Sleep Problems In Patients With Type 1 Diabetes Mellitus
Sleep Problems in Patients with Type 1 Diabetes Mellitus Erkan Sari, Oguzhan Babacan, Sirzat Yesilkaya, Onur Akin, Kursat Fidanci, Gokalp Basbozkurt, Berna Fidanci, Celal Saglam, Galip Erdem, Omer Saglam, Ediz Yesilkaya. Aim: Chronic diseases are associated with sleep disorders. Sleep and related problems usually escape from attention of both physicians and families. It is aimed to investigate the sleep quality in adolescents with type 1 diabetes mellitus. Material-methods: Reliability and validity confirmed Pediatric Sleep Questionnaire was conducted 30 adolescent with type 1 diabetes and age matched 55 healthy teenagers. Results: Mean diabetes duration of patients was 4.53.5 years. Recent three HbA1C average was 7.66%0.77 . Although scores of snoring, breathing and behavior were similar score of sleep quality and intra-day activity was significantly different . Conclusion: Sleep is very important for healthy life, and good school performance. It should be kept in mind that chronic diseases like T1DM affect sleep quality. Sleep related problems usually missed by parents and physicians must be exposed and looked for solution if possible. Key words: sleep disorders, type 1 diabetes mellitusContinue reading > >
How Does Sleep Affect Type 1 Diabetes
Regardless of the cause of sleep disturbance, poor sleep is strongly associated with increased glucose variability. In one meta-analysis of 22 studies, Reutrakul et al. found that adults with type 1 diabetes who slept less than six hours had poorer glycemic control. The question is, does glucose variability cause poor sleep, or does poor sleep cause glucose variability?
Both are probably true. As discussed above, self-reported surveys generally reflect my own experiences of sleep disturbances caused by hyper- and hypoglycemia . There is also evidence to support the idea that sleep deprivation affects insulin sensitivity, and with it, glucose levels. One small 2010 study by Donga et al. found that a single night of partial sleep restriction reduces insulin sensitivity by 1421%. In other words, a bad nights sleep can actually significantly increase the amount of insulin a person needs the next daythough not, in my experience, in a predictable way.
These changing physical needs, combined with the mental effects of poor sleep, can make blood glucose management incredibly challenging. Like most people, living with diabetes or not, I am usually irritable after a night of poor sleep. On top of this, reduced insulin sensitivity makes it tougher to manage my blood glucose, which in turn makes me even more irritable. After a night or two of bad sleep, dealing with the regular maintenance of type 1 diabetes can feel nearly impossible.
How Can Type 1 Diabetes Affect Sleep
We all know the miserable after-effects of a poor nights sleep. Unfortunately, that dreary, frazzled, anxious state can be a more common reality for for someone with Type 1 diabetes. Doctors at the Sleep Disorders Program at the Louis Stokes Cleveland VA Medical Center estimate that 40-50% of people with diabetes complain of poor sleep. And getting a good nights rest can help in blood glucose management as well as overall health. So what should you watch out for if you have Type 1? And how can you better your odds of a good nights rest? Here are the most common sleeping disorders that you may be faced with and some basic advice on how to maintain healthy sleep hygiene.
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How Does Type 1 Diabetes Affect Sleep
The relationship between type 1 diabetes and sleep is a complex one, and it is made more complicated by a minimal body of research that relies heavily on self-reporting. Having lived and slept with type 1 diabetes for years, I know my own sleep has often been impacted by hyperglycemia, hypoglycemia, and fear of hypoglycemia . These causes have been tentatively explored in the research on type 1 diabetes and sleep, but some more than others.
Perhaps the least explored of these topics is the impact of hyperglycemia on sleep. One of the primary symptoms of hyperglycemia is frequent urination, also known as osmotic diuresis. Common sense would dictate that it is tough to get a restful sleep when you wake every hour to use the bathroom, and I can personally confirm that nocturnal hyperglycemia has this effect for me. However, as of 2016, no formal studies had been reported on this topic according to a comprehensive literature review by Farabi.
In addition to hypoglycemia itself, FoH sometimes affects my sleep quality, especially when my blood glucose levels are less consistent than usual. There has been some research that aligns with this experience, including a . which reported that patients with poor sleep quality also had significantly greater nocturnal glucose variability and FoH. This correlation makes sense: It is difficult to sleep when you cant trust your own body.
Tips For Better Sleep
There is no magic bullet to help people with T1D or their caregivers get better sleep. As parents you will always worry about your childs blood sugar throughout the night, and as individuals with T1D you will always want to make sure you are safe throughout the night. But you can use some tips to get a better night sleep.
Getting a good nights rest is important for everyones health and well-being. Although type 1 diabetes will interrupt your sleep at times, getting regular sleep is important for your long term health!
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Blood Pressure And Sleep In Type 1 Diabetes
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 . In two separate studies that did not include a control group, adults with type 1 diabetes who were non-dippers had shorter sleep durations as measured by PSG and wrist actigraphy . 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.
