“I have dealt with chronic fatigue and poor sleep for three years now, and it just seems to be getting worse,” said a member of MyObesityTeam. If you’re living with obesity, you might relate. Sleep problems are common and can take a toll on your health, mood, and daily life. Poor sleep can also lead to more weight gain over time. In the United States, more than 40 percent of people live with obesity, and over 20 percent have a sleep disorder. Getting good sleep is an important part of staying healthy and feeling your best.

You’ve probably heard that obesity and obstructive sleep apnea (OSA) are often connected. But what you might not know is that people living with obesity may have other sleep problems, too.

In this article, we’ll look at four common sleep problems people with obesity may face, along with treatments that can help improve sleep and overall health.

1. Obstructive Sleep Apnea

OSA happens when the upper airway becomes blocked during sleep, causing pauses in breathing. During these gaps in breathing, the brain and body receive less oxygen, which can cause more health problems.

People living with obesity are much more likely to develop OSA because of excess weight around the neck, which can put pressure on the airway while lying down. In one study from Wolters Kluwer UpTo Date — an online medical resource used by doctors and health professionals — 63 percent of men whose body mass index (BMI) was greater than 30 had OSA, compared to just 11 percent of men whose BMI was below 25.

OSA symptoms include loud snoring, gasping for air while asleep, daytime sleepiness, morning headaches, and brain fog.

If you or a loved one is experiencing OSA, ask your doctor if a polysomnography (sleep study) would be right for you. This test can be done in a sleep lab or at home, depending on resources, your symptoms, and your preferences.

Treating Obstructive Sleep Apnea

There are many ways that doctors treat OSA. They may recommend lifestyle changes, including sleeping upright to prevent the airway from closing, avoiding alcohol and certain medications, and encouraging weight loss through physical activity and diet. Sleeping on your back can make symptoms worse, so sleeping on your side is recommended. To prevent rolling in your sleep, some doctors even recommend wearing a backpack to bed.

The most effective way to help people with moderate to severe OSA breathe better at night is by using positive airway pressure (CPAP), a machine that keeps the airway open by gently blowing air through a mask. For people with more severe OSA, CPAP therapy is the best choice to improve breathing throughout the night, reduce daytime symptoms, and prevent complications like hypertension (high blood pressure). In severe cases, bilevel positive airway pressure (BiPAP) is needed. This machine delivers two different levels of air pressure — a higher pressure when you breathe in and a lower pressure when you breathe out — to help keep the airway open. Other options to manage OSA in those who don’t tolerate CPAP treatment may include surgery and mouth appliances.

2. Insomnia

Living with obesity makes you more likely to experience insomnia, which is defined by difficulty falling asleep or staying asleep or waking up too early. The causes of insomnia are numerous, including hormone imbalances, metabolic issues, and stress. “Daily stress is keeping me awake at night,” one MyObesityTeam member said.

Sometimes, comorbidities (two medical conditions at the same time) — such as gastroesophageal reflux disease (GERD) and osteoarthritis — can cause nighttime discomfort and sleep disruption. One member of MyObesityTeam who had recently been diagnosed with pseudogout (a type of arthritis) said, “I’m exhausted from not being able to sleep from the pain.”

Some studies have found that insomnia may lead to obesity in the long term. This is because when you have trouble sleeping, your body releases hormones that can lead to weight gain. These hormone changes can make you hungrier and slow down your metabolism.

Treating Insomnia

Treating insomnia involves combining lifestyle factors, mental healthcare, and medications. Your treatment may depend on the type of insomnia you have.

It’s important to consider good sleep hygiene when assessing why you might be experiencing insomnia. Examples of sleep hygiene recommendations include:

• Waking up and going to bed at the same time every day
• Avoiding naps, caffeine, nicotine, and alcohol
• Sleeping in a quiet, dark, cool room
• Using earplugs and/or white noise to prevent sudden noises from waking you up
• Avoiding food close to bedtime
• Exercising at least four hours before you go to sleep

Many people with long-term insomnia find cognitive behavioral therapy (CBT) helpful for targeting the thoughts that keep them up at night and for building routines that support better sleep. Medications to help with sleep are often used alongside behavior changes and therapy.

3. Restless Legs Syndrome

Restless legs syndrome (RLS) is exactly what it sounds like — a brain condition that causes an uncontrollable urge to move the legs. This condition often gets worse at night, making it hard to fall asleep or causing you to wake up during the night. People with RLS may also have relationship challenges, as their movements can often wake up a partner. Research shows that RLS is more common in people with obesity, possibly tied to brain chemical (dopamine) levels, genetics, or lack of iron in the blood.

Treating RLS

Some home remedies that people often use to treat RLS include:

• Soaking in warm baths before bedtime to relax the muscles
• Applying warm or cold packs to reduce sensations
• Practicing good sleep hygiene
• Exercising a few hours before bed every day
• Avoiding caffeinated drinks

Doctors may also consider prescribing certain medications to treat severe or long-term symptoms.

Many of the strategies to treat RLS are also useful for improving sleep quality, supporting weight loss, and boosting overall health.

4. Hormonal Disruptions

Obesity itself is associated with changes in levels of hormones (the messengers of information in the bloodstream). Disruptions of different types of hormones can have negative impacts on sleep quality. In reverse, poor quality sleep can cause increases in hormones leading to weight gain.

For example, poor sleep is associated with disruptions to leptin, the fullness hormone, and ghrelin, the hunger hormone. That’s why when you’re sleep deprived, you may find yourself craving higher-calorie snacks or not getting satisfied by small meals. Out-of-balance leptin and ghrelin can cause behaviors that contribute to weight gain, such as overeating.

Additionally, many people with obesity may be resistant to a hormone called insulin, especially if they’re also living with type 2 diabetes. When insulin isn’t working properly, blood sugar spikes throughout the night, leading to restless sleep. Furthermore, poor-quality sleep can cause insulin resistance, leading to a vicious cycle.

Treating Hormonal Imbalances

To combat the cycle of obesity-related hormones causing poor sleep and vice versa, there are some steps you can take. First, speak to your doctor about your sleep troubles to get evaluated for other medical causes, like diabetes or thyroid disorders. If you and your doctor believe that sleep problems are related to your BMI, making healthy food and exercise changes can impact your sleep quality in the long term.

The Link Between Sleep and Obesity

Poor sleep can contribute to weight gain by increasing overeating behaviors and reducing the energy you have to be physically active. People with obesity are at higher risk for developing various sleep disorders, including OSA, RLS, and insomnia.

Talk to Your Doctor

It might feel impossible to break the cycle of weight gain and poor sleep, but help is available. Talking to your doctor about sleep problems can lead to solutions like lifestyle changes, mental health support, medications, and devices to help you sleep better.

Luckily, many lifestyle changes that can help improve sleep — like eating balanced meals, exercising, and avoiding alcohol — can also help in your weight loss journey. You are not alone — speak to your healthcare provider to create a personalized treatment plan that will get you sleeping soundly at night.

Find Your Team

On MyObesityTeam, the social network for people with obesity and their loved ones, more than 56,000 members come together to ask questions, give advice, and share their stories with others who can relate to their experiences living with obesity.

Have you struggled with your sleep? What do you do to prevent restless nights? Share your experience in the comments below, or start a conversation by posting on your Activities page.