Diabetes Forecast

The Healthy Living Magazine

13 Best Sleep Tips

Actions that will help you wake up rested and refreshed

By Laura Williamson , , ,
african american man and woman sleeping in bed


Don’t go on the computer and start reading e-mail right before you go to bed.
—Helaine Resnick, PhD, MPH

Anyone who has tossed and turned all night or woken up feeling sluggish knows the value of getting a good night’s sleep—and the misery of living without one. Unfortunately, poor sleep is all too familiar for many people living with diabetes.

“About 40 to 50 percent of people with diabetes complain of poor sleep,” says Kingman Strohl, MD, director of the Sleep Disorders Program at the Louis Stokes Cleveland VA Medical Center.

A much larger number of people with diabetes may experience some kind of sleep problem or sleep disorder but not recognize it as a health-related condition, says Naresh Punjabi, MD, PhD, professor of medicine and epidemiology at the Johns Hopkins University School of Medicine.

“One of the things we’ve learned over the last two decades is that diabetes itself increases the risk of sleep disorders,” he says. (Most of the research relates to type 2.) On the flip side, not getting enough sleep has also been shown to have a detrimental effect on blood glucose levels and is associated with an increased risk for developing type 2 diabetes in the first place, creating something of a chicken-and-egg question.

Regardless of which came first, the answer is for people to treat both: Experts agree that well-controlled diabetes leads to better sleep, and better sleep leads to better control of blood glucose levels.

“Refreshing sleep and restorative sleep can improve glucose metabolism, reduce sleepiness during the day, and may improve your ability to adhere to medications and therefore better manage your diabetes,” says Strohl.

Here, five experts highlight several challenges that people with diabetes have when it comes to getting a full night’s sleep—and some tips for putting those issues to rest.

Sleep Apnea

The most common sleep disorder in people with diabetes is sleep apnea. A person with sleep apnea stops and starts breathing repeatedly while asleep. Signs of sleep apnea include drowsiness during the day and nighttime snoring. A 2009 study published in Diabetes Care found that 86 percent of people with diabetes also experience sleep apnea, with 55 percent reporting moderate to severe apnea warranting treatment.

One reason the numbers are so high is because of the excess weight associated with type 2 diabetes, which can lead to extra fat in the neck that constricts the airway, says Strohl. He explains that people who are overweight may develop sleep apnea before they develop type 2 diabetes, and that sleep apnea can contribute to its development.

 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.

“During the day, these people can be tired,” says Punjabi. That can make it difficult to manage diabetes because “they are not motivated to exercise and engage in healthy behaviors,” he says.

Sleep Tips

  • Lose the extra pounds: “If sufficient weight is lost, you can get rid of the [obstructive] sleep apnea,” says Punjabi. “However, we know this is a difficult task.”
  • Get tested: If you feel drowsy or your partner says you snore, ask your doctor about doing a sleep study to see whether continuous positive airway pressure (CPAP) therapy might help. CPAP machines and masks, worn while sleeping, increase air pressure in the throat so that the airway doesn’t collapse when a person breathes in. “CPAP does alleviate sleep apnea for many people,” says Colleen Lance, MD, assistant professor of medicine and clinical director of sleep operations at University Hospitals Case Medical Center in Cleveland.
  • Other treatments: Finally, if CPAP doesn’t work, says Lance, there are alternative treatments, including a dental appliance that brings the lower jaw forward to open the airway, surgery to remove excess upper airway tissue, and a new device that can be implanted to stimulate the nerve that moves the tongue so it doesn’t obstruct the airway.

Leg Movements/Restless Leg Syndrome

Restless leg syndrome and periodic leg movements can also make it a struggle to sleep peacefully through the night. Restless leg syndrome (an uncontrollable urge to move the legs before falling asleep) can be caused by high blood glucose levels, thyroid disorders, and kidney problems, Lance says.

“There’s also a lot of overlap with neuropathy, or nerve pain, and it can be very hard to tease out which it is,” she says. “Or they could have both.”

People with periodic leg movements have muscle twitches in the lower extremities, which occur during sleep. The difference between these disorders and neuropathy, Punjabi says, is that in the morning, the urge to move the legs vanishes, whereas nerve pain or tingling does not.

