Uncontrolled diabetes could disrupt multiple organs and end up as a lifelong condition affecting many physiological functions, including sleep. People affected with diabetes are more likely to develop sleep disorders mainly due to fluctuating blood glucose levels and other co-morbidities.
The link between diabetes and sleep disorder
“Diabetes and sleep are closely linked. Diabetes can cause sleep disorders and lack of sleep could also worsen diabetes,” says Dr. Sweta Budyal, Consultant – Diabetology & Endocrinology, Fortis Hospital Mulund, Mumbai.
Dr. M S Kanwar, Senior Consultant and Advisor, HOD. Dept of Pulmonary, Critical Care and Sleep Medicine, Lead of Lung Transplant, Indraprastha Apollo Hospitals, New Delhi says that poor sleep and diabetes is a closed loop where both these conditions feed off each other.
“Diabetes could lead to multiple conditions leading to sleep impairment. This lack of proper sleep could further worsen your diabetes management,” he adds.
These experts point out that sleep disorders like sleep apnea or chronic insomnia could lead to glucose intolerance and blood sugar fluctuations by increasing the levels of stress hormones.
Dr. Budyal explains that if high sugar levels are not controlled even after conventional treatment, then doctors opt to examine multiple lifestyle factors including sleep duration and stress levels.
According to a research article published in the World Journal of Diabetes, in addition to causing direct sleep disturbances because of nocturia and diabetic neuropathy, diabetes is also associated with several chronic illnesses like obstructive sleep apnea, hypertension and depression which can impair sleep and quality of life.
Common sleep disorders associated with diabetes
1. Obstructive sleep apnea
“Diabetes alone does not cause sleep apnea. Metabolic syndrome, which is a constellation of diabetes, obesity and hypertension is a main reason for this sleep disorder,” says Dr. Kanwar.
Dr. Budyal explains that most people diagnosed with type 2 diabetes are likely to be overweight and obese with high chances of developing obstructive sleep apnea. Excess fat deposition at the narrow area of oropharynx near the throat leads to the narrowing of airways obstructing oxygen intake through the nostril and mouth increasing the risk of sleep apnea.
“Sleep apnea leads to poor sleep quality because of interruption of sleep, because of repetitive choking, repetitive stoppage of breathing leading to arousals,” says Dr. Kanwar. He adds that this sleep arousal makes the sleep quality very poor and the sleep stages are haywire leading to disruption in the sleep cycle.
2. Insomnia
Diabetes can worsen insomnia as blood sugar variations at night could lead to disrupted sleep patterns or keep the person awake if it is combined with extreme bouts of stress and anxiety. Dr. Kanwar says that in people diagnosed with chronic diabetes and insomnia, counselling and medical intervention is often required to reduce stress and manage diabetes.
3. Restless leg syndrome
“Restless leg syndrome is a sleep disorder caused by diabetic neuropathy, which causes peripheral numbness, pain and tingling sensations in your limbs,” says Dr. Kanwar. Diabetic neuropathy is nerve damage caused by diabetes, says Dr. Budyal. She adds that the symptoms include burning sensation and pricking in the legs. These symptoms are experienced more often in the night, disrupting their sleep.
Dr. Kanwar adds that it is a sleep disorder that does not let people sleep easily because of the pain and the tendency to itch their legs, and it interferes with their sleep quality.
“Diabetic neuropathy is seen in most people diagnosed with chronic diabetes and have unmanaged blood glucose levels for a long time,” says Dr. Kanwar. Strict blood glucose management is necessary to minimise further health complications.
4. Nocturia
Nocturia is the condition when sleep is disturbed during the night due to the frequent urge to urinate. When your body produces excess urine, the condition is called polyuria. When this excess urine gets accumulated in the bladder at night, it is called nocturia polyuria.
Diabetes is one of the main conditions that causes polyuria as the kidney cannot retain excess glucose in the blood and filters it out into the bladder to be expelled with urine. Dr Budyal says that people with poorly managed blood glucose levels will wake up multiple times at night to urinate, disrupting their sleep cycle. Dr. Kanwar adds that they tend to pass more urine at night.
5. Mental health issues
Diabetes can also cause depression and anxiety. “There are several studies showing that about 50% of diabetics can be affected by depression and anxiety which often leads to poor sleep quality,” says Dr. Budyal. She adds that depression and anxiety lead to insomnia, which, in turn, leads to poor sugar control.
Dr. Kanwar explains that conditions like insomnia, polyuria, sleep apnea or restless leg syndrome, lead to either daytime sleepiness or non- refreshing sleep and lethargy, tiredness, fatigue the whole day. This also leads to mental health problems, like depression and anxiety. All these conditions should be tackled individually while controlling diabetes.
Takeaways
Uncontrolled diabetes can lead to many issues including sleeplessness. If the quality of sleep is bad, it could lead to various health issues. Insomnia, obstructive sleep apnea, polyuria, restless leg syndrome and mental health issues are caused due to diabetes.
