How to Better Live With and Manage Type 1 Diabetes: (Don’t) Sleep (on it)!

Most (if not all!) of us have unfortunately experienced a least one bad night’s sleep. We remember all too well the fatigue, the cranky mood and the feeling of unease that come from not sleeping well, or not sleeping enough. 

Inadequate or insufficient sleep affects not only mood, but also immunity, metabolism (the body’s chemical and biological mechanisms), heart health and mental health. So, a good night’s sleep is essential to support both our physical and mental health. 

However, while one-third of Canadians get less than 7 hours of sleep per night (the minimum number of hours recommended), this proportion may be even higher among people living with type 1 diabetes (T1D).

T1D and quality sleep: not as easy as you’d think

Sleep can be difficult for people living with T1D, especially when dealing with hypo- or hyperglycemia. Their sleep can be disrupted:

• Every time they need to wake up to check and correct their blood sugar level, and then wait for it to get back in range,
• Whenever alerts from their continuous glucose monitoring (CGM) system or insulin pump keep going off,
• When they feel discomfort from wearing their device.

Poor sleep can have as much of a negative impact on the quality of life and overall health of people with T1D as with the general population. Poor sleep quality or insufficient sleep is associated with higher glycated hemoglobin (HbA1c) results and may increase the burden of blood sugar management as well as the risk of long-term diabetes-related complications. 

The SLEEP 2022 conference, where recent studies on sleep were presented, featured a study conducted by American researchers on sleep and cardiometabolic risks in people living with T1D.

Participants in this study—42 teenagers and 42 adults—wore a CGM and a device on their wrist to estimate how much they slept during one week. Some health parameters such as HbA1c, insulin sensitivity (how well an insulin unit is able to lower blood sugar), waist circumference, blood cholesterol level and blood pressure were also measured.

The results show that: 

• People living with T1D don’t get enough sleep: More than two-thirds of participants did not sleep enough (less than 7 hours per night). 

1. Insufficient sleep is associated with increased weight, waist circumference and blood pressure, as well as lower insulin sensitivity (often associated with certain health problems such as heart disease).

Although this study provides information on the potential outcomes of insufficient sleep, further research is still needed to better understand and quantify these outcomes and, more importantly, to determine whether there is a causal relationship. While the outcomes suggest a causal relationship, this still needs to be demonstrated.

How can I get a good night’s sleep?

Fortunately, there are some strategies that can help improve sleep quality and duration, so that you can get a good night’s rest and wake up re-energized: 

1. Prioritize sleep and recognize its effect on your health.
2. Allow enough time to get the recommended hours of sleep you need.
3. Plan for consistent and regular bedtimes and wake-up times during the week, and follow the same routine as much as possible on weekends and vacations.
4. Avoid caffeine, alcohol or large meals at night and before bedtime.
5. Promote a relaxing environment: keep the noise to a minimum, dim the lights and keep your room at a comfortable temperature.
6. Avoid screens (e.g., television, cell phone, computer) before bedtime.
7. Try to insert your blood sugar management devices on your body in a spot that will allow you to be comfortable during the night (e.g., if you sleep on your back, you may want to place your CGM sensor closer to the front of your arm).
8. Recognize situations that can lead to nighttime hypoglycemia (e.g., physical activity, heavy alcohol use, insulin bolus to correct blood sugar at bedtime). This will allow you to find strategies (e.g., snacks, reduced insulin doses) to reduce this risk.
9. If you continue to experience poor sleep, talk with your healthcare team to see whether other elements might be at play (e.g., fear of nighttime hypoglycemia). This can help you find strategies to overcome these difficulties. Some conditions, such as sleep apnea, can significantly disrupt sleep and affect blood sugar.

In short, sleep is important for both mental and physical health. If you don’t experience restful sleep or have difficulty falling asleep or staying asleep, we encourage you to discuss this with your healthcare team.

References:

• Khan M.S., Aouad R. The Effects of Insomnia and Sleep Loss on Cardiovascular Disease. Sleep Med Clin. 2022 Jun;17(2):193-203. doi: 10.1016/j.jsmc.2022.02.008. PMID: 35659073.
• Chaput J.P., Wong S.L., Michaud I. (2019, September 6). Government of Canada. Sleep duration and quality among Canadians aged 18-79 years. Retrieved August 13, 2022, from https://www150.statcan.gc.ca/n1/pub/82-003-x/2017009/article/54857-fra.htm 
• Reutrakul S, Thakkinstian A, Anothaisintawee T, Chontong S, Borel AL, Perfect MM, Janovsky CC, Kessler R, Schultes B, Harsch IA, van Dijk M, Bouhassira D, Matejko B, Lipton RB, Suwannalai P, Chirakalwasan N, Schober AK, Knutson KL. Sleep characteristics in type 1 diabetes and associations with glycemic control: systematic review and meta-analysis. Sleep Med. 2016 Jul;23:26-45. doi: 10.1016/j.sleep.2016.03.019. Epub 2016 Jun 8. PMID: 27692274.
• Simon S., Snell-Bergeon J., Schauer I., Nadeau K., 0599 Sleep duration across the lifespan in type 1 diabetes and association with cardiometabolic risk, Sleep, Volume 45, Issue Supplement_1, June 2022, Page A263, https://doi.org/10.1093/sleep/zsac079.596
• Klein, H. E. (2022, June 7). Dr. Stacey Simon explains effects of type 1 diabetes on sleep. AJMC. Retrieved August 13, 2022, from https://www.ajmc.com/view/dr-stacey-simon-explains-effects-of-type-1-diabetes-on-sleep 
• How type 1 diabetes can affect sleep. BETTER. (2021, October 7). Retrieved September 4, 2022, from https://type1better.com/en/how-type-1-diabetes-can-affect-sleep/ 
• What to do when you’re losing sleep with type 1 diabetes. JDRF. (n.d.). Retrieved September 4, 2022, from https://www.jdrf.org/t1d-resources/living-with-t1d/mental-health/losing-sleep/ 
• Klein, H. E. (2022, July 12). Dr. Stacey Simon gives advice for high-quality sleep among children with T1D. AJMC. Retrieved August 13, 2022, from https://www.ajmc.com/view/dr-stacey-simon-gives-advice-for-high-quality-sleep-among-children-with-t1di