Understanding the complex relationship between diabetes and sleep.
By Ally Hadfield
Diabetes and poor sleep are closely intertwined. When we sleep, our blood sugar levels rise. Our bodies produce insulin to bring our glucose levels back in check. When we don’t get enough sleep, over time, our bodies begin to lose their sensitivity to insulin, and we become at risk of developing type 2 diabetes. Diabetics either do not produce enough insulin or are resistant to it. For them, a sleep deficit can be especially concerning.
Unfortunately, poor sleep is so prevalent among Americans that the Centers for Disease Control and Prevention (CDC) calls insufficient sleep a public health epidemic.
What is Diabetes?
Diabetes is a chronic condition in which your blood glucose, or blood sugar, is too high because your body either doesn’t produce insulin, doesn’t make enough insulin, or doesn’t use the insulin it has effectively. Elevated blood sugar levels over time can lead to numerous health problems.
More than 34 million people in the United States have some form of diabetes. The two most common forms are type 1 and type 2. Type 2 diabetes is by far the most common form of the disease, making up 90-95% percent of all cases. Type 2 diabetes occurs when the body either doesn’t produce enough insulin or is resistant to insulin. This form of diabetes is often referred to as adult onset diabetes, though it is becoming more common among children, teenagers, and young adults.
Type 1 diabetes is rarer. It occurs when the pancreas either produces little or no insulin. This form of diabetes typically appears in children and adolescents and is often referred to as juvenile diabetes.
There is no cure for diabetes, but in most cases, it can be managed by diet and/or medication. Untreated diabetes can lead to other health problems like heart disease, stroke, kidney damage, and nerve damage. In severe cases, diabetes can lead to amputation, coma, and death.
About 88 million American adults have elevated blood sugar that is not high enough to qualify as diabetes. This is a condition called prediabetes, according to the CDC. Without intervention, people with prediabetes will go on to develop type 2 diabetes within 10 years.
Common Symptoms of Diabetes
- Extreme Hunger
- Poor wound healing
- Weight loss or weight gain
- Frequent urination
- Excessive thirst
- Dry mouth and itchy skin
- Blurred vision
People with prediabetes and type 2 diabetes usually don’t know they have the condition because they have no prominent symptoms and the disease usually develops slowly. Some people can have the disease for years and not know unless their doctor orders a blood glucose test or they develop symptoms and seek medical attention.
Type 1 diabetes is different. Symptoms of type 1 diabetes usually appear suddenly. For many children with type 1 diabetes, the first sign is bedwetting during the night when they didn’t previously wet the bed at night.
Diabetes and Sleep
Numerous studies have proven there is a clear link between insufficient sleep and the development of diabetes. That’s because disrupted sleep can adversely affect your blood glucose control, making you prone to diabetes. It can also worsen diabetes.
To add insult to injury, some symptoms associated with diabetes can disrupt your sleep, such as frequent urination which continues during the night when you’re trying to sleep. High blood sugar can also cause tingling or numbness in your hands and feet, a condition known as diabetic neuropathy. These uncomfortable sensations can prevent you from falling asleep or wake you during the night in search of a more comfortable position.
Research also shows that diabetics are at greater risk of having a sleep disorder, such as insomnia, obstructive sleep apnea, or restless leg syndrome.
Low Blood Sugar
Diabetes treatments and other conditions can cause your blood sugar to plummet, a condition known as hypoglycemia. Symptoms of low blood sugar include confusion, heart palpitations, shakiness, and anxiety. This can be quickly treated by consuming high-sugar foods or beverages like orange juice or non-diet sodas.
Uncontrolled diabetes can cause high blood sugar, or hyperglycemia. This can occur after consuming foods high in carbohydrates or as a side effect to medication. The main symptoms of high blood sugar or high glucose include headaches, fatigue, blurred vision, hunger, frequent urination, and difficulty concentrating.
High Blood Sugar
When your blood sugar is elevated, your kidneys are forced to work harder to filter and absorb the excess glucose. If your kidneys can’t keep up with your body, the excess glucose is excreted into your urine. This can dehydrate you, and make you feel thirsty. As you drink more fluids to quench your thirst, you urinate even more. Excessive thirst and increased urination can also disrupt your sleep, causing you to wake frequently at night to drink water or use the bathroom.
