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May, 2017 >>

Sleep hygiene and diabetes: Suggestions for primary care

Avinash De Sousa  ( Research Associate, Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, India. )

Sanjay Kalra  ( Department of Endocrinology, Bharti Hospital, Karnal, India. )

Abstract

Sleep problems are common in chronic disorders like diabetes and are the result of poor diet and unhealthy lifestyles. Comprehensive management of diabetes entails lifestyle management and restoration of good habits. Sleep hygiene maintenance helps persons living with diabetes enjoy a better quality of life by restoring normal sleep patterns and thereby improving glycaemic control.
Keywords: Diabetes, Glycaemic control, Sleep hygiene.


Introduction

Modern lifestyle and the demands of globalization have taken a toll on human beings and have led to development of lifestyle disorders like diabetes and others.1 One of the effects of modern lifestyle is a reduction in total sleep time or duration and poor quality of sleep seen in most individuals.2 This has led to the need for proper sleep hygiene inculcation in patients in order to maintain a healthy lifestyle.3

Diabetes and Sleep

There is a direct connection between diabetes and sleep habits. Research has shown that both decreased (< 6 hours) and increased duration of sleep (> 9 hours) predisposes to insulin resistance and alters glucose metabolism leading to diabetes.4 Decreased total sleep time related to stress and poor quality of sleep even though the duration of sleep is normal is a risk factor for the development of various disorders including diabetes.5 Epidemiological data has established strong links between sleep problems and diabetes.4

The need for Holistic Diabetes Management

The management of diabetes involves much more than just insulin and oral medication. Diet, regular exercise and lifestyle modification along with behavioural changes and cutting down on nicotine and tobacco play a vital role in controlling blood glucose.7 Management of depression, anxiety and other psychological problems that may increase stress and thereby alter diabetic parameters are also essential in the holistic management of diabetes.8
There is also a need to incorporate sleep hygiene and sleep psycho-education programmes into the management of patients with lifestyle disorders like diabetes.9 This goes a long way in promoting relaxation and wellness. This in turn leads to better control of one's blood glucose. Sleep assessments may be needed in patients with diabetes as many studies hint at the association between sleep disturbances, diabetes, obesity and obstructive sleep apnoea.10

Sleep Hygiene — The Main Guidelines

Sleep hygiene entails educating the patient about normal sleep, its variations, its problems and suggesting guidelines to maintain normal and restful sleep.11 In diabetes and other disorders the following guidelines are suggested to correct sleep problems:

Pre Bedroom Suggestions

Don't go to bed unless you are sleepy — If you are not sleepy at bedtime, then do something else like reading a book, listening to music and relaxing to feel relaxed and sleepy.
If you are not asleep after 20 minutes, then get out of the bed. Find something else to do which can make you feel relaxed.
Avoid cat naps if you can. If you have to take a nap, try to keep it short (less than one hour).
Do not have any caffeine after 4pm.
Do not have alcohol within 8 hours of your bedtime.
Do not have a cigarette or chew tobacco before bedtime.
Do not go to bed hungry and don't eat too much before sleeping.
Avoid rigorous exercise within 4 hours of your bedtime.
Bedroom Suggestions
Get up at the same time every morning. Do this even on weekends and holidays.
Get a full night's sleep on a regular basis. Get enough sleep so that you feel well-rested nearly every day.
Don't read, write, eat, watch TV, or talk on the phone in bed.
Make the bedroom dim lighted and non-distracting.
Do not discuss issues that may lead to arguments prior to sleep.
Do not think about the next day prior to sleep.
See that the bed, bed-sheet and pillow you use is comfortable.
Daily Activities Suggestions
Keep a regular schedule. Regular times for meals, medications, chores, and other activities helps to keep the inner body clock running smoothly.
Find time for stress management.
Try to get rid of or deal with things that make you worry.
Managing one's anxiety and depression side by side is essential for sleep hygiene.
You should exercise on a regular basis, but do it earlier in the day.
Avoid using sleeping pills and use them only under medical supervision.


Conclusions

Sleep hygiene training may play a vital role in diabetes control and lifestyle management of patients with diabetes. It is imperative that sleep hygiene be included in comprehensive treatment programmes for diabetes management and will help improve the overall quality of life of people with diabetes.


References

1. Hu FB. Globalization of Diabetes The role of diet, lifestyle, and genes. Diabetes Care 2011; 34: 1249-57.
2. Lopresti AL, Hood SD, Drummond PD. A review of lifestyle factors that contribute to important pathways associated with major depression: diet, sleep and exercise. J Affect Disord 2013; 148: 12-27.
3. Gellis LA, Lichstein KL. Sleep hygiene practices of good and poor sleepers in the United States: an internet-based study. Behav Ther 2009; 40: 1-9.
4. Zizi F, Jean-Louis G, Brown CD, Ogedegbe G, Boutin-Foster C, McFarlane SI. Sleep duration and the risk of diabetes mellitus: epidemiologic evidence and pathophysiologic insights. Curr Diabetes Rep 2010; 10: 43-7.
5. Touma C, Pannain S. Does lack of sleep cause diabetes. Cleve Clin J Med 2011; 78: 549-8.
6. Cappuccio FP, D'Elia L, Strazzullo P, Miller MA. Quantity and quality of sleep and incidence of type 2 diabetes a systematic review and meta-analysis. Diabetes Care 2010; 33: 414-20.
7. Beihl DA, Liese AD, Haffner SM. Sleep duration as a risk factor for incident type 2 diabetes in a multiethnic cohort. Ann Epidemiol 2009; 19: 351-7.
8. Nouwen A, Winkley K, Twisk J, Lloyd CE, Peyrot M, Ismail K, Pouwer F, European Depression in Diabetes (EDID) Research Consortium. Type 2 diabetes mellitus as a risk factor for the onset of depression: a systematic review and meta-analysis. Diabetologia 2010; 53: 2480-6.
9. Vgontzas AN, Liao D, Pejovic S, Calhoun S, Karataraki M, Bixler EO. Insomnia with objective short sleep duration is associated with type 2 diabetes. Diabetes Care 2009; 32: 1980-5.
10. Surani SR. Diabetes, sleep apnea, obesity and cardiovascular disease: Why not address them together. World J Diabetes 2014; 5: 381-4.
11. Irish LA, Kline CE, Gunn HE, Buysse DJ, Hall MH. The role of sleep hygiene in promoting public health: A review of empirical evidence. Sleep Med Rev 2015; 22: 23-36.
12. Kumar S, Hari Kumar KVS. Sleep hygiene and diabetes. J Pak Med Assoc 2016; 66: 1665-8.


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