Sleep apnea is a far greater problem than it gets credit for — especially for people living with diabetes.
Difficult to diagnose without proper overnight testing, too many people struggling to breathe properly during their sleep may not have any idea they aren’t getting enough oxygen every night.
But sleep apnea can impact many aspects of your day-to-day life and overall health. And its link to diabetes is indisputable.
In this article, we’ll discuss what sleep apnea is, common causes and symptoms, its relationship with type 1 and type 2 diabetes, and today’s best treatment options.
What is sleep apnea?
Sleep apnea (also known as “obstructive sleep apnea” or “OSA”) is a condition defined by long pauses in breathing while you sleep. To qualify, the pause of breathing must be at least 10 seconds long, according to the National Sleep Foundation.
The pause in breathing is the result of muscles of the back of your throat closing partially or failing entirely to stay open for varying periods of time while you sleep.
The reason these pauses in breathing are worrisome and troublesome is that it can create a significant lack of oxygen in your blood which then leads to a variety of other problems.
Consequences of untreated sleep apnea
- Daytime exhaustion and fogginess
- High blood pressure
- Cardiac arrhythmia
- Congestive heart failure
- Heart attack
- Depression and mood issues
- Memory issues
- Insulin resistance
- Increased risk of type 2 diabetes
- Drowsy driving
OSA can develop in children, too, although less common.
Causes of sleep apnea
While anyone could potentially develop sleep apnea, the following are characteristics or habits that increase your risk of developing the condition, according to Harvard:
- Obesity: about 2/3s of people with OSA are overweight or obese
- Family history of OSA or snoring
- Abnormally smaller lower jaw or other abnormal facial characteristics
- Recessed chin
- Being male: far more people with OSA are male versus female
- Smoking cigarettes
- Large neck circumference
- Large tonsils
- Drinking alcohol before bedtime
- Post-menopausal (for women)
- Hypothyroidism (low levels of thyroid hormone)
- Acromegaly (high levels of growth hormone)
- Being over the age of 40 years old
- Being African-American, Pacific-Islander, or Hispanic
While there is another type of sleep apnea that results from your brain failing to manage normal breathing, that type is rare.
The type most commonly experienced by the general population is obstructive sleep apnea and affects approximately 18 million people in the United States.
The signs and symptoms of sleep apnea are often easy to dismiss or easy to mistake as individual issues rather than many symptoms related to the same condition.
The National Sleep Foundation lists the following as common signs and symptoms of sleep apnea:
- Chronic snoring
- Constantly feeling sleep-deprived
- Difficulty concentrating
- Sexual dysfunction
- Learning and memory difficulties
- Falling asleep during normal daytime activities
If you are a chronic snorer or suspect any of these symptoms may be regularly present in your life, talk to your primary care doctor about scheduling with a sleep specialist who can assess you for sleep apnea.
Sleep apnea and diabetes: how are they related?
Research has demonstrated over and over again that OSA and diabetes have an undeniable relationship, and are often found in the same patient.
Let’s take a look at some of the most significant research.
Sleep apnea increases blood sugar levels
OSA has been found to increase oxidative stress, inflammation, neuroendocrine dysregulation, and alter glucose homeostasis, according to this 2016 study from the American Diabetes Association.
The study’s finding urges healthcare professionals to assess every patient with type 2 diabetes for potential signs of sleep apnea, and vice versa — assessing patients with sleep apnea for high blood sugar levels.
“Early recognition and interventions for OSA can be expected to improve insulin sensitivity and control of hyperglycemia in many patients. Clinicians must remain vigilant for signs and symptoms of OSA and monitor compliance with CPAP along with weight management, diet control, and medication adherence in patients with type 2 diabetes.”
Sleep apnea linked to insulin resistance and type 2 diabetes
This 2018 report on OSA evaluated dozens of studies on the condition and its implications and connections with other conditions.
Sleep apnea increases your risk of type 2 diabetes
This 2017 study from Taiwan determined that patients with OSA had a much higher likelihood of developing type 2 diabetes. In contrast, the study also determined that patients with type 2 diabetes did not necessarily have a higher likelihood of developing OSA.
This simply means that OSA seems to be a precursor for developing type 2 diabetes, but type 2 diabetes is not a precursor to developing OSA in patients who have not already developed this sleep condition.
A 2018 study from Japan echoed similar findings.
“OSA patients are more likely than non-OSA populations to develop type 2 diabetes, while more than half of type 2 diabetes patients suffer from OSA.”
Using a CPAP to treat OSA improves insulin resistance
A CPAP device — which stands for “continuous positive airway pressure” — is the primary method of treatment for OSA, and this 2018 study from Japan found that consistent use of a CPAP improves a patient’s levels of insulin resistance.
