Diabetes Self-Management Articles

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Getting the Sleep You Need

by David Spero, RN

While sleeplessness can promote diabetes, symptoms associated with high blood glucose, low blood glucose (hypoglycemia), and some diabetes complications can also interfere with sleep. If your blood glucose level is high, you may be in the bathroom urinating every few hours during the night. Hypoglycemia can cause nightmares, night sweats, or headache; hunger that wakes you up to get food; or symptoms associated with daytime hypoglycemia such as rapid heartbeat, dizziness, or shaking. Tracy Kuo, PhD, insomnia specialist and clinical psychologist at the Stanford Sleep Disorders Clinic, says that a vicious circle can occur with diabetes and insomnia because “diabetic neuropathy can cause restless legs and pain. Fatigue from a poor night’s sleep may keep some people with diabetes from getting enough daytime activity, which in turn makes it harder to sleep the following night.”

Things that keep us awake
As many as 36% of Americans have some type of sleep disorder. That’s a huge number. Why is sleeping so difficult? Sleep specialists have identified the following reasons, among others.

Substances. Sleep specialist Peter Hauri, Ph.D., Co-Director of the Mayo Clinic Sleep Disorders Center, says, “There are three things that have an excellent chance of helping you sleep, no matter what other factors are involved. These things are reducing caffeine, limiting alcohol, and stopping smoking.”

Although coffee and soft drinks are the most commonly recognized sources of caffeine, chocolate, some teas, and some medicines also contain caffeine. Even one cup of tea or a chocolate bar in the afternoon can keep some people up after midnight. Dr. Hauri suggests cutting all caffeine out of your diet. Once you get some normal sleep going, you can try slowly adding the caffeine back. If you smoke, nicotine cravings don’t stop at night, and they can wake you up. The only way out of this trap is to stop smoking completely. Of course, smoking and diabetes are a horrible combination anyway, so if getting a good night’s sleep encourages you to quit, it’s a win–win proposition.

People used to think an alcoholic drink was a good sleep aid, hence the term “nightcap.” But Dr. Hauri says, “Drinking alcohol late in the evening produces troubled and fragmented sleep. The person does not sleep soundly but wakes up several times and does not get back to sleep promptly. By morning, there invariably is less sleep than without alcohol.” Some foods, especially spicy foods, also cause insomnia in some people.

Sleeping pills. Almost all sleep specialists now try to avoid prescribing sleeping pills for people with chronic sleep problems. Although they can be useful for treating some short-term sleep disturbances, hypnotics (sleeping pills) are not usually given to people with chronic insomnia because they can become habit-forming, and people may even experience a rebound effect of more pronounced insomnia when the drugs are stopped. People also rapidly build up a tolerance to many sleep medicines, needing more and more over time to get to sleep. In addition, with some drugs, you can wake up in the morning feeling as tired as if you hadn’t slept at all. You’re also in danger of falling if you wake up in the night to go to the bathroom with sedatives in your system. This is a major cause of broken hips and other injuries for older people, especially people in nursing homes. Over-the-counter sleep medicines are just as bad, according to Dr. Buda.

Depression. Both insomnia and “hypersomnia” (sleeping too much) are classic symptoms of depression. If you lie in bed having thoughts of hopelessness or worthlessness, especially in the early morning, you may be depressed. Because depression is a risk factor for other problems and because it is treatable, you should seek professional help.

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