Diabetes and Sleep Problems
Sleep difficulties are more common in people who have diabetes than in people who don’t. That’s because having diabetes raises the risk for certain sleep problems such as sleep apnea and restless legs syndrome. Learn more about how diabetes affects sleep, the common types of sleep problems and most importantly, how they can be treated so that you can finally get a good night’s sleep.
Frequently Asked Questions
How may my diabetes be affecting my sleep?
The classic symptoms of uncontrolled diabetes include feeling very thirsty and having to urinate often. As a result, you may wake up several times during the night to use the bathroom and/or get something to drink. Doing so can keep you from getting a good night’s sleep. Low blood glucose, or hypoglycemia, may also wake you up during the night with symptoms of feeling sweaty, shaky, dizzy or hungry.
What are common sleep disorders?
Common sleep disorders include sleep apnea, restless legs syndrome and insomnia.
Sleep apnea is a condition that occurs when your breathing stops while you are asleep. The most common kind of sleep apnea is obstructive sleep apnea (OSA). OSA occurs when your throat closes off when you try to breathe while asleep. This happens because the muscles that usually keep your throat open are relaxed during sleep. People who are overweight or have certain face shapes are at risk for OSA because they have a narrower throat. When the throat closes off, there is a pause in breathing and blood oxygen levels drop. Eventually, the person wakes up briefly, which gets the throat muscles working again and opens the throat so breathing can resume. This can cause a gasping for air or a full awakening in the middle of the night. If the breathing stoppages occur frequently through the night, they can prevent one from getting into deeper stages of sleep and so make their sleep less restful.
Restless legs syndrome (RLS) is a condition marked by an uncontrollable urge to move the legs, often with an uncomfortable feeling in the legs that occurs around bedtime. It can feel like something is creeping or crawling on your skin, an electrical sensation, or a need to stretch. This feeling gets better when you move your legs even for a few seconds but starts to come back when you stop moving. It is different from muscle cramps or charley horses that some people also frequently get at night. The uncomfortable sensations can be bothersome enough that it is difficult to fall asleep.
Insomnia means different things to different people, but generally it refers to difficulty falling asleep, staying asleep, or poor quality sleep. Insomnia can be normal in the short term, but can be an issue if experienced over a longer period of time. Many things can contribute to insomnia, including depression, anxiety, medications, a poor sleep routine, and other sleep disorders such as sleep apnea and RLS. Stress and worry are also frequent causes of insomnia. Sometimes, after not having slept well for a few nights, the worry and anxiety about not sleeping well and feeling like you really need to get a good night’s sleep can lead to a vicious cycle preventing sleep and worsening the insomnia.
If I have diabetes, am I at high risk for sleep apnea?
Yes, having diabetes puts you at higher risk for sleep apnea and other sleep difficulties, such as restless legs syndrome, compared to people without diabetes. If you have sleep apnea, you may stop breathing for short periods of time while you sleep. When you stop breathing, you wake up and your breathing then returns to normal. These frequent interruptions in your sleeping pattern can prevent you from getting into deep, restful stages of sleep. Treatment is available for sleep apnea, and may include losing weight, changing your sleeping position, treating allergies and using a CPAP (continuous positive airway pressure) machine or other devices.
How do I know if I have sleep apnea?
The most common symptoms of sleep apnea are snoring, waking up during the night, and feeling sleepy or tired during the day. Some people wake up gasping for breath, have headaches in the morning, or don’t feel refreshed when they wake up in the morning. Not everyone has these symptoms, though. Sometimes, the only clue is that someone else notices pauses in your breathing when you are asleep. The only way to know for sure if you have sleep apnea is to get a sleep study. Sleep studies can be done in a sleep lab or in your own home with a monitor that records your breathing while you sleep.
What happens in a sleep study?
A sleep study usually takes place in a special sleep lab set up like a hospital room with a lot of monitors and equipment. You will go to the sleep lab in the evening and be given a private room where a sleep technician will place sensors all over your body. There will be monitors on your head to measure your brain activity to see when you are sleeping and what stages of sleep you are in. There will be monitors over your nose and mouth to measure the air you breathe in and out. Monitors on your chest measure your breathing efforts and your heartbeat, while monitors on your legs measure twitching or movements in your legs. A clip on your finger or ear measures the oxygen level in your blood.
Once the technician finishes applying all the monitors, they will have you get into bed. All of the wires coming from the sensors will be bundled together in to one thick cable to make it easier to disconnect things if you need to get up in the night to use the bathroom. After some tests to make sure everything is recording correctly, you will be asked to go to sleep. The technician will be watching all of the recordings on a computer next door, and may come in to adjust things if there is a problem during the night. In the morning, the technician will wake you up and remove the monitoring equipment.
