Diabetes and sleep apnea combine to make a killer disease. They lead to obesity and heart disease, fatigue and high blood sugars. But you can do something about both.
Type 2 diabetes and apnea are two very different conditions that are often found together.
You could be diabetic and have obstructive sleep apnea without knowing you have either one.
Most of us had insulin resistance for years before we were diagnosed with type 2 diabetes.
Both diabetes and sleep apnea lie hidden in far too many of us. How does this happen?
You might think you are sleeping well the whole time that obstructive sleep apnea is making your diabetes worse.
One third of men with type 2 diabetes also have sleep apnea. In men older than 60 the number becomes almost two thirds. Among women the number is about one half.
If you snore at night and you are observed to stop breathing and then gasp for air or cough, that is obstructive sleep apnea (OSA) at work.
Several things can cause your airway to close when you sleep. Being overweight is number one because losing weight improves and often ends sleep apnea.
During sleep your throat muscles relax so that a large uvula, the thing that dangles at the back of your throat, blocks your windpipe.
Your tongue also falls back into your throat as you sleep. Overweight people have larger tongues.
The more fat stored around your neck and abdomen, the worse the sleep apnea is likely to be.
Because you can have sleep apnea without knowing it, OSA often goes for years untreated. That is why it is a silent killer.
Apnea means you go for a few seconds to several minutes without breathing. This puts a strain on your heart every time it happens. The longer you have apnea, the worse the damage.
If you have obstructive sleep apnea, you get high blood pressure that does not respond to medication like it should.
As soon as sleep apnea is treated, blood pressure goes down.
Apnea also leads to increased insulin resistance. Treating sleep apnea improves insulin resistance very quickly.
Being unable to breathe will jerk you awake sometimes hundreds of times a night, preventing the kind of deep sleep you need for restoring your body and mind.
So you cannot stay awake during the day. Sleepiness at work or while driving causes accidents.
OSA sufferers could die in an accident or die in their sleep because they did not wake up during an apneic event.
It is quite possible to have diabetes and sleep apnea without knowing it. Of the type 2 diabetics tested in one research study, over one-third had OSA. None of them knew.
Their unexplained fatigue, depression and reduced insulin sensitivity were blamed on their type 2 diabetes, when sleep apnea was the culprit.
Researchers were surprised to find that being overweight does not affect the risk of having diabetes and sleep apnea together.
When type 1 diabetic children were tested for sleep apnea, it was found in one-third of them. Most of them were normal or underweight.
Type 1 diabetics suffer from the same complications of sleep apnea as type 2. They get fatigue and depression from lack of deep sleep and hard to control blood sugars.
Treating obstructive sleep apnea does more for a diabetic than any medication to improve blood sugar levels.
The reason? Treating OSA will lower insulin resistance and stress from bad sleep that makes blood sugar difficult to control.
People who are treated for OSA get better blood pressure readings too.
They lose the fatigue and depression from lack of deep sleep. So if you are diabetic, find out whether you have sleep apnea, and begin to treat it.
Exercise and weight loss help both type 2 diabetes and sleep apnea.
There are also special exercises you can do to improve OSA.
For mild to moderate symptoms, tongue and soft palate exercises help.
Do some tongue exercises. Try to touch your chin with your tongue. Wag it from side to side as far as you can.
For the soft palate, gargle loudly with some warm water.
These may sound silly, but they come straight from the American Journal of Respiratory and Critical Care Medicine.
Sleep doctors say it helps to change your sleep position. Avoid sleeping on your back.
How? Try adding a pocket to the back of your pajamas. Put a tennis ball in it so you won't want to roll over on your back. Or use pillows to prop yourself on your side.
Losing weight can help if abdominal and neck fat is the cause of your apnea.
Do not drink alcohol at night or take drugs that relax your muscles. If you smoke, stop.
These things have helped mild sleep apnea.
But if you have moderate to severe obstructive sleep apnea you will probably need a "continuous positive airway pressure" machine, or CPAP.
The pump is
about the size of a small humidifier. It pushes air through a tube into a mask you
have to wear. It hisses like a humidifier too.
The pressured air blowing over your nose stops most snoring and apnea events once the pressure level is adjusted to your needs.
During your apnea test, a technician counts the number of apnea events you have, how long they last, and how much REM and deep sleep you get.
Then you wear the machine while different masks and pressures are attempted to find the right one for you.
It takes time to get used to
sleeping with a CPAP mask.
The constantly blowing air causes stuffy nose and headaches, which is why most machines have an attached humidifier. The mask can irritate your face too.
But cost is the main reason people do not get CPAP. The test is expensive and takes many hours in a lab.
The good news is that most insurance, including Medicare, does cover the test and the CPAP machine.
There are even machines you can rent to do a test in your own home, but this can go wrong in so many ways.
Plus you will probably need confirmation and adjustment by a doctor before insurance will pay for it.
But the results for your diabetes and sleep apnea are immense: lower blood sugar and blood pressure levels, easier weight loss, better sleep.
However, CPAP works only as long as you keep using it. Stop, and sleep apnea comes back.
CPAP does not cure sleep apnea. You may have to use the machine for the rest of your life.
But the type 2 diabetes cure of weight loss and lifestyle changes can end the symptoms of sleep apnea as well.
Some people have seen their sleep apnea disappear after they lost weight from exercise and healthy eating.
You could try surgery, but the results of throat and tongue surgery are often disappointing and temporary.
There are also tongue clamps and jaw braces that are supposed to keep your airway open at night.
Be careful about them, though.Check with your dentist to make sure you are not pulling your jaw out of alignment.
Those contraptions can be a waste of money because they often do not work.
You need to know if you have both diabetes and sleep apnea.
Do you notice fatigue, lack of energy and sleepiness during the day? If others say you snore and stop breathing at night, this is classic sleep apnea.
Get the test because diabetes and sleep apnea are a deadly combination.
It will be possible to lose weight more easily, take less medications, and use less insulin after you start using a CPAP machine. It has happened many times.
Anything that makes your diabetic condition easier to treat is worth doing. Treating diabetes and sleep apnea will add years to your life.
It may give you a chance to do the things you care about and live to see the fruits of your dreams. That is what I hope for.
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