WESTCHESTER, IllNovember is Diabetes Awareness Month. Recent estimates show that at least 171 million people worldwide suffer from diabetes, and that, by the year 2030, this number is projected to double. The American Academy of Sleep Medicine (AASM) reports there is growing evidence linking sleep deprivation and sleep disorders to the development, or worsening, of diabetes. The AASM encourages those who regularly fail to get a sufficient amount of sleep to seek professional help for their sleep problem in order to reduce their risk of developing or further aggravating their diabetes.

Lawrence Epstein, MD, medical director of Sleep HealthCenters, an instructor of medicine at Harvard Medical School, an AASM past president and a member of the AASM board of directors, says that several large studies show that people who don’t get enough sleep have higher rates of diabetes.

“Restricting sleep to four hours a night for only a few days causes abnormal glucose metabolism, suggesting the mechanism for increased rates of diabetes in sleep deprived individuals,” says Dr. Epstein. “Additionally, sleep disorders that disrupt sleep, such as obstructive sleep apnea (OSA), also increase the likelihood of developing diabetes. Treating the sleep disorders improves glucose metabolism and diabetes control. These studies underscore the fact that sleep is integral to good health.”

According to Donna Arand, PhD, of the Sleep Disorders Center at Kettering Hospital in Dayton, Ohio, while the exact mechanisms by which sleep loss affects glucose tolerance are not known, a couple of connections have been identified.

“Sleep loss has significant effects on the endocrine system, which is responsible for the release and inhibition of various substances, including insulin,” says Dr. Arand. “It does this through two pathways: the autonomic nervous system and the pituitary gland. The autonomic nervous system is composed of an activating or excitatory system called the sympathetic nervous system and an inhibitory system called the parasympathetic system. During sleep, the activity in the sympathetic nervous system decreases while the parasympathetic system increases.”

Dr. Arand warns that sleep loss reverses the activity levels.

“Endocrine systems, including pancreatic insulin secretion, are sensitive to this balance, so it would be expected that any changes in this balance would disrupt endocrine systems,” says Dr. Arand. “Sleep also affects the activity of the pituitary gland, the “master” control for the endocrine glands throughout the body. When sleep occurs, a relay system affects the pituitary gland, which then alters the pattern of release of hormones. While it is not clear exactly how sleep loss leads to insulin resistance, the autonomic nervous system and pituitary connections provide underlying mechanisms supporting a relationship between sleep loss and the development of diabetes.”

Ronald Kramer, MD, medical director of the Colorado Sleep Disorders Center in Englewood, Colo., says that, while most patients with diabetes are more than aware of the importance of proper diet and exercise in the management of their diabetes, independent of which, if any, medications their doctors recommend, what people with diabetes also need to incorporate into a healthy lifestyle are good sleep patterns that ultimately result in feelings of optimum alertness and daytime functioning. Anything less may add further to the medical burden and potential problems the patient with diabetes faces, says Dr. Kramer.

Dr. Kramer adds that there are numerous ways that disrupted sleep from any cause can affect the diabetic patient.

“Direct effects of poor sleep can lead to daytime fatigue or sleepiness, or both, and that has the direct consequences of making it hard for individuals to get motivated to find time to do and perform appropriate exercise,” says Dr. Kramer. “Fatigue and/or sleepiness also makes it hard for individuals to keep their appetites and motivations in check to stick to appropriate diets and to also avoid the wrong types of food. In other words, poor sleep or poor sleep patterns can rob you of self-control when it comes to maintaining an appropriate lifestyle.”

Dr. Kramer warns that patients, their families and caregivers, as well as medical providers, should realize that the amount of sleep required to maintain a healthy lifestyle for the diabetic is no different than for all people, regardless of whether or not they have a chronic illness.

Several studies that outline the connection between poor sleep and risk of diabetes were presented at SLEEP 2007, the 21st Annual Meeting of the Associated Professional Sleep Societies, this past June:

  • Measured sleep predicts changes in glucose metabolism. This finding is consistent with experimental research suggesting that sleep affects risk of diabetes.
  • Mexican-American veterans with type 2 diabetes are at greater risk for restless legs syndrome (RLS), significantly more likely to snore and for OSA. The RLS might be linked to diabetes-related peripheral neuropathy.
  • Both short and long sleep durations are associated with an increased prevalence of high hemoglobin A1c, suggesting an increased risk of diabetes.
  • There may be a higher prevalence of OSA in Hispanic population with diabetes.

Other similar research has shown that those who report loss of OSA symptoms have a lower incidence of diabetes. In addition, men who get little sleep (up to five or six nightly hours) or a lot of sleep (more than eight hours per night) are more likely to develop diabetes than men with moderate amounts of nightly sleep. Finally, there is an increased risk of diabetes and hypertension among pregnant women with sleep apnea.

The AASM offers the following tips on how to get a good night’s sleep:

  • Follow a consistent bedtime routine.
  • Establish a relaxing setting at bedtime.
  • Get a full night’s sleep every night.
  • Avoid foods or drinks that contain caffeine, as well as any medicine that has a stimulant, prior to bedtime.
  • Do not go to bed hungry, but don’t eat a big meal before bedtime either.
  • Avoid any rigorous exercise within six hours of your bedtime.
  • Make your bedroom quiet, dark and a little bit cool.
  • Get up at the same time every morning.

On average, most adults need seven to eight hours of sleep each night to feel alert and well-rested.

Those who have a sleep problem are encouraged to consult with their primary care physician or a sleep specialist at a sleep facility accredited by the AASM. Detecting and treating a sleep disorder can cause a dramatic improvement in your sleep. This will allow you to sleep your best at night and feel your best during the day.

For a listing of AASM-accredited facilities in your area, visit www.SleepCenters.org.

AASM is a professional membership organization dedicated to the advancement of sleep medicine and sleep-related research.

To arrange an interview with an AASM spokesperson, please contact Jim Arcuri, public relations coordinator, at (708) 492-0930, ext. 9317, or jarcuri@aasm.org.

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