This article was originally authored by Vanessa Caceres on U.S. News and World Report on September 12th, 2017, featuring insights from Orange Regional Medical Center’s Associate Medical Director for the Center of Sleep Medicine, Dr. Ofer Jacobowitz.
Got sleep apnea?
If you have Type 2 diabetes, there’s a good chance you do. In fact, at least 50 percent of people with Type 2 diabetes have obstructive sleep apnea, or OSA, and some research estimates put that number as high as 60 to 80 percent, says Dr. Ofer Jacobowitz of ENT and Allergy Associates in New York.
So what is sleep apnea exactly? It refers to interrupted breathing or shallow breathing while you sleep, according to the National Heart, Lung, and Blood Institute. Your breathing may pause for a few seconds or up to a few minutes, and that can happen multiple times each night.
If left untreated, that interrupted breathing and the decrease in quality sleep can lead to a higher risk for health problems, including heart attacks, high blood pressure, irregular heartbeat, stroke and even dementia. It also can worsen your diabetes, says Dr. David M. Rapoport, professor of medicine pulmonary, critical care and sleep medicine and research director at the Mount Sinai Health System Integrative Sleep Center in New York. Because of poor sleep quality, you also can raise your chance of getting in a car accident while you are driving.
Men over age 40, especially those who are overweight or obese, are particularly at a higher risk for sleep apnea, says Dr. Joseph Krainin, chief medical advisor of SoClean. However, anyone can get it, even if you are thin.
There are a few reasons why you’re at a greater risk for OSA when you have Type 2 diabetes. “Due to lack of sleep, stress and excess weight, anyone with sleep apnea symptoms also could suffer from diabetes, and vice versa,” Krainin says. “Interrupted sleep, which occurs with sleep apnea, can cause an increased stress response and lead to difficulty keeping good sugar levels under control, which is a sign of diabetes.”
In addition, if you have excess weight around the neck, that can interfere with your airway while you sleep. That can lead to breathing problems.
Snoring can be a symptom of sleep apnea. Here are some other sleep apnea symptoms, according to Dr. Robert S. Rosenberg, medical director of the Sleep Disorders Center in Prescott Valley, Arizona, and author of “The Doctor’s Guide to Sleep Solutions for Stress & Anxiety”:
- Frequent urination.
- Headaches when you wake up.
- Sleepiness during the day (think of the guy who can’t help but doze off while watching TV).
- Depression that doesn’t respond to therapy.
- Trouble sleeping through the night, even if you take sleep medications.
- Waking up and gasping or choking for air.
- Frequent and unexplained night sweats.
Although it’s not a substitute for a formal diagnosis, smartphone apps that report on your sleep quality can provide some clues to how well you are sleeping, Jacobowitz says.
If you suspect that you have sleep apnea, talk to your doctor about having a sleep study. A sleep study can analyze whether or not you have interrupted breathing at night. Sleep studies have typically involved going to a special laboratory overnight, but at-home sleep studies are becoming more common, Rapoport says.
If your doctor says that you have sleep apnea, you’ll learn about the treatments for it. “There are multiple treatments,” Jacobowitz says. “They all are good, but none are perfect. I try to find the method to match to each person.”
One well-known treatment is called a continuous positive airway pressure machine, or CPAP. Users wear a CPAP at night to provide a more consistent airflow. “CPAP treatment is the most commonly prescribed treatment and is often referred to as the ‘gold standard’ treatment option with roughly 80 percent of sleep apnea sufferers using it as their treatment option,” Krainin says.
You may have heard that a CPAP is difficult or awkward to use. “Don’t listen to your friends who will tell you how horrible the treatment is,” Rosenberg says. “The new machines and masks are very user-friendly.” CPAP technology also has become smaller over time. However, in some patients, it can take several tries to fit the CPAP mask correctly. If you have trouble with it, talk to your doctor so he or she can recommend adjustments versus giving up completely. If you feel anxious about using a CPAP, your health provider likely will have some suggestions to help make you feel more comfortable using it.
Another treatment option for OSA is a dental device you wear at night that moves the jaw forward and increases the diameter of the throat. The device is widely used, but it also has a higher failure rate, Rapoport cautions.
In some patients, surgery is a helpful option, including bariatric surgery to help lose weight. Of course, losing weight through eating changes and physical activity also can help eliminate sleep apnea, Rapoport says. Newer options for sleep apnea are also on the horizon.
If you have diabetes, you use insulin and you are starting to use a CPAP, monitor your blood sugar more carefully. “CPAP can decrease the insulin requirement, potentially leading to problematic hypoglycemia, particularly during the night. This is particularly relevant for diabetics who are on an insulin pump,” Krainin says.
Although untreated sleep apnea can wreak havoc on your body when you have diabetes (or even if you don’t), the good news is that proper treatment for sleep apnea can improve your blood sugar control and your hemoglobin A1C. “If you have an insulin pump to help treat your diabetes, treating your sleep apnea with a CPAP may result in needing to decrease your insulin requirement,” Krainin says.
However, there’s a catch based on recent findings. “It appears that sleep apnea results in the most negative effects on diabetes during REM, or dream sleep,” Rosenberg says. “Most dream sleep occurs towards the end of the night. We are finding that patients who take off their masks and turn off their CPAPs two to three hours before awakening are not getting much improvement in their diabetic control, while those who keep it on it all night do.”
About The Center for Sleep Medicine at Orange Regional Medical Center
The Center for Sleep Medicine, led by Dr. Alan Schaffer, Medical Director and Dr. Ofer Jacobowitz, Associate Medical Director, provides professional consultations and diagnostic services for all types of sleep disorders.
An accredited center of the American Academy of Sleep Medicine, Orange Regional offers treatment to adults and children ages 2 and up. We also perform sleep studies at The Center, which are painless, non-invasive tests conducted by our Board-certified physicians and specially-trained technicians to monitor breathing, heart rate, blood oxygen levels, eye movement, muscle tone and other factors.