Sleep and Diabetes: What’s the Connection?

Sleep disturbances, including insomnia, sleep-disordered breathing, sleep apnea, and restless leg syndrome, are very common in the United States. In people with diabetes, disordered sleep can upset blood glucose levels, and erratic blood glucose levels can disrupt sleep in a vicious cycle. Here are the findings of the latest research into the association between sleep and diabetes and the newest approaches to treating insomnia and getting a good night’s sleep.

Sleep disorders in the United States

If you’re having trouble sleeping, you’re not alone. It appears that Americans are not getting enough sleep. According to a review in the medical journal The Lancet in 2012, nearly one quarter of all adults are dissatisfied with their sleep patterns, and 10 percent have full-blown insomnia.

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Insomnia can take many different forms. It may mean taking a long time to fall asleep — 30 to 45 minutes or more. It may mean waking up many times each night. For some people, the problem may be waking up early and being unable to get back to sleep. Some people simply wake up feeling tired and are unable to function well during the day.

Many factors can contribute to insomnia, including chronic stress or a sedentary lifestyle. Major life events such as divorce, death of a spouse, job changes, or moving to a new home can also trigger insomnia. Working at night or having frequent, major changes in work hours can also disrupt sleep.

Insomnia can be caused by any number of medical conditions, including heart failure, gastroesophageal reflux disease (GERD), lung disease, arthritis, Alzheimer’s disease and incontinence. Insomnia, in turn, can contribute to psychological depression, high blood pressure, diabetes, and congestive heart failure.

The diabetes connection

For over a decade, medical researchers have known that insomnia and sleep-disordered breathing — a condition characterized by loud snoring in which breathing stops and starts repeatedly — are more prevalent in people with Type 2 diabetes. Furthermore, they are realizing that sleep disorders can disrupt diabetes control and contribute to Type 2 diabetes. In a 2015 study reported in the journal Diabetes Care, researchers examined the association between Type 2 diabetes and sleep-disordered breathing, insomnia, and daytime sleepiness in 5,888 participants 65 years of age or older from four U.S. communities. They found that sleep apnea, snoring, and daytime sleepiness were correlated with higher fasting glucose levels, lower insulin sensitivity, and higher insulin secretion. The risk of developing Type 2 diabetes was linked with sleep apnea, snoring, and daytime sleepiness.

Getting a good night’s sleep

People vary widely in terms of how much sleep they need each night. One way to determine how much sleep your body needs is to take note of how long you sleep when you don’t set an alarm, such as over the weekend or while on vacation. If you sleep substantially while on vacation, that is a clear sign that you aren’t getting the sleep you need in everyday life.

There are a number of different approaches to treating insomnia. Doctors often first try to treat insomnia using behavioral approaches, such as sleep hygiene education.

Sleep hygiene

Sleep hygiene includes the following measures to help people sleep.

• Avoid alcohol, caffeine, and nicotine, especially right before bedtime. Caffeine and nicotine are both stimulants. Alcohol, which is a depressant, keeps you in the light stages of sleep, making you feel less refreshed in the morning.

• Get plenty of exercise, which can combat stress and help you feel pleasantly tired at the end of the day. However, avoid strenuous exercise within a few hours of going to bed because it can rev up the body.

• Avoid looking at screens, such as computers and smartphones, right before bed.

• Avoid watching TV, eating, or reading in bed because these activities can weaken the association between bed and sleep.

• Get into a pleasant and relaxing bedtime routine, such as reading or listening to quiet music before you go to the bedroom.

• Don’t go to bed until you are sleepy.

• Don’t work too hard at falling asleep. If you awaken during the night and can’t get back to sleep after several minutes, get out of bed. Find something monotonous to do, like folding laundry.

• Try to go to bed and wake up at the same time each day, even on weekends. That helps get your body into a regular routine.

• Avoid eating a large meal or drinking a large amount of liquid before bedtime. This can lead to heartburn or the need to get up during the night to urinate.

• If there is too much noise in your environment, consider getting a white noise machine to help you tune it out.

• Make your bedroom dark or, if necessary, wear shades over your eyes.

• Keep your bedroom at a comfortable temperature.

Relaxation therapy

Relaxation therapy may also help some people sleep, especially if anxiety is keeping them awake. One approach is a tension-relaxation exercise, in which a person tenses his or her muscles for one to 10 seconds and then relaxes them, starting with muscles in the face and gradually moving down the body to the feet.

Biofeedback

Biofeedback is also an effective tool for alleviating insomnia related to stress. In this technique, patients are able to observe changes in what are normally involuntary processes — such as heart rate, blood pressure, and muscle tension — and learn to control them.

Electromyography (EMG) biofeedback measures the tension in muscles. Sensors are placed over the forehead or neck muscles or other muscle groups throughout the body. The sensors measure muscle tension, which is then displayed on a computer screen. By becoming more aware of the tension in their muscles, patients can learn to relax.

In respiratory feedback, belts with sensors are placed around the chest to record a patient’s breathing patterns. People who are anxious tend toward rapid and shallow breathing. With the help of the biofeedback therapist, the patient learns to breathe deeply and slowly to help relieve anxiety.

In neurofeedback, sensors are placed on the head, enabling patients to see for themselves how the electrical activity of the brain changes as they relax. With the help of the biofeedback therapist, patients learn how to slow their brain activity to alleviate stress.

In thermal biofeedback, sensors are attached to the fingers or feet to monitor temperature. Stress produces cool or cold skin, whereas relaxation warms the skin. Patients read a digital display of the temperature, which is accompanied by a sound that rises in pitch as the skin temperature rises. Thus, patients learn to control their stress by initiating stress-reduction techniques when their skin temperature is low.

Cognitive therapy

Cognitive therapy seeks to break the vicious cycle in which people worry too much about their insomnia, which in turn makes the insomnia worse. Cognitive therapy is designed to identify negative thoughts that contribute to anxiety and replace them with more positive, constructive ways of thinking. Cognitive behavior therapy, which typically lasts eight to 10 weeks, combines cognitive therapy with sleep hygiene education.

If insomnia interferes with a patient’s ability to function during the day, the doctor may prescribe medications. Sedative-hypnotic medications are the most commonly prescribed to treat insomnia, such as quazepam (brand name Doral), triazolam (Halcion), estazolam (Prosom), temazepam (Restoril), flurazepam (Dalmane), zaleplon (Sonata), eszopiclone (Lunesta), and zolpidem (Ambien). All these medications have side effects that the doctor and patient must weigh against the consequences of the patient’s insomnia. Sleep disorders such as insomnia and sleep apnea can have devastating effects on your blood glucose control and your health in general. If you are having difficulty sleeping, do yourself a favor and consult your health-care team.

Want to learn more about sleep and diabetes? Read “Getting the Sleep You Need,” “Why Sleep Is Important With Diabetes,” and “Sleep Apnea: A Hidden Enemy in Diabetes.”