I will admit that sleep was the last piece to fall into place as I began to think of developing my own program. After years of working in the mainstream weight-loss industry—which virtually ignores sleep—I had a lot to learn. I’d hear things from time to time about the impact of sleep on weight, but to be honest, I didn’t really listen. I thought that sleep might affect weight loss for those with severe insomnia or sleep apnea, but not for average people with everyday sleep challenges. Then, a few years ago, I had the opportunity to meet and work alongside Dr. Michael Breus, America’s “Sleep Doctor.” We were serving as judges on Transformation Nation, Dr. Oz’s yearlong health initiative, and spent several days together poring over the applications of those who hoped to win the grand prize. Sleep was one of the seven health indicators being considered, and the time I spent in that room alongside Dr. Breus and the other judges (among them Deepak Chopra, Dr. Oz, and even the deputy director of the CDC) was like a master class not only on sleep, but wellness as a whole. After meeting Dr. Breus, I read his books and found myself surprised and fascinated by the wide-ranging effects lack of sleep has on the body and brain. When you’re not getting enough sleep, the resulting imbalance of hormones and decrease in overall performance is staggering. I began to address sleep with all of my clients, and I knew it would have to be one of the pillars of Target 100.
Sleep is a basic need, like nourishment and hydration. Unfortunately, what I hear from clients is that it has become a casualty of busy schedules, viewed as the most expendable piece in an increasingly demanding puzzle. Something has to give, right? People who would never think of starving themselves to save time see no problem with cutting back on sleep—it seems like the logical thing to do when you need extra hours in the day; we can’t bend time, so we abuse our bodies. The pace of modern life has left us unable to catch up, and created an environment where “busyness” is a badge of honor. The result is the frazzled stay-at-home mom—whose husband works long hours to keep them financially afloat—responsible for three children and all of their activities, meals, and attendant tasks, who wakes in the night and finds herself unable to get back to sleep, running through the calendars and lists she keeps in her head. It’s the working couple who are both gone from dawn to dusk, with long commutes and nonexistent work/life boundaries, checking email at 11 PM and pecking away at laptops in bed. The rapid rise of mobile technologies, unrealistic expectations, and demands for greater productivity and availability keep us running ragged. It’s funny, when I interview new clients, we can often trace the beginnings of weight gain to times that included little sleep. Sometimes it is a loss in the family, sometimes it is a job change or the birth of a baby. Yet they rarely make the connection themselves, until I ask—it is the last place we look when we find ourselves gaining weight. We examine our food intake, our exercise routines, but our sleep habits never cross our minds.
I am not going to bore you with pages and pages about the mechanics of sleep and why it’s important to your health. As with stress, the unfortunate truth is that knowing about the impact on health alone usually isn’t enough to spur change. Instead, I am going to give you a layman’s overview of how sleep impacts weight. Hopefully, this understanding will inspire you to do something about your sleep habits. The important word to recognize in that sentence is “habits.” Your sleep is already habit driven—and luckily, by now you are an old pro at understanding and changing habits.
Sleep is the crucial time the body uses to recover after the day, to replenish, nourish, and detoxify itself. Forget juice “cleanses”—along with hydration, sleep is the most powerful detox there is. During sleep, the liver scrubs toxins from our system, the brain “washes” itself of waste, tissue is repaired throughout the body . . . and hormones are produced and regulated. When we don’t get enough rest or that rest is fragmented, we disturb critical processes that support a healthy, balanced metabolism. Study after study reveals that those who sleep less than seven hours a night weigh more, gain more weight over time, and have a harder time losing weight. When we get less than seven hours of sleep, our levels of the appetite-boosting hormone ghrelin increase by about 15 percent while appetite-suppressing leptin decreases by the same amount. When you are short on sleep, you may notice that you are hungrier all day; there are multiple reasons for this, including your desire for more energy and the mistaken idea that food will supply it, but it is this ghrelin/leptin imbalance that ultimately sends you heading for the vending machines. This imbalance is the genesis of that frustrating experience we’ve all had of wanting to stick to our healthy plans but feeling driven to seek out high-fat, salty, and sugary foods.
