The Link Between Sleep Health and Diabetes Explained

Most people are aware that family medical history, what you eat, your weight, and being active can prevent type 2 diabetes, or diminish its risks for other chronic health issues in those already diagnosed.

But do you know that diabetes can have a major impact on your sleep health? Inversely, not getting the required minimum sleep of seven hours a night for most adults can increase your risk of diabetes. That’s mostly because sleep deprivation can throw hormone levels out of whack, including the body’s ability to produce enough insulin, the hormone that regulates blood sugar. People with type 2 diabetes don’t use insulin efficiently (insulin resistance) and don’t produce enough insulin (insulin deficiency).

March 14-20 marks “Sleep Awareness Week 2021” — which coincides with the annual “Spring forward” time of adjusting to daylight savings time. Losing an hour of sleep this past weekend is just a reminder of year-round sleep health issues for many people. And many sleep disorders have been made worse by the stress and disruptions of the year-long pandemic.

“There are sleep disorders that can make the risk for diabetes higher,” said Dalia Lorenzo, M.D., a neurologist with Miami Neuroscience Institute, part of Baptist Health South Florida. “And diabetics have a higher incidence of sleep disorders. So, it’s a two-way street.”

(Watch now: Hear from Dalia Lorenzo, M.D., a neurologist with Baptist Health’s Miami Neuroscience Institute, about sleep health issues. Video by Dylan Kyle.)

About half of all people with diabetes have some form of nerve damage, which can include neuropathy. Peripheral neuropathy can cause tingling, pain, numbness, or weakness in your feet and hands, and can contribute to “restless leg syndrome” — a major contributor to lack of sleep.

“Patients who have diabetes will have a higher incidence of things like sleep apnea, incidence of limb movements (such as restless leg syndrome),” said Dr. Lorenzo. “There may be many of reasons for that. For example, diabetics do suffer from neuropathy, know which is the tingling, burning, numbing sensation that tends to affect their feet first — then eventually their hands. And it can cause quite a bit of pain and difficulty getting to sleep.”

The Quality of Sleep

Sleep health is not just about getting enough hours of shut-eye. It’s also about the quality of sleep. In particular, a decrease in slow-wave (or “deep”) sleep — which is considered essential for overall health — seems to play a big role in maintaining proper insulin sensitivity and blood sugar control. REM (Rapid Eye Movement) sleep is the deepest stage of sleep when you’re most likely to dream, and when breathing, heart rate, and blood pressure usually rise to near-awake levels. REM sleep typically makes up about 20 to 25 percent of total sleep time in healthy adults.

For adults, quality sleep typically means that you fall asleep in 30 minutes or less, and you sleep soundly through the night, with no more than one awakening. And if you do awake in the middle of the night, ideally you would drift back to sleep within 20 minutes, according to sleep health experts.

“You go through deeper and deeper stages of sleep, and those stages are orchestrated in an architecture over the seven-hour period that most people sleep,” explains Dr. Lorenzo. “At the beginning of that period of time, you’re going through a slow wave sleep, which is very restorative for the brain. And then every 90 minutes, you go into a REM period, which is associated with dreams and has some functions that are important. This cycle changes over the seven-hour period.”

Sleep Apnea and Insulin Sensitivity

Clinical studies have established a link between breathing disorders during sleep, primarily obstructive sleep apnea (OSA), and insulin resistance and glucose intolerance.

“There is some evidence that the low oxygen that occurs with sleep apnea can actually

damage some of the pancreatic islet cells — the cells in the pancreas that are responsible for insulin secretion,” said Dr. Lorenzo. “There is some evidence that obstructive sleep apnea can decrease the insulin sensitivity.”

Continuous positive airway pressure (CPAP) therapy uses a machine to help a person who suffers from OSA breathe easier during sleep. “We know that CPAP treatment for obstructive sleep apnea is extremely beneficial in many other ways — for the cardiovascular risks and stroke risks,” says Dr. Lorenzo. “Sleep apnea is a big risk factor for stroke among men particularly.”

Doctors advise their patients with insulin resistance, also referred to as pre-diabetes, to focus on lifestyle changes, such as eating more nutritious foods in appropriate portions and regularly exercising. Add better sleep hygiene – or getting enough sleep and keeping a consistent sleep schedule — to the list of vital lifestyle changes, says Dr. Lorenzo.

