If you’re living with diabetes, then you already have plenty of extra things to worry about in a typical day — deciding what and when to eat, getting enough exercise, monitoring your blood sugar, regulating insulin levels, possibly managing neuropathy or taking care of wounds, and lots more. The last thing you need is to start losing sleep, as well.
But many people with diabetes find themselves stuck in a difficult Catch-22: not getting enough sleep can make your diabetes worse, but diabetes symptoms can also make it harder to sleep. So the question becomes, what steps can you take to manage your disease in a way that lets your body rest and heal itself each night, regulate your glucose levels properly while you sleep, and then wake up feeling refreshed and ready to face another day?
The good news is, you are not alone in facing this question, and there are many resources out there that can help. About 84.1 million have prediabetes (which can lead to type 2 diabetes if not treated), and in 2015 the Centers for Disease Control estimated another 30.3 million American adults have diabetes. This means just under 10 percent of the U.S. population must implement measures for managing the disease and reducing its effects.
One of those measures is improving sleep. Sleep and diabetes have a very clear, but somewhat complicated, connection. While nearly 100 million people are affected by diabetes or are at risk for it, more than a third of Americans are not getting enough sleep every night. In fact, not getting enough sleep makes an adult twice as likely to develop Type 2 diabetes. Why? There are several reasons.
First, poor sleep quality not only makes it difficult to control blood sugar if you have a type 2 diabetes diagnosis, but it also makes it easier to develop diabetes if you’ve been diagnosed with a prediabetic condition.
Researchers are not completely sure of the reasons for this, but what they do know is that the body requires a deep sleep state to use insulin properly for regulating blood sugar. When you don’t get enough sleep, your body’s hormones are altered. This destabilizes blood sugar levels while also hindering your metabolic function.
On top of hindered metabolic function, once you have diabetes, you face a higher risk of developing sleep apnea and other sleep disorders. In addition, other symptoms of diabetes, like frequent urination or excessive thirst, can make it difficult to stay asleep. Diabetic neuropathy — pain and burning in the feet and legs — can make comfortable sleep difficult.
So what can you do? Whether you have diabetes already or are at risk for developing it, better sleep is a reasonable and attainable goal. There are simple measures you can take to improve the quality of your sleep. This guide will take a look at why improved sleep is so important for those dealing with diabetes or at risk for developing it, and how you can get better sleep.
Understanding the Connection Between Sleep and Diabetes
Before we can look at what you can do to improve your sleep, we must first understand the connection between sleep and diabetes. The full extent of this connection is still not understood, even by medical professionals, but it’s clear that blood sugar, diabetes, and sleep are all connected. Here’s a closer look at this relationship to help you understand what may be going on in your body and with your sleep.
- Recognize that deep sleep is the most restorative. When you get between four and six hours of sleep per night, you get less deep sleep. Since Stages 3 and 4 of sleep are the most restorative stages of sleep, getting them has a direct impact on your insulin production and blood sugar levels. Too little sleep prevents your body from reaching these restorative stages (including the REM stage).
- Understand the connection between sleep and metabolic function. While you sleep, your body restores and repairs itself on a cellular level, a process known as metabolic function. When you do not get enough deep sleep, your metabolic function is damaged, and this affects all areas of your body, including hormone production.
- Realize that ongoing sleep loss causes the body to release less insulin. Studies have shown that when you’re running on too little sleep, your body does not create enough insulin, the hormone that regulates blood sugar.
- Know that too little sleep increases stress hormones. When you’re not sleeping, your body increases the production of stress hormones like cortisol. This not only makes it hard to fall asleep but also negates some of the effects of insulin. The combination of these stress hormones with decreased insulin results in too much blood sugar in the blood.
- Recognize the risk of changes to your appetite due to too little sleep. When you do not sleep well, your body starts to crave carbohydrates and other sugary foods. If you indulge in these and give in to an increased appetite, your blood sugar and insulin levels will change. You may also gain weight, and obesity is a major risk factor for developing type 2 diabetes. This type of change makes it even easier to develop the condition and makes it hard to manage if you already have it.
- Acknowledge the link between poor sleep and obesity. Though obesity is not the same as diabetes, the two problems are closely linked, and poor sleep is a contributing factor to obesity.
