The Relationship Between Sleep and Diabetes

Author: Ashley Smith

Introduction

It's that time of the semester! Midterms are starting, stress is accumulating, and most frequently, all-nighters are beginning! Every student wants to get the highest grades possible, and who wouldn’t want extra time to study? However, with all the all-nighters, sleep is greatly impacted. The bags under each student’s eyes and the lack of sleep catch up to them as they grab another cup of coffee. But what truly happens when a person experiences a disruption in sleep? What is the relationship between sleep and diabetes? Let’s find out!

Overall Changes in Glucose Regulation with Sleep

Both the quantity and quality of sleep can affect the risk and control of type 2 diabetes. People who get short amounts of sleep show greater levels of insulin resistance, higher fasting glucose, and an increase in glycated hemoglobin (HbA1c). Changes in glucose regulation occur as sleep progresses (Darraj, 2023; Tsereteli et al., 2021). During sleep, there are both rapid eye movement (REM) and non-REM (NREM) sleep stages, with each cycle lasting around 90 minutes. However, without completing full sleep cycles, glucose regulation can be impacted. For example, insulin sensitivity is impaired, as reduced insulin sensitivity due to sleep deprivation can increase blood sugar levels, thus increasing the risk of type 2 diabetes or worsening diabetes control (Darraj, 2023; Tsereteli et al., 2021). Moreover, circadian rhythms are regulated by sleep. When sleep is irregular, circadian rhythms also change, affecting glucose metabolism, which further increases the risk of type 2 diabetes and insulin resistance. Lastly, a lack of sleep disrupts hormonal regulation by increasing cortisol, the stress hormone, which raises blood glucose levels and contributes to insulin resistance (Darraj, 2023; Tsereteli et al., 2021).

Sleep Apnea and Sleep Disorders

Although all-nighters can contribute to sleep deprivation, other causes include sleep apnea, obesity, insomnia, and excessive sleeping. Specifically, sleep apnea is a sleep disorder in which a person repeatedly stops and starts breathing during sleep (Darraj, 2023). This respiratory issue can cause changes in glucose regulation, increasing insulin resistance in individuals who do not already have type 2 diabetes, thereby raising their risk (Darraj, 2023). Insulin resistance in sleep apnea occurs due to changes in oxygen and glucose metabolism. When a person frequently stops and starts breathing during sleep, their sleep becomes fragmented, disrupting the slow-wave sleep phase and reducing oxygen levels in the body. These changes in glucose metabolism contribute to insulin resistance (Darraj, 2023).

Interventions for Sleep

Although sleep deprivation can impact blood glucose levels, whether due to all-nighters or sleep disorders, there are interventions to improve sleep. For example, Cognitive Behavioral Therapy (CBT) can significantly enhance sleep quality. Although CBT is commonly used to treat anxiety and depression, it can also improve sleep hygiene and education, ultimately increasing sleep efficiency and total sleep time. In patients with type 2 diabetes, CBT has been shown to improve glycemic control by reducing HbA1c and fasting glucose. Likewise, for patients with sleep apnea, using a Continuous Positive Airway Pressure (CPAP) machine can further help regulate glycemia (Herth et al., 2023). A CPAP machine uses air pressure to keep the airway open and breathing regular during sleep, leading to significant improvements in HbA1c levels (Herth et al., 2023). Lastly, for individuals struggling with insomnia or difficulty falling asleep, short-term use of melatonin may be beneficial (Henson et al., 2024). Melatonin is a natural hormone that can also be taken as a supplement to regulate sleep-wake cycles and circadian rhythms (Henson et al., 2024). Supplementing with melatonin has been shown to improve sleep maintenance and quality, which can benefit fasting glucose and insulin sensitivity. However, more research is needed to determine the long-term effects of melatonin on diabetes management (Henson et al., 2024).

Conclusion

Overall, pulling all-nighters to study for midterms can lead to sleep deprivation, as can other sleep disorders such as sleep apnea and insomnia. However, given the impact of sleep on glucose regulation, it becomes clear just how important sleep truly is! While it may be tempting to stay up all night to ace a midterm, getting a full night’s sleep can be just as beneficial, not only ensuring you are well-rested for your exams but also to help regulate your glucose levels.

References:

Darraj, A. (2023). The link between sleeping and type 2 diabetes: A systematic review. Cureus. https://doi.org/10.7759/cureus.48228 

Henson, J., Covenant, A., Hall, A. P., Herring, L., Rowlands, A. V., Yates, T., & Davies, M. J. (2024). Waking up to the importance of sleep in type 2 diabetes management: A narrative review. Diabetes Care, 47(3), 331–343. https://doi.org/10.2337/dci23-0037 

Herth, J., Sievi, N. A., Schmidt, F., & Kohler, M. (2023). Effects of continuous positive airway pressure therapy on glucose metabolism in patients with obstructive sleep apnoea and type 2 diabetes: A systematic review and meta-analysis. European Respiratory Review, 32(169), 230083. https://doi.org/10.1183/16000617.0083-2023 

Tsereteli, N., Vallat, R., Fernandez-Tajes, J., Delahanty, L. M., Ordovas, J. M., Drew, D. A., Valdes, A. M., Segata, N., Chan, A. T., Wolf, J., Berry, S. E., Walker, M. P., Spector, T. D., & Franks, P. W. (2021). Impact of insufficient sleep on dysregulated blood glucose control under standardised meal conditions. Diabetologia, 65(2), 356–365. https://doi.org/10.1007/s00125-021-05608-y