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Shh – Optimizing Sleep in Diabetes Care

by Christine Craig, MS, RD, CDCES

Sleep is associated with both physical and mental well-being. Yet, about one-third of the US population regularly experiences sleep disruptions.Sleep dysregulation is associated with an increased risk of Type 2 Diabetes, cardiovascular disease (CVD), and elevated A1C levels for individuals with type 1 and type 2 diabetes. Recognizing this, the 2025 ADA Standards of Care calls out the importance of screening for sleep health and promoting healthy habits. Through a gentle SHH, Diabetes Care and Education Specialists can address sleep health as a vital component of diabetes care, through Screening for sleep disorders, providing Help, and supporting the cultivation of effective sleep Habits.

Screening  

Healthy sleep is defined by adequate duration, quality, timing, regularity, and the absence of sleep disorders.3 Among these, sleep quantity has the most substantial evidence linked to health outcomes. As diabetes educators, we can incorporate sleep health into routine care by asking simple, open-ended questions such as:

  • “What is your regular sleep schedule?”,
  • “How many hours of sleep do you typically get each night?”, or
  • “How well do you feel rested when you wake?”.

These questions provide a quick snapshot, but for deeper understanding, validated tools such as the Munich Chronotype Questionnaire, Pittsburgh Sleep Quality Index, or Epworth Sleepiness Scale are used to evaluate sleep patterns, quality, and daytime sleepiness.3

Additionally, consumers and providers can use wearable technology such as fitness trackers and smart apps to provide data on sleep schedules and efficiency. Obstructive Sleep Apnea (OSA) can occur in greater than 50% of individuals with type 1 diabetes and 24-86% of individuals with type 2 diabetes1. If sleep disorders such as OSA are suspected, questionaries such as the STOP-Bang help identify risks and referral for sleep study as indicated. For individuals with OSA, CPAP therapy and GIP and GLP1-RA medications may improve glycemia and reduce CVD risk.

Help

Addressing sleep disturbances requires practical, evidence-based strategies. Assessment and interventions that prevent nocturnal hypoglycemia and address fear of hypoglycemia can improve sleep hygiene for individuals with diabetes. Cognitive Behavioral Therapy for Insomnia (CBT-I) helps individuals sleep better by identifying and changing thoughts and behaviors that make sleeping difficult. It is considered a first-line, evidence-based treatment for improving sleep quality and reducing disruptions.2 This approach focuses on behavioral strategies such as:

This intervention has shown promise in individuals with diabetes, improving sleep outcomes and glycemic management and empowering individuals to improve sleep health. As diabetes educators, we can work with providers to obtain referrals to licensed sleep therapists or online CBT-I programs, which may offer accessible and structured support.

Pharmacological options may be considered if sleep issues persist despite behavior changes. However, these options should be carefully evaluated for side effects and the risk of dependency. Combining pharmacological approaches with sleep education—emphasizing good sleep hygiene, creating a bedtime routine, and identifying triggers for poor sleep—can offer comprehensive support.

Habits

Exploring personalized sleep habits may impact the health of individuals with diabetes. Consider habits such as maintaining a consistent sleep schedule, creating a relaxing bedtime routine, limiting screen time in the evening, assessing the sleep environment, and minimizing disruptions, such as noise or light, can also promote better sleep quality. Through a gentle SHH, Diabetes Care and Education Specialists can address sleep health as a vital component of diabetes care, through Screening for sleep disorders, providing Help, and supporting the cultivation of effective sleep Habits.

References

  1. Sleep Health. Downloaded from https://nhlbi.nih.gov/health-topics/education-and-awareness/sleep-health on December 14, 2024.
  2. American Diabetes Association. Standards of Medical Care in Diabetes—2025. Diabetes Care. 2025.
  3. Joseph Henson, Alix Covenant, Andrew P. Hall, Louisa Herring, Alex V. Rowlands, Thomas Yates, Melanie J. Davies; Waking Up to the Importance of Sleep in Type 2 Diabetes Management: A Narrative Review. Diabetes Care 23 February 2024; 47 (3): 331–343. https://doi.org/10.2337/dci23-0037

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