This excerpt from Take Charge of Your Child's Sleep: The All-in-One Resource for Solving Sleep Problems in Kids and Teens was used with permission from Marlowe & Company, copyright 2005.

Overweight and overtired: How those excess pounds might be costing your child a good night's sleep

It is clear from almost any newspaper or magazine article you read these days that we are a nation of overeaters, and as a consequence have one of the highest rates of obesity in the world. Sadly, this epidemic has now hit our country's children as well. In the 1970s, 4 percent of children six to eleven years old were obese. In 1999-2000 the figure rose 15 percent and has continued to climb. Today nearly 22 percent of preschool children in the United States are defined as overweight and 10 percent are obese. Certain racial and ethnic groups (Mexican Americans, non-Hispanic blacks) are at an even igher risk for obesity. Obesity in children and teenagers is associated not only with obesity in adulthood, but also with an increased risk for heart disease, diabetes, and high blood pressure later in life.

But what does weight have to do with sleep? Plenty, evidently. First, there are now a number of studies that suggest there is a link between sleep loss and weight gain. Some of these studies (in adults) have looked at how sleep deprivation changes the body’s normal metabolism and hormone function, and the results are not good. Not getting enough sleep seems to affect not only how (in)efficiently you metabolize calories, but also how hungry you feel (by altering the level of a number of hormones—serotonin, leptin, perhaps others—in the body). Think about how many times you’ve tried to keep yourself awake at 2:00 AM by eating doughnuts or pizza. Or how you’ve used a “carb fix” as a pick-me-up when feeling drowsy in the middle of the day (maybe this does more to explain the typical ten-pound weight gain of the sleep-deprived college-freshman than dining hall food). This hormonal imbalance may eventually place people at greater risk for diabetes as well.

Other research has also found a negative relationship between weight and sleep in children (the less you sleep, the more likely you are to be obese). One study in Japan found a link in six- and seven-year-olds between obesity and later bedtimes and fewer hours of sleep. Children who got less than eight hours of sleep had an almost three times greater risk of being obese compared to children who got ten or more hours. In addition, some of these studies suggest this relationship may also go in the other direction. In other words, the risk of being obese decreases with each additional hour that your child sleeps! This may well be the single greatest argument you’ll ever have in getting your teenage daughter to go to bed at a reasonable hour.

In addition, being overweight or obese can greatly increase your child’s chances of having a serious sleep disorder. Obstructive sleep apnea is a breathing disorder that occurs during sleep and affects about 1-3 percent of children in the United States. It often leads to problems with attention, behavior, and academics. The most common cause in children is related to being overweight or obese (the best predictor of sleep apnea in adults is having a neck size of seventeen inches or above). Over the past ten years in our sleep clinic, we have clearly evaluated more and more overweight and obese children and teenagers for sleep apnea. In fact, about two-thirds of the children we diagnose with sleep apnea are overweight or obese.

Overall, the risk of sleep apnea in obese children is four to five times that of normal weight children. Yet fewer than 50 percent of pediatricians state that they ask questions about sleep problems "most of the time or often" in their obese patients. So it is very important that parents of overweight children be aware of this possible link with sleep apnea. You should also be aware of the most common symptoms of sleep apnea (loud snoring, breathing pauses, restless sleep, daytime tiredness), so that these can be brought to the attention of your child's doctor for further evaluation.

The combination of obesity and sleep apnea may also have greater consequences than either condition alone. As it has in adults, sleep apnea in obese children has been associated with insulin resistance, a condition that increases the risk of heart disease, high triglyceride levels, and diabetes later on. Studies also suggest that both obesity and sleep apnea in children are independently associated with a decreased quality of life (physical, emotional, social, academic functioning) and together may present an even greater challenge.

Finally, the relationship between sleep and obesity may involve other issues. For example, in obese adolescents decreased physical activity and more disturbed sleep go hand in hand. This suggests that one possible factor in adolescent obesity might be poor quality sleep. Obesity leads to daytime fatigue, which makes teens less likely to exercise, which eventually leads to more weight gain, and so on. As already mentioned, children who watch a lot of television and spend most of their time in sedentary activities are more likely to be overweight. They are also more likely to have sleep problems which, in turn, may result in their being less active, gaining more weight, and then developing more sleep problems.

What A Parent Can Do

• Limit fatty foods and foods high in calories. Junk the junk food. Discourage between-meal snacks.
  
• Encourage outdoor and physical activity. Schedule time for your child to be outdoors and to spend at least thirty minutes a day being physically active.
  
• Limit television viewing, computer time, and video games. Cut back on all the electronics!
  
• Watch out for school lunches. Often the biggest culprits in the high-calorie, high-fat sweepstakes are the school cafeteria and vending machines. You probably have some handle on what your kids eat at home, but much less control over what they eat when they're out of your sight. This requires some combination of teaching your kids about healthy food choices and making sure the bad choices they do have are as limited as possible.
  
• Be aware of the sleep and weight connection. If your child is overweight, look for signs of obstructive sleep apnea, and let your pediatrician know if you see any of them. Make sure that lack of sleep doesn't play a role in causing the weight problem. Keep track of when and under what circumstances your child is most likely to overeat and note if these are times when he seems sleepy or tired.
  
• Make healthy eating, like healthy sleep, an important priority for your whole family.