Insulin Resistance Caused by Sleep Apnea

Hi all,

I’m having a bit of a heated argument on my Sleep Apnea forum over the connection between diabetes and sleep apnea. I’m saying that left untreated, sleep apnea contributes to insulin resistance. And i think that’s backed up by scientific research: “compared with normal subjects (apnea-hypopnea index < 5 events/h), those with mild, moderate, and severe SDB displayed a 26.7, 36.5 and 43.7% reduction in insulin sensitivity, respectively, independent of age, sex, race, and percent body fat.”

That said, some folks are taking issue with that, saying that I’m overstating the connection. Please let me know your thoughts. (fyi: full text of the argument/discussion is at the sleep apnea and diabetes discussion on my site)

Mike, I’ve just read about this research and plan to discuss it with my doc at my appt this week. I went in to discuss my concern that I have sleep apnea when I got the diagnosis of type 2 diabetes. I am curious if we correct the sleep apnea, if it out insulin will become less resistant.


this is very fresh research, which is why i wouldn’t be surprised if otherwise well-intentioned physicians, health providers, etc., aren’t aware of it yet. that said, i don’t want people to mislead others into thinking the connection doesn’t exist. it can make a big difference in who decides to get screened for diabetes and sleep apnea, respectively… don’t you think?

I would have to see the evidence. I really don’t have an opinion at this point. I would be careful before jumping to any conclusions. Correlation and causation are two different things.

I remember a lot of "dorky " kids being into Dungeons & Dragons years ago. Can you say that being “dorky” causes a person to be interested in Dungeons & Dragons? …One does not necesarily cause the other. There was only an observed correllation.

Some people with sleep apnea are overweight. It could be that being overweight contributes to insulin resistance. I realize that not all people with sleep apnea are overweight… it’s just a thought.

A connection does not always indicate cause and effect. Or the cause and effect may be reversed. I’m learning that a whole train of things that have happened to me over the past 25 years have been caused by increasing insulin resistance (such as otherwise unexplained weight gain), NOT the other way around. I suspect it may also be so with sleep apnea. The problems caused by insulin resistance, which include the extra fat around the neck, are what lead to sleep apnea. They occur together as part of the same syndrome that brings on high blood pressure, diabetes eventually, etc.

Insulin resistance, untreated (and no one treats it until it becomes diabetes) contributes to increased fat around the belly and the neck, which contributes to sleep apnea.

Dear Mike.

There is no doubt in my mind that there is a strong correlation between the 2 events. In my case I developped full fledge diabetes after a nose operation intended to help with the sleep apnea. The recovery period after the operation made my nightime breathing even worst. So it could be considered slight evidence as a causative factor for diabetes.

To prove correlations we would have to be able to manipulate the experiment. Take a large group of people without diabetes and without sleep apnea and induce sleep apnea in a randomized half and see if the sleep apnea group develops more diabetes.

This experiment would have been easy had the 2 totalitarian powers won ww2.

Also you can see that open mouth breathing will contribute to poorer gum health which is inflammatory and known to not help with BG control. I have at present a gum infection and BG totally out of control.

Poor sleep is known to destroy the body in many ways.

One thing that can be looked up is to see if the incidence of sleep apnea has increased as much over time as diabetes this could be impossible to do as the measurements of sleep may not be as good as the diagnostics of diabetes. Again this only gives you a correlation.

I would tend to support your hypothesis that sleep apnea contributes to insulin resistance. But have no idea how to prove it.

Well like someone said below, correlation does not make causation. HEre is a web site that suggests correlation.

My guess is that as one gains weight they are more at risk for sleep Apnea and type 2 Diabetes.

Rick Phillips

Dear Rick.

In my case no, the nasal congestion is independent of body weight. After developing diabetes subsequent to my nose operation I was able to loose 85 lb. From a very low calorie diet and mucho exercise, and getting a good night sleep may have helped enormously also to loose weight.

Well within a year the nose operation failed completely and I was back to sleep apnea without regaining much weight. Sleep went to rat s==t. A few years later with poor sleep I started to regain weight. So sleep apnea may cause weight gain is also a possible senario in my case. Would be interesting to see how much sleep apnea is caused by nasal problems and how much by weight related issues in the general population.

The whole health problem is a feedback loop so the only thing we can tell is that problems are correlated. The doctors should screen sleep apneacs for diabetes and diabetics for sleep apnea.

The only way to find cause and effect is you have to manipulate the experiment.

Another funny coincidence is that I went to the sleep clinic 10 years ago the Doctor there knew nothing about the effects of diabetes on sleep. We should definitely continue this blog and also another one on sleep and BG control.

I recall reading something about poor sleep raising cortisol levels which have been shown to interfere with the metabolic process and raise insulin resistance. Anyone who’s had sleep apnea (me) knows that not only can it cause poor sleep, it can startle you awake when you stop breathing which would further raise the cortisol levels. So, I’m in full support of your argument. There are plenty of articles out there that support the cortisol link to insulin resistance, and there also seem to be several that indicate poor sleep can raise cortisol. To me, your argument seems perfectly logical.

Thank goodness I became diabetic. It more or less forced me to get healthy. One result being, after losing nearly fifty pounds, my sleep apnea has vanished.

Dear Mr. Peachy.

If I remember correctly Cushing’s disease causes diabetes. So yes too much cortisol is related to insulin resistance and insulin resistance to weight gain. My wife has a BMI of 24 and I think has sleep apnea and in my case it is nasal congestion but many of the cases can be due to excess body weight. Would be interesting to find a breakdown of the causes of sleep apnea.

Hey Mike, my husband is about 400 lbs or more. He is one that will not go to the doctor for anything. Infact my blood pressure pills my doctor writes enough for him. He is that bad. I know he has a bad heart. In the last year he could not sleep, thought he was sleeping but he wasnt. He would fall asleep on the way home from work. He is probably diabetic, but will not get checked. Anyway, it got to where he was vomiting up blood, and it scared him a little so he went to the doctor and they sent him to a sleep clinic. He now wears a cpack at night, and he feels 100% better. He eats nothing but sweets and he has an enlarged heart, so I know he is not long for this world. He doesnt eat healthy either. He would rather have a hamburger and fries instead of veg. and chicken. Cant help him. I think he wants to die. We have alot of kid problems and it has been hard, I will admit. We are raising 2 grandchildren and it is rough. WE are both 55, and its not easy, but I dont wish to die. I want to live to see these kids grow up and get married, I hope. But what I am saying is possibly this would help you alot. Have you ever tried it? I went with a mouth piece to control my snoring, because they said it was not as bad for a cpack. And it does keep me from snoring. Got it at my dentist. Hope this helps. Becky

I’m sorry to hear about your husband, Becky. I do appreciate your advice to get a CPAP. I actually use one-- I even blog about my experiences with it from time to time on my website ( So while I’m doing what I can about this condition, I’m sure many members of this forum who have sleep apnea and don’t know about cpap can benefit from your post. I can tell you that CPAP has made a WORLD of difference in my life, and I’m very grateful to have come to it.

Warm regards,

I hope that you have had an opportunity to go on a C-pap machine. I sleep with one, don’t have apnea but “hypopnea” (which is a very fun word to say but just means low breath as opposed to no breath with apnea), and I sleep a million times better.

Oh, and…part of the reason I sleep so well with my C-pap is that it also overrides the nasal congestion I fought for years and years and that kept me awake way more than the hypopnea did (I was finally tested because my snoring bugged my husband). Even with a miserable cold I put on my “magic sleep machine” and sail away to slumber land.