Diabetes continues to affect more than 30 million people across the United States. As the seventh leading cause of death in the country, [1] it has been of great concern for experts for decades. Of the different types of diabetes, diabetes type 2 remains the most common. This chronic disease happens as a person develops resistance to insulin, a hormone that helps shift glucose molecules from the bloodstream to the liver, fat, muscles, and cells, where it is broken down for energy. Diabetes type 2 happens when either the body fails to produce enough insulin or when insulin fails to shift glucose to body cells. Consequently, the level of blood glucose begins to rise, leading to a high sugar state called hyperglycemia, the hallmark of diabetes. If not managed properly, diabetes can bring severe consequences for the kidneys, heart, and other organs.
While many people may not appreciate it, diabetes and sleep share an intricate connection with one another, often leading to another. However, the good news is it is possible to manage both diabetes and insomnia or other sleep-related issues with a combination of diet and exercise.
Can Diabetes Cause Insomnia? The Relationship Explained
According to experts, one in every two people with type 2 diabetes suffer from sleep-related issues secondary to high blood sugar and other diabetic symptoms. [2] Hyperglycemia, a state of high blood sugar, and hypoglycemia, a state of low blood sugar, often cause insomnia in addition to next-day fatigue in many people. Additionally, the feelings of stress and depression due to this chronic illness further contribute to keeping a person awake at night.
When people have high blood sugar levels, their kidneys attempt to overcompensate by causing them to urinate more frequently. When this happens during the night, a person may have to take additional trips to the bathroom, disrupting their sleep. Similarly, hyperglycemia can also cause other symptoms, like increased thirst, headaches, and tiredness, all of which interfere with sleep.
On the other hand, going too many hours without having something to eat or taking the wrong dose of diabetes medication may sometimes cause hypoglycemia in patients. These hypoglycemic states can lead to nightmares, irritability, excessive sweating, or confusion at night. People with diabetes experiencing any of the symptoms mentioned above must talk to a doctor, especially if they are frequently disturbing their sleep. A doctor can analyze the situation more carefully and work with patients to find ways to keep their blood sugar levels more stable.
Diabetes Insomnia: How Does Poor Sleep Affect Blood Sugar?
Just like diabetes can cause issues with sleep, sleep issues can also play a role in triggering or exacerbating diabetes. When a person gets poor or less restorative sleep, it causes their blood sugar levels to peak. [3] However, experts are unsure whether one directly causes the other or if other variables are involved in this phenomenon. So far, research proposes that sleep restriction directly affects blood sugar levels as it affects insulin and cortisol while triggering oxidative stress in the body.
Over one-quarter of individuals with diagnosed diabetes report getting less than six hours of sleep or more than eight hours, which increases their risk of having a hyperglycemic episode at night. In addition to raising blood sugar levels in diabetic individuals, a lack of sleep also triggers insulin resistance, a phenomenon that typically becomes apparent in childhood. Studies also propose that irregular or late sleeping can lead to high blood sugar, even in people with no official label of diabetes. However, certain other variables have an effect in triggering this phenomenon, such as the fact that people with an irregular sleep schedule are more vulnerable to following an erratic diet plan.
Sleep deprivation also increases the levels of the hunger hormone, known as ghrelin, along with leptin, which induces feelings of satiety. To compensate, people with poor sleep habits may seek relief and comfort in foods that spike blood sugar levels and put them at risk of obesity, a strong risk factor for diabetes. Some experts believe that diabetics with poor sleep schedules are less likely to follow other diabetes self-care tips, such as regular exercise and regular glucose monitoring, due to excessive tiredness.
In addition to directly affecting blood sugar levels, a poor sleep pattern in diabetics can also take a toll on their long-term health. For instance, such people are vulnerable to developing serious psychological distress. Research also suggests that people with diabetes who are not getting enough sleep consistently are more likely to experience cognitive decline in the later stages of life.
Low Blood Sugar and Insomnia: Common Sleep Disorders Affecting the Diabetic Population
People with type 2 diabetes are more likely to experience sleep disorders than the general population. Some of the most common sleep disorders seen in this population include the following:
Restless Legs Syndrome
Also known as RLS, restless legs syndrome affects approximately one out of every five people with type 2 diabetes. The condition is marked by tingling and irritating sensations in the legs that interfere with a person’s sleep. People with diabetes also develop peripheral neuropathy secondary to nerve damage caused by high blood sugar levels. The symptoms of peripheral neuropathy are very similar to those of RLS and may include pain, tingling, and numbness in the peripheral extremities, particularly the legs. Individuals who report these symptoms must get medical attention as soon as possible, as peripheral neuropathy requires urgent treatment to reduce long-term damage to the nerves.