- Get screened for sleep concerns, like sleep apnea. Those who have a diabetes diagnosis should be screened for sleep disorders, especially sleep apnea.
For more information about the connection between sleep and diabetes, visit:
- Joslin Diabetes Center: Sleep Problems and Diabetes
- U.S. National Library of Medicine: Sleep Disorders in Type 2 Diabetes
- Diabetes.co.uk: Diabetes and Sleep
Recognizing the Problems Impacting Sleep for Diabetic Individuals
You already know that diabetes is not an easy disease to live with, imposing challenges upon many areas of your daily life. Sleep is just one of those areas, and it can be a difficult one to navigate. Here are some of the reasons why it may be hard to get quality sleep while learning to manage your diabetes.
- Diabetes can cause hypoglycemia. When your blood sugar drops, you may experience night sweats. Night sweats are a common problem for people who have to take multiple injections of insulin during the day. At night, without a constant influx of insulin, your blood sugar may not be as well maintained, and this will wake you up.
- Diabetes can cause frequent thirst and urination. When your blood has too much sugar, the kidneys dump it through the urine. This, in turn, can dehydrate you, causing you to wake up to use the restroom or get a drink.
- Diabetic neuropathy is uncomfortable. Diabetes, if left unchecked, can permanently damage the nerves. Often affecting the hands or feet, diabetic neuropathy can be very painful, creating a burning, itching, or tingling sensation and making it difficult to sleep.
- Diabetes is linked to serious problems, like sleep apnea and restless leg syndrome, that make sleep difficult. Treating these underlying health conditions can often improve your sleep.
- Low blood sugar can cause irritability and anxiety, which makes sleep difficult. When your blood sugar drops at night, you may experience anxiety and irritability, mental states which can lead to disruptions in sleep.
General Tips to Improve the Quality of Your Sleep
Improving the quality and length of sleep is critical when you’re dealing with a diabetes diagnosis. While the disease adds a layer of challenge to this task, some tips for improving sleep are universal, regardless of your health conditions. If you feel that lack of sleep is impacting your risk for developing diabetes or making your diabetes more difficult to control, consider these tips.
- Set and stick to a bedtime and waking time. Going to bed at the same time each night will train your body’s internal clock to go to sleep more quickly. Similarly, you should avoid sleeping extra late on the weekends, which can confuse your body.
- Make your room dark. Too much light in your room, even from electronics or night lights, can make sleep difficult. Consider room-darkening blinds, and choose electronics, clocks, and other items that do not create significant light.
- Exercise regularly, but early in the day. Exercise is important for people living with diabetes, but exercising within three hours of bedtime can raise your endorphin levels and make it difficult to sleep.
- Keep the sleeping room at a comfortable temperature. Many people with diabetes struggle with night sweats. While this is due to blood sugar changes, getting too hot due to external conditions will only add to the problem. Similarly, if the room is too cold, you may not be able to get comfortable. Aim for a sleep temperature between 60 and 67 degrees at night.
- Nap strategically. Napping can be good for your body, but a nap too close to bedtime will make it hard to fall asleep. Avoid napping in the late afternoon or early evening.
- Turn off screens an hour before bedtime. If you need some wind-down time before bed, make sure it involves something that’s screen-free. Avoid looking at your phone, tablet, or TV in the hour before bedtime, as the blue light they emit can prevent sleep.
- Lay off the caffeine in the afternoon. Don’t have your afternoon coffee or soda, unless it’s caffeine-free. The caffeine may stay in your system and prevent you from falling asleep.
- Keep your blood sugar balanced. Unbalanced blood sugar affects many parts of your health, so keep it balanced. Stay on top of your diabetic care routine to improve your overall sleep.
- Learn to manage stress. Diabetes can be a stressful condition to live with, and stress hormones can make it difficult to sleep. Learn healthy mechanisms for coping with stress, such as yoga, meditation, deep breathing, and visualization. Also, consider getting help from a therapist, if needed.
- Create a bedtime ritual. Doing the same activities every night at bedtime will teach your body that it’s time to wind down and sleep.
- Keep your bed comfortable. Uncomfortable mattresses or pillows will erode your sleep, so make sure they are as comfortable as possible. If you’re looking for a new bed, keep in mind your sleeping position to help you find the best mattress for you.
