If you frequently toss and turn at night, you spend your days feeling like a zombie. That’s bad enough, but here’s an even better reason to find a fix for your sleep problem: It could cause or worsen diabetes. Studies have long hinted that people who struggle with sleep are top candidates for developing diabetes. But until recently, no one was sure just how much getting too little shut-eye can mess up your metabolism and raise your risk for developing the disease. And some doctors still pooh-pooh the idea that sleep deprivation plays an important part in triggering diabetes.
It’s getting harder and harder to ignore the connection, however. In 2010 researchers in England looked at stacks of studies and found “unambiguous and consistent evidence that having insomnia puts you at risk for diabetes. They determined that people who sleep less than five or six hours a night are significantly more likely than sound sleepers to develop diabetes. And don’t think that just because you drift off quickly every night you’re in the clear. The study found that people who can fall asleep, but frequently wake up in the middle of the night and end up eyeballing the ceiling for hours, were an alarming 84 percent more likely to develop type 2 diabetes. These findings proved true for men and women, as well as people of all races.
It’s not entirely clear why insomnia may trigger diabetes, though it’s known that getting too little shut-eye causes certain hormone changes that interfere with good control of blood sugar. In fact, sleep problems are deeply connected with insulin resistance, high blood sugar, and hormone changes that lead to weight gain. At the same time, the growing obesity epidemic is bringing on a new wave of sleep apnea periods of breathlessness at night that also raise risk for being overweight and for developing diabetes and heart problems, too. A lack of sleep is also guaranteed to raise your stress levels during the day. It’s tough staying calm and centered when a tired mind meets an emotional challenge—whether it’s an angry boss, a rude driver on the road, or a broken dishwasher at home.
Better sleep leads to better health. Get this one right and the rest—from reducing stress to taking control of top blood-sugar challenges—will be far easier.
Create a Sleep-Friendly Environment
Many of us don’t get enough sleep, simply because we choose to stay up late (there are always bills to pay and late-night TV for laughs). Or if we do hit the hay on time, we toss and turn, replaying the day’s worries, fighting the lingering effects of that late-afternoon cup of coffee, or trying to ignore the noise of a sleeping spouse or the discomfort of a sagging mattress. If that’s you, a deep, refreshing night’s sleep is just a few fixes away. These strategies will help you prepare your mind, body, and bedroom for a full dose of slumber.
Wake up at the same time every morning. This is one of the surest ways to train your body to fall asleep at the same time every night. Experts say that keeping a regular sleep schedule is critical to keeping insomnia at bay.
Beware Sunday night insomnia. Staying up late on Friday and Saturday nights and sleeping in on Saturday and Sunday mornings is frequently the gift we give ourselves on weekends after a hard week at work. Yet that little gift—small as it is—is enough to mess with your biological clock. Even if you get to bed early on Sunday night, you will not be ready to sleep, and you will not end up being the happy camper you were expecting come Monday morning.
Get some exercise every day. Physical activity improves sleep as effectively as powerful sleeping pills called benzodiazepines in some studies. On average it reduces the time it takes to get to sleep by 12 minutes, and it increases total sleep time by 42 minutes.
Wait till you’re pooped. Ever find that you get really sleepy at 10 P.M., that the sleepiness passes, and that by the time the late news comes on, you’re wide-awake? Some experts believe sleepiness comes in cycles. Push past a period of sleepiness and you likely won’t be able to fall asleep very easily for a while. If you’ve noticed these kinds of rhythms in your own body, use them to your advantage. When sleepiness comes, get yourself to bed, pronto.
Don’t sleep on a full tummy. If you know that you have a busy day planned for tomorrow, have your big meal at lunchtime and a lighter meal as early as possible in the evening. If you find you are still hungry before bedtime, avoid sugar; try a small handful of nuts.
Relax before you turn in. According to a National Sleep Foundation poll, during the hour before bed, around 60 percent of us do household chores, 37 percent take care of children, 36 percent do activities with other family members, 36 percent are on the Internet, and 21 percent do work related to their jobs. A better plan: Read a book, listen to music, take a warm bath, or do some light stretching. The goal is to build a routine that relaxes your body and tells your mind that sleep is up next.
Curfew the computer. Researchers at Stanford University have found that the light from your monitor right before bed is enough to reset your whole wake/sleep cycle—and postpone the onset of sleepiness by three hours. PS: That goes for all your electronic toys: Readers, tablets, games —and the TV.
Be cool, real cool. Lowering the temperature in your home or bedroom will signal to I your body that it’s time to sleep, experts say. It’s generally agreed that 65°F is the optimal temperature for great sleep.
