World Diabetes Day: The link between sleep disorders and diabetes management

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According to the World Health Organization estimates, about 422 million people worldwide have diabetes, and 1.5 million deaths are directly attributed to diabetes each year. Even though diabetes can be treated and its consequences avoided or delayed with diet, physical activity, medication and regular screening and treatment for complications, the number of cases and the prevalence of diabetes have been steadily increasing over the past few decades. To bring awareness to this growing global concern, World Diabetes Day is observed around the globe on November 14 every year.

Clinical research has shown that a significant number of diabetic patients suffered from sleep disorders. "Sleep apnoea is characterised by frequent episodes of involuntary pause in breathing during sleep. Studies found that moderate to severe sleep apnoea increases the risk of developing type 2 diabetes by 30 to 50 per cent. If left untreated, sleep apnoea may increase fasting glucose and average blood glucose levels. In diabetic individuals sleep apnoea exacerbates diabetes-related complications and worsens overall health outcomes," explains Dr. Praveen Kumar B.S, consultant of pulmonology, at Manipal Hospital.

On World Diabetes Day, medical experts delve into the intricate connection between sleep disorders and the complexities of diabetes and highlight the criticality of sleep in diabetes management. They also share practical lifestyle modifications that can be adapted by individuals to enhance their quality of sleep to improve overall wellbeing.

How do sleep disorders impact diabetes management?

"Increasing evidence indicates that sleep disorders, particularly sleep-disordered breathing (SDB) such as obstructive sleep apnoea (OSA), hurt glycaemic control, complicating diabetes treatment and increasing the risk of complications," shares Dr Harshitha Boyareddigari, consultant, diabetes and endocrinology at Manipal Hospital, Sarjapur. Below, he outlines how poor sleep impacts and may worsen diabetes management.

Dysregulated insulin resistance

Illnesses, such as sleep apnoea, that disrupt deep sleep interrupt glucose regulation. Sleep enhances insulin sensitivity, which helps to stabilise blood glucose However, frequent awakenings prevent us from reaching the deep, restorative sleep stages necessary for hormonal balance. This disruption makes our bodies less responsive to insulin, leading to higher blood sugar levels and making diabetes management more difficult for individuals with sleep apnoea.

Increased stress hormones

Sleep disturbances caused by SDB result in the overproduction of cortisol, a stress hormone that increases the levels of blood glucose. Cortisol stimulates the liver to release more glucose into the bloodstream, further elevating blood sugar levels. For diabetics, this extra sugar causes blood sugar to spike and makes control even more difficult. This creates a vicious cycle, as increased stress hormones further hinder insulin's effectiveness. High cortisol over a long time makes our insulin resistance poorer, so the blood glucose regulation does not work anymore properly.

Altered appetite hormones

Poor sleep unbalances the levels of leptin (the satiety hormone) and ghrelin (the hunger hormone), leading to more appetite and cravings, most commonly for high-energy foods. These foods lead to quick spikes in blood sugar levels making diabetes management even more challenging. Plus, the excess weight you pack from overeating contributes to insulin resistance and makes blood sugars harder to control.

Inflammation and cellular stress

Oxygen deprivation during sleep interruptions leads to oxidative stress and inflammation, both impairing insulin signalling and glucose metabolism. Sleep deprivation leads to chronic inflammation and contributes to the progression of diabetes complications, such as neuropathy, retinopathy, and cardiovascular disease.

Increased fatigue and decrease in physical activity

Daytime lethargy as a result of poor sleep quality decreases physical activity motivation, an important facet of diabetes control. Moderate exercise enhances insulin sensitivity, but sleep problems cause chronic fatigue which then reduces physical activity and worsens a sedentary lifestyle that causes more insulin resistance.

Impaired cognitive function and bad decisions

Sleep deprivation brings a decline in your mental faculties, affecting both judgment as well as memory. For diabetics, this may result in poor compliance with treatment, such as forgetting to take medicine or not checking out glucose. Not getting enough sleep can make a person more likely to engage in unhealthy behaviours, such as making poorer food choices or not working out, which ultimately makes blood sugar control worse.

Disrupted biological clock

Circadian rhythm may disrupt the metabolism via sleep disorders, such as glucose metabolism. Higher evening blood glucose levels due to circadian misalignment leads to impaired glucose control and hyperglycemia.

Recommended sleep duration for people with diabetes

"Quality sleep is essential, which means maintaining a regular sleep-wake schedule, minimising sleep disruptions, and avoiding any factors that could contribute to insomnia. Restorative sleep supports better blood sugar control, mood stability, and immune function," suggests Dr Piyush Lodha, endocrinologist at Ruby Hall Clinic, Pune.

He recommends that adults with diabetes aim for 7 to 9 hours of quality sleep per night. This sleep should ideally be uninterrupted and restful, as continuous sleep allows the body to manage insulin and blood glucose levels more effectively.

When should a sleep specialist or healthcare provider be consulted?

People with diabetes should consult a healthcare provider or sleep specialist if they experience persistent sleep disturbances or suspect sleep disorders such as insomnia, sleep apnoea, or restless legs syndrome. Lodha points out some key indicators to watch out for:

1. Frequent difficulty falling or staying asleep.
2. Excessive daytime sleepiness despite adequate sleep duration.
3. Snoring, gasping, or pauses in breathing during sleep (potential signs of sleep apnoea)
4. Persistent high blood sugar levels despite good diet and exercise habits, may be aggravated by poor sleep.
5. Trouble managing mood, irritability, or cognitive difficulties due to lack of sleep.
6. Addressing these sleep issues with a specialist can lead to better blood sugar control, improved diabetes management, and enhanced overall health and well-being.

Lifestyle changes for better sleep hygiene to improve diabetes management

The criticality of good sleep has been established when it comes to diabetes management. Improving sleep hygiene can significantly reduce the risk of insomnia and improve diabetes management. Dr Anu Gaikwad, consultant diabetologist and HOD geriatric medicine at DPU Super Specialty Hospital, Pimpri, Pune recommends following practical lifestyle modifications to enhance your quality of sleep.

Maintaining a regular sleep schedule
Going to bed and waking up at the same time daily helps regulate the body's internal clock, making it easier to fall and stay asleep.

Physical activity
Regular exercise, preferably in the morning or early afternoon, can improve sleep. However, vigorous exercise should be avoided close to bedtime, as it can be stimulating.

Avoid stimulants before bedtime
Both caffeine and alcohol can interfere with sleep. Caffeine, particularly after noon, can delay sleep onset, while alcohol may disrupt sleep cycles later in the night, leading to less restful sleep. Avoid nicotine, or any other stimulants close to bed time as it disturbs the sleep.

Skip heavy meals before bed
Eating large meals close to bedtime can cause discomfort and indigestion, which can make it difficult to sleep. A light, healthy snack, if needed, is a better choice.

Create a soothing sleep environment
Relax, either by reading or meditation, before sleep to allow the body to know that it is time to sleep. Your bedroom ideally should be cool, dark and quiet. Investing in comfortable bedding and reducing exposure to noise or light (e.g., using blackout curtains) can help.

Regulate screen time
Avoid using electronic devices before sleep as the blue light from phones, tablets, and computers can interfere with melatonin production, the hormone that regulates sleep. Turning off screens at least an hour before bedtime can promote better sleep.

Practice relaxation techniques
Soothing practices such as deep breathing, meditation, or reading a book before bed can help lower stress and signal the body to prepare for sleep.

Also Read: Consuming junk food while watching TV is increasing diabetes risk in children