Getting enough sleep is essential for good health.  

Often people do not get enough good quality sleep during the nightIssues for people with diabetes include experiencing poor quality sleep due to overnighvariations in blood glucose levels (BGL), BGL monitoring and alarmsor from experiencing symptoms of diabetes including having a dry mouth or the need to pass urine during the night.1 Sleep apnoea may also be an issue.  

What is Sleep Apnoea? 

Sleep apnoea is a common sleep condition, where a person’s throat becomes partially or completely blocked while they are asleep, causing them to stop breathing.2 As a result, blood oxygen levels fall.3 Typically, people stop breathing from a few seconds up to ninety secondsThe person wakes briefly and begins breathing again. This can happen many times in a night and is known as apnoeas. The person is often unaware this occurs but generally feels tired.2 

When people are diagnosed with diabetes, it is thought that between 50-80% of people also experience sleep apnoea.1  

Symptoms and Causes 

Adults and children can both experience sleep apnoea. The symptoms of sleep apnoea include: 

  • Pausing in breathing while sleeping, that other people notice, 
  • Tossing and turning, 
  • Snoring, 
  • Waking up and choking or gasping for air, 
  • Feeling tired and unrefreshed after sleeping. 

Often adults who are middle aged or older and who are above the recommended healthy weight range are affected. Excess weight can cause narrowing of the throat due to fatty tissue. A larger waistline can make the area around the lungs smaller, causing the throat to collapse. People can be born with a narrower facial structure and throat which may also be the cause of sleep apnoea.  

There is a strong link between sleep apnoea and the incidence of type 2 diabetes.4 A small pilot study showed 40% of adult participants with type 1 diabetes also had sleep apnoea.5 

Children can experience sleep apnoea, this is generally as a result of enlarged tonsils or adenoids.2   However, a study that reviewed sleep apnoea in a group of children aged 5 – 11 years with type 1 diabetes, found children with type 1 diabetes were more likely to experience sleep apnoea compared to those children that did not have type 1 diabetes. The risk of sleep apnoea episodes was higher in children that had haemoglobin A1C (HbA1c) results higher than 8.0%, when compared to those children with a lower HbA1c result.5 

As type 2 diabetes increases amongst children and teenagers, sleep apnoea will need to be considered if sleep issues arise.  

Treatment 

People that sleep on their backs are more likely to experience sleep apnoea episodes.1 Sleeping on your side reduces the likelihood of sleep apnoea occurring. Devices such as special pillows or wedges may help. 

Good sleeping habits and routine prior to bed can help improve sleep. Achieving a healthy weight and reducing alcohol consumption can also help reduce and relieve sleep apnoea in adults. 

Mild sleep apnoea is often relieved or reduced by changing sleep positions. Moderate to severe sleep apnoea requires active treatment. This may require device such as a continuous positive airway pressure (CPAP) machine or an oral appliance such as a mouth guard that is fitted by a specialist dentist.1 

Investigations into sleep apnoea via a sleep study can occur in a number of ways.  

Level 1 Sleep Study

General practitioners can screen for sleep apnoea via a screening questionnaire and refer to a sleep specialist for a level 1 sleep study or polysomnography. This may require an overnight stay in a sleep lab or sleep hospital, fully supervised and observed. This can be Medicare funded, but there is usually an out of pocket payment that may be covered by some private health insurance policies.6 This can occur in the private and public health systems. Public health sleep services generally have a long wait period. 

Level 2 Sleep Study 

A level 2 sleep study is similar to level 1; however, it occurs inhome and without supervision. The service may be Medicare funded via general practitioner referral. Results are still reviewed by a sleep physician. 6 

Level 3 Sleep Study 

A level 3 sleep study is often offered in pharmacies without a referral. This type of sleep study is not as comprehensive as a level 1 or 2 sleep study but the data is still assessed by a sleep physician and a sleep report produced. 6 This type of service may suit time poor people or those who do not have ready access to sleep clinics. 

CPAP is usually recommended to help with sleep apnoea. Some private health insurers may cover some of the cost of CPAP machines. Those with private health insurance are recommended to investigate if their health insurer will cover the cost of CPAP machines. 

Children who appear to live with sleep apnoea are recommended to be referred to paediatric sleep specialists for review. 

 

References 

  1. Sleep Health Foundation. Diabetes and Sleep. Accessed 20th August 2020 from https://www.sleephealthfoundation.org.au/diabetes-sleep.html 
  1.  Health Direct. Sleep Apnoea. Accessed 20th August 2020. From https://www.healthdirect.gov.au/sleep-apnoea 
  1. Sleep Health Foundation. Obstructive Sleep Apnea (OSA). Accessed 20th August 2020 from https://www.sleephealthfoundation.org.au/obstructive-sleep-apnea.html 
  1. Reutrakul, S. and Mokhlesi, B. 2017.  Obstructive Sleep Apnea and Diabetes. A State-of-the-Art Review. Chest. Vol:5 Issue: 152. Pp 1070-1086. 
  1. Farabi, S. 2016. Type 1 diabetes and sleepDiabetes Spectrum.Vol:29, issue 1. P 10-13. 
  1. Australasian Sleep Foundation. Obstructive Sleep Apnoea for Health Professionals. Accessed 28th August 2020 from https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0006/212919/Obstructive_Sleep_Apnoea_Guidelines.pdf 
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