Sleep Apnea: A Hidden Enemy in Diabetes
Published March 31, 2015 by Martha Zimmer
After working with sleep doctors for many years, I knew a lot about OSA. But when I was diagnosed with Type 2 diabetes, the whole subject took on greater importance.
Why do I call OSA a hidden enemy? Because it is easy to have the condition for years without being aware of it. Like diabetes, it can sneak up on you.
One connection to diabetes is that OSA may worsen insulin resistance. Sleep doctors have seen proof: When OSA is treated, their patients’ blood sugar levels improve.
What is apnea?
If others say you snore, stop breathing, and gasp for air or choke while sleeping, you may have OSA. It is caused by a relaxed throat and tongue that close up your airway, making you unable to breathe.
If your tongue is large or if you have fat deposits in the airway or around your neck and abdomen, sleep apnea can be severe. This is why OSA is so common among obese people.
Not being able to breathe for seconds and even minutes puts a strain on your heart. As noted above, it also increases insulin resistance. So you may have high blood pressure and high blood sugar that do not respond to medication as they should.
Doctors now understand that lack of deep sleep makes diabetes worse, adding to your body’s stress. OSA contributes to this by forcing you out of deep sleep over and over, sometimes hundreds of times a night as you struggle to breathe.
OSA is called a silent killer because it makes you sleepy during the day, which leads to accidents while driving or at work. Also, people with OSA can die in their sleep due to sudden heart attacks, possibly from low oxygen levels or the stress of frequent awakenings.
Do you have it?
Although one in three adults with Type 2 diabetes has sleep apnea, most people with OSA don’t know it.
In a study of children with Type 1 diabetes, about a third of them had sleep apnea, too. This made the researchers scratch their heads, because these children were not overweight. The cause for the connection between OSA and Type 1 diabetes is not clear yet, although there are theories (such as that autonomic neuropathy, damage to the nerves that control involuntary bodily functions, plays a role).
What does all this mean for you? Your chance of having some form of sleep apnea is high if you have diabetes.
If someone watches you as you sleep, does he see you stop breathing and gasp for air? Do you snore a lot? Are you sleepy when you should feel rested? Unexplained fatigue, depression, and blood sugar that resists treatment are symptoms of OSA.
You should know that people who are treated for OSA lower their blood pressure and blood sugar readings. They feel better with less fatigue and less depression.
There is some proof of a connection between lack of sleep and weight gain. Sleep doctors observe that treatment for sleep apnea does seem to make it easier to lose weight.
One doctor said he felt that treating OSA was one of the best medications for treating diabetes. He based this on watching insulin resistance and stress levels go down in people he treated.
Testing for sleep apnea has become mainstream, so it is covered by health insurance and Medicare. It means sleeping in a hospital or sleep center and being hooked up to monitors while you sleep, but it is painless.
How is it treated?
According to a study in the American Journal of Respiratory and Critical Care Medicine, you could try tongue and throat exercises. Some exercises to try include repeatedly sliding the tip of your tongue along your soft palate from front to back, or five times a day placing the tip of your tongue between your teeth and swallowing five times.
Another suggestion is to stop sleeping on your back. Sleep doctors say to sew a pocket in the back of your pajamas and put a tennis ball in it so you will not roll onto your back. Some people use pillows to prop themselves on their side.
Others try elevating the head of the bed so they do not sleep flat. But the most helpful thing for most people is losing some weight. This makes the tongue and throat less fatty and relieves sleep apnea in many cases.
Here are some more helpful tips: Never drink alcohol at night or take drugs that relax your muscles. Stop smoking.
For severe OSA, the most effective treatment is a continuous positive airflow pressure, or CPAP, machine.
The machine is about the size of a humidifier and has a tube that leads to a mask or nose plugs you wear while you sleep. The setup takes a while to get used to, and some people never do.
But the results of treating OSA and diabetes are well documented with lower medication needs, better sleep, more energy, and easier weight loss.
CPAP does not cure sleep apnea, but some people do lose enough weight to be able to stop using the machine. And it improves their diabetes and sleep, which also improves their quality of life.
Since both sleep apnea and Type 2 diabetes are improved only after you discover you have them, getting tested is a great investment in your future. If you ignore them, the complications may eventually catch up with you.
I hope this information is helpful to you.