Sleep Disturbances Common With T1d
Type 1 diabetes is a disease that must be monitored around the clock. When children are awake, it is easier to tell when blood sugar may be spiking too high or dropping too low. At night, this is more challenging, and it is essential to continue testing blood sugar levels to stay within the target range and administer insulin as necessary.
Children typically rely on their parents to manage their diabetes and monitor blood sugar, whether done manually or through a continuous glucose monitor . A recent study found that children who use a CGM often sleep better at night, but it is their parents who have more disturbances in their sleep due to reacting to CGM data.
As part of a larger study, researchers evaluated the sleep quality of 46 parents of children with type 1 diabetes. The children were between the ages of 2 and 5, and some used CGMs while others did not. Parents reported on the time their children went to bed, woke up, and how long they slept. The average was 10.4 hours per night. Also, all 11 families who used CGMs wore accelerometers that tracked their sleep patterns for a minimum of four nights. The accelerometer showed an average of 9.8 hours of sleep per night for children.
According to the study, Among the full cohort, 63% of parents reported checking their childs blood glucose levels at least a few nights per week. Parents of children using CGMs reported a higher frequency of nighttime blood glucose monitoring compared with parents of children without a CGM.
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What Sleep Disorders Are Common In People With Diabetes
Individuals with type 2 diabetes have a higher chance of developing accompanying sleep disorders, the most common being restless legs syndrome and obstructive sleep apnea.
- Restless Legs Syndrome : Approximately one in five people with type 2 diabetes have restless legs syndrome, marked by tingling or other irritating sensations in the legs that can interfere with getting to sleep. People with diabetes are also at risk for another condition called peripheral neuropathy. Caused by nerve damage, the symptoms of peripheral neuropathy are very similar to RLS and include numbness, tingling, and pain in the extremities. People who experience these symptoms should consult a healthcare provider, as peripheral neuropathy requires treatment to reduce long-term nerve damage.
- Obstructive Sleep Apnea : Obstructive sleep apnea is a sleep disorder in which a person momentarily stops breathing at recurring intervals throughout the night. In most cases, the person is not aware this is happening, though a bed partner may observe snoring and gasping. These lapses in breathing cause micro-arousals that interfere with the natural progression of the sleep stages and impair sleep quality. OSA typically occurs in people who are overweight or obese, as they often have a thicker neck circumference that interferes with the airway. The condition can be treated with a continuous positive airway pressure device that keeps the airway open to restore normal breathing and reduce interruptions to sleep.
Why Do We Need Sleep
Sleep has a profound effect on brain function and is critical for the growth of new brain cells and formation of new connections. Getting adequate sleep helps with memory and learning, particularly in the way it allows our brains to filter out and store the important bits of information we have gathered throughout the day and store these to memory.
Our brains also use sleep as an opportunity to flush out toxins that have accumulated throughout the day. Some of these toxins, called beta-amyloids, are associated with an increased risk of brain disorders like of Alzheimers disease. Other aspects of brain function such as attention, creativity and decision-making ability are also heavily dependent on adequate sleep.
Sleep has a significant influence over our physical health as well. Not only is it essential for the growth and repair of our muscles and other cells throughout our body, it also strengthens our immune system and improves our ability to fight infection. Interestingly, sleep also helps to maintain the balance between the hormones which regulate our feelings of hunger and fullness in relation to food. Poor sleep has been shown to affect this balance which to some extent may explain why there is an increased risk of obesity with inadequate sleep over the long term.
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Sleep Affects Other Hormones That Influence Metabolic Health
Sleep deprivation also increases production of cortisol, which can make cells more resistant to insulin. Lack of sleep also triggers changes to other hormones, including thyroid stimulating hormone and testosterone, which can lead to
Melatonin, which plays such a critical role in maintaining regular sleep patterns in keeping our circadian clocks synchronized, also appears to affect insulin. Weve known for several years that certain gene variants associated with melatonin receptors are strongly linked to higher risks for type 2 diabetes. Recent research has shown higher levels of melatonin reduce the ability of insulin-making cells in the pancreas to release insulinand that people with those genetic variants experience this insulin-suppressing effect more strongly.
All these changes sleep and circadian-related changesto insulin and blood sugar, and other hormones that affect metabolism occur in healthy and non-diabetic people, bringing them closer to prediabetes and eventually diabetes. These sleep-related changes also happen in people who have diabetes, making the condition harder to treat and control effectively.
The Pros And Cons Of Naps
Napping may leave you less tired at bedtime, setting the stage for insomnia. Some experts, including Dr. Bootzin, have a strict rule: No naps! Others are more flexible, but the National Sleep Foundation suggests limiting a nap to no more than 2030 minutes, while the American Academy of Sleep Medicine says a nap should be less than an hour and no later than 3 PM. Long naps should be avoided if you have insomnia.
