Conquer Your Weight

Dr. Sarah Stombaugh: This is Dr. Sarah Stombaugh, and you are listening to the Conquer Your Weight Podcast, episode number 57. Announcer: Welcome to the Conquer Your Weight podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here's your host, obesity medicine physician and life coach, Dr. Sarah Stombaugh. Dr. Sarah Stombaugh: Hello everyone and happy New Year. I am so excited to have you all here with me today. We are getting into a great episode. I have a guest with me today who will be talking about the role of sleep in weight loss. This is so, so, so important. Most of my friends and family know that I absolutely love sleeping and it is one of the things that I work hard with my patients to help support them in their comprehensive weight loss plan, including things like sleep. So we are going to talk about that today with Dr. Brown. Before we do, I want to invite you to join my medical practice. If you live in Illinois or Virginia, maybe you're a longtime listener, maybe you've just started listening, but if you were thinking 2024 is the year that I am ready to lose weight for good, maybe you've been wondering about all those new weight loss medications. Are you a good candidate for them? Maybe yes, maybe no. I dunno. Let's talk about it. So any potential patient can do a 30 minute free meet and greet with me. I love to do this, to learn about what are your goals, how can I help support them? If you are a great fit for my practice, I will invite you to join my practice. If you are not, no hard feelings at all, people who have done consults with me will tell you, oh gosh, I knew that her program wasn't going to be the right fit for this specific reason, but she gave me really good recommendations about what to bring back to my primary care physician. So my goal is to help support you in whichever way I can. I would love for you to be a patient in my practice, but however I can support you, I am here to do that. So pop on over to my website, it's www.sarahstombaughmd.com. Fill out the form on the individual visits page and you and I will get scheduled to see each other for that 30 minute free meet and greet. Visit now for today's episode. Alright, I am so excited today. I have a special guest with me, Dr. Funke Afolabi-Brown. She is the founder of the Restful Sleep Place and just a great source of information for all things related to sleep. And so I'm so excited. Thank you for being here today, Dr. Brown. I'm so excited to share what you have to offer. All of my people, I want all my patients to be making sure they get plenty of sleep. And I'm here, I'm having you here to tell them how to do that. So thank you for being here. Dr. Funke Afolabi-Brown: Oh, thank you. Thanks for having me. I'm excited to be here. Dr. Sarah Stombaugh: Yes, thank you. So tell us a little bit about yourself and your background and how you came to be where you're at right now as a private practice owner and all the good stuff sleep medicine related. Dr. Funke Afolabi-Brown: Yeah, so it's been an interesting but exciting journey. So I started off with medical school just before we got on here. We were talking about how much you love sleep. I just felt I did not have a good relationship with sleep to start. And so just on my own personal journey with struggling with all the effects of sleep deprivation and insomnia, and then on top of that, having kids who didn't really sleep that well, I think that really then made me realize how much sleep was, or lack of sleep was impacting every aspect of my life. And so when I talk about sleep, I talk a lot about boundary setting and boundaries with ourselves is the first place to start on. So that was what I did. And so I realized right away what I'd been missing. And it was almost like you see something, you can't unsee it. And so I really made it my mission now to help families, to help busy moms and the children with improving sleep. Of course, I did extra training, so in addition to my pediatrics training, my pulmonary training, I really just was drawn to understanding the science of sleep. So I did a sleep fellowship. And so that was what then really pivoted me into a career where I'm doing a lot more with focus on sleep medicine, but I do also coach moms because I realize that a lot of times, even though I'm helping kids sleep better, it's really the moms that are going to be helping to enforce those practices. And when they're exhausted and sleep deprived, all else just falls apart. So that's how I got here. Dr. Sarah Stombaugh: Absolutely. Well, and I love that. So your sleep habits, did that even drive you to some of your training in deciding to become a sleep medicine physician? Dr. Funke Afolabi-Brown: Yeah, exactly. It was like most of us in medical school, it was more of you burn the candle on both ends. The exhaustion and trying to survive on a few hours of sleep was almost like a badge of honor, but I was just suffering in silence. And so that really caused a lot of anxiety and things. So just with setting