Does T2D Cause Sleep Problems?

You go to bed early, only to find yourself still wide awake at 2 AM.

Or you do fall asleep, but wake up an hour later, and every hour thereafter.

Or maybe you toss and turn, unable to slumber again after waking up in the middle of the night.

That’s often how it goes for about 77 percent of people with type-2 diabetes (T2D).¹

In this article, we’ll explore the link between T2D and a variety of sleep problems:

• Abnormal blood sugar and sleep
• Restless legs syndrome
• Insomnia

Abnormal blood sugar is a hallmark of T2D. Let’s see what its effect is on sleep.

Abnormal blood sugar and sleep

When your blood sugar levels are persistently high (the medical term is hyperglycemia), you’ll eventually be diagnosed with diabetes (either type 1 or type 2).²

Being hyperglycemic makes you pee often. This means you may have to get up from bed frequently at night to use the bathroom.³

Having excess sugar in your blood also draws water from your tissues. This causes dehydration — a cue for you to wake up and drink water.³

Plus, hyperglycemia may make you feel warm, irritable, or tense at night. These feelings can hinder you from falling or staying asleep.³

Sometimes your blood sugar may fall below normal levels at night. This condition (called hypoglycemia) can happen when you’ve had an active day or exercised near bedtime. If you’re insulin-dependent, you may get hypoglycemic at night in two other ways. One is by eating too little food after your usual nighttime insulin dose; second is by taking more insulin than prescribed in the evening.^4,5

Hypoglycemia at night can make you sweaty, shaky, and hungry. It can give you nightmares too.³ 

To correct high or low blood sugar levels at night, most people either take an insulin shot or eat some carbs. These adjustments will likely make you feel more alert, adding to your struggle to sleep again.³ 

Restless legs syndrome

Around 25 percent of diabetic people suffer from restless legs syndrome (RLS).⁶ 

RLS — also called primary RLS, idiopathic RLS, and Willis-Ekbom Disease — is a chronic disorder that causes unpleasant sensations in your legs. They may ache, throb, or itch. You may also feel like something is pulling, crawling, or creeping on them. These sensations, in turn, make you strongly want to move your legs to ease the discomfort. But the sensations often return once you stop moving your legs.⁷ 

RLS symptoms usually occur in the late afternoon or in the evening. They’re often most intense at night while you’re resting. RLS can make it hard for you to fall asleep or go back to sleep after waking up.⁷ 

Over time, uncontrolled high blood sugar can damage your nerves, including those in your feet and legs. This damage is called peripheral neuropathy, and it contributes to RLS.^8,9 

How exactly does high blood sugar damage your nerves? And why only in your legs? When your blood sugar (glucose) levels are elevated, glucose breaks down differently. The different pathway yields a byproduct called sorbitol. When sorbitol enters your nerves, it attracts water, making your nerves larger. But the nerves in your feet and legs pass through nerve tunnels. This means that your nerves get compressed and squeezed — and damaged — as they grow bigger.¹⁰ 

Also, excess glucose can combine with the proteins that make up your soft tissues. This reaction produces harmful compounds called advanced glycation end products (AGEs). AGEs can scar and stiffen the soft tissues comprising your nerve tunnels. So, the nerves in your legs get compressed even more.¹⁰ 

High blood sugar isn’t the only underlying cause of sleep disorders among type-2 diabetics. Particularly in insomnia, insulin resistance plays a key role.¹¹ 

Insomnia

Insulin resistance happens when your muscle, fat, and liver cells don’t seem to respond to insulin. This hormone released by your pancreas helps blood glucose enter your cells for energy use. It also signals your liver and muscles to store glucose as glycogen. Over time, insulin resistance leads to persistently high blood sugar levels — and ultimately, to a diagnosis of T2D.^12,13 

The effects of insulin resistance don’t stop with elevated blood sugar. Insulin resistance also drives your fat tissues to release excess fat into your bloodstream. The excess fat then gets stored in your liver and skeletal muscles. A fatty liver, in turn, is linked to fat accumulation around other organs in your abdomen, including your stomach and intestines. This preferential storage of fat around your middle is called abdominal obesity, and it’s associated with high levels of cortisol, the “stress hormone.”^14,15,16,17 

Ordinarily, cortisol production in your body follows a 24-hour pattern that coincides with your sleep-wake cycle. In general, you should produce the lowest amount of cortisol around midnight, allowing for restful sleep. Your cortisol level should then peak about an hour after you wake up. But with insulin resistance leading to abdominal obesity, you can have persistently high cortisol throughout the night. The result? Insomnia.^17,18 

Insomnia is a common sleep disorder. With this condition, you’ll have a hard time falling asleep at night. You may also struggle to stay asleep. Without a good night’s rest, you’ll feel tired and sleepy during the day. Plus, insomnia can make you cranky, anxious, or depressed. It can lead to difficulty remembering things or focusing on tasks as well.¹⁹ 

Conclusion

T2D can disrupt sleep in various ways.

Abnormal blood sugar levels due to T2D can lead to frequent sleep interruptions at night. 

Over time, high blood sugar can result in peripheral neuropathy and ultimately, restless legs syndrome.

What’s more, insulin resistance can drive abdominal obesity and persistently high cortisol levels, which in turn are linked to insomnia.

That’s why addressing T2D can help improve your sleep, your energy levels, and the overall quality of your life.

Want to know how to reverse T2D the natural way? Click here to learn more about the Diabetes Diet Solution.

References

1. Predictors of sleep disorders among patients with type 2 diabetes mellitus - ScienceDirect
2. Hyperglycemia (High Blood Sugar): Symptoms & Treatment (clevelandclinic.org)
3. Does diabetes have a negative effect on sleep? (medicalnewstoday.com)
4. Avoiding Nighttime Hypoglycemia | Joslin Diabetes Center
5. Nocturnal hypoglycemia (alberta.ca)
6. Prevalence of restless legs syndrome in people with diabetes mellitus: A pooling analysis of observational studies - eClinicalMedicine (thelancet.com)
7. Restless Legs Syndrome | National Institute of Neurological Disorders and Stroke (nih.gov)
8. Peripheral Neuropathy - NIDDK (nih.gov)
9. Restless Leg Syndrome - Causes, Relation to Diabetes, Symptoms and Treatment
10. The connection between diabetes and restless legs syndrome (andersonpodiatrycenter.com)
11. Prevalence of Insomnia (Symptoms) in T2D and Association With Metabolic Parameters and Glycemic Control: Meta-Analysis | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic (oup.com)
12. Insulin Resistance: What It Is, Causes, Symptoms & Treatment (clevelandclinic.org)
13. Glycogen: What It Is & Function (clevelandclinic.org)
14. Pathogenesis of Lipid Disorders in Insulin Resistance: A Brief Review - PMC (nih.gov)
15. The role of fatty acids in insulin resistance | Lipids in Health and Disease | Full Text (biomedcentral.com)
16. What causes the insulin resistance underlying obesity? - PMC (nih.gov)
17. Insomnia is associated with an increased risk of type 2 diabetes in the clinical setting | BMJ Open Diabetes Research & Care
18. Cortisol and Sleep: Can It Cause Insomnia? What Else? (healthline.com)
19. Insomnia - Symptoms and causes - Mayo Clinic