People with diabetes often have poor sleep quality and have difficulty falling asleep or sleeping soundly. Some people with diabetes sleep too much, yet others do not sleep enough. According to the National Sleep Foundation, 63% of American adults are not getting enough sleep, which directly affects their health, safety, and mental well-being.
Sleep problems in people with type 2 diabetes are caused by several things, including obstructive sleep apnea, pain or discomfort, restless leg syndrome, always wanting to go to the bathroom, and other problems associated with type 2 diabetes.
Sleep problems and type 2 diabetes
Sleep apnea
Sleep apnea refers to pauses in breathing that occur during sleep. The period of time when breathing stops is called apnea, and it is caused by an obstruction in the upper airway. The apnea may be interrupted by a brief awakening that does not fully awaken you and you are not even aware that your sleep is disturbed. However, if your sleep is tested in a sleep lab, the testers will record changes in your brain waves, which are some of the characteristics of sleep arousal.
Sleep apnea causes lower levels of oxygen in the blood because the blockage in the airway prevents air from getting to the lungs. Low blood oxygen levels can also affect brain and heart function. As many as two-thirds of people with sleep apnea are obese.
Sleep apnea changes our sleep biological clock and sleep stages. Some studies have shown that changes in sleep stages are associated with a decrease in growth hormone, which plays a key role in body composition such as body fat, muscle and abdominal fat. Researchers have found a possible link between sleep apnea and the development of diabetes and insulin resistance (the body’s inability to use insulin).
Peripheral neuropathy
Peripheral neuropathy, or nerve damage in the feet and legs, is another cause of sleep disruption. This nerve damage can lead to loss of foot perception or symptoms such as tingling, numbness, burning, and pain.
Restless legs syndrome
Uncomfortable legs syndrome is a specific sleep disorder that causes an uncontrollable and violent urge to move the legs. This sleep disorder is often accompanied by abnormal sensations in the legs, such as tingling, stretching, or pain, making it difficult or uncomfortable for the patient to fall asleep.
Hypoglycemia and hyperglycemia
Either hypoglycemia (low blood sugar levels) or hyperglycemia (high blood sugar levels) can affect sleep in people with diabetes. Hypoglycemia can occur when no food is eaten for several hours, such as overnight, or when too much insulin or medication is used. Hyperglycemia occurs when blood sugar levels are above normal. Hyperglycemia can also occur when you consume too many calories, forget to take your medication, or become ill. Excessive mental stress can also raise your blood sugar.
Obesity
Obesity, or excess body fat, often causes snoring, sleep apnea, and sleep disorders. Obesity increases the risk of sleep apnea, type 2 diabetes, heart disease, high blood pressure, arthritis, and stroke.
How are sleep problems diagnosed?
Your doctor will ask about your sleep patterns to find out if you have trouble falling asleep or always have trouble staying asleep well, if you are drowsy during the day and have trouble breathing (including snoring), have pain in your legs, or move or kick your legs when you sleep.
Your doctor may refer you to a sleep specialist who will perform a special sleep study called a polysomnogram to measure your activity level during sleep. The results of the sleep study can help your doctor make an accurate diagnosis and develop an effective, safe treatment plan.
How do you treat sleep problems in people with type 2 diabetes?
There are several ways to treat sleep problems in people with diabetes, depending on the condition:
Sleep apnea
If you are diagnosed with sleep apnea, your doctor may recommend that you lose weight, which allows you to breathe more easily.
Another possible treatment is continuous positive airway pressure (CPAP). For CPAP, a mask is placed over the patient’s nose and/or mouth. A blower forces air through the nose and/or mouth. The air pressure is adjusted so that it is sufficient to prevent collapse of the upper airway tissue during sleep. The pressure is constant and continuous. The CPAP prevents airway closure while it is in use, but when the CPAP stops working or is used improperly, apnea reappears.
Peripheral neuropathy
To treat pain from peripheral neuropathy, your doctor may prescribe commonly seen pain medications (such as aspirin or ibuprofen), antidepressants (such as amitriptyline), or anticonvulsants (such as gabapentin, tiagabine, or topiramate). Other therapeutic drugs include carbamazepine, pregabalin, lidocaine injection, or capsaicin cream.
Restless legs syndrome
Many medications are used to treat restless legs syndrome, including dopamine, sleep aids, anticonvulsants, and pain relievers. Your doctor may also prescribe iron supplements if your iron levels are low.
There are also several medications for insomnia, including:
- Over-the-counter medications, such as antihistamines, including Benadryl. These medications should not be taken long-term and are used in conjunction with changes in sleep habits.
- Medications used to treat sleep problems, such as eszopiclone, suvorexant, zaleplon, and zolpidem.
- Benzodiazepines are among the older prescription medications that sedate patients, relax muscles, and lower anxiety levels. Benzodiazepines commonly used to treat insomnia include alprazolam, diazepam, estradiolam, fludiazepam, lorazepam, temazepam, and triazolam
- Antidepressants, such as nefazodone and very low doses of doxepin.
What can I do to improve my sleep?
In addition to medications, suggestions for improving sleep include:
- Learn relaxation and breathing techniques.
- Learn relaxation and breathing techniques.
- Listen to soothing music or CDs with nature sounds.
- Get regular exercise and don’t exercise a few hours before bedtime.
- Don’t eat caffeinated foods at night, and don’t drink alcohol or consume nicotine.
- When you can’t fall asleep, get up and go to another room to do something. Go back to bed when you feel sleepy.
- The bed is for sleep and sex only. Don’t lie in bed watching TV or reading a book. That way, going to bed is a cue to sleep, not a way to stay awake in bed.
Are there other links between sleep and type 2 diabetes?
Some studies have shown that sleep is the most common form of diabetes.
Some studies have shown that people with poor sleep habits are at greater risk of developing obesity and type 2 diabetes. Chronic sleep deprivation may lead to insulin resistance, which can lead to hyperglycemia and diabetes.
Some studies have shown that chronic sleep deprivation can affect the hormones that control appetite. For example, recent findings suggest that sleep deprivation is associated with lower levels of leptin, the hormone that helps control carbohydrate metabolism. Regardless of how many calories you consume, decreased leptin levels increase your body’s need for carbohydrates.