Sleep disorders and diabetes: a vicious circle!

What is diabetes and what are sleep disorders? 

Diabetes is a chronic disease characterised by an excess of sugar in the blood (also called "hyperglycaemia"). In the UK, more than 4,5 million people are currently living with diabetes, almost 90% of whom - with type 2.

Sleep disorders such as insomnia, sleep apnoea and restless legs syndrome affect affect about 1 in 3 people in the UK. These disorders disrupt the quality and quantity of sleep, having a direct impact on the health and quality of life of those affected.

Diabetes and sleep disorders are closely linked. Poor sleep can disrupt blood sugar regulation, increasing the risk of diabetes or worsening the disease in diabetic patients. Conversely, variations in blood sugar levels associated with diabetes, such as nocturnal hyperglycaemia or hypoglycaemia, can lead to frequent awakenings.

How does diabetes influence the patients' sleep? 

Difficulties falling asleep and staying asleep are more frequently encountered in diabetic patients. Diabetes, like most chronic conditions, can lead to changes in sleep quality. It is therefore associated with a higher frequency of sleep disorders, particularly insomnia.

Fluctuations in blood glucose levels 

Major variations in blood sugar levels can affect the sleep of diabetes patients.

In the event of hyperglycaemia, the body reacts by producing large quantities of urine (polyuria), leading to frequent awakenings at night. These interruptions disrupt the sleep cycle, depriving those affected of restful sleep.

On the other side, hypoglycaemia (an excessive drop in blood sugar) can lead to night sweats, nightmares and jerking awakenings.

Complications linked to diabetes

Diabetes is often associated with chronic complications that affect sleep.

Diabetic neuropathy, for example, results in nerve pain, particularly in the legs, which can make it difficult to fall asleep or cause people to wake up at night. In addition, many people with diabetes suffer from restless legs syndrome, a condition that causes an irresistible urge to move the legs, especially at night, further disrupting sleep. 

In addition, obstructive sleep apnoea is a frequent co-morbidity among diabetics, particularly those with type 2 diabetes. This respiratory disorder, which manifests itself as temporary pauses in breathing during the night, has been strongly correlated with insulin resistance, exacerbating diabetes.

Behavioural disorders caused by diabetes 

Living with diabetes can generate anxiety, especially about managing blood sugar levels and the fear of complications. This anxiety, which can even lead to depression, often results in insomnia and a poorer quality of sleep. This emotional spiral makes the day-to-day management of the disease even more difficult.

How do sleep disorders affect diabetes patients? 

Dysregulation of the biological clock and sleep disorders are known to promote type 2 diabetes. Studies have shown significant changes in glucose metabolism due to sleep deprivation.

Sleep apnoea and insuline resistance

Sleep apnoea is an aggravating factor in diabetes. It causes intermittent hypoxia (lack of oxygen) which generates oxidative stress and systemic inflammation in the body, promoting insulin resistance. In fact, studies show that people with untreated sleep apnoea have an increased risk of developing type 2 diabetes or of having their diabetes poorly controlled.

Sleep deprivation and blood sugar management 

Lack of sleep reduces insulin sensitivity and disrupts blood sugar regulation. According to research, sleeping less than 6 hours a night can alter the way the body uses insulin, raising blood sugar levels.

In non-diabetics, long-term inadequate sleep is also associated with an increased risk of developing type 2 diabetes. Conversely, a study published in 2015 in the journal Diabetes Care shows that sleeping more than eight hours can also promote the development of type 2 diabetes.

The impact of sleep on weight and diabetes 

Chronic sleep deprivation disrupts the hormones that regulate hunger, notably ghrelin, which stimulates appetite, and leptin, which signals satiety. This often leads to over-consumption of food, particularly carbohydrates, and thus encourages weight gain, a key risk factor in the development of type 2 diabetes. Obesity further exacerbates sleep disorders, creating a negative loop where diabetes, sleep and weight influence each other.

Diabetes and sleep disorders: how to break the vicious circle? 

When blood sugar levels are out of control, sleep is disrupted, which in turn worsens blood sugar regulation. This mechanism creates a real vicious circle.

For example, high blood sugar levels at night can lead to frequent awakenings and fragmented sleep, which increases stress on the body. This lack of sleep reduces insulin sensitivity and further disrupts diabetes management. Without intervention, this process can quickly become difficult to interrupt, increasing the risk of long-term complications.

This vicious circle has major impact on general health, with long-term physical and mental consequences. These include chronic fatigue, weight gain, an increased risk of cardiovascular complications and an impact on mental health. Quality of life is also affected, leading to difficulties in social, family and professional relationships.

That is why it is absolutely essential to take into account the interaction between diabetes and sleep disorders, to ensure complete and effective management of the condition(s).

Here are a few tips for breaking this circle, improving diabetes management and promoting better sleep:

• Improve sleep quality: establish a regular routine, create a calm, dark and cool environment, and avoid screens before bedtime,
  
• Manage your diabetes correctly: monitor your blood sugar levels and follow a well-balanced diet rich in fibre and low in refined sugars,
  
• Be physically active: do regular exercise, avoiding strenuous activity before bedtime,
  
• Talk to a healthcare professional: assess sleep disorders and adjust diabetes treatment according to the impact of sleep,
  
• Use stress management techniques: practise meditation, deep breathing and yoga to reduce stress,
  
• Check your medication: assess the side effects of diabetes or sleep medication,
  
• Treat specific sleep disorders: consider a treatment such as CPAP for sleep apnoea associated with diabetes.

NB! 

The link between the different types of diabetes and sleep disorders is therefore complex and bidirectional, creating a real vicious circle that profoundly affects patients' health.

Recognising these mutual effects means that the right kind of treatment and disease management can be introduced for each patient. Improving sleep quality can help better control diabetes, and vice versa, good diabetes management can improve sleep quality.

If you are diabetic and suffer from sleep disorders, it is recommended that you see a sleep specialist as a complement to your diabetic monitoring.

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