A. Modern society is prone to sleep disturbances. These include diagnosed and undiagnosed sleep disorders. Insufficient sleep is the most common type of sleep disorder. People don't get enough sleep. They want to make the most of social networking and leisure opportunities. The most sleep-deprived children in high school are likely to be the highest-sleeping age group. Their sleep habits and health priorities set them up for not prioritizing sleep as an essential pillar of their health.
It is common to have irregular sleep patterns. American workers make up 16% of the total population. Their day-to-day sleeping patterns are also irregular. You might wake up at 2 a.m., get back to sleep the next day and then leave early the next morning. Social jet lag is a similar behavior. This refers to being sleep deprived during the week and then trying to catch-up during weekends. It is common in adolescents and young adults.
Many sleep problems have been linked to diabetes, insulin resistance, prediabetes, or both. These issues can also impact glucose tolerance. Experiments have shown that when healthy volunteers are forced to sleep irregularly during the night, it can lead to a decline in insulin sensitivity and glucose tolerance.
This is because modern living has led to sleep irregularities, which increases the risk of developing diabetes. This is in addition to the well-established connection between type 2 and sleep disorders such as insomnia and obstructive sleeping apnea. OSA is a condition that affects approximately two-thirds (or more) of type 2 diabetics. The severity of the OSA can affect the glycemic control of people with diabetes. The more severe it is, the lower the insulin sensitivity.
Q. Can a sleep disorder or sleep problem increase your risk of developing type 2 diabetes?
A: Yes. Numerous studies have demonstrated that frequent awakenings, irregular sleep patterns, inadequate sleep, excess sleep, and repeated nighttime awakenings all contribute to glucose intolerance. Poor sleep can also worsen diabetes or prediabetes.
People without other diabetes risk factors may also experience sleep problems. The effects of decreased sleep in controlled laboratory conditions on healthy, young adults with no diabetes risk factors or obesity have been studied. Insufficient sleep for as little as four to five days was associated with a decrease in insulin sensitivity of between 25% and 30%. There is strong evidence to suggest that inadequate sleep can have a negative effect on glucose tolerance, leading people otherwise in good health to develop prediabetes.
The results of subsequent cohort studies revealed that participants who slept for less than 7 to 8 hours were 40% more likely to develop diabetes after accounting for age, body mass, sedentary status, family history, and other factors.
We know that people with severe OSA, or sleep disorders, are at higher risk of developing type 2 diabetes. These two epidemics are responsible for the dramatic rise in diabetes prevalence.
It is worth noting that sleep problems, such as difficulty falling asleep or staying asleep, can have an impact on diabetes risk similar that having a family history with type 2 diabetes.
Q. Can treating sleep disorders and other problems improve glucose control in people with type 2 diabetes?
A: At the moment, we are just beginning to study the effects of sleep disturbances on glycemic control. There aren't many intervention studies. A few studies have looked at short sleepers and found that they were more responsive to insulin when their sleep time was extended. Studies have shown that short sleepers who are more active during the night may be less hungry and feel fuller and can lose weight. More studies are needed in larger groups.
OSA is the only known sleep disorder that has been well researched. Several studies have examined continuous positive airway pressure (CPAP), to determine if this treatment can lower glucose levels and improve glycemic control. Mixed results were reported. Some clinical trials of CPAP compared to placebo treatment showed an impact on glucose metabolism and insulin sensitivity. Others did not.
The problem is that CPAP compliance is usually poor when you are doing a study in real-life situations. The best compliance is when the device is worn for only a few hours each night. Compliance can be optimized in laboratory studies. We conducted a proof of concept study that involved the treatment of type 2 diabetic patients for a week. The CPAP device was used to help them sleep at night in the laboratory. The sleep technicians solved every problem with the CPAP machine. We saw a drop in glucose levels of about 12 mg per deciliter after a week. This is clinically significant. It is the equivalent to what you can do with one drug.
The clinic's outcome is affected by the mix of results. CPAP technology has improved tremendously. There are now devices that are more comfortable, smaller and lighter and are easier to use. Dental appliances can also be used to reduce the severity and duration of OSA. Most health care professionals don't believe that sleep apnea is a problem. Health care professionals are discouraged from treating OSA in diabetes.
Q: Do health care professionals need to screen patients for sleep disorders? How can they help patients with poor sleep or sleep disorders?
A: All health care professionals ask about your weight, diabetes history, and exercise routinely. Even a skilled diabetes specialist will often not ask questions about sleep. Many health care professionals won't ask patients if they have a job or if they are coming to the clinic from work. If the night was spent awake, any biochemical test results can be affected.
These are some questions that every patient should ask. What is your work schedule like? Are you a good sleeper? When do you get up in the morning? When do you rise in the morning? And how about weekends? Are you able to sleep on a regular basis? A few simple questionnaires can be completed by health professionals during an in-person visit or remotely. For example, the sleep quality survey (PDF 6.2 MB), which assesses sleep quality and habitual sleep duration. A scale for daytime sleepiness External Link is another that can be used to reveal the effects of OSA on daytime function. A scale for sleep apnea External link is also available (PDF, 58KB). These questionnaires provide a valuable insight for health care professionals on sleep issues that might need treatment or behavioral improvements. It's as simple as making sleep part the patient's medical history.
The American Diabetes Association's External Link annual recommendations do not mention insufficient sleep. OSA is one of the factors that can affect glucose tolerance. This is a good first step. The International Diabetes Federation also includes language about sleep in their guidelines External link . (PDF, 383KB) I hope that more providers are informed about these guidelines and will be able to follow the recommendations.
Q. What else should health care professionals know about patients with diabetes and sleep disturbances?
A: In reality, we are looking at the triangle of metabolism and sleep. There is food all day. Some people eat more calories than they normally do. As the day progresses, they snack throughout the night. This decreases the time between meals and can affect glucose regulation. You can modify the sleep duration and encourage dietary changes which in turn can impact glucose metabolism.
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