ESPE Yearbook of Paediatric Endocrinology

Brief summary: This ‘Letter to the Editor’ provides a critical review on how behavioural and physiological aspects of type 1 diabetes (T1D) and its management can interfere with standard principles of good quality and duration of sleep.

Quality of sleep is important for general human functioning, cognitive performance, emotional well-being, as well as immune function and cardiovascular health (1). The benefits of optimal sleep apply to everyone and even more to people with T1D, given the known associations with glucose regulation and cardiovascular health (1). However, individuals with T1D do not meet the recommended duration of sleep for age (2).

Sleep and T1D can be seen as ‘jarring bedpartners’ due to several reasons. T1D is a complex medical condition requiring frequent glucose monitoring and insulin administration. Episodes of acute hyperglycemia or hypoglycaemia can occur at any time of the day. In young children, risk of hypoglycemia is particularly high at night, and this often causes fear and lack of sleep in their caregivers. Of note, optimal sleep occurs when we feel safe, and this can be difficult for people with T1D or their caregivers. When treatment decisions need to be made at nighttime this might be suboptimal due to sleep deprivation of sleep inertia. Use of diabetes technology, such as continuous glucose monitoring, can interfere with sleep. Although technology has undoubtedly improved diabetes management, nighttime alarms, signalling abnormal glucose levels, or system malfunctioning, can lead to sleep disruption (3). In addition, standard approaches used to improve sleep, such as the advice to parents to let babies to ‘self soothe’ can be problematic for caregivers of children with T1D, who need to provide support overnight to their children. Techniques such as behavioural therapy including promotion of sleep restriction to produce more consolidated sleep could be unsafe for people with T1D.

More research into sleep and T1D is advocated by the authors, including qualitative studies to gain more insight into causes and consequences of sleep disturbances, and attitude and sleep priorities for people and caregivers. Longitudinal studies looking at associations between sleep and diabetes outcomes are also needed, as well as intervention studies aiming at improving sleep quality.

References: 1. Li J, Cao D, Huang Y, et al. Sleep duration and health outcomes: an umbrella review. Sleep Breath. 2022;26(3):1479–1501. 2. Jaser SS, Foster NC, Nelson BA, et al. Sleep in children with type 1 diabetes and their parents in the T1D Exchange. Sleep Med. 2017;39:108–115. 3. Cobry EC, Karami AJ, Meltzer LJ. Friend or Foe: a Narrative Review of the impact of diabetes technology on sleep. Curr Diab Rep. 2022;22(7):283–290.