Sleep: The One Thing You’re Not Doing That Could Improve Your Eating Disorder Recovery

iStock_000088101817_XXXLargeWe often get so focused on EATING in recovery that many patients overlook the importance of sleep. Sleep is one of the most important, and one of the most neglected, components of comprehensive recovery.

Most of us have experienced one or two nights of sleep deprivation and understand how difficult it can be to function optimally the next day. But did you know, that over time, chronic sleep debt could worsen your emotional and physical health?

Sleep must become a higher priority

Sleep deprivation is known to enhance negative affect and depressive/anxious symptoms, like difficulty concentrating, irritability and more. Sleep deprivation is also associated with poor physical health, increasing the risk of chronic disease. To sum it up, if you are not sleeping well, it is very hard to live well.

Unfortunately, many people look at sleep as an afterthought — and have lives that reinforce this, including checking social media late at night, binge watching Netflix shows and even working in bed.

Poor sleep means poorer quality of life. Period.

Sleep deprivation linked to binge eating

Every day, I work with patients who struggle with loss of control eating. Many have poor sleep habits and many have gotten used to sleep deprivation being their “new normal.”

Approximately 75 percent of patients who struggle with binge eating also struggle with a comorbid mood, anxiety or substance use disorder. Poor sleep can make this worse.

Here’s the science: Research shows that resting metabolic rate increases with the stress of not sleeping, yet research also shows that sleep deprivation (poor quality, interrupted, nonrestorative or inadequate sleep) promotes weight gain. How is this possible?

Studies show an association between sleep deprivation and increased loss of control eating after dinner and before bedtime. The theory is that people consume more calories when sleep deprived, in order to have the energy to stay awake during what may be their only leisure time.

These behaviors (i.e. loss of control eating, screen time) further disrupt sleep, creating a vicious cycle the next day.

Another link to eating disorder behavior is that sleep deprivation dysregulates the hormones that determine hunger and fullness cues. Here’s how it works:

  • Part of the pathophysiology of Binge Eating Disorder is a disruption in hunger and satiety (fullness) cues, and the hormones underlying these cues.
  • People who are sleep deprived have difficulty feeling satiety cues.
  • People who are sleep deprived also have difficulty directing their attention away from food cues and find it difficult to stop a response to food cues once the response or behaviors have started.

Also, high levels of stress and low levels of coping resources can make an individual vulnerable to eating disorder behaviors. All of these issues compound recovery and need to inform our treatments.

Improve your sleep with these 5 tips

On a positive note, sleep is a behavior. Like any other behavior, it can be modified and changed. If you are having trouble sleeping, take a good look at your pre-bedtime habits and modify what you can by trying one or more of these strategies:

  • Turn off screens at least one hour before bed. Electronic devices may be forcing you to stay up later and blue light from these devices can disrupt sleep.
  • Establish a set wake and sleep time, and make these consistent during the week and weekend. Sleeping in on weekends disrupts sleep cycles further.
  • Do not train yourself to stay in bed awake! If you are still awake after 10 minutes of staring at the ceiling, get up and read with low light in an alternate space until you are sleepy. Return to bed and repeat this process again if needed.
  • Create a sleep environment conducive to sleep. Your sleep environment should be calm, cool and clutter free.
  • Unwind with a soothing bedtime ritual: take a hot shower or bath, drink hot tea, journal or listen to music. This is preferable to willing your body to “calm down” after you are already in bed.

Change can be hard, especially without support. And, it can take time to create good sleep and eating habits, and reset your circadian rhythms or body clocks. Know that a drastic change in behavior could cause distress, and you may feel worse initially. Sleep studies are available, and can be very beneficial, to help you determine if you have an organic sleep disorder or simply have poor sleep habits.

Remember, your old behaviors must have worked for you in some way or you would not have continued them. If you find it hard to make changes to your sleep routine on your own, help is out there!

The importance of sleep in recovery

In recovery, patients often underestimate the benefits of sleep and how it affects their mood, eating, well-being and the ability to be present in their lives. When we are sleep deprived, it is hard to find the energy to do the things we love. And, it is even harder to recover when we are not connecting to others, our lives or our bodies in a meaningful way. Sleep deprivation can leave us vulnerable to feeling worse and more vulnerable to engaging in eating disorder behaviors.

By improving your sleep, you will have more energy to spend on recovery and more energy to build a life worth living. In recovery, we encourage our patients to balance accomplishment-oriented and pleasurable activities, encouraging them to connect more with others to decrease shame and isolation. But it is hard to do this when exhausted.

I want my patients to have every advantage possible when it comes to their recovery. Focusing on sleep facilitates recovery and improves quality of life, which only perpetuates recovery!

Julie Kabat Friedman, PhD is Vice President of the Compulsive Overeating Recovery Effort (CORE) Program at ERC Insight in Chicago. She is also Assistant Professor in the Department of Psychiatry at Northwestern University Feinberg School of Medicine.