Improving your sleep habits may help you manage blood glucose
Although diabetes is a condition that has been studied for decades, the field of sleep medicine is now emerging. Researchers and healthcare providers have come to learn more about how sleep affects your health, including how poor or even excessive sleep can impact both the development and management of diabetes.
Sleep deficiencies and circadian disruption have been shown to contribute to many independent risk factors for type 2 diabetes — including weight gain, obesity, timing and the amount of food intake and insulin sensitivity. When combined, all of these risk factors have been shown to promote a metabolic environment that favors the progression to type 2 diabetes.
ARE YOU SLEEP-DEPRIVED?
Many providers often overlook sleep deprivation as an independent risk factor for type 2 diabetes. However, recent clinical studies have proven that sleep-deprived patients can suffer from a decreased release of insulin, which is critical for adequate control of blood sugar.
Everyone normally goes through many sleep cycles throughout the night, including light sleep, deep sleep and REM (dreaming) sleep. Recent evidence has shown that the most amount of insulin secreted during sleep is during deep sleep. In general, most people spend a majority of the first half of the night in deep sleep and a majority of the second half of sleep in REM sleep. So a majority of insulin released during sleep happens in the first half of the night. The recommended amount of sleep per night — particularly for those with diabetes — is at least six to eight hours.
Many people say their ability to control what they eat decreases significantly when they are sleep-deprived. This can be explained by the fact that stress hormones (such as cortisol released during times of sleep deprivation) reduce the ability to fight cravings and urges. The result of both decreased insulin secretion and poor diet control is a decreased ability of the body to keep blood sugar levels in normal ranges.
The good news about sleep deprivation is that it’s metabolic, and hormonal changes can generally be normalized after just two consecutive days of adequate sleep. In general, on the first night of adequate sleep, most people spend more time than normal in deep sleep. So those with diabetes may have an improved release of insulin.
On the second consecutive night of adequate sleep, most people spend additional time in the REM stage of sleep. This has been commonly referred to as REM-rebound, and frequently those who experience it say that they have more dreams than usual.
Just like sleep deprivation, excessive sleeping has also been linked to both an increased risk of developing diabetes and more difficulty controlling blood sugar in patients with diabetes. Multiple recent studies have shown that people who sleep too much can also be at risk of developing diabetes. Several of these studies found that those who sleep longer than nine hours per night have a decreased glucose tolerance. This means that the body does not respond as well to increased blood sugar.
A common complaint of those who say they sleep more than they would like to is that they still feel tired when they wake up. There are many possible causes for this, one of which is called obstructive sleep apnea. Sleep apnea is a relatively common sleep disorder, especially among people with diabetes. In general, some red flags for sleep apnea that warrant evaluation include snoring, obesity, increased neck circumference and excessive daytime sleepiness. If you still feel excessively tired after a full night of sleep — and have some of these symptoms — you should reach out to your provider for further evaluation, as treatment of sleep apnea has also been proven to improve blood sugar control.
WHAT MAY COMPROMISE SLEEP
Many times, after taking a thorough patient history, providers find that the biggest reason for difficulty sleeping is poor sleep hygiene. Basically, sleep hygiene refers to your routine both before and during sleep. Tips to improve your sleep hygiene follow.
1. Prior to going to bed, find a relaxing activity. Reading a book may help calm you down before you fall asleep. It’s best to avoid all electronics before going to sleep, including cell phones and tablets, etc., as white light from these devices actually stimulates the brain to release chemicals to keep you awake.
2. You probably have heard more than once that your bed should be for two things only: sleep and sex. Activities unrelated to sleep, such as working on your computer, watching television, worrying about what happened during the day or what may happen tomorrow, etc., over time results in reprogramming your brain not to associate your bed with sleep but instead to associate it with whatever else you are doing when you should be going to sleep. Basically, it’s best to physically lie down in your bed only when you are planning to go to sleep. That way, your brain will associate your bed with sleep.
3. If you are already having difficulty falling asleep, your habit/mindset of sleeping in your bed may have already been altered from years of experience. A common theme among those who have difficulty falling asleep in their beds at home is that they tend to sleep very well (or at least better) when they are not at home. This can, at least in part, be explained by the fact that the experience of having difficulty sleeping in your bed at home contributes toward the overall feeling that you “do not sleep well” in your bed. Also, many people who suffer from this type of thinking also report that they sleep better in other places in their home (such as the couch or a comfortable chair). The best way to correct this is to go to your bed when you are exhausted and feel as though you can no longer stay awake. If, upon lying down to try to go to sleep, you do not fall asleep within 20 to 30 minutes, leave your bed and go to another room to do something that will calm you down/make you feel more sleepy (such as reading a book, meditating, etc.). Then, when you feel more relaxed/sleepy, try to go back to your bed to sleep. It’s important to be patient with yourself, as the process of improving your ability to sleep in your bed can take a long time.
Poor sleep (in the form of either inadequate or excessive sleep) can significantly impact your body’s ability to metabolize sugar. Over time, this may result in either the development of diabetes or, if you already have the disease, additional difficulty in controlling your blood sugar. The good news is that many people with diabetes who have difficulty sleeping can frequently improve their control of blood sugar once they improve their sleep habits. If you have diabetes and have difficulty sleeping, it’s a good idea to reach out to your provider for further evaluation.