By Virginia Gurley, MD, MPH

MB (Marc Braman, MD, MPH):
Dr. Gurley – welcome back, and thank you for sharing your expertise with us on Diabetes and Sleep.

VG (Virginia Gurley, MD, MPH):
Thank you, Dr. Braman.

MB:
In an earlier session we talked about how eating large dinners too close to bedtime and skipping breakfast each worsen blood sugar control in diabetes – it is essentially an abuse of our metabolism furnace by starving it when it needs fuel, and choking it when it needs to rest. What are some of the other relationships between type 2 diabetes and sleep?

VG:
Another important of effect sleep is simply the impact of sleeping either too little or too much on the risk for developing diabetes. Many studies have found that not getting enough sleep, and getting too much sleep, both seem to increase the risk for developing diabetes, especially the adult onset type 2 diabetes.

MB:
Very good, so on the prevention side of things, very important. As far as sleep, how much sleep is too little and how much is too much? There is a lot of debate about this.

VG:
Yes there is and unfortunately, not all studies use the same definition of what’s too little sleep, but many studies define too little sleep as less than six hours per night. They define too much sleep as almost always about more than nine hours of sleep. Interestingly, both too little and too much sleep are both associated with about a 30% increased risk for developing type 2 diabetes.

MB:
Ok, what about for someone that already has type 2 diabetes, how does the amount of sleep affect their metabolic disease?

VG:
Well, for people with type 2 diabetes, there is a similar negative impact of short sleep where studies find that sleeping less than six hours each night triggers higher blood sugar levels, and also more variability in blood sugar and then, also higher Hgb A1c, which is a measure of blood sugar levels over a long period of time.

MB:
So, getting at least seven or eight hours of sleep each night should be a real priority for people with type 2 diabetes. Are there other sleep-related lifestyle habits that can help people with type 2 diabetes?

VG:
Yes, not only is the length or duration of sleep important, but lifestyle habits that help the body produce higher levels of melatonin (that’s a hormone in the brain that’s produced during sleep) also seems to improve blood sugar control. So, that means getting daily morning and late afternoon exposure to bright light, ideally sunlight, and avoiding bright lights and backlit screens like computers, smart phones and TVs for at least 60 minutes before bedtime.

MB:
Anything else we should know?

VG
Yes, it’s pretty common in people with type 2 diabetes that is not well controlled for them to wake up several times during the night to use the bathroom. This is because too much sugar in the blood increases how much urine the body makes, and these nighttime trips to the bathroom really reduce the quality of sleep. So doing a good job managing blood sugar has the added benefit of improving the quality of your sleep.

MB:
So, sleep is part of lifestyle prevention and treatment of type 2 diabetes. And as a bonus, controlling your sugar is part of treating sleep disruption from having to urinate so often. Thank you Dr. Gurley.

VG:
Thank you, Dr. Braman.

Sleep Optimization and Diabetes Control: A Review of the Literature. Arora T, Taheri S. Diabetes Ther. 2015 Dec;6(4):425-468. Epub 2015 Nov 4.

Effect of diabetes mellitus on sleep quality. Surani S, Brito V, Surani A, Ghamande S. World J Diabetes. 2015 Jun 25;6(6):868-73. doi: 10.4239/wjd.v6.i6.868. Review.

Virginia Gurley, MD, MPH

Dr. Gurley is Founder and President of AuraViva, a health education organization dedicated to increasing accessibility and efficacy of healthy lifestyle strategies. She has over 25 years experience designing and implementing health promotion and disease prevention programs and has served 15 years in physician executive positions. She is faculty at the American College of Lifestyle Medicine and member of American Academy of Sleep Medicine.

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