How Can Type 1 Diabetes Affect Sleep?


We all know the miserable after-effects of a poor night’s sleep. Unfortunately, that dreary, frazzled, anxious state can be a more common reality for someone with type 1 diabetes. Doctors at the Sleep Disorders Program at the Louis Stokes Cleveland VA Medical Center estimate that 40-50 percent of people with diabetes complain of poor sleep. And getting a good night’s rest can help in blood glucose management as well as overall health. So what should you watch out for if you have type 1? And how can you better your odds of a good night’s rest? Here are the most common sleeping disorders that you may be faced with and some basic advice on how to maintain healthy sleep hygiene.

Sleep Apnea

A person with sleep apnea stops and starts breathing repeatedly while asleep, preventing them from achieving deeper states of sleep. Warning signs of sleep apnea include:

  • daytime drowsiness
  • excessive nighttime snoring

There are two kinds of sleep apnea—

  • Obstructive sleep apnea – occurs when the upper airway or throat region narrows, oxygen levels decrease and eventually the brain triggers a response to wake the person up (at least enough to take a full breath and reopen the airway).
  • Central sleep apnea – occurs when brain signals to the muscles that control breathing are confused.

Both types of sleep apnea prevent a person from getting the kind of deep, restful sleep needed to wake up feeling refreshed.

While scientific research has long highlighted a correlation between type 2 diabetes and obesity and an increased risk for obstructive sleep apnea, sleep apnea occurrences is also high in those with type 1 diabetes. Some studies have found obstructive sleep apnea in as many as 30 percent of adults with type 1 diabetes. And the majority of those tested maintained a healthy, normal weight and body mass index. Sleep apnea occurrences were also found to be highest in those who have been affected by type 1 diabetes the longest.

If you’re feeling generally fatigued or depressed from a lack of sleep or having trouble controlling your blood sugar despite a healthy lifestyle, then sleep apnea could be the culprit.

What to do

The first step is to address the issue with a doctor. If you have a child with type 1 diabetes who has sleeping issues, consult his or her pediatrician. Your doctor may suggest conducting a sleep study to further identify additional sleep issues.

Once sleep apnea has been diagnosed, it can generally be easily treated with the use of oral breathing devices worn at night or a continuous positive airway pressure machine that aids in breathing. These machines essentially force small amounts of oxygen into your airways to prevent your breathing from ceasing. While the machines and masks can be a bit cumbersome at first, they result in better and safer sleep.

Restless Leg Syndrome

Restless leg syndrome (RLS) is a sleep disorder characterized by unpleasant creeping, crawling, tingling or painful sensations in the legs while at rest. During the day or while in motion you feel fine, but as soon as you settle in to rest an uncontrollable urge to move the legs grips you. The syndrome can be caused by high blood glucose levels, thyroid disorders and kidney problems, and is a common sleep complication for type 1 patients.

What to do

There is no easy diagnostic test for RLS, so doctors tend to rely on patient experiences when seeking to diagnose. If the urge to move your legs doesn’t go away with activity, or if there is constant nerve pain or tingling as well, you might be dealing with a neuropathy (nerve pain) issue, not restless leg syndrome, which is a neurological disorder.

  • Look into your iron levels first. Iron deficiency has been known to cause RLS. Iron replacements and supplements are easy to take, but consult your doctor for dosage guidelines, as too much iron can have detrimental effects on the body.
  • Cut back your caffeine level as too much of the stimulant has also been shown to cause mild cases of RLS.
  • And if you smoke, quit. Tobacco is a known trigger for RLS.
  • Regular exercise may help regulate sleep in general, decreasing the impact of after-dark RLS incidents.
  • Hot or cool or compresses, leg massages and stretching before bed may also provide some relief.
  • Lastly, there are several drugs that doctors prescribe to treat RLS (from dopaminergic agents to benzodiazepines and anticonvulsants). So, if lifestyle changes don’t offer relief, talk to your physician about medicinal options.

Night Seizures

Researchers estimate that 75 percent of diabetic seizures occur at night. Very low blood sugar levels can cause seizures. If you have type 1 diabetes you can often sense the warning signs of a blood-sugar plummet when awake, but it’s more difficult during sleep.

Insulin pumps with constant blood glucose monitoring can help reduce the risk of seizures from dangerous nighttime lows. While users often report sleeping through the low blood glucose level (BGL) alarms the devices use, some devices are capable of constant monitoring that predicts level spikes and dips, and in the process, suspends your insulin while you sleep if you are at a dangerous low. In general though, a continuous glucose monitor can be helpful in monitoring blood glucose levels.

General Sleep Hygiene

Whether your sleep problems are related to your diabetes or other factors, all  patients with type 1 diabetes (T1D), like all people in general, benefit from healthy sleep. Here are a few general sleep hygiene tips to adopt to ensure you’re doing as much as possible to dial in a better night of shuteye.

  • Follow a routine – Our bodies follow biological rhythms, which, when disrupted, can lead to poor sleep. Try to go to bed at the same time every night, and wake up at the same time every morning.
  • Avoid stimulants – drinking caffeine, exercising, smoking, doing housework, or working too close to bedtime can make it more difficult to fall asleep.
  • Stay away from screens – Our bodies process the light from screens as blue light, which is the same way we process sun light. So, by hovering over a phone, tablet, or laptop screen right before bed, one may actually be tricking his or her brain into thinking it’s morning, not night. Instead read a book, magazine or newspaper.
  • Set up a disruption-free environment – Make sure your sleeping space is dark. Throw the dog or cat off the bed. They’ll still love you, and you’ll better enjoy their company when well-rested!

Read more on Daily Life with Type 1.

WRITTEN BY BT1 Editorial Team, POSTED 05/12/16, UPDATED 12/22/22

This piece was authored collaboratively by the Beyond Type 1 Editorial Team.