Diabetes and Sleep
It’s widely agreed upon among researchers that there is indeed a link between diabetes and sleep habits. Answering the question of why sleep is linked to diabetes is relatively straightforward. Less sleep decreases your ability to regulate blood sugar, leaving you vulnerable to developing Type 2 diabetes.
But explaining exactly how sleep affects diabetes is complicated. Because of the direct and indirect link associated with sleep and diabetes, experts have identified a multi-faceted view of just how sleep deprivation puts our body at risk for diabetes.
Sleep affects your metabolism, appetite, diet, cravings, and hormones like insulin. Any of these things, when out of balance, can cause your health to nosedive, placing you at risk for a disease that affects millions.
The American Diabetes Association reported 30.3 million Americans had diabetes (both types) in 2015. This equates to a little under ten percent of the population. Ninety percent of diabetics in the country have been diagnosed with Type 2 diabetes.
In 2017, the Centers for Disease Control reported an additional 84.1 million people have prediabetes, a condition where your blood sugar levels are higher than normal. Prediabetes easily leads to a diagnosis of type 2 if not treated.
Because of the wide-reaching effects of diabetes, it’s critical to understand how sleep decisions impact your overall health, especially when stacked against this deadly disease. First, let’s take a look at the disease itself.
Insulin is the hormone responsible for turning sugar, commonly referred to as glucose, into energy. When it comes to diabetes, your body’s relationship with insulin is a key contributing factor, whether it’s because of surplus production or a complete lack of production.
When all systems are working properly, the pancreas sends insulin into the blood, giving the green light to sugar to enter your cells, creating energy and regulating your total blood sugar levels.
Type 1 Diabetes
Type 1 diabetes is categorized as an inability to produce insulin. Type 1 diabetics’ bodies simply can’t produce the hormone on their own. In fact, the body’s immune system mistakenly identifies these insulin cells as harmful intruders, destroying them. Without insulin, the glucose can’t enter your cells and instead builds up— sometimes fatally— in your bloodstream.
According to Beyond Type 1, an information source for Type 1 diabetics, approximately 1.25 million people have been diagnosed with Type 1 Diabetes, and 200,000 are under the age of 20. Beyond Type 1 projects 5 million people will be diagnosed with Type 1 diabetes by the year 2050. Additional statistics for Type 1 diabetics report that roughly 40,000 people are diagnosed each year.
While the exact cause of this type of diabetes is unknown, significant risk factors for developing Type 1 diabetes include:
- Family history: You face a marginally higher risk of being diagnosed with this disease if an immediate family member also has Type 1 diabetes.
- Genetics: Your genetic makeup is a strong indicator, as certain genes present a higher risk than others when it comes to developing Type 1 diabetes.
- Geography: Interestingly enough, Type 1 diabetes has higher incidence rates the farther away you travel from the equator.
- Age: Type 1 diabetes most commonly appears in children ages 4 to 7, as well as ages 10 to 14.
Type 2 Diabetes
Type 2 diabetes differs slightly from type 1. While most Type 2 diabetics can produce insulin, the challenge comes because their bodies don’t respond to it. Eventually, if the disease progresses aggressively enough, the pancreas may stop creating insulin altogether.
Most commonly, poor sleep habits are directly and indirectly linked to a heightened risk for Type 2 diabetes rather than Type 1 diabetes. This is because our sleep habits are closely connected to the body’s processes for producing insulin.
Significant risk factors for Type 2 diabetes include:
- Family history: A previous family medical history of diabetes leaves you with a greater risk for being diagnosed with this disease.
- Health: High blood pressure, poor cholesterol, polycystic ovary syndrome, depression, a history of gestational diabetes, a history of heart disease or stroke can all be risk factors for Type 2 diabetes.
- Activity: A sedentary lifestyle is a major risk factor for this form of diabetes.
- Age: Your risk of developing Type 2 diabetes increases after age 45.
- Body composition: Overweight or obese individuals are more likely to develop Type 2 diabetes. Many comorbid conditions related to obesity lead to poor insulin production and response, leaving too much sugar in the bloodstream.
