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Sleep is critical for people with type 2 diabetes. Poor sleep contributes to elevated blood sugar, insulin resistance, hormonal imbalances (like cortisol, ghrelin, and leptin), and reduced motivation to maintain healthy routines (Harvard Health Publishing; Pacheco and Singh). When sleep is disrupted, people are more likely to overeat, skip exercise, and experience mood changes—all of which can worsen diabetes outcomes (Sleep Foundation).

Lack of sleep also raises the risk of obesity and metabolic disorders. Chronic insufficient sleep affects insulin activity and glucose tolerance and leads to long-term complications including cardiovascular issues and cognitive decline (Pacheco and Singh).

Aging can further affect sleep by shifting circadian rhythms, reducing melatonin production, and shortening total sleep time, making restful nights more difficult for older adults (Harvard Health Publishing).

How Diabetes Affects Sleep

Many people with type 2 diabetes experience poor sleep quality. One in two people with type 2 diabetes struggle with sleep due to unstable blood sugar levels and these and other symptoms:

• frequent urination at night (caused by high blood sugar)
• nightmares, sweating, or confusion (caused by low blood sugar)
• pain or tingling from peripheral neuropathy
• stress, depression, or anxiety related to diabetes (Pacheco and Singh)

These symptoms contribute to insomnia, fatigue, and next-day irritability.

How Poor Sleep Affects Blood Sugar

Sleep problems not only result from diabetes but can also worsen it. Poor or irregular sleep can lead to other side effects:

• increasing blood sugar levels by disrupting insulin and cortisol regulation.
• impairing glucose metabolism due to reduced slow-wave (deep) sleep (Pacheco and Singh).
• increasing hunger and cravings due to hormonal changes (Harvard Health Publishing).
• encourage skipping exercise and making poor diet decisions (Sleep Foundation).

People who sleep less than six or more than eight hours per night often have worse glycemic control. Poor sleep is also linked to insulin resistance even in those without diabetes (Sleep Foundation).

Common Sleep Disorders in People with Diabetes

Obstructive sleep apnea (OSA) is a condition where the airway becomes blocked during sleep, leading to repeated breathing interruptions. These micro-arousals lower sleep quality and oxygen levels and are common in people with type 2 diabetes (Johns Hopkins Medicine).

Symptoms include the following:

• loud snoring
• gasping or choking during sleep
• gaps in breathing, which are often noticed by a partner
• excessive daytime sleepiness (Johns Hopkins Medicine)

OSA increases the risk of heart disease and worsens blood sugar control. It is treated with a CPAP device and supported by weight loss (Pacheco and Singh).

Restless Legs Syndrome (RLS) causes uncomfortable sensations in the legs and the urge to move them. RLS, which can overlap with diabetic neuropathy, requires clinical assessment (Pacheco and Singh). About 20 percent of people with type 2 diabetes experience RLS.

Gastroesophageal reflux disease (GERD) is a condition where stomach acid flows back into the esophagus, causing discomfort at night and interrupting sleep. People with diabetes should avoid acidic or spicy meals and eat at least 2 to 3 hours before bed (Harvard Health Publishing).

Evidence-Based Tips for Better Sleep

Below are evidence-based tips for better sleep from the Mayo Clinic, the National Sleep Foundation, the Sleep Foundation, Harvard Medical School, and Johns Hopkins Medicine:

Environment and Setup

• Maintain a cool bedroom (60 to 67°F) (Sleep Foundation).
• Block out light with blackout curtains or sleep masks (Sleep Foundation).
• Minimize noise with earplugs or white noise machines, fans, or mobile apps (Sleep Foundation).
• Invest in a supportive mattress and breathable bedding (Sleep Foundation).
• Keep your bedroom dark, quiet, clutter-free, and technology-free (Harvard Health Publishing).

Routine and Schedule

• Go to bed and wake up at the same time daily, including weekends (National Sleep Foundation).
• Limit naps to 20 to 30 minutes and avoid late-day napping (Mayo Clinic).
• Create a calming wind-down routine: take a bath, stretch, meditate, or listen to soft music (Harvard Health Publishing).
• Disconnect from screens one hour before bed to reduce blue light exposure (Sleep Foundation).
• Use your bed only for sleep and sex to build strong associations (Harvard Health Publishing).
• If you can’t fall asleep in 20 minutes, leave bed and return once sleepy (Mayo Clinic).

