'To sleep, perchance to dream'* — and to make some growth hormone

Every parent knows that children grow at night. Not a surprise since there is pulsatile secretion of growth hormone during the night, particularly during stages 3 and 4 non-REM sleep. The importance of this pattern is perhaps best seen in children treated with chronic corticosteroid therapy in whom growth may be stunted. Their response to GH stimulation tests (e.g. insulin, arginine) is normal but nocturnal GH production is markedly impaired.

What about adults? Why is GH important after growth is completed? Just ask professional athletes who use this and anabolic steroids as performance enhancing. (Better yet, ask why Congress spent time and taxpayers’ money addressing this issue.) GH promotes the conversion of body fat to muscle!

Many of your patients have disturbed sleep and are missing the nocturnal spikes in GH. Sleep apnea is a common complication of obesity and obesity may complicate sleep disturbances. This is particularly a problem in patients with type 2 diabetes.

With poor sleep there is a strong chance of waking up tired and not having enough energy while awake to burn off excess body fat. Add to that the limited nocturnal GH secretion making it even harder to get rid of fat and a vicious cycle is set up. Fortunately the condition can be quickly recognized with a sleep study (almost a must test for patients with type 2 diabetes) and both CPAP and BiPAP restore nocturnal GH secretion.

How wonderful to wake up refreshed, full of energy and ready to burn up those calories!

* Hamlet (III.,1. 65-68)