The Link Between Diabetes and Sleep
According to the Journal of Clinical Endocrinology and Metabolism, sleep deprivation is an overlooked, yet strong risk factor for developing Type 2 diabetes because of the major disruption it causes to hormone production in the brain.
Decreasing your sleep to four or even six hours a night can put you at a greater risk for Type 2 diabetes. Here’s how it works: when you skimp on sleep, your body doesn’t produce as much insulin. Remember, this is the hormone that helps control your blood sugar.
To compensate, your body produces more stress hormones (like cortisol) to help you stay awake, but at a cost. The increased cortisol levels combat insulin’s effectiveness to regulate your blood sugar, leaving you with higher levels of sugar in your blood, making you a prime candidate for Type 2 diabetes.
Researchers at the University of Warwick, based in the United Kingdom, found that both quantity and quality of sleep (or perhaps the lack thereof) are key factors that continue to predict the likelihood of developing Type 2 diabetes.
Quantity of Sleep
Experts say the optimal amount of sleep each day should be seven to eight hours. This healthy habit, they say, will easily lower your risk for Type 2 diabetes.
A Harvard T.H. Chan School of Public Health found that women middle-aged and older who either sleep too little (six hours or less) or sleep too much are at an increased risk for developing Type 2 diabetes. In fact, those who sleep too much— defined as an average two-hour increase above standard recommendations over several years— had a risk increase of 15 percent.
Research out of Columbia University shows that habitually short sleep can cause insulin resistance. Poor sleep can ramp up your sympathetic nervous system, the part of your nervous system responsible for your body’s fight-or-flight responses. Increased activity within the sympathetic nervous system can misalign hormone production.
Additionally, high activity within the sympathetic nervous system can also manifest itself as an increased heart rate and blood pressure— central cogs in the insulin health machine. Over time, this increased activity, combined with other related factors like cortisol production, can leave you vulnerable to developing Type 2 diabetes.
An additional Harvard study suggested that simply increasing your nightly sleep average to the recommended amount, especially if it comes after years of poor sleep habits, may not be enough to completely lower your risk. Because of this, it’s important to alter any poor sleep habits now to ensure optimal health for years to come.
Quality of Sleep
One of the reasons quality sleep is so important when it comes to diabetes risk is because of all the restorative work that happens during the deep stages of REM sleep. When you reach these levels, both in REM and non-REM sleep, your brain is able to maintain the recommended insulin levels.
While you sleep, your body cycles between non-REM and REM sleep. Both are important for your body’s overall upkeep. A cyclical pattern, sleep ideally begins with the three stages of non-REM sleep followed by REM, or rapid eye movement, sleep. The pattern then repeats.
The stages of Non-REM sleep, each lasting from five to 15 minutes, are as follows:
- Stage 1: In this first phase, you are barely asleep and can be woken easily. This phase can last five to ten minutes.
- Stage 2: In this light sleep, your heart rate and body temperature begin to decrease as your body prepares for a deeper stage of sleep.
- Stage 3: You’ve reached deep sleep. During this stage, it’s harder for someone to wake you up and when you do, you often feel confused or disoriented. It is during this stage of sleep that your body begins its restorative work of regrowing tissue, strengthening bones and muscles, and cultivating a healthy immune system.
What follows, normally 60 to 90 minutes after falling asleep, is your first REM sleep, which lasts about 10 minutes. As the cycle of non-REM and REM sleep continues, your REM sleep stage gradually gets longer, extending from the initial 10 minutes to a full hour.
Slow-wave sleep, which occurs in the final stage of non-REM sleep, is considered the most restorative form of sleep and is vital to maintaining healthy insulin levels which regulate your blood sugars. This critical stage of sleep also helps restore metabolic, endocrine and cardiovascular systems.
For more information on the link between diabetes and sleep, visit:
- American Diabetes Association – Sleep Duration as a Risk Factor for the Development of Type 2 Diabetes
- Sleep disorders and the development of insulin resistance and obesity
Sleep, Appetite, and Diabetes
Additional, indirect ties between sleep habits and diabetes can damage your health. Disruptions to your sleep patterns can misalign how your brain calculates your appetite. If you’re sleep deprived, it’s common to overeat because of imbalanced hormones which signal that you’re hungry, even after you’ve enjoyed a full meal. These cues can lead to overeating and weight gain— both precursors to Type 2 diabetes.
