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The Type 2 Diabetes and Sleep Apnea Connection

Updated: Jan 16, 2018

If you have type 2 diabetes, there’s another condition that you should be aware of: sleep apnea, a disorder in which people experience pauses in their breathing throughout the night, possibly for one minute or more. In fact, according to a study published in 2013 in Family Medicine, people with type 2 diabetes can have a nearly 50-50 chance of being diagnosed with this sleep disorder.

That’s a problem, since sleep apnea can worsen diabetes symptoms and lead to problems like high blood pressure, heart disease, or even stroke, says David Marrero, PhD, president of healthcare and education at the American Diabetes Association and director of the Diabetes Translational Research Center at the Indiana University School of Medicine in Indianapolis.

“Untreated sleep apnea is associated with increases in glucose and poor quality of life stemming from chronic fatigue,” says Dr. Marrero. “It’s also associated with cardiovascular disease, which is why it’s so important for people to get their sleep apnea diagnosed and treated.”

Sleep apnea and type 2 diabetes often coexist because of shared risk factors like obesity. According to the American Academy of Sleep Medicine, the more severe the untreated sleep apnea in a person with type 2 diabetes, the poorer their levels of glucose control.

Read on to learn more about sleep apnea and how you can treat it effectively.

Sleep Apnea: It's More Than Just Snoring

Sleep apnea is a sleep disorder that’s characterized by pauses in breathing. These episodes, called apneas, can wake the sleeper as he or she gasps for air, which can lead to poor sleep and chronic tiredness.

The most common type of sleep apnea is obstructive sleep apnea (OSA), in which the airway is blocked or collapsed. Common symptoms include loud snoring, which occurs as the air squeezes past the obstruction. Other symptoms include daytime sleepiness, morning headaches, and more.

More than 18 million Americans are estimated to have sleep apnea, according to the National Sleep Foundation, but many more go undiagnosed.

“Many people aren’t aware that they’re struggling to breathe at night,” says Marrero. “Unless you recognize your symptoms, you can go for years without knowing you have it.”

The Connection Between Type 2 Diabetes and Sleep Apnea

The cause of sleep apnea and how it connects to type 2 diabetes has a lot to do with weight, says Marrero. People with type 2 diabetes may be obese, insulin resistant, and have large amounts of visceral fat (the fat deep inside the body that surrounds the organs). The extra weight causes the tissues in your neck and throat to fall into your airway, resulting in a blockage, says Marrero.

Sleep apnea can also increase blood sugar levels because of the stress associated with chronic sleep deprivation and abrupt awakenings in the night. “When you get stressed, your body releases stress hormones that can do things like release stored glucose into your liver,” Marrero explains. Over time, the increase in blood sugar levels can contribute to insulin resistance.

How to Test Yourself for Sleep Apnea

Not sure if you have sleep apnea? The most common symptom of obstructive sleep apnea is loud, persistent snoring, which may include pauses followed by gasping or choking. (Keep in mind that not all snorers have sleep apnea.) Other symptoms include chronic fatigue, problems concentrating, mood swings, and difficulty controlling blood pressure and blood sugar levels.

To determine whether you should be evaluated for sleep apnea, Marrero suggests asking yourself the following STOP test questions. “If you answer yes to two or more of them, talk to your doctor,” he says.

• S – Do you snore loudly? (Loud enough to be heard through a closed door)

• T - Are you tired or fatigued? (For example, you fall asleep while driving or during inactive times throughout the day)

• O - Has anyone observed that you stop breathing during sleep?

• P – Do you have, or are you being treated for, high blood pressure?

How to Get a Diagnosis for Sleep Apnea

If you answered yes to two or more of these questions, make an appointment to see your doctor. An MD will ask you questions about your medical history, do a physical exam, and may even talk to your family members to find out how much you snore and if you choke while you sleep.

The next step may be a sleep study, called a polysomnography, which will determine how well you sleep, and for how long. “These studies are typically performed overnight in a sleep lab where technicians wire you up and observe your pattern of breathing and movement,” Marrero explains. Afterward, your doctor can identify any sleep problems you may have and determine their severity.

Another way to diagnose sleep apnea is to use an outpatient device called a pulse oximeter that your doctor can prescribe for you to use at home. Home sleep evaluation is less expensive than going to a sleep lab, but the results might not be as accurate.

How to Treat Sleep Apnea

Make lifestyle changes. If your sleep apnea is mild, you may only need to make some simple lifestyle changes like losing weight (which helps keep your throat open by reducing pressure on the neck) and avoiding alcohol and drugs (they can relax the tongue and cause it to fall back and obstruct the airway). Quitting smoking can also help, as can sleeping on your side.

Use a continuous positive airway pressure (CPAP) machine. The most common device used to treat moderate or severe sleep apnea is called a CPAP machine. You wear a mask-like device over your nose, and the machine blows air into your throat to keep your airway open. The air pressure is adjusted to be just enough to keep your throat from closing up or becoming blocked while you sleep. Studies show that CPAP therapy is especially important during the deepest stages of sleep.

A study published in 2014 in Diabetes Care found that sleep apnea episodes that occurred during the rapid eye movement (REM) phase of sleep, which typically occurs during the early morning hours, had the most detrimental effects on long-term blood sugar control. Another study published in 2015 in the American Journal of Respiratoryand Critical Care Medicine found that wearing a CPAP device for eight hours can improve blood sugar levels and reduce the risk for diabetes in people with prediabetes.

“Sleeping with a CPAP device may not be comfortable, but it’s important to use it,” says Marrero. Once properly adjusted, CPAP usually makes people with severe sleep apnea feel much better.

Ask about dental devices. Dentists with special expertise in treating sleep apnea can design custom dental devices that help keep the airway open during sleep.

Consider surgery. Certain procedures can either reset your lower jaw or widen your breathing passages by stiffening, shrinking, or removing excess tissues in your throat or mouth. These techniques physically enlarge the airway, making it less likely to collapse and obstruct air passages while you sleep.

If you have type 2 diabetes, it’s important to watch for symptoms of sleep apnea and get it properly diagnosed and treated. Once you do, you’ll likely see an improvement in your blood sugar levels and sleep quality. Plus, “if you have type 2 diabetes, it will be easier for you to control it if you start removing the stress hormones that are caused by these frequent interruptions of sleep,” says Marrero.

By Sarah Hutter

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