Diabetes and sleep problems often go hand in hand. There’s evidence that not sleeping well can increase your risk of developing diabetes and vice-versa where having diabetes can also cause sleep loss.
While it is understood that Type 2 diabetes is often caused by an unhealthy diet, sedentary lifestyle, lack of physical activities and obesity, we often discount the role of inadequate sleep as being one of the key reasons that can lead to diabetes.
1. What is Sleep Health and what constitutes Good Sleep?
Sleep health is mostly defined in the context of individual, social, and environmental needs, which means that good sleep health may not look the same in every situation or for every individual. It can be defined as a multidimensional pattern of sleep-wakefulness, adapted to individual, social, and environmental demands, that promotes physical and mental well-being. 1
Good sleep health is characterized by subjective satisfaction, appropriate timing, adequate duration, high efficiency, and sustained alertness during waking hours. While the parameters to measure good sleep are common, sleep quality and sleep quantity are not directly associated. For example, you may sleep for a long period of time, but it may be a disturbed sleep and therefore not considered quality sleep. The one commonality however is that both sleep quality and quantity are affected by sleep hygiene.
2. What is Sleep Hygiene?
Sleep Hygiene means habits that help you have a good night's sleep. Common sleeping problems (such as insomnia) are often caused by bad habits reinforced over years or even decades. Good sleep hygiene can be achieved by harnessing positive habits making it easier to sleep soundly and wake up well-rested.
3. What are some good sleep hygiene practices?
- Create an environment / daily routines that promote consistent, uninterrupted sleep.
- Keep a stable sleep schedule, and make your bedroom comfortable and free of disruptions
- Follow a relaxing pre-bed routine
- Building healthy habits during the day
4. What are some Signs of Poor Sleep Hygiene?
- An overall lack of consistency in sleep quantity or quality are the most telling signs of poor sleep hygiene.
- Having a hard time falling asleep
- Experiencing frequent sleep disturbances
- Suffering daytime sleepiness
5. How Does Diabetes Affect Sleep?
Diabetes and sleep are intricately connected, and many people with type 2 diabetes and having unstable blood sugar levels experience poor sleep quality or insomnia leading to fatigue the next day. 2
It’s not entirely clear whether one causes the other or whether more variables are at work, but research shows that sleep restriction affects blood sugar levels due to its effects on insulin, cortisol, and oxidative stress. 3
Here are a few other reasons how both High and Low Blood Sugar Levels affect sleep
- High blood sugar goes into the urine and pulls water from your tissues making your kidneys overcompensate leading to polyuria (a condition where the body urinates more than usual) and frequent trips to the bathroom thus disrupting sleep.
- Frequent urination can make you feel dehydrated, causing increased thirst (polydipsia) and prompting you to get up for water.
- Both high and low blood sugar cause symptoms of headaches, dizziness, shaking and tiredness that can interfere with falling asleep.
- Low Blood sugar caused by not eating for a long time can cause you to feel irritated and confused when you wake up.
- Low Blood Sugar may also be caused due to taking a wrong balance of your medicine which can make you have nightmares and break out into a sweat.
- Similar to some other chronic conditions, having diabetes brings about stress and emotional anxiety that can keep you up at night.
- Getting poor sleep or less restorative slow-wave sleep has been linked to high blood sugar levels in people with diabetes and prediabetes.
- In addition to raising blood sugar levels in people who already have diabetes, sleep deprivation also raises the risk of developing insulin resistance in the first place.
6. Does Sleep impact your Diet and Weight Loss?
Yes, it most definitely does! We all have Two main Hunger Hormones called Ghrelin & Leptin that have opposite functions like On and Off buttons.
When you are sleep deprived, your body secretes much higher than normal levels of ghrelin, the hunger hormone. Likewise, levels of leptin (the hunger-regulator hormone) decrease. Cortisol levels (the stress hormone) are also raised, meaning - all roads lead to increased 'fake' hunger, calorie consumption, and obesity risk.
- Ghrelin : Stimulates Hunger --> You feel Hungry
- Leptin : Turns Off Appetite --> You feel Full.
Impact of the Hunger Hormones on Diet and Weight
- When you don’t sleep well, Ghrelin goes up and Leptin goes down tricking your body into thinking it needs to compensate for low energy levels.
- This makes you less satisfied with what you're currently eating, making you crave sugary foods like soft drinks, candy, prompting you to consume more calories than needed.
- This in turn increases blood glucose levels leading to hyperglycemia, which if left uncontrolled for long periods causes damage to multiple organs in your body.
- So if you haven't slept well, you are more likely to seek relief from easy sources of quick energy for the body and brain, which in the long-term has higher risk for cognitive decline later in life.
For more on the impact of Hyperglycemia, check out our article on 101 Guide to Healthy Blood Sugar Ranges.