When you don’t get enough sleep, your body can’t produce enough of the hormones that regulate your hunger and feelings of fullness. These misaligned hormones can increase cravings for unhealthy carbohydrates and sugary foods. These habits can wreck your insulin and blood sugar levels and cause obesity, another major risk factor for Type 2 diabetes.
Research has also shown that when your body is sleep-deprived, it can actually start to resist insulin. Insulin works in tandem with the body’s circadian rhythms. When your environment and routine signal to your brain that it’s time to sleep— like when the sun sets at night— your cells slow down, and even resist insulin. Poor lifestyle habits, such as late-night eating before sleep, can lead to insulin resistance and weight gain.
However, insulin levels can improve with healthier sleep habits. When your blood sugar is properly regulated, you will sleep better and longer through the night and wake up with more energy. Tips for better sleep habits are listed below.
Sleep, Obesity, and Diabetes
When the amount of time you sleep each night consistently decreases, your risk of obesity increases, raising with it your risk of Type 2 diabetes. Poor sleep directly meddles with your metabolism, leading to poor eating habits and weight gain. Nearly 40 percent of adults in the US are considered obese.
Experts report that eating either a lot of food or heavy food late at night can disrupt sleep patterns. This nighttime eating, especially for women, researchers found, negatively impacted sleep in a variety of ways:
- Sleep efficiency: The amount of time you spend in bed compared to the amount of time you actually spend sleeping.
- Sleep latency: The amount of time it takes you to fall asleep.
- Wakefulness: The amount of times you wake during the night.
- Amount of time spent in REM: Stage three is considered the most restorative phase of non-REM sleep and allows you to reach REM. When you don’t reach stage three of this deep sleep, it’s impossible for your body to reach the optimal levels of rest and recovery.
These negative sleep patterns in women, especially, were directly linked to higher fat intake at night, which decreased sleep efficiency, and increased nighttime wakefulness. Women who consumed more calories at night also took a longer time to fall asleep and had poor sleep efficiency.
Experts say nighttime eaters eat 12 percent more calories than people who only eat during the day. Often times, nighttime eaters are more likely to binge-eat, which often leads to going to bed with high blood sugar. The timing of this excessive eating causes your body to store surplus sugar as fat because your body can’t burn it off as easily when you’re lying in bed. If you do tend to get hungry in the evening hours, try eating some of the best foods for sleep instead of sugary, fatty snacks.
Diabetes and Sleep Problems
Diabetes and sleep disorders are inextricably linked. As explored above, when sleep disorders are ignored, the physical ramifications on your brain’s hormone production can lead to Type 2 diabetes. What’s more, sleep disturbances are common side effects among Type 2 diabetics, as those diagnosed report higher instances of insomnia, poor quality of sleep, and fatigue.
Some experts suggest the sleep disorders many diabetics suffer from could be the result of comorbid disorders related to Type 2 diabetes, such as obesity. All the same, the connection between sleep disruptions and diabetes is strong.
Diabetes and Sleep Apnea
Another highly common sleep disorder among diabetics is obstructive sleep apnea. Diabetes and sleep apnea share common risk factors such as obesity and high blood pressure. Additionally, sleep apnea has been known to increase the risks for Type 2 diabetes itself because of how it impacts glucose metabolism and creates insulin resistance.
Because of these hormonal impacts, sleep apnea can also intensify symptoms of diabetes and lead to additional conditions such as high blood pressure, heart disease, and stroke.
Sleep apnea is characterized as pauses in a person’s breathing throughout the night. These pauses can last up to a minute or longer in some cases. Any breaks in breathing can send alerts to your brain and wake you up. Studies have shown that patients with Type 2 diabetes have up to a 50 percent higher chance of being diagnosed with sleep apnea.
Common symptoms of sleep apnea include:
- Nighttime wakefulness
- Morning headaches
- Irritability and depression
- High blood pressure
Some studies have found that treating sleep apnea in diabetic patients can help improve both disorders, specifically because of how treatment improves a patient’s glycemic control.
