Open and available for virtual telehealth and in-person appointments. Book Now!

Sleep, Activity, and Mood: Where Osteopathy & Nutrition Meet

What happens when we sleep? There are a great number of critical functions which occur that are critical to maintaining normal physiologic functions and repairing the body.  They include, but are not limited to:



However, if your diet is off and you’re misaligned, it may be difficult to achieve the restorative sleep you need to properly heal. Not to mention, inappropriately timing our lifestyle behaviors will disturb circadian rhythms, leading to altered physiologic responses such as poor sleep. For example, having late-night dinner and/or watching the news right before bed will have drastic consequences on a person’s sleep patterns. 

Let’s start with food. Poor sleep and high sugar intake are common in adolescents and adults. It’s been known for decades that dietary sugar intake is reportedly higher in children with sleep disturbance. In fact, a high sugar diet has a significant and immediate negative impact on decreasing the amount of time spent in stage one and two sleep.  It also decreases attention span but increases it ONLY AFTER sleep, indicating a mediating effect of sleep (Blunden et al., 2011). What this looks like in practice:  replace fruit juices, milk (naturally rich in sugar), and sugar-laden processed foods (i.e., cookies, cakes, granola and protein bars, candies, chips, etc..) with more tasty herbal teas like hibiscus, for example since they’re delicious and with no risk of side effects.

The healing effect of sleep is profound. The problem is the body eventually can’t keep up with the damage from high-sugar meals and hence, the amazing repair work done only during sleep diminishes. This is known as “energy toxicity” -- a huge problem since it leads to chronic short sleep cycles where it becomes increasingly difficult to achieve deep, restorative sleep (Chen et al., 2008; Patel & Hu, 2008). Poor sleep leads to many poor health outcomes such as learning disorders (i.e., dyslexia), mental health issues (i.e., anxiety, depression, bipolar), excess weight gain/obesity, diabetes, and autoimmune disease, to name just a few. 

Several clinical trials have found that sleep restriction leads to increased energy intake, energy intake from snacks, and intake of calorie-dense foods (Bosy-Westphal et al., 2008; Nedeltcheva et al., 2009; Brondel et al., 2010; St-Onge et al., 2011; Markwald et al., 2013; Spaeth et al., 2013; Spaeth et al., 2014). This means altering sleep can fundamentally affect the food choices one makes and disrupts their macronutrient profile. Stated differently, if you are not adequately addressing sleep, then it makes improving the diet more challenging and life more stressful.

The literature makes a pretty convincing link between short/disrupted sleep duration and food intake, but not many studies have used controlled conditions to determine how food intake affects sleep. So, in general, there is little information on the role of diet on sleep patterns. That’s why the topic is not of discussion, and if it is, the topic centers around which one came first: The chicken or the egg? Studies are also small, of short duration, and with no clear focus on nighttime sleep episodes. Most of the effects of diet on sleep is based on epidemiological findings—findings that rely on self-report of food in-take or on the acute effects of a single meal (and we know that a single meal does not accurately reflect the composition of the whole diet). 

Recently, ad libitum food intake (i.e. eating whatever you want, whenever you want) was associated with a decrease in slow wave sleep and an increase in sleep onset latency (St-Onge et al., 2016). Indeed, over a third of individuals in this study increased their sleep onset latency to over 30 minutes after the ad libitum feeding day. This is clinically significant because the 30-minute sleep onset latency threshold is typically used as a cut-point to indicate sleep onset insomnia (Schutte-Rodin et al., 2008). A higher intake of saturated fat (i.e., animal protein in the form of dairy products, meat, poultry, eggs, fish, or nuts) with a lower intake of plant-based fiber (i.e., green vegetables) was associated with lighter, less deep and restorative sleep. Finally, increased intake of both sugar and non-sugar/non-fiber carbohydrates (i.e., bread, pasta) was associated with more nocturnal arousals during sleep

Since there is currently very little information on the role of diet on sleep, very little guidance is traditionally given regarding how to optimize diet and lifestyle.  This is where integrative health providers play an essential role in understanding this connection and how to effectively address sleep disorders.  For example, a nutritionist can recommend the ideal diet suitable for sleep based on the person’s physiological needs. By focusing on returning the body back to proper alignment, an osteopath can stimulate deeper relaxation and lower stress cortisol levels. 

