Sleep and diabetes: the seemingly contradictory relationship explained

Jack Woodfield
By Jack Woodfield
4th January 2017
In Depth
 
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A complicated relationship exists between sleep and diabetes, which is characterised by a number of apparent contradictions.

For example, lack of sleep can increase the risk of type 2 diabetes, but sleeping in at the weekend can also increase this risk. Diabetes complications can make you very tired, but these same complications can make it harder to sleep. The juxtapositions go on…

Sleep is a very broad state. It’s a bit like diet. Different things work for different people. Some people require eight or more hours a sleep a night to feel refreshed the next day; some can live with less than four.

When diabetes is thrown into the equation, it’s convoluted further. Studies often oppose each other regarding sleep and diabetes risk or management, and you’d be forgiven for asking, “well how much sleep do I actually need a night?”

To answer, there isn’t really an official answer. But living as healthily as possible is crucial, whether you are at risk of diabetes or have already developed it, to ensure your body is best equipped to get a good night’s rest.

Sleep and diabetes management

Unfortunately, having diabetes does mean that it can be harder to sleep well.

When your blood glucose levels are too high it can make you feel too warm or irritable to sleep; hyperglycemia can also increase how often you urinate during the night as your body tries to excrete excess glucose. When your levels are low, on the other hand, treating hypos can too disrupt your sleep.

Moreover, fatigue is a symptom of both hyperglycemia and hypoglycemia. People are often a bit foggy upon waking up in the night and this can blur normal symptoms of high and low blood sugar.

Worse still, you might find that experiencing either hypoglycemia or hypoglycemia overnight can make you more tired the next morning or after meals.

Testing your blood sugar to make sure your fatigue is not related to blood glucose levels is one of the many cyclical challenges of diabetes – and it can be exhausting, figuratively and literally.

But keeping good control of blood glucose levels can be significantly beneficial in improving your sleep. Furthermore, testing your blood sugar before bed and treating any problems beforehand can help you avoid interrupted sleep.

Sleep and diabetes risk

The relationship between sleep and diabetes risk is even more convoluted.

While diabetes can cause fatigue and sleeping problems, feeling consistently tired can actually be symptomatic of either type 1 or type 2 diabetes.

Type 2 diabetes in particular has a complex association with sleep, with several studies highlighting different findings relating to how sleep affects diabetes risk.

One of the more regular reported results is that getting poor sleep increases the temptation to drink sugar-sweetened beverages.

“Short sleepers may seek out caffeinated sugar-sweetened beverages to increase alertness and stave off daytime sleepiness,” said the University of California’s Aric A. Prather, whose 2016 study investigated the effects of sleep loss during weekdays.

Regular consumption of sugary drinks often leads to weight gain which increases the risk of type 2 diabetes. But getting a good night’s sleep can help regulate bodily processes such as appetite and weight control, and this decreases those cravings.

So what exactly is classed as a good night’s sleep?

Both high and low blood sugar can make it hard to sleep for people with diabetes

Both high and low blood sugar can make it hard to sleep for people with diabetes

A 2015 study from the University of Alabama reported sleeping for less than seven hours per night increased the risk of type 2 diabetes because of “secondary eating and drinking”, also known as “unconscious eating and drinking”, which refers to eating and drinking done while distracted by other activities such as television or a computer screen.

Earlier this year, Dutch researchers then reported that women who sleep for eight hours or more could have a lower type 2 diabetes risk, but not men.  However, another study found that sleeping for eight hours a day could increase the risk of stroke.

As for children – teenage boys, in particular – a loss of slow-wave sleep could make them at risk of type 2 diabetes and other health issues in adulthood.

It’s all enough to make you want a lie down.

But then there’s the issue of lie-ins. The advice in general seems to be to avoid naps and lie-ins as short sleep can alter your circadian rhythms, our internal body clocks that respond to natural daylight and darkness. Disrupting circadian rhythms can affect the metabolism, immune system and cardiovascular system.

Let’s recap then. Not sleeping enough increases the risk of type 2 diabetes, while sleeping too much has its own set of health problems.

Essentially, nobody’s sure exactly how much we should all sleep. Scientists generally tend to agree, though, that adults need between 6-8 hours sleep a day.

Sleep complications

To further obstruct the path to slumber, a number of sleep complications exist which can be very problematic for people with or without diabetes.

One of the most common is sleep apnea, characterised by the narrowing of the throat walls and the interruption of normal breathing. The resultant lack of oxygen forces the brain to wake up and often leads to daytime fatigue.

Sleep apnea can be an early warning sign of type 2 diabetes developing, particularly among older men, while people who already have type 2 diabetes have a one in four chance of developing sleep apnea.

Essentially, nobody’s sure exactly how much we should all sleep. Scientists generally tend to agree, though, that adults need between 6-8 hours sleep a day.

It is these interruptions to deep sleep that impact type 2 diabetes risk as the metabolism is affected and the body’s response to weight control is altered.

People who already struggle with weight control are particularly prone to developing sleep apnea, while obesity is the most common cause of type 2 diabetes. Losing weight can therefore be beneficial in reducing the risk of sleep apnea, diabetes, and improving quality of sleep.

Other sleep complications that can affect people with diabetes include peripheral neuropathy, restless leg syndrome, dawn phenomenon and somogyi phenomenon. While different treatments are prescribed for different conditions, maintaining good blood glucose levels helps people with these complications in nearly all cases.

Getting a good night’s sleep

Eating healthily and getting appropriate exercise can help people with sleep complications get improved sleep, less pain and reduced fatigue. Your doctor can help explain treatment options if you are experiencing complications relating to your diabetes and/or a specific sleep complication.

There are also a variety of tips that can help people with diabetes improve their quality of sleep.

Furthermore it’s important – albeit easier said than done – to try and not get despondent about lack of sleep.

Research will continue to tell us how much sleep we should be getting, but it can be muddled and conflicted. Don’t get bogged down comparing your own sleep patterns to the latest headlines. It can be hard enough to get good quality sleep; the last thing you then need is to worry you’re not getting enough.

What do you think?