Some common ways to combat sleep apnea include:
- Weight loss: Eating healthy during recommending times of the day combined with physical activity can help with weight loss, and improve your overall breathing patterns at night. In fact, a loss of even 10 percent of your body weight can begin to reverse symptoms of sleep apnea.
- Sleep position: Sleeping on your side, rather than on your back, can help reduce symptoms. The best mattress to support side sleepers could be beneficial as well.
- Keeping your airway clear: Be sure to treat allergies, colds or other nasal problems, as these can exacerbate symptoms of sleep apnea.
- Improve airway pressure: One common treatment for severe cases of sleep apnea is a “continuous positive airway pressure” machine, often called a CPAP for short. This machine blows pressurized air through a hose into a mask fastened over your mouth or nose. This machine increases the air pressure inside your throat, stopping it from closing up while you sleep.
- Appliance treatment: In some cases, you may be able to wear an oral appliance that pulls your bottom jaw forward, opening your airway while you sleep.
Diabetes and Insomnia
Experts have reported a trend among people with diabetes and insomnia, and not just because of the troublesome symptoms that accompany both types of diabetes.
A study published in the Indian Journal of Endocrinology and Metabolism reported that diabetes itself could be reason enough for many sleep disturbances. This is because of the many tolls the disease takes on the central nervous system, causing major alterations to brain functions, which can negatively impact endocrine functions. Simply put, changes in the brain can affect its ability to produce the correct amounts of hormones that regulate metabolism, mood, and sleep.
While there are a host of factors that contribute to insomnia and its symptoms, many side effects associated with diabetes cause sleepless nights, such as:
- Restless legs syndrome: This condition creates strong, uncomfortable feelings in your legs, including electric, twitchy, aching or tingling sensations that leave you with an insatiable urge to move them. Often, moving your legs can relieve the unpleasant sensations, but this makes sleep highly elusive.
- Hyperglycemia: High blood sugar. This condition, common among diabetics, can induce fatigue, and headaches. It can also leave you feeling thirsty, prompting you to drink more and urinate more frequently throughout the night, disrupting your sleep.
- Hypoglycemia: Low blood sugar. Also common among diabetics, this condition affects your energy, leaving your physically depleted. It can cause sleep disruptions, even causing you to cry out during sleep.
- Peripheral neuropathy: This condition occurs when your nerves that carry messages from the brain to the spinal cords are damaged or diseased— in this case, by diabetes. Symptoms include weakness and pain from the nerve damage, often in your hands and feet. These damaged nerves may signal pain to the brain from simple things like the sheets touching your body in bed.
- Nocturia: This condition, caused by hyperglycemia, causes the body to void excess sugar in your system through urinating. It can also lead to increased risk for urinary tract infections, all of which are disruptive to your sleep.
- Depression: Depression, a serious mental illness, is one of the biggest factors in sleep disruption among people with diabetes. Those suffering from depression may also suffer from anxiety and stress, each of which can impact sleep and affect blood glucose levels.
For more information about diabetes and sleep disorders, visit:
- Indian Journal of Endocrinology and Metabolism – Sleep disorders in Type 2 diabetes
- American Academy of Sleep Medicine – Obstructive sleep apnea during REM sleep is significantly associated with Type 2 diabetes
- American Diabetes Association – Sleep apnea in Type 2 diabetes
Helping Diabetic Children Sleep
Children are one of the groups most susceptible to Type 1 diabetes. In fact, Type 1 diabetes is one of the most common chronic illnesses diagnosed in children. Sleep disturbances among diabetic children can worsen their blood sugar regulation.
The University of Arizona reported that children with diabetes who suffered from more instances of nighttime apnea experienced higher blood sugar and were found to be hyperglycemic more often. This is in part because of how the child’s sleep disturbances affect their slow-wave sleep, the most restorative stage of sleep— an element of sleep critical to glucose and insulin regulation.
Because sleep disturbances are so common among children with Type 1 diabetes, experts suggest parents educate themselves on healthy sleep patterns that can help alleviate some of the sleep struggles their children — and they themselves, consequently— may experience. Being proactive about the child’s sleep, experts suggest, can improve both the child and the parent’s overall mood.
