Diabetes and Sleep Problems: Causes and Treatment Options

There’s nothing like a good night’s sleep — but if you live with type 1 or type 2 diabetes, that can be easier said than done.

There are a variety of ways diabetes can impact the quality of your sleep, and it’s actually very important that you don’t just “endure it” and accept too little sleep as part of your life because that can wreak havoc on your diabetes, too.

Let’s take a look at all the ways diabetes can affect your sleep (and lack of sleep can affect your diabetes), and what you can do about it.

How low & high blood sugars affect your sleep

Fluctuations in your blood sugar can easily keep you up all night long.

Waking up in the middle of the night with a low or high blood sugar not only takes away from the hours you ought to be sleeping but also leaves you groggy and potentially fighting high blood sugars the next day from increased cortisol.

Consistent low or high blood sugars mean that your diabetes medications need to be adjusted — immediately — with support from your healthcare team.

Low blood sugars

A low blood sugar can easily wake you up in the middle of the night. You might be low enough that you’re covered in sweat, or you’re just starting to dip low and your body is alerting you more subtly.

According to the American Diabetes Association (ADA), symptoms of a low blood sugar can include:

• Feeling shaky
• Being nervous or anxious
• Sweating, chills, and clamminess
• Irritability or impatience
• Confusion
• Fast heartbeat
• Feeling lightheaded or dizzy
• Hunger
• Nausea
• Color draining from the skin (pallor)
• Feeling Sleepy
• Feeling weak or having no energy
• Blurred/impaired vision
• Tingling or numbness in the lips, tongue, or cheeks
• Headaches
• Coordination problems, clumsiness
• Nightmares or crying out during sleep
• Seizures

Low blood sugars can be the result of too much insulin with your dinner or even too much insulin in general. If you’re taking a non-insulin medication that lowers blood sugar levels (like Metformin or Victoza), you likely need a lower dose if you’re experiencing regular low blood sugars.

If you’ve lost weight, improved your diet, or started exercising regularly, you could have naturally improved your sensitivity to insulin and thus need less than you are getting — especially in the hours while you sleep. (Remember, even fast-acting insulin stays in your body for about 4 hours, which means insulin you took at 9 p.m. can easily cause a low blood sugar at 1 a.m.)

High blood sugars

High blood sugars don’t carry the same uncomfortable “emergency”-like feelings that come with a midnight low blood sugar, but they can still interfere with a good night’s sleep — especially because high-blood sugars can make urinating every few hours necessary. 

If you wake up in the middle of the night feeling desperately thirsty and just generally uncomfortable, make sure to check your blood sugar.

Catching that high blood sugar at midnight and taking a correction dose of insulin means you have an opportunity to get better sleep for the rest of the night and wake-up in your goal range. 

But consistently high blood sugars while you sleep are a sign that your insulin doses or other non-insulin medications need to be adjusted. 

Tips for managing overnight low or high blood sugars

• Talk to your healthcare team ASAP about adjusting your medication dosages
• Consider getting a continuous glucose monitor to help you keep a better eye on your overnight blood sugar trends, and to simply keep you safer while you sleep.
• Remember, a low blood sugar is not an opportunity to eat everything in the kitchen. This will make it harder to fall asleep, and likely result in a rebounding high blood sugar by morning.
• Keep fast-acting glucose near your bed at all times, like juice boxes, glucose tabs, Smarties, Pixie Stix to treat low blood sugars quickly and efficiently.
• If you take insulin to correct high blood sugars, carefully calculate your correction dose based on how many points 1 unit of insulin lowers your blood sugar. If you are at 300 mg/dL, and 1 unit of insulin lowers your blood sugar by 25 points, you’ll likely need at least 6 units of insulin to bring you down below 150 mg/dL.

Read more about the best ways to treat low blood sugars as quickly as possible without over-eating.

