Insomnia and related sleep disorders are often-ignored health complications in people with diabetes. Experts point out that people with type 2 diabetes often find it difficult to either fall asleep or remain in a state of deep and peaceful sleep.
Several factors contribute to insomnia in people with diabetes, including peripheral neuropathy-related discomfort or pain, restless legs syndrome and rapid changes in blood glucose levels during the night leading to hypoglycaemic and hyperglycaemic events.
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“If the person has diabetes, then the risk of insomnia is higher,” says Dr M S Kanwar, senior consultant, department of pulmonology, critical care and sleep medicine, Indraprastha Apollo Hospitals, New Delhi. People who have insomnia will be tired and lethargic throughout the day but may not tend to fall asleep during the day,” he adds.
“Sleep and diabetes are very intricately connected,” says Dr A Sharda, consultant endocrinologist and diabetologist, Manipal Hospital, Millers Road, Bengaluru. People will have trouble falling asleep, staying asleep or both. Both conditions are referred to as insomnia. The circadian rhythm gets disrupted in people who have chronic insomnia.
Circadian rhythm is the internal 24-hour time cycle of the body. Often referred to as the biological clock, it controls various physiological processes including sleep and waking up.
Diabetes also triggers increased thirst and frequent urination, which also act as sleep hurdles. Dr Kanwar tells Happiest Health that sometimes blood sugar levels fluctuate throughout the night, causing sleep problems and signs of hypoglycaemia. So, if the sugar levels are not well-regulated during sleep, there will be a huge variation in sugar levels. This might cause frequent thirst, hunger as well as urination in the middle of the night.
“Diabetics can develop neuropathy, which can cause pinprick sensations, paresthesia in the legs and restless leg syndrome, all of which disrupt sleep quality and cause insomnia,” he adds.
“Anxiety-associated insomnia has gradually increased over the last three decades,” says Dr Kanwar. High stress levels along with high glucose levels increase the risk of insomnia. People constantly worry and think at night, making it impossible for them to fall asleep. For those who tend to be oversensitive, nervous and anxious, this pattern repeats.
Diabetes, a risk factor for insomnia
“Lack of sleep also leads to poor control of diabetes,” says Dr Sharda.
According to experts, young people with chronic insomnia have more risk of developing type 2 diabetes. “People under the age of 40 are fifty per cent more likely to develop type 2 diabetes if they have chronic insomnia,” she points out.
“Sleep disorders are often ignored unless they become serious,” says Dr Mahesh D M, consultant, endocrinology, Aster CMI Hospital, Bengaluru. He recalls a case study of a software professional with constantly fluctuating blood glucose levels. His work used to extend into the night, causing him to sleep less at night. His irregular sleep routine started affecting his glucose level and this resulted in poor sleep quality. “Maintaining a regular sleep schedule would help to restore the balance of glucose, which will also help to restore sleep,” he adds.
Dr Mahesh says that it’s important to keep in mind that any meal high in carbohydrates has the potential to disrupt sleep. So, balancing that with appropriate fat and protein can help in restoring sleep. He also suggests avoiding caffeine and other stimulants that will keep one active. “Doing regular exercise is also beneficial because it lowers your stress hormones,” he adds.
“Diabetics should make sure that the sugar levels remain within the normal range,” says Dr Kanwar. He adds that before going to sleep, one should check the sugar level. If it is way up or down, then it is possible that it could get worse during the latter part of the night. However, if it’s within the control range, then even if it jumps 50 or 40 up or down, it’s not going to cause more urination, sweating or palpitation.”
Tips to manage and avoid insomnia
- Avoid eating large meals at night
- Avoid sleep for at least two hours after eating a substantial meal
- Room temperature and noise level should be reduced
- Phone, laptop and television should be turned off 30 minutes before going to bed, as prolonged exposure to blue light emitted from these devices could lead to sleep disruption
Other common sleep disorders in people with diabetes
Restless legs syndrome (RLS):
“People with diabetes frequently experience restless legs syndrome, which affects one in five diabetics and causes tingling pain and an odd sensation in their legs; this can interfere with sleep,” says Dr Sharda.
Additionally, peripheral neuropathy (damage to the peripheral nervous system) can occasionally cause problems for diabetics at night — people may experience abrupt pain and cramping as well as a burning sensation in their feet. The symptom of peripheral neuropathy is restless leg syndrome which includes numbness, tingling and pain in the legs.
Obstructive sleep apnea (OSA)
Obstructive sleep apnea is a disorder in which an individual stops breathing for brief periods throughout the night. “People with type 2 diabetes who have obesity have higher body mass index and fat deposition that leads to sleep apnea,” says Dr Mahesh.
Takeaways
Sleep hygiene is closely linked with diabetes management. Fluctuating sugar levels along with diabetic co-morbidities like obesity and hypertension could lead to an array of sleep disorders including insomnia and obstructive sleep apnea. Experts opine that like most diabetes-related complications, these sleep disorders triggered due to poor blood sugar management could be controlled to a great extent by adopting a healthier lifestyle and diet.
