Sleep is a physical and mental resting state, in which a person becomes relatively inactive and unaware of their environment. The amount of sleep a person needs varies individually and depends on various factors, one of which is age. Most adults need about 7 to 8 hours of sleep, but infants and teenagers need more sleep.
Adequate and quality sleep is necessary for good health. There is a relationship between sleep disorders and various metabolic disorders such as diabetes, obesity, hypertension, and cardiovascular diseases. Sleep duration among the general population has been reducing gradually over the years. The timing of sleep is also becoming unpredictable because of urbanisation and industrialisation. Many people sleep for short periods (they get less than 6 hours of sleep every night). Then are also people who sleep for long durations (more than 9 hours). Ideally, any adult should sleep for 7-8 hours
Those affected most by sleep disturbances include
- shift workers
- long haul truck drivers
- taxi drivers
- mothers, especially nursing mothers
Sleep Disorders and Diabetes
Diabetes Mellitus and sleep disturbances are common health problems that feed off each other. This means that sleep disturbances are most common among people who are diabetic whereas shorter sleep duration and irregular sleep behavior have been linked with higher incidence of obesity, metabolic syndrome, and Diabetes Mellitus. Persons with diabetes report higher rates of
- poor sleep quality
- excessive daytime sleepiness
- higher use of sleeping medications
- excessive sleep
This is usually as a result of multiple factors such as
- discomfort or pain associated with peripheral neuropathy
- restless legs syndrome – uncontrollable urge to move your legs
- periodic limb movements – cramping or jerking of the legs during sleep
- rapid changes in blood glucose levels during night leading to hypoglycemic and hyperglycemic episodes,
- nocturia – waking up to urinate at night
- obstructive sleep apnea – snoring, excessive daytime sleepiness despite sleeping enough
Sleep disturbances ( on the other hand increase the activity of the sympathetic nervous system, the same system that is activated by Stress, leading to insulin resistance, decreased insulin secretion and elevated glucose levels.
Sleep disturbances and deprivation also increases the levels of circulating hunger hormone, ghrelin and decreased levels of circulating satiety hormones, leptin, leading to overfeeding. This tendency to overfeed is coupled with the fact that those who sleep less are more likely to consume energy-rich foods, get higher proportions of calories from fats or refined carbohydrates, consume lower proportions of vegetables and fruits, and have more irregular meal patterns than those sleeping more. Ultimately increasing the risk of being obese and developing the metabolic syndrome (increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels).
Besides, studies have shown that Type 2 diabetics who are having either less or excess sleep tend to have albumin in their urine, a marker for impaired kidney function.
People living with diabetes should aim for the recommended 7-8 hours of sleep every night and minimize the number of times they get less than 6 hours or more than 9 hours of sleep per night.
Signs of sleep deprivation that one should be on the lookout for?
- Lack of concentration
- Excessive snoring
- Difficulty learning new concepts
Management of sleep disorders
a). What to do
- Establish a regular time to go to bed (sleep) and wake up (rise time)
- Eat at least one hour before bedtime
- Ensure your diet is rich in fruits and food with sleep promoting effects especially close to bed time. These include Kiwi; tart cherries/juice; fatty fish; melatonin rich milk – milked at night;
- Exercise – Find the time that works best for you and improves your sleeping pattern.
- Establish a comfortable sleep environment (e.g. comfortable bed and clothing)
- Sleep in a dark and quite area
- Establish a regular relaxing pre-sleep routine to be used every night before sleep such as listening to soft music, taking a warm shower or reading a book
b). What not to do
- Taking daytime naps
- Too much use of caffeine or nicotine, especially late in the evening and at night
- Taking alcohol before bedtime
- Sleeping too hungry or after too heavy a meal at night
- Late night television watching, phone calls or being on the screen checking WhatsApp etc.
- Trying too hard to fall asleep – This will only make you more anxious and increase your wakefulness. if you have not fallen asleep after 20 minutes of being in bed, try doing something relaxing like reading a book or listening to music.
c). Associated comorbidities in diabetes leading to poor sleep
- Fluctuation in blood glucose – optimum glycemic control
- Obstructive sleep apnea – Weight loss; Identification and treatment of anatomic upper airway obstruction; Nasal continuous positive airway pressure (CPAP)
- Restless leg syndrome – Identifying and correcting iron deficiency or thyroid disease; Doctor prescribed medication
- Peripheral neuropathies – optimum glycemic control; analgesics; Doctor prescribed medication.