boundaries in the sense of prioritizing my sleep, prioritizing that as a critical part of my wellness overall. It was something that I knew was easy, it was practical. It's not easy, but it was practical. It had a significant benefit. It was something I could work on actively and it would impact how I made decisions around other aspects of my health, my parents and my mental health, all of that. So that was where I sort of pitched tend to start. And then by the time I started my own clinical practice and seeing patients in clinic, I was even more drawn to it because everything people talked about, all I could see was, well, how's that impacting your sleep? Or how is your lack of sleep impacting that outcome? And so then that now prompted me to get that extra training and really a lot of my practices around talking about changing our relationship with sleep, helping people see that sleep is not the enemy, sleep is our friend, And really it really is. It affects, like I say, every single system in our body from all the way from top to bottom. And so yeah, that's been kind of a foundational part of what I do now. Dr. Sarah Stombaugh: Yeah, well, and I think when we have that personal journey, it can inform so much this curiosity that brings us to serve and to share that with our patients. And I was sharing with you before we started recording, like I said, I am a great sleeper. I always have been. When I was an infant, my mom was like, is there something wrong with this baby? She sleeps so much. And that has always been, and I've just been on the spectrum of I get eight hours of sleep. It's not like I'm sleeping 12 hours a night or anything, but I simply love sleeping and it's always been a priority of mine. And I agree that certainly in certain areas like medicine, there's this badge of honor of, oh, I can survive on five hours of sleep. Okay, great, good for you. But that's going to cause a lot of other issues. And in our society, I feel like that being tired, not getting enough sleep, people wear that sometimes as a badge of honor. Like, oh, I'm so busy, I don't have time to sleep. And it has really profound health impacts. So I'd love to hear from you just broadly, what are some of the biggest health impacts that we see when people are not getting enough either quality or quantity of sleep? Dr. Funke Afolabi-Brown: Yeah, that's such a great question. I think again, it's every aspect of life. So when we start off, we could even start off from just our brain health and our minds. That fuzzy feeling you would get from just one bad night of sleep, imagine that multiplied or amplified over time. And so some of the science has already been established that one of the roles that our brain, that sleep has on our brain health is actually detoxifying and filtering out waste substances. So when we don't get enough sleep, we're not giving our brains that opportunity to recover fully. And so those deficits that really need sleep to be able to be removed, we don't really get that. And so they've been research that has shown that some of those deficits include things like amyloid or waste products, amyloid beta, which has been shown to be associated with Alzheimer's. So in addition to just the memory lapses, you might imagine now setting yourself on a trajectory to have long-term memory issues, especially if this is not corrected. And then I would just stay there with the mind and think about things like our mental health and our mood. One of the benefits of sleep is with emotion regulation, memory consolidation and decision making. So when our emotional wellbeing, when our learning is impaired because we're not getting enough sleep that's going to affect our day, that's going to affect the quality of decisions we make. And I know we're going to be talking about weight loss, but when we think of decision making that is really, really critical on that weight loss journey. It's going to affect our relationships, our interactions. There's been studies to show that anxiety, depression, risk risk-taking behaviors, resilience and empathy are all affected by the amount of sleep you get. So between that mom you want to be and that mom that shows up at the kids when they do something and you're finding yourself really, really just yelling and angry and irritable. Sometimes it's just about getting enough rest. Now, if we switch gears a little and talk about our physical health, one of the most, well-researched areas has been our heart help. So different cardiovascular issues have been affected, are affected by sleep. So there's increased risk of hypertension, abnormal heart rhythms, strokes and things like that are associated with poor sleep. And then metabolism is a big one as well. So hormone regulation can be affected by sleep. And so we have increased risk of insulin resistance and diabetes and obesity and the consequences of that with poor sleep, you have higher inflammation. So cortisol, the stress hormone is high and we know that affect so many other functions in our body. And then things