Diabetes and Sleep
Soft blankets, the cool side of the pillow, that cozy feeling right before your eyes close ... sleep is awesome.
How much sleep do we really need? The National Sleep Foundation recommends that newborns (0 - 3 months old) sleep 14 - 17 hours, infants (4 - 11 months old) sleep 12 - 15 hours, toddlers (1 - 2 yrs) sleep 11 - 14 hours, preschoolers (3 - 5 yrs) sleep 10 - 13 hours, school-age kids (6 - 13 yrs) sleep 9 - 11 hours, teens (14 - 17 yrs) sleep 8 - 10 hours, young adults (18 - 25 yrs) sleep 7 - 9 hours, adults (26 - 64 yrs) sleep 7 - 9 hours, and older adults (over 65 yrs) sleep 7 - 8 hours.
Diabetes is not known for being kind to sleep patterns. For people living with diabetes, there's plenty to keep you awake at night. From worries about sleeping through low blood sugars, to waking to urinate if blood sugars are high, to alarms from insulin pumps and continuous glucose alarms, there are many diabetes-related sleep disturbances.
What can you do to help get a good night's sleep?
Stay in range. High blood sugar overnight can make for very restless sleep, and can also interrupt sleep with the need to get out of bed to drink water and use the bathroom. Lows also interrupt sleep, as they require middle-of-the-night treatment. The more stable blood sugars are overnight, the better your sleep quality. Work with your care team to adjust overnight basal rates and routines to achieve solid overnight numbers.
Manage your beeps. If you're wearing a continuous glucose monitor, you know that the alarm feature can help alert you to blood sugar excursions (aka going above the high blood sugar threshold and below the low blood sugar threshold). The safety net provided by CGM alarms is important to adults with type 1 diabetes and parents of children with diabetes alike ... but alarm fatigue is definitely a stressor when it comes to sleeping well. Consider adjusting your alarm thresholds overnight to values that you feel are important; for example, some people with diabetes keep their high alarm slightly higher at night than during the day, and they may also decide to adjust their rate change alerts.
Ban screens from the bedroom. Using screens, like phones, tablets, and computers, can really mess with your sleep cycle. The National Sleep Foundation cites the blue light from devices as problematic for levels of melatonin (natural sleep-inducing hormone). According to their site, "When people read on a blue light-emitting device (like a tablet, rather than from a printed book) in the evening, it takes them longer to fall asleep; plus, they tend to have less REM sleep (when dreams occur) and wake up feeling sleepier— even after eight hours of shuteye."
Watch your caffeine intake. Caffeine is found in lots of foods and drinks (like coffee, tea, soda, chocolate, etc), and while it can increase alertness, moderate doses can also cause anxiety, headaches, and insomnia. Watch your caffeine consumption, especially in the afternoon and close to bedtime, as it can make falling asleep a challenge.
Exercise! Regular exercise can help you stay awake better during the day and can also make falling asleep easier, in addition to increasing overall physical health, so it's a triple-win. Did you know that exercise raises your body temperate by a few degrees, and it's the "cooling down" to a normal temperature that can trigger drowsiness and help you sleep? This is actually why evening exercise isn't the best time, as it takes several hours for your body temperate to regulate and hit that "cool down" pay off. The best times to exercise are in the morning or afternoon.
Have a routine. COVID-19 has disrupted many regular routines, and the anxiety about a global pandemic, plus increased screen time and overall stress, has made a detrimental dent in our sleep patterns. But there are things we can do to help establish a sleep routine that can help make bedtime better. Have a fixed wake-up time to help establish a target bedtime, and make adjustments gradually. Wind down about 30 minutes before going to bed, and consider keeping electronics out of the bedroom.
Screen for sleep apnea. Obstructive sleep apnea - where a person stops-and-starts breathing throughout the night - has historically been closely linked to type 2 diabetes, but newer research has shown that people with type 1 diabetes are also dealing with obstructive sleep apnea. Talk with your doctor about screening for sleep disturbances if you are struggling to feel rested.