**im Hill:** Welcome to “Weight Loss And…”, where we delve into the world of weight loss. I'm Jim Hill.

**Holly Wyatt:** And I'm Holly Wyatt. We're both dedicated to helping you lose weight, keep it off, and live your best life while you're doing it.

**Jim Hill:** Indeed, we now realize successful weight loss combines the science and art of medicine, knowing what to do and why you will do it.

**Holly Wyatt:** Yes, the “And” allows us to talk about all the other stuff that makes your journey so much bigger, better, and exciting.

**Jim Hill:** Ready for the “And” factor?

**Holly Wyatt:** Let's dive in.

**Jim Hill:** Here we go. Welcome to another episode of “Weight Loss And…” I'm Jim Hill along with Holly Wyatt. Holly, we got a great topic today, something that I care deeply about. Sleep.

**Holly Wyatt:** Yes.

**Jim Hill:** Now I know we get a lot of questions from listeners about sleep. And there's actually been a ton of great research on sleep lately.

It's something a lot of good researchers are going after. To help us make sense of this today, we have one of the very top obesity researchers in the world, Dr. Marie-Pierre St-Onge. Dr. St-Onge is an Associate Professor of Nutritional Medicine and Director of the Center of Excellence for Sleep and Circadian Research. She's a member of the New York Nutrition Obesity Research Center. We've talked about these before, NORC; Nutrition Obesity Research Centers.

We have one here at UAB. In fact, our podcast is done as part of NORC. But Marie-Pierre is part of the New York NORC. This is actually one of the oldest NORCs that really has been doing excellent nutrition research for a long, long time. We're going to talk with Dr. St-Onge today about the research in this area. And at the end, how it may apply to your own weight loss journey. Welcome, Marie-Pierre.

**Marie-Pierre St-Onge:** Hi. Thank you for having me. It's a pleasure to be here.

**Jim Hill:** Start by giving us a cliff notes of your academic journey. How did you get where you are? And what are you doing these days?

**Marie-Pierre St-Onge:** Yeah. Well, so my journey into sleep is a serendipity, really, being at the right place at the right time. My background is in nutrition. As you mentioned, I earned my PhD in nutrition at McGill University and then moved on for a postdoctoral fellowship at the New York Obesity Research Center to really dig deeper into my knowledge of body composition, and energy balance regulation. And I set out to really look at the impact of diet and various dietary factors, different foods on energy balance regulation.

**Jim Hill:** Oh, one of my favorite things, Marie-Pierre: energy balance regulation. We talk about it all the time.

**Marie-Pierre St-Onge:** Yes. Really, I wanted to know, are there any foods that we can eat that would have less of an impact on positive energy balance, really helping to tip the balance towards negative energy balance? And then I moved to UAB and I had my first faculty position at UAB.

**Jim Hill:** Oh, that's right. I did see that you were here. I forgot to mention that.

**Marie-Pierre St-Onge:** Correct. And this was around 2004. And it was at the time when a lot of epidemiological studies were coming out, showing an association between sleep duration and obesity. But those were population-based studies.

There were cross-sectional studies. There were some longitudinal studies showing that people who have a higher BMI sleep less. People who sleep too little tend to have a higher risk of obesity. And also that individuals who sleep too little tend to gain more weight over time. But those were association studies. And the NIH put out a call for applications related to sleep and energy balance. I was in the nutrition department and the sleep researchers wanted to respond to this RFA we call it Request for Applications.

And they didn't know how to measure energy balance. So they came to nutrition and I was there just a young faculty starting up my lab. And at the end of the meeting, I thought, well, sleep, that's an interesting topic. I don't know too much about it actually. I didn't know much about it at the time.

But I could apply the methods that I knew of measuring energy balance to that field of sleep. And many years to get the first RO1, right? It's not an easy process. But I did finally get the first RO1 which was entitled Sleep and Energy Balance. Looking at how restricting sleep, and reducing sleep in people who have adequate sleep, can lead to positive energy balance, really getting at the causality of that association. Is there something about sleep that causes people to gain weight? Is there that causal effect?