7. What are the most common Sleep Disorders in People With Diabetes?
Individuals with type 2 diabetes have a higher chance of developing accompanying sleep disorders, the most common being Restless Legs Syndrome and Obstructive Sleep Apnea.
a. Restless Legs Syndrome (RLS)
Restless legs syndrome, is marked by tingling or other irritating sensations in the legs that can interfere with getting to sleep. People with diabetes are also at risk for another condition called peripheral neuropathy. Caused by nerve damage, the symptoms of peripheral neuropathy are very similar to RLS and include numbness, tingling, and pain in the extremities.
b. Obstructive Sleep Apnea (OSA)
Obstructive sleep apnea is a sleep disorder that occurs in people who are overweight or obese where the individual momentarily stops breathing at recurring intervals throughout the night. In most cases, the person is not aware this is happening, though a partner may observe loud snoring and gasping. These lapses in breathing cause brief awakenings that interfere with the natural progression of the sleep stages and impair sleep quality.
8. Sugar.fit Interventions for a Good Night’s Sleep
Careful management of blood sugar levels can help improve sleep for people with type 2 diabetes. Some good sleep hygiene habits for both day and night-time habits, like-
Adhere to a Diet plan that works for you and keeps your blood sugar in control.
Eat Light to Sleep Right
Tip: Avoid having a heavy meal, as they not only impact your blood sugar levels, but eating close to bedtime can keep your blood sugar high overnight, which will affect the quality of your sleep. Instead, opt for a minimum-grain or grain-free meal at dinner. This not only improves your digestion but also reduces inflammation and blood sugar levels. A grain free meal excludes all grains, as well as grain-derived foods like bread, pasta, muesli, rice and wheat. This can be substituted with pseudo cereals (quinoa, amaranth, and buckwheat), fruits, fibre-rich vegetables, protein rich dairy or non-dairy products like meat, fish, eggs, milk, cheese, and yogurt. Some good options are Vegetable or Lentil soups and smoothies OR 1 Bowl of Raw vegetables like Carrots or Cucumber with lemon.
Get regular exercise as physical activity improves insulin sensitivity and is also associated with better sleep.
Don't Stress, Stretch!
Tip : Try this simple experiment. Check your blood sugar values before you exercise, and then take it again afterwards to see and understand what exercise does to your blood sugar. When you exercise, your muscles take up the glucose from your blood for energy; thus regulating your blood glucose levels. Even if you are insulin resistant, exercising improves the effect of insulin, meaning in time it can also correct insulin resistance. To know more about how physical activity helps you control and reduce your risk, check out our article on The relationship between Diabetes and Fitness.
Keep a regular sleep schedule and avoid caffeine, nicotine and alcohol before bed as they can cut into sleep quality.
Coffee Nay ---> Sleep Yay!
Tip : Caffeine is a stimulant found not only in coffee but also in coffee, soda, iced tea, chocolate, and various over-the-counter medications. Alcohol impacts the liver in doing its job of regulating blood sugar, reduces REM sleep, causes sleep disruptions and can also interact with medications prescribed for diabetes. For a good night’s sleep, avoid and restrict consumption of caffeine, nicotine and alcohol for at least four to six hours before bedtime.
Keep the bedroom cool, dark, and quiet
Peace and Quiet to Sleep Tight
Tip : Minimize noise, light, and excessive cold or hot temperature during sleep by using ear plugs, window blinds, or an electric blanket or air conditioner appropriately.
Set a Specific Time to Sleep and Wake up everyday
A Time to Rise + A Time to Rest
Tip : Get up at the same time each morning. Keep your biological clock going in the right direction, otherwise you will be fighting against it. Do not nap during the day. The time it takes you to fall asleep is decreased by the longer you have been awake.
Find your own wind-down routine to help you prepare for bed.
Forget the Daily Grind and Unwind
Tip : This is not a time to be rushing about or planning for the next day's events. Finish your chores and preparations for the next day at least an hour before getting into bed. Use this hour to unwind and set the mood for relaxation by taking a warm shower, do a relaxing skincare routine or read a book.
Go Screen Free; Blue light suppresses Melatonin, the hormone necessary for falling asleep.
No Light for a Good Night
Tip : Electronic back-lit devices like cell phones, tablets, readers, and computers emit short-wavelength enriched light, also known as blue light. Fluorescent and LED lights also emit blue light, which reduces or delays the production of melatonin and decreases sleepiness. Blue light can also reduce the amount of time you spend in slow-wave and rapid-eye movement (REM) sleep, two stages of the sleep cycle that are vital for cognitive functioning. 4
In general, people with diabetes have to be very careful about sleep because anything that throws off their routine can make them feel a lack of energy and fatigue. The more fatigued they feel, the more their motor is running, and the more likely they are to develop insulin deficiencies. While there is no formula for how much sleep you need, on an average, we all need 7.5 hours per night. The good news is that careful attention to diet, exercise, and blood sugar levels can make a world of difference to sleep quality and, in turn, to overall health.
Want to know if you are sleep-deprived? If you use an alarm clock, you can try this simple test. Does your brain awaken you before the alarm goes off? If yes, you are getting adequate sleep. If you have persistent sleep problems, consult your clinician to get treatment for continuously disrupted sleep. Making just one or more lifestyle changes to manage your blood sugar levels has the potential to make a big difference to your sleep quality.