Two-thirds of patients with sleep apnea are also obese, greatly increasing their risk of developing Type 2 diabetes. Ruth Simpson has been a slave to constant and excessive fatigue most of her life. Nagging exhaustion prevents her from accepting social invitations and the retired Scarborough teacher is in bed by 7p.m. most nights. The older she got, the more illogically extreme her fatigue became.

As a young girl, she was always a snorer. But as time wore on, Simpson, now 60, was waking up with sore throats and tension between her ribs, making more bathroom trips throughout the night and was putting on a lot of weight.

She was diagnosed with Obstructive Sleep Apnea, a disorder characterized by frequent episodes of blocked breathing. Ather doctor’s appointment, Simpson was also waned of the links between sleep apnea and cardiovascular problems or diabetes. A year later, in 2001, Simpson went back to the doctor, as her exhaustion had become worse. She was diagnosed with Type 2 diabetes. “It all played havoc with my health,” she says ‘I feel like I wasted 10 years of my life because of fatigue.” A growing body of research is finding links be­tween sleep deprivation or sleep disorders and Type 2 diabetes. It’s a connection that receives little attention when it comes to the management of the disease.

‘We know that sleep is helpful to our bodies. We talk about it as a way of providing nutritional support to the body,” says Dr. Harvey Moldofsky, medical director of the Sleep Disorders Clinic and Centre for Sleep and Chronobiology in Toronto. ‘The regulatory functions of our body are all tied to the sleep/wake cycle. When sleep is disturbed, our immune system weakens and our hormones are thrown off.”

Chief among these hormones are those that govern what Moldofsky calls “the appetite of our behavior,” or food cravings. These metabolic changes increase our desire to eat, which in turn leads to obesity: the leading risk factor for diabetes.

It’s all interconnected, experts say, and at the core of the problem is North America’s increasingly obese population.

“Two-thirds of patients with sleep apnea are obese,” says Dr. Michael Farkouh, a Canadian cardiologist and associate professor of the Mount Sinai Medical Center in New York “Obesity is a greater predictor of sleep apnea than age by four times. And obesity is a risk factor for diabetes. They all march together.”

For Simpson, not only is everything tied together, her life is a vicious cycle of exhaustion and weight gain. During her sleep test, doctors found that Simpson stopped breathing for 30 seconds, every 90 seconds.

In sleep apnea, the muscles in the upper throat relax during sleep, closing the airway and preventing air from getting into the lungs. She would wake up 70 times through out the night but was unaware of the interruptions in the morning. Her oxygen blood saturation levels were also dangerously low.

This lack of oxygen and sleep animates the sympathetic nervous system, which secretes adrenalin into the blood stream. That reduces the ability of insulin — whose job it is to regulate blood sugar levels — to help cells in the body absorb glucose, making the patient both insulin resistant and glucose intolerant, explains Dr. Douglas Bradley senior investigator and director of the Sleep Research Laboratory at Toronto Rehab.

‘There is a significant relationship between sleep apnea and actual Type 2 diabetes,” Bradley says.

When Simpson was working as a special education teacher in Scar­borough, she would spend her lunch hours napping, and slept through all her weekends.

‘I slept in order to work,” Simpson, 60, says. ‘When I got home, I would fix dinner and be in bed by 7 or 8 p.m. Friends knew never to call me after 9 p.m. and dinner out with friends had to be early?’

She noticed that her neck got larger and she was putting on extra weight: over the span of 10 years, she gained 90 pounds on her 5-foot frame.

“When your body’s not well, you don’t have the energy to exercise,” she says. “I started gradually putting on the weight and couldn’t get it off.”

While the link between sleep apnea and diabetes is well-established, new research is also emerging about the role of sleep deprivation in diabetes. In a study out of Columbia University re­searchers followed 8,992 subjects between the ages of 32 and 86 in an epidemiological study that spanned 10 years.

They found that those who slept five or fewer hours, as well as those who slept more than nine, were significantly more likely to develop Type 2 diabetes, compared to those who reported sleeping seven hours — even after adjusting for variables like obesity, physical activity, age and ethnicity. Experts advise getting seven to eight hours of sleep a night.

But if sleep apnea is linked to poor glucose control, logic dictates that treating the sleep disorder has the potential to also manage diabetes, an exciting prospect for researchers and patients alike.

“By following behavioral modifications like weight loss and better management of sleep apnea, there’s an opportunity to turn this around and improve the way patients feel,” Farkouh says


While there’s more research to be done, experts say the importance of adequate and quality sleep is often overlooked in the management of diabetes and should be given its due, alongside nutrition and exercise. The International Diabetes Federation offers these facts:

  • Up to 40 per cent of people with Obstructive Sleep Apnea will have diabetes, but the incidence of new diabetes in people with OSA is not known.
  • The prevalence of OSA in diabetics may be 23 per cent, while the prevalence of some form of sleep-disordered breathing may be 58 per cent.
  • Studies show an association between the two conditions independent of obesity.
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