It may make you feel guilty, or as if something is wrong with you, but in fact something is right: This is a deep biological drive, an internal force that does not bow easily to “willpower” and does not care about your goals. Your body has one goal—to stay alive—and it is doing what it believes it needs to do based upon the way it is being treated. I’m going to repeat this, because it is just that important: When you miss sleep, the hormone that tells you it’s time to eat increases by 15 percent while the hormone that signals you to stop eating decreases by 15 percent. That is a massive disadvantage you are battling. It’s like starting a baseball game five runs down.
Another, potentially more serious problem is that it only takes about four days of sleep deprivation to throw off your body’s response to insulin. Insulin is the hormone that tells your body that your blood sugar is high enough and signals it to store fat. Studies at the University of Chicago show that after just a few days of shortened sleep times, sensitivity to insulin drops by more than 30 percent. If your body stops responding to insulin, fat and sugar stay in the bloodstream, and the pancreas releases more and more insulin until your body finally gets the message. But cells can only store so much glucose and fat, and by this point, scrambling, your body starts storing the excess in organs like the liver. Not only does insulin resistance increase the likelihood of gaining weight, it is the driving factor behind metabolic syndrome and what eventually leads to the development of type 2 diabetes. In a frustrating cycle, high blood-sugar levels from sleep deprivation prompt the body to try to get rid of extra sugar via the kidneys, making it more likely you’ll wake in the night to go to the bathroom . . . further disrupting your sleep.
Deprive your body of sleep and you could follow the exact same diet as a well-rested friend and make a fraction of the progress. Many times I’ve seen diet gurus or program leaders look skeptically at clients who claim to be “doing everything right” and yet seeing few results. They respond with disbelief or by suggesting the client further restrict calories, sending a clear message: one of shame, suggesting the client must be at fault. Many who work in the weight-loss world still refuse to believe there is more to the equation than food and exercise, calories in and calories out. When I have a client who comes to me crying about doing “everything right” and getting nowhere, I know something else is going on, and I’ve found the most common “something else” is sleep. I wish someone had told me this earlier. After my sons were born, I had sixty-five and fifty pounds to lose, respectively. People had promised me that breastfeeding and getting back to healthy eating habits would “melt” the weight right off. Instead, I jumped onto a weight-loss plan and watched as almost nothing happened until each of my sons began regularly sleeping through the night. In retrospect, I wish that, along with tracking my food and exercise as I worked to lose weight after they were born, I had also tracked my sleep. I’ll bet that the plateaus I experienced would line up nicely with times when the boys were not sleeping well—and so neither was I.
A few final sobering sleep facts:
Fact: People who miss out on sleep are stimulating the same brain system that marijuana activates to create the “munchies.” In a study, sleep-deprived participants could literally not resist tempting food placed in front of them—even though they had already eaten a full meal. Those who were well rested could give the snacks a pass.
Fact: Those who sleep less than six hours a night actually have shorter life expectancies. Staying up late and waking early may feel like it’s netting you extra time, but it’s not.
Fact: Studies have found that when dieters cut back on sleep over a fourteen-day period, the amount of weight they lost from fat dropped by 55 percent, even though their calorie intake stayed the same. They also felt hungrier and less satisfied after meals, and suffered from low energy.
This target calls for you to add 100 minutes of extra sleep a week. (Yes. I just asked you to sleep more. Who knew you could lose weight by spending more time in bed?) You may have heard that we “naturally” sleep for just as long as our bodies need to. Not in this day and age. Our natural sleep rhythms are a mess. Our environment has left many of us chronically sleep deprived, and not only are we not getting enough sleep, the quality of the sleep we do get is often very low. Each “stage” of sleep has important functions, and many of us are missing out on the deep sleep we need, due to waking in the night.
