When we think “diabetes”, a number of conditions immediately come to mind, such as hypertension, chronic kidney disease, or peripheral neuropathy. Most diabetics with advancing stages of the disease suffer from at least one of these in some capacity. But we often forget about other conditions that are also caused by diabetes, which the VA very often forgets as well. Obstructive sleep apnea (OSA) is one of these. According to the American Academy of Sleep Medicine, Type 2 diabetics and people with hypertension (two conditions that go hand-in-hand) are much more likely to have obstructive sleep apnea than other people. In fact, research has shown that treating sleep apnea can help in the management of these conditions, including improved insulin sensitivity, blood pressure, and cholesterol.
What is sleep apnea?
Obstructive sleep apnea occurs when muscles in the back of the throat intermittently relax and block the airway during sleep. When these muscles relax, the airway narrows or closes as you breathe in, and breathing may be inadequate for 10 to 20 seconds. The brain senses this impaired breathing and briefly rouses you from sleep so that you can reopen the airway. This awakening is usually so brief that you won’t remember it. You may make a snorting, choking or gasping sound. This pattern can happen five to thirty times per hour, all night long. Impaired breathing may be worsened by alcohol or sedative use at bedtime, by causing the muscle tone to relax too much and by delaying arousal, thereby prolonging pauses between breathing. Many people do not realize they have such interrupted sleep or have this condition at all.
A noticeable sign of obstructive sleep apnea is snoring. Another sign is intermittent pauses in breathing during sleep. You may not notice the pauses or snoring while you sleep, but your partner might. With obstructive sleep apnea, snoring is loudest when sleeping on your back, and quiets when turning on your side. Heavy snoring is the major manifestation of obstructive sleep apnea and a predictor of obstructive sleep apnea.
OSA can be treated two ways. The most common way is a CPAP machine. Continuous positive airway pressure (CPAP) machines feature a piece that fits into the nose or is placed over the nose and mouth during sleep. The machine delivers air pressure through the piece that is constant and somewhat greater than that of the surrounding air, which is just enough to keep the upper airway passages open. The air pressure prevents OSA and snoring.
The other way OSA can be treated is a mouthpiece that is designed to keep the throat open. Some devices keep the airway open by bringing the jaw forward. Others hold the tongue in a different position. For all oral devices, a dentist is consulted to ensure the best fit and follow-up therapy.
So what is the link between OSA and Type 2 Diabetes? Two disorders such as OSA and diabetes would seem to have no connection at all.
The American Academy of Sleep Medicine puts it simply. “The severity of the sleep disorder directly impacts diabetes symptoms,” they say. “The more severe a diabetic’s untreated sleep apnea, the poorer their glucose control.” A study conducted in 2002 suggested that OSA has multiple adverse outcomes, including hypertension, Brady- and tachyarrhythmias, coronary artery disease, myocardial ischemia, congestive heart failure, and insulin resistance. Who would have thought that sleep apnea could cause so many problems?
In 2002, the American Journal of Epidemiology published an article that described habitual snoring as a risk factor for Type II Diabetes. This article studied 69,852 female nurses from the Nurses’ Health Study cohort. With such a large population sample, the researchers were able to adjust for multiple variables, such as age, body mass, smoking history, and degree of physical activity. This allowed the study to be more accurate as a whole.
The researchers explained that snoring or sleep apnea might increase diabetes risk by triggering metabolic processes involving insulin action and glucose regulation. Upper airway obstruction, caused by snoring or sleep apnea, can lead to oxygen desaturation, which increases catecholamine and cortisol levels in the bloodstream. Cortisol and catecholamines, as well as glucagon, are catabolic hormones that regulate blood sugar when blood sugar gets too low. They increase blood glucose by reducing uptake of the sugar by various organs in the body. Catecholamines (such as norepinephrine and dopamine) can be released in high levels by psychological reactions or environmental stressors, such as elevated sound levels, intense light, or low blood sugar levels. Cortisol is a steroid hormone that is produced in the adrenal gland, some external factors can stimulate its production, there’s a whole section about this in prohormones.co. It is released in response to stress and low blood glucose concentration. It also increases blood sugar by counteracting insulin, suppresses the immune system, and aids in the metabolism of fat, protein, and carbohydrates.
With these two insulin-resisting chemicals elevated in the bloodstream, the body over-produces glucose. And because cortisol counteracts insulin, the body does not release enough insulin to regulate or lower blood sugar levels. Over time, perpetually elevated levels of catabolic hormones cause the body to develop severe insulin resistance.
The results of the 10-year follow-up to this study showed that regular snorers had a higher mean body mass index, a higher waist-to-hip ratio, and a higher prevalence of high blood pressure and high cholesterol levels. Compared with non-snorers, women who snored regularly were at a five-fold higher risk of developing diabetes, while the risk was doubled among those who snored occasionally. Even after body mass index, smoking, and family history of diabetes had been factored in, both occasional snorers and regular snorers still had a significantly elevated risk of diabetes.
As the medical community is discovering more and more, sleep has plays an intrinsic role in the body’s ability to perform necessary functions. Therefore, the reverse is also true— impaired sleep or the lack of sleep can inhibit the body from performing those functions properly. In this case, obstructive sleep apnea can induce a severe state of insulin resistance, which turns into Type 2 Diabetes.
While your partner’s repeated complaints of your heavy snoring disrupting their beauty sleep might be annoying, don’t ignore them. It may be very worth your while to have this condition checked by a sleep specialist. If you already have Type 2 Diabetes that is service-connected through the VA, you can file a claim for sleep apnea as secondary to diabetes. The amount of medical literature linking diabetes and OSA is growing, along with awareness of this problem. Ask your doctor to write a short statement for you, giving his/her opinion that it is at least as likely as not that your OSA condition is caused or related to your Type 2 diabetes condition. This will significantly assist your VA claim.