Sleep & Diabetes

Sleep & Diabetes

Both the quantity and quality of sleep play important roles in healthy living.1 Although sleep and diabetes have a complex relationship, various studies suggest a bidirectional association and recognize that good sleep can help with diabetes management.2 

Sleep Disorders Are Common in Diabetes – Sleep disorders such as insomnia, obstructive sleep apnea (OSA), and restless legs syndrome (RLS) are more prevalent in diabetic individuals than in the general population.2,3 Diabetes-related comorbidities such as obesity, neuropathic pain, nocturnal hypoglycemia, and increased sympathetic activity may contribute to the development of these disorders. Among individuals with type 1 diabetes mellitus (T1DM), approximately 30-50% report poor sleep and >50% have moderate to severe OSA.2 Among individuals with type 2 diabetes mellitus (T2DM), an estimated 39% is affected by insomnia, 24-86%  by OSA, and 8-45% by RLS.

Sleep Disorders Are a Risk Factor for T2DM – Studies suggest that sleep disturbances may be linked to the development of T2DM through various mechanisms, including accelerated loss of pancreatic b-cell function, increased levels of cortisol (a stress hormone associated with central adiposity and insulin resistance), increased inflammation, increased food consumption and weight, and decreased physical activity.2,4 

Sleep Disorders Are Linked to Poor Glycemic Control in T1DM and T2DM – Sleep deprivation is also associated with greater risk of developing impaired glucose tolerance and diabetes,5 and insomnia is linked to increased hemoglobin A1c levels in T2DM.3 Experimental short-term sleep deprivations have shown to decrease insulin sensitivity.4,6,7  In addition to the physiological changes, sleep disturbances have been linked to decreased engagement in diabetes self-management, posing barriers to achieving glycemic targets.2,8

The Burden of Diabetes Management Can Disrupt Sleep – Individuals with T1DM and T2DM commonly experience diabetes distress, characterized by feeling overwhelmed with the burdens of self-care and concerns and guilt over complications.9,10 This emotional distress, especially fears of developing hypoglycemia or other diabetes-related complications at night, can often disrupt sleep.2,8 Diabetes technology has been cited to both alleviate and aggravate the burdens; some have described devices such as continuous glucose monitors to disrupt sleep with alarms and malfunctions, while others experienced improvements in sleep as they trust the devices to notify them of issues during nighttime.


1. Lao XQ, Liu X, Deng HB, et al. Sleep Quality, Sleep Duration, and the Risk of Coronary Heart Disease: A Prospective Cohort Study With 60,586 Adults. J Clin Sleep Med. 2018;14(1):109-117. doi:10.5664/jcsm.6894
2. ElSayed NA, Aleppo G, Aroda VR, et al. 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes—2023. Diabetes Care. 2022;46(Supplement_1):S68-S96. doi:10.2337/dc23-S005
3. Schipper SBJ, Van Veen MM, Elders PJM, et al. Sleep Disorders in People With Type 2 Diabetes and Associated Health Outcomes: A Review of the Literature. Diabetologia. 2021;64(11):2367-2377. doi:10.1007/s00125-021-05541-0
4. LeBlanc ES, Smith NX, Nichols GA, Allison MJ, Clarke GN. Insomnia Is Associated With an Increased Risk of Type 2 Diabetes in the Clinical Setting. BMJ Open Diabetes Res Care. 2018;6(1):e000604. doi:10.1136/bmjdrc-2018-000604
5. Gottlieb DJ, Punjabi NM, Newman AB, et al. Association of Sleep Time With Diabetes Mellitus and Impaired Glucose Tolerance. Arch Intern Med. 2005;165(8):863-867. doi:10.1001/archinte.165.8.863
6. van Leeuwen WMA, Hublin C, Sallinen M, Härmä M, Hirvonen A, Porkka-Heiskanen T. Prolonged Sleep Restriction Affects Glucose Metabolism in Healthy Young Men. Int J Endocrinol. 2010;2010:e108641. doi:10.1155/2010/108641
7. Buxton OM, Pavlova M, Reid EW, Wang W, Simonson DC, Adler GK. Sleep Restriction for 1 Week Reduces Insulin Sensitivity in Healthy Men. Diabetes. 2010;59(9):2126-2133. doi:10.2337/db09-0699
8. Carreon SA, Cao VT, Anderson BJ, Thompson DI, Marrero DG, Hilliard ME. “I Don’t Sleep Through the Night”: Qualitative Study of Sleep in Type 1 Diabetes. Diabetic Medicine. 2022;39(5):e14763. doi:10.1111/dme.14763
9. Ducat L, Philipson LH, Anderson BJ. The Mental Health Comorbidities of Diabetes. JAMA. 2014;312(7):691-692. doi:10.1001/jama.2014.8040
10. American Diabetes Association. Standards of Medical Care in Diabetes—2022 Abridged for Primary Care Providers. Clin Diabetes. 2022;40(1):10-38. doi:10.2337/cd22-as01



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