There is no question that there are many unique challenges that come with managing diabetes. One often overlooked aspect of diabetes management is sleep. Quality sleep is crucial for maintaining healthy blood sugar levels and overall metabolism. Let’s explore how you can improve your sleep and, in turn, your health. 

During sleep, our bodies undergo various phases, including non-rapid eye movement (NREM) and rapid eye movement (REM) sleep. NREM sleep is further divided into stages 1, 2, and 3, with stage 3 being the deepest, also known as slow-wave sleep. These phases are essential for different processes within the body, including glucose metabolism (the way your body processes and uses sugar or carbohydrates for energy) and insulin sensitivity (how easily your body uses insulin, which helps this process) (35). 

Our brain’s primary source of energy is glucose. With the brain accounting for about 2% of our body weight, it consumes about 20% of the body’s energy utilization (37). During NREM sleep, particularly slow-wave sleep, the brain focuses on restorative functions and experiences reduced glucose utilization, allowing for more stable blood glucose levels. These phases of deep sleep are crucial for maintaining insulin sensitivity, as they help the body efficiently use insulin to regulate blood sugar levels. Research has shown that disruptions to sleep, such as waking up to go to the bathroom during slow-wave sleep, can make it harder for your body to use insulin properly and control blood sugar, increasing the risk of Type 2 Diabetes (1,2). 

Obstacles to Better Sleep 

Many people with diabetes struggle with waking up at night due to an overactive bladder. This frequent disruption can significantly impact sleep quality and, consequently, blood glucose regulation. Research indicates that an overactive bladder is associated with poor sleep patterns, which can worsen diabetes symptoms by disrupting the body’s ability to regulate blood sugar levels effectively (11). Additionally, waking up feeling hot or experiencing hot flashes can further disturb sleep, making it difficult to achieve the restorative slow-wave sleep necessary for efficiently using glucose for energy. Studies have shown that hot flashes and night sweats, common during menopause, are linked to poor sleep quality and an increased risk of Type 2 Diabetes (7). 

Another sleep disruption is alcohol consumption. While it might help you fall asleep initially, it often causes disruptions later in the night. This can lead to fragmented sleep and reduced time spent in the crucial slow-wave sleep phase. Alcohol has been shown to interfere with sleep processes, leading to decreased sleep quality and increased sleep interruptions (12). Stress and anxiety can also interfere with the ability to fall and stay asleep, further complicating blood sugar management. Chronic stress and anxiety are known to elevate cortisol levels, which can disrupt sleep and negatively impact the way the body uses glucose for fuel (13). 

Strategies for Achieving Better Sleep 

To address the obstacle of waking up multiple times for bathroom trips, consider incorporating oat bran and pumpkin seeds into your diet. Foods high in fiber, such as oat bran, can help manage overactive bladder symptoms by improving bowel regularity and reducing bladder pressure (14,15). A delicious and easy way to do this is by making a smoothie with unsweetened soy milk (which contains magnesium known to support sleep), oat bran, a banana (containing magnesium and potassium, which help the body relax), and a touch of honey. 

Another food that supports sleep is tart cherry juice, as it is a natural source of melatonin, a hormone that regulates the sleep-wake cycle. 

Another strategy is to ensure that, while focusing on water intake, you are also mindful of consuming electrolytes. This can be as simple as adding a touch of coconut water and sea salt or an electrolyte packet to your water throughout the day (16). These may help reduce nighttime awakenings due to an overactive bladder.  

Think Before You Drink 

Eliminating, or at least limiting, alcohol intake can improve your sleep quality. While alcohol can initially make the body feel drowsy and help you fall asleep faster, it interferes with sleep quality, leading to an unrestful night’s sleep. As your body breaks down alcohol, it can cause you to wake up frequently throughout the night, even if it’s just for a moment or two. This fragmented sleep means you will spend less time in the deep sleep stages, which are the most important for feeling rested and allowing your body to recover. This can further lead to higher blood sugar levels, making it harder to manage diabetes or increasing the risk of a Type 2 diabetes diagnosis (17-20). 

Caffeine is another substance that should be avoided in the afternoon and especially close to bedtime. Caffeine is a stimulant that can keep you awake and alert, which is problematic in the evenings. Even if you are someone who can drink an espresso and go right to sleep, caffeine can reduce the quality of your sleep, leaving you less rested in the morning. As previously mentioned, this poor sleep quality can lead to difficulty managing blood sugar levels (21-23). 

Herbal teas like peppermint and chamomile are excellent for promoting relaxation. Enjoying a cup before bed can help you wind down and prepare for a restful night. Chamomile contains apigenin, an antioxidant that binds to certain receptors in your brain, promoting sleepiness and reducing insomnia (24,25). Peppermint tea has been shown to have calming effects that can help reduce anxiety and improve sleep quality (24). 

Necessary Nutrients 

Additionally, maintaining gut health through a balanced diet can positively impact the precursors to our sleepy hormones. A healthy gut microbiome is essential for the production of neurotransmitters that regulate sleep. Having a healthy gut is crucial for making chemicals that help us sleep well. One study found that having more types of good bacteria in our stomachs was linked to better sleep quality and more hours of sleep (26). 

Other research demonstrated how dietary fiber intake improves the gut microbiome, which then influences the production of serotonin. 90-95% of the body’s serotonin is produced in the gut (34). Serotonin is another factor that is crucial for sleep regulation (27). An easy way to focus on improving your gut health is by making sure you have fruit at breakfast and vegetables at every lunch and dinner! 

Supplements such as magnesium glycinate and amino acids like tryptophan can support better sleep. Magnesium plays a role in supporting deep, restorative sleep by maintaining healthy levels of GABA, a chemical in your brain that helps you feel calm, relaxed, and promotes sleep (30, 35). Magnesium is best taken in the evening or shortly before bedtime. You can even get creative with it and make mocktails with magnesium glycinate powder, mineral water, and a little tart cherry juice concentrate for some extra melatonin. Tryptophan is a small protein that can be converted into serotonin and melatonin, both of which are critical for regulating sleep. Tryptophan is found in foods like pumpkin and chia seeds, almonds, edamame, oats, and yogurt. It is also a protein that you can supplement to gain better rest. Research has shown that supplementation with tryptophan can improve sleep quality (31). Always consult with your health professional before starting or stopping medications or supplements. If you are taking any psychiatric medications, supplementation with tryptophan could cause serotonin toxicity known as serotonin syndrome. Always consult with your health professional before starting or stopping medications or supplements. 

Consistency is key. Besides implementing some of the above strategies, establishing a regular sleep-wake cycle by going to bed and waking up at the same time every day can naturally enhance sleep quality over time. Creating a routine around bedtime can make it easier and quicker for you to fall asleep each night. Your routine can include something such as turning off all blue light (e.g., TV in the bedroom or phone scrolling), reading a book, practicing relaxation techniques, or taking a warm bath (32,33). There is power in prioritizing your sleep. If someone could bottle up all the positive health benefits of sleep, they would fly off the shelves and be on backorder. By incorporating these tips and strategies, you can improve your sleep quality, which in turn can help manage your blood sugar levels and overall health. Remember, it’s important to experiment and find what works best for you. Sweet dreams! 

Sending Health Your Way!

The Tula Clinical Team

Austin MS, RDN, CSR, LDN, CD
Aubree RN, BSN