“We have good epidemiologic studies showing that short sleepers, long sleepers or erratic sleepers do have a higher incidence for obesity and type 2 diabetes,” says Dr. Lorenzo. “Actually, when you look at how much that predisposes you to diabetes — it predisposes you to diabetes as much as not exercising regularly or inactivity. This is a problem because in the modern times we spend a lot of time in front of computers and there’s a lot more sleep fragmentation because people are expected to be much more available, and this is a problem.”

The Link Between Sleep Health and Diabetes Explained

Most people are aware that family medical history, what you eat, your weight, and being active can prevent type 2 diabetes, or diminish its risks for other chronic health issues in those already diagnosed.

But do you know that diabetes can have a major impact on your sleep health? Inversely, not getting the required minimum sleep of seven hours a night for most adults can increase your risk of diabetes. That’s mostly because sleep deprivation can throw hormone levels out of whack, including the body’s ability to produce enough insulin, the hormone that regulates blood sugar. People with type 2 diabetes don’t use insulin efficiently (insulin resistance) and don’t produce enough insulin (insulin deficiency).

“There are sleep disorders that can make the risk for diabetes higher,” said Dalia Lorenzo, M.D., a neurologist with Miami Neuroscience Institute, part of Baptist Health South Florida. “And diabetics have a higher incidence of sleep disorders. So, it’s a two-way street.”

About half of all people with diabetes have some form of nerve damage, which can include neuropathy. Peripheral neuropathy can cause tingling, pain, numbness, or weakness in your feet and hands, and can contribute to “restless leg syndrome” — a major contributor to lack of sleep.

“Patients who have diabetes will have a higher incidence of things like sleep apnea, incidence of limb movements (such as restless leg syndrome),” said Dr. Lorenzo. “There may be many of reasons for that. For example, diabetics do suffer from neuropathy, know which is the tingling, burning, numbing sensation that tends to affect their feet first — then eventually their hands. And it can cause quite a bit of pain and difficulty getting to sleep.”

The Quality of Sleep

Sleep health is not just about getting enough hours of shut-eye. It’s also about the quality of sleep. In particular, a decrease in slow-wave (or “deep”) sleep — which is considered essential for overall health — seems to play a big role in maintaining proper insulin sensitivity and blood sugar control. REM (Rapid Eye Movement) sleep is the deepest stage of sleep when you’re most likely to dream, and when breathing, heart rate, and blood pressure usually rise to near-awake levels. REM sleep typically makes up about 20 to 25 percent of total sleep time in healthy adults.

For adults, quality sleep typically means that you fall asleep in 30 minutes or less, and you sleep soundly through the night, with no more than one awakening. And if you do awake in the middle of the night, ideally you would drift back to sleep within 20 minutes, according to sleep health experts.

“You go through deeper and deeper stages of sleep, and those stages are orchestrated in an architecture over the seven-hour period that most people sleep,” explains Dr. Lorenzo. “At the beginning of that period of time, you’re going through a slow wave sleep, which is very restorative for the brain. And then every 90 minutes, you go into a REM period, which is associated with dreams and has some functions that are important. This cycle changes over the seven-hour period.”

Sleep Apnea and Insulin Sensitivity

Clinical studies have established a link between breathing disorders during sleep, primarily obstructive sleep apnea (OSA), and insulin resistance and glucose intolerance.

“There is some evidence that the low oxygen that occurs with sleep apnea can actually

damage some of the pancreatic islet cells — the cells in the pancreas that are responsible for insulin secretion,” said Dr. Lorenzo. “There is some evidence that obstructive sleep apnea can decrease the insulin sensitivity.”

Continuous positive airway pressure (CPAP) therapy uses a machine to help a person who suffers from OSA breathe easier during sleep. “We know that CPAP treatment for obstructive sleep apnea is extremely beneficial in many other ways — for the cardiovascular risks and stroke risks,” says Dr. Lorenzo. “Sleep apnea is a big risk factor for stroke among men particularly.”

Doctors advise their patients with insulin resistance, also referred to as pre-diabetes, to focus on lifestyle changes, such as eating more nutritious foods in appropriate portions and regularly exercising. Add better sleep hygiene – or getting enough sleep and keeping a consistent sleep schedule — to the list of vital lifestyle changes, says Dr. Lorenzo.

“We have good epidemiologic studies showing that short sleepers, long sleepers or erratic sleepers do have a higher incidence for obesity and type 2 diabetes,” says Dr. Lorenzo. “Actually, when you look at how much that predisposes you to diabetes — it predisposes you to diabetes as much as not exercising regularly or inactivity. This is a problem because in the modern times we spend a lot of time in front of computers and there’s a lot more sleep fragmentation because people are expected to be much more available, and this is a problem.”