Sleep Hygiene: A Checklist for People With Diabetes
By Erin Davis
There is more to managing diabetes besides diet, physical activity, and medication. Making sure you get enough sleep is fundamental to helping you hit your glucose targets.
Sleep is essential for health, but between family, work schedules, and household duties it can be difficult to prioritize. And it can be even trickier for people with diabetes. The average adult needs around seven hours of sleep per night. If you’re 65 or older, you need closer to eight hours.
Easier said than done, right? That’s because so many factors play into sleep quality including diet, hormones, mental health, and even blood sugar. If you live with diabetes, not getting enough sleep can make your condition harder to manage. Here’s how sleep affects the body (and vice versa), plus a sleep hygiene checklist to help you get a sound snooze.
Does lack of sleep affect blood sugar?
You may have noticed that when you have a bad night’s sleep, your blood sugars are high. It’s not just a fluke. Sleep, or lack thereof, impacts blood glucose levels, and in turn, glucose can affect sleep quality.
While you’re sleeping, your body is performing serious maintenance. Say if your sleep is interrupted – due to something like waking for a baby or dealing with continuous glucose monitor (CGM) alarms – you may find it difficult to manage your blood sugar.
This was the case for diabetes care specialist Megan Warnke, who has been living with type 1 diabetes for 17 years. Warnke found out firsthand how lack of sleep can affect blood glucose.
“When I was pregnant with my first baby, I would set multiple alarms throughout the night to check on my blood glucose,” she said. “I wanted to make sure it wasn’t going too high or low as blood sugar targets are much tighter during pregnancy. This lack of sleep made it harder to control my blood glucose during the day.”
Hormones and sleep
Sleep is regulated by hormones like melatonin and cortisol. These two work in tandem to regulate your circadian rhythm or body’s internal clock. Melatonin makes you sleep, while cortisol wakes you up.
When you’re deprived of sleep, these hormones change. Studies have found that lack of sleep may result in increased cortisol levels. Since cortisol is a stress hormone, high levels can raise blood glucose. While this is a good thing when your body needs to respond to stress or flee from danger, having chronically high cortisol levels can negatively impact the body in ways like impairing sleep.
Diet and sleep
You may have noticed that on days you lack sleep, you are hungrier and crave carbohydrates. That’s because sleep deprivation increases the hormone ghrelin, which increases hunger. At the same time, it decreases leptin another hormone that makes you feel full. Inadequate sleep may also make you more likely to eat emotionally.
“Poor sleep leads to low energy, less activity, and possibly increased snacking and stress eating,” said Dr. Paul Breyer, chief of pediatric endocrinology at Dayton Children’s Hospital. “Getting less than six hours of sleep can cause higher blood sugars the following day.”
Not only do sleep disturbances cause changes in hormones and diet, but a night of tossing and turning is also linked to poor self-care. Warnke said that frequently waking up during the night impacted her functioning the next day, such as having trouble concentrating and completing daily tasks.
Mental health and sleep
Sleep isn’t just physical; your mental health can also have a big impact. For example, stress can cause short-term disturbances in sleep. That’s because when you’re stressed, your mind is racing and cortisol levels are elevated. So it’s no surprise that sleep is hard to come by if you’re under a great deal of stress.
Mental health disorders are associated with long-term sleep problems. Anxiety and mood disorders like depression may make it difficult to sleep. Studies have found that in people with certain mood disorders, like schizophrenia and bipolar disorder, lower amounts of melatonin are released, which may be a contributing factor to poor sleep.
The association between sleep and mental health goes both ways. Not surprisingly, lack of sleep may exacerbate the symptoms of mental health disorders. Sleep helps regulate emotions, making it easier to cope with the everyday stressors of life. Getting too little sleep can disrupt your mood and leave you feeling more anxious or irritable.
Insomnia and diabetes
Insomnia, or the inability to fall or stay asleep, affects many people with diabetes. You may have to go to the bathroom in the middle of the night. Maybe you’re experiencing pain or restless legs (people with diabetes are at higher risk for restless leg syndrome). Your CGM alarm might be going off and you need to check your blood sugar. And unfortunately, it can be difficult to fall back asleep once you’re up.
If you regularly experience insomnia or poor sleep, Breyer recommends closely monitoring blood sugar and maintaining proper sleep hygiene.
“Adhere to your diet plan to avoid overeating due to stress and boredom,” Breyer said. “Get up and take a walk to help lower blood sugars. Avoid taking naps in order to keep a regular sleep schedule.”
Sleep hygiene checklist
You can improve your ability to fall and stay asleep by prioritizing sleep hygiene. Here are some easy actions you can check off before bed each night:
Set a consistent bedtime: Even on the weekends or days off, try to go to bed at the same time.
Turn off electronics: Your phone, computer, or TV might be preventing you from being able to relax and fall asleep. Try to disengage and turn off any screens at least an hour before bed.
Dim or turn off the lights: Decreasing the light level in your room can help you feel sleepier. Lowering lights incrementally over an evening can also signal to the body it’s time to settle down and rest.
Lower the temperature: The National Sleep Foundation recommends that a temperature of 65 degrees Fahrenheit is best for sleep. If you’re a hot sleeper, there are lots of options for cooling sheets and covers.
Limit beverages, especially alcohol: Caffeine and alcohol can impair your sleep. Unless it’s needed for a low, try to avoid sugary drinks like soda or juice before bed.
Avoid large meals before bed: A light snack before bed is fine, but eating a large meal before bed can make it difficult to rest well. For people with diabetes, it could also result in a middle-of-the-night high or low.
Create a bedtime routine: The great thing about a bedtime routine is it’s unique to you. Incorporate any activity that helps you to unwind from the day, including meditation, a nice bath, or reading a book.
Keep your bedroom a sleep-only zone: You want your mind and body to associate your bed with sleep, not TV, work, or social media. Try to limit the bedroom to sleep and sex and utilize a separate space for everything else.
Find an outlet for stress: Stress is one of the number one factors that can impact sleep. Journaling, talking to a friend, exercising, and watching a funny movie are all healthy ways to cope with life’s stressors – and will set you up for a good night’s sleep.
Eat a variety of fruits and vegetables: If you are deficient in micronutrients like vitamins and minerals you may have sleep problems. The best way to get vitamins A, C, D, E, and K, plus minerals like calcium and magnesium, is through a diet rich in fruit and vegetables.
Above all, don’t ignore your sleep problems.
“My best advice is to bring up any sleep concerns to your healthcare professional,” Warnke said. “Whether you’re having trouble falling asleep, staying asleep, waking up frequently, or feeling fatigued, let your provider know. They can order labs, sleep tests, adjust medications, or refer you to a specialist for treatment.”
Learn more about sleep and diabetes here: