The Link Between Diabetes and Insomnia

From verywellhealth.com

Diabetes is a chronic disease that causes a disruption in the metabolism of sugar (glucose) resulting in high blood sugar. In the U.S., 11.3% or 37.3 million people have diabetes, and 23% or 8.5 million people are undiagnosed.

Taking care of your diabetes means addressing behaviours that can contribute to blood sugar control, such as managing stress, eating healthy, and exercising regularly. Adequate sleep is also important. On average, adults need roughly seven to nine hours of sleep, and kids need even more. Research indicates that lack of sleep can increase the risk of diabetes, but can diabetes cause insomnia?

This article explores the relationship between diabetes and insomnia, as well as treatment options.

Nastasic/E+/Getty Images

THE LINK BETWEEN DIABETES AND SLEEP

Diabetes and sleep are connected—if one is not optimal, the other can be impacted. For example, high blood sugar (hyperglycaemia) can cause increased thirst and urination. When this occurs overnight, sleep is disrupted by frequent trips to the bathroom. A person experiencing low blood sugar (hypoglycaemia) may wake up irritable or from sweating, palpitations, or confusion.

Insufficient sleep disrupts hormonal balance, dropping leptin (satiety hormone) levels and increasing ghrelin (hunger hormone) levels. This hormonal disruption can lead to excess consumption of food, which can increase blood sugar.

Studies show that inadequate sleep is associated with an increased risk of type 2 diabetes. In addition, difficulty falling and staying asleep, daytime drowsiness, and poor sleep quality have been reported by people with type 2 diabetes. Research suggests that the prevalence of insomnia (symptoms) is 39% in people with type 2 diabetes.

SLEEP ISSUES ASSOCIATED WITH TYPE 2 DIABETES

Studies show a relationship between sleep problems and insulin resistance, prediabetes, and diabetes. Insulin is a hormone; its main function is to assist glucose in reaching the cells so it may be used for energy. Lack of sleep can increase insulin resistance (the cells become resistant to insulin) and overtime elevated blood sugars can increase the risk of prediabetes and type 2 diabetes.

People with type 2 diabetes are more likely to have conditions that impact sleep, such as sleep apnoea, peripheral neuropathy, and restless leg syndrome.

Sleep Apnea

Sleep apnoea, also referred to as Obstructive Sleep Apnoea (OSA), affects about two-thirds of people with type 2 diabetes. It is a sleep disorder in which a person's breathing starts and stops throughout the night due to recurrent upper airway collapse and is associated with full-body inflammation and oxidative stress. OSA can cause impaired glucose tolerance with insulin resistance. The more severe it is the greater impact it will have on glycaemic control.

Peripheral Neuropathy 

Diabetic peripheral neuropathy is nerve damage caused by diabetes that impacts the feet, legs, hands, and arms. This is the most common type of neuropathy in people with diabetes and affects about one-third to one-half of people with diabetes.

Peripheral neuropathy can cause pain, numbness, tingling, and a burning sensation. It is associated with sleep disturbances and poor sleep quality. Lack of sleep also increases pain sensitivity. Researchers suggest that because these conditions are connected, they should be treated simultaneously.

Restless Legs Syndrome

Restless legs syndrome (RLS) affects about 21% of people with type 2 diabetes and is the fourth leading cause of insomnia. The compulsion to move the legs typically occurs at night or when at rest. Symptoms of RLS are very similar to peripheral neuropathy and include things such as pain, burning, numbness, tingling, and electrical simulations.

Although frequently unrecognized, RLS impairs sleep quality and is associated with increased drug consumption at night and depressive and anxious symptoms. RLS may be a risk factor for hypertension and cardiovascular disease.

Primary Insomnia

Primary insomnia is defined as difficulty sleeping and staying asleep that typically lasts three weeks or longer. This type of insomnia also makes you feel tired and irritable during the day. Primary insomnia is not caused as a result of a medical condition or medication. There is no known cause.

