The Link Between Sleep Apnea And Diabetes

What is sleep apnea?

Sleep apnea is a sleep disorder that causes a person to stop breathing intermittently throughout the night. This condition can be mild or severe and can have a significant impact on your quality of life.

Getting adequate sleep is important for things like focus, attention, memory, and other cognitive functions that allow us to carry out our daily activities and perform well in work and life. Sleep apnea causes nightly disruption that can leave people feeling fatigued, even after eight or more hours of sleep.

Types of sleep apnea

There are three types of sleep apnea:

• Obstructive sleep apnea

• Central sleep apnea

• Complex sleep apnea syndrome

Obstructive sleep apnea

This is the most common type of sleep apnea. When the throat muscles relax during sleep, it can lead to loud snoring and choppy breathing patterns. Obstructive sleep apnea often runs in families. 

Central sleep apnea

This type of sleep apnea is characterized by breathing that starts and stops at quick intervals. Central sleep apnea is caused by the brain not sending the right signals to the muscles in your throat that control your breathing. It's often the result of other health conditions, like stroke or heart failure.

People with central sleep apnea may still snore, but it tends to be less loud and frequent than those with obstructive sleep apnea. 

Complex sleep apnea syndrome

This condition is also called treatment-emergent central sleep apnea. It is a combination of obstructive and central sleep apnea.

The condition sometimes appears when a person receives treatment for obstructive sleep apnea¹ with a continuous positive airway pressure (CPAP) machine, which leads to the development of central sleep apnea.

Symptoms of sleep apnea

All three kinds of sleep apnea tend to cause a similar set of symptoms, including:

• Fatigue and sleepiness

• Headaches

• Snoring 

• Gasping or choking while sleeping

• Sore throat and dry mouth in the morning

• Reduced attention span

• Frequent urination at night

• Night sweats

• Irritability

Not everybody with sleep apnea will experience all of the above symptoms, but you can make an appointment to speak with your doctor if you experience several of them for an extended period of time.

Although symptoms often resolve with proper treatment, there are some long-term effects that can occur if sleep apnea is left untreated.

Long-term effects of sleep apnea

When sleep apnea is left untreated, it can lead to an increase in blood pressure, heightened inflammation around the body, and changes in both carbon dioxide and oxygen levels. These factors can substantially increase a person's risk for heart arrhythmias and heart failure over time. In fact, approximately 50% of people with sleep apnea also have atrial fibrillation or heart failure. 

Other long-term effects of untreated sleep apnea include an increased risk of diabetes, stroke, obesity, and more.

Risk factors of sleep apnea

Anyone can develop sleep apnea, but there are certain risk factors that increase a person's likelihood of suffering from the condition. Some of the most common risk factors of sleep apnea include:

• Being born male

• Having a family history of sleep apnea

• Being an older adult

• Regularly drinking alcohol and smoking

• Being overweight or obese

People with one or more of these risk factors won't necessarily develop sleep apnea, but they are more likely to than people without the risk factors. 

Direct causes of sleep apnea

Sometimes sleep apnea arises independently, and at other times it is directly caused by another condition or factor. Some common causes of sleep apnea include having:

• A neuromuscular disorder, like amyotrophic lateral sclerosis (ALS)

• Heart failure

• Lung disease

• Kidney disease

These conditions are listed as a direct cause of sleep apnea rather than just being associated with the condition because, in many cases, sleep apnea would not exist in a person unless the above conditions were present first. 

Does sleep apnea cause diabetes?

No, sleep apnea does not directly cause diabetes. However, many people with diabetes also have sleep apnea and vice versa. This is because the risk factors associated with sleep apnea are also associated with diabetes, though you can develop one or both conditions even if you don't have any risk factors.

Sleep apnea may not be a cause of diabetes, but it can still impact an existing diabetes diagnosis. 

How sleep apnea affects diabetes

The main way that sleep apnea impacts diabetes is by an increased carbon dioxide level in the blood due to periods of not breathing while sleeping. Increased blood carbon dioxide levels worsen insulin resistance. Insulin is the hormone responsible for allowing glucose from the blood into your cells, where glucose is used as energy. Insulin resistance makes this process more difficult, leading to higher blood sugar. 

This is especially problematic for people with diabetes who are trying to control blood sugar levels that are already elevated. It can be difficult to get your diabetes under control while you struggle with sleep apnea.

It is important to talk to your doctor if you think you have sleep apnea, especially if you already have diabetes.

Preventing sleep apnea

Most doctors and medical professionals agree that taking steps toward prevention when possible is better than treating a condition after it develops. The same is true for sleep apnea², though not every case of sleep apnea can be prevented.

People with smaller airways or who develop a neuromuscular disorder may not be able to do much to prevent sleep apnea, but there are steps that you can take to reduce your odds of developing sleep apnea.

Making lifestyle changes is the best way to prevent sleep apnea. These include:

• Reducing or completely eliminating alcohol consumption

• Quitting smoking

• Achieving or maintaining a healthy weight through a balanced diet and regular exercise

• Eliminating the use of sleep medications, which can relax the muscles in your throat

• Sleeping on your side instead of on your back

These lifestyle changes won't prevent everybody from developing sleep apnea, but they can help some people avoid the condition. They can also help to improve symptoms of sleep apnea once they arise.

Treatment options for sleep apnea

Besides the lifestyle changes mentioned above, there are a few excellent treatment options for sleep apnea that can help you sleep better, wake up feeling more rested, and reduce the other unpleasant symptoms associated with the condition.

Before you can receive treatment, your doctor will review your symptoms and family history, and they may order a sleep study. Home sleep tests are now available, which can be done at home instead of in a sleep laboratory for people who don't have other sleep disorders and severe medical problems.

If you do have other conditions, your doctor may recommend a polysomnogram (PSG), which allows a healthcare professional to monitor different elements while you sleep in a sleep study lab. 

If you are given a diagnosis of sleep apnea, you  are likely to receive one or more of these common treatments:

Mechanical therapy

Mechanical therapy also referred to as positive airway pressure (PAP) therapy, involves using machines that send air into the nose and mouth while you sleep. The most common device is the CPAP machine, but there are also bi-level PAPs and adaptive servo-ventilation (ASV). 

Mandibular advancement devices

Mandibular advancement devices bring the lower jaw forward or prevent the tongue from blocking the throat. These dental devices can help to ease snoring and reduce the symptoms associated with mild to moderate obstructive sleep apnea.

Surgery

If you don't respond to other treatments, or the structure of your throat is the cause of your sleep apnea, your doctor may recommend surgery. The most common surgical procedures for sleep apnea are minimally invasive, and usually don't require a long recovery time.

Tips for better sleep

If you struggle to get a solid night of sleep on most occasions, there are a few ways to help improve your sleep in the short- and long-term, such as:

• Avoid caffeine in the afternoon and evening

• Reduce alcohol and nicotine intake, especially later in the day

• Keep naps short and early in the day

• Only use your bed for sleeping and sexual activity

• Exercise during the morning or afternoon

If you still struggle to sleep after trying the above measures, or you continue to wake up drowsy, talk to your doctor about further interventions. 

The lowdown

Sleep apnea and type 2 diabetes share similar risk factors, though sleep apnea is not considered a direct cause of type 2 diabetes.

Whether you have one or both conditions, lifestyle changes can dramatically improve symptoms and your overall health. It is also recommended to see your doctor for regular checkups, as they can help you build and maintain a treatment plan that makes you feel better in both the short and long term.