Diabetes and sleep disorders -
Obstructive sleep apnea OSA and type 2 diabetes frequently occur together, and there is strong evidence to suggest the two pathologies are linked. Few studies have investigated the prevalence of sleep apnea in type 1 diabetes.
In another study of adults with diabetes 58 with type 1 diabetes , However, only 1. Subjects who had OSA were older, had a longer duration of diabetes, and were more likely to have retinopathy than those who did not have OSA OSA was common in a group of normal-weight mean BMI Although limited, these studies demonstrate that OSA is more common among individuals with type 1 diabetes than among those without diabetes, and the presence and severity of OSA are linked to glycemic control in both children and adults with type 1 diabetes.
Larger-scale studies are needed to confirm these findings. Studies investigating the incidence of other sleep disorders such as insomnia and narcolepsy in type 1 diabetes have not been reported in the literature.
One study found that restless legs syndrome, a problem that is common in adulthood but of unknown prevalence in childhood, was not more common among children with type 1 diabetes than among healthy control subjects 5. Research has shown that individuals with type 1 diabetes have a decreased awakening response to hypoglycemia during sleep 16 , 17 , which could be the result of decreased counterregulatory response 18 — Unfortunately, nocturnal hypoglycemia is a common occurrence in both children and adults with type 1 diabetes 21 — Adults subjectively report that nonsevere hypoglycemic events disrupt their sleep, and many have difficulty falling back to sleep after treating their hypoglycemia 25 , The impact of hypoglycemia on sleep architecture has been minimally investigated.
However, only 6 of the total 20 subjects experienced hypoglycemia in this study, in which blood glucose was obtained via intravenous catheter every 30 minutes In another study, the number of full awakenings was significantly higher in children with type 1 diabetes, but there was no relationship between awakenings and the occurrence of hypoglycemia measured by continuous glucose monitoring In the same study, slow-wave sleep stages 3 and 4 was significantly more prevalent during episodes of hypoglycemia.
Using actigraphy to discriminate between sleep and wakefulness, hypoglycemia during sleep was associated with increased motor activity in adolescents with type 1 diabetes Few studies have addressed the impact of hypoglycemia on sleep architecture in adults with type 1 diabetes. Still, the prevalence of nocturnal hypoglycemia combined with anecdotal subjective reports of sleep disruption from hypoglycemia highlight the need for future studies designed to fully characterize the impact of hypoglycemia-related sleep disruption.
Interestingly, it has been reported that hypoglycemia does not alter the acoustic arousal threshold in adolescents with type 1 diabetes 17 , indicating that alarms may be helpful in alerting individuals when hypoglycemia occurs during sleep.
Melatonin is an important regulator of the sleep-wake cycle. These results suggest that hyperglycemia may negatively affect maintenance of a normal circadian cycle. Minimal research has been done investigating the direct impacts of hyperglycemia on sleep.
As reviewed previously, there is a strong connection between disrupted sleep and poorer glycemic control; however, these studies were unable to determine causality. As noted above, one study found that sleep restriction led to impaired insulin sensitivity the next day in individuals with type 1 diabetes, which would disrupt glycemic control It also is possible that sleep may be disrupted by the symptoms of hyperglycemia.
Hyperglycemia leads to osmotic diuresis, resulting in the need to urinate more frequently, which may lead to sleep disruption, although no studies investigating this phenomenon have been reported. Studies comparing the effects of hyperglycemia versus euglycemia on sleep architecture in both children and adults are needed to determine whether hyperglycemia has a detrimental effect on sleep architecture.
Increased glycemic variability has been positively correlated with subjectively reported mean sleep latency 7. Pillar et al. This finding raises the possibility that the rate of change in glucose levels may affect sleep architecture. These results highlight a need for more studies to investigate the influence of glucose variability, a common feature of type 1 diabetes, on sleep.
Blood pressure normally declines during sleep; loss of this decline is associated with increased risk for sustained hypertension, as well as an accelerated rate of development of complications Larger studies that include a control group are needed to confirm whether short sleep duration increases the risk of or accelerates the development of cardiovascular and microvascular complications and whether this is specific to type 1 diabetes.
Evidence from the literature supports the likelihood that adults and children with type 1 diabetes have altered sleep architecture and reduced sleep quality relative to individuals without diabetes.
Alterations in sleep architecture may be the result of both behavioral and physiological aspects of diabetes and its management. Sleep apnea may be more prevalent in people with type 1 diabetes, and presence of OSA has been linked to impaired glycemic control.
