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Diabetes And Sleep. What Is The Link?

Many individuals with diabetes complain of poor sleep quality and lack of sleep affects blood sugar levels, thus creating a vicious cycle. While sleep apnea is commonly associated with diabetes, other sleep conditions may also develop. What is the link between diabetes and sleep? Let’s review this connection in this article. 

Sleep apnea 

It is well known the link between type 2 diabetes and excess weight, high blood pressure, and heart diseases. But there is another risk factor for diabetes: sleep apnea, specifically obstructive sleep apnea (OSA).

Sleep apnea affects sleep quality because it is characterized by episodes of interrupted breathing. The most common form of sleep apnea, OSA occurs happens  the tissue located in the back of the throat collapses in the airways and blocks normal breath.

Studies found that 71% of individuals with diabetes have this form of sleep apnea, being a lot more prevalent in those with diabetes compared with only 4-10% prevalence seen in the general population.

Being overweight or obese increases the risk of both diabetes and sleep apnea. Signs and symptoms of sleep apnea include episodes during which a person stops breathing (usually observed by the partner), loud snoring, gasping for air, morning headaches, excess fatigue during the day, and irritability. 

Other sleep disorders associated with diabetes

  • In addition to sleep apnea, researchers found that diabetes is also associated with abnormal sleep duration, including short and long sleep, as well as other sleep disorders. Insomnia, for example, correlates with increased HbA1c levels, which estimate how well diabetes is controlled long term. The good news is that treating sleep disorders has been shown to improve diabetes control and overall health,  too. 
  • Closely related to sleep apnea, restless leg syndrome is another sleeping disorder that is more common in those with diabetes compared with those without diabetes. Restless legs syndrome is actually a  sleep movement disorder that causes an uncomfortable sensation (ie numbness, tingling), associated with  an urge to move the legs when trying to fall asleep. That uncomfortable sensation is temporarily relieved by movement. Diabetic neuropathy and insulin therapy may further increase the likelihood of having restless leg syndrome.
  • Narcolepsy is another sleep disorder characterized by extreme sleepiness during the day and sudden attacks of sleep. It causes serious disruptions of day to day activities. Sometimes narcolepsy is associated with cataplexy, which is defined as a sudden loss of muscle tones, usually triggered by a strong emotion. Narcolepsy seems to increase the risk of diabetes and other metabolic disorders. How these two conditions are related is not exactly known, but scientists believe that orexin, a brain chemical may play a key role. Orexin deficiency is a hallmark of narcolepsy, and shortage of this brain chemical triggers increased food intake, abnormal glucose tolerance, insulin sensitivity and promotes obesity. 

Sleep disorders affect health in many ways  

Sleep apnea contributes to insulin resistance, glucose intolerance, makes diabetes harder to control, and also increases the risk for high blood pressure, heart diseases, abnormal heart rhythm (arrhythmia), and stroke. Short sleep duration strongly correlates with excess body weight. 

In addition to influencing blood glucose levels and increasing the risk of diabetes complications, sleep disorders have also been linked with depression, hormonal imbalances, increased risk of autoimmune diseases, poor quality of life, and premature death. 

Tips to improve sleep (and better manage diabetes)

Sleep tests and other investigations can help identify sleep disorders. It is important to work with the doctor to get them treated. CPAP machines help manage sleep apnea, and prescription medications are available for restless leg syndrome, narcolepsy, and other sleep disorders- including stimulants, antidepressant drugs, muscle relaxants 

When it comes to diabetes management, sleep is likely as important as the diet. Both the quantity and quality of sleep matter. On average, a person needs about 7,5 hours of sleep, although this need varies due to age, genetics, and other factors. For optimal benefits, sleep in a completely dark environment, with no TV or other electronics in the bedroom.  Add a blue light protector to the devices or avoid using them a couple of hours before bedtime. Even better, read a book before going to sleep. Stress management using deep breathing, meditation, yoga or psychotherapy helps improve sleep and also blood glucose levels. Keep the temperature on the lower side, ideally between 60 and 67 F (15.5 and 19.4 C) is the ideal room temperature for sleep. Stick to a routine-try to go to bed and wake up at the same time, even during the weekend.  Short naps can be taken during the day, but have to be short, about 20-40 minutes to avoid problems falling asleep later on. Daily exercise in the morning or afternoon helps improve sleep at night. Avoid nicotine and alcohol. 

How do you know you get enough sleep? If you sleep throughout the night without waking up,  you wake up without the alarm and feel energized and refreshed, you probably had a good night’s sleep.

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