Sleep Apnea and Diabetes: A Link We Can’t Ignore


As the year winds down, November is often when our lives ramp up. Millions of Americans will make travel plans, tick items from shopping lists, and plan for homecomings and reunions during the holiday season. A huge segment of our busy population will have one more thing to manage during the season of multitasking: Type 2 diabetes.

In fact, November is American Diabetes Month, which aims to bring awareness to the condition. 30 million Americans will live with some type of diabetes, a metabolic disease that interferes with vital insulin levels. As of 2010, diabetes was the 7th leading cause of death in the US, more than AIDS and breast cancer combined. What’s more, people managing the most common type of diabetes — Type 2 diabetes — will also be at risk for or already have Obstructive Sleep Apnea (OSA), sometimes without even knowing it.

Consider this: A conservative estimate puts the prevalence of OSA at an overall occurrence of about 4-10% of the population. But when you only take the portion of the population with Type 2 diabetes into consideration, that number doesn’t double or triple. It skyrockets — to 71%.

The shared risks of Sleep Apnea and Diabetes

OSA is a serious sleep disorder. When tissue from the soft palate relaxes during sleep, it can obstruct the airway and disrupt airflow, sometimes hundreds of times a night. Left untreated, people with OSA can experience dangerous fatigue, an increased risk of stroke, hypertension, and cardiovascular disease, and a dip in mental and emotional well-being.

Any of this sound familiar? It should: these are some of the risks also associated with untreated or unmanaged diabetes. And as with diabetes, some people brush off the symptoms of OSA, misunderstanding the seriousness of the symptoms.

With the prevalence of OSA in people with diabetes so high, it’s important to take a closer look at the link between the two. Because in addition to the high prevalence of OSA among diabetics, there’s also evidence that suggests the reverse is true.

Let’s look at the overall population again: over 9% of Americans have diabetes. Now let’s take just the population of people with OSA into consideration. Again, that number makes a big jump — all the way up to 29%, according to a 2014 study.

Which came first, Diabetes or Sleep Apnea?

Oh, if only it were that simple. We know that OSA is a potential complication of Type 2 diabetes, and we know that diabetes is more likely to develop if you have OSA. But untangling which causes which or what comes first is much harder to do.

It could be that OSA and diabetes share a number of risk factors, like obesity and heart disease. It could be that there’s evidence that shows a link between drops in blood oxygenation and negative changes in glucose levels during sleep — which can in turn interfere with insulin resistance.

There’s also the potential role that cortisol plays: it spikes when our sleep is disrupted and can throw a wrench into the body’s natural ability to regulate glucose; throws metabolism out of whack; and can even pave the way to insulin resistance. Insulin resistance is of course at the core of diabetes, while sleep disruption is the hallmark of OSA.

But the truest answer to whether diabetes precedes sleep apnea or sleep apnea precedes diabetes is: neither and both.

There’s evidence enough to suggest that the presence of one can at the very least exacerbate the other. The main takeaway is that to be at risk for one is to be at risk for both.

Why a conversation with your doctor might be in order

If you have diabetes, you should absolutely talk to your doctor about assessing your risk for sleep apnea, and the opposite is also true: if you have sleep apnea you owe it to yourself to ask about the potential for developing diabetes.

A sleep study with a board-certified sleep physician can help determine whether or not you already have OSA, and many sleep specialists can help you arrange for a sleep test that you can take in the comfort of your own bedroom.

Knowing whether or not you have OSA can equip you with the tools you need to examine and mitigate your risk for Type 2 diabetes, and a diagnosis of OSA in people who have already developed the disease represents a path forward through treatment.

Continuous Positive Airway Pressure — or CPAP — therapy, for instance, can not only help you reclaim your sleep health if you’re living with Diabetes Type 2. Studies have also shown that it can help regulate insulin sensitivity in diabetics with severe sleep apnea.

But the bottom line is this: knowledge is one of the most useful tools you can have for managing either (or both!) conditions. Now that you know about the link between sleep apnea and diabetes, and what that might mean for your health, it’s important to put that knowledge to use.

Do you manage sleep apnea and diabetes? Let us know in the comments below!