Sleep Tips

  • Look into iron levels: Iron deficiency can cause restless leg syndrome, says Punjabi, who recommends asking your doctor about testing for deficiency and using iron replacements. Iron replacements and supplements should not be used in excess. Too much iron can cause an upset stomach, constipation, nausea, and abdominal pain.
  • Consider medication: Many neuropathy medications also work for restless leg problems.
  • Quit smoking: Tobacco can trigger restless leg syndrome, so if you need one more reason to quit, here it is. “It’s hard to get the legs under control if someone is still smoking,” says Lance.


The inability to fall asleep or stay asleep is generally referred to as insomnia, and it can occur on its own or it can accompany other sleep disorders, says Susan Zafarlotfi, PhD, assistant professor of sleep disorders and medicine in the Department of Psychiatry at Rutgers New Jersey Medical School, who treats patients with insomnia in her private practice.

“Often a patient may be getting treated for the sleep apnea, but they are ignoring the insomnia,” she said. “You have to treat them all.”

Sleep Tips

  • Find the underlying cause: Zafarlotfi does not recommend sleeping pills. “These are a Band-Aid therapy, and people will form a tolerance to these drugs,” she says. She prefers to screen and treat for underlying problems, such as anxiety and depression, and to treat insomnia with cognitive behavioral therapy (a type of therapy in which a patient works with a therapist to change his or her behavioral response to negative thoughts) or by working with the patient’s health care provider to resolve any medical issues.

Complications of Diabetes

There are many complications associated with diabetes that can make it more difficult to get a good night’s sleep, says Punjabi. Neuropathy is high on the list. “The pain itself wakes you up,” he says. “Any sort of pain will disrupt your sleep.”

High or low blood glucose can contribute to restless sleep, too. And the symptoms of high blood glucose may occur before people are even aware they have diabetes, says Helaine Resnick, PhD, MPH, principal investigator of the Sleep Heart Health Study and scientific editor for the journal Diabetes.

High blood glucose in particular can cause thirst, frequent urination, headaches, and hunger, all of which can wake a person up during the night. Low blood glucose can also cause hunger, restless sleep, headaches, and night sweats.

Sleep Tips

  • Glucose control: Manage blood glucose levels to avoid diabetes-related symptoms and complications. For those on insulin, work with your doctor to adjust medication, food, and exercise to avoid low blood glucose overnight.

Poor Sleep Hygiene

Sleep hygiene refers to the daily practices that allow people—with or without diabetes—to get the sleep they need to feel alert and refreshed the following day.

“These are the general health rules of sleep, which many people did not learn growing up,” says Strohl, noting that the most important rule is to create a mindset and environment that helps you get adequate rest.

Sleep Tips

  • Follow a routine: Many people tend not to keep a good sleep schedule, Punjabi says. Our bodies naturally follow biological rhythms, which, when disrupted, can lead to poor sleep. “Stick to a schedule of regular sleep habits,” he says. “Go to bed at the same time every night, wake up at the same time every morning.”
    Resnick agrees. “We are meant to be habitual creatures,” he says. “Have a routine that your body can come to recognize, and stick with it.”
  • Avoid stimulants: Drinking caffeine, exercising, smoking, doing housework, or working too close to bedtime can make it more difficult to fall asleep. “In order to promote good-quality sleep, we should have a period of winding down,” says Resnick, who suggests a warm shower or reading a book before bedtime. “Don’t go on the computer and start reading e-mail right before you go to bed. Your mind gets distracted. You get anxious. Leave it till the next day.”
  • No alcohol before bed: A glass of wine seems relaxing and might help you to fall asleep, but you won’t stay asleep if you drink it too close to bedtime, says Strohl.
  • Turn off the light: Electronic devices often have a small colored light to indicate the device is turned on, says Lance. But this light also “tells your brain that it’s daytime when it’s not. Turn off all your devices when you go to bed,” she says, or put them someplace where you can’t see the light.
  • Provide a disruption-free environment: “Maybe it’s time to throw the dog or cat off the bed at night,” Strohl says.

Finally, if you’re having problems with sleep, or if your spouse, partner, or others who share your home notice you snore excessively or stop breathing during sleep, be sure to mention it to your doctor. “It’s often the last thing people will talk to their physician about,” says Strohl.


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