like personal safety, especially if you're somewhere where you are making very critical decisions. If you're in the medical field or you are operating heavy machinery where you really do need to be alert, those things can be very, very devastating. Or you're driving and you're drowsy driving because you enough sleep. So really every aspect of our health can be affected by our sleep, which is why it's just so important to get enough and to get good quality sleep. Dr. Sarah Stombaugh: Yeah. Well, and I think we think about even as physicians, some of the regulations physicians used to work, they still do work a lot of hours, but there's been regulations put in place to maximize the work week to 80 hours. And all of that is because of decision making that was inhibited. And there were cases where people had negative outcomes because there were residents who were just so stinking tired. And to be in that position and put yourself in that position or be in a position where you're not able to get the sleep that you want, and I even think about myself, I mean, I'm kind of mean when I'm tired, I'm generally a really balanced person and generally really kind. But my ability to cope when I am tired, I'm kind of a mean person. And so I see that short-term impact, which I think sometimes we know those long-term impacts, but it can really hard a single night here won't do damage a couple nights there. But when you can look at some of those short-term impacts and then start to understand what those long-term impacts are, it's really valuable. So you alluded to the role in obesity and like you said, we have increased cortisol, we know that there's increased insulin resistance that happens for my patients who are working on losing weight and struggling to get the amount of sleep that they want. What would you advise them in terms of how can this really impact our weight specifically? Dr. Funke Afolabi-Brown: Yeah, this has been another area that's been quite well researched. There are different ways by which sleep can affect our weight or either our weight gain or ability to lose weight effectively. And there are now studies that are now being done that are actually becoming really popular where they are now, they have groups where they sort of randomize them or group them into a group where they have this generic or general weight loss recommendations. And then they have other groups where they say weight loss recommendations with appropriate sleep hygiene or whatever, healthy sleep habits, and very, very clear as day, the group that has both groups might lose weight, but the group that loses weight most effectively are the ones where sleep is also being optimized. So honestly, really right now, I think appropriate weight loss, appropriate metabolism is so important for us to have good sleep. Now, the way this impacts, the way our sleep can impact our weight is it's kind of multiple fold to start, I would say is again that decision making ability. So one of the things I always say is when you have been sleep deprived, if you've had a night of crappy sleep one, you tend to have increased hunger. So the reason why is the hormonal, they're actually two appetite hormones. One is called leptin and the other is ghrelin. And the leptin hormone is just a, we call it a satiety hormone. So it helps when you're full and it's enough, and the ghrelin is what kind of signals now to your brain that you are hungry. And so there's almost like a switch or a flip when we don't sleep well. So you may find out that you feel less full, you are more hungry, you're more peckish. And again, back to that decision making capacity, when you are sleep deprived and you go to the free to grab something in that moment, you are not going to be grabbing a carrot. You're probably going to be grabbing the carrot cake. So you suddenly then have a decrease in that ability to say, okay, you know what? This is what I need to be eating right now. I should be taking salad or something. But you will actually crave salty sweets and more high refined sugar meals at that time. So that's one or two. And then another one is the motivation. So motivation drops when we don't get enough sleep. So while you might say, yes, I know that I should get out there and go to the gym or do a really quick workout, when you don't sleep well, you do feel fatigued, you feel tired, you are less inclined to get out there and be physically active if that's part of your weight loss regimen. And then there's increased risk of injuries and slower, there's a slower rate of metabolism that happens such that even when you decide that, okay, yes, I'm going to get out there and exercise, you lose less. You don't burn as many calories because of the inflammation and because of that sleep deprivation. So there are multiple ways by week this happens. And then the other piece I would say is that when, especially if you have people that are overweight, there are other conditions that can affect their sleep, i.e. things like obstructive sleep apnea. So if with