Sleep, Stress, and Diabetes

I’m not a “studies show this, studies show that” kind of guy, but I think this one is important: After just two weeks of a shortened sleep schedule, insulin resistance and impaired glucose tolerance developed in healthy volunteers.


Published in the Journal of Clinical Endocrinology & Metabolism, the study, out of the University of Chicago, reports on 11 volunteers. Their mean age was 39 and their average body-mass Index (BMI) was 26.5 (a BMI in the “overweight” range). The experimental group was allowed to spend no more than 5.5 hours per day in bed. The other group was allowed to remain in bed about 8.5 hours a night.

The test lasted 14 days. Volunteers in both groups were discouraged from exercising and encouraged to eat as much as they wanted. This was to mimic Western lifestyles, according to lead researcher Plamen Penev, MD, PhD.

After at least three month’s time off, the groups were reversed. The low-sleep group was allowed to get more sleep and followed the same eat-anything diet and low-exercise plan, while the other group was told to sleep less. (This format is called a “crossover design,” because both groups get to try both arms of the trial.)

Body-mass index and weight both increased more during the shortened-sleep phase — BMI by 0.7 points, weight by 2.3 kilograms (roughly 5 pounds). The 2-hour glucose tolerance test results for people in the short-sleep groups averaged 144 mg/dl, compared with 132 mg/dl in the longer-sleep groups. Other tests showed reduced insulin sensitivity in the low-sleep groups.

“When part of a Western-like lifestyle, recurrent sleep restriction can also result in reduced insulin sensitivity,” researchers said.

It’s not the first time science has linked poor sleep to diabetes. An article in the December 2007 edition of the journal Sleep reported that sleeping an average of five hours or less or nine hours or more per night increased the risk for Type 2 diabetes. This was based on data from almost 9,000 people self-reporting on their sleep for over ten years. The long or short sleepers had an almost 50% greater chance of developing diabetes than those who averaged seven hours of sleep. This study used data from the first NHANES, or National Health and Nutrition Examination Survey, one of the biggest studies in the world on the effects of lifestyle.

What Does This Mean?
Scientists admitted that they had no idea how lack of sleep contributed to diabetes. They thought that too much sleep might indicate that inflammation was already occurring, perhaps leading to diabetes. But they couldn’t explain the low-sleep connection.

I’m highly suspicious that the connection has to do with stress. In the University of Chicago study, shortened sleep was accompanied by a 25% increase in nighttime norepinephrine levels. Norepinehprine is a stress hormone. And we know that stress contributes to insulin resistance and diabetes.

I think we should all try to get our 7–9 hours of sleep each day. 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 that many of us get even less. The study found that people with lower income slept less. Men slept less than women, and black people slept less than white people. 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.

So unless you’re rich (and white), you’re probably not getting enough sleep. And maybe not even then. Although the people in this study spent an average of 7.5 hours a night in bed, they spent only 6.1 hours asleep.

We don’t know if it’s the lack of sleep itself that causes problems. It might be that the stress that keeps you awake also causes insulin resistance. But studies suggest that average sleep times have declined since 1900, when people reported sleeping nine hours a night. Studies from the 1970s found self-reported average sleep times closer to seven hours. And the newest study shows that actual sleep (measured with a wrist meter) was closer to six hours.

So what to do? Obviously, we want to reduce stress and get more sleep. Unless you’re really swamped with work and family duties, you should have time for seven hours’ sleep. It might take some work, but let’s face it. As health recommendations go, “sleep more” is a pretty pleasant one.

Remember, there’s no danger of overdoing it. Unless you’re seriously depressed or have another underlying medical condition such as a sleep disorder, you can’t really oversleep. Your body just won’t sleep when it’s not tired. The place to start is by keeping a sleep log to find out how much you’re actually sleeping now. Then see how you can increase that time. Let us know how it goes. I’ll be right there with you — I think I really need to practice what I’m preaching on this one.

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  • Deb

    This is fascinating. The same thing is true with fibromyalgia – many of its symptoms can be mimicked simply by loss of quality sleep. True fibromyalgia also has a sleep disorder in which deep sleep is interrupted, but folks who’d like to see how it feels to have fibro can just sleep less for several days or a week!
    No wonder I also got diabetes, since I wasn’t getting a lot of sleep and because of my fibromyalgia, the sleep quality was poor.
    Obviously sleep does a lot more than knit the raveled sleeve of care.

