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By Ross Wollen

December 23rd, 2022

The experts have selected a brand-new focus for doctors and caregivers who treat diabetes: sleep health.

The directive comes from the American Diabetes Association (ADA), which issues a new version of its Standards of Medical Care in Diabetes annually. This is the single most influential document in diabetes treatment, at least for Americans. The recommendations in this guidance govern the way that diabetes is treated in the country.

The 2023 edition, which was released on December 12, has an entirely new section on sleep health and explains in detail why diabetes experts now believe that sleep health can be such an important part of diabetes health.

Here’s the most important takeaway: Diabetes healthcare providers are now recommended to “consider screening for sleep health in people with diabetes” and to “refer to sleep medicine and/or a qualified behavioral health professional as indicated.”

In other words, if you’re having any problems getting healthy sleep, your sleep problems are now officially diabetes problems, and your doctor, nurse, or diabetes educator should help advocate for you to get the sleep help that you need.

Making the Case

We’ve discussed the many connections between sleep and diabetes in detail: The Importance of Sleep Health for Diabetes. Here, we’ll go over the evidence that led the ADA to make the change.

• Sleep disorders are a risk factor for developing type 2 diabetes.

Many elements of suboptimal sleep — including short sleep duration, obstructive sleep apnea, shift work, and insomnia — have been found to correlate with type 2 diabetes development and progression, enough for poor sleep to be named a significant risk factor for the disease.

• Sleep disorders may be a risk factor for developing gestational diabetes.

One large review, which evaluated 16 studies with data on millions of pregnant women, showed that women who got either too little sleep or too much sleep were more likely to develop gestational diabetes. Poor sleep quality, snoring, and obstructive sleep apnea only increased the risk.

• Sleep disturbances make diabetes self-management much more difficult.

If you live with diabetes, you know how true this is. When we’re exhausted, we are not in the right frame of mind to make the kind of methodical decisions that optimal diabetes care so often demands of us.

• Sleep disorders are extremely common in diabetes.

The ADA reports that more than half of people with type 1 diabetes have obstructive sleep apnea. In type 2, it could be as much as 86 percent! Insomnia, sleep disturbances, and restless leg syndrome are all common as well.

That so many people with diabetes deal with sleep disorders is further proof that there’s a significant link between sleep health and metabolic health — and all the more reason for diabetes doctors to make sleep health a priority.

• Diabetes can interfere with sleep (especially type 1).

Intensive insulin management leads to all sorts of sleep disturbances. Insulin pumps and continuous glucose monitors sound alarms in the middle of the night (sometimes these alarms are important, and sometimes they’re erroneous). Extreme blood sugars cause us to wake up drenched in sweat, disoriented, famished, or all of the above.

And then there’s the way that diabetes distress can impact sleep: It’s not easy to sleep well if your head isn’t in the right place, and diabetes is unfortunately associated with very high rates of stress, anxiety, and similar mental health challenges. The ADA cites a qualitative study that identified diabetes-related “emotional distress” as a major cause of sleep difficulties. Putting it all together, some people with diabetes almost never enjoy an uninterrupted good night’s sleep, which puts them at risk of the many health problems associated with poor sleep.

• Sleep therapy can reduce A1C and insulin resistance.

We know from a 2022 study that cognitive behavioral therapy can help patients improve both their metabolism (A1C, fasting blood sugar, and blood pressure) and their sleep quality. Pharmacological intervention may help too; a 2021 study found that both behavioral medication and sleeping pills can improve insulin resistance and may also improve A1C.

Additional Factors

We actually think that the ADA is only scratching the surface here in connecting sleep health to diabetes health:

• Sleep quality is intertwined with diet quality. A poor night’s sleep makes you more likely to binge on unhealthy foods, and unhealthy foods probably lower sleep quality, a vicious cycle.
• Good sleep is essential for a properly functioning immune system — a special concern for people with diabetes, who are generally more susceptible to infections and illnesses.
• Good sleep is also essential for good mental health, another huge issue for many people with diabetes.
• Sleep quality and quantity can moderate your risk for cardiovascular disease.

We’ve got links and details on all of the above in our article on the importance of sleep health for diabetes.

For ideas on how to create healthier sleep habits, check out this link from our partners at Everyday Health: Sleep 101: The Ultimate Guide to a Better Night’s Sleep.

The Bottom Line

Sleep is a surprisingly important factor in diabetes management, in so many ways. Getting the right amount of sleep isn’t a cure-all, but it can help get your health back on the right track, putting you in the best possible position to manage your diabetes optimally.

If you have sleep issues, it may be time to take them seriously as a health problem that you need to solve. Consider this news an encouragement to discuss any sleep issues with the healthcare provider you see for your diabetes. There’s a growing recognition that sleep health and metabolic health are intimately related, and it may soon become easier for you to get the help you need.