Sleep problems in diabetes: breathing disorders, pain, going to the toilet

It is not uncom­mon for dia­bet­ic patients to seek med­ical atten­tion for var­i­ous sleep dis­or­ders. It is impor­tant to find out all the fac­tors that dis­rupt a good night’s rest, since lack of sleep increas­es the lev­el of stress, which neg­a­tive­ly affects meta­bol­ic process­es, includ­ing blood sug­ar lev­els. One of the rea­sons may be polyneu­ropa­thy, which pro­vokes pain in the legs or con­stant awak­en­ings to go to the toi­let. In addi­tion, the caus­es of sleep dis­tur­bances can be res­pi­ra­to­ry dis­or­ders — sleep apnea syn­drome asso­ci­at­ed with over­weight. The med­ica­tions tak­en by patients may also have some influ­ence. There­fore, it is impor­tant to always under­stand the caus­es of insom­nia and elim­i­nate them as much as pos­si­ble.

Sleep disorders in diabetics

Doc­tors keep repeat­ing that a good night’s sleep, prop­er nutri­tion and main­tain­ing a healthy weight are ben­e­fi­cial for all peo­ple. But these good habits are espe­cial­ly impor­tant for those peo­ple who have been diag­nosed with dia­betes. Often, patients come to the doc­tor with com­plaints that they do not sleep well: in the evenings they can­not fall asleep for a long time, sleep is rest­less, with fre­quent awak­en­ings, or super­fi­cial, in the morn­ing there is a feel­ing of weak­ness and lethar­gy. There are sev­er­al typ­i­cal rea­sons why sleep may be dis­turbed dur­ing the devel­op­ment of dia­betes. It is impor­tant to find out which of them affect the patient.

Blood sugar fluctuations and trips to the toilet

First of all, pro­nounced fluc­tu­a­tions in blood sug­ar lev­els at night can dis­rupt sleep. Very high blood glu­cose lev­els can lead to pro­fuse uri­na­tion, and sleep can be inter­rupt­ed by fre­quent trips to the toi­let. This is pos­si­ble if blood sug­ar lev­els are poor­ly con­trolled due to eat­ing dis­or­ders, med­ica­tion, or insulin admin­is­tra­tion. If blood sug­ar becomes too low at night, symp­toms such as rest­less sleep, exces­sive sweat­ing, and tachy­car­dia may occur. This leads to awak­en­ing, requires imme­di­ate cor­rec­tion of the sit­u­a­tion.

Respiratory disorders: sleep apnea

A breath­ing dis­or­der such as sleep apnea is sig­nif­i­cant­ly more com­mon in dia­betes. The term “apnea” lit­er­al­ly means “lack of breath­ing”. Thus, sleep apnea refers to short-term dis­or­ders of pul­monary ven­ti­la­tion, last­ing no more than 1–2 min­utes, when breath­ing is extreme­ly weak or absent dur­ing sleep. Anoth­er cause of sleep dis­tur­bances may be snor­ing asso­ci­at­ed with over­weight, which often accom­pa­nies dia­betes.

Usu­al­ly sleep apnea, night­time snor­ing is noticed by the patien­t’s spouse or fam­i­ly mem­bers, and such inter­mit­tent breath­ing can be seri­ous­ly scary. The patient him­self may feel tired or sleepy dur­ing the day, suf­fer from impaired con­cen­tra­tion. Breath­ing dis­or­ders increase the like­li­hood of heart attack and stroke, and the more severe the sleep apnea, the greater the risk for severe dia­betes itself.

Complications of Diabetes Affecting Sleep

Anoth­er com­mon prob­lem in some peo­ple with dia­betes is dia­bet­ic polyneu­ropa­thy. It can cause pain in the legs, such as a burn­ing or tin­gling sen­sa­tion, which can dis­turb sleep. Anoth­er sleep dis­or­der called rest­less legs syn­drome can make you want to move your legs while falling asleep and cre­ate unpleas­ant, uncom­fort­able sen­sa­tions that pre­vent you from sleep­ing nor­mal­ly. Because of these prob­lems, peo­ple with dia­betes are more like­ly to expe­ri­ence night­time insom­nia and day­time sleepi­ness.

Other causes of insomnia: stress, medications

Insom­nia can also occur as a side effect of cer­tain med­ica­tions, such as anti­de­pres­sants, and depres­sion may be more com­mon in peo­ple with chron­ic con­di­tions, such as dia­betes.

Sleep dis­rup­tion can cause an increase in stress hor­mones that make it dif­fi­cult to con­trol weight. This forms a vicious cycle that is asso­ci­at­ed with dia­betes, obe­si­ty and sleep dis­or­ders. To find out what is caus­ing your sleep prob­lems, your doc­tor will like­ly rec­om­mend a sleep study. Dur­ing the study, heart rate, body move­ments and brain activ­i­ty are mon­i­tored. This is to assess how well the patient is sleep­ing and to deter­mine what may be caus­ing insom­nia.

Approaches to the treatment of sleep disorders in diabetics

It is impor­tant to find out all the caus­es of sleep dis­or­ders and elim­i­nate them, so that patients with dia­betes have a good rest at night and do not feel lethar­gic and sleepy dur­ing the day. For exam­ple, if a doc­tor has iden­ti­fied sleep apnea, CPAP ther­a­py is indi­cat­ed, the use of a spe­cial mask for the mouth and nose, which helps pre­vent res­pi­ra­to­ry arrest dur­ing sleep and the devel­op­ment of tis­sue hypox­ia, includ­ing the brain. Treat­ing sleep apnea can help with blood sug­ar con­trol, insulin resis­tance, and oth­er symp­toms asso­ci­at­ed with heart dis­ease. In addi­tion, weight loss can help improve and pos­si­bly elim­i­nate sleep apnea.

To main­tain blood sug­ar lev­els, some patients are shown the use of a con­tin­u­ous mon­i­tor­ing sys­tem. It is some­times okay to wake up once or twice a night dur­ing the week to check your blood sug­ar lev­els and track fluc­tu­a­tions. Typ­i­cal­ly, med­ica­tion or dietary adjust­ments can help resolve this issue.

For rest­less leg syn­drome, your doc­tor may pre­scribe med­ica­tion. You may also need to check your iron lev­els, as low lev­els can con­tribute to the prob­lem, espe­cial­ly in pre­menopausal women.

Tips for Patients

There are sev­er­al things you can do on your own to improve sleep:

• Make sleep a pri­or­i­ty. It is impor­tant to go to bed at the same time, leav­ing unfin­ished busi­ness, and be sure to sleep for at least 8 hours.
• Sleep in a dark, calm, cool room, remove all gad­gets, TV and elec­tri­cal appli­ances from the bed­room.
• Sleep­ing pills and strong seda­tives should be avoid­ed. They can wors­en sleep apnea and have oth­er side effects.
• Use the bed only for sleep­ing. If you have prob­lems falling asleep after 15–20 min­utes, you need to get out of bed and read a book (prefer­ably not on a tablet or elec­tron­ic device).
• Make exer­cise a habit. This will help you sleep bet­ter at night.