TREATMENT

Insufficient sleep can impact your quality of life. Management of sleep disorders often requires multiple steps, including relief of symptoms and treatment of the contributing conditions. If you have diabetes, and your sleep is impaired as a result of inadequate blood sugar control, the best thing to do is get your blood sugars in a healthy range.

You will need to investigate why your blood sugar is elevated. Are you exercising enough, taking medication as prescribed, eating a healthful diet? These are just some of the variables that can impact blood sugar control. Reach out to your medical team for support.

If another condition is causing your sleep trouble, you will need to receive treatment for that condition. For example, if you have sleep apnoea, your healthcare provider may recommend a Continuous Positive Airway Pressure (CPAP) machine, Bilevel positive airway pressure (BiPAP), or other alternative treatments.

However, if another health condition is causing your sleep problems, you will want to treat that condition. In some instances, when lifestyle isn't enough, medications can be prescribed to treat underlying conditions.

SUMMARY

People with diabetes are at increased risk of having sleep-related issues. These issues can be caused by a secondary condition associated with diabetes, such as neuropathy or OSA, or as a result of diabetes symptoms, like excessive thirst or urination. If you are having trouble managing your blood sugars and as a result, your sleep is impaired, you should contact your medical team. Improvements in sleep quality can improve your glycaemic control and vice versa.

A WORD FROM VERYWELL

It is not uncommon for people with diabetes to have difficulty sleeping. Sleep disruption can lead to feelings of fatigue and irritability. Sometimes changing your routine, by limiting screens before bed, and reducing caffeine is enough to improve sleep. However, in many instances, treatment of the underlying issue will be necessary. Find the support and education you need to get better rest and feel more energized.

FREQUENTLY ASKED QUESTIONS

• Can diabetes cause chronic insomnia?

  People with diabetes can experience insomnia if their blood sugars are not at goal or if they have another underlying health condition that is affecting their sleep. Depression is another condition associated with diabetes that can seriously impact sleep. If you are experiencing depressive symptoms, you should contact your medical team right away.

• Will insomnia go away on its own?

  Insomnia is defined as a chronic difficulty of falling asleep, staying asleep, or waking up early, despite adequate opportunity to sleep at least three times a week during one month. If you experience difficulty sleeping for a few nights because you are not feeling well, chances are you don't have insomnia. However, if you have chronic sleep issues, the likelihood of it going away on its own is probably not realistic.

• Can a person with diabetes take melatonin?

  Melatonin supplementation is often used as a sleep aid because it plays a role in regulating sleep. Melatonin has also been shown to lower glucose and blood pressure. If you have diabetes and are taking medications to lower your blood sugar or blood pressure, you should discuss the safety of use with your healthcare provider before starting.

• https://www.verywellhealth.com/diabetes-and-insomnia-5218041
  

 

Struggling to sleep following a COVID-19 infection? You’re not alone, experts say

From abc.net.au

When Jen Martin tested positive for COVID-19 in early February, she was surprised by just how unwell she felt.

"I didn't have a fever but I had very serious aches and pains, crazy lethargy, and a hacking cough," she says.

"I certainly felt worse than I had expected to, having heard all of the stories about it being mild."

Six weeks later, the Melbourne-based academic still feels pretty average, dealing with regular headaches, daily fatigue, and disrupted sleep.

"In the early days, the cause [of my sleep problems] was obvious — I couldn't stop coughing," she says.

"But even since I've stopped coughing, I've noticed this very, very interrupted sleep pattern."

For someone who is fully vaccinated and "pretty fit", Dr Jen Martin was surprised by how much COVID-19 affected her.(Supplied)

Jen says she's able to fall asleep reasonably quickly, but often finds herself awake two hours later.

She struggles to get back to sleep and stay asleep for more than an hour, before abruptly waking again — a cycle that repeats itself throughout the night.

