People who have diabetes often have poor sleep habits, including difficulty falling asleep or staying asleep. It's estimated that one in two people with Type 2 diabetes have sleep problems due to unstable blood sugar levels and accompanying diabetes-related symptoms which can include obstructive sleep apnea, leg pain or discomfort, restless legs syndrome, and increased nighttime urination
High blood sugar (hyperglycemia) and low blood sugar (hypoglycemia) during the night can lead to insomnia and next-day fatigue. When blood sugar levels are high, the kidneys overcompensate by causing you to urinate more often. During the night, these frequent trips to the bathroom lead to disrupted sleep. High blood sugar may also cause headaches, increased thirst, and tiredness that can interfere with falling asleep. By contrast, going too many hours without eating or taking the wrong balance of diabetes medication can also lead to low blood sugar levels at night. You may have nightmares, break out into a sweat, or feel irritated or confused when you wake up.
Lack of sleep has been found to be a contributor to Type 2 diabetes and sleep deprivation can lead to a pre-diabetic state. Here is how it happens.
When you don't get enough sleep, the hormone levels in your body can become irregular. This includes your cortisol level. Cortisol is a hormone that keeps your body awake. When you lack sleep, the body may produce additional cortisol. When cortisol production increases in the body, blood sugar levels may also increase. In an attempt to balance the increase in blood sugar levels, your pancreas will produce extra insulin to process the additional sugar in your body. However, the higher levels of cortisol make it harder for the insulin to do its job effectively. Overtime, the pancreas cannot keep up with the work of keeping your blood sugar levels normal resulting in unhealthy amounts of glucose in the bloodstream.
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 which make it hard to get a good nights sleep.
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.
Complications From Lack of Sleep
If you have diabetes, too little sleep negatively affects every area of your management, including how much you eat, what you choose to eat, how you respond to insulin, and your mental health.
If you get less than 7 hours of sleep per night regularly, your diabetes will be harder to manage. During sleep your brain stores memories, your muscles are repaired, your heart rate goes down, and your blood pressure falls. Lower resting heart rate and blood pressure are particularly important if you have Type 2 diabetes, since having the condition makes you twice as likely to be diagnosed with heart disease.
Too little sleep can also:
- Increase insulin resistance.
- Make you hungrier the next day and reduce how full you feel after eating.
- Make you more likely to reach for junk foods—those that are high in carbs and sugar.
- Make it harder to lose weight.
- Raise blood pressure and seriously increase the risk of a heart attack.
- Make your immune system less able to fight infections.
- Increase your risk of depression and anxiety.
How Can I Improve my Sleep?
Some 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. Afternoon and evening caffeine can affect your body for up to 8 hours. Alcohol in the evening can affect how you breathe when you sleep. It can also wake you up and affect your sleep quality.
- Avoid large meals late at night. Eating late can cause indigestion and higher blood sugar levels overnight.
- Avoid or minimize napping especially after 3 p.m. This can make you less tired when it’s time for bed.
- 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.
- Try cognitive behavioral therapy (CBT), which is a first line treatment for insomnia.
One of the best things you can do is to wake up and go to bed at around the same time every day, even on weekends, making sure you get enough quality sleep consistently. These tips can also help:
- Keep your bedroom dark, quiet, relaxing, and cool. Experts recommend a temperature of 65 degrees for your best rest.
- Remove electronic devices such as TVs, computers, and smartphones from the bedroom.
- Get some physical activity during the day.
- Have a routine that gets you ready for bed and helps you mentally unwind and relax like taking a shower, reading, or writing in a journal.
- Get in bed only when you’re tired.
It typically takes about three weeks to start to form a habit, so it’s important to stick with it. When you’re getting enough sleep, you may find that you have an easier time controlling your blood sugar. You’ll be more alert during the day, have more energy, less stress, and an overall better mindset for monitoring and managing your diabetes.