“Reduced sleep hours lead to increased apetite”

Isabel do Carmo, a professor at the Faculty of Medicine of Lisbon, endocrinologist, a leading Portuguese expert in obesity and eating behaviour, says that there are people with insomnia who can only go back to sleep after eating – the so-called “night eating syndrome” – and that almost all severely obese patients have sleep apnoea. Complex carbohydrates, vegetables and fruits are the best foods for a healthy sleep, she says. A many-sided personality with an intense political past, before and after April 25, Isabel do Carmo still recalls the sleep problems she had at the time she was a political prisoner.


In your clinical practice do you see many patients with eating disorders that are a direct consequence of insomnia and other sleep disorders?
I see many people whose daily lives do not allow them to have enough hours of sleep. In fact, many workplaces abolished the 8-hour workday paradigm. Employers and bosses call it “flying the company’s flag”… Then there are all those things like transportation, children, cooking dinner, preparing things for the next day. And sleeping hours get shortened. This leads to increased appetite as if it were a kind of compensation. It mainly occurs in the “hour of the wolf”, at the end of the day. Children who sleep less also tend to eat more; it is proven. And then there are people who can only overcome insomnia if they eat – it is the so-called “night eating syndrome” (NES). The concept was created by a great US psychologist, called Stunkard, who passed away last year.

What about the other way around, insomnia and sleep disturbances leading to eating disorders?
NES may be a consequence or a cause of sleep disorders. There may be a base insomnia associated with the NES. Or there may be a problem of binge eating, whether during the day or at night, where eating at night is part of a whole of uncontrollable appetite and satiety cycle.

Do you see many obese patients with sleep apnoea? Is obesity an increasingly important factor for this condition?
Almost all grade 2 and specially grade 3 obese (with a higher than 40 body mass index) show sleep problems, snoring and sleep apnoea or hypopnoea syndrome. They wake up tired and they have daytime sleepiness. However, most of them feel they sleep well at night and do not have any insomnia complaints. It is the partners who complain. As we all know, bad sleep and nocturnal apnoeas are a cardiovascular risk factor and they alter cognitive function. After a great weight loss, as in the case of bariatric surgery, they get “smarter”…

Is good nutrition essential for better sleep?
A balanced diet is certainly a contribution to good quality sleep. But we must distinguish between the so-called “healthy eating”, in which the ingested calories are equivalent to the amount spend, and the king of diet whose aim is to lose weight and must therefore be low-calorie. The latter, if it is too restrictive, may disturb sleep. On the other hand, people may feel hungry during the night if they take foods with a high glycemic index, such as sweets, white bread and some fruits, in the evening or at bedtime, when the glycemic peak falls and insulin peak remains high. In turn, of course, one should not make a meal in the two hours before sleep.

What are the best foods for a healthier sleep?
Foods that are easy to digest and low-fat. Complex carbohydrates and vegetables and fruits are good. But people who have irritable or spastic colon should be careful. In this case legumes, such as beans, chickpeas and lentils and vegetables with lots of fibre, can cause intestinal discomfort, including wind, and disturb sleep. Now this may not happen immediately after eating, but up to 72 hours later. In this case each person should know himself/herself and know what foods are bad for his/her intestines.

You are a multifaceted figure, a reputable doctor, an interventional citizen with a unique and intense political past, before and after April 25. Was there any situation where fatigue or sleep threatened a revolutionary and illegal action in which you were involved?
Quite often. In clandestine struggle stages people stay up all night and of course there is fatigue and sleepiness. It takes a lot to endure. There is a book by Nuno Bragança called Directa [Sleepless night] which addresses this issue. Today, I am engaged in “Livre/Tempo de Avançar” [a citizen candidacy for the 2015 Portuguese elections] and I leave meetings at midnight.

You have been a political prisoner before and after April 25. What has changed in prison before and after the revolution? And what remained the same?
I was in isolation before and after April 25. The big difference was that after April 25 I could receive books. Isolation is always hard and after April 25 I went through nine months of isolation, in a closed cell with a 15-minute break a day. But I had my son with me and I had books, newspapers and magazines. It made all the difference. Before April 25 clocks were left out so that we would not know what time of day it was. On the other hand, neither the PIDE [Portuguese secret police during the dictatorship] nor the Judicial Police beat me, but in the first case that situation could well arise and, in the second, it did actually happen to some of my comrades.

How did you sleep in prison? Was it that only the first few days were hard? In Caxias [a prison for political dissidents], prior to April 25, I had serious insomnia problems one night after drinking instant coffee all day because I had a jar of it and hot water and I had nothing else to do. It turned into a caffeine overdose. I had no awareness of what I was doing. Apart from this, I slept reasonably, but on two conditions: I needed to read at bedtime, which was either impossible or difficult, and I needed to drink coffee upon waking up, to avoid the coffee dependency syndrome. When I became more stabilized in prison, I could make coffee at night and take it in a thermos bottle beside the bed.