**Jim Hill:** Just because sleep and obesity are related doesn't mean that it causes anything, right? And so that's why the epidemiology studies can give us some ideas of what might be going on. But it's the type of research then that you've been doing to say, hey, let's look at is sleep actually causing these effects.

**Marie-Pierre St-Onge:** Yes, these epidemiological studies really help to spark research questions, right? Because we don't know causality often with those studies.

**Holly Wyatt:** Well, I think that this is a really important question. We have a high prevalence of obesity. There's a high prevalence of sleep disorders. It's really common in the United States, both those things. I think it's estimated between 50 to 70 million people may suffer from some type of sleep disorder.

**Jim Hill:** When we talk about disrupted sleep, that's a whole mixture of stuff. So when you look at sleep disturbances, how do you sort of categorize these?

**Marie-Pierre St-Onge:** Right. So my lab has been mostly focused on sleep duration. So for clinical intervention studies, we take people who have good sleep and then get them to reduce their sleep duration and evaluate that influence on energy balance, and cardiometabolic risk factors. So we start with people who have good sleep and we verify that. We have various tools to determine if people have good sleep. So we rely on some questionnaires, not only through questionnaires but also through what we call wrist actigraphy. We measure participants' sleep patterns and determine if their sleep is of good quality. Is it continuous?

Is it of good duration? So there's this concept of sleep health that has six components to sleep health. It was coined by Daniel Buysse at the University of Pittsburgh. It's called RU-SATED. So R for regularity, having regular sleep. So going to bed and waking up at the same time, roughly every night.

S for satisfied. So are you satisfied with your sleep when you wake up in the morning? Are you happy with how you slept?

Do you feel refreshed? A is for alertness. So after waking up, during your day, are you able to stay awake? And are you alert throughout the day without needing to nap or dozing off?

T is for timing. So appropriate timing of your sleep. For good sleep, you should be sleeping at night, not sleeping during the day. People who work during the night have a harder time with their sleep because they're trying to sleep against our natural rhythms.

E is for efficiency. The amount of time that you spend in bed is mostly spent to sleep. So you could spend 10 hours in bed, but only be sleeping for seven hours. That's not very efficient. But if you sleep seven hours and you're in bed for seven and a half hours, that's highly efficient sleep. That's good quality sleep. And then duration of at least seven hours of sleep at night. So the D is for duration. So RU-SATED?

**Jim Hill:** So the big one there is how do sleep problems affect weight regulation?

**Marie-Pierre St-Onge:** Right. So there are multiple studies that have shown how having insufficient sleep, including our own research, showing that when you don't sleep enough, when you have too little sleep, you tend to eat more. And there are so many studies that have been published, and there have been multiple meta-analyses actually.

So a glomeration of multiple clinical intervention studies to show the effect of these various studies, showing anywhere between 250 to 400 calories more when people are restricted in their sleep.

**Jim Hill:** Wow. That's actually a lot. That's a pretty big effect.

**Holly Wyatt:** So what's too little sleep? I know the listeners thinking, “Okay, wait a minute. Do I qualify for too little sleep?”

**Marie-Pierre St-Onge:** Right. So the clinical intervention studies in this area have been mostly short-term, severe, acute sleep restriction studies. So our first study in this area, we asked our participants to spend only four hours in bed.

That's not sustainable long-term. We could only do this in the context of a laboratory over, five nights. And when we did that, our participants ate 300 calories more. But there are other studies that maintained shorter sleep to about five and a half hours time in bed. That's a little more sustainable. They did that for about two weeks, again showing 250, 300 calories more being consumed, compared to the same period of time when participants can get adequate sleep of over seven hours of sleep per night.

