Obstructive sleep apnea is a potentially serious, often overlooked medical condition in which your airways get blocked temporarily while you sleep, stopping your breathing for a period of time. It’s more common in people who are overweight or obese, and diabetes is also a recognized risk factor for it.
Not only is diabetes a risk factor for sleep apnea, but having sleep apnea can result in worse blood glucose control — probably because of the important role that restful sleep plays in blood glucose regulation. In a recent news item, we noted that one of the most common treatments for sleep apnea — continuous positive airway pressure (CPAP) — is linked to lower blood glucose levels in people with diabetes.
One of the potential effects of sleep apnea is mood disturbance — the result of not getting enough restful sleep, or being woken up at night and not being able to fall asleep again easily. People with sleep apnea may find themselves groggy and unfocused during the day, and if they have diabetes, they may find that managing it feels more stressful than it perhaps should. But a recent study shows that these mood-related effects from sleep apnea are more likely to affect younger adults with diabetes.
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Less mood disturbance, diabetes distress in older adults
The study, published in the journal The Science of Diabetes Self-Management and Care, examined age-related differences in mood, diabetes-related stress and functional outcomes in activities that might be affected by impaired sleep in adults with type 2 diabetes and obstructive sleep apnea. Researchers used data that was pooled from two different randomized controlled trials, involving a total of 145 participants — with 36 of them age 65 or older. All of the participants experienced at least some insomnia (inability to fall asleep) along with their sleep apnea, as indicated by their responses on a clinical questionnaire.
The researchers found that older adults had better mood scores based on their answers to questions, as well as lower diabetes-related stress and less functional impairment in daily activities. Not surprisingly, more severe insomnia was linked to a worse mood, greater diabetes-related distress and greater functional impairment. On questions related to functional outcomes, older adults reported less difficulty with general productivity, social situations, being active and maintaining a sense of vigilance, as noted in a Healio article on the study.
Greater insomnia severity was also linked to greater daytime sleepiness, and tended to occur in people who had diabetes for a longer duration. These results suggest, the researchers wrote, that “diabetes care and education specialists should assess patients for impaired sleep” — in particular if they’re younger or have had diabetes for a longer period of time.
Making sense of sleep differences based on age
In some ways, the finding that younger adults are more vulnerable to poor outcomes if they have diabetes and sleep apnea is surprising, since younger people tend to experience better self-reported sleep in general, based on other studies. But this result underscores just how damaging sleep apnea can be, at least in people with diabetes — setting younger adults with these conditions apart when it comes to sleep quality.
The researchers speculated that older adults may be better at coping with the effects of sleep disturbances simply because they’ve lived with these disturbances longer and learned to adapt. But that idea is somewhat undermined by the finding that a longer duration of diabetes was linked to more severe insomnia, more daytime sleepiness and lower functional outcomes.
Instead, it’s possible that when diabetes and sleep apnea affect younger people, the disease processes involved may be somewhat different and more damaging to sleep-related outcomes. If that’s the case, then it’s especially important for doctors to screen younger (under age 65) people with type 2 diabetes for sleep disturbances, and to make sure they get treated for sleep apnea if they have it.