The Causal Relationship Between Lack of Sleep and Diabetes

Zorina Sun

Abstract: Sleep Deprivation refers to the state when an individual does not get an adequate amount of good sleep. It is common in this fast-paced society, as people are spending a lot of time on studying, working and leisure activity. Thus, it is very significant to note the possible effects of lack of sleep on individual’s health. This paper evaluates the causal relationship between chronic lack of sleep and diseases, specifically, Type 2 Diabetes.

Sleep deprivation is very common in society today. There are several factors leading to this, including the increase in environmental light and electric light, use of electronic devices and the internet, and so on. According to the 2009 Sleep in America Poll, Americans are more likely to be working longer hours or multiple jobs, and concerned about personal finance, employment, and the economy, in the current economic climate. 1 Thus, sleep deprivation is partly self-imposed, as people choose to leave less time for sleep. Data from recent laboratory studies indicates that significant sleep loss exists in one-third or more of normal adults. 2 According to recent polls from the US Centers for Disease Control and Prevention, approximately 29% of US adults sleep less than 7 hours per night, and about 60 million of them have chronic sleep and wakefulness disorders. 3 People are sleeping less nowadays, and sleep disorders are on the rise.

There are five stages of sleep, including rapid eye movement (REM) sleep and nonREM sleep (stages 1, 2, 3, and 4). In the non-REM sleep stage, stages 3 and 4 are the deeper stages, which are also known as slowwave sleep. 4 Sleep has often been thought of as a “restorative” process for the mind and the body, and it also affects many metabolic and hormonal processes.

There is a very close relationship between sleep deprivation and diabetes. As Dr. Carol Touma and Dr. Silvana Pannain found, “people with diabetic should be systematically assessed for obstructive sleep apnea, and patients with known obstructive sleep apnea should be screened for diabetes.”4 The relationships between lack of sleep and diabetes can be explained by glucose tolerance and glucose metabolism.

1) Glucose Tolerance Glucose tolerance plays an important role in this causal relationship. It refers to the ability to maintain euglycemia. Normal glucose tolerance depends on the ability of the pancreatic beta cells to produce insulin. Beta cells are cells that make insulin, a hormone that controls the level of glucose (a type of sugar) in the blood. When pancreatic beta cells fail to compensate for a decreased insulin sensitivity, insulin secretion increases to maintain normal glucose levels, and diabetes becomes manifest.

4 A research article from Nedeltcheva, Kessler, Imperial, and Penev examined the effects of less-severe sleep deprivation in sedentary middle-aged men and women. The population of this study sleeps 5.5 hours per night for 14 nights. The lack of sleep is shown to decrease insulin sensitivity in the absence of adequate beta cell compensation. This causes a decrease in glucose tolerance and eventually leads to diabetes. 5 The short

lower parasympathetic activity, which are both associated with glucose metabolism. 13 The sympathetic nervous system prevents insulin release while the parasympathetic system promotes it. Thus, these changes would cause an increase in glucose level, and therefore diabetes.

14

Sleep plays a very important role in glucose tolerance and metabolic function, as well as creating other problems on top of diabetes. While it is important to note that there is a possible limitation to the present study because all the data collected was selfreported and thus might not be very

1 Malik, Syed W., and Joseph Kaplan. "Sleep deprivation." Primary care: Clinics in office practice 32, no. 2 (2005): 475-490. 2 Bonnet, Michael H., and Donna L. Arand. "We are chronically sleep deprived." Sleep 18, no. 10 (1995): 908-911. 3 Centers for Disease Control and Prevention (CDC. "Perceived insufficient rest or sleep among adultsUnited States, 2008." MMWR. Morbidity and mortality weekly report 58, no. 42 (2009): 1175-1179. 4 Touma, Carol, and Silvana Pannain. "Does lack of sleep cause diabetes." Cleve Clin J Med 78, no. 8 (2011): 549-58. 5 Nedeltcheva AV, Kessler L, Imperial J, Penev PD. Exposure to recurrent sleep restriction in the setting of high caloric intake and physical inactivity results in increased insulin resistance and reduced glucose tolerance. J Clin Endocrinol Metab 2009; 94:3242–3250. 6 Shankar, Anoop, Shirmila Syamala, and Sita Kalidindi. "Insufficient rest or sleep and its relation to cardiovascular disease, diabetes and obesity in a national, multiethnic sample." PloS one 5, no. 11 (2010): e14189. 7 Touma, Carol, and Silvana Pannain. "Does lack of sleep cause diabetes." Cleve Clin J Med 78, no. 8 (2011): 549-58. 8 "Clinic Chat: Counterregulatory Hormones." Type 1 Diabetes Family Centre. Last modified September 14, 2020. https://www.type1familycentre.org.au/post/clinicchat-counterregulatory-hormones. 9 Spiegel K, Leproult R, Colecchia EF, et al. Adaptation of the 24-h growth hormone profile to a accurate. People may include the time period of “trying to sleep” when they report, making the actual amount of sleep time lower. However, there is still a proven close relationship between sleep deprivation and disease. Based on data obtained by Shankar et al,

“perceived insufficient rest/sleep was found to be independently associated with CHD, stroke, diabetes mellitus and obesity.”15 Thus, it is very important for us to get enough sleep (at least 7 hours), but not too much. Studies also show that the risk of diabetes is higher with either too little or too much sleep. 16 Adequate amounts of good sleep should be a goal for a healthy lifestyle, especially for people with diabetes. 16

state of sleep debt. Am J Physiol Regul Integr Comp Physiol 2000; 279:R874–R883. 10 Vgontzas AN, Papanicolaou DA, Bixler EO, et al. Circadian interleukin-6 secretion and quantity and depth of sleep. J Clin Endocrinol Metab 1999; 84:2603–2607. 11 Vgontzas AN, Zoumakis E, Bixler EO, et al. Adverse effects of modest sleep restriction on sleepiness, performance, and inflammatory cytokines. J Clin Endocrinol Metab 2004; 89:2119–2126. 12 Dansinger, Michael. "Insulin Resistance: Symptoms, Causes, Tests, Treatment, and Prevention." WebMD, June 23, 2021.https://www.webmd.com/diabetes/insulinresistancesyndrome#:~:text=Insulin%20resistance%20is%20w hen%20cells,blood%20sugar%20levels%20go%20up . 13 Spiegel K, Leproult R, L’hermite-Balériaux M, Copinschi G, Penev PD, Van Cauter E. Leptin levels are dependent on sleep duration: relationships with sympathovagal balance, carbohydrate regulation, cortisol, and thyrotropin. J Clin Endocrinol Metab 2004; 89:5762–5771. 14 Teff KL. Visceral nerves: vagal and sympathetic innervation. JPEN J Parenter Enteral Nutr 2008; 32:569–571. 15 Shankar, Anoop, Shirmila Syamala, and Sita Kalidindi. "Insufficient rest or sleep and its relation to cardiovascular disease, diabetes and obesity in a national, multiethnic sample." PloS one 5, no. 11 (2010): e14189. 16 Touma, Carol, and Silvana Pannain. "Does lack of sleep cause diabetes." Cleve Clin J Med 78, no. 8 (2011): 549-58.