**Jim Hill:** All right. And then on the other end, how much is too much?

**Marie-Pierre St-Onge:** You know, it's always a U-shape, right?

**Jim Hill:** Yeah, exactly. You got to hit the sweet spot, don't you?

**Marie-Pierre St-Onge:** You have to hit the sweet spot. So there are some studies that show that there are associations with obesity for people who sleep longer. Now, most of the evidence in this area is again for population-based studies, where individuals who report longer sleep duration, have a higher risk of obesity or have higher BMI. That may be due to different medications, depression is also associated with longer sleep duration and higher risk of obesity.

This is something that's a lot more difficult to isolate in the laboratory. Right? So it's easy for us to take people who sleep well and restrict their sleep. It's relatively easy to get people who sleep too little and get them to sleep appropriately. Dr. Tasali at the University of Chicago has done this sleep extension studies.

There's been other people who have looked at that and other pilot studies as well. But to get at the long sleep, you actually would have to take people who sleep adequately and get them to sleep even longer. That might be hard. Yeah, that's not really feasible. So that's why we're really not as well equipped to evaluate the causality of these associations.

**Jim Hill:** When you talk to people, what are some of the reasons people tell you that they don't get enough sleep?

**Marie-Pierre St-Onge:** So oftentimes it's just curtailing their sleep for competing behavior. He's right. They have a lot of work to do or they just want to watch TV, relax, not sleep. Other environmental factors that may be at play. There's also a lot of research these days about the social determinants of health and how various social discrimination and disparities like this can influence sleep. And when you think about sleep and how we sleep and how well we sleep, it's really related to many different aspects of our lives.

Our environment is very important. If you're living in an environment where there's a lot of outside noise, it's very difficult to get good sleep. If you're economically disadvantaged and you have to work multiple jobs, it's also harder to get good sleep at night. Crowding and housing can also influence sleep so there are so many things that can influence people's sleep. It's no wonder that poor sleep and sleep difficulties are so prevalent.

**Holly Wyatt:** Yeah. So for our listeners, how can they tell if they have a sleep problem? I know there are other areas you can wear.

**Jim Hill:** Yeah. You can monitor your watch or your phone.

**Holly Wyatt:** Yeah. A ring, right? You can wear a ring. I mean, so, can you give us, is there a way without one of those devices you can tell? And then do you think those devices are good?

**Marie-Pierre St-Onge:** Yeah. So I have a watch. It tells me I sleep. I never, I rarely look at my sleep from my watch. Really, what I want to know w, whatever the watch says, right? How do I feel today? How do I feel about my sleep last night? Am I refreshed? Am I energetic?

Am I alert? Do I feel good? Do I feel good about my sleep? It doesn't really matter what the watch says. So to me, if you wake up in the morning and you have the worst night's sleep, or you perceive that you've had the worst night's sleep if your watch tells you you've had seven and a half hours of sleep last night, is it good?

Is it bad? What difference does it make if you feel you didn't have sleep? Right? So I think just going on your feelings - did you have good sleep? Did you not have good sleep? People usually know.

**Jim Hill:** Yeah. We've all had that. We wake up and we've slept poorly and we feel just awful. I think we know what that feels like.

**Holly Wyatt:** You know, I had a special device to look at my sleep because I was determined to figure out, you know, and it said when I was in deep sleep or this kind of sleep and that kind of sleep. And I would find myself in the middle of the night looking at it to see where I was. And I was like, I think this is defeating the purpose, right?

**Marie-Pierre St-Onge:** Yeah, this does defeat the purpose. But one thing that's important though is if you're not feeling refreshed during the day, you're not feeling alert during the day, while you've had ample opportunity for sleep, you need to wonder why. Why is it that I've spent all this time in bed, eight hours, nine hours? I might have slept eight hours.

Why am I not feeling refreshed? Right? Because then maybe there's something underlying, there's some underlying problem, right? So individuals who have sleep apnea, for example, they may not have short sleep. They may have plenty of sleep, but their sleep is not of good quality because they get these arousal from apnea events that happen or hypopnea events that happen repeatedly throughout the night.

