How to Get a Good Night’s Sleep with Diabetes

Disrupted sleep can be a common nuisance when living with diabetes—whether you’re experiencing it yourself or you’re a spouse or caregiver of someone with it. Learn more about how to improve your sleep and manage these disorders.

Insomnia is something of an epidemic, with more than 1 in 3 adults regularly not getting enough sleep, according to the CDC. Constant diabetes-related insomnia can accumulate over time and potentially lead to negative consequences. While many diabetics may have disrupted sleep, there are steps you can take to help you get a full night’s sleep.

Sleep Quality vs. Quantity

When sleep is regularly disrupted, you miss out on the restorative processes that take place overnight. It’s not just the amount of sleep (how many hours) that matters, but also the quality (how well). A goal of 8 hours of sleep a night is great, but even if you get enough hours, your sleep quality can be poor.

I can personally attest to having spent years as a “diabetes zombie” after my 5 year old Emma was diagnosed with T1D. It was 2007 and she was not yet using a continuous glucose monitor (CGM). But while we weren’t woken up by the bells and whistles of diabetes tech, we had set alarms for blood sugar tests and a baby monitor so she could signal when she was low and we were about to run. It was a tough time and my sleep hasn’t been the same since.

When assessing sleep, research suggests that quality is a more important metric than quantity. But how do you know if you’re getting enough sleep?

According to a panel of experts convened by the National Sleep Foundation, adults need between 7 and 9 hours of sleep each night, while teenagers need around 8 to 10 hours.

Chronic sleep disruptions can be particularly problematic. These patterns can interfere with everyday life and lead to daytime sleepiness and other health issues related to mood, brain function, and heart. Simply put, a lack of sleep can affect the way you think and feel.

sleep disorders and diabetes

Researchers have been using the term diabetes distress since the mid-1990s. Diabetes distress refers to the emotional impact of living with or supporting a loved one who has diabetes. Because diabetes is a 24/7 condition, sometimes it can’t help but interfere with sleep times, potentially causing even more stress and anxiety.

Karen Oller of Phoenix, Arizona — who was diagnosed with type 1 diabetes 23 years ago — is very familiar with disrupted sleep and the stressful, groggy mornings that follow. “I would say my sleep is moderately affected by diabetes,” Oller said. “I only sleep 2 or 3 nights a week with no diabetic breaks.”

Oller was diagnosed 5 years after marrying her husband Matt – who was diagnosed with T1D at the age of 14. Because Karen and Matt both have T1D, their son Carson was enrolled at birth in a UCLA T1D trigger study that tracked his autoantibodies over time. Shortly before his 14th birthday he also developed T1D.

Sleep and mental health are closely linked. Research suggests that many, if not all, mental illnesses are associated with disrupted sleep quantity and quality. Over time, repeated disruptions can lead to changes in the brain’s levels of serotonin, a chemical sometimes known as the “happy hormone” because it regulates mood, appetite, and sleep.

What are common causes of insomnia in diabetes?

If nighttime blood sugar is out of range, you are more likely to have a disturbed night’s sleep. When using diabetes devices, some nights it can be difficult to take a break from the constant warnings.

“My sleep is mostly interrupted by the care,” says Oller. “Technology is great – it helps me sleep better, but it’s not perfect. For example, last night, Carson (her son) changed his sensor, ate Cheez-Its — and as a 16-year-old, he’s staying up late. He went to bed after dosing insulin for the carbs he ate and at 1:30 am I got a Dexcom notification on my phone. His blood sugar was 49 – and he doesn’t wake up when his blood sugar is low – even when his pump is alarming. Our pediatrician says he should outgrow it, but he hasn’t.”

Researchers are increasingly interested in studying secondary sleep disorders, or sleep disorders that result from a separate medical condition (such as diabetes). While more research is needed in this area, some of the most common causes of diabetes-related insomnia include:

• Blood glucose level check alarms set

• Correct ups and downs

• CGM Alerts (High, Low, Out of Range Alerts)

• Insulin pump alert (low insulin, occlusions, charge/battery low)

• Anxiety or concern about diabetes or your loved one’s diabetes

• Additional trips to the bathroom

• Increased thirst

There are some common sleep disorders that can contribute to diabetes sleep problems, including sleep apnea and restless legs syndrome. If you think you have any of these conditions, be sure to tell your doctor. both are treatable and can improve sleep quality.

Can sleep disruption affect diabetes management?

A good night’s sleep may have an impact on blood sugar. And in general, disrupted sleep patterns have a wide range of potential health effects. Diabetes breaks are similar in nature to sharing your bed space with someone who snores. All disruptions add up, but in diabetes, those disruptions often require actions like a “midnight picnic.” It’s not just about turning around and nudging someone awake to stop snoring.

My girls are 18 months apart; Emma has T1D and Hannah, my oldest, had night terrors. I’m sure my cortisol (the “stress” hormone) levels were through the roof for several years since I was layering this on my own T1D. I never discussed this with my providers at the time, but I wish I had. While my T1D was treated well, it would have been helpful to have more insight into the physiology behind these stress-related glucose fluctuations.

Why is that important? Interrupted sleep is stressful and can increase cortisol levels. It’s the body’s half-hearted attempt to increase alertness, but high cortisol levels can actually increase the need for more insulin. This is why healthy sleeping habits are important.

How do I improve my sleep quality?

While sleep experts warn of the potential harm of electronic devices during sleep for people with and without diabetes, as diabetics know, their devices don’t just turn off. People using diabetes devices have alarms and alerts that can go off at any time of the day or night. That being said, there are some things you can do to increase the chances of getting a better night’s sleep pattern.

• Set a specific time or use an alarm when it’s time to go to bed

• Identify other health factors that may affect sleep

• Personalize CGM goals and alerts and upload your data to an app to see patterns during sleep

• Identify behaviors associated with these patterns

• Check with your care team between appointments and make small adjustments regularly

• If fear of hypoglycemia or diabetes is keeping you awake, let your medical team know

• Turn off your personal alarms and have another loved one or caregiver monitor them instead — take time off, if possible.

• Take the night off. Switch tasks with another adult. (carers and parents)

Diabetes management is best done in routines. If you do similar things at similar times, you’re more likely to get the same results. This may mean exercising, eating dinner, going to bed, or having a similar snack at regular times. Predictability is a good thing. Although it may sound boring and it doesn’t always have to be, it just makes life easier.

Should I see a doctor about my sleep disruption?

If you’ve made the suggested changes but are still having regular sleep disruptions, talk to your diabetes care team. They can help you figure out why diabetes is keeping you awake. Although CGM and automated insulin delivery (AID) devices are very helpful in tackling nighttime lows (and the worries that come with them), the alarms can be unrelenting.

Research suggests that disrupted sleep can have short- and long-term health consequences and increase the risk of:

“I haven’t seen a healthcare provider for sleep disruption, but what helps me is a regular sleep schedule,” Oller said. “I go to bed early and get up early. I’m often tired in the mornings, but I wake up and push myself – there’s no time for a nap either. Having a good attitude has helped tremendously with the sleep deprivation my husband and I struggle with.”

It’s easy to think you’re “okay” and getting enough sleep. But a sleep app, digital tracker, or printable tracker can tell you otherwise. If you find yourself in a pattern of frequent awakenings from diabetes, take action and discuss strategies with your doctor to improve your sleep.

To learn more about how to improve your sleep, check out these resources: