Sugar Plum Fairies
Ask any layman what diabetes is, and chances are that he or she can give you a somewhat accurate answer. Not so for the connection between type 2 diabetes and sleep, as the sugar plum fairies of Tom, Dick, or Harry are anything but innocuous. With 35 percent of Americans reporting less than the recommended seven to nine hours of sleep each night, the gate has been flung open to a horde of health problems on the morning’s horizon, ranging from sleep apnea and compromised immunity to high blood pressure and diabetes mellitus. This wasn’t always the case, however, as Americans used to sleep more in the good old days. Between 1959 and 2002, as the story goes, with the good life becoming ever so much more difficult to attain, and with a shift in the collective psyche toward a workaholic paradigm, the percentage of people sleeping fewer than seven hours a night on a regular basis more than doubled. At the same time, the number of cases of diabetes grew precipitously, and almost overnight the young at heart went from dreaming sugar plum fairies to becoming plump, highly sugared, diabetic patients. Recent studies bear this out.
In a 1999 study published in The Lancet, when a group of healthy young people was restricted to just four hours sleep for six nights in a row, its collective ability to use sugar shifted dramatically to that of old men, demonstrating that adequate sleep promotes not only sound minds but also healthy bodies. Then came a study published in the 2008 Proceedings of the National Academy of Sciences demonstrating the influence of deep, or slow-wave, sleep on the risk of developing diabetes. When deep sleep was restricted, metabolic changes increasing the risk of diabetes occurred. Voilà! It became clear that not only the amount but also the quantity of sleep were key to diabetes prevention. Now, while these and other studies show that sleep can affect sugar metabolism, there has been no definitive proof to date that inadequate sleep causes diabetes. To assert anything else would be tantamount to laying claim to being an eyewitness to unicorns, fairies, or the Loch Ness monster. The jury is still out, however, and the evidence is mounting. For example, a 2010 study in Diabetes Care found that people with sleep problems or some form of chronic insomnia are more likely to develop type 2 diabetes than sound sleepers. So, the next time the boss at work catches you taking a snooze or an afternoon siesta, just claim you’re increasing your productivity by preventing type 2 diabetes.
Now, this is all well and good, but let’s not place the cart before the horse in all cases. What about those unfortunate souls that are already prey to diabetes? How does sleep affect their conditions? The relationship between adequate sleep and enhanced immunity has been shown time and time again, but what about the connection between sleep and hemoglobin A1C (or average blood sugar over two to three months)? The reader knows where this is going. Otherwise, the author would have never brought it up. A 2006 study published in the Archives of Internal Medicine, in fact, found that diabetics reporting poor quality sleep were victim to higher A1Cs. Not only that, but a chain of events is set in motion that leads to high blood pressure also, and we have all heard in our favorite televised news programs that lack of sleep makes dieting that much more difficult.
The brain has an internal clock, or circadian rhythm, as it is commonly known, that is closely linked to sugar metabolism and other bodily functions. When the clock is out of synch, due to too little sleep, sleep at the wrong times, or unnatural sleep, as well as a high-fat diet, the normal harmony between the clock and behavior is disrupted. Instead of the pancreas producing more insulin by day and more glucagon, an additional hormone to keep the body fueled, at night, chaos ensues. So, once again, sleep becomes a major protagonist, center stage, in the drama of diabetes. The question remains, however, does better sleep in habitually poor sleepers prevent or improve diabetes? Can something as simple as sleep be a magic bullet in the arsenal amassed against this chronic malady? While it is still too early to tell, studies have shown that treatment of obstructive sleep apnea (OSA) improves both sleep and blood sugar levels. There may be a direct connection, indeed!
To ensure that sugar plum fairies are the food of our dreams, and not the result of our dreams of food, we can make a concerted effort to get more and better sleep by scheduling bed and wake-up times at the same times each day, avoiding nicotine, caffeine, and alcohol, exercising early, not late, in the day, removing the television from the bedroom, not going to bed on a full or empty stomach, and, when all else fails, seeking professional help for prescription or over-the-counter sleep medications. Being a dreamer has had a bad connotation for far too long now!
© 2011, Albert M. Balesh, M.D. All rights reserved.
In a 1999 study published in The Lancet, when a group of healthy young people was restricted to just four hours sleep for six nights in a row, its collective ability to use sugar shifted dramatically to that of old men, demonstrating that adequate sleep promotes not only sound minds but also healthy bodies. Then came a study published in the 2008 Proceedings of the National Academy of Sciences demonstrating the influence of deep, or slow-wave, sleep on the risk of developing diabetes. When deep sleep was restricted, metabolic changes increasing the risk of diabetes occurred. Voilà! It became clear that not only the amount but also the quantity of sleep were key to diabetes prevention. Now, while these and other studies show that sleep can affect sugar metabolism, there has been no definitive proof to date that inadequate sleep causes diabetes. To assert anything else would be tantamount to laying claim to being an eyewitness to unicorns, fairies, or the Loch Ness monster. The jury is still out, however, and the evidence is mounting. For example, a 2010 study in Diabetes Care found that people with sleep problems or some form of chronic insomnia are more likely to develop type 2 diabetes than sound sleepers. So, the next time the boss at work catches you taking a snooze or an afternoon siesta, just claim you’re increasing your productivity by preventing type 2 diabetes.
Now, this is all well and good, but let’s not place the cart before the horse in all cases. What about those unfortunate souls that are already prey to diabetes? How does sleep affect their conditions? The relationship between adequate sleep and enhanced immunity has been shown time and time again, but what about the connection between sleep and hemoglobin A1C (or average blood sugar over two to three months)? The reader knows where this is going. Otherwise, the author would have never brought it up. A 2006 study published in the Archives of Internal Medicine, in fact, found that diabetics reporting poor quality sleep were victim to higher A1Cs. Not only that, but a chain of events is set in motion that leads to high blood pressure also, and we have all heard in our favorite televised news programs that lack of sleep makes dieting that much more difficult.
The brain has an internal clock, or circadian rhythm, as it is commonly known, that is closely linked to sugar metabolism and other bodily functions. When the clock is out of synch, due to too little sleep, sleep at the wrong times, or unnatural sleep, as well as a high-fat diet, the normal harmony between the clock and behavior is disrupted. Instead of the pancreas producing more insulin by day and more glucagon, an additional hormone to keep the body fueled, at night, chaos ensues. So, once again, sleep becomes a major protagonist, center stage, in the drama of diabetes. The question remains, however, does better sleep in habitually poor sleepers prevent or improve diabetes? Can something as simple as sleep be a magic bullet in the arsenal amassed against this chronic malady? While it is still too early to tell, studies have shown that treatment of obstructive sleep apnea (OSA) improves both sleep and blood sugar levels. There may be a direct connection, indeed!
To ensure that sugar plum fairies are the food of our dreams, and not the result of our dreams of food, we can make a concerted effort to get more and better sleep by scheduling bed and wake-up times at the same times each day, avoiding nicotine, caffeine, and alcohol, exercising early, not late, in the day, removing the television from the bedroom, not going to bed on a full or empty stomach, and, when all else fails, seeking professional help for prescription or over-the-counter sleep medications. Being a dreamer has had a bad connotation for far too long now!
© 2011, Albert M. Balesh, M.D. All rights reserved.
posted by Dr. Al at
6/11/2011 07:01:00 PM
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