So they're constantly being aroused to a lighter stage of sleep. But sleep is quite dynamic and you have cycles of sleep throughout the night. And within these cycles, there are stages of sleep. And each cycle throughout the night differs from one another.

So there's a lot going on. So what happens when you have sleep apnea, for example, is when you have an apnea or hypopnea event, you stop breathing, you get aroused, so you start breathing again. When this happens, it brings you to a lighter stage of sleep. So you're not able to get into deep sleep because you're constantly being aroused to a lighter stage of sleep. And then when you wake up the next morning, you don't feel as refreshed because you haven't had that good restorative sleep.

So if you're feeling tired during the day, despite having good opportunity for sleep, it would be time to speak to a healthcare professional to get evaluated for sleep apnea, especially ly this is something that's found often in individuals who have excess body weight.

**Jim Hill:** And it's treatable. There are things you can do. Yeah. We've gotten you off track a little bit. I want to go back to my question on how sleep affects energy balance. You told us you eat more. Is there more to the story?

**Marie-Pierre St-Onge:** Yeah, yeah, yeah. There's a lot more to the story.

**Jim Hill:** I thought so.

**Marie-Pierre St-Onge:** Yeah. So we evaluate how much people eat and we find that they eat more. We also looked at appetite-regulating hormones in our work. We found that there are differences between men and women in terms of the impact of sleep restriction appetite-regulating hormones. It was quite interesting that men have had an increase in ghrelins, the hormone that stimulates appetite. Women had a reduction in glucagon glucagon-like, which is a hormone that's associated with satiety. And when I think about this, I think, okay, there could be different mechanisms that influence food intake between men and women.

But at the end of the day, it all leads to the same outcome, right? Either through increased appetite or reduced satiety. So men aren't wanting to eat more frequently. Women have a harder time stopping eating as a result of sleep restriction.

**Holly Wyatt:** But I love, I mean the GLP one, that's very interesting given the medications now. That's the hormone that the medications are working on if you take the medication. And so if that sleep may be through that same pathway. So getting good sleep may be similar to getting the shot, not exactly, but in the same type pe thing.

**Marie-Pierre St-Onge:** Yeah, well, it could potentially potentiate the impact. Right?

**Jim Hill:** Because we do have naturally occurring GLP-1. So I got a couple of questions. Do we know how it changes what they eat? If they eat more, is it they're going out and steaming more broccoli? I suspect not, but…

**Marie-Pierre St-Onge:** No, no, in our work, it's been mostly higher-fat foods. Others are still showing higher snack foods, higher refined carbohydrate foods, not, no, not putting together a salad. Or if you are, for me, pouring the dressing on a little too thick, if you do.

**Jim Hill:** I have to ask about the other side of the equation. Does it do anything to energy expenditure?

**Marie-Pierre St-Onge:** Yes. So that's also something that we researched with Ari Shecher when he was a fellow in my lab at Columbia, we have a metabolic paper. We did a study in a metabolic chamber to look at the impact of sleep restriction and women. This was actually funded by a pilot feasibility grant from the NORC.

**Jim Hill:** Yeah, let's plug the NORCs. Yeah.

**Marie-Pierre St-Onge:** So we did this pilot study, we had women sleep four hours versus eight hours. So spend four hours of sleep opportunity versus an eight-hour sleep opportunity. They did that for one night. And then we started measuring their energy expenditure in the metabolic chamber on day two. They slept through the night in the metabolic chamber, either with a four-hour sleep opportunity or an eight-hour sleep opportunity. Then we had minute by minute-by-minute their energy expenditure throughout that 24-hour pe24-hour during the day, there was absolutely no difference in energy expenditure between the two conditions. The lines on the graph were superimposable, exactly the same patterns of energy expenditure, where the difference differences lay was when women were told to light off and go to sleep, their energy expenditure went down. If they were asked to keep lights on and remain awake for an extra two hours, energy expenditure remained slightly higher at the same level as wake energy expenditure. When they slept, they had the same energy expenditure during the sleeping hours. And then the women being awoken two hours earlier in the sleep episode, their energy expenditure went up during those hours. So overall, there was an increase in energy expenditure from being awake for an extra four hours. But it was entirely accountable for the added costs of maintaining wakefulness. So we know that we have a higher metabolic rate when we're awake than when we're asleep.