How lack of sleep can affect your diabetes

Too little sleep creates a state of stress on your entire body, physically and mentally. Sleep doesn’t just give your bones and muscles a rest, it also helps your brain rest, recover, and essentially heal from its work that day.

A day here or there of too little sleep isn’t a big deal, but regularly getting too little sleep will eventually take its toll.

Your body can and will react to inadequate sleep in several ways:

• increased hormones like cortisol and adrenaline, which blunt your sensitivity to insulin and trigger your liver to make more glucose
• increased appetite to compensate for exhaustion, which can lead to binge-eating and poor food choices
• increased weight gain, blood pressure, heart rate, and blood sugar levels
• increased irritability, which can affect your performance at work and school, your relationships
• increased depression and anxiety because your brain isn’t getting the recovery time it needs in order to function properly
• decreased sex drive and fertility

Other sleep disorders associated with diabetes

Living with diabetes can increase the risk of experiencing several other common and uncommon sleeping disorders. 

Sleep apnea

Sleep apnea (also known as “obstructive sleep apnea” or “OSA”) is very common in people with diabetes — especially in those struggling with obesity or being overweight.

OSA is defined by long pauses in breathing while you sleep. To qualify, the pause of breathing must be at least 10 seconds long, according to the National Sleep Foundation. It’s the result of your throat muscles partially closing or closing entirely for varying periods of time during your sleep.

If you share your bed with a partner, they may have commented by now on your loud and disturbing snoring.

The National Sleep Foundation lists the following as common signs and symptoms of sleep apnea:

• Chronic snoring
• Constantly feeling sleep-deprived
• Difficulty concentrating
• Depression
• Irritability
• Sexual dysfunction
• Learning and memory difficulties
• Falling asleep during normal daytime activities
  Disturbed sleep

If you ignore it, it can lead to a variety of other issues.

Consequences of untreated sleep apnea

• Daytime exhaustion and fogginess
• High blood pressure
• Cardiac arrhythmia
• Congestive heart failure
• Heart attack
• Stroke
• Depression and mood issues
• Memory issues
• Insulin resistance
• Increased risk of type 2 diabetes
• Drowsy driving

Tips for managing sleep apnea

If you think you are struggling with sleep apnea, you’ll need to ask your primary care physician for a referral to do a sleep study. This sounds scarier than it is. Basically, you’ll sleep at an in-patient facility so medical professionals can observe your breathing while you sleep. 

If you qualify for sleep apnea, you’ll have a variety of options to treat and manage your sleep apnea:

• Continuous positive airway pressure (CPAP) device: A mask that covers your mouth and/or nose and delivers air to help keep your airway open while you sleep
• Oral Pressure Therapy (OPT): Similar to a CPAP device but without the mask, this treatment is a mouthpiece that delivers air to help keep your throat properly open while you sleep.
• Expiratory Positive Airway Pressure (EPAP): This device covers your nostrils with a disposable adhesive value that opens and ensures your airway stays open. 
• Dental appliances to reposition jaw and tongue
• Upper airway surgery to remove excess tissue: If you have an anatomical facial abnormality, it could be corrected with surgery and enable your jaw and throat to stay open properly during your sleep. 
• Lose weight: Weight-loss can have a significant impact on sleep apnea. If you’re reluctant to use a device, let sleep apnea be the motivation you need to lose weight.
• Avoid, reduce, or limit alcohol intake
• Quit smoking
• Sleep on your side instead of on your back

Do not ignore sleep apnea! It may seem like no big deal — just a little snoring, right? Wrong. This sleep issue can be very destructive to the rest of your health. Tackle it head-on.

Restless leg syndrome

Also known as “Willis-Ekbom Disease,” restless leg syndrome (RLS) usually interferes most with getting a quality night of sleep. 

“Symptoms commonly occur in the late afternoon or evening hours, and are often most severe at night when a person is resting, such as sitting or lying in bed,” explains the National Institute of Health.  “Moving the legs or walking typically relieves the discomfort but the sensations often recur once the movement stops.”

