This month, two studies about the impact sleep apnea treatment had on diabetes were published in the American Journal of Respiratory and Critical Care Medicine. 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.
This is modern science at its finest: critically re-evaluating important questions from multiple perspectives to try to determine the truth about these complex aspects of health. Unfortunately, this can be very confusing to laymen, especially sleep apnea patients who are struggling with these conditions. Let’s look at what these studies actually said to determine what their overall message is.
The Devil Is in the Details
Part of the confusion comes from “headline science”–the way 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 conclusion of the study.
But even more important are the details of how the study was carried out. For these studies, the designed as very different. 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 it’s mild and is 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 have use your CPAP 35% of the time you’re sleeping 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’re actually leaving 60% of your REM sleep untreated. That means that CPAP just can’t make as much difference in diabetes as we would like.
CPAP Alternatives Could Be Better for Diabetes
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 much greater impact on diabetes.
If you are using CPAP but aren’t seeing an improvement in your symptoms, you might need a new treatment that will help you remain compliant. To learn more about oral appliances in the Detroit area, please call (248) 825-8277 today for an appointment with a sleep dentist at the Michigan Center for TMJ & Sleep Wellness in Troy, MI.