What are the daytime effects of sleep debt, and how can they hamper my blood sugar control?

Low Energy: daytime somnolence (extreme sleepiness); frequent napping
• Beware of driving; increased risk of accidents
• May be too tired to prepare “healthy” meals or eat on schedule
• Likely not to maintain exercise regimen

Impaired Cognition

• Impaired psychomotor performance; longer periods of sleep loss lead to greater impact on speed of performance (e.g.: preparing and administering insulin injections may become more challenging)
• Reduction in performance of reasoning tasks (e.g.: sticking to diet, carb counting)
• Impaired short term memory or recall (e.g.: remembering to test or give insulin on schedule, recalling what you ate for lunch for food diary)
• Impaired decision making under conditions of uncertainty, worse with age (e.g.: selecting best choices from a restaurant menu)
• Typically affects tasks that are long or monotonous with no feedback or motivation (e.g.: driving leads to increased accidents and citations)

Depressed Mood: irritability, depression, anxiety; lack of motivation
• can lead to failure to follow prescribed plan, poor health habits, missed appointments, lack of foot care
• lack of stamina may lead to social isolation, limiting social and physical activity, and even development of pressure ulcers or other wounds due to self-negligence

*There is strong evidence of the reversal of all of the effects of sleep loss following recovery from sleep deprivation. Energy improves as fatigue fades. Memory improves via restored brain neurons; recall and concentration improve. Mood gradually returns to what is normal for you. Some of these factors will improve more quickly than others, and each person’s experience will differ to some degree.

A Final Word on Sleep Restriction:

Sleep Restriction in general appears to increase appetite and food cravings by altering levels of unique hormones in the body. Chronic Sleep Deprivation results from long-term inadequate sleep quantity and/or quality, ultimately leading to weight gain, insulin resistance and/or glucose intolerance, and increased fatigue. This begins a forward-moving cycle of increased hunger coupled with decreased physical activity that is almost certain to result in weight gain, and consequently worsening control of diabetes. This cycle has been shown to lead directly to the Metabolic Syndrome, cardiovascular diseases and diabetes in previously healthy people.
The impact of sleep deprivation appears to impact so many systems that many experts are predicting that sleep habit will be added to diet, exercise and smoking as major modifiable risk factors for a number of chronic diseases in the foreseeable future.

Sleep hygiene for optimum health:

• Keep regular bed- and wake times, even on the weekends
• Try not to nap during the day. If you must nap, limit to brief periods (10-15 minutes rest)
• Ensure bedroom conditions are conducive to sleep (dark, quiet, comfortable temperature, comfortable pillow and mattress; use earplugs or eyeshades if necessary)
• Restrict caffeine to before 10:00 a.m.; give it up altogether ideally.
• Do not smoke during the evening hours (if you must smoke at all).
• Limit alcohol to light consumption (it can fragment sleep architecture leading to frequent waking)
• Limit food and beverage intake for three hours prior to bedtime, if permitted by your meal plan.
• Regular exercise is a must, but finish at least four to six hours prior to bedtime. An exception is for those with anxiety, in which case light exercise before bedtime may help them to relax.
• Get at least 30 minutes’ exposure to sunlight in the morning hours, and avoid bright lights in the evenings. This includes avoiding computer and TV screens in the hours prior to bedtime.
• Do not bring business or homework into the bedroom; no TV either. Recreational reading is OK. Keep the bedroom a place for quiet and rest.
• Practice stress management techniques as necessary or appropriate.
• Keep a bedside diary to record problems, plans etc. so they don’t remain in your mind preventing sleep. Avoid reading or watching news about troubling events just before bed.
• A warm bath one to two hours prior to bedtime may help promote sleep. A warm glass of milk helps for many people as well, but be sure it fits into your meal plan.

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