People with diabetes hear constantly to exercise, eat right, and check blood sugars. Doctors rarely mention the importance of sleep, but good sleep is among the best diabetes medicines.
A paper from Penn State University found that the risk of death from stroke and heart disease was significantly higher in people who get less than six hours of sleep a night. Researcher Julio Fernandez-Mendoza, PhD, said, short sleep “multiplies the risk of poor outcomes in people with CVD [cardiovascular disease] or stroke.” Heart disease and stroke are the leading causes of diabetes-related deaths.
“We have to look beyond sleep apnea,” said Dr. Fernandez-Mendoza. “Most of these patients without sleep apnea but with coronary vascular disease or stroke complain of poor sleep or chronic insomnia. We know now that when such objective short sleep is present their long-term prognosis is much worse.”
Obstructive sleep apnea (OSA) has been known for years to increase risk of Type 2 diabetes, heart disease, and early death. In sleep apnea, people stop breathing repeatedly while asleep, because their airways are blocked by relaxing throat muscles. They wake up to clear their throat so they can breathe and then fall back asleep, over and over, usually without being aware of it. Penn State researchers found that people with OSA had three times the risk of Type 2 diabetes and four times the risk of high blood pressure (hypertension.)
According to the American Sleep Association, “animal studies show that sleep is necessary for survival.” The immune system, our bodies’ repair system, is strengthened by sleep. Rats deprived of sleep developed sores on their tails and paws because their immune systems weren’t working.
I don’t know how the rats were kept awake, but this sounds like a very cruel study. Rats normally live for two to three years. Those deprived of REM (dream-time) sleep survived only about five weeks on average, and rats deprived of all sleep stages lived only about three weeks.
Sleep “may help the body conserve energy and other resources that the immune system needs to mount an attack” on invaders or heal injury. When we’re awake, our bodies may work so hard on immediate needs that they don’t have time to heal.
According to the Sleep Association, the nervous system needs sleep to keep functioning well. “Some experts believe sleep gives neurons a chance to shut down and repair themselves. Without sleep, neurons may become so depleted in energy or so polluted with byproducts of normal cellular activities that they begin to malfunction.” Sleep is crucial for good memory function and learning, which may be why children need more sleep than adults.
In addition to allowing nerves to recharge, sleep seems to promote the body’s creation of proteins. Proteins are the building blocks of animal life. Pretty much every vital chemical in the body, from insulin to hemoglobin, is a protein or made from proteins.
The website How Sleep Works says sleep is a time where the body resets itself. Toxins are neutralized, normal levels of chemicals are restored. Apparently “REM sleep is largely devoted to brain repair and restoration,” they say, “while non-REM [deep] sleep is principally a time for body repair and restoration.”
Basically, being awake is stressful, and sleep is healing. One result is that people who get less sleep have much more insulin resistance and higher blood sugar levels.
Why it’s hard to sleep
Our society does not value sleep and makes it difficult in dozens of ways.
If you have trouble getting to sleep, stress is often the problem. If you find yourself waking in the night, that is often a physical symptom such as sleep apnea, jumpy legs, or an overactive bladder. It could also be hunger or low blood sugar. If you find yourself waking too early with a head full of worries, that could be hunger or it could be depression or anxiety.
Some people don’t have good places to sleep. Imagine trying to get a good night’s sleep if you’re homeless. It can’t be done. But even housed people can have too much noise, too much light, too uncomfortable a surface, or too much household stress to sleep well.
Some medications, such as those containing caffeine, can keep you awake. Getting wound up before bed on the computer or watching TV might make sleep difficult. Lack of physical movement during the day makes it hard to sleep at night. Vigorous exercise before bedtime can excite you and make it hard to let go.
How to get more sleep
All bodies need to sleep, even if our minds don’t want to. Here are some ways:
1. Get checked for medical problems that might be waking you up. For example, there are good treatment options for OSA, including CPAP machines, the new Provent nasal valves, and the Inspire implantable stimulator that keeps your airways open.
2. Set up your environment for sleep — have a comfortable bed, a dark room (or an eye mask, if needed), and quiet (use earplugs, if nothing else).
3. Set up your evening for sleep — do a quieting half hour before bed, with meditation, quiet music, cuddling, or petting time. Don’t take your smartphone to bed; don’t watch the news or upsetting shows in bed. In fact, don’t use your bed for anything except sleep and sex, or stretching in the morning before you get up.
4. Set up your days for sleep — get sunshine during the day. Use a sunlamp if there’s no sun where you live. Sunshine causes your body to produce the neurotransmitter serotonin. This converts to melatonin, which helps with sleep at night. Get some physical movement, so your body doesn’t want to move when it’s time to sleep.
5. Prevent hunger and low blood sugar. A bedtime snack including protein and some complex carbohydrate might help you stay asleep.
6. In consultation with your health-care provider, consider proven sleep supplements such as magnesium and valerian.
7. Get help with anxiety, stress, and depression, if you think those might be problems.
8. Accept that sleep is important. It’s not being lazy; it’s not shirking your responsibilities. Your body needs it. You may have to spend some time in the day clearing up things that are worrying you, like taking care of the kids so that you can relax and heal at night.
Want to learn more about getting sleep with diabetes? Read “Getting the Sleep You Need,” “Have Diabetes? Can’t Sleep? Don’t Eat These Tonight,” “Eating for Better Sleep,” and “Getting to Sleep and Staying There.”
David Spero, BSN, RN
A nurse for 25 years at University of California San Francisco and Kaiser hospitals, and one of the first professional health coaches. Nurse Spero is author of Diabetes: Sugar-Coated Crisis and The Art of Getting Well: Maximizing Health When You Have a Chronic Illness, as well as co-author of Diabetes Heroes and the diabetes chapter in Where There is No Doctor. He writes for Diabetes Self-Management, Pain-Free Living, and Everyday Health.
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