increased weight you're more at risk for obstructive sleep apnea. Now with obstructive sleep apnea, your sleep is further fragmented, there's more inflammation that puts you at risk for all these other issues. Again, obesity, insulin resistance, hypertension and things like that. So it becomes this issue cycle. And so I would say those are the broad ways by which I want people to think about sleep when they're thinking about their entire wellbeing overall, including their weight loss journey. Dr. Sarah Stombaugh: Yeah, oh, absolutely. I love how you show how it's so multifactorial because it is, right? It's not just this, it's psychological, it's physiological. There's a lot of things that are coming together to make it really challenging. And I think one of the things that I will often say to my patients is that your body is craving energy and the best way that you should have gotten that energy may have been sleep. And when you didn't have that option, your body's like, okay, let me look for energy and other sources like these processed carbohydrates, which do invariably give you that sort of sugar rush quickly and give you a little burst of energy making you feel worse in the long run, but can give you that kind of burst of energy to be able to do whatever you need to do throughout the day. And yeah, it's that role of insulin resistance. I remember reading a study where they took completely healthy college aged men, and after I forget, it wasn't very long, it was a few days worth of poor sleep. They were getting four hours of sleep per night. They all had signs of insulin resistance in their blood, and that just stands out to me in such a profound way of just a couple of bad nights. And the impacts that that can have on our health is really significant. It also, I don't know if I've shared this story in my podcast, I share it with a lot of my patients. I had a patient in residency, I remember this patient so fondly, he had gotten health insurance for the first time. He was in his late fifties and he had gone his entire life without health insurance and got a job and came into my clinic and he was like, Hey doc, I'm totally healthy. But when he said he was healthy, he actually just had not been diagnosed with any medical conditions. So it turned out that he had all of the medical conditions and he had significant obesity. I don't remember his exact height, but let's say he was like five 10. He weighed about 300 pounds and we set this routine together where every visit we would see each other once a month and he would have a health goal and I would have a health goal. And my health goals were like, let's address your hypertension. He was like, I'm concerned about my erectile dysfunction. And so we each had our own priorities and we kept working towards those to improve his overall health and one of his big goals to work on losing weight, and that was a big interest of mine even back into residency. And so this man, he did anything I told him to. He was just such a perfect patient, showed up and just like, Hey, I'm here to do everything you say. He was eating well, he was exercising, had really phenomenal results with his weight loss and was able to lose actually about 50 pounds with doing that. But as sort of month by month, we're going, and this is my concern and this is your concern, and we're checking off the box of each of the dozens of things on this list. We discussed sleep apnea. I was quite sure he would have sleep apnea based on his body habitus based on his oral exam. So he got diagnosed and treated for sleep apnea. He had been at a weight plateau. He had lost his 50 pounds, was still struggling with significant obesity. He got treated for sleep apnea. And when I tell you that the weight fell off of his body, I mean he lost another 50 pounds he was eating while he was exercising, he was doing all of these other things, but he had been doing that and then just the diagnosis and treatment of his sleep apnea, he lost another 15 pounds or 50 pounds it felt like overnight. I mean it happened, it did take months, but it was the type of thing where that was the only shift and it just made such a profound impact. And you are talking about that diagnosis of sleep apnea, that can be such a chicken and egg thing, and we're not getting good sleep. We struggle with our weight when we have more weight, we have more sleep apnea, and that can be a really bad spiral. Dr. Funke Afolabi-Brown: And honestly, I feel like that exactly what you said when you are at the point where the weight loss seems to be plateauing, you don't have to wait till then. I think it should just be part of that sort of plan. Is there in addition to sleep deprivation, in addition to maybe you're not getting sufficient sleep, what's the quality of the sleep and really trying to address that, especially with a lot of people that are overweight with women too. Even people with normal weight. There's something that often gets missed for a while. So it's incredible to hear that story. Dr. Sarah Stombaugh: