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Link Between Sleep Quality and Successful
Diabetes Management

By Judith Riddle

Regulating and maintaining healthful sleep habits may be a key to successful diabetes management, according to Terese C. Hammond, MD, fellowship director of the division of pulmonary, critical care, and sleep medicine, and medical director at Keck Hospital of the University of Southern California Sleep Disorders Center in Los Angeles.

Hammond spoke at the annual meeting of the American Association of Diabetes Educators in August. The title of her presentation was “Insufficient Sleep: Implications for Metabolism and Type 2 Diabetes Management.”

Hammond said too little sleep (less than seven hours) or too much (more than nine hours) is associated with several negative health outcomes, especially in patients with diabetes and other chronic medical conditions.

“Insufficient sleep has a profound effect on obesity, energy expenditure, and caloric intake, especially carbohydrate intake,” Hammond said. “Behavioral interventions to address insufficient sleep can positively impact sleep duration and long-term health outcomes.”1

Sleep duration is associated with metabolic syndrome and high lipids; insufficient sleep is linked with impaired glucose tolerance, obesity, changes in food desirability, increased food intake, reduced insulin sensitivity, and decreased leptin and increased grehlin (hormones that control appetite).

“I’m aware of research that shows even a single night of sleep deprivation can impair insulin sensitivity by about 25%,” says Jill Weisenberger, MS, RDN, CDE, FAND, CHWC, a private practitioner in Newport News, Virginia, and author of Diabetes Weight Loss — Week by Week and other books. “I’m also aware of research showing that sleep deprivation leads to increased snacking of [unhealthful] carbohydrate-rich foods.

“Sleep is a common topic of conversation with my patients,” Weisenberger continues. “Many people think of sleep as optional, but sleep isn’t optional. Sometimes when I bring up the relationship of sleep to insulin sensitivity and appetite, it’s the first time they’re hearing this, so I set one-week and two-week goals with most patients. We often include a bedtime goal. They’re in charge of what time they go to bed, what time the alarm rings, and what they do for a bedtime routine.”

Toby Smithson, MS, RDN, LDN, CDE, a spokesperson for the Academy of Nutrition and Dietetics, founder of DiabetesEveryday.com, and author of Diabetes Meal Planning and Nutrition for Dummies, says, “Reducing stress is an important part of effective diabetes management, and getting seven to eight hours each night is one practical way to reduce stress. When there’s poor sleep quality, blood glucose levels tend to rise due to effects on the circadian rhythm.” In addition, Smithson says, “Poor sleep lowers levels of HDL cholesterol, raises triglycerides, increases levels of insulin resistance, and raises levels of body fat. Sleep disruption is associated with metabolic factors related type 2 diabetes and heart disease.”

When working with patients who have diabetes, Smithson says she sets small, achievable goals geared toward establishing a sleep routine. “Some of my patients work swing shifts and find it hard to get seven to eight hours of sleep. Examples of goals I’ve used include taking a warm shower before bedtime, reading a book before bedtime, listening to soft music, and eating a high-fiber, low saturated-fat diet during the day,” Smithson says.

Moreover, suboptimal sleep duration was positively associated with diabetes in African Americans and whites, although diabetes prevalence was higher at any level of sleep in African Americans.

While sleep can be a major factor in diabetes diagnoses and management, cognitive behavioral therapy (CBT) can be used effectively to restore optimal levels of sleep.

CBT addresses major factors tied to lack of sleep: worry and rumination, unhelpful beliefs about sleep, misperception of sleep and daytime deficits, and adhering to behaviors that maintain unhelpful beliefs about sleep.

“CBT is a good treatment for poor sleep quality,” Smithson says. “People with diabetes have much to think about throughout the day as they manage their blood glucose levels. CBT may offer treatment in easing patients’ minds before bed so they can have a restful sleep,” she says.

According to Hammond, “The good news is that behavioral interventions to address insufficient sleep can positively impact sleep duration and long-term health outcomes.”1

— Judith Riddle is editor of Today’s Dietitian.

1. Sleep matters: explaining the relationship of proper sleep with successful diabetes management. American Association of Diabetes Educators website. https://www.diabeteseducator.org/news-and-publications/press-releases/press-releases/2016/08/14/sleep-matters-explaining-the-relationship-of-proper-sleep-with-successful-diabetes-management. Published August 14, 2016. Accessed November 4, 2016.