Link Between Lack of Sleep and Type 2 Diabetes
During the night when you are asleep, from about 4 a.m. to 8 a.m., your blood sugar levels increase, a phenomenon known as the dawn effect. In healthy individuals, the insulin hormone comes to the rescue, telling the cells in your body to absorb the glucose in your blood in order to bring your blood sugar levels back to normal. In people who are diabetic or otherwise resistant to insulin, the hormone cannot effectively remove the sugar from your blood, causing your blood glucose levels to continue to increase.
One study involving about 4,000 people looked at how sleep affects insulin resistance. Researchers found that people who experience short sleep duration — considered to be 6 hours or less — were twice as likely to be less sensitive to insulin or to have diabetes.
When blood glucose levels remain high, a seemingly never-ending cycle kicks in. Insulin resistance prevents the cells in your body from converting the food you have eaten into energy. This, in turn, causes an increase in hunger, which can lead to overeating. And, of course, overeating can lead to obesity, which is a risk factor for diabetes as well as sleep disorders like insomnia and obstructive sleep apnea. Sleep disorders can also hinder sleep, which can disrupt sleep.
Sleep Disorders Connected to Diabetes
Common Sleep Problems
Sleep apnea, also referred to as obstructive sleep apnea or OSA, is a sleep disorder that occurs when breathing is briefly and repeatedly interrupted during sleep. This happens when the tissues in the mouth fall to the back of your throat and obstruct your airway. This forces you awake during the night in order to catch your breath. In extreme cases, sleep apnea can cause low blood oxygen levels. This dangerous combination of fragmented sleep and oxygen starvation can lead to high blood pressure, heart disease, and mood and memory problems.
According to an analysis in the European Respiratory Journal, several studies have shown that OSA impairs insulin sensitivity and glucose tolerance. Likewise, drops in oxygen saturation during the night can cause insulin resistance.
OSA should be diagnosed by a doctor or sleep specialist. The disorder is usually treated with devices like a CPAP machine that increases the air pressure in your throat to prevent your airway from collapsing when you draw a breath.
Restless Leg Syndrome
Restless leg syndrome, or RLS, is a condition that causes a creepy sensation in the legs that gives you an irresistible urge to move them. The feeling is often described as an itching, crawling, pulling, aching, throbbing, or pins-and-needles sensation. These unpleasant episodes usually occur at night when you’re trying to sleep and as a result, can disrupt sleep.
People with diabetes are at risk for peripheral neuropathy, sometimes called diabetic neuropathy, which is a type of nerve damage caused by chronically high blood sugar. It causes numbness or tingling, usually in the feet and legs. Studies have shown that this type of nerve damage can lead to restless leg syndrome in patients with type 2 diabetes.
The best way to relieve symptoms of RLS is getting up and moving the legs, however, this can disrupt sleep as well. In more severe cases, medications called dopamine agonists are prescribed.
If you have trouble falling asleep, or if you wake up in the middle of the night and are unable to fall back to sleep, you may suffer from insomnia. Chronic insomnia increases the risk of type 2 diabetes. And, the longer you suffer, the greater your risk, a new study confirms. That’s because insufficient sleep adversely affects your body’s sensitivity to insulin and hinders its ability to lower blood sugar when spikes occur during the night.
Insomnia has many causes, and finding the root of your sleeping difficulties can help improve your sleep. For example, if stress and anxiety are keeping you up at night, consider relaxation exercises or talking with a therapist. Avoiding stimulants like caffeine later in the day and big meals before bedtime can help. Also establishing a regular bedtime schedule and routine. You may also consider sleeping pills or supplements, like melatonin.
Strategies to Improve Sleep with Diabetes
Aerobic exercise can help you burn off stress and is a great way to burn calories as well. But try not to exercise within three hours of bedtime. Exercise releases endorphins, the “feel good” hormone, which can make falling asleep difficult.
Avoid Caffeine and Alcohol Before Bedtime
Caffeine in the afternoon can prevent you from falling asleep. Alcohol, on the other hand, can help you fall asleep quicker. But if you drink too much alcohol, you are at risk of waking up during the night and not being able to fall back to sleep.
Cognitive Behavior Therapy
Diabetes is a chronic disease, and people who suffer from long-term illnesses are more prone to depression, which can cause insomnia. Talking with a cognitive behavior therapist can help you process your anxieties and help you get a good night’s sleep.
Numerous studies have shown how diabetes can adversely affect sleep, and how short sleep durations can drive down your body’s sensitivity to insulin. It’s a seemingly never-ending cycle. Understanding how sleep impacts your diabetes, and vice-versa, can help you find strategies to manage your disease and get a better night’s sleep.
The information provided here is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other health care professional with any questions you may have regarding your medical condition.