  • Deb

    This is fascinating. The same thing is true with fibromyalgia – many of its symptoms can be mimicked simply by loss of quality sleep. True fibromyalgia also has a sleep disorder in which deep sleep is interrupted, but folks who’d like to see how it feels to have fibro can just sleep less for several days or a week!
    No wonder I also got diabetes, since I wasn’t getting a lot of sleep and because of my fibromyalgia, the sleep quality was poor.
    Obviously sleep does a lot more than knit the raveled sleeve of care.

  • Kathy

    This article is quite interesting. I was recently diagnosed with sleep apnea and prescribed cpap therapy. My diagnosis came as a complete shock. I thought that my numerous trips to the bathroom at night were because of my diabetes. Now that I’ve been on cpap therapy for about 6 weeks I only get up once a night, if that, and my sleep quality is greatly improved. I had absolutely no idea that sleep was so important.

  • Phyllis

    I might have time for sleep but tell that to my body! Many nights I get less than 6 due to pain, stuffy nose, or being too hot, no matter what I do and believe me I’ve tried just about all there is – Lately, it’s abit better but it’s a night by night thing……

  • CalgaryDiabetic

    It is obvious that a goodnight sleep is a must to stay healthy. What is not obvious is how to achieve it. The more so if you have a chronic disease.

  • Norma

    I suffered broken sleep for 3 years during and after menopause. I went to sleep okay, but awoke after 4 hours and couldn’t get back to sleep for at least 2-3 hours. I’d tried medication, but don’t really like to take anything if I don’t have to. I’d heard QiGong and Tai Chi were good for your health and started doing it 3-4 times a week and after about four weeks I slept all night. I was thrilled and continued to practice. It’s been 9 months now and I still am sleeping throughout the night. I also have more energy and better focus. I’m very grateful to have stumbled across this internal martial art. Wouldn’t give it up!

  • Nancy Russell

    This was certainly true for me. My job became so stressful that I was not sleeping. The blood sugar raised and my overall health decreased. I quit/retired and within 6 months, sleep was only slightly better and the A1C has been on a slow decline.

  • Symposier

    My endocrinologist told me that as diabetic I should sleep 8hours every night, this is to help the way insulin and glucose is metabolized, If we have a daily routine, our body will be more used and will not have problems. This researches seems to be very interesting, a lot of people is not getting enough sleep hours. Hope that people can read this article and start taking more serious their sleep time.

  • Margaret Ngim

    In regards to sleep article can afternoon naps be included as getting the proper amount of sleep?

  • David Spero RN

    This is a good question about naps. I don’t think there is a definite answer yet. Naps seem to be good for heart and general health, if you don’t overdo it. Too much napping interferes with nighttime sleep, which is bad. But shorter naps are probably quite good for you. Some European studies show that those who nap each day have fewer heart attacks.

  • Bev

    I also have diabetis. I try and look for sugar free things to eat. I have discovered that every diet product out there has a sugar substatute called Aspertame Aspertame is very very bad for your body. It gives you flu like symptoms. Head aces. and the same thing that fibromialgia caues. before you eat or drink any thing check for Aspertame if it is in the product Please do not use it. and with in a few weeks you will feel like a new person. I am talking from experience here. Look it up and see what it does to your body you will never touch it again.


  • debbie

    My boyfriend is a stage 2 diabetic, he is 66yrs old and he sleep a lot. His naps are 2-3 hours 2 times a day. Is that heathly?

  • Dave

    This is interesting, I’ve been a Diabetic for a number of years, however through my 20s and 30s I was heavily addicted to caffeine and slept between 3 to 4 hours on average. This probably explains the onset of my Diabetes, since I was quite active, and have no Diabetes in my family (that I know of).

  • Frank

    Longer and less interrupted sleep clearly seems better for me. However, it’s difficult to achieve if you’re a spontaneous, now’s the time variety of person. On the one hand, every additional med or techno device (clap, cgm, pump) is an imposition that assails ideal living; but it prolongs living, and in fact often improves it, once the initial utilization curves are maneuvered. So I succeed inconsistently, but I believe that’s better than merely accepting your sleep deficits. If I can reduce late night insulin resistance by improved sleep, I think it would improve my long-term prognosis and also improve (and maybe even stabilize) my levels of energy during the day. The component of energy as part of the recipe for a fulfilling life cannot be overemphasized.