Bed Buddies: Diabetes & Sleep Apnea

Depending on your lifestyle, 6 to 10 hours of sleep each night typically is what the body needs to repair the day’s damage and restore you to a better level of functioning the next morning. Conversely, a lack of adequate rest means cellular damage throughout the body goes unrepaired, and that’s enough to make any task seem far more difficult than it should. It’s also enough to make any health condition you have far worse than it already is.

Case in point: Recent research shows that as many as 50 percent of people with Type 2 diabetes also have sleep apnea, and the added stress caused by the lack of quality sleep is making their diabetes worse. Both diabetes and sleep apnea can persist for years before a patient seeks treatment, and while there’s no cure for either, doctors believe having one could significantly impact your odds of having the other. If one of these conditions goes untreated, your risk for serious health complications increases, but if both are ignored, those risks multiply.

Diabetes increases your risk for high blood pressure, renal failure, blindness, foot ulcers, amputations, heart disease and stroke. If you also have sleep apnea, the added stress placed on your body could make your diabetes worse, and also increase your risks for each of the health complications associated with diabetes. Learning more about how sleep affects diabetes is the first step toward resting a bit easier about your health.

Associated Risks

Type 2 diabetes is a chronic condition in which the body is unable to use the insulin it produces to metabolize glucose for the production of energy. Sleep apnea is defined as the intermittent interruption of breathing during sleep. While the two may seem completely unrelated, there is one thing they have in common – insulin resistance.

The main purpose of insulin in the body is to initiate the use and removal of glucose – or sugar – from the blood stream. When a person develops Type 2 diabetes, he or she becomes resistant to the effects of insulin. This insulin resistance causes glucose levels to rise, and excess sugar in the blood triggers a physiological chain reaction that ultimately can lead to arthrosclerosis, heart attack and stroke.

A variety of risk factors contribute to insulin resistance and Type 2 diabetes. Some you can change and some you cannot. “Some risk factors are non-modifiable,” explains Andrée de Bustros, M.D., an endocrinologist with Palos Medical Group. “They include a positive family history for the disease; older age; being of African-American, Hispanic or Native American decent; and having a history of gestational diabetes or polycystic ovarian disease.”

While there’s not much you can do about genetics, there are risk factors you can change. They include eating a diet high in fat, sugar and cholesterol, and being inactive. These are among the biggest risk factors for Type 2 diabetes because they may lead to hyperglycemia and increased body weight. But there’s one more risk factor many people don’t realize, and that is stress.

Just like eating a jelly donut, persistent stress also can increase blood glucose levels. Stress causes the body to produce excessive amounts of the hormones adrenaline and cortisol in an attempt to provide bursts of energy when needed. While that’s a good thing during the occasional stressful situation, in the presence of too much adrenaline – caused by unrelenting stress – fat cells can become resistant to insulin. As a result, glucose levels in the blood rise, and so does your risk of diabetes and heart disease.

Even though you’re not awake when it occurs – or even feeling particularly stressed – sleep apnea is a form of physical stress. Untreated sleep apnea causes individuals to stop breathing again and again while sleeping. For some, these interruptions can occur hundreds of times a night and often for a minute or longer. The resulting lack of oxygen puts the body into a physical state of stress.

“Sleep apnea causes episodic hypoxia, or poor oxygenation, in the body,” says Dr. de Bustros. “This in turn is a great stressor for the body, resulting in the release of stress hormones, which can cause insulin resistance.” This insulin resistance may lead to Type 2 diabetes and all of its associated complications, including high blood pressure, heart disease and stroke

Symbiotic Solution

The association between Type 2 diabetes and sleep apnea is becoming increasingly apparent. A study conducted at Yale School of Medicine found individuals with obstructive sleep apnea are more than twice as likely to develop Type 2 diabetes. The study also shows the more severe the sleep apnea, the greater the risk for developing the disease.

“By causing both insulin resistance and deficiency in insulin secretion, sleep apnea causes hyperglycemia and pre-diabetes, and eventually these conditions can progress to diabetes,” explains Dr. de Bustros. “In fact, recent studies show that in diabetic patients, untreated sleep apnea also correlates to poor diabetes control.”

Sleep apnea alone comes with its own set of health risks, many of them similar to those associated with diabetes. Research shows people with mild to moderate obstructive sleep apnea are twice as likely to develop high blood pressure. Those with severe sleep apnea are three times as likely to have high blood pressure. High blood pressure is the No. 1 cause of heart disease and stroke.

Conversely, studies also show that treating sleep apnea can improve blood glucose levels. “Treatment of sleep apnea with continuous positive airway pressure (CPAP), as well as other modalities, has been shown to have a positive effect on diabetes control,” says Dr. de Bustros. “By decreasing hypoxia at night, there is less insulin resistance and glucose levels in the morning are improved. Moreover, patients are energized during the day and are able to follow-through with their diet, exercise and treatment regimens.

If you have type 2 diabetes, or are at high risk for the disease, and you are a chronic snorer, experience daytime fatigue or have trouble concentrating, you should consider being evaluated by your physician or a sleep specialist for sleep apnea. Treating your sleep problems could not only help you feel more rested during the day but it could even help you control your diabetes.

To schedule a sleep study or sleep consultation, call Palos Community Hospital Sleep Disorders Center at (888) 753-3777 or visit us online at http://bit.ly/needsleep for more information.

Do you have trouble getting a good night's sleep? Take our Sleep Disorders Quiz at http://bit.ly/zzzsquiz to discover what may cause a sleepless night.