For more tips on getting a good night’s sleep, visit:
- Sleep Education: Healthy Sleep Habits
- National Sleep Foundation: Healthy Sleep Tips
- Harvard.edu: 12 Simple Tips to Improve Your Sleep
- American Nurse Today: Tips for Achieving Healthy Sleep
- NAEYC: Encouraging Healthy Sleep Habits
Dealing with Sleep Apnea
If you have diabetes (or are at risk for developing it), you also may have sleep apnea. Whether diabetes makes the risk of sleep apnea higher, or sleep apnea increases the risk of diabetes remains to be seen, but the two conditions have a clear clinical connection. If you have diabetes or prediabetes, consider asking your doctor to screen you for sleep apnea. If you’ve already been diagnosed with sleep apnea, here are some tips to help you sleep better.
- Treat allergies. If you have seasonal allergies, talk to your doctor about how to best treat them. Allergies can make your throat and nasal tissues swell, narrowing your airway. Again, narrowed airways are not something you want when dealing with sleep apnea. The solution may be saline nasal spray or allergy medications, but your doctor should advise you about the options.
- Establish a solid sleep routine. Sleep apnea makes it hard to get restful sleep, so make it easier on your body by implementing and following a solid sleep routine.
- Lose weight. Losing weight is difficult when you have diabetes, but it’s the best way to treat sleep apnea for many people. When you have excess body fat, especially around the neck, it can restrict your airway. Even just a 10% loss in weight can reduce sleep apnea symptoms significantly.
- Talk to your doctor about dental appliances to treat sleep apnea. Some patients with sleep apnea can effectively treat their symptoms with a dental appliance that repositions the lower jaw and tongue. This only works for mild conditions of sleep apnea.
- Discuss the benefits and drawbacks of a CPAP machine. CPAP, which stands for “continuous positive airway pressure device,” involves a mask designed to blow air into the airway so it stays open while you’re sleeping. For many, it’s the most effective way to treat sleep apnea, but sleeping with a CPAP can be challenging. You will need to follow your doctor’s recommendations if this is the means you choose to treat sleep apnea.
For more information about sleep apnea, its connection to diabetes, and how to sleep with this condition, visit:
- U.S. National Library of Medicine: Obstructive Sleep Apnea and Type 2 Diabetes: Is There a Link?
- Cleveland Clinic: Sleep Apnea Can Make Managing Diabetes More Difficult – What You Need to Know
- Mayo Clinic: Sleep Apnea
- National Institute on Aging: Sleep Apnea
- American Sleep Apnea Association: Diabetes and Sleep Apnea Discussed on the Diabetes Late Nite Podcast
Diabetes and Restless Legs Syndrome
Another condition that commonly affects those with diabetes is restless legs (or leg) syndrome. If you’ve experienced it, you know the madness it can cause in the middle of the night. Restless legs syndrome is a neurological disorder that causes the intense urge to move your legs while trying to sleep. It can be hard to fall asleep or stay asleep with this condition.
Sadly, the syndrome is common for people with diabetes, as diabetic patients are more prone to the disorder than the general population. If you find that you’re waking up frequently or cannot fall asleep because your legs will not stop jerking (or if a sleep study has found that you have restless legs syndrome), here are some tips to help you sleep:
- Ask your doctor about medications. Some medications can help with restless legs syndrome. Drugs that affect calcium channels or dopamine levels in the brain can reduce the impact of the condition. Muscle relaxants also may help.
- Take a warm bath with Epsom salts. Epsom salts are high in magnesium, which is calming to the nerves and muscles. Add one cup of Epsom salts into a bath, then soak for at least 15 minutes. A warm bath also calms and relaxes the nerves and muscles. Take one before bed and you may have fewer problems with restless legs syndrome.
- Use hot and cold packs. Applying hot and cold packs — especially an alternating use of the two — can calm the symptoms of this condition.
- Exercise regularly. Exercising early in the day can reduce the impact of your restless legs syndrome at night.
- Reduce caffeine intake. Caffeine intake can exacerbate the twitching and other symptoms of restless legs syndrome, so reduce your intake throughout the day.