"I try strategies to get back to sleep, knowing that I've got work the next day and I'm feeling really tired … but I just really struggle, it's very frustrating."

Early mornings, which used to be the most productive part of her day, are now noticeably slower, on account of feeling "dozy".

"I feel very grateful that I have a job that I can largely do from home," Jen says.

"But there's just this little voice in the back of my head that's like, 'Jeez, it would be nice to get a solid sleep one of these days'."

Sleep disturbances seen in post-COVID patients

While most people with a mild or moderate case of COVID-19 recover within about two weeks, others experience lingering symptoms, such as fatigue and shortness of breath.

Sleep disturbances are a well-documented symptom of long COVID, which is generally regarded as the persistence (or emergence) of symptoms at least three months after a SARS-CoV-2 infection. 

But respiratory and sleep physician Megan Rees says people can also experience sleep problems during the acute phase of a COVID-19 infection and in the weeks and months that follow.

Dr Megan Rees is currently treating patients at the Royal Melbourne Hospital's post-COVID clinic.(ABC News: Nico White)

"At least a third to half of our patients say [their sleep] is worse than it was before they got COVID-19," says Dr Rees, who is head of the Royal Melbourne Hospital's Sleep and Respiratory unit.

"There certainly appears to be an increase in sleep disorders in patients both during the early recovery — just a few weeks after they've had COVID — and also in those who have more persistent symptoms long-term."

When it comes to sleep disturbances, Dr Rees says people recently recovering from COVID-19 — and those diagnosed with long COVID — experience "a mixture of problems".

"There seems to be a bit of insomnia, so difficulty being able to sleep at the time that you want, but also feeling tired and wanting to sleep during the daytime," she says.

"In addition to that, there is what we call 'phase delay' or a disruption to your natural circadian rhythm.

"People aren't always finding it easy to be awake at the time they usually like to be awake, and have difficulty being asleep at the time they want to be asleep."

What triggers sleep problems following COVID-19?

The cause is likely to be "multifactorial", Dr Rees says, meaning there's usually several factors involved.

"There's likely to be, to some extent, a direct viral effect — so viruses cause a lot of inflammation in the body, and those inflammatory chemicals as they circulate can disrupt sleep," she says.

"Predominantly, they make you more fatigued or wanting to sleep at different times, but they can also upset your natural rhythms."

Earlier this year, Australian researchers found that people with long COVID — even those whose initial infection was mild — had a sustained inflammatory response for at least eight months after their infection. 

Dr Rees says more research is needed to understand the impacts of this ongoing inflammation, but that "it's not surprising that an inflammatory illness like COVID-19 could disrupt sleep".

"Sleep is a really complex process that actually takes a lot of coordination between various aspects of your brain to achieve," she says.

The persistence of physical symptoms, particularly chest pain and breathlessness — "two of the most common symptoms seen in people as they recover" — can also cause disruptions to sleep.

"Those symptoms can be quite frightening and people can be concerned that something more serious, like a heart attack, is occurring," she says.

"If you wake up with chest pain, it's pretty hard to go back to sleep."

Even for people whose physical symptoms have resolved, they may still feel afraid to fall asleep weeks or months later, worried they will struggle to breath.

In addition to the illness itself, Dr Rees says changes to regular routines during the isolation and recovery periods can also put people's sleep routines out of whack.

"Often you do have a disruption to your normal rhythms of life, so people might be sleeping in, watching screens a little more in the evenings, or having afternoon naps," she says.

"They might also not be able to do as many of their usual activities that help them have a normal sleep cycle so that they're alert in the mornings and tired in the evenings.

"That natural cycle, where we follow the sun rising and the sun setting, is often a bit disrupted."

Anxiety and ongoing stress a key factor

According to respiratory physician Anthony Byrne, the anxiety that's often triggered when people become unwell may also play a part in disturbing sleep.