You went on a hunger strike when you were arrested. How was your sleep at that time?
I went on a 30-day hunger strike. I do not remember having any sleep disturbances. But I lacked my coffee, because, despite this drink being calorie-free, we did not accept it, so that they would not through that accusation on us.

Did you dream about escape and freedom while in prison?
It’s amazing, but I simply do not remember. It went off.

As you said, you had your child by you when you were arrested. Did he have trouble sleeping?
My son slept very well. Having the mother by his side is certainly a great safety for a child to sleep. I told him a story every night.

Did you read a lot in prison? What did you read?
I read a lot every day. I did not have to prepare meals nor clean a lot. In the collective moments we would hold meetings, do yoga, theatre and commented readings. Besides that I had plenty of time to read. I read Carl Marx’s Capital, which I would probably never fully read if I was not in prison. Afterwards we would talk about our readings together. I read the poetry of Eugénio de Andrade and Manuel Pina. I read Deleuze, Simone de Beauvoir, Sartre… And many novels.

You said in an interview that there were also amusing moments in prison. Can you recall them?
We were a group of six young people: Clara Castilho, Fernanda Fráguas, Fernanda Flórido, Olímpia and Vitória Lobo Soares. In our area there were many women and some of them were quite some characters. Some situations were hilarious. Once we decided to make cheese from milk… Somehow we managed to produce curdle and we left it on top of a closet where no-one could see it. It really began to smell. And the guards thought the smell came from the gypsies. Even we did not fully realize what was happening. So they made the gypsies take a bath, which was not easy… It was especially difficult for the eldest one, who had never bathed in her life. When we found out, of course we laughed a lot. But it was a positive thing in terms of collective hygiene… Another time I decided to dance rock, just like in my teenage days, together with a huge girl who wore a fur cap and was arrested for attempted murder after an old man who held her. With twists and turns and passing under the legs, we both fell flat on our faces, very loudly. We laughed like fools…

I believe it was traumatic for your going to high school at Maria Amália in your youth for two years? Did you feel harassed by the moral repression? Maria Amália High School was a typical case of the regime’s way of repression – which was worsened by the fact that it was a girls’ school. We had to wear tights and, in gym classes, a knee-length divided skirt, while the gym teacher sat next to the brazier. Running in the hallways was not allowed. Sanctimoniousness was widespread. There were favourite girls. It was a bad dream.

What do you think about expression that God does not sleep?
It’s a very typical expression from the religions of the Book. God is the avenger, the one whose beards seem to thunder in the sky, who will avenge on our enemies one day, on those who do us harm. He was not merciful, despite what people may say. If we do not get justice right away, God is always wide awake, and one day he will bring us justice. And the enemy will be beautifully treaded down. Oh joy, it is such a relief that God was not asleep, since he suffers from permanent insomnia…

Have there been situations in your life when sleep was good advisor? To what extent did it help you?
Sleep is always good advice. I know, when I am too tired and trying to find a solution, a word, a project, that the best thing to do is to sleep. The next day I will find it, for the unconscious will have worked alone. And the more cognitive areas will have rested.

Do you fall asleep easily? Are you more of an “owl” or a “lark”?
I fall asleep easily if I have a book before falling asleep. I am an “owl”, which, as the name implies, is socially frowned upon. All our lives we are governed by schedules, discipline, by the comments of the “larks”, all fresh and bright, filled with energy as soon as the sun rises. I can only put my brain to work normally around 10 or 11 p.m. But I have spent my life getting up early against my will, except on holidays and weekends. Now, I continue to work hard, but at “decent” hours and after having slept nine hours. I gained vitality.

Do you remember any amusing story involving sleep or lack thereof? Whenever I would apply for tenders at hospitals or at the university – which was quite frequent – I had many sleepless nights studying hard. On one such occasion, after much work and a sleepless night, I attended the Cascais Jazz Festival, which was emblematic of the “lefties” before April 25. Jazz as it was, there was a lot going on, with trumpets, percussion, everything. I slept through the whole festival. Other time I left the hospital emergency, we got into the car and drove to Madrid, to a political meeting. When we were at the meeting we heard a bang in the hallway. We figured it could be a bomb. I ran barefoot, because I had taken off my shoes to relieve. It was a Spanish comrade, lying on the corridor. I jumped on his chest as if I was still in the emergency. He ended up a little weary, but it was a simple fainting; he soon recovered and the meeting went on.