People with diabetes often experience something called peripheral neuropathy, which describes pain, numbness, and burning that occurs in the arms, hands, legs, and feet (especially the feet). This kind of pain (related to diabetes) is neurological, meaning it originates in the nervous system.
For these people, sleep is twice as hard to achieve: diabetes can have a disruptive impact on sleep stages and cycles, and pain from peripheral neuropathy can further delay or interrupt sleep.
When both diabetes and pain disrupt sleep, you can experience ongoing problems with sleep fragmentation and even chronic insomnia.
What makes things even worse? Not getting enough sleep makes us even less tolerant of pain. It’s a vicious cycle!
The relationship between poor sleep, diabetes, and peripheral neuropathy
Dr. Steven Y. Park writes a blog about sleep-breathing disorders. He had this to say following an encounter he had with one of his patients, who saw improvements in his peripheral neuropathy following treatment of sleep apnea with CPAP:
“Knowing that obstructive sleep apnea and diabetes frequently go hand in hand, and that diabetes and peripheral neuropathy also go together, there’s a good possibility that the first and the last can also be linked as well.”
It certainly makes sense. Some research shows that the oxygen-deprivation problems that occur in those with untreated sleep apnea can lead to problems with nerve function in the feet and hands. Treatments for sleep-breathing disorders have also been shown to improve peripheral nerve function.
Ultimately, the best way to deal with these unfortunate situations is to treat both the sleep problem and the pain. Better sleep improves daytime function, can relieve pain, and will improve your tolerance to peripheral neuropathy when it does occur.
Best practices for relieving peripheral neuropathy
While there are no quick solutions to addressing poor sleep or chronic pain, you can achieve some improvements at bedtime by working hard to apply good sleep hygiene practices. These include the following:
- Keep a regular bedtime routine and honor a consistent bedtime and wake schedule. This simple effort can normalize a sleep pattern in concert with your natural circadian rhythms.
- Find ways to relax the mind and the body at bedtime. Some great options for diabetics include:
- light reading
- a warm (not hot) bath
- soft music
- deep breathing exercise
- mild stretching
- Write down your worries in a journal, or list your plans for the next day to capture thoughts before they can race once you're in bed
- Avoid certain foods, beverages, and substances for several hours before bedtime:
- Caffeine products should be consumed no later than 4 hours prior to bedtime
- Quit smoking; while it may seem to be a good way to relax, it actually doesn’t support healthy sleep
- Heavy meals (especially those laden with fats and calories) should be avoided; also, allow at least 2 hours between dinner and bedtime so your body has a chance to metabolize the last meal of the day
- Don’t drink at bedtime, as alcohol will mess with blood sugar and cause mid-sleep arousals when the alcohol is metabolized, due to a withdrawal response
- Turn off your handheld electronics and put them away 1 hour before bedtime; this includes, smartphones, tablets, handheld games, and laptops. If you watch TV, keep the volume lower and the content of your programming mild and relaxing
- Good sleep hygiene includes sleeping in a sleep-conducive environment:
- Make sure your sleeping space is very dark and quiet
- Keep your sheets and bedding clean and fresh, and make sure bedding is not tight where it touches your legs and feet for optimal comfort
- Sleep on a supportive mattress and use a supportive pillow
- Keep the temperature low (good sleep requires you to have a lower core body temperature)
- Treat your pain.
- Over-the-counter medications, some with sleep-supporting antihistamines, may be all you need to curb your bedtime pain
- For severe pain, talk to your doctor about appropriate pain relief prescriptions
- If pain is not extreme but still disrupts sleep, you might try other kinds of medications which can help you relax and fall asleep
- Weight loss allows your body to move more easily and freely during the day, resulting in less pain and discomfort at night. Also, if you lose some weight, your diabetes itself may improve. Fat cells in the body tend to retain more water than muscle tissue; with fewer fat cells, you’ll retain less water and notice less swelling in your feet as well as experience less pain.
- Get some daily exercise, even if it’s mild. A short walk every day keeps the joints and muscles loose and functional. Regular mobility improves circulation, which can provide relief for those with peripheral neuropathy
- Avoid long naps. A quick 30-minute nap every once in a while is not a bad thing, but regular snoozes during the day that last for 1 or 2 hours can make it harder to fall asleep at night
If you have repeated problems with falling asleep or staying asleep, and you’re carrying around more weight than you need, you might benefit from undergoing a sleep study. It couldn't hurt to ask and might do you a world of good. Diabetics who are obese and have sleep apnea may be at especially high risk for glucose-insulin imbalances in the early mornings, a recurrent problem known as the "dawn phenomenon."
Dr. Park suggests at his blog that “Knowing that obese diabetics can have up to an 80% chance of having obstructive sleep apnea, perhaps the answer should be yes” to having a sleep apnea screening.
After all, more than 90 percent of all cases of treatment-resistant insomnia are ultimately found to be cases of untreated sleep apnea.If you discover you have sleep apnea and treat it, you could be one in a long line of patients who found relief from peripheral neuropathy as well. If you knew you had sleep apnea and could treat it, why wouldn't you?