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R.F. JOHN HOLTZEN, D.M.D.

You may know that researchers have linked obstructive sleep apnea (OSA) with a number of other serious long-term health problems, including heart disease, high blood pressure, and obesity. But you may not know that numerous studies have found a strong link between sleep apnea, sleep disturbances, and type 2 diabetes. In fact, according to a 2003 study, an estimated 40 percent of those diagnosed with OSA have also been diagnosed with type 2 diabetes.

Understanding the connection between sleep apnea and diabetes may help both individuals and society at large stay healthier, both when it comes to healthy sleep and when it comes to healthy blood sugar regulation. Ultimately, successfully treating and controlling your sleep apnea may help control your diabetes, while successfully treating and controlling your diabetes may help control your sleep apnea.

Disturbed sleep and blood sugar levels

The duration of your nightly sleep and the quality of your sleep are two important aspects of regulating your blood sugar and preventing the progression of diabetes. Sleep apnea causes sufferers to stop breathing at night – sometimes dozens of times per hour. This constant struggle for air makes it impossible to experience healthy sleep cycles and can trigger hormones that can cause insulin resistance.

In addition, people who are not well rested may eat more in response to their fatigue and in hopes of restoring their energy. Those who don’t get enough sleep are also often too tired to regularly exercise, a habit that helps control blood sugar and slow the progression of diabetes. Finally, the chronically tired may make poor food decisions because they are too fatigued to shop and prepare healthy meals. For example, a person exhausted from a night of poor sleep may opt for fast food over preparing a balanced meal of unprocessed foods at home.

All in all, researchers have found that those with severe sleep apnea have a 30 percent higher risk of developing type 2 diabetes, while those with moderate sleep apnea have a 23 percent higher risk of developing type 2 diabetes. While the reasons for this correlation are not totally clear, it is likely due to several different factors.

A two-way street

While studies have shown that sleep apnea and poor sleep can lead to insulin resistance and promote diabetes, there is also evidence that uncontrolled diabetes may have an adverse affect on sleep apnea. For example, both OSA and diabetes have been linked to obesity, and suffering from either the untreated sleep disorder or the untreated insulin disorder may increase body mass index (BMI). As weight increases, both diabetes and sleep apnea worsen and symptoms may become more severe. Further, controlling weight is more difficult for those with OSA, both because of metabolism issues and fatigue issues.

The road back to health

It follows that treating type 2 diabetes may help alleviate sleep apnea symptoms while treating OSA may help insulin production. Just last month, researchers at McGill University in Montreal found that sleep apnea sufferers with pre-diabetes could stall the progression of their disease simply by wearing a continuous positive air pressure (CPAP) device for eight hours each night.

Specifically, the scientists recorded that over a two-week period, OSA patients with pre-diabetes who were treated for their sleep disorder were significantly more glucose tolerant than those who were treated with a placebo. They also determined that the levels of stress hormones in the patients with treated sleep apnea fell by 28 percent.

The head researcher admitted, however, that although CPAP devices helped their patients slow the progression of diabetes, eight hours of consistent CPAP usage each night is difficult to achieve in real life.

Both sleep apnea and diabetes are affecting an increasing number of Americans and Montanans – and both are seen as serious public health issues. Understanding how these two conditions affect each other will be vital to treating patients, restoring their health, and improving their quality of life.

What you should do

If you have been diagnosed with OSA as well as type 2 diabetes or pre-diabetes, it is imperative that you treat both conditions with the help of a knowledgeable medical professional. Receiving a correct diagnosis as well as a working treatment for both conditions will likely be key to controlling your illnesses and maintaining your health.

Also understand that controlling your diabetes will not likely cure your OSA without separate treatment, while controlling your OSA will not likely cure your diabetes without further treatment. However, recognizing how the two conditions work hand-in-hand can help you and your doctor develop a treatment plan that works best for you.

Successful sleep apnea treatments

Although many people with OSA find correct and consistent CPAP usage difficult to manage, there are a number of increasingly effective ways to treat sleep apnea. Those with mild to moderate sleep apnea should consider lifestyle changes, including an increase in activity, a decrease in calories, or simply a change in the position they sleep in (sleeping on your back aggravates sleep apnea). Those with moderate to severe sleep apnea may consider more decisive and permanent treatments, including sleep apnea surgery.

At the Surgical Arts Centre here in Western Montana, we believe that successful evaluation and treatment of sleep apnea is vital to a healthier and happier life. We offer sleep apnea consultations that can help you better understand the severity and the cause of your OSA. Additionally, we perform a procedure called bimaxillary advancement, which moves both the upper and lower jaw forward to increase the airway and greatly improve nighttime breathing. The vast majority of OSA sufferers who have the bimaxillary advancement surgery no longer need to continue CPAP therapy or treat their sleep apnea in any way.

Questions and or comments regarding this week’s health column please contact R.F. John Holtzen, D.M.D. at the Surgical Arts Centre, 1201 Westwood Drive, Suite A, Hamilton, MT 59840. Working together to build a healthier community.

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