Blacken the room. You sleep better in the dark. If your eyelids flutter open as you move from one stage of sleep to another, even streetlights or a full moon can wake you. Why? Blame it on melatonin, the hormone that makes you sleepy. Darkness encourages high levels, but light shuts it down—-even dim light or brief light exposure.
No more night-lights. That goes for clocks, too, as well as any blinking lights from electronic devices. Turn your clock’s face or digital readout away so you can’t see it. We wake slightly throughout the night. Your brain can misinterpret even such dim lights and wonder if it should wake you up. Do all you can to keep things dark, researchers say it tells your brain to stay asleep? If you have to get up to visit the bathroom at night, keep the path from bed to toilet clear so you can navigate it with a minimum of light (use enough to stay safe, of course). A night-light in the bathroom is a good idea.
Relax your body. If your mind is relaxed but your body is tense, do some low-intensity stretches and exercises to relax your muscles, especially those in your upper body neck, and shoulders. Try the relaxation routine and progressive muscle relaxation exercises you’ll find later in this chapter.
Keep a worry book. Put a small journal and a pen on your bedside table. If you wake up in the wee, small hours and begin worrying, jot down your thoughts. Then close the book, put it on your nightstand, turn out the light and go back to sleep.
Don’t just lie there. Snoozing from 11:30 P.M. until 2:00 A.M., tossing and turning until 4, then sleeping until 6 gives you eight hours in bed but only 42 hours of sleep—and letting yourself toss and turn at night to the point of frustration creates anxiety about sleep that can make insomnia worse. If you wake at 00:00 A.M., get up and go read a book or magazine in the living room. Don’t go back to bed until you feel sleepy enough to fall asleep. It’s tempting to stay in a warm, cozy bed even if you’re not asleep, but remind yourself that it’s important to get out of bed when you’re awake. If you don’t, a part of your mind will begin to associate the bed with being awake rather than being asleep, making falling asleep more difficult.
Train your pets to sleep elsewhere. Up to 25 percent of insomniacs may have their pets to blame for their lack of snooze time, say Mayo Clinic researchers who inter viewed 300 patients at the clinic’s Sleep Disorders Center. Pets wake us up by walking around at night, jumping on the bed, and demanding to be let outside for middle- of-the-night bathroom breaks. Consider investing in a white-noise machine to cover up their sounds, shut your door and insist they sleep elsewhere, or talk with your vet about introducing your animal to sleeping in a pet crate. Healthy pets can also be trained gradually to wait till morning for a bladder break; your vet can help you do this the right way.
Cut out caffeine. In a study of thousands of Australians, those who got 240 milligrams of caffeine a day—about the amount in two 8-ounce cups of coffee or 2½ shots of espresso—had a 40 percent higher risk for insomnia than those who skipped it. Caffeine blocks the action of a sleep-inducing brain chemical called adenosine. It takes three to seven hours for your body to metabolize just half the caffeine in a cup of tea or coffee. If you can’t live without it, relegate your caffeine to the morning.
Fight Insomnia the Smart Way
Tossing and turning again? You’re not alone. At least one third of all adults have a hard time falling asleep or staying asleep—at least one night per week. When does “I can’t get to sleep” qualify as insomnia? Experts say you’ve crossed the line and may need treatment if on three or more nights each week you need more than 30 minutes to fall asleep and/or you awaken in the middle of the night and have trouble getting back to sleep.
If that’s you, be sure to start with all of the sleep tactics on the following pages. Experts recommend them for people with insomnia; too, because they’ll help your mind and body establish a healthier sleep schedule. If you still feel you’re losing out on zzzzs, move on to these strategies.
Rewire your circuits. The most successful treatment for insomnia is called cognitive behavioral therapy (CBT). In more than 20 studies involving 470 patients with insomnia from a variety of causes, CBT worked just as well as sleeping pills at increasing sleep and improving sleep quality—and it was better than sleeping pills at helping study participants fall asleep faster.
CBT involves meeting with a trained therapist to discover information about what keeps you from sleeping (the “cognitive” part) and learn how to alter your behavior (the “behavioral” part) so that you can improve your sleep. It may take as few as four or five 30-minute sessions to effect change; some people will need three months of sessions to conquer insomnia.
Unfortunately, certified cognitive behavioral therapists are scarce. To find one, visit wwwacademyofct.org and click on “Find a Certified Cognitive Therapist.” Fill in your zip code or city and state on the pop-up, and a list of therapists in your area will appear. If none do, or if you don’t have time for even the small number of sessions CBT requires, you can visit www.cbtforinsomnia.com. For a fee ($34.95 at press time) you can take an online tutorial based on a Harvard University CBT insomnia program to retrain your brain for a better night’s sleep.
