The sleep you get at night affects your diabetes management during the day. For our Tuesday night Twitter discussion, our community members chatted about how to get better sleep for better management. Our special guest was Dr. Gary McClain, therapist, author, and patient advocate specializing in helping people with chronic conditions. We were also joined by Jewels Doskicz, RN, T1D, and mother to a T1D.

Q. What is a typical night’s sleep like for you?

A. Dr. Gary: It seems like I have a conversation with a client almost every day about sleeping poorly. So many people are not sleeping well. I think in many ways we live in an age of anxiety. I think sleep difficulties are just common these days. Good sleep takes effort. 

Jewels: It varies. Sleep is never the same when you live with diabetes and its unpredictability.

Other participants:
• Typical night's sleep? Usually collapsing into a semi-comatose state that will be interrupted occasionally by continuous glucose monitor alarms.
• Depends on if I silence my Dexcom alarm. I am a heavy, short sleeper. Can't wake me, but only for about five solid hours.
• I was usually up every night with a high or low for one of us, but not anymore with the open apps artificial pancreas. I actually sleep all night!

Q. List some of the benefits of getting a good night’s rest.

A. Dr. Gary: There are so many benefits to getting a good night’s sleep. What I find with my clients is that they have greater peace of mind when they have had a good night’s sleep. A sense of well-being. When we have had sleep, our ability to evaluate a situation and make a decision is that much sharper. Just having energy to get through the day is a huge benefit of getting a good night’s rest. I think being well rested also helps us to be kinder and more patient toward others. So better relationships! 

Jewels: Three benefits of good sleep: clear thinking, heightened energy, and improvements in blood sugars.

Other participants:
• Look better, feel better, better blood glucose.

Q. What are your barriers to getting the sleep your body needs?

A. Dr. Gary: The barrier I hear about the most of from my clients is just too many thoughts bouncing around. A noisy mind! My mind is noisy too! I also think worrying about the future keeps you up at night. All that what-if thinking. Our minds have a way of turning little things into big things. If we let ourselves dwell on the unimportant, sleepy time will suffer. Chronic conditions can do that to us. And let’s not forget caffeine. It is easy to get into a cycle of caffeine to stay awake during the day after not sleeping well at night. 

Jewels: My biggest barrier is that diabetes doesn't sleep and worry doesn't dissipate overnight. My parental worry, especially when my daughter was very young with T1D, was super heightened overnight.

Other participants:
• Has anyone mentioned the old fear of dying of hypoglycemia in your sleep?
• Barriers to good sleep are Dexcom alerts from out of range blood glucose, husband snoring, and worries coming to life at night.
• Blood glucose is sometimes a problem, but my main barrier is my own mental state. I think too much and don't really want to sleep.

Q. Stress and poor sleeping patterns raise levels of the stress hormone cortisol, which may affect blood glucose levels. How does sleep impact your diabetes control?

A. Dr. Gary: My clients with diabetes often tell me they crave carbs even more when they are tired. Their body wants the energy. Me too! We try to do too much multitasking. That leads to stress and affects sleep. I also find that when I don’t sleep well, I am extra hungry the next day. I think it is my body needing more energy. My clients have also mentioned overeating the day after a night with poor sleep. That can be hard on your diet. With depression, everything is multitasking: each effort is connected to a web of others. We’re exhausted before we start.

Jewels: Consistent [healthy] sleep patterns create an underlying ease with managing diabetes.

Other participants:
• Bad nights usually cause bad mornings. Sometimes by highs that won’t go down. Sometimes by lows and then more highs.
• Been told it’s a hormonal thing. Lack of sleep can equal stubborn high blood glucose readings the next day that aren't really correctable.

Q. In what ways does a lack of sleep impact how you feel about diabetes?

A. Dr. Gary: I think lack of sleep can increase feelings of helplessness and hopelessness. That impacts your outlook. It’s harder to be objective when we are tired, so we are more likely to fall victim to our emotions and catastrophic thinking. Adequate sleep promotes a sense of optimism. That’s important when you are living with a chronic condition like diabetes. 

Jewels: Waking night after night, year after year with diabetes doesn't improve my love of it. 

Other participants:
• When I link diabetes and lack of sleep, it is usually labeled guilt. Ate too much. Drank too much. Slept too little.
• For me, it’s not the outlook, it’s that I’m not functioning at full capacity. I need to make important decisions.
• Next day, blood glucose control is harder, and so is mental capacity to care. Affects immediate health.

Q. Why and how often does diabetes wake you up? How does this impact your everyday life?

A. Dr. Gary: It can be hard to get back to sleep after getting up to use the bathroom. Doing something to calm and relax yourself can help. If you’re concerned about your diabetes, anxious thoughts can wake you up. And then there is the fear factor, which can also affect sleep. Waking up in the night can be frustrating. But if you get more anxious because you can’t sleep, you may be awake that much longer. I encourage clients to not turn sleeplessness into a catastrophe. They will be that much more anxious. Trouble falling back to sleep is annoying but not a crisis.

Jewels: Diabetes awakens me on many nights with beeps and bleeps. Disruptions of sleep impact energy levels and patience.

Other participants:
• I rarely have a night that Dexcom doesn't wake me. Sometimes high. Sometimes low. Usually both.
• Erratic sleep creates carb overload the next day.
• At least a few mornings every week, hypoglycemia. I'm pretty hypo aware when it gets super low before falling dangerously low.

Q. How do you prepare for a good night’s sleep? What are your rituals?

A. Dr. Gary: I think ritual is a good word to use here. Having a regular routine based on what works for you can help a lot. I think this is unique for everyone. The key is to have your own toolkit with what you need to relax and get in a sleep mindset. Humans are creatures of habit. Rituals give our lives structure and can help reduce stress. I have my own ritual of relaxing for a half hour and reading before I hit the sack. It helps me to start the night on the right foot. I also make a list of whatever I have to do the next day. That way, those loose ends are not bouncing around in my mind.

Jewels: I try my best to keep the same bedtime routine. Daily exercise and approaching bedtime with normalized blood sugars helps.

Other participants:
• I have found doing things like washing my face and brushing my teeth need to be done a couple of hours before bed.
• I put the dog out, head upstairs, go to bed, start watching TV, fall asleep. I know TV is supposed to be bad, but it works for me.
• I can't get sleepy with silence and darkness, so TV, music, or device games are important rituals. Sometimes a little whiskey is required.

Thank you to all of our T1Ds, T2Ds, diabetes advocates, and especially Dr. Gary and Jewels for joining our conversation. Add to this chat by commenting below, or join us for more chats every Tuesday at 9:00 p.m. ET by following @DiabeticConnect on Twitter and using #DCDE.