Overweight diabetics struggle to sleep soundly

People with diabetes often snore, snort and startle all through the night.

Nearly 8 percent of Americans have diabetes, and most have the form known as type 2. The heart and kidney risks are well-known. Now, a Temple University researcher says another danger may lurk while diabetics sleep.

Listen: [audio:090615tesnore.mp3]

Rudy Daisey spends his days listening to people sleep. It’s noisy work. As the body relaxes, the airway closes slightly, and then, this…

When the airway shuts completely, that’s an apnea. Some patients have as many of 200 apnea episodes in a night. Over and over the brain sends distress signals to the body: Wake up and breathe!

Daisey: When we heard somebody snoring like that we’d say: Well, he’s sleeping well. Well we know now that’s not always true.

Daisey is a registered sleep technician at the Beebe Sleep Disorder Center in Rehoboth, Delaware. Patients crawl into bed, and Daisey wires them for sound. A definitive diagnosis takes many tests, but Daisey says he usually knows sleep apnea when he hears it.

Daisey: Usually just a gasping, or a loud snort, or a real loud snore. ‘Huuuhh’ or a real loud ‘hnk.’

The problem is more than a poor night’s sleep. Sleep apnea patients have higher risks for stroke and high blood pressure.

Gary Foster is an obesity specialist with the Temple University School of Medicine. He and colleagues tested more than 300 patients for sleep apnea.

Foster: To our surprise 86 percent of people who were obese and had type 2 diabetes had sleep apnea and didn’t know it.

Undiagnosed means untreated, and Foster says that the big dilemma. When you combine sleep apnea with diabetes, a patient’s risks for cardiovascular problems could shoot up.

Diana Smith from Lewes, Delaware has lived with diabetes for 23 years, but says no one warned her about sleep apnea.

Smith: I would wake up choking which I found out later was because my body had stopped breathing, and so that choking was me gasping for air, and you know, struggling to take that breath.

Smith says her blood sugars spiked out of control around the same time she started to experience nighttime restlessness and daytime sleepiness.

Smith: And of course your brain’s not going to work right because it’s not getting the oxygen it needs, so it’s very difficult to be focused on things.

Experts say that kind of cognitive impairment is a special concern for diabetics, who have to constantly monitor and adjust their medication.

During a sleep study patients are connected to half-a-dozen sensors that record muscle tension, brain waves and heart rate. Colored lines march across Rudy Daisey’s computer screen. When the green line goes flat, the patient has stopped breathing for nine, 10, even 15 seconds.

Daisey: Think about it, if you sit there and hold your breath yourself, and count to 15 seconds, it’s a lot longer than you think.

For most patients the treatment is positive airway pressure.

A machine, fitted with a mask and hose, blows air up through the nose and down the airway to keep the throat propped open. Diane Smith wears the mask every night and says it works.

Smith: My sugar levels are dropping back to a normal range. My body is getting the oxygen it needs, it’s working better.

In the Temple University study many patients who had no symptoms at all, turned out to have sleep apnea. Dr. Foster says that makes it tricky to know who should get tested. A sleep study requires an over night stay and can cost as much as two thousand dollars.

Foster: From a healthcare point of view you can’t send all of your patients for a sleep study.

Foster wants people with diabetes, and their doctors, to be aware of the possibility of sleep apnea. But he says not everyone has the same risk. In the Temple study, it was the heaviest people and those with the widest waists who were most likely to have sleep apnea.

The Temple University study “Obstructive Sleep Apnea Among Obese Patients With Type 2 Diabetes” is published in the June 2009 issue of Diabetes Care.