Is there a relationship between insulin resistance and insomnia?

From the Guidelines

Insulin resistance and insomnia are interconnected health issues that can negatively impact each other, and addressing sleep disturbances is crucial for improving insulin sensitivity and overall health outcomes in individuals with diabetes, as recommended by the most recent guidelines 1.

Key Recommendations

• Improving sleep hygiene by maintaining a consistent sleep schedule, creating a dark and cool bedroom environment, and avoiding screens before bedtime is essential for addressing insomnia and insulin resistance.
• Dietary changes, such as limiting sugar and refined carbohydrates and emphasizing protein, healthy fats, and complex carbohydrates, can help improve insulin sensitivity and sleep quality.
• Regular exercise, particularly 150 minutes of moderate activity weekly, can improve both insulin sensitivity and sleep quality, as supported by studies on exercise and type 2 diabetes 1.
• Stress management techniques like meditation, deep breathing, or yoga can help reduce cortisol levels that worsen both conditions.
• If insomnia persists, short-term use of melatonin (1-3mg) taken 1-2 hours before bedtime may help establish better sleep patterns.

Rationale

The relationship between insulin resistance and insomnia is complex, with sleep disturbances contributing to insulin resistance and vice versa. The most recent guidelines recommend screening for sleep health in people with diabetes and counseling them to practice sleep-promoting routines and habits 1. Improving sleep quality can help improve insulin sensitivity, and addressing insulin resistance can help reduce the risk of sleep disturbances. A study on facilitating positive health behaviors and well-being to improve health outcomes in diabetes-2024 found that sleep education, or sleep hygiene, improves sleep quality, reduces A1C, and decreases insulin resistance in adults with type 2 diabetes 1.

Additional Considerations

• Medications like metformin (starting at 500mg daily, potentially increasing to 1000-2000mg daily in divided doses) might be prescribed by a healthcare provider to address insulin resistance.
• Cognitive behavioral therapy for insomnia can demonstrate improvements in sleep outcomes and possible small improvements in A1C and fasting glucose, as supported by studies on sleep and diabetes 1.
• Referral to sleep specialists to address the medical and behavioral aspects of sleep is recommended, ideally in collaboration with the diabetes care professional.

From the Research

Relationship Between Insulin Resistance and Insomnia

• Insulin resistance is a common feature of several health problems, including type 2 diabetes mellitus, polycystic ovary disease, and cardiovascular disease 2.
• Research suggests that short sleep duration is significantly associated with insulin resistance, with inflammatory markers and biomarkers playing a role in this association 3.
• The causal relationship between sleep deprivation and insulin resistance is multifactorial, and further studies are needed to understand the mechanisms better 3.
• Sleep disturbances, including insufficient sleep, poor sleep quality, and insomnia, have been identified as independent risk factors for the development and exacerbation of insulin resistance 4.
• The role of sleep disturbances in insulin resistance is supported by evidence from various studies, which highlight the importance of addressing sleep disorders in the management of insulin resistance 3, 4.

Mechanisms Linking Insulin Resistance and Insomnia

• Inflammatory markers such as C-reactive protein (CRP) and serum amyloid A (SAA) may play a significant role in the pathogenesis of the association between sleep deprivation and insulin resistance 3.
• Biomarkers such as glucagon-like peptide-1 (GLP-1) and circadian misalignment may also contribute to the relationship between sleep disturbances and insulin resistance 3.
• The exact mechanisms linking insulin resistance and insomnia are not fully understood and require further research to elucidate the underlying pathways 3, 4.

Implications for Management and Treatment

• Addressing sleep disorders, such as insomnia, may be an important component of managing insulin resistance and preventing metabolic complications 3, 4.
• Lifestyle interventions, including dietary changes and exercise, may also play a critical role in managing insulin resistance and related health problems 2, 5.
• Further research is needed to understand the relationships between sleep disturbances, insulin resistance, and metabolic health, and to inform the development of effective management and treatment strategies 3, 4.