Some suggestions to help children with diabetes sleep include:
- Stick to your treatment plan: Making sure your child’s medical needs are met is very important for better sleep. If insulin is part of your child’s treatment plan, be sure they take it as prescribed. Routines can be invaluable for healthy sleep patterns.
- Healthy lifestyle: Apart from other benefits, a healthy diet and exercise can prepare your child’s body for restful sleep at night.
- Sleep hygiene: Respecting circadian rhythms, following a bedtime routine, avoiding screentime before bed, and creating a soothing sleep environment can help your child sleep better.
For more information about diabetes in children, visit:
- American Diabetes Association – Type 1 diabetes and sleep
- WebMD – Does my child have Type 1 diabetes?
Helping Adults with Diabetes Sleep
Sleep health is so important for people with diabetes that in 2017, the American Diabetes Association recommended sleep assessments for diabetics as part of their overall medical evaluation. Experts say some of the best ways for people with diabetes to balance their sugar levels are through sleep quality, getting sleep disorders under control, and proper sleep hygiene.
Some recommendations for helping adults with diabetes sleep better include:
- Weight loss: Weight loss for diabetics can improve overall health and sleep. It can eliminate other, related disorders such as sleep apnea, improving both the quality and quantity of your sleep.
- Manage your blood sugar: Though it can be challenging, managing your blood sugar levels can promote healthy sleep by helping you avoid troublesome side effects caused by high or low blood sugar such as hunger, restlessness, frequent urination, night sweats and headaches.
- Cognitive behavioral therapy (CBT): This highly effective form of therapy seeks to change false, unhealthy beliefs about insomnia and sleep by altering the patient’s attitude about sleep. These unhealthy beliefs can often create anxiety over sleep expectations, resulting in insomnia. CBT works to change sleep habits, conditions and schedules. The National Institute of Health recently recommended CBT as an effective way of managing the effects of chronic insomnia.
- Relaxation therapy: Relaxation is a helpful practice that can quiet your mind and slow your thoughts. When practiced regularly, these tools can become invaluable assets when preparing for sleep. Focusing your thoughts teaches you to clear your mind, which can relax tension in your muscles, calming your body for sleep. Mindfulness can help you stay present, combating both depression and anxieties that could make sleep elusive.
Tips for Better Sleep
Experts have reported that many of the comorbid conditions diabetics face, like obesity, can be treated through proper sleep health. Though it may take some lifestyle changes, as well as personal, introspective changes, relief is possible.
Some suggestions for a better night’s sleep include:
- Set a routine: By staying consistent with a regular bedtime and wake up time, you promote healthy circadian rhythms which, when respected, allow you to sleep longer and better.
- Exercise: This recommendation comes with a handful of benefits for anyone who suffers from diabetes. In addition to overall health benefits, exercise will wear out your body, helping it feel more tired and ready for sleep. Be sure to avoid strenuous exercise too close to bedtime, as this can actually keep you awake rather than make you tired.
- Limit naps: Daytime naps can offset your natural circadian rhythms. Even though an afternoon nap can help you feel more rested, it can actually cause more harm than good in some cases, making it harder to fall asleep at night.
- Comfortable sleep environment: Create a sleep atmosphere conducive to healthy sleep hygiene. Keep pets and children out of your bed. Keep the bedroom cool and dark. Avoid screen time while in bed, and up to two hours before turning in for the night. Another healthy practice is to avoid using your bedroom for anything other than sleep. Keep work or homework, for example, out of your main sleeping area.
- Create a relaxing routine: A consistent, calming routine sends signals to your brain that it’s time to get sleepy. A warm bath, a relaxing activity or some light reading can be great cues for you to start feeling sleepy.
- Don’t prolong sleep: If you’re feeling sleepy, turn off the light and go to sleep!
- Healthy diet: A healthy diet, including keeping caffeine consumption in moderation can help prepare your body all day long for healthy and quality sleep.
- Cut yourself some slack: We can be our own worst enemies when it comes to falling asleep. If you’re trying too hard, you can easily send your mind spinning, resulting in sleep-evading anxiety. If you’ve tried for 20 minutes or so to sleep, but to no avail, get up, take a short walk around your home, read a book, or try a relaxing activity until you feel sleepy.