During the day, there was absolutely no difference in energy expenditure between the two conditions. The lines on the graph were superimposable, exactly the same patterns of energy expenditure, where the difference differences lay was when women were told to light off and go to sleep, their energy expenditure went down. If they were asked to keep lights on and remain awake for an extra two hours, energy expenditure remained slightly higher at the same level as wake energy expenditure. When they slept, they had the same energy expenditure during the sleeping hours. And then the women being awoken two hours earlier in the sleep episode, their energy expenditure went up during those hours. So overall, there was an increase in energy expenditure from being awake for an extra four hours. But it was entirely accountable for the added costs of maintaining wakefulness. So we know that we have a higher metabolic rate when we're awake than when we're asleep.

And that's where that's where it was. But the difference was about 90 calories for a four-hour sleep deficit, right? And when we looked at their energy intake, it was a 300 calorie.

**Jim Hill:** More than compensated. So

**Marie-Pierre St-Onge:** Completely. Yes, absolutely.

**Jim Hill:** Wow. I love that. That's such a great example of energy balance where there might be some positive things and some negative things going on. But at the end of the day, it's the net.

**Marie-Pierre St-Onge:** Right. But also one thing that we didn't measure in free-living free-living physical activity, right? The metabolic chamber is very small, right? It's either a large bathroom or a small probably the side of my office, a small office, right? So there's not much opportunity for movement in that metabolic chamber.

So we don't capture that free-living activity. If you'sleep-deprivedved, are you going to take the stairs or the elevator? Are you going to walk faster, run faster and r, and work out harder than if you'sleep-restrictedted?

**Jim Hill:** Do we have any science around that? Do we know if that's the case or not?

**Marie-Pierre St-Onge:** Yeah, there's some studies that I've looked at that too. So that was actually one study that is quite that old now, but they did an inpatient sleep restriction study of insufficient sleep versus adequate sleep. So they had one day where participants weren't allowed to leave the facility and one day where they were allowed to leave the facility. So when they had, when they measured physical activity, when participants were on the metabolic ward, there was no difference between adequate sleep or insufficient sleep. But when they were allowed to walk out, then there were differences, right? So they had more vigorous activity levels when they were well rested compared to when they were sleep-restricted.

**Holly Wyatt:** What about the other direction? So a lot of my patients and the listeners who are big on physical activity, who go out and get physical activity, who exercise, have they ever looked at how exercise impacts sleep instead of how sleep impacts exercise going the other way? Do a bout of exercise, how does that impact sleep?

**Marie-Pierre St-Onge:** Yes, the people who exercise then have better sleep, longer sleep.

**Jim Hill:** Yes!

**Holly Wyatt:** And timing. People always say, no, do I do it right before bed? Should I do it first in the morning? Is there any, anything about when to do it?

**Marie-Pierre St-Onge:** Yeah. So that's also something that people are interested in. Right now, I think there, there's some nuance. It's not, it's not so clear. I, there was one study that was recently published in which chronotype played a role. So for people who were morning chronotype, exercising later in the day had a negative impact on their sleep, but not for people who were late chronotype. But that's something to keep into consideration. I always have these, I don't research exercise, but I'm, you know, an active person, I exercise quite a bit. So I'm quite interested just on a personal level.