Yeah, thank you. I had to share it. So thanks for listening to that. Lemme ask you, I do a sleep screening based on when I do an intake with my patients. I'll go through a lot of different questions. If they're not seeing a sleep medicine physician and I have concerns, I'll make sure that they have a referral to see a sleep medicine physician. But to someone who's listening to my podcast, what are things that someone should be looking out for to say like, oh, I wonder if I have sleep apnea or another health condition that I should be seeing a sleep medicine physician for? Dr. Funke Afolabi-Brown: Yeah, that's a great question. I would say for most people, that issue of sleep apnea tends to be relatively common. That being said, insomnia is also a really big problem as well, even with people who probably your audience as well. So with sleep apnea, I mean the typical things you would find would be snoring, gasping pauses and breathing during sleep, waking up with a really dry mouth, sometimes waking up multiple times to use the bathroom, sometimes waking up and feeling a headache For women, it's interesting, you may not hear the sort of Darth Vader loud or lawnmower type of snoring. It may just be a soft snore and just some mild non-specific symptoms like headaches, tiredness, depression. So this is why we really want women to just really key in and lean in a little bit into how they're feeling. Because most times when women complain of these symptoms, they just told, oh yeah, it's your hormones, right? The hormones is a bad rap, right? Yes, there's a role for that, but it would be, especially if you are a middle aged woman, maybe a little bit even for not even that overweight, that's just something you want to pay attention to. Is my spouse telling snoring? Am I finding out that I'm waking up with a dry mouth and things like that. So that would be definitely something you want to pay attention to and seek help with a sleep specialist. Then the other one I would say with the insomnia is of course we all have occasional here and there abouts of acute insomnia, the stress in the family, there's a move, you got sick, you had surgery. But if you are at the point where it's been going on for, I would say a while, we usually will see three months, but you don't have to wait three months to suffer where you are having multiple days or multiple nights of difficulties falling asleep or staying asleep. Maybe your mind is racing, maybe something happened in the past and now you're in this spiral where you're just having a hard time sleeping. That tends to be something that we would want you to seek help with. And then again, in women, I would say I see it more commonly is just very restless and poor quality sleep. And sometimes that may be related to restless leg syndrome where you have this discomfort in your legs related to many times related to iron deficiency, but we'll see it also in women who, or people that have either kidney disease or maybe on certain medications as well. So if you're having those issues, what it's doing is it's fragmenting your sleep overnight such that you may wake up and still feel very tired. So I would say those are broad ones that you want to consider. Now we also then have more or less common, I would say conditions like narcolepsy for instance, where people have severe sleepiness regardless of getting enough sleep overnight. And so in those kind of situations, they're finding themselves falling asleep at random, sometimes inappropriate places. They may have hallucinations as well. They may have what we call cataplexy or sudden loss of tone with emotion. So if you're seeing those, absolutely, you definitely need to get tested for that. So those would be some just really broad strokes, but definitely the insomnia, the sleep apnea are very big and more common ones that I want people to be very aware of, and they've been really most researched when it comes to their impact on our daytime function, on our metabolism and other aspects of our health. Dr. Sarah Stombaugh: Yeah. Oh, I love that. And I have a lot of patients who live by themselves, and so having cues, having a dry mouth for example, is a really good thing to clue into because you don't have a bed partner or someone who's in your home who knows if you snore or if you pause breathing. It's nice to have other things that you can be paying attention to. So I appreciate you mentioning that. Dr. Funke Afolabi-Brown: Yeah, no, and I wanted to add for that also a common read. I mean, do you snore? I don't know if I snore unless my spouse doesn't. I'm asleep. Hopefully I'm not aware that I snore, right? So there's so many things we could do now you can actually record if there's concern, especially if you're waking up with a dry mouth and it's not because you've not had sufficient fluid intake all day, and so you're slightly dehydrated, right? If you've been feeling like that it's worth recording yourself or just turn on the audio record overnight and just kind of get a sense from that. But that