Vitaly B. Kaliberdenko , Darya V. Sukharnikova , Artem K. Matevosyan , Kristina O. Kordik , Ernest E. Aramyan , Maksim S. Zinchenko
Abstract
Insomnia disorders are a common problem among patients with type 2 diabetes mellitus, which can negatively affect their overall health and disease management. This paper discusses the basic principles of insomnia treatment in this group of patients, including cognitive behavioral therapy, pharmacotherapy, and non-medicinal methods. Special attention is paid to the clinical features of insomnia in the context of diabetes, such as the effect of hypoglycemia and chronic stress on sleep quality. Lifestyle correction approaches are also being considered, such as dietary recommendations and physical activity that can help improve sleep. The need for an integrated approach to the treatment of insomnia disorders is emphasized, with an emphasis on individualizing therapy depending on the clinical characteristics and needs of the patient.
Keywords: insomnia, type 2 diabetes mellitus, sleep disorders, psychological health.
About the Author
Vitaly B. Kaliberdenko 1 , Darya V. Sukharnikova 1 , Artem K. Matevosyan 1 , Kristina O. Kordik 1 , Ernest E. Aramyan 1 , Maksim S. Zinchenko 11 Vernadsky Crimean Federal University, Simferopol, Russia
References
1. Бурчаков Д.И., Тардов М.В. Инсомния (бессонница): причины, методы лечения и клинические ситуации. Consilium Medicum. 2020;22(2):75-82. DOI: 10.26442/20751753.2020.2 Burchakov D.I., Tardov M.V. Insomnia (sleeplessness): causes, treatment methods and clinical situations. Consilium Medicum. 2020;22(2):75-82. DOI: 10.26442/20751753.2020.2 (in Russian).
2. Кемстач В.В., Коростовцева Л.С., Алехин А.Н. и др. Исследования психофизиологических аспектов и этиопатогенеза инсомнии: российские и зарубежные подходы. Вестник Российского университета дружбы народов. 2020;17(2):288-309. DOI: 10.22363/2313-1683-2020-17-2-288-309 Kemstach V.V., Korostovtseva L.S., Alekhine A.N. et al. Studies of psychophysiological aspects and etiopathogenesis of insomnia: Russian and foreign approaches. Bulletin of Peoples' Friendship University of Russia. 2020;17(2):288-309. DOI: 10.22363/2313-1683-2020-17-2-288-309 (in Russian).
3. Стрыгин К.Н., Полуэктов М.Г. Инсомния. Медицинский совет. 2017;(S):52-8. DOI: 10.21518/2079-701X-2017-0-52-58 Strygin K.N., Poluektov M.G. Insomnia. Medical Council. 2017;(S):52-8. DOI: 10.21518/2079-701X-2017-0-52-58 (in Russian).
4. Пчелина П.В., Полуэктов М.Г. Эволюция инсомнии: переход из кратковременной в хроническую. Медицинский совет. 2020;(19):70-7. DOI: 10.21518/2079-701X-2020-19-70-77 Pchelina P.V., Poluektov M.G. Evolution of insomnia: transition from short-term to chronic. Medical Council. 2020;(19):70-7. DOI: 10.21518/2079-701X-2020-19-70-77 (in Russian).
5. Бокебаев Т.Т., Касенова А.С., Утегалиев А.А. Влияние инсомнических нарушений на показатели качества жизни у пациентов с сахарным диабетом 2 типа. Нейрохирургия и неврология Казахстана. 2017;3(48):26-30. Bokebaev T.T., Kasenova A.S., Utegaliev A.A. The impact of insomnia disorders on quality of life indicators in patients with type 2 diabetes mellitus. Neurosurgery and neurology of Kazakhstan. 2017;3(48):26-30 (in Russian).