- Massage the affected limb. If you’re suffering from a bout of restless legs syndrome (or similar symptoms in your arms), try gently massaging the troubled limb with essential oils like lavender.
- Don’t resist the urge to move. Trying to hold your legs still might only make your symptoms worse, so if you do feel the need to move, give in to the need.
- Eat iron-rich foods. Red meat and other iron-rich foods can restore the iron balance in the body, which may help reduce your restless legs syndrome problems.
For more information about restless legs syndrome, its connection with diabetes, and how to manage it, visit:
- Restless Leg Syndrome Foundation: Treatment
- Cleveland Clinic: Restless Legs Syndrome Treatment and Management
- Patient Care: The Restless Legs Syndrome-Diabetes Link
- Diabetes.co.uk: Restless Leg Syndrome
- American Diabetes Association: Restless Legs Syndrome and Quality of Sleep in Type 2 Diabetes
- Mayo Clinic: Restless Legs Syndrome
Managing Chronic Insomnia and Diabetes
Chronic insomnia affects around a third of patients with diabetes. The risk for chronic insomnia increases with age, and as many as 27% of patients who have insomnia don’t even realize they’re struggling. If you’re dealing with insomnia, here are some tips that might help.
- Know the signs to watch for. Sometimes insomnia goes untreated because patients don’t realize they have it. Some signs of insomnia include trouble falling asleep at night, waking too early without being able to fall back asleep, waking up feeling unrefreshed, or the inability to stay asleep. If you have these problems, you may not be experiencing enough deep sleep cycles to attain that restorative sleep.
- Improve your sleep environment. If no medical cause is found for your insomnia, check your sleep environment for potential problems. Is your bed comfortable? Is the temperature good? Is the room too bright? If not, sleep may be more difficult to attain.
- Improve your sleep hygiene. Are you engaging in activities that sabotage your sleep? Put a stop to these to improve your sleep drastically.
- Talk to your doctor about your medications. Some diabetes medications, like Metformin, can increase insomnia symptoms. Ask if a medication adjustment could help you sleep.
- Don’t immediately get up. If you can’t sleep, don’t take it as a sign that you should get up and “try to get some work done.” Instead, remain in bed, relaxing your muscles, for at least 20 minutes. If that doesn’t work, go to another room and read in dim lighting until you feel sleepy again. Don’t start doing something productive; this will cue your body that night is for working, not sleeping.
- Consider sleep-compression training. This is a process where you set your wake-up time and put yourself to bed exactly six hours before then. Do this for up to two weeks until you start falling asleep almost instantly. Then, push your bedtime back 15 to 30 minutes, repeating the process for up to two weeks. Continue this training until you’re sleeping 7 to 8 hours a night. The forced sleep deprivation will make it easier to fall asleep every time your head hits the pillow, and soon you will train your body to sleep a healthy amount.
- Avoid spending long hours in bed. It may seem like going to bed earlier is the cure for insomnia, but spending 10 to 12 hours in bed — most of them sleepless — can actually make the problem worse. Teach your brain and body that the bed is only for sleeping by adhering to a solid sleep schedule.
- Change your negative sleep thoughts. If you find yourself lying in bed thinking that you’ll never sleep again, then you may be sabotaging your own relaxation. These negative thoughts about sleep actually trigger a rise in your heart rate and blood pressure, which can prevent sleep. Instead, when you have these thoughts, focus your mental energy on relaxing your muscles and breathing deeply to channel the thoughts into a more relaxed state.
- Recognize the link between poor sleep and insulin resistance. In people with diabetes, insulin resistance is very dangerous. In one study, those who slept poorly had an 82% higher resistance to insulin in the morning than those who slept well. For this reason, aggressive treatment for your sleep concerns is important.
- Recognize that chronic sleep loss also reduces insulin sensitivity. In another study, men who slept only 5 hours per night for a week had significant reductions in their insulin sensitivity, indicating that chronic sleep debts can add up to blood sugar and diabetes-related problems.
