Sleep plays an important role in maintaining overall health influencing everything from cognitive function and mood to cardiovascular and immune systems. One of the most significant and often underappreciated roles of sleep lies in diabetes management. While the causes and management of diabetes are commonly associated with diet, physical activity, and genetic predisposition, sleep remains a crucial yet frequently overlooked factor. There is a two-way relationship between sleep and diabetes. Understanding this interconnection is essential not only for individuals currently living with diabetes but also for those at risk. This article will discuss how sleep affects blood sugar and its role in the management of diabetes.
How sleep affects blood sugar regulation
The human body follows circadian rhythms, which are 24-hour biological cycles that control hormone production, metabolism, and energy balance. Sleep plays a crucial role in maintaining these rhythms. One of the most significant metabolic processes affected by sleep is glucose regulation. During restful sleep, the body undergoes various restorative processes that optimise insulin sensitivity and regulate blood sugar levels. However, when sleep is inadequate in either quantity or quality, these processes are disrupted.
Chronic sleep deprivation increases levels of cortisol, a stress hormone that promotes glucose production in the liver. At the same time, it diminishes the body’s sensitivity to insulin, the hormone responsible for transporting glucose from the bloodstream into cells for energy. This dual effect of higher blood glucose production and reduced cellular uptake can result in sustained elevations in blood sugar levels.
Sleep deprivation directly impacts two critical hormones that regulate hunger and satiety, leptin and ghrelin. Under normal conditions, leptin suppresses appetite by signalling fullness to the brain, while ghrelin stimulates hunger. However, inadequate sleep causes a decrease in leptin levels and an increase in ghrelin levels. The resulting hormonal shift creates stronger hunger signals and reduces feelings of satisfaction after eating. This often leads to increased consumption of energy-dense foods, particularly those high in sugar and fat. Over time, these dietary changes combined with the metabolic effects of sleep loss significantly elevate one’s risk for developing obesity and type 2 diabetes.
Research revealed a U-shaped association between sleep duration and the risk of developing type 2 diabetes, indicating that both short and long sleep durations are linked to an increased risk of the disease. Even a single night of partial sleep deprivation can induce insulin resistance in multiple metabolic pathways in healthy individuals. These findings reflect that sleep is not merely a peripheral lifestyle factor but a core component of metabolic health.
How diabetes can disrupt sleep
Just as poor sleep can contribute to the development or worsening of diabetes, diabetes itself can severely impair sleep quality. Individuals with diabetes frequently need to pass urine during the night because of high blood glucose levels, and this prevents them from getting uninterrupted sleep. When blood sugar is elevated, the kidneys work harder to eliminate excess glucose through urine, often resulting in multiple bathroom trips that fragment sleep.
Research showed that there is a high prevalence of sleep impairment in patients with diabetic neuropathy. It is a complication of diabetes that involves nerve damage and causes pain, tingling, or burning sensations, particularly in the legs and feet. These uncomfortable symptoms are often worse at night and disrupt sleep. Similarly, some individuals experience restless legs syndrome (RLS), an uncontrollable urge to move the legs, which can significantly delay the onset of sleep or cause repeated awakenings.
Blood sugar fluctuations themselves can also contribute to sleep disturbances. Hypoglycaemia (low blood sugar) during the night can cause symptoms such as sweating, shakiness, and confusion, often awakening the individual. Conversely, hyperglycaemia (high blood sugar) can lead to increased thirst, irritability, and discomfort that interferes with falling or staying asleep. Psychological factors also play a role. Living with a chronic illness like diabetes often involves high levels of stress, anxiety, and worry. This mental load can lead to insomnia or poor sleep quality.
Sleep disorders common in people with diabetes
Several specific sleep disorders are prevalent among individuals with diabetes, and their presence can significantly complicate diabetes management. Among the most serious is obstructive sleep apnoea (OSA), a condition characterised by repeated airway obstructions during sleep, resulting in intermittent oxygen deprivation and frequent awakenings.
People with diabetes particularly those with type 2 diabetes are at elevated risk for sleep disorders like OSA due to shared risk factors such as obesity, age, and metabolic dysfunction. OSA has been shown to worsen insulin resistance, increase systemic inflammation, and elevate cortisol levels, all of which can destabilise blood glucose control. Unfortunately, many cases of OSA remain undiagnosed, especially in patients who attribute their fatigue to diabetes itself rather than a coexisting sleep disorder.
In addition to OSA, insomnia and restless legs syndrome are also commonly reported among individuals with diabetes. Insomnia, whether related to stress, physical discomfort, or nocturia, can result in chronic sleep restriction, further impairing glucose metabolism. Meanwhile, restless legs syndrome, often linked to iron deficiency or peripheral nerve damage, adds another layer of complexity to sleep disturbances in diabetic patients. Recognising and treating these sleep disorders is essential. They are not merely side effects of diabetes but active contributors to poor glycemic control and reduced quality of life.
Breaking the cycle: How better sleep supports diabetes management
Fortunately, the interplay between diabetes and sleep is not an unbreakable cycle. Improved sleep quality can lead to measurable improvements in blood sugar regulation, mood, energy levels, and overall well-being. For individuals with diabetes, taking steps to optimise sleep can significantly enhance their ability to manage their condition effectively.
- Keeping a consistent meal schedule helps to regulate blood glucose levels and supports the body’s natural circadian rhythm.
- Keeping to a regular sleep schedule enhances hormone balance and sleep quality.
- Avoiding caffeine, alcohol, and heavy meals before bedtime prevents night-time blood sugar spikes and promotes restful sleep.
- Monitoring and managing blood sugar before sleep reduces the risk of nocturnal hypoglycemia or hyperglycemia.
- A light, balanced bedtime snack may help to maintain stable glucose levels overnight.
- Practising stress-reduction techniques like mindfulness, meditation, or deep breathing supports both sleep and blood sugar control.
Finally, treating underlying sleep disorders such as OSA, insomnia, or RLS is crucial. Continuous positive airway pressure (CPAP) therapy for OSA, behavioural interventions for insomnia, and medications or lifestyle changes for restless legs syndrome can all help to restore quality sleep. This supports better metabolic control and reduces the burden of diabetes symptoms.
When to seek professional help
Individuals experiencing persistent sleep disturbances, especially those with diabetes, should not hesitate to seek professional help. Untreated sleep disorders can significantly affect glycaemic control, increase the risk of diabetes complications, and diminish overall quality of life.
A qualified healthcare provider can provide a comprehensive assessment to identify underlying causes of sleep difficulties. Whether it involves screening for sleep apnoea, adjusting diabetes medications, or offering tailored lifestyle interventions, professional guidance can make a meaningful difference.
Still concerned about diabetes and sleep?
The link between diabetes and sleep is deeply interconnected. Poor sleep can worsen blood sugar control, while diabetes symptoms can make restful sleep difficult to achieve. Ignoring either side of this relationship can create a self-reinforcing cycle that affects health and well-being. Understanding and addressing this connection is critical for effective diabetes management. By prioritising sleep as part of a comprehensive care plan, individuals can improve not only their metabolic health but also their daily quality of life.If you suspect that your sleep problems are affecting your diabetes or that your diabetes is disrupting your sleep it may be time to seek professional support.
A sleep expert can find out the root causes of sleep disturbances and can offer you suitable solutions. Dr Dipesh Mistry is a dual-trained consultant with expertise in the treatments of sleep disorders and psychiatric conditions. Schedule a consultation with Dr Mistry to receive a personalised assessment and begin a path toward improved sleep, balanced blood sugar, and better overall health.