The standard recommendation is to get anywhere between seven and nine hours of sleep per night, but I have found that almost everyone has a much more specific amount of sleep they need to function at their best. This is probably not surprising to you. Even in my own family there is a great variance: my oldest son has never needed nearly as much sleep as my younger son does. I need at least seven hours most nights and work hard to get them. (Now that I am aware of how sleep deprivation drives my hunger and weight, I am very serious about my sleep!) This is another area where you’ll need to be a bit of a scientist whose subject is yourself. Uncover the right amount of sleep for you by keeping track of your sleep and how you feel the next day. If you are one of the rare people who is getting enough sleep, you can use this target to focus on the quality of that sleep instead of adding minutes—most of us, however, will need to do both. Once in a while, poor-quality sleep actually causes someone to sleep too much without ever being fully rested. As I dig in with my clients, I almost always find multiple sleep issues. Adding minutes will force you to address factors, like bedtime routines, that also impact the quality of your sleep. Looking for ways to improve the quality of your sleep will make it easier for you to fall asleep and stay that way, ultimately adding sleep minutes. Again, you will have to do some investigation into your own sleep patterns. Do you find that the sun wakes you too early? Are you too hot at night? Do you wake up frequently on nights when you drink alcohol? Are you unable to fall asleep due to anxiety over the day ahead?
Our sleep struggles are as individual as we are, but every one of us can benefit from better sleep, and there are endless ways to improve it. Sleep is one of those things we take for granted as “natural,” but healthier sleep habits will not happen magically. They must be consciously tackled, triggered, and consistently tended, just like any others.
Our biggest problem is that we treat sleep like it should happen at the snap of our fingers. Because it is supposed to be “natural,” we also see it as somewhat mysterious. We have sleep all wrong, thinking of it as both more simplistic and more complicated than it really is. Imagining it like an on/off switch we can’t quite control, we lie down and wait for it to flip. For some reason, while we frequently complain to friends and colleagues about being tired or busy or “up late,” we act like it can’t be helped, as if waking four or five times a night is inevitable, suffering in silence until we get desperate enough to begin taking sleep aids—many of which have side effects that actually make the problem worse. Magazine articles are filled with “tips” on how to get better sleep, but those tips can’t be implemented without relying on habit-formation science. There are myriad environmental changes to consider, from light and sound to temperature, what to wear and what bedding to use, devices to try and advice to absorb. We read the articles, but this seldom translates into action because we do not approach sleep with the methodical determination we would a problem at work or an unhealthy diet, and our sleep habits are deeply ingrained. Sleep is such a habit-driven activity that we continue doing what we know “works,” even if it doesn’t work very well! Clients come to me with terrible sleep habits: dozing with the television on, on couches, or spending half of their nights in their children’s beds, just to name a few. These sleep routines have become habit, and they don’t want to mess with the status quo and risk a night of sleeplessness as they adjust to something new, unaware that they are torpedoing their weight loss. But sleep isn’t a mysterious on/off switch that flips, sleep is a process—one that most of us have never had proper training in. We need to wind down, relax, and prepare for sleep. It should be planned for and protected the way we would any of the other important activities in our lives, like work, meals, or exercise. Viewing sleep as a process is a difficult jump to make, but once you do, you’ll see there is a logical place to begin your work on this target: with your morning and evening routines.
We’ve looked at morning and evening routines through the lenses of many other targets, from food to stress, but they are perhaps more crucial than ever when it comes to sleep. How much and how well you sleep are the direct result of these routines, and inevitably, I hear that clients have given them little thought. These critical moments of our day are haphazard and disorganized at best. I watch friends construct carefully considered bedtime routines for their children while completely ignoring their own. Why do we think this is less important for us? In fact, as we age, our systems are increasingly less resilient, making the renewing properties of sleep more vital than ever, while the pressures of adult life make the transition from stress to rest more difficult.
WORDS OF LIZDOM
Morning and evening are sacred times. Protect them by establishing routines that are both restful and rejuvenating. These routines are a cornerstone of your weight-loss success.
