Diabetes Self-Management Blog

Want to live longer? Get more sleep. A new study from the New England Research Institutes shows that waking more than twice a night to urinate increased mortality risk 50% among men and more than 30% among women. Nocturnal awakenings to use the bathroom also doubled the mortality risk in people younger than 65.

(You might ask, isn’t everybody’s mortality risk 100%? That’s true, but “mortality risk” refers to the risk of dying within a set time, say one year.)

These findings confirm what has been reported many times before. This study from England found lack of sleep can more than double the risk of death from cardiovascular disease.

In general, most people need between 7 and 9 hours of sleep a night for best health. Unfortunately, a July 2006 report in the American Journal of Epidemiology reports that the average American gets less than 7 hours of sleep nightly. That means many of us get even less. The study found that people with lower income slept less. Men slept less than women, and blacks slept less than whites. Black men averaged only 5.1 hours of sleep, which is classed as “sleep deprivation.” Interestingly, these are the same patterns you see in overall health and longevity.

Of course, too much sleep is also a bad sign. But most people who oversleep don’t do so out of habit. They sleep too much because they’re already sick, depressed, ill-fed, or exhausted. But under-sleeping can make healthy people sick and make existing problems worse.

So why do people sleep too little, and what can we do about it? I recently started working with a new client. He’s 66, with Type 2 diabetes. He plays two sets of tennis a day and eats pretty well, but his blood glucose still runs high. I think it’s because he sleeps so poorly. He’s up five times a night to go to the bathroom.

Getting up at night to urinate (nocturia) is one major reason for lost sleep. Doctors used to think that, in men, nocturia was usually caused by an enlarged prostate gland. Men had their prostates surgically reduced to treat nocturia, but many of these men got no relief.

It turns out that men and women are about equally likely to suffer from nocturia, so it couldn’t be mostly about the prostate. Low-level infections and nerve problems in the bladder are among other urological causes of nocturia.

Nocturia is the most commonly cited reason for awakening by men and women alike, but that may be misleading. People may wake for other reasons and assume it was because they had to urinate.

Diabetes can cause broken sleep in two ways. High blood glucose leads to increased urination, while low blood glucose causes people to wake up from hunger. They may think they woke to urinate, when it was really the low blood glucose levels.

People with sleep apnea often think they are waking to urinate, when actually they are fighting for air. Having jumpy legs or “restless leg syndrome” is a neurological problem that can cause waking, which may be mistaken for nocturia.

The Web site Stop Being Tired (SBT) lists the following causes for waking up and suggests solutions.

  • Sound: If there’s too much noise in your environment, get a white noise machine to block the sound, wear earplugs, or tell whoever is making the noise to cut it out. You need your sleep.
  • Alcohol may help you fall asleep, but tends to wake you up in the night. So don’t drink in the evening.
  • Medicines: Ask your doctor or pharmacist if your meds could be waking you up.
  • Allergies: SBT identifies cow’s milk as a frequent allergic cause of waking; people often drink a glass of milk at bedtime.
  • Low blood glucose: If you suspect this may be waking you up, (for example, if you have dawn phenomenon), figure out what you can to do avoid it. Perhaps changing evening snacks or medicines will stop these mild hypoglycemic episodes.
  • Deficiencies of magnesium, iron, tryptophan, or vitamin B6. You can get these from food or in supplements.
  • Stress: Here are some tips on reducing stress or coping with it through relaxation.
  • Lack of exercise: I think this might be the most common cause. Bodies won’t sleep if they’re not tired. Don’t exercise too vigorously in the evening, though. It may wind you up. Something mild like yoga or qi gong is really good for sleep.
  • Room too hot or too cold: SBT says room temperature should be between 60°F and 65°F for best sleep.

I really want to stress this. Sleep is crucial to health, although we don’t know all the reasons. If you’re having nocturia, or if you’re tired in the morning and don’t know why, get yourself checked out for urinary problems and for sleep apnea. Consider the other possibilities listed here and see what you can do about them.

Check in with us and let us know what’s working and what isn’t. Sleep is a really important part of self-management.


  1. Dear David

    You wonder then if the diuretic I am taking to reduce a slightly elevated BP is doing more harm than good. I try and take mine at 6 am(when I wake to pee) and hope that the effect wears off by the next evening, it does not entirely.

    Posted by calgarydiabetic |
  2. This helped me understand why I get up in the middle of the night. I try to limit my liguid intake so I don’t wake up. I will definitely try to get more sleep.

    Posted by Lorraine |
  3. Dear David,

    I was having urinary tract infections, one after another. My glucose was high and I was waking up to pee 3 or 4 times a night. I have been taking a low dose of macrobid, watch my diet and my evening snack, and now wake up to urinate only once a night but when I do wake up, it is a race to make it to the bathroom in time. One problem solved, one problem to replace it. Never-the-less, it is an improvement!

    Linda, Montana

    Posted by linda garrow |
  4. Great info! Sleep is so necessary for good health - no matter what other conditions you might have. sleep apnea can often be treated just by controlling one’s weight. In my blog http://howtosleepinfo.com I have lots of info on sleep problems, such as sleep apnea, and getting a better night’s sleep. Thanks!

    Posted by Wil Dieck |
  5. Magnesium supplements really help me with nocturia
    I found this by accident. I was having very severe leg muscle cramps . Concurrently I was also having to get up 5 times a night to urinate. I took a dose of a magnesium powder supplement with magnesium citrate and amino acids. Because of the severity of the cramps I took four tspns of the powder instead of the recommended one. The cramps eased over the next few days and went away. That night I was amazed that I did not go once to the toilet. I slept all the way through!. Since then I usually go once. Recently I started going more frequently, as I haven’t maintained the regime of taking the powder. I took it again, and the result was repeated. Wonderful!!!

    Posted by Michel |
  6. Great tip, Michel. I’ll try it and hopefully others will too.

    Posted by David Spero RN |

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