The Intersection of Sleep Quality and Diabetes: Strategies for Better Management

Diabetes has been proven to impact your sleep quality. Around one in two people with diabetes mellitus (type 2) struggle with a sleep disorder, like insomnia and next-day fatigue.

Does that mean you’re highly likely to have sleep disruption with diabetes? And is there a way to stop these sleep issues in their tracks?

Here’s how to improve your sleep habits and prevent diabetes from affecting your good night’s rest.

The effects of diabetes on sleep—and vice versa—tie back to insulin resistance. Insulin is a hormone that facilitates the transfer of glucose from the blood to the cells in the organs, muscles, and fat.

When the body cells cannot utilize insulin in the bloodstream, this is called insulin resistance.

This resistance causes glucose to build up in the blood. If blood sugar levels remain high for long periods, your kidneys have to work overtime to filter the extra sugar that passes into urine. This can lead to frequent bathroom trips at night and difficulty staying asleep.

In addition, high blood sugar levels can cause increased thirst, fatigue, and headaches, which can lead to inadequate sleep.

If you take the wrong dosage of medication or go too many hours without eating, you could end up with low blood sugar levels when sleeping. This may cause you to experience extreme sweating or nightmares — and you may wake up in a foul mood or have a headache.

All of this means that your blood sugar levels — whether high or low — cause sleep disturbance, and the opposite is also true.

Poor sleep has been linked to high levels of blood sugar in people with pre-diabetes or types 1 and 2 diabetes. This is because lower-quality sleep impacts insulin, increases cortisol levels, and heightens the impact of oxidative stress, which is a major risk factor in the onset and progression of diabetes.

Several studies have also shown that lack of sleep can lead to acute inflammation that causes insulin resistance and an increase in inflammation markers that contribute to metabolic syndrome (a combination of high blood pressure, blood glucose, and cholesterol levels).

Even a modest two-hour decincreasesrease in sleep was shown to increase oxidative stress, which leads to macro- and microvascular complications , such as diabetic retinopathy, kidney disease, and coronary artery disease.

Aside from that, sleep deprivation can significantly impair glucose tolerance/the acute insulin response to glucose and increase evening stress hormone levels, which can lead to insomnia, turning into a vicious cycle.

A lack of sleep can also cause a significant increase in ghrelin, the hormone that makes you hungry, and a huge decrease in leptin, the satiety hormone. Sleep prompts these hormones to send hunger signals when your body doesn’t need to eat, leading to an increase in overall food intake, which could cause obesity and cardiovascular disease.

Poor sleep quality also has implications for diabetes self-management. People who don’t sleep well are more likely to find it difficult to control their diabetes. This may be because of eating at irregular times or experiencing disabling symptoms like headaches.

Obstructive sleep apnea (OSA) is a disorder that occurs when you stop breathing during your sleep. This can cause you to wake up frequently, leading to decreased total sleep time, fragmentation, and excessive daytime sleepiness.

Being obese can increase your risk of developing OSA and insulin resistance. A study found that 85.4% of patients with obesity and type 2 diabetes had obstructive sleep apnea, 50% had moderate to severe OSA (with 15 events/hour), and only 13.4% showed no signs of it.

Another study showed that 37.2% of people with glycosylated hemoglobin (HbA1c) higher than 7% experienced breath-stopping events caused by OSA. This was most likely because of inadequate glycemic control, as HbA1c results show how well blood glucose has been managed for the previous 3 months.

Restless legs syndrome (RLS) is a disorder that occurs when you have a persistent drive to move your legs, especially when sleeping. It requires the presence of the following symptoms to be diagnosed:

• An urge to move the legs

• Feeling a jittering, itching, painful, crawling, or creeping sensation in the legs that can only be relieved through movement

• An unpleasant sensation that worsens when trying to sleep

• Experiencing unpleasant leg sensations during the night

While the primary cause of RLS is unknown, it has been linked to diabetes and sleep deprivation. A 2005 comparative study found that 27% of patients with diabetes had RLS.

Another study also found that diabetic patients with RLS were more likely to have poor sleep quality , reduced sleep efficiency, and higher daytime sleepiness. They also took a longer time to sleep, which contributed to adverse effects on their blood sugar.

When your blood sugar is too high or too low, it fragments your sleep and causes you to wake up every few hours. This means the first thing you should do to improve your sleep quality is manage your blood sugar levels well.

You can start by visiting your doctor and deciding on a treatment plan that works for you. This should include the food you can eat, the medications you have to take, and how you will monitor your blood glucose.

Once you have your plan in hand, stick to it like glue. This should help prevent blood glucose levels from bouncing up and down and disrupting your sleep.

If you have diabetes, avoid drinking caffeine at night. That’s because caffeine causes a spike in your blood sugar levels.

It also:

• Blocks the production of the adenosine receptor that causes you to fall asleep

• Increases the effects of adrenaline, dopamine (the “feel good” hormone), and serotonin

• Causes the liver to release glucose into your blood. If this happens too often, it can make it difficult to control your diabetes.

Caffeine sources you should avoid include coffee, tea, and chocolate. Even decaf coffee/tea should be used with caution, as they contain some trace amounts of caffeine .

You need to get at least seven to nine hours of sleep every day, but if you have diabetes, you’re likely getting less than that because of sleep disturbances.

This means the best thing you can do for yourself is to set your sleeping environment up for success while sticking to your treatment regimen. This includes:

• Remove all electronic devices, such as computers, smartphones, and TVs, from your room and stop looking at them at least an hour before going to bed.

• Make sure your bedroom is dark, quiet, and cool — around 65˚F. You can invest in black-out curtains and noise dampers if you live somewhere bright and noisy.

• Could you set up a daily routine that lets you unwind before going to bed? This could include reading a book, taking a warm bath, or meditating.

Also, if it’s 10 pm and you don’t feel tired, don’t get into bed. You might not be able to sleep and may just toss and turn all night. Instead, start your bedtime routine and ease yourself into sleeping once you’re ready.

According to the American Academy of Sleep Medicine, around seven in ten type 2 diabetes patients have OSA. If you suspect you have sleep apnea, your doctor should administer a sleep test.

They will then walk you through your treatment regimen, consisting of a mouth guard, a continuous positive airway pressure (CPAP) machine, losing weight, or making lifestyle changes. They’ll also help you understand how to manage sleep apnea with diabetes.

If you’ve skipped out on some sleep during the night, you might want to make up for it in the afternoon. This isn’t the best course of action if you want to sleep well at night.

Napping in the afternoon — especially when you’re sleep-deprived — causes you to feel more energetic when it’s actually time for bed and can throw off your sleeping schedule.

But that doesn’t mean you shouldn’t take any naps. Instead, try to schedule your naps before 1 pm. That way, you’ll get some rest and will still be able to stick to your sleep schedule.

Eating a heavy meal at night can cause blood glucose spikes, leading to sleep-disrupting symptoms. Instead, you want to make your breakfast your heaviest meal of the day. This will help reduce the chances of a glucose spike near bedtime.

If you’re hungry after dinner, you can always snack on a handful of nuts, a hard-boiled egg, carrots, air-popped popcorn, celery and hummus, and Greek yogurt with pumpkin seeds. Just make sure to consult your doctor before choosing your bedtime snacks.

A good night’s sleep is one of the best things you can do for yourself. That’s because too little sleep negatively impacts your diabetes control, which in turn worsens sleep quality, leading to a vicious cycle.

The good news is that you can easily get ahead of these issues and sleep soundly at night by ensuring your diabetes is always in control.

If you find traditional insulin injections standing in the way of good blood sugar control, shop for InsuJet needle-free injectors for painless insulin administration.