Role of Sleep in Diabetes Care: Challenges and Solutions - Dr Amitabh Sur

Diabetes is a long-term illness that affects the body's ability to metabolize glucose, the primary fuel cells use for energy. Sleep is a vital function that is essential for the body and mind to relax, rest and recover.

Diabetes and Sleep have a complex and reciprocal relationship that can influence each other in positive and negative ways. It is crucial to understand how diabetes affects the quality and quantity of sleep, and how sleep affects diabetes management and outcomes.

How Diabetes Affects Sleep

People with diabetes may experience various sleep problems due to the symptoms and complications of the condition. Some of the common sleep issues that people face are:

• Insomnia

Insomnia is the difficulty falling asleep or staying asleep. It can make a person feel tired or sleepy throughout the day. Anxiety, stress, or depression, which are common psychological challenges for people with diabetes, can also cause insomnia.

• Sleep Apnea

Sleep Apnea is a common condition in which a person’s breathing stops and restarts many times while they sleep, thus preventing the body from getting enough oxygen. Obstructive sleep apnea (OSA) affects about ~67% of people with type 2 diabetes. In people who have diabetes, OSA severity can lower insulin sensitivity.

• Restless Legs Syndrome

Restless Legs Syndrome is an uncomfortable sensation in the legs accompanied by an urge to move them constantly, especially at night. The condition also affects people with peripheral neuropathy, nerve damage to the feet and legs.

• Periodic Limb Movement

Periodic Limb Movement is a condition that causes involuntary jerking or twitching of the legs or arms during sleep. It can affect people with peripheral neuropathy or low iron levels.

How Sleep Affects Diabetes

Sleep is not only affected by diabetes but also affects diabetes in various ways, such as:

• Blood Glucose Regulation

Sleep regulates blood glucose levels and insulin sensitivity, critical factors in diabetes management. Lack of sleep or poor sleep quality can impair the body's ability to use insulin and lower blood glucose levels, leading to hyperglycaemia or high blood glucose.

• Hormone Balance

Sleep balances hormones responsible for metabolism and energy expenditure. Lack of sleep or poor sleep quality can increase ghrelin, a hormone that stimulates hunger, and decrease leptin, a hormone that suppresses appetite.

This leads to increased food intake and weight gain, which can worsen diabetes and increase the risk of complications. Lack of sleep or poor sleep quality can also increase the levels of cortisol, a stress hormone that can raise blood glucose levels and blood pressure.

• Inflammation and Immunity

Sleep influences the immune system and the inflammatory response, essential for fighting infections and healing wounds. Lack of sleep or poor sleep quality can impair the immune system and increase the levels of inflammatory markers, thereby increasing the risk of infections and complications, such as foot ulcers, kidney disease, and cardiovascular disease.

As people with diabetes may experience different sleep problems, they need to prioritize sleep as part of their overall diabetes care plan. Some of the strategies that can help are:

• Follow a regular and consistent sleep schedule that allows seven to nine hours of uninterrupted sleep, and avoid substances that can interfere with sleep quality or duration.

• Eat a balanced diet with fibre, lean protein, healthy fats, fruits, and vegetables. Drink enough water throughout the day to stay hydrated. Avoid food and limit drinks before bedtime.

• Exercise regularly, preferably in the morning or afternoon, to improve blood circulation, lower blood pressure, and regulate blood glucose levels.

• Seek medical advice for any sleep disorders, such as sleep apnea, restless legs syndrome, or periodic limb movements, and adhere to treatment plans outlined by healthcare professionals.

• Practice good sleep habits, limit screen time and exposure to blue light, and engage in relaxing activities like reading, listening to music, or meditating before bedtime.

It is essential to take a comprehensive approach to managing both diabetes and sleep. Remember, sleep is not a luxury, but a necessity. By making it a priority and with the support and guidance of healthcare professionals, patient support programs, and a community of individuals facing similar challenges, you can improve your sleep quality and quantity and enhance your diabetes management.