Is diabetes keeping you up at night?

Hormone changes are known to alter insulin sensitivity and glucose metabolism, as well as interfere with women's sleep patterns. But little was known about the association between diabetes and sleep disturbances during the menopause transition until now, as a new study concludes that women with diabetes are at greater risk for sleep disturbances. Study results are published online today in Menopause, the journal of The North American Menopause Society (NAMS).

Estrogen and progesterone are known to influence cell response to insulin. As a result, it has been suspected that the hormone changes of the menopause transition could cause fluctuations in a woman's blood sugar levels, putting her at greater risk of diabetes. Statistically, midlife women have a higher prevalence rate of type 2 diabetes during the menopause transition.

Similarly, hormone changes have been shown to affect a woman's quality of sleep. Mainly because of night sweats and hot flashes caused by hormone changes, about 42% of premenopausal and 60% of postmenopausal women reportedly have sleep disturbances. For those with diabetes, sleep difficulties could be worsened by various diabetes symptoms and related medications that cause, among other problems, more frequent urination that could wake women up multiple times during the night. At the same time, sleep is identified as a key factor in trying to prevent and manage diabetes.

Despite all these acknowledged associations, few studies to date have evaluated the possible association between diabetes and sleep disturbances during the menopause transition. However, a new study based on data from two larger Internet survey studies showed that the mean total number of sleep-related symptoms was significantly higher in those with type 2 diabetes than those without the disease. The severity of the sleep problems was also greater for women with diabetes. Although this association was demonstrated in four major racial/ethnic groups in the United States it was particularly pronounced in Asian women.

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Study results appear in the article "Sleep-related symptoms of midlife women with and without type 2 diabetes mellitus."

"This study suggests worse sleep-related symptoms in postmenopausal Asian women with type 2 diabetes compared with those without diabetes," says Dr. Stephanie Faubion, NAMS medical director. "Further study is needed, given the limitations of the analysis, but this report highlights the fact that sleep problems are common in midlife women. Sleep is an important determinant of health, and women with poor sleep should be seen and evaluated for common and treatable sleep disorders such as insomnia, obstructive sleep apnea, and restless legs syndrome.