Sweet Dreams: Your Guide To Managing Diabetes With Super Sleep by drtalks

Sweet Dreams Your Guide to Managing Diabetes with Super Sleep

A. Wells MD SLEEP MEDICINE PHYSICIAN

Table of Contents SLEEP IS GOOD MEDICINE

WHAT IS HEALTHY SLEEP?

SIGNS YOU NEED BETTER QUALITY SLEEP

BLOOD SUGAR, APPETITE & WEIGHT GAIN

SLEEP DISORDERS THAT AFFECT PEOPLE WITH DIABETES

MORE ABOUT OBSTRUCTIVE SLEEP APNEA

OBSTRUCTIVE SLEEP APNEA MYTHS

WHAT IS PAP THERAPY?

DO I NEED A SLEEP STUDY?

CAN I GET A HOME SLEEP APNEA TEST?

STRATEGIES FOR BETTER SLEEP

INSIDE THE SUPER SLEEP MD PROGRAM

Dr. Audrey Wells, MD Dr. Wells is a seasoned sleep medicine physician and professional mindset coach. She is on a mission to promote good sleep as good medicine. She helps people with sleep apnea get fully treated without sacrificing comfort. Through Super Sleep MD, she offers a comprehensive library of self-directed courses, a group coaching program, and a private Facebook community. There are free educational resources and more on her website SuperSleepMD.com.

Sleep is good medicine... Healthy sleep is foundational to your mental and physical well-being. But did you know that your sleep can affect your risk for diabetes? If you already have diabetes, sleep can also impact managing this condition. The link between sleep and diabetes is so significant that addressing one can help improve the other.

Connections Between Diabetes and Sleep Sleep affects blood sugar control. During sleep, your body releases glucose into your bloodstream, but your insulin response is reduced. This can result in higher blood sugar levels if you have diabetes, particularly if accompanied by poor sleep quality or quantity. Diabetes can cause sleep problems. If you have diabetes, you are more likely to experience sleep disturbances related to insomnia, sleep apnea, and restless leg syndrome. These conditions can make falling and staying asleep harder, further disrupting your blood sugar control and leading to complications. Sleep deprivation can make diabetes worse. Too little sleep or frequent sleep disruptions can cause insulin resistance, which means the body has more difficulty using insulin effectively to control your blood sugar levels. This leads to higher blood sugar levels and, over time, a higher risk of diabetes complications. Better sleep can improve diabetes management. Uninterrupted sleep can help people with prediabetes or diabetes improve their blood sugar control and reduce the risk of complications.

Healthy sleep is critical for reducing risk factors for long-term health issues. Page 03

What is healthy sleep? Sleep is vital for optimal brain function and overall wellness. Many critical metabolic processes occur during sleep that regulates hormone production, memory, and mood. Deep, restful sleep is associated with a lower risk for chronic health conditions, including diabetes, obesity, cardiovascular disease, and depression. But what does healthy sleep mean, exactly? Healthy sleep means getting enough sleep. You have a personal sleep requirement that is necessary for you to feel your best. Most adults should aim for 7-9 hours of sleep each night. Few individuals can function normally on less than 6 hours of sleep. Healthy sleep means getting highquality sleep. This process includes regular cycling of the different sleep stages and spending adequate time in deep (or slow-wave) and REM sleep. An untreated sleep disorder or purposefully restricting your sleep is a barrier to sleep quality.

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Healthy sleep means your sleep period is timed appropriately. You have a natural circadian rhythm, regulated by various factors, and influences every organ and system in your body. Light exposure is the primary signal for wakefulness – while darkness or dim light signals it is time for sleep. Eating schedules, social activities, and exercise can also influence your body’s rhythm. The consistency of your sleep timing plays a vital role in sleep quality. Healthy sleep has no shortage of benefits, and sleep is a significant lifestyle factor that affects your diabetes risk and the ability to manage your blood sugar levels. Prioritizing good sleep also reduces your risk of diabetesrelated complications and helps keep medication use to a minimum. Every night is a new chance to practice supporting your health with good sleep. But what if you’re having sleep problems?

