If you’re reading this at 2 am because your CGM alarm woke you up, or your child with diabetes woke you up, or you had to pee — yet again — we feel you, and want you to know you're doing great.
Sleep is elusive for many people with diabetes, so you’re not alone. However, we can’t stress enough how important rest is for the management of your disease. That’s why we put together this list to help you understand the link between sleep and diabetes, whether you have it, or a loved one does.
There are two main types of diabetes, and a third type, which is a combination of the two. Though they share a name, the diseases are vastly different, in both treatment and cause, but many of the symptoms are the same. While type one is a genetic auto-immune disease often beginning in childhood or early adolescence, type two usually develops later in adulthood and is associated with genetics and lifestyle.
LADA, or Latent Auto-Immune Diabetes in Adults is a disease where some sort of trauma to the insulin-producing cells causes an autoimmune reaction which slows and eventually stops insulin production. This usually occurs in adulthood, causing it to often be misdiagnosed as type two diabetes. Some with LADA even have insulin resistance, making treatment a little more tricky than in the other two types.
Diabetes Mellitus translates to “Sweet Siphon” from Greek because sweet urine flowed out of ancient diabetic people like a siphon. Nice imagery, but surprisingly accurate. This occurs because of excess sugar in the bloodstream that is filtered out into the urine, making you extremely thirsty and needing to urinate often.
Insulin is the naturally produced chemical that takes sugar from the blood and deposits it into the cells. For those with type one, high blood sugar is caused by a lack of insulin production due to an auto-immune disease. With type two, this is caused by insulin resistance. When the body can’t use insulin or doesn’t have it, all that sugar stays in the blood and can cause some serious damage.
If you have diabetes, you may be thinking that all of this is great, but why am I awake right now at 2 am? We’re getting there. Blood sugar affects more than you may think.
While most of the body needs insulin to take sugar from the blood, some organs such as the kidneys, eyes, nerves, and brain can bypass this process and just take sugar directly from the bloodstream.
When there is too much sugar these organs will become overloaded, which could lead to a variety of problems, but the ones that are likely to affect rest are frequent urination, excessive thirst, insomnia, and restless leg syndrome. Before you panic, sugar levels usually need to be significantly elevated for extended periods before most of these conditions can occur, so let’s look at some of the more common effects of irregular sugar levels and how they affect your rest.
Temporary high blood sugar, also known as Hyperglycemia can cause headaches, fatigue, frequent urination, and nerve pain. For some, this could lead to nerve damage in areas like the intestines, leading to symptoms of constipation or sudden urges to defecate. It could also contribute to chronic pain or neuropathy.
Each of these symptoms can occur at night and wake you up, making it hard for the body to relax and fall asleep again. In some cases, high blood sugar can cause nightmares or night sweats, making it difficult to rest.
When insulin does its job too well, either due to overdose or the body spontaneously deciding to produce insulin, diabetics can have hypoglycemic episodes or low blood sugar.
Other than triggering glucose monitor alarms, low glucose levels can cause dizziness, fatigue, fainting, shakiness, irritability, chills and in some cases death. It is not a condition that can be put off until morning and when you find yourself sitting on the floor of the kitchen pounding fruit snacks at three am more than twice a week, you may be searching for a solution.
While there are currently no preventative measures for type one diabetes, there are some practices that can reduce the risk for type two. Doctors and researchers do not claim to know what definitively causes the disease, but they do know a thing or two about preventing it. Unsurprisingly, rest is an important factor.
Researchers at Cedars-Sinai Medical Center found that just one night of sleep deprivation can decrease insulin sensitivity equal to the effect of six months of a high-fat diet.
This means that for people with type two diabetes, or others dealing with insulin resistance, getting enough rest could contribute significantly to managing blood sugar.
Many researchers have found a significant link between sleep apnea and type two diabetes, however. According to the American Diabetes Association, obstructive sleep apnea can contribute to the onset of type two diabetes due to the increased insulin resistance and slowed glucose metabolism.
One of the more common sleep disorders associated with diabetes is insomnia. This could be due to the metabolic changes that accompany diabetes, or it could be the result of some medications for treating type two diabetes, such as Metformin according to The Sleep Doctor.
Other contributing factors could be increased stress, or increasing age, according to a study in India. Other studies have linked women with diabetes in menopause to have an especially difficult struggle with rest due to the hormonal changes that reduce sleep chemicals such as adenosine and melatonin in the body.
This is important because adenosine is the chemical that creates sleep pressure, or drowsiness and melatonin is the chemical that tells your body it’s dark outside and time to sleep. Without the regulation of these hormones; your body likely will not be able to regulate sleep-wake cycles accurately.
Night sweats are common among women in menopause, or anyone undergoing any sort of hormone therapy, but for those with diabetes, this can be an important risk factor to identify. For those using insulin therapy, night sweats could be a sign of a dangerous hypoglycemic episode. These night sweats may not always wake those with diabetes, which is a contributing factor for morbidity in patients, according to Diabetes Self-Management.