Breathing and Relaxation

• Try diaphragmatic breathing: Inhale into your lower belly (not your chest), hold for a few seconds, and slowly exhale. Repeat while focusing your attention on your breath (New Beginnings Mini-Lesson).
• Journal, pray, or use gratitude reflections to unwind before bed (New Beginnings Mini-Lesson).

Daytime Habits

• Get 30 minutes of natural light exposure daily (Sleep Foundation).
• Stay physically active: aim for daily movement but avoid intense activity close to bedtime (Harvard Health Publishing).
• Lack of physical activity is a common sleep disruptor; include even light movement each day (Harvard Health Publishing).
• People after menopause have a higher risk of sleep apnea and may require screening (Johns Hopkins Medicine).

Food, Drink, and Medication

• Finish eating meals two to three hours before bedtime; avoid large, spicy, or acidic meals late in the day (Harvard Health Publishing).
• Limit caffeine after 2:00PM. (Sleep Foundation).
• Avoid alcohol and nicotine near bedtime. Even low amounts of alcohol (one drink) may help you fall asleep faster but often lead to lighter, fragmented sleep later in the night. Moderate to high alcohol intake (two or more drinks) disrupts REM sleep and can increase nighttime awakenings. Alcohol also acts as a diuretic and may increase the need to urinate, worsening sleep and sleep apnea symptoms. It’s best to avoid alcohol, particularly in the hours leading up to bedtime (Sleep Foundation).
• Adhering to a structured diet plan can indirectly support better sleep by reducing glycemic variability (New Beginnings Mini-Lesson).
• Talk to your provider about supplements like melatonin (Sleep Foundation).

Learn more by watching the YouTube video “5 Simple Tips For Getting a Good Night's Sleep.”

Medication Use

When lifestyle changes are not enough, your doctor may prescribe sleep aids. These can help with falling or staying asleep but must be used carefully (Harvard Health Publishing).

• Always inform your doctor about other medications you are taking to avoid dangerous interactions.
• Use the lowest effective dose for the shortest possible time.
• Take medication exactly as prescribed by your healthcare provider.
• Avoid alcohol while using sleep medications.
• Do not drive after taking a sleep aid.
• Clear your nighttime walking path to prevent falls (especially if you frequently get up to urinate).

Side effects may include daytime drowsiness, dizziness, dry mouth, appetite changes, and vivid dreams. These effects may increase fall risk, particularly for older adults (Harvard Health Publishing). include dry mouth, dizziness, daytime drowsiness, strange dreams, or stomach discomfort

Professional and Psychological Support

• Talk to your provider if sleep challenges persist or worsen (Mayo Clinic).
• Request evaluation for sleep apnea, RLS, or GERD if relevant symptoms are present (Johns Hopkins Medicine).
• Consider a formal sleep study if breathing interruptions or daytime sleepiness are suspected (Johns Hopkins Medicine).

More Information

Harvard Health Publishing. “8 Secrets to a Good Night’s Sleep.” Harvard Medical School, 20 Nov. 2023.

Johns Hopkins Medicine. “Diabetes Education #29: Wake-Up Call.” Johns Hopkins Health System, 2023.

Mayo Clinic. “Sleep Tips: 6 Steps to Better Sleep.” Mayo Clinic, 2023.

National Sleep Foundation. “10 Tips for a Better Night’s Sleep.” SleepFoundation.org, 2023.

Pacheco, Danielle, and Abhinav Singh. “Lack of Sleep and Diabetes.” Sleep Foundation, 26 Oct. 2023.

Sleep Foundation. “20 Tips for How to Sleep Better.” Sleep Foundation, 8 Dec. 2023

New Beginnings Mini-Lesson: Sleep Health. American Diabetes Association, 2024, New Beginnings Mini-Lesson: Sleep Health | Diabetes | CDC