Insufficient sleep is a public health problem that affects a majority of adolescents in the United States. But when it comes to children and adolescents with type 1 diabetes, research has shown that they have significantly shorter sleep duration than teens without diabetes (about 26 minutes less). Not surprisingly, teens with type 1 experience more sleep disturbances related to diabetes, such as hypoglycemia, as well as alarms from diabetes technology, especially in continuous glucose monitoring (CGM) systems.

The American Academy of Sleep Medicine provides recommendations for sleep based on age. For children ages 6-12, the recommendation is 9-12 hours; for teens ages 13-18, it is 8-10 hours; and for adults, it is 7-9 hours. In the studies our team at Vanderbilt University have conducted with adolescents, we have classified “insufficient sleep” as getting less than 8 hours of sleep on most school nights.

The Impact of Insufficient Sleep

The consequences of insufficient sleep could be serious. For adolescents with type 1 diabetes, insufficient sleep and poor sleep quality have been linked with lower levels of adherence to diabetes treatment recommendations (e.g., fewer blood glucose checks and insulin boluses), higher A1C, and greater insulin resistance. Sleep can have an effect on diabetes management through both direct and indirect pathways. Experimental studies of sleep restriction demonstrate that short sleep duration causes elevated blood glucose and insulin resistance (direct effect), and insufficient sleep has negative effects on cognition and behavior that impair people’s ability to manage diabetes (indirect effect).

Sleep is a potentially modifiable risk factor that may have both a physiological and behavioral impact on diabetes outcomes. Given the strong associations between sleep and diabetes outcomes, researchers at the University of Arizona are testing a sleep-extension intervention for adolescents with type 1 diabetes. Our research team at Vanderbilt is also conducting pilot studies in both teens and younger children to test the effects of a sleep-promoting intervention, which consists of individual “sleep coaching” sessions with teens (or with parents, for younger children) to promote healthy sleep habits.

Identifying sleep promoting interventions is important because indicators suggest that more consistent sleep patterns and extended sleep result in improved glucose levels and diabetes management.

Let’s Talk About Sleep

It’s important to promote healthy sleep habits with our patients. Healthy sleep habits for all adolescents include:

• Turning off electronics before bedtime (or setting a screen curfew 30 minutes before bedtime).
• Sleeping without screens (phones, tablets, and TVs) in the bedroom
• Getting regular exercise; and
• Maintaining a regular sleep schedule (going to bed and waking up at about the same time every day).

For adolescents with type 1 diabetes, some sleep disturbances can be prevented by checking blood glucose (or calibrating a CGM) before bedtime and treating highs and lows.

Health care professionals can start the conversation by asking about sleep – it is often overlooked as a potential risk or protective factor for diabetes management. One of the easiest recommendations can be to aim for consistent bedtimes/waketimes. Emerging evidence suggests that variability in sleep timing is even more detrimental for diabetes outcomes than obtaining insufficient sleep.

Do you ask your patients about their sleep behaviors?