Diabetes often referred to by doctors as diabetes mellitus, describes a group of metabolic diseases in which the person has high blood glucose (blood sugar), either because insulin production is inadequate, or because the body's cells do not respond properly to insulin, or both.
Sleep disturbance, which is often observed among patients with diabetes, is possibly caused by impaired glucose metabolism or physical and psychological discomfort due to the disorder. In addition, a recent prospective study of women has indicated an interesting association between sleep patterns and later-onset type 2 diabetes, with a greater incidence among both short-term (<6 h) and long-term (>8 h) sleepers. Disturbance in sleep quality may also affect the later onset of overt diagnosis of type 2 diabetes.
Multiple factors contribute to insomnia complaints in patients with diabetes. In type 1 diabetes, rapid changes in glucose levels during sleep have been postulated to cause awakenings. For individuals with type 2 diabetes, sleep disturbances may be related to obesity or obesity-associated sleep disorders, such as sleep apnea. Sleep-disordered breathing correlates highly with obesity in the diabetic population. A strong association also exists between obesity, impaired glucose tolerance, insulin resistance, and sleep-disordered breathing. Furthermore, the severity of sleep-disordered breathing, as measured by the apnea-hypopnea index, correlates with the severity of glucose intolerance, insulin resistance (inability of a body to use insulin), and diabetes. Although obstructive sleep apnea is the
most common type of sleep-disordered breathing, central-type apneas and periodic breathing have been reported in patients with autonomic diabetic neuropathy.Autonomic diabetic neuropathy, which is seen in diabetes may damage the nerves in the feet and legs, is an important cause of sleep disruption. This nerve damage can cause a loss of feeling in the feet or symptoms such as tingling, numbness, burning, and pain.
Estimates suggest that up to 40% of people with OSA will have diabetes. In people who have diabetes, the prevalence of OSA may be up to 23%, and the prevalence of some form of sleep disordered breathing may be as high as 58%.Glucose tolerance tests showed that the short sleepers were experiencing hormonal changes that could affect their future body weight and impair their long-term health. To keep their blood sugar levels normal, the short sleepers needed to make 30% more insulin than the normal sleepers.
After restricting 11 healthy young adults to four hours' sleep for six nights, researchers’ level found their ability to process glucose (sugar) in the blood had declined—in some cases to the level of diabetes.
There is evidence that treatment of sleep disorders, such as sleep apnea, can improve glucose control and insulin sensitivity. Advances in behavioral therapy for insomnia, as well as improved safety and tolerability of the newer hypnotic agents and better control of neuropathic symptoms, have resulted in improvements in the management of sleep disruption in diabetics. Treatment of these common sleep disorders and education regarding healthy sleep behaviors can improve the health and quality of life of patients with diabetes.