Cortisol is the “fight or flight” hormone, and it’s what helps you rise in the morning. So when cortisol levels are high, we are awake. The problem is when cortisol remains high, especially at night, we can’t sleep.  By helping the body relax, osteopathy plays a crucial role in optimizing sleep. This translates into increased healing and cellular energy production.

After initial osteopath treatments, the body becomes better equipped to maintain homeostasis of all organ systems. When the musculature relaxes, so, too, does the sympathetic nervous system, relieving destressed adrenal glands and high blood pressure. In 2020, the physiological state of being in sympathetic overdrive is demanding and exhausting. It’s not sustainable to your health because it’s not sustainable for your sleep.

Without question, when the body is properly aligned and functioning optimally, we feel lighter. Our whole mood improves. Our days are brighter. We become more physically active. And we can do more with our body on any given day. This, in turn, makes our sleep more healing. This is the physiologic state we should be in more often.

A growing body of research suggests osteopathy is a fantastic way to decrease stress, restore the body to its natural function, and increase healing  (Korotkov et al., 2012). It’s a powerful aid to many health concerns—everything from managing hormonal changes during pregnancy to treating chronic pain. Osteopathy can be thought of as addressing many complaints all at once, compared to taking a drug for pain, a drug for stress, and another drug for hypertension. It’s clear which option offers you the most freedom to thrive and no side effects. 

Osteopathy is a noninvasive, drug-free treatment option (aka., no risk of addition, surgical complications, or side effects). It is rarely contraindicated with any other potential treatments.

In sum, diet and osteopathic treatments can influence nighttime sleep propensity, depth, and architecture.

What Our Patients Are Saying

“COVID-19 has been a challenging time to maintain healthy eating habits. Between working full time and attempting to homeschool my three young children, I've found myself turning to bad health habits more often than not as a way to cope with the stress of our new reality. A few weeks ago it became clear I needed support, education and accountability to help create a better health path forward. After only a few minutes on my Zoom chat with Advanced Health’s nutritionist Nicole Bianchi, I immediately started to feel more hopeful than I have in 3 months. Nicole approaches her work with empathy, kindness and wisdom - who doesn't need all 3 of those these days? It also becomes clear within a few minutes how incredibly SMART and educated Nicole is about her craft. I was blown away by how she educated me about the information behind her approach - by the digestible (pun intended ;-) information she shared and tools she offered to help me reach my goals. I'm only a week into the plan Nicole set for me and I'm already noticing a change in energy levels, weight and confidence that I haven't felt in months, if not years. If anyone is struggling with putting down the wine (and Doritios :) as a way to wash away a day of shelter in place and the turmoil our country is currently in, call Nicole STAT. I'm feeling so blessed that I did and more confident than ever marching towards my health and wellness goals. Stay safe all and THANK YOU NICOLE!” - Erica

“Julie has been great in helping me get back on track post-concussion. Andrew, the acupuncturist at SF Advanced Health, referred me to Julie as I started to get worried that my injury might also have spinal-related issues from the whiplash.  Julie’s therapy has been very helpful. She does a great job of listening to your symptoms, taking notes, and explaining the work as she's doing it.” - Audrey 

Are you considering osteopathic treatment or nutrition counseling to help you aid in relaxation, be rid of underlying tension, and/or better managing? Check out Advanced Health’s virtual educational seminar by our nutritionist Nicole Bianci and osteopath Julie Duggan on WEDNESDAY, October 21st at 6:30 p.m. 

Dr. Bhandari and the Advanced Health Team Are Here to Support Your Health.

Our expert team of integrative holistic practitioners work with patients suffering from chronic health concerns.  We help our patients reverse disease by better understanding how the body optimally functions and providing personalized treatment plans. To learn more and book an appointment, contact Advanced Health or call 1-415-506-9393.


Altevogt, B. M., & Colten, H. R. (Eds.). (2006). Sleep disorders and sleep deprivation: an unmet public health problem. National Academies Press.

Barrett, J., Lack, L., & Morris, M. (1993). The sleep-evoked decrease of body temperature. Sleep, 16(2), 93-99.

