Sleep-Deprived Teens – A Neglected Diabetes Landmine

By Divya Gopisetty

The importance of sleep for teens with diabetes. Plus, key sleep strategies from young adults living with diabetes! 

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Being a teenager brings many challenges: keeping up with schoolwork, dealing with peer pressure and finding community, changing hormones, applying to college, working a first job, and more. This can be a difficult and stressful time! Teens with diabetes must navigate blood sugars on top of it all. With so much going on, it is easy to deprioritize one of the most essential diabetes habits: sleep.

Children and adolescents with diabetes report poorer sleep quality. Studies show that they spend more time in stage 2 (lighter) sleep and less time in stage 3 (deeper) sleep than people without diabetes, likely due to overnight hassles: high and low blood sugars, checking blood glucose, and technology interruptions. Sleep is currently in a crisis in teens and adolescents, and this can make blood sugar harder to manage at an already-hard time. In his recent article, Adam shared the importance of sleep for people with diabetes:

Read on to learn more about how much sleep is needed for teens and practical strategies to achieve better sleep while managing diabetes, including avoiding diabetes food landmines, being proactive to avoid disturbances at night, and prioritizing sleep through healthy behaviors. Adam’s recent review of Why We Sleep by Dr. Matthew Walker has a deeper dive on sleep.

How Much Sleep Do I Need?

See the chart below for the sleep recommendations from the National Sleep Foundation.

As you can see, teens need more sleep than adults. However, on average, teens only get about seven hours of sleep per night. In his article on sleep, Adam described that the circadian rhythm of teenagers runs on a later schedule than adults – teenagers feel sleepier later at night and therefore need to wake up later. (Note: this is not a sign of laziness, but is actually a biologically hardwired difference.) It is natural for teenagers to not be able to fall asleep before 11 pm. However, this brings a real challenge: many schools start extremely early. This, combined with pressure from schoolwork and time consuming after-school extracurriculars, can make it difficult for teens to get the recommended 8-10 hours of sleep.

How Can I Improve My Sleep? Strategies from Teens with Diabetes

With the expertise of young adults living with diabetes (type 1 and prediabetes, specifically), we consolidated the following strategies for better sleep.

Avoid diabetes food landmines by understanding your individual blood glucose patterns and trends.

• Choose low-carb snacks if you decide to eat late at night. Alondra Zambrano, a college student living with type 1 diabetes, tells us that late-night snacking was hard to completely avoid in college. Instead, she’s found tasty low-carb alternatives (olives, nuts, cheese, etc.) that won’t dramatically impact her blood glucose levels.

Think ahead to minimize the number of disturbances at night.

• Wear automated insulin delivery (AID), if it’s accessible to you. AID systems – like Medtronic’s MiniMed 670G and Tandem’s Basal-IQ system – have algorithms that take over decision making and are linked to a lower number of high and low events at night.

• Keep your blood glucose meter and your hypoglycemia food (juice boxes, glucose tablets, etc.) next to your bed.  Peninah Benjamin, a college student with type 1 diabetes, explained, “If I end up having to go to the kitchen at night, I run the risk of overeating.” ­

• Adjust your diabetes technology alarm settings so that you are not as likely to be disturbed. Sarah Loebner, a young adult living with type 1 diabetes, gives herself a little extra wiggle room with her hyperglycemia alert (i.e., using a 200 mg/dl alert at night versus a 150 mg/dl during the day) so that she has fewer alarms at night. Jamie, who uses the DIY AID system Loop, points out that not all AID systems give you the flexibility to set target ranges. Read more about Jamie’s experience with Loop.

• Calibrate your sensor right before going to bed. Peninah shares, “If using a CGM that needs calibration, calibrate it right before going to bed to avoid the disturbance in the middle of the night.”

• Use Night Shift mode on Apple Devices, Night Mode on Android devices, and f.lux on your computer to reduce the amount of blue light exposure from screens before going to bed. Experts recommend avoiding screen time within 60 minutes of bed, as light exposure can disturb body’s natural melatonin production. Melatonin is a hormone that regulates sleep and wake cycles.

• Remove disruptive technology from the bedroom. Teens who leave devices on (phones, computers, television) are estimated to get 30 minutes less sleep on school nights than those who never leave devices on. Dr. Walker described that removing technology from the bedroom (for example, charging your phone in a different room) is the single best thing that you can do to improve sleep.

Prioritize high-quality sleep as much as possible. In school, there may be pressures to stay up late to hang out or finish homework assignments.

• Sleep will improve your diabetes management, overall health, and learning. Sarah says that, for her, long nights lead to high, resistant-to-bolusing blood glucose values for the next 12 to 24 hours. She said that she had to learn the hard way – that sleep is important for overall physical and mental health and for keeping blood glucose values in range, which are huge factors for how she felt during the day.

• Find your motivation to prioritize sleep. A college student living with prediabetes was told by her healthcare provider that sleep loss can lead to weight gain. A lack of sleep also makes it much harder to lose weight. However, she was not told that there was a direct connection with insulin resistance and her prediabetes. Knowing that she can battle her prediabetes with more quality sleep is motivation for her to prioritize sleep even as a busy college student.

• Sleep will help you perform better in all aspects of life. “At 11 pm, if I have to choose between studying 1 more hour for a test and going to sleep, I go to sleep.” Jamie has found that prioritizing sleep “will help you perform better on tests, sports and extracurricular activities, and spend quality time with your friends and family.”

If you are interested in reading more about strategies to sleep better, check out Adam’s full article here that shares some expert tips from Dr. Walker’s leading research.

Thanks to JDRF blogger Jamie Kurtzig, young adult and future physician’s assistant Sarah Loebner, Close Concerns’ Dartmouth Fellow Peninah Benjamin, the College Diabetes Network’s Alondra Zambrano, and the founder of Carb DM Tamar Sofer-Geri for their incredible insights and help with putting this piece together!

This article is a part of a series to support adolescents with diabetes funded in part by The Ella Fitzgerald Charitable Foundation.