Signs you need better quality sleep Take action if you experience these symptoms Sleeping less than 7 hours each night Repeatedly waking up during the night or having prolonged awakenings Not feeling rested even after uninterrupted sleeping An irregular sleep pattern, with more than an hour of variability in your bedtime or wake-up time Experiencing symptoms of sleep disorders or bedpartner reports symptoms Problems with weight management, blood glucose control, blood pressure control, or mood

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Blood sugar, appetite & weight gain Poor sleep is an underrecognized risk factor for developing type 2 diabetes. During sleep, the body releases hormones that help regulate blood glucose levels. Disruptions in sleep or sleep loss can interfere with the production of these hormones, leading to imbalances in blood sugar levels. Even before laboratory values are abnormal, chronic sleep loss has a negative impact on your metabolism. For example, young and healthy volunteers with sleep restriction show decreased glucose tolerance and reduced insulin sensitivity in less than a week. Even partial sleep deprivation for one night has been shown to cause increased blood sugar levels and evidence of insulin resistance. Over time, the effects of sleep loss accumulate and result in an increased risk for prediabetes and type 2 diabetes. Sleep disturbances, which include insufficient sleep, irregular sleep, and untreated sleep disorders, are common in modern society. Studies show that many sleep problems are associated with insulin resistance, prediabetes, and diabetes and significantly impact glucose tolerance. If you have diabetes, too little sleep negatively affects your diabetes management, including how you respond to insulin and other medications. People with diabetes and sleep loss experience lower energy levels and low mood. Sleep loss also affects your appetite, what you choose to eat, and your ability to manage your weight.

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Sleep plays a role in regulating appetite and weight through several mechanisms Appetite

The hunger hormone ghrelin is higher with sleep loss, so you feel more hungry. Less sleep causes the satiety hormone leptin to lower, making you less satisfied with food.

Metabolism

Eating Opportunity

Being awake longer means there is more opportunity for you to eat. This eating opportunity is not offset by calories burned by being awake. In addition, sleep deprivation is associated with impulsivity and a preference for high carbohydrate, high fat, highly processed snack foods.

Fatigue & Mood

Sleep loss causes a drop in core body temp and changes in glucose processing, and insulin resistance. Lack of sleep is a stressor, so cortisol is increased, inflammation is increased, and thyroid hormones can be dysregulated.

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Insufficient sleep correlates with more sedentary behavior, less motivation, and negative mood , including irritability, apathy, anxiety, and depression.

3 Common Factors

Sleep disorders that affect people with diabetes An untreated sleep disorder is an obstacle to getting healthy sleep. People with diabetes often struggle with the following three sleep disorders:

High blood sugar levels may cause frequent bathroom use during the night (nocturia), with difficulty returning to sleep.

Obstructive Sleep Apnea (OSA): Obstructive sleep apnea is a serious breathing disorder that occurs during sleep. Moderate to severe sleep apnea has a prevalence of 23% in women and 49% in men. About two-thirds of people with diabetes have sleep apnea. OSA is characterized by frequent interruptions in breathing during sleep due to the collapse of soft tissues in the upper airway. These breathing events cause drops in blood oxygen levels, which is irritating to the brain. While it is commonly associated with nighttime snoring and daytime sleepiness, symptoms may be subtle or absent.

Restless leg syndrome (RLS): This issue is defined as a person’s uncontrollable urge to move their legs due to uncomfortable sensations that may be difficult to describe. It is worse at night and is especially bothersome during rest. People with RLS will kick, squirm, or massage their legs to lessen discomfort. Some people with RLS feel compelled to get out of bed and pace or stretch. Consequently, RLS makes it difficult to fall asleep. It may be a challenge to differentiate RLS from peripheral neuropathy, a complication of diabetes.

Insomnia: This condition presents when a person has difficulty falling asleep or staying asleep. Insomnia may result from another sleep disorder or a medical condition. People with diabetes may experience insomnia due to high blood sugar levels or neuropathy, a complication of diabetes that can cause pain and discomfort.

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It's important to note that poor sleep quality or quantity can also be a symptom of depression or anxiety, both common in people with diabetes. Therefore, it's essential for people with diabetes who are experiencing sleep disturbances to discuss their symptoms with a healthcare provider to determine the underlying cause and appropriate treatment.

More about Obstructive Sleep Apnea (OSA) Obstructive Sleep Apnea deserves special mention as a sleep disorder that affects diabetes risk and diabetes management. There is a bidirectional relationship: people with OSA are at risk for diabetes, and people with diabetes are at risk for OSA. OSA disrupts the body’s regulation of glucose and insulin. These two chronic conditions antagonize each other, and an affected person is at high risk for accelerated complications such as high blood pressure, heart attack, stroke, weight gain, kidney disease, and depression. Because the combination of diabetes and sleep apnea is so common, the threshold for sleep testing should be low. Similar to diabetes, aging and obesity are risk factors for OSA. OSA prevalence is as high as 86% in people with obesity and type 2 diabetes. The prevalence of OSA in people with type 2 diabetes is estimated to be up to 58% in older cohorts. It is estimated that 80% of people with OSA are undiagnosed. The more severe the OSA, the lower the insulin sensitivity and the greater the complication risk. The longterm health consequences of OSA and diabetes overlap. Like diabetes, untreated sleep apnea can result in cardiovascular, metabolic, and neurocognitive consequences.

