Type 2 diabetes and its impact on sleep

Type 2 diabetes is the most common type of diabetes diagnosed in adults, accounting for around 90% of diabetes in this age group. Sleep quality is an important issue in diabetes. It can increase the risk of developing type 2 diabetes and many people affected by the condition experience poor quality sleep.

Sleep disorders include difficulty falling asleep, staying asleep or sleeping too much. In people with diabetes, factors that can impact the quality of sleep include high or low blood glucose during the night, being overweight and feeling depressed or stressed because of the condition.

Living with diabetes does not necessarily mean that sleep will be impacted. Symptoms and how they are experienced and managed play an important role. For example, when blood glucose levels are high, extra blood glucose goes into the urine and draws water from the tissues. This causes a person to urinate more often. High blood glucose can also impact sleep by causing headaches and increased thirst. In a similar way, the symptoms of low blood glucose – such as shakiness, dizziness and sweating – can impact sleep. Therefore, keeping blood glucose levels within the recommended range is important for a good night’s sleep.

Over time, poor quality sleep can have a long-term impact on people with type 2 diabetes. People who resort to sleep medication or have trouble staying asleep are more likely to report serious psychological distress. Adults with type 2 diabetes who experience interrupted sleep may also be less likely to follow other recommended elements of diabetes self-care, such as regular physical activity and blood glucose monitoring.

There are three common sleep disorders that affect people with diabetes:

• Obstructive Sleep Apnoea (OSA), the most common sleep disorder in people with diabetes and a risk factor for type 2 diabetes. OSA is characterised by temporary interruptions of breathing at recurring intervals throughout the night. In most cases, people affected are not aware that this is happening, but bed partners may observe snoring and gasping. This sleep disorder typically affects people who are overweight or obese, as they often have a thicker neck circumference that interferes with the airway. However, OSA has also been found to increase insulin resistance in people without diabetes and of normal weight. 
• Restless Legs Syndrome (RLS), characterised by tingling or other irritating sensations in the legs that can interfere with falling asleep. RLS is associated with iron deficiency. Risk factors include high blood glucose levels, kidney problems and thyroid disorders.
• Insomnia, a sleep disorder associated with an increased risk of developing type 2 diabetes. It is characterised by recurrent trouble falling and staying asleep. Stress and high blood glucose levels impact the risk of insomnia.

My personal experience and conversations with other people with diabetes who experience regular problems sleeping have allowed me to gather a number of insights on the issue.

The problems often begin before diabetes is officially diagnosed, sometimes a few years before. A common pattern is feeling tired during the day, which leads to going to sleep before 9pm, waking up at 1am and not being able to fall back to sleep until hours later. Regular visits to the toilet throughout the night and feeling hungry are common. This pattern is often made worse when the person affected is stressed about something.

Most of the people I spoke to reported spending the time awake doing chores, watching TV, using their devices or reading. The majority reported feeling tired the next day. Some experienced severe weight loss while others gained weight during periods of sleep loss. Everyone indicated that the issues were ongoing and they were not able to resolve them.

How to cope with sleep issues

Careful management of blood glucose levels and good sleep hygiene habits can help improve sleep for people living with type 2 diabetes. Here are some recommended daytime and nighttime habits:

• Adhere to a diet plan that helps keep blood glucose levels within the recommended range.
• Avoid consuming food and drink that contains caffeine (e.g. coffee, tea, soft drinks, chocolate) in the afternoon.
• Make dinner the lightest meal and finish it a few hours before bedtime, avoiding spicy or heavy foods that can cause heartburn or indigestion during the night.
• Avoid smoking. This can worsen sleep apnoea and other breathing disorders such as asthma, disrupting sleep.
• Avoid alcohol before going to bed. Although alcohol can help people fall asleep faster, the effects quickly wear off after a few hours as the body tries to eliminate it. Allow a minimum of 3 hours between drinking alcohol and going to bed.
• Get regular exercise. Physical activity contributes to improved blood glucose management and canimprove mood, helping to sleep better. It is recommended to get at least 30 minutes of exercise five days a week.
• Keep a regular sleep schedule. Going to bed at the same time every night, even on non-working days, helps to establish an internal sleep/wake clock and reduces the amount of tossing and turning required to fall asleep.
• Keep the bedroom cool, dark, and quiet. Light tells the brain that it is time to wake up and the light from electronic devices makes it harder to wind down. Put devices away an hour before bedtime to fall asleep quicker and sleep more soundly. Even a small amount of ambient light from cell phones or computers can disrupt the production of melatonin, a hormone that helps regulate sleep cycles.
• Avoid exercising and doing work around the house before going to bed. This speeds up blood flow and the body takes longer to calm down and fall asleep.

Useful links:

• https://www.everydayhealth.com/type-2-diabetes/sleep-whats-the-connection/
• https://www.everydayhealth.com/hs/type-2-diabetes-care/sleep-better/
• https://www.webmd.com/diabetes/features/diabetes-lack-of-sleep