Promoting Healthy Sleep in Children with Type 1 Diabetes

From diatribe.org

Getting quality sleep is challenging for children with type 1 diabetes, who deal with sleep disturbances like device alarms, low episodes, and more. Here we share sleep-promoting strategies researchers have found most effective for kids with diabetes.

Most parents can rattle off a hundred reasons why their child doesn’t get enough sleep. School, screen time, social engagements…the list goes on.

Lack of sleep, especially in growing children, can have serious consequences including behavioural problems, anxiety and depression, poor performance in school, and thoughts of suicide. 

Getting quality shut-eye is even more challenging for children and teenagers with type 1 diabetes, who face additional sleep disturbances like diabetes device alarms, low blood sugar episodes, waking up to go to the bathroom, and more.

While we often focus on the consequences of not enough sleep, Sarah Jaser, director of paediatric psychology at Vanderbilt University Medical Centre, said we can also look at sleep as an important tool for blood sugar management. In one study, 15-20 more minutes of sleep per night was linked to better adherence to a diabetes care regimen (like testing glucose levels and bolusing insulin for meals) in adolescents with type 1 diabetes. 

“It's really important to consider sleep in this population because it has so many different pathways to affect diabetes management,” said Jaser. “Sleep can actually help with diabetes management and behavior.”

How much sleep do kids need?

Here’s what the American Academy of Sleep Medicine recommends for children and teens:

• Infants 4-12 months: 12-16 hours

• Children 1-2 years: 11-14 hours

• Children 3-5 years: 10-13 hours

• Children 6-12 years: 9-12 hours

• Teenagers 13-18 years: 8-10 hours

“We know that most people are not achieving these goals,” said Jaser. “And it's particularly challenging for youth with diabetes.”

The reality is that roughly 35 percent of adolescents ages 17 and younger don’t get the recommended amount of sleep. Studies have also found that children and teens with type 1 diabetes get less sleep (an average of 26 minutes) than those without diabetes. 

In her own research, Jaser found that specific sleep interventions increased sleep duration in children with type 1 diabetes by 48 minutes, and overall, had significant benefits on their quality of life.

Sleep-promoting strategies for youth with diabetes

Simply telling kids to get more sleep isn’t usually the most effective, Jaser said. It’s about finding motivating factors and creating individualized goals that promote healthy changes in sleep habits.

While there are universal sleep hygiene practices recommended for everyone (like avoiding caffeine before bed), other night-time tips might work for some but not others. Here are some sleep-promoting strategies researchers have found most effective for kids living with diabetes:

• Maintain a consistent sleep schedule: Easier said than done, right? What’s important to note here is it’s not just how much sleep you get, it’s the timing of it – both factors can influence blood sugar management. Enforcing consistent bedtimes is often easier in younger children (teens may need some strong words of encouragement), but is important for building a reliable sleep schedule. This is important to keep in mind on weekends and during summer months when kids’ daily obligations and activities tend to differ from their regular weekday routine.

• Limit distractions: This is one of the most popular pieces of sleep-related advice for a reason. Especially for kids, screen time is a major factor. Remove electronics from the room or set a “communication curfew” for friends and classmates. Of course, many kids with diabetes rely on apps and electronic devices to alert them to changes in blood sugar. To limit distractions, many apps work on do not disturb or airplane mode. 

• Use technology productively: This might seem counterintuitive, but from Jaser’s research and feedback from patients, some technology can actually help kids fall asleep. Music, relaxation apps (try putting your smartphone on night mode to avoid bright screens), and white noise machines are all options that may encourage sleep.

• Keep a sleep diary: For inconsistent or irregular sleepers, it can be really hard to track sleep cycles. Keeping a diary beside the bed allows parents, caregivers, and kids to track patterns of behaviour and set goals to achieve consistent sleep. Some technology can help track sleep as well.

• Practice relaxation and mindfulness: Falling asleep is a big barrier, especially with worries around middle-of-the-night lows and other diabetes-related sleep disturbances. Practicing yoga, meditation, deep breathing, and tactics like progressive muscle relaxation are all easy strategies to practice before bed that can make a big difference in falling and staying asleep.  

• Educate kids on healthy sleep habits: Childhood sleep disturbances don't always go away without some support or treatment. A lot of times these issues can carry on into adulthood, progressing into conditions like insomnia. Teaching children at an early age about sleep hygiene enables them to take an active role in learning about sleep and establishing healthy habits that work for their individual circumstances. If you’re a parent or caregiver, you can enlist the help of your child’s medical team to prioritize sleep as part of their diabetes care plan.

“For those of us working in the diabetes space, it’s important for us to particularly ask about how diabetes is getting in the way of sleep,” Jaser said. “We can look at it as a point of opportunity. If we can improve or intervene on the sleep end, we can have a cascade of positive effects.”

https://diatribe.org/promoting-healthy-sleep-youth-type-1-diabetes