**Jim Hill:** By the way, she has a bicycle hanging in the background. So she's not kidding.

**Marie-Pierre St-Onge:** I do have a bicycle hanging on my wall. There are different activities that you could do at different times of day. And I'm out there asking you the sleep exercise researchers, you know, could you look at how different types of exercise performed at different times of day influence sleep, right?

So doing harder bouts of physical activity earlier in the day versus later in the day. The recommendations are always not to have, you know, very strenuous activity, very close to bedtime. That's something that raises your heart rate and your, and your body temperature too close to bedtime, because then it's really hard to quiet down and get a good night's sleep. But I think that anything that exerts you during the day will lead you to sleep better at night. There could be very well studies where, you know, doing more of those meditation-type exercises or yoga, calmer activities of stretching in the evening may be useful for sleep.

**Holly Wyatt:** Yeah, I do think intensity plays some role in it. I know when I do a very intense activity, it affects my sleep differently than if I do something that's not as intense. And then I love that it may be different between individuals, depending on that chronotype, that piece that you were talking about.

**Jim Hill:** So I've really been fascinated by sleep. And so I'm going to ask you, I'm going to speculate in a minute, I'm going to ask you to do it. I've always thought that sleep is this time where your brain sort of goes offline, you know, you don't have a lot of stuff you need to pay attention to. And it's kind of where you can do the housekeeping things. You can sort of add up energy balance and these kinds of things. Have you thought about that? What do you think is going on?

**Marie-Pierre St-Onge:** Well, there's a lot of cognitive processes that have been during sleep. So sleep is involved in memory consolidation, learning, and making all those connections in the brain of things that happen during the day. So, you know, I think that sleep is a lot more active than we think.

**Jim Hill:** You know, Marie-Pierre, when I started in the obesity world, sleep wasn't even in the equation. Nobody talked about sleep. But from what you've told us today, oh my gosh, it's affecting intake and expenditure and exercise.

Holy cow, this is important stuff. I want to ask one more question before we get to the What do you do about it? Shift workers, people that are in, you know, look at these people, they'll work a night shift and then they'll work a day shift. God, it seems to me like that would be awful.

**Marie-Pierre St-Onge:** It's very difficult. So sleep, as I mentioned, is a dynamic process, but it's regulated through two different systems. We call these two different processes, right? A homeostatic process and a circadian process. So the homeostatic process of sleep is such that you build up sleep pressure as the day goes on. So the longer you remain awake, the longer you want to, the more you need sleep. So that builds up during the day and then you want to get tired enough, you fall asleep. But there's a circadian process too that acts in concert with this homeostatic process and somewhat opposes the process such that your circadian system is made to get you to fall asleep stay asleep at night and be awake during the day. So this is why when we go to bed and fall asleep to say 10, 11, 8 p.m., we're not up at 3 a.m. Once you've dissipated all of that sleep need because now you have the circadian system that kicks in and says, hey, no, no, no, you're staying asleep until 6, 7 a.m. or so, right? And this is why we're not falling asleep at 2 or 3 p.m. in the afternoon. No, it's not time for sleep.

You're not primed to sleep. So what happens with shift workers is they're trying to sleep against the circadian system. They've built up the sleep pressure over the nighttime and during the daytime, they want to fall asleep. But the circadian system opposes their ability to sleep for a prolonged period of time. So often what they'll get is four or five hours of sleep during the day because it's just how the system is made. It's not made for us to be sleeping when it's light right outside.

**Holly Wyatt:** So I have one more question, Jim.

**Jim Hill:** All right. Make it short. We got to get to the good stuff.

**Holly Wyatt:** Yeah, I know. But this isn't about me. This is about my neighbor or my best friend. They want to know they want to know naps. Thumbs up, thumbs down.

