Treating Diabetes by Curing Sleep Apnea
Before speaking with Dr. Ruben Cohen, an oral and maxillofacial surgeon based out of New York, we expected his primary concerns for people with diabetes to be about those oral complications we've all heard so much about: gum disease, the dangers of not flossing regularly, infections, and the like. So, we were surprised to find that Dr. Cohen was actually most adamant about treating sleep apnea as the first step toward resolving a host of other diabetes-related complications.
Diabetes and sleep apnea: What's the link?
The relationship between diabetes and sleep apnea is a complicated one. The two diseases are often comorbid. Rates of obstructive sleep apnea (OSA) are much higher among people with diabetes: 23 percent of men with diabetes were found to have OSA, compared to just 6 percent of the general population. At the same time, rates of diabetes are higher among people with OSA. The two diseases also share risk factors, including obesity and advancing age. More than half of obese individuals are considered to be at high risk for developing OSA. Further, studies have suggested that having OSA increases the risk of developing type 2 diabetes. OSA can also worsen glycemic control in existing diabetes. Having diabetes is a risk factor for developing sleep disorders, and may worsen preexisting OSA. Research to uncover the exact nature of this relationship is ongoing.
Diabetes and sleep apnea also share a long list of potential complications, including high blood pressure, cardiovascular disease, eye disease, changes in glucose metabolism, and weight control problems. "OSA makes weight loss difficult," Dr. Cohen said. "The constant stress of not sleeping causes high levels of cortisol and steroids." These hormones make weight loss more difficult. Being perpetually tired also makes finding the energy to hit the gym much harder, according to Dr. Cohen.
Tired all the time?
It is difficult to determine the number of people with OSA, as it often goes undiagnosed – which is where Dr. Cohen comes in. Many people think that sleep apnea only afflicts middle-aged, overweight men who snore loudly. Dr. Cohen warned us against buying into this common misconception. "Many people, especially women, aren't screened or diagnosed because they don't know what to look for," he said. While OSA is more common in men than women, it is believed that more women than men suffer from undiagnosed OSA. Menopausal women are more likely to suffer from OSA, as are people with a large neck size (17 inches or greater in men, and 16 inches or greater in women). So, what should you look for? "Snoring, feeling tired during the day, feeling like you never got a good night's sleep, and falling asleep throughout the day," answered Dr. Cohen, adding that "while loud snoring is often a sign of OSA, you can have sleep apnea without snoring". Click here for more symptoms of OSA.
OSA is commonly treated with a continuous positive airway pressure mask (CPAP), worn while sleeping. However, "CPAP can be difficult for some patients to tolerate," said Dr. Cohen. For those patients, an oral appliance, placed in the mouth and designed to advance the lower jaw while sleeping, may be an option.
If you are overweight, losing weight will help improve your management of both diabetes and sleep apnea. "Weight is definitely a factor, especially as you get older and heavier," explained Dr. Cohen. Find out more about bariatric surgery here.
While treating OSA for the sake of finally getting a good night's rest is important in its own right, treating OSA can help treat, and maybe even eradicate, many other diabetes complications. In addition to decreasing daytime sleepiness and removing a barrier to effective weight loss and/or management, treating sleep apnea can:
- Improve psychological well-being
- Improve memory, concentration, and other cognitive functioning
- Improve erectile dysfunction
- Lower blood pressure levels
- Increase productivity during the day, including fewer sick days from work
- Decrease the risk of traffic accidents
For people with diabetes, getting treated for OSA is especially important: some researchers have found that insulin sensitivity improved and A1C levels decreased after a few months of CPAP treatment.
Speak to your diabetes healthcare team, which includes your dentist, if you or a loved one has symptoms of sleep apnea. Questions your healthcare provider may ask you include:
- Do you snore?
- Are you excessively tired during the day?
- Have you been told you stop breathing when you sleep?
- Do you have high blood pressure?
- Is your neck size greater than 17 inches (men), 16 inches (women)?
If you are diagnosed, take the Dr. Cohen approach to OSA management: instead of trying to treat the disease in a vacuum, "sleep apnea should be treated like a syndrome – treatment for OSA isn't just about opening the blocked airways, but also about addressing all of the other medical issues." And getting a better night's sleep through sleep apnea treatment can go a long way toward resolving diabetes complications.
1 - Grunstein R et al. (2007). Two year reduction in sleep apnea symptoms and associated diabetes incidence after weight loss in severe obesity. Sleep 30(6).
2 - Mary S et al. (2002). Obstructive sleep apnea is independently associated with insulin resistance. American Journal of Respiratory and Critical Care Medicine 165(5).
3 - Tasali E, Mokhlesi B, Van Cauter E. (2008). Obstructive sleep apnea and type 2 diabetes: interacting epidemics. Chest Journal 133(2).
4 - Tipton J. (2001). Clinical Inquiries: What are the benefits of treating sleep apnea? The Journal of Family Practice 50(12).
5 - Young T, Evans L, Finn L, Palta M. (1997). Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep 20(9).
Reviewed by Joy Pape, RN, BSN, CDE, WOCN, CFNC. 9/12
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