Bad Sleep-Type2 Diabetes-Bad Sleep: The Chicken and Egg that Can Foul a Night in the Nest

T2D Diabetes 438 views
Written by Timothy Pfaff

Chronic sleep problems can aggravate type-2 diabetes, which can also cause sleep problems. Herewith, the ABC’s of the Zzzzzz’s.

Bad Sleep-Type2 Diabetes-Bad Sleep: The Chicken and Egg that Can Foul a Night in the Nest

If there’s one thing holistics has taught us, it’s that everything affects everything. The vectors of sleep problems and disorders and type-2 diabetes are a great, often baffling, case in point.

We’ll go directly to the separate topics here, but understand that even they are not discreet. There’s cross-over as well as cause and effect. And, as always, in most cases there’s help, and, as in most cases, your knowledge is power.

Sleep apnea

Sleep apnea is condition characterized by interruptions of regular breathing while sleeping. It may or may not be accompanied/caused/detected by snoring. It happens when the upper airway becomes blocked during sleep, either making breathing irregular, interfering with breath flow, or even stopping it altogether, in the last case sometimes for alarmingly long (to witnesses) periods.

It’s basically as serious as it is common. And your intuition is correct in telling you it’s not a good thing. It can, given enough time between breaths, be fatal, or course. But mostly its negative effects are felt (by the sleeper, not the witness/auditor) as a feeling of inadequate sleep upon awakening. The cause, of course, is inadequate oxygenation of the blood.

It is related to type-2 diabetes in several ways. First, it may signal type-2 diabetes in someone unaware of having it—“it” in this case being either sleep apnea or type-2 diabetes.

Second, there is research that suggests that sleep apnea—common in diabetics—plays a role in the development of diabetes and insulin resistance in particular. Dr. Mark Mahowald, director of the Minnesota Regional Sleep Disorders Center in Hennepin County, says that the body’s response to sleep deficits can mimic insulin resistance. “There is some evidence that sleep deprivation could lead to pre-diabetic state,” he adds.

Sleep apnea is often associated with obesity, which is also associated with diabetes, of course. But while it is more common in obese people, and in men, it is by no means limited to those groups or cross-groups. People of perfectly normal body weight, and women, can also have sleep apnea, which may also result from obstructions in the sinuses or other areas of the upper respiratory system.

Sleep apnea remedies and amelioratives

This is a matter as complex as the problem is multi-faceted and common. If you are or are made aware of sleep apnea of any degree of seriousness, consult your doctor and ask for a referral to a specialist or sleep clinic if necessary.

Effective remedies could be as simple as changing sleep positions—particularly stopping sleeping on your back—to help keep airways open naturally. A few strategically placed pillows could make a difference.

For some people, non-invasive or minimally invasive soft appliances provide an adequate solution. There are various kinds of soft plastic mouthpieces that help keep airways open with a minimum of discomfort. For some people, soft cloth slings from the underside of the jaw to the top of the head can help assure placement that keeps airways open.

Increasingly people are turning to bedside devices (CPAP machines) that combine a face mask with an air source that may include additives to relieve breathing obstructions or enhance oxygen intake to safe levels. (There can be too much oxygen intake, too.) It is our anecdotal information that few people sustain use of these devices over long periods of time, simply because they are cumbersome and can feel confining or otherwise uncomfortable.

They resemble and are about the size of ventilators seen at hospital bedsides, and usually involve a face mask and flexible plastic tubing connecting the mask to the device. Only in part because these devices are expensive, it is recommended that you not invest in one without a full consultation with a sleep specialist.

The same holds true for the other, more compact devices listed above. Sleep apnea is serious and warrants rigorous medical investigation. Self-reliance on devices—widely advertised in popular media—is the equivalent of and as dangerous as self-diagnosing, -treating, and –medicating and is therefore highly unadvisable.

Insomnia and diabetes

Yet another two-way street, not infrequently related to/caused by the above.

If you pay any attention to these things, insomnia is all the rage. Everyone’s doing it, and not nearly enough people are complaining about—or doing something about it.

Wholly anecdotally and utterly devoid of hard evidence, we trace the trend to the first dot.com boom, which brought with it a devastating epidemic of the romance of work. Now we’re in a tech boom.2, and a new baby boom, and the latte is the new speed. Our amateur, armchair detective work done, we proceed to its medical implications.

If you’re not what (insufferable) good sleepers call a “good sleeper,” the diabetic tendency toward more frequent urination could have big impact(s) on your night’s sleep.

There are entire books—shelves of them, in fact—about insomnia, and we recommend you buy a couple of thick ones, as attempting to read and comprehend them makes them famously effective sleep aids.

Blood glucose levels that are either too high or too low can cause sleep disturbances and/or insomnia. A study published in Diabetes Care and summarized here showed the following, verbatim:

“It was found that the diabetics who were also poor sleepers had 23 per cent higher levels of blood glucose in the morning, as well as 48 per cent higher levels of blood insulin. For insulin resistance, these figures meant that poor sleepers with diabetes had 82 per cent higher insulin resistance than normal sleepers with diabetes.