especially for someone who leaves who's by themselves, I think is really something we need to just pay attention to. So yeah, I'm glad you mentioned that. Dr. Sarah Stombaugh: Yeah, I do advise people to do the audio recording, but I just have them do it on the general audio recording on their phone. Is that how you recommend it as well? Or are there apps specifically that people should be looking for? Dr. Funke Afolabi-Brown: There are a gazillion sleep tracker apps. You can, a lot of them do track snoring, but your general audio on your phone is just fine because one of the things I want people to be very cautious about, it's a slippery slope because a lot of times we're very intentional about wanting to optimize our health until we get all our sleep gizmos and gadgets and trackers, and many times we get into what we call orthosomnia where you start to become obsessed with the data, oh my goodness, I didn't get enough deep sleep. My sleep is broken. And this then causes anxiety, which then causes insomnia, which we don't want for you. So just use general phone, just approach you from a place of curiosity, and then you just get the help you need if you have concerns. Dr. Sarah Stombaugh: Yeah, I appreciate you mentioning that because I definitely have patients with the aura sleep rings. Not that there's anything wrong with that, but it's interesting. I've had people who have been like, oh, my app or my ring or my watch or my activity tracker said this about my sleep. I'm like, okay, but how do you feel? And they're like, oh, I feel great. Okay, well, who cares what your app says? It doesn't really matter if you're feeling well, no, if you're feeling bad and you're combining that together, you may be getting some useful information. But I appreciate you saying that because just like anything, I think it's really easy to get maybe overly invested in it and sort of obsessed as opposed to just that curiosity. So I love that. Well, as we wrap up today, Dr. Brown, I would love to hear, especially because you do some coaching, but I have listeners who are all over. And so tell us if someone is interested in learning more about you, if they're interested in working with you, how can they do that? Dr. Funke Afolabi-Brown: Yeah, so I offer in addition to my clinical practice, which is really focused on sleep in children and young adults, and I'm licensed in Pennsylvania, California, New Jersey, and what you would do would be get on my website at therestfulsleepplace.com and you could schedule a 15 minute check-in to just really even talk about what's going on and we could see if it would be a good fit. I also offer coaching, so that's across, of course, state lines mainly for high achieving women and also moms that have sleep issues. I get a lot of women who may be struggling with insomnia or setting boundaries or just managing their sleep schedule. And so we really offer that service as well where we'll be able to go through my program where we really then are helping you achieve your goals, especially where sleep is concerned, and help you to get to where you are going by making sure that sleep is not a deterrent. And that's also through my website and there's a coaching page on my website, and so you could schedule an appointment there as well for us to talk. I usually offer a 20 minute consultation call to talk through what's going on and what your needs are. And sometimes it's sleep training. So sometimes moms are just beside themselves. They're like, I would get good sleep if this child of mine was able to sleep well, so I offer that as well. So that would be really helping you to essentially teach your child to sleep independently, and I think that's just such a powerful tool that has lifelong impact. That's a way to also work with me. Dr. Sarah Stombaugh: Yeah, I love that, and especially because you are a physician, I think being able to recognize where are the behavioral aspects of it, but then when does it cross into this territory of maybe your child has undiagnosed sleep apnea and they need their tonsils out or they need these other things. I think being able to either support patients in that way or point them in the direction of someone who's in their state. I love that you have that, because that's not always the case with some people who are offering similar type services or maybe what looks similar on the surface are quite a bit different underneath the surface. Excellent. Dr. Funke Afolabi-Brown: Yeah, absolutely. Dr. Sarah Stombaugh: Yeah. Well, thank you so much for joining me today, Dr. Brown. This was really a pleasure. I know my listeners are going to love to hear it. I have one other episode on sleep, and it was one of my most downloaded episodes ever. So I think people are going to wonder how they can get it and how they can learn more about the role that sleep has in their weight and in their overall health. So thank you for being here today. I really appreciate it. Dr. Funke Afolabi-Brown: Thank you so much for having me. It's been such a pleasure.