Mini-Lesson: Sleep Health
New Beginnings: A Discussion Guide for Living Well With Diabetes
What You Need to Know
Getting enough sleep is important for overall health. Poor sleep habits can make it hard for people with diabetes to control their blood sugar. Busy schedules, stress, too much exposure to electronic devices, and certain foods, drinks, and medicines taken before bed can affect sleep patterns. Recognizing challenges with sleep and finding strategies to overcome them can help.
This lesson has resources and questions to lead a small group discussion with people who have diabetes. It can be used as part of an existing class or as a stand-alone activity. This discussion can be led by a diabetes care and education specialist, health educator, community health worker, peer counselor, or anyone with training and experience leading support groups and group education.
By the end of this session, participants will be able to
- List benefits of sleep to mental and physical health
- Assess their current sleep pattern and identify ways to improve it
Key Message
- Sleep contributes to a healthy lifestyle and has been shown to affect A1C levels. Fitting a goodnight’s sleep into a busy schedule can be challenging.
- Being aware of your sleep habits and patterns and finding ways to improve them, can help you take small steps to improve your sleep behaviors.
Going Virtual Tips
- Take a few minutes at the beginning of the session to explain the features of the video teleconferencing platform and the ground rules for virtual sessions. For example:
- Mute video or phone when not speaking.
- Say your name before speaking (especially on the phone).
- Participants are not required to have or use a video camera. They can submit photos of themselves instead. This may make group members more comfortable.
- During the activity, share the handout on the screen. Ask participants to type the number they used to rate their sleep (1 to 10) in the chat box. Ask them to share why they chose the number if they feel comfortable doing so. Use the interactive whiteboard feature to brainstorm ways to improve sleep habits.
Handouts
- Tips to Improve Sleep Health [DOC – 44 KB] (includes a “rate my sleep” scale)
Session Outline
What is good sleep and why is it important?
Group Leader Instructions
Group Leader Instructions
Talking Points and Discussion Questions
Talking Points and Discussion Questions
Say:
Say:
Sleep is an essential part of life. It can be easy for some people but challenging for others. For example, it may take you more than 20 minutes to fall asleep once you get into bed. But your spouse or other family members might fall asleep as soon as their heads hit the pillow. Both situations are normal.
According to the Centers for Disease Control and Prevention, 1 in 3 US adults say they usually get less than the recommended amount of sleep.
Let’s take a closer look at what good sleep is and what factors contribute to poor sleep. Many things can get in the way of the quality and quantity of your sleep. For example:
- Use of electronic devices before bed.
- Light and noise distractions.
- Pre-bedtime eating and drinking habits.
- Stress, anxiety, or depression.
- Medication side effects.
- Lack of physical activity.
- Daytime naps of more than 30 minutes.
Sleep is an essential part of life. It can be easy for some people but challenging for others. For example, it may take you more than 20 minutes to fall asleep once you get into bed. But your spouse or other family members might fall asleep as soon as their heads hit the pillow. Both situations are normal.
According to the Centers for Disease Control and Prevention, 1 in 3 US adults say they usually get less than the recommended amount of sleep.
Let’s take a closer look at what good sleep is and what factors contribute to poor sleep. Many things can get in the way of the quality and quantity of your sleep. For example:
- Use of electronic devices before bed.
- Light and noise distractions.
- Pre-bedtime eating and drinking habits.
- Stress, anxiety, or depression.
- Medication side effects.
- Lack of physical activity.
- Daytime naps of more than 30 minutes.
Ask:
Ask:
Why do you think sleep health is important?
Why do you think sleep health is important?
Say:
Say:
Getting enough good sleep helps:
- Keep your immune system strong..
- Keep your blood sugar and blood pressure levels more consistent.
- Balance hormone levels in the body, such as insulin, ghrelin (a hunger hormone), and cortisol (a stress hormone).
- Make it easier for you to function mentally and physically at work or in other daily tasks.
Getting enough good sleep helps:
- Keep your immune system strong..
- Keep your blood sugar and blood pressure levels more consistent.
- Balance hormone levels in the body, such as insulin, ghrelin (a hunger hormone), and cortisol (a stress hormone).