“Kristen Knutson, lead author on the study, commented, ‘People who have a hard time controlling their blood glucose levels have a greater risk of complications. They have a reduced quality of life. And, they have a reduced life expectancy.’

“Eve Van Cauter, co-author of the study, also said, ‘This suggests that improving sleep quality in diabetics would have a similar beneficial effect as the most commonly used anti-diabetes drugs.’”

Remedies

In all seriousness, insomnia is one of the plagues of mankind. There is a reason forced sleep deprivation is a form of torture.

Accordingly, all manner of remedies and cures have been offered, from the warm glass of milk before bed to the intake of strong narcotics by many means. If insomnia is a problem for you, it probably is affecting your health, and you should talk to your doctor about ways to address it that are appropriate for you.

Insomnia—and even fear of not being able to fall asleep—are leading “reasons” people turn to alcohol and narcotics for intended relief. Such relief as those “remedies” bring is usually short-lasting and the attendant addiction problems are not.

In the realm of prescription and “over-the-counter” drugs, opinions fly thick and fast in all directions. Don’t self-medicate and talk to your doctor about anything you take for sleep, or plan to.

People often turn to antihistamines, “night-time” cough and cold remedies, certain anti-depressants (particularly the tricyclics), and literally whatever they think will “get them through the night.”

While it is unadvisable that anyone self-medicate in that way, it is particularly hazardous to people with diabetes, since those "legal," over-the-counter medications may have adverse interactions with prescribed medications needed to treat diabetes.

Low night-time blood sugar

People who are taking insulin or other drugs to control blood glucose are at some degree of risk of reaching low blood sugar levels during the night, particularly problematic for heavy sleepers. The result is difficulty awakening and low energy the subsequent day. One indicator of likely low nocturnal blood sugar is waking up sweating.

Restless leg syndrome (RLS) and neuropathy

Diabetes and the blood-sugar irregularities that come with it often cause a twitching of the lower extremities while in bed (RLS) or some forms of peripheral neuropathy. A helpful Q&A about a range of diabetes-related sleep problems is available here. A more detailed discussion of diabetic neuropathy is provided by the Singapore Diabetic Foot Centre here.

Low-sleep induced high blood sugar generally

In The Sleep-Diabetes Connection,” WebMD explains it thus: “In short, diabetes and sleep problems often go hand in hand. Diabetes can cause sleep loss, and there’s evidence that not sleeping well can increase your risk of developing diabetes.”

Quoted in that article, Lynn Maarouf, education director of the Stark Diabetes Center at the University of Texas Medical Branch in Galveston, is quoted as saying the following, in verbatim:

“Any time your blood sugar is really high, your kidneys try to get rid of it by urinating, so you are probably getting up and going to bathroom all night long -- and not sleeping well.”

Maarouf says high blood sugar is a red flag for sleep problems among people with diabetes for another reason. “People who are tired will eat more because they want to get energy from somewhere. That can mean consuming sugar or other foods that can spike blood sugar levels.”

The answer: good sleep hygiene

The realization that proper sleep is an essential factor in maintaining good health is now so clear that the emphasis is now described with the term “sleep hygiene.” The term refers to the many factors that are at play in getting proper and sufficient sleep. Common features are:

  • Setting a regular sleep schedule and sticking to it
  • Sleeping in a room as dark and quiet as you can tolerate
  • Avoiding heavy (in some cases all) eating before bed, even after dinner
  • Limiting (or eliminating) caffeine and/or alcohol throughout the day

That’s a short and far from complete list, and sleep hygiene is a large topic unto itself and effectively different for every individual. Severe sleep problems are best treated in sleep clinics available in many urban areas, in hospitals and independent of them.

A deep discussion of sleep problems, specifically related to anxiety—itself not uncommonly an aspect of living with diabetes—is available in a guide at Tuck Sleep, at https://www.tuck.com/anxiety-guide-sleep/

Sources/Reading:

https://www.nhlbi.nih.gov/health-topics/sleep-apnea

https://www.webmd.com/diabetes/type-2-diabetes-guide/type-2-diabetes-sleep

https://www.diabetes.co.uk/diabetes-and-sleep.html

https://www.diabetes.co.uk/news/2011/May/poor-sleep-raises-diabetic-insulin-levels,-according-to-study-99880077.html

https://www.diabetes.co.uk/pre-diabetes.html

https://www.diabetes.co.uk/news/2011/May/poor-sleep-raises-diabetic-insulin-levels,-according-to-study-99880077.html

http://www.joslin.org/info/sleep_problems_and_diabetes.html

https://www.singaporediabeticfootcentre.com.sg/diabetic-neuropathy/?gclid=EAIaIQobChMIz53BytuJ2QIVkYuPCh2ZBQthEAAYASAAEgIsnvD_BwE

https://www.everydayhealth.com/type-2-diabetes/living-with/type-2-diabetes-and-sleep/

http://www.alaskasleep.com/blog/blood-sugar-and-sleep-problems

https://www.insomnia.net/sleep-health/diabetes/

https://www.tuck.com/anxiety-guide-sleep/

 

 

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