If you find yourself frequently waking to night sweats, it may be a good idea to start checking your blood glucose measurement upon waking to help you determine whether you need to adjust your insulin dosage, alcohol consumption, sexual activity, or evening exercise.
Night sweats could also be a sign of high blood sugar as well, so it’s always important to check your glucose before making any management decisions.
While daytime tiredness may be a symptom for most people who experience sleep issues, with diabetes it could come from a variety of causes. A lack of rest will certainly contribute, but this could also occur from high or low blood sugar, or even diabetic ketoacidosis, a condition where elevated blood sugar leads to a toxic acid build-up that could be fatal.
Checking your blood sugar frequently may help manage daytime tiredness as you learn which foods and activities tend to spike your sugar and could make you sleepy and ready for a nap. While these daytime naps after a meal may feel helpful, they can contribute to poor rest at night.
Rather, these highs should be corrected by the method recommended by your doctor. While exercise can sometimes help, exercising while ketones are present in the blood could be dangerous. Other options include taking medicine, or delivering insulin when necessary.
This often frustrating condition can contribute both to keeping a person with diabetes up at night or their partner. While it may seem easy for some people to just recommend laying still, for those with RLS it isn’t that simple. The movements are driven by an uncomfortable sensation in the limbs (usually the legs or feet) that is somewhat alleviated by movement.
These symptoms are often found in people of increased age who have diabetic peripheral neuropathy, or nerve damage linked to elevated blood glucose levels. For these patients, RLS isn’t easily cured but avoiding caffeine, exercising early in the day, and decreasing anxiety may help alleviate the problem.
Find Out More: Restless Leg Syndrome Guidelines
A long documented correlation exists between diabetes and sleep apnea, indicating that the disorder could be a contributing risk for the development of type two diabetes. Some studies suggest that the two are both intimately tied with obesity, as excess soft tissue in the airways could cause a breathing obstruction, which could contribute to poor sleep, insulin resistance, and the development of both conditions.
Sleep apnea can lead to restless nights, daytime tiredness, exhaustion, and irritability. To combat these symptoms, some doctors recommend using a CPAP machine to create a rhythmic flow of breath or wearing specific oral devices may also help according to the Mayo Clinic.
If you have obstructive sleep apnea and are considered to be obese, you may consider weight loss as an option for decreasing your airway blockage.
Possibly one of the most common nighttime disturbances among people with type one diabetes is the sound of a glucose alarm. Whether your blood sugar has spiked, suddenly dropped, or the alarm goes off when you aren’t in danger at all, it inevitably starts a long process. First, you check your sugar, then you eat fifteen (maybe fifty) grams of carbs, wait fifteen minutes, check again, and by the time you can safely go back to sleep you’re wide awake.
While we don’t recommend losing the monitor, especially if you’re experiencing frequent lows in the middle of the night, your doctor may be able to help you adjust the amount of basal insulin you are taking at night, or maybe suggest taking it earlier in the day to prevent nighttime lows.
These frequent disturbances may be helping keep you alive, but when the cost is a good night’s sleep, we recommend looking for ways to remedy the situation.
Neuropathic pain can be one of the most uncomfortable and disturbing sensations for people with diabetes, but the good news is that there are treatment options. While some doctors prescribe pain relievers, others will recommend antidepressants to disrupt the pain. According to the Mayo Clinic, some patients find relief in natural remedies such as acupuncture.
Finding relief is important to restore a natural sleep cycle, as getting enough rest may help control blood sugar, preventing further nerve damage when paired with other healthy habits.
For those with high or uncontrolled sugar, bathroom urges accompanied by excessive thirst may wake you up frequently in the night. This is a good sign that your sugar is elevated and you may want to employ your usual correction methods. Bathroom urges should dissipate as sugar becomes more controlled over time, but it’s a good idea to discuss your symptoms with your doctor to determine if diabetes is the cause of your frequent urination at night.
Having diabetes means making many health decisions daily to stay alive, and stay healthy. From deciding how many units of insulin to inject, how long to exercise, or how many carbs to consume, you are your best resource when it comes to day-to-day care. However, when it comes to making larger decisions such as changing your dosage ratio, starting a new diet, or beginning a new treatment, it’s always a good idea to consult a doctor.
For most people with diabetes, most doctors will recommend at least a yearly visit with an endocrinologist, or more frequently when there are complications or a new diagnosis. However, many primary care doctors also have experience in treating diabetes and can help with dosage and diet adjustments. When you visit, here are some treatment questions you can bring up.
While a simple google search will tell you accurately that it is entirely possible that diabetes could be the reason for your exhaustion, your doctor will be able to screen for other health concerns that may be a contributing factor.