For more information about chronic insomnia and diabetes, visit:
- U.S. National Library of Medicine: Diagnosis and Treatment of Chronic Insomnia
- Insomnia.net: How Is Diabetes Affected By Insomnia
- EndocrineWeb: Chronic Insomnia Increases Risk of Type 2 Diabetes
- Diabetes Self-Management: Getting the Sleep You Need
- American Diabetes Association: Insomnia and Physical Activity in Adults with Prediabetes
Blood Sugar Control and Sleep
Many sleep-related problems associated with diabetes can be connected to blood sugar. If your blood sugar gets too high, for instance, you may struggle with excessive bedtime sweating, thirst, or urination, all of which can make it hard to get a good night’s sleep. Consider these tips to help you manage your blood sugar at night and help prevent some of these problems.
- Use a continuous glucose monitoring device. These devices monitor your blood glucose level throughout the day, sending an alert when numbers get too high or low. While the alert may disturb your sleep, it will allow you to address your blood sugar levels quickly, so you can get back to sleep. Continuous glucose monitoring also shows you trends that may help you and your doctor adjust medications to avoid dips or spikes during the night. Talk to your doctor about whether or not you’re a good candidate for this device.
- Monitor nighttime blood sugar levels for a week. Waking at night to check blood sugar levels may seem counterproductive, but it can help you see what’s happening while you sleep. Schedule wake-ups a couple of times per night for a week to track your blood sugar. If you notice alarming trends, make adjustments to either your diet or medications to stop the spikes and dips.
- Follow your treatment plan. Speak with your doctor about devising a recommended treatment plan, and follow it faithfully. It will likely include dietary and exercise changes and, potentially, medications.
- Have a healthy bedtime snack. If you struggle with nighttime blood sugar swings, a healthy bedtime snack may help. Whole grains without much sugar or complex carbohydrates are all good options.
For more help managing your blood sugar levels, especially at night, visit:
- Medical News Today: Which are the Best Bedtime Snacks for Diabetes?
- Cleveland Clinic: Blood Sugar – Hidden Causes of High Blood Sugar Levels in the Morning
- DiaTribe: The Overnight Blood Sugar Conundrum
- Today’s Dietitian: Correcting Morning Blood Sugar Highs
- Diabetes Strong: How to Treat Low Blood Sugar at Night
Managing Other Sleep Concerns Caused By Diabetes
Restless legs syndrome, sleep apnea, and blood sugar fluctuations are common sleep-disrupting symptoms of diabetes, but they are just a few among the many you could be experiencing. Diabetes is a chronic disease with a wide range of symptoms, and some of these will almost certainly affect your sleep. Here are tips to help manage related problems more effectively:
- Stay hydrated. People with poorly controlled diabetes may suffer from excessive thirst. While proper hydration will not fix blood sugar-related thirst, it can help prevent you from waking due to natural thirst. Keep yourself well hydrated throughout the day.
- Keep bathroom trips short and sweet. Urination at night can be a side effect of high blood sugar levels. You can’t avoid bathroom trips, but you should avoid checking your phone or reading while in the restroom. Do what you need to do, then get back into bed.
- Eat properly before bed. Hunger during the night indicates poor blood sugar control. Have a healthy bedtime snack with protein but no sugars or carbs. And do not indulge in a heavy meal right before hitting the hay.
- Keep the room at a comfortable temperature. Night sweats can be a sign of low blood sugar. In addition to balancing your blood sugar, do what you can to keep your room and bed at a comfortable temperature.
- Massage your hands and feet to avoid pain from neuropathy. If you have diabetic neuropathy, you may struggle to sleep due to the sensations in the affected limbs. Massage can stimulate the nerves and relieve pain.
A Good Night’s Sleep Starts with Good Diabetes Care
Does poor sleep increase the risk of diabetes, or does diabetes cause you to sleep poorly? The answer is likely a mixture of both, and researchers are still not quite certain. What is clear is that the link between diabetes and sleep is undeniable.
If you aren’t sleeping well, you put yourself at a higher risk for developing diabetes or related complications. Yet the condition itself can make sleep difficult, with restless legs syndrome, neuropathy, or overall restlessness making it hard to fall asleep in the first place — and then nighttime sweating, thirst, or urination waking you when you finally do fall sleep.
To address these problems and increase your chances of healthy sleep every night, start by making your sleeping space as comfortable as possible. Then, focus on your diabetes care. By combining well-controlled blood sugar, good sleep hygiene, and a comfortable sleeping space, you may find that your sleeping concerns will become more manageable, or disappear completely.