Recently, devices have been developed that can be used to do a sleep study in your own home. These devices measure breathing but don’t have the sensors on your head to measure sleep. They are used mostly to test for sleep apnea. If you get a home sleep test, you will receive instructions on how to put on the monitors – usually plastic tubing goes in your nose, some bands go around your chest and stomach, and a clip goes on your finger. You will put the device on when you get ready to go to sleep and turn it on. When you wake up in the morning, you will turn it off, take the monitors off, and then return the device. The information about your sleep will have been recorded through the night and will be downloaded from the device to be reviewed by your doctor.
How is sleep apnea treated?
The most common treatment for sleep apnea is a machine called “continuous positive airway pressure” (CPAP). CPAP consists of a machine that blows air under pressure through a hose that attaches to a mask. Patients with sleep apnea wear the CPAP mask at night when they go to sleep and the air blown by the device keeps their throat from closing, allowing them to breathe normally. This treatment works very well in normalizing breathing, but it can be difficult for patients to get used to sleeping with a mask on their face. Masks come in different styles – some just cover the nose, some the nose and mouth, and some go in the nostrils. Another common treatment option is called an “oral appliance.” Oral appliances are typically made by a dentist based on a mold of your teeth. The most common style of oral appliance uses your upper teeth as a brace to pull your lower jaw forward. By pulling your lower jaw, your tongue moves forward and opens up the back of your throat.
In cases of mild sleep apnea, treatment can include weight loss and positional therapy. Positional therapy is a method of avoiding sleeping on your back (the position in which sleep apnea is worst). This can be accomplished by wearing something that makes it uncomfortable if you are on your back. For example, some people sew a tennis ball into the back of their pajama shirt.
There are surgical operations that can be used to treat sleep apnea as well, focusing on opening up the throat. For people who are significantly overweight, weight loss (bariatric) surgery can also be considered.
How does a CPAP machine work?
The CPAP mask creates a seal over your nose (and sometimes mouth, too) and is connected to a machine that blows air at a set pressure. The positive pressure from the blower makes the pressure inside your throat positive and keeps the walls of your throat from collapsing. This allows air to get into the lungs as it would normally and prevents the oxygen levels from falling. Often the large amount of air being blown by the CPAP can cause the nose or throat to dry out. Most CPAP machines come with a humidifier to try to increase the humidity in the air being blown to prevent this side effect.
Does sleep apnea affect my heart?
Sleep apnea can affect the heart in several ways. When you stop breathing and your oxygen levels drop, levels of adrenaline increase. This causes your blood pressure to rise. People with sleep apnea are at higher risk of developing high blood pressure; the good news is that treating sleep apnea helps to lower blood pressure. In addition to higher blood pressure levels, people with sleep apnea are at higher risk for heart attacks, strokes, and heart failure (a condition where the heart has difficulty pumping blood forward). Irregular heart rhythm, such as atrial fibrillation is more common in those with sleep apnea, as well. Some studies suggest treating sleep apnea can lower the risk for these heart problems.
Will treating sleep apnea improve my diabetes?
Treating sleep apnea can help in several ways. With relief of fatigue, you will likely find that you have more energy and can be more physically active. This, in turn, can help you better manage your diabetes. Treating sleep apnea has also been shown to decrease insulin resistance – the main cause of type 2 diabetes – and lower the risk of heart disease and stroke.
Even though I get enough sleep, I feel tired a lot and have nodded off at work. Why might this be?
There could be several reasons for feeling tired and nodding off. One of these reasons may be sleep apnea, a sleep disorder that is common among people with type 2 diabetes. Other reasons include restless legs syndrome, peripheral neuropathy (a type of nerve damage), uncontrolled blood glucose, depression, stress and anxiety. Talk with your healthcare provider about your symptoms and how they can best be treated to help improve the quality of your sleep.
I have pain in my feet that keeps me awake at night. What could be causing this?
Neuropathy, or nerve damage, is one of the major complications of diabetes. Painful neuropathy is a common cause of sleep problems for people with diabetes. There are many medications that can control the pain and improve sleep. Ask your provider about the different medications that are available and what would be best for you to try.
Sometimes at night my legs feel “twitchy” and I have to keep moving them. Could this be restless legs syndrome?
Yes, this could be restless legs syndrome (RLS). RLS is a condition characterized by an uncontrollable urge to move your legs, often combined with uncomfortable feelings in the legs. The uncomfortable feeling is often described as something creeping or crawling on the legs, an electrical shock, or a need to stretch, and is often felt deep inside the leg. Sometimes it can feel painful. In all cases, the discomfort gets better when you move the legs but often comes back quickly when you stop moving. The symptoms typically start in the evening around bedtime and can interfere with being able to fall asleep.