Auto-immune disorders often come in pairs or trios, according to the Benaroya Research Institute. If you have type one diabetes, it could be worth asking about other endocrine issues or thyroid problems that could contribute to fatigue.
While there is a wide variety of sleeping pills on the market including both over the counter and prescribed options, popular options include melatonin and sedatives. These pills are often used as short term solutions for sleeping difficulty, but there are some concerns to be aware of.
Some studies link melatonin to increased insulin resistance in type two diabetes, hardly resolving the problem of insulin resistance due to sleep deprivation.
Additionally, some sedatives can be addictive and could potentially cause problems if you need to be awakened by your glucose alarm should the medication increase or drop your blood glucose levels.
Talking to your doctor should help you learn the risks involved with sleeping pills and determine the right step for your diabetes management.
While there currently is no cure for diabetes, in some cases, healthy habits can reverse symptoms of type two diabetes or go into remission, according to US News & World Report.
Combined with exercise, healthy eating habits, and visits to the doctor, proper rest could be part of the process in reversing some of the symptoms of type two diabetes. To learn what you can do to improve health and possibly reverse your diabetes, talk to your doctor about your options.
If you often experience night sweats, it’s a good idea to ask your doctor about the cause. If you are experiencing frequent blood sugar fluctuations in the night, you may need to adjust your insulin intake or other habits.
Waking up sweaty is not a condition that should be taken lightly, as it could be a sign of a serious condition like hypoglycemia or diabetic ketoacidosis. Talking to your doctor should help you determine what your next step should be, and how you can prevent night sweats.
While a tingling sensation in the legs could be a symptom of Restless Leg Syndrome, it could also be a sign of neuropathic pain caused by damage to the nervous system. To determine the cause of the tingling sensation, we recommend talking to your doctor who should be able to quickly perform some diagnostic tests.
There are three types of sleep apnea, obstructive, central, and a combination of the two according to the American Association for Sleep Technologists. While central sleep apnea is due to issues with brain function, obstructive sleep apnea is caused by obstruction to the upper airway, which could be resolved with weight loss in some cases. One study suggests that losing 10% of body weight could account for a 26 percent improvement in nighttime breathing.
However, before attempting a radical weight loss solution, we recommend talking to your doctor to determine this is the best and safest way to treat your sleep apnea.
The best advice for better rest begins with proper diabetes management, which sounds easier than it is. However, having a stable blood glucose that is within target ranges should help with most sleep-related issues, from reducing risk complications to eliminating annoying interruptions.
If you’re finding it difficult to properly manage your sugar, talk to your doctor about a continuous glucose monitor, or other options that could lighten your load.
People with diabetes are at a higher risk for dehydration than others because the kidneys need to use a lot of water to filter out all the sugar. This can lead to dehydration and frequent urination, sometimes even when your glucose seems controlled.
This can be a major contributor to sleep problems when you wake a few times a night to use the restroom. However, even when your sugar is controlled you may find yourself dealing with the effects of dehydration. From itchy skin to waking up parched, drinking enough water during the day (but not right before bed) and keeping your sugar in the proper range could help you sleep better through the night, and help you avoid diabetic ketoacidosis.
If you find yourself frequently waking to the sound of your continuous glucose monitor warning your about a high or low trend, you may want to consider adjusting your basal insulin dosage.
While you sleep, blood sugar should be stable except for a spike near dawn as cortisol production increases. If you find your sugar spikes at night, you may consider splitting your basal insulin dose in half to take both in the morning and night, so the insulin can work while you sleep. If you are going low at night, you may consider avoiding carbs before bed to avoid dosing insulin or reducing your basal insulin.
As always, we recommend discussing these options with a doctor before making any changes to your dosage instructions as there could be other issues at play.
Eating before bed could increase your blood glucose levels, or cause a hypoglycemic event if you inject too much insulin. If you find yourself often dealing with these results, you may consider avoiding food a few hours before bedtime or choosing to only eat low carb options.
For those with sleep apnea, getting into a healthy weight zone could help reduce the obstruction in the nasal passage and could even help reverse the symptoms of diabetes altogether. Your doctor should be able to let you know if this is a safe option for you and help you determine how to go about losing weight.
Exercise could be a great way to help manage blood sugar, helping to both increase insulin sensitivity, and increasing the amount of slow-wave or restorative sleep you get each night.
We would recommend talking to your doctor before beginning a rigorous exercise routine however, as exercise could cause serious illness if there is a build-up of ketones in the bloodstream.
Diabetes and sleep have a complicated relationship, however, the cycle is in your favor. The better you can manage the symptoms of your diabetes, the better your sleep should be, and the cycle should continue onward and upward.
As you begin your journey to improve your sleep and the management of your disease, we encourage you to be positive and look for resources both online and in your community to help you learn the best options for your care. Apart from your team of medical professionals, many forums, support groups, and organizations are there to help you with your diabetes management.