Potential causes of RLS

Research has found a link between dopamine and RLS. 

“Dopamine is needed to produce smooth, purposeful muscle activity and movement.  Disruption of these pathways frequently results in involuntary movements.”

The dysfunction may be in the production of dopamine or your body’s ability to properly use available dopamine.

RLS may also be a symptom of a larger health issue, such as:

• end-stage renal disease and hemodialysis
• anemia (iron deficiency)
• side-effects from a medication you’re taking, including drugs for nausea, depression, psychosis, cold and allergies
• consumption of alcohol, nicotine, and caffeine
• the last trimester of pregnancy
• neuropathy

While there are a variety of treatment options used to potentially help relieve RLS, the first step is to properly pinpoint the cause of your RLS. If the cause is low iron levels, this is easily treated with an iron supplement.

If the cause is your alcohol consumption, you’d need to avoid alcohol if you want to eliminate or reduce the symptoms. 

Take a look at the potential causes of restless leg syndrome and work with your healthcare team to determine the most likely cause for your body.

Neuropathy

The burning and tingling that comes with neuropathy are enough to drive a person crazy let alone keep them up at night. Painful, incredibly uncomfortable, and impossible to ignore, neuropathy symptoms are not easy to endure.

The American Diabetes Association (ADA) estimates that about half of everyone with diabetes will have some degree of neuropathy. 

Peripheral neuropathy is the most common among people with diabetes. Also referred to as “diabetic neuropathy” or “PN,” it develops when severe nerve damage has occurred within your hands, fingers, toes, legs, feet, and/or arms. 

These areas also struggle to get adequate fresh blood due to limited blood flow which worsens symptoms and endangers the wellbeing of that part of your body

Here are the most common symptoms of peripheral neuropathy:

• Burning
• Tingling
• Numbness
• “Freezing” pain
• Sharp “electric” stinging
• Very sensitive to touch
• Eventual loss of feeling
• Eventual loss of balance in muscles of the affected area
• Eventual weakness in muscles of the affected area

If you believe you may be experiencing symptoms of undiagnosed neuropathy, talk to your healthcare team as soon as possible.

Tips for managing neuropathy

Are you taking a medication for nerve pain? Gabapentin is the most commonly prescribed to help relieve and reduce nerve pain. It also causes a bit of grogginess so it could help you sleep more for that reason, too.

Reducing your alcohol intake, quitting smoking, and improving your overall diet all play into the severity and further development of neuropathy.

Another critical part of managing neuropathy is getting your blood sugars down into a healthier range. If you’ve been diagnosed with neuropathy but you haven’t yet improved your blood sugars, this should become an ultimate focus of your time and effort. 

You’ll improve your sleep, improve your symptoms, and reduce your risk of eventually needing an amputation if a small cut or blister on your foot becomes infected.

How to improve your sleep quality

Getting good sleep isn’t always as simple as closing your eyes and hoping for the best. Instead, there are many things you can do and can avoid ensuring you get plenty of sleep.

Getting a good night’s sleep as a person with diabetes isn’t easy!

• Talk to your healthcare team about increasing the “high alarm” on your continuous glucose monitor to lessen the frequency of being interrupted
• Talk to your healthcare team about improving your overnight blood sugars and insulin doses to ensure better sleep
• Keep fast-acting glucose next to your bed to treat midnight lows so you don’t end up in the kitchen eating everything in sight
• Check your blood sugar every night before bed
• Make your bedroom dark using shades, curtains, etc.
• Don’t bring your phone to bed
• Don’t stare at the phone/computer screen during the last hour before bed
• Use a fan-based noise machine for natural white noise
• Create your own restful ritual: 5 minutes of yoga, relaxing music, hot shower, etc.
• Avoid high-sugar meals right before bed
• Identify known habits that interfere with your sleep

Sleep is a complicated thing. We all need it. You can’t avoid it. But getting the amount you need when you need it is easier said than done.