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Open airway

Wake

Normal blood oxygen

Sleep

Low blood oxygen

Obstructed airway

Effects of Obstructive Sleep Apnea (OSA) The figure above depicts one cycle of obstructive sleep apnea (one event). Notice that there are two effects with each obstructive event, which happens repeatedly throughout the night: Low blood oxygen. Drops in blood oxygen levels occur as a result of an obstructed airway Wake (but usually not to full consciousness). Brief arousals from sleep occur to open the airway in response to low oxygen levels OSA severity is described by the number of airway obstructions per hour of sleep time. Mild OSA is 5-14 airway obstructions per hour of sleep. Moderate OSA is defined as 15-29 airway obstructions per hour of sleep. Severe OSA means obstructive events happen 30 or more times per hour of sleep.

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A person with 15 airway obstructions per hour of sleep time (on the border between mild and moderate OSA) would have about one hundred obstructive sleep apnea events in 7 hours of sleep. This staggering statistic means that low blood oxygen levels and recovery occur up to 100 times per night (also called intermittent hypoxemia). Sleep disruptions are also occurring 100 times per night. These events cause stress hormones to be released and oxidative stress in response to intermittent hypoxemia, sleep loss, and activation of the sympathetic (fight/flight/freeze) nervous system. Untreated sleep apnea also results in inflammation due to poor sleep quality and repeated cycling between normal and abnormal blood oxygen levels. There is a strong correlation between untreated moderate or severe OSA and problems with glycemic control and insulin resistance. The same is true when OSA is selectively worse during REM (dream) sleep. Studies of sleep apnea severity in people with diabetes show a significant positive correlation between the number of airway obstructions per hour and A1c after controlling for multiple confounders.

Health risks

SEVERE Sleep Apnea

MODERATE Sleep Apnea

MILD Sleep Apnea

Normal Breathing

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Obstructive Sleep Apnea Myths Myth: Only people with obesity get sleep apnea. Fact: About 20% of people with sleep apnea have a normal body weight. Myth: You can’t have sleep apnea if you don’t snore. Fact: Snoring is not always perceived, and some people with very severe sleep apnea don’t make any noise because they have complete airway obstructions. Myth: OSA is just a nuisance and doesn’t necessarily need to be treated. Fact: OSA is a breathing disorder with serious consequences if left untreated. Myth: If you have OSA, you have to use CPAP. Fact: CPAP is considered first-line treatment for sleep apnea because it is more than 95% effective. But each individual gets to choose their sleep apnea treatment. PAP therapy is only effective when it is used. If a trial of CPAP is not wanted or not successful, there are other sleep apnea treatment options.

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What is PAP Therapy? PAP stands for Positive Airway Pressure. The two most common forms of PAP Therapy are CPAP (C for Continuous airflow, one prescribed setting) and AutoPAP (Auto-adjusting airflow within a prescribed range of settings). PAP therapy uses a machine that delivers air pressure through a mask to help keep the airway open so you can breathe normally. This process ensures normal blood oxygen levels because your airway stays open. Without drops in blood oxygen levels, you can stay asleep and have normal sleep cycling. OSA is an entirely treatable condition. Research studies have demonstrated that when OSA is fully treated with CPAP, insulin resistance and glycemic control improve in people with prediabetes and type 2 diabetes. This reduces the risk of diabetesrelated complications. Improvements can be expected to occur after about three months of treatment for those who use CPAP nightly and throughout the night (greater than 6 hours of use). Changes in A1c levels usually stabilize after six months of effective CPAP treatment.

Common treatments for sleep apnea CPAP machine (gold standard) Oral Appliance Therapy Weight loss Surgical procedures Aside from improving blood glucose control, sleep apnea treatment can significantly improve your sleep quality, duration, and timing–allowing you to get healthy and enjoyable sleep again. People often enjoy an energy boost and better memory, concentration, and mood during the day. Driving safety improves. The risk for heart attack, stroke, irregular heart rhythms, and dementia decreases. All of these benefits underscore the importance of healthy sleep to your longevity and quality of life.