"Being unwell with a severe virus, whether or not you're in hospital, would cause most people to have some level of anxiety about their own health and how they're going to go in the short term as well as in the long term," says Dr Byrne, who treats both acute and long COVID patients at St Vincent's Hospital in Sydney.

"There's a lot of worry and concern: will I have these symptoms forever? When will these symptoms go away? Am I going to get long COVID?"

Dr Byrne says research suggests people who had been infected with COVID-19 experienced increased levels of anxiety, and that there is a clear link between anxiety and poor sleep.

Pre-pandemic, Dr Anthony Byrne oversaw St Vincent's Hospital's tuberculosis treatment. These days, his patients have long COVID.(Getty Images: Lisa Maree Williams)

"The circadian rhythm is a natural rhythm inbuilt in us that means we have a certain amount of circulating melatonin and other factors in the blood that allow us to sleep at night," he says.

"When you have anxiety and other neurotransmitters that are overactive in the brain, you get an inability to relax … you're sort of in a fight/flight response, and so it's hard to settle down.

"Then you can have this delayed sleep onset or difficulty getting to sleep … and that's one of the things that has been found in patients post-COVID."

Anxiety is also closely linked with insomnia, which can sometimes begin during times of increased stress, and continue even once the stress has gone away.

Dr Byrne says the psychological impacts of a severe COVID infection can sometimes be seen months after infection.

"One example is a young healthy guy that developed long COVID symptoms after he was admitted to hospital with COVID pneumonia," Dr Byrne says.

"One reason that he was waking up at night was because he was getting flashbacks to when he was really breathless and on oxygen at the hospital.

"Even though he recovered from that, it was almost like post-traumatic stress."

COVID-19 may expose existing sleep problems

While Dr Bryne acknowledges that sleep disturbances post-COVID are "a big, important problem", he says it's important to note that some sleep issues may have existed prior to infection.

"Obstructive sleep apnoea, for example, is a risk factor for severe COVID and is often undiagnosed [prior to COVID infection]," he says.

"It's a very well-researched disorder that affects sleep quality and the ability to feel refreshed.

"So you can get this overlap of disorders, which are not causing long COVID, but they're there, and they're potentially modifiable and treatable."

Dr Anthony Byrne and his colleagues at St Vincent's Hospital and UNSW are currently researching long COVID.(Getty Images: Lisa Maree Williams)

When investigating the cause of sleep problems following COVID-19, Dr Byrne says it's important to do a comprehensive assessment of existing health problems and sleep habits before "laying blame solely on the shoulders of COVID".

"When you go to see a GP or sleep physician, one of the first things that will be asked is: what's your sleep routine?" he says.

"How's your sleep hygiene? Are you going to bed at a reasonable hour? Are you avoiding caffeine and cutting out all the usual things?

"Good sleep hygiene is important … and often that's not happening."

A lot of people are also already experiencing heightened anxiety because of the pandemic, which may well be exacerbated if they get infected and become unwell, he adds.

"If you’ve got a background anxiety disorder and then you’ve got COVID on top of that, it's going to make things worse — including sleep problems."

Do these COVID-related sleep problems usually go away?

The good news, according to Dr Rees, is that most post and long COVID patients, in her experience, improve with time.

"We certainly understand a lot more about [persistent symptoms] now, and we are seeing a slow, steady recovery for the vast majority of people," she says.

For those in the community struggling with sleep problems following a COVID infection, Dr Rees says there are a few things worth trying to improve sleep quality.

"I guess the first thing to say is that you're not crazy: you've had a serious infection and this unfortunately can be a part of that illness, but it should get better over time," she says.

The first thing she recommends to improve sleep is to ensure you follow a regular sleep-wake cycle.

"I recommend light exercise outside in the mornings, ideally walking without sunglasses," Dr Rees says.

"Then towards the end of the day, have some relaxing, wind-down time in the evening, ideally without screens."

