Diabetes Self-Management Blog

Fatigue, defined as physical or mental exhaustion, can be the most crippling thing about diabetes. Last week we looked at about 20 causes of fatigue. Fortunately, there are an equal number of treatments. Sleep is one of the most important.

According to the book Power Sleep by James Maas, PhD, and others, “[Sleep] restores, rejuvenates, and energizes the body and brain… [It affects] energy, mood, body weight, perception, memory, thinking, reaction time, productivity, performance, communication skills, creativity, safety, and good health.”

Most people in modern societies do not get enough sleep. Before the electric light, average sleep time was ten hours a night, which Dr. Maas’ team says is “ideal for optimal performance.” The average sleep time has dropped steadily since then. Now Americans average seven hours a night, and fully one third of them sleep six hours or less.

Strong association has been found between glucose levels and sleep. The less sleep, the higher the glucose numbers. High glucose is itself a cause of fatigue, so more and better quality sleep is crucial.

But how to do that? One thing is to relax before trying to sleep. It’s very hard to sleep with stress, tension, anger, fear, or pain. The saying “don’t go to bed angry” isn’t just marriage advice. Do you have a way of settling yourself down before you hit the sack? Are there any stressful things hanging over your head you can resolve, or write down for consideration tomorrow?

I tell myself, “You’ve done enough for today. Take it up again tomorrow.” Some time spent in prayer, meditation, or relaxation might give you a more restful night, hopefully leading to more energetic days.

There’s a whole science of sleep hygiene, habits that make for good sleep. Things like dimming the lights an hour before bed, making sure your room is dark and at a comfortable temperature, and having a “bedtime ritual” that you follow faithfully.

Bedtime rituals can include gentle exercise. I do seated qi gong (video) for about 20 minutes before sleep. I also have an electric massage pad that I can lean against for ten minutes to get a back rub. Both of those things seem to help. Vigorous exercise before bed is a bad idea, though. It will tend to keep you awake.

There may be some truth to the “early to bed, early to rise” folk wisdom. Matthew Walker, director of the Sleep and Neuroimaging Lab at Beth Israel and Deaconess Medical Center, says that we sleep more deeply (non-REM sleep) in the early part of the night. As morning approaches, we move more into REM (dreaming) sleep. Both are important, but the earlier sleep may be more restful, so we shouldn’t feel bad about going to sleep early.

But it’s not just the number of hours in bed that counts. It’s also the quality of sleep. Are you tossing and turning all night? Finding a quality mattress and good blankets is one of the of the most important health investments you can make. Having a quiet room also makes a big difference. If you can’t quiet the room, earplugs or a white noise generator can help keep you asleep.

Frequent trips to the bathroom can be sleep killers. Nocturia (urinating at night more than once) can be due to bladder or prostate problems, which should be checked. But people often wake up and decide their bladders must have woken them, when something else is really the cause.

In people with diabetes, low blood sugar is a common cause for waking, but another common cause in adults is obstructive sleep apnea (OSA.) Because muscles relax during sleep, the tissues of the mouth and throat can sag in, not leaving enough room for air to pass through. Blockage can also occur in the nose, and sometimes the tongue falls back and gets in the way of breathing. You can see a good animation on OSA here.

Since sleeping on the back promotes OSA, sleeping on a side or having the head elevated might stop it. Most people need pillows or bolsters to keep them on their sides, though, and it may be too uncomfortable for some. There are also dental appliances that help keep the throat open, and CPAP (continuous positive airway pressure) machines that keep the airway open by pushing air through. There are also medicines to reduce swelling and stuffiness in the nose. It’s worth trying any of these approaches, if you have a problem with OSA.

Unfortunately, some people, like caregivers for young children or adults with dementia, can’t afford to sleep too soundly. This is a bad situation for a person with diabetes. If you’re in this situation, I hope you can get some caregiving help.

If you have any of these sleep disruptors, or others, like a hypoglycemia alarm that wakes you up, it’s important to know how to get back to sleep. Don’t start thinking! Concentrate on your breathing until you can nod off again.

I believe that daytime sleep (naps) are also good for you. Harvard Health Letter reports tha “New research suggests adding daytime sleep to your schedule as a way to make up for the normal, age-related decay in the quality of nighttime sleep.” They add that naps may “improve learning, memory, and creative thinking.”

The Harvard scientists advise keeping naps short (20–30 minutes,) finding a “dark, quiet, cool place,” scheduling naps instead of waiting until you’re exhausted, and not feeling guilty about it.

This last advice, to me, is most important about sleep in general. We have to get over thinking that sleep is a waste of time, or that life will pass us by if we sleep too much. Sleep is good for us, which means it’s good for the people in our lives. It may also be the number one remedy for fatigue, although it’s not the whole story.

Next week: fighting fatigue by reducing stress. Meanwhile, please comment here and check out my new blog entry on Reasons to Live called “The Soft Survive.”


  1. Thanx for this post, for me it makes sense, mostly because I know how important sleep is for regenerating cells when exercising a lot ;-)

    What I don’t understand is even though I sleep enough (never less than 8-9 hours) and go to bed early, I can’t weak up. When I sleep…I sleep, I never wake up (or very seldom when BGs are to low). I’m tested negative for apnea.

    When my clock rings in the morning 05:45 I’m more tired than before i went to sleep and fall asleep at once again, this results in I first get up at 06:30. This is very frustrating because my day always starts with stress because I get up to late. ;-(

    Does anyone have a clue what could be the reason for this?

    Kind regards,

    Posted by Guido van Gucht |
  2. I have been a diabetic for 4 years now and I wonder about why I have trouble sleeping. Thank you for the information

    Posted by Ruth |
  3. Guido, you are sleeping well but still tired. So how is your glucose when you wake up? Morning fatigue is also a classic sign of stress. Beyond sugar and stress, I’m not sure what the problem might be. Does the fatigue wear off, or are you tired all day?

    Posted by David Spero RN |
  4. Dear David

    My BGs varies, especially in night/morning times. I know (by experience) that higher BGs in the morning increase the “feeling” of being tired. The “feeling” I was talking about is a little different. I’ll try to explain:

    When I wake up I feel so tired that I can fall asleep again, normally my alarm clock wakes me 4 to 5 times. Once I pull myself together and decide I have to wake up the “feeling” will disappear in 1 - 1½ hours, after this time I can tell you I’m filled with A LOT of energy. ;-) Like I told before I ride my bike a lot (approx. 10.000 km a year) so my fatigue is not chronically, but very annoying ;-)

    Last check up my doctor discovered my levels of D-vitamin were very low (tippical for people living in Scandinavia) after taking supplements my fatigue hasn’t been as much as before.

    I think one of the biggest reasons is off course stress, but havening shortage of various minerals, vitamins, etc. can increase both your “stress level” and your psychological health and therefore indirectly your level of fatigue. What do you think??

    Kind regards,
    Guido van Gucht

    Posted by Guido van Gucht |
  5. I agree with you, Guido. Glad the Vitamin D is helping. Hope you can reduce the stress, too.

    Posted by David Spero RN |

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