In the previous chapter, we talked about my client Stacey’s morning routine, and how remaking that routine allowed her to defeat the chronic lateness that was setting her up for a day of stress and poor choices. It probably won’t surprise you to hear that her evening routine was equally chaotic. Most nights Stacey was working on her laptop—while also watching TV—until right before bed. She often struggled with late-night snacking (driven by commercials on TV, banner ads on her computer, and being up for so many hours after dinner) and had trouble falling asleep, no doubt in part because of spikes in her blood sugar (and all that screen time—studies show that the light emitted by screens can disrupt your sleep all night long). Her lack of sleep contributed to her difficulty getting up in the morning, which of course contributed to her stress and feeling behind at work, which in turn made her more likely to stay up late working—you can see how all the targets, and sleep and stress in particular, are deeply intertwined.
We created a new nighttime routine for Stacey, one that would support the process of sleep. She set an alarm on her phone for 10 PM each night, alerting her to turn off her computer, turn lights down around the apartment, and begin her bedtime routine. She then spent the next thirty minutes brushing her teeth, getting into her PJs, and cleaning up a bit so she wouldn’t wake to a mess. She also took a magnesium supplement (a natural sleep aid) at that time. All screens, including her phone, were banned after the 10 PM alarm sounded. You’ll remember from our discussion in the last chapter that I had Stacey buy a good, old-fashioned alarm clock instead of using her phone so she was not tempted to check email or social media first thing upon waking; this is just as important as a tool to avoid checking email “just once more” before falling asleep. I know all too well the disruption of checking email “for the last time,” only to find a message from your boss that sends your stress levels through the roof. That is a surefire sleep killer. And guess what? Your email will still be there in the morning. If it isn’t urgent enough for someone to call or show up pounding on your door, it can absolutely wait. We have gotten into the habit of signing over our nonwork hours to our jobs, but I am betting you do not get paid so much that it is worth sacrificing your health.
Stacey found triggering her new routine was critical. Each night when the alarm went off, she was taken completely by surprise and had trouble shutting things down because she “wasn’t quite finished.” As the weeks went on, it became easier and easier, both to remember the alarm was coming and to shut down when it did. Dimming the lights, taking her magnesium supplement, and turning off the screens helped Stacey get to bed on time, fall asleep more quickly, and experience better-quality sleep. We improved things further by adding logical rules like if she was working on her laptop, she should turn off the TV, and vice versa. To control triggers to eat, Stacey started DVRing her favorite shows so that she saw fewer commercials while watching TV, and she began turning off the lights in her kitchen after 8 PM. Along with alarms on her phone, we used sticky notes around the apartment to remind her not to bring screens into bed, to turn down certain lights, and to stop eating. The new routine, although difficult to adjust to at first, gave Stacey the immediate rewards of more energy, less stress, and increased weight loss.
Many clients stumble by thinking of sleep as only a nighttime consideration. It isn’t! Bedtime routines are a perfect place to start, but the changes we made to Stacey’s morning routine—getting up earlier, easing into the day with relaxation, using a “real” alarm clock—all supported her ability to get more sleep at night. Just like your diet or hydration, sleep requires planning and awareness throughout your day: what you eat, how much you exercise, how much caffeine you drink . . . all of these things affect sleep.
You can use the following worksheet to plot out your sleep goals and make them a reality.
I hold an intense boot camp in my backyard periodically for small groups, introducing the concepts and strategies of Target 100 over the course of ten weeks. I start most sessions by asking members to share what they’ve been working on that week and how it’s affecting their lives, and during a recent check-in, one member, Amy, chimed in to say that, as she pushed for greater awareness in each of the targets, she’d suddenly realized balance was the foundation of the whole program. We begin by focusing on one thing at a time, but eventually it becomes about balancing our efforts among all six targets and understanding the way they work together—and this, not mastering any one area individually, is what makes Target 100 work long term. I couldn’t have said it better myself. Balancing focus on all the targets relieves so much of the anxiety associated with the weight-loss process because it makes everything easier and thus more sustainable. The targets are intricately connected—you can look at any single target and see how it affects the others and is affected by them in turn.
To use the subject of this chapter as an example, it is clear that our sleep will never come as easily into line without considering the other targets as well.
Sleep needs . . .
Exercise and movement. Studies show that sleep is radically improved with regular exercise. This isn’t rocket science: you’ve probably noticed that if you tire yourself out doing yardwork, you’ll fall asleep more easily that night. Exercise and movement also reduce stress, help alleviate the aches and pains of sitting at a desk all day, increase levels of feel-good hormones like serotonin, and stabilize blood sugar—all things that support your shut-eye.
