Are you tired even though you went to bed early? Do you snore? If so, you could have sleep apnea. More than 18 million Americans have been diagnosed with the condition, and many more don’t know they have it.
The Diabetes Connection
Unfortunately, for people with type 2 diabetes, sleep apnea is common.
Type 2 diabetes is a chronic condition in which the body isn’t able to properly use insulin to metabolize glucose for energy production. Insulin’s primary role is to help remove glucose — or sugar — from your blood. Type 2 diabetes is the result of increasing insulin resistance, which allows sugar levels to increase, and can trigger other health problems.
Sleep apnea is characterized by pauses in breathing and dangerous drops in oxygen during sleep, which can wreak havoc on managing diabetes. Insulin resistance and weight gain are a factor in both conditions, as we’ll explain.
Stress and Insulin Resistance
While you can change some risk factors, there’s one many people aren’t even aware of: stress.
Just like eating sweets and carbohydrates, constant stress can increase blood glucose levels. Stress hormones, such as epinephrine and cortisol, then kick in. Their natural function is to boost energy when needed during a fight-or-flight response. If you’re in imminent danger, that’s good. But too much adrenaline — caused by unrelenting stress — can make fat cells resistant to insulin.
How does this connect to sleep? Even though you’re not awake, sleep apnea is a form of physical stress. Untreated, it causes you to stop breathing, perhaps hundreds of times a night, sometimes for a minute or longer. This results in a lack of oxygen that takes a toll on your body.
“Sleep apnea causes poor oxygenation and can lead to a buildup of carbon dioxide in the body,” says Damon Tanton, MD, an endocrinologist at Florida Hospital. “This additional stress leads to releasing stress hormones, and can lead to insulin resistance.”
This resistance may progress to type 2 diabetes and other related health problems such as high blood pressure, heart disease and stroke.
Treating sleep apnea can lead to better blood glucose control by reducing insulin resistance and improving alertness and motivation. “Correcting sleep apnea is an important step toward controlling type 2 diabetes,” says Dr. Tanton.
Sleep Loss, Weight Gain
A 2012 study in the journal Science Translational Medicine found that sporadic and irregular sleep may also cause a decreased metabolic rate (how fast your body burns calories while resting), which could contribute to weight gain and many long-term health problems, including diabetes.
“Sleep apnea is most commonly a missed diagnosis, especially in patients struggling with weight issues. Signs can be as subtle as daytime fatigue and mild snoring despite getting eight hours of sleep at nighttime,” says Gitanjali Srivastava, MD, internist and obesity medicine specialist at Florida Hospital.
Treatment, Minus the Mask
“Continuous positive airway pressure (CPAP) is the most common treatment,” says Jeffrey Lehman, MD, an otolaryngologist at Florida Hospital. Using mild air pressure, CPAPs keep airways open. Yet some patients grow frustrated and stop using their CPAPs, causing the apnea to return. Now there’s an alternative.
TransOral Robotic Surgery (TORS), a minimally invasive technique, may be an option. Using the da Vinci® Robotic Surgical System, areas of the throat that were once difficult to reach can now be accessed. TORS provides surgeons with enhanced agility, precision and a 3-D advanced imaging system. Because the procedure is performed through the mouth, there’s no visible scar, less blood loss and a faster recovery.
“Now, we’re able to remove tissue that contributes to airway blockage with no external incisions, and patients go home the next day, sleeping healthfully,” says Dr. Lehman.