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Tue, Jan. 21

Poor sleep negatively affects blood sugar control in diabetics

Dear Dr. Rosenberg:

My 12-year-old grandson has diabetes and is on insulin. He stays up late and sleeps no more than seven hours at night. His physician is having a hard time controlling his blood sugar. Could his sleep have anything to do with this?

A: Recent studies have shown that poor sleep and sleep apnea can have significant effects on blood sugar control in adolescent diabetics. Previously, this was thought to be a problem seen only in adult noninsulin dependent diabetics. However, a recent study in the journal Sleep showed that juvenile diabetics with underlying sleep disorders were far more likely to be difficult to be controlled. Your grandson should be sleeping about 10 hours at his age. The difference may explain the difficulty in controlling his blood sugar.

Dear Dr. Rosenberg:

I have difficulty with falling and staying asleep at times, but not every night. How do I know if it is a problem that requires treatment?

A: First of all, does it impact your quality of life? That is, does it cause sleepiness, irritability or trouble concentrating the next day? Secondly, how long and how often do you experience this? We define chronic insomnia as occurring three times a week for at least three months. If you fit the above, it might be a good idea to speak to your healthcare provider. Untreated, it can become worse and lead to mood disorders such as depression.

Dear Dr. Rosenberg:

I underwent a sleep study about a year ago. I was told that I had significant sleep apnea during dream sleep, but they told me that overall my sleep apnea was not severe enough to warrant treatment. I don't understand this. Could you please explain?

A: What you are describing is called REM-related sleep apnea. Because our muscles are weakest during REM sleep, some of us tend to have sleep apnea only or predominantly during dream sleep. Unfortunately, most insurance companies look at the number of times one stops breathing per hour overall. If you stop breathing only during REM sleep, you might not qualify for treatment, because dream sleep usually occupies less than 25 percent of total sleep. We in sleep medicine think this is rather archaic and are trying to get the rules changed.

Dear Dr. Rosenberg:

My doctor thinks I have sleep apnea because I snore and my wife says I stop breathing in my sleep. Several of my friends have CPAP machines. If I do indeed have sleep apnea, I would rather have one of those dental appliances made. How can one tell if they will be successful?

A: The best predictor of success is the number of times one stops breathing. In last month's edition of the journal Chest, a study was published comparing CPAP to oral appliances. In those with mild to moderate disease, the results were similar. However, in severe disease - determined by number of events per hour - oral appliances did not work as well as CPAP. This is the best study I have seen to date in terms of predicting success.

Dr. Robert Rosenberg, board-certified sleep medicine specialist, will answer readers' questions by incorporating them in future columns. Contact him at askthesleepdoc@yahoo.com or via mail at the Sleep Disorders Center of Prescott Valley, 3259 N. Windsong Dr., Prescott Valley, AZ 86314.

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