Obstructive Sleep Apnea
Also known as OSA, obstructive sleep apnea is a type of breathing disorder in which a person stops breathing momentarily several times throughout the night. In most instances, the person is not aware of these breathing pauses, and it is usually their bed partner who notices them gasping and snoring as they sleep. These lapses in breathing sometimes lead to micro-arousals or brief awakenings, stopping the natural progression of a person through the usual stages of sleep while impairing the overall sleep quality.
OSA is very common in people who are obese or overweight as they have a thicker neck circumference, which easily interferes with their airways. For most people, OSA requires treatment with a CPAP device or continuous positive airway pressure that keeps the airway open and restores normal breathing while minimizing sleep disruptions.
Diabetes Insomnia Treatment: How to Cope?
Careful management of daily blood sugar levels is the best way to minimize sleep disruptions secondary to type 2 diabetes. Additionally, since diabetes and sleep share a close relationship, experts encourage adopting healthy sleep hygiene and habits that promote restful sleep at night. Some tips to keep in mind in this respect include the following.
Avoid using electronic devices before bedtime
Avoid using cellphones, laptops, or e-readers at night, as these devices emit a certain type of light known to disrupt sleep cycles. If you habitually read a book before going to sleep, stick to the old-fashioned way of reading paper-based books to quieten the mind while not exposing your eyes to excessive strain.
Say no to alcohol close to bedtime
While alcohol is often a part of late-night parties, drinking too close to bedtime can interrupt the sleep cycle, making people with diabetes an insomniac.
Get rid of all distractions
Get rid of anything that may distract you from peacefully transitioning into sleep. For instance, if you receive too many messages that urge you to check your phone constantly, switch off your cell phone close to bedtime and consider buying an alarm clock as a replacement.
Use white noise
Although waking up to birds chirping sounds like a pleasant morning, it can sometimes disrupt the usual sleeping patterns. Other sounds with similar effects on sleep include the ones coming from people leaving for early-morning jobs, street sweepers, or garbage collectors. For people who are light sleepers, getting a source of white noise can be a good way to solidify and regulate their sleep cycles.
Fix a sleep schedule
Try going to bed at the same time every night and waking up at a fixed time each morning. Do not let go of this habit even on the weekend, as this will allow your body to slowly adjust to these times accordingly. With some attempts, you will notice feeling tired around your bedtime and wake up on your own at your fixed wake-up time without needing an alarm clock.
Avoid stimulants at night
Avoid consuming anything that stimulates the body and keeps you awake, such as caffeinated beverages or even exercise too close to bedtime. Even if you do wish to do some workout at night, it can be a slow-paced yoga session that helps your body slowly prepare for sleep. Working out strenuously will speed up blood circulation, and your body may need some additional time to calm down.
Create an environment suitable for sleep
A comfortable environment makes a huge difference in the amount of time a person needs to drift off into sleep. Consider investing in a comfortable mattress and get some soft pillows to support your body. Moreover, adjust your bedroom temperature according to your comfort level to easily sleep. Research suggests that cooler temperatures are more likely to help a person sleep, so consider using a fan or opening a window if the room feels a bit hot.
If your blood sugar and sleep problems still continue to bother you, do not hesitate to ask a doctor for advice. Based on personal circumstances, a doctor may recommend certain sleep aids for better diabetes control in addition to other ways of sleep management. They may sometimes request a sleep study to see if you are experiencing an underlying sleep disorder and prescribe appropriate treatment as needed.
FAQs
Can lack of sleep cause high blood sugar?
Multiple studies have proven that any type of sleep disruption, including too much sleep, frequent nighttime awakenings, and insufficient sleep, can all affect blood sugar, increasing it in most cases.
Why do diabetics wake up too often between 3 am to 8 am?
People with diabetes are unable to release enough insulin to match the early morning rise in their blood sugar levels. Known as the dawn phenomenon, this uncontrolled blood sugar spike typically happens during the early hours of the morning, usually between 3 am to 8 am, causing a person to wake up.
What should be the best bedtime ritual for people with type 2 diabetes?
Experts recommend people with type 2 diabetes do something to relax and quieten their mind and body close to bedtime. For instance, they may engage in gentle yoga, take a warm bath, or read a book.
References
1 Huang YC, Zuniga JA, Garcia AA. Association between sleep and serious psychological distress in patients with diabetes. Psychology, Health & Medicine. 2019 Sep 14;24(8):925-35.
2 Zhu B, Quinn L, Kapella MC, Bronas UG, Collins EG, Ruggiero L, Park CG, Fritschi C. Relationship between sleep disturbance and self-care in adults with type 2 diabetes. Acta diabetologica. 2018 Sep;55:963-70.
3 Yoda K, Inaba M, Hamamoto K, Yoda M, Tsuda A, Mori K, Imanishi Y, Emoto M, Yamada S. Association between poor glycemic control, impaired sleep quality, and increased arterial thickening in type 2 diabetic patients. PloS one. 2015 Apr 14;10(4):e0122521.