Diabetes and Obstructive Sleep Apnea
Sleep and blood sugar levels have an intricate relationship. As alterations in one can affect the other, it is not uncommon for people with diabetes to have difficulty sleeping. Effectively managing the condition and practicing good sleeping habits can help people with diabetes get enough good quality sleep.
Diabetes is a chronic condition that impairs the body’s ability to use glucose, resulting in fluctuations in blood sugar levels. Episodes of low and high blood sugar — known as hypoglycemic (hypo) and hyperglycemic events, respectively — can cause symptoms that may disturb sleep, such as thirst and an urge to urinate.
Low quality sleep can also make it more difficult to control diabetes, as it can affect how people manage the condition. Additionally, diabetes is associated with some sleep disorders, which can make it more difficult to achieve a good night’s sleep.
In this article, we discuss the relationship between diabetes and sleep and suggest tips to help manage both of these.
Diabetes can have a negative effect on sleep, and people living with diabetes often report poor sleep. Evidence notes that diabetes and sleep disturbances have a dual-sided relationship. This refers to how blood glucose control can worsen the quality of sleep while sleep disturbances can affect blood sugar levels and elevate the risk of developing insulin resistance.
How it may disturb Sleep
Having diabetes does not necessarily mean that a person will experience difficulty sleeping. However, certain symptoms are more likely to result in sleep disturbances.
For example, high blood sugar levels can lead to frequent urination. As such, if a person experiences a hyperglycemic event at night, they may need to get up to use the bathroom. Additionally, when the body has extra glucose, it draws water from the bodily tissues, leading to dehydration. This may prompt a person to wake up and drink water.
Hyperglycemia may also cause a person to feel warm, irritable, and unsettled at night. These symptoms may affect a person’s ability to fall and stay asleep.
A person with diabetes may also experience the Somogyi effect or dawn phenomenon. Both terms refer to a sudden rise in blood sugars either due to a rebound effect of low blood sugars or hormonal changes in the body.
Similarly, symptoms of low blood sugar levels can also lower sleep quality. It is not uncommon for people to experience a hypoglycemic event during their sleep, which can cause them to feel sweaty, shaky, and hungry and to experience nightmares.
Although a person may not wake up or notice any hypo symptoms, low blood sugar can still interfere with sleep and affect the quality of life, mood, and ability to work. It may also make people less likely to notice and respond to the symptoms of a hypo during the day.
Furthermore, waking up due to a blood sugar disturbance requires a person to correct their glucose levels with either insulin or carbohydrates. Making these adjustments may cause a person to feel alert and struggle to fall back asleep.
- Sleep apnea: There are different types of this condition, in which a person’s breathing repeatedly stops and starts during sleep. Sleep apnea is more common in those with type 2 diabetes, particularly those who carry excess body weight, which can restrict the air passages.
- Restless legs syndrome (RLS): A person with RLS experiences twitchiness and discomfort in their legs during sleep. It is likely more common in individuals with diabetes due to diabetic neuropathy, which refers to nerve damage.
- Insomnia: This is when a person has difficulty falling or staying asleep. As diabetes can disrupt or change sleeping patterns, insomnia can occur as a potential complication.
Sleep disorders can affect not only sleep quality and duration but also glucose metabolism and weight regulation. The possible complications of a lack of regular, sufficient sleep in someone with diabetes can include:
- an increase in insulin resistance
- an increased appetite and a stronger urge to eat non nutritious foods
- making it harder to maintain weight
- raising blood pressure
- impairing the immune system and its ability to fight infections
- increasing the risk of depression and anxiety
Evidence also suggests that low-quality sleep can increase the risk of developing type 2 diabetes.
The Centers for Disease Control and Prevention (CDC) note that most adults require 7 or more hours of sleep a night. The organization adds that 1 in 3 adults do not get enough sleep and that conditions such as diabetes can contribute to this.
The right sleeping habits, known as good sleep hygiene, can help people achieve a good night’s sleep. These habits may include:
- having consistent bedtime and getting up at a similar time in the morning, even at weekends
- sleeping in a quiet, dark, and relaxing environment that is at a comfortable temperature
- removing electronic devices, such as phones, tablets, and TVs, from the bedroom
- avoiding large meals, caffeine, and alcohol close to bedtime
- being physically active during the day, as exercise can help a person fall asleep more easily at night
Diabetes Management Tips
Although diabetes is not currently curable, people can manage the condition at home. Often, this involves following nutrition and exercise plans, as well as taking insulin or other diabetes medications.
The American Diabetes Association notes in its 2017 guidelines that self-management and education are also crucial aspects of diabetes care. The CDC adds that participating in self-management education programs can help people learn skills to prevent or reduce complications and improve their quality of life.
Living with diabetes can negatively affect sleep, and insufficient sleep can make it more difficult to manage diabetes. Certain symptoms of diabetes, such as hypos and hyperglycemic episodes, can disturb sleep. Additionally, people with diabetes may develop sleep disorders that can further disrupt sleep.
As such, it is important for people living with diabetes to practice good sleep hygiene to maximize their likelihood of getting sufficient good quality sleep. Good habits include exercising during the day, having a nighttime routine, and creating a suitable environment for sleep.