“CPAP improved glucose metabolism determined by the oral glucose tolerance test in OSA patients, and several studies have shown that CPAP improves insulin resistance, particularly in obese populations undergoing long-term CPAP.”
This is significant in terms of treating a patient with both OSA and type 2 diabetes. By treating the OSA, the patient may see modest to moderate improvements in their blood sugar levels and overall diabetes health, too.
Both type 2 diabetes and OSA increase risk of cardiovascular disease
“As both diabetes and OSA lead to cardiovascular disease, clinicians and healthcare professionals should be aware of the association between diabetes and OSA,” explains the same 2018 study from Japan.
The study suggests that healthcare professionals should heavily consider treating patients with type 2 diabetes and/or OSA with a CPAP device to reduce the known stress both conditions have on a patient’s cardiovascular system.
OSA increases the risk of STDR (sight-threatening diabetic retinopathy)
This 2017 study from the United Kingdom found that patients with type 2 diabetes and existing diabetic retinopathy had a significantly increased risk of developing proliferative diabetic retinopathy, which is defined by the patient’s worsening vision.
Using a CPAP device to treat the OSA resulted in a reduction of the progression of the STDR in these patients, but it was determined that further studies are needed to focus more intensely on the benefits of treating OSA to inadvertently treat STDR.
Patients with type 1 diabetes have a higher risk of OSA
“The prevalence of asymptomatic OSA is high in a cohort of patients with type 1 diabetes,” determined a 2017 study from Denmark.
Other risk factors for the type 1 diabetes population included being older, overweight, and existing diagnosis of nephropathy (kidney disease).
“OSA was present in 32 percent of the patients with normal BMI, in 60 percent of overweight patients, and in 61% of obese patients,” explains the study.
Additionally, the study found that patients with type 1 diabetes and OSA showed very few symptoms, particularly very rarely reporting sleepiness compared to patients without OSA. This makes it harder to catch, diagnose, and treat.
Healthcare professionals treating patients with type 1 diabetes should keep in mind that this population should be potentially screened for OSA if they are also over the age of 40, overweight, and have nephropathy.
If you think you may have sleep apnea, the first place to start seeking help is through your primary care doctor.
Most likely, if you share your bed with a partner, it isn’t going to be news to you that you have a severely loud or disruptive snore. You might even want to try setting your phone up to record the sound of your own snore. This alone could reveal long gaps in breathing or very turbulent, inconsistent snore rhythms.
Your doctor will then recommend you partake in a sleep study which means you’ll stay overnight at a “sleep center” to have your breathing monitored for an entire night.
They will also monitor your eye movement, muscle activity, heart rate, respiratory effort, airflow, and the amount of oxygen in your blood.
This will give your healthcare team a clear understanding of whether or not you have sleep apnea, and how severe your sleep apnea may be based on just how little oxygen your body is getting while you sleep.
The number one treatment for sleep apnea, as mentioned earlier, is a CPAP device.
A CPAP looks more uncomfortable than it really is, which can deter patients from pursuing getting treated in the first place.
A CPAP is a mask that fits over your mouth and/or your nose, and it blows air into your airway to help keep it adequately open while you sleep.
Research has found that it is by far the most effective treatment for sleep apnea, but one tricky aspect of this method is getting patients to use it consistently.
The device itself also makes a light and soft noise when it’s turned on, which is similar to the sound of a noise machine. Ideally, the sound itself doesn’t interfere with your sleep and possibly improves your sleep by providing white noise.
What else can you do to treat sleep apnea? Let’s take a look at all of the options recommended by the National Sleep Foundation:
- Continuous positive airway pressure (CPAP) device: A mask that covers your mouth and/or nose and delivers air to help keep your airway open while you sleep
- Oral Pressure Therapy (OPT): Similar to a CPAP device but without the mask, this treatment is a mouthpiece that delivers air to help keep your throat properly open while you sleep.
- Expiratory Positive Airway Pressure (EPAP): This device covers your nostrils with a disposable adhesive valve that opens and ensures your airway stays open.
- Dental appliances to reposition jaw and tongue
- Upper airway surgery to remove excess tissue: If you have an anatomical facial abnormality, it could be corrected with surgery and enable your jaw and throat to stay open properly during your sleep.
- Lose weight: Weight-loss can have a significant impact on sleep apnea. If you’re reluctant to use a device, let sleep apnea be the motivation you need to lose weight.
- Avoid, reduce, or limit alcohol intake
- Quit smoking
- Sleep on your side instead of on your back
While sleep apnea doesn’t sound terribly alarming at first, it can create a great deal of stress in the body and in your life if left untreated.
This easy-to-miss condition can put your longterm health in danger. Don’t hesitate to get tested if suspect you may be struggling with sleep apnea.