The Missing Puzzle Piece In Your Diabetes Self-Care Routine: Sleep

The Missing Puzzle Piece In Your Diabetes Self-Care Routine: Sleep

Read time: 8 minutes

  • You know that managing diabetes means being mindful of your nutrition, activity levels, and, in some cases, medication you might take. But how much importance do you place on sleep in your diabetes self-care routine?
  • It’s not just that a poor night of sleep can affect your blood sugar; unmanaged blood sugar levels can also make it harder to sleep well.
  • To prioritize sleep in your day-to-day, you have to practice consistency, understand why sleep is important to your lifestyle and your health goals, and be patient with yourself.

Living with diabetes means you’re already accustomed to healthy habits like meal planning, carb counting, exercise, and maybe even medication. But how often are you thinking about what’s happening with your health at night when you go to sleep? Do you give your sleep schedule the same attention you do other aspects of your self-care? Why is sleep even relevant to your diabetes management?

To address that last question, first, it’s worth noting that estimates suggest more than half of all people with type 2 diabetes may have obstructive sleep apnea, a condition that causes you to repeatedly stop and start breathing while you sleep (snoring is one of the most common signs). Over time, sleep apnea can put a lot of stress on your body, particularly your heart, and may increase your risk of issues like high blood pressure, heart attack, or stroke.

So, what explains this relationship between sleep apnea and type 2 diabetes? And how else is blood sugar related to sleep health?

The Bidirectional Relationship Between Sleep and Blood Sugar

According to the National Sleep Foundation, sleep and blood sugar are related to one another in both directions: Poor sleep health can lead to imbalanced blood sugar levels, and unmanaged blood sugar can negatively impact your sleep.

Let’s start with sleep’s effects on blood sugar. First, when you’re sleep-deprived, your appetite hormones are, to put it simply, “messed up,” says Abhinav Singh, MD, MPH, FAASM, medical director at the Indiana Sleep Center. Lack of sleep is associated with increased production of ghrelin, a hormone that regulates hunger, and a decreased production of leptin, a hormone that regulates fullness.

As a result, explains Dr. Singh, you’re hungrier—and you’re probably craving sugary, fatty foods and drinks to comfort yourself and offset your fatigue. Once you’re in this cycle of losing sleep and comforting yourself through food, it can be hard to break the pattern and get back on track, and in the process, your blood sugar levels might be impacted.

At the same time, research also shows that, even in young healthy people who don’t live with diabetes, lack of sleep appears to lead to increased insulin resistance and higher blood sugar. Why? Biologically, sleep deprivation can cause the body to produce higher levels of stress hormones like cortisol, which can raise blood sugar and make fat and muscle cells resistant to insulin.

And what is “lack of sleep,” exactly? Most experts recommend at least seven or eight hours, but in reality, plenty of people sleep less than seven hours a night—even though it’s really not enough, says Dr. Singh.

“So, imagine you’re chronically sleep-deprived for one, two, three, four, five years,” he explains. If you’re actually eating excess sugar and experiencing those biological effects on your blood sugar and insulin throughout that time, your weight may begin to rise, you might experience more insulin resistance, and your pancreas may need to work harder to keep your blood sugar stable. “At some point,” says Dr. Singh, “your pancreas may become so overworked that they’re no longer able to properly manage your blood sugar, and that’s when diabetes can develop.”

Now, that’s just the effects of sleep quantity on your blood sugar and other metabolic health factors. But sleep quality can be an issue as well. In fact, it may be even more problematic because you may think you’re getting enough sleep, but if you have a condition such as sleep apnea—which, again, is prevalent in both the general population and among people with type 2 diabetes (not to mention the condition is underreported)—that could make your seven or eight hours of sleep worth more like four or five, says Dr. Singh.

“When you snore, your airway collapses, and your oxygen levels drop a bit for a few seconds,” he explains. “In response, your body temporarily panics and produces stress hormones, which raise both your blood sugar and blood pressure, and your airway opens back up for you to breathe again. If you’re snoring throughout the night, this cycle repeats dozens, even hundreds of times, spiking your blood sugar and blood pressure, again and again, leaving you with low-quality sleep.”

In the opposite direction, if your blood sugar is high and unmanaged, your body makes more urine, which will make you get up to use the bathroom more at night, says Dr. Singh, thus interrupting your sleep. You’re also more prone to increased thirst and headaches when blood sugar levels are elevated, which may make it harder to sleep as well.

Low blood sugar at night, on the other hand (also known as nocturnal hypoglycemia), can disrupt your sleep by making you feel shaky and restless. That said, though, some people who experience nocturnal hypoglycemia are totally unaware they’re having lows; they might wake up feeling unrested or with a headache, or they may have night sweats or nightmares. It’s also possible to wake up with high blood sugar in the morning with nocturnal hypoglycemia due to what’s called a rebound effect. Wearing a continuous glucose monitor (CGM) overnight (or checking blood sugar around 2 a.m.) can help you figure out if nocturnal hyperglycemia is contributing to your poor sleep. (At the same time, though, keep in mind that, if your blood sugar is dropping or spiking out of your target range overnight while you’re wearing a CGM, the CGM’s alarm may be triggered and disrupt your sleep as well.)

