A lack of proper sleep can have wide-ranging health effects on the human body, including weakening the immune system, raising blood pressure, and triggering weight gain thanks to hormonal imbalances.

A 2011 study found that 35 percent of people with type 1 diabetes have poor sleep, compared to people without diabetes. Why? Further 2016 research shows that in people with type 1, disrupted sleep is the result of both behavioral and physiological aspects of diabetes and its management.

The good news? There are things that you can do to take action to up your odds of being in that 65 percent of people who get a restful night’s sleep.

Blood sugar off the rails, on either the high or the low side, is disruptive to sleep — so working with your medical team to keep your nighttime blood sugar in range sets your body up for a good night’s sleep.

Dr. Elizabeth Halprin, clinical director of adult diabetes at Joslin Diabetes Center in Boston, reminds us that high glucose levels “cause increased urination, oftentimes at night,” and that “getting up to urinate multiple times will cause interrupted, non-refreshing sleep cycles.”

And that’s not the end of it. Once high blood sugar disturbs sleep, the sleep disturbances, in turn, raise blood sugar yet further, which triggers more sleep issues. It’s a never-ending cycle. A 2013 study published in the journal Diabetes Care shows that adults who sleep less actually have higher A1C levels.

On the other end of the glucose spectrum, while most type 1s have a degree of fear around the risks of nocturnal lows, even mild lows can have an impact on sleep. Halprin says, “Hypoglycemia can cause sudden waking and even nightmares.”

And speaking of nighttime highs and lows…

While continuous glucose monitoring (CGM) has been a game changer when it comes to blood sugar control, perspective, and patient safety, it’s re-defined the notion of invasive technology. Many T1s with unstable blood sugar patterns suffer a nightly barrage of sleep-jarring alarms that leave them zombie-like from fatigue the next day.

But there’s help. Most modern CGM systems allow for different alarm settings at different times of day. For some, especially those seeking tight control, slightly laxer nocturnal high alarm thresholds and rate change alerts may allow for a more restful night without comprising safety.

Granted, this may result in mildly higher overnight blood sugars, but tight numbers with interrupted sleep will do the same thing, while possibly leading to other health issues.

“Alarms need to be assessed and tailored so they are not waking the patient unnecessarily,” says Halprin. “Targets can be adjusted at night to not sound, if not critical.”

Many sleep experts recommend banning all electronics from bedrooms, as they tend to distract people, keeping them up. This is particularly true of TVs, and to a lesser extent, computers, but it’s mostly an increasing problem with smartphone devices.

Adding to the distraction problem, according to the National Sleep Foundation, is the fact that the blue wavelength light emitted by the screens of most portable devices mimics sunlight, inhibiting the body’s sleep-inducing production of melatonin. The Foundation notes: “When people read on a blue light-emitting device (like a tablet, rather than from a printed book) in the evening, it takes them longer to fall asleep.”

This biomedical factor has led to a “digital curfew” recommendation for kids and teens, with electronics being powered down 1 to 2 hours before bedtime. To improve your own sleep, consider a bedroom ban or digital curfew for yourself.

Of course, leaving your smartphone in another room won’t work for everyone, Halprin points out. “People also use their smartphones as the receiver for CGM, so they must keep them nearby.”

On the other hand, you may also be able to deploy technology in the opposite direction — to help you sleep. Check out Healthline’s review of the top insomnia apps. They vary, but features include:

  • sleep data tracking to help you understand your sleep cycles
  • white noise or nature sounds to mask environmental noise pollution
  • non-disruptive alarms that target your wake up time to match your natural sleep rhythms
  • meditation or hypnotherapy recordings
  • recorded bedtime stories and meditations

Some apps interface with wearable tech like smartwatches as well.

Especially in these times of worrisome national and international health news, and the increased potential risks for people with diabetes, it can be hard to resist the temptation to check the news right before turning in to bed. You don’t want to miss anything, but of course the news can be very disturbing and get your mind racing.

Try to “log off” news at least an hour before bed. Rest assured, literally, the news will still be there in the morning.

However, experts say that a nightly ritual of reading a good book can be a great stress reliever and actually help you settle down to sleep.

Dr. William Polonsky, director of the Behavioral Diabetes Institute in San Diego, says, “Telling your mind to just leave you alone is rarely effective. When you can’t fall asleep because your mind is whirring and whirring about COVID-19 or anything else, it may not help to just tell your mind to ‘leave me alone and let me sleep.’”

Rather, his suggestion is to take the time to acknowledge fear or stress, and actually write it all down before getting in bed. In other words, be a stenographer to your busy, worrying mind. Write down all the things that are worrying you and more. “No need to fix it, just get it down,” Polonsky says, and then you can try to “leave it there” for the night.

It’s all too easy to reach for energy drinks, soda, or coffee in the late afternoon for that “pick me up” to power through a tough day. But the caffeine that powers those drinks is a central nervous system stimulant with a half-life in the human body of 5 hours on average. (This means that if you drink 10 milligrams of caffeine, after 5 hours you still have 5 milligrams in your system.)

In fact, a 2013 study found that caffeine consumed 6 hours before bedtime can disrupt sleep. So if you drink coffee in the afternoon, make sure it’s more than 6 hours before you plan to go to sleep for the night.

An additional concern when it comes to caffeine is its diuretic effect, which can increase urination.

Atmosphere matters a lot, too. Creating a bedroom environment conducive to good sleep helps start the process off to a good start. Consider:

  • lighting
  • wall colors
  • temperature
  • bedding
  • incense
  • essential oils
  • calming pillow sprays

All should be maximized to create an environment that you find relaxing. And don’t forget your own body, either: Will you sleep best in pajamas, an old shirt, or nothing at all?

Humans are creatures of habit, so sleep experts say establishing a routine helps establish healthy biological rhythm that naturally leads to sleep.

This may seem like no-brainer, but take a few minutes to think about whether you have a steady pattern of doing the same things before bed each night: going to bed at the same time and rising at the same time 7 days a week?

While exercise is an important key to good health, and helps in maintaining blood glucose control, working out before bed can have a negative impact on sleep because it raises body temperature, speeds heart rate, and stimulates the nervous system.

Historically, experts cautioned against any late-day workouts. But Harvard’s Dr. Howard LeWine says recent research has shown that evening workouts are rarely a problem for most people, so long as they are completed at least an hour before bedtime. If you’re considering working out late in the day, definitely keep close track of how this impacts your sleep, to see if it’s the best choice for you.

Halprin cautions, “Care needs to be taken with sleep medications as we don’t want a patient to sleep through a severe low glucose event. I would suggest trying usual sleep hygiene measures first, followed by herbals, followed by medications if the previous do not work.”

Some good natural sleep aids include chamomile, valerian, hops, and melatonin.

Contact your doctor if you are considering taking natural sleep aids. Even though they can be purchased without a prescription, they can interfere with some prescribed drugs.

So there you have it, 10 tips to help you fall asleep and sleep better, even while managing diabetes.

One last note before we say good night: If you’re feeling poorly rested, even after what seems like a good night’s sleep, talk to your doctor about getting tested for sleep apnea, which research shows might affect as much as 30 percent of type 1s.