In addition to avoiding the blue light that's emitted from electronic devices, she recommends limiting alcohol intake and cigarettes.

"Although you will doze off more easily if you have a few drinks, alcohol prevents you from going into those deeper, restorative phases of sleep."

Dr Bryne adds that melatonin tablets, over-the-counter or via prescription, may also help to alleviate sleep issues.

Finally, Dr Rees says if people haven't yet received their COVID-19 booster vaccine, persistent COVID symptoms weren't a reason to delay it.

"People were a little worried that getting vaccinated might worsen their long COVID symptoms, but actually the reverse is true," she says.

"We've found that people who've already been suffering from long COVID can have their symptoms reduced if they get a booster dose."

https://www.abc.net.au/news/health/2022-03-24/sleep-problems-after-covid-19-insomnia-post-viral-fatigue/100933636 

The best sleep apps

From livescience.com

We run through the best sleep apps for a good night's rest 

More than 5 million Americans struggle to get to sleep each night according to a 2019 study from Iowa State University, but after two years of COVID-19, the issue is becoming even more common. Research published in the journal Sleep Medicine in January 2021 revealed that during the pandemic the number of people with clinical insomnia (where sleeplessness occurs for at least three nights a week for three months or more) had risen by 37%, with prescription for sleep medications also rising by 14%. It’s now estimated that 30-35% of adults will suffer from insomnia at some stage of their lives.

It’s hardly surprising, then, that those struggling to get a good night’s sleep will try almost anything and everything to help them get some much-needed shut eye. From soothing music to sleep scripts, medication to meditation, there is a huge array of treatments available for people with insomnia, but many are now turning to technology to help them, and sleep apps are becoming increasingly popular. 

We asked Michael J. Breus, nicknamed “‘The Sleep Doctor” — a clinical psychologist, fellow of the American Academy of Sleep Medicine   — to talk us through some of the best sleep apps on the market.

SOMRYST

(Image credit: Somryst)

A groundbreaking app for chronic insomnia that uses CBTi (cognitive behavioural therapy), Somryst is a prescription digital therapeutic (PDT) that has Food and Drug Administration (FDA) approval. 

Over a course of six to nine weeks, patients are given brain-training challenges, lessons and strategies to improve the way they approach sleep, while doctors can access real-time data on their patients’ progress. “If you can’t find a sleep therapist, or prefer self-study, this is the software for you,” Breus said. “It’s very straightforward too and has clinical data to show its effectiveness.” 

In clinical studies of more than 1,400 adults with chronic insomnia, Somryst reduced the amount of time it took to fall asleep by 45% and the amount of time spent awake at night by 52%.

Available on iOS and Android. Check your medical insurance for cover.

REFLECTLY

(Image credit: Reflectly)

A kind of digital diary, Reflectly helps you to compile a virtual journal, prompting you with questions about your day and your feelings to help declutter your mind of any nagging thoughts that may stop you sleeping. Sleep diaries are often prescribed by medical professionals to more accurately assess the severity of a patient’s insomnia but Reflectly does it digitally. Simple to use and easy to navigate, it’s powered by AI, learning from your responses over time to provide more effective feedback and show you how fluctuations in your mood have affected your sleeping patterns.

Available on iOS and Android. Free to download. Premium subscription available from $10 a month.

MUSE

(Image credit: Muse)

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If the idea of meditating to help you sleep appeals but you don’t know where to start, then Muse, an electroencephalography (EEG) device worn in a headband with an accompanying app, is the perfect companion. Just connect your smartphone to the device (via Bluetooth), open the app and put your Muse headband on. Once you’ve closed your eyes, it will monitor your brain activity, translating it into the right kind ambience to help aid sleep. It also has a sleep-inducing feature the company calls a “Digital Sleeping Pill.” 

Research shows that mindfulness meditation can help combat insomnia and it’s certainly worked for Breus. “I hate to meditate so this has been a lifesaver,” he said. “The real-time biofeedback results for my own meditation practice has been inspiring too. In fact, I’ve just discovered I have logged over 7,000 minutes of meditation.

