A common issue for people living with diabetes, and their carers, is getting enough good quality, uninterrupted sleep. Statistics suggest that up to 45% of adults and almost 50% of teenagers do not get enough sleep.

People living with diabetes can face significant sleep disruption because of issues such as:

• Anxiety due to nocturnal hypoglycaemia (for both those living with diabetes and their carers)
• Alarms set to check blood glucose levels during the night
• Waking to go to the toilet during the night
• Fluid requirements due to a dry mouth and high blood glucose levels
• Snoring, tossing and turning from sleep apnoea

However, some of the newer technologies now available are proving to be very effective in managing the issues that have traditionally interrupted sleep.

Continuous glucose monitors (CGM)

Significant game changers are continuous glucose and flash monitoring devices, such as Dexcom G6, Medtronic Guardian 3 and Freestyle Libre 2.

These devices are wearable sensors that contain a soft filament which sits below the skin in the interstitial fluid. This sensor measures the blood glucose levels of the person wearing the device approximately every five minutes, continuously. This data is then either sent to a smart phone or a “reader”. The smart phone or reader interprets the data and will set off an alarm if the blood glucose reading is heading high or low, thus preventing a hyperglycaemic or hypoglycaemic episode. The alarm will inevitably wake a person up if necessary.

One of the most beneficial aspects of continuous glucose monitors is that the alarms for highs and lows can also be sent to a carer’s smart phone. These alarms raise awareness that a person living with diabetes may be about to experience nocturnal hypoglycaemia, and wake them and their carers to treat the low blood glucose.

Insulin pumps

Insulin pumps made for people living with type 1 diabetes deliver rapid acting insulin through tubing and pump 24 hours a day, rather than up to five (or with corrections, more) daily injections. One of the benefits of an insulin pump in aiding sleep improvement is the capacity to program the insulin requirements of the person wearing the insulin pump.

Basal insulin (or background insulin) is required to ensure that the body’s cells have a steady supply of glucose to use for energy when a person is not eating, such as overnight.

Basal insulin requirements are affected by body size, physical activity levels, stage of growth and hormone levels. The dawn phenomenon is where people experience an abnormally high blood glucose level in the morning due to growth hormone and cortisol. For those using long-acting basal injections, their insulin activity frequently begins to wane during the early morning hours (depending on the type of insulin and route of administration). As a result, there is not enough insulin to prevent hyperglycaemia. However, insulin pumps can be programmed to an individual’s basal insulin requirements based on continuous monitoring blood glucose data. This will help to keep blood glucose levels in target and prevent glucose rises and falls.

Continuous positive airway pressure (CPAP) machines

Sleep apnoea is a condition where a person’s throat becomes partially or completely blocked while they are asleep, causing them to stop breathing. As a result, blood oxygen levels fall. Sleep apnoea is commonly experienced by people living with type 2 diabetes, although those living with type 1 diabetes can also experience this condition. Symptoms of sleep apnoea include:

• A pause 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

Mild sleep apnoea is often relieved or reduced by changing sleep positions. Moderate to severe sleep apnoea requires active treatment. This may require devices such as a continuous positive airway pressure (CPAP) machine which can be fitted by a specialist or pharmacist that has been trained in fitting sleep apnoea devices. CPAP machines enable those living with sleep apnoea to experience a better night sleep.

Sleep apps

Smart phone apps are a great resource that can be used to help analyse and improve sleep. Useful apps include:

• Sleep tracking apps – These apps analyse sleep patterns such as snoring and sleep talking, and monitor bedtime behaviour patterns to help improve sleep habits. Examples include: SleepScore and Sleep Cycle
• Sleep apnoea apps – These apps record and interpret snoring and advise if you are at risk of sleep apnoea. Examples include SnoreLab, Snore Control and SleepCheck
• Screen time apps – These apps can help you analyse your personal screen time usage and place limits around screen time which may be most useful in the evening prior to bedtime. Examples include: Digital Wellbeing (Android), IOS Screen time (Apple) and screen restriction apps such as Space and Freedom

We wish you a goodnight and sleep well!

By Alison Crow, Pharmacist and CDE