6. Shinalieva K, Kasenova A, Akhmetzhanova Z et al. Association of Insomnia with Anxiety and Depression in Type 2 Diabetic Patients: A Cross-Sectional Study. Iran J Med Sci 2023;48(5):448-55. DOI: 10.30476/ijms.2023.96017.2755
7. Mohammadi S, Dolatshahi M, Zare-Shahabadi A, Rahmani F. Untangling narcolepsy and diabetes: pathomechanisms with eyes on therapeutic options. Brain Res 2019;(1718):212-22. DOI: 10.1016/j.brainres.2019.04.013
8. Weng N, Luo YW, Xu JD, Zhang Y. Abnormal nocturnal behavior due to hypoglycemia: a case report. Medicine 2019;98(6):e14405. DOI: 10.1097/md.0000000000014405
9. Martynowicz H, Gac P, Brzecka A et al. The relationship between sleep bruxism and obstructive sleep apnea based on polysomnographic findings. J Clin Med 2019;8(10):1653. DOI: 10.3390/jcm8101653
10. Sweetman A, Melaku YA, Lack L et al. Prevalence and associations of co-morbid insomnia and sleep apnoea in an Australian population-based sample. Sleep Med 2021;(82):9-17. DOI: 10.1016/j.sleep.2021.03.023
11. Koopman ADM, Beulens JW, Dijkstra T et al. Prevalence of insomnia (symptoms) in T2D and association with metabolic parameters and glycemic control: meta-analysis. J Clin Endocrinol Metab 2020;105(3):614-43. DOI: 10.1210/ clinem/dgz065
12. Chew M, Tan NYQ, Lamoureux E et al. The associations of objectively measured sleep duration and sleep disturbances with diabetic retinopathy. Diabetes Res Clin Pract 2020;159:107967. DOI: 10.1016/j. diabres.2019.107967
13. Tahrani AA, Ali A, Raymond NT et al. Obstructive sleep apnea and diabetic nephropathy: a cohort study. Diabetes Care 2013;36(11):3718-25. DOI: 10.2337/dc13-0450
14. Tahrani AA, Ali A, Raymond NT et al. Obstructive sleep apnea and diabetic neuropathy: a novel association in patients with type 2 diabetes. Am J Respir Crit Care Med 2012;186(5):434-41. DOI: 10.1164/rccm.201112-2135OC
15. Labarca G, Dreyse J, Salas C et al. Risk of mortality among patients with moderate to severe obstructive sleep apnea and diabetes mellitus: results from the SantOSA cohort. Sleep Breath 2021. DOI: 10.1007/s11325-020-02283-y
16. Gabric K, Matetic A, Vilovic M et al. Health-related quality of life in type 2 diabetes mellitus patients with different risk for obstructive sleep apnea. Patient Prefer Adherence 2018;(12):765-73. DOI: 10.2147/PPA.S165203
17. Allen RP, Picchietti DL, Garcia-Borreguero D et al. Restless legs syndrome/Willis-Ekbom disease diagnostic criteria: updated International Restless Legs Syndrome Study Group (IRLSSG) consensus criteria–history, rationale, description, and significance. Sleep Med 2014;15(8):860-73. DOI: 10.1016/j.sleep.2014.03.025
18. Bener A, Al-Hamaq AOAA, Ağan AF et al. The prevalence of restless legs syndrome and comorbid condition among patient with type 2 diabetic mellitus visiting primary healthcare. J Family Med Prim Care 2019;8(12):3814-20. DOI: 10.4103/jfmpc.jfmpc_463_19
19. Modarresnia L, Golgiri F, Madani NH et al. Restless legs syndrome in Iranian people with type 2 diabetes mellitus: the role in quality of life and quality of sleep. J Clin Sleep Med 2018;14(2):223-8. DOI: 10.5664/jcsm.6938
20. Rizzi M, Barrella M, Kotzalidis GD, Bevilacqua M. Periodic limbic movement disorder during sleep as diabetes-related syndrome? A polysomnographic study. ISRN Endocrinol 2011;p.246157. DOI: 10.5402/2011/246157
21. Stenvers DJ, Scheer F, Schrauwen P et al. Circadian clocks and insulin resistance. Nat Rev Endocrinol 2019;15(2):75-89. DOI: 10.1038/s41574-018- 0122-1
22. El Tayeb IM, El Saghier EOA, Ramadan BK. Impact of shift work on glycemic control in insulin treated diabetics Dar El Chefa Hospital, Egypt 2014. Int J Diabetes Res 2014;3(2):15-21. DOI: 10.5923/j.diabetes.20140302.02
23. Manodpitipong A, Saetung S, Nimitphong H et al. Nightshift work is associated with poorer glycaemic control in patients with type 2 diabetes. J Sleep Res 2017;26(6):764-72. DOI: 10.1111/jsr.12554
24. Jørgensen JT, Karlsen S, Stayner L et al. Shift work and overall and cause-specific mortality in the Danish nurse cohort. Scand J Work Environ Health 2017;43(2):117-26. DOI: 10.5271/sjweh.3612
25. Yoshikawa F, Shigiyama F, Ando Y et al. Chronotherapeutic efficacy of suvorexant on sleep quality and metabolic parameters in patients with type 2 diabetes and insomnia. Diabetes Res Clin Pract 2020;(169):108412. DOI: 10.1016/j.diabres.2020.108412
26. Mast R, Rauh SP, Groeneveld L et al. The use of antidepressants, anxiolytics, and hypnotics in people with type 2 diabetes and patterns associated with use: the Hoorn Diabetes Care System Cohort. Biomed Res Int 2017;p.5134602. DOI: 10.1155/2017/5134602