Limit your time in bed. It sounds crazy, but one of the most effective strategies to combat insomnia is to restrict the number of hours you spend in bed.
The reason is that most people who have been struggling with insomnia will do seemingly practical things like go to bed a couple of hours early to try to sleep. It rarely works, researchers have found, so most of those people end up spending seven hours in bed but only sleep for five.
Be drowsy before hitting the hay. Don’t go to bed until you truly feel like you can fall asleep. And remember what we said previously: Don’t stay in bed when you’re awake or the association you make (bed = awake) can program you for insomnia. Get up, go into another room, and do something boring and quiet for a while. When you’re really sleepy, go back to bed.
Sleep Apnea and Diabetes
If you wake up in the morning feeling tired, irritable, sad, forgetful, and head achy, there’s a good chance that you have sleep apnea, a sleep-related breathing disorder that affects millions of people—including many with diabetes.
When you have sleep apnea, your breathing actually stops or becomes very shallow I as you sleep. Hundreds of times every night, your breathing may pause for 10 or more seconds, depriving your body of oxygen, increasing your heart rate, and preventing you from entering the important stages of deep sleep that restore mind and body. You may awaken slightly as you struggle to take a breath. By morning you may not recall any of your nighttime awakenings. But they have a profound effect on your blood sugar, your heart, and your brain.
Most sleep apnea is a type called obstructive sleep apnea, or OSA. It occurs when : the soft tissue in the back of the throat relaxes and blocks the passage of air until your airway opens—often with a loud choking or gasping sound—and you begin to breathe again. Getting your sleep apnea diagnosed and treated will help you get a good night’s sleep and feel refreshed. It can also help you control your blood sugar and reduce your odds for diabetes-related kidney damage, one recent study shows.
SYMPTOMS OF SLEEP APNEA
If you have one or more of the following symptoms, you may have sleep apnea. Consult your doctor for a diagnosis.
You snore loudly. About half of all people who snore loudly have OSA. It’s a sign that your airway is partially blocked. Ask your sleep partner if you snore loudly at night, and whether he or she has noticed if you seem to stop breathing during sleep, then catch your breath again with a loud snort.
You have a large neck. The size of your neck can be a telltale sign because it’s a reflection of being overweight—and carrying extra pounds is a major risk factor for sleep apnea. Women with OSA often have a neck size of more than 16 inches; men, 17 inches.
You wake frequently for bathroom breaks. If you’re not drinking loads of water before bed and you’re not taking high-dose water pills, you shouldn’t wake more than once or twice a night to use the bathroom. People with OSA often visit the bathroom three or more times each night.
You feel sleepy in the morning after eight or more hours of sleep. Or you become dangerously drowsy during the day. People with OSA can become so sleepy that they fall asleep while driving.
HOW TO FIX SLEEP APNEA
If you nodded your head to any of the above, then chances are, you have sleep apnea. Don’t ignore the situation—tackle it head on. Here’s how.
Lose weight. Dropping pounds can reduce sleep apnea. When University of Wisconsin Medical School researchers tracked 690 Wisconsin residents for four years, they found those who lost 10 percent of their body weight saw apnea improve 26 percent. Almost any amount of weight loss helps. Extremely overweight people who underwent surgical weight loss procedures to drop 25 to 50 percent of their body weight saw a 70 to 98 percent drop in sleep apnea in one study. And among people who lost just seven to nine percent of their weight (about 14 to 18 pounds for someone weighing 200 pounds), sleep apnea scores fell by about 50 percent. Weight loss usually is not a replacement for CPAP or surgery, if you need them, but it can help make those treatments even more effective.
See a sleep specialist. A sleep doctor will check your mouth, nose, and throat and make a recording of what happens with your breathing while you sleep. This may require an overnight stay at a sleep center.
Ask about continuous positive airway pressure (CPAP). This “gold standard treatment uses a small, quiet air compressor to gently push air through a mask over the sleeper’s nose. The extra pressure keeps airways open, so you breathe normally all night. When researchers analyzed 36 CPAP studies involving 1,718 people with sleep apnea, they found that those who used this system improved daytime alertness by nearly 50 percent, cut the number of sleep interruptions by eight per hour, and boosted the amount of oxygen in the blood significantly.
In one Chicago study, people with diabetes and apnea saw blood-sugar levels drop three months after starting CPAP therapy. Other research shows it can also lower blood pressure and even improve the size, shape, and pumping action of the heart good news because people with sleep apnea often have enlarged hearts. Talk to your doctor about this therapy and whether it might be right for you.