When I was a young medical student and resident and my husband was a struggling entrepreneur, we admittedly had very poor sleep hygiene. We stayed up late studying, working, finishing projects, and even watching movies, hanging out with friends and partying on occasions. We actually thought we would get away with it! But as I became older, had kids, and began practicing as a specialist, I could see the kind of toll these poor habits had been taking on my patients and on myslelf!
A seemingly simple act of satisfying, undisturbed night’s sleep that lasts at least 8 hours seems more illusive than we would like to believe, with our modern lifestyles.
Habits such as erratic sleep behavior, shorter sleep times, working or watching television late into the night, excessive alcohol or food consumption at night time, high stress levels, insomnia which are part and parcel of modern society, have been itself linked with higher risk of obesity, metabolic syndrome, and T2DM. Shorter sleep cycles or poor quality of sleep causes sleep neuroendocrine deregulation in your brain. It increases your appetite by increase ghrelin and lowering leptin hormones. It also increases sympathetic activity and cortisol production; both in return worsen insulin resistance increasing risk of prediabetes and diabetes in otherwise healthy individuals. Even in patients with pre-existing diabetes, poor sleep hygiene leads to weight gain and worsening of A1c values.
OSA is a sleep-related breathing disorder characterized by collapse of the upper airway leading interrupted oxygen supply to the brain during sleep. This leads to frequent awaking, waking up gasping for air or sweating, morning headaches, loud snoring, daytime sleepiness, rapid weight gain, worsening of sugars in the morning, worsening of hypertension and low testosterone. 23% of patients with type 2 DM suffer from sleep apnea, many of them undiagnosed and many untreated or inadequately treated.
Once a person develops diabetes, sleep becomes even more elusive with night time leg pains from neuropathy, muscle aches, frequent waking up to urination, and glycemic control with too many highs or too many lows affecting sleep quality. This in return makes overall glycemic control more challenging. When I take care of my patients with diabetes, I make a point to enquire into their sleep habits and identify possible interventions or diagnoses that can help improve their glucose control and overall health. I have personally experienced the benefits of improved sleep hygiene in terms of increased focus, energy and in weight management. Diabetes is after all a very complex disease and requires a multipronged approach for truly successful outcomes. A good night’s sleep is certainly an under rated but a very valuable tool in my intervention strategies.