Studies on the health effects of naps have given conflicting results. But for some, napping can be a healing break from the stresses of the day. In a review of the medical literature, Masaya Takahasi, DMSc, of Japans National Institute of Industrial Health, found several studies that indicate that short naps may be linked to a reduction in the risk of heart disease.
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How Does Diabetes Affect Sleep
Its estimated that one in two people with type 2 diabetes have sleep problems due to unstable blood sugar levels and accompanying diabetes-related symptoms, High blood sugar and low blood sugar during the night can lead to insomnia and next-day fatigue. As with many chronic conditions, feelings of depression or stress about the disease itself may also keep you awake at night.
When blood sugar levels are high, the kidneys overcompensate by causing you to urinate more often. During the night, these frequent trips to the bathroom lead to disrupted sleep. High blood sugar may also cause headaches, increased thirst, and tiredness that can interfere with falling asleep.
By contrast, going too many hours without eating or taking the wrong balance of diabetes medication can also lead to low blood sugar levels at night. You may have nightmares, break out into a sweat, or feel irritated or confused when you wake up.
Talk to your healthcare provider if you are experiencing fatigue, trouble sleeping, or any other worrying symptoms. They can help analyze the reason and work with you to keep your blood sugar levels more stable.
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Expert Critique
Most adults fall short of the recommended 7-8 hours of sleep every night and this can be even more complicated for those of us with type 1 diabetes . Interrupted sleep can lead to stress and poor blood sugar management, which in turn leads to more sleep disturbance. This can become a vicious, hard-to-break cycle. Further, sleep disturbance leaves us groggy and then more prone to mistakes in disease management. So, the first step is for patients to recognize that getting a good night sleep is essential for controlling their diabetes.
In most people, even those without diabetes, sleep disturbance is usually secondary to what is termed poor “sleep hygiene” and often not caused by other sleep disorders. Achieving good sleep hygiene through various lifestyle changes can improve sleep duration and quality. One of the most recently cited reasons for sleep difficulties is increased “screen time” specifically at nighttime before sleep. Along with less screen time, other strategies to promote sleep hygiene include:
- Avoiding stimulants such as caffeine and nicotine close to bedtime
- Participating in aerobic activity as little as 10 minutes a day.
- Avoiding heavy or rich food, such as fried or spicy food before bed.
- Limiting daytime naps to less than 30 minutes.
These are simple sleep habit modifications that truly improve quality of sleep and in turn lead to better diabetes management.
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Adherence And Diabetes Management
The reported changes in sleep patterns and architecture have implications for self-management and adherence behaviors, and this has been demonstrated in pediatric T1D populations. Hazen and colleagues found that, in addition to poorer glycemic control and higher average BG levels, parent report of sleeping more than other children was associated with less frequent BG checks, and lower self-reported adherence . The act of sleeping too much may preclude engagement in some adherence behaviors, as children may be asleep at times that they are required to check BG or administer insulin. In contrast, McDonough et al. found that for adolescents using insulin pumps, an increase in sleep duration of as little as 15 to 20 minutes resulted in an additional BG check or insulin administration the following day . Similarly, Jaser and Ellis found BG monitoring was positively associated with sleep duration in adolescents . When analyzed by gender, they found that for males, better diabetes management was related to longer sleep duration .
The Day After A Bad Nights Sleep
Not getting a good nights sleep risks setting you up for a bad day. Its never been scientifically proven that not sleeping well influences blood sugar levels, but some people living with Type 1 diabetes feel that they experience a cause-and-effect link between the two, in both ways. After a bad nights sleep, you may experience hypos or hypers without any real explanation.
Its also important to note that sleep plays an important role in digestion. When youre sleeping, hormones are produced to help with digestion and to help manage appetite during the day. Disrupted or insufficient sleep will alter these hormone secretions. So, perhaps thats why some people feel theres a link?
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How Can You Get Back To Sleep
Its not always easy to nod back off after being woken up by your blood sugar monitor. Some people manage to doze off again by just closing their eyes, but its not that simple for everyone. Breathing techniques, meditation, or relaxation exercises can help you unwind and fall back asleep. Think about it
Waking Up To Birds Tweeting No More Like Alerts Beeping
For those who dont feel the effects of night-time hypoglycemia, continuous blood sugar monitors emit sound alerts when the reading drops below a certain level. Not the nicest of alarms, but all the same, necessary for avoiding a major glycemic crisis!
Speaking of alarms All insulin pumps have alert systems, either to indicate that the insulin reservoir is almost empty, or to notify you that you have an issue, such as an occlusion. Before going to bed, make sure that theres insulin left in the pump, as this will avoid wake-up calls in the middle of the night, meaning youll enjoy a better nights sleep. As for an occlusion, its better to be safe than sorry and interrupt your nights sleep for a few minutes to fix the issue.
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