**Marie-Pierre St-Onge:** Depends. So if you really are falling asleep and too tired to continue during the day, okay, a nap is okay. But keeping it short and keeping it early because of what I've just said about the sleep pressure, right? So now if you're taking a nap at 4, 5, 6 p.m., you've built up your sleep pressure, you're dissipating that sleep pressure. What happens when you want to fall asleep at 10, or 11 p.m., you don't have that sleep. You haven't built up enough sleep pressure to fall asleep again. So now you get into this vicious cycle of not being able to fall asleep and then you wake up because you need to go to work, you're set time, and then you're tired again at 4 o'clock. So keep them short and early. But ideally, my preference is to not nap and get adequate sleep at night.

**Jim Hill:** In the next few minutes, tell us a little bit about what people can do if they feel like they're not getting enough sleep, they're not getting quality sleep, etc.

**Marie-Pierre St-Onge:** Right. So there are many things that you could do, behaviors during the day that can be helpful for sleep at night and then also the sleep, the environment in the bedroom at night can be conducive to sleep too. So we talked about being physically active.

That's good advice to get good sleep at night. My PhD is in nutrition. I've been very interested in the past few years to look at how diet can influence sleep at night. And so having a healthy diet during the day can have benefits for sleep at night. We're seeing associations with the Mediterranean diet being helpful for sleep at night, having more fruits and vegetables, whole grains of fiber, and lower saturated fat intake. So those are important food components to think of for better sleep. And then having a wind-down routine at night so you're calming yourself down, not getting aroused before going to bed, getting into a calmer situation, exposing yourself to bright light in the morning, and dimming the lights at night. I do this at home. I dim the lights in the living room before going to bed, kind of priming my body to get good sleep.

**Jim Hill:** Does weight loss itself help sleep?

**Marie-Pierre St-Onge:** There's good evidence that weight loss will help with sleep apnea. So reducing sleep apnea and those disorders could also be helpful for sleep as well.

**Jim Hill:** I'm going to ask each of you about your own sleep, but I'm going to start out because what you said is very important to me. I recognized early on in my career, my life, that I needed eight hours of sleep. And I really prioritized it. I really did because when I didn't get eight hours, I didn't feel good. As I've gotten older, I find now I need about seven hours.

Okay. But the other thing I love is a nap. I've come to embrace a nap. I agree. I usually do it early, like I like to do it mid-afternoon, usually only about 15 or 20 minutes. That works for me, but I realized that for me to perform my best, I had to get adequate sleep. And I think that's probably true of a lot of our listeners. So Marie-Pierre, you go next and Holly go last.

**Marie-Pierre St-Onge:** One thing that I did mention about another tip for getting good sleep is regularity. That's something of a hot topic these days, regularity of sleep, being good for cardiometabolic health and weight management, and all that. I go to bed at the same time every day, 10 p.m. 10 p.m. is when we close up shop, make it, you know, start going to bed and wake up pretty much at the same time every day. So regimented that we are, that our dog goes to the back door at 10 to 10 because it like, now's the time.

**Jim Hill:** I love it. That's so terrific.

**Marie-Pierre St-Onge:** I get my full seven, seven, and a half hours on a regular basis. I would say most days.

**Jim Hill:** Holly, what about you?

**Holly Wyatt:** Yeah. So I probably have trouble going to sleep and mostly it's because my brain doesn't turn off. I'm constantly kind of thinking and so I've had to really work on how to slow that down at night.

So that's probably my trouble spot. Once I'm asleep, I'm pretty good at staying asleep and getting good quality sleep. I definitely see a relationship between exercise. Having that exercise is really important for me to get that quality of sleep. One thing I do that's a little bit different and I don't know that there's any data behind this, but I do take, I really like a 17-minute nap and I do it with sound therapy. So I listen at the same time. So when it comes on and at 17 minutes it goes off and I naturally wake up. So that's kind of the 17 minutes.

And for me, that's extremely restful. I don't know what's going on, but it's working. So I use it. I use a 17-minute nap if I feel like I need a re-boost.

