and cognitive impairment. Some studies (but not all) suggest long-term users may have an increased risk of mortality.

Older adults are the group most likely to be using sleeping pills on a nightly basis. Yet as we age, our bodies process drugs more slowly. Older adults taking sleeping pills are at increased risk for daytime grogginess, car crashes, and falls.

Finally, concerns about drug tolerance (the need to take more of a drug to get the same effect) and drug dependency may make you uncomfortable enough to want to explore the idea of discontinuing your sleeping pills.

How Not to Kick the Habit

Researchers and clinicians agree: if you’ve used sleeping pills for a long time, it’s not wise to go cold turkey. Rebound insomnia (a temporary worsening of sleep) will likely occur, tempting you to start taking the pills again. In addition to rebound insomnia, you may suffer withdrawal symptoms: anxiety, restlessness, tremor, sweating, agitation, and even seizures. Weaning off sleeping pills gradually is a better strategy.

A Drug Tapering Regimen

This is where the doctor comes in. Knowing your medical history and the particulars of the sleeping pill you’re taking, he or she can plan with you what the best tapering strategy will be.

It’s going to depend on a number of things:

  • How long you’ve been taking the drug.
  • The half-life of the drug and the likelihood of withdrawal symptoms. Some drugs take longer to pass through your system than others. Withdrawal symptoms can occur within 1 to 2 days for sleeping pills with short half-lives and within 3 to 7 days for sleeping pills with longer half-lives. The taper can be planned accordingly.
  • The nightly dose you’re taking. “Providers should consider moderate reductions at higher doses and smaller reductions at lower doses to prevent excessive withdrawal symptoms,” writes Sarah T. Melton, Doctor of Pharmacy, in a paper for Medscape.com.

The taper should occur slowly and gradually. Two commonly recommended dose reduction schedules are these:

  • A 25% reduction of the dose every 2 weeks
  • A 25% reduction the first week, a 25% reduction the second week, and a 10% weekly reduction thereafter

But in difficult situations, drug tapers may take as long as 6 months. The schedule the doctor proposes has to feel comfortable to you, too.

Tapering off sleeping pills while going through cognitive behavioral therapy for insomnia (CBT-I) can greatly improve your chances of success with the taper and improve your sleep at the same time. For details, check out this blog post on CBT and stopping sleep meds.

Protein-Rich Dieting Helps Sleep

I’m not going to plug the high protein diet as the surest path to weight loss (although some say it is). But I do want to pass on the news that going on a high protein diet may be a path to better sleep, especially in people who are overweight or obese.

This is not just the conclusion of single study, which may or may not hold up over time. Rather, a protein–sleep connection has been documented in a handful of recent studies. If you’ve got insomnia and can afford to lose a few pounds, consider these results.

high-protein diet improves sleep qualityI’m not going to plug the high protein diet as the surest path to weight loss (although some say it is). But I do want to pass on the news that going on a high protein diet may be a path to better sleep, especially in people who are overweight or obese.

This is not just the conclusion of single study, which may or may not hold up over time. Rather, a protein–sleep connection has been documented in a handful of recent studies. If you’ve got insomnia and can afford to lose a few pounds, consider these results.

A Link Between Protein Consumption and Sleep Quality

Two studies were conducted by nutritionists at Purdue University. In a pilot study, they enrolled 14 overweight men and women, average age 56. Participants went on low calorie diets for 12 weeks. The percent of calories from protein in their daily diet varied in 4-week periods: either 10%, 20%, or 30%, in random order.

The upshot: Diets higher in protein significantly improved sleep quality (as measured by scores on the Pittsburgh Sleep Quality Index) regardless of whether the main source of protein was beef and pork or soy and legumes.

A total of 44 overweight men and women, average age 52, participated in the second study. Again, all participants went on low calorie diets. But this time, about half ate meals containing a typical amount of protein (the control subjects). Meals consumed by the other half were about twice as high in protein. At the beginning of the study, the sleep quality of both groups (as measured on the Pittsburgh Sleep Quality Index) was the same.

The upshot: By the end of this 16-week study, the group eating the protein-rich diet reported significantly better sleep quality than the controls.

The researchers conclude that “the consumption of a greater proportion of energy from protein while dieting may improve sleep in overweight and obese adults.”

A Quick Look at Sleep and Protein in Other Research

Other researchers have found a link between protein consumption and sleep.

Authors of a Korean study analyzed data from over 14,000 subjects ages 20–79 to see if dietary factors modified the association between sleep duration and obesity. The results showed that sleep duration correlated positively with protein consumption and negatively with carbohydrate consumption.

