Stop Waking Up! (Part 2)

Last week, we talked about how sleep apnea (SA) is common in people with diabetes and may even be a major cause of Type 2 diabetes. This week, we’ll focus on treatment.


In the recent Diabetes Self-Management article “Sleep Apnea and Type 2 Diabetes: A Vicious Circle,” SA expert Ralph Pascualy, M.D. writes that treating SA can:

  • Lower blood pressure
  • Raise insulin sensitivity (a good thing)
  • Reduce inflammation
  • Reduce risk of cardiovascular events (such as heart attacks)
  • Reduce utilization of health-care resources, and
  • Improve quality of life

Treating SA also helps people lose weight and gain energy and reduces the risk of auto accidents (because you’re less sleepy). But how do you treat it?

SA Self-Management
If you have SA, there are things you can do for yourself.

  • Get as much sleep as you can. Sleep deprivation increases snoring. Your sleep will be rough enough anyway, so get enough bed time, and do all the things you can to prevent insomnia.
  • Try not to sleep on your back.
  • Cut back on or stop smoking and drinking.
  • Do not take sleeping pills (they can increase snoring and may increase SA).
  • See a doctor about clearing up nose congestion or nose anatomy problems. Options can occasionally include surgery. Mouth breathing increases your chance of SA.
  • Raise the head of your bed.

If your SA is mild, self-care may be all you need. But if you still feel bad or snore loudly after self-management, you should ask your doctor about a CPAP.

The Magic Machine
Many people with SA benefit from CPAP (continuous positive airway pressure). CPAP can be delivered by a nose, mouth, or face mask attached to an air pump. The air flow acts like a splint, keeping the airways open.

Lyle D. Victor, M.D., writes that the pressure can be set to the user’s comfort level. Some machines have variable pressure settings so patients can “ramp up” to a level that stops SA but keeps them comfortable. These may be called “BiPAP” (for “bilevel”) or APAP (for “auto-adjustable”) positive airway pressure.

Complications of CPAP use can include nasal dryness and congestion, claustrophobia, and eye irritation. It’s important to try several masks to find the most comfortable fit. There are dozens of shapes and fits. (See more at

Dr. Victor advises adding humidification to the air flow. The humidification helps the nose and throat irritation that can be CPAP’s main side effect. You may also need some emotional support as you get used to it.

Getting Used to It
A report from the University of Maryland says that “All patients should be warned that the first few nights of CPAP therapy are unnerving. The device often produces anxiety, primarily because of the mask. Starting out with low pressure to get used to the mask may help.”

Some people find that their chest feels sore in the morning at first. This is because of having more air in their lungs.

CPAP is not curative. It’s symptomatic relief. You may have to wear it for a long time, even for life. But thousands of people are finding it incredibly valuable. And as you get healthier and stronger, and perhaps lose some weight, you may be able to stop.

What have been your experiences with CPAP? What self-management measures have you tried, and how have they worked? How is it going for you? Let us know by commenting here.

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  • Judy

    I use a cpap machine but in your article it says you should not sleep on your back – if I don’t I can’t use the machine – I can’t find a mask that works when I sleep on my side, and yes, I’ve tried several.

  • germare

    I was diagnosed with sleep apnea & use a cpap with nostril pillows. This realy works for me. It’s more comfortable than the mask. I sleep for 5 to 7 hrs.without waking & feel completely rested.

  • janet jensen

    My apnea was diagnosed at age 69 and was the last of 4 family members to know about it. My brother and 2 sisters also use CPAP’s. Two of us also have Restless Limb Syndrome for which we were prescribed klonopin. I also had insomnia at same time. Use of CPAP has made a huge difference in my energy. I also have pre-diabetes and am on no medication, except the endocrinologist wanted me to use Amaryl to stimulate the pancreas to make insulin. I have doubts about that, but she said my pancreas will “wear out” and have to use insulin sooner.
    I know sleep apnea & diabetes can go together.

  • David Spero RN

    Judy, it’s important not to sleep on your back BEFORE you get the CPAP. I think most CPAP users do sleep on their backs, at least sometimes. It still might help to have your head elevated. What do other people think?

  • Barbara

    My mother is a diabetic, not on insulin yet. She snores unrealistically for a lady. I work for a Sleep services company but have been unable to get her to even think about Apnea. Now her physician is wanting to attach a pacemaker to her heart as he has told her that her heart stops beating for a brief moment at a time. I absoultely do not believe he has her best interest at heart. After all, pacemaker verse Sleep study, more money for him. Forgive me, I am a little disgusted with him. But after reading your article David, I have renewed hope that I can convince her to get that second opinion.
    Thank You for your concern for America’s health,
    Barbara Grice

  • Sharon

    David, I enjoy your articles. Thank you for all of the information you provide.

    I’m a disabled 62-year-old T2, with multiple diabetic complications, on oral meds and insulin. A few months ago, I was diagnosed with severe sleep apnea; however, I am unable to purchase a CPAP because my insurance does not cover it and I am living on a very small fixed income.

    Does anyone know of an organization or medical institution that might provide CPAP machines and/or accessories to those of us that cannot afford treatment? I belong to Kaiser Permanente (HMO), and the only answer I could get from them was, “Oh, that’s too bad.”


  • David Spero RN

    I would put some pressure on Kaiser to pay. Do you have any durable medical equipment coverage at all? In any event, this will save them money, because you won’t be as sick and won’t need as many of their services.

    Do you have an advocate (a friend, family member, or someone on staff) who has a loud mouth and can fight for you? I think you can win this one, although it might take a while.

    Good luck and let us know how it goes.

  • Dave Michaels

    My best CPAP compliance tip? Try taking an antihistamine just before bed. Not something that makes you drowsy like Benadryl. If you can’t keep the mask on it a clogged nose might be the culprit.