CONNECTING SLEEP + DIABETES HEALTH

Besides stress, I would say that the second most common complaint I hear from my diabetes clients is how they want to improve their sleep quality, but they don't know-how. Whether it's waking up with CGM alarms or a general feeling of sluggishness and brain fog, our sleep dramatically impacts whole-person health. 

Sleep is a foundation on which all pillars of diabetes health rest - no pun intended. Inadequate sleep compromises the effectiveness of all essential health pillars like diet, exercise, mental health, and diabetes management. The leading causes of death in developed nations, heart disease, cancer, dementia, obesity, and diabetes, have causal links to sleeplessness (1).

The number one risk for people with diabetes is heart disease. In a 2011 study, tracking a half-million people from various ages and ethnicities from eight countries over 25 years, progressively shorter sleep increased the risk of developing or dying from heart disease by 45% (2).

In another study on non-diabetic individuals, participants were limited to four hours of sleep a night for six nights. By the end of the week, participants were 40% less effective at metabolizing glucose (3). For people with T1D, this might not seem relevant because we produce little, if any, insulin, but consider that insulin is insulin. The insulin you inject still is impacted by sleeplessness. 

The primary mechanism behind sleep deprivation is a familiar perpetrator, the sympathetic nervous system. People with diabetes have less parasympathetic tone at night than non-diabetics, meaning we have a harder time turning off our nervous system's activation response (5). Left on for extended periods, and our nervous system becomes maladaptive, affecting every organ system in the body. 

During sleep, our body regenerates the body and reorganizes the brain. Growth hormone - a great healer of the body because it replenishes the lining of our blood vessels - produced in deep sleep. During non-REM sleep, part of our sleep cycle, our brain sends calming signals to the sympathetic nervous system, preventing the type of stress responsible for insulin resistance, hypertension, and stroke (6).

There are many ways you can improve your sleep hygiene with yoga and lifestyle modifications. Here are my top 5:
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1. Breathwork - Set a timer for ten minutes. Get comfortable and focus on a 1:2 ratio. Inhale 4, exhale 8. Another alternative is inhaling 6, exhale 8. Anytime the exhale is longer than the inhale, you'll help turn on your parasympathetic nervous system. A regular breathing practice will help reset your nervous system to be more adaptive and resilient for longer durations of time. 
2. Yoga nidra - increases non-REM brain activity. Adding a regular practice twice at least a week can help you tack on several extra minutes of this essential sleep cycle, increase your energy, reduce insulin resistance, and boosting brainpower. 
3. Turn off electronics after 9p. It is no secret that blue light messes with our brain's ability to turn off and wind down. Consider a book and a bath rather than the scroll. 
4. Alter your in-range limits on your CGM - Pick a broader threshold for normal levels at night to avoid alarms keeping you up. 
5. Eat an earlier + smaller dinner. A big reason why we have overnight highs is too big of a meal and not enough time to digest it. Consider a South American approach by switching your main meal to lunch. 

References:
(1) Walker, Matthew P. Why We Sleep: Unlocking the Power of Sleep and Dreams. First Scribner hardcover edition, Scribner, an imprint of Simon & Schuster, Inc, 2017, pp 164.
(2) Walker, Matthew P. Why We Sleep: Unlocking the Power of Sleep and Dreams. First Scribner hardcover edition, Scribner, an imprint of Simon & Schuster, Inc, 2017, pp 165.
(3) Walker, Matthew P. Why We Sleep: Unlocking the Power of Sleep and Dreams. First Scribner hardcover edition, Scribner, an imprint of Simon & Schuster, Inc, 2017, pp 171.
(4) Bernardi, L., et al. "Impaired Circadian Modulation of Sympathovagal Activity in Diabetes. A Possible Explanation for Altered Temporal Onset of Cardiovascular Disease." Circulation, vol. 86, no. 5, Nov. 1992, pp. 1443–52. ahajournals.org (Atypon), doi:10.1161/01.CIR.86.5.1443.
(5) Walker, Matthew P. Why We Sleep: Unlocking the Power of Sleep and Dreams. First Scribner hardcover edition, Scribner, an imprint of Simon & Schuster, Inc, 2017, pp 168. ​