Sleep: A Fickle Friend

My relationship with sleep has always been odd. I love sleep. But when I was a child, I had night terrors. I always needed a night light, and I still can't sleep in total darkness. I'm also a violent sleeper. My friends who've shared rooms with me say I run in my sleep, kick in my sleep, throw things in my sleep...

I wake up and the room is a mess. My stuffed animals are everywhere. My blankets are askew. Bottom line is, my sleep has never been particularly restful.

As I adjust to adulting and having a full-time job, one of the things I've prioritized is trying to get as restful a night's sleep as possible. But the more time I spend trying to get a good night's sleep, the more I am reminded of an unpleasant truth: type 1 is not at all conducive to rest. And I am not alone in this. Other T1D's feel the same, as do their family members I'm sure. How does any parent of a T1D child get a full night's rest? My mom still doesn't sleep, and I'm 26 (sorry mom).

There's many parts of diabetes that interfere with sleep. To start, the equipment. Anyone with a pump knows what it's like to wake at 3am entangled in tubing (Podders excluded). There are times when I drift seamlessly between sleep and wake, just long enough to grab my pump, roll to the side, and place it so it's not wrapped around my waist. This may not be a lot of time awake, but it adds up.

Then there's the tech. CGMs can simultaneously help and interfere with sleep, depending on the person. On the one hand, the CGM is a great tool for waking those who don't feel their lows or highs. This is essential for getting a good night's sleep - because who can rest when they're worried about dropping low and not feeling it? Those who don't feel their lows and parents of young children can more than likely rest easily knowing their CGM is there for them. On the other hand, some CGMs are less accurate than others. False alarms ringing out in the night are incredibly frustrating. There's also the risk of over-checking and over-treating - seeing a downward/upward arrow when you roll over and glimpse at your graph, and giving an unneeded correction or laying awake with worry. Much like having a cell phone in the bed, the CGM is stimulation. It is a double-edged sword.

What else?
High BG - up all night to pee.
Low BG - up all night to eat. Followed by a rebound and a wave of nausea.
Bum pump site - have you ever had to change your site in the twilight hours while still half-asleep? Not fun.

Along with all of this comes the general anxiety of just being diabetic - and trying to sleep. Whether it's worrying about lows or highs, worrying about whether a correction will work and how you'll be when you wake up, or trying to remember if you've re-stocked your bedroom juice, diabetes is not a disease that plays nice with restful sleep. Because of this, I try to get into my bed early enough that I have more than enough time to get in eight hours - since I know 100% of the time in bed will likely not be spent sleeping.

The Monster Under the Bed

It is a thief in the night.  The monster under the bed. The lingering thought in the back of your mind that sticks from when you are brushing your teeth, through your dreams and nightmares, and into the early morning. Will I go low tonight? Will I wake up in a cold sweat dying for cupcakes and ice cream? Is my meter near my bed? Is there juice near my bed?

Nighttime low blood sugar isn't the most pleasant of things to talk about, but it's something that has really be gnawing at my restful sleep the past couple of nights. I am fortunate enough (knock on wood) to wake up when my blood sugar goes low. However, this typically is never a pleasant experience.  When I was young, I would sit straight up in my bed and call for my mom until she came and fed me juice and wiped away the cold sweat that had accumulated all over my face.  Now, I half-wake, toss and turn, mumble to myself, and have a strange internal conversation until I finally roll over and grab my meter:

"Get up. Open your eyes. You are low."

"No."

"Just roll over. Just test and you can go back to sleep."

"No. Too tired. Too asleep."

"I SAID GET UP."

I'm not quite sure why this conversation happens and why I don't just sit up and test. Is it sleep deprivation? Is it my subconscious trying to be in denial of my diabetes need? Either way, it scares me when I wake up and find that I am in fact low. Why was I trying to stay asleep? Which leads me to further worry about those who do not wake up when they feel low. Thankfully, modern medicine has come a long way and many sensors can now stop incoming insulin when they read a low blood sugar.

However, this doesn't make nighttime hypoglycemia any less stressful, both for parents and for those with type 1. It is a haunting that we have to learn to cope with. And it doesn't exactly do wonders for one's psychological well-being. Things such as nighttime lows remind me why those with type 1 diabetes are much more susceptible to depression and anxiety. And that's okay. It is something we have to talk about, and something we have to deal with. Much like our blood sugar levels. It's all part of the job.