Furthermore, lack of the normal decline in blood pressure during sleep may be linked to short sleep duration in people with type 1 diabetes, and this may accelerate the development of cardiovascular and microvascular disease. Additional research is needed to better understand the mechanisms determining why and how sleep is disrupted in individuals with type 1 diabetes and what impact sleep disruption may have on diabetes management and control.
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Previous Article Next Article. People living with other types of diabetes who take insulin or other glucose-lowering medication may also experience high and low blood sugar levels during the night.
Having a hypo in the night can lead to daytime sleepiness the next day, and regularly experiencing hypos in the night can lead to irregular sleep patterns, such as going to sleep at different times.
High blood sugar levels, known as hypers short for hyperglycaemia can also impact your sleep. When blood sugar levels are high, it can increase the number of times you go to the toilet, which can interrupt your sleep.
High blood sugar levels can also cause symptoms such as feeling thirstier and having a headache and might make it harder to get straight back to sleep.
If you live with diabetes and regularly struggle with high or low blood sugar levels at night, or you are the parent or guardian of a child living with diabetes who struggles to sleep because of low or high blood sugar levels, you can ask your healthcare team for advice.
We know that poor quality sleep can affect blood sugar levels while we sleep, but more research is needed to see how sleep interventions could help people with or at risk of type 2 diabetes.
Insomnia can also increase the risk of developing type 2 diabetes, according to research led by the University of Bristol , that we funded. Diabetes technology has the potential to improve the quality of sleep for people living with diabetes. Sometimes known as an artificial pancreas, hybrid closed loop systems are designed to keep blood sugar levels more stable throughout the day and night, and they can reduce how many hypos someone living with type 1 diabetes experiences.
Parents of a child living with diabetes see benefits too. Research has previously shown that when closed loop systems were tested in children, nine out of 10 parents said they reported less trouble sleeping.
Sleep and blood sugar levels have an intricate relationship. As alterations in one can affect the other, it is not uncommon for people with diabetes to have difficulty sleeping. Effectively managing the condition and practicing good sleeping habits can help people with diabetes get enough good quality sleep.
Episodes of low and high blood sugar — known as hypoglycemic hypo and hyperglycemic events, respectively — can cause symptoms that may disturb sleep, such as thirst and an urge to urinate.
Low quality sleep can also make it more difficult to control diabetes, as it can affect how people manage the condition. In this article, we discuss the relationship between diabetes and sleep and suggest tips to help manage both of these. Diabetes can have a negative effect on sleep, and people living with diabetes often report poor sleep.
Evidence notes that diabetes and sleep disturbances have a dual-sided relationship. This refers to how blood glucose control can worsen the quality of sleep while sleep disturbances can affect blood sugar levels and elevate the risk of developing insulin resistance.
Having diabetes does not necessarily mean that a person will experience difficulty sleeping. However, certain symptoms are more likely to result in sleep disturbances.
For example, high blood sugar levels can lead to frequent urination. As such, if a person experiences a hyperglycemic event at night, they may need to get up to use the bathroom. Additionally, when the body has extra glucose, it draws water from the bodily tissues, leading to dehydration.
This may prompt a person to wake up and drink water. Hyperglycemia may also cause a person to feel warm, irritable, and unsettled at night.
A person with diabetes may also experience the Somogyi effect or dawn phenomenon. Both terms refer to a sudden rise in blood sugars either due to a rebound effect of low blood sugars or hormonal changes in the body. Similarly, symptoms of low blood sugar levels can also lower sleep quality.
It is not uncommon for people to experience a hypoglycemic event during their sleep , which can cause them to feel sweaty, shaky, and hungry and to experience nightmares. Although a person may not wake up or notice any hypo symptoms, low blood sugar can still interfere with sleep and affect quality of life, mood, and the ability to work.
It may also make people less likely to notice and respond to the symptoms of a hypo during the day. Furthermore, waking up due to a blood sugar disturbance requires a person to correct their glucose levels with either insulin or carbohydrates.
Making these adjustments may cause a person to feel alert and struggle to fall back asleep. Some sleep disorders that may relate to both type 1 and type 2 diabetes include:. Sleep disorders can affect not only sleep quality and duration but also glucose metabolism and weight regulation.
The possible complications of a lack of regular, sufficient sleep in someone with diabetes can include :. Evidence also suggests that low quality sleep can increase the risk of developing type 2 diabetes.
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