Why Is Sleep Important for Patients With Diabetes?

Diane is one of those patients who avoids taking medication at all costs. When I shared that her blood test results indicated prediabetes and suggested that she go on metformin, she hesitated, asking, "Oh no, isn't there something natural I can do?"

I responded, "How are you sleeping?"

"Not long and not great," she replied. "I'm usually tired in the morning."

"Then, let's try to improve your sleep first," I told her and explained that inadequate sleep impairs the body's ability to process sugar. "When you don't get quality sleep, the stress hormone cortisol increases, which releases stored glucose, making it harder for insulin to properly regulate sugar," I said.

Diane added that she tends to snack into the late evening, usually on cookies or tortilla chips, another habit that interferes with her sleep and her metabolism.

A prediabetes or diabetes diagnosis is often frightening to patients. But we physicians can ease their minds by giving them tools to manage their condition. And one of the best and most effective for them to manage is sleep.  

Florence Comite, MD

Improving sleep habits is a powerful, proactive step. I've seen its effect in my own life as I work to manage my glucose and insulin resistance. Sleep is vital for healthy aging, and it can be highly motivating. After all, who doesn't appreciate a good night's sleep, waking up full of energy and raring to go?

A few adjustments to Diane's sleep routine soon helped her get 7 hours of quality sleep and improved her glucose, as well. At her follow-up appointment, she agreed to try metformin to bring her A1c to optimal levels.

Sharing tips like this with your patients will help them take personal control and potentially reverse prediabetes and prevent diabetes. Here are others to share with your patients:

1. Take some time to explain how poor-quality sleep disrupts blood glucose metabolism and can throw a monkey wrench into the body's circadian rhythm, raising cortisol which affects glucose.

2. Ask your patients if they've noticed strong cravings for quick-energy sources like doughnuts, orange juice, sugary cereal, or other processed carbohydrates following a night of less-than-sufficient sleep. That's a direct result of sleep deprivation, which disrupts the balance of ghrelin and leptin, the hunger and satiety hormones.

3. Explain how sleep deprivation and the resulting cravings for carbs will trigger a cycle of sugar swings. Patients will also be excited to learn that avoiding these rollercoaster-like swings through better sleep habits will help them avoid truncal weight gain.  

4. Share that better-quality sleep will also improve their mood, reduce anxiety, and combat depressive symptoms. Check if your patient is struggling with signs and symptoms of clinical depression, because people with diabetes are 20% more likely than those without diabetes to struggle with anxiety and are two to three times more likely to suffer from depression, according to the Centers for Disease Control and Prevention.  

5. Follow up the truth about diabetes, prediabetes, and insulin resistance with optimism and proof. Explain that science has proven that diabetes is reversible. Share examples (anonymous, of course) of patients in your practice who have done just that, along with details, highlighting the key role that sleep played in their return to good health. Many of my clients are "data junkies" who love keeping up on the latest scientific research. You may have similar patients who would appreciate a link to a relevant study or a copy of an article written for lay readers, such as this one from UC Berkley showing how deep-sleep brain waves improve blood glucose control.

6. Prescribe a continuous glucose monitor (CGM) and suggest that patients use a sleep tracker (which can monitor overall health, factors such as stress, activity, and other variables) such as an Oura Smart Ring, Whoop, Fitbit, Garmin, or Apple Watch. A CGM is an incredibly useful educational tool, helping people with prediabetes and diabetes understand how food, activity, stress, and sleep affect their blood glucose. Show them how that knowledge can help dramatically improve their health. Even self-quantifier patients are incredulous about the hacks possible when they are more aware of metabolic alterations due to sleep, food, activity and more.

7. Give patients a handout of simple tips for improving their sleep hygiene. These can be found on the CDC website and at the American Academy of Sleep Medicine, but here are some that I often recommend:

   • Avoid eating for 2 hours before bedtime. Especially avoid carbohydrates, sweets, and alcohol. All disrupt sleep and elevate levels of cortisol, which has an impact on blood glucose.  Some individuals may require a protein snack to sustain glucose through the night. Generally, I recommend a handful of nuts or some cheese.

   • Go to bed early enough to get at least 6 hours of sleep; 7-8 hours of sleep is best. To ease into that routine, start the bedtime routine 15 minutes earlier than usual for 1 week, then add another 15 minutes.

   • Be consistent. Get up at the same time every day, even on weekends. There are apps that will help you wake up gradually, tapping into the "light sleep" portion of your sleep cycle, to avoid jarring you awake. Apps such as Sleep Cycle, Calm, and others can also help you fall asleep more easily.

   • Establish a bedtime routine. Avoid using devices, as their blue light may disrupt the sleep cycle.

   • Read a book, meditate, take a warm bath with Epsom salts. The dissolved magnesium in the water penetrates skin, relaxes muscles, and may help bring on slumber.  

   • Keep the bedroom dark, cool, and quiet to make falling asleep easier. Darkness spurs the pineal gland to secrete melatonin, a hormone that encourages sleepiness. 

   • Exercise in the morning if possible. Exercising late in the day can disrupt sleep.  

Finally, a self-care tip for physicians: Put that handout of healthy sleep tips on your refrigerator door at home. Remember, we clinicians are busy people who owe it to our patients to improve our own sleep habits so that we are healthier, more alert, and effective personally and professionally.  

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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Why Is Sleep Important for Patients With Diabetes? - Medscape - Nov 22, 2023.