Jeremy Gilbert, MD, FRCPC

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Abstract: Reduced sleep duration and quality can affect slow wave sleep (SWS) or restorative sleep, which is associated with an increased risk of developing type 2 diabetes mellitus. In patients who have been diagnosed with type 2 diabetes mellitus, treating nocturia and the associated deterioration of sleep duration and quality is particularly important to avoid the worsening of symptoms and the potential development of serious complications. Low-dose sublingual desmopressin (25 µg for adult women or 50 µg for adult men) has proven effective in reducing nocturia with the goal of improving SWS.

Key Words: type 2 diabetes mellitus (T2DM), sleep duration, sleep quality, sleep hygiene, slow wave sleep (SWS), optimal glycemic control, desmopressin.

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Type 2 diabetes mellitus (T2DM) is an increasingly common chronic disorder.

Type 2 diabetes mellitus (T2DM) rates have risen in recent years in proportion to rising obesity rates, increasing BMIs, and ever more sedentary adult populations.

Research has demonstrated that reduced sleep duration and quality can affect slow-wave sleep (SWS), which is associated with an increase to the risk of developing type 2 diabetes mellitus.

In patients with type 2 diabetes mellitus, treating nocturia and deteriorated sleep duration and quality may be useful to reduce symptoms of hyperglycemia and potentially reduce the development of serious complications.

The initiation of SWS coincides with the hormonal changes that affect glucose regulation.

When researchers supressed SWS in young, healthy, adult participants, they found a significant decrease in insulin sensitivity.

Low-dose sublingual desmopressin (25 µg for adult women or 50 µg for adult men), in addition to optimal glycemic control, has proven effective in reducing nocturia in patients with type 2 diabetes mellitus.

When nocturia events are decreased or eliminated, SWS is improved.

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Jason Strauss, MD, Departments of Psychiatry and Medicine, Division of Gerontology, Harvard Medical School; Beth Israel Deaconess Medical Center, Boston, MA; Hebrew Rehabilitation Center, Roslindale, MA; Cambridge Health Alliance, Cambridge, MA, USA.

Sleep disturbances are frequently seen among older adults with dementia, leading to significant distress for both patients and their caregivers. It is likely that neuronal loss in key areas of the brain contributes to sleep disturbances in this population. When evaluating older adults with dementia and insomnia, try to obtain information regarding all details of their sleep, and determine whether medical, psychiatric, or environmental factors may be contributors. In treating sleep disturbances in older adults with dementia, behavioural interventions should first be used to improve sleep hygiene. At the present time, there are not enough data to standardize recommendations for pharmacological treatment of insomnia in this population, so treatment should be guided by attempting to minimize potential side effects and interactions with other medications.
Key words: sleep, dementia, older adults, sleep hygiene, pharmacological treatment of insomnia.