27. Riemann D, Baglioni C, Bassetti C et al. European guideline for the diagnosis and treatment of insomnia. J Sleep Res 2017;26(6):675-700. DOI: 10.1111/jsr.12594
28. Tsunoda T, Yamada M, Akiyama T et al. The effects of ramelteon on glucose metabolism and sleep quality in type 2 diabetic patients with insomnia: a pilot prospective randomized controlled trial. J Clin Med Res 2016;8(12):878-87. DOI: 10.14740/ jocmr2754w
29. Doosti-Irani A, Ostadmohammadi V, Mirhosseini N et al. The effects of melatonin supplementation on glycemic control: a systematic review and meta-analysis of randomized controlled trials. Horm Metab Res 2018;50(11):783-90. DOI: 10.1055/ a-0752-8462
30. Harashima S, Nishimura A, Osugi T et al. Restless legs syndrome in patients with type 2 diabetes: effectiveness of pramipexole therapy. BMJ Support Palliat Care 2016;6(1):89-93. DOI: 10.1136/bmjspcare-2014-000691
31. Kwatra V, Khan MA, Quadri SA, Cook TS. Differential diagnosis and treatment of restless legs syndrome: a literature review. Cureus 2018;10(9):e3297. DOI: 10.7759/cureus.3297
32. Montagna P, Hornyak M, Ulfberg J et al. Randomized trial of pramipexole for patients with restless legs syndrome (RLS) and RLS-related impairment of mood. Sleep Med 2011;12(1):34-40. DOI: 10.1016/j.sleep.2010.08.005
33. Martínez-Cerón E, Barquiel B, Bezos AM et al. Effect of continuous positive airway pressure on glycemic control in patients with obstructive sleep apnea and type 2 diabetes. A randomized clinical trial. Am J Respir Crit Care Med 2016;194(4):476-85. DOI: 10.1164/rccm.201510-1942OC 34. Labarca G, Reyes T, Jorquera J et al. CPAP in patients with obstructive sleep apnea and type 2 diabetes mellitus: systematic review and meta-analysis. Clin Respir J 2018;12(8):2361-8. DOI: 10.1111/crj.12915
35. Yang X, Yang J, Yang C et al. Continuous positive airway pressure can improve depression in patients with obstructive sleep apnoea syndrome: a meta-analysis based on randomized controlled trials. J Int Med Res 2020;48(3):300060519895096. DOI: 10.1177/0300060519895096
36. Baslas V, Chand P, Jurel SK et al. A pilot study to determine the effect of three months of oral appliance therapy using a mandibular advancement device on HbA1c in subjects with type 2 diabetes mellitus and obstructive sleep apnea. J Prosthodont 2019;28(3):271-5. DOI: 10.1111/jopr.12973
37. Schwartz M, Acosta L, Hung YL et al. Effects of CPAP and mandibular advancement device treatment in obstructive sleep apnea patients: a systematic review and metaanalysis. Sleep Breath 2018;22(3):555-68. DOI: 10.1007/ s11325-017-1590-6
38. Tang Y, Sun Q, Bai XY et al. Effect of dapagliflozin on obstructive sleep apnea in patients with type 2 diabetes: a preliminary study. Nutr Diabetes 2019;9(1):32. DOI: 10.1038/s41387-019-0098-5
39. Kuna ST, Reboussin DM, Strotmeyer ES et al. Effects of weight loss on obstructive sleep apnea severity. ten-year results of the sleep AHEAD study. Am J Respir Crit Care Med 2021;203(2):221-9. DOI: 10.1164/rccm.201912-2511OC
40. Kothari V, Cardona Z, Chirakalwasan N et al. Sleep interventions and glucose metabolism: systematic review and meta-analysis. Sleep Med 2021;(78):24-35. DOI: 10.1016/j.sleep.2020.11.035
41. Alshehri MM, Alothman SA, Alenazi AM et al. The effects of cognitive behavioral therapy for insomnia in people with type 2 diabetes mellitus, pilot RCT part II: diabetes health outcomes. BMC Endocr Disord 2020;20(1):136. DOI: 10.1186/s12902-020-00612-6
42. Brouwer A, van Raalte DH, Nguyen HT et al. Effects of light therapy on mood and insulin sensitivity in patients with type 2 diabetes and depression: results from a randomized placebocontrolled trial. Diabetes Care 2019;42(4):529-38. DOI: 10. 2337/dc18-1732
43. Groeneveld L, den Braver NR, Beulens JWJ et al. The prevalence of self-reported insomnia symptoms and association with metabolic outcomes in people with type 2 diabetes: the Hoorn Diabetes Care System cohort. J Clin Sleep Med 2023;19(3):539-48. DOI: 10.5664/jcsm.10380
For citation: Kaliberdenko V.B., Suharnikova D.V., Matevosyan A.K., Kordik K.O. Aramyan E.E., Zinchenko M.S. Principles of treatment and clinical features of insomnia disorders in type 2 diabetes mellitus. Clinical review for general practice. 2025; 6 (8): 65–68 (In Russ.). DOI: 10.47407/kr2025.6.8.006761
All accepted articles publish licensed under a Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.




