Type 2 Diabetes and Sleep Problems

Poor sleep and type 2 diabetes…Which comes first? It turns out that the relationship between type 2 diabetes and sleep has “chicken, or egg?” origins.

Ongoing periods of poor sleep (due to insomnia, shift work disorder, or sleep apnea) have been shown, by research since the late 1990s, to be directly connected to the development of type 2 diabetes.

Meanwhile, for those people who already have type 2 diabetes, sleep itself can be aggravated by fluctuating blood glucose levels and daytime fatigue, which may lead to long naps, which make it hard to fall asleep at night. It’s a vicious cycle.

The poor sleep and type 2 diabetes connection

Sleepless nights. Fragmented sleep. Late bedtimes due to social or work obligations. Trouble with insomnia. We’ve all had these, on occasion.

However, when you lose sleep, night after night, for months or weeks on end, enduring broken sleep as a “normal” sleep pattern, your risk factors for developing type 2 diabetes increase dramatically. Why?

It turns out that the sleeping period isn’t just a hibernation cycle, but an active period for the brain and body. During sleep, the brain deep cleans itself, the bloodstream repairs damage and promotes healing at the cellular level, and the body enjoys a rebalance of its systems, including the ones which manage metabolism.

Causes of lost sleep are many: stress and anxiety, other medical conditions, and sleep disorders like sleep apnea that go undetected (and untreated).

In particular, insomnia, shift work disorder, and sleep apnea are three sleep problems which are significantly linked to diabetes. This is because all three sleep disorders cause surges of stress hormones during the time when the body should normally be at rest.

Endless nights of poor sleep overload the body with stress hormones. This has a major negative impact on body chemistry, including imbalances in metabolic products like blood glucose and insulin over the long term.

Daytime sleepiness is another hidden concern for those who are prediabetic. Fatigue from poor nighttime sleep can lead to the need for naps during the day. A short nap may refresh you, but longer naps have been shown to be linked to type 2 diabetes. They may also disrupt your circadian rhythms enough to make it hard to fall asleep at night.

How type 2 diabetes can rob your sleep life

You can expect certain kinds of symptoms to bring additional discomfort and disruption to your sleep life when you have type 2 diabetes.

Nocturia

Frequent nighttime urination is common among people with type 2 diabetes. Several nightly trips to the bathroom are a consequence of high blood pressure related to having diabetes. The kidneys work overtime to process extra sugars and salts.

(Note: Having untreated sleep apnea or prostate problems may also be a cause of nocturia.)

Restless legs

This sleep disorder occurs when the legs develop unpleasant sensations at bedtime, making it difficult to fall asleep. People with diabetes often also deal with neuropathic pain, often felt in the legs at night. Another lesser known, but no less common, problem is periodic limb movements of sleep (PLMS), which can lead to sleep fragmentation.

Dawn Phenomenon

Everyone experiences this daily morning transition, in which melatonin in the bloodstream is supplanted by cortisol (a stress hormone) as the body prepares to awaken after a night of sleep.

For people with diabetes, this circadian transition can lead to glucose-insulin imbalance (usually a significant rise in blood sugar without a commensurate rise in insulin) upon awakening.

Without tending to this rise with the aid of insulin, people with diabetes may eventually find themselves at an increased risk for stroke, kidney disease, eye problems, neuropathy or heart disease.

Drug side effects: Metformin, a drug used to control blood sugar, has been found to cause sleeplessness.

If you have diabetes and you can't sleep

Getting good sleep is not optional for anybody, least of all those with chronic conditions like type 2 diabetes. Here are some tips for prioritizing sleep:

• Ask your doctor for help. They can help you interpret your sleep problems and may refer you to a sleep study to rule out separate conditions that are easy treated.
• Be wary of long afternoon naps. They can send your circadian system out of kilter.
• Practice good sleep hygiene. This can include any or all of the following:
  • Keep a stringent bedtime and wake time schedule to best reset and support your circadian rhythms.
  • Practice bedtime rituals that can relax you, such as stretching, massage, listening to music, reading, or a warm bath.
  • Avoid substances that disrupt sleep, such as alcohol, caffeine, and nicotine.
  • Ensure your sleeping space is dark, quiet, comfortable, and cool.
  • Exercise in the early part of the day to ensure a strong circadian reset.
  • Don’t eat a large meal right before bedtime, but also don’t go to bed without dinner. A smaller evening meal or healthy bedtime snack should help.