So along with weight loss here’s another reason to avoid pasta and fill up on fish: it might help you sleep longer.

College students were the focus of yet another study, this one looking at how dietary factors and psychological distress predicted sleep quality. Food choices that reduced the odds of poor sleep quality were

  • healthy dairy (by about 14%) and
  • healthy protein (by over 32%).

Once again, protein consumption is linked to better sleep.

The specific relationship between protein consumption and the sleep of people with insomnia has yet to be studied. But if you can afford to lose a few pounds and want to improve your sleep, try bumping up the protein and cutting back on carbs.

Make Sure It’s Healthy Protein

But make sure it’s healthy protein and not the bad stuff. Complete proteins, which contain all essential amino acids, are abundant in these foods:

  • meat (leaner cuts that are antibiotic and hormone free)
  • poultry (organic and cage free, if possible)
  • fish (wild is usually healthier than farmed)
  • eggs (from organic cage-free chickens, when possible)
  • dairy products

Incomplete proteins, which come from non-animal sources, are healthy choices, too:

  • nuts
  • seeds
  • beans
  • whole grains

If these are your main sources of protein, take care to eat them in combination with supplementary protein. Not just beans, but rather beans and brown rice.

Protein sources to avoid are fatty and processed meats such as bacon, sausage, deli meats, and hotdogs.

Straighten Up the Room for a Better Night’s Sleep

My husband is a neatnik and champion sleeper, and I’m messy and prone to insomnia. Could there be a relationship between household clutter and sleep quality?

Yes, says Pamela Thacher, a psychology professor at St. Lawrence University in Canton, New York. The results of a survey Thacher and student Alexis Reinheimer conducted recently suggest that hoarders are more likely to have sleep problems than people living with less clutter, and that getting rid of clutter might be conducive to better sleep.

sleep better in an uncluttered roomMy husband’s a real neatnik in his office at home, purging his files monthly, and I’m especially aware of this on New Year’s Day. Not only are the holiday cards long gone from his desk. During his December vacation he whittles his to-do pile down to nothing.

My files, in contrast, are bulging from years of neglect, and this year’s holiday cards are still on my desk. I can’t imagine whittling my piles down to nothing. The neatest my office gets is when there are no piles of stuff on the floor.

My husband is also a champion sleeper—whereas I’m prone to insomnia. But could there be a relationship between household clutter and sleep quality?

Yes, says Pamela Thacher, a psychology professor at St. Lawrence University in Canton, New York. The results of a survey Thacher and student Alexis Reinheimer conducted recently suggest that hoarders are more likely to have sleep problems than people living with less clutter, and that getting rid of clutter might be conducive to better sleep.

More About the Survey*

People with hoarding disorder tend to have difficulty using rooms for their intended purpose, and Thacher and Reinheimer wondered if hoarders with cluttered bedrooms might experience more sleep problems than people with neater rooms.

To conduct their survey, they advertised online for people interested in hoarding, sleep, or clutter and recruited 281 participants. Based on their responses to survey questions, 83 were deemed at risk for hoarding disorder. The remaining respondents served as the controls.

What They Found Out

Hoarders reported significantly lower sleep quality and more sleep-related daytime disturbances than controls. Contrary to expectation, though, it was hoarders’ living rooms (rather than their bedrooms) that were the most likely to be cluttered and unusable. But their kitchens and bedrooms were also significantly more cluttered than those in the control group.

“It seemed like even people without hoarding disorder had what we call a dose response—meaning that the more clutter you had, the more likely you were to have a sleep disorder,” Thacher said, quoted online in U.S. News & World Report.

Clutter, Sleep, and Me

This makes perfect sense to me. I doubt I’d qualify as a hoarder, but my office is usually disorganized—and the amount of clutter varies depending on how busy I am and how stressed out I feel. The times when the office gets practically impassible are also the times when my insomnia is at its worst. Only when the stress has passed do I start sleeping better and take a stab at tidying up the office and the rest of the house.

I have no trouble thinking that the state of my room is related to the state of my sleep, but the idea that cleaning up my room would help me sleep is a bit of a stretch. Thacher is moving ahead with her research, though, conducting a study on non-hoarders with sleep problems to see if getting rid of clutter in their homes improves their sleep.

“A clean bedroom might set your mind at rest,” she said.

* Read a summary of Thacher’s research on hoarding and sleep on page 329 of the 2015 abstract supplement of the journal Sleep.

If you’ve noticed a relationship between sleep and clutter in your home, how would you describe it?