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Do I need a sleep study? Healthy sleep is

healing.

But sleep apnea is a breathing disorder that puts you at risk for disease, weight gain, memory and concentration problems, and emotional dysregulation.

Consider a sleep evaluation if you have one or more of these symptoms: Nighttime

Daytime

Snoring Hard to get to sleep Frequent awakenings Stop breathing during sleep Wake up gasping for air Two or more bathroom trips at night

Wake up with a headache Tired, fatigued, or sleepy during the day Memory or concentration problems Increased appetite or weight gain Feeling sluggish or foggy Mood problems

Especially if you have one or more of these conditions: Diabetes or pre-diabetes Overweight or obesity (BMI more than 30) Diagnosed with high blood pressure Heart rhythm problem (such as AFIB) Angina, or heart pain Coronary artery disease

Heart attack Heart failure Stroke or TIA Pulmonary hypertension COPD or another chronic lung disease Acid reflux during sleep

intended to serve as medical advice. The content here is not intended to replace a relationship between you and your medical provider.

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Can I get a Home Sleep Apnea Test? Home sleep apnea testing (HSAT) has been on the rise over the last 10 years. Since the pandemic, many more people have had a home sleep apnea test to look for problems with breathing during sleep. There are many different kinds of home sleep apnea tests. Sleep testing is most often ordered after a clinic visit with a sleep specialist. The type of test recommended to you will be based on your symptoms, medical history, insurance, and other factors. Visit the SuperSleepMD.com/resources page to learn more. Note that some insurance companies REQUIRE home sleep apnea testing as the initial diagnostic measure. Contacting your insurance company before your sleep clinic visit will help you to understand if this mandate is in place for you. You can also get information about the cost and coverage of testing and treatment options. Like all medical tests, HSATs have advantages and disadvantages:

Advantages of HSAT Comfort and convenience of testing at home Fewer sensors applied (no scalp sensors) Lower cost compared to an in-lab sleep study More accessible (pick up or mail delivery) May have a shorter wait time for test Disadvantages of HSAT ONLY tests for sleep apnea (no other sleep conditions) Estimates sleep time Estimates sleep stages (deep sleep, REM) May underestimate sleep apnea severity May give a false negative result Ultimately, people who have a sleep evaluation establish a collaborative relationship with their sleep specialist. Let your provider know if you have a strong preference for sleep testing, and move forward with your goal of healthy sleep in mind.

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Strategies for better sleep Set a schedule

Prioritize your sleep time, keeping a regular wake-up time and going to bed when you feel sleepy. Consider tracking your sleep with a wearable device. Get bright light in the morning, preferably by spending at least 15 minutes outdoors in the sunlight. Turn down the lights at bedtime. Light in the evening suppresses your own body's production of melatonin. Avoid looking at electronic screens at night, especially between 11 pm and 4 am. Avoid naps for more than 30 minutes and after 3 pm. Take care of your physical body with a combination of aerobic exercise, strength training, balance maneuvers, and stretching. Follow a daytime schedule with socializing, regular meals, and activities. Create a contrast between day and night.

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Evaluate & Treat

Treat underlying sleep conditions. Insomnia responds well to guided behavioral therapy, which is a safer approach compared to routinely using medications. Note that untreated sleep apnea causes breathing problems and sleep problems. Review your medications and supplements with your prescribing physician to determine if any may be causing agitation. Be aware that supplements often contain caffeine or other stimulants. Caffeine, tobacco, and alcohol, especially within 6 hours before bedtime, have negative effects on sleep. Take care to limit caffeine intake to the morning hours. Stop eating at least 3 hours before bedtime to allow adequate time for digestion and preserve sleep quality.

YOUR NEXT STEP... Visit SuperSleepMD.com to access Super Sleep Resources

SUPER SLEEP ACADEMY Community Support Private Consultations Group Coaching Packages Schedule a Consult

DON'T SUFFER THROUGH ANOTHER SLEEPLESS NIGHT!

INSIDE THE SUPER SLEEP MD PROGRAM Understand the root causes of your sleep problems so you can solve your tiredness Access to credible and science-backed information from a sleep medicine physician Get comfortable with CPAP treatment for sleep apnea, or choose an alternative so you can get all the healthy sleep you deserve Take advantage of personalized attention in group video visits for faster results Don't wait to experience your best night's sleep EVER! Join the private Super Sleep MD Facebook group community focused on sleep apnea treatment support.

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