**Jim Hill:** Wow. Interesting. I have learned a ton in this episode. I'm going to take a shot at summing up, but you guys jump in if I've missed anything. The first thing is if you are trying to manage your weight, pay attention to your sleep because it is important. If you're not getting enough sleep, if you feel like you wake up and the quality of sleep isn't good, you need to address that. If you have an issue with sleep apnea, that's a medical problem that can be treated and it can really help with weight loss and weight loss maintenance. The things you can do, are diet and exercise. I mean, it comes up over and over, but again, another important reason to exercise and another important reason to pay attention to your diet. If you're sleeping poorly, what may result at the end of the day is you're going to take in more calories than you would if you had quality sleep. And that's why it's so important to look at addressing your sleep issues.

Be regular. It's okay to take a nap, maybe if it's a short one and earlier in the day. But overall, it's important. Your quality sleep can help in weight management. What have I missed, Marie-Pierre?

**Marie-Pierre St-Onge:** Well, now you're talking. There's one study that Jim, that you would really be interested in that I didn't talk about. It was a weight loss study. It was a controlled feeding weight loss study. Two weeks within-participant design, participants had a controlled diet, restricted in calories for this period of time. They were allowed to sleep about five and a half hours in one condition, and seven and a half hours in the other condition.

Okay? Weight loss was the same. They were given the food, right? But the composition of weight loss was different. They lost less fat mass and more fat-free mass on the short sleep condition compared to the adequate sleep condition. Their resting metabolic rate was reduced to a greater extent, and their respiratory quotient was higher in the short sleep condition compared to the adequate sleep condition.

**Jim Hill:** Which means they're burning less fat if you have the higher respiratory question.

**Marie-Pierre St-Onge:** Exactly. Burning less fat. So to me, it just means that if you're trying to lose weight, your body, even in the context of a controlled diet, what's happening is timing you for more weight regain once you're done.

**Jim Hill:** Wow. I love that study. That's an energy balance study. I love it. That reminds me, if people feel like they need help with sleep issues, are there places they can go? Are there people who have expertise in this to help?

**Marie-Pierre St-Onge:** Yes, there are sleep medicine specialists. The board-certified in sleep medicine. So doctors are trained in sleep medicine. A lot of psychologists are trained in sleep medicine as well. So behavioral sleep medicine specialists. There's the American Academy of Sleep Medicine, where they can get resources, and the Society for Behavioral Sleep Medicine as well.

**Jim Hill:** Fantastic. So there is a way to get help. So if sleep is an issue, you feel like it's not where it needs to be. Get some help.

**Marie-Pierre St-Onge:** Absolutely.

**Jim Hill:** Wow. Thank you so much. This was awesome. Holly, do you have any last-minute comments here? You want the last word today?

**Holly Wyatt:** No, I won't take the last word, although this is awesome. I think this is one of the things people don't think about, but really can impact so many aspects of their lives, including their body weight, which is what a lot of people are out there working on. So great information. Thank you so much.

**Jim Hill:** And I love your research. You're just doing such amazing things. And it's, I'm glad you're here at UAB. It started it all, but I love where you're going. So we will keep an eye on your research and see where that goes.

**Marie-Pierre St-Onge:** Thank you so much.

**Jim Hill:** Thank you. And we will talk to you on the next episode of Weight Loss And.

**Holly Wyatt:** Bye, everybody.

**Jim Hill:** And that's a wrap for today's episode of Weight Loss And… we hope you enjoy diving into the world of weight loss with us.

**Holly Wyatt:** If you want to stay connected and continue exploring the “Ands” of weight loss, be sure to follow our podcast on your favorite platform.

**Jim Hill:** We'd also love to hear from you. Share your thoughts, questions, or topic suggestions by reaching out at [weightlossand.com](http://weightlossand.com/). Your feedback helps us tailor future episodes to your needs.

**Holly Wyatt:** And remember, the journey doesn't end here. Keep applying the knowledge and strategies you've learned and embrace the power of the “And” in your own weight loss journey.