Diabetes and Sleep Apnea: How Sleep Affects Blood Glucose and Diabetes
Are you irritable or depressed? Have you fallen asleep at the wheel? Do you have high blood pressure? You may have sleep apnea, which can make diabetes more difficult to control. Find out how to treat this common problem and help regulate your blood glucose.
Treat Apnea to Control Diabetes?
Sleep apnea can affect diabetes control in many ways. Struggling for air may put your body into fight-or-flight mode, releasing stress hormones that can raise blood glucose levels. If you’re tired, you won’t want to take that walk around the block after lunch. While you’re at work, you might keep snacking to stay awake.
But can treating sleep apnea lead to better blood glucose control? Arvind Cavale, M.D., an endocrinologist in Feasterville, Pennsylvania, refers about 60 percent of his patients with type 2 diabetes for sleep studies. Cavale says treating sleep apnea reduces insulin resistance, improves alertness and motivation, and leads to more stable blood glucose levels. “We use correction of sleep apnea as a tool in controlling diabetes,” he says.
Does This Sound Like You?
This is not a happy scenario: You’re soooo tired. As soon as your head hits the pillow, you’re asleep. But a little while later, someone nudges you awake. You go back to sleep. Just as you get into a deep sleep, you’re nudged again. Sleep … nudge … sleep … nudge. All night long.
The next day, you might wake up with a headache, snap at your family over breakfast, have trouble concentrating at work.
Irritability. Car accidents. Depression. High blood pressure. All because of those nightmarish nudges throughout the night.
If you have obstructive sleep apnea syndrome (OSA), you’re getting those nudges. It’s your body fighting for air. And sleep apnea may be one explanation for difficulty in controlling blood glucose and blood pressure levels.
Partial Air Blockage
With OSA, something partly or completely blocks your airway when you’re asleep. It could be your tongue. It could be the soft tissues in the back of your throat relaxing too much.
Snoring is a sign that air is being forced past a partial blockage. With a complete blockage, you come out of a deep sleep or even wake up completely as you gasp for air. You fall back asleep, but your airway soon gets blocked again. This could happen hundreds of times a night. You aren’t aware of these episodes, but you feel the consequences the next day.
Maybe you’ve chalked up your symptoms to other factors, such as diabetes, age, or job stress. It’s time to figure out if it’s OSA. With treatment, you can start sleeping — really sleeping. You’ll be amazed at the difference.
With an overnight sleep study, your doctor can find out if you have sleep apnea and how bad it is. Your doctor may order in-home monitoring or refer you to a sleep center. Check your insurance plan — it may require you to go to a certain sleep center.
At the sleep center, a technician tapes sensors on you (this takes awhile) and then leaves you alone to sleep. Electrodes on your scalp measure your brain waves, which show when and how long you sleep. Sensors near your eyes detect how long you are in REM (restorative) sleep. A sensor on the tip of your finger records your blood oxygen levels to see if they drop. Your heart rate, breathing rate, and the flow of air through your mouth and nose are also recorded. (The medical term for this recording is polysomnography.) A doctor evaluates the results.
Treating Sleep Apnea
The International Diabetes Federation (IDF), in its 2008 consensus statement on obstructive sleep apnea (OSA) and diabetes, notes two treatments for OSA that help most people: weight loss for those who are overweight, and CPAP (continuous positive airway pressure) for those with moderate to severe OSA.
In the recent Sleep AHEAD study, 306 obese people with type 2 diabetes had at-home sleep studies, which showed that 86 percent had OSA. On average, participants got little or no air 20 times an hour.
Most of the participants then entered another study to see if weight loss would lessen apnea. Participants who lost more than 22 pounds saw big improvements in their sleep apnea; for some, apnea resolved completely.
The IDF says CPAP therapy “is currently the best treatment for moderate to severe OSA and should be considered where appropriate.”
With CPAP (pronounced “C-pap”), you wear a mask over your mouth and/or nose at night, and a machine gently blows air through the mask. The air pressure is adjusted so it’s just enough to keep your airway open.
It may take several weeks and machine adjustments before CPAP therapy works well for you. Don’t give up prematurely. Successful treatment with CPAP can make a remarkable difference in your quality of life.
Personal Experience with CPAP
When Harry met Sally, Sally thought Harry was intolerable. Over time, she began to see his good points, fell in love, and lived happily ever after.
Many users of a common sleep apnea device experience a similar evolution. Ken Russell, PWD type 2, of Burlington Township, New Jersey, got his first continuous positive airway pressure (CPAP) machine two years ago. “I almost threw it away,” he says.
Ken learned about sleep apnea at a diabetes seminar. He had two of the prime symptoms: loud snoring and poor sleep. “I would wake myself up and be uncomfortable,” he says. “For years, I really never did get a full night’s sleep.”
He talked to his doctor, who referred him to a sleep center. Ken had a two-part sleep study. The technician attached myriad sensors and monitored Ken’s sleep for a few hours. It was obvious Ken had apnea. The technician then fitted Ken with a CPAP machine and told him to go back to sleep. The technician remotely adjusted the settings on the CPAP machine using feedback from the monitors. All of this information went to Ken’s doctor, who prescribed CPAP therapy.
Two weeks later, a medical equipment company delivered a CPAP machine to Ken’s home and showed him how to use it. Ken tried it for a week and called the company. “I said, ‘This isn’t going to work. Come back and pick it up.'”
A technician came the next day and made some adjustments, including increasing the ramp time, which is how long the machine takes to build up to the air pressure you need when you’re asleep. If you fall into a deep sleep quickly, you need a short ramp time. Ken needed a longer ramp time.
The technician also suggested that Ken wear a chin strap to keep his mouth closed. That didn’t work. “I had slept with my mouth open for 64 years,” Ken says. “I tried a chin strap, but I felt like I was in a football helmet.”
After another call to the company, the owner switched Ken to a bi-PAP machine. Air pressure is higher while inhaling and lower while exhaling.
A week and a half later, Ken called the owner to tell him the new machine seemed to be working for him.
Ken now has more than 11,000 hours on the machine. He routinely gets 7.5-8 hours of sleep a night. “Out of seven nights, I sleep through six,” he says. “I don’t even get up to use the bathroom. I don’t take a nap anymore in the afternoon. My blood glucose levels are more stable.”
STOP to Take This Test
If you answer “yes” to two or more of the following questions, make an appointment with your doctor to talk about sleep apnea.
S: Do you snore loudly? (Louder than talking or loud enough to be heard through closed doors.)
T: Do you often feel tired, fatigued, or sleepy during daytime?
O: Has anyone observed you stopping breathing during your sleep?
P: Do you have or are you being treated for high blood pressure?
Note: STOP was developed by doctors in Canada (as reported in Anesthesiology, May 2008) to screen patients scheduled for surgery, because sleep apnea makes surgery riskier.
American Sleep Apnea Association
Find a local support group, or ask questions in the forum section. A few examples of discussion threads: “Removing mask in my sleep,” “Can’t breathe with nasal pillows,” “DME aggravation.”
Go here to “learn, vent, laugh, and share about everything CPAP,” the site says. For example, “Newbie would like to hear success stories, please” generated more than 50 replies.
American Academy of Dental Sleep Medicine
This Web site is for dentists, but there is a Patients tab with information about oral appliances (mouthpieces) that may help with mild or moderate sleep apnea. You can also read about surgeries that may help people with problems such as enlarged adenoids or tonsils.