Late-Night Eating Can Exacerbate Sleep Apnea Problems
Late-Night Eating Can Exacerbate Sleep Apnea Problems
It's the holiday season, and for some this means a lot of rich and high-carb foods at relatively late hours. While this may be a special occasion, the habit of late-night eating is a widespread problem that can exacerbate sleep disorders and contribute to weight gain and obesity. For those with sleep apnea, the consequences of this repeated behavior can be very serious. While doctors have known for some time about the relationship between sleep apnea, weight, and diet, more recent studies have uncovered further links between late-night eating and apnea severity. This means that, when it comes to eating, watching the clock is more important than ever. All habits are hard to break, but night eating can feel almost instinctual for many. Whether before bed or in a half-asleep stupor, the urge to hit the kitchen for something sweet or salty (or both) can be quite compelling. But with further sleep apnea complications at stake, it is a good time to hold back on those urges and emphasize discipline over appetite. A good meal is always an important part of life, but balance and timing are the keys to healthy living.
The Science of Late Eating
Several recent studies have demonstrated strong links between late eating, late eating duration (the time from first to last meal of the day), and weight gain, which is a leading risk factor for obstructive sleep apnea and other sleep disorders. In general terms, those who do most of their eating late in the day or at night are more likely to develop sleep apnea and other related sleep problems. More specifically, as reported by the study “Eating Late Negatively Affects Sleep Pattern and Apnea Severity in Individuals With Sleep Apnea,” late breakfasts, lunches, and dinners all had a measurable effect on sleep quality and duration, as well as late-night snacking and binge eating at late hours. Late breakfasts were associated with Waking After Sleep Onset (WASO), and waking during stage N1, and REM (rapid eye movement) sleep. Late lunches were associated with sleep onset latency, waking during the N1 stage, and daytime sleepiness. And late dinners were associated with both latency and higher Apnea-Hypopnea Index (AHI), as well as poor sleep quality in general. Overall, the study concluded that late eating has a negative effect on sleep patterns and sleep apnea events. While numerous studies have documented the relationship between weight and late eating, more recent research has looked into the specific mechanisms involved in late ingestion and how it affects overall health. In one example, the thermic effect of food (TEF) also known as specific dynamic action (SDA), was shown to cause metabolic problems during later hours of ingestion. Defined as the increase in metabolic rate during periods of digestion, the thermic effect of food is actually lowered by late-hour consumption, and especially during sleep. Thus, a possible consequence of eating late meals is a positive energy balance that leads to weight gain over time. This means that more energy is being consumed than is being used by the body, contributing to metabolic changes such as fat storage, which can further exacerbate existing problems with sleep apnea or related disorders.
As other studies have found, the circadian rhythm has a direct effect on digestion and metabolic functions. Our bodies tend to follow the daily passing of light, from energy expenditures in the day hours to calming effects in the evening. When we sleep, our bodies tend to resist digestion, leading to disturbances that can develop over time into larger problems. The disorder known as night eating syndrome (NES) is the most salient example, combining eating problems with sleep problems, and developing over time from daily habits. Night eating is a behavior that has a short-term reward with consequences, and many habits follow that same pattern. If you eat late because you are hungry, the issue may be more about timing than cravings, but if you continually eat or snack at night, the routine has likely become a habit. Since sleep apnea leads to awakenings during the night, the disorder itself can leave patients susceptible to nighttime habits such as eating or drinking. As expected, a strong correlation exists between AHI and awakenings, or more specifically, the number of times a person gets out of bed. So if the problem is associated with snacking or getting up to eat, it is likely that sleep apnea is both contributing to the behavior and worsening due to its consequences. In such cases, simultaneous treatments may be in order, and PAP therapy can be a great distraction from the draw of the kitchen.
Treatments and Therapies
Because night eating can so easily develop into night-eating syndrome or other disorders, it is important to treat it accordingly. One of the first approaches to sleep-behavior control is sleep restriction. Sleep restriction is a part of a larger approach called cognitive behavioral therapy for insomnia (CBT-I), and begins by simply reducing the amount of time you spend in bed to match your sleep time. In other words, bedtime is for sleeptime. In time, sleep restriction leads to sleep consolidation, which is defined as optimal sleep efficiency, where little time is spent lying in bed awake or rising from bed to engage in habitual behaviors. You don’t have to have insomnia to learn CBT-I. It is simply a form of therapy for behavioral change, helping to increase discipline and support healthy sleep and eating. Patients involved in CBT-I often keep a sleep log to record the amount of time they are asleep or awake, and how much of their awake-time is spent in bed. They are told to identify their triggers and keep track of the routine. By planning meals and seeking emotional support, individuals with night-eating problems can reduce the stress involved in taking control, and focus instead on the long-term benefits of healthy choices, both for sleep and for eating. Cognitive approaches work only if discipline is possible, and only if you learn to prioritize health over immediate gratifications. In addition to cognitive therapies, diet and exercise are often the cornerstones of any treatment related to problem eating or obesity, as well as for sleep apnea.
Other treatments include meditation techniques, pharmacotherapy, and dietary restrictions aimed at more holistic approaches to health. Many researchers agree that more studies are needed to address sleep disorders and their related behaviors. Given the chronic sleep disturbances and comorbid conditions involved, methods to improve dietary patterns and metabolic health should be a top priority for doctors as well as patients.
American Journal of Clinical Nutrition - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5657289/
American Journal of Nutrition - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5657289/
BMC Gastroenterology - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6381712/
Eating Behavior - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5124514/
Journal of Clinical Sleep Medicine - https://www.ncbi.nlm.nih.gov/pubmed/30853037
Neuropsychiatric Disease and Treatment - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4371896/
Obesity (Silver Spring) - https://www.ncbi.nlm.nih.gov/pubmed/26414564
Psychiatric Clinics of North America - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3222864/