If there’s anything that people living with type 1 diabetes (T1D) have in common, it’s that we struggle to get a good night’s sleep.
Between extreme high and low blood sugars, late night device alarms, trips to the bathroom, and the overnight anxiety that T1D can often bring, there can sometimes be little to no room for good sleep in our daily routine.
Studies showTrusted Source that sleep disturbances are highly common with any kind of diabetes, and that with T1D, “sleep may be disrupted as a result of both behavioral and physiological aspects… [and] may negatively affect disease progression and development of complications.”
Let’s talk about how T1D impacts sleep and what you can do to improve the quantity and quality of your sleep.
Lack of sleep is risky business
According to the Centers for Disease Control and Prevention (CDC)Trusted Source, nearly one-third of American adults are not getting enough sleep, which the American Academy of Sleep Medicine defines for adults between 18 and 60 years old as 7 or more hours per night.
People living in cities and in the Northeast get the least amount of sleep, according to the CDCTrusted Source, and almost 11 percent of Americans are getting less than 6 hours of sleep per night.
Chronic lack of sleep is associated with an increased risk of obesity, heart disease, type 2 diabetes, hypertension, stroke, increased stress, increased incidence of accidents, and even premature death.
The CDC also notes that students who sleep fewer than 7 hours per nightTrusted Source are also more likely to participate in risky behaviors, such as not wearing a helmet when riding a bike, not wearing a seatbelt when driving, and drinking and driving, compared to students who sleep 9 or more hours per night.
Getting adequate amounts of sleep is especially important for people living with T1D, as sleep deprivation can cause insulin resistanceTrusted Source, mental distress, and makes the management of diabetes much harder overall.
Health benefits of sleep
It’s no surprise that like eating right and getting regular exercise, sleep is crucial for good physical and mental health. When someone sleeps, their body regenerates and repairs damaged cells from everyday wear and tear. Sleep helps to clear out blood vessels, reducing inflammation and preparing the body for the next day.
Sleep also rebalances the body’s hormone levels, playing a key role in the levels of cortisol, serotonin, melatonin, ghrelin, adrenaline, and leptin in the body, which help the body manage everything from manage stress and energy levels, control anger, sustain drive, manage hunger and satiety, and maintain emotional well-being.
Sleep also protects the body’s immune system, helping people to battle everyday infections and viruses better. For example, one studyTrusted Source found that when exposed to the common cold virus, people who slept fewer than 7 hours per night for 2 weeks were 3 times as likely to develop a cold than those who had slept 8 or more hours each night for 2 weeks.
Sleep disorders impacting people with T1D
While many sleep disorders are associated with type 2 diabetesTrusted Source (T2D), people living with T1D are often plagued with sleep disorders as well, including children, adolescents, and adults. One study found that people with T1D experienced subjective poor sleep quality 35 percent of the time, compared to 20 percent of the time for people without T1D.
Sleep disorders commonly associated with T1D include:
- Nocturia, a condition in which you repeatedly wake up during the night due to the need to urinate. This is common in people with T1D due to hyperglycemia (overly high blood sugar), which causes frequent urination.
- Obstructive sleep apneaTrusted Source and sleep disordered breathing, which occur when the muscles that support the soft tissues in your throat temporarily relax. When this happens, your airway can narrow or even close, and breathing is momentarily cut off.
- Central sleep apnea, another form of sleep apnea in which you briefly stop breathing during sleep, when the brain signals that control breathing during sleep get confused.
- Restless leg syndrome, in which involuntary leg jerking and leg cramping throughout the night disturbs both the quality and quantity of sleep. Adults with diabetes have a higher incidence of this syndrome than the general public.
- General sleep disturbances and poor sleep quality. In one 2020 study surveyTrusted Source, children with T1D reported much higher levels of sleep disturbances than children without T1D. In another studyTrusted Source, adults with T1D between the ages of 30 to 40 reported that their sleep quality was worse off those without T1D, based on six measures for quality of life.