“There is no question it helps my sleep.”

Available on iOS and Android. Free to download. Muse 2 Headband and Annual Premium Subscription from $207.98.

SLEEPSCORE

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(Image credit: SleepScore Labs)

Sleepscore uses sonar technology to track your sleep; the app sends sonar waves from your phone to measure everything from your breathing patterns to how long you were awake at night. By tracking your light, deep and REM sleep, the app is able to give you a sleep score each night, which you can then work to improve. It also measures the no, while the Premium version offers unlimited sleep tracking and will even compile a sleep report that you can share with your doctor.

Available on iOS and Android. Free version, or premium version at $7.99 per month.

OURA

(Image credit: Oura)

Oura is a ring that’s worn on a finger. Oura’s impressive range of monitors ensures you keep tabs on everything from your heart rate to your body temperature, but its ability to track your sleep is perhaps its best feature. Not only will it accurately assess the quality of your sleep in each stage of the night (light sleep, deep sleep and REM sleep), but it will even kick in when you steal a nap in the afternoon. 

Once it learns how and when you sleep, the app will then offer optimised advice as to how you can best prepare for sleep each night. “I use this to accurately track my sleep daily,” Breus said. “It has the most reliable accuracy data of any tracker on the market, and with the long battery life and easy-to-wear ring, it’s really easy to access that critical data you need for a good night’s sleep.”

Available on iOS and Android. Free to download. Ring costs $299.

PZIZZ

(Image credit: Pzizz)

Pzizz uses the power of sound, or “psychoacoustics,” to create soundtracks of music, rhythms, sounds and spoken words, or ‘dreamscapes’, to help you fall asleep and wake up feeling refreshed. Tailored to the various stages of your sleep cycle, it uses clinically tested techniques as such heart rate and diaphragmatic and variability breathing, mindfulness meditation and muscle relaxation to help create the ideal conditions for sleep.

The app has three settings — Sleep, Nap and Focus. Select Sleep or Nap, and you can choose the length of the dreamscape you prefer, as well as picking the speed of the soothing music or narration you’ve decided on. A wake-up function is also available that aims to bring you around in the best possible mood. Pzizz also features ‘focuscapes’ in Focus mode, for those times when you need something to help you concentrate during the day.

Available on iOS and Android. Free version or Premium subscriptions from $9.99 a month.

HEADSPACE

(Image credit: Headspace)

Headspace is another app that aims to help with meditation, as well as potentially improving sleep. “Headspace also has really gotten the meditation thing down to a science for many, but it’s also really great for sleep,” Breus said. Download the app for free and you’ll get limited access to a range of audio experiences, or “sleepcasts” that aim to help users to relax, unwind and ease into sleep. 

There are also hours of soothing soundscapes that help to create a tranquil setting for a great night’s sleep. Access to the full range of Headspace’s content, with over 40 tailored meditation courses, including ones for sleep and stress, requires a subscription.

Available on iOS and Android. Free to download. A 14-day free trial is available.

SLEEP CYCLE

(Image credit: Sleep Cycle)

It may sound sinister, but Sleep Cycle listens to you while you sleep, recording everything from your snoring levels to the ramblings made when you’re deep in dreams. It will then track your night’s sleep in graph form, putting the audio soundtrack over it so you can see what was happening at various stages of the night. 

The beauty of Sleep Cycle is that it’s also fully integrated with Apple Health, so you can exchange data seamlessly, and it doesn’t require any additional equipment or wearables – just place your phone next to your bed, turn on the app and drift off. 

Just be careful what you say in your sleep.

Available on iOS, Android and Huawei. $9.99 per month or $39.99 per year. Free trial available.

This article is for informational purposes only, and is not meant to offer medical advice.

https://www.livescience.com/best-sleep-apps