Diabetes in South Florida
Diabetes and prediabetes are on the rise among kids and adults in the United States. Here’s what has been going on in South Florida.
Genetics, weight gain and diet are often associated with the risk for diabetes, but according to new studies, lack of sleep can also increase the risk of developing diabetes.
“There is impairment in the way the body is able to produce and use insulin when people are subject to prolonged sleep deprivation or poor quality sleep,” says Dalia Lorenzo, M.D., a neurologist with Baptist Health’s Miami Neuroscience Institute.
Lorenzo says that there are also effects in the other direction — where people with diabetes tend to have worse sleep than those without diabetes.
“Patients with diabetes can have higher rates of nerve damage in the legs called peripheral neuropathy, which will cause pain in the feet and legs that can make it difficult to get good quality and good amounts of sleep,” says Lorenzo.
She points out that patients with diabetes tend to be overweight, which can increase their risk for sleep disordered breathing, like sleep apnea.
“Once a patient does have diabetes, there is almost a vicious cycle that can be set up where their diabetes causes them to have worse sleep and their poor sleep worsens their diabetes,” she says.
Sleep Apnea and REM: Effects on Hormones
Sleep apnea, Lorenzo says, is a particular problem.
“First, it interrupts the continuity of the sleep stages that a person needs to go through in order to get restorative sleep,” she says.
She says that there is an architecture to efficient sleep and that people need to go through progressively deeper stages of sleep and periodic REM periods throughout the night in order for sleep to be refreshing.
“When a person snores loudly or is constantly obstructing their breathing, the sleep architecture is interrupted repetitively and the sleep is not refreshing,” she says.
“There can be curtailment of slow-wave sleep and this in particular has effects on hormone balance,” she adds.
Obstructions to breathing can cause decreases in the level of oxygen that is in the blood and the level of oxygen that makes it to the brain.
Lorenzo says that in some sleep apnea patients, this can happen 30 to 70 times an hour.
“This degree of oxygen deprivation, night after night, is expected to damage cells. Not only the cells in the brain, but also cells in the pancreas that are important in secreting insulin,” she says.
A large-scale study (of nearly 7,000 patients), titled “Effect of Interaction Between Slow Wave Sleep and Obstructive Sleep Apnea on Insulin Resistance,” found that obstructive sleep apnea, combined with an extreme lack of slow-wave sleep, has a more harmful effect on insulin resistance than obstructive sleep apnea itself. It was published this summer in The National Center for Biotechnology Information.
“It is known that deprivation of slow-wave sleep causes changes in the way hormone regulation occurs that favors insulin resistance, which is a prediabetic state,” says Lorenzo.
“This effect is magnified in patients that have obstructive sleep apnea,” she adds.
Lucky Number Seven (Hours of Sleep)
The American Academy of Sleep Medicine and the Sleep Research Society recommends that adults aged 18–60 years sleep at least seven hours each night for optimal health and well-being.
Adolescents need eight to 10 hours of sleep per night. But according to a Behavioral Risk Factor Surveillance System (BRFSS) survey, more than two-thirds of U.S. high school students report getting less than eight hours of sleep on school nights. Female students were more likely to report not getting enough sleep than male students, according to the survey.
Dr. Brian Gotkin, a pulmonologist, oversees the Memorial Sleep Medicine Center at Memorial Healthcare System in Hollywood. It does not serve as a research clinic, but rather, serves as a diagnostic center.
The center has been operational for nearly three years and is accredited by the American Academy of Sleep Medicine.
The center aims to diagnose sleep disorders such as sleep apnea or narcolepsy and works with multiple departments including pulmonology, cardiology and integrative medicine to diagnose and treat patients.
“Lack of sleep will lead to less energy and more tiredness. Less energy will lead to less exercise. Less exercise will lead to weight gain and ultimately problems with diabetes,” says Gotkin.
“Sleep has an important role on people who are at risk for developing diabetes,” he says, citing that some studies have shown that a lack of sleep can lead to insulin resistance.
“That means that for the same level or higher levels of glucose created by our body, our body’s ability to lower our glucose levels with insulin is impaired,” he says.
Gotkin says that if people are unable to lower their glucose levels, it can exacerbate problems with glucose regulation and contribute to Type 2 diabetes.
“Physically,” he adds, “lack of sleep can lead to problems with diabetes, obesity, and cardiovascular disease.”
He adds that lack of sleep can affect many hormone levels such as growth hormone, cortisol levels, thyroid levels and testosterone.
The University of Miami Sleep Center has been operational for more than 15 years and is also accredited by the American Academy of Sleep Medicine.
Sleep specialists interpret information collected during sleep studies and send a formal report with recommendations to the patient’s primary care doctor upon completion of the study.
UM’s sleep center offers non-surgical and minimally invasive surgical treatments, which include myofunctional therapy, upper airway stimulation, uvulopalatopharyngoplasty, and endoscopic sinus surgery.
“Sleep deprivation may cause cognitive impairment, impaired immune system, daytime fatigue and it increases the risk of developing diabetes mellitus Type 2,” says Alexandre Abreu, M.D., a pulmonologist and sleep medicine specialist with University of Miami Miller School of Medicine.
Nationwide Sleep Problem
According to a study in the Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Report, more than a third of American adults are not getting enough sleep on a regular basis.
Additionally, according to the CDC, healthy sleep duration was lower among Native Hawaiians/Pacific Islanders (54%), non-Hispanic Blacks (54%), multiracial non-Hispanics (54%) and American Indians/Alaska Natives (60%) compared with non-Hispanic whites (67%), Hispanics (66%), and Asians (63%).
This story was originally published November 23, 2021 7:00 AM.