Fig. 4. Insufficient sleep affects energy intake and energy expenditure, which leads to a positive energy balance and the risk of weight gain.

During experimental conditions of insufficient sleep in healthy adults, when energy intake is designed to meet the energy balance demands for a typical day with adequate sleep at baseline, there is an increase in energy expenditure due to the increased wakefulness and a negative energy balance (that is, energy expended is greater than energy consumed). Concurrently, hunger will increase owing to changes in appetite hormones. However, if sleep is restricted and food is provided ad libitum, participants will eat far more calories than expended during the additional wakefulness despite changes in appetite hormones that would promote satiety. These extra calories put participants into a positive energy balance and weight gain if maintained over time. Moreover, the increase in calories occurs predominately in after-dinner snacks, a time in which the energetic response to energy intake is decreased, further promoting a positive energy balance and weight gain. +, Positive energy balance; –, negative energy balance.