Diabetes Self-Management Blog

“I don’t think I have insomnia,” said Mabel, a 63-year-old elementary school teacher with Type 2 diabetes. “I go right to sleep at 10 PM. But I wake up to pee, and I can’t sleep again. I start thinking about things, and my brain just keeps running.”

“Usually, the first time, it’s not so bad,” Mabel explained. “But the second time, which is usually around 3 AM, I start worrying about my adult kids, and how the car needs repairs, and how my nephew wants to join the military, and on and on. I can’t stop it.”

Mabel is describing a classic case of sleep maintenance insomnia — falling asleep but not maintaining it. Many people with diabetes share Mabel’s problem, because diabetes will wake you to urinate, or because of sleep apnea, jumpy legs, or low blood glucose. If you fall asleep again easily, it’s no big deal, but if you can’t, you toss and turn and get up exhausted instead of refreshed. How can we fall back asleep more easily?

It turns out that experts totally disagree on this, which typically means there is no one solution that’s right for everyone. Helene Emsellem, MD, author of Snooze…or Lose! told National Public Radio, “When you wake up in the middle of the night, staying in bed and listening to some music or a book on tape with the lights out may help with the transition back to sleep.”

But health writer Jeff Foster says the opposite: “Get up, get out, and get moving. Don’t turn on bright lights…or TV…but turn on a dim lamp and read an uneventful book (one you’ve previously read or even a manual.” Soon your mind will start to slow down and you can softly drift off to sleep again, he claims.

Alternatively, you can often meditate back to sleep. Mabel’s nonstop thoughts are normal; the brain is always thinking. That’s what it’s made to do. You can’t stop it, but often you can block the unwanted thoughts with meditation or imagery.

One way is to focus on your body. Hypnotherapist Kathy Doner, MD, told Health.com, “Try placing your hands on your belly. When you breathe in and breathe out, your hands may gently move. Focusing on this movement gets your mind off of your busy thoughts and onto your body. You can distract yourself and bring yourself to a different place.”

Another way is to block thoughts with a repetitive image (like the classic sheep jumping over a fence) or by repeating a simple “mantra” (a word or phrase like “Peace” or “Om” or “sleep” or whatever works for you.)

It helps if you don’t get too wide awake in the first place. Unfortunately, it may be dangerous to try to maneuver to the bathroom without being fully awake. That’s a common way falls happen. But if you can start saying your mantra the moment you sit up and keep it going until you’re comfortably back in bed, your automatic thoughts might be blocked.

I don’t have scientific evidence for this, but I find it’s sometimes easier to get back to sleep if I lie down in the same position I was in when I woke up. Similarly, remembering a dream you were having tends to put you back under its spell.

If you find yourself waking and it’s not to urinate, and it’s not sleep apnea, it might be worth checking your blood glucose. You might be low. Even if your blood glucose is normal, Jeff Foster advises “have a light snack. Sometimes if you’re hungry, your stomach will keep waking you up until you give in to its desire for food.” He suggests foods with serotonin or tryptophan, such as turkey, fruit, or nuts.

Sometimes you can’t stay asleep because your body or subconscious mind have other priorities. If you haven’t moved enough during the day, your body might want to move at night. If you have work that needs doing, it might help to do some of it.

Mabel finally discovered a way to get back to sleep. “I get up and lay out my clothes and class materials for the next day. I don’t turn on any bright lights, and I try not to think too much, but after that I seem to relax.”

She also found that what she does during the day affects her sleeping at night. “I think I needed to move more. I started walking home from work, and now I’m waking twice a night instead of four times. I wish I could sleep straight through, but it’s an improvement,” she said.

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