November 2012 Question 1
Should RDs discuss a client's sleep behavior when counseling for weight loss? If so, what would you say if your client told you he or she had many restless nights or slept less than 6 hours per night?
posted by Unknown @ 3:36 PM
16 comments
16 Comments:
Yes, an RD should definitely discuss a patients sleep habits and stress reduction habits if consulting for weight loss. I would ask the client why they sleep less than 6 hours and see if they feel tired in the day. I would also ask food choices later in the day and early in the morning to see if it seems like they are making choices related to stress/sleep deprivation. If a client has issues that are preventing their sleep it will be on a case by case basis the tactic it will take to help them get the rest they need. Education I feel will be of little use here but giving practical advice on how to achieve more sleep might be more effective in my opinion.
Sleeping behaviors are a component of wellness, so I think it would be appropriate for an RD to spend a portion of the session addressing this topic. If restless nights were frequent for my client, I would ask why this may be occurring. It may be due to a busy schedule, stress, or it may be normal for that individual. It is also important to talk about eating patterns to find out whether the lack of sleep is affecting the time the client is eating (late at night), food choices, and the amount of food being consumed.
I agree with Nate that giving practical advice about sleep would be more appropriate than spending a large portion of the session educating. If sleep deprivation is taking an obvious tole on the health of the individual, it may be appropriate to refer them to someone who specializes in sleep disorders and can provide the resources needed to help the client.
I think sleep behavior is definitely a component of weight loss that should be discussed to get a complete picture of the challenges the pt. is facing. Many who need to lose weight will be experiencing sleep disturbances such as sleep apnea that they may not be aware of due to the extra pounds. And not getting enough rest could definitely impact how effective their efforts will be to eat right and exercise.
If a pt. were sleeping less than 6 hours a night I would want to ask questions to determine why that is. If it was because of something like sleep apnea, I would want to refer them to the appropriate resources. If it was due to stress or being too busy, I would offer tips to get better sleep. I wrote a short article on this topic while at CCC and there are a variety of tactics that can be utilized.
I agree with Angela that not just stress and eating behaviors impact sleeping. It is good to have a working knowledge of conditions like sleep apnea in order to to a basic screening to see if a patient would be a candidate for sleep apnea testing.
I also feel it is appropriate for Rd's to address sleep habits in their counseling for all the reasons listed in the flow chart. I know that sleep deprivation makes me more prone to eating larger quantities in a subconscious effort to give myself energy. It also makes sense that people who are awake longer have more opportunity to consume more calories in the day. I would counsel my clients about what a good amount of sleep is, how exercise can help, and perhaps refer them to a specialist if I thought it was negatively effecting their health.
As Angela stated, there are often times people who have sleep apnea that have real weight issues. My uncle was one case and sleep apnea literally almost killed him. He gained about 50 lbs over the course of several years and couldn't do a thing to get the weight off. It wasn't until a diagnosis of sleep apnea (he was clueless he had a problem all those years) that he was able to drop weight and start feeling human again.
I think that sleeping patterns should be discussed with a client who wants to lose weight. I would want to discuss how many hours the client typically sleeps each night. Because sleep has such an effect on energy levels and daily schedules I would like to compare the client’s food recall to the number of hours the client slept each night and make connections to eating patterns. Also, if a client was getting less than 6 hours of sleep regularly I think education would be really helpful on how to get more sleep, plan meals ahead, how to incorporate exercise, and overall work with their daily schedule to make minor adjustments that the client would be willing to implement.
I think that in order to truly help your client with their weight loss, you have to discuss a number of lifestyle factors besides just food. Weight loss is so much more than just calories in and calories burned. Approaching weight loss with a wellness mindset may help the client actually be successful in losing weight and keeping it off.
I agree with everyone who stated they would figure out "why" a client wasn't getting enough sleep each night. It's impossible to fix a problem if the cause is unknown. If the issue is medical versus mental, different resources can be utilized in order for the client to start getting a more restful night's sleep.
I do think that RDs should discuss sleep patterns with clients wanting to lose weight. Given the recent literature supporting several reasons why sleep patterns and weight status may be correlated, and also the fact (like many of you have said) that sleep affects many other aspects of wellness besides weight, I think it's appropriate. If a client told me that they regularly sleep less than 6 hours per night, I would explain that it may not be causational, but that getting help to get their sleep pattern more substantial and normalized may help them throughout their journey of weight loss.
I hadn't even thought about sleep apnea until I read some of your posts. You all make great points that even if a client is in bed for 8+ hours, the quality of their sleep due to sleep apnea could be poor. This could definitely affect attempts at weight loss.
Sleeping behaviors can affect your mood and mood can definitely have an affect on eating behaviors. Staying up at night can also lead to increased eating. I think it absolutely should be discussed but if that is the person's normal habits and they truly do not believe it has any affect on them you should not dwell on it. Either way, bring it up quickly, explain the impact it may have on a person's eating habits and judge their response to see if they are interested. If they are not, move on.
I agree with Nate, we are dietitians, and we are there to offer everything we can but if the problem is beyond our scope of education we may need to refer them to someone else. I think it is important for us to identify a problem if it is there but not to try to educate on something we may know very little about.
Erin, I like your comment about helping clients use their food recall as a way to help them make connections between sleep and eating behaviors. Like Amy mentioned, I know I tend to snack more mindlessly if I am tired and trying to stay up to work on a project. Many people may not be conscious of that connection.
Erin, I like your comment about helping clients use their food recall as a way to help them make connections between sleep and eating behaviors. Like Amy mentioned, I know I tend to snack more mindlessly if I am tired and trying to stay up to work on a project. Many people may not be conscious of that connection.
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