The Link Between Sleep Apnea and Diabetes

A good night’s sleep is essential to maintaining our overall health and wellbeing.

Sleep helps you feel better, regulates hunger, prevents your body from being overly stressed, and has a lot of other important functions for the human body.

One common cause of sleep disturbances is a condition called sleep apnea, and it can have a host of negative health effects, especially on blood sugar levels and glucose dysfunction.

In this article, Nutrisense dietitian Katrina Larsen, MS, RD,N, LD, CDCES will discuss how sleep apnea can affect individuals with diabetes and share evidence-based lifestyle tips for improving sleep apnea.

So, let’s take a deep dive into the risk factors for sleep apnea and the link between sleep apnea and diabetes care.

What is Sleep Apnea?

Sleep apnea is a type of sleep disorder that causes interrupted sleep. In sleep apnea, your body stops breathing for a period of time before starting again. This typically happens multiple times throughout the night.

According to the Sleep Foundation, people who have obstructive sleep apnea will experience interrupted sleep due to their breathing being obstructed throughout the night. This creates sleep fragmentation, which negatively affects your quality of sleep and can even lead to higher blood pressure.

This condition can be diagnosed through a test called polysomnography. Home sleep tests can also be conducted to monitor your heart rate and breathing patterns.

Different Types of Sleep Apnea

Obstructive Sleep Apnea

Obstructive sleep apnea, or OSA, is characterized by restricted upper airways, which can lead to reduced breathing while sleeping.

The obstruction is usually due to the throat and respiratory muscles relaxing too much, and can be caused by hormones, large tonsils, or even obesity. Individuals with symptoms of OSA may experience daytime sleepiness.

Central Sleep Apnea

This type of sleep apnea has less to do with muscle, and more to do with brain signals.

In central sleep apnea, the area of the brain that regulates breathing may have poor communication with breathing muscles. This can be caused by improper signaling, a poor mind-muscle connection, or an issue with that specific brain region.

Risk Factors for Sleep Apnea

There are a variety of factors that can increase your risk for sleep apnea. Here are the most common ones discussed in a systematic review of the condition:

• Living at higher altitudes
• Family history of obstructive sleep apnea (OSA)
• Old age

• Craniofacial abnormalities. A certain skull and face structure can contribute to poor muscle tone.
• Obesity or a high BMI
• Metabolic syndrome
• Smoking
• Alcohol use

The Sleep Apnea and Type 2 Diabetes Connection

So, how are sleep apnea and type 2 diabetes mellitus connected?

Research shows that type 2 diabetes, which affects glycemic control and blood sugar levels, is associated with OSA. In fact, OSA is more prevalent in those with type 2 diabetes compared to non-diabetics.

People who have sleep apnea (specifically OSA) are also more likely to develop type 2 diabetes. According to the American Diabetes Association, sleep apnea can also affect glucose metabolism in individuals with type 2 diabetes.

This may be because the two conditions can cause low grade inflammation, oxidative stress (this can be created by elevated glucose levels over time), and changes in hormones.

Sleep apnea can also affect heart health. This condition has been associated with high blood pressure and cardiovascular disease, which are commonly linked to high blood sugar or hyperglycemia.

Negative Health Benefits of Poor Quality Sleep and Sleep Apnea

Over time, the short-term effects of poor quality sleep can add up and lead to other health conditions such as:

Emotional Distress

Mental health disorders such as depression have been associated with disrupted sleep and emotional distress, especially in teenagers. Poor quality sleep can also lead to reduced quality of life in those with chronic conditions.

Reduced Cognitive Function

Interrupted sleep can lead to a reduced ability to think and remember in healthy individuals. It can also cause brain fog and affect your mood.

Increased Risk of Cardiovascular Problems

Sleep deprivation or interruption can lead to the “fight or flight” stress activation in your body and cause vasoconstriction (or narrowing of your blood vessels). This proinflammatory state can increase your risk of conditions such as hypertension and other cardiovascular issues like heart disease.