People with both T1D and T2D have high rates of these disordersTrusted Source, and the disorders often correspond with both higher rates of neuropathy (nerve damage) and nephropathy (kidney disease).
These conditions contribute to not only insomnia but daytime sleepiness as well, which has negative effects not only on diabetes management, but overall quality of life. When you don’t get enough sleep, you will most likely need more insulin (due to insulin resistance from spiked cortisol levels) to control blood sugars.
Your body will be naturally hungrier when your hormonal leptin levels are off balance, which makes eating, managing meals, and counting carbohydrates more difficult.
Worse yet, you’ll be more fatigued throughout the day that affects not only your school or work performance, but you may find it harder to have the energy to exercise, cook, and generally take good care of yourself. All of this can make diabetes management a disaster.
Another problem is that if you’re struggling with daytime sleepiness and take a nap midday, you may then struggle to sleep soundly that same night, which can lead to chronic insomnia, only exacerbating the issue. All of this can snowball into higher blood sugar and A1C levels, and more difficult management overall.
People with diabetes share their sleep woes
Glen McCallum, a software engineer and T1D from Vancouver, Canada, tells DiabetesMine, “I’ve been diagnosed with what my endocrinologist calls ‘positional sleep apnea’. I randomly wake up every few weeks with a pounding headache and can’t look at screens. It almost feels like jetlag and lasts most of the day.”
He continues, “That’s why I never schedule anything for the morning. I used to get discouraged setting goals and then skipping exercise simply because I could not get out of bed.”
Leo Koch, a teenager who has lived with T1D for most of his life and lives in Waterville, Maine, has struggled with sleep disturbances since he was diagnosed at 2 years old.
His mother, Hilary, tells DiabetesMine that anything from “a pump occlusion, a series of lows due to exercise, or highs due to growth hormones or stress can cause a night of turbulent sleep for Leo.”
“The difference is now that he’s older, he’s more engaged in his own management, and he isn’t as sound a sleeper as he once was. It’s almost as if just by having type 1 diabetes, he doesn’t sleep as well,” she adds.
Poor sleep quality is all-too-familiar as well for Abby Burch, of northern Indiana, who has lived with T1D for 9 years. She tells DiabetesMine, “I’ve woken up to pee in the middle of the night and found myself crying on the toilet because I couldn’t get the toilet paper to tear off… and then I realized I woke up because I was low, not because I had to pee.”
Even if you’re not high or low, simply managing diabetes 24/7 can disrupt sleep, especially if you don’t use a continuous glucose monitor (CGM).
Kiran Kumar, of Faridabad, India, tells DiabetesMine, “My child was just diagnosed with T1D in August, 2020, but since we’re not yet on the CGM, we have been advised to check blood sugar at least twice in the night: once at 2 a.m. and again at 5 a.m.” That takes a toll on the whole family’s sleep.
“Another constraint to good sleep is the administration of his [insulin] at 10:00 at night. It requires the whole family to be awake, with alarms on multiple devices, and has significantly impacted sleep quality as well as quantity.”
Recent calls for sleep guidelines for T1D
All of these issues have led researchers and experts to call for new sleep guidelines for people affected by T1D (and in some cases, even their families). Dr. Michelle Perfect, associate professor of disability and psychoeducational studies at the University of Arizona, has been vocal calling for specific sleep screening recommendations for people with T1D, after reviewing nearly 60 studies on sleep.
In an article she published in the journal Nature and the Science of Sleep, she states that there’s statistically significant evidence that sufficient sleep is correlated with healthy outcomes in people with T1D. She suggests that sleep quantity and quality should be addressed during routine health screenings in people with T1D (just like having your weight or blood pressure measured, for example).
Some tools she recommends to assess sleep in the clinical setting include the Children’s Sleep Habit Questionnaire and the Pittsburgh Sleep Quality Index for children. Additionally, she has recommended that CGMs can provide key insights into sleep patterns (as well as any low or high blood sugars that may affect REM cycles), and adjusting insulin levels before sleep may help prevent overnight blood sugar disturbances.
