People who have diabetes often have poor sleep habits, including difficulty falling asleep or staying asleep. Some people with diabetes get too much sleep, while others have problems getting enough sleep. According to the National Sleep Foundation, 63% of American adults do not get enough sleep needed for good health, safety, and optimum performance.
There are several causes of sleep problems for people with type 2 diabetes, including obstructive sleep apnea, pain or discomfort, restless legs syndrome, the need to go to the bathroom, and other problems associated with type 2 diabetes.
Sleep Problems and Type 2 Diabetes
Sleep apnea involves pauses in breathing during sleep. The periods of stopped breathing are called apneas, which are caused by an obstruction of the upper airway. Apneas may be interrupted by a brief arousal that does not awaken you completely — you often do not even realize that your sleep was disturbed. Yet if your sleep was measured in a sleep laboratory, technicians would record changes in the brain waves that are characteristic of awakening.
Sleep apnea results in low oxygen levels in the blood because the blockages prevent air from getting to the lungs. The low oxygen levels also affect brain and heart function. Up to two-thirds of the people who have sleep apnea are overweight.
Sleep apnea alters our sleep cycle and stages of sleep. Some studies have linked altered sleep stages 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 inability of the body to use insulin).
Peripheral neuropathy, or damage to the nerves in the feet and legs, is another cause of sleep disruption. This nerve damage can cause a loss of feeling in the feet or symptoms such as tingling, numbness, burning, and pain.
Restless Legs Syndrome
Restless legs syndrome is a specific sleep disorder that causes an intense, often irresistible urge to move your legs. This sleep disorder is often accompanied by other sensations in the legs such as tingling, pulling, or pain, making it difficult to fall asleep or stay asleep.
Hypoglycemia and Hyperglycemia
Both hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar) can affect sleep in those with diabetes. Hypoglycemia may occur when you have not eaten for many hours, such as overnight, or if you take too much insulin or other medications. Hyperglycemia occurs when the sugar level rises above normal. This may happen after eating too many calories, missing medication, or having an illness. Emotional stress can also cause your blood sugar to rise.
Obesity, or too much body fat, is often associated with snoring, sleep apnea, and sleep disturbance. Obesity increases the risk of sleep apnea, type 2 diabetes, heart disease, hypertension, arthritis, and stroke.
How Are Sleep Problems Diagnosed?
Your doctor will ask you about your sleep patterns, including whether you have trouble falling or staying asleep, are sleepy during the day, have difficulty breathing while asleep (including snoring), have pain in your legs, or move or kick your legs while sleeping.
Your doctor may refer you to a sleep specialist who may do a special sleep study called a polysomnogram to measure activity during sleep. The results of the sleep study can help your doctor make an accurate diagnosis and prescribe an effective and safe treatment.
How Are Sleep Problems Treated in Type 2 Diabetes?
There are several treatments for sleep problems in people with diabetes, depending on the condition:
If you are diagnosed with sleep apnea, your doctor may suggest that you lose weight to help you breathe more easily.
Another potential treatment is continuous positive airway pressure (CPAP). With CPAP, patients wear a mask over their nose and/or mouth. An air blower forces air through the nose and/or mouth. The air pressure is adjusted so that it is just enough to prevent the upper airway tissues from collapsing during sleep. The pressure is constant and continuous. CPAP prevents airway closure while in use, but apnea episodes return when CPAP is stopped or is used improperly.
To treat the pain of peripheral neuropathy, your doctor may prescribe simple pain relievers such as aspirin or ibuprofen, antidepressants such as amitriptyline, or anticonvulsants such as gabapentin (Gralise, Neurontin), tiagabine (Gabitril) or topiramate (Topamax). Other treatments include carbamazepine (Carbatrol, Tegretol), pregabalin (Lyrica), lidocaine injections, or creams such as capsaicin.
Restless Legs Syndrome
Various medications are used to treat restless legs syndrome, including dopamine agents, sleeping aids, anticonvulsants, and pain relievers. Your doctor may also prescribe iron if you have low iron levels.
There are also several medications that treat insomnia, including:
- Over the counter drugs such as antihistamines including diphenhydramine (such as Benadryl). These drugs should be used short term and in conjunction with changes in sleep habits.
- Medications used to treat sleep problems such as eszopiclone (Lunesta), suvorexant (Belsomra), zaleplon (Sonata), and zolpidem (Ambien).
- Benzodiazepines are an older type of prescription medicine that cause sedation, muscle relaxation, and can lower anxiety levels. Benzodiazepines that were commonly used for the treatment of insomnia include alprazolam (Xanax), diazepam (Valium), estazolam (ProSom), flurazepam, lorazepam (Ativan), temazepam (Restoril), and triazolam (Halcion)
- Antidepressants such as nefazodone and very low doses of doxepin (silenor).
How Can I Improve my Sleep?
In addition to medications, recommendations to improve sleep are:
- Learn relaxation and breathing techniques.
- Listen to a relaxation or nature sounds CD.
- Get regular exercise, no later than a few hours before bedtime.
- Don’t use caffeine, alcohol, or nicotine in the evening.
- Get out of bed and do something in another room when you can’t sleep. Go back to bed when you’re feeling drowsy.
- Use the bed only for sleeping and sexual activity. Don’t lie in bed to watch TV or read.This way, your bed becomes a cue for sleeping, not for lying awake.
Are There Other Links Between Sleep and Type 2 Diabetes?
People who have poor sleep habits are at greater risk for becoming overweight or obese and developing type 2 diabetes, according to several studies. Chronic sleep deprivation may lead to insulin resistance, which can result in high blood sugar and diabetes.
Some studies show that chronic sleep deprivation can affect hormones that control appetite. For example, recent findings link inadequate sleep with lower levels of the hormone leptin, which helps control the metabolism of carbohydrates. Low levels of leptin have been shown to increase the body’s craving for carbohydrates regardless of the amount of calories consumed.
Trish Cruz, RN
SOURCES: Medscape: “Expert Column — Sleep Disorders in Diabetes.” Yaggi, H.K. Diabetes Care, 2006. Nilsson, P. Diabetes Care, 2004. Mallon, L. Diabetes Care, 2005.