Pain and Sleep: Diabetic Neuropathy
According to the American Diabetes Association diabetes affects more than 29.1 million Americans, approximately 9.3% of the population. Diabetes is an endocrine disorder, meaning that it affects hormone levels. Although much of the attention is paid to the effects of diabetes on the blood sugar levels and the cardiovascular system, diabetes can also harshly affect sleep. One of the most common complications of diabetes is known as diabetic neuropathy, a pain condition that can disrupt the sleep cycle.
What Is Diabetic Neuropathy?
Diabetes is a condition in which the body cannot effectively respond to the hormone, insulin. In healthy individuals, insulin sends signals to our cells to tell them to pull excess glucose (sugar) from the bloodstream. This keeps blood sugar levels within a healthy range, allowing us to function normally. When the body alters its production of insulin or becomes less sensitive to the hormone, cells no longer receive these signals and do not properly clear glucose from the bloodstream. This leads to episodes of hyperglycemia, or high blood sugar. Upon being diagnosed with diabetes, individuals can begin taking medications and enact major lifestyle changes in attempts to achieve glycemic control.
Diabetes is a systemic disease, meaning that it has widespread effects on multiple body systems. For example, the nervous system can be severely affected by diabetes in a condition known as diabetic neuropathy, one of the leading complications due to diabetes. There are four main types of diabetic neuropathy, each with its own unique symptoms:
Peripheral Neuropathy
Peripheral neuropathy is the most common form of diabetic neuropathy, often occurring in individuals with a long history of the disease. Symptoms include numbness, tingling, burning sensations, inability to feel pain, temperature changes, increase sensitivity to touch, and muscle weakness. Typically, these problems begin in the feet and legs before spreading to the hands and arms. Many people with this form of neuropathy say it is worst at night time.
Autonomic Neuropathy
In addition to affecting the peripheral nervous system, diabetes can impact the autonomic nervous system, which controls many of your internal organs. Damage to these nerves may lead to bladder problems, difficulty swallowing, constipation, nausea and vomiting, changes in sweating, and difficulty regulating body temperature.
Radiculoplexus Neuropathy
Sometimes called diabetic amyotrophy, radiculoplexus neuropathy impacts the nerves in your hips, thighs, butt, and legs. This form of neuropathy is characterized by severe pain in the hip or thighs, abdominal swelling, weakened and atrophied thigh muscles, and weight loss. Symptoms often start on one side but may spread to both sides of the body.
Mononeuropathy
In some cases, diabetes affects a single nerve, a condition known as mononeuropathy. Mononeuropathy can cause severe pain in the shin, foot, lower back, pelvis, thigh, or chest. Fortunately, these symptoms typically subside after several weeks.
Causes of Diabetic Neuropathy
The nervous system consists of bundles of neurons, the cells that send signals throughout your brain and body. Each individual neuron is small and delicate, requiring a constant stream of oxygen and glucose to survive and function properly. People with diabetes have high blood sugar making blood vessel walls weaker. This particularly affects capillaries, the tiny blood vessels that serve the nerve fibers. As a result, nerves do not receive the nutrients they need and may begin to undergo dysfunction and/or deterioration.
Additionally, the presence of too much glucose in the blood can affect the nervous system as excess glucose may disrupt the ability of neurons to effectively send their signals. This is another contributor to neuropathy. In some cases, the immune system may inappropriately target neurons, leading to inflammation that damages the nerves. This can exacerbate diabetic neuropathy and contribute to additional pain.
The Link Between Diabetic Neuropathy and Sleep
Diabetes does not just disrupt your blood sugar but can also have a serious impact on your sleep. Diabetic neuropathy symptoms wax and wane throughout the day, but they are often worse at night. In some severe forms of the condition, people say that even the feeling of a sheet on their body is unbearable. This is because of the heightened sensitivity to pain observed in peripheral neuropathy.
Like other causes of pain, there is a two-way relationship between diabetes and sleep. First, diabetic neuropathy leads to uncomfortable pain that is often worse at night. This makes it difficult for people with neuropathy to fall asleep and maintain high quality sleep. As a result, you may feel unrested and chronically tired in the morning. These feelings of chronic fatigue actually make pain worse, meaning that you are likely to experience another poor night of sleep. Finding effective treatments for diabetic neuropathy and sleep problems is the best way to break this cycle.
In addition to diabetic neuropathy itself, sleep apnea may frequently co-occur with diabetes. In one study of diabetes patients, 30.5% of participants had moderate obstructive sleep apnea, with 22.6% having severe sleep apnea (Foster et al., 2009). Some people with diabetes do not realize they have sleep apnea and left untreated, sleep apnea is highly disruptive to sleep, leading to repeated awakenings during the night and poor sleep quality. Thus, individuals with diabetic neuropathy may also be experiencing sleep apnea, creating a double whammy situation that impairs their sleep.
Treatments for Diabetic Neuropathy and Sleep Problems
The number one way to prevent diabetic neuropathy is to keep blood glucose levels well regulated. Diabetic neuropathy is associated with a longer course of diabetes, poor glycemic control, being overweight, and developing kidney disease. The risk of these diabetic complications can be reduced by taking measures to better manage your diabetes.
Interventions to Improve Glycemic Control
Lifestyle changes remain the best intervention for managing diabetes symptoms. This begins with dietary changes, including limiting your intake of carbohydrates. Carbohydrates are broken down into sugar, causing blood sugar levels to spike. Working with a nutritionist can be helpful to identify healthy dietary choices.
Physical activity is also central to managing both diabetes and sleep problems. Staying physically active helps your body more effectively regulate its glucose levels. In turn, this can prevent further nerve damage and alleviate the painful symptoms of diabetic neuropathy. Exercises that improve blood flow in your feet are particularly useful, as peripheral neuropathy often affects the feet first. Walking, swimming, dancing, or cycling are great, low-impact activities that can build your strength and potentially reduce pain.
Sleep Hygiene
Practicing good sleep hygiene is also important for people with diabetic neuropathy, as these practices set you up for a good night of sleep. This includes limiting screen time before bed, maintaining a stable bedtime and wake-up time every day, avoiding caffeine or excessive alcohol before bed, and creating a nightly routine. Although these practices do not control diabetic neuropathy symptoms per se, they can make it easier for you to fall asleep and maintain good quality sleep.
If you have sleep apnea, it is imperative that you comply with CPAP treatment recommendations. Using a CPAP every night ensures that your brain gets enough oxygen during sleep, improving sleep quality.
Interventions for Better Pain Management
Your doctor may recommend other treatments for pain, such as physical therapy or acupuncture. By alleviating pain, these therapies may help you better get to sleep and stay asleep. Some patients also find that capsaicin cream, made with the chemical that makes chili peppers hot, can lessen the painful symptoms of diabetic neuropathy. You may need to experiment with several treatments before you find a combination that works best for you.
Your doctor may also recommend certain medications to alleviate pain associated with diabetic neuropathy. For example, antidepressant medications such as tricyclics or selective serotonin reuptake inhibitors may be effective at boosting serotonin levels in the brain, which can alleviate pain. These medications can also improve sleep quality for some individuals.
Other medications may include anti-epilepsy medications. Over-the-counter pain medications may also be useful for managing diabetic neuropathy symptoms that affect your sleep. Working in consultation with your diabetes doctor and a sleep specialist is the best way to find pain and sleep treatments that work.
If you are experiencing diabetic neuropathy and sleep problems, there are treatments that can help. The first step is to undergo an evaluation at your Seattle sleep center, where we will make an accurate diagnosis of your sleep difficulties. Then, we provide personalized treatment recommendations to help you manage your pain and sleep difficulties.
