Living with type 1 (T1D) or type 2 (T2D) diabetes is a hot topic. That’s why people managing their diabetes say, “Get sleep while you can!”
There are many issues in diabetes management and associated medical conditions that cause sleep issues. Not getting the proper amount of sleep can cause health issues in anyone. However, it makes managing blood sugar more difficult for someone with diabetes.
High blood sugar and sleep
Not getting enough sleep increases the risk of being overweight and obese. Obesity itself increases a person's risk for developing type 2 diabetes. Sleep influences proper hormone balance. People not getting the proper amount of sleep may eat more, compensating for the lack of energy with food.
Lack of sleep makes a person more insulin-resistant. Therefore, their blood sugars are higher, making diabetes management more difficult and, in turn, more difficult to get restful sleep. In addition, high blood sugar often means more frequent visits to the bathroom during the night, which further disrupts sleep. As a result of not getting enough sleep, the body requires more insulin and/or medication (due to insulin resistance) to keep blood sugar within the target range.
Low blood sugar and sleep
People taking insulin, and even some oral diabetes medications, face an increased risk of low blood sugar during the night. This is especially true if they are more physically active than normal during the day. Additionally, if they ate less than normal or incorrectly carb-counted food intake, they may experience low blood sugar overnight.
Continuous glucose monitors (CGMs) wake people up in the middle of the night with alarms, because their blood sugar is low. Some people with diabetes often set alarms to alert themselves to check their blood sugar throughout the night. This is vital for those with hypoglycemia unawareness because they cannot sense when their blood sugar is low. Once a person realizes that their glucose level is too low during the night, they need to eat to bring it up. Then they need to wait until it goes up and stays in the normal range. In addition, a person’s heart often races from the adrenaline of letting blood sugar levels fall too low.
In addition, if a person’s blood sugar is high during the night, or if it shoots up after being low, the person wakes up to go to the bathroom throughout the night. Furthermore, increased thirst causes them to drink more water, which in turn means more trips to the bathroom, hence disrupting their sleep cycle even more. So, keeping blood sugar levels within normal ranges during the night is key to sleeping well with diabetes.
Common sleep issues in people with diabetes
There are a couple of different types of sleep apnea, but the most common is obstructive sleep apnea (OSA). OSA is also one of the most common sleep issues in people with diabetes. In fact, OSA is a risk factor for developing type 2 diabetes, and more than two-thirds of people with type 2 diabetes have sleep apnea. The more severe the OSA, the more insulin resistance a person experiences (i.e., needs more diabetes medication(s) to keep blood sugars in their target range).
A primary sign of OSA is snoring. They also may stop breathing for short periods while sleeping. During an episode, the person often wakes up coughing, choking, or gasping for air. This, of course, disrupts their sleep cycle.
Losing weight can help reduce sleep apnea symptoms. Also, often medical professionals refer people to have a sleep study conducted — called polysomnography (PSG). This is a test that is used to diagnose various sleep disorders, including sleep apnea, insomnia, and narcolepsy. During the sleep study, a machine records blood oxygen levels, heart rate, breathing, brain waves, and eye and leg movements.
The results of the sleep study will lead your health professional to prescribe one of several different sleep treatments. A common and effective treatment for OSA is a continuous positive airway pressure (CPAP) machine. It is one of the most common treatments for sleep apnea. Using a CPAP device involves wearing a mask that covers your nose or nose and mouth. A tube is attached to the CPAP machine that blows air into the mask. The pressure from the forced air keeps a person’s airways open while sleeping, so they’re continually receiving the proper amount of oxygen.
While this may seem awkward to sleep with at first, people get used to it — but, more importantly, they wake feeling better rested. Treating OSA can help improve diabetes management and reduce the risk of heart attack and stroke.
Restless leg syndrome (RLS)
People suffering from restless leg syndrome (RLS) or Willis-Ekbom Disease experience an uncomfortable urge to move their legs. This condition is especially common in the evening or overnight while in bed, making it more difficult or impossible to fall or stay asleep.
Peripheral neuropathy, a common complication of diabetes, also has similar symptoms that may be accompanied by pain, making it difficult for a person to fall or stay asleep. Since the sensation is only relieved by moving, people need to keep their legs moving and don’t sleep well. Not sleeping because of RLS greatly affects a person’s overall health and impacts how they function throughout the day.
People with high blood sugar, neuropathy, iron deficiency, kidney issues, thyroid disorders, or who smoke are at higher risk for restless leg syndrome.
Restless leg syndrome is diagnosed by symptoms because there is no specific test for it. Treatment includes managing any underlying medical issues such as peripheral neuropathy, anemia, and kidney issues. Lifestyle changes can also help with symptom management, including avoiding alcohol and tobacco, getting regular physical activity, massages, and warm baths. In addition, several classes of medication may help to reduce symptoms.
People with insomnia have difficulty falling and/or staying asleep and, thus, lack quality rest. Short-term insomnia often happens when a person is experiencing a lot of stress or a change in their schedule. Chronic insomnia is diagnosed when a person’s symptoms occur at least three times per week for a period of more than three months. This is important for people living with diabetes because high blood sugar can also cause insomnia.
Insomnia is diagnosed by a healthcare provider based on health history and symptoms. Keeping a sleep diary can be helpful. A sleep diary consists of sleeping habits, including when a person goes to sleep, wakes up, takes naps, drinks caffeine or alcohol, and exercises. A medical professional may also recommend participating in a sleep study and ordering a blood panel. In addition to the good sleeping habits listed below, there are different types of cognitive behavioral therapy and medications that can be prescribed to treat insomnia.
Tips for creating good sleeping habits
- Try keeping your blood sugar in your target range by taking your medications and eating accordingly
- Get regular exercise (just not right before bed)
- Avoid smoking or drinking beverages with caffeine before bed
- Avoid eating large meals right before going to bed
- Go to bed and wake around the same time every day
- Avoid screens (phone, computer, tablet) right before bed
- Keep the bedroom cool, dark, and quiet
- Use your CPAP machine if you have one
Jeoffrey A. Bispham, Allyson S. Hughes, Ludi Fan, Magaly Perez-Nieves, Alicia H. McAuliffe-Fogarty; “I’ve Had an Alarm Set for 3:00 a.m. for Decades”: The Impact of Type 1 Diabetes on Sleep. Clin Diabetes 1 April 2021; 39 (2): 153–159. https://doi.org/10.2337/cd20-0026
Gary D. Foster, Mark H. Sanders, Richard Millman, Gary Zammit, Kelley E. Borradaile, Anne B. Newman, Thomas A. Wadden, David Kelley, Rena R. Wing, F. Xavier Pi Sunyer, Valerie Darcey, Samuel T. Kuna, for the Sleep AHEAD Research Group; Obstructive Sleep Apnea Among Obese Patients With Type 2 Diabetes. Diabetes Care 1 June 2009; 32 (6): 1017–1019. https://doi.org/10.2337/dc08-1776
Lal RA, Basina M, Maahs DM, Hood K, Buckingham B, Wilson DM. One Year Clinical Experience of the First Commercial Hybrid Closed-Loop System. Diabetes Care. 2019 Dec;42(12):2190-2196. doi: 10.2337/dc19-0855.
Edinger JD, Arnedt JT, Bertisch SM, Carney CE, Harrington JJ, Lichstein KL, Sateia MJ, Troxel WM, Zhou ES, Kazmi U, Heald JL, Martin JL. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med. 2021 Feb 1;17(2):263-298. doi: 10.5664/jcsm.8988. PMID: 33164741; PMCID: PMC7853211.