Unfortunately, the science on this is mixed. Consider two studies about the impact sleep apnea treatment had on diabetes that were published in the American Journal of Respiratory and Critical Care Medicine in the same month. One study showed that treatment helped people control their diabetes. The other said it didn’t help diabetes or quality of life at all, though it did impact blood pressure and daytime sleepiness.
It can be hard to understand what these and other studies have to say about the impact of sleep apnea treatment on your health. Detroit sleep dentist Dr. Jeffrey S. Haddad at the Michigan Center for TMJ and Sleep Wellness can help you understand how you might benefit from sleep apnea treatment.
The Devil Is in the Details
Part of the confusion comes from “headline science”– how the media represents scientific discoveries to the public. These representations attempt to boil a study down to its bare bones as a single-sentence headline based on the study’s conclusion.
But even more important are the details of how researchers conducted the studies. These studies utilized very different designs. Although both studies were randomized clinical trials with a control arm, one focused on people who had uncontrolled diabetes, and the other focused on people who had their diabetes under control.
Worse Diabetes Benefits More
The study showing that sleep apnea treatment helped diabetes was the one using people who had poorly controlled diabetes. It’s quite likely that sleep apnea treatment will only make a significant difference in people whose diabetes is worse. For people with poorly controlled blood sugar, sleep apnea treatment might be a vital part of diabetes management.
On the other hand, if your blood sugar levels are already under control, sleep apnea treatment might not help as much. If your diabetes is already well managed, sleep apnea treatment may be unnecessary, especially if your apnea is mild and unlikely to cause cardiovascular risks.
CPAP Could Limit Effectiveness
Both these studies used CPAP as their sleep apnea treatment of choice. On the one hand, CPAP is the gold standard of sleep apnea treatment, but it has limitations that might be significant for diabetes control.
CPAP compliance tends to be relatively low–most estimates say 60-70%, although some are as low as 50% or less–but even those are inflated numbers. CPAP compliance is set at just four hours a night, 21 nights a month. If you sleep 8 hours a night, you actually only use your CPAP 35% of sleeping hours to be considered compliant. And that might just not be enough for diabetes control.
The body’s mechanism for blood sugar regulation occurs during REM sleep, which mostly occurs in the second half of sleep. If you use your CPAP for four hours a night, you leave 60% of your REM sleep untreated. That means that CPAP just can’t make as much difference in diabetes as we would like.
If you’re not getting the results you want from CPAP, it might be time to talk to a Detroit sleep dentist.
Treatment Could Help with Diabetic Retinopathy
Perhaps even more important than the impact of sleep apnea treatment on diabetes is whether treatment can improve the progression of diabetes-related health effects. Diabetic retinopathy (DR) is a complication caused by changes in your blood and blood vessels related to diabetes. Diabetes is hard on blood vessels, especially small ones, such as the ones in your eye. When these blood vessels get damaged, your vision can suffer.
DR starts when diabetes causes damage to blood vessels in the eye, creating a shortage in the blood supply. When the body senses this shortage, it tries to grow new blood vessels. But these new blood vessels can distort and damage the retina. The new and old blood vessels can leak, causing a fluid buildup around the retina. The swelling, scarring, and other damage to the retina diminishes vision and may even cause it to be lost altogether.
Retinopathy More Common–and More Severe
Studies show that sleep apnea can increase the risk of DR and the threat of sight-threatening diabetic retinopathy (STDR). DR is a common complication of diabetes, but it wasn’t known how much impact sleep apnea could have until recently. For this new study, researchers followed 230 patients with diabetes, none of whom had previously been diagnosed with sleep apnea. Nor had they been diagnosed with other respiratory conditions. At the start of the study, patients were tested for DR and sleep apnea. For DR, they used detailed scans of the eye. For sleep apnea, subjects were given a multichannel home test. These are both good diagnostic tests, which makes the study’s results more robust.
The test showed that 64% of the patients had sleep apnea and 36% had (STDR). Although this coincidentally adds up to 100%, there was significant overlap between these two populations. Researchers found that diabetics with sleep apnea were 2.3 times more likely to have STDR than those without sleep apnea.
The risks continued as researchers followed the population for an average of 43 months. They found that diabetics with sleep apnea were 5.3 times more likely to develop proliferative or pre-proliferative DR, a form that can turn into STDR.
Sleep Apnea Treatment Seems to Help
This study was mostly looking at risk, but it did come up with an incidental insight about the impact of treatment on the risk of DR. It seems that patients who got CPAP treatment during the study reduced their risk of developing proliferative DR. These results were statistically significant, but researchers warned that more studies should be done to confirm the result.
If you’re looking for effective sleep apnea treatment in Detroit, a sleep dentist could help.
Treatment Could Help with Diabetic Kidney Disease
Diabetic kidney disease (DKD), also called diabetic nephropathy, is another dangerous complication of diabetes. Your kidneys have an intricate structure of blood vessels that helps them perform their job of filtering waste from your blood. Poorly controlled diabetes can damage these blood vessels, making it harder for your kidneys to work effectively.
One of the ways that doctors measure the health of your kidneys is with a urine albumin to creatinine ratio (UACR) test. Because your kidneys should keep albumin in the blood and let creatinine enter urine, the higher this ratio, the worse your kidney function.
In DKD, people can see their UACR increase rapidly, especially if sleep apnea is making it harder to keep your blood sugar under control. A recent study (published in November 2022) showed that sleep apnea treatment led to an 11% decrease in UACR over a year.
However, it’s important to note that not all patients saw this benefit. The UACR reduction was only significant for patients who used their CPAP as often as recommended. In this study, that was 125 patients out of the initial 185, about 68%.
CPAP Alternatives Could Be Better for Diabetes in Detroit
Because of the limits of CPAP, it might not help blood sugar control in diabetics. But alternatives like oral appliances have a much higher compliance rate, approximately 95% by CPAP standards, with 84% of people achieving all night every night compliance. That could have a much greater impact on diabetes. A Detroit sleep dentist could help you understand your alternatives and how they might help you.
If you are using CPAP but aren’t seeing an improvement in your symptoms, you might need a new treatment to help you remain compliant. To learn more about oral appliances in the Detroit area, please call (248) 480-0085 today for an appointment with a sleep dentist at the Michigan Center for TMJ & Sleep Wellness in Rochester Hills.