Insomnia is a common issue reported by patients both before and after bariatric surgery. Not only can sleeplessness lead to grouchy mornings and less-than-productive days, inadequate sleep is also a contributing factor in weight gain. Lack of sleep can have serious effects on a person’s quality of life and can occur for many reasons such as discomfort after surgery, altered sleeping positions, overnight upset stomach, etc.
Many patients also have sleep apnea (a sleep disorder in which a person has interrupted breathing while asleep) before bariatric surgery. While studies show that sleep apnea can be improved with bariatric surgery and general weight loss, patients should continue to take any prescribed treatment for sleep apnea until directed otherwise by a doctor.
The quantity and quality of sleep can be improved by practicing what’s called good “sleep hygiene.” Sleep hygiene involves several behaviors that lead to good bedtime habits and overall better sleep on a regular basis. Here are some tips to try to improve your sleep hygiene.
1. Turn your bedroom into the perfect sleep environment.
Think of a bat cave: quiet, dark, and cool. This kind of environment can help promote sleep! Light is a key factor that controls the body’s internal clock. At night, the body releases a hormone called melatonin which promotes sleep. Too much light at bedtime, such as from a television or cell-phone screen, can prevent the body from realizing it’s time to go sleep. You can also use heavy curtains, blackout shades, or an eye mask to help block light if needed. If you’re very sensitive to noise, consider sleeping with earplugs or a “white noise” machine. If tolerable, try to keep the temperature comfortably cool between 60 and 75 degrees Fahrenheit.
2. Create a soothing pre-sleep routine that works for you.
No matter how stressful or busy your day was, try to engage in relaxing activities before bed to smoothly transition from wake to sleep. Soothing activities can include taking a bath, reading a book, drinking caffeine-free tea, or meditating. Avoid stressful activities such as working, discussing emotional issues, or even watching the nighttime news.
3. Establish a consistent sleep schedule.
Try to go to bed and wake up at around the same time every day to set your body’s internal clock. As difficult as it may be, this includes on the weekends to avoid having to start all over again on Monday. Even if you did not sleep overnight, get up at your usual time; the extra sleepiness should help you sleep better the following night!4.
4. Try not to take a daytime nap. If you must, nap early.
Afternoon napping can be a major deterrent to a successful bedtime routine and to attaining a full night’s sleep. If you really need a nap, keep it short (around 30 minutes) and before 5 pm.
5. Avoid caffeine, alcohol, and nicotine which can interfere with sleep.
Caffeine (found in coffee, tea, chocolate, and energy drinks) is a stimulant that can keep you from falling asleep. Alcohol and nicotine from cigarettes can be sedating and make you sleepy at first but ultimately have stimulating properties that can lead to bad quality sleep. Try to avoid these kinds of stimulants 4 to 6 hours before bedtime. Although alcohol is not recommended for post-bariatric surgery patients, those who drink alcohol should limit intake to 1 to 2 drinks a day.
6. Try to eat dinner early and keep after-dinner snacks to small portions. Also, balance your fluid intake.
Especially if you’re still re-introducing new foods back into your diet and don’t yet know how your stomach will handle it, try not to eat within 3 hours of bedtime. Avoid foods that you know might cause indigestion and keep evening meals light (no pepperoni pizza for dinner). Stay hydrated even at night but avoid drinking fluids too close to bedtime so that you don’t have to wake up to use the bathroom in the middle of the night.
7. Exercise earlier in the day.
Try to exercise earlier in the day or at least 3 hours before bedtime. Working out too late at night stimulates your brain and could keep you up for several hours.
Still can’t sleep?
Some bariatric patients still need a pharmacologic option to help them sleep despite practicing good sleep hygiene. Melatonin is a naturally occurring hormone that plays a large role in sleep and is released by the body mostly at night when it is dark. Melatonin is available as an over-the-counter dietary supplement and can help with temporary sleep problems.
Not only does melatonin have sedative effects, it also has anti-inflammatory and antioxidant properties and can thus help relieve minor pain. One study has even found that taking melatonin after weight-loss surgery improved quality of recovery, especially when considering the quality of sleep and pain levels.
Talk to your pharmacist about which over-the-counter melatonin product might be best for you.
Ivry M, Goitein D, Welly W, Berkenstadt H. Melatonin premedication improves quality of recovery following bariatric surgery – a double blind placebo controlled prospective study. Surgery for Obesity and Related Diseases. 2017;13(3):502-506. doi:10.1016/j.soard.2016.11.001.
Life After Bariatric Surgery. American Society for Metabolic and Bariatric Surgery. https://asmbs.org/patients/life-after-bariatric-surgery. Accessed April 20, 2018.
Twelve Simple Tips to Improve Your Sleep. Healthy Sleep. http://healthysleep.med.harvard.edu/healthy/getting/overcoming/tips. Published December 18, 2007. Accessed April 20, 2018.