Sleep needs . . .
A healthy, low-sugar diet. Carb-heavy foods cause blood-sugar spikes and disrupt our natural metabolism and sleep cycles. Overeating can cause reflux, heartburn, or gastrointestinal issues that wake us in the night. Getting enough protein and managing the timing and amount of our alcohol and caffeine consumption can all affect sleep—we can enhance sleep further when we stop eating two hours before bedtime.
Sleep needs. . .
Hydration. Dehydration can make us feel agitated or anxious, and wake us with thirst or muscle cramps. It can cause problems with digestion or lead to poor eating that in turn interferes with rest in the ways discussed above. It can deprive us of the energy we need for sleep-supporting exercise. More directly, remember that water makes up 73 percent of your brain: being dehydrated can disrupt normal brain functions while sleeping. Staying hydrated during the day and then avoiding water for the two hours before bedtime can go a long way toward helping you sleep through the night.
Sleep needs . . .
Stress relief. If we do not address our stress levels, sleep will continue to be a struggle. Stress undermines our good intentions and drives us to sugary foods that wake us in the night. Adrenaline and cortisol pumping through our systems make it impossible to rest, and anxiously churning minds that can’t turn off lead inevitably to insomnia. You can’t learn to sleep well without learning to relax.
I hope that over the course of looking at these six targets together, you’ve learned something that has changed your perspective. I have watched so many fall prey to the magical thinking that promises that the latest fad diet will finally be “the thing” that works. I did it (many times) myself. I understand the appeal of narrowing your focus when it comes to weight loss: removing decisions and temptations can feel really good in the beginning. Finally, you don’t have to think so much! We have become so overwhelmed with options that it feels easier and safer to just take a bunch of those options off the table. With Target 100 I am asking you to do exactly the opposite of narrowing your focus: I want you to broaden your awareness. Expand your idea of what weight loss looks like to include factors you never considered before. What do you have to lose by trying something new? With well over 65 percent of our country overweight or obese, what we are doing now is obviously not working. The simplistic equation of “eat less and move more” is not working, and drastic “quick fix” solutions are not working either, because neither address the whole picture of why the weight crept on to begin with. This physically and emotionally harmful cycle has got to stop. I am asking you to be brave enough to view your body as a fully functioning system, one that doesn’t need punishment, but instead requires care. We spend so much time caring for others—it’s time to start caring for ourselves.
1. Get new bedding—buy sheets that feel cool against your skin, find a breathable comforter or mattress pad, or try a weighted blanket.
2. Try turning the thermostat down a few degrees more at night.
3. Begin dimming lights two hours before bedtime.
4. Set an alarm to remind you to head to bed thirty minutes early.
5. Remove screens from the bedroom.
6. Stop using your phone as an alarm.
7. Try nighttime yoga or meditation.
8. Keep a glass of water next to your bed so that you don’t have to go to the kitchen if you wake up thirsty.
9. Read before bed instead of watching TV.
10. Burn a calming scented candle—like lavender—before bed.
11. Find comfortable sleep clothes.
12. Try a sound machine.
13. Try natural sleep aids like chamomile tea or a magnesium drink before bed.
14. Try using new tech: a wearable device to track and monitor sleep, a wearable alarm to wake you in the best sleep cycle, or an alarm that wakes you gradually with natural light.
15. Take a bath before bed.
16. Create a sleep schedule, and go to bed and wake up at the same time for a full week.
17. Stop eating two hours before bedtime.
18. Add room-darkening shades or drapes.
19. Invest in better pillows/mattress.
20. Clean and organize your bedroom so it is free of chaos.
21. Get outside into natural light at least once every day (going to and from the car doesn’t count).
22. Stop drinking caffeine at 2 PM.
23. Try limiting alcohol to before or during dinner.
24. Use your bed only for sleep and sex.
25. Keep a sleep diary to uncover your sleep issues, then make a plan to address one at a time.