L-Tryptophan May Help You Sleep

Interesting but dangerous: that’s what I heard about L-tryptophan supplements for several years. Research starting in the 1960s was showing that L-tryptophan might be an effective remedy for insomnia.

Then came the tryptophan-related outbreak of eosinophilia-myalgia syndrome (EMS) in 1989, killing 37 people and sickening thousands. The United States subsequently banned the supplements, and research on L-tryptophan and sleep came to a halt.

Now reviewers of alternative treatments for insomnia are again mentioning L-tryptophan as a substance of interest. Here are the pros and cons.

Mild Insomnia may respond to treatment with L-tryptophan supplementsInteresting but dangerous: that’s what I heard about L-tryptophan supplements for several years. Research starting in the 1960s was showing that L-tryptophan might be an effective remedy for insomnia.

Then came the tryptophan-related outbreak of eosinophilia-myalgia syndrome (EMS) in 1989, killing 37 people and sickening thousands. The epidemic was traced to contaminated L-tryptophan produced by a single Japanese company, but the United States banned L-tryptophan supplements from 1990 to 2001. Research on L-tryptophan and sleep came to a halt.

Now reviewers of alternative treatments for insomnia are again mentioning L-tryptophan as a substance of interest. Here are the pros and cons.

What It Is

L-tryptophan is an essential amino acid the body requires in order to synthesize proteins and other key molecules. It’s a precursor to serotonin, a neurotransmitter important to sleep, and melatonin, a hormone secreted at night.

Humans cannot produce L-tryptophan on their own. So it has to be gotten from food (or supplements). In one experiment, depriving insomniacs of L-tryptophan made their insomnia worse, as recorded by studies conducted in a sleep lab. Low levels of tryptophan resulted in sleep that was lighter and less continuous. This suggests that something about L-tryptophan facilitates sleep.

Laboratory tests show that tryptophan administered at night increases concentrations of both serotonin and melatonin in the brain. So its sedative effects are probably due to its enhancement of the melatonin or the serotonin system.

Randomized Controlled Trials

Taken at bedtime in amounts of 1 to 4 grams, L-tryptophan has been found to be at least somewhat effective for people with insomnia in several studies, including double-blind trials. But results from three randomized controlled trials, considered the highest standard of evidence, are mixed.

  1. In an early study of 96 “serious insomniacs,” weeklong treatment with tryptophan was compared with weeklong use of a placebo. No differences were noted during the tryptophan treatment—but participants taking tryptophan reported falling asleep more quickly than normal in the week following treatment.
  2. In a subsequent study, people with severe chronic insomnia were divided into two groups: one group took tryptophan nightly for 4 weeks, followed by 4 weeks of placebo; the other began with placebo and after 4 weeks swtiched to tryptophan. Group A reported improved sleep quality while taking the tryptophan; group B did not.
  3. In a more recent study, tryptophan from squash seeds and pharmaceutical-grade tryptophan, both in the form of food bars, significantly improved sleep duration and sleep quality in study participants compared with a food bar containing carbohydrate alone. The tryptophan from squash seeds outperformed the pharmaceutical-grade tryptophan in reducing time awake at night.

Well yes, these results are underwhelming.

Consider This, Too

Other research is more encouraging. L-tryptophan in some studies has reduced participants’ sleep latency and cut down on nighttime wake-ups. Reviewers make these comments:

  • The best results seem to occur in cases of mild insomnia with long sleep latency.
  • People with more severe forms of insomnia may need to take L-tryptophan for several nights before they notice improvement in their sleep.
  • In people with sleep maintenance insomnia, L-tryptophan may be more effective for those who wake up several times a night rather than for those who awaken less frequently.           

Foods High in Tryptophan

As alternative treatments for insomnia go, L-tryptophan supplements are now considered safe and relatively free of side effects. (For pregnant and breast-feeding women, however, L-tryptophan is listed as “likely unsafe.”)

But you may be able to get most of what you need in your daily diet. Meat, fish, and seafood contain lots of of L-tryptophan; eggs, cheese, and milk contain quite a bit, too. The following foods are also high in L-tryptophan:

  • soybeans and soy products
  • sesame seeds
  • seaweed
  • spinach
  • mushrooms, wild and garden variety
  • turnip and mustard greens
  • asparagus

One last caveat. By itself, L-tryptophan does not cross the blood-brain barrier. Combining an L-tryptophan-rich food with a carbohydrate greatly improves L-tryptophan uptake in the brain. So for your evening snack, have your cheese on a cracker and your tofu with rice.

If you’ve tried L-tryptophan supplements, what effect did they have on your sleep?