Sleep, Skin and Diabetes - Dr. Elizabeth Aguilar Power Point (& collective student's paper)

When people think about diabetes, they often do not consider the many aspects of life that living with diabetes can affect. Studies have been done to determine the association between poor sleep and diabetes. Sleep is an extremely important factor of everyday life and health that has been decreasing throughout the years in the adult population. Insomnia has become more and more prevalent and some trials have been done to look into metabolic effects correlating with sleep restriction. Self-reported sleep times of less than 6 hours a night or 9 or more hours were associated with impaired glucose tolerance and diabetes mellitus. However, older age, greater waist girth, women, and minorities were factors more associated. Hormones like leptin and ghrelin are affected by lack of sleep, and there are hormones that are associated with diabetes because they antagonize the action of insulin and can result in impaired glucose tolerance as well. Hormones like cortisol and insulin are involved in sleep disturbances, pre-diabetes and diabetes, and stress.

It is estimated that half of patients living with diabetes have sleep problems due to hormonal imbalance and unstable blood sugar levels. Both high and low blood sugar during the night can lead to insomnia and next-day fatigue. The symptoms related to these two conditions can cause disruptions during sleep or make sleep next to impossible. In the same way that blood sugar imbalance can affect sleep, poor sleep hygiene can also affect blood sugar levels. Poor sleep can increase blood sugar even in non-diabetics. Sleep deprivation raises levels of ghrelin, the hunger hormone, and decreases levels of leptin, the hormone that makes people feel full. To compensate for lower energy levels, people who sleep poorly may be more likely to seek relief in foods that raise blood sugar and put them at risk of obesity, which is a risk factor for diabetes.

Individuals with diabetes are also more likely to develop sleep apnea or restless legs syndrome. RLS can develop as a result of diabetic neuropathy which can also include numbness, tingling and pain in the extremities. Both of these conditions can make it difficult to fall asleep. Obstructive sleep apnea is common in people who are obese, which is a large population of diabetic patients. Sleep apnea can interfere with slow-wave sleep, but it also periodically cuts off the body’s oxygen supply. The effects can lead to insulin resistance and impaired metabolism of glucose.

Pharmacists can counsel their patients living with diabetes to have good sleep hygiene and good nonpharmacologic efforts to manage their diabetes. This can include adhering to a healthy diet, getting regular exercise, having a sleep schedule, avoiding caffeine or cigarettes especially before bed, and keeping the bedroom a relaxing environment for sleep and relaxation.

Danielle Pacheco. Lack of Sleep and Diabetes. Sleep Foundation, Nov 2020. Retrieved from https://www.sleepfoundation.org/physical-health/lack-of-sleep-and-diabetes#:~:text=It's%20estimated%20that%20one%20in,insomnia%20and%20next%2Dday%20fatigue