Does diabetes increase my risk of having restless legs syndrome?
Restless legs syndrome (RLS), a condition that causes unusual feeling in the legs during the night, is more common for people with diabetes than for those in the general population. It may be a feature of diabetic neuropathy. RLS is also seen more commonly in other conditions including multiple sclerosis, Parkinson’s disease, and kidney disease.
How is restless legs syndrome treated?
Treatment of restless legs syndrome (RLS) depends on the severity of symptoms, how often they occur, and how much they interfere with your sleep or other aspects of your life. Distracting mental and physical activities, such as playing word games or doing house chores may help relieve some of the symptoms. Some people report that stretching, taking a warm bath, or exercising helps their symptoms. If symptoms occur almost every night, they can be treated with medications that help reduce the urge to move and the uncomfortable sensation. There are several different types of medications used, including some that are used for other conditions such as pain. Iron supplements can be helpful if the iron levels in your body are low.
Once in a while I wake up during the night feeling shaky and sweaty. Is this due to my diabetes?
It may be. Feeling shaky and sweaty can be symptoms of hypoglycemia, or low blood glucose. It is important to know if your blood glucose level is dropping in the middle of the night. The next time you wake up during the night with these symptoms, check your blood glucose. This way you will know if the symptoms are caused by hypoglycemia or something else.
I have to get up several times during the night to use the bathroom. What is causing this?
One thing that may be causing this is hyperglycemia, or high blood glucose levels. When blood glucose levels are high, the kidneys form more urine and fill the bladder. This causes excessive urination, which means that you have to get up (often, during the night) to use the bathroom. Another possibility is sleep apnea. When people with sleep apnea are trying to breathe their diaphragm muscle can push down forcefully putting pressure on the bladder. As a result, when they wake up after a breathing stoppage, people with sleep apnea often feel the need to urinate. Other things can cause frequent urination and waking up to urinate including urinary tract infections and prostate enlargement in men. Let your healthcare provider know that this is happening so that he or she can determine the cause and prescribe appropriate treatment.
How much sleep do I need every night? What is the downside if I don’t get enough sleep?
Most people need between 7 and 9 hours of sleep each night. In the short term, a lack of sleep can lead to feeling tired or sleepy, feeling irritable, trouble paying attention and high blood glucose levels. Over time, not getting enough sleep can increase the risk for heart disease, type 2 diabetes, high blood pressure, stroke and obesity. If you have difficulty falling or staying asleep, talk with your healthcare provider. You may have a sleep disorder and/or you may need to focus on improving your diabetes control.
What things can I do to improve the quality of my sleep?
There are a number of steps that you can take to help you sleep better. Aim to get up at the same time every day, even on days when you’re not working. Limit the use of electronic devices (phone, tablet, computer) before going to bed. Exercise during the day but not too close to bedtime. Limit caffeine and alcohol in the afternoon and early evening. Sleep in a cool, dark room. If you can’t sleep, get out of bed and try reading, listening to music, meditating or practicing relaxation exercises.
I have trouble falling asleep at night, but I don’t want to take a sleeping pill. What else can I do?
Aim to be physically active during the day but not too close to bedtime. Avoid drinking caffeine after noontime and avoid drinking alcohol late in the evening. Using electronic devices, such as your computer, tablet or smartphone too close to bedtime may make it difficult to fall asleep – the light from the screens can trick your brain into thinking it’s daytime, so try to avoid using these two hours before you go to sleep. Sticking with a regular sleep schedule and keeping any naps fairly short may also help you fall asleep. Make sure your bedroom is restful and comfortable – not too warm and not too cold. Practicing relaxation techniques, such as deep breathing, meditation or gentle yoga may help calm you enough so that you fall asleep. If, however, you try these tips for a couple of weeks without success, talk with your provider about the possibility of a sleep disorder.
I recently gained quite a bit of weight and now I’m waking up a lot during the night. What could this be?
If you have recently gained weight or are overweight, you’re at higher risk of having a condition called obstructive sleep apnea (OSA). OSA is a type of sleep disorder in which your throat can close in your sleep. As a result, you may snore, stop breathing, or wake up gasping or choking. Frequent episodes of apnea, or lack of breathing, can disrupt your sleep. The next morning, you may feel tired, groggy, irritable and/or have a headache due to a lack of good quality sleep. You may be more likely to fall asleep during the day.
Diabetes and Sleep Problems
Learn more about the common causes of sleep problems among people with diabetes as well as common treatment options.
Download the Joslin Diabetes Center booklet Diabetes & Sleep Problems below.
Page last updated: July 31, 2014