While lack of sleep has dire consequences on human health, it has time and again proved to have led to various comorbidities like diabetes, obesity and heart conditions. A study released by JAMA Network Open (2024) concluded that short sleepers are more prone to type 2 diabetes. The reason, experts say, is that individuals get less restorative sleep maintaining overall health. Happiest Health spoke to sleep specialists and endocrinologists to explore how short sleep leads to type 2 diabetes.
In a paper titled “Habitual Short Sleep Duration, Diet, and Development of Type 2 Diabetes in Adults” published in JAMA Network Open (2024), the researchers’ worked with nearly 248,000 people in the UK, mostly around 55 years old, with more than half being women. The researchers found that people who slept less than five hours a night had a higher risk of getting type 2 diabetes compared to those who slept more. The ‘sleep’ factor was found to be so crucial that even if someone had a healthy diet, not getting enough sleep still increases their risk of diabetes.
Commenting on the study published in Jama Network Open, Dr V Mohan, diabetologist and chairman, Dr Mohan’s Diabetes Specialities Centre (DMDSC) and Madras Diabetes Research Foundation (MDRF) tells Happiest Health that at least five and a half hours of sleep is needed to reduce the risk of diabetes. This study also states that a minimum of six hours and a maximum of eight hours is optimal for good health.
Dr Mohan added, “We have found in the PURE study that a minimum of six hours and a maximum of eight hours is optimal for good health. Those who sleep less than six hours and more than eight hours had increased risk of diabetes, cardiovascular disease and even increased risk of mortality.”
The link between sleep and diabetes
It is a well-known association that getting an average of less than eight hours of sleep for most people can cause weight gain and lead to insulin resistance that causes diabetes. This is a vicious cycle, says Dr Vivek Padegal, senior consultant and director of Pulmonary and Sleep Medicine, Fortis Hospital, Bengaluru. Highlighting the importance of sleep, he said that getting enough sleep will ensure you wake up fresh and energetic. When you get less than six hours of sleep, it is a sign of impending health hazards.
“However, the research suggests, if you are not getting enough sleep, it can increase cortisol levels (stress hormones) leading to weight gain and an imbalance of leptin (hunger hormone), which causes neurochemical issues causing obesity,” he added.
Due to stress, the counter regulatory hormones like epinephrine, non-epinephrine, cortisol etc. are also triggered. “All these counter regulatory hormones oppose the action of insulin leading to diabetes. The lack of sleep increases the activity of the sympathetic nervous system and alters the gut microbiota. There could also be changes in the skeletal muscle energy metabolism. All these factors can predispose to diabetes,” added Dr Mohan.
Both the hours of sleep and the timing of sleep is important, says the expert. In the PURE Study, it was seen that those who slept between 10pm to 12am faired the best and had the lowest mortality, while those who slept much earlier, say 7pm or earlier had increased mortality and those who slept very late, say 1am or 2am also had increased risk of mortality.
The researchers in the paper also highlighted that lack of sufficient sleep can lead to insulin resistance, where cells do not respond properly to insulin, resulting in elevated blood sugar levels over time.
Short REM sleep is the cause for diabetes
While sleep has a restorative value, it is important to get enough restorative sleep. “This is possible only when you get extended Rapid Eye Movement (REM) sleep,” says Rakesh Sahay, endocrinologist and professor at Osmania University, Hyderabad.
There are different stages of sleep and the REM sleep or the dream stage is the one that can give maximum restoration to the body, says Dr Sahay. He also said that, then for individuals who get short sleep (light sleep) their circadian rhythms will be disturbed.
“When circadian rhythms are disturbed, there are hormonal imbalances that occur and the metabolism of the individuals’ changes. These imbalances are mostly seen in the night shift workers across the time zones,” he added.
The changes in the circadian rhythm, metabolism adds to the stress in individuals- these are all pathways for developing Type 2 diabetes. “These are also factors that lead to weight gain, again a factor that has link with diabetes. Therefore, one must get undisturbed and sufficient sleep, to stay away from becoming a diabetic,” added Dr Sahay.
Experts say that if type 2 diabetes is left untreated or poorly managed, it can lead to serious complications such as heart disease, stroke, kidney disease, nerve damage (neuropathy), eye damage (retinopathy), foot damage, hearing impairment, and neurodegenerative disorders like Alzheimer’s disease.
How to lower the risks for type 2 diabetes?
Type 2 diabetes requires lifelong management, which includes a combination of lifestyle changes, regular medical check-ups and adherence to treatment plans, reducing the risk of complications. Managing sleep has also turned out to be critically important as a part of the therapy.
For people with lifestyle disorders
Manage weight: Obesity can lead to an increase risk of chronic conditions. Exercise, conscious consumption of food, and ensuring you are not sleep-deprived can help you manage weight. Sleep deprivation could be the square one destination that leads to obesity, and type 2 diabetes.
Exercise daily: From a 30-minute walk, to jogging, stretching, or yoga—inculcating an hour of physical activity daily can improve your metabolism and regulate production of hormones.
Eat wisely: Foods rich in calories need to be cut down. Balancing carbohydrates and cutting down on processed foods and calorie-rich food needs to be adopted. This research also says that, diets like the Mediterranean diet are known to lower Type 2 diabetes risk.
Insulin therapy: In type 2 diabetes, the body either doesn’t produce enough insulin or doesn’t use it effectively, causing high blood sugar levels. Insulin therapy can therefore help by providing the body with the insulin, it needs to process glucose properly. Insulin is typically injected under the skin using a small needle or insulin pen, and the dosage is prescribed by specialists.
People with sleep disorders
The research says that not just lifestyle conditions, sleep disorders like Obstructive Sleep Apnea (OSA) can also cause sleep deprivation leading to Type 2 diabetes. Therefore, experts recommend good sleep habits, limiting alcohol intake, maintaining a healthy body weight and following a balanced diet to manage OSA.
How to manage sleep to prevent type 2 diabetes?
Takeaways
- Lack of sufficient sleep increases the risk of developing Type 2 Diabetes, even among those with a healthy diet.
- Short REM sleep, particularly during the dream stage, is crucial for metabolic balance and diabetes prevention.
- Proper management of sleep, along with lifestyle changes and possibly insulin therapy can help manage the condition.
(With inputs from Steni Simon & Rooplekha Das)