Your New Health Goal: A Good Night’s Sleep

Regardless of how your sleep hygiene may be affecting your blood sugar (or vice versa), it’s clear that the two influence each other in several ways. That means improving one will inevitably involve improving the other—and multiple studies show that improving your sleep health, whether that means getting more rest or better-quality sleep (or both), can translate to improvements in blood sugar management for those who live with diabetes.

Even in healthy populations, prioritizing a good night’s sleep can have very real impacts on multiple aspects of metabolic health. In a recent JAMA paper, researchers showed that adults with a body mass index (BMI) between 25 and 29.9 (considered overweight) who habitually slept fewer than six and a half hours per night were able to increase their sleep duration by, on average, a little over an hour after just one personalized sleep hygiene counseling session (which involved tailored advice about their individual sleep environments, sleep duration, etc.). Compared to those who didn’t receive the same sleep intervention, those who did receive sleep counseling were not only more likely to sleep for about an extra hour, but they also reduced their overall caloric intake by an average of 270 calories per day.

So, how can you go about prioritizing sleep in your own self-care routine?

  • First, establish how much sleep you actually need. While the average recommendation is to sleep for seven or eight hours a night, Dr. Harpreet Nagra, PhD, a licensed psychologist and VP of behavioral science at One Drop, points out that everyone’s needs are different. “Some people need more sleep; some people need less,” she explains. “It might not be a bad idea to do some self-experimentation with your sleep schedule to find out which duration feels right for you.”
  • Find a routine that works for you, and stick to it. Consistency matters when it comes to sleep hygiene; that goes for not just the amount of time you’re actually sleeping, but also the time you go to bed, the time you wake up, and what you do with the time right before you hit the hay. For instance, maybe you know your body normally winds down around 9 p.m. and that you seem to feel your best on about eight hours of sleep. That means you’ll want to stick to that 9 p.m. bedtime and 5 a.m. wake-up as much as you can—even on weekends. “You also want to have a consistent pre-sleep routine,” adds Dr. Nagra. “It could be as simple as shutting off the TV at a certain time, putting on your PJs, or taking a bath.” The key is to come up with habits that signal to your brain that it’s time to unwind.
  • Try a “brain download.” Translation: Download all the thoughts in your brain—from the stresses of the day you just had to the worries you have about tomorrow—and put them down on paper. “This is an exercise that I encourage a lot of people to do before bed, especially if they have anxiety about falling or staying asleep,” says Dr. Nagra. “Keep a notepad next to your bed, and just before you’re ready to fall asleep, write out all the things, write out everything that’s going through your mind: to-do lists, problems you’re trying to solve—whatever it is, figure out a way to write it all out so that your mind can rest, let it all go, and recover to move forward to the next day.”
  • Boost motivation by finding your “why.” When you think about your sleep hygiene, ask yourself why it matters to you. How might a healthy sleep schedule affect other goals you have for yourself? You know now that taking care of your sleep health can also benefit your blood sugar, your weight, and more. But what else could you get out of a more organized sleep routine? “For example, maybe you might find motivation in the idea of having a cup of coffee at dawn and seeing the sunrise,” says Dr. Nagra. “Or maybe you’re a working mom who’s motivated by the idea of having some alone time in the morning, or even at night when there are finally no more distractions.” Bottom line: If you ever start to question why it’s worth putting so much effort into your sleep hygiene, remind yourself of what you gain from that dedication, both in your health and your peace of mind.
  • Start small with any changes you make. Whether you’re experimenting with how much sleep you’re getting or implementing a new bedtime routine, take it slow. If you’ve fallen into a habit of sleeping only a few hours a night and you want to work on sleeping more, find your sweet spot gradually. “Rather than going from a few hours of sleep to a full eight hours, maybe think about adding a half-hour of sleep each night,” suggests Dr. Nagra. “Slowly make these changes to allow your mind and body to adjust. Then, the more you stick with it, the easier it’ll be for you to see the fruits of your labor.”
  • Be gentle with yourself. Consistency may be key when it comes to sleep health, but that doesn’t mean you have to be “perfect” and follow a rigid schedule day in and day out. Life will get in the way sometimes, and that’s ok. “It’s really just about trying your best,” says Dr. Nagra. “Be compassionate with yourself, and show up for yourself and your goals as often as you’re able to.”

This article has been clinically reviewed by Lisa Graham, RN, BSN, CDCES, clinical health coach at One Drop, and Alexa Stelzer, RDN, LD, CDCES, clinical health coach at One Drop.

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Allie Strickler
Apr 11, 2022

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