She advocates for more research to build the correlation between better T1D management and sleep.
Additionally, Dr. Samantha Carreon, a pediatric psychologist at the Resilience and Diabetes Behavioral Research Lab, in Houston, Texas, presented research at the 2021 American Diabetes Association’s Scientific Sessions showing that parents of children with T1D experienced more sleep challenges during the COVID-19 pandemic compared to pre-pandemic times, despite fewer T1D-related sleep disruptions and less daytime impairment.
This may be due to new pandemic-related stressors, differing and oftentimes unpredictable routines, and more demanding T1D management in these unprecedented times.
How to get better (and more!) sleep
So, what can we do about all of this?
Diabetes experts, like Adam Brown, have written extensively about the importance of sleep health for diabetes. Brown is the former diabetes technology editor for diaTribe and author of a hands-on guidebook for thriving with T1D and using technology for improved health outcomes.
In one article, he writes: “Lack of sleep gets too little attention in our world, and particularly in diabetes, and I hope this piece highlights what a tragic mistake that is. Fortunately, sleep is a solvable problem — there are excellent, cost-free, proven strategies to improve it!”
He currently tells DiabeteMine that “my personal No.1 sleep helper, by far, is automated insulin delivery/hybrid closed loop. I just started on [Tandem Diabetes] Control-IQ system today and expect my success with sleep to be similar! My second best recommendation to improve sleep is reducing caffeine intake, especially after 2 p.m.”
Creating good sleep habits can take time, he says, but the following strategies can help you improve your sleep, which can improve not only your diabetes management but your overall health as well:
- Get out in the daylight and do some exercise daily, so you’re tired by day’s end.
- Avoid caffeine (coffee, soda, tea) in the afternoons and evenings.
- Limit liquids in the evenings, so you don’t need to use the restroom during the night.
- Stick to a sleep routine by going to sleep and waking up at the same time every day, including on weekends.
- Check your blood sugar right before bed, and make sure it’s in a safe range for you.
Turn off unnecessary notifications on your phone (keep all CGM and insulin pump notifications on, however!)
- Turn your thermostat down to around 65°F (18°C).
Invest in quality curtains to make your bedroom as dark as possible.
- Take a warm bath before bed.
- Keep all pets away from your bedroom, and especially off of your bed.
- Limit screens at bedtime (especially reading the news or checking your work email, which can spike stress).
- Eat foods that contain melatonin, like cherries, oatmeal, pomegranate, grapes, or walnuts.
- Create an evening routine of meditation, yoga, reading, or journaling before bed.
- Invest in a white noise machine to help soothe you to sleep.
- Try the Sleep As Android app that monitors sleep patterns, deep sleep percentage tracking, time for bed notifications, snooze limits, sleep advice, and more.
- Try the Hatch Gentle Alarm Clock that mimics the sunrise to wake you up, instead of relying on sudden, loud alarms like a traditional alarm clock. It comes equipped with soothing sounds as well, for a more refreshing, natural way to wake up.
If these tactics are not working for you, work with your care team to see if alternative interventions may be necessary to improve the quality and quantity of your sleep.
People with all types of diabetes are more susceptible to sleep disorders than those living without the condition. Over time, chronic poor sleep may lead to many other health issues, including higher risks of obesity, heart disease, stroke, and even premature death.
These issues are exacerbated in the T1D population, with poor sleep leading to insulin resistance, lower immune function, increased hunger, worse decision making, and increased risk of accidents, which can lead to more difficult diabetes management.
Many people are calling for sleep screenings for people with T1D, to better detect a range of disorders, from sleep apnea to nocturia and restless leg syndrome, so early interventions can be introduced. Early interventions can improve not only one’s overall quality of life, but can vastly improve diabetes management and clinical outcomes as well.
If T1D is interfering with your ability to sleep well, don’t shrug it off. There are steps you can take to improve sleep, and your overall quality of life.