What is the relationship between insomnia and metabolic syndrome?

From the Guidelines

Insomnia and metabolic syndrome are closely linked, and addressing sleep issues is crucial while managing metabolic risk factors to improve overall health and reduce morbidity, mortality, and enhance quality of life. The relationship between insomnia and metabolic syndrome is complex, with poor sleep quality and duration exacerbating metabolic syndrome components, such as glucose metabolism, blood pressure, and lipid profiles 1.

Insomnia Treatment

For insomnia treatment, cognitive behavioral therapy for insomnia (CBT-I) is the recommended first-line approach, which includes sleep restriction, stimulus control, and relaxation techniques 1. If medication is needed, short-term use of medications like zolpidem (5-10mg), eszopiclone (1-3mg), or trazodone (25-100mg) at bedtime may help, but should be used cautiously.

Metabolic Syndrome Management

For metabolic syndrome management, lifestyle modifications are essential, including a Mediterranean-style diet rich in vegetables, fruits, whole grains, and lean proteins, while limiting processed foods and added sugars 1. Aim for 150 minutes of moderate exercise weekly, with both aerobic and resistance training. Weight loss of 5-10% can significantly improve metabolic parameters.

Key Considerations

• Poor sleep disrupts glucose metabolism, increases cortisol levels, and affects hunger hormones like ghrelin and leptin, which can worsen metabolic syndrome 1.
• Metabolic issues like insulin resistance can disrupt sleep quality, creating a vicious cycle that worsens both conditions.
• Treating both conditions simultaneously is essential for breaking this cycle and improving overall health, reducing morbidity, mortality, and enhancing quality of life.
• Current guidelines consider a reduction in body weight by low caloric diet and physical exercise as the first and main treatment strategy in subjects with the metabolic syndrome 1.

From the Research

Relationship Between Insomnia and Metabolic Syndrome

• Insomnia has been reported to underlie the development and aggravation of metabolic syndrome, including hypertension, cardiovascular disease, and diabetes 2.
• The risk of insomnia patients suffering from hypertension, hyperglycemia, hyperlipidemia, and obesity in metabolic syndrome was 1.41 times, 1.29 times, and 1.31 times than people without insomnia, respectively 3.
• Metabolic syndrome refers to the clustering of risk factors for cardiovascular disease and diabetes, including central adiposity, hypertension, dyslipidemia, and hyperglycemia, and has been linked to impaired sleep, including insomnia 4.

Treatment and Management

• Treatment of insomnia is important for both the management and prevention of comorbid disorders, such as metabolic syndrome 2.
• Cognitive behavioral therapy for insomnia (CBT-I) is considered a first-line intervention for insomnia and has been shown to be effective in reducing insomnia severity and improving mental health in patients with comorbid mental disorders 5, 6.
• Sleep hygiene education and adequate drug therapy are also recommended for the management of insomnia in patients with metabolic syndrome 2.

Associated Risks

• Insomnia has been associated with an increased risk of developing metabolic syndrome, including hypertension, hyperglycemia, hyperlipidemia, and obesity 3.
• The combined odds ratio value and 95% confidence intervals of the hypertension group was 1.41 (1.19-1.67), the hyperglycemia group was 1.29 (1.11-1.50), and the obesity group was 1.31 (1.03-1.67) 3.