- Make it easier for you to function mentally and physically at work or in other daily tasks.
Read:
Read:
Let’s consider an example:
Jenny is not sleeping well. She gets only 5 hours of sleep most nights. She drinks 2 glasses of wine and eats dinner right before going to bed. She doesn’t have time to exercise because she works long hours. Also, streetlights outside her window make her room bright.
Let’s consider an example:
Jenny is not sleeping well. She gets only 5 hours of sleep most nights. She drinks 2 glasses of wine and eats dinner right before going to bed. She doesn’t have time to exercise because she works long hours. Also, streetlights outside her window make her room bright.
Ask:
Jenny is not getting the recommended 7 to 9 hours of sleep each night. She is drinking alcohol and eating dinner too close to bedtime. Physical activity is not part of her daily routine. She is likely stressed because of long work hours. The light outside her window is not allowing a dark sleep environment.
Ask:
Jenny is not getting the recommended 7 to 9 hours of sleep each night. She is drinking alcohol and eating dinner too close to bedtime. Physical activity is not part of her daily routine. She is likely stressed because of long work hours. The light outside her window is not allowing a dark sleep environment.
How do you think Jenny feels when she gets up in the morning?
What might be getting in the way of Jenny’s sleep?
How do you think Jenny feels when she gets up in the morning?
What might be getting in the way of Jenny’s sleep?
Ask:
Jenny may not be able to address all of these issues at once, she can start by trying light-blocking curtains or a sleep eye mask. She could also reduce her alcohol consumption or eat a smaller meal before bedtime. This may mean that she will need to adjust her meal and snack patterns earlier in the day to make sure she meets her dietary needs.
Ask:
Jenny may not be able to address all of these issues at once, she can start by trying light-blocking curtains or a sleep eye mask. She could also reduce her alcohol consumption or eat a smaller meal before bedtime. This may mean that she will need to adjust her meal and snack patterns earlier in the day to make sure she meets her dietary needs.
What can she do to try to get a better night’s sleep?
What can she do to try to get a better night’s sleep?
Sleep health and chronic disease
Group Leader Instructions
Group Leader Instructions
Talking Points and Discussion Questions
Talking Points and Discussion Questions
Say:
Say:
Sleep is important for making sure you are well-rested for your day. It helps your body stay strong and lowers your risk of developing chronic health problems like heart disease and high blood pressure. It can also help lower your risk of diabetes-related complications.
When you don’t get enough sleep on a regular basis, less insulin is available in your body after you eat. Your body may produce more of a stress hormone called cortisol, which keeps you awake and makes it harder for insulin to do its job.
Too little sleep also increases your appetite by telling your body to release more of the hunger-promoting hormone ghrelin and less of the hormone that signals that you’re full.
Sleep is important for making sure you are well-rested for your day. It helps your body stay strong and lowers your risk of developing chronic health problems like heart disease and high blood pressure. It can also help lower your risk of diabetes-related complications.
When you don’t get enough sleep on a regular basis, less insulin is available in your body after you eat. Your body may produce more of a stress hormone called cortisol, which keeps you awake and makes it harder for insulin to do its job.
Too little sleep also increases your appetite by telling your body to release more of the hunger-promoting hormone ghrelin and less of the hormone that signals that you’re full.
How to fit quality sleep into a busy schedule
Group Leader Instructions
Group Leader Instructions
Talking Points and Discussion Questions
Talking Points and Discussion Questions
Say:
Say:
When you feel overwhelmed by all of the things that you juggle each day, improving your sleep habits can seem impossible. But small changes to sleep habits can make a big difference. Even just improving your sleep habits on some nights during the week can help boost your energy levels.
When you feel overwhelmed by all of the things that you juggle each day, improving your sleep habits can seem impossible. But small changes to sleep habits can make a big difference. Even just improving your sleep habits on some nights during the week can help boost your energy levels.
Activity:
Activity:
Ask:
Ask:
Does anyone want to share their sleep score?
What tips can you put into practice to get your score closer to a 10?
Does anyone want to share their sleep score?
What tips can you put into practice to get your score closer to a 10?
Say:
Say:
Try adjusting your sleep habits this week—at least for 1 or 2 nights—and see if you can rate your sleep any higher.
Try adjusting your sleep habits this week—at least for 1 or 2 nights—and see if you can rate your sleep any higher.
Ask:
Ask:
What is one thing you learned about sleep health that surprised you?
What is one thing you learned about sleep health that surprised you?
Say:
Say:
You can definitely take steps to try to improve your sleep habits. But if lack of sleep is affecting how you feel and function during the day, you should talk to your health care provider.
You can definitely take steps to try to improve your sleep habits. But if lack of sleep is affecting how you feel and function during the day, you should talk to your health care provider.
Close the session
- Take final questions.
- Thank the group for their participation.
- Encourage participants to try changing their sleep habits at least once during the next week.
- Remind participants about the next session. Ask if they have specific questions or issues they would like addressed.
- Ask participants to do the session evaluation.
Sample Activities
Relaxation Technique: Breathing and Focus
This technique comes from the National Sleep Foundation and is useful for anyone who has trouble falling asleep. Practice this exercise when you are ready to fall asleep, especially if your mind is racing or preoccupied.
Find a comfortable position in bed. Let yourself relax and start to notice your body and any sensations you are feeling. Feel the connection between your body and the surface you’re lying on. Relax any tension and soften your muscles.
Focus your attention on your body. If your mind starts to wander to thoughts or worries, gently bring it back to your body. It’s very common to become preoccupied while you’re lying in bed. It takes time and practice to learn how to focus your attention on the body only.
Start to notice your breath and where you feel it in your body. You might feel it in your abdomen, your chest, or in your nostrils. Focus your attention on the full breath, from start to finish. If your mind is wandering, just notice that it has wandered and gently redirect it back to your breath.
Take a deep breath into your lower belly (not your chest) and feel your abdomen expand with air. Hold this position for a few seconds and then release it. Notice your belly rising and falling and the air coming in and going out a few times. Imagine the air filling up your abdomen, and then traveling out your airways, over and over.
Continue to do this for a few minutes, focusing your mind back to your body and on your breath coming in and going out. Any time a thought crosses your mind, release that thought and refocus on the breath. Feel yourself relaxing even more deeply. Practice this silently for a few minutes.
Do a scan of your body, noticing any areas where you might feel tension. Start at the top of your head and move down slowly to your toes, relaxing any tension you find. Direct your breath into that area of your body to help release the tension.
After you have scanned your body, return to the simple breathing pattern. Continue to notice your breath and picture it flowing into and out of your belly.
Sleep Diary
You may find that you can fall asleep easily on some nights, but you have trouble on other nights. Consider keeping a sleep diary to figure out what does and does not work for your body.
The National Sleep Foundation has a sleep diary template that only takes a few minutes to fill out. Consider keeping a sleep diary for a week and see if you can become more mindful about your sleep habits.
- Centers for Disease Control and Prevention (CDC): Sleep health and sleep disorders
- Healthy People 2030: Sleep Health
- Medline Plus: Healthy Sleep
- National Sleep Foundation: How Much Sleep Do We Really Need?
- Mayo Clinic: Sleep Tips: 6 Steps to Better Sleep
- National Sleep Foundation: Relaxation Exercise
- Sleep Diary
Brouwer A, van Raalte D, Rutters F, et al. (2020). Sleep and HBA1c in patients with type 2 diabetes: which sleep characteristics matter most? Diabetes Care. 43(1): 235-243.
Grander M, Seixas A, Shetty S, and S Shenoy. (2016). Sleep duration and diabetes risk: population trends and potential mechanisms. Current Diabetes Reports. 16(11): 106.
Khandelwal D, Dutta D, Chittawar S, and S Kalra. (2017). Sleep disorders in type 2 diabetes. Indian Journal of Endocrinology and Metabolism. 21(5): 758–761.
Mokhlesi B, Temple K, Tjaden A, et al. (2019). Association of self-reported sleep and circadian measures with glycemia in adults with prediabetes or recently diagnosed untreated type 2 diabetes. Diabetes Care. 42(7): 1326-1332.