Diabetes and Sleep Apnea

By Matt T. Bianchi, MD, PhD
Chief, Division of Sleep Medicine

In an era when advanced technologies, imaging, genetics, and personalized medicine is making heroic steps towards improving healthcare it may come as a surprise that a common and serious disorder with multiple available treatments remains largely undiagnosed. Yet such is the case for sleep apnea, which affects about 10% of adults but is diagnosed in fewer than half of these.  Sleep apnea is defined as repeated obstructions in breathing during sleep, each lasting typically 20-30 seconds.  These events can range from complete obstruction (apnea) to partial obstruction (hypopnea) and are often accompanied by drops in oxygen.

Sleep apnea is more common in people with diabetes, especially if other risks like obesity are present. Undiagnosed sleep apnea can increase risk of heart attack and stroke – which are already increased in those with diabetes. Sleep disturbances such as sleep apnea can also make it harder to keep blood sugars under control. Other risk factors include male sex, older age, smoking, and alcohol use. Those who have already had a heart attack or stroke, or who have poorly controlled blood pressure, are also at increased risk.

Diagnostic testing, performed in the laboratory or sometimes even at home, involves monitoring breathing and oxygen levels. Pauses in breathing (obstructions) occurring at 5 or more times per hour indicate sleep apnea is present. Increased pause rate means increased severity of the problem (15-30 is moderate; >30 is severe). This disorder often comes with snoring, sleepiness and being overweight – but not in every case.

There are many treatment options for those with sleep apnea. Wearing a mask known as continuous positive airway pressure (CPAP) while sleeping is the standard treatment. Although some initially find the prospect of this treatment daunting, there are dozens of different kinds of masks to help accommodate each person’s needs and comfort. Alternatives come in two categories: surgical and non-surgical. Surgeries include soft palate surgery and jaw advancement surgery, as well as a new stimulator device that acts like a pacemaker to prevent obstructions in sleep. Dental appliances can be made that pull the bottom jaw forward in sleep – these are made by specially trained dentists.

For some people, the sleep apnea is present mainly when they sleep on their back.  In these cases avoiding that position can be helpful. This can be accomplished with a shirt/vest that has a bumper on the back that makes back-sleeping uncomfortable. (The challenge is that some people end up sleeping on their back for some or all their sleep regardless.) Finally, weight loss can be helpful for those patients who are overweight. Whichever treatment pathways are chosen, alone or in combination, it is best to speak with your doctor about your choices and how to monitor your progress.


Getting Enough Sleep

Woman Sleeping

Do you know how much sleep you get a night?  Are you one of the lucky people who gets the recommended 7-8 hours, or do you usually make do with 5-6 (or less)?  In today’s world of 24/7 communication, sleep can be a luxury when the work day continues even after getting home, or seem like a waste of time—after all, there are countless TV shows to watch, blogs and news feeds to read and e-mails to send.  

The Centers for Disease Control and Prevention (CDC) recently reported that about a third of Americans don’t get enough sleep.  Back in December, the Boston Globe had an article suggesting getting enough sleep as a New Year’s resolution.  Last month the Washington Post ran a special feature devoted to sleep, and the National Sleep Foundation designated March 7-13, 2011 as National Sleep Awareness Week® in an effort to raise awareness of the importance of sleep.  We all sleep, so why all this attention on something so, well, ordinary? 

Sleep is a necessary part of life and the amount and quality of sleep you get each night touches on nearly every aspect of waking life.  Probably the most obvious benefit of getting a good night’s sleep is feeling rested and refreshed the next morning.  Getting enough sleep at night can stave off drowsiness and fatigue the next day and improve concentration, learning and memory.  Beyond that, regular adequate sleep helps support the immune system, making it easier for the body to resist illness and fight infection.   

On a much grander scale, too little sleep may be a contributing factor to weight gain and obesity.  Studies have shown that sleep deprivation affects the levels of two hormones that regulate appetite—leptin and ghrelin—which may prompt overeating, especially of high calorie foods.  Maintaining a healthy weight can help lower blood pressure and reduce risk of heart attack or stroke; so a good night’s sleep is just as important as diet and exercise in maintaining a healthy lifestyle.  

As important as a restful night’s sleep is, there are a number of sleep disorders that can interfere with falling asleep and staying asleep.  Sleep apnea, for example, is a condition where breathing stops briefly while asleep.  These interruptions in breathing occur multiple times throughout the night, and can make it difficult to get a sound night’s sleep.  Risk factors for developing sleep apnea include smoking, being overweight and narrowing or obstructions in the airways.  

Do you wake up feeling tired in the morning?  Does your spouse complain about your snoring?  Sleep apnea is common in people with Type 2 Diabetes; talk to your healthcare provider if you have difficulty sleeping.  Stop by the National Sleep Foundation’s website for tips and suggestions for developing healthy sleep habits. 

(Information reviewed by MGH Diabetes Center)