Blunden, S., Watson, E., Rigney, G., Banks, S., Coussens, S., Hendrie, G., & Kohler, M. (2011). TO-136 THE EFFECTS OF A HIGH SUGAR DIET ON SLEEP QUALITY AND ATTENTIONAL CAPACITY IN PREPUBESCENT GIRLS: A PRELIMINARY STUDY. Sleep Medicine, 12(1), 9.

Bosy-Westphal, A., Hinrichs, S., Jauch-Chara, K., Hitze, B., Later, W., Wilms, B., ... & Müller, M. J. (2008). Influence of partial sleep deprivation on energy balance and insulin sensitivity in healthy women. Obesity facts, 1(5), 266-273.

Brondel, L., Romer, M. A., Nougues, P. M., Touyarou, P., & Davenne, D. (2010). Acute partial sleep deprivation increases food intake in healthy men. The American journal of clinical nutrition, 91(6), 1550-1559.

Chen, X., Beydoun, M. A., & Wang, Y. (2008). Is sleep duration associated with childhood obesity? A systematic review and meta-analysis. Obesity, 16(2), 265.

Korotkov, K., Shelkov, O., Shevtsov, A., Mohov, D., Paoletti, S., Mirosnichenko, D., ... & Robertson, L. (2012). Stress reduction with osteopathy assessed with GDV electrophotonic imaging: effects of osteopathy treatment. The Journal of Alternative and Complementary Medicine, 18(3), 251-257.

Markwald, R. R., Melanson, E. L., Smith, M. R., Higgins, J., Perreault, L., Eckel, R. H., & Wright, K. P. (2013). Impact of insufficient sleep on total daily energy expenditure, food intake, and weight gain. Proceedings of the National Academy of Sciences, 110(14), 5695-5700.

Nedeltcheva, A. V., Kilkus, J. M., Imperial, J., Kasza, K., Schoeller, D. A., & Penev, P. D. (2009). Sleep curtailment is accompanied by increased intake of calories from snacks. The American journal of clinical nutrition, 89(1), 126-133.

Patel, S. R., & Hu, F. B. (2008). Short sleep duration and weight gain: a systematic review. Obesity, 16(3), 643-653.

Schutte-Rodin, S., Broch, L., Buysse, D., Dorsey, C., & Sateia, M. (2008). Clinical guideline for the evaluation and management of chronic insomnia in adults. Journal of clinical sleep medicine, 4(5), 487-504.

Spaeth, A. M., Dinges, D. F., & Goel, N. (2014). Sex and race differences in caloric intake during sleep restriction in healthy adults. The American journal of clinical nutrition, 100(2), 559-566.

St-Onge, M. P., Roberts, A. L., Chen, J., Kelleman, M., O’Keeffe, M., RoyChoudhury, A., & Jones, P. J. (2011). Short sleep duration increases energy intakes but does not change energy expenditure in normal-weight individuals. The American journal of clinical nutrition, 94(2), 410-416.

St-Onge, M. P., Roberts, A., Shechter, A., & Choudhury, A. R. (2016). Fiber and saturated fat are associated with sleep arousals and slow wave sleep. Journal of Clinical Sleep Medicine, 12(1), 19-24.

Stradling, J. R., Chadwick, G. A., & Frew, A. J. (1985). Changes in ventilation and its components in normal subjects during sleep. Thorax, 40(5), 364-370.

Snyder, F., Hobson, J. A., Morrison, D. F., & Goldfrank, F. (1964). Changes in respiration, heart rate, and systolic blood pressure in human sleep. Journal of applied physiology, 19(3), 417-422.

Spaeth, A. M., Dinges, D. F., & Goel, N. (2013). Effects of experimental sleep restriction on weight gain, caloric intake, and meal timing in healthy adults. Sleep, 36(7), 981-990.

Vanoli, E., Adamson, P. B., Ba-Lin, Pinna, G. D., Lazzara, R., & Orr, W. C. (1995). Heart rate variability during specific sleep stages: a comparison of healthy subjects with patients after myocardial infarction. Circulation, 91(7), 1918-1922.


Dr. Payal Bhandari Dr. Payal Bhandari M.D. is a leading practitioner of integrative and functional medicine in San Francisco.

You Might Also Enjoy...

The Impact Heat Has on Health

The frequency and intensity of heatwaves and its cumulative impact on health has risen through the decades. This is having unimaginable consequences.