People with diabetes certainly aren't immune to issues with insomnia or other sleeping problems that occur with age, jet lag or seasonal affective disorder. When that happens, sometimes counting sheep just doesn't cut it. But there has been concern discussed recently in the D-OC about using sleep aids with diabetes. A thread on TuDiabetes starts off with the notion that "any kind of sleep aid is taboo for an insulin-dependent diabetic." So we decided to put on our Mythbusters hat and investigate whether this claim is true or false...
Although there aren't any recommended sleep aids specifically for people with diabetes, Kelley Champ Crumpler, a diabetes nurse educator and the wife of an endocrinologist, primarily recommends melatonin to treat sleeping problems. Melatonin is a naturally occurring hormone in your system that helps to control your sleep and wake cycles. Unlike insulin, melatonin is a hormone that is synthetically made and can be ingested, so a natural supplement is available over-the-counter (usually found in the vitamin section of your grocery store).
"We have them start with a small, 1 mg tablet before bed, and can taper up as needed," Kelley says. "Melatonin won't render you useless like other sleep aid/hypnotics will. It's even safe for children to use."
If that doesn't work, Kelley says that using an antihistamine that contains either diphenhydramine (found in Benadryl or nighttime pain relievers like Tylenol PM or Advil PM) or doxyalimine (found in the over-the-counter sleep-aid tablets Unisom).
Anecdotal evidence on some of the diabetes forums shows that melatonin and antihistamines are the most popular way of treating insomnia. These meds are also "light" enough that they won't knock you out so much that you won't wake up naturally in an emergency — or from a low blood sugar. Overnight hypoglycemia or hypoglycemia unawareness is the number one cause for concern, which is why Kelley encourages testing blood sugar at bedtime or even wearing a continuous glucose monitor if you have access to one.
In addition to treating with meds, investigate possible causes of insomnia, which include: consuming caffeine too close to bedtime (last cup should be four to six hours before), exercise before bed, stress, or other stimulants. Some prescription medications, called sedative hypnotic sleep aids (Lunesta, Ambien, etc.), can be used if the other options don't work, but those should be used as a last resort and always start with the lowest dose and taper up, Kelley says.
Like any medication, sleep aids can also cause side effects and some can be particularly addictive, so talk to your doctor about the best med for you, and make sure to let him/her know if you notice any unwanted changes. Sleep aids are generally not safe if you're pregnant or drinking alcohol. You also don't want to take sleep aids for a long time period, so make sure to consult with your doctor if your insomnia doesn't get better after a couple of weeks.
Of course, we'd love to hear about it if anyone out there has a useful, diabetes-friendly sleep aid suggestion: Grandma's old-fashioned warm milk? Wait, no... too many carbs?