We don’t know yet if not getting enough sleep causes high blood glucose or if high blood glucose causes us not to get enough sleep. But a new study shows for the first time that too little or poor sleep does go along with higher A1C levels.
The Archives of Internal Medicine, a publication of the American Medical Association, on Monday published this new study by Eve Van Cauter, Ph.D., of the University of Chicago’s Department of Medicine, and three colleagues. Dr. Van Cauter is probably the world’s leading sleep researcher, with 154 peer-reviewed articles by her, almost all dealing with sleep.
The study compared sleep duration and quality as reported by 161 patients recruited at the University of Chicago Hospital. Because ethnic groups other than blacks were underrepresented in the sample, they limited the study to that group.
Can we extrapolate the research findings to all of us with diabetes? We don’t have the proof yet. But I don’t see any reason to think otherwise.
The research findings are clear and worth the attention of all of us. The people in the study judged the amount and quality of their sleep in terms of their reported "sleep debt." In those without complications a reported sleep debt of three hours per night went along with A1C levels 1.1 percent above the average. For those with complications the level was 1.9 percent above average.
The medicines that we take for diabetes don’t generally help us bring down out A1C levels any more than this. "The magnitude of these effects is comparable to those of widely used oral antidiabetic agents," the study concludes.
About 20 percent of the people in the study have "sleep-related breathing disorders," generally known as sleep apnea. But even when the researchers excluded this group from their analysis, the connection between high A1C levels and poor sleep remained.
Obstructive sleep apnea is much more common among people with diabetes. Researchers at Sweden’s Uppsala University found that 36 percent of men with type 2 diabetes have severe obstructive sleep apnea, while only 14.5 percent of those with normal blood glucose levels have it.
Both diabetes and sleep apnea are characterized by insulin resistance. And several studies have found that CPAP treatment significantly improved the insulin sensitivity of people with diabetes.
A few years ago a doctor diagnosed that I have sleep apnea, and I have been using a CPAP device ever since. My wife says, however, that I don’t snore any more, so my weight loss on Byetta may have cured my sleep apnea. But now I am so used to sleeping with the CPAP that I haven’t yet been able to sleep without it
If you have sleep apnea, you need to deal with it, and except for long-term weight loss, a CPAP device is generally the best way. It will give you much better sleep in fewer hours.
Whether or not you have sleep apnea, you need to give yourself the opportunity to get enough quality sleep. There really isn’t anything that you can do to help yourself reduce your A1C levels with less effort or cost.
David Mendosa was a journalist who learned in 1994 that he had type 2 diabetes, which he wrote about exclusively. He died in May 2017 after a short illness unrelated to diabetes. He wrote thousands of diabetes articles, two books about it, created one of the first diabetes websites, and published a monthly newsletter, “Diabetes Update.” His very low-carbohydrate diet, A1C level of 5.3, and BMI of 19.8 kept his diabetes in remission without any drugs until his death.