14 Mar Sleep Well
We’re literally springing forward! If you haven’t already, change the time on your diabetes devices (insulin pump, blood glucose meter, and continuous glucose monitor). And, while missing that extra hour of (precious, seemingly rare) sleep, take stock of what you can do to improve sleep habits as part of diabetes management.
Lack of sleep gets too little attention in how we approach health, particularly diabetes management. Society wears sleep deprivation as a badge of honor—the glorification of a busy, ambitious life and ability to do it all. Reject the notion and reframe the priority. Sleep is staggeringly important, impacting every single area of diabetes – how much we eat, what we choose to eat, how we respond to insulin, emotional rationality, energy to exercise, and far more. Too often, adequate rest falls victim to anxiety (sharp and piercing like a CGM alert that wakes you in the night or a persistent hum muted—but coursing constantly–in the background of life during the pandemic).
Fortunately, lack of sleep is a solvable problem! There are excellent, effective, and cost-free techniques to improve it. Scientists have devoted their careers to developing and proving sleep strategies. (If we’ve learned one thing this year, I hope it’s to value and follow science.)
Why We Sleep: Unlocking the Power of Sleep and Dreams by Dr. Matthew Walker is worthy of the top spot on your “to be read” list. Yes, there is the jaw dropping revelation that, “No facet of the human body is spared the crippling, noxious harm of sleep loss” (Why We Sleep, page 133), AND there are solid tips for better sleep. It makes for an eye-opening read. Forgive the pun.
We’re incorporating valuable takeaways from Dr. Walker’s research, Adam Brown’s piece “The Most Destructive Diabetes Landmine: Lack of Sleep?” and our own hard-won insights into how to minimize type one diabetes (T1D) driven sleep disruptions.
1) Prioritize Sleep
Sleep improves diabetes management, overall health, and learning. But, it’s frustratingly elusive for little ones (“I’m thirsty!,” “One more story?,” I need to go to the bathroom!”), tweens and teens (later circadian rhythms, early school starts, increased workload and emotional pressures), and parents of kids with T1D (“Is that an alert on low?” “Do you have a high BG? Are you checking for ketones?”). Yes, that’s an incredibly inclusive group, covering almost everyone. Everyone.
As Ellie enters the tween years and, appropriately, assumes significantly more of the daily responsibilities of diabetes management, we have discussed potential pitfalls–missed boluses, carb counting inaccuracies, challenging meals, peer pressure, growth spurts/hormones, and self-consciousness centered around the wearing of devices. I thought we covered–and were successfully sidestepping–most diabetes landmines. Unfortunately, we overlooked sleep (arguably the most significant). Lack of sleep drives and damages other metrics of diabetes, as Walker and Brown point out. These include, but aren’t limited to:
- Increasing insulin resistance
- Driving poor food choices and amounts
- Compromising the immune system
- Impacting mood and emotions, raising the risk of depression and anxiety (essentially undermining abilities to manage and cope with diabetes)
2) Avoid or Mitigate Sleep Disturbances
We’re prioritizing sleep even in a pandemic that has played havoc with any hint of normalcy or routine, and we’re taking significant steps to help consistently get better rest:
- Calibrating before bedtime
- Having low to zero carb evening snacks and skipping caffeine entirely (This isn’t about eliminating treats but rather swapping out popcorn for cheese, sidelining diet Coke after mid-afternoon, choosing lighter dinners, etc.)
- Streamlining overnight diabetes management, keeping essential supplies next to the bed (We don’t want to be racing to the refrigerator in the middle of the night to treat a low, and we want Ellie to have everything her health requires at her fingertips—especially overnight. We keep Skittles and juice boxes on her nightstand along with her meter, lancing device, test strips, etc.)
- Using automated insulin delivery technology if available (During the early months of Ellie’s diagnosis we tested her BG every night at midnight and again at 3 a.m. If under 110, we gave her a cup of ice cream with fat to prevent a sudden spike and carbs to prevent an undetected low. Ellie’s closed loop system, with its auto mode for basal delivery and CGM, was a game changer. We breathed an enormous sigh of relief and rested a bit easier with alerts and alarms to signify–and help prevent–overnight emergencies. If your child has automated insulin delivery devices, consult with your endocrinology team about overnight settings. Some people change the settings for alerts so as to not interrupt sleep. We maintain the same settings (i.e., alerting on low at 80) because we still harbor worries about Ellie’s vulnerability to undetected/untreated lows and highs in the overnight hours. We don’t want to inadvertently miss or deliberately ignore any overnight alert. Ever.
- Reducing blue light exposure and limiting technology in the bedroom (This is easier said than done. With distance learning, social distancing, and a bevvy of normal activities cancelled or dramatically reconfigured, Ellie’s phone is not only a direct line to her dearest friends but the conduit for middle school social life. We are a lot more lax than we were in early 2020 and are trying to reign this in to support quality rest. It’s a constant struggle for balance.)
- Consistently going to bed each night and getting up every morning at the same times
3) Identify the need and commit to new behaviors
Why We Sleep is clear that everyone needs a minimum of 7 hours of sleep to function optimally. The National Sleep Foundation recommends younger children (ages 6-12) sleep 9-11 hours nightly and teens (ages 14-17) sleep 8-10 hours per night.
Sleep offers extraordinary benefits for diabetes (and overall health). There is a relatively narrow range of choices and proven habits that can help increase and improve sleep. A no cost management tool that benefits physical and emotional health is the stuff of dreams! Read more, talk over issues with your healthcare team, learn what works for you, and rest easy, friends.
Sources and Additional Information:
Why We Sleep: Unlocking the Power of Sleep and Dreams by Matthew Walker, PhD
“The Most Destructive Diabetes Landmine: Lack of Sleep?” by Adam Brown