Poor Metabolic Health or Metabolic Syndrome

Disrupted sleep can negatively affect metabolic health by reducing insulin sensitivity. This can also affect energy metabolism, and can even cause overeating.

Long-term disrupted sleep has been associated with type 2 diabetes, dyslipidemia (or poor blood lipid levels) especially in obese patients. Individuals with OSA may find they have impaired glucose tolerance (or glucose intolerance).

Increased Risk of Certain Cancers

Sleep disruption can increase your risk of cancer. One large study done in the Taiwanese population found that those who had interrupted sleep (either from insomnia or obstructive sleep apnea) had increased risk of breast, nasal, and prostate cancers.

Research also suggests that interrupted sleep can also increase the risk of colorectal cancer.

How is Sleep Apnea Treated?

There are a variety of ways that your doctor may choose to treat your sleep apnea. 

The most common treatment option involves the use of a CPAP, or continuous positive airway pressure machine. This machine helps regulate your breathing into “healthier patterns” to disrupt the constant stop and start pattern of your breathing. 

Research shows that CPAP therapy can reduce insulin resistance. It may also help improve glycemic control in type 2 diabetic patients or those who have been diagnosed with prediabetes. 

Some sleep studies show that the effects of continuous positive airway pressure can include improved glucose tolerance, especially in those who have more severe OSA.

Other Factors Affecting CPAP

Some research suggests that the effects of CPAP may be dependent on body weight. Those who use a CPAP treatment and lose weight during this treatment appear to be more likely to reap the benefits of better glycemic control.

Weight loss done in a healthy, sustainable way can maximize your success as you use a CPAP. This is where dietitian support can be beneficial in ensuring improvements in both sleep apnea and glucose control (leading to optimized blood glucose levels).

Dietitian-Recommended Lifestyle Changes to Improve Sleep Apnea

Some lifestyle changes can be effective at addressing sleep apnea and improving sleep quality. Our dietitian nutritionist and certified diabetes specialist, Katrina Larsen, MS, RD,N, LD, CDCES, has had extensive experience working with individuals with diabetes.

Here is what Katrina had to say on the effects and treatment options of sleep apnea.

First Steps for Sleep Apnea Treatment

“First and foremost, if you suspect you have obstructive sleep apnea, I recommend you get evaluated by a qualified professional.

“If you already do have a diagnosis, make sure your adaptive equipment fits right and works well. For example, a CPAP machine might be prescribed to help your airway stay open while sleeping. If it doesn’t fit well, though, it won’t do its job. 

“If you suspect your CPAP isn’t fitting well or working right, don’t delay in addressing it. Every night you sleep with a restricted airway is another night of potentially higher glucose levels, increased insulin resistance, and higher risk for developing complications.” 

Weight Loss, Glucose Levels, and Sleep Apnea

On the effects of obesity, Katrina advises: “If you are in a larger body, you may be more prone to sleep apnea. Reducing body size through weight loss has been shown to improve sleep apnea in some cases.

However, lean people and people with smaller bodies can absolutely experience sleep apnea as well. Over 50 percent of people with diabetes have sleep apnea.”

“Snoring also has a very high association with sleep apnea. It’s clear that sleep apnea can lead to diabetes and if you already have diabetes, sleep apnea can make it more difficult for you to manage your glucose levels.

“When breathing patterns are interrupted, carbon dioxide increases in your blood and can impact your insulin sensitivity. If you snore or have sleep apnea, it is important to pay close attention to your glucose levels and take measures to prevent or manage your glucose.”

Other Treatment Options for Sleep Apnea

“Exercise can also be a very powerful tool for managing glucose and improving insulin sensitivity,” shares Katrina.

Managing carbs and stress levels are also really important for maintaining health with sleep apnea. Using a continuous glucose monitor is one of the best ways to get insight into your own glucose patterns and help you see how your lifestyle changes impact your glucose patterns.”