I’m so tired! How to sleep well with diabetes and why it's so important.

Do you ever find yourself feeling exhausted, yet keep pushing through? This is a badge of strength and commitment to your family, career or whatever you hold dear, right?

Societal pressures encourage individuals to put sleep at the bottom of the priority list in order to gain a competitive edge.  The old adage that “you can sleep when you’re dead” is a common mantra, and who couldn’t use a cup of coffee about now?  

However, sleep deprivation is a form of torture used to coax terrorists into revealing their darkest secrets.  Why do we torture ourselves? Insufficient sleep can lead to inattentiveness, poor memory, reduced ability to reason and heightened emotional reactivity.  Several studies have linked inadequate sleep to impaired glucose metabolism and insufficient sleep may be a risk factor for developing type 2 diabetes (T2DM), high blood pressure and obesity.  

According to the National Sleep Foundation (NSF) the recommended sleep duration for an adult is seven to nine hours.  Individual sleep requirements vary from person to person. Golem’s study (2014) indicates an association between being overweight and those who sleep less than five hours or more than nine hours per night.  Broussard, et al (2012) conducted a study with healthy adults over four consecutive nights.  There were two groups, one that spent 8.5 hours in bed and one that spent 4.5 hours in bed. The normal sleep group averaged 7.87 hours, while the sleep restricted group averaged 4.35 hours. At the end, a biopsy of abdominal subcutaneous adipose tissue was collected and insulin sensitivity in adipocytes was determined.  The study also looked at total body insulin sensitivity using frequently sampled intravenous glucose tolerance tests.  The results showed a 30% reduction of cellular insulin sensitivity in adipocytes and 16% decrease in the total body insulin sensitivity among the sleep restricted group compared to the normal sleep group.

Furthermore, Brady and Hall (2016) describe a 2014 study with 482,502 individuals.  The results demonstrate that the group sleeping between 7-8 hours had the lowest risk of Type 2 diabetes. For each hour less of sleep the relative risk was 1.09 and for each hour of longer sleep the risk was 1.14. They went on to share the results of a study comparing patients with Type 2 diabetes and Obstructive Sleep Apnea (OSA) who used continuous positive airway pressure (CPAP) with patients who did not receive treatment.  There were 150 people in each group.  After five years, the group using CPAP had an average hemoglobin A1C (HBA1c) of 8.2% while the group not using CPAP had an average HbA1c of 12.1%.  This suggests that those who used an intervention to improve sleep had better blood sugar control as evidenced by the lower HbA1c in the treatment group.

If you are a provider or patient that has addressed diet, activity, stress management and proper pharmacologic measures and are still missing your desired target, sleep status may need to be considered. Once the decision has been made to improve sleep it is important to find ways to do so.  Here are some tips that may help:

  • Avoid caffeine intake and engaging in physical activity too close to bedtime.
  • Be mindful of electronic devices.  Not only is the light from the device an issue, but the content may be stimulating, making it difficult to go to sleep.
  • If you smoke, quit.  Cigarette smoking can make it difficult to transition into the different stages of sleep, increase teeth grinding during sleep and increase the incidence of restless leg syndrome.
  • Start a bedtime routine.  This prepares your body and mind for sleep.

In conclusion, sleep is a fundamental part of well-being.  Sleep requirements vary from person to person and some people may suffer from a sleep disorder.  Please talk to your healthcare provider to determine what the best sleep options are for you.  

Sweet dreams!

By: Delica Johnson RN, CDE
Fit4D CDE

 

References:

Devon L. Golem, J. T.-B.-B. (2014). An Integrative Review of Sleep for Nutrition Professionals. Advances in Nutrition: An International Review Journal, 742-759. doi:10.3945/an.114.006809

Brady, E. M., & Hall, A. P. (2016). Sleep and type 2 diabetes mellitus. Practical Diabetes, 33(1), 
23-26 4p. doi:10.1002/pdi.1993

Broussard, J., Ehrmann, D., Van Cauter, E., Tasali, E., Brady, M., Broussard, J. L., & ... Brady, M. J. (2012). Impaired insulin signaling in human adipocytes after experimental sleep restriction: a randomized, crossover study. Annals Of Internal